Oireachtas Joint and Select Committees
Tuesday, 12 July 2022
Joint Oireachtas Committee on Justice, Defence and Equality
Sanctions for the Possession of Certain Amounts of Drugs for Personal Use: Discussion
James Lawless (Kildare North, Fianna Fail)
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I welcome our witnesses. I apologise for the delayed start to the meeting. Today is particularly busy in Leinster House, as the witnesses are aware, and a number of votes are taking place. We were a little delayed getting back to the committee room to start proceedings. Apologies have been received from Senator Martin and Deputies Carroll MacNeill and Alan Farrell. On behalf of the committee, I send condolences to Deputy Farrell on the death of his father on Saturday.
I remind members, and inform the witnesses who are not familiar with proceedings, to mute their mobile phones or, ideally, to place them in aeroplane mode. This is because they can interfere with the recording even if they do not appear to do so at the time. It can play up afterwards in the context of the sound system. I ask people to be aware of this. Some members are joining us online. They are very welcome. I ask them to mute their microphones when they are not speaking and to remember to unmute when they are speaking to ensure that the proceedings flow smoothly.
I look forward to what I think is going to be a very interesting discussion. The topic is an examination of the current approach to sanctions for the possession of certain amount of drugs for personal use. It is a little bit of a long-winded way to say decriminalisation. We are examining whether the current approach of sanctions, including legal sanctions, work appropriately or should other methods or approaches be considered.
I welcome Dr. Garrett McGovern, medical director of the Priority Medical Clinic in Dundrum. From the Cannabis Risk Alliance, I welcome Professor Bobby Smyth and Dr. Hugh Gallagher, who is a specialist in addiction medicine. From Patients for Safe Access, I welcome Mr. Kenny Tynan, executive director, and Mr. Martin Condon, director. From Crainn, I welcome Mr. Brendan Minish, who is a board member. Mr. Minish is joining us online. I am delighted to have an international guest at today's meeting. I welcome Dr. Nuno Capaz, who is the director of the Portuguese Commission for the Dissuasion of Drug Addiction. I look forward to the benefit of his experience. It will be particular interesting to see what is done elsewhere. It is often good practice to look abroad and see what has worked or not worked elsewhere.
Witnesses and members are reminded of the long-standing parliamentary practice that they should not criticise or make charges against any person or entity by name or in such a way as to make him, her or it identifiable, or otherwise engage in speech that might be regarded as damaging to the good name of the person or entity. If their statements are potentially defamatory in relation to an identifiable person or entity, they will be directed by me to discontinue their remarks. If this occurs, it is imperative that they comply with the direction. For those witnesses participating remotely the same advice applies, with the added caveat that even though we have had hybrid meetings for some time it is as yet untested what degree of privilege extends across an Internet connection. As I often say, it is good manners not to disparage people who are not present and cannot reply.
The way we operate meetings is to invite a short opening statement from each organisation that comes before us. We have set this at three minutes per organisation. This might seem short, but there will be ample time over the course of the meeting to come back in several times. After each organisation has had its three minute slot to make opening remarks, set the scene and give an idea of where it is coming from, we go to members in the order in which they have indicated. The members generally have a seven minute slot which they can use for a monologue or for rapid fire questions and answers. It is up to each member how they choose to use their time. After seven minutes I will move on to the next member so that everybody gets to speak. Generally, we find this conducive to good debate. If organisations or groups are not asked a question I may invite their representatives to come in if they have not spoken as the debate goes on. I hope this is all clear.
I invite Mr. Minish to make his opening statement on behalf of Crainn. I look forward to hearing what he has to say.
Mr. Brendan Minish:
I thank the committee for the invitation to come before it to discuss drug decriminalisation. We at Crainn have been working as advocates for policy reform, harm reduction and the safe regulation of cannabis for almost a year through various online outlets. We have run a number of campaigns online and in person and we work hard to make the case for drug policy reform to the public and legislators.
Irish drug policy has failed society and the vulnerable people it was supposed to protect. For many years, our drug death rates have been among the highest in Europe, at three times the EU average. Hundreds of people in Ireland die every year due to our current approach to drug policy. Addiction and substance abuse are health issues and not criminal ones. Current policy is outdated and clearly does not recognise this fact. A functioning drug policy is one that works towards reducing the harms of drugs. This is possible and it has been done before.
Ireland has much to learn from jurisdictions such as Portugal, Switzerland, Malta, Vancouver and many more. However, we should not copy and paste one programme and expect it to work here. We must come up with our own plan, inspired and influenced by other policies and the latest data. In our submission to the committee, we outline a number of recommendations, taking into consideration what has worked in other areas, what has not worked in other areas and what we hear from those who consume drugs and support services.
We propose that Ireland needs a clear, cohesive multi-year plan that outlines exactly how we are going to reduce drug-related harms.
We need to know where we are going to allocate funds, not only to services but to education as well. Relevant Ministers should show steadfast dedication in diverting the direction of drug policy, not least by meeting with foreign partners and putting together a working policy and updating it in order to ensure it meets current needs. Our future drug policy should also be centralised around a set of core pillars, similar to what is being done in Vancouver and Switzerland. Harm reduction must be central to these pillars.
We also propose a rethinking of how we treat cannabis possession in Ireland. Not only does personal possession of this drug account for the majority of drug-related court cases, costing the State much in funds and also ruining future opportunities for many people, but we have also seen alarming trends in counterfeit cannabis that has extreme adverse health impacts. Regulation is absolutely necessary.
We need engagement across the country that will target areas hit by addiction while being flexible enough to adapt to emerging drug trends. We see services in other countries, such as mobile overdose prevention clinics in Portugal, that can access areas in which infrastructure is not yet established. Pragmatic solutions like this are necessary in Ireland. Without a coherent, compassionate and health-led plan involving all stakeholders, Ireland will fail to make any progress in tackling drug-related harms to society and users.
We acknowledge in our submission the different kinds of drug use and how policy should approach them. We can tackle the alarmingly high rates of addiction in this country. It has been done elsewhere, but we cannot do it without a plan. Our submission provides overviews and analyses of Ireland and the wider world, offers some concrete solutions and raises issues often not covered by the mainstream focus. We hope the committee will consider what we have contributed with due care and will continue to engage with stakeholders on the ground in Ireland and across the world.
James Lawless (Kildare North, Fianna Fail)
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I call Dr. McGovern.
Dr. Garrett McGovern:
I thank the committee for giving me the opportunity to present my thoughts on this important issue. I have worked as a doctor in addiction treatment for almost 25 years. In many ways, I started at the deep end in treating heroin addiction. This was at a time when the methadone treatment protocol was implemented, which helped people address their addiction. What struck me in those days was that almost all the people I encountered were in the criminal justice system for possession of drugs charges, many of them over many years. Looking back to those early naive days as a doctor cutting his teeth in an area where there was little or no training, I would be lying if I said I thought anything of it at the time. I did not. I just accepted it. People committed the crime and people did the time.
As the years progressed and I became more experienced and picked up qualifications through training, it began to dawn on me that I was treating a recognised illness, drug addiction, and yet the patients I was treating had to break the law to keep that addiction going. Thankfully, opioid substitution treatment, with a stellar international evidence base of effectiveness, is able to treat the problem and remove opioid withdrawal symptoms and craving so the need to use large amounts of heroin is significantly reduced. Without treatment, the problem is usually overwhelming and causes huge harm to sufferers, their families and their communities. Why, in these circumstances, do we criminalise the very same people for showing symptoms of their disease?
