With the third-highest overdose death rate in Europe, Ireland is trying to change its approach to drugs. 

But the country’s first Medically Supervised Injection Facility (MSIF), which experts say has the potential to save lives, remains unopened over a decade since it was first proposed.

On a blustery November’s day in Dublin, small groups of people linger near the entrance to Merchant’s Quay Ireland (MQI) as they wait for the Riverbank Centre to re-open for its afternoon services.

MQI is one of several homelessness and addiction charities in the inner city area and was selected by Ireland’s Health Service Executive in 2018 to trial an injection facility for 18 months. 

With illicit drug use and associated harms rising across the country in recent years, the injection facility could be a revolutionary approach to problematic drug use in once-conservative Ireland.

The country was reported as having the third-highest overdose death rate in Europe by the European Union’s drug agency in 2020, with 409 deaths that year, 70% of which involved opioids. Yet, despite the numbers creeping up over a decade since the project was first proposed, the MSIF has still not been developed.

What happens in a safe injection room?

Inside a Medically Supervised Injection Facility, users can take illegal drugs such as cocaine and heroine under the supervision of medical staff.

It gives them access to clean needles and other supplies, with medical staff on hand, and also acts as a gateway for getting help to fight the addiction. 

“You can’t help people recover if they’re not alive,” says Dr Jo-Hanna Ivers, a professor academic working on addiction issues at Dublin’s Trinity College.

Proponents of the MSIF argue that an injecting facility is there for the most vulnerable intravenous users who will use drugs whether they have a safe space to do so or not. 

The MSIF, they say, will not only reduce deaths and other drug-related harm but will help to build critical relationships between MQI’s medically trained staff and users to support them in seeking treatment.

“You have to start with harm reduction,” says Dr Ivers. 

On the margins of society

Newly appointed as the head of MQI after over thirty years working in the Irish prison service, Eddie Mullins says that seeing through the implementation of the MSIF is his “number one priority”.

“Unless there’s a major blockage from somewhere along the line, there’s no reason we will not open for the 1st of September 2024,” says Mullins. “That’s our objective, and I remain committed to that because I think we can do it,” he tells Euronews.

Mullins insists the government and health authorities are “very supportive” of the initiative. 

“I have to give credit where credit is due. My experience over the last eight weeks has been nothing but positive,” Mullins says after meeting with Ireland Minister for National Drugs Strategy, Hildegarde Naughton, who offered her full support to his project. 

“We used to say ‘there are no votes in prison’ and there are also very few votes among chronic drug users,” he says. 

“The general commitment to people on the margins is probably less than in other sections of society. [The MSIF] is one of those initiatives that people are holding their breath on because it is very pioneering in many ways for a country like Ireland.”

In response to a request for comment on the delays, Minister Naughton’s office said that since December 2022, “the HSE and MQI have been developing plans to progress the establishment of the facility” and the establishment of the facility remains “a Ministerial priority”.

Political inertia

The delays to the facility’s opening have caused many to blame a lack of political will, despite parties across the board voicing their support.

“I feel hopeful [that the MSIF will open] but I’m not sure that it will happen in the lifetime of the current government,” says Gary Gannon, Social Democrats TD for Dublin Central, adding that he believes the government may shelf the project and leave it for the next administration to take up. 

A general election is expected in the next 18 months. 

Continued stigma

Aodhán Ó Ríordáin, a Labour TD and former minister of the National Drugs Strategy who pushed through the 2015 bill for a safe injection facility, points out that stigma remains a significant obstacle to the MSIF, or any broader change to drug policy.

“I, as a politician, will get much further in my political career if I say things like ‘tough on drugs, zero tolerance, more guards [police]’,” says Ó Ríordáin. “That’s music to the ears of your average voter.”

Stigma against drug users is still widespread in Irish society, says Ó Ríordáin, leading to policies that continue to dehumanise those with an addiction. 

“It’s been extremely disappointing for me that almost eight years after the government decided to legislate for it, it’s still not open,” he says. “And, as a result, we’ve lost lives.”

Local opposition

There’s ongoing opposition to the drugs safe injection facility from local businesses, residents and the local primary school which previously blocked its construction. 

For MQI, Mullins says that addressing the concerns of locals remains the main obstacle. “Our [community] stakeholders and neighbours will never love the facility, but we will be able to co-exist and minimise the impact,” he says.

Locals are open about their fears of an injection facility on their doorstep. While business representatives declined to comment on the proposed September opening, locals did not hesitate to voice their opposition.

A manager at the Brazen Head, a pub particularly popular with tourists, said illicit drug use in the area is a major problem, with people using the pub’s entranceway to consume. 

“I don’t have a clue how to fix [the drugs crisis] but it’s definitely not a good idea to open an injection facility right beside a school and in the middle of the tourist area,” he told Euronews.

The continued opposition is something politician Gary Gannon believes should not stand in the way of the MSIF’s opening. 

“Hearing community voices is important but there’s also medical best practice that needs to be taken into consideration,” he says. 

“People have had any number of years to learn. Now we need to get on with it.”