Why not locate drug injection centres in hospitals?

There has been much debate in recent weeks about the merits, legal, planning or otherwise of the High Court’s ruling to overturn the decision by An Bord Pleanála to grant planning permission for the country’s first legal drug injection centre at Dublin’s Merchant’s Quay.

But is anyone asking the much bigger questions for the city. Why do we segregate the medical treatment of those who suffer from substance abuse from general medical services in hospitals? And just why, as a city, do we concentrate such facilities in the inner city?

Why are such facilities concentrated in the inner city at all? Why is it assumed that this is the right place for these medical services in the first place?

What is unique about drug addiction facilities that we automatically accept their segregation from all other medical services? Is it because the wider public simply doesn’t want to see users of such a service in a place (hospital), where they themselves are likely to visit at some point in their lives?

Is it because there is an assumption that the management of these medical facilities would be too onerous on hospital service providers? If so, it immediately raises the question: how exactly are the streets managed around such facilities today? And if the answer is “poorly”, is that why we concentrate such services in the inner city “out of sight”?

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There are undeniable challenges in ensuring the streets around such facilities are well managed and cleaned. To deny otherwise is simply disingenuous. I suspect, however, that the standards of duty of care are likely to be higher in the grounds of a national hospital where a wider cross section of societies’ political or social interests are represented than on any one particular inner-city street where local residential voices are less powerful. That alone is a compelling and equitable reason that substance abuse services be provided in public hospitals.

But why are such facilities concentrated in the inner city at all? Why is it assumed that this is the right place for these medical services in the first place? As a planner working in Dublin City Council for some 20 years, I can attest this was rarely questioned. If questioned, the same answer invariably followed: because there is a local “demand” for these services in the area. What does that even mean? Are we not social stereotyping about the inner city here?

Kitty Holland in this paper (July 26th) writes that the Ana Liffey drug treatment centre estimates there are 400 on-street intravenous drug users in Dublin. Even if we were to assume all of these individuals reside inside Dublin’s canal ring – there is no evidence that they do – with some 130,000 people currently living in the area, that means 99.7 per cent of its residential population are currently not in direct need of such services.

And have policymakers given thought to what the concentration of such highly visible facilities in disadvantaged neighbourhoods communicates to the young teenagers and children living in close proximity? “This is a service for you, your future, this is a service that will be part of your life”. Arguably, the isolation and concentration doubly marginalise both the local neighbourhood and those in need of treatment.

The concentration of substance abuse services in standalone buildings concentrated in the most disadvantaged parts of the inner city needs greater social and political interrogation

The “decentralization” (a public policy buzzword) and concentration of such services, often in super-sized standalone treatment facilities tend to be located in the most vulnerable and marginal parts of the inner city where rental values or property prices to accommodate such services are at their lowest. Such facilities are also located in areas where there is relatively weak residential political power. Socially disadvantaged communities, foreign-born residents and those who rent their homes, for a variety of complex reasons tend to offer the least effective resistance to development that they may not wish to see in their area. Put bluntly, they are least likely to object to planning applications.

For obvious reasons, the short-term, visible and social costs of drug addiction in Dublin’s inner city tend to get stressed. The personal stories are harrowing. The intergenerational destruction to families is well documented. But as a city we need to have a more honest and grown-up discussion around the spatial planning of such medical services for those in need, in particular the largely ignored inequalities around access to power of local residential communities.

Ironically, this is all too clear in the Merchant Quay decision, where it was reported that Mr Justice Garrett Simons said the main reason for his ruling was the “inexplicable” and “startling” failure of the planning board to deal with the concerns of St Audoen’s National School in its decision to grant permission.

This is a discussion that needs to take a wider perspective of needs and responsibilities. The concentration of substance abuse services in standalone buildings concentrated in the most disadvantaged parts of the inner city needs greater social and political interrogation. Who really benefits? Few of the complex social and yes, economic, costs are adequately quantified or costed. They should be.

– Paul Kearns is a former planner with Dublin City Council and the co-author of two books on Dublin planning