Last week the Health Equity Program (HEP) in association with University of Limerick Medical Society (Med Soc) hosted Marcus Keane, a barrister and head of policy and advocacy at the Ana Liffey Drug Project in Dublin. Marcus’s talk, entitled “Harm Reduction: A Healthcare Providers Perspective”, was an introduction to the scope of Ana Liffey’s services in addiction treatment and an engaging discussion on the role of harm reduction practices in healthcare settings. Ana Liffey is governed by principles of harm reduction, the goal of which is ultimately to reduce negative consequences of drug use. The harm reduction principles include attitudes that are non-judgmental towards drug use, pragmatic by creating goals that are actually attainable and evidence-based when implementing treatment. Ana Liffey is unique in dealing poly-drug users with multiple exacerbating factors such as poverty and homeless who can often be excluded from standard residential rehabilitation centers due to strict exclusion criteria. Part of Ana Liffey’s work is to keep these poly-drug users engaged and retained in treatment by adequately managing their addiction issues always within the context of their social and environment issues. Ana Liffey recognizes that a drug-free society is not possible in reality and the goal is to manage drug use in the least harmful way possible. The majority of our discussion surrounded the future implementation of medically supervised injecting centres (MSICs) in Ireland. Medically supervised injecting centres are a clinical space where people can inject their own drugs under medical supervision. MSICs exist in order to reduce harms to the individual injecting (reducing abscesses and infections of the injecting site) and the general public (unsafe disposal of injections). Several countries are currently using it such as Canada, Australia, Germany and other places around Europe. Research shows that MSICs are cost effective, increase entry to treatment, improve health outcomes, improve public amenity, do not encourage drug use and do not increase drug related crime. However, despite the evidence that MSICs are beneficial, there still persist myths that MSICs are a free for all for drug users, a prescribing service and that it is the only solution necessary. There are also several exclusions to participation in MSICs such as individuals under the age of 18, pregnant women, those with obvious intoxication and naïve injectors. There was significant debate in the crowd surrounding the exclusion of pregnant women as some felt that pregnant women should be included. Pregnant women are a vulnerable population and their drug use will happen regardless of access to MSICs or not. The reality is that you cannot eradicate the drug use altogether, however, you can reduce the harm to both the mother and fetus if it is performed in a medically supervised manner. Additionally, getting pregnant women involved in the MSICs may also allow them access to other higher level social services and healthcare programs which they may desperately need. Ideally, the aim is to find ways to improve access to vulnerable populations and minimize the exclusion criteria necessary for MSICs. Ana Liffey is currently working directly on the proposal, legislation and implementation of MSICs in Ireland, which will hopefully be a reality soon. You can read more about the Ana Liffey Drug Project on their website at http://www.aldp.ie/ Norah MacMillan is a 1st year medical student at the University of Limerick GEMS
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CaesuraRotating views on various subjects concerning health (in)equity Health Equity NutSome streams of consciousness on the subjects of the tragic and the mundane. Archives
February 2021
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