An aggressive interviewer challenged Terry Maguire on drug consumption rooms, but evidence took a back seat to politics and ideology
When I arrived at the BBC temporary studio, just before 12.30pm, not only was the door locked, but the inside security shutter was down and I couldn’t get in. My phone rang — it was Chris asking if I was near, as I was on-air in a few minutes. Having explained the situation, he directed me to the back entrance two streets away and I sprinted off.
An anxious Chris met me at the gate, handed me a visitor’s lanyard and hurried me through myriad security doors, up a lift, across a corridor and told me to drop my coat and bag on the floor as he pushed me into the studio.
I was quietly taking my seat as our host asked my fellow guest, a Green Party Belfast City Councillor, to describe what he saw when he visited the Medically Supervised Injection Facility in Dublin at Merchant’s Quay, and if he thought it would be a good idea for Belfast.
Cllr Brian Smyth was very impressed indeed, he told us, and went on to describe the rooms, the staff support, and preliminary outcomes. With the facility being operational for 12 months as part of an 18-month pilot, the initial data suggested a 40 per cent reduction in overdoses with no fatalities at the site.
Moreover, the hospital close by also reported a similar reduction in overdoses at the emergency department since the centre opened. Belfast needs a drug consumption room to address the significant drug misuse problems that plague Belfast city centre, Cllr Smyth concluded.
“Terry Maguire, you don’t agree?”
Having just got my breath back, and fully aware that this is why I had been invited, I started by saying that anything we can do to save lives from drug overdose we must consider. Drug consumption rooms/medically supervised injection facilities are not a new idea, going as far back as the 1990s in some European countries.
More recently, they have been used in North America and Canada in response to the fentanyl crisis. This, I thought, gave me some cover from accusations of being a right-winged fascist thug when further on I would object to what seems such a reasonable, compassionate, and sensible idea.
I tried to establish the facts. The evidence for the effectiveness of these facilities is, to say the least, ‘weak’, and there is a risk that although overdoses might be reduced, the local drug problem could worsen due to the impression given that the State now sanctions illicit drug use. At this time, there might be better ways to invest…
Our host cut in. “They either are effective or they are not. Can you answer the question?”
He was trying to knock me off course, but I continued: “There have been too few good studies and the current evidence would not give us the confidence to invest
in drug consumption rooms.”
“Again, you are talking money. I want
to know do they work?” he insisted. Frustrated with me, he moved back to Brian, asking the same question.
Brian reiterated the preliminary statistics from the Dublin facility but our host, no doubt seeking impartiality by being equally rude to both of us, interrupted him again.
“Why focus on Dublin, which is only open for 12 months. I want to know if the international evidence tells us they work.”
Both of us were confused, I was certainly stuck; we were being badgered by a radio host looking for a yes/no answer to a question that really didn’t have a yes/no answer.
I took a deep breath and decided to attack. The evidence for the effectiveness of drug consumption rooms is “weak” — which means that the published studies are mainly of poor quality and the few good studies that do exist do not show strong evidence of effectiveness regarding a number of outcomes. I suddenly realised how difficult it is to simplify a complex point, but I persevered.
A study, published in 2021, looked at all the studies on drug consumption rooms and how effective they are. It found more than 700 studies, of which only 22 were deemed to be of good quality. Of these 22 studies, 16 were about one drug consumption facility in Vancouver, Canada. The conclusion of this systematic review is that there ‘may’
be some positive outcomes; a reduction in overdose (fatal and non-fatal), a reduction in incidence of blood-borne infection (HIV and hepatitis), more addicts going into treatment, and no increase in crime or nuisance in the locality where the facility existed. This is as much as the evidence tells us.
“These are all good things, are they not?” our host inquired.
Not necessarily. The word ‘may’ proves the evidence is ‘weak’ and therefore might not justify funding the project.
“There you go again, talking about money,” he admonished me.
I decided to continue to attack. He was being naive in the extreme not to appreciate that we need the evidence to determine our investment decisions, I told him. This is how healthcare commissioning works. Where an initiative has ‘weak’ evidence and only ‘may’ provide positive outcomes, then
it might be better to invest your money into something that will give more bang for your buck.
A drug consumption room will cost £1 million to set up and £2million to run annually. The total substance misuse budget for Northern Ireland is £30 million, with a strategy that is already short £6.3 million annually, and a drug consumption room is not an item on this strategy’s wish list. So, we should invest in services that have better evidence.
Perhaps it was the tone I heard through my earphones, perhaps I was getting too assertive, and I know too well how scathing and mocking I sound when I become irritated. I checked myself.
We already have ongoing investment in drug treatment services, opiate substitution services, and needle and syringe exchange, I informed him. These are harm reduction services that have good evidence and they need additional investment.
“Are you objecting on moral grounds?” he snipped at me. Oh God, I thought, he really thinks I am a right-wing fascist thug.
“Certainly not,” I stated as firmly as I could.
A male caller came on Line One, an elderly man with a posh North Co Down accent who said he was appalled by the suggestion that public money would be spent supporting drug misuse.
“Is this supporting drug misuse, Terry Maguire?”
Harm reduction funds safer drug use that helps society, I suggested. We had arrived at the dichotomy that defines current public debate on drug misuse. It’s now a binary issue of right versus left. For the right, the drug user is a morally weak and slothful freeloader. For the left, he or she is a victim suffering from a clinical disease and needs to be cared for.
Our Co Down caller was followed by a social worker from Newry with a distinctly north Dublin accent — not so posh — who claimed to be “working closely with addicts”, “keeping them safe”, and “providing them with tents”. It was his job, he said, to keep them alive, he must keep them alive at any cost and there was another point he wanted to make but our host interrupted, saying we were out of time and had to go to the one o’clock news.
And that was it. Chris escorted us out into the corridor where I was reunited with my coat and bag. Brian, palpably relieved, said the interview was savage. He was never challenged so aggressively on any topic before. He got off lightly, I told him. For example, I chose to ignore his claim that deaths from overdose in Northern Ireland had doubled in recent years. Deaths had, in fact, fallen by a third since 2020. Scaremongering is never a good look when called out. He accepted that drug consumption rooms — either the
Scaremongering is never a good look when called out
model he had seen in Dublin or other iterations — will not be a magic bullet, but he did think they were worth trying.
I worried, I told him, that the harm reduction lobby was becoming ideological instead of taking the time to look at the evidence. Of course, reduce harm where we can, but we also need to invest in empowering recovery — an aspect which is receiving very little attention or investment.
I really did worry that, with a drug consumption room in place, the next step for the harm reduction lobby would be heroin assisted therapy — addicts being provided with the very drug we want to get them off. Then, not only can we monitor and keep them safe, but we can also ensure that the drugs they use are of the highest quality at no cost to them.
Cllr Smyth went off to his offices at City Hall and I went back to the pharmacy and as the afternoon went on and I engaged with my methadone and buprenorphine patients, I realised that they are largely male, aged 25-34, mostly homeless, have chaotic lives and suffer significant mental health problems. They have only relationships with other addicts. At least my group is now engaging with services, but they remain embedded in the drug culture on our streets, so I worry they will never break free.
The prevailing view on drug abuse in Belfast is indifference. However, if the nuisance increases or there are reports of increased deaths on the streets,
Cllr Smyth might just get his drug consumption room — not on evidential grounds, but on the grounds of moral outrage and the need to be seen to be doing something.
Terry Maguire owns two pharmacies in Belfast. He is an honorary senior lecturer at the School of Pharmacy, Queen’s University Belfast. His research interests include the contribution of community pharmacy to improving public health.
