Oireachtas Joint and Select Committees
Wednesday, 22 March 2017
Select Committee on Health
Misuse of Drugs (Supervised Injecting Facilities) Bill 2017: Committee Stage
This meeting has been convened to consider the Misuse of Drugs (Supervised Injecting Facilities) Bill 2017, the purpose of which is to provide for the establishment, licensing, operation and regulation of supervised injecting facilities for the purposes of reducing harm to people who inject drugs; enhancing the dignity, health and well-being of people who inject drugs in public places; reducing the incidence of drug injecting and drug-related litter in public places and thereby enhancing the public amenity of the wider community; and providing for other relevant matters. I welcome the Minister of State at the Department of Health with responsibility for communities and the national drug strategy, Deputy Catherine Byrne. I also welcome her officials, Mr. Eugene Lennon and Mr. Eamonn Quinn. I ask Deputies to turn off their mobile phones because they can interfere with the recording of the proceedings. I have done so myself. I note that there are no proposed amendments to the Bill.
The first relates to a small wording matter in section 3(2). First of all, we may look to discuss the matter and then we may look to amend it.
Section 3(2) states: "When determining whether or not to grant a licence in accordance with subsection (1), the Minister may consult such persons as the Minister considers appropriate, including the Executive and An Garda Síochána." Is it possible to incorporate strengthened wording here? Perhaps we could insert the expression "shall consult with persons as the Minister considers appropriate, including the Executive and An Garda Síochána." That would strengthen the consultative arrangement. The same applies in section 3(6). Could we insert "shall" instead of "may"? Does the Minister of State have any thoughts on that?
We reserve the right to do that on Report Stage and Final Stage. That is what I am suggesting. I am keen to get the views of the Minister of State. What are the thoughts of the Minster of State on that specifically?
I do. I wanted to get some clarification first. The word "may" is used under the advice of the Attorney General. If "shall" is put into the Bill, it limits me when it comes to discussing the matter further with other people. The use of "may" enables consultation with other people. The use of "shall" is a more definite decision and I would have to do it.
The use of "shall" would possibly formalise a process of consultation between the health service and the Garda and would formalise it legally. It would also empower the Minister to consult with others, as appropriate. It is only technical wording, but I believe it would uphold the process of consultation with the same people with whom we want to progress this important legislation. It would help from a health aspect to formalise it. I realise it is a minor technical point, but I believe it is worthy of consideration in the context of the Bill.
It comes down to the legal implications of the Bill. It may have other difficulties for us. That is where our concerns arise. The expression "shall not grant a licence" is used in other sections. The section in question is a little more open, or soft, rather than open, in the sense of the Minister making the decision.
There is another issue there. I had this discussion 40 years ago in the House. It relates to where "may" and "shall" are in conflict. In the case of "may" the person with the authority had direction to do or not to do whatever is proposed or not proposed. If the Bill states "shall" then there is no discretion. It shall happen on every occasion. That is the difference.
One aspect of this may be worthy of consideration. Let us consider the expression: "the Minister shall consult with such persons as the Minister considers appropriate, which may include". The idea is to proscribe a process of consultation without necessarily ring-fencing the Minister in respect of who that might be. I believe it is worthy of consideration that the Minister would uphold a greater threshold of consultation under the section in question. Would that be more appropriate?
I will put it as plainly as possible. Would it be possible to speak to Deputy Chambers afterwards about the wording? My advice is that the Attorney General believes the use of "may" is appropriate at this stage. I will have to talk to Deputy Chambers about it and get some more advice on it.
Unfortunately, I was ill for the debate on Second Stage. That is why I wanted to make some points on Committee Stage. I appreciate what the Minister of State is trying to do here, but this is dangerous territory for the State to be involved. This is not about outside agencies. This is about the State doing something that allows for illegal drugs to be brought into premises under the control of the State.
