Treating Longford’s Heroin Problem

Below is a long-form piece on heroin in my home town of Longford, and the paucity of treatment facilities for addicts, which originally appeared in July 1 edition of the Sunday Business Post.

He smiles when he recalls the first time he used. It was 1995 and he was 17, just out of secondary school in his native Longford. Every few weeks he would travel 25 miles to Athlone to get his hands on some hash, something he enjoyed smoking with his friends but was difficult to get in Longford. One day the man he met in Athlone had something new, something he’d never seen before: heroin.

‘I’d never even heard of it, except from Father Kenny (a priest in the local secondary school),’ says Paul, not his real name, sipping from a glass of Lucozade in an empty bar in Longford town, less than a mile from where I grew up. That night in Athlone he injected for the first time: ‘The (dealer) said it was the only way he knew how to take it.’

His life was never the same again. Nowadays he is clean but his blackened teeth and gaunt frame are testimony to over a decade spent on and off heroin, in and out of jail in Ireland and England.

If heroin was ‘unknown’ in the Longford of 1995, that is no longer the case. Heroin is ‘a significant problem’ in county Longford, with numbers requiring treatment ‘increasingly considerably’, according to Close to Home, a report published by the Midland Regional Drugs Task Force in 2010. In 2004, just one person in the whole county presented for treatment for either heroin or cocaine use; by 2007 the number of cases had jumped to 28. As use has increased so too have deaths. Within the past year and a half, at least two people I know personally have died in Longford while using heroin.

Like many places outside Dublin, treatment services in Longford have struggled – and, at times, failed – to catch up with the rise in heroin use. Many health professionals, particularly doctors, are wary of dealing with users. Until very recently, needle exchange operated out of a shopping centre car park on the edge of town. There is still no methadone clinic or no full-time drugs service in the town.

Paul has witnessed first hand the spread of heroin in Longford. ‘Back in the late 90s there were six of us users in the whole of the county. Now it’s like walking around Dublin, down Thomas Street or Meath Street. It’s multiplied a thousand fold, it’s unbelievable,’ he says.

‘It shocks me to see the number of people on (heroin) in Longford. People who would have looked down on you for doing it, people from good families are all on it.’

He is visibly nervous to be back in Longford, back where he spent so many years using. Now living in the countryside he has driven in especially to meet me and will leave as soon as our conversation is finished. ‘I stay away from (Longford town), it’s too easy to fall back into old ways here…everyone I know here in the town are still using.’

Heroin use is higher in Ireland than in any other EU state, according to a report from the European Monitoring Centre for Drugs and Drug Addiction released at the end of last year. There are, on average, eight cases of heroin use per 1,000 people in the 15-64 age group in Ireland, compared with an average of four across the European Union.

Where previously heroin was largely a metropolitan problem, its use has spread far beyond the deprived inner-city neighbourhoods, where it first emerged in the late 1970s and early 1980s. The National Drugs Strategy, published in 2009, acknowledges this changing geography. The ‘nature and scale of the drug problem in Ireland’ has, the Strategy says, ‘undergone some notable changes’: ‘While the prevalence of heroin has ameliorated to an extent in the Dublin area, this has been offset to a degree by its wider dispersal around the country.’

The number of cases presenting for treatment with opiate problems (mainly heroin) outside Dublin has risen dramatically over the last decade, according to treatment data from the National Documentation Centre on Drugs Use (NDC). In 2004, NDC records show that 103 people sought treatment for opiate problems in the Midlands (counties Westmeath, Laois, Offaly and Longford). By 2010, this figure across the four counties had more than doubled, to 208.

It is worth noting that the treatment data relates to an individual treatment episode and not an individual. The same person could, in theory, be counted more than once if they tried and failed a program, most likely methadone, and returned again within a calendar year. Nevertheless, treatment figures are a useful heuristic for estimating heroin use, especially as users are often unwilling to reveal details of their habit in surveys. Drugs-related deaths are also on the increase: in 2004, 12 drug users in the Midlands died due to poisoning. In 2009, this figure had risen to 23.

