THE Ana Liffey Drug Project Mid-West have provided a positive response to substance abuse in the city through its ‘low threshold — harm reduction’ model since opening its doors in 2012. Limerick Post reporter Alan Jacques met with its outreach team who work with some of the city’s estimated 800 heroin users.
WHILE the profile of heroin users around the country indicates that many become involved in drugs to cope with past traumas and hurts, a more disturbing picture has emerged on the streets of Limerick.
At the height of Limerick’s gangland feud, one young man in a disadvantaged city estate made the “conscious decision” to start using heroin as an escape from the vicious cycle of violence in his community. He said he took heroin so as to be considered unreliable and escape pressure to be involved in gangland activity.
“By using drugs, he would have been considered unreliable by these criminals and was then left alone and not bothered by the gangs. It would have been very difficult for young men in these areas to escape the feud. He thought he would probably get off heroin easily enough, but 10 years on he was still using,” Dawn Russell, Head of Services at Ana Liffey Drug Project told the Limerick Post.
The Ana Liffey Drug Project was established as Ireland’s first ‘low threshold – harm reduction’ service during the height of the drugs epidemic that swept through Dublin’s North Inner City area in the early 1980s. The response to heroin use at the time was muddled at best and for those whose lives were being destroyed by substance abuse, the organisation founded by Jesuit priest Frank Brady must have seemed a ray of light in a time of dark despair.
Since opening its doors in Limerick in May 2012, Ana Liffey has engaged with the most marginalised members of society and offered a hand of friendship to those who know little other than despair and chaos in their daily lives. The number using heroin in Limerick is estimated at about 800 and, since setting up in Limerick almost three years ago, Ana Liffey has engaged with 460 heroin users in the Mid-West, with all but about 20 of these located in the city.
Based in the Fairgreen, the group operates in Limerick, Clare and North Tipperary, among people affected by problem substance abuse, their families and the wider community. Currently engaging with around 120 drug users locally, the organisation provides a range of services including assertive outreach, needle and syringe programme, medical services and assessment for residential treatment.
The profile of drug users availing of Ana Liffey’s services nationwide is typically 70/30 in favour of men. However, in Limerick, Ana Liffey staff have noted these numbers balance out at 50/50 between the sexes.
They have also noted that drug users in Limerick report issues, seemingly unique to the city.
Where many drug addicts report violence and abuse in their past, in Limerick, people presenting to the Ana Liffey claim that this threat of violence and abuse is ongoing for them.
“Compared to other regions in the country, we get much higher reports of physical attacks in Limerick. Drug users here are facing that threat of violence every day — it’s imminent,” said Ms Russell.
“Be it domestic abuse, sexual abuse, violence, intimidation or family feuds, we have seen a trend in Limerick where substance users are particularly vulnerable. We’ve also heard horror stories from women in Limerick about men, often much older men, who appear to be kind and offer to take them in and give them a bed for the night, only later for these women to be opportunistically attacked or abused. It’s a hellish and chaotic existence,” she added.
Director of the Ana Liffey Drug Project, Tony Duffin, agrees that the profile of its clients in the Mid-West region distinguishes it from other areas.
“Many of the women who access our services in the Mid-West report that they are victims of significant levels of abuse. Often they do not wish to report their experiences to the Gardaí for fear of reprisal from the alleged perpetrators or their associates — either immediately after reporting or in the years to come,” Mr Duffin explains.
The situation for men in the region is also concerning, and they too often report being victims of violence.
Mr Duffin said that the fear associated with violence could impact on the individual’s ability to make positive choices.
“This is highlighted by the experience of the young man who reported to us that he made a conscious decision to take heroin so that he would be considered unreliable and untrustworthy. In this way, he hoped to escape the pressure he was coming under to be involved in organised crime,” he commented.
While the levels of violence reported to the Ana Liffey in Limerick are high compared to other parts of the country, the other issues people experience are similar to those in other areas.
“Both men and women are often homeless as well as using drugs problematically. The lasting solutions to these problems are appropriate housing with support, provided on a ‘housing first’ basis, and timely access to suitable treatment and rehabilitation,” Mr Duffin stated.
But there’s a distinct lack of options in these areas.
