SPECIAL REPORT, DAY 2: Fighting back against heroin’s stranglehold

NOBODY in Cork is denying that heroin is gaining a steadier foothold in the city.

Gardaí, addiction workers, youth workers, social workers, city councillors: They all acknowledge it’s a growing issue, a problem that up until 2006/07 was rare, isolated, and relatively stagnant.

In recent weeks, the city’s leading garda blamed a significant rise in muggings and thefts in Cork city centre on heroin addicts desperately needing their next fix. Chief Superintendent Mick Finn told the October meeting of the Joint Policing Committee that these crimes were up by 41% between July and September compared with the year previous. There was “no doubt”, he said, this was linked to the increased use of heroin.

When it comes to heroin, local politicians tend to articulate the fears of a community, and fear is the operative word when it comes to heroin. More and more people are coming to city councillors incandescent about discarded needles, about users shooting up in public spaces. And then there are many older people, says Independent city councillor Mick Finn, “scared and intimidated by junkies, by how their street has changed, by what could happen”.

Two Cork mothers spoke in Part One of this series of how their sons’ lives collapsed within months of taking heroin regularly. “The speed of the deterioration, I couldn’t believe it,” said ‘Margaret’. Her son was only on heroin for six months before dealers attempted to pipe-bomb their house.

It’s when the user is evicted or when their parents can’t take any more that the addicts tend to arrive at the St Vincent de Paul or the Simon homeless shelter.

Cork Simon Community CEO Dermot Kavanagh says “the day has long passed” that alcohol was invariably the substance being abused by their clients in Cork.

“In the last several years, it’s opiates and polydrug use, and this has created challenges.

“There was a time when there was only a handful of opiate users in the city, maybe they did go to Limerick or Dublin for their heroin, but there have been very significant Garda seizures in recent years, one of €100,000, and if they’re supplying a local market, it suggests there is strong demand, which is unfortunate.”

Unlike elsewhere in the country, heroin only came to Cork recently. In the 1980s and 1990s, hash, ecstasy, and, latterly, cocaine were the illegal drugs most abused in Cork. It was said the local families that controlled Cork’s drug supply had forged a ‘gentleman’s agreement’ to keep the city, unlike Dublin, heroin free. But users tell us the growing heroin market in Cork is now a free-for-all. “It’s all nations, everyone, every colour, black, white, Travellers the lot, they’re all selling,” says ‘Susan’.

The big fear in local communities and among youth and social workers is that if the growing problem isn’t tackled, it could explode, as happened with horrifying consequences in Dublin in the 1980s.

Mr Kavanagh, who spent 16 years working at the Merchant Quay drugs project in Dublin, stresses that heroin use in Cork is nowhere near that of Dublin. “There are certainly over 15,000 opiate users in the Dublin area in a catchment area of 1.2m people,” he says. “The greater Cork metropolitan area has about a quarter of that, or 300,000 people, and yet the number of opiate users is at best in the hundreds, not thousands, and you would expect it be 3,000 to 4,000.

“So something has to be said for the response here. They did invest in services in Cork at a relatively early stage compared to Dublin, but that’s not to say that more isn’t needed.”

There are currently 250 people on methadone or drugs counselling programmes in Cork, according to HSE addiction services. The HSE and voluntary sector drugs workers estimate that another 250 heroin users are not in treatment, with some arguing there may be twice that, or up to 500 heroin users, not in treatment.

City councillors such as Sinn Féin’s Chris O’Leary and Independent Mick Finn have warned the Cork Local Drugs Task Force has seen cuts of 25% to funding since 2008, the period when the problem really started to accelerate. They want to see this trend reversed urgently, drugs education increased at primary school level, and zero tolerance initiatives introduced to undermine supply.

“The gardaí seem to be going after the big guys but we need to hit the small dealers too, the guys handing out bags outside the shop, on the green,” says Mr Finn. “A message needs to be sent out that this and public drug taking won’t be tolerated. The city needs to fight back.”

A number of city councillors also accused the HSE and gardaí of taking a ‘head-in-the-sand’ approach to heroin, with Mr O’Leary saying “the authorities had been attempting to muzzle people on the rise of heroin in Cork”.

However, according to workers in treatment services and local drugs projects, “this couldn’t be further from the truth”.

“In 2008 and even earlier, we were acknowledging that we were facing challenges over a growth in heroin usage,” says David Lane, HSE South co-ordinator of drug and alcohol services. “Back then, we had a skeleton staff in this area, one part-time doctor, no nursing staff, no clinical psychologist, not many counsellors and just one treatment centre. We also had a significant number on waiting lists for treatment.

“Within 12 months, we had a massive investment and now we have nearly three full-time doctors, two nurses, a clinical psychologist. We’ve doubled the number of counsellors and we’ve opened up a new clinic, Heron House at Blackpool Retail Park.”

There are also eight adult and four adolescent detox beds for HSE South clients in an array of voluntary treatment services in counties Carlow, Kildare, Kilkenny, and Cork. Mr Lane acknowledges that, while local community drugs projects experienced a 25% cut in funding since the downturn, overall investment in opiate addiction services in Cork and Kerry rose by €1.5m annually since 2008.

For their part, gardaí at Cork headquarters Anglesea Street point to their heroin unit and formal meetings with statutory agencies, such as the HSE, Cork City Council, and homeless services, to discuss heroin. Yesterday, the JPC held a meeting specifically on heroin.

However, it seems more needs to be done, with the HSE, gardaí, and homeless services readily admitting heroin is extending its grip. A bag of heroin can be bought for as little as €25 on the streets of Cork.

