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Opinion: How the pandemic acted as a catalyst for change in delivering vital homelessness services

Tony Duffin, CEO of Ana Liffey Drug Project describes how a shift in policy around Covid-19 brought about the changes to drug treatment that had been sought for years.

Tony Duffin CEO of Ana Liffey Drug Project

THE FIRST WAVE of Covid-19 acted as a catalyst for change in the delivery of services to people who are homeless, and who use drugs, in Dublin.

Ana Liffey Drug Project works with people who use drugs; to reduce the harms drug use causes them, their families and the community. We work in Dublin and the Midwest of Ireland, and we work in partnership with State agencies and other charities.

Since Covid-19 reached Dublin, the epicentre of the pandemic in Ireland, Ana Liffey has focused our efforts almost entirely on people who are homeless and who use drugs, as it was recognised that this population were particularly vulnerable to the effects of Coronavirus infection. This is due to the poor health of this group; the poor living conditions they experience and their lack of access to health services.

On 12 March 2020 schools in Ireland closed to help reduce the spread of Covid-19. Five days later, on St Patrick’s day, Taoiseach Leo Varadkar addressed the nation stating that:

Never will so many ask so much of so few

The Taoiseach was, of course, referring to the heroic people on the frontline of the response to Covid-19 in Ireland. Ten days later, on 27 March, at midnight, further restrictions designed to reduce the spread of Covid-19 came into place.

Fighting the fear

Fear and uncertainty permeated the public and professional consciousness. This sense of fear was palpable amongst many of our client group.

Very early on, some people we work with did not understand why services they normally attended were shut; why the shops were shut; why people were wearing masks; why the streets were so empty; or why everyone wanted to keep their distance from each other? Ana Liffey’s team did a lot of explaining about the rapidly evolving situation when working on our street outreach during the early days of the first wave of Covid-19.

It was a time that demanded action. It was clear that the perfect should not be allowed to become the enemy of the good, and this view – that policymakers must respond quickly and not fear taking risks nor making mistakes – drove much of the policy innovation during this time. 

Led by the HSE and the Dublin Regional Homeless Executive (DRHE), and working in partnership with other addiction and homeless charities – the first wave of the virus in Dublin saw an extraordinary effort to reduce the spread of Covid-19 amongst people who are homeless and who use drugs.

A strategy that included providing accommodation to allow isolation of positive, and suspected cases, was implemented by the DRHE and staffing was funded by the HSE. People who were homeless who were deemed vulnerable due to age or medical condition were moved to single occupancy accommodation so that they could be shielded from infection.

In addition, homeless accommodation with large numbers of residents saw people transferred in order to decrease occupancy levels and thereby to reduce the risk of spreading Covid-19.

A spectrum of treatment

To reduce the need for people who were shielded from going out and potentially exposing themselves, and others, to Covid-19, it was necessary to provide them with not just appropriate accommodation, but also with improved access to methadone maintenance treatment; high dose Benzodiazepine therapy; and the home delivery of such prescription drugs.

Improved access and availability of Naloxone, which is used for the complete or partial reversal of opioid overdose, was also deemed important during this period of increased isolation when people may be at an increased risk of a fatal overdose.

Thankfully, there was significant success with this.

Between 9 March and 1 June, there was one Covid-19 related death amongst the Dublin homeless population and 63 cases of Covid-19 infection amongst single homeless people – much lower numbers than predicted.

Before 2020 all of these policy choices were limited by regulatory obstacles and uncertain political will. The pandemic crisis facilitated a number of practice changes that had persuasive arguments in their favour before it arrived.

Why it took Covid-19 to overcome barriers to seemingly obvious practice reforms is difficult to discern. It could have been the effect of the fear and uncertainty that was palpable as Covid-19 spread across the nation, or the unification of the health service with a clear single mission.

Perhaps, though, more controversially, it may have been the fact that the public health arguments in favour of harm reduction had previously related to the protection of People Who Use Drugs whereas the arguments that arose during the Covid-19 crisis related to protecting the public at large. More research would be needed to attempt to find the answers.

What is important and at this juncture is that we retain, and expand upon, these policy gains which were made during the first wave of Covid-19 in Ireland.

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For more information, you can download our study – ‘Harm reduction in the time of Covid-19: Case study of homelessness and drug use in Dublin, Ireland’.

Tony Duffin is the CEO of Ana Liffey Drug Project.  Visit aldp.ie for more information about Ana Liffey.

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About the author:

Tony Duffin  / CEO of Ana Liffey Drug Project

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