While I do not wish to go back to Second Stage, nobody knows how this legislation will work out and I ask that we at least introduce a provision into the Bill on Report Stage for the legislation to be brought back before the House after, say, a year in operation in order that we have a second look at how it operates. If the Minister of State were listening to me, I might make my point-----
We are asking people to support legislation which allows people to bring drugs bought illegally into premises - it could be literally outside the door of these premises - under certain circumstances with no obligation that the person using the drugs inside engage in any form of rehabilitation. In most other similar legislation, we spend most of our time helping people caught up in the dreadful position of being drug takers and drug addicts. In my constituency, down the road from my constituency office, is a methadone centre, over which I came under pressure for years because the constituents did not like it. However, I recognised that it was an attempt to get people off hard drugs. It is still in operation and I will continue to support it. I do not have a problem helping people who take drugs with this dreadful problem. I do have a problem with the fact that we are now as a State closing our eyes to drugs sold illegally on the street being brought into premises to be used in those premises, which are under the care and responsibility of the State, and that there would be no obligation on the user to engage in any form of rehabilitation on that premises. There is nothing in the legislation which states that these people should engage, or even be encouraged to engage, in a form of rehabilitation.
A very serious step has been taken in proposing legislation that the State get involved in this regard. It would be different if it were a private matter, but it is proposed that the State set up these premises and take responsibility for them and that the taxpayer pay for them. This is not just Deputy Seán Barrett trying to be awkward; it is a very serious situation, as far as I am concerned. I am not suggesting for one minute that we should not do everything we possibly can to help people caught up in this situation. However, we have an obligation when passing legislation that it can stand up to scrutiny. As lawmakers, we cannot turn a blind eye to drugs sold illegally being brought into premises run by the State and used in those premises and pretend it is legal without any suggestion of rehabilitation. At the very least, the Bill should be brought back to Report Stage after 12 months to whoever is in these Houses to examine what exactly has occurred after these measures have come into play. There is not yet any provision in the Bill for this. I ask the Chairman for his indulgence in respect of my comments. As I said, I would have made these points earlier, only that I was out sick when my Second Stage slot was available. I am availing of the opportunity to speak now because this is a terribly serious matter. I have been in this House since 1981 and I do not ever remember legislation being brought into the House for Members to pass which would in effect turn a blind eye to the sale of illegal drugs and provide for a premises in which those illegal drugs could be taken without any suggestion of help for the people taking the drugs. That is the point I wish to stress.
Yes. Deputy Barrett began by speaking about methadone clinics and the fact that in the past there were huge objections to them in communities and that we as public representatives were asked to stand over them. The fact is that many methadone clinics have made a huge impact on people's lives. I remind the Deputy that the legislation is committed to in the programme for Government and that we are committed as a Government to supporting a health-led approach to drug use rather than one based on criminal justice. Unlike Deputy Barrett, I am not an expert on the law or anything else but I wish to point out a few things to him. For far too long, people who are addicts have been labelled across this country, in every little town and village and in our capital city, as people who do not matter. They do matter.
I was asked to reply. They are human beings who at a certain time in their lives need these services. They largely do not connect with any other rehabilitation services or any other services. They are chronic users, many of whom are at the very edge of addiction, some of whom are at the end of their lives. As we all know if we read the many articles on the matter that have appeared in newspapers and magazines over the years, many of them have died on the streets, in back lanes.
There are 90 of these units across the world. Everywhere they have been provided, yes, there was opposition when they began to operate but that has all subsided because people see definite change not only in the communities in which they live - for example, a reduction in material being left behind in public places by drug users - but also in the facilities themselves being provided to people with chronic conditions. For many of them, it is the first step into any facility where they have the services of doctors and nurses, if required, and there are people who come out the other end. This is an opportunity for this little country of ours to reach out a hand to these people who perhaps in the past felt very isolated and not very well looked after by the State. It is the first time we have had legislation that could save the lives of those who are addicted to drugs, and it is about saving lives. One can get into other arguments on the matter. We have sat with An Garda Síochána and consulted with a range of many people across the medical sector, all of whom have indicated to us that they fully support the legislation as currently proposed. All I ask Deputy Barrett is that he give it a chance. We all deserve a chance in life, as do these people. The Deputy can home in on the fact that they are chronic users of illegal drugs, but that is a different argument altogether. These are human beings who find themselves in the position of chronic drug use. This is the first opportunity they are getting to go into clean, safe environments where they can build up trust with the doctors and nurses and other people working there and, perhaps, in time, come through a process of rehabilitation. All we ask is that we be given an opportunity to introduce the Bill in order to allow these people, who are the most marginalised in society and whom most communities do not want, the opportunity to have a life and perhaps an opportunity to save their lives as well. Nobody has died in any of these facilities.
