HAND OUT THE HEROIN?

Would the distribution of free heroin help or aggravate the Republic's
drug problem? Kathryn Holmquist hears both sides of the debate

The Republic has the fifth-highest incidence of heroin addiction in
Europe, and the average age of addicts, at 24, is the youngest in the
EU, a full decade lower than in the Netherlands. There are two ways of
addressing this social epidemic: one pragmatic, the other moralistic.

Moralists believe that the only solution to addiction is
detoxification and AA-style group therapy with a goal of lifelong
abstinence. But there is a difference between a socially stable
celebrity checking herself into the Priory Clinic for a spot of rehab,
and a street addict who is surviving on crime and the next fix.

"To say we have to have abstinence is unreal. It's ideal, but not
practical. In reality that does not work," says Shane Butler,
addiction studies specialist at Trinity College Dublin. Butler
believes addiction is linked to a deeper set of practical and
emotional life problems involving poverty and disadvantage. Unless
these problems are eased, any addict attempting to remain drug-free is
doomed to failure.

Butler and his fellow "pragmatists" - who represent the vast majority
of those treating drug addiction in the Republic - take a "harm
reduction" approach which entails "engaging" addicts by offering
needle exchange, by prescribing opiates such as methadone and by
providing social and psychological support in an attempt to stabilise
addicts' lives, with consequent benefits for addicts and society.
Whether or not the addict becomes drug-free is not seen as a measure
of success or failure of such programmes.

"Methadone has been likened to insulin for a diabetic; it enables the
addict to lead an ordinary life," says Butler.

The moralistic view is represented by the anti-drugs crusader Grainne
Kenny, whose training as a counsellor comes from "all over the place".
Widowed last year, Kenny is the founder and international president of
Europe Against Drugs (EURAD), a 20 year-old body with no current
funding source, and which Kenny runs on an overdraft from a premises
in DFAn Laoghaire.

Kenny is totally opposed to "harm reduction" of any kind, whether it
involves needle exchange, methadone maintenance or prescribed heroin.
She sees the fact that only 10 per cent of harm reduction clients
worldwide kick the habit as a measure of failure.

It was she who stirred up controversy recently by calling on the
Franciscan Friars to pull their funding from the Merchant's Quay
Project. Kenny made the call in response to a publicly reported
comment by Merchant's Quay director Tony Geoghegan.

He believes that heroin could be used therapeutically - as it is in
the Netherlands and Switzerland - in highly controlled residential
harm reduction programmes as which are part of a spectrum of
treatments, a view which the Franciscans support. Geoghegan does not
advocate "handing out free heroin willy-nilly", but does believe that
"if we are serious about treating heroin addiction, we must look at
all the options".

For a minority of hard-core heroin users, prescribing heroin may be
the only way to get them to stop committing crimes, harming others and
destroying their own health. A Swiss Ministry of Health study of a
heroin distribution project showed a 60 per cent reduction in robbery
and an 85 per cent reduction in theft by addicts. The health of the
addicts also improved as they got off the crime/drugs treadmill and
had an opportunity to look at the wider issues in their lives.

Geoghegan's call for prescribed heroin to be considered, was rapidly
interpreted as a call for "free heroin for junkies" and was likened by
Grainne Kenny as giving alcohol to alcoholics.

Kenny rejects the Swiss research results, quoting Dr Ernst Aeschbach,
a psychiatrist and psychotherapist who believes that "the assertions
of positive results from the Swiss heroin distribution projects are
inconsistent with the goal of abstinence". Dr Aeschbach also argues
that the study did not establish that the improvements in health of
addicts in the study were due to heroin distribution.

You could argue the research results all day, but what really matters
in this controversy is that misinformed public reaction might
influence political decision-making. Kenny's reaction "panders to the
fears of those people who are not au fait with the area", making it
even more difficult to establish drug treatment programmes at local
level, believes Geoghegan.

This public spat has, however, highlighted a larger issue, which is
that heroin addiction is as complex as it is difficult to treat,
although great strides have been made in the Republic in the past 10
years.

"It's easy to detox people and put them out on the street drug-free,
but they are certainly not going to stay drug-free unless they address
all the other peripheral issues. Otherwise you are setting them up to
fail," says Geoghegan.

An interim drugs advisory group has been sitting to discuss the
setting up of a National Drugs Advisory Body, based on a UK model.
Among the group are civil servants, representatives of Merchant's
Quay, Shane Butler of Trinity College Dublin, Mary Ellen McCann of the
Ballymun Youth Action Project and Gary Broderick of the Ana Liffey
harm reduction agency, which was founded in 1982.

Butler, McCann and Broderick have their own views on the use of heroin
in harm reduction programmes. Butler supports limited, well-controlled
heroin use in the context of harm reduction for the same reasons as
Geoghegan, while McCann is reserving judgment until she sees more
research. She is also concerned that any treatment be offered in the
"context of holistic care for the addict".

Broderick takes a social perspective, believing that if the public is
opposed to therapeutic heroin use for addicts, then this method would
do more harm than good by further alienating addicts. Social and
cultural approval of treatment methods is essential for them to
succeed, in his opinion. Butler believes that communities are becoming
more sophisticated in their views of the drug problem and accepting
that stable, monitored and controlled lifelong drug use may be the
only way some people can work, go to school and have a normal life.

His view is that it's easy for some middle-class people to pontificate
because they have never had to deal with a heroin problem in their own
communities. Once you get a heroin problem on your doorstep and learn
to know addicts as mothers, fathers, sisters, brothers and children -
you realise your approach has to be pragmatic.

Responsibility opens doors

The Merchant's Quay Project has been inspired, developed and sponsored
since its inception in 1989 by the Franciscan Friars. The project's
budget runs to pounds 1.5 million per year and it caters for 5,000
addicts - over one-third of the entire drug-using population of Dublin.

Two hundred people per day are seen by a range of services, such as
crisis intervention, a drug-free service, an advocacy service and
needle exchange. There is also a "stabilisation" day programme -
catering for about 40 people per day - which is funded by FC1S and
the local Vocational Education Committee. Clients on the stabilisation
programme are maintained on methadone, while learning to sort out
other issues in their lives.

A 12-bed residential unit offers a 12-week detox programme in which
the clients' goal is to become drug-free. Those who succeed may be
offered a place on a drug-free farm in Tullow, Co Carlow, where 10
residents at a time live for one year, learning agricultural skills
and providing some food for the Merchant's Quay Project.

Residents also pursue education through the local community college
and psychological growth through group therapy, to address the issues
underpinning the addiction.

The Franciscans' main aim is to provide "a legitimacy and
respectability that opens doors", says the centre's director, Tony
Geoghegan.