Following twelve months field research, Darkness on the Edge of Town: Exploring Heroin Misuse in Athlone & Portloise was published as a book in 2005. Authors Dr. Niall McElwee & Grainne Monaghan spent time on the streets, in homes, at court sittings and in the offices of various health providers in two Irish towns in the midlands interviewing those persons involved in heroin misuse - addicts, dabblers, doctors, nurses, psychiatrists and police officers to name but some.

1. Heroin Misuse in Athlone & Portlaoise
Dr Niall McElwee
Senior Editor,
Dissertation Doctor’s Clinic
Dr. Niall McElwee, Dissertation Doctor's Clinic/Research from the Archives

2. Dr. Niall McElwee, Dissertation Doctor's Clinic/Research from the Archives

3. A Relational Research Approach
We were not particularly interested in numbers of people using heroin, but more in how heroin misuse effects the individual, the family and those trying to provide services.
Dr. Niall McElwee, Dissertation Doctor's Clinic/Research from the Archives

4. The Duty to do no Harm in Research
It is my belief that social research into ‘marginalised populations’ should, as fully as possible, involve those people and should result in some tangible benefits to them (OPAC Model of research)
Dr. Niall McElwee, Dissertation Doctor's Clinic/Research from the Archives

5. Our Study
Took place over a nine month period in 2004 in two towns in the midlands – Athlone and Portlaoise
36 Agencies
32 Service/Non Service Users
32 Questionnaires
Dr. Niall McElwee, Dissertation Doctor's Clinic/Research from the Archives

6. We Knew Starting out…
In a general population survey conducted by Friel, Nic Gabhainn & Kelleher (1999) heroin was found to be the drug least used in the general population.
Dr. Niall McElwee, Dissertation Doctor's Clinic/Research from the Archives

7. Our Research Approach
Individual in-depth interviews were the main research instrument used
We ‘hung out’ for hours, days and nights in both towns in all sorts of areas, agencies and homes (the relational research model)
Dr. Niall McElwee, Dissertation Doctor's Clinic/Research from the Archives

8. Our Research Approach
Our colleague, Ferghal McHugh (Athlone Institute of Technology) also analysed 32 in-depth questionnaires with over 70 questions seeing background information and biographical/treatment details
Dr. Niall McElwee, Dissertation Doctor's Clinic/Research from the Archives

9. These are Real People
I don’t want our interviewees to be reduced to mere statistics…
These are real people with real identities who are on a journey, who have stepped for a time off a known path. Please don’t lose sight of this. It could, one day, be your son, brother, sister, cousin, friend. That was, for sure, one of our main findings…..
Dr. Niall McElwee, Dissertation Doctor's Clinic/Research from the Archives

10. Has the Study Proven Useful?
We believe we can say that our book did, at least, contribute to a more extensive consultation in the Midlands area of Ireland which has been acknowledged by the Health Services Executive.
Dr. Niall McElwee, Dissertation Doctor's Clinic/Research from the Archives

11. What We Were Told…
In the town of Portlaoise, people living in the communities most affected by heroin reported things like, “nearly everyone uses heroin”
“I think that nearly everyone of them are drugged. There’s loads doing it”
Most commonly reported figures were between 70 and 250 persons.
Dr. Niall McElwee, Dissertation Doctor's Clinic/Research from the Archives

12. Portlaoise Town
Perceived to be a ‘new’ phenomenon
Younger cohort of users
Smoking heroin is perceived as the main method of using
Feeling that more needs to be done by statutory services
Commonality of both towns is the strong Dublin influence
Dr. Niall McElwee, Dissertation Doctor's Clinic/Research from the Archives

13. What We were Told…
In Athlone, the most common figures from heroin users themselves was between 80 - 300.
“I wouldn’t be able to put a figure on it. I’d say it’s in the hundreds, like they mightn’t be regular users, but regular users and dabblers”.
Dr. Niall McElwee, Dissertation Doctor's Clinic/Research from the Archives

