Dublin. Photo by Paul Roban
In the early 1980s, a man named Tony "King Scum" Felloni began importing large quantities of heroin into the Republic of Ireland. The drug quickly began to work its way into daily life in Dublin's working-class areas, and thanks to its relatively addictive nature it has remained wildly popular. Take a walk down certain streets in Dublin and you'll get a pretty good indicator of its prevalence in the capital.
Unfortunately, the government's plans for treating heroin addiction nowadays appear to be much the same as they were in the 80s: almost nonexistent. The government at the time paid very little attention to the problem, and—despite the implementation of new, progressive harm reduction laws in other European countries—Ireland's attitudes are still very much lingering in the decade of fax machines and Billy Idol.
According to the 2012 annual report by the European Monitoring Center for Drugs and Drug Addiction, Ireland has the highest number of heroin users per capita in Europe. They claim that seven people in every thousand are addicted to the drug, which translates to roughly 30,000 Irish citizens. Worryingly, Ireland also has the third highest death rate from drug use in Europe, behind only Norway and Estonia. The EU average is 21 deaths per million people; for Ireland, it's 68 per million.
But these stats don't tell the whole story. For years, heroin use in Ireland was confined to Dublin. This is no longer the case; usage of the drug has spread throughout the country and is now having an impact in many smaller towns and cities. Unfortunately, while addiction is now more far-reaching, treatment has predominantly stayed within the confines of the capital.
I spoke to Dr. Cathal Ó Súilliobháin, an addiction specialist with the Health Service Executive (HSE), Ireland's national health service, about the problem. He told me that, in some parts of the country, there is absolutely no treatment whatsoever. "In the midlands, there are very limited clinic places and no doctors in general practice able to initiate treatment," he said. "West of the River Shannon, there are none, and that includes Donegal county—not a single one."
The lack of services to deal with the growing heroin problem outside Dublin needs to be addressed. There are only six needle exchanges outside the capital (most of which only operate for a couple of hours a week) means that users are likely to end up sharing gear, and, unlike the government's policies, HIV and hepatitis rates didn't decide to stay in the 80s. That could potentially have disastrous consequences on rural communities that have already been adversely affected by the emigration crisis; as Cathal told me, "We are sitting on a time bomb. I would be concerned that you could easily see something like a mini-HIV epidemic starting in one of these areas."
With little or no services in areas outside Dublin, you'd have thought that concentrating treatment in the capital would leave the city well-equipped to help its addicts. But, again, there doesn't seem to have been much progress made over the past few decades. There are roughly 9,200 Irish people undergoing methadone treatment, most of them in Dublin, and that's the only care available. A number of other treatments—anti-opiate implants and buprenorphine, among them—are available in various other modern European states, so why hasn't Ireland adopted any of them?
Because in Ireland, addiction isn't seen as a medical issue—addicts are perceived by most to be criminals who can't be trusted, let alone make decisions for themselves. The state knows best and the state knows you should be treated with methadone. If you don't trust the state's judgement, then you can fuck off out the door and find your own treatment—i.e. score, shoot up, and end up back where you started.
Dr. Garrett McGovern
I spoke to Dr. Garrett McGovern, who specializes in addiction and spoke in favor of the recent Irish cannabis decriminalization bill, which, predictably, was voted down by the government earlier this month. "We really haven’t got a handle on who's using heroin," he told me. "The figures tend to be crunched a little bit, and it all comes from people in treatment. But not everybody who has an opiate habit should be or wants to be on methadone and all it entails, and we forget about them. We don’t provide any services for them. You come up for treatment and we give you methadone. You might not want methadone, and you’re told that we can’t do anything for you."
I also spoke to current heroin user "Zoe," who's taken heroin—she's been using with her boyfriend—for the past ten years. She's been taking methadone for the past seven years, but hasn't received much in the way of treatment beyond that. "We go to see our doctor once every two weeks," she said. "We do a urine test and we get handed our methadone script. We haven't been offered any other help."
Many users supplement methadone with heroin, which means they fail the urine tests they're required to pass in order to get a weekly prescription. If they fail, they have to go to the pharmacist every day to take their dose under supervision. The problem with this is that not everyone has schedules that permit them to make daily visits. "If a heroin addict misses their methadone dose they go into panic mode," Zoe said. "The choice you're left with is to either go through a night of withdrawal, or else score heroin. In this situation, we'd always score."
She continued: "I explained this to my doctor and he said that if I couldn't make it to the [pharmacist] on time, I should work less hours. I told him that my boss couldn't give me that option, so my doctor suggested that I leave my job. My job was the only thing keeping me on the straight and narrow, yet my doctor suggested that I leave a good job and sign on the dole so I could get to the chemist on time each day. That seemed like a really bad idea, so thankfully I didn't take my doctor's advice."
Clearly, not every medical practitioner in Ireland would offer such awful advice—but it does indicate that there's a systemic problem when it comes to the provision of harm reduction treatment in the country. And just to add a little more despair to an already dire situation, budgets for services to treat people with opiate problems are being slashed.
So what can be done? There is no way that Ireland will contemplate decriminalization any time soon. But as Dr. McGovern told me, attitudes must change somehow. "Let me be very clear about legalizing drugs: legalizing cannabis should be a no-brainer," he said. "In terms of heroin, people must be asleep in this country. They don't realize that in Switzerland, there are 23 [specialist] clinics. In England, they have [tried out] heroin prescriptions. Holland and Australia—these countries are already [prescribing heroin] to give safe drugs to heroin users who don’t settle on conventional methods, and it has shown to be very effective."
The recent cannabis decriminalization bill could have acted as an important stepping stone towards rethinking Ireland's drug policy, but it was laughed out of Irish parliament and the proponents of the bill were labelled nutcases by the government. That attitude also trickles down to a number of Irish media outlets, with some adopting the overly simplistic rationale that everyone with a drug problem is a criminal rather than a person with dependency issues who may have turned to crime to support his or her habit.
The solution seems glaringly obvious: treat addiction, cut down on crime. Unfortunately, the government has chosen to keep its blinders on—and until it takes them off, Ireland is destined to keep topping European drug surveys.
Follow David on Twitter: @davidfleming68
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