The Minister can make a decision to close down this premises overnight if he or she wants to. The Minister can make a decision to have a review of the facility at any time. That is what the legislation is there for.
I do not want to start a big row. I have the height of respect for any Member who has been here since 1981 and gets legislation far better than I probably ever will. I understand some Members’ concerns about the turning of a blind eye to the sale of illegal drugs. As I said on Second Stage, the legal classification of a drug does not change its side effect profile. It does not matter whether it is legal or not. It will be the same side effect and same problem.
I have worked in methadone services for years and was a pharmacist in regional towns 12 years ago during the epidemic stages of heroin use in the midlands. To echo what the Minister of State said, this cohort is on the fringes of society and has managed to escape the GP, local community services and so forth. These are vulnerable people down alleyways or in backyards, sharing syringes and bits of tinfoil, using bad diluents and bad solvents and ending up with secondary conditions as a result of their heroin habit. We can either let these people continue to die in alleyways or we can try to do something about it. We can all say it is terrible and ask why people take these drugs. We can honestly make efforts towards dealing with the societal issues which lead people into this but that is a work in progress. This legislation is about dealing with a problem on our doorstep.
Sometimes medicine is not about curing people. Sometimes it is just about managing people and giving families a chance. The Minister of State spoke about saving lives. This sort of service can save the lives of the individuals in question but it can have a massive knock-on effect for their families too. There is an attitude that heroin use only affects the worst-off in society and is a certain class issue. It happens in nice sitting rooms the same way it happens in alleyways, however. In anything we do with health policy, it should be to try to reduce harm.
I understand the issues of the legality and the scheduling of heroin. While it is a schedule 1 drug here, these facilities have been established in other countries where it is also a schedule 1 drug. If it can happen in other countries, it can happen here. I would not be against a review of the facility or policy in a year’s time. However, I do not envisage a situation where, if an injecting centre is set up and these clean environments are provided, people will wake up some morning and decide to start taking heroin. This is for people already on heroin. There is a small cohort of users who cannot be targeted by services. When it comes to rehabilitation points, these people are not in any way engaged. If we can get them into these centres and develop a rapport and relationship with the people on site, we then have some chance of tapping in and improving their lives, the lives of their families and communities.
I echo what Deputy O’Connell said. We have the highest number of intravenous drug users in Europe. The negative health outcomes of leaving users on the streets and ignoring the problem are not working. The evidence base is what we should all be focused on as legislators. The evidence base from cities across the world is that such facilities have a positive effect in bringing people into a pathway of harm reduction and then rehabilitation. That is why I and my party support the piloting of such a centre.
Will the licence for the injecting facility come under the Criminal Justice (Public Order) Acts 1994 and 2003? What is the comparative regime or will there be a new licensing regime? Is the Minister of State intending to amend those two Acts or will their provisions suffice?
The only legislation being amended is the Misuse of Drugs Act. As it is a pilot project, it will automatically come under review. As I said, the Minister can intervene at any time if he or she feels a facility is not being run properly or is not adhering to the legislation.
Section 5 states:
Where the Minister is satisfied, having consulted with the Executive, An Garda Síochána, or such other persons as the Minister considers appropriate, that the licence holder has become ineligible to hold a licence, or is in breach of regulations made under this Act or the conditions of the licence concerned, the Minister may—(a) revoke the licence, or
(b) suspend the licence.