I also encounter people in my work who do not have an addiction as such but who may have been referred to me or been required as part of a court order to seek help for possession of what are usually small amounts of cannabis, cocaine or sometimes other drugs. They are irregular users but because of the illegality of the drugs they use, they find themselves facing conviction and a criminal record for an endeavour they would see as no more abnormal than going out to have a few drinks with their friends. The implications of a criminal conviction can be severe. Stigma, shame and potential restrictions on travelling abroad are real concerns. To put one person through the criminal justice system for simple possession is costly in human and financial terms and yet the international evidence base shows it has little or no effect on the likelihood of that person using drugs again.
We need a fresh approach to this problem and one rooted in evidence rather than moral ideology. We know from the experience in Portugal, where drugs were decriminalised in 2001 and a health-led system replaced a punitive one, that the country reversed its trends in overdose and HIV transmission prevalence. Presenting for treatment for an addiction problem was no longer stigmatising. It was normal. While Ireland currently has no plans to regulate illicit drugs, it is worth noting that in countries that have taken this approach, with cannabis, for example, the sky has not fallen in. In Ireland, people who use cannabis, many now for medical as well as recreational reasons, are criminalised for possession for personal use. Many have had to go abroad to be able to access cannabis for chronic medical conditions. This is inhumane and just plain wrong.
During the presentation of these statements, the committee will doubtlessly hear about how harmful cannabis is, that the drug causes psychosis and other mental health problems and that people who use it should be prosecuted and criminalised because that will be better for them. I treat cannabis problems, and while the majority of cannabis users use the drug without many problems, a significant minority develop consequences of addiction, including mental health problems. We must remember these problems are occurring in a paradigm of prohibition and criminalisation, so none of them can be blamed on a legalised, regulated system. We do not have one in Ireland.
Whatever views people may have on legalising cannabis, there is no justification for criminalising people who use the drug. I urge the committee not to be swayed by arguments contending that criminalising people is good for them because it acts as a deterrent for further drug use. There is no evidence internationally that this is the case. As Abraham Lincoln once said:
Prohibition goes beyond the bounds of reason in that it attempts to control a man's appetite by legislation and makes a crime out of things that are not crimes. A prohibition law strikes a blow at the very principles upon which our government was founded.
Many years later, another US President, Jimmy Carter, remarked - and this is particularly relevant to today’s debate - “penalties against possession of a drug should not be more damaging to an individual than the use of the drug itself”. I thank the committee for giving me the opportunity to speak.
James Lawless (Kildare North, Fianna Fail)
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I thank Dr. McGovern. That was very interesting. I call Professor Bobby Smyth.
Professor Bobby Smyth:
I thank the committee for the opportunity to contribute. The Cannabis Risk Alliance, CRA, constitutes an informal group of doctors from a wide range of specialties who are concerned about the substantial increase in cannabis-related harms evident in Ireland over the past decade. We have no funding and no employees. I am a child and adolescent psychiatrist working in this area and my colleague, Dr. Hugh Gallagher, is a GP specialising in addiction medicine. As doctors, we strongly support a health-led approach to cannabis and wider drug policy. Laws and sanctions are used across many areas of public health to nudge the behaviour of citizens away from risky behaviours and towards healthier ones. We recognise that the criminal justice system often plays a role in achieving positive outcomes in areas of public health, including in efforts undertaken to curtail mortality and injury related to road traffic collisions and, most recently, during the Covid-19 pandemic. In our view, criminal justice and health are not opponents. Consequently, there is no inherent contradiction in there being criminal justice input into our health-led drug policy.
There is evidence from Irish and international research that young people factor the risks of criminal justice sanctions into their decisions regarding drug use. In an Irish study of third level students published this year, almost half of those who reported abstinence cited such concerns about criminal sanctions as being one of the many reasons behind their personal decision not to use drugs. The public health risk arising from a reduction in sanctions is that we reduce the deterrent effect provided by the current system. We believe there is a real risk that a reduction in sanctions could cause use and associated health harms to escalate. The weight of evidence from national and international research indicates that sanctions have a small but important effect. Please bear in mind that small effects across large populations are clinically important.
The Department of Health working group on this topic recommended in its 2019 report that there should be a tiered response when people are found to be in possession of drugs by members of An Garda Síochána, commencing with a health referral. When this topic is discussed in any forum, Portugal is usually brought up for mention as a model. However, Portuguese drug policies are generally poorly understood. Contrary to what most people believe, drug use is still prohibited in Portugal. In 2001, Portugal moved to use administrative responses when people are found in possession of drugs for personal use. What gets ignored are the profound changes that were made to the country's addiction treatment system in the two to three years prior to that change. A move was made from a treatment model which demanded abstinence to one focused on harm reduction and that sought to provide wrap-around social supports to people in addiction treatment.
Across this range of policy changes, which included the modification of the treatment model, there were improvements in a number of measures relating to drug-related harm. However, not all trends have been good in Portugal. Adolescent cannabis use has approximately doubled. Portugal now has the second highest prevalence of daily cannabis use among adults in Europe according to a recent report. Rates of psychiatric admissions due to psychosis associated with cannabis increased almost thirtyfold and rates of treatment entry for cannabis dependence compare unfavourably with those here in Ireland.
When drug policy is discussed in Ireland, we tend to completely overlook our own successes. Like Portugal and most of Europe, we altered our treatment response in the mid- to late 1990s. This yielded a 95% decline in adolescent heroin addiction and huge falls in cases of HIV and hepatitis C among people who inject drugs. Those falls have been of the order of 75% to 90% over the past 20 years. My adolescent addiction service actually shut down the specialist heroin treatment service four years ago because it was no longer needed. These notable achievements have occurred without any significant legislative change.
As doctors concerned about drug-related harm, which, of course, includes harm to others, we recognise that the criminal justice system can have a role in deterring drug use. We see it used frequently in other areas of public health. There is a significant risk in reducing this deterrent effect. In the absence of any concrete specific proposed alternative, however, it is difficult to give a firm opinion as to whether we should move to an alternative regime of administrative sanctions. A lesser sanction that is more consistently enforced could, in theory, have a similar deterrent effect. With regard to the sanctions currently available to the courts, we view the option of imprisonment for personal drug use to be excessive and unreasonable.
James Lawless (Kildare North, Fianna Fail)
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I thank Professor Smyth. I call Mr. Condon, who has three minutes to outline his views to the committee.
Mr. Martin Condon:
I thank the committee for giving us the opportunity to speak as witnesses on this important topic. I am here today as one of the directors of Patients for Safe Access. We are a group made up of patients and cannabis experts. We are dedicated to ensuring safe and legal access to cannabis for therapeutic use, research, protecting the rights of medical cannabis patients and ensuring that patients and medical professionals have access to up-to-date scientific evidence.
