IT HAS BEEN a decade since a supervised facility for people to inject drugs less harmfully was first proposed for Dublin.

It has been almost five years since Supervised Injecting Facilities have been legal in Ireland. It is time one was opened.

Street-based injecting

Street-based injecting refers to the practice of injecting drugs in public or semi-public places. Street-based injecting is harmful. There are harms affecting the people who are injecting and also harms that affect the community where injecting occurs.

A Supervised Injecting Facility is a type of Drug Consumption Room. Supervised Injecting Facilities focus on injecting drug use and seek to reduce harm through the supervision of people who inject illicit or unknown drugs in a more hygienic and less public environment than otherwise; the provision of sterile equipment; the provision of advice on safer injecting practise; intervening when an overdose occurs; and by referring people to other services, e.g. health, social, housing, legal, etc.

For many years, drug use in Dublin’s public spaces has been and continues to be, a matter of significant concern. For example, in 2005, the Lord Mayor’s Commission on Crime and Policing highlighted the public perception of the problem of public injecting in Dublin, “injecting in public places…a sight [which] causes distress to members of the public who feel threatened by such overt drug abuse on the streets…and a perception of lawlessness often ensues”.

‘The worst thing’

In 2011 a public survey by Dublin City Council described ‘antisocial’ behaviour, including drug-related activities, as being the worst thing about Dublin. In that survey, there were over 400 mentions of drugs and drug use in the open responses.

The persistence and significance of the problem over the last two decades suggest that existing policy responses have been ineffective in reducing associated drug-related harms.

Elsewhere, other public health-focused responses, such as Supervised Injecting Facilities, have been implemented successfully. But they have yet to be replicated in Ireland.

Advocacy

Established in 1982 as the first organisation founded on the principles of Harm Reduction in Ireland, Ana Liffey Drug Project marks its 40th anniversary in 2022. Harm Reduction organisations seek to reduce the harm that illicit drug use causes to individuals, families and communities.

A decade ago, on Friday 20 January 2012, Ana Liffey launched its 2012 – 2014 strategic plan. One of its strategic goals was the development of a Supervised Injecting Facility for people who inject drugs in Dublin City Centre.

This was a further step in the organisation’s efforts toward significant change for the people the charity serves – many of whom are engaged in street-based injecting of different types of unknown and illicit drugs.

As such, they are at significantly increased risk of harm, including contracting HIV and Hepatitis C, vein damage, and overdose. Whilst opening a Supervised Injecting Facility made sense to Ana Liffey, in 2012 it was not a goal in the National Drug Strategy at that time, and it was a controversial subject.

However, the evidence increasingly proved the effectiveness of Supervised Injecting Facilities as a harm reduction strategy in places like Kings Cross, Sydney; the Downtown Eastside of Vancouver; and across Europe.

Legislation

The well-established facilities in these places operate within the law. In cities and countries where new facilities are proposed, existing laws often need to be challenged or changed. Recently, in Glasgow, for example, Peter Krykant took the bold step of committing an act of civil disobedience by opening a mobile Supervised Injecting Facility on 31 August 2020.

However, Ana Liffey’s strategy has been a judicial one. In June 2014, having been approached by Ana Liffey, the Bar Council of Ireland’s ‘Voluntary Assistance Scheme’ began to draft a piece of legislation with the aim of introducing Supervised Injection Facilities.

On 21 May 2015 the Voluntary Assistance Scheme presented draft legislation to Ana Liffey; who in turn presented it to then Minister of State with responsibility for the National Drugs Strategy, Aodhán Ó Ríordáin. The draft legislation would, if enacted, establish a legal framework within which Supervised Injecting Facilities could operate in Ireland. The Minister brought this draft legislation to the Department of Health, where work began in earnest on the legislation, following the legislative processes of the Oireachtas.

There was cross-party support for the bill – which passed in the Dáil without amendment and was introduced to the Seanad, where it also passed without amendment.

On 16 May 2017, having considered the Misuse of Drugs (Supervised Injecting Facilities) Bill 2017, President Higgins signed the bill and it accordingly became law. We are not aware of draft legislation being provided to a Minister by advocates and leading to legislation being enacted happening before, nor since.

Once the legislation was enacted, the work of implementing Ireland’s first Supervised Injecting Facility began. Government funding was included in the estimates for the 2018 Budget; a procurement process was implemented by the HSE; on 16 February 2018, Merchants Quay Ireland was selected as the preferred provider and their Riverbank Building, on Merchants Quay in the Dublin 8 area, was identified as the location of Ireland’s fixed site Supervised Injecting Facility, which would open as an 18-month pilot project.

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A local planning and related legal process ensued – much of which has been well documented recently in the media. Suffice to say here, that by February 2020, a new barrier to implementation had emerged when the neighbouring primary school filed a High Court challenge against the planning permission.

The planned Supervised Injecting Facility has yet to open, meaning people remain out on the streets and in alleyways injecting drugs in unsafe, unhygienic and very public conditions.

Deferred policy

Today, 20 January 2022, is 10 years since Ana Liffey began to advocate for Supervised Injecting Facilitates. Ten years is a long time, yet Supervised Injecting Facilities
have still to be established in Ireland, despite the Oireachtas’ decision that they are worth legalising to improve public health.

The delay is disappointing for people who have worked to develop Supervised Injecting Facilities and for the people who would benefit from using them. That said, the Irish experience is not different to experiences elsewhere – for example, Portugal and Melbourne both experienced many years of deferred policy implementation before recently succeeding in opening facilities similar to the one proposed for Dublin.

And, in Scotland, Peter Krykant’s mobile unit stopped operating in May 2021; however, Peter expects that an official Supervised Injecting Facility will open in Glasgow in the first half of 2022.

This year marks 40 years of Harm Reduction in Ireland, 10 years of advocacy for Supervised Injecting Facilities, and five years since the Oireachtas decided the facilities could improve public health. Indeed, at yesterday’s meeting of the Committee on Health in the Oireachtas, Minister of State with responsibility for the National Drug Strategy, Frank Feighan TD, acknowledged the huge need for a Supervised Injecting Facility at Merchants Quay; that he is fully supportive of the Government’s decision to establish that facility and that doing so is a key action in the National Drug Strategy.

It is time one was opened – to take an important step in keeping people safer from harm.

Written by Tony Duffin, CEO of Ana Liffey Drug Project and Eugene McCann of Simon Fraser University. A new working paper on the campaign to establish a Supervised Injecting Facility in Dublin, Ireland is published today: ‘Empathy, Evidence, & Experience: Learning from overseas to respond to street based drug injecting in Dublin City Centre’ (Working Paper) McCann, E. & Duffin, T. January 2022.