14: Drug use and street homelessness during a pandemic
Synergetic working with a vulnerable population
In 2017, a sudden rise in the number of people injecting in public areas in Belfast city centre required a new response that met the needs of this population. There was also an associated rise in discarded injecting equipment and both fatal and non-fatal overdoses. Local authorities knew little about this new group of people who used public spaces such as public toilets, alleys, and scrub areas as their injecting environment. A large Northern Ireland (NI) organisation, Extern was already working with a range of vulnerable populations including those who are homeless and who use drugs in Belfast and other areas throughout NI. Two senior Extern workers began a mapping exercise in summer 2017, logging and removing discarded injecting equipment and recording engagement with people who use drugs. It was soon clear that the scale of the issue had been underestimated. Extern offered assistance with practical support for individuals with a range of interventions including needle exchange, responding to potential overdoses, signposting to appropriate services such as housing, wound care, substitution, blood borne virus (BBV) vaccination, testing, and treatment.
Subsequently, eight staff within Extern were trained in assertive outreach and a small pot of funding was secured. The organisation piloted an assertive outreach service to continue to remove discarded equipment and engage with people who inject drugs in the city centre. The project established relationships with injectors who were unknown to other support services and worked in partnership to effect positive change for the service users. The majority of service users’ injecting knowledge and practice was poor, so soft tissue infections were very common, and overdoses were an almost daily occurrence among the wider population.
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