Dublin has outperformed even best-case scenarios for COVID-19 mortality among homeless and drug using populations, according to a report released from the London School of Economics (LSE) and the Ana Liffey Drug Project.

The report called Saving Lives in the time of COVID-19 – Case Study of Harm Reduction, Homelessness and Drug Use in Dublin, Ireland reveals that a pragmatic and well-coordinated government response alongside housing provision and the expansion of harm reduction services, saved lives and ensured the protection of a vulnerable group. Once it was recognised that one of the main deterrents to compliance with isolation and shielding was substance use, harm reduction services were quickly expanded in Dublin. These included improved access to methadone treatment; improved access to naloxone; and the home delivery of prescription drugs. This quick decisive action resulted in only 63 homeless people in Dublin being diagnosed with COVID-19. There was one COVID-related death, a fraction of what had been predicted.

According to the authors, COVID-19 acted as a catalyst for change in the delivery of harm reduction measures, with decisions that would normally take months or years effected within days and weeks.

The report co-author and Executive Director of the International Drug Policy Unit at LSE, Dr John Collins said: “Ireland has shown itself as a policy innovator during the COVID-19 crisis and has outperformed even best case scenarios for mortality among homeless and drug using populations in Dublin. As some countries tentatively emerge from the first wave of COVID-19, it is important to take stock of lessons learned.”

Dr Austin O’Carroll, Clinical Lead for Homelessness in Dublin said: “As the COVID pandemic approached there was a palpable fear amongst the homeless population and those who provided services to them. Homeless people, who have the worst health indices in the Western World and who either sleep rough or live in shared accommodation, found themselves in a precipitously dangerous and vulnerable situation.”

Dr O’Carroll said that if action was not taken immediately, they envisioned the epidemic sweeping across the sector causing multiple hospitalisations and a high death rate. The housing, homeless health and harm reduction agencies came together and their response was swift, highly coordinated and extremely effective. It responded to a public health emergency by addressing all the social determinants of health including accommodation, physical and mental health service provision, psychological support and addiction treatment.

“The sector was very happily surprised by not only the low rate of infection and negligible death rate, but also by the noticeable improvement in general health and wellbeing in the homeless population. This served as a timely reminder that there are inextricable links and vicious circles between housing and health, housing and substance use and health and substance use.”

Tony Duffin, CEO of Ana Liffey Drug Project added: “Thanks to the determined effort of all those involved, during the first wave of COVID-19 in Ireland, the number of COVID infections amongst people who use drugs and who are homeless in Dublin was lower than had been anticipated.

“As highlighted by this paper, a Harm Reduction approach has been, and will continue to be, an important element of the public health response to COVID-19 for this cohort; it is crucial to help stop the spread of the virus and to reduce drug-related harm.”

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