An Phoblacht/Republican News   ·   Thursday October 26 1995

"Show us some respect"

SMILING THROUGH STANDING APPLUASE, John and Finola Bruton swept down the side aisle in the O'Reilly Hall, University College Dublin. It was Saturday last, 21 October. The Taoiseach was addressing the one-day Fine Gael conference on Drugs and Crime. He didn't have a lot to say on the subject. In a speech lasting 20 minutes, drugs were mentioned twice, once in a scripted reference to driving dealers out of estates, the second time in an added remark that "young people must have the knowledge and the courage to say No to drugs." His government's objectives on all issues could be expressed in one concept, John Bruton said. "Respect. Mutual respect and self-respect." Under the influence of these and other high words, everyone went home happy. Here was a party content with itself; the begrudgers simply didn't count.

Earlier in the day, drugs were the definite focus for about a dozen people blending in with morning drizzle on Pearse Street. But respect got a mention too. Waiting outside the state's main drug treatment centre, they would have been an unremarkable sight for any passing Fine Gaelers. Unlike one-day conferences on Ddrugs and crime, they're always there.

Amongst those waiting, Joe is preoccupied with keeping warm until his friend comes out of the clinic. He needs to borrow a fiver off her, he says, because he's "dying sick". Joe is on the 'night train' in Pearse Street - a methadone program for users who fail to keep to the rigid standards of the daily maintenance regime. He's been a heroin user for 16 years and believes total abstinence from all drugs is "all right as an end goal but it's just not feasible in the beginning or for a while because drug addiction is not only a physical addiction, it's 16 years of a mental addiction as well." On the night train you go in three times a week and get 50 mls of physeptone, "enough to fill your back tooth", Joe says. "They give you phy with one hand and a packetful of needles with the other - they call it damage control."

David Murphy's brother Joseph was rejected on the Pearse Street treatment programme in July when his urine sample showed he had been using heroin. The next morning he was found dead from an overdose. David is standing outside the clinic, showing a magazine photo of his dead brother. The magazine is called Reality. His mother Bernie was the focus of media attention earlier this month when her cry for treatment for her remaining sons was broadcast by RTÉ. A street trader, she has heard that Gardai have raided houses throughout Dublin and confiscated sparklers and fireworks ready for the Halloween market. "If they can pinpoint exactly who's got the sparklers and where they are, how come they can't do the same with the drug dealers?", she asks.

Joe claims that every one of his friends know people who have died as a direct result of the policies of the state clinic. "We're not treated as humans, we're treated like the scum of the earth," he says, "but we wouldn't be here if we didn't want treatment; all we want is for them to show us some respect."

Back at the Fine Gael conference, Justice Minister Nora Owen told the party faithful that she has allocated £413 million to "assist the Gardaí" in "fighting the drugs menace". They also heard that 80% of crime is drug-related. The advantage of a proper drug treatment service in terms of crime reduction alone would seem apparent.

So how much money is going towards tackling the treatment deficit in the area most affected by drug use and drug-related crime, the Greater Dublin region? Dr Joe Barry, AIDS/Drugs Co-ordinator for the Eastern Health Board (EHB) tells me this year's allocation is £4.6 million. That goes to fund the three Eastern Health Board clinics that exist in addition to the Pearse Street Centre, which is controlled by the Department of Health. It also includes grant aiding of voluntary agencies by the EHB.

If £4.6 million seems small compared to the overall crime budget, it is also less than what it costs the state to keep prisoners from Dublin's north inner city in Mountjoy Prison. A September 1994 report prepared by consultants for ICON, the Inner City Organisations Network, found that the cost of keeping north inner city prisoners in Mountjoy was £5.8 million. Most of Mountjoy's 600 prisoners come from the north inner city, the majority on drug-related offences.

HEPATITIS C

But of even more concern to health providers must be the fact that there are serious health costs attached to a stay in Mountjoy. Kevin was on the Remand Wing 'B', in Mountjoy from the 27 February to the first week in April. When he went in he was smoking heroin but had never used needles. "They put me on the seven-day detox but it didn't work, I was very sick afterwards 'cause I had a big habit on the gear." Kevin started injecting and came out of prison with Hepatitis C. "There'd be one dirty needle going around a landing and maybe 20, 30 people using it - that's how everyone's catching the virus, they're catching it in that kip."

If Kevin has just left the starting line of 'the Mountjoy process', Esther has been around the track a number of times. She was 12 years old when she starting using drugs and has been in and out of prison since she was 15. Barred from the Pearse Street clinic for five years, she stole to feed her habit. She now has AIDS and is back on the Pearse Street program, having been referred there from hospital weighing six and a half stone. She expects to be back in prison next month, following a court appearance on old charges.

Dr Joe Barry of the EHB believes that the methadone treatment available outside the prison should also be available inside, but he adds that the EHB are not responsible for health provision for Mountjoy inmates. On RTÉ's Morning Ireland on 23 October, the Governor of Mountjoy defended medical provision in his prison, describing it as "very professional".

Local Sinn Féin Councillor Christy Burke has another view. He describes prisoners with an addiction being put in a basement overnight before seeing a doctor and prison officers going around adminstering physepthone. He tells how one of his constituents, Pat Brennan, died of an overdose after returning from a day's parole. A known addict, no one had examined him on his return. "There has to be a hospital wing in the prison and proper medical facilities, not just phy in the morning. People with an addiction should be given every chance to kick their habit, and there should be proper follow-up when they leave prison."

