Heroin: the next generation

 

Addiction to the drug is changing. In Dublin, methadone programmes have created a generation of older users who may never get clean. Outside the capital, heroin use is rampant. And the closure of head shops means a new wave of young ‘polydrug’ users must now get their fix on the street, writes UNA MULLALLY

IRELAND HAS AN estimated 20,000 or so heroin users, about 15,000 of them in Dublin. The signs of heroin addiction – drug dealing, drug taking, begging and antisocial behaviour – are obvious to any of us. But the ways heroin is used, and the profile of those using it, are less visible, and have changed dramatically in recent years.

In Dublin, drug-treatment centres are faced with a third generation of users. A trend described by drug-treatment workers as the greying of methadone will see the heroin substitute become a medicine dispensed into old age.

Young addicts in the capital are diversifying their intake of drugs. Heroin is just one of a cocktail that many users take, creating a polydrug dependence that is increasingly difficult to address.

In rural areas heroin users are getting younger. In the past three decades heroin use has spread from inner Dublin to its suburbs and to other cities and is now available in almost every town. Heroin has become like an unwanted house guest who refuses to leave. Sixty-three per cent of drug takers seeking treatment in Ireland use heroin, which is much higher than the EU average of 47 per cent. The vast majority of drug overdoses are still associated with heroin.

The National Drugs Strategy 2009-2016 established various goals, among them that all problem drug users under the age of 18 would be able, by 2012, to access treatment within a week of assessment (or within a month in the case of over-18s).

Such targets are beginning to look like fantasies. As services battle against cuts, and heroin use and addiction get pushed down the list of national priorities, there’s a fear that the crisis that devastated parts of Dublin in the 1980s and 1990s is being replicated around the country. It’s not so much a question of how we fix the problem; it’s about how we even keep up.

OLDER USERS: THE GREYING OF METHADONE

It’s a busy Friday afternoon at Merchants Quay Ireland, a centre providing services to drug users and homeless people, which began offering help to those with drug problems and HIV in 1989. The centre is a stone’s throw from Dublin City Council’s civic offices at the tail end of Temple Bar.

In the drop-in centre people pack the rooms, drinking tea, watching TV and reading newspapers. The eastern European men always sit around the same table. As busy as it is, there’s one element of the crowd of people at Merchants Quay that’s absent: teenagers and people in their early 20s.

“Our average age has gone up here significantly,” says Tony Geoghegan, the Merchants Quay chief executive. “It used to be about 22 for women and 23-24 for men, but is significant.”

In 1997, there were 2,000 people attending the Merchants Quay Health Promotion Unit. By 2009, that had grown to 4,656 people. The average age of an addict attending the project in 1997 was 24. By 2009, that average was 33. The oldest addicts the unit dealt with a decade ago were 52; two years ago that had risen to 65. The “greying of methadone” is a clear trend.

One of the recovering addicts at the drop-in centre is typical of this development. Mike (not his real name), from Dublin but currently homeless and living in hostels, is 43; he started taking heroin when he was 28. Although he’s in a methadone programme he had taken heroin a few hours before we met.

“I didn’t need it. I just took it. I think I was just a bit pissed off,” he says. “You’ll never give it up. You’ll always dabble in it. Stupid, really, when you think about it.”

Mike began taking drugs at the age of 10; he first took heroin to escape the fear that one of his daughters had been abused after she came into contact with a rapist and child molester. “It’s a nice drug and it’s a horrible drug, if you know what I mean,” he says. “If you get caught up in it you lose everything. And when you lose everything you don’t realise it until it’s all gone. It’s hard to get your life back on track afterwards, because you just don’t want to.”

Mike goes on to talk of heroin’s stranglehold: “You won’t get rid of heroin anyway. It’s here to stay. Whether you like it or not, that’s the way it is. There’s too much money in it.”

In contrast, he says, the price of cocaine is impractical for an addict to sustain: “Coke is a rich man’s drug. You can’t be buying that every day; you’d have nothing. At least with heroin you can get money for it, but coke you’re talking about four, five, six hundred pound a day. With heroin you’re only talking about a hundred pound a day. Three bags would do anyone a day, and if anyone says they’re using more than three bags a day, that’s ridiculous; they don’t need to use it. You need one for the morning – that would cover you for the whole morning – one for the afternoon and then one for the night. You’re brand new then.”

