Medically Supervised Injection Centres – October 2021
CLDATF Position Paper on Medically Supervised Injecting Facilities – October 2021
The Cork Local Drug & Alcohol Task Force (CLDATF) is a mechanism which enables local communities, statutory and voluntary agencies work together to address substance misuse across the city. Developing and providing funding to services since 1998 to meet emerging needs and tackle the prevalence of various substances.
Service Provision to Injecting Drug Users in Cork
HSE Drug and Alcohol Services and community projects funded by the CLDATF have been providing services to opiate users for over two decades. However, local evidence and data from the National Drug Treatment Reporting System indicated an increased prevalence of opiate use in the Cork area from 2008 onwards. Injecting drug use began to increase from an initial low baseline in Cork city to coincide with increasing levels of opiate use. A Needle Exchange / Outreach Support Worker was recruited to engage with people who inject drugs. Through street work the Needle Exchange / Outreach Support Worker builds a rapport with people who use drugs around the city, offering advice and information on harm reduction and treatment options. Drug using equipment is provided to service users. Injecting drug users and staff who work with people who inject drugs are trained in the administration of Naloxone, a medicine which counters the effects of opioid overdose.
Supporting Communities and Businesses in relation to Injecting Drug Use in Cork
The Needle Exchange / Outreach Support Worker provides support and advice to residents and businesses where injecting drug use occurs in their communities or on their premises. The staff of businesses can receive training on the safe disposal of drug litter. Locations that have a higher prevalence of injecting drug use are monitored regularly and drug litter bins have been installed in these areas to safely collect drug paraphernalia. Over the past number of years the installation of drug litter bins in Cork City have been erected and moved to alternative areas to coincide with the moving prevalence of injecting drug use around the city. The environments of drug litter incidents responded to date in 2021 consist of residential areas including apartment complexes, retail settings, the grounds of religious buildings and educational settings.
International Evidence Supporting Medically Supervised Injecting Facilities
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 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, many of whom are isolated from mainstream healthcare and service delivery. Medically Supervised Injecting Facilities (MSIFs) are interventions supported by a strong evidence base which can be effective in reaching this group. MSIFs 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 MSIFs 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.” 
This is not to say that Medically Supervised Injecting Facilities are a panacea; they are not. 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.
National Substance Misuse Strategy 2017-2025
Misuse of Drugs (Supervised Injecting Facilities) Act 2017
“Reducing Harm, Supporting Recovery- A health-led response to drug and alcohol use in Ireland 2017-2025” is the current national substance misuse strategy. It aims to treat “substance abuse and drug addiction as a public health issue, rather than a criminal justice issue” (Department of Health, 2017, p.3) . Strategic action 2.2.29 commits to the delivery of a pilot supervised injecting facility to “provide enhanced clinical support to people who inject drugs and mitigate the issue of public injecting” (Department of Health, 2017, p.90).
The Irish government passed the Misuse of Drugs (Supervised Injection Facilities) Act 2017. The purpose of this Act is;
“to provide for the establishment, licensing, operation and regulation of supervised injecting facilities for the purposes of reducing harm to people who inject drugs; to enhance the dignity, health and well-being of people who inject drugs in public places; to reduce the incidence of drug injection and drug-related litter in public places and thereby to enhance the public amenity for the wider community; and to provide for matters related thereto” (Department of Justice, 2017, p.3) .
In the autumn of 2017, the HSE approved the tender to provide the first pilot of a medically supervised injection facility (MSIF) in Ireland to Merchants Quay Ireland, a drug and alcohol service with charitable status in Dublin. However, due to continuous planning objections to the proposed MSIF at Merchants’ Quay, the facility is yet to be piloted in Ireland (An Board Pleanála, 2019) . To date this on-going High Court case has continued to delay conversations about progressing the establishment of medically supervised injection facilities in other locations such as Cork City.
CLDATF Position on Medically Supervised Injection Facilities
– A Call to Action for a Medically Supervised Injection Facility for Cork
The Cork Local Drug & Alcohol Task Force first voiced support for Medically Supervised Injecting Facilities in 2015 when a motion was passed by the board to call for support and further exploration of Medically Supervised Injecting Facilities as part of a suite of harm reduction measures. The passing of Misuse of Drugs (Supervised Injection Facilities) Act 2017 is greatly welcomed by CLDATF members. Meetings with previous Ministers with responsibility for the National Drugs Strategy indicated that Cork City would be considered as a site for Medically Supervised Injection Facility. However, the delay in piloting a Medically Supervised Injection Facility in Dublin has had an impact on progressing this much needed service for Cork.
The Cork Local Drug & Alcohol Task Force is calling on-
- Local residents, communities and businesses in the Cork City area to support the CLDATF in our endeavor to advocate for a Medically Supervised Injection Facility for Cork City.
- The Minister for Public Health, Wellbeing and the National Drugs Strategy, Frank Feighan TD, to commit to providing funding for a Medically Supervised Injection Facility for Cork City as a matter of urgency.
 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
 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
Department of Health (2017) Reducing Harm, Supporting Recovery A health-led response to drug and alcohol use in Ireland 2017-2025. Dublin: Government Publications.
 Department of Justice (2017) Misuse of Drugs (Supervised Injecting Facilities) Act 2017. Dublin: Government Publications.
 An Board Pleanála, (2019) Board Order ABP-305215-19. Dublin: An Board Pleanála. Retrieved December 2nd, 2020 from https://www.pleanala.ie/anbordpleanala/media/abp/cases/reports/305/r305215.pdf