“Just Say No” just doesn’t work. An interview with Tony Duffin, CEO of the Ana Liffey Drug Project.

Tony Duffin is the CEO of the Ana Liffey Drug Project, a Dublin-based non-profit organisation which advocates for a health-based, harm-reductive approach to the issues of drug-use and drug policy in Ireland. First established in 1982, the Ana Liffey Drug Project offers services to people who use drugs in the Dublin, Mid-West and North-East regions of the country.  Express: How would you explain to the college demographic what the whole idea of ‘harm reduction’ is?Duffin: The whole thrust of it is that drug use is a health issue, and the response should be a health-based response. We know that the “just say no” messages of yesteryear just don’t work. People use drugs for different reasons. It can be an addiction issue, or it can be non-problematic. But nonetheless, it is always about wanting to feel differently. We neither promote nor denounce drug use as an activity. It is what it is. We’re a harm reduction agency, we deal with what’s put in front of us. It’s a compassionate and pragmatic response to people who use drugs. We work with people wherever they are at in their drug use, and we keep them as safe from the risks they’re taking as we can. For example, if somebody is an injecting drug user, we give them clean needles and we make sure that they’re safe. If someone is a recreational drug user who’s taking ecstasy at the weekend, we give them harm reduction advice to keep them safe. We always say – and it is true – that it is safer not to take drugs at all; but if people do decide to use, we talk to them and educate them. Express: What measures can be taken by young people to ensure that they are safer from harm, if they or their friends choose to take drugs? (Might be an idea to put this in a special box of its own if it fits?, Maybe with the title ‘Tony Duffins Guide To Safe Drug Use’ or something like that?Duffin:Number 1 – Know Your Source. Know where you’re getting your drugs from. You can never be sure of exactly what you’re buying because it’s an illicit market, but there is evidence to say that people are safer when they buy consistently from someone they’ve bought from before. We’re not encouraging that, it’s just harm reduction advice. Number 2 – Avoid using alone. It’s very important to stay together and mind your friends. Whether it’s alcohol or ecstasy or any drug that you might be taking: don’t leave your friends on their own. Be a good friend to them and look after them. And similarly, don’t use alone yourself.Number 3 – Start with a small test dose. Leave at least two hours between uses. You know, people may decide that they’re going to use an ecstasy pill, and we know that MDMA is stronger than it has been – ever. This means that there is more of an overdose risk. Break it in half, break it into quarters, see how it works on you and wait as long as possible. Be very careful around dosage. Because these drugs are illicit, no one can advise you on what is a safe dose. Number 4 – Use one drug at a time and never mix with alcohol. Poly-drug use is a major problem in Ireland – people mixing more than one drug and not understanding the interactions those drugs have, especially with alcohol. Alcohol is a drug and people should be aware that it can interact with cocaine for example, and create another drug within the body called Cocaethylene, which can be more harmful than either cocaine or alcohol alone. So, you’re putting yourself at further risk when you take more than one substance. Number 5 – Don’t share drug paraphernalia. People might associate that more with injecting; but if you’re using a straw or a tooter to snort cocaine and you pass it to somebody else, there may be blood in it – and you’re putting yourself at risk of contracting Hepatitis B or some other bloodborne virus. So, you need to be aware of indirect sharing as well.Number 6 – Carry condoms. People take drugs, they feel disinhibited, and sexual activity may be heightened. So, carry condoms with you and use them to protect yourself from any sexually transmitted diseases. Express: The ALDP seems to go above and beyond in its efforts to reduce drug-related harm. What motivates you and your team to fight so fiercely for this cause?Duffin: We’ve been around since 1982. We were the first low-threshold harm reduction service in Ireland. We believe in the importance of engaging with people. The best way to do that is to keep your entry criteria as client-focused as possible. We never bar anyone entirely from our services. It’s challenging work, it’s tough work, but it’s worth doing. We do see people moving on to more stable choices in their lives, up to and including recovery and abstinence. We’re in the streets with people; we’re in their homes; we’re in the coffee shops meeting with them, because that’s where they are. It’s all about being creative and innovative with how we manage our relationships with people.Express: What is your response to people who view things like supervised injection facilities and the distribution of hygienic drug paraphernalia as being too radical and somehow ‘enabling addicts’?Duffin: People take drugs already. If there’s a fear that we’re going to have people taking drugs in the street, overdosing, dying and contracting HIV – that’s already happening. What we’ve done, for example: criminalising drug use – that hasn’t worked. I understand that some people still think that this is radical and enabling; but we’ve been around since 1982. it’s not new. It’s not radical. It is progressive. When I say ‘progressive’, I’m talking about drug policies that help people achieve their potential; policies that save lives and policies that save tax-payers’ money. Harm reduction policies save our money. We keep people away from ambulances and A&E, which are hugely expensive. The more we do – in terms of supervised injection facilities and hopefully decriminalising drugs for personal use in the near future in Ireland – we’ll see all of the negatives that we see out there today, in terms of having the highest ecstasy use in Europe per capita; having one of the highest overdose rates in Europe; having HIV rates that need to be managed and reduced; all of these things can be helped if we deliver more progressive drug policies. If you look back at 1977, forty-one years ago when we criminalised drug-use, we now have more drugs; we now have more people using drugs; they’re more toxic; they’re cheap, and we’ve got more harm in our communities. So, it wasn’t the right policy approach to drug-use. Express: From a young age, we are taught to villainise those affected by drug addiction. We are led to believe that these people are somehow evil and sub-human. What caused you to be so staunchly opposed to these ideas? Duffin: We definitely have stigmatised people who take drugs, and we have to change the way we think and talk about them. In Portugal, they found that after ten to fifteen years of decriminalisation, people no longer viewed [people who use drugs] as criminals. They viewed them as being people who needed help and support. When drug use is criminalised, it leads to people being viewed in a stigmatised way. People use the work ‘junkie’ towards people I know and work with. It’s very disturbing and upsetting to people who have very serious health problems. You wouldn’t find any other group of people with serious health problems being spoken of in the same way. People talk about people ‘doing it to themselves’. The people I know who are addicted to drugs – they’re often people who were traumatised when they were young. They may have been sexually or physically abused. Even if someone takes drugs and doesn’t have such a problem, it’s still a health issue. The risks that they take are a health issue. Express: Recently, posters have appeared around our college campus which state “Drugs: Zero Tolerance – Don’t Ruin Your Student Experience”. What are your thoughts on this abstinence-based approach to drug use? Duffin: I think that the more mature thing to say to somebody would be that it’s safer not to use drugs. There are risks associated with drug-use. If you choose to take those risks, you may or may not have a problem. [An abstinence-based approach] just doesn’t resonate with people who use drugs. The “Just Say No” campaigns just don’t work. What does work is talking to people about their drug-use in a mature way. I have worked with people who have ended up saying “You know what? I’m not going to do this”; and that’s a great outcome, right? Equally, they might say “I’ll take the harm reduction advice and I will keep myself as safe as possible”; and that can save people's lives. I know you’ve got the posters on your campus from the other perspective, but I’ve got one in front of me right now that says “Do you use cocaine? It is always safest not to use drugs” and then goes on to list how best to keep yourself safe. That [poster] was made between Ana Liffey and the HSE. It is a well-established, evidence-based approach to keeping people alive and well. All I want is for people to be safe, to live and to go on and enjoy their lives. That might not necessarily include drugs, it may or may not; but our job is just to keep people as safe as possible.  Find out more about the Ana Liffey Drug Project:Website: www.aldp.ieTwitter: @AnaLiffeyFacebook: Ana Liffey Drug Project