A shifting landscape in Ireland’s views towards drug use

An epidemic of fentanyl overdoses is plaguing the world and yet Ireland seems to be lagging behind other nations in its response. What needs to be done to stop this crisis and does the solution lie in a “miracle drug” called Narcan?

A change seems to be occurring in Ireland’s political landscape as the legacy of the conservative state is slowly being dismantled through amendments to the constitution.  Recent referenda on divorce, marriage equality and reproductive rights all spring to mind when we think of how Ireland has changed in recent years.  While these remain contested issues, Ireland  now seems to think of itself  as moderately progressive.

Why, then, are its drug use policies so archaic? This issue has long been either trivialised, dismissed as a stoner’s desire for  legal cannabis, or surrounded by  moral panic: “You can have a methadone clinic, but not in my neighbourhood – think of the children!”. But with Ireland having one of the highest overdose rates per capita in Europe, and the growing concern over synthetic opioids (e.g Fentanyl) at the forefront of experts’ minds, this issue cannot be ignored for much longer. 

Ireland is facing ‘a choice between evolution or revolution’ in how the country responds to drug use”

This sentiment for reform was echoed by the recent findings of the Citizens’ Assembly on Drugs Use, the most comprehensive national effort to address drug policy in Ireland’s history. Trinity News spoke to Paul Reid, chair of the Assembly and former Health Service Executive CEO, about how it reflected the public’s changing consciousness.  In his words, Ireland is facing “a choice between evolution or revolution” in how the country responds to drug use.  Their conclusions were clear: change needs to happen, and fast.  

This is all the more relevant now, with recent warnings on November 10 about dangerous synthetic opioids circulating in Dublin, resulting in 40 known overdoses in a period of 38 hours.  Synthetic opioids are potent and dangerous, and have the capacity to be 50 times stronger than heroin. To provide some perspective,  the devastating overdose rates caused by these drugs in the United States have been described in countless studies as the country’s “most consequential preventable public health problem.”

Despite the fact that synthetic opioids have been recognised as a threat by the European Monitoring Centre for Drugs and Drug Addiction, Irish politicians are still slow to act. A prime example of this is the distribution, or lack thereof, of Narcan in Ireland. Narcan or Naloxone is a drug which reverses the effects of an overdose long enough for emergency responders to arrive.  You might have seen TikToks or infographics, often made by student advocate groups, with snappy instructions on how to administer this potentially life saving drug.  But did you know that it is not widely available in Ireland?

Currently, Narcan can only be obtained with a prescription, unless it is distributed by drug treatment workers. Only in the last year has St James’ hospital launched a scheme giving at-risk patients free take home Narcan kits (THN).  When Trinity News mentioned this scheme in an interview with Prof. David Best (Professor of Addiction Recovery, Leeds Trinity University), he was surprised, remarking that he was involved in the first peer-to-peer Narcan training scheme in the UK over 16 years ago.  He added how six weeks earlier he had visited a treatment centre in Texas, which had Narcan available in every bedside locker.  This seemed to him like a fundamental first step in responding to drug overdose, stating starkly: “You cannot recover if you are dead.”  

“Ireland follows a policy of criminalisation, which considers harm reduction and recovery for drug users as a secondary consideration”

To understand how Ireland came to lag behind so severely, you must examine the core values at the heart of drug policy.  At present, Ireland follows a policy of criminalisation, which considers harm reduction and recovery for drug users as a secondary consideration.  Government officials themselves have admitted that recovery is a “weak point” in Ireland’s Drug Response Strategy.  This “weak point” highlights what experts identify as a lack of political will to resolve the issue, citing stigma as the main barrier to action.  

The fact is that drugs hurt some communities more than others, according to a leading expert in this field Dr. Austin O’Carroll.  As he explains, this is because it is widely acknowledged that trauma is the root of addiction. Thus, people who grow up in disadvantaged areas have a much higher chance of undergoing trauma, and are therefore more predisposed to battling addiction.  Reid went so far as to express the belief that if drugs impacted wealthier areas at the same rate as disadvantaged ones, this would be more of a political priority.  Thus, for Reid and O’Carroll,  the systemic dehumanisation of drug users is not just harmful to themselves, but to society as a whole.

A key takeaway from the European Working Group On Drugs Oriented Recovery Research conference, which took place at Trinity College Dublin this year, is that in order to holistically and effectively respond to drug use, it needs to be viewed as a wider community issue. It is clear that such an attitude is lacking in Ireland. And although addiction does not discriminate, while it is important to acknowledge the class-based element, such considerations should not curb empathy or attention. Furthermore, with synthetic opioids increasingly affecting more widely-consumed party drugs, the risk of fatality for any and all drug users is on the rise.

Such measures not only empower students… but also give them the tools to potentially save a life”

Though the Citizens’ Assembly offers hope for a move towards more progressive policies, it is not enough for them to be implemented in a vacuum. Ireland must create engaged and active communities which can effectively implement harm reduction; this conversation can no longer be relegated to the outskirts of society.  One way to begin this process could be to bring concrete harm reduction support into institutions such as Trinity.  This is already widely practised across many American universities where the provision of free Narcan and training to students has been normalised in response to the Fentanyl crisis. Such measures not only empower students who may need help themselves, but also give them the tools to potentially save a life.  

As a country, we have the chance to put this infrastructure in place before it reaches crisis point, but a shift in attitude is needed within the wider public consciousness. Drug use and drug-related deaths should no longer be viewed with the apathy we have come to expect. Outside of specific services for drug users, “awareness” campaigns about not mixing substances and drinking water should not be the limits of  harm reduction policies. Ireland, along with the rest of Europe, can and must make this a political priority.  The question that remains is whether attitudes will shift in time.