The first medically supervised injection facility in Ireland and the UK will open in Dublin in September, providing “dignity” and “humanity” to some of the “most marginalised” people in society, says the charity operating it.
Eddie Mullins, chief executive of Merchant’s Quay Ireland (MQI) and former governor of Mountjoy Prison, describes the new facility as “exciting”, adding it will remove some open drug use from the streets, reduce drug-related litter, and save lives.
Included in the Programme for Government the facility has been almost a decade in the making, having first been proposed at Cabinet in 2015 by Aodhán Ó Ríordáin, then minister of State with responsibility for the National Drugs Strategy. Enabling legislation followed. It was beset by delays and objections, notably by a local primary school, in the planning process, and permission was granted in December 2022.
The facility, where people who use drugs intravenously will be able to come in off the streets and inject safely under the supervision of a nurse, will open as an 18-month pilot initially. It will be located in the basem*nt beneath MQI’s Riverbank location in the south inner city, and will operate seven days a week, for about seven hours a day.
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Showing The Irish Times around what is still a shell, Mullins points out where service users will arrive in. “They will be met by a medical person who’ll go through their history and, critically, find out what drugs they’ve taken and when.”
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They will then be shown to one of seven bays around a nurse’s station, provided with injecting equipment and supervised while they inject their own drugs.
“The injecting is all done by the client. Location of the vein will be done by the client,” says Mullins. “The nurse could intervene if they think it’s a bad vein to use, advise on a better vein. They will support the client.” The service user will stay for up to 30 minutes for observation.
“We’ll be looking for the impact on the person, to make sure they don’t go into overdose. But also to use the conversation – ask where are they at, what they want to do, whether they’re ready to start engaging in recovery or detox programme. We’ll encourage them to go upstairs [where there is a cafe], for a meal or a cup of coffee.”
Some rules may face pushback from service users, he agrees. Bays will be for single individuals only, meaning couples will not be able to inject together. The facility will be no smoking, and no pets will be allowed. He is confident however, having spoken to operators of similar facilities in other jurisdictions, people will get used to them.
Supervised injection facilities exist in several European jurisdictions, including the Netherlands, Germany and Spain, as well as in certain cities in the United States and Canada.
Asked whether the facility could attract more drugs to the area – posing dangers to the public including schoolchildren – Mullins points to the “rigorous planning process” the centre has been through to get to this point.
“We are working with the community to minimise any potential negative impacts. We’ll structure operating hours to avoid school opening times. We’ll have community safety wardens out to support people moving along the street.”
He is confident visible drug use will reduce and discarded drug paraphernalia will lessen.
Accurate figures as to how many active intravenous drug users are in Dublin are not available, though the Ana Liffey addiction project estimated in 2021 about 400. MQI’s harm-reduction service, which provides clean injecting equipment and pipes, supported 3,808 individuals in 2022.
Homeless intravenous drug users are “incredibly vulnerable”, says Mullins. “We know they are injecting in inhumane conditions – in alleys, parks, squats.” It was “amazing” there had not been a fatality – at least none known of – among such drug users as a result of a particularly potent batch of heroin, adulterated with nitazene, in circulation since November. “We have had 65 overdoses, but no fatality. That is down to the preparedness of emergency services and responders to administer naloxone [opioid overdose antidote].” Those drug users were found in time for the naloxone to be effective, he says.
Figures from the Health Research Board show 69 homeless people died as a result of drug overdose in 2020, of whom 24 “had a lifetime history of injecting”. Of these 69 deaths, 17 were of people injecting at the time they died. The figures underline the urgency of an medically supervised injection facility, says Mullins.
Asked if he sees many of the young men at MQI he had known previously in Mountjoy, Mullins says: “That’s one thing that has shocked me. People I thought were at a low point in their lives in prison come out and six weeks later they are here and a lot worse. In a very short period of time after release they have deteriorated. It is depressing.
“Stigmatising people who are chronically ill through addiction is not the way to deal with this matter. Drugs at the end of the day are painkillers. A lot of addiction starts through early childhood trauma.
“We believe the [facility] will be very successful and it will save lives. It is exciting because for the first time we are saying: ‘People in addiction are unwell’ and we are treating them with a bit of dignity.”
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