Medically Supervised Injection Centres

Statement in Support of the Provision of Medically Supervised Injecting Centres in Ireland November 2015

Background

At its meeting of 17th November 2015, the Cork Local Drug and Alcohol Task Force passed a motion calling for support and further exploration of Medically Supervised Injecting Centres (MSIC) as part of a suite of harm reduction measures. While the decision of the Task Force is not indicative of the individual positions of the organisations and individuals represented on the Task Force, it is nonetheless worth noting that no Task Force members present at the meeting abstained from the vote or voted against the motion. This brief statement sets out the reasons behind the Task Force’s position.

Cork Local Drug and Alcohol Task Force

Today, the CLDATF funds twenty-one projects across Cork City. The projects we fund have developed over the years to meet emerging needs and the increasing prevalence of various substances within communities. The CLDATF board is comprised of a range of stakeholders including the community, voluntary and statutory sectors. Services including information and awareness raising, assessment, care planning, case management, brief interventions, holistic therapies, advocacy, onward referral, community-based counselling & pre and post treatment support are available from CLDATF funded projects.

Injecting Drug Use in Cork

Information below gathered from the Cork City Needle Exchange worker over the past 8 months:

  • Increase in dangerous injecting practices e.g rise in groin injections
  • Unsafe environments in which IV drug users prepare their hit e,g squats, churches, grounds of churches, apartment complex stairwells, parks, public steps, local business premises
  • 68 separate contacts with IV drug Users
  • Closure of local toilets due to IV drug use
  • Collection of drug litter from local businesses

 Evidence Based Drug Policy

If communities, cities and countries are to be effective in addressing problems associated with illicit drug use, there is a need to follow the best available evidence. This means responding to drug use with localised, targeted and inclusive interventions, which match the particular patterns of drug use in an area. It is well recognised that Ireland, and Irish cities in particular, have significant numbers of people who consume drugs by way of injection[1], many of whom are isolated from mainstream healthcare and service delivery. Medically Supervised Injecting Centres (MSICs) are interventions backed by a strong evidence base which can be effective in reaching this group. MSICs have been shown to improve both health related indicators for drug users and broader environmental indicators such as the reduction of unsafely discarded paraphernalia. The evidence for MSICs is summarised by the European Monitoring Centre for Drug and Drug Addiction as follows:

“… the benefits of providing supervised drug consumption facilities may include improvements in safe, hygienic drug use, especially among regular clients, increased access to health and social services, and reduced public drug use and associated nuisance. There is no evidence to suggest that the availability of safer injecting facilities increases drug use or frequency of injecting. These services facilitate rather than delay treatment entry and do not result in higher rates of local drug-related crime.” [2]

This is not to say that Medically Supervised Injecting Centres are a panacea; they are not. In order to be effective, they need to be properly integrated into mainstream service delivery. In this regard, there are many other issues in current Irish drug policy which needs to be addressed, including the provision of accessible residential stabilisation, detoxification and rehabilitation services for polydrug users and people with complex and multiple needs. However, it is not currently illegal to provide such services – providing them is a matter of resourcing. On this point, The Task Force notes that some of the public dialogue that has been against the provision of MSICs is on the basis that implementing MSICs will be expensive, and will thus take resources from other areas which also require investment. There are three arguments which counter this position. First, any intervention needs to be examined not simply in terms of cost, but in terms of cost effectiveness. In this regard, it is important to note that dealing with overdose in public settings is expensive and inefficient. A 12 month study of opioid overdose in Dublin[3], revealed that the National Ambulance Service and Dublin Fire Brigade responded to 479 call outs, 212 of which were on the street. The EMCDDA note that a study of the Sydney MSIC shows that there were fewer emergency service call-outs related to overdose when the centre was open[4].There have been 5 studies on the cost-effectiveness of Vancouver’s Insite Centre, and 2 on the cost-effectiveness of the Sydney MSIC, all of which have found the centres to be cost effective. Second, MSICs are progressive policies, which may be attractive to international philanthropic investors, or to local investment from existing NGOs in Ireland. There is no reason to automatically assume that the entire cost of implementing MSICs in Ireland will be shouldered by the taxpayer through the executive function of the state. Finally, the issue of cost is separate and distinct from the issue of whether communities should be able to consider MSICs as an option for addressing issues related to public injecting in their area.

At the moment, this opportunity is not afforded to communities – to provide an MSIC under the current legal framework is to break the law, meaning that if communities identified a need in their area which could be addressed by the provision of an MSIC, they would not be able to do so. In circumstances where on average, one person a day dies by overdose in Ireland, this position is untenable. Given the impact of public injecting on health, the Irish Medical Organisation note that it is imperative that MSICs are considered in the Irish context:

“Several other EU states, such as Portugal, Germany, and Spain have introduced such sites, which concentrate on harm reduction and prioritising the health interests of the drug user. International research has established the ability of such facilities to reduce drug-related harm to users, and so this option must be properly assessed as a potential viable public health measure to tackle drug-related harm.” [5]

Regardless of resourcing issues, it should be legally possible to deliver an appropriate range of evidence based services for drug users in Ireland, and MSICs are one such service. Given the challenges that Cork, and Ireland more generally, faces concerning injecting drug use, the Cork Local Drug and Alcohol Task Force supports the recent calls for the implementation of MSICs where needed in Ireland.

 A Call to Action

With the foregoing in mind, Cork Local Drug and Alcohol Task Force hereby calls for:

  1. The passing by the Oireachtas of legislation permitting the operation of MSICs in Ireland
  2. Locations for MSICs in Ireland to be decided on a needs basis
  3. An explicit action setting out a timescale for implementation of Medically Supervised Injecting Centres to be included in the in next National Drug Strategy
  4. The establishment of detailed outcome based evaluation plans where Medically Supervised Injecting Centres are implemented

[1] See, for example, Jennings, C. (2014). Re-establishing Contact: A profile of clients attending the Health Promotion Unit – Needle Exchange at Merchants Quay Ireland. Dublin: Merchants Quay Ireland

[2] European Monitoring Centre for Drugs and Drug Addiction (2015). “Drug consumption rooms: an overview of provision and evidence”. Available online at: http://www.emcdda.europa.eu/topics/pods/drug-consumption-rooms#ref23Online

[3] Klimas et al, 2014

[4] Source

[5] IMO (2015) IMO Position Paper on Addiction and Dependency. Online at http://www.imo.ie/news-media/publications/Addiction-and-Dependency-IMO-Position-Paper-(HR2).pdf; page 17