I do not know if I was deliberately misunderstood or not but this emotional stuff trotted out to me, as if I am some sort of a bad boy by being opposed to help being given to people who are unfortunate enough to be caught up in this drug situation, is far from what I said. I do not have a problem with the legislation. I have a problem with what is not in it. There is no question here of any form of rehabilitation built into the legislation. There is no form of any answer as to how these drugs will be taken in when they are illegal.
We are lawmakers. This is not about emotion. I have as much sympathy for people caught up in the drugs war or in drug-taking. I have 13 grandchildren and five kids. I understand it perfectly. I have been a public representative for years. I understand all that emotional stuff. Coming back on top of me as if I am some sort of a cold individual who does not have any concern about these people is not correct. Of course, I have concerns. However, we have to remember we are lawmakers.
It is not me. We are lawmakers. When passing laws, we must ensure they stand up to scrutiny and we have to be able answer people. There are two questions I posed. It is a real problem and we cannot hive it off by becoming emotional about the unfortunate people in question.
The main problem concerns where these people are going to buy the drugs. These are illegal drugs being brought into premises that are the responsibility of the State. The State has an obligation to uphold two laws, one on the purchase of illegal drugs and the second on the use of such drugs.
As I have said, nothing I am asking for is in this legislation. There should at least be a provision allowing the legislation to be reviewed or a provision allowing advice to be made available to people so they may come off drugs. The legislation is purely functional. Section 2 is on the application for a licence. The interpretation section speaks for itself. Section 3 is on the granting of a licence, section 4 is on the surrender of a licence, section 5 is on the revocation of a licence, and section 6 is on the transfer of a licence. Section 7 refers to the authorised user, section 8 is on the obligation of the licenceholder to provide information, section 9 is on the liability of the licenceholder, section 10 is on the disapplication of sections 3, 19 and 21 of the Act of 1977, section 11 is on the power of Garda to enter a supervised injecting facility and section 12 concerns regulations. There is nothing in the legislation that would suggest that, as part of this process, we are trying to help people, not just give them some comfort regarding how they inject themselves. There is nothing in the legislation about any form of rehabilitation or even a mention of the word. Second, we still have not answered the question that, as legislators, we will be obliged to answer, namely, the question of how these people will get the illegal drugs. They are being purchased by drug dealers, who will be able to operate within 50 yd. of the injecting facilities. I do not want to be presented as somebody who is not sympathetic to people who are caught up in this horrible situation. Of course I am as anxious as anybody else to help them. This, however, is legislation that we have to stand over.
We carried out pre-legislative scrutiny on this Bill. We had a debate in the Dáil on Second Stage and I understand that Deputy Seán Barrett was unavailable on both occasions. I am quite happy to listen to his comments, however. He can bring them up when the legislation goes back to the Dáil. With regard to the Bill itself, there have been no amendments. I do not know whether the Deputy's comments can be introduced by way of amendment because it is too late.
I was asking the Minister whether she would consider the points I am making, which refer to real problems. At the very least, we should provide that the legislation can be reviewed. I am not asking that we throw out every provision in this legislation and I am not trying to be unsympathetic to those with a drugs problem but, as a legislator, I am trying to produce legislation that will stand up to scrutiny. As it stands, it will not. The only defence will be the emotional side, involving our being questioned whether we are going to do nothing about these unfortunate people. That is not an answer to legislation. We are the makers of the law and we should ensure it will stand up to scrutiny.
It may be worth examining the incorporation of some reference to rehabilitation in the Title or a certain section. We all agree this is a gateway to harm reduction and that it would be desirable to follow through with rehabilitation and intervention to give people a chance. Even in terms of language, it is worth signalling to the Oireachtas and the people that this is what we are trying to do. It is making an intervention, first at the harm-reduction level and then giving people the rehabilitative piece. An effort has been made to model this legislation on measures in places that have actually have tried to achieve this objective. That it is not mentioned formally could indicate this is not what we are focused on, although it is what the Minister of State is focusing on, as I know. Perhaps it is worth incorporating in the Title or elsewhere a reference to following through with rehabilitative intervention, thus signalling it is something the Minister of State is trying to achieve. It is not in the Bill currently.
