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Dublin: 10 °C Wednesday 17 October, 2018
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'Life is so much more chaotic': A day on addiction outreach in Limerick city

Crack-cocaine is on the increase, and the housing crisis means people are spending prolonged periods in precarious living situations.

shutterstock_95617918 Source: Shutterstock/Lukasz Pajor

THE LACK OF affordable rented housing in Limerick means people who have spent years trying to overcome addiction issues and secure themselves regular accommodation are being forced to remain in precarious situations in hostels where drug use is taking plcae, or in households with an abusive partner or family member.

Rachel O’Donoghue, team leader with Ana Liffey Drug Project (ALDP) Mid-West, says her team has witnessed the effects of the spiralling housing crisis first-hand in the six years since the addiction and homelessness charity set up in the city. 

In the past, she explained, securing a flat for someone who had been through a detox programme was a relatively straightforward affair. 

“Now it’s nearly impossible to find private rented accommodation unless you go to a housing service – we have people who are coming out of treatment and then they end up going back into a hostel, you know, where there are people using drugs. So that’s not ideal, that’s not going to be good for anyone’s aftercare.”

Faced with an alternative that might mean living in a household where, for example, domestic violence is taking place, people often find themselves stuck in hostels for prolonged periods. 

“You have people that are really stuck in their circumstances – really, really stuck and it can be very difficult to navigate out of some of those circumstances.

We used to be able to sit down in our drop in centre and every week we’d have people looking up Daft and taking numbers and making phone calls. We don’t do that anymore. There could be one flat up on Daft, if you’re lucky, that would be affordable to our service users so even that option is nearly gone.

Rents in Limerick city are up more than 20% in the past year – with an average unit now costing just over €1,100. According to Daft.ie’s latest quarterly report, rents surged by over 6% in the urban area between April and June this year – the largest three-month rise on record. 

Across Munster, there were just 640 homes available to rent in the second quarter of this year. The housing waiting list for Limerick is 2,630

Outreach 

TheJournal.ie spent a morning with ALDP’s team in Limerick recently as staff conducted their usual Friday morning outreach operation. 

The organisation, which has operated in Dublin since the early 80s, set up in Limerick in 2013. Its primary aim is to help chaotic drug users by addressing basic needs like health and housing – and then to engage with them about potential future options, like detox or residential treatment. 

The small team (there are just four full-time staff) provides needle exchange and other support services for the entire county of Clare and for North Tipperary, in addition to Limerick city and county.

On a particular weekday morning, a project worker could face a drive to Kilrush, Roscrea or Newcastle West. On the day I visited, however, staff were heading out in two cars on the Limerick city and suburbs route – visiting hostels and meeting service-users one-on-one at pre-arranged locations.

Before we set out from the ALDP centre on Steamboat Quay, a message was sent to a text group of service-users letting them know the team would be out in the city with a stock of needles and other clean injecting paraphernalia.

2 A supply of syringe barrels, needles and other paraphernalia packed for distribution around Limerick. Source: Daragh Brophy/TheJournal.ie

The organisation is funded to do inreach to a number of hostels around the city, and to a soup kitchen run by the St Vincent De Paul. They call the staff in advance and let them know they’re on the way. 

In the car, O’Donoghue answered text messages and calls from the passenger seat, setting up a schedule for the morning, as a colleague manned the steering wheel. 

Only a handful of people came out to meet us at the back of the car on our first stop, outside one of the city’s larger hostels. One man was given a small supply of needles – along with items like sterile wipes, citric acid packets and small, single-use pots that can be used to cook up heroin. 

A few minutes later, a second man came out to collect some clean crack pipes. There’s been a steep increase in availability and use of crack-cocaine in Limerick in the past year-and-a-half – and ALDP has responded by distributing sterile pipes that include a gauze to smoke the substance through. 

