Drugs strategy fails communities

Despite the radical recommendations made by a government report in 1996, the numbers of drug users are increasing and services cannot respond to demand. By John Byrne

Essential services needed to reduce and respond to drug use do not exist in many of the communities most in need, nine years after a government report clearly stated that they should be put in place. The number of drug users in Ireland has increased since that report was published, and "blackspots" are developing outside Dublin, where plans to deal with drugs problems have not yet been finalised.

In 1996, a government report, known as the Rabbitte Report (named after its chairman, Pat Rabbitte of the Labour Party), identified 11 "priority" areas which were suffering from "acute" drug problems, all of them socially deprived communities.

This was the first official acknowledgement of the link between poverty, deprivation and problem drug use. "All available evidence suggests that the demand for heroin is highest in the areas of greatest economic and social disadvantage... strategies to deal with the problem need to be focused on these areas", it said at the time.

While many of its recommendations have been implemented – such as the establishment of Local Area Drug Task Forces in these "priority" areas – many people who work in these communities feel that the National Drugs Strategy has not followed through on the spirit of the Rabbitte Report.

The current position

The framework for dealing with the problem, the National Drug Strategy 2001-2008, published a progress report on 29 March 2005. People who work with problem drug users are critical of it.

"If you were to read the report, you'd think that there is no real drug problem, that everything is under control", said Tony Geoghegan, director of the Merchants' Quay Project, an agency that works with problem drug users in central Dublin. "It's definitely a case of putting their best foot forward."

One key area that has been criticised is the availability of needle exchange facilities in Ireland. These give users access to clean injecting equipment and help reduce the risk of catching diseases such AIDS and Hepatitis C. Facilities have been in place in Dublin for some years now, but they are unsatisfactory, according to Tony Geoghegan.

"They're not available on the weekend, or outside office hours", he says.

Their availability is also limited outside of Dublin, where there is a growing drug problem, despite the National Drug Strategy's aim to have ensured "access for all injecting drug misusers to sterile equipment" by 2004. Although the Progress Report says that "additional services were developed... in both the Northern and South Western Area Health Boards... [and] in partnership with homeless agencies and for women working in prostitution" those working with drug users say facilities are still completely inadequate.

"I have records of drug users travelling from Portlaoise and Arklow all the way into Merchants Quay in Dublin just to get clean injecting equipment. This shows great responsibility on the part of drug users, but not on the part of the government", says Sean Cassin of the Voluntary Drug Treatment Network, a national body that represents drug treatment and rehabilitation workers throughout the country.

"There is a serious lack of needle exchange programmes outside of Dublin. There are more opiate users outside Dublin now than ever, particularly in blackspots like the south east, the midlands, Galway and Limerick", he says.

He was also very critical of the absence of needle exchanges in prisons. "There is no needle exchange programme in prisons, and that is tantamount to negligence. Hepatitus C is a huge problem in prisons because they're sharing needles. The prison authorities won't allow users to use sterilisation tablets. There should be an equivalence between the services in prison and those outside prison."

The 2001 National Drug Strategy also aimed to "establish an effective regional framework to support the measures outline in the report by end of 2001". This was not achieved until 2004, and has lead to much bad feeling among those who work with drug users outside Dublin.

"The National Drug Strategy has been very slow in implementing the Regional Drug Task Forces", says Bill Ebbitt, the Interim Regional Task Force Coordinator.

"There was a lot of goodwill at the outset among key players on the ground outside Dublin – those providing drug services, those availing of them, those in the voluntary sector – but because it was so long in being established, there is now a lot of frustration at regional level.

"One of the main reasons for this is that no full-time Regional Task Force Coordinator was provided, it had to be done on a part-time basis. It's just not feasible to do it like that. We really could have done with more direction from the National Drugs Strategy Team.

"The task forces are up and running now, and we're developing plans, and consulting with the relevant people, but it has been too slow. Additional commitment and resources are necessary.

"The services that are here at the moment meet some of the needs, but certainly not the full need. They require considerable development.

The National Drug Strategy also aimed to set up a pilot pharmacy needle exchange scheme, and if it was successful, to extend the programme where required. But this has not happened, with the Progress Report stating that "the outstanding issues are being addressed." Sean Cassin is critical of the way it has been handled.

"The Department of Health has failed to get pharmacists on board in terms of distributing methadone prescriptions", he says.

"Problem users have to travel to one town to get their prescription and another to get the methadone. The Irish Pharmacists Association support the idea [of pharmacists distributing methadone prescriptions], but community pharmacists want their employment situations standardised and the Department has failed to do that."

Another issue relates to the extremely low number of hospital beds available for drug users to "detox" in. "There is a complete lack of detox beds in hospitals. There are 14,000 heroin users in Dublin alone and there are 20 detox beds available for them", says Tony Geoghegan.