The strategic aims and objectives of the current Irish national drug strategy include the reduction of harms related to substance use, namely by (i) enabling people with drug use problems to access treatment; (ii) reducing risk behaviours, harms to individuals, families and communities, and dependency; and (iii) minimising the harm to those who continue to engage in drug-taking activities that put them at risk.
In Ireland, harm reduction services are delivered by local authorities and community-based organisations. The provision of needle and syringe programmes (NSPs) is a central element of harm reduction service provision. There are three models of NSPs: fixed-site facilities, outreach syringe provision and pharmacy-based programmes.
The total number of syringes given out by pharmacies, outreach workers and at community-based syringe programmes in Ireland in 2017 exceeded half a million. Harm reduction facilities usually provide a range of sterile injecting equipment and materials, including different sizes and types of needles and syringes, alcohol swabs, and citric or acetic acid. Condoms, Stericups or cookers and sterile water, non-toxic foil (for smoking heroin), syringe identifiers and tourniquets are also available through the NSPs. Pharmacies in each local and regional Drug and Alcohol Task Force area in Ireland (apart from counties Dublin, Kildare and Wicklow, which are served by a mix of fixed-site and outreach needle exchange programmes) take part in NSPs, distributing packs containing injecting equipment for either 3 or 10 sterile injections. The extension of the pharmacy programme started in 2011 has been successful, and at the end of 2017, there were more than 100 pharmacies providing needle exchange, and around 1 750 individuals used pharmacy needle exchanges each month in 2017. The pharmacy-based programme is well accepted and now provides the most widespread type of syringe outlet in Ireland. In areas without a local clinic or mobile unit, staff complement the distribution of injecting material with ‘backpacking’, a process whereby paraphernalia are delivered by staff directly to known drug users.
A recent review of Irish NSPs, published in 2015, identified the need to standardise the monitoring of services provided, to increase both the uptake of testing for blood-borne viral infections and the uptake of vaccination, and to provide a wider range of drug use paraphernalia to clients. The evaluation of the pharmacy-based programme showed satisfactory results overall, but it pointed to the need to better match the contents of injecting equipment kits to users’ needs, as well as to further reduce stigma. Further recommendations were to offer in-pharmacy testing for blood-borne viruses or efficient referral, as well as to increase the competence of pharmacy staff in giving harm reduction advice and support. In Ireland, the hepatitis B virus vaccine is recommended for several high-risk groups, including prisoners and people who inject drugs.
In 2015, a 2-year naloxone demonstration project was initiated in Ireland. The project involved the distribution of a pre-filled syringe of naloxone on prescription and training opioid users to administer it. During the demonstration project, five emergencies were recorded in which the naloxone given out under the project was successfully used to reverse overdoses and save lives. By June 2017, approximately 800 people had received training and 1 200 naloxone kits had been distributed.
Based on enabling legislation adopted in 2017, preparations are under way for the opening of a supervised drug consumption facility in Dublin in 2019. The facility will be managed by the largest Irish harm reduction service provider, MQI.
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