Dáil Éireann debate -
Thursday, 1 Jun 2000

Vol. 520 No. 3

Adjournment Debate. - Heroin Related Deaths.

Mr. Broughan

I thank the Ceann Comhairle for allowing me to raise this matter. Last week my colleague, Deputy Upton, spoke movingly of the deaths of young Rosie Lakes and other heroin addicts. Now, a few days later, we appear to have a major health problem on our hands. It is sad to consider that the recent spate of deaths might only be the tip of the iceberg. In my constituency I have noticed a steady but silent holocaust of young people dying at home and on the street as a result of heroin addiction.

It is incomprehensible that the Taoiseach, who represents probably the most deprived constituency in Ireland and is familiar with this problem, has not already ordered a strong emergency response from the health and justice Departments. The news in recent days of the sudden deaths of 14 drug users has highlighted the ongoing problem of people with severe heroin addiction. The current spate of deaths is comparable to a major fire or transport disaster and there is an onus on the Government to begin an emergency programme.

As the similarity with the addiction deaths in Glasgow is so striking, we must pay close attention to Scottish medical personnel. Dr. Laurence Gruer, a consultant with the Greater Glasgow Health Board, has indicated that addicts who injected directly into the muscle may have been contaminated with a mysterious new bacteria which then invaded their organs and destroyed their systems. One of Dr. Gruer's colleagues told Vincent Browne a week ago that a batch of very pure heroin had been responsible for many of the Glasgow deaths. One of its effects is to close down functions such as breathing and this was responsible for the deaths in the Glasgow area.

There is now an emergency in Dublin and the Government must take responsibility for dealing with it. The health authorities and the Garda should be given guidelines to expedite measures to treat addicts, control the use of heroin and find the source of the contaminated drugs. Only those presenting themselves for treatment are getting updated information on the risks of injecting heroin. The majority of addicts are not receiving treatment and they need up to date reports on the issue. The only way of targeting many of them is through personal contact. Additional staff must be deployed to work with voluntary organisations in making contact with addicts who are not presenting themselves for treatment and are not involved with their local drugs task forces.

In addition, addicts should be given increased access to methadone dispensing services. The message must be conveyed throughout the city that heroin should not be injected. According to the information available to date, addicts are only attending hospital at the last minute if they develop acute symptoms after taking heroin. They have a higher chance of survival if they are identified early. All Dublin hospitals, therefore, should have emergency plans and deal with addicts as a priority.

I commend the Government on some of the initiatives it has taken in relation to the local drugs task forces, particularly the Minister of State, Deputy Ryan. Areas such as Kilbarrack, Darndale, Belcamp and Kilmore in my constituency led the way in the provision of local treatment and rehabilitation centres. However, more must be done. Many parishes in the city do not have a treatment facility and there are long waiting lists for those which have. In the last five weeks, up to half a dozen parents and friends of addicts called to my clinics to tell me they were fearful their son, daughter or friend would die from heroin addiction if they did not receive assistance and treatment.

When the drugs task forces were launched by the then Minister of State, Deputy Rabbitte, they were considered an effective means of coming to grips with this tremendous catastrophe which affects at least 13,000 people in the city. Today's Irish Independent claims that the current drugs crisis has little to do with class issues but is the result of the authorities not devising a coherent or workable anti-drugs policy. However, it is a class issue. Many of the worst affected areas do not have enough health resources or resources for the drugs task forces or Garda Síochána. In the Dublin North-Central and Dublin North-East constituencies, for example, there are approximately 180 gardaí to police 250,000 people.

We need a proactive emergency programme to deal not only with the current crisis but also with the overall problem of heroin addiction which is devastating the city of Dublin.

Mr. Martin

I share Deputy Broughan's concern about the recent deaths from heroin and I extend my deepest sympathy to the families of all those concerned. I am advised by the Eastern Regional Health Authority – ERHA – that it is continuing to monitor this situation carefully.