“Ultimately, Ireland has limited resources to deal with problem drug use and associated issues. Both nationally and locally, we need to target the resources we have towards evidence informed interventions that reduces the harm drug use causes to individuals, families and communities in cost effective ways.”
Most of Ana Liffey’s clients are between 20 and 30 years old and also tend to present as poly-drug users. Funded predominantly by the State, Ana Liffey does not charge for any of its addiction services and team members emphasise the importance of treating its clients with “respect and dignity”.
“A lot of the time we are the first to engage and have a real conversation with people. Drugs are a big part of their identity and they tend to isolate themselves, as they have not had very many positive experiences. They are very vulnerable and live totally chaotic and traumatic lives,” said Ana Liffey’s Team Leader in Limerick, Rachel Conway.
A direct link has emerged in the city in the last couple of years between young people abusing benzodiazepines, known as ‘benzos’ and ‘upjohns’, and the increase of heroin use. ‘Benzos’ includes drugs such as Xanax and Valium and their more dangerous street versions such as ‘stick’.
Ana Liffey have also seen evidence of Limerick drug users taking Lyrica, a prescription drug for controlling seizures and treating nerve pain.
“I was on Xanax, I was on more than I should have been. I was out of my head going out doing very stupid things and then I started dabbling with heroin. My mother died three years ago and I got on Xanax first and then I went completely off the rails and pushed everyone that was near to me away,” 22-year-old Ana Liffey service user Carol (not her real name) told the Limerick Post.
“I just constantly wanted to be stoned and live in a different world. I’d take anything at all just to take away that reality. My mother and her partner were heroin addicts so I had seen it from a very young age. I knew all about it and I swore I’d never go down that path, but you don’t know what’s in front of you. I had witnessed my mother on heroin since I was around seven or eight up till 18 when she died,” the young woman admits.
Research undertaken by homelessness agency Novas Initiatives, revealed that in an 18-month period between May 2012 and November 2013, they responded to 34 overdoses — an average of one incident every two weeks. The first study of its kind in Ireland, it confirmed that benzodiazepines and heroin were the drugs most frequently used by those interviewed in Limerick, with one-fifth injecting daily.
This week the Limerick Post joined Ana Liffey Mid-West’s outreach team in the city centre as they set out to provide clean needles and syringes to drug users; a health promotion intervention grounded in the organisation’s harm reduction philosophy.
Team Leader Rachel Conway and Project Worker Aoife Marshall both carried plastic bags filled with injecting equipment and other drug paraphernalia such as needles, syringes, water, pots, bins and Vitamin C, available at no cost to those who might need it. The Mid-West outreach team also offers a wide range of advice and support regarding safer drug use and safer injecting techniques, tailored to the drug users needs. The aim of this service is to reduce the damage associated with sharing used injecting equipment.
“This all helps the wider community,” Rachel explains.
“You can’t just tell them to give up drugs altogether because they are not ready for that. We engage with them and if we get them to trust us, that’s a big thing. We work with them to find a way to be able to look after themselves and keep them safe by not overdosing,” she said.
One drug user we met begging on Denmark Street is freezing cold so the outreach team buys him a warm coffee and engages him in even warmer conversation to gage his wellbeing. This human interaction manages to bring a smile to the young man’s face and the team moves on happy in the knowledge that he has no pressing health issues.
“It’s quiet today. Sometimes they come into town early, get their money and disappear then to buy their drugs,” Rachel points out.
Set up as an alternative to the ‘just say no’ abstinence-based approach of the eighties, Ana Liffey works on the frontline engaging and supporting those who’ve slipped off the radar. The organisation’s work brings about positive change in the lives of substance users in a non-judgmental environment.
For 22-year-old drug user Carol, this model has made a positive difference.
“I made lovely friends here and the support is brilliant. They go out of their way to get you here. They give you help and I want to thank them because they are a very good group of people. God only know where half of us would be without them,” she says.
As I depart the Ana Liffey Mid-West team on the city’s streets, the words of Dr Seuss spring into mind: “Unless someone like you cares a whole awful lot, nothing is going to get better. It’s not.”
For more details on Ana Liffey Drug Project log on to www.aldp.ie or call their Freephone number 1800 78 68 28.
