Saturday 24 August 2019

Detox beds, not injecting rooms, are the answer to drug problem

People protest outside Leinster House about the increase in homelessness on the first anniversary of the death of Jonathan Corrie in 2015. Photo: Arthur Carron
People protest outside Leinster House about the increase in homelessness on the first anniversary of the death of Jonathan Corrie in 2015. Photo: Arthur Carron

David Quinn

It is now two years since Jonathan Corrie was found dead in a doorway near Leinster House. The incident caused much hand-wringing over the homelessness problem in Ireland. There was a call for more hostel beds.

But then we discovered that Mr Corrie had been offered a bed in a hostel by homelessness services several times and refused it. As more information came to light, it turned out that Mr Corrie's big problem was drug addiction.

The other day, the Health Research Board produced figures for the number of drug-related deaths during the period 2004-2014. In 2014, there were 697 such deaths.

Bit by bit, Ireland is liberalising its approach to illegal drugs. The Government has said it will not oppose a bill aimed at permitting the use of 'medical cannabis', and active consideration is being given to injecting rooms for heroin users.

No proper national debate is taking place on either of these issues. Have authoritative voices been sought out who would critique the cannabis proposal?

Do we know whether or not the medical benefits of cannabis can be reproduced by other means, by drugs that are not seen as 'gateways' to other drugs?

Is permitting the medical use of cannabis the slippery slope to permitting cannabis use, full stop?

In a submission to the Oireachtas Justice Committee last year, the Irish Hospital Consultants Association (IHCA), in a submission concerning proposals to liberalise drug policy along the line of Portugal, said: "While there appears to be an international desire among enthusiasts of liberalisation of drugs policy to view the decriminalisation approach adopted by Portugal as an unqualified success, there are very divergent views on its impact."

It said that cannabis use among Portuguese teenagers had doubled since decriminalisation in 1995, while in Ireland it has halved where it remains criminalised.

Heroin-related deaths in Portugal have dropped since heroin was decriminalised, but is this the sole reason? What about other drug-related deaths?

The IHCA also said in its submission: "We are very concerned that much of the public discussion on this topic in Ireland has been profoundly unbalanced, with positive experiences of other countries being greatly exaggerated and adverse consequences being ignored."

The public discussion is still "profoundly unbalanced".

The figures produced by the Health Research Board this week should give us further pause. Many people probably believe that most drug-related deaths in Ireland are heroin-related. That is emphatically not the case. Out of the 697 drug-related deaths here in 2014, 90 were mostly due to heroin, roughly an eighth of the total.

If we look at deaths that were purely due to drug-poisoning (354 in total), the percentage caused mainly by heroin rises to a quarter.

Non-poisoning drug-related deaths in 2014 totalled 343. A quarter were by hanging. Many more were the result of cardiac problems, liver disease and so on. Drug abuse takes its horrible and inevitable toll.

Returning to the deaths by drug-poisoning, prescription drugs are implicated in three-out-of-four deaths. Diazepam, better known as Valium, was a major culprit, as was methadone, a heroin-substitute.

Alcohol was implicated in a third of all the deaths by poisoning.

Consider the implications of this. While we are being distracted by debates about injecting rooms, we are losing sight of the much bigger picture, which is to say the sheer number of deaths caused by legal drugs and alcohol.

Most addicts who die by poisoning die because they have used several drugs at the same time, and, again, most of these are legally available. A heroin-related death appears to be rarely due to heroin only.

So, should Valium be prescribed less often? Should methadone be prescribed less often?

There are around 10,000 people in Ireland taking methadone, an incredible total. Is this saving lives? Even though many deaths involved methadone, maybe things would be even worse if it wasn't prescribed.

On the other hand, if you go back to 2004, there were 'only' 40 deaths that mainly involved methadone, compared with 98 two years ago. The number of mainly heroin-related deaths has gone from 29 to 90. So one figure has more than doubled and the other has trebled.

Injecting room advocates will insist that a dozen fewer heroin-related deaths per year (say) would justify going down this road. Maybe, but it would also be another step towards wider cultural acceptance of heroin.

The much better way to go is quite obvious; do a lot more to help people break their reliance on legal and illegal drugs, including alcohol.

While there are 10,000 people taking methadone, and 20,000 using heroin (the two figures often overlap), there are a pitiful 200 or so 'detox' beds in the country, many of them run by Sr Consilio and Cuan Mhuire.

Far less is spent by the State on those treatment places than on methadone. That is immoral and indefensible. The fact is that injecting rooms will hardly put a dent in the number of drug-related deaths in this country each year. If we're sincere about tackling the problem, we need far more treatment places. But I doubt if we are really that sincere about it. Instead, we'll go for headline-grabbing quasi-solutions like injecting rooms because it looks radical and edgy.

Irish Independent

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