14. Athlone Town
Has experienced heroin use since the 1980’s
Injecting heroin and addiction problems are features for some of the landscape
More people in the older age bracket
(25+)
Some agencies feel that the situation has improved since 2001
“I think the last four years there has been a number of agencies trying to address the problem…that stopped it from becoming a bigger problem”
Dr. Niall McElwee, Dissertation Doctor's Clinic/Research from the Archives

15. Some Comments on Media Reporting
In the main, the print media tended to sensationalise our study & focus only on negative aspects of the study (and there were some positives!)
Dr. Niall McElwee, Dissertation Doctor's Clinic/Research from the Archives

16. The Midlands Problem?
Considerable differences even within the provincial towns
Urban/Provincial divide
Service provision
Service access
Confidentiality
Funding allocations
Dr. Niall McElwee, Dissertation Doctor's Clinic/Research from the Archives

17. The ‘Experts’ Give Varying Figures
All of the service providers gave us different figures for heroin misuse in their towns. This presented us with enormous problems around triangulation
Dr. Niall McElwee, Dissertation Doctor's Clinic/Research from the Archives

18. Everyone has a Different Journey
Drug users are often divided into three distinct categories – experimental users (curiosity and often under peer pressure), recreational users (taken regularly but at intervals) and problem drug users (dependent characteristics). We have met persons from all three categories in our study and this is a key point to understanding heroin use/misuse.
Dr. Niall McElwee, Dissertation Doctor's Clinic/Research from the Archives

19. Stages of Development
People at different stages of developing problems with heroin in both towns
“It wouldn’t surprise me to discover that there’s maybe 200 people out there who are developing problems around heroin”
Dr. Niall McElwee, Dissertation Doctor's Clinic/Research from the Archives

20. Accessing Services
Confidentiality in assessing services is a real issue for people and a major part of why many do not seek support
“You go to the Chemist with a prescription and everyone knows”
Dr. Niall McElwee, Dissertation Doctor's Clinic/Research from the Archives

21. Heroin Misuse
Males are females are reported as using heroin in both towns
“It would be 50/50, definitely, yeah. No, it would be, probably a few more lads”
Unusual to have one partner in a relationship using heroin.
Dr. Niall McElwee, Dissertation Doctor's Clinic/Research from the Archives

22. Supply
On many occasions, interviewees in both towns joked
“Give me €25 and I’ll get you a bag of heroin right now”
“If I wanted heroin right now, there’s a fistful of people I could score from”
Dr. Niall McElwee, Dissertation Doctor's Clinic/Research from the Archives

23. So, they suggested they use Heroin to…
Escape
Pain in Life
To help cope
Experiment
Peer involvement
Family involvement
Feels good
Nothing else to do
Dr. Niall McElwee, Dissertation Doctor's Clinic/Research from the Archives

24. Agencies were trying hard but…
Not an issue that can be effectively dealt with by one agency but as a community we need to listen courageously and collectively to seek potential solutions
“We are all doing great work, but not tying in”
Dr. Niall McElwee, Dissertation Doctor's Clinic/Research from the Archives

25. What Good Has Come?
All of our recommendations have been subsumed into the Regional Action Plan
All the actions have been approved in principal
A full-time GP Co-ordinator is in position and is about to train Level 1 GP’s
Additional Nursing Staff have been appointed to the Clinics
Dr. Niall McElwee, Dissertation Doctor's Clinic/Research from the Archives

26. What Good Has Come?
Outreach services to satellite clinics outside of the main areas are to be established
€100,000 has been approved for outreach workers in the area of harm reduction & needle exchange
Dr. Niall McElwee, Dissertation Doctor's Clinic/Research from the Archives

27. What Good Has Come?
Task Force has funding for:
Follow up care programmes
Peer led initiatives
4 regional drop in points
Interagency capacity Development
Dr. Niall McElwee, Dissertation Doctor's Clinic/Research from the Archives

28. Concluding Comments
Heroin misuse must be tackled from a multi-disciplinary perspective
Accurate figures will only emerge over time and through careful triangulation
Collaborative effort between the agencies is crucial
All individuals with individual stories
Not to act now in a preventative manner will create enormous issues later
Dr. Niall McElwee, Dissertation Doctor's Clinic/Research from the Archives