was a statistically significant association, Table 3, between
employment status and admitted heroin use with 65% of those
who misused being unemployed as compared to 27% who were
employed and 8% who were not available for work. In contrast,
among those attenders who did not admit heroin use 50%
were employed. Eighty-five per cent of opiate users attending
Jervis Street had needle marks, confirming the preference
of Dublin drug users to inject rather than smoke or sniff
heroin. Two-thirds of the opiate users were self-referred
whereas only one-third of those on other drugs were self-referred.
Opiate users who were not self-referred were referred by
the courts, by hospitals, by general practitioners, by
the family or other concerned adults, by the Drug Squad,
the gardai, or by counselors from the Eastern Health Board.
highest rates for attendance for treatment of opiate misuse
were for those resident in north and south central Dublin,
but there were attenders from all areas of residence in
the Dublin and Dun Laoghaire County Boroughs. Approximately
half (398) of all opiate users attending the Centre in
1985 were tested for the antibody to the AIDS virus by
the ELISA test, and 27% were positive. Males exceeded females
in a ratio of 3 : 1.
Data from this paper show a drop in
the number of persons presenting for
the first time for treatment of opiate
misuse at the Jervis Street Drug Centre
in 1984 and 1985. These findings support
evidence from the gardai,7 from
data on hepatitis patients from the virus reference laboratory,
U.C.D. (personal communication) and from a recent study
undertaken in a north central Dublin area8 that
there has been a marked decline in opiate misuse in Dublin
for these two years compared with previous years.
reasons for this fall are no doubt complex. However,
some responses to the epidemic of opiate misuse, which
peaked in 1983, can be identified. The government reacted
by introducing more punitive legislation for drug-related
offences with the Misuse of Drug Act 1984, and the implementation
of sections of the Criminal Justice Bill in 1985. The
submissions of the Special Government Task Force of Ministers
in 1983 were responsible for creating greater awareness
among the public of the dangers of drug misuse through
the introduction of a Diploma Course in Addiction Studies
in Trinity College and the development of "life skills" programmes
by the Health Education Bureau which were introduced
into a number of schools on a pilot basis. Research projects
at the request of the Government were carried out by
the Medical Social Research Board which has greatly increased
knowledge of the problem. A National Co-ordination Committee
on Drug Abuse was set up to advise the Government on
an ongoing basis on general issues regarding the prevention
and treatment of drug misuse. There has been an increase
in the success of the Dublin Drug Squad in dealing with
major drug pushers and knowledge about drugs has been
disseminated through drug courses in Garda Headquarters
since 1981 and to Gardai of all ranks. The Garda Annual
Report on Crime. 1984,7 showed a drop in the number of
persons charged for drug-related offences and in drugs
seized, especially heroin, suggesting that there was
less coming into the country than formerly. The churches
have played an active role in discouraging drug usage
and in assisting those with drug-related problems. The
success of local residents' associations, including the
Concerned Parents Group, in their stand against drug
pushing has also been an important factor.
is difficult to estimate at all accurately the current
number of opiate users in Dublin. During the seven years,
1979-1985, there were 1,877 first contacts for opiate
use, usually heroin, at the Jervis Street Centre. This
figure reduces to 1,783 for the greater Dublin area,
as we know that approximately 5% of opiate users attending
the Centre came from outside Dublin for treatment.9 Earlier
studies showed that roughly 65%-70% if users identified
in the community had attended the center,3-5 while findings
from a study in a north central Dublin area8 show
that about one-quarter of those misusing opiates two
to five years ago, and who were not in prison, were not
at the time taking opiates. A rough estimate, therefore,
including the first contacts at the drug center in 1986
would be that there have been about 3,000 opiate users
in the Dublin area of whom perhaps 2,000 are still taking
opiates when they can get them.
of a decline in opiate misuse in the Dublin area in 1984
and 1985 is welcome. In particular, the noted drop in
the number of first contacts attending the Jervis Street
Centre and the proportion shown from community based
studies who appear to have "matured out" of heroin -
an occurrence also observed in some other countries10 is
encouraging. However, it is disturbing to find that 27%
of heroin users attending the Centre in 1985 were positive
for antibodies to the AIDS virus. This virus was only
identified in 1983 and new information about it is becoming
available all the time. It was formerly believed that
5%-10% of those with AIDS antibodies would go on to develop
AIDS, but recent information from the United States suggests
it may already by as high as 30% within five years.11 Furthermore,
as the virus is spread by blood to blood contact and
by sexual intercourse, intravenous drug users run the
risk of becoming infected through sharing needles and
syringes and, if infected themselves, of passing on the
infection to their sexual partners and to other intravenous
drug users with whom they share their "gear". A further
problem is that pregnant women can pass on the virus
to their unborn babies.12
can be no complacency regarding the drug problem in Dublin.
A decline in opiate misuse for the two year period 1984
and 1985 could easily be reversed by a subsequent ruse
or by misuse of other drugs. There was a considerable
increase in 1986 in the number of first contacts for
opiate misuse. This rise could represent a real increase
in opiate users in the greater Dublin area or a shortening
of the period between starting on the drug and attending
the Centre. Further analysis should settle this question.
from this paper and from previous studies of drug use
in the Dublin area3,4,8 shows that opiate misuse is predominantly
a problem of the inner city area and that it is associated
with unemployment and poor living conditions. A previous
study13 which matched the age sex of heroin
users with non-heroin users in the north central Dublin
area revealed that 95% of heroin users were unemployed
at the time of interview, compared with 48% for the control
group, the norm for that area. Two recent studies in
parts of Glasgow14 and the Wirral area of
Merseyside15 suggest a more than incidental
link with unemployment and deprivation and high heroin
use. In the Glasgow study the author suggests that a
sense of futility in young people living in areas of
high unemployment together with the ease of access to
heroin may mean that they are more willing to seek immediate
gratification without thought of the future. A strikingly
similar picture emerged in the Wirral area where 80%
of known heroin users were unemployed and areas of deprivation
and heroin misuse overlapped. The established association
between high levels of unemployment and heroin misuse
in the Dublin context should be addressed by providing,
as a matter of urgency, opportunities for employment
and social activities for young people from the inner
city areas. There is also need for comprehensive education
and prevention programmes using all the available media
and person to person contact to dissuade people from
experimenting with drugs.
We wish to express our thanks to Deirdre Carey for
her help in the data processing and preparation of the
tables and to Margaret Sullivan who typed the manuscript.
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