I am also here as an epilepsy patient who has no other choice but to rely on the black market to access cannabis to treat my condition. This is solely due to an overly restrictive medicinal cannabis access programme, MCAP, leaving me with no option in treating my condition. Due to this, I am labelled a criminal by our society and our justice system. I have a number of criminal convictions for my continued use of cannabis. As a result, I was denied a travel visa to travel to the US where I would have had the opportunity to represent Cork Institute of Technology as part of the students for sensible drug policy society. While there, I was to take part in the 2016 United Nations General Assembly Special Session on Drugs, which was taking place in New York city. I was robbed of this opportunity to learn and grow as a campaigner and to network with world leaders on this issue of drug use. I wish I could say that this was the worst thing that happened to me as a result of cannabis prohibition but it was not. I was unfortunate enough to get an all-expenses-paid stay at the five-star Cork prison at a time when prisoners still had to relieve themselves in a pot in their cells. They would then have to empty those pots the next morning when the cell doors were opened. I had to lie to my daughter, who was only five years old when this happened, about where I was because at that time she knew prison as a place for bad people.
When cannabis was made illegal in Ireland, this was done with good intentions. The latter were much like the good intentions of those who also made condoms illegal and prohibited same-sex relationships. Much has changed since then. Condoms are available throughout society and same-sex relationships are no longer prohibited. We see now that these prohibitions were wrong. They caused much more harm in society and needlessly made criminals out of people who otherwise would have never committed a crime. They say one of the reasons cannabis is illegal is due to its affect on a person's mental health. With that in mind, I ask the committee to consider what affect taking a father away from his young family is going to have, not only on that individual but also on his loved ones and friends. I also ask whether the harms of carrying a criminal conviction and of having been incarcerated outweigh the harms of cannabis.
When brought before the courts, I could never apologise for my use of cannabis because my use of cannabis was beneficial to me. By speaking on my own behalf in court while representing myself for personal possession of cannabis, I hoped that the judge would see I was not a criminal. Sadly, that did not prove to be the case. I wish this was an isolated incident but it was not. We have seen many cases in Ireland where patients are criminalised for self-medicating with cannabis. In one case in West Cork, a patient suffering with chronic pain was criminalised for being in possession of €4 worth of cannabis. This man had his name and address printed in the media, which added more undue stress to his life. What happened did not just impact on his life, it also had an impact on the lives of his family and friends. We have patients who feared being criminalised but could not go without access to cannabis to treat their condition, forced to pack their bags and leave our shores to become medical cannabis refugees in other countries.
I have listed a number of patients in my statement, but I will shorten it because I am aware that I am out of time. Alicia Maher, who is also another director of Patients for Safe Access, suffers with long-term chronic pain as a result of complications from a series of surgeries she had as a teenager. Alicia said cannabis has helped when other pain medications were failing. She had to pack her bags and leave our shores and, as a result, is another of Ireland's medical cannabis refugees. Alicia left Ireland in November 2019 and moved to Alicante, Spain. She received a ministerial licence in May 2020 but because the medicine would not be reimbursed under the medicinal cannabis access programme, she had to stay in Spain. Also, the products available under the MCAP were not sufficient to treat her condition.
There is no reason to criminalise people using or growing cannabis to treat their conditions, and there is certainly no reason to prevent access to cannabis for research and medical use. Cannabis needs to be removed from the misuse of drugs Act and regulated in a similar way to alcohol and tobacco. Patients who need cannabis for health reasons should be given access to cannabis in a safe, quality assured way in the same manner in which they have access to other prescribed medicines. I will finish with a quote from our now Minister for Health, Deputy Stephen Donnelly: "If a grown adult wants to grow a herb and then smoke it, and there are no negative consequences for other people, then they should be allowed to do that."
I again thank the committee for hearing us on this important issue. We hope our contributions here today will help in some way to further break down the barriers preventing access to cannabis as a medicine and the needless criminalisation of people in Ireland.
James Lawless (Kildare North, Fianna Fail)
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I thank Mr. Condon and welcome Dr. Capaz. I thank him for joining us. Dr. Capaz has three minutes to make his opening remarks.
Dr. Nuno Capaz:
I am a sociologist and I work at the Dissuasion Commission of Lisboa. The Dissuasion Commissions are the administrative authorities that were created in 2001 to deal with the procedures regarding the possession of illicit substances for personal usage. In 2001, Portugal decriminalised the possession of illicit substances for personal usage as a part of very comprehensive change in our drug policy. The basic goal was to deal with drug-related issues as a healthcare problem and steer away from the criminal and judicial system. The drug policy change was based on the four-pillar approach and the Dissuasion Commissions were the law enforcement pillar.
Decriminalising drug usage for us meant we downgraded the possession of up to ten days’ use from a criminal offence to an administrative offence. In our legal framework nowadays being caught with a small amount of any illicit substance is very similar to being caught driving without the seat belt on or talking on the mobile phone while driving. It is illegal but is not considered a criminal offence and therefore there is no need to activate the criminal or judicial system. The Dissuasion Commissions were created under the ministry of health and they work as a diversion scheme. When a drug user is caught in possession of illicit substances for personal usage, he is notified to present himself in a structure under the remit of the Ministry of Health, which, after conducting a risk assessment screening, will determine if there will be any administrative sanctions applied or if any sort of suggestion of referral will be made.
James Lawless (Kildare North, Fianna Fail)
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I thank Dr. Capaz. He is the first to come in under his time. He will have plenty of opportunities to engage as the meeting goes on. Next we will go around the table and take members of the committee with questions and points to share. I call Senator Ward. He will be followed by Senator Ruane.
Barry Ward (Fine Gael)
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I am actually very sympathetic to much of what has been said here. As somebody who works in the criminal justice system, primarily as a criminal defence barrister, I come across people in different categories in regard to drugs offences. Obviously, we are talking about people in a particular category, namely, possession for personal use. I am extremely alive to what has been said about the criminalisation of individuals who make a personal choice, be that for their own personal enjoyment of for the reasons that have been outlined by Patients for Safe Access either. I understand entirely what has been said in that regard.
We are losing the war on drugs. Not only that, it has become a war of attrition. If we think about the amount of money we spend fighting the kind of cases the witnesses are talking about and what could be done with that money, even if never left the criminal justice system and was reinvested in An Garda Síochána, in particular in diversion programmes or programmes to deal with crime in other areas outside of drugs, we would do a huge service to the country.
That said, it is not that simple. One of the major problems I have with a policy that involves blanket decriminalisation of cannabis or a larger spectrum of drugs is that at the moment they are bound up with criminal organisations. There is an inextricable link between the organised crime that is providing the drugs and the drugs themselves. It is not the case that when a patient, for legitimate reasons, decides to obtain drugs that there are not victims as a result of that. That is the difficulty I have.
Other people will make the argument about the slippery slope and all of the rest. Leaving that aside, can the witnesses tell us how the logistics of this would work? Let us consider what would happen if we said in the morning that cannabis for personal use is okay. Who would provide it thereafter? Who would profit from that? We could put a place a regulatory regime; I would have no difficulty with that. More importantly, what we do to prevent a situation where the country becomes a de factosource for the international trafficking of drugs?
James Lawless (Kildare North, Fianna Fail)
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Was that addressed to any particular witness?
Barry Ward (Fine Gael)
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Mr. Condon seems anxious to answer.
