A MSIF is a clean, safe, medically-supervised service for people who inject drugs.  As a compassionate, person-centred healthcare environment, which respects the dignity of service users, we believe that the MSIF is a vital first step in reducing harm and supporting a person towards recovery.

Ireland has a significant and growing drugs issue. In addition there is an acute housing crisis. Both of these challenges are at their most severe in Dublin. Unfortunately the issues of drugs and homelessness have become enmeshed with the result that more vulnerable people are visible on our streets. One of the consequences of this interplay between drugs and homelessness is that public injecting and drug litter have become an increasingly common occurrence. Alongside this, Ireland continues to have one of the highest rates of drug-related deaths in Europe. The MSIF aims to reduce drug-related deaths, reduce the risk of disease transmission, and connect the most vulnerable and marginalised people with treatment and healthcare services. In addition, research from MSIF internationally shows a decrease in public injecting and drug-related litter.

One of the main goals for this facility is to provide an opportunity for health interventions in a marginalised community. At Merchants Quay Ireland, we already provide a wide range of primary health care services and our best hope of effective intervention is by having these services all in one place, alongside the Medically Supervised Injecting Facility.

The first MSIF opened in Switzerland in 1986, and to date there are around 90 such facilities around the world. The MSIF at Merchants Quay Ireland will be a pilot project, and as such, the first in Ireland.

There will be several levels of governance.

Merchants Quay Ireland will establish an Operational Governance Committee, to oversee the management of the facility from a practical day to day point of view, providing for communication, consultation, and cooperation regarding operational matters. Merchants Quay Ireland will also establish a Medical Clinical Governance Committee to address clinical governance issues in line with best medical and social care practice.  Alongside these, a Monitoring Oversight Committee will be established. This committee will be chaired by Dr Eamon Keenan, National Clinical Lead, HSE Addiction Services on behalf of the HSE, and its membership will include representatives from the Gardaí, local authority and other experts.

The MSIF will be fully funded by the HSE.

The MSIF will be licensed by the Minister for Health, but operationally run by Merchants Quay Ireland. It is an 18 month pilot project.

No.

The MSIF is specifically for people who are injecting drugs. No smoking or other drug taking will be permitted.  Current drug trends indicate that people who will use the MSIF are most likely to inject opiates and/or cocaine.

No. The service does not promote drug use. The service seeks to reduce harm and drug related overdose deaths and connect people with treatment services and other health and social services.

No. It is anticipated that the MSIF will be open 6am-10am, 2pm-5.30pm, and 7pm-9pm on Monday to Friday. On Saturday and Sunday it will be open 6am-10am, and 3.30pm-9pm.

At our Riverbank Centre, we provide a wide range of homeless, primary healthcare, and drug services. Our drop-in, Night Café and extended day services offer meals, crisis support, information, advice and assistance to people who are homeless and rough sleepers. Our primary healthcare facility includes a GP service, nursing, mental health services, dental services, chiropody, and counselling. At Riverbank, we also have a Health Promotion Unit (HPU), which provides people who use drugs with information about the risks associated with drug use and the means to minimise such risks. We also offer people who use drugs a pathway into treatment and the possibility of living life without drugs.

There may be a need to move some services temporarily during construction. Any such decisions will be made in consultation with service users, Dublin City Council, and the HSE.

In line with current MQI practice and policy, first time heroin users will be admitted to the MSIF subject to a robust assessment and induction process. They will also be offered a safer injecting information intervention and linked with the full range of drug treatment services.

Pregnant people who are injecting drug users are a very vulnerable group and will require specific supports.  This group will not be excluded from the service and we will have a dedicated staff member with expertise in this area. We will obviously be reviewing this prior to opening and ensuring that our own practice is in line with current Irish legislation and international best practice. We, of course, are aware of our responsibilities under the Children First Act 2015 and will act in accordance with these.

87% of drug MSIFs internationally do allow pregnant people to use their services[i]. We will also be seeking guidance from the HSE, TUSLA as well as discussions with MSIFs internationally.

[i] Belackova, V., Salmon, A. M., Schatz, E., Jauncey, M. (2017). Online census of Drug Consumption Rooms (DCRs) as a setting to address HCV: current practice and future capacity, Amsterdam, Sydney: International Network of Drug Consumption Rooms, Correlation Network, Uniting Medically Supervised Injecting Centre p18

No.

This isn’t an ‘either or’ situation. In Ireland, there are two people dying every day from a drug related cause. People can only be rehabilitated if they are alive, and the MSIF is proven to save lives. It is a vital first step in engaging hard to reach, often excluded, injecting drug users in the continuum of drug treatment and healthcare services. Furthermore, by promoting safer injecting practice, the MSIF reduces the risk of harm to people when they are at their most vulnerable.

Merchants Quay Ireland currently provides 10 medically supervised residential detox beds and 26 residential drug-free rehabilitation beds. We would like to see more investment in those services. However, we believe there also is an urgent need to reduce the number of overdoses in Ireland, as well as address the significant health risks that result from unsafe injecting.

No.

The MSIF will have space for approx. 30 clients in Queue area, 15 in assessment/waiting area, 7 in Injecting room and 20 in Aftercare. We estimate that around 60 clients will access the MSIF each day.

People who use the MSIF are able to use the other MQI services including our drop in and holistic support services. Our Community Engagement team will work proactively with clients and the local community to mitigate against loitering and anti-social behaviour in the local area.

The Gardaí are currently working on a policing plan for the area, in line with best international policing practice. We have always and will continue to work closely with the Gardaí, who were involved with the evaluation group which awarded the tender to MQI, and will sit on the Monitoring Committee when the MSIF opens.

We fully appreciate the concerns raised by staff and parents of children at St. Audeon’s National School. No one wants children exposed to the sight of drug use and drug litter. We believe that the MSIF can provide an effective response to the concerns raised. Research from MSIFs abroad have shown a reduction in public injecting and drug litter. We are keen to maintain a dialogue with St Audoen’s, as we are with all those living, working or studying in the Merchant’s Quay area, to ensure that the MSIF benefits everyone.

The evidence from other countries shows that MSIFs do not increase drug use, drug dealing, or crime in the areas in which they are located. This is largely because they are located in areas where injecting is already occurring in public spaces.

One of the aims of the MSIF is to reduce the level of drug litter in the area currently, and international experience suggests this will be one outcome of the service. In Sydney, public injecting and injection-related litter reduced by half following the opening of the MSIF, while in Barcelona the area surrounding the MSIF saw a fourfold decrease in the number of unsafely disposed syringes being collected in the vicinity.

Merchants Quay Ireland will work to ensure that a dialogue is maintained with businesses and residents in the area. We do not anticipate any increase in anti-social or illegal behaviour. In line with our commitment as part of securing the MSIF licence, we will be establishing a Community Consultation Committee, which will provide local businesses and residents with the opportunity to give feedback on the impact of our services. We are also expanding our Community Engagement Team. The Team currently work weekdays 7am to 7pm and can be reached on 086 17441404.

We are keen to see this service open as soon as possible, but there is a range of regulatory process that we need to go through. At time of writing, we are engaged with planners, architects, engineers preparing a planning application and hope to submit this in the coming weeks.

There is a set time frame with planning, which can take 3-6 months, and until we secure planning permission we cannot start on refurbishment of the basement. Our best estimate at this point is that it would be the end of 2018 or early 2019 before start refurbishment work.