TEN YEARS INTO Ana Liffey Drug Project’s work at its Limerick-based service, the people seeking the team’s services each day are “more unwell than ever”.
“Generally, they’re very sick at the moment,” team leader Rachel O’Donoghue told The Journal as she carried out outreach work around the city centre on a Tuesday morning, the week before Halloween.
“They’re more unwell, more excluded from society.”
Until a few years ago, she said:
“Street homelessness wasn’t really ever a massive issue in Limerick city.
There was always people that I knew that were sleeping rough but now it’s a lot more visible. You can’t deny that.
As in other major Irish towns and cities, there are complex social issues to factor in when it comes to addiction and homelessness. Trauma and drug use go back decades in some families. One estate in the city – St Mary’s Park – was shown to be the most disadvantaged area in Ireland just a few years ago.
The combined impact of the housing and cost-of-living crises has only served to exacerbate problems in more recent years, the NGO’s outreach workers told us as we spent a day on duty with them.
They also highlighted a lack of local treatment options for people keen to attempt going drug free.
Health
The team’s project workers gather every weekday morning for a planning meeting at around 9.30. The staff members, each of whom fill the role of key worker for a number of clients, give updates.
One man known to the service had been found sheltering from heavy rain in a doorway with a hoodie pulled over him the previous day. There were reports of an elderly couple, also known to the service, who were now living in a tent in an area known to be used by rough sleepers. There were concerns about the woman’s mental health.
Amid the more extreme cases there were reports of various clients needing to be brought to hospital and the GP. Staff members were assigned to pick them up from various hostels around the city.
Blood clots are a common issue among people who seek Ana Liffey Mid West’s services, the staff members said – but there can be any number of physical and mental health reasons drug users seek out the help of the service.
According to O’Donoghue: “A big part of the work we do is actually supporting people around their health, it’s not necessarily addiction – it’s often ‘how are you’, ‘how are you feeling’?
We had a man a couple of weeks ago, who we didn’t know, come in for a needle exchange. He visibly looked in a lot of pain and was wincing as he was talking to us.
We’re were like, ‘What’s going on? Come in. Would you like to come in and have a cup of tea?’
He did come in. And he started crying. We ended up bringing him to the GP that afternoon, and the GP said that he had actually the worst case of trench foot he’d ever seen.
So the levels of sickness that we’re seeing in people is massive.
Four years on
Despite the worsening situation over recent years, there are bright points throughout the day. There are bright points almost every day, the staff members stress.
At that morning meeting, for instance, there was also an update on a client the team had worked with over the previous months. He’d been homeless when he came on their radar, but was now set up in temporary accommodation and had had an offer of a job in recent days. Although he was living outside the region generally covered by Ana Liffey, a key worker was staying in touch with him by phone and was planning a visit.
There’s another positive development later in the morning: Four years ago, when The Journal last went on outreach with Ana Liffey in Limerick, we met a man in his late 30s who had spent years injecting heroin. Speaking to us in the back of a car as he was being brought to have bandages changed he spoke hopefully of the future, but it was clear he was in a very fragile state.
As we walked near Colbert Station, on this latest visit, the same man pedalled over on a mountain bike looking far healthier. He’d been living for a number of years in a rented flat, we were told – but rent increases meant he’d had to move out and he was now back in a hostel.
It’s an all too common situation at the moment, O’Donoghue explained. A few years ago, rental options were slim. Now – due to surging prices and lack of supply – they simply don’t exist.
The latest Daft rental report showed average monthly rent for a one bed flat in Limerick at just over €1,000 – an increase of almost 20% on the previous year.
Similarly, an increase in the level of polydrug use (use of multiple drugs) means that, due to their complex needs, many of the service’s clients don’t meet the established threshold for access to detox beds or other residential treatment centres.
“They need a lot of support around their addiction. Depending on where they’re at, a lot of the guys will mention Beaumont as the buzzword, or Coolmine,” Barry Lynch, a city-based project worker at the service explained.