Heroin can now be found across the country, from Tralee to Tullamore, Bantry to Ballyshannon. ‘These days it’s available in every town in Ireland. There’s heroin in every town in Ireland,’ says Irish Sun crime correspondent Paul Williams, who grew up in Ballinamore, in neighbouring Leitrim, and cut his teeth as a reporter on the now defunct Longford News.

Longford is no exception. I grew up in College Park, a sleepy estate of pebble-dashed semis a ten-minute walk from the centre of the town. Walking through College Park a decade and a half later everything seems pretty much as it was, save a few more ‘for rent’ signs, a few less children playing on the green and the unattractive eight-foot high metal grill that blocks off both ends of the concrete pedestrian walkway that I used to walk along to get to a nearby football pitch. The council erected the barricade a couple of years ago: the walkway had become a shooting gallery for local heroin addicts.

In many respects, Longford is a fertile breeding ground for heroin. The recession has exacted a heavy toll. In the centre of town, young men lean on street corners, watching the traffic inch along the languorous one-way system. Work is in short supply: between December 2007 and April of this year, the number of people on the live register in the county more than doubled, to 5,053. Vastly improved transport links with Dublin have made it easier to transport drugs to Longford. A plethora of half-finished houses and neglected or empty estates, away from prying eyes, provide ideal venues for users.

On a bright, midweek afternoon, a local community activist takes me on a tour of an estate where Longford’s heroin problem is probably most evident. In one particularly unloved corner of this vast, sprawling mass of houses, built in the shadow of the social welfare office, a house has been freshly burnt out. Charred wood litters the driveway. Nearby a child’s bicycle lies on the pavement outside a house. In the distance, the temporary roof of St Mel’s Cathedral, gutted in a fire three years ago this Christmas day, shines in the sun.

‘That’s a shooting gallery. That was a shooting gallery,’ my guide, who was born and raised in Longford, points at an abandoned semi, graffiti on the boards where the windows should be. A little further down the street he gestures at a row of well-kept semis, a fleet of expensive cars sitting outside the front. ‘That’s a dealer’s house. That’s a dealer’s house.’

‘Many people have died of drug overdoses in the last twelve months,’ says Longford Town Councilor, Tony Flaherty. ‘Heroin and cocaine can be got as easy on the street as fags in a shop.’

A Longford doctor who treats opiate addicts says he ‘didn’t see any heroin’ when he opened his practice a decade ago, but there has been a significant increase in recent years. ‘Ninety-seven per cent are young, 20, 25, not any older. The majority belong to excellent families, are well educated.’

The GP, like many I spoke to in Longford, prefers to remain anonymous, in part due to fears of recriminations from the powerful drug dealing networks that operate in the county: ‘The people involved in the heroin business have very big hands; they can do anything, they can destroy your life,’ he responds when I ask if I can use his name in this piece.

Councilor Flaherty has experienced the omnipotence of Longford’s drug dealers first hand. In 1997, then a novice councilor, Flaherty made an impassioned speech to Longford Town Council about the influx of drugs – at the time mainly ecstasy and speed – into the town. Flaherty’s comments made local and the national news. Repercussions were swift.

Speaking to me in the town council chambers, an airy room lined with old photographs that belies its location above a supermarket in the centre of Longford, Flaherty looks down at the floor as he recalls what happened next: ‘I had just finished doing an interview with RTE and was walking back to the car. A guy came up beside me, he said ‘come here, I want to show you a problem with my house.’’ Flaherty reluctantly followed. He was met by a gang of indignant local drug dealers. ‘The ringleader had a knife in his hand. He told me what he’d do to me if I didn’t shut up about drugs in Longford.’

Almost a decade and a half on, reports of drug-related crime pepper the inside pages of the local newspaper. Most local politicians, however, are still reluctant to address the issue head on. ‘You don’t get votes for it,’ says councilor Flaherty, who admits he has some sympathy for his colleagues’ wariness when it comes to drugs: ‘I seen (what happens) myself 15 years ago. I don’t know if I’d go through that again.’

