High time we tackled State’s heroin problem. For years I have been trying to go down that road. Check Portugal.

The Irish Times – Monday, January 9, 2012

BRIAN O’CONNELL

ANALYSIS: EUROPEAN UNION figures out last November articulated clearly
what many frontline addiction and healthcare workers have been
noticing in Ireland for several years. Heroin use and addiction in
Ireland are rising at an alarming rate.

The EU figures, published by the European Monitoring Centre for Drugs
and Drug Addiction, showed that among the 15-64 age group there is now
an average of eight cases of heroin use per 1,000 population in
Ireland, whereas the EU average is four. This places us at the top of
the league of EU countries where opioid use (which in the main relates
to heroin) is recorded.

The mortality rate among Irish adults due to drug-induced deaths is
also high – the second-highest in the EU – with about 70 deaths per
million population, which is 3½ times higher than the EU average.

The heroin problem in Ireland is something which, perhaps naively,
many thought had been dealt with after its emergence in the late 1970s
and early 1980s, when its use was thought to have peaked around 1983.

Back then, it was mainly an urban problem, predominantly found in
Dublin among the under-25 age group. These were first-time heroin
users, and knowledge of and treatment for drugs-related HIV and other
diseases were less advanced or coherent among the medical profession
than they should be today.

Perhaps it is no accident also that Ireland’s current rise in heroin
use has coincided with another economic depression. The existing
heroin problem has been on the increase from about the mid-noughties
onwards. And in contrast to a generation ago, it is not so easy
associate its use with particular geographic areas or demographic
groups any longer. There are still many under 25-year-old first-time
heroin users living in the capital, but there are also likely to be
users in their 30s and 40s in places like Tralee, Ennis, or Tullamore.

Having spent time travelling to several parts of the country affected
by the problem, there seems to be an increased determination towards
tackling the issue through voluntary and public health organisations
and a collective awareness of its severity.

Waiting times for access to treatment, be it counselling services,
methadone or inpatient treatments, have been reduced and there would
seem to exist a better geographic spread of services available. No
longer are addicts from midlands areas expected to make their way to
Dublin to access treatments, as outreach programmes now bring services
directly to them.

Significant emphasis is placed on methadone treatment programmes. It
is administered in much the same way insulin might be given to a
diabetic. The argument for its use is that it allows addicts become
long-term chemically stable and affords them an opportunity to have a
semblance of a normal life.

People on methadone can hold down regular employment and exercise
daily in the gym while on long-term programmes. And it’s hard to argue
against the alternative life of an addict without methadone supports.
Too often though, methadone is seen as an end solution rather than a
means with which to achieve a drug-free conclusion.

The supports needed to allow those on methadone make the transition to
a drug-free life are not nearly as developed and advanced as the
networks now established with pharmacies and local GPs to administer
the drug. A black market for methadone has emerged in Ireland and
deaths related to the medication are, according to one AE consultant,
Dr Chris Luke, becoming far too common.

In the late 1990s, Portugal tackled its heroin problem, which saw the
country with upwards of 100,000 heroin addicts by the end of that
decade. It took the step in 2001 of decriminalising possession of all
drugs (for personal use) and replacing time behind bars with therapy.

So a person found guilty of possessing a small amount of narcotics is
now assessed by a panel which often includes a psychologist, social
worker and a member of the judiciary. Together, they will decide the
appropriate treatment for that person.

Coupled with this, huge efforts were made to encourage addicts to
return to the workplace and access education. Affirmative action was
introduced for former and current addicts and a societal shift in
attitudes took place.

Initial results show that five years after decriminalisation, illegal
drug use has declined and instances of drug-related diseases have also
fallen.

The numbers seeking drug treatment rose dramatically in the first five
years after the changes, while heroin-related deaths dropped by half.
Theft and crime rates have also fallen as a byproduct of the new drug
regime.

There are, of course, different cultural and historical perspectives
between Ireland and Portugal and it could be argued that significant
numbers of Irish people will engage in irresponsible behaviour
regardless of the drug, legal or otherwise (our dysfunctional
relationship with alcohol being the perfect example).

But the experience in Portugal is almost certainly worth considering
as Ireland battles with what some are calling its latest heroin
epidemic.

Brian O’Connell is author of Wasted: A Sober Journey Through Drunken
Ireland . Twitter: @oconnellbrian