THE MUNDANE TRAGEDY OF DRUG DEATHS

It shouldn't have taken the arrival of a mysterious new illness to get
those of us who work in the media to pay attention to the regular drumbeat
of drug-related deaths that rolls beneath the daily movement of ordinary
life in contemporary Ireland. Because news is supposed to be new, we often
miss the terrible significance of things that have become numbingly familiar.

To our shame, it took an element of novelty and mystery - the dangerous
infection that has increased the rate of death among heroin-users - to
bring into focus an awful obscenity that had become almost invisible.

Some people, though, have been paying attention, among them Ray Byrne of
the department of social studies in Trinity College Dublin. By monitoring
the files of the coroners in Dublin, he has created a precise picture of
what has become a mundane tragedy.

The first and starkest fact that emerges from Ray Byrne's study is the
sheer scale of the problem. The Dublin City and County Coroners conducted
645 inquests in 1999. No fewer than 86 of these (13.33 per cent) were
deemed to have been drug-related deaths.

This was also the annual average death rate in the Northern conflict
between 1976, when it settled down into a "long war" of attrition, and
1994, when the IRA and loyalist ceasefires took effect. Drug deaths, in
other words, are the Republic's "acceptable level of violence", a
background level of horror which society deplores but comes to take for
granted.

Through the 1990s the number of drug-related deaths has risen at a higher
rate than in any other EU country. It was estimated there were 13,460
opiate-users in Dublin in 1996. By the end of February 2000, however, only
4,353 were receiving methadone treatment in the Eastern Regional Health
Authority area, suggesting that something like 10,000 people are injecting
heroin in and around the city every day.

Since addicted heroin-injectors face a risk of death maybe 20 or 30 times
that of the general population, chances are many of these people will die
as a result of drug use.

But why should be this continuing tragedy be taken for granted? The answer
is immediately obvious from Ray Byrne's study. 71 per cent were unemployed.
Most came from the poorest areas of Dublin. Of the 86 who died, 10 were
from Ballymun, nine from the north inner city, seven from the south inner
city, nine each from DFAn Laoghaire-Rathdown and Tallaght, and eight each
from the Canal Communities and Clondalkin. To an overwhelming extent, then,
the people killed by drugs lived in the places that the brave new world of
bustling, go-getting, affluent Ireland prefers to ignore.

Some notion of what might have been going through the minds of these people
can be gathered from the suicide notes left by some of the 11 addicts last
year which were referred to at their inquests. One declares: "I've lost
control. I don't want to end up an everyday junkie. I can see no future in
it; I'm sick of fighting it".

Another wrote: "At last my nightmare is over. With me being on drugs, I
didn't realise how much I loved you. I don't know what else to do. I cannot
live like this any more."

One of the most shameful facts highlighted by Ray Byrne's analysis is the
stark inadequacy of drug treatment in prisons. Everyone knows that a high
proportion of those who end up in prison are drug-users. Their time in the
custody of the State should be an opportunity for a real intervention in
the form of effective treatment.

Yet in 1999 seven of those who died from drug-related causes were either on
temporary release or had recently been released from prison. One person
actually died in Mountjoy Prison, and a second collapsed there and died in
the Mater Hospital.

These figures are consistent with those for 1998, when one person died in
Mountjoy and another nine had been recently released, or were on temporary
release. In a horrible irony, a prison term may actually increase the
addict's chances of dying. When an addict gets out of jail, after a period
of being "clean" inside, his tolerance for heroin will have dropped, making
him much more vulnerable to an overdose.

Most shocking of all, however, is Ray Byrne's conclusion that the terrible
death toll is not inevitable. "It is clear", he writes, "that some
opiate-related deaths are potentially preventable. A range of relatively
simple and for the most part inexpensive interventions could reduce the
incidence of such tragedies. These interventions include both improved
quality and range of services for and greater dissemination of risk factors
to opiate-users".

One of the key problems, for example, is not overdosing from a single drug,
but from a mixture of drugs. Just seven of the 86 who died last year had a
single drug contributing to their deaths. The rest died because they had
used a lethal cocktail, with an average of three drugs and in one case
seven drugs being found in the bloodstream. In nearly three-quarters of
deaths benzodiazepines were implicated. Yet little attention is paid to
these drugs.

Ray Byrne notes that in Germany, Switzerland, the Netherlands and Australia
the state provides "fixing rooms" to give addicts a hygienic and supervised
environment in which to inject, and this greatly reduces risk. A Swiss
experiment in which the state provided heroin on prescription to addicts
also saved lives.

For many people, these kinds of radical policies are understandably
repellent. But if, in trying to end the Northern conflict, the State came
to accept the need to rethink the conventional wisdom, why should the same
energy and radicalism not be devoted to a tragedy that is costing as many lives?