Dr. Bernard Kenny:

I am the director of addiction management in primary care. The Irish College of GPs recognises addiction as a complex, chronic, relapsing disease involving a common pathway with both physiological and psychological components. Drug use and addiction adversely impact individuals, families and communities and are associated with significant morbidity and mortality. There is a close causal relationship between addiction, social deprivation and childhood trauma. Engaging people who use drugs in harm reduction services and treatment is known to be protective. GPs see people who use drugs as our patients and members of our communities rather than criminals. The number of people seeking treatment for addiction to illicit substances is increasing annually. There are several barriers to people who use drugs seeking treatment. Social stigma significantly affects willingness to report illicit drug use, reveal addiction and access appropriate healthcare. Fear of punishment and criminal conviction are further barriers. Legislative changes should address the many barriers to treatment. The Irish College of GPs recognises the detrimental impact of penalisation and stigma on people who use drugs and those seeking addiction treatment, sustained recovery from addiction and access to meaningful employment.

The Irish College of GPs supports the overarching recommendations of the citizen's assembly report, pivoting from a narrow legalisation-decriminalisation criminal justice approach to a comprehensive multifaceted, bio-psychosocial approach addressing supply reduction, addiction prevention, harm reduction, treatment and recovery services, all underpinned by enhanced resourcing with relentless prioritisation of disadvantaged communities. A piecemeal approach to managing drug and other addictions is doomed to failure whereas, with a comprehensive approach, the gains for personal and public health are enormous.

The HSE is committed to a health-led approach to drug use in Ireland. GPs, when appropriately resourced, are well placed to offer timely equitable access to high-quality addiction management, helping reduce patient harm and support recovery. The European Drug Report 2024 noted that Ireland had 322 drug-induced deaths in 2020. These 322 fatal overdose deaths exclude other drug-related deaths associated with drug use such as accidents, violence and suicide.

This is the highest rate among EU member states at 97 deaths per million of population compared with the EU average of 22 deaths per million. A report from the Health Research Board documents that more than 13,000 people were treated for problem drug use in 2023 - the highest annual number ever recorded. The evidence is clear. Early detection and management of drug use can prevent progression to dependence.

GPs see and support families and loved ones devastated by these tragic and preventable drug-related fatal overdose deaths. Together we can disrupt the cycle of harm and stigma of illicit drug use. A strategic health-led approach to drug misuse and treatment of addiction is resource intensive. It is critical that legislative reform is underpinned by significant and targeted investment. Addiction is raised in approximately 10% to 20% of all GP consultations. Having an appropriately trained GP workforce is essential to ensure identification and treatment of both chemical and behavioural addictions. Addiction medicine training is an essential component of the GP trainee curriculum in the Irish College of GPs. GPs have different roles in managing drug use and addiction depending on the substance involved, be it alcohol, sleeping tablets, benzodiazepines, pain medication or illicit drugs such as cannabis and cocaine.

More than 350 GPs have completed additional addiction specialist training delivered by the Irish College of GPs. These GPs primarily treat people with opioid use disorder. Given the changing pattern of drug use in Ireland, the Irish College of GPs supports an expansion in access to, and a range of treatments offered via HSE specialist clinics. The expansion of services to include evidence-based treatment for all chemical and behavioural addictions is required to meet the increasing needs of patients presenting for treatment. Assessment, intervention and ongoing management of addiction is time consuming and resource intensive. There is limited access nationally to public clinical psychology and counselling. Limited access to inpatient residential recovery beds and inadequate resourcing of GPs negatively impacts the quality of care provided and restrict the availability of treatment options.

Addiction is a complex interplay of biological, psychological and societal factors. Societal factors play a significant role in the risk factors for addictions and support options for recovery. While drug use is prevalent among all socioeconomic groups, disadvantaged communities, where health needs are greatest are often neglected and at greatest risk - the inverse care law. Criminalising drug use further marginalises people in these communities. Housing insecurity and homelessness exacerbate the risk and severity of substance use disorders. Supportive housing programmes alongside addiction treatment facilities improve recovery outcomes for people who use drugs, their families and communities. Focused and sustained efforts are required to plan and deliver appropriate healthcare to these communities including easy access to primary care-led, patient-centred, holistic and multidisciplinary addiction treatment.

The Irish College of GPs welcomes this opportunity to engage with and support the Oireachtas committee to transform Ireland’s approach to drug use and people who use drugs. We see people who use drugs as our patients and members of our local communities rather than criminals. We recognise stigmatisation, penalisation and social deprivation as significant barriers to treatment, which impede chances of a sustained recovery for people who use drugs. We support a compassionate, non-judgmental, non-punitive and health-led approach to people who use drugs seeking help with drug use and addiction. We support legislative changes that reduce stigma related to illicit drug use by comprehensively supporting people suffering from and impacted by addiction. We recognise that criminalising our citizens who use drugs does not address or solve the societal problems of drug misuse. We support timely and equitable access to a human rights-based healthcare for all and a national policy to meaningfully address the social determinants of health.

We welcome any questions.