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Opioid misuse in Dublin
Opioid misuse tests the extent to which we can adhere to a multisectoral approach to public health. It reflects the intersection between healthcare, criminal justice and cultural issues in a phenomenon that is harmful to the health of individuals and communities. A review of how opioid misuse has been tackled in Dublin over the past two decades can operate as a case history of how a public health issue was dealt with by a particular society and political system.
EVIDENCE AS A FORCE FOR CHANGE
Being an island on the edge of Europe with a very conservative tradition contributed largely to the fact that up to the end of the 1970s opioid misuse was rare in Ireland. In the early 1980s it became apparent that an epidemic of opioid misuse among young adults had developed in Dublin's inner city.1 Throughout the 1980s this problem continued to develop, but was confined within inner city Dublin. The health sector response was mediated through the National Drugs Treatment and Advisory Centre, which operated primarily from an abstentionist model. Detoxification was offered to opioid users who were prepared to express a commitment to ceasing opioid misuse. HIV testing began in Ireland in 1985 and it was clear within a short time that a large proportion of people with HIV infection in Ireland acquired their infection from injecting drug use. This was in marked contrast to Britain where HIV was more commonly associated with sex between men.2 This contrast was partly explained by the fact that the epidemic was on a much smaller scale in Ireland and a relatively high HIV transmission rate in Dublin's injecting drug using community at the beginning of the epidemic accounted for a large proportion of the cases from the 1980s onwards. In 1991 and 1992 the Department of Health …