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Dublin's approach to supporting drug users during pandemic saved lives, report finds

Sixty-three homeless people were diagnosed with Covid-19 and there was one death, a fraction of what had been predicted.

File photo of a used syringe in Dublin city.
File photo of a used syringe in Dublin city.

DUBLIN’S APPROACH TO supporting drug users and homeless people during the Covid-19 pandemic saved lives, according to a new report from the London School of Economics (LSE) and the Ana Liffey Drug Project (ALDP).

The paper states that “a pragmatic and well-coordinated government response”, alongside housing provision and the expansion of harm reduction-services, saved lives among the vulnerable group.

Sixty-three homeless people in Dublin were diagnosed with Covid-19 and there was one death, a fraction of what had been predicted.

Harm-reduction services were quickly expanded in Dublin at the start of the pandemic – including improved access to methadone treatment and naloxone (medication used to reverse the effects of opioid drugs like heroin), and the home delivery of prescription drugs.

Source: LSE/YouTube

The report states that the extension of these services was significant in protecting homeless people from Covid-19.

The authors note that prior to the outbreak of the virus, these services were “limited by regulatory obstacles which were rapidly removed in response to coronavirus”.

They suggest that Covid-19 “acted as a catalyst for change in the delivery of harm reduction measures, with decisions that would normally take months or years effected within days and weeks”.

Prior to the pandemic, GMQ Medical (a primary care service for homeless people in Dublin) had a methadone treatment waiting time of 12-14 weeks due to a cap on the number of patients it could treat.

In response to the virus, national contingency guidelines were issued allowing for the expansion of services, leading to reduced waiting times for access to treatment. Other drug treatment clinics also agreed to take on homeless patients resident in hostels in their catchment areas.

As a result, waiting times dropped from 12-14 weeks to two to three days.

Replicable across the world 

Commenting on the situation, paper co-author and Executive Director of the International Drug Policy Unit at LSE, Dr John Collins said Ireland has “shown itself as a policy innovator during the Covid-19 crisis and has outperformed even best-case scenarios for mortality among homeless and drug-using populations in Dublin”.

Collins said the report “highlights how Dublin’s success emerged from a variety of factors including a sense of national emergency, pragmatic and well-coordinated government policy, the provision of housing, the expansion of harm-reduction services and the bravery of frontline service providers”.

He added that these policies are “replicable across the world and in many cases merely represent a reduction in barriers to service provision, rather than a radical departure from existing approaches”.

Collins said the improvement in services “should not be allowed to roll back as and when the virus recedes”.

“Covid-19 has meant that policy barriers in Ireland that may have taken years to reduce have been pushed aside in a matter of weeks. If these gains are kept in place, aside from the lives saved during the Covid-19 pandemic, they will more than likely continue to save lives long into the future.”

‘Dangerous position’ 

Dr Austin O’Carroll, Clinical Lead for Homelessness in Dublin, noted that as homeless people sleep rough or live in shared accommodation, and many of them have underlying health problems, they “found themselves in a precipitously dangerous and vulnerable situation” in recent months.

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“If action was not taken immediately, we envisioned the epidemic sweeping across the sector, causing multiple hospitalisations and a high death rate.”

O’Carroll said the swift action taken by housing, homelessness, health and harm-reduction agencies saved lives and prevented a mass Covid-19 outbreak.

“The sector was very happily surprised by not only the low rate of infection and negligible death rate, but also by the noticeable improvement in general health and wellbeing in the homeless population.”

Tony Duffin, CEO of the ALDP, said the paper highlights that a harm-reduction approach “has been, and will continue to be, an important element of the public health response to Covid-19″ among vulnerable groups.

“It is crucial to help stop the spread of the virus and to reduce drug-related harm,” he added.

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Órla Ryan

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