Address by Minister Aodhán Ó Ríordáin T.D to the London School of Economics IDEAS Forum
Firstly, I would like to thank Doctor John Collins of the LSE IDEAS International Drug Policy Project for inviting me to give the key note address at today’s drug policy planning workshop. It is truly a great honour to share the platform this afternoon with such eminent policy makers, experts, academics and practitioners.
The drug problem is a constantly changing phenomenon. Governments around the world are constantly trying to play catch up to deal with a very sophisticated and lucrative market. If we are to make any headway in addressing the problem, we need to review, renew and revise our drug policies to meet emerging challenges.
As we prepare for the United Nations General Assembly Special Session on the World Drug Problem in 2016, we have a real opportunity to have a constructive, comprehensive and wide ranging debate on our approach to this complex problem. I believe that we need to be radical and change how we think and talk about drug addiction. We need to have discussions like today in think tanks, universities, parliaments and small rooms across the globe so that we can develop a more modern and comprehensive response to tackling drug trafficking and consumption.
From my work as a teacher and principal in Dublin’s North Inner City for many years, I am acutely aware of the devastating consequences of drug abuse for those using drugs, their families and the wider community as a whole.
Drug addiction affects all demographics; rich and poor as well as young and old. Often there can be an intergenerational cycle of alcohol and drug misuse where young people’s attitudes are not only influenced by their peers, but also coloured by the behaviour and attitudes of an older generation. I am firmly of the view that there needs to be a cultural shift in how we regard substance misuse, if we are to break this cycle and make a serious attempt to tackle drug and alcohol addiction.
Evolution of Ireland’s drug policies
Prior to the 1980s, the Irish drug scene – which effectively was the Dublin drug scene – had almost no heroin and very little intra-venous drug use of any kind. Treatment tended to lean towards abstinence models.
This changed during the early 1980s with the large-scale use of heroin in areas of socio-economic deprivation in Dublin and particular concern around the spread of HIV among injecting drug users.
In the early 1990s, methadone maintenance treatment clinics were set up in the worst hit areas of Dublin with a subsequent major demand for these services. Even today there is a high demand for methadone maintenance treatment, even though the number of new entrants is somewhat in decline in recent years.
National Drugs Strategy 2001-2008
The heroin problem of the 1990s represented a crisis not only for the communities directly concerned, but for Irish society as a whole. In order to provide a whole of government response, Ireland adopted the first comprehensive seven year National Drugs Strategy in 2001. The Strategy involved dealing with problem drug use through four pillars – supply reduction, prevention, treatment and research.
Drugs Task Forces were established at local and regional level in order to provide a coordinated response to the drug problem in local communities. The Task Forces brought together elected representatives, representatives from the community and voluntary sectors and relevant local statutory and Government agencies, who worked together to tackle drug abuse at a community based level. To this day they still operate across the country attempting to curb the very worst problems associated with drug abuse.
In 2007, a Mid-Term Review of our Strategy recommended the expansion of treatment options to deal with a growing poly-drug use problem. It called for earlier access to treatment for drug users, an increase in the numbers of GPs and Pharmacists providing methadone treatment and the expansion of needle exchange to deal with the increased incidence of hepatitis C and the on-going prevalence of HIV. These recommendations were taken into account in Ireland’s current drugs strategy.
In 2009, the ROSIE study on drug treatment outcomes in Ireland carried out by Professor Catherine Comiskey (with us today) was published by the National Advisory Committee on Drugs. This report concluded that drug treatment, including methadone maintenance treatment, results in reduced drug use, improved health and social outcomes for clients, and a reduction in drug-related crime.
Methadone is now the primary treatment option for opioid dependency in Ireland, although it is intended to provide wider access next year to an alternative opiate substitution treatment for a specific cohort of drug users.
The drug problem in Ireland is no longer an exclusively heroin problem. Cannabis use has become more prevalent and is normalised in some communities.
A further challenge for our services – a legacy of earlier decades – relates to the ageing cohort of methadone users who have spent years on opiate substitution treatment and who have complex needs and poor physical health. In a population of 4.6m, there are 10,000 people currently in methadone treatment. And 1 in 3 has been in treatment for more than 10 years and one in 5 is aged over 45.
While the number of new entrants to methadone treatment is decreasing, the number of patients outside Dublin continues to grow as demand for drugs services across Ireland is increasing.
Polydrug use is endemic among people attending drug treatment. According to treatment data for the period 2009 to 2013, almost two thirds of those people who sought treatment for a drug as their main problem, also reported a problem with additional drugs. During my short time as Minister of State with responsibility for Drug Strategy, I have met medical practitioners who feel that the changing nature of Ireland’s drug problem has made it much more difficult to treat patients.
And poly-drug use makes treatment even more complex. The consumption of more than one drug increases the risk of overdose and makes treating the resulting overdose more difficult.
In recent years the number of polydrug deaths has overtaken the number of single drug deaths. Alcohol, benzodiazepines and opiates are most commonly implicated in poly-drug deaths – and prescription drugs feature very highly in this. Our problem today is far more wide reaching than it was twenty years ago.
