Working Life: If you’re struggling with chems use, there’s no shame in reaching out

Dr Ralph Hurley O’Dwyer, specialist registrar in public health medicine at the Department of Public Health, HSE Dublin and Midlands

Dr Ralph Hurley O’Dwyer, specialist registrar in public health medicine at the Department of Public Health, HSE Dublin and Midlands. Picture: Moya Nolan

“I grew up between Clane and Newbridge in Co Kildare, but Kilkenny city, where my parents are from and where I spent much of my childhood, has always felt like home.

“My decision to become a doctor was shaped by two close family experiences. When I was 10, my grandmother suffered a stroke, requiring prolonged hospital care. At 12, my youngest brother Robin was born very prematurely. Initially, we thought he would survive but he died of a severe infection at just two months old.

“I saw the impact healthcare workers can have on people’s lives. I wanted to offer that same care to others.

“Before moving into public health in 2024, I worked mainly in infectious diseases, particularly with people living with HIV.

“The first patient I saw as a 19-year-old medical student was a young man living with HIV. He had been admitted to hospital with unexplained weight loss and later diagnosed with a HIV-associated cancer. Five years later, as a newly-qualified intern, I met him again — on the night he died. I was asked to make sure he was comfortable and I still remember every detail of that final encounter. He was my first patient. He and his story have had a profound impact on my life.

“Many patients you see as an infectious diseases doctor are among the most marginalised in society: The homeless, intravenous drugs users; refugees, LGBT+ people. My move into public health was driven by a desire to work upstream — to help prevent the greatest amount of suffering possible, particularly for those who already face discrimination.

“I recently led a national HSE survey on chemsex — the use of drugs to enhance, facilitate, or prolong sex. It’s a growing phenomenon in Ireland, particularly among gay and bisexual men. While many experience no major harm, chems drugs carry serious health risks. Unfortunately, support services are very scarce — we urgently need to do better. As a gay man, this work feels particularly meaningful, and I hope it guides the development of better supports.

“If you’re struggling with chems use, there’s no shame in reaching out. Support is available at sexual health clinics around the country, including the Sexual Health Centre Cork and the GUIDE and GMHS clinics in Dublin.”