Ana Liffey Drug Project is a leading harm reduction NGO in Ireland. On the occasion of the 40th anniversary of the organisation, we interviewed its CEO, Tony Duffin, about recent developments in harm reduction and drug policy reform in the country.
Drugreporter: First of all, let me congratulate you on the 40th anniversary of Ana Liffey Drug Project! This is a time of celebration and reflection: How did you mark the occasion?
Tony Duffin: Thanks Peter! Our celebratory events to mark our 40th Year were held very recently – Firstly, on Thursday 10th November the Lord Mayor of Dublin officially named Ana Liffey’s premises at 48 Middle Abbey Street ‘The Matthews Building’; in honour of Eddie Matthews for his dedicated voluntary work over many years on the Board of Ana Liffey. The event was attended by Eddie’s family, friends, and colleagues. The event was a lovely celebration of Eddie’s volunteerism with Ana Liffey.
Secondly, on Tuesday 15th November we held a an event in Limerick City, to mark ten years of Ana Liffey Drug Project operating in the Mid-West Region; Limerick County TD, Niall Collins – the Minister of State for Skills and Further Education – attended and welcomed the findings of the new research ‘Doing More – The Health and Social Impacts of Crack Cocaine use in Limerick City’. He welcomed the allocation of funding by the State to support Ana Liffey to employ two addiction outreach workers in the Mid-West Region, one worker specialising in reaching, and case managing, members of the LGBTQI+ community; and the other worker with a similar function focussing on the Traveller Community. He also launched Ana Liffey’s new mobile health unit purchased with a grant from the JP McManus Benevolent Fund. A significant service development which helps to deliver harm reduction services to people in a flexible and accessible manner; and to reduce the risk of overdose, and other drug related harms, in Limerick City and across the Mid-West Region.
Thirdly, on Thursday 8th December Ana Liffey celebrated its 40th year by holding a conference in Dublin City. The conference included presentations and panel discussions on a range of topics, comprising of service users, peer workers, frontline workers, researchers, and policy experts. With presentations on the health impacts of crack cocaine use in Limerick City; supporting recovery; and decriminalisation advocacy efforts in five international jurisdictions. There were also panel discussions on health-led approaches to people who use drugs; another about innovating to prevent fatal overdose; a panel which involved a discussion with Ana Liffey team members about delivering innovative services; and, finally, a panel discussion about the meaningful participation of people who use drugs.
As you can see these all took place in the space of one month; and while it was a very busy period, I’m pleased to say that all the celebratory events went really well and we received great feedback on each of them.
Your organisation opened the first harm reduction service in Ireland, challenging the monopoly of abstinence-based approaches. How do you see the change in attitudes to harm reduction in Ireland in the ensuing decades, and how much progress have you made?
In Sept 1982, Ana Liffey was established by Father Frank Brady and Mara de Lacy. Much is written about the inception of Ana Liffey. Dr Shane Butler, who was involved with Ana Liffey in its early years, acknowledged the importance of Ana Liffey’s establishment in his 2003 paper, “Doing Drugs from an Ivory Tower”. Reflecting on his twenty years of delivering addiction studies at Trinity College, Shane highlighted the importance of Ana Liffey’s establishment as the first service provider established on the principles of harm reduction. Paving the way for a wider Harm Reduction response to the HIV/AIDS crisis in the mid-1980’s; which ultimately contributed to the reduction of the transmission of the then newly identified and frightening virus.
Throughout its history Ana Liffey has been creative and innovative in how it helps and supports people who we serve. For example, in the late 1990’s and early 2000’s the former Director of Ana Liffey, Brian Melaugh, initiated and delivered an inreach service to homeless families living in B&B – supporting children and their parents who used drugs. This innovative work was an important step in supporting parents who use drugs – reducing stigma and achieving good outcomes for the children and their parents.
Bringing us back to more recent times (as in the mid-1980’s when Ana Liffey is acknowledged and respected as an early responder, in Ireland, to the global epidemic of HIV/AIDS); in March 2020, Ana Liffey found themselves facing into the fear and uncertain permeating society as COVID-19, the global pandemic, took a grip on Ireland.
The work that Ana Liffey did during the COVID-19 crisis was a massive effort. As a team Ana Liffey were clear that our role was to stay out there and deliver services. Led by and with the support of the Health Service Executive (HSE), we worked in partnership, in Dublin and Limerick, adapting quickly and delivering much needed services. This partnership work was extremely successful.
So to answer your question Harm Reduction has come a long way since Ana Liffey’s inception in 1982 – Harm Reduction is now a central component of drug policy and service delivery in Ireland.
Ireland has one of the highest overdose rates in the European Union, and there has been a sharp increase in cases since 2015. What is behind of this alarming trend and how can you, as a harm reduction organisation, respond?
The causes are well documented by Ireland’s Health Research Board and the European Monitoring Centre for Drugs and Drug Addiction. However, amongst the cohort of people we serve – opiates, street tablets, crack cocaine and polydrug use are all factors in fatal and non-fatal overdose.
In our day-to-day work, as a harm reduction service we listen to the people who use our services. We listen for drug use trends; we talk to peers and partner agencies.
We know that ‘one swallow doesn’t make a spring’ i.e. a new drug mentioned by one of the people who use our services is not a drug trend. However, when we have multiple sources over a period of time – then we use this triangulated information and we respond to it accordingly.