As with many addicts of his age, occasional heroin use and constant methadone use – he’s on 100ml a day – are a long-term prospect for Mike. He describes “a constant circle” of heroin use and methadone treatment. “They say it takes some spark in your life to make you give it up,” he says. “I haven’t hit that road yet. I hope to God I hit it soon. I’m fed up the way I am, going around the last 10, 11 years.”

Methadone is a cheap treatment for heroin addiction, but it’s also, seemingly, a solution without end. Geoghegan has been seeking statistics from the HSE on the average time spent on methadone, to no avail.

“I have mixed feelings in relation to methadone and harm reduction in general, even though I’ve always been a very strong advocate of harm-reduction services, and we were the first voluntary needle exchange and all that sort of stuff,” he says. “But I do think that methadone is a holding exercise for people. And unless resources are put into people, they’re not necessarily going to move, and it can be a quagmire for people. They can get stuck in methadone.”

THE NEW USERS: POLYDRUG ADDICTS

Fr Peter McVerry is sitting at his office desk in the basement of a building on Sherrard Street in north inner Dublin. In 1985, before many of the people he deals with were born, McVerry had established what became the Peter McVerry Trust, providing services to young homeless people.

He has seen drug use change over almost three decades. While heroin use is growing in rural Ireland and is still the mainstay of the older generation in Dublin, opiates are waning in popularity among young drug users in the capital. For them, the wide availability of alternatives to heroin has created a more complicated polydrug usage.

In McVerry’s experience, the drug of choice for young people in Dublin who previously would have gravitated towards heroin is “head-shop stuff”, chiefly mephedrone, a stimulant that has become popular over the past two years. Mephedrone had been for sale legally in head shops, opening up a network of access to young people who previously would not have been buying drugs from dealers. The closure of those shops pushed the trade on to the street, decreasing purity and increasing the price.

McVerry says the head-shop situation was “a disaster. Young people became involved in the drug culture through the head-shop stuff who would never have gone near an illegal drug dealer on the street to buy drugs. Now that they’ve got involved in that culture, they’re continuing their involvement in that culture and they’re buying the stuff illegally.”

The move away from heroin into more complex addiction throws up new problems. At any one time McVerry’s services are dealing with 200 to 250 people, aged 11 upwards. Some use the residential services, some use the drop-in services, some are in other programmes. The average age is early 20s, and the trust also has hostels for under-18s. Drug use is starting earlier, and McVerry is dealing with people who started smoking cannabis aged nine, before moving on to hard drugs aged 15 or 16.

“Some nights they’ll use cocaine, sometimes they may take heroin, sometimes they may take head-shop stuff – or, if it’s available, they may take all three in the same night. That’s really worrying; it’s very difficult to deal with that,” says McVerry.

His centre now has a drug-stabilisation programme to treat this form of addiction. “They start the programme using maybe five, six drugs a day, and, hopefully, after three months at the other end of the programme they’re only using one drug. So they’ve learned to control their drug use, and then the possibility and the opportunity exists, if they want, to come off that drug . . . Polydrug use has become the norm now, and that is really a frightening situation, because it’s very, very difficult to deal with.”

OUTSIDE DUBLIN: THE YOUTH USERS

In the clean, tourist-friendly city of Kilkenny, the Fianna Fáil councillor Joe Malone is trying to deal with the heroin problem that lies beneath the mellow surface. Malone knows about 100 local addicts by name. During our meeting they approach him in the street and update him on where they’re living and how much methadone they’re on. At one point a mother stops him to talk about her son, who died of an overdose in 2005, before reeling off the names of other deceased young men. Users in Kilkenny tend to be much younger than in Dublin.

Ten years ago, as heroin began to seep into the area, Malone dealt with his most extreme case, that of a heroin addict who was just eight years old. That boy is now in prison. Malone says he can identify children in primary school who are likely to become addicts.

Kilkenny’s drug-treatment service focuses on supplying addicts with methadone and providing assistance in the form of one drug worker who works a two-and-a-half-day week. The county is so under-resourced that an electrical-goods shop in the city doubles as an informal drop-in centre for addicts and others with mental-health issues. A lack of needle-exchange services means that those addicts who are not desperate enough to share needles have to travel to Dublin to get clean ones.

Recently Malone has been helping a local woman, Mary (not her real name), a 20-year-old recovering addict who has relapsed, having previously come off both heroin and methadone. She has been using heroin since she was 13, when a man who raped her provided her with the drug. By the time she was 14 she had moved from smoking to injecting.

Like many young addicts Mary grew up in a violent household where addiction was part of her daily existence. When she was 11 her mother, an alcoholic, used to wake her so that she would have a drinking partner for the morning.