Mr. Martin Condon:
Let us take the money out of it. Malta has a very good model whereby it allows a co-operative type model to be set up. A local community can come together and grow cannabis for people in the community who need it. That takes the money out of organised crime groups. There will be very little market left over once patients such as myself no longer have to rely on them.
Barry Ward (Fine Gael)
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Would Mr. Condon propose that it only be available to patients or would he have it widely available through that model?
Barry Ward (Fine Gael)
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That gives rise to another difficulty. I do not think anybody is suggesting that cannabis or any other drugs are good for people. The argument is that the consequences of cannabis use are worse for people than the damage the drug does to society or individuals. Do we really want to promote a situation whereby the State is sponsoring the distribution of a substance we know is not good for people? I am sure the witnesses could give me a list of other products that are equally damaging. Alcohol is the obvious example. Even products containing sugar can be dangerous.
Barry Ward (Fine Gael)
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Do any of the other witnesses agree with that?
Dr. Garrett McGovern:
There are two separate pieces. The debate today is about decriminalisation. We are not talking about legalisation. I would be in favour of looking at the regulation of all drugs. It is not going to happen in my lifetime. It will happen at some stage, but I do not know when. I take the Senator's point.
There is a suggestion from what he is saying that in order to have one thing we have to have the other. I do not think that is the case. There were almost 16,000 convictions relating to drugs last year. Some 69% of the total number related to personal possession, as well as the distribution and sale of drugs. We have to ask, for what? It does not stop people in possession of drugs from using them. There is no evidence anywhere that having criminal sanctions stops people using drugs or reduces their prevalence. We need to separate the two issues. They are, of course, related, but in 2022 there are no grounds whatsoever to criminalise people who use drugs for their own personal enjoyment or develop problems. That is, arguably, even worse.
Barry Ward (Fine Gael)
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I do not disagree that they are two separate issues. As Dr. McGovern said, they are related. If we decide to decriminalise the personal use of cannabis, for example, the reality is that people who are using it for personal reasons will obtain it from people who grow it in contravention of the law, operate outside of the law and are, invariably, but not exclusively, involved in illegal organised criminalised activity. This is the one difficulty I have. Are we not, therefore, creating a market for criminal gangs to sell their product? Is that not an unintended or unfortunate consequence of the policy of decriminalisation?
Dr. Garrett McGovern:
I do not think so because I do not think it has any impact on the prevalence of those people using drugs. Whether illegal or legal and regulated, people will still use drugs. The debate here has been a little dominated by cannabis, but we cannot forget other drugs. Drug problems and use is not just down to regulation; there is a whole cultural and socioeconomic aspect to this, which includes social marginalisation and deprivation. It is a complicated issue. I do not think for one minute that if the issue we are discussing was addressed tomorrow that would solve all of our problems. However, it would go some way to show that we are serious about a heath led approach to drug use.
James Lawless (Kildare North, Fianna Fail)
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I will bring in Mr. Minish because he has his hand up to reply. We will then move on to the next member.
Mr. Brendan Minish:
I want to reply to the Senator. The suggestion we have made around cannabis is that small-scale personal production of plant-based drugs should be tolerated. In a decriminalised world, if we are not moving towards a legal regulated market, the model could allow the establishment of social clubs like what has happened in Spain. While there is some criminality hanging around that, the State should be most concerned with the most violent and organised crime. We have to realise that we have created and handed criminals the entire market it by keeping the substances illegal. It will take time to replace that with something else. Right now, punishing users is a wrong way to go after organised crime. We should be working in a top down, rather than a bottom up, manner. At the moment, a lot of criminal cases are simple possession cases which is a travesty.
James Lawless (Kildare North, Fianna Fail)
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Did Mr. Minish use the phrase "plant based"?
Mr. Brendan Minish:
Yes. In our submission we used the term "plant-based drugs" because this is about decriminalising the personal possession of drugs and there are other plant based drugs that people are consuming. We want, where possible, for people to come out of the black market because it is causing a great deal of harm to society, more so, in many cases, than the substances themselves.
James Lawless (Kildare North, Fianna Fail)
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In order that we are all on the same page, how does Mr. Minish define plant-based drugs?
Mr. Brendan Minish:
I do not know if there is a clear definition, but mushrooms are used quite a lot recreationally and therapeutically. Some people use opiates and might wish to grow poppies and make tea. I do not know. My point is that it something is derived from a plant it seems slightly at odds to keep it illegal if we are allowing personal possession. We are not dealing with the source. We want to try to connect people with the source without the criminal element. If people can produce drugs themselves individually or as a collective, that allows them to step out of the wider criminality that has taken over all of the markets.
James Lawless (Kildare North, Fianna Fail)
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I thought intuitively that might be what you meant. I can see that cannabis herb and mushrooms are plant based. Opiates are plant-based, but they are processed. Where would you draw a line in terms of that distinction? Are you referring to things which can be sourced in a relatively pure form, as opposed to things that have a chemical element or are processed?
Mr. Brendan Minish:
That is not our area of expertise, but it needs to be looked at and considered. Historically, people boiled poppy heads to produce weak opium teas and so on. They might be less harmful forms of the substance than injectable forms and might help people find some sort of middle ground. Again, our area of expertise is cannabis and that is what we spent most of our time looking at.
James Lawless (Kildare North, Fianna Fail)
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With things like peyote and mescaline, people use all sorts of different native substances.
James Lawless (Kildare North, Fianna Fail)
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We will move on to the next round. The next member to speak is Senator Ruane. As with the last round, she will have seven minutes, which includes questions and answers.
Lynn Ruane (Independent)
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I thank the witnesses for their contributions. Although I agree with most of them, we are definitely on different sides of the debate and have been for a long time. I want to recognise their contributions. They are in a minority today. I will try to be kind.
I do not misunderstand, in any shape or form, the Portuguese model or many other models. However, I have concerns about some of the submission relating to the Portuguese model.
Rather than using up my time by going through the submission word by word, it might be more beneficial for me to engage directly with the witnesses at another stage about how particular research pieces are not in context, as I would understand or read it. It would probably be too pedantic for me to do so in this session today.
I will give an example of what I am talking about. When drug policy is discussed in Ireland, we tend to completely overlook our own successes and then we talk about opioids and the reduction in heroin use. That is not because of legislation. It is also wrapped up in drug trends and how drug use evolves and changes when different drugs come on the market and certain drugs become much more prevalent. I do not think there is a relationship, in any sense or form, between the two.
Many people of the late 1980s and 1990s who were my friends and community are dead. We talk about the success of heroin use changing but many people are dead, in prison or sitting at home at the age of 40, 50 or 60 because they cannot engage in employment. It is not Ireland's success because those people are still there. We do not have enough information about its being a success because they are not hindered by the convictions that they would have had been handed down while they were drug users. Some of that stuff, which is not really related to prohibition working in any sense or form, or to harm reduction fully working, needs to be teased out. I am uncomfortable with some references to success. I do not know if we would frame a reduction in heroin as a success, because people whose lives were affected are still very much struggling.
We need to be careful on the committee, because there are three conversations going and I am sure it is quite confusing. We are discussing the ideas of medicinal cannabis, legalisation and decriminalisation. We also have another conversation, on which we all agree, in that sometimes problematic drug use is harmful. I was a problematic drug user. I frame myself as a drug user now, not a problem drug user. I have developed drug services and now I work in the legislative framework. I have had many journeys through this discussion. I am very aware that there are three or four conversations happening now that are probably a bit confusing. We might need to have further committees to separate those conversations out. I do not think anyone disagrees that we need to have people working with problem drug use. We just do not feel that they need to be in a courthouse or in prison.