At a drop-in clinic in Longford, a community worker says official reticence about heroin, and other drugs, extends beyond fear of reprisals. ‘The people with power have been in denial for so long. They’ve said ‘there’s no problem here’ for so long, that to admit anything now would be impossible in their eyes.’

Some are concerned that any acknowledgment of a drugs problem, especially heroin, would further damage Longford’s already fragile reputation. In this climate anyone who speaks about the problem risks censor, for ‘talking down the town’ or, worse, breaching the omerta that problems should be dealt with internally, in private, if they are to be dealt with at all.

‘If publicity about the size of the problem in Longford comes out we could we could lose out but that’s a very narrow, short-term view,’ says the community worker. ‘While we continue with this policy of denial it’s only going to get worse.’

Authorities have been slow to react to the scale of the drugs problem outside the capital. ‘What’s happened in the rest of the country mirrors what happened in Dublin (in the 1980s),’ says Tony Geoghegan, director of Merchant’s Quay, a charity that which began working with drug users in Dublin in 1989, partly in response to the significant increase HIV/AIDS infection rates among heroin addicts. In recent years, Merchants Quay has expanded its services across the country: it now has two premises in Athlone, a drop-in centre and an office, as well as an outreach worker in Longford two days a week and a dedicated Traveller support worker.

Geoghegan believes there is an ‘evolution’ in the understanding of drugs in a community, starting with blanket denial and ending in an acceptance that the problem exists and needs to be addressed. ‘There will always be a percentage of any community that will have problems with drugs, just as there will always be a percentage of any community that has problems with alcohol or mental health problems,’ he says. ‘What you have to do is provide access to treatment.’

The main treatment for opiate users in Ireland is methadone, a heroin replacement that is used to stabilize addicts and, in part, to reduce the crime that is associated with the drug. The number of people on methadone programs across the country has almost trebled in less than fifteen years. In 1998, there were 3,681 people on methadone treatment across the country. At end of October 2011, 9,264 were receiving methadone, according to figures released by the Health Service Executive.

In the Midlands area, 180 clients were attending the Methadone Maintenance Programmed as of March of this year, a HSE spokesperson told the Sunday Business Post. There are also 36 pharmacists in the Midlands dispensing methadone on a daily basis to 291 clients.

Yet access to facilities is a major stumbling block for many users who want to seek treatment. Longford has no methadone clinic: anyone in the country on the methadone program is expected to travel to Athlone twice a week on a special bus to receive treatment. This time-consuming process can continue for anything up to a year or more before responsibility for prescribing and administering their methadone is passed over to a local GP and pharmacy.

Getting onto a methadone program in the first place can be difficult. The National Drugs Strategy aspired to have all problem users accessing treatment within one month of assessment by 2012. However, waiting times for methadone programs in Athlone are, on average, around nine months, a figure on a par with many other regional centres. One Longford doctor reported patients buying methadone on the street and self-medicating while waiting for a treatment slot to open up.

‘If you are trying to engage people with treatment access is crucial. Motivation comes and goes,’ says Tony Geoghegan from Merchant’s Quay, who notes that drug users from outside the capital often come to the charity’s Dublin centre in search of treatment. ‘The waiting list thing is very difficult. It can be very off-putting, especially when the nature of addiction is ambivalent – most people you talk to on heroin want to get off it but at the same time they don’t want to or they can’t,’

In many areas, there is a paucity of doctors who are qualified and willing to prescribe methadone. At present just two GPs in Longford are trained to level 1 methadone prescribing, the minimum standard required to participate in the scheme. In nearby Mullingar, there are apparently no GPs prescribing methadone.

Physicians are ‘worried about being called the ‘drug doctor’ or the ‘methadone doctor,’ says a Longford GP who does take part in the scheme. ‘But it only takes a couple of minutes to listen to these people with drug addictions, to find out what their problems are and to start helping them.’ Treating drug users could also jeopardize doctors’ far more lucrative private practice.