I saw some sensationalist media coverage of crack cocaine use in the town of Limerick, claiming that there is a “crack supermarket” there. How do you see the situation?
Through the work of our Mid-West team, we had known that crack cocaine had become a significant issue over the past number of years; however, over the last 18 months the situation has worsened and, funded by the HSE, Ana Liffey recently commissioned a piece of research to look at the health and social impacts of crack cocaine use in Limerick City; and we will publish that research online shortly. Suffice to say the health impacts include damaged lungs, blood clots, weight loss, psychosis, depression, anxiety, inability to work, relationship breakdown and more. The research also found that increased risk taking included selling sex to earn money and snowballing to get a better high/feeling.
There are number of recommendations within the research; however the one I would like to highlight here is the improved engagement between addiction services and law enforcement agencies. Ana Liffey provides a service in Dublin called the Law Engagement & Assisted Recovery (LEAR) project. This is a good example of how a ‘low threshold – harm reduction’ service can work closely with the police – taking direct referrals from An Garda Siochana to the Ana Liffey. A model that would work well in Limerick City.
Ana Liffey has been a strong advocate for the decriminalisation of drug use. There is a Conservative-led government coalition right now in Ireland, do you see any chance that any positive change can happen in the near future?
A mid-term review was recently completed of the National Drugs Strategy and, six strategic priorities have been identified for the remainder of the strategy. The Minister of State, Frank Feighan TD, put in place new, revised oversight structures to support the implementation of the strategic priorities. This includes establishing strategic implementation groups.
I was recently appointed as independent chair of ‘Strategic Implementation Group 5: Promote Alternatives to Coercive Sanctions for Drug-Related Offences’. Membership of the group reflects the partnership model underlying the National Drugs Strategy. Part of the work of the group is to oversee and support the implementation of the Health Diversion Program which was initially announced in August 2019 – when the Government announced significant reforms to the possession of drugs for personal use in line with its commitment to pursue a public health approach to drug use in Ireland.
In answer to your question, I am hopefully that real progress can be made towards the implementation of the Health Diversion Program in 2023.
The COVID-19 pandemic put harm reduction services to the test in many countries. But it also opened the door for innovations. How did you respond to the crisis?
The HSE recognised that we are solution focused, adaptable, dynamic and willing to change. Also, they recognised the strong relationships we have with people who use drugs and people who are homeless. Everything that one should expect from a ‘Low Threshold – Harm Reduction’ Service.
So, from the outset and during the depths of the COVID-19 pandemic Ana Liffey – supported by the HSE and others – adapted and expanded our services. The pressure on our team members was often immense, but I’m proud to say that they gave it their all. We played our part in reducing the incidents of severe sickness and death due to COVID-19 amongst the people we serve.
Amongst many other duties during the pandemic – the team were redeployed to work in accommodation centres and COVID-19 positive units; and they staffed the COVID-19 vaccine unit that we provided ourselves.
As I said, we played our part during a very difficult period; however, overwhelmingly it was the pragmatism and partnership work between state and civil society that sums up that period for me.
Finally, I would encourage people to read the paper ‘Harm reduction in the time of COVID-19: Case study of homelessness and drug use in Dublin, Ireland’ Which gives insight into how Dublin appears to have performed very well as compared to various scenarios for COVID-19 mortality amongst homeless and drug using populations. It describes the importance of strategic clarity and delivery, housing, lowered thresholds to methadone provision, Benzodiazepine (BZD) provision and Naloxone availability were key determinants of policy success.
Ana Liffey is an important voice internationally as well, you chair the Steering Committee of the Correlation European Harm Reduction Network. How do you see trends in drug policy reform and harm reduction in the EU?
Thanks, for your kind words!
Drug policy remains a cross cutting policy arena e.g. health, justice, social welfare, housing, etc. The responses are multi-faceted Supply & Control; Education & Prevention; Harm Reduction; Treatment & Rehabilitation; Recovery; and more besides. As such drug policy reform remains complex.
Also, drug policy reform is not just about ‘evidence informed’ responses. It is also informed by what people ‘like’. As such politicians; civil servants, public servants and civil society play an important role in how policy is set and also implemented. These stakeholders engaging with each other is essential if we want to see progressive health led drug polices implemented in a way that is meaningful for people who use drugs. Indeed, in this regard, civil society organisations across the EU should further support service users/peers to engage with civil/public servants in meaningful dialogue.
Across some EU jurisdictions there has been progress in implementing alternatives to coercive sanctions for the possession of drugs for personal use. We would do well to maintain our focus on this work; and work towards a consistent response across the EU.
Can you tell me what harm reduction means to you, and what keeps you motivated in your daily struggles in spite of difficulties?
I believe in a ‘Low Threshold – Harm Reduction’ ethos as espoused by Ana Liffey Drug Project.
I began working in this field in 1993 in SoHo, London. I didn’t know the language of ‘Low Threshold – Harm Reduction’ back then; but, I was lucky enough to join a team of people who worked in such a way. It made complete sense to me and I was so taken by it that it would become my work for 30 years (so far).
It is the simplicity of the ethos – to neither promote nor denounce substance use but seeking to respond to problems associated with it; being pragmatic; believing in rights and responsibilities; and making a positive contribution to society.
Also, never barring people from our services – supporting the team members to find ways to creatively work with people and maintaining a constructive relationship with someone. Knowing that there is a team of people working on the frontline like this motivates me each day to support them in whatever way required of me.