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The case for injection sites

25 Apr 2016

Pic: Getty Images

Dear Editor,
Considering the recent political and media support around medically supervised injection sites, they now seem inevitable in Ireland. Rather than ‘if?’ the question has become ‘how?’

The necessary amendment to allow for these sites, which are found in dozens of cities throughout the world, is overwhelmingly supported by community, voluntary and business interest groups.

A review by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) notes that almost 90 such sites exist in Europe. Concurrently, well known sites exist in Canada (InSite) and Australia. The EMCDDA notes that these sites: “Primarily aim to reduce the acute risks of disease transmission through unhygienic injecting, prevent drug-related overdose deaths and connect high-risk drug users with addiction treatment and other health and social services.”

Research shows that they do not increase drug use, injecting, loitering or dealing. They can increase referrals to treatment, reduce drug-related deaths, increase general health and humanise a section of society often labelled as dirty and undeserving — which can serve as an important gateway for the road to stabilisation and accessing other treatment facilities. As noted by Tim Bingham, drug policy specialist, “they’re a no brainer”.

Recently Help Not Harm co-hosted an event in Dublin with InSite for Community Safety entitled ‘Out of Harm’s Way’, featuring Liz Evans, co-founder of InSite. The title is a nod to a successful event preceding the opening of InSite in Vancouver and similar events have also recently taken place in Glasgow and New York.

Mephredrone, a former ‘head-shop’ drug, is known to be injected in Ireland and it is also suspected to be a significant risk factor for the development of HIV by the Health Protection Surveillance Centre. The Centre is currently in the process of an epidemiological study of this relationship. It notes that the trend has “mainly been seen in chaotic drug users, who report poly-drug use, and are often homeless” with the patterns of use of the drug being associated with “more frequent injecting, and unsafe sexual and needle-sharing practices”.

Similarly, several ‘conventional’ drugs like cocaine and various prescription drugs feature prominently in the Irish drug-injecting scene, as evidenced by Merchants Quay’s study of attendees of their Health Promotion Unit’s needle-exchange service. Thus, limiting the legislation to the use of heroin would be turning a blind eye to the fact that this only represents a fraction of overall injecting drug use in Ireland.

Injecting is also only one route of administration, though there are many forms that are particularly dangerous. Logically, providing new injection equipment will lead to decreased sharing, which will dramatically decrease the risk of blood-borne diseases like hepatitis C and HIV. It will also reduce risks associated with blunt needles, unsterilised water/equipment etc.

Concurrently, education and support can also lead to a transition to less risky injection practices and access of other treatment options. Smoking can reduce the risk of harms (e.g. abscesses) and risks (e.g. blood-borne diseases) are also dramatically reduced by the provision of new equipment.

Realistically, some people will inject, others will smoke and some will do both. Limiting the legislation to injecting prevents those who smoke from accessing support, reduces the potential of transitioning to smoking and could potentially even increase a transition to injecting in order to access services.

Drug consumption rooms in the Netherlands, for example, are almost exclusively smoking rooms because the patterns of use have changed. Policymakers should legislate in a manner that allows this to occur.

As reported by the Forensic Science Laboratory, adulteration and contamination of commonly injected drugs like heroin and cocaine is commonplace in Ireland. Such adulteration and contamination can compound health problems already caused by the consumption of the drugs, particularly if injected.

Research repeatedly shows that some of the most evidence-based drug education preventative strategies are the ones that communicate credible evidence of potential short-term harm.

Forensic drug testing could be one such method and the provision of such an intervention should not be prevented by unnecessarily restrictive policy. Testing could lead to quicker detection of particularly dangerous and lethal drug batches, which in turn could be communicated to on-site service providers and service users, potentially saving lives and almost certainly leading to decreased consumption of particularly harmful substances.

Generated data could also be transmitted to the National Advisory Committee on Drugs and Alcohol (NACDA) Early Warning and Emerging Trends subcommittee, which in turn could potentially communicate this information to all relevant Irish service providers through a centralised system.

Policymakers should introduce the necessary amendments with urgency, not to limit drug consumption to heroin or injecting and allow for on-site forensic testing.

Florian Scheibein,
Member of Help Not Harm and YouthRISE’s International Working Group (IWG),
With contributions from Tim Bingham.


Click here to view the full article which appeared in Irish Medical Times: Opinion