Methadone itself is no magic bullet. For many users it can be almost as difficult to give up as heroin. And it is not always effective. Only 27 per cent of clients complete their methadone treatment, according to the 2009 National Drug Treatment Reporting System. Another 10 per cent were reported as stable and transferred to other services and reported. One-third of clients either left the methadone program, or were refused further sessions.

Methadone is a toxic substance that, if abused, can be fatal. Methadone was implicated in 66 deaths in 2009. Heroin was involved in 108 deaths in the same year, according to research from the National Drug-Related Death Index.

Addicts often use heroin alongside their methadone, or simply sell their dose on the street. The latter can be a particularly costly pursuit: at least one addict in the Longford area is missing presumed death following threats from drug dealers about selling his methadone freelance on the street.

But methadone’s benefits outweigh its costs, says Jon Brier, a pharmacist working in Longford. ‘It depends what you deem success. If I’ve someone on 40ml of methadone and they’re not burglering people anymore to feed their habit? Well I deem that success.’ Brier is also chairperson of Longford Drugs Forum, a voluntary group established in 2007 to improve the inter-agency response to the drugs problem across the county.

Demand for drugs services and treatment is growing in rural Longford. ‘A lot of our clients would be from rural areas, literally side of the road kind of places,’ says Dawn Russell, project manager for the Ana Liffey drug project in the Midlands and North East Regions, which, since last year, has been running a one-day a week ‘harm reduction service’ in Longford, conducting needle exchange in homes around the county, providing advice and counseling, particularly for users that are under 18.

‘We very rarely get people presenting with just opiate issues’ says Russell. These ‘polydrug’ users often combine alcohol, heroin and benzodiazepines (prescription drugs used mainly for treating psychological disorders), a potent cocktail that is popular in areas right across Ireland.

The ready availability of legal drugs on Ireland’s streets has led to the introduction of legislation that will make it an offence to possess tranquilizers without a valid prescription being drawn up. Roisin Shortall, junior minister with responsibility for the national drugs strategy, hopes that this legislation will reduce the sale and resale of prescription medication.

A former opiate user living in Longford, who we will call Alan, explains how he would supplement his heroin with legal drugs: ‘I’d go around all the doctors in town trying to get anything I could. There were a couple (of doctors) that were easy enough conned. I’d score sleeping tablets, benzodiazepines, medium strength-morphine. The morphine I’d just shoot up.’

At that stage he had been on heroin for over five years. He was already an addict when he returned to Longford from overseas, but if anything his addiction got worse, not better, back home.

He lost his job, was thrown out of the family home for stealing and was living in a house near one of the main centres for heroin dealing in Longford. Besides visiting the town’s physicians, he fed his growing habit by passing dud cheques. Until, one day, the gardai, following a tip off from the bank, called to his door. Faced with a potential prison sentence, he decided to try coming off heroin. His father was ‘afraid of me’ but reluctantly agreed to let him back, if he agreed to enter a residential treatment program.

‘I didn’t sleep for the first week. At this stage I was pretty fucked, I was using all day, prescription drugs, the gear.’ He tried, and failed, a number of residential programs before finally being accepted on to a three-month program run by Marist brothers in Athlone. He has not used heroin since he left the unit, almost eight years ago. ‘I don’t think I could ever go back (to using),’ he says.

Residential units can have an important role to play in drug treatment, particularly for those on methadone long-term who want to become completely drug-free, says Tony Geoghegan from Merchant’s Quay. However, there is not enough access to these spaces. Although there are around 10,000 methadone users in the State, at any one time there are only 30 to 40 detox beds in the whole country.

The Marist centre in Athlone has closed, as have a number of similar residential programs in the Midlands area. A dedicated residential treatment centre in Mullingar, due to open in 2013, is on hold following complaints from local residents.