A smokeable form of cocaine made by chemically altering cocaine powder to form crystals or rocks, crack-cocaine produces a short but intense high with effects much stronger than the powdered version of the drug. It’s been around in the city occasionally before, O’Donoghue explained – but availability surged around last December. 

Similar to needle exchange, crack pipes are distributed as a harm reduction measure – smoking crack from homemade pipes can increase toxicity and cause further health problems, as the drug user inhales plastics and or other substances that are heated up in the smoking process.  

The effect of the drug is very noticeable. As it’s a stimulant (and one that wears off quickly) people can stay away awake for days on end on a binge, and the wear and tear on the body can be significant. As O’Donoghue explained, the popularity of the drug has lead to an increase in anti-social behaviour too. 

“What we are seeing is people are getting into more trouble – getting arrested more often. People aren’t able to control themselves basically. They’re spending large amounts of money, huge amounts of money … and the come down is very hard. 

So you know there’s concerns about things like unprotected sex and street work because of all the money that needs to be raised, and crime obviously is a concern.

crack A sterile crack pipe. Source: Ana Liffey Drug Project

Homeless services across the city have noticed people who use crack-cocaine becoming more chaotic in their behaviour.

We’d have huge concerns about people’s health too -  they’re not keeping appointments. Then, because they’ve no concept of time or what’s going on, you know, they’re losing their phones, they’re losing their wallets, missing appointments with us … not booking into a hostel and then ending up with no bed at night. Just in general life is so much more chaotic. 

Although use of crack-cocaine has increased in the city – it’s from a relatively low base. Around 20 people who engage with Ana Liffey are regular users of the drug – although other heroin users would seek it out occasionally. 

The Limerick-based service engaged with more than 250 individuals last year. Many would be addicted to heroin, benzodiazepine-based sedatives or other psychoactive substances – and there’s another small cohort of atypical service users who use the needle exchange to inject steroids.

Needle exchange programmes are in operation across Ireland’s towns and cities. The aim is to reduce the damage associated with sharing used syringes – including the spread of blood-borne diseases like HIV, and to cut down on overdose and other health problems. 

Outreach

The morning of our visit was a relatively quiet one for the team, O’Donoghue explained, as we continued to other scheduled stops around Limerick. The hostels get regular visits – but people can contact the team from anywhere in the city to arrange a meet up. 

Mid-morning, a steroid-user in his mid-20s arranged to meet with the team in a car-park out in the suburbs – and later on, back in the city centre, we waited to pick up a man in his late 30s who had spent years injecting heroin.

He’d almost lost the use of his legs recently due to serious infections brought about by his heroin use but was now on a methadone programme. ALDP project workers brought him to get his bandages changed every few days at a HSE centre in the city.  

Speaking to me in the back of a car, he explained how he had started taking drugs while still in his teens. Originally from Eastern Europe, he had been begging in the streets when he was initially approached by Ana Liffey project workers. In the last few years, he said, they had helped him control his drug use and start planning for the future – he now had a place in a hostel and said he was hoping to start looking for a job soon. 

4 Source: Daragh Brophy/TheJournal.ie

Needle exchange and outreach is only a part of each project worker’s workload each week. Every team member also has a caseload to work on – they’ll meet with someone once a week (sometimes more often) to help them assess their options and set goals for the future. 

Ana Liffey works with a range of other services for homeless people in the city – often helping service-users link up with charities like Novas, the Peter McVerry Trust or the Simon Community to seek out longer-term housing. 

Most people will come to us and say ‘I want to get clean’. That’s what people’s goals are generally speaking – but for a lot of people that goal is going to be hard to meet so we ask what do you need to do first to reduce your use? How many drugs are you using? Maybe let’s talk about targeting one of those drugs.

As part of an ongoing conversation, options like  methadone maintenance programmes and benzodiazepine detox programmes are discussed. 

Then you can maybe talk about – do you really want to go to residential treatment? Let’s look at that. If you really don’t want to go to residential treatment what are your other options within the community?

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