Harm reduction and sensible drug policies
Amidst high profile violence relating to the illicit drug trade in Ireland, Garrett McGovern, a medical director and GP specialising in addiction medicine, reflects on the current status of Irish drug policy.
I treated my first patient with heroin addiction over 20 years ago at the same time methadone treatment became enshrined in law through the methadone treatment protocol. Like many of my colleagues I had little or no training in the field. For the next few years, I was flying on the seat of my pants. Punitive practices were commonplace in those days. Methadone doses were reduced for ‘dirty urines’ (a pejorative, stigmatising euphemism for a positive opiate drug screen). Patients were viewed suspiciously. “Not to be trusted. They’re out to deceive you, get more medication and lie about their drug use. Learn how to say no,” was the advice I was given by more experienced colleagues.
What struck me most about the people I was treating was that they knew far more about drug use than I did and yet as a doctor I was expected to make them better. How? By treating them to a lesson if they used heroin or other illicit drugs. Thankfully, around 20 years later times have changed. Opioid substitution treatment (OST), whilst much maligned, is an established treatment for treatment of heroin addiction. It has over five decades of research showing its effectiveness and is listed as an essential medication by the World Health Organisation (WHO). The detractors call it liquid handcuffs but there has been no better intervention at reducing heroin use, fatal overdose risk and the transmission of bloodborne viruses such as HIV and Hepatitis C. The drug will not work for every person every time. No different than any other medication.
In 2001, Portugal removed criminal sanctions for possession of illicit drugs for personal use. Drug use was treated as a health, rather than a criminal justice, issue. Almost 20 years later the outcome of this major shift in drug policy is plain for all to see. In 1999, Portugal had one of the highest prevalence of HIV infection and drug related deaths in the EU. Today, that trend has virtually reversed. The stigma associated with drug use has reduced and people with drug problems are not afraid to address their problem and seek help. This policy is good for people who use drugs but also for people who don’t use drugs. It is a win-win for society.
In 2016, legislation was passed in Ireland to open the first medically supervised injecting centre (MSIC). An MSIC is a facility where people who use drugs (primarily heroin injecting) can do so in a safe, hygienic environment and in the presence of trained staff who are on hand to provide sterile paraphernalia as well as offer advice on safer injecting and additional services available, while also intervening in emergency situations such as overdose. There are 100 or so of these facilities worldwide and the outcome studies to date have been very positive. There has not been a single death in any of the facilities internationally and the local area where the MSIC is situated reported significant reductions in drug related litter. Merchants Quay Ireland, a charity organisation with a longstanding track record for helping vulnerable drug users and homeless people will deliver this service. In spite of strong objection from local businesses and residents, the green light has been given for the service to open and this should happen in 2020.
The last six or seven years has seen a revolution in Irish drug policy. There is still a lot of work to be done but we are the verge of adopting policy that will change the way drug use is views as well as saving the lives of many people. These are exciting times.
Dr Garrett McGovern is a GP Specialising in Addiction Medicine and Medical Director of the Priority Medical Clinic in Dundrum and a member of the International Doctors for Healthy Drug Polices (IDHDP).
