Should drug users have a safe space to inject?

It’s looking increasingly likely that medically supervised injection centres will open within the next year. What will they mean for addicts and communities affected by drug use?

 

Almost every day in Dublin, the emergency services are called to the scene of a drug overdose. Walk down any alleyway in the capital, and the evidence is there: discarded needles, citric wrappers, tinfoil and, occasionally, human excrement. In August, there was a media furore when a passenger shot up on Dublin Bus, but anyone who regularly uses the Luas red line will almost certainly have witnessed a similar scene.

A study of Dublin ambulance services showed that, in 2012, there were at least 469 overdoses, of which 13 were fatal. In the suburbs, people tend to overdose at home; in the city, it happens on the streets. Separately, data from the Health Research Board suggests that, on average, one person dies of a drug overdose per day in Ireland – about twice the death rate from road crashes.

This may be about to change. Dublin’s Ana Liffey Drug Project, working with the Bar Council’s voluntary assistance scheme, has drafted legislation that would allow addicts to take drugs in a safe, medically supervised injection centre (MSIC).

Such centres already exist in more than 90 sites around the world, including in Australia, Spain, Norway and Switzerland. Now, the Minister of State with responsibility for drugs, Aodhán Ó Ríordáin, wants to see them here – and he seems to have the backing of the Taoiseach and the Minister for Health.

Opposition

Emily Egan is a senior counsel who worked on the legislation, drawing together a volunteer group of barristers with medical, planning and environmental expertise, who met every two weeks for a year and figured out the practicalities.

“It means that a doctor or nurse could show a drug user how to administer without overdosing, getting gangrene or losing a limb. The ultimate aim is to see whether they can be directed to outreach, detox, education or social services for assistance.”

The proposed Act would amend the Misuse of Drugs Act to allow the existence of MSICs. Egan points out that nothing in the draft legislation would impinge on the powers of the Garda to arrest people for possession outside the centres; however, those working with drug addicts believe they would be unlikely to do so. Although the initial proposals have focused on Dublin, the legislation could allow MSICs to open anywhere in Ireland.

Retailers and residents’ groups in Dublin have expressed concerns about drug paraphernalia in parks, playgrounds and streets.

Numerous studies have shown that the risk of HIV infection from a needlestick injury is less than 1 per cent, although the risk of Hepatitis B can be as high as 30 per cent. However, the psychological trauma can be crippling.

‘They just can’t stop’

“Addicts often have experienced abuse and neglect in childhood. The centres would help to better manage the situation and save lives.”

Duffin recently attended an MSIC at King’s Cross, Sydney, which opened in 2001. Addicts arrive, have a brief assessment, are given clean equipment, and supervised when they inject. The risk of abscesses, infections and overdoses is reduced.

There has been no recorded incident of a fatal overdose at an MSIC anywhere in the world. As relationships of trusts are built up, addicts can get referrals to treatment and rehabilitation services.

“Everyone wants to know where they will be placed,” he says. “It needs to be where drug users are already injecting. International evidence refutes the idea it will draw addicts to the area. Drug users are already in the city.

“It’s not as simple as just removing drugs and moving people on. MSICs have been shown to work across the world, and it’s time we had them here.”

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