When I arrived at the temporary studio not only was the door locked but the inside security shutter was down and I couldn’t get in. My phone rang; it was an assistant asking was I close as I was on-air in a few minutes. Having explained, he directed me to the back entrance two streets away. I sprinted off. An anxious Chris met me at the gate, handed me a visitor’s lanyard and hurried me through myriad security doors, up a lift, across a corridor and told me to drop my coat and bag on the floor as he pushed me into the studio.
I was quietly taking my seat as our host asked my fellow guest, Green Party Belfast City Counsellor, Brian Smyth to explain what he found when he visited the Quay’s Medically Supervised Injection Facility in Dublin and if he thought it would be a good idea for Belfast. The Green Party supports a more liberal drug policy often citing Portugal as the ideal while failing to properly study and understand the context and the wider outcomes of the Portuguese experiment.
Counsellor Smyth was very impressed indeed, he told us, and went on to describe the rooms, the staff support and preliminary outcomes. Operational for 12 months in an 18th month pilot the initial data suggested a 40% reduction in overdoses with no fatalities at the site. Indeed, the hospital close by reported a similar reduction in overdoses at A&E since the Centre opened. Belfast needs a drug consumption room to address the significant drug misuse problems that plague Belfast City Centre, he concluded.
“Terry Maguire, you don’t agree?”
Having just got my breath back, and fully aware this is why I had been invited I started by saying that anything we can do to save lives from drug overdose we must consider. Drug consumption rooms/medically supervised injection facilities, are not a new idea going as far back as the 1990s in some European countries and more recently in North America and Canada; there a response to the fentanyl crisis. This, I thought, gave me some cover from accusations of being a right-winged fascist thug when further on I object to what seems such a reasonable, compassionate and sensible idea.
I tried to establish the facts. The evidence for the effectiveness of these facilities is to say the least “weak” and there is a risk that where overdoses might be reduced the local drug problem might worsen as we give the impression the State now sanctions illicit drug use. At this time there might be better ways to invest……
Our host cut in. “They either are effective or they are not. Can you answer the question?”
He was trying to knock me off course but I continued; “There have been too few good studies and the current evidence would not give us the confidence to invest in drug consumption rooms.”
“Again, you are talking money, I want to know do they work?”, he insisted. Frustrated with me he moved back to Brian asking the same question.
He reiterated the preliminary statistics from the Dublin facility but our host, no doubt seeking impartiality by being equally rude to both of us, interrupted him again.
“Why focus on Dublin, which is only opened for 12 months I want to know if the international evidence tells us they work.”
Both of us were confused, I was certainly stuck, we were being badgered by a radio host looking for a yes/no answer to a question that really didn’t have a yes/no answer.
I took a deep breath and decided to attack. The evidence for the effectiveness of Drug Consumption rooms is “weak” which means that the published studies are mainly of poor quality and the few good studies that do exist do not show strong evidence of effectiveness on a number of outcomes. I suddenly realized how difficult it is to simplify a complex point but I persevered.
A study, published in 2021, looked at all the studies on Drug Consumption Rooms and how effective they are. It found over 700 studies of which only 22 were deemed to be of good quality. Of this 22, 16 were about one drug consumption facility in Vancouver, Canada. The conclusion of this “Systematic Review” is that there “may” be some positive outcomes; a reduction in overdose (fatal and non-fatal), a reduction in incidence of blood bourn infection (HIV and Hepatitis), more addicts going into treatment and no increase in crime or nuisance in the locality where the facility existed. This is as much as the evidence tells us.
“These are all good things are they not” our host inquired.
Not necessarily. The word “may” proves the evidence is “weak” and therefore might not justify funding the project.
“There you go again, talking about money” he admonished me.
I decided to continue to attack.
He was being naive in the extreme not to appreciate that we need the evidence to determine our investment decisions, I told him. This is how healthcare commissioning works. Where an initiative has “weak” evidence and only “may” provide positive outcomes then it might be better to invest your money into something that will give more “bang for your buck”. A drug consumption room will cost £1 million to set up and £2million to run annually. The total substance misuse budget for N. Ireland is £30 million with a strategy that is short £6.3 million annually and a drug consumption room is not an item in this strategy’s wish list. So, we should invest in services that have better evidence.
Perhaps it was the tone I heard through my earphones, perhaps I was getting too assertive and I know too well how scathing and mocking I sound when I become irritated. I checked myself.
We already have ongoing investment in; drug treatment services, opiate substitution services and needle and syringe exchange, I informed him. These are harm reduction services that have good evidence and they need additional investment.
“Are you objecting on moral grounds?” he snipped at me. Oh God I thought, he really thinks I am a right-wing fascist thug.
“Certainly not”. I stated as firmly as I could.
A male caller on line-one, an elderly man with a posh North Co. Down accent, said he was appalled by the suggestion that public money would be spent supporting drug misuse.
“Is this supporting drug misuse Terry Maguire?”
Harm reduction funds safer drug use that helps society, I suggested. We had arrived at the dichotomy that defines current public debate on drug misuse. It’s now a binary issue of Right vs. Left. For the Right the drug user is a morally weak and slothful free-loader. For the Left, he or she is a victim suffering from a clinical disease and needs to be cared for.
Our Co. Down caller was followed by a “social worker” from Newry with a distinctly north Dublin accent – not so posh – who claimed to be “working closely with addicts” “keeping them safe” and “providing them with tents”. It was his job, he said, to keep them alive, he must keep them alive at any cost and there was another point he wanted to make but our host interrupted saying we were out of time and had to go to the news.
And that was it. Escorted us out into the corridor, where I was reunited with my coat and bag. Counsellor Smyth, palpably relieved, said the interview was savage. He was never challenged so aggressively on this topic before. He got off lightly, I told him. For example, I chose to ignored his claim that deaths from overdose in N. Ireland had doubled in recent years. If you take the 115 deaths in 2013 and compare with the 218 deaths in 2020, you might make that case, but the 2023 deaths were 169, confirming deaths are, in fact, falling in recent years. Scaremongering is never a good look when called out. He accepted that Drug Consumption Rooms, either the model he had seen in Dublin or other iterations, will not be a magic bullet but he did think they were worth trying.
I worried, I told him, that the harm reduction lobby was becoming ideological rather than objectively looking at the evidence. Of course, reduce harm where we can, but we also need to invest in empowering recovery, which was receiving very little attention or investment. I really did worry that, with a Drug Consumption Room in place, the next step for the harm reduction lobby would be Heroin Assisted Therapy; addicts provided with the very drug we want to get them off. Then, not only can we monitor and keep them safe but we can also ensure that the drugs they use are of the highest quality at no cost to them.
Counsellor Smyth went off to his offices at City Hall and I went back to the Pharmacy and as the afternoon went on and I engaged with my methadone and buprenorphine patients I did realize that they are largely; male, aged between 25 to 34, are mostly homeless, have chaotic lives and suffer significant mental health problems. They have only relationships with other addicts. At least my group is now engaging with services but they remain embedded in the drug culture on our streets so I worry they will never break free.
The prevailing view on drug abuse in Belfast and generally across N. Ireland is indifference. However, if the nuisance increases or there are reports of increased deaths on the streets Counsellor Smyth might just get his Drug Consumption Room not on evidential grounds but on the grounds of moral outrage and the need to be seen to be doing something.
I am a pharmacist in Belfast.
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