I have a question for Dr. Capaz. I do not know whether it is because of language, but people seem to be much more open when we talk about diversion. When we mention decriminalisation, however, people seem to feel that somebody is getting off with something or that the justice system will disappear. Is there a difference between a dissuasion service and decriminalisation? Are they effectively the same?
Dr. Nuno Capaz:
In our case, they are the same. The dissuasion commission is the administrative authority that we created because it is still illegal to have any illicit substance in one's possession in Portugal. Therefore, there are consequences. A procedure is opened when the police officer apprehends someone with a substance. The difference is that it is not a criminal procedure. It is an administrative offence procedure. People are referred to dissuasion commissions. That is the sense in which I have mentioned the diversion scheme. Instead of sending people to court, we are sending them to a structure under the ministry of health.
Lynn Ruane (Independent)
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Brilliant. I would like to clarify Professor Smyth's statement in his contribution that "drug use is still prohibited in Portugal". I can be corrected on my understanding here. Maybe Professor Smyth is right. Drugs possession is not prohibited. The substance is prohibited. Is that not the differentiation between the two? The substance is prohibited and is still illegal, but the possession of it for personal use is not, which means that drug use falls into the non-criminal category as long as it is within the prescribed ten-day amount.
Lynn Ruane (Independent)
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Great. Portugal has had its model for 20 years. If that model was to be revisited now, 20 years on, as part of an examination of what Portugal has or has not done or what it could do better, would Dr. Capaz have any updated references to how it would do decriminalisation now? If it was looking at it again, what would it do? Twenty years is a long time for the framework to be in place.
Dr. Nuno Capaz:
The main difference would be the treatment that we gave cannabis. We put cannabis on the list of all the other illicit substances because, back then, the only condition that the government put on the group of experts that looked into the drug policy change that we were going for was that we should be inside the UN conventions that we signed. Therefore, there was no talk about regulating cannabis. Twenty years afterwards, that argument would be slightly different, not least because some countries decided not to follow the UN conventions and it was not a big deal.
Lynn Ruane (Independent)
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Portugal would decriminalise all substances, as is, but regulate cannabis.
Lynn Ruane (Independent)
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Has the Portuguese model been effective in addressing problematic drug use?
Dr. Nuno Capaz:
Yes. It did not solve the problem, but it helped to manage it. The question about drug policy and criminalisation is that criminalising a substance is based on the principle that the problem is the substance. The substance is the chemical thing. Addiction is not the chemical thing. It is as simple as that. Therefore, there is no point in criminalising a chemical substance, because it will not stop people from using it.
Lynn Ruane (Independent)
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Thank you. That is very clear.
James Lawless (Kildare North, Fianna Fail)
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Dr. Capaz mentioned that addiction is not chemical. Does he see addiction as psychological?
Dr. Nuno Capaz:
Addiction is not just psychological. There are many factors. It is economic, social and psychological. It is also chemical. It is not just because one criminalises a substance that addiction will go away. Otherwise we would not be here and the prohibitionist system would have been working for the past 100 years. I guess we all agree that it is not working. That is why we are all sitting here discussing this.
Pa Daly (Kerry, Sinn Fein)
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Over the years, I have seen considerable stigma attached to many offences, particularly in relation to cannabis. I have seen people criminalised or even brought to court. One does not necessarily even have to have a conviction. If one is going to the United States, the question on the form was always about whether one was ever charged with an offence, rather than whether one ended up with a conviction. It led to loss of opportunity with regard to emigration and employment, consequences that were far in excess of what was done by a young man, usually, who was taking a substance and doing no harm no anybody else apart from himself.
Some changes were made over the years. The adult caution system came in. Close to the last minute, the possession of cannabis was removed from the list. A local garda superintendent who was dealing with one of a group of lads who might have taken responsibility for some cannabis that was in between the seats of a car, even though he might not have had any more responsibility than anybody else, might have felt that it was a once-off. However, there was no discretion, even for a local superintendent in a rural area, not to charge that person. There is a lot of fundamental unfairness in that system. At the same time, one sees people who are taking cocaine, in particular. They are enriching the Kinahans by buying cocaine. That has considerable consequences if one is balancing up the common good of society in general.
I have a question for Dr. Capaz. I am trying to figure out how the system works over there. Who decides whether it constitutes possession or supply? Does the tetrahydrocannabinol, THC, content come into it? There has been concern over the past 20 years that THC levels have risen and that more harm is being done to young men whose brains are still physically developing into their 20s. The concern is that they are, in effect, getting brain damage.
I also have a question for Mr. Condon and Mr. Tynan about their proposals. It has been suggested that small amounts should be decriminalised, as opposed to the stuff coming into the market in larger amounts. Do they think all drugs should be decriminalised? At what level do they think it should become a criminal offence? Those are my two questions.
Dr. Nuno Capaz:
On the first part, we have a threshold chart that quantifies what is considered to be ten days' usage for every illicit substance. We have a chart that quantifies what a personal dose is for every substance. Then we multiply this by ten and if a person has more than that, it might be considered a criminal offence and they will be referred to a court of law. If a person is below that limit, they will be sent to the dissuasion commission as an administrative offence. The police officers also have to cross-check with other indicators such as if there is any surveillance material, if it is a trafficking situation, if the substance is divided into individual doses or if the person also has a lot of money in their possession. The threshold chart determines where the police send the paperwork in the beginning and then either the courts or the dissuasion commission determines, after talking to the person, if it a personal use situation or a supply situation. If it is a supply situation, it is always a criminal offence regardless of the amount of substance. If it is a supply situation, the court keeps in mind the active principle contained in the substance to determine and fine-tune the individual doses of that substance and it can refer the procedure to us even though the person had more than ten days' usage. The threshold chart is basically there to remove the discretionary power from the police officer on the street.
Dr. Nuno Capaz:
It is exactly like driving under the influence of alcohol. I am 1.94 m tall. If I am asked to walk a straight line, I will probably not be able to do it even when totally sober. My feet are too far away from my brain. If a person is a gymnast, they could be completely drunk and would not fail that straight line test. That is why a breathalyser is used and the straight line test or the touching the nose exercise and things like that are no longer used.
Pa Daly (Kerry, Sinn Fein)
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Okay. I thank Dr. Capaz.
Pa Daly (Kerry, Sinn Fein)
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I had a question on whether the THC content comes into it. I think Dr. Capaz has answered that sufficiently in what he said.
Mr. Martin Condon:
From a patient's perspective, a patient should be able to get access to cannabis through their health professionals. When it comes to how much cannabis a patient should be allowed, that should be decided between the patient and their doctor. It is common practice that a patient would normally have a month's worth of their prescription on hand in order to do whatever it is that needs to get done within that month.
