BEING THERE:With services ranging from needle exchange to full rehab, Merchant's Quay Ireland treats drug addicts as human beings rather than blights on the landscape, offering them some dignity and respect, writes Róisín Ingle

A young man with cheekbones to die for walks into a room on Dublin's Merchant's Quay carrying two plastic bags of used needles. "Can you give me 200 brown ones?" he says. "200?" asks the man in the needle exchange whose name is Chris. "Yeah," says the man, "it's only because I can't come here every week." "No problem," says Chris, as the man empties his used needles into the yellow plastic bucket, which is also known as a "sin bin".

"What else do you need?" he asks. "Citric acid? Water? Swabs?" The man nods and Chris packs everything tightly into a brown paper bag. A fresh stock of syringe barrels, clean needles, citric acid - used to break down heroin before it's injected - alcohol swabs and clean water. He seals the package neatly with a white label. "Thanks for packing it so small," says the man putting the supplies in his inside pocket.

Everything required for the hygienic injection of heroin or cocaine is stocked on the shelves at Merchant's Quay Ireland, the drugs and homeless service which is also home to the State's only full-time needle exchange. The needles come in colour-coded packets, brown and orange for the arms, green and blue for the groin. "It's dangerous, injecting into the groin, but if they are going to do it they need to use the stronger needles," says Chris. There are other needles for the tiny veins in the hands; these delicate spikes are known as "baby browns".

Business is brisk, with around 150 visits a day, twice the number that would have used the facility 15 years ago. Chris finds out whether clients of the service are using safely and encourages them to bring back their used needles.

When a young man comes in saying he's been injecting in his neck, he is warned of the danger. "That's madness," says Chris. "You will kill yourself doing that." He talks about the safe injecting class they hold here most afternoons. "I'll show you how to find the right veins, don't be injecting into your neck."

It's not a counselling session. They do that elsewhere in the centre. Still, a one-on-one in the needle exchange will often be the first place a client feels confident enough to ask for help in getting on a methadone maintenance programme although, with more than 9,000 already parked on such treatment schemes, they can often face a long wait. Or maybe they want to find out about getting a detox bed to get off drugs. Again, that's not easy because, even with 15,000 heroin addicts in Dublin there are fewer than 25 detoxification spaces available.

Around the corner from the needle exchange is the drop-in centre which opens from 7am for breakfast and provides tea, phone calls and practical support.

This is where those using the drugs and homeless service come when they are not on the Liffey boardwalk, or subtly scoring on the streets outside, or tapping for cash beside the Ha'penny Bridge or sheltering from the rain in Busaras. The staff listen without judgement to the horror stories, treating clients like human beings instead of blights on the landscape, offering the dignity and respect which is in short supply outside of these walls.

The team at Merchant's Quay support their clients, providing information and practical help on everything from temporary accommodation to getting clean. Staff doctors and nurses and dentists tend to their physical ailments, the fallout from self-neglect and life on the streets.

Clients are kept alive with the twin strategy of health promotion and harm reduction. The behaviour threshold here is so low that people are rarely barred from the service. Or if they are, and it's usually for taking drugs on the premises, they will always be let back in.

Some staff would like to see consumption rooms in the centre where clients can inject safely with doctors present because, without such a facility, there are overdoses every week, in the toilets or just outside the door.

IT'S BREAKFAST TIME. Clients spill into the centre, where there are tables and chairs and telephones, so you can ring your mother and tell her you're alive. There's one section where the Polish people sit, segregated by the language barrier. The room fills. People with sunken eyes, hollow cheeks, scarred faces, gammy legs, people who smell, people who shout, people who stretch out across chairs, dead to the world.

Here's a woman called Sam who was sexually abused by her father, who spends her nights working Benburb Street, her mornings going back and forth on the red Luas line until the drop-in centre opens. A woman who has Hepatitis C, who buried a tiny baby a year ago, who keeps his crumpled picture in her pocket, who thinks things will change even as the porridge she can't keep down congeals in a bowl.