As the Chairman probably knows, I raised issues concerning this subject on the pre-legislative stage. Originally my understanding was that we did have a methadone-like element included but I was wrong. The purpose of the exercise has already been pointed out. This proposal is not aimed at reduction but at protecting the health of those who are already serious users of illegal drugs. It is merely to give some sort of control over the manner in which the drugs are used.
Deputy Seán Barrett made a valid point in that the question arises as to whether we can, on the one hand, be opposed to the use of illegal drugs while, on the other, allowing their use and supervising their consumption in an enclosed setting. There are regulations in this area, which the committee has already discussed.
I am not an expert in this area and do not know the likely outcome in the event of a constitutional challenge. I do not know what that would involve. It is in this regard that a challenge could arise. The purpose of the exercise, as I see it now, is not reduction but merely regulating the manner in which drugs are consumed and trying to ensure the worst-case scenario does not prevail, as happened in the past whereby injecting took place in all kinds of places, including in front of children and passers by. The methods of such injecting are such as to raise serious health issues, which in turn could become a legal responsibility of the State at some stage down the road if, for instance, it were seen to ignore what is happening in the public arena.
I would have no problem with the Minister of State including, if she desires it, a clause stipulating the legislation should be reviewed after a year or two to ascertain its effectiveness or otherwise but we need to realise what the purpose of the exercise is. There are two distinct issues that could well be in conflict. One is the administration of the law, as it stands, and the other seems to be in conflict with that. The purpose of the exercise, however, is not to have one confront the other; rather, it is to confront the issue of people injecting themselves in stairwells using unhygienic procedures and of their overdosing regularly. The contention under this legislation is that there would be advice to users that would in some way influence them to prevent overdosing. I hope that works.
I brought to the Chairman's attention earlier today another element that may be helpful in this matter. It would introduce a reduction measure that could be very beneficial. That will have to be done separately. I was asked to bring it to the attention of the committee. I will give the information to the Chairman and other members of the committee at a later stage.
The objective of the Bill is harm reduction. It cannot reduce the extent to which drugs are used by people. Without a doubt, the facilities would see supplies drawn from illegal sources. I raised that question previously. I raised it in the context of whether the Garda has a right to accost users of illegal drugs going to or from their injecting facilities.
I was concerned as to why the gardaí would not have the right to do so. That was where my misunderstanding was. We are informed that it is legally applicable. It does not matter whether something is in the programme for Government or not. The Government can never introduce legislation that it knows to be illegal or unconstitutional. It cannot be done. This is what I spoke about earlier this morning. We as politicians very often have great ideas that might not necessarily be applicable and certainly might not be legal in certain circumstances. That something is in the programme for Government does not make any difference. Legislation coming before the House at any particular time must be known not to be in conflict with the Constitution.
When we had our hearings, we heard some very distressing evidence that 200 people are dying from overdoses from IV drug abuse combined with other drugs on the streets and in their flats around Dublin. This is an opportunity and an attempt to reduce those deaths by whatever number we can. It is harm reduction and it is life-saving legislation.
I accept fully what the Chairman is saying. I pose the question as a law maker. We are ignoring reality. We are ignoring the fact that these drugs will be brought into a premises in which the State is involving itself. That is the point I am making. Second, no attempt has been made to at least put in a provision that facilities will be made available for those who wish to be weaned off these drugs. I have no problem with the principle of taking these people off the street but as law makers, we must deal with reality and the reality is that we cannot introduce legislation that is clearly against another piece of legislation which says it is illegal to purchase drugs and that it is illegal to have drug dealers effectively standing outside selling them. That is the point.