We were talking about wider adult use of cannabis. I do not see why there is a need for arbitrary limits, which is what they are at the end of the day - just arbitrary limits. When it comes to things like alcohol and tobacco in society, if a person goes down to the shop, they can buy as much alcohol or tobacco as they like. It is not until we see that there is an intention there, or that they are breaking a law in terms of illegally selling that afterwards, that they become a target of the authorities. Cannabis should be treated differently. A person should be allowed to have as much cannabis as they would like to have at home, and as many cannabis plants as they would like to have at home. The onus should be on the authorities to prove lawbreaking. Simply having a huge amount of cannabis is not proof they were going to sell it afterwards and thus break the law. When we talk about other drugs, personally I have no problem with the wider decriminalisation of all drugs. I am not talking for Patients for Safe Access when I say that. Arbitrary limits are only going to put pressure on people on the street. They will not do much to tackle the problem of drug dealing. We need a proper and safe supply of drugs to people who use drugs. In such circumstances, the worry of drug dealers will go away. If you can get safe access to your drug of choice through whatever regulated means that may be, you do not have to support drug dealers afterwards. There should not be arbitrary limits on the amount in your possession. The focus should be on the point of supply and the safety of that supply of the drug as well.
James Lawless (Kildare North, Fianna Fail)
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Thank you. I want to give an indication to the members of the running order. We are going to take Deputy Martin Kenny in a moment, followed by Deputy Costello and then Deputy Gino Kenny. We might have a second round then as needed.
Martin Kenny (Sligo-Leitrim, Sinn Fein)
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I thank all the witnesses. I have a couple of small points to make because some of my questions have already been asked. It seems to me that the old adage about the war on drugs not working is very true. That war has generally been on the supply side. We have always been trying to stop supply, find the people who are supplying it, find the dealers and cut them out. We need to look more at the demand side - why society continues to have a demand for all of these substances - and deal with that. This means looking at it more from a medical and addiction perspective. That is what the general consensus is around the table. That said, the big anomaly that always comes up seems to be when the person who is in possession of drugs for their own use is also the same person who has possession of drugs to supply. That is an issue. That crossover will happen, particularly when we have people who unfortunately have an addiction problem and in order to pay for that problem are going to sell drugs to others who have an addiction problem. What methodology is in place, particularly in Portugal, to deal with that particular issue? Is it that the supply of the drugs is coming from a different source which is not the illegal source but one that is regulated and is in place and provided for through some mechanism of the State or with the sanction of the State? I would like to get clarity around that.
Dr. Nuno Capaz:
We do not have any sort of safe supply of any illicit drugs. We just decriminalised the possession. We did not mess in any way with the supply side of the chain. If people want to use illicit drugs, they still have to go to the black market. As to the usage and supply situations, normally what happens is that this is very complicated to prove in court because very tiny amounts of substance and of money are involved. Therefore there is no proof to be collected by the police officers. We also noticed from daily practice in Portugal that those situations normally go away if the usage part is dealt with. If we can get a user who is also supplying into a treatment programme, they will automatically stop supplying because they will not need money to support their own supply. What happens is that the court knows it will not be able to convict a person because the user's supply is basically a friendship thing. It is someone who lives outside the big cities but has a car and so is able to drive to the main city to buy substance and take it back to his own town for a couple of friends. It is not really supply. It is basically the same thing as someone buying a little bit of cannabis and sharing it with a couple of friends. Is that supply? Theoretically and under the law, it is supply. They are handing out a substance for another person to use but are not getting rich out of it so it is not a dealing situation as we normally perceive it in court. The answer to the question is "No". We do not have safe supply in Portugal.
Martin Kenny (Sligo-Leitrim, Sinn Fein)
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Does Dr. Capaz understand the dilemma that this presents from the point of view of getting this situation to work in a way that means the State does not become an advocate for the illegal supply of drugs?
Dr. Nuno Capaz:
I understand but if you bear in mind that we are talking about people who use drugs and not about the drugs themselves, each situation contains a dilemma. Everyone has different reasons, backgrounds and motivations to use a drug although the drug might be the same.
The reason that this change in policy worked for us was because we decided to change it from the criminal system to the healthcare system. Naturally, that means the criminal system focuses on the substance, the drug, and the healthcare system focuses on the person, not the substance, and therefore we are able to apply the law differently to everyone. It is the small supply or the user's supply. Every case is the case. There is not going to be a rule that will solve everyone's problem. Dealing with it as a healthcare issue allows us at least to assess the situation by itself and according to the person.
Martin Kenny (Sligo-Leitrim, Sinn Fein)
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I thank Dr. Capaz. That is useful. I would like to hear the views of the other contributors on that issue. As has been said, we use a lot of other drugs in our society all the time. Tobacco has been mentioned. Alcohol probably causes more harm in Irish society than most things because we have huge issues with it. However, we regulate it. We know the strength of the bottle of whiskey or the can of beer. There is a regulated system in place which ensures that people are not going to be poisoned, although many would say that any of it is poison. Is there a value in having a regulatory process in place? What are our guests' views on that?
Professor Bobby Smyth:
My response to that would refer back to alcohol. We regulate alcohol and the quantity of alcohol is stated on the bottle. The Deputy appears to be questioning whether we could do the same for drugs as if that system is working or is associated with low rates of harm. Alcohol kills more people each year than all illegal drugs combined. In the national drug-related deaths index and the drug poisoning data, the substance that tops the list in those deaths is alcohol. That should remind us that simply legalising and regulating access to a substance certainly does not eliminate harms. It suggests to me that one does not even reduce them and may actually increase them. As one normalises the behaviour one massively increases the pool of the population who use that substance, as is the case with alcohol. Some 80% of Irish adults use alcohol whereas only 8% in any given year will use any of the illegal substances.
The Deputy used the term "war on drugs". That is an unfair characterisation of Ireland's drug policy over the last couple of decades. Drug policy is now led by the Department of Health. To say it is waging a war on drugs is unfair. It is a reference that people who support drug legalisation regularly use. It is a smear on European drug policy and relates, obviously, to the policies adopted in the United States half a century ago. It is not really relevant to the modern discourse, which is health-led.
James Lawless (Kildare North, Fianna Fail)
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That concludes the Deputy's time slot, but Mr. Minish wanted to speak before we move on to the next member.
Mr. Brendan Minish:
Yes, I want to comment on what Professor Smyth said. The drug use in higher education in Ireland, DUHEI, study that he cited in his introduction that showed some deterrent effect also showed that over half of our third level students have used drugs, and 37% within the last year. I believe the figure of 8% is an old figure. This follows more of a European trend and what we need to do is regulate around the harms. There must be safe supply and we need to cross this bridge, particularly with some of the more addictive substances. It will be a difficult conversation, but we had safe supply back in history when these compounds were supplied through pharmacies.
Professor Bobby Smyth:
When I said 8%, that is drawn from the general population survey which includes the entire population age range. Obviously the sector of the population most likely to report drug use in the past year is adults and older teenagers. Hence the figure in the third level survey that was quoted is higher than the proportion-----
Lynn Ruane (Independent)
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One could ask every politician in these Houses if they have used drugs and they would lie because of the stigma and prohibition. If we were to remove prohibition, we would see an increase in the figure because people will not feel they need to lie because they feel like criminals. Half of the Members of the Houses probably use drugs, but they are not going to say it.
James Lawless (Kildare North, Fianna Fail)
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Senator, you will have your chance when we do the next round.
Lynn Ruane (Independent)
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No, that is not what he is saying.
