Saving lives in the time of COVID-19. Case study of harm reduction, homelessness and drug use in Dublin, Ireland.

Dublin has outperformed even best-case scenarios for COVID-19 mortality among homeless and drug using populations. The experience provides important lessons for policy discussions on the pandemic, as well as broader lessons about pragmatic responses to these key client groups irrespective of COVID-19. The overarching lessons is that when government policy is well coordinated and underpinned by a science-driven and fundamentally pragmatic approach, lives are saved. Within this, 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. Further, given the rapid collapse in policy barriers to these interventions that COVID-19 produced, it is important to secure and protect these improved policy responses into the post-COVID-19 era

A milestone in drug policy: saving the lives of people who use drugs and were homeless in Dublin during the covid-19 pandemic

Dublin has outperformed even best-case scenarios for COVID-19 mortality among homeless and drug-using populations, write Austin O’Carroll, Tony Duffin and John Collins (LSE). When government policy is well coordinated and underpinned by a science-driven and fundamentally pragmatic approach, lives are saved

Chronic illness and multimorbidity among problem drug users: a comparative cross sectional pilot study in primary care

<p>Abstract</p> <p>Background</p> <p>Although multimorbidity has important implications for patient care in general practice, limited research has examined chronic illness and health service utilisation among problem drug users. This study aimed to determine chronic illness prevalence and health service utilisation among problem drug users attending primary care for methadone treatment, to compare these rates with matched 'controls' and to develop and pilot test a valid study instrument.</p> <p>Methods</p> <p>A cross-sectional study of patients attending three large urban general practices in Dublin, Ireland for methadone treatment was conducted, and this sample was compared with a control group matched by practice, age, gender and General Medical Services (GMS) status.</p> <p>Results</p> <p>Data were collected on 114 patients. Fifty-seven patients were on methadone treatment, of whom 52(91%) had at least one chronic illness (other then substance use) and 39(68%) were prescribed at least one regular medication. Frequent utilisation of primary care services and secondary care services in the previous six months was observed among patients on methadone treatment and controls, although the former had significantly higher chronic illness prevalence and primary care contact rates. The study instrument facilitated data collection that was feasible and with minimal inter-observer variation.</p> <p>Conclusion</p> <p>Multimorbidity is common among problem drug users attending general practice for methadone treatment. Primary care may therefore have an important role in primary and secondary prevention of chronic illnesses among this population. This study offers a feasible study instrument for further work on this issue. (238 words)</p

The use of psychotherapeutic interventions by primary care GPs in Ireland in the treatment of their methadone patients: a grounded theory study.

BACKGROUND: The methadone protocol placed responsibility on general practitioners (GPs) for the methadone treatment of stabilised drug-addicted patients. The protocol emphasised a medico-pharmacological model with minor reference to psychotherapeutic treatment. AIM: This qualitative study investigated how primary care GPs in Ireland use psychotherapeutic interventions in the treatment of methadone patients. METHOD: A grounded theory methodology was used. FINDINGS: There is a wide variation in the beliefs and knowledge of methadone-prescribing GPs regarding the efficacy of psychotherapeutic interventions for patients on methadone maintenance. GPs do not formally integrate psychotherapeutic interventions into methadone patient treatment. Accessing psychotherapeutic services raises concerns for GPs in terms of availability, location and quality. Primary care GPs who offer methadone maintenance view opiate abuse as a health issue similar to other such issues within their community. They take a holistic view of their methadone patient and, without formal guidelines, develop individual approaches to the use of psychotherapeutic interventions. The absence of a framework for the use of psychotherapeutic interventions in primary care methadone treatment in Ireland militates against the development of a basis for improving practice

Health of the homeless in Dublin: has anything changed in the context of Ireland's economic boom?

Background: In the context of the Irish economic boom we assessed the health, service utilisation and risk behaviour of homeless people in north Dublin city and compared findings with a 1997 study. Methods: A census of homeless adults in north Dublin city was conducted in 2005 using an adapted interviewer-administered questionnaire from the 1997 study. Results: A total of 363 (70%) of the target population participated. Compared to 1997 the population was younger (81% versus 70% under 45 years, P < 0.01) with a higher proportion of women (39% versus 29%, P < 0.05) and long-term homeless (66% versus 44%, P < 0.001). Drug misuse superseded alcohol as the main addiction with a doubling of the proportion reporting past or current drug use (64% versus 32%, P < 0.001). The prevalence of comparable physical chronic conditions was largely unchanged while depression (51% versus 35%, P < 0.01) and anxiety (42% versus 32%, P < 0.05) had increased. There were high rates of blood-borne infections, such as HIV (6%), hepatitis B (5%) and hepatitis C (36%) in 2005 and dental problems (53%) all of which can be associated with drug use. Access to free healthcare had not increased. Similar proportions reported not having medical cards (40% versus 45% NS). Homeless people continued to have higher usage of secondary care services than the general population. Conclusions: This study shows a changing disease profile among the homeless population consistent with a growing drug using population. It confirms that the homeless population in Dublin in terms of health remain excluded from the benefits of an economic boom despite a government policy aimed at redressing social inclusion