‘An Irish solution to an Irish problem’: Harm reduction and ambiguity in the drug policy of the Republic of Ireland

Abstract

While policy makers in the Republic of Ireland had been concerned with illicit drug use since the late-1960s, it was only from 1980 onwards that the emergence of a culture of intravenous heroin use in areas of generalised social deprivation in Dublin gave urgency to this policy process. This paper traces the gradual introduction, on public health grounds, of harm reduction practices and services – such as methadone maintenance, needle exchange and the creation of outreach and locally-based services – following the identification in the mid-1980s of needle-sharing amongst injecting drug users as one of the key routes for the transmission of HIV in this country. It is argued that harm reduction in the Republic of Ireland has been largely implicit, in the sense that political leaders have generally not encouraged or participated in explicit public debate on this topic, nor have they ever publicly announced that this concept now underpins much of the healthcare system's responses to illicit drug use. It is also argued that this covert style of policy making has persisted, despite the more recent proliferation of formal policy-making structures and the dominance of a rhetoric which emphasises strategic management and the allegedly transparent and evidence-based nature of drug policy. This tactic of shrouding drug policy in ambiguity is discussed in the context of the wider tendency within Irish political culture to manage sensitive and potentially divisive social issues in such a manner. It is concluded that the ambiguity which surrounds harm reduction in Ireland has been functional in that it has confused and frustrated ideological opponents of this concept, but dysfunctional in that it has not facilitated the emergence of more tolerant or respectful attitudes towards drug users and may have delayed the introduction of a wider range of harm reduction practices.