Dr. Cian Ó Concubhair:

If the State is serious about trying to reduce the harm of violent drug black markets, it should move to legally control and regulate all these substances. That can look very different depending on what the substance is. My colleague, Dr. Ian Marder, often says to students that morphine and bread are both legal, but the State adopts radically different regulatory approaches to that. Taking substance by substance, you would look at the evidence of harm. I refer to people such as Professor David Nutt in Imperial College London. He is a world leader in categorising the harms we can attribute to different substances. He places alcohol, opioids and cocaine at the higher harm end because risk of death and addiction are high and the social and health consequences of use tend to be quite harmful. At the lower end of the scale there are things such as psilocybin and other psychedelics, which have a very low risk or almost no risk, of addiction. There can be some harm but much of that is around the lack of regulation of the market. Much of the harm that can result from certain kinds of drug use comes from toxic supply, or a failure of the State to regulate that market. Cannabis is often put at the lower to mid range, with a low to moderate risk of harm. MDMA is put alongside that.

The reason I raised MDMA is that it was unfortunate in the citizens' assembly that not much attention was paid to MDMA for whatever reason. A number of jurisdictions, such as the United States and Australia, are legalising MDMA in clinical settings. There is a growing body of evidence which finds that using MDMA in a clinical setting can be very advantageous in treating post-traumatic stress disorder. There are very good reasons to examine MDMA for that purpose. Beyond that, it is low to moderate risk. There is a low risk of addiction and it is one of the most commonly used substances in Ireland. It would make sense. Some jurisdictions, such as the Netherlands, are beginning to explore what a legal open-access market to it would look like. Some jurisdictions there - they tend to have empowered local democracies - that is, some localities in the Netherlands are exploring what legal access to MDMA might look like for what we call "recreational users", looking at the harms and how to control for that. The nature of MDMA has shifted, particularly ecstasy tablets, over the past 20 years. It used to be that they were very low strength, whereas now they are very high strength. That is causing issues. It is a really good example of the problems arising from the failure to regulate. MDMA in and of itself is not necessarily a very dangerous substance; it just becomes very dangerous in the unregulated market.

In terms of cannabis and other substances such as that, the social club model holds an awful lot of promise because it offers an opportunity. It is maybe not the best opportunity to reduce the criminal market as the evidence seems to be that if we want to quickly reduce the size of violent black markets, we would go for something closer to the Canadian or American models. If we want to balance that against concerns about growth in use, there is evidence from the US stating that problematic use is growing with the commercial model. If we are concerned about that, however, then the social club model is a happy medium between that. It encourages people to cultivate on their own but also gives an opportunity to people who are not in a position to cultivate to lawfully access cannabis in quite a heavily regulated sphere.