James Lawless (Kildare North, Fianna Fail)
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I will move on to the next speaker. I see people shaking their heads. That is part of the process here. We have a debate and people express their opinions. They are entitled to do so. Other people may have different opinions and are equally entitled to express them. Deputy Costello has the floor.
Patrick Costello (Dublin South Central, Green Party)
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Picking up on the themes from Deputy Martin Kenny and Senator Ruane, there are many different things here that are being mushed together, but there are separate conversations and separate streams here. On Deputy Martin Kenny's point about demand reduction, yes we had partial successes perhaps in the mid to late 1990s, as Senator Ruane mentioned, but much of that was driven by the Rabbitte report and by a concentrated effort to reduce demand for drugs. That involved a great deal of investment in communities and community development and tackling poverty, with the Combat Poverty Agency and the like. All these things have since fallen away. There are incredibly important things we should be doing. However, they are separate from the question of criminalisation. Demand reduction is essential and I would like to hear what Portugal is doing about that, but we will come back to that piece.
The question is whether criminalisation is causing more harm or whether it is causing a benefit. One of the things I look at is the huge number of drug deaths in this country compared to other European countries. We were a lot slower in rolling out naloxone in this country, partly because of the stigma and illegality. We have talked about the social impacts and the impact of criminalisation on supply for medical use. I would like to hear from Dr. McGovern and Professor Smyth about the impact of the stigma of criminalisation on things such as naloxone and access to treatment. I would also like to hear what Portugal is doing about demand reduction.
One of the questions from several members of the committee is one I echo and relates to the alternative supply routes, and if we have some time at the end we could explore that. Obviously, we do not want to be supporting organised crime. There are many alternative models. We have heard about Malta. I understand Spain has growing collectives and Switzerland allows personal growing. I would like to give some space to hearing about the alternative supply routes that take the criminal out of it and might introduce a healthy amount of VAT into the State coffers.
Will Dr. McGovern and Professor Smyth speak on the negative impacts of criminalisation in respect of access, treatment, naloxone, overdose and the like?
Dr. Garrett McGovern:
First, the stigma associated with heroin use is far greater than that associated with any other drug I can think of. It is slowly being matched by crack cocaine, probably, although not so much with powder cocaine. I work with those people every day, as does Senator Ruane. Many people were afraid to come for treatment back in the day. We did not have opiate substitution treatment services and we did not have naloxone until recently. When talking about stigma, some commentators have called it a form of drug apartheid whereby some drugs are treated differently from others.
I have never known a drug quite like heroin in terms of the way the people who use that drug are talked about by other people, who know very little about the drug and very little about the communities in which those people live. When I started working in the late 1990s there were people who would not come to the clinic because it was in the neighbourhood in which they lived. They asked me if there was another way they could see me because they did not want to come through the front door as many of the people who lived close to them did not know they were using that drug. That is a horrible thing. One is trying to help somebody with a health problem, yet the person is shying away from treatment. Looking at the statistics there are probably almost 12,000 people on opiate substitution treatment. It is climbing a little. There are probably a lot of people, and I have met them, who would not go to a treatment clinic because of the stigma associated with the labelling of that disease.
I will not mention it in this room but we know what all that language is. When we are talking about stigma relating to drug use, we are really talking about stigma relating to specific drugs and that drug is different from other drugs. I would not say it is a developing problem but crack cocaine is a problem in many marginalised communities now. We are late to the table with Naloxone. We could have a whole debate about the way it should be wheeled out. We should take a very low-threshold approach to Naloxone. I am against the idea that it is on prescription and is given by a doctor. I do not think there is any evidence whatsoever that Naloxone is misused. It should be low-threshold because it can save people's lives. It can save them immediately.
Professor Bobby Smyth:
The question was if criminalisation impacts access to treatment. I fully agree with Dr. McGovern when he said people who use heroine are viewed completely differently, from a stigma perspective, from users of other substances. There is a clue in that in terms of the relationship between the illegal status of a drug and the stigma associated with it. All drugs are illegal but people who use cannabis have a very stigmatised attitude towards people who use heroine. Professor Jamie Saris from Maynooth University conducted research where he interviewed people at all levels within the drug use and supply network and what he found was a remarkable degree of stigma held by drug dealers. They are clearly involved in an activity you would imagine should carry more stigma than any in the general population but their view of people who used heroine was phenomenally negative. The stigma tends to be associated with the drug. That is not to do with its illegal status. It is to do with the degree of risk other people see associated with that particular behaviour. There is huge stigma associated with alcohol dependence. Dr. McGovern talked about people being reluctant to access methadone treatment within their own neighbourhood. Dr. Gallagher might talk to the issues of alcohol treatment in adults. People who are alcohol dependent are often reluctant to access treatment in their own area because there is a stigma associated with being addicted and having an addiction. To say stigma is as simple as being linked solely to just the illegal status of a drug is grossly simplistic.
There is a sense that many people who use drugs are at very high risk of convictions. I work with and meet hundreds of young people annually who use drugs and who access our service. I honestly cannot think of the last time I met a young person, under 18 years of age as that is the primary age group I work with, who had a drug possession conviction. I remember someone worried about it years ago but not in recent years. An Garda Síochána seems to have a lot of discretion, certainly for those under 18. At most people get a JLO but generally just a caution.
Patrick Costello (Dublin South Central, Green Party)
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That is more to do with our response to youth offending in general. I would not read significance into that-----
James Lawless (Kildare North, Fianna Fail)
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I thank Deputy Costello and I welcome Deputy Gino Kenny. He has seven minutes to put his questions and comments.
Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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I thank the witnesses for coming today. This is a very worthwhile debate. I want to go back to the future. That future is in the mid-1970s, 45 years ago and relates to the Misuse of Drugs Act. That is where we started. Obviously that law is still prevalent today. That law was introduced to do a number of things: to stop the proliferation of drugs and to give people criminal sanction for possession or the sale of that material. In my opinion, it has done the opposite. It has enriched a certain number of people in society. It has created a black market and criminal gangs, and it has brought chaos to certain communities in Ireland.
Given all of that, one would have to ask whether the laws around drugs are working or whether they are working against people. I say they are working against people. Senator Lynn Ruane, myself and a few others played a football match in Mountjoy Prison last week. It was a really educational experience. I asked the governor how many people were in Mountjoy for drug related offences. He said more than 80%. He said 80% of people are in prison for one form or another of drug related issues. It is obvious the law does not work. Anyone who says the laws around drugs work is part of the problem.
Given that, we have to do something different. I argue we need to do something very different. The HSE and the Government have paid a lot of lip service to a health-led approach. We are talking about the citizens' assembly next year and that is welcome but this has been talked about for decades. Decriminalisation and even regulation are not a silver bullet by any means. Drugs do terrible things to people who do things they would never do. Drugs do terrible things to communities but drugs are a reality, whether they are illegal or not. In that vein, I am of the opinion we need to do something completely radical. We have to do the opposite now. The more we criminalise people, the more this situation continues.
I have a number of questions to put to Professor Smyth. Are there any circumstances where he could see a model of regulation being put in place rather than what we have at the moment? As a medical doctor and a citizen of this country, are there any kind of circumstances that he could see being introduced, as this system does not work?