When we talk in the rose garden of Kilkenny Castle she explains how she recently inflicted serious self-harm, and shows several scars. She has also tried to take her own life, but was rescued by gardaí. Today her nose is swollen, having been broken during an altercation with a sibling. In the past she has stabbed and been stabbed, and a bench warrant is out for her arrest. She is articulate and polite, apologising profusely every time she starts to cry.

“The things I done, even looking back on it, I’m disgusted with myself, to be honest with you,” she says, talking about how she would get money to feed her habit. “The only thing I had left of my mother was her wedding ring. I pawned that in because I was dying sick, and I got fifty quid for it. I broke into a house and I robbed a laptop and sold that. I robbed the best part of stuff out of my father’s house, his telly, the whole lot, for heroin. I sold all my jewellery. I’m engaged to the boyfriend, and the other day I pawned my engagement ring.”

Having been in treatment three times, Mary is desperate to be drug-free. This time last year she weighed six stone. At Christmas, Malone stepped in and provided Mary and her boyfriend with food. Now she’s trying to get a flat so that she can stop sleeping rough in a multi-storey car park. She craves normality.

“I want my Leaving Cert,” she says. “People might laugh at me, but I want my Leaving Cert and then go and do social studies for three years. Until then I have to get myself together. I want to be a counsellor, I want to help people, young people like me who grew up in a house of addiction and became addicts themselves.”

But staying clean here is difficult. The heroin now on the streets of Kilkenny is “rocket fuel”, says Mary, illustrating its ease of availability with a click of her fingers.

A DRUG CATASTROPHE, OR CAN WE FIX IT?

Kilkenny, like most small towns outside Dublin, is about 20 years behind the capital in terms of the sophistication of its services. Joe Malone’s solution to the city’s heroin problem is clear-cut: “We need awareness, we need education, we need services. We need three workers: one in the city, one in the north of the county and one in the south.”

For Peter McVerry, the biggest issue in addressing heroin addiction lies in the lack of a custodial drug-treatment centre. It was provided for in the 1977 Misuse of Drugs Act, but 34 years later it has yet to come to pass.

“A lot of people who use drugs end up committing crimes to feed their drug habit or selling drugs to feed their drug habit,” he says. “They end up in custody. And a lot of them would love to take the opportunity to deal with their drug problem, and that opportunity is not there. In a prison population of about 4,500 we have nine detox beds in the whole prison system.

“I think a custodial drug-treatment centre is urgently required, which would give people who have been caught committing crimes, including very serious crimes, the opportunity to deal with their drug problem as an alternative to going to prison.”

McVerry says there are also too few residential care centres, which help addicts in a protective environment. “But residential care is very expensive, and that’s why it’s not available. I mean, I don’t know what it costs to keep somebody on methadone, probably it costs about €50 a week. Residential detox costs €1,500 a week, so for the Government it’s a no-brainer: they’re going to go for the methadone.”

Ultimately, McVerry believes, it is the lack of both political and public will that continues to allow the spread of heroin and other drugs. “Deaths from drugs or drug-related causes are very, very prevalent. I would think it’s almost certain that there are far more deaths from drug-related causes than there are from traffic accidents, yet there’s this huge big public focus on trying to reduce the number of people who die on our roads, perfectly correctly, but there is no such focus on trying to reduce the number of people who die from drugs. There isn’t the same public concern or public reaction to it.”

McVerry speaks with his own brand of calm exasperation. He knows that funding for services will continue to be cut and that the problems of the young people coming to him will continue to get worse. He knows that Ireland is sleepwalking towards another catastrophe as, little by little, the signs that crystal meth is chugging its way to our shores become clearer, through sporadic seizures and occasional cases of addiction. He will continue to work to make the lives of some of the most vulnerable people in our society better.

“Every drug user I have worked with has wanted to come off drugs, including coming off methadone,” McVerry says. “They’ve wanted to be free of all drugs. Now it may take a while for that to happen. When you first start using drugs, they’re very pleasant, you enjoy them, you want to continue enjoying them, you don’t want to give them up. But there comes a point where users do want to give them up, and you only have a window of opportunity there for a few weeks, a couple of months, and if you don’t take that window of opportunity to help them give up, you’ve lost it.

“So if you’re on a waiting list for 12 months, you’re just going to get demoralised, you’re going to get fed up, you’re going to stop being motivated to try and come off drugs. And then you lose them.”