Our comfortable hypocrisy with addiction…

Q. What is the similarity between the DUP’s Christopher Stalford, the SDLPs Paul McCusker and the N. Ireland Office. A. An interest in drug addiction services. But there the similarity more or less ends. I feel genuinely sorry for Christopher Stalford for falling into such a simple trap. He was only doing what politicians do, supporting and articulating the concerns of his constituents, in this case, those living in the Donegall Pass and Botanic area. Christopher is concerned that the availability of some addiction services is negatively impacting the local communities around Donegall Pass and Botanic. Enough is the rallying cry and Christopher, on a roll and leading the charge, was sadly unseated from his stallion over some unsavoury descriptions of service users. He called them “junkies” and “smackheads”. Oh Christopher.

Paul McCusker, who we can safely say has a very different view of addicts found these comments “hurtful”. Paul only sees them as hapless victims and was often seen at the end of last year working in an outreach centre where, on one occasion, he was forced to break off from a TV interview to assess someone just arrived and who might be suffering from an overdose. He was forced again to break off his interview to help the young woman into a recently arrived ambulance. Paul is a compassionate and committed man.

Christopher and Paul define the opposite ends of the spectrum with which we as a society view drug addiction. We have developed comfortable hypocrisy with the problem quite happy to by sympathetic so long as the problem is elsewhere. We expect people like Paul McCusker to roll up their sleeves and do our dirty work and then we expect people like Christopher Stalford to move the addicts on if they get too close.

Belfast’s growing drugs problem was largely focused in recent years around the city centre and indeed a year ago Boots the Chemists in Donegall Place decided to remove one of its services due to concerns about user behaviour. A service was planned for the lower end of the Donegall Road but threats and intimidation of the pharmacy meant that the service could not be opened leaving the problem in the city centre.

In March with the Covid-19 lockdown, the city centre problem moved up to Botanic. And it’s a growing problem. In 2007 fifty people in N. Ireland tragically died of a drug overdose. In 2017 the number was 156. £8 million is spent annually on services to “reduce drug harms” yet the N. Ireland Audit Office in a recent report is unconvinced that it can honestly say that this investment represents value for money. From the report:

Alcohol misuse alone costs Northern Ireland as much as £900 million a year, with up to £250 million of this falling on the already stretched Health and Social Care sector. Despite these significant costs, the Department of Health allocates a relatively small budget to tackling the problem – £8 million for implementation of its Drugs and Alcohol strategy, and a further £8 million for statutory addiction services from the mental health budget (around 5 per cent of the budget).

Whilst alcohol misuse remains the most prevalent substance issue in Northern Ireland, the number seeking treatment for drug misuse has grown significantly, doubling from 2,107 people in 2007 to 4,183 people in 2019. The number of deaths relating to substance misuse is also rising, with drug misuse deaths more than trebling in the last decade. The level of harm is most acute in areas of high deprivation, where deaths related to drug and alcohol misuse are around four and a half times that seen in the least deprived areas.

The reports also reveals that prescription drug misuse is a growing problem in Northern Ireland, with the majority of drug related deaths now involving prescription drugs such as pregabalin and diazepam. Northern Ireland prescribes more pregabalin and diazepam per capita than anywhere else in the United Kingdom. While the potential for the misuse of pregabalin is widely known and guidance was provided to all GPs and community pharmacists in Northern Ireland in 2012 and 2016, prescriptions of the drug have continued to rise.

Recreational drug use is not without its consequences. The “harms” done are myriad; the individual suffers physically, mentally and socially, families are torn apart and children damaged and wider society suffers as addiction fractures communities.

Off course alcohol remains our biggest addiction problem but, as the Audit Office report notes, the problem is changing and becoming more complex. Poly-drug use is more commonly seen in A&E departments where 25% of patients are there because drugs or alcohol are a cause.

Of the estimated £900 million annual cost of this problem, £250 million is borne by the Health and The Social Care sector. Every day in Northern Ireland, an average of 200 hospital beds are occupied where substance misuse is a contributing factor an increase of 35 per cent in the last five years. In England, these bed days have decreased by almost one quarter over the same period. The numbers locally seeking treatment for drug misuse have increased significantly from 2,107 in 2007 to over 4,100 in 2019.

We as a society have a naïve assumption that the availability of “services” will address the problems of addiction. Alex Bunting of Addiction NI rightly points out that with the scale of the problem an £8 million investment in services is derisory. But the “services” currently funded, important as they are, are merely a sticking plaster unable to cover this gaping and spreading sore. Services are focused on harm reduction; clean needles to make injection safer, naloxone to stop overdose deaths and methadone to stop addicts breaking into our homes and stealing our valuables so they can pay for the drugs that they continue to use. Yes, some addicts get off drugs but this is a slow and disappointing journey the real investment needed to rehabilitate these broken desperate people is simply, it seems, too much. The N. I Audit Office cites its disappointment that our GPs have more or less washed their hands of the problem.

I would respectfully ask that politicians by their words do not support the threatening of community pharmacists. We are doing a difficult job in difficult circumstances. We provide these services to keep the wider society safe. Without these services there will be; more used needles on the streets, more HIV and hepatitis C infection, more overdoses and more deaths.

Tackling drug abuse and addiction within the current policy framework is a mucky, thankless, disappointing and sometimes hopeless task. But this will continue until the next moral crisis explodes as happened last year in Scotland when finally the number of deaths became just morally unacceptable.

couleurs et sel” by Jeanne Menjoulet is licensed under CC BY-ND