Gerard Spillane, regional manager at Focus Ireland and another former Merchant’s Quay employee, is urging people to be patient. Hesays current initiatives will pay off, but need to be continued and augmented. “Realistically, the guards can’t police needles being thrown around the place or people shooting up in public, they can’t follow them around,” says Mr Spillane. “I must say, Chief Supt Mick Finn, has been very open on heroin and supports our issues. Yes, we are seeing increases in heroin use, but we are not seeing the explosion of 1980s Dublin, as the services and innovative practices are in place.”

Eleanor O’Sullivan, director of services at Youth Work Ireland, runs the Gurranabraher-Churchfield drugs outreach projects. She says “there are drugs services there for people”, but, like anywhere, getting clients to use them is the challenge.

Her team of outreach workers, including family support worker Therese Spillane, go out into the community and meet heroin users when gardaí, family members, or the person themselves alert them to a problem. “It’s all about engaging and building a relationship with the user so they become aware of the services that are there to keep them safe and of the many treatment options,” says Ms Spillane. She admits, though, that, due to cuts to funding, her team find themselves doing more “reactive than proactive educational” work these days.

People outside addiction services think a heroin addict seeking to reform must move from abuse to detox to treatment, after which he or she will end up drug-free. But that won’t happen for everyone, more “pathways” are required, according to Focus Ireland and Cork Simon, with research pointing towards the more effective “harm reduction model” of needle exchange, methadone replacement, and residential treatment.

“Back in the 1980s in Dublin, you had nothing. You had Jervis Street, that was it and it was simply offering abstinence ordinated treatment and so you went quickly from a scene that involved a small number of people to a scene that involved thousands,” says Mr Kavanagh. “It was only after the first National Drugs Strategy, when we started to invest in outreach, drug substitution services and residential treatment and an array of pathways for people, that heroin stopped growing exponentially.”

The success of this harm reduction model, he says, is evidenced by the current average age of the Dublin opiate user; they’re now in their 30s. The older age profile demonstrates, he says, that fewer young people in Dublin are starting to take heroin, as users are increasingly in some form of counselling or treatment and so not encouraging others to buy and smoke or inject heroin.

“From experience, investing in services works. It is effective, but it takes a while,” says Mr Kavanagh.

Mr Spillane and Mr Kavanagh both warn that “zero tolerance” might look — and sound — like a solution but it doesn’t work.

“Unfortunately, it is internationally recognised that ‘good drugs policy is bad voter or government policy’, as it isn’t immediately obvious to communities that there is a plan in place,” says Mr Spillane.

“The initial reaction to the drug problem in Dublin was draconian legislation and heavy policing of drug scenes and it didn’t work there or anywhere. First of all, people in drug use have a very strong desire to use and those on the other end have a very strong desire to make money, and there is an endless supply of people in dire straits who will take the risk of being arrested.

“I’ve seen hundreds of arrests in Dublin and the next day there are hundreds more on the street to replace them. I wouldn’t put my hopes on zero tolerance.”

However, not all are convinced of the merits of the “harm reduction” approach to heroin addiction, and this is evidenced by Cork’s failure to have a permanent needle exchange which users could access 24/7.

According to Mr Lane, several chemists in the city are part of a scheme to distribute needle packs, including needles, spoons, citric acid, and wipes to heroin users. There are also a small number of chemists and services distributing methadone. He says a growing number of chemists are requesting to take part in the needle exchange scheme which, as well as reducing the public health risk of discarded needles and needle-sharing, is seen as a way of “planting the seed of treatment”, as these pharmacists are also trained to build relationships with users.

“When it comes to heroin addiction, the measure of success is not just getting people off drugs but it is improving their health and safety and helping clear the fog in their heads so they can consider a different way of life,” says Mr Lane.

Elsewhere around the world, where heroin abuse is far more entrenched, authorities have gone so far as to bring in ‘safe-use rooms’ where users can inject in private. However, the users cannot leave these rooms without meeting a counsellor and medical staff.

There have been calls for these from the Dublin Lord Mayor, Oisín Quinn, but others espousing the abstinence model have reacted with horror, again suggesting they condone drug use and that the drug-free model must be prioritised over harm-reduction models such as methadone substitution.

Addiction services in Cork may be light years away from such developments but as Ms O’Sullivan says: “When it gets into a city, it is near impossible to get out.” Her project in Gurranabraher provides diversionary activities for teenagers at risk such as music classes, rapping, and youth cafes on Friday nights which gardaí strongly support (see Page 6).

As the country gradually leaves austerity behind, investment in these early intervention services needs to increase, not decrease, as has been the case in Cork City. Drug user ‘Susan’ also warns that early interventions for children at risk must become a priority at primary school. “Schools need to look more at why a kid is troublesome,” she says. “They need to offer help, they also need to talk about drugs. I see kids smoking joints and drinking at 10 and 11 now.”

According to family support worker Ms Spillane and councillor Mr O’Leary, there also needs to be a huge investment in housing, counselling, and educational supports for users when they leave treatment so the chances of relapse are reduced.

And Mr Spillane in Focus Ireland believes Cork needs to introduce an aftercare service for children leaving care, as research shows the majority leaving long-term care aged 18 end up on heroin. More level two GPs, who can prescribe methadone, must also be brought on board, he says. Others in addiction services point to the need to increase links with mental health services, to work towards a permanent needle exchange unit, and even respite services for drug users.

“We won’t be taking our eye off the ball,” says Mr Lane.

However, as he and others remind me, 85% of admissions to addiction services in Cork and Kerry are still because of alcohol abuse.

READ THE FULL REPORT HERE

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