On average, one person a day in Ireland dies by overdose, roughly twice the number that die on the roads. Ireland is reported as having the third highest level of overdose deaths per capita in Europe. Over the years my colleagues and I have seen first-hand the devastating effect these deaths have (as do any deaths) on the deceased’s family, their friends and the wider community. We have attended many funerals. We have worked hard in the aftermath of an overdose death to support loved ones. The age profile of those who die by overdose unfortunately means that many leave young children behind. This situation will continue unabated unless action is taken to reduce the number of overdose deaths in Ireland.
The problem is not insurmountable. Ireland has a small group of people at a high risk of overdose. It includes those who inject drugs and those who use multiple substances. Equally, there are a number of key evidence based initiatives which can be introduced to help reduce overdose deaths. International Overdose Awareness Day on Sunday provides an opportunity to consider what we should be doing to tackle overdose in Ireland. Here are three suggestions.
First, we should distribute naloxone among drug users and their families. Naloxone is an opioid antagonist, effectively reversing the effects of having consumed opiates, such as heroin. Currently, it is not widely available in Ireland, although there is strong evidence for its role in addressing overdose. The Advisory Council on the Misuse of Drugs in the UK, in recommending that naloxone be made more widely available across that jurisdiction concluded that:
“The efficacy of naloxone is not in dispute. Naloxone is a WHO-recommended medicine, and efficacy has been proven in several published studies and pilots. Naloxone is a safe, effective drug, with no dependence-forming potential. Its only action is to reverse the effects of opioid overdoses, and it is already used by emergency services personnel in the UK for this purpose.”
Of the 365 overdoses in Ireland in 2011, opiates were implicated in at least 128. So, widespread naloxone availability is an obvious first step if we’re serious about reducing death from overdose. It is widely used in community settings in other jurisdictions – and is also used in the US. There are technical legal barriers to the immediate widespread introduction of naloxone in Ireland, and overcoming these barriers should be prioritised as a matter of urgency.
Second, we should be trialling a Medically Supervised Injecting Centre (MSIC) in Dublin City Centre. MSICs allow drug users to inject their (illegally obtained) drugs in a clinical location and under medical supervision. While superficially controversial, there is compelling evidence for the success of MSICs in achieving specific outcomes. It has been demonstrated that such services are associated with a reduction in injecting in public places (an overdose risk factor), and a reduction in discarded used syringes and drug-related litter, issues often raised as problems in Dublin’s city centre. MSICs can also reduce ambulance call-outs for drug overdoses and be a successful gateway to treatment. No person has ever died of an overdose in a drug consumption room – and over 90 such services currently operate worldwide. As with naloxone, there are legal barriers to the provision of MSICs here. However, Ana Liffey Drug Project is working with the Voluntary Assistance Scheme of the Bar Council of Ireland to develop draft legislation which would permit their operation.
Third, we should have a National Overdose Prevention Strategy. This is essential if we are to have a long lasting impact on overdose and be able to measure the lives saved. It is important that the actions we take to address overdose are evidence based, and coherent and consistent throughout the country. Significant work has been done on the development of a National Overdose Prevention Strategy in recent times, and a completed strategy is expected to be published in due course. This is welcome. However, there is a need to ensure that adequate funds are made available for its implementation. This is, after all, a matter of life and death.
Drug use is an emotive topic – it often generates strong and polarised opinions. However, drug use and its attendant issues, such as overdose, are much studied and there is much objective evidence as to what works in terms of limiting the damage that drug use causes to individuals, families and society. It is this evidence – like naloxone, like medically supervised injecting centres – that we need to be brave in putting our resources behind now, so we can reduce the significant harm that currently results from overdose in Ireland.
Tony Duffin is the Director of the Ana Liffey Drug Project. See aldp.ie