Medically Supervised Injecting Centres
It is easy to forget that behind every drug user, there is a human being. Addiction is not a choice, it’s a healthcare issue. This is why I believe it is imperative that we approach our drug problem in a more compassionate and sensitive way. One of the key things that I aim to achieve during my remaining time in office is the introduction of a medically supervised injecting centre for intra–venous drug users.
In Ireland, there is a problem with street injecting, particularly in Dublin. These drug users are at increased risk of overdose and blood borne disease infections, and the general public is at risk owing to unsafe disposal of syringes and other drug paraphernalia.
A recent report from the European Monitoring Centre for Drugs and Drug Addiction found that supervised drug consumption facilities can be an effective intervention in harm reduction and a means to encourage drug users to enter treatment. These facilities have been shown to be effective in engaging difficult-to-reach populations of drug users. This is especially the case for marginalised groups, such as the homeless, and those who use drugs on the streets or in other risky and unhygienic conditions.
I have asked officials in my Department to examine proposals for the provision of medically supervised injecting facilities as a response to this issue. This is in line with similar models in Sydney and parts of Europe.
A medically supervised injecting centre is not a “free for all” for those who wish to inject drugs; it is a clinical, controlled environment which aims to engage a hard to reach population of drug user and provide defined pathways to higher threshold treatment services such as medical and social interventions and counselling services.
As front-line services, consumption rooms are often among the first to gain insights into new drug use patterns and thus could have a role to play in the early identification of new and emerging trends among the high-risk populations using their services.
Research has shown that the use of supervised injecting centres is associated with self-reported reductions in injecting risk behaviours that increase risk of blood borne virus transmission, overdose and death.
The impact of injecting centres on the reduction of HIV or hep C virus incidence among the wider population of intra-venous drug users remains unclear. However, as the recent spike in blood borne viruses in Dublin was among those who are most likely to avail of supervised injecting facilities, I hope that the introduction of these facilities may reduce the risk of future spikes occurring.
A medically supervised injecting centre is not the answer to the drug problem, but could form part of a suite of harm reduction measures, as a way of managing the problem.
Alternative approaches to drugs policy – decriminalisation
Since taking up my new role as Minister for Drugs, I have spoken to a lot of people who would like to see a more compassionate approach to those who experience drug problems. Too often those with drug problems suffer from stigma, due to a lack of understanding or public education about the nature of addiction. This stigma can be compounded for those who end up with a criminal record due to possession of drugs for their own use.
It is against this background that there is now an emerging debate in Ireland on whether an alternative approach to the possession of small quantities of illicit drugs for personal use should be considered.
A parliamentary committee on Justice, Defence and Equality visited Portugal in May this year to see at first hand the strategies in place for dealing with drug use. A report published by the Committee after the visit noted that:
- Drug addiction and use is treated as a health issue and is therefore moved from the criminal justice arena; and
- More police resources and court time is now concentrated on curbing the activities of drug dealers and drug traffickers.
The Committee has initiated a drugs policy review and is currently hearing from a wide range of organisations and individuals in Ireland on whether a similar approach to the classification of small quantities of drugs should be considered in Ireland.
During the summer, I held a Think Tank on Ireland’s drug problem to give those working in frontline services a chance to voice their thoughts on what needs to be done for the future. What emerged was a strong consensus that drugs across the board should be decriminalised. Most of those present wanted to see resources focused on keeping drug users out of prison.
I believe that there needs to be a clear distinction between decriminalisation and legalisation. This was echoed amongst those in attendance and there was certainly no desire for a permissive approach to drugs. Like me, many of those present believed we could learn from the Portuguese experience.
I am in favour of a decriminalisation model, but it must be one that suits the Irish context and be evidence based. I believe that this kind of approach will only work if it is accompanied by timely treatment and harm reduction services, backed up by wrap-around supports which foster recovery – such as housing, health and social care. Above all, the model must be person-centred and involve an integrated approach to treatment and rehabilitation based on a continuum of care with clearly defined referral pathways.
Our national drugs strategy remains the cornerstone of our approach to the drug problem and continues to be firmly focused on recovery. However, the ever changing drugs landscape requires us to renew our focus on emerging challenges and strive to innovate when new issues come to the fore.
Ireland is entering a new and exciting phase, as we embark on developing a new drugs strategy to meet the challenges ahead. An examination of the approach to drugs policy and practice in other jurisdictions will help to identify any additional evidence-based approaches which might be considered in an Irish context.
Ireland has international obligations in the area of drug control and when considering alternative policies, we do have to be mindful of these obligations. We are a party to the United Nations Conventions on the control of illicit drugs and the Government’s position regarding controls is in line with the UN Conventions and international law. However, we have an important opportunity along with the other UN member states to have a constructive dialogue on our drug policies and interventions ahead of UNGASS next year and I look forward to that discussion.
Into the future, I believe that more needs to be done to raise awareness of the dangers associated with problem drug use and to promote healthier lifestyle choices among the general population. I am convinced that there needs to be a significant cultural shift in our attitude towards substance misuse and a change in our own behaviour – particularly around alcohol. It’s time to have a wider conversation in rooms like this, in the chambers of our parliaments and amongst those working in the sector on the next steps in tackling drug abuse across the world. The more we talk and engage in far reaching discussions, the more we can build the best approach to helping those with addiction problems.