Getting streetwise

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The Ana Liffey Project is a national addiction service dedicated to harm reduction – Stephen Parkin talks to director Tony Duffin about their innovative street -based outreach work in Dublin.

Ana Liffey Project

 If you’ve visited Dublin recently, you may have noticed that something innovative is afoot on the streets of Ireland’s capital city – quite literally. The Ana Liffey DrugProject has recently expanded its peripatetic needle and syringe programme (NSP) as part of a progressive form of innovative outreach work. The 2013 version of the project, which was originally launched in June 2010, combines old-fashioned footwork with telecommunications, emerging technologies and high-visibility promotional material on the streets.

The project was brought to my attention during a recent visit to the Republic of Ireland and I was fascinated by the initiative because of its relevance to topics that I have spent almost six years researching in various towns and cities throughout the UK – namely street-based injecting and drug-related litter. I was so impressed by the project that, on my return to England, I contacted the director of the Ana Liffey Drug Project, Tony Duffin, to find out more about this potentially groundbreaking venture. 

Street-based injecting

Ana Liffey Drug Project is a national addiction service with a low threshold harm reduction ethos. The organisation receives 

funding from a number of sources, including the Health Service Executive, drug and alcohol task forces, the Probation Service of Ireland, other local authorities and government departments. One of the ways Ana Liffey engages with drug users and other stakeholders is in the reduction of drug-related harm associated with episodes of street-based injecting, which often takes place in public places throughout Dublin city. As an indicator of the frequency of public injecting in the city centre, a recent report (Re-establishing contact: A profile of clients attending the health promotion unit – needle exchange at Merchants Quay Ireland) highlighted that 14 per cent of the 388 injecting drug users attending a fixed-site city centre NSP reported regular injecting in public places ‘in the last month’. This translates to approximately 55 individuals of the cohort regularly involved in episodes of street-based injecting in concealed alleyways and side streets throughout the city.

Furthermore, as there are few public conveniences in Dublin city, street-based injecting sites are located in what I have termed category B and category C settings, such as alleyways, doorways and secluded settings hidden from public view, or in ‘opportunistic’ settings concealed within business premises. These are places that are among the most harmful environments for street-based injecting drug use. For these reasons, Tony Duffin made the case for introducing medically supervised injecting centres to Dublin at a recent safer city for all seminar (http://www.aldp.ie/resources/video).

‘If You Bang it, Bin It!’

Bang it, Bin It

In the meantime, the Ana Liffey Drug Project is continuing to provide a proactive outreach service as part of an ongoing harm reduction response to street-based injecting drug use. This involves two outreach workers walking the streets of central Dublin equipped with, among other things, a pink vanity case for carrying out street-based interventions. The case makes it easy for clients to locate the staff, who often deliver the service in busy city centre locations. Within it is a range of injecting equipment and other paraphernalia that would be available from a more orthodox (static) NSP.

As such, water-amps, swabs, filters, steri-cups and a range of ne edles (including Exchange Supplies’ ‘NeverShare’ variety) and barrels can be provided, along with harm reduction brief interventions. Each NSP pack given out also has an adhesive label on it that promotes safer disposal with the peer-designed slogan, ‘If You Bang it, Bin It!’ – itself an illustration of dynamic, creative and innovative outreach work that challenges many drug-related outreach projects’ reluctance to walk the streets with injecting equipment for wider distribution.

Dotted around the city centre on many of the public litter bins are dedicated advertising slots that have been provided by Dublin City Council at no cost to the Ana Liffey Drug Project. Duffin explained that these prime advertising sites provide the ideal opportunity to publicise and promote the project’s outreach work, and its 1800-78-68-28 Freephone line gives callers information and signposting to services.

Lifeline

Staff at Ana Liffey have combined the telephone service with the outreach service to create a genuinely innovative and rapid response NSP throughout the city centre. As Duffin says, ‘All our staff are very client focused – we’re constantly seeking new ways to reach marginalised clients, or to improve accessibility to existing services.’ In the case of the NSP, individuals may call the 1800 number free of charge and be transferred to an outreach worker’s mobile phone. The client and workers arrange a mutually convenient time and location to meet, giving an opportunity to discuss injecting paraphernalia and how the client can obtain new equipment and return used paraphernalia. They are also offered sharps boxes in an attempt to minimise drug-related littering. As with conventional NSP, this meeting also provides opportunities to conduct some form of limited intervention, such as checking an individual’s physical injecting sites and inspecting any related injuries, and providing a referral to the blood borne virus nurse at Ana Liffey’s medical surgery.

Provision of equipment takes place in a discrete manner and does not involve the open distribution of injecting equipment for all to see. As with conventional NSP, activity data is collected by the outreach team, including documenting the interaction and what items may have been distributed and returned. In the first five months of this year, 381 NSP interventions were done under this system of outreach, including telephone referrals.

Pioneers

 Further developments in this street-based project are to pilot the use of a tablet, or other portable device, that can be linked to a centralised system for recording similar Syringesdata within static sites of NSP and have the ability to show harm reduction videos relating to safer injecting. This would help to feed live data to a master-monitoring system and provide immediate up-to-date information regarding process, performance and outcome of all relevant activity. Ana Liffey also intends to promote its Freephone number across the 12 counties of Ireland where they currently provide direct client services through a telecommunications hub, linking Freephone callers throughout Ireland to satellite Ana Liffey outreach teams that can best respond to the caller’s needs.

 This street-based form of NSP is innovative because, as far as I am aware, it is the only service where the caller is directed by internal transfer within the offices of a central location to an outreach team’s mobile phone. However, what struck me most about Ana Liffey’s outreach project is the pioneering and inventive application of old and new methods – combining peer-based outreach with portable telecommunications that in turn are advertised by traditional methods using street-based furnishings (litter bins). As the latter are positioned in street settings they are more likely to be noticed by the target population of this particular project – people who are homeless and/or those participating in street-based injecting.

 Simplicity and technology underpin the initiative to provide a method of actively engaging with street-involved individuals who may not necessarily be in contact with mainstream drug services. I am further impressed by how the project genuinely reflects the original street-based ethos that defined harm reduction throughout the UK during the 1980s.

In terms of drug-related outreach work, however, the project ticks all the required boxes. In addition to engaging with hard-to-reach populations, it also involves participation, intervention, advice and information, and creates opportunities for referral to other services while complying with the need for confidentiality. In short, it is a project that is consistent with the practice and principles of harm reduction, and its street-based focus provides culturally relevant and environmentally significant opportunities for interaction and communication.

 Indeed, this is a project that should be given some consideration in other settings and could very easily be emulated throughout the UK and beyond, made easier by Ana Liffey’s culture of sharing their resources, knowledge and expertise as much as possible. 

 Stephen Parkin is a research fellow at the University of Huddersfield and is the author of Habitus and drug using environments (published by Ashgate Sociology, 2013). Email: s.parkin@hud.ac.uk

Tony Duffin is director of the Ana Liffey Drug Project. Further details of the street work described above are available from tony.duffin@aldp.ie