The Attorney General has scrutinised the Bill, which has been given the opportunity to be brought to the House and the committee. The Bill purposely states that the purpose is to reduce harm to people who inject drugs; enhance the dignity, health and well-being of people who inject drugs in public places; and reduce the incidence of drug injection and drug-related litter in public places and thereby to enhance the public amenity for the wider community. I am very passionate about the fact that we have an opportunity in this country to make legislation that would help those people who society in general disregards. I am passionate about that and I will not apologise for it. I am not accusing anybody in the Dáil or this committee of not having a heart or not believing that these people should be helped. I never said that. I may come across as being emotional at times but that is who I am. I am passionate about this legislation and I am passionate because we have studied different countries and looked at legislation. We visited a particular facility in Copenhagen and saw at first hand people who are chronic users who are at the lowest ebb in their lives being treated as human beings with trust and dignity and given an opportunity to be examined by doctors, nurses and other professionals when they are in the facility and have rehabilitation added to their services if they wish. Many of them have never entered a facility like this before. That is what this is about. It is a pilot project. In response to Deputies Barrett and Chambers, I do not know whether it will work in Dublin but I think it is worth a try. Given that it has happened in other countries, we must give these people an opportunity.
Representatives from An Garda Síochána appeared before the committee and we have spoken at length with them as well. There are people injecting and using drugs openly on the streets of Dublin night and day. In many ways, but for the pragmatic and professional way in which An Garda Síochána operates, I can guarantee that there could be 300 people in jail in the evening. Gardaí in the city get to know people on their way to facilities like Merchants Quay Ireland or the Ana Liffey Drug Project at an individual level. They know they are addicted. They know they are not drug pushers. There is no other group of people dealing with a very serious illness on a daily basis, namely, addiction. I am very sorry if I come across as being emotional and passionate about this but I feel strongly that we are not the first ones to do this. There are 90 such projects in the world and they work. The statistics show that they work so why can we not try this in Ireland?
I understand Deputy Barrett's legal mind. I am not a legal person and would never come into any room or Chamber and insult anybody about whether they were compassionate or not. That is not my job. My job as Minister of State is to bring legislation through the Houses that will facilitate harm reduction to help those who are chronically ill. That is why we are here and this is why I believe this legislation is so important. It is an opportunity for us as a State to recognise that all people in the State have a right to be looked after if they are ill. These people are ill. I am not doubting Deputy Barrett, Deputy Chambers or any other Deputy in this committee or the Chambers who thinks otherwise but I think it is worth a try. We are not doing it on our own. We have gone through extensive discussions and have met with different groups, including An Garda Síochána and the HSE. Dr. Eamon Keenan was with us in Copenhagen. We have spoken to different people who are already seeing the benefits of a facility like this. That is what this legislation is about. It is up to the Minister of State of the day, be it me or somebody else, to intervene if they feel the facility is not working to the regulations arising under the Bill. This will be done. I cannot give any guarantee other than I believe this facility is needed in Dublin at this point in time. We need to go ahead with this pilot project. Nobody deserves this facility more than those people, who are the most marginalised. We all see them on a daily basis if we walk through this city or any other city in this country. They are human beings.
I beg the Chairman's indulgence for a moment. I do not doubt for one minute the sincerity of the Minister of State. I do not doubt for one minute what she is trying to achieve. This is fine. I share her concerns and understand what she is trying to do. We are here to pass legislation that will stand up to scrutiny. What I am trying to say is that we should put every effort into the legislation, regardless of whether it is another section or not or, as Deputy Chambers mentioned, a provision stating that facilities be made available if those people who are using this facility wish to avail of advice about drugs. We should put in something like that. At least it shows that we are not blinded by emotion. We must always temper our emotions when passing legislation and realise that we must stand over what will become an Act. If any of us are questioned about how we can pass legislation that will allow for people to stand outside one of these facilities and sell illegal drugs to people going in and do nothing about it, we need to have an answer. Secondly-----
We have concluded the Bill.
I thank the Minister of State, Deputy Catherine Byrne, and her official, Mr. Eugene Lennon, for attending the select committee. I thank the select committee members for attending and making their contributions.