We tell them – okay, well, if you want to go there, this is where you need to be. It’s a lot of harm reduction or reduction in use. So there’ll be a lot of drug diaries, helping them to reduce their drug use within the community down to a level where we can look at pre-entries into places like Coolmine – helping them reduce down to a level where they can go in and they’re ready.
Whenever a bed at, for instance, Beaumont’s substance misuse ward becomes available, two members of the Ana Liffey team have to drive the person seeking treatment to Dublin for an initial assessment before repeating the trip weeks later when the patient is actually admitted.
“We do need something more locally, definitely,” Lynch stressed.
Crack pipes
As in Dublin, as part of its basic health approach Ana Liffey’s Limerick centre provides clean syringes to drug users as part of a harm reduction effort to prevent the spread of HIV and other blood-borne diseases.
Coming up to lunchtime, a service-user who dropped to the door of the centre on Steamboat Quay was happy to chat about his situation and why he’s calling to collect new syringes.
Aged in his late 30s, he said he’s been using drugs on and off for around 20 years. He’s using both crack and heroin at the moment – sometimes injecting both in a practice known as ‘snowballing’.
Use of crack-cocaine – a smokeable form of cocaine that produces a short but intense high – has been on the rise in the city in recent years. Along with syringes, Ana Liffey also hands out sterile crack pipes to service-users in a bid to cut down on them inhaling toxic fumes from homemade ones.
Aside from the obvious danger posed by smoking the drug, there are also dangerous secondary impacts: as it’s a stimulant anyone taking it can stay awake for days on a binge and the wear and tear on the body can be significant.
The results of a study carried out by the University of Limerick and published yesterday found that the main health impacts on drug users in the city are chest and throat problems, damaged lungs, blood clots, weight loss, body pains and damaged teeth.
According to the study, which is based on interviews with current crack-cocaine users, the mental health impacts included psychosis, depression and paranoia. Participants spoke of engaging in sex work to earn money to buy the drug.
The heroin problem hasn’t receded as a result of the increased availability of crack – instead, clients are more likely to be using both. Latest national figures show an increase by 58% per cent in polydrug use over recent years amongst those seeking treatment for substance abuse.
To tackle overdoses, Ana Liffey has been spearheading a drive in recent years to promote use of a drug called Naloxone which blocks and reverses the effects of heroin and other opioid drugs. Their work includes training hostel staff and other agencies in how to administer it.
Service-users carry the drug with them – as do project workers, O’Donoghue explained. It can be administered immediately to someone in throes of an overdose, and the effects can be dramatic.
I’ve used it on somebody that was overdosed in a stairwell. He was completely unresponsive, he was starting to go blue.
It was my first time actually administering it and he literally sat straight up. It’s amazing what it can do.
The thing with Naloxone is somebody can fall back into an overdose when it wears off, so you still have to call the ambulance and make sure they get to hospital.
In the afternoon another project worker – Brian O’Donovan – showed us around the team’s new mobile health unit: a custom-fitted van used for outreach in the wider Mid West region.
Donated by JP McManus, the van can be used for one-to-one consultations – and in recent months the work has taken O’Donovan and other team members across Clare and North Tipperary as well as Limerick city and county.
The van provides a safe space for people seeking help or who simply want to talk about their drug use – including for those who may not feel comfortable being seen to be in contact with services in their own local area.
“Especially in rural areas where there is a lot of drug use, there’s also a lot of intimidation,” O’Donovan explained.
“So if someone is seen to be engaged in a service they will nearly be approached by people saying ‘you can’t be engaging with these people, you can’t be talking to these people’.”
‘Naming it’
At around 5pm each evening, the team has its final meeting of the day – another opportunity to share news about clients and what they might need, and also a chance for staff members to talk about how they’re coping with the demands of the job.
The atmosphere in the office – despite the nature of the work – is generally upbeat and good humoured, Rachel O’Donoghue stressed.
That said: “You do see terrible things and terrible things happen to people and, you know, the stigma and all that is really hard – sometimes it gets really frustrating.”
Each team member has a layer of additional support from an external supervisor – but the evening meetings help too.
If there’s something really heavy or something that people are worried about we always name it at the end of the day – that way it leaves it here and we get it off our chest.
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