Ireland’s current drugs strategy emphasises a health-led response to drug use in Ireland.1 Consistent with this focus, a pilot supervised injecting facility (SIF) will open in 2018 in Dublin city centre. As Ireland moves towards implementation of the country’s first SIF, information with regard to public injecting among drug users in Dublin’s inner city is important. A 2017 report from the Ana Liffey Drug Project (ALDP) examined street-based injecting in Dublin city centre.2

Harms associated with street-based injecting

The report highlighted the harms associated with street-based injecting. These include both private harms affecting individuals who are injecting and public harms which impinge on the community where injecting is occurring. Private harms include evidence suggesting that injecting in public places is conducive to hasty injecting, leading to safety and hygiene concerns. Public harms include drug-related litter in public and semi-public locations, thus creating a safety hazard to other individuals.

Street-based injecting in Dublin city

A small number of studies have attempted to assess the prevalence of street-based injecting among drug users in Dublin. In 2013, Merchants Quay Ireland reported that 14% of subjects who used their needle and syringe exchange service generally injected in public places.3 More recently, ALDP asked individuals who use their Dublin services to take part in a survey. It was found that 28% of respondents reported injecting drug use in the last seven days; 18% of respondents reported mostly injecting on the street or in a service during this time.

It was noted that the issues facing this group are many and complex, with polydrug use and sharing of paraphernalia being of particular concern. In addition, 28% of respondents in the ALDP survey indicated having prior experience of overdose. The risk of fatal overdose is a constant reality among street-based drug injectors. As the Health Service Executive notes:

Public injecting is visually apparent in Dublin city centre through people using drugs and from drug-related litter …. Between 2012 and 2014 there were 25 drug-related deaths among people who inject drugs in public places in Dublin and 18 drug-related deaths among people who inject drugs who were in touch with homeless services in Dublin.4

Public harms associated with street-based injecting

In late 2016, ALDP undertook a small project to document drug-related litter in the north inner city area of Dublin. Each afternoon a staff member walked two alternating routes in the area for two weeks; each route was covered every second day. In total, 57 separate instances of drug-related litter were identified, with over 1,750 individual pieces of litter being recorded. Litter was observed in a number of locations, but there were two ‘hot spots’2: the area bounded by Capel Street, Ormond Square, Mary’s Abbey and Ormond Quay, and that bounded by Jervis Street, Abbey Street Middle, O’Connell Street Lower and Ormond Quay.

Evidence of water for injection, citric acid and syringe caps were most frequently observed, and were recorded at 84%, 82% and 78% instances, respectively. Syringes were observed at 53% and needles at 51% of the total instances. Faeces were recorded at over one-quarter of locations, highlighting the lack of public toilets in the area.

Conclusions

The authors concluded that street-based injecting is an issue which requires attention in Dublin city centre, as the current situation perpetuates the use of high-risk environments by people who inject drugs as well as resulting in drug-related litter. Providing injecting drug users with the opportunity to access safer injecting spaces (such as supervised facilities) is a pragmatic approach to addressing this issue, as these services have repeatedly been shown to be effective in reducing harm, including overdose.5 Other interventions identified by ALDP included the following:

Peer-led approaches to promoting safer disposal/return of drug-taking paraphernalia

Continued outreach to identify people engaging in street-based injecting

The removal of barriers that hinder the ability of people engaged in street-based injecting from accessing the services they require.

2  Keane M, Korovich M, Duffin T and Russell D (2017) At the dark end of the street: a report on street based injecting in Dublin city centre. Dublin: Ana Liffey Drug Project. https://www.drugsandalcohol.ie/27953/

3  Jennings CJ (2013) Re-establishing contact: a profile of clients attending the Health Promotion Unit — needle exchange at Merchants Quay Ireland. Dublin: Merchants Quay Ireland. https://www.drugsandalcohol.ie/19914/

4  Health Service Executive (2017) Frequently asked questions: supervised injecting facilities. Available online at

https://www.drugsandalcohol.ie/27269/

5  Potier C, Laprévote V, Dubois-Arber F, Cottencin O and Rolland B (2014) Supervised injection services: what has been demonstrated? A systematic literature review. Drug Alcohol Depend, 145: 48—68.