On 9 May, the Greater Glasgow Health Board reported that there was a growing number of cases of unusual severe illness among heroin drug injectors in Glasgow. On 19 May a description of the Glasgow cases was issued on the European infection warning system requesting health authorities throughout Europe to actively seek similar cases in their own areas. The illnesses appeared to be related to injecting heroin into tissues rather than veins which caused severe damage and extensive necrosis. In severe cases there was a rapid deterioration over a number of days which developed into a septic shock syndrome. The alert was then issued by the national disease surveillance centre to directors of public health. When the ERHA department of public health received this warning, it immediately contacted the hospitals in its region to pass on the alert and to ascertain if there were similar cases here.

The ERHA department of public health's inquiries found that since 1 May, 14 heroin users have been hospitalised from the Eastern Regional Health Authority region suffering from severe unidentified illness. They all met the case definition which is an injecting drug user with evidence of a severe inflammatory process. Seven of these patients have died. Three of the remaining patients have been discharged from hospital and four are still receiving treatment.

The ERHA is working closely with the authorities in Glasgow, the National Disease Surveillance Centre and the Centre for Disease Control in Atlanta to try to isolate and identify the exact cause of the illness. The ERHA department of public health has received notifications from the city and county coroner of 19 deaths of heroin users since April. The Garda are investigating 14 of these cases and, of these, seven fit the case definition above, four do not and three are being further investigated.

The ERHA department of public health is also at present investigating the cause of the death of another heroin user who died in a Dublin hospital on Wednesday, 31 May 2000. It has not yet been established if this case will fit the case definition.

The Eastern Regional Health Authority has been introducing measures to inform drug misusers of the present dangers and to encourage people into treatment. It has advised any heroin users who develop a significant swelling or abscess, particularly near an injection site, to seek medical help from their doctor or hospital as soon as possible. It has also advised any heroin users who develop unusual symptoms of illnesses to seek medical help immediately. The three area health boards have posted notices in their health centres, drug treatment centres and other facilities warning people that there may be contaminated heroin on the streets. They have also notified general practitioners in the areas.

Outreach workers have been focused in areas where drug users may not have heard of the current risks. The area health boards have appealed widely through the media to heroin users to stop using the drug and to contact a clinic for assessment for treatment. Services have been expanded to meet an increased demand where the risk of contaminated heroin may encourage drug users to come off the drug. Patients on low dose methadone will be given the opportunity for increased enrichment of the dose to discourage the practice of topping up with heroin.

Arrangements are also being made to increase treatment capacity in a number of specific areas, James's Street, Crumlin, Cabra and Finglas, Darndale and Inchicore. The boards are working to the best of their ability to significantly increase the number of additional treatment places being made available. Two mobile buses will continue to provide emergency services at Dr. Steeven's Hospital, Ballymun, Blanchardstown, Empress Place and other suitable locations. I understand that, arising from these initiatives, 70 new patients had presented themselves up to Tuesday of this week.

The boards have also established a freefone helpline which is operating seven days a week and which people can call if they are worried about drug using practices. This helpline will also offer advice to heroin misusers and information and referral to treatment centres.

The EHRA is taking all appropriate action in this matter and I am assured of its continued efforts in this regard. I again express my concern at the number of deaths caused by this episode and my sympathy to the families of those involved. I wish to condemn all those involved in supplying heroin to users who are the unfortunate victims of their deadly trade. I wish to place on the record that the Taoiseach has taken a deep personal interest in this issue and has initiated co-ordination between my Department, the Minister of State, Deputy Eoin Ryan, the National Drugs Advisory Board and the Faculty of Public Health Medicine and so on, all of whom are actively involved in trying to isolate the cause of this problem and deal and expand advice and treatment facilities. Resources are not an issue in terms of opening more treatment facilities in Dublin. There are other factors, particularly the NIMBY factor, which has retarded the expansion of treatment centres in some areas in the city. However, the authorities will not rest until the cause of this problem is isolated and action is taken to help those suffering from the effects of this contaminated heroin.