WHAT IS ‘HARM reduction’?

From a practical perspective, harm reduction is simply working to reduce the negative consequences associated with drug use. It is not incompatible with abstinence, but recognises that abstinence may not be a realistic goal for all people at all times.

At the Ana Liffey Drug Project, we do a lot of harm reduction work. Many of our clients are polydrug users, often living chaotic and troubled lives. Many, for whatever reason, do not see themselves as having the internal resources to stop using drugs by themselves; equally, they generally do not meet the criteria required to access intensive residential treatment services.

Overdose is a constant presence – on average, about one person per day dies of overdose in Ireland – and Christmas and New Year are, understandably, an emotional time for many of our clients. There are many reasons for this including isolation from family and loved ones and a feeling of exclusion as people see others enjoying the festive season.

We typically see an increase in both fatal and non-fatal overdoses during this period.

Excess

However, the holiday season is a time of excess (and, often, stress) for everyone, not just for those people who use our services. Many people will celebrate (or cope) by using drugs, including alcohol, excessively.

There is simple, basic harm reduction knowledge which everyone should have. Of course, it’s always safest not to drink or use drugs at all, but if you (or those around you) do, here are three important things to be mindful of:

• Pace yourself. All drugs, including alcohol, take time to have an effect, particularly when swallowed. If you’re going to take ecstasy over the holiday season, remember that there was PMA/PMMA implicated in a number of overdoses and deaths across Europe. PMA/PMMA has similar effects to MDMA, but is toxic at lower doses and takes longer to have an effect, meaning that people often take a second dose before the first has taken effect. If you’re just planning on drinking, the same logic applies to doing shots – space them out. Find out more here.
• Educate yourself. Take responsibility for your drink and drug use. Many drugs interact with each other – if you’re going to use more than one drug, find out what these interactions are. For example, cocaine and alcohol, taken together, result in a third chemical – cocaethylene – being produced during the metabolic process. Cocaethylene is toxic in itself, and has its own set of health effects to be considered. Find out more here.
• Upskill yourself. Know how to respond to someone who is overdosing. If anything does go wrong, its important that someone in the group knows what to do – a single cool head in a crisis is a very valuable thing. Know the basic facts, and when and how to put someone in the recovery position. There’s some helpful information in this leaflet — and here’s a great video.

Most importantly, remember that drug use, including alcohol use, causes harm.

As we face into 2015, a lot has been achieved in highlighting and gaining national recognition for the massive problem of overdose death in Ireland — including the development of the HSE’s Naloxone Pilot (Naloxone is a life saving drug which temporarily reverses the effects of opiates like heroin).

However, we need to do more, because one death is too many.

Over the years my colleagues and I have seen first-hand the devastating effect these deaths have on the deceased’s family, their friends and the wider community.

We have attended many funerals.

We have worked hard in the aftermath of an overdose death to support loved ones (the age profile of those who die by overdose unfortunately means that many leave young children behind).

Unfortunately, this situation will continue unless action is taken to reduce the number of overdose deaths in Ireland.

At Ana Liffey, we work to address this, both through directly working with people to help them reduce the harm their drug use is causing, but also through lobbying for the introduction of innovative services informed by the best available evidence.

Our current strategic plan includes two such services – a residential treatment service with no unnecessary barriers to entry, which allows those with the most need to access the most intensive treatment; and a medically supervised injecting centre, which would provide a place for injecting drug users to inject under medical supervision, thus reducing the need for public injecting. We look forward to progressing them in 2015.

Drug use is an emotive topic. It often generates strong (and polarised) opinions.

However, the reality is that drug use and its attendant issues, like overdose, are much studied and there is much objective evidence as to what works in terms of limiting the damage that drug use causes to individuals, families and society.

It is this evidence – like Naloxone, like medically supervised injecting rooms, like accessible residential treatment – that we need to continue to be brave in putting our resources behind now, so we can reduce the significant harm that currently results from overdose in Ireland.

Tony Duffin is the Director of the Ana Liffey Drug Project. You can find out more about Ana Liffey’s work at www.aldp.ie