How can we reduce drug deaths in Cork city?

Between 2013 and 2022, 359 people in Cork died from drug poisoning, according to the latest report from the Health Research Board.

Of the 343 drug poisoning deaths in Ireland in 2022, almost half (44%) were people residing in Dublin, while 40 (12.2%) resided in Cork.

The figures have remained at that level since 2019, with drug poisoning deaths in the city hovering within the range of 42-52 each year.

The question that needs to be asked is, in term of comprehensive services to respond to these figures, what would be the best fit for Cork? Would it benefit from a supervised injection facility? Would a mobile service adequately address these needs? Or would a drug consumption facility be more appropriate?

The Government decided the first supervised injection facility (SIF) would be based in Dubin city centre on a pilot basis. A licence was granted to Merchant’s Quay Ireland to operate one for 18 months. It opened just over a year ago, and a review is expected to take place in the summer.

But it is not just drug consumers and their immediate family that have a problem with drug use. It is having a negative impact on the city, including public areas like parks.

This is a complex problem with implications for wider communities caught up in the cross hairs of anti-social behaviour aligned with drug use.

A report on problem drug use in Cork city was published last March – the first such study to examine drug use at local rather than national level. Commissioned jointly by the Health Service Executive Cork and Kerry, and Cork City Council, it examined the scale of the problem using multiple data sources.

The study was undertaken by the School of Public Health, UCC, in collaboration with the Health Research Board and the National Suicide Research Foundation.

The researchers identified an estimated 859 problematic opioid users in Cork city in 2022; and an increase in the use of cocaine (including crack) and amphetamines, with these rises more pronounced among young adults. Notably, the study found that the prevalence of opioid use has remained relatively stable – a trend reflected in national data.

National studies have consistently shown a majority of opioid users in Ireland are male aged 35-64; with evidence of a steady decrease in the number of opioid users at younger age groups - 15-24 years and 25-34 - receiving treatment, alongside an increase in the number of those aged 35-64 years over time.

Similar trends are seen in Europe. The researchers suggested this may reflect a wariness of opioid use among younger users having witnessed the harmful effects of heroin on previous generations.

Irish treatment data shows that cocaine has become the most common primary drug of interest among new treatment entrants. Additional research indicates a rise in the use of non-prescribed medications or ‘street’ tablets among young people. Consequently, observed trends in opioid use among young people may reflect a shift towards more accessible and inexpensive drugs that are perceived as less harmful than opioids.

After the opening of the medically supervised injecting facility in Dublin, a similar facility is being considered for Cork city after a delegation from Cork City Council, the HSE, and An Garda Síochána travelled to Lisbon to learn from policy there. The researchers noted that, aside from naloxone, syringe, needle and other drug-taking paraphernalia provision, current harm reduction strategies in Cork city are mainly focused on education, assessment, treatment and support services, pre- and post- treatment.

However, a key finding of the research was that almost a third of problematic opioid users in the city were unknown to service providers. The researchers suggested a supervised drug consumption facility in the city might provide a connection point in the harm reduction system for those not in treatment.

“This could create a safe environment for problem drug users by providing clean syringes, blood-borne virus and drug testing, basic first aid assessment, information on the dangers of polydrug use, counselling and immediate overdose response,” the researchers concluded.

Such a facility could also facilitate positive interactions with the harm reduction system that could provide a signpost to services available, including access to treatment.

Public areas in the city would benefit from a reduction in drug-related litter and open-air ‘drug dens’ on the streets and in public spaces.

Concerns have been raised about the provision of a mobile supervised injection facility compared to the facilities in the well-resourced building in Merchant’s Quay, Dublin.

Eddie Mullins, CEO of Merchant’s Quay, has suggested that he saw a mobile unit as quite ineffective.

“In our facility, a client comes in, they’re met at reception, show us their drugs, they are taken to an injection room and spend 15 minutes there, then 30 minutes in an aftercare room where we monitor them,” he said.

“We couldn’t keep a person for 45 minutes in a van, and it wouldn’t be easy to get the same interventions, then get them to see a GP or a project worker if they’re struggling with their mental health.”

Supervised drug consumption facilities have the capacity to move drug use into a safer more controlled environment, with ancillary supports and services, as well as returning streets and public spaces to communities.

We have yet to see whether the introduction of a medically supervised drug injection facility in Dublin will form a template for safer drug consumption spaces in other cities across Ireland, including Cork. However, comprehensive drug services respond only to the acute needs of people that have fallen through the gaping holes in the system.

As important as medically supervised injection or drug consumption facilities is the provision of robust supports, that allow for strong community cohesion and a collective identity - for people who spend a large chunk of their lives without either.