Dr. Eamon Keenan:

I thank the Chairman and members for inviting us here to talk about this very important topic. The IHCA has decided to make a submission on this issue because we were concerned about a lack of balance in the debate to date. The public discussion on drug decriminalisation or legalisation appears to have looked at the positive results of liberalisation as opposed to perceived negative consequences.

We fully accept that obtaining a criminal record for the use of a drug brings with it significant adverse consequences which would be removed with decriminalisation. However, the risk of a criminal record may act as a deterrent to drug use for some people. It has been noted that decriminalisation is a risk factor for future use and a concern exists that decriminalisation is simply one step along the way to the legalisation and production of drugs.

Increased use of any drug is likely to result in increased need for accessible treatment and there has been little planning or resourcing for this. Any treatment should be readily available prior to changing a law to facilitate increased drug usage.

We are concerned that the debate focuses on rights without offering adequate consideration of the harmful effects of drug use. Many drugs have specific harms, but taken as a whole, they generally do affect one’s capacity to function normally when intoxicated. The emergence of the new psychoactive substances has been noted with concern by many clinicians in Ireland and abroad. One of the major selling points of these substances is the fact that they can be marketed as legal for some time until legislation can be put in place to deal with their distribution and use. The fact that they are legal has been reported as one of the factors that people consider when they use the substance. We feel it is important that the negative effects of substance use, as well as perceived positive effects, are discussed in the public domain.

In the Netherlands, prevalence data on use of cannabis and other drugs concluded that the policy of depenalisation did not increase the prevalence of cannabis use. However, they did detect a significant escalation in use of cannabis following the commercialisation of cannabis via coffee shops.

Much has been said about Portugal. In 2001, Portugal introduced a new law which significantly changed the legal response to drug users. They ended criminal sanctions for drug possession for personal use but developed commissions for the dissuasion of drug addiction to direct drug users into treatment. At the same time, they also developed a drug strategy, similar to our own national drugs strategy, which is likely to have had an impact on the current situation in Portugal. The Portuguese model is viewed by some as an unqualified success but there are divergent views on this. For example, the Cato report said it was a resounding success, while the APLD report considered it a failure. Both reports have been objectively reviewed and both appear to be very selective in the data which they chose to report. It has also been argued that the policy of decriminalisation may result in more people entering treatment. Two other factors need to be considered in relation to this. First, the commissions for the dissuasion of drug addiction, CEDTs, in Portugal mandated that approximately one third of the people referred to them had to enter treatment because they were deemed to be addicted to the possessed substance. Second, it has also been suggested that the decriminalisation of drug use made people more willing to seek help from health professionals. There is evidence that some measures of the level of drug-related harm deteriorated after the new policy was introduced in Portugal. There was an escalation in deaths linked to substances other than heroin. There was also an escalation in cannabis use among teenagers. Our point here is that people can reach different conclusions based on which data they choose to interpret.

There is a constantly evolving picture in the United States concerning drugs, specifically cannabis. Different states having differing approaches to cannabis in relation to decriminalisation, medicinal use only, full legalisation or prohibition. Future research from this area will give us an opportunity to examine how these approaches impact on rates of drug use and attitudes among people over time. This is why we feel we should not rush into this decision but take the opportunity presented by the change in legislation in other countries to assess the impact on drug trends, population health, and society in general.

In the past, the Government has utilised the National Advisory Committee on Drugs - now the National Advisory Committee on Drugs and Alcohol - to provide scholarly reports on various contentious topics, including harm reduction approaches and dual diagnosis.

There is an opportunity now to commission a piece of independent, evidence-based research to inform legislators of the intricacies of the proposed approach in this area. The probability that decriminalisation will result in increased treatment entry is to be welcomed. However, decriminalising any substance gives some tacit consent to its use and, by extension, the State has a moral responsibility to manage the potential negative health impact for at least some of the people who use those drugs. This requires proactive planning by treatment commissioners and treatment providers, which has not occurred to date.

As the National Drugs Strategy 2009-2016 draws to a close, we are strongly of the view that these factors should be taken into account in developing any new national strategy for 2016 onwards. We very much welcome being at the table for these discussions because treatment provision for people with drug-related problems has gone off the agenda in recent times.