Alan credits the residential program with giving him a chance to stop using and to rebuild his life, but he believes the social situation he emerged back is the main reason he has been able to stay clean. ‘I was the only culchie (on the program), the rest were all Dubs. They were going back to the city. I was going home, I didn’t have to start working, I didn’t have the pressures they had. I was able to go back and stay away from all the people that reminded me of (heroin).’

People coming off drugs ‘need something positive to run alongside the change,’ says a Longford-based community worker. Many opiate users are from deprived backgrounds, lack education or work skills, have a history of unemployment and, after treatment, are returning to a community in which drugs are a major part of life.

The Attic, an after school youth café opened in 2006, is a space young people in Longford can go that is always drug-free. Next to a guitar hanging on the club’s brightly coloured walls is a poster explaining how a drugs conviction can lead to being rejected for a visa. Beside the pool table a plethora leaflets describe the effect of drugs and alcohol.

Theresa Connell, the Attic’s youthful drug education officer, says that the key is engaging with people ‘as early as possible’. ‘They’re drinking at younger, they’re getting bored quickly and the experimentation develops from there,’ she says. Delaying the first use of alcohol is crucial; the Attic, with its computers and other distractions, is one way of achieving that goal.

Tony Flaherty thinks the Attic has ‘done an awful lot’ for young people, ‘but we need three or four Attics in the town alone.’ Flaherty still believes that the justice system needs to be stronger, but his views have changed a lot in the fifteen years since he castigated Longford’s drug dealers, in the council chambers. He now thinks that recognizing the drug problem, providing treatment services for addicts and education for parents and children is the only viable option.

‘Fifteen years ago I was interested in solving the crime, now I’m about education,’ says Flaherty. ‘The issue is there, it’s the awareness that needs to be brought out.’

Outside the Box

In the late 1980s, Switzerland had a serious heroin problem. Public parks in Zurich, Bern, and other smaller Swiss cities had effectively become open-air drug markets and shooting galleries. Dealers sold heroin in broad daylight. Addicts often overdosed and died in the parks.

Police responded with repression. But it never worked – dealers and users just moved on to the next park. As HIV/AIDS began to spread rapidly through the intravenous drug using population it became clear that something needed to be done.

In 1994, Switzerland became one of the first countries to experiment with heroin-assisted treatment for hardened addicts. Other measures, such as supervised injection rooms, were introduced as part of a new emphasis on harm reduction.

Many Swiss opiate users receive methadone treatment. However, heavy users who have tried and consistently failed on methadone programs and have health problems associated with their drug use qualify for state-administered heroin.

In 2010, 1,370 patients across Switzerland received heroin treatment, which is administered from 21 centres as well as two prisons. Giving heroin to addicts might seem like a controversial and politically unpopular but the measure was approved in a public referendum, in 1999.

In Switzerland it was obvious that ‘simple solutions wouldn’t work’, says Professor Daniel Kübler, a drugs policy analyst at the University of Zurich. Now, after almost twenty years, the country has ‘a solution that is quite differentiated, at different levels, and at different moments in an addiction that helps to manage a complex problem’.

‘Single measures might look contradictory on their own but looked at the whole it makes sense,’ says Prof Kübler.

Tony Geoghegan, director of Merchant’s Quay, thinks Ireland could learn from countries that have taken a more nuanced approach to drug treatment. ‘We have adopted a one size fits all approach, says Geoghegan. ‘(But) methadone isn’t going to suit everyone and that type of approach isn’t going to fit everyone.’

Geoghegan says that more needs to be done to break down attitudes towards drug use and to improve treatment across Ireland.

‘Zero tolerance sounds good and is very popular but it doesn’t really work,’ Geoghegan says. ‘It makes more sense to address the underlying issues, and to invest in skills and training (for users).

‘We need a greater emphasis on drugs as a health and a social problem rather than a law and order issue. It costs about €70,000 a year to keep someone in prison. If drugs are the root cause of someone committing a crime, then not to address that is crazy.’