At the beginning of the month, Fianna Fáil leader Bertie Ahern, from whose constituency a significant portion of Mountjoy inmates come from, made a statement on drugs and crime. He had no proposals to offer as to how the Mountjoy process of churning out more addicts who commit crime to fund their habit could be halted. Instead he pledged that a Fianna Fáil government led by him would proceed with building a prison in Castlerea, County Roscommon.

MORE GARDA POWERS

On 19 July, Justice Minister Nora Owen issued a statement on new government measures to combat drugs. As well as new powers for Gardaí, customs officials and the naval service, a new Garda Drugs Unit was established. Out of a five page statement, two short paragraphs were on demand reduction and education. Owen's speech to last weekend's Fine Gael conference was no different. She even hinted that she too had not given up the ghost on Castlerea.

In Tallaght, volunteers who work, in Nora Owen's words, "at the coalface of the drugs crisis", take a dim view of all the talk of government initiatives and action. In their local area crime has dropped in the past year by 25% according to official statistics and they are amused that a Garda statement claims this is due to the force's efficiency and the addition of three Gardai to local duty. They wonder if three Gardaí can make such a difference then can they not claim some of the credit themselves, as they have removed the need for 30 heroin addicts to commit crime in the space of three months.

In Fettercairn and Killinarden, the first community- based voluntary drug treatment programs in Europe are up and running since July. Totally unfunded, they were set up and are being administered by local people. Sixteen addicts in Fettercairn and 15 in Killinarden have signed a contract with a doctor to go on a methadone maintenance program administered from the local community centres. Heroin users are receiving medical treatment and counselling and support services in their local area from people they know and trust. Liam Collins, co-ordinator of the Fettercairn program, explains: "We know what we need within our own communities and what will and won't work. We'd be thinking pain and suffering while the statutory bodies would be thinking finance and caution."

Over a period of 18 months, heroin use in Tallaght had escalated. In November 1994, community groups decided to research a community response. As part of this, Killinarden Community Council chairperson, Cecil Johnson and others visited a drug dependency clinic in Merseyside, England. Adapting a treatment model which had resulted in no HIV infections and no deaths in the Merseyside program over a six-year period, a program was approved by the Community Council's AGM. The EHB, with whom the community had held several meetings, was still saying it was considering a suitable site for a treatment clinic and asking the community to hold off on its own project when Killinarden's program began on 27 July.

Jane Wade is one of the program's administrators. Her son is a heroin addict who's now receiving treatment elsewhere. Her experience in trying to get him treatment led her to involve herself in the local program. She says: "If someone came in and said I have cancer, you'd put your arms around them. If you hear it's drugs, you back off. When the people who joined our program saw someone cared for them, we got an honesty and openness where before there was only denial and betrayal."

Another parent of a recovering addict, Breda, says the program has given pride back to the individual user. "Two of them have gone back into full-time employment already and others are thinking about starting training courses."

Official figures state there are 400 drug users in Tallaght. The community groups' figures are five times that amount. Their programs are small and they have little room for immediate expansion of them but their response is still more than Eastern Health Board could muster. Up until their program launch, there was one drug addiction counsellor for the whole of the Tallaght area and beyond, covering a population of around 146,000 in total. Now there are two, "a 50% increase!", Liam Collins remarks.

Dr Joe Barry of the EHB gives a careful response on the question of staffing levels. "All I can say is we have more than we had. I think we had 10 addiction counsellors at the end of 1992 and we now have 24 and we're recruiting more."

Asked why the EHB provides no treatment service for heroin smokers he concedes this is an issue on which more needs to be done but says: "Based on the treatment program places we have at the moment we can't meet the needs of all the injecters, never mind the smokers." As to why this is the case he points to public opinion being against the provision of treatment. "It's not plain sailing to set up clinics, even in areas where drug use is prevalent."

In Blanchardstown, where drug use is prevalent, the EHB has met with stormy seas in its bid to set up a clinic at the local hospital. But the Tallaght program and the Clondalkin project referred to in the last AP/RN feature on drugs show that when local communities are involved in setting up their own facilities, the Blanchardstown experience need not happen.

Councillor Christy Burke calls for "community courage and political courage in the provision of proper healthcare for our addicts". He believes current Eastern Health Board methods amount to a fire brigade service "which will only dampen the fire, not put it out" but says there is a willingness now to act which wasn't there in the '80s.

INVOLVING GPs

Dr Anjum Madani administers the methadone programs in Tallaght and is involved in setting up similar projects in Clondalkin and throughout the city. He says there is a definite need for treatment clinics but they must be used appropriately. "GPs must be given the necessary renumeration and support facilities to administer methadone locally. Satellite clinics should focus on counselling and support services and other medical services for their clients. They should only dispense methadone for very dangerous or difficult clients who can't use the local GP service."

Despite a government protocol on GPs dispensing methadone agreed in 1991, Dr Madani says the government has done nothing to encourage its implementation. An initiative of the Irish Medical Organisation in which he and 30 other GPs are involved is the only action taking place.

Dr Madani is highly critical of government inaction. "Irish government policy is not proactive but reactive. People on the ground have been hitting home the truth and the government has been merely responding to the pressure when it was unavoidable."

On Thursday, Health Minister Michael Noonan opened ten detoxification beds at Cherry Orchard hospital, bringing the 26-County total detox beds figure up to 20. Interviewed by local Sinn Féin representative Martina Kenna before the opening, one of the Cherry Orchard patients had this to say about the state's approach: "People have to pretend they want to give up drugs in order to get treatment. It's no wonder the success rate is so low if the system is all based on lies."