Drugs harm reduction expert, Tony Duffin, welcomes supervised injection room opening

Yesterday, the Oireachtas Drugs Use Committee heard that Ireland's first medically supervised injection facility (MSIF) will open in Dublin by the end of this year, a process that Tony Duffin, CEO of the Ana Liffey Drug Project says has been a long time in the making.

"We began advocating for supervised injection facilities on the 20th of January 2012 so that by the time it opens, it'll be thirteen years later", Duffin explains. He notes that those involved in the project have found it a "very difficult process" and "would have much preferred to open up much sooner" than by the end of 2024.

The legislation for the MSIF was officially introduced in 2017 after being championed by then Minister for Drugs, Aodhán Ó Ríordáin. The tender to operate the MSIF pilot scheme was won the following year by Merchants Quay who were then thwarted in their attempts to open it by a series of prolonged planning wrangles.

Despite the delays, Duffin is glad to see the centre announce its opening, stating that the harm reduction facility is a necessary addition to Dublin's infrastructure. The opening of the centre will mark nearly a year since the city experienced an “unprecedented” amount of drug overdoses across the span of two days due to the presence of synthetic opioids within the drug market.

"Injecting still happens on the streets of Dublin, and it will respond to injecting in the area where Merchant's Quay is based," he resumes. "We know from the evidence that it won't have a honeypot effect, it won't draw people from all over the city to go to it, but it will help reduce street-based injecting in the area, which is what it's intended to do."

The injection centre, as well as aiming to reduce blood-borne viruses, is expected to have a positive effect in terms of "getting people through to treatment and rehabilitation faster than it would have been if people were left in the streets injecting."

Following the same MSIF model that has proven successful in the likes of Vancouver, Sydney and Paris, people will enter the facility, be logged into a computer system and wait their turn to enter one of the injection rooms.

"There's engagement and discussion with the member of staff about not only drug use, but also other issues in their lives," Duffin says. "They sit down and prepare their drugs as they would normally, but in a very safe space with a clean worktop and sharps (needles) available. Afterwards, the equipment will be disposed of, and the person can go to another room to chat to a member of the team before they leave the premises. The staff can then monitor the person to see how they are doing."

In the event that a person overdoses, nursing and project staff are there to intervene and may provide naloxone and oxygen, as well as an ambulance to bring them to the hospital should it be needed.

"It's quite a straightforward piece of work, to be honest," Duffin continues. "Many of the actual interventions are standard nursing interventions that would be utilised in other environments. It's just that it's a particular environment where people use illicit drugs."

The MSIF will operate on a 12-month pilot basis before being fully evaluated. The hope is that other supervised injecting facilities will then be opened in other towns and cities with chronic heroin addiction problems.

"I don't know if we'll see more centres, but I do think there is a need for them," Duffin states. "Dublin has drug use going on all over the city. It definitely needs more than one, to my mind anyway, and I know my colleagues in Cork are very keen to open up a fixed site in Cork City Centre, but they have to wait until the evaluation is done on the Dublin pilot."

Whilst the inclusion of injection centres is detrimental to harm reduction and health-focused strategies regarding people who use drugs, Duffin says that since 2012, when lobbying for the centre first began, drug trends across Dublin have changed. This shift may result in a demand not just for injection centres but rather drug consumption facilities that would cover a broader spectrum of drug use.

Dublin has seen a significant rise in the use of Crack Cocaine. A report conducted for the Europe Drug Report in 2019 found that Ireland is one of six countries where the use of crack cocaine has increased in the past five years.

"Now we have a very significant problem with smoking crack in the city and other forms of drug use. So, you know, there's a good argument to be made to expand the injecting room to address those kinds of drug-taking problems in the streets, like drug consumption rooms."

The facility was expected to open its doors in September; however, due to planning delays and complaints, it is now likely that the MSIF will begin operating later in the year.

Previously, talking to Hot Press, a Merchant's Quay spokesperson said: “The vast majority of people injecting publicly are doing so in Dublin 8 and across the river in Dublin 3, which is why the MSIF needs to be here where the problem is rather than two miles away. This is a health-lead response to an addiction problem, which exists within the community.

"Our clients are somebody’s mother, father, brother, sister, son, daughter, friend or neighbour. They’re local residents too. For me, a lot of the understandable anxiety – those businesses complaining about people injecting in their toilets and parents concerned that their kids are seeing public injecting on their way to and from school – actually make a case for the MSIF.

“It’s entirely up to clients whether they inject and leave straight away, spend half-an-hour in the aftercare area and then leave, or ask to be referred upstairs," they continued. "They’re far more likely to access other services if they’re housed in the same building.”