Here's a tall man with faraway eyes called Darren who is on methadone and topping up with heroin and is HIV-positive. Who says, in that slow, monotonous, heroin-addled voice, that he nearly got it together a couple of weeks ago, until it all went pear-shaped again.

"I was after stopping drinking, I was after stopping using, I was looking for a way out but then I didn't get it together. Nobody wants to be here, nobody wants to be doing this. You have no plan for your life, the money I spent on drugs over the years I could have bought two houses. You see people doing well and you want to swap places with them but you can't," he says.

And he might be talking about people, like Chris from the needle exchange, who began using drugs at the height of what some refer to as the opiate epidemic of the 1980s in Dublin, which is why he knows so well how to find the veins. Chris, who by 13 was on heroin, being injected by members of his own family. Chris, who spent the next 10 years in a blur of drugs and crime and prison and unimaginable madness.

"It's hard to explain. It was just normal, the whole of the inner city was ravaged with it," he says. Facing charges, another five-year stretch in prison, he chose another path and has now been clean for eight years.

He went through every treatment facility available in this country, including High Park in Drumcondra, which is one of Merchant Quay Ireland's residential treatment centres. It's on the site of the last Magdalene Laundry, a large white building where the nuns used to live. There are 13 spaces here, taken up by addicts who have managed to wean themselves down to 30mg of methadone or who have managed to supply clean urine samples and are ready to go through community-assisted detox.

Only weeks ago most of the young men here were incoherent, dangerous looking, out of it, the kind of people some of us cross the street to avoid

They are the same people, except now they talk as if emerging from a bad dream. Dan is a 24-year-old from Cork who was physically and mentally abused by his mother and turned to drink and drugs as an escape. His two small children are his motivation to get clean and he's so determined that, after the 17-week programme is over, he will stay in aftercare with the Merchant's Quay project rather than move back to Cork, which he says would be "too risky".

"There's a stereotypical view of addicts," he says. "A lot of people just think it's their own doing but for myself personally that was my way of surviving and as it progressed it left me homeless and suicidal. Without places like this I wouldn't be here today. These places save lives. But there's not enough of them."

Billy is a 26-year-old from Co Dublin who says it's only after three weeks in High Park that he is getting to know his personality, to notice he has feelings and learn techniques to deal with those feelings so he never goes back using again.

He introduced his younger sister to heroin, "someone to support my habit", he says, guilt thick in his voice. "She is on methadone now and I'm hoping she might see what I'm doing and get treatment herself." Billy met Chris in Merchant's Quay last year. "He told me about this place and how I might get a bed here. I couldn't believe the strength of him, he looked so healthy and strong, his life seemed so good. I wanted to know how I could get that."

It's an intense regime. Every hour is accounted for. The bedrooms are inspected each morning. There's group work. Chores. Counselling. Walks. No physical contact. No abusive behaviour tolerated. Residents are "pulled up" for the smallest misdemeanour, such as not clearing away a coffee cup. This is all part of the therapy. "You don't get to hide from yourself, not for a minute, and that's how it needs to be," says Dan. Not everyone will complete the programme - ex-clients of High Park who have died since leaving the facility are commemorated in the grounds - but when they do there is extensive after-care at Merchant's Quay where clients are given the support to stay clean.

BACK IN THE needle exchange, Chris is kept busy. 10 orange, 20 blue, five green. Many clients ask him about his runners, the shiny, all-white footwear that is something of a trademark. He has 130 pairs of white runners, collecting them is his only remaining vice. He says if he could introduce changes to the government's drug strategy, it would be to increase the pathways leading away from heroin and methadone maintenance - the cheap fix - making detox an easier option for people and increasing the numbers of residential beds.

"There are plenty of addicts who don't want to get out of where they are, but one day they might and there needs to be places for them to go when that happens," he says.

"Once you taste even a little bit of the cleanness it's much harder to go back using drugs, you have so much knowledge it becomes much harder because you think of consequences and things that never occurred to you before treatment. Once you have the knowledge you can never use in peace again."

• Some names have been changed