Professor Bobby Smyth:
As the Deputy knows, we currently regulate the sale, manufacture, distribution of a drug - it is called alcohol. As I said, it kills more people than all illegal drugs combined. It does so not because it is intrinsically more harmful or dangerous than heroine or crack cocaine. It does so largely because its use is normalised and because there is regulated access to it. We face challenges in terms of our alcohol policy. We are where we are with alcohol and hence we had the public health alcohol Bill a number of years ago and it has slowly been enacted. These are small steps in the right direction. All of these increased restriction. I would be very loath to move any other substance into that category of regulated sale until I saw our current legal drug regulated more effectively and the harms with it massively reduced.
Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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What Professor Smyth is saying is that he is not open to regulation alone.
Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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Even though, as we have seen in Portugal, the hard evidence is that it saves lives. That is really what it comes down to.
Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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In Portugal, it is a fact. Thousands of people are alive today because of the system that was introduced in Portugal. It is a fact. Is Professor Smyth denying that fact?
Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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Yes.
Lynn Ruane (Independent)
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I do not think that any of us is disagreeing with that as a parallel measure.
Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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Is Professor Smyth not of the opinion that what has happened in Portugal has saved lives and has brought people out of the criminal justice system? This system works. Decriminalisation only goes so far. I would be of the opinion that cannabis, in particular, needs to be regulated. It needs to be legalised and regulated. People stigmatise and put out this claptrap all the time saying that we have to accept the laws around drugs, which criminalise people, but does not work. If it does not work, then we have to do something different.
Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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We need to go beyond that.
Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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I am starting from 2001.
Lynn Ruane (Independent)
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They are not criminalised.
Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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Would Professor Smyth agree that Portugal has a better system than Ireland? "Yes" or "No".
Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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But it saves thousands of people's lives. It has. That is fact.
Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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Can I ask Dr. McGovern the same question?
Dr. Garrett McGovern:
Professor Smyth stated that alcohol policy in this country is dangerous. While we have not got alcohol policy quite right, there is no doubt that if alcohol was made illegal tomorrow, there would be an exponential increase in the harms involved. We cannot, in a vacuum, look at making alcohol illegal and leave it at that; we would need to compare doing so with what the alternative is. That is what we are doing in the context of all the other drugs. The problem is that whenever someone says that legalisation does not work, we cannot point to any examples in this country of a legalised system of currently illicit drugs. Therefore, you have to ask the question as to what you would do to make the situation better if you are not going to regulate those drugs. I can only read from this that you would make them more prohibited and make the sanctions greater. I would like an answer to that because I never get an answer when that question is asked. We tend to only talk about legalisation. We have only known a paradigm of prohibition.
There is no doubt that, in the context of the most important metrics, the Portuguese model, while not perfect by any means, has put Portugal in a far better situation than is was in 2001. Yes, regulation or changing drug policy is only one factor. They increased the level of help and support that people got and the stigma around seeking help was reduced. You look, therefore, at increased numbers in isolation. When the level of stigma goes down, people admit things. Senator Ruane made the point that people will lie. They will do so for very good reason. We can sit here today and continue to do what we are doing, but more and more people will come to harm and die. That is a fact. It is irrefutable.
James Lawless (Kildare North, Fianna Fail)
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I know Dr. McGovern made the point in a rhetorical sense, but we are not doing the same that we have always done. That is why we are here today; to have the discussion to see where we should go next.
James Lawless (Kildare North, Fianna Fail)
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We are out of time for this block, so we will not have time for a question-and-answer session between witnesses.
Mr. Brendan Minish:
I wanted to take issue with a point Professor Smyth made. He stated that there was a thirtyfold increase in cannabis psychosis in Portugal. I know the paper in question. There are issues about how the data was gathered. It was gathered in the context of admission data, so it obviously relates to people feeling open. If you take this paper at worst possible value and treat all the numbers with respect, it implies that approximately five in 100,000 cannabis users - or one in 20,000 - will develop psychosis. In terms of deterrents, we have arrested for possession on average about 16,000 people a year. Assuming that they all reform themselves and never use cannabis again, we are preventing less than one case of cannabis psychosis a year through our use of the justice system. That seems a very unfortunate way to use a justice system.
James Lawless (Kildare North, Fianna Fail)
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That concludes the round. I will invite members to come in a second time if they wish. Before that, I will take the opportunity to put my own questions.
We have touched on this matter already but something that often comes to mind is that there is a drug which many enjoy socially, and have it with friends and family, at licensed premises and at home. A small minority struggle with it and have it as a demon. That drug, of course, is alcohol. It has greatly varying strengths with some very low strength beers on the market going up to very strong spirits. Then there is the small unregulated space, such as with poitín, ouzo or grappa, depending on the country. Some are for sale legally and some are not. They have different potencies. Were alcohol to have been introduced to the market suddenly now or in the past half century, would it be in the same category as cannabis, for example or would it be treated differently? If it was to be introduced tomorrow and we did not have all the laws that we do, what could or should be done? Would witnesses be saying that we should criminalise or ban it? Would we say that people who have a bottle of Heineken in their back pocket should be sent to Mountjoy or would we say that they should use it freely? What could or should we do, were that the case?
Mr. Martin Condon:
There has already been an example of alcohol prohibition - not in Ireland but in the USA. We saw the problems that were created. It was not that someone was going around with a bottle of Heineken in their back pocket but that people moved to harder substances, with whiskey and spirits, because the volume became a problem. Obtaining beer would have become a problem but whiskey and so on would have been easily available. We have seen the effects of alcohol prohibition. If alcohol was only invented tomorrow, we have seen the results that prohibition could bring to society with the machine guns, the tommy gun that became infamous because of alcohol prohibition. When we apply that to other drugs we see the Kinahans, another infamous name. That speaks for itself.
Professor Bobby Smyth:
The question was what would happen were alcohol discovered tomorrow. In terms of the ranking of harms associated with drugs and substances and the risks, alcohol is probably somewhere in the middle. I do not think that it would be the substance plucked out of the lot that we would choose to regulate first. As I said earlier, however, we are where we are with alcohol. As Mr. Condon said, prohibition did not work largely because of enforcement and compliance issues. You cannot put the genie back in the bottle. I recognise that prohibition is not an answer for alcohol, we just need to regulate it better. For me, that is an extra reason to worry about moving down the path of legalising other drugs because when things get worse following that, as I believe that they will, it will be too late. You will not be able to put that genie back in the bottle either. We will then have two, if not more, legal, addictive, intoxicating substances available and doing increased harm across the population.
James Lawless (Kildare North, Fianna Fail)
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To what extent is it an accident of history? At one stage, opium dens were popular in polite society and cocaine, according to Sherlock Holmes, was frequently used in Baker Street and other places. Maybe there were economic, trade or political reasons that some substances were bad and some were not.
Mr. Brendan Minish:
On alcohol, there have been a couple of studies to rate the harms of alcohol against other substances, licit and illicit. A 2015 European survey of drug harms found that alcohol was about twice as dangerous as any of the other substances. It ranks considerably more severe, both in its impacts to the users and to society than even opiates. To say it is middle-ranking is incorrect.
James Lawless (Kildare North, Fianna Fail)
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Witnesses may feel free to disagree on different points. Everyone is entitled to their opinion. I have another question that arises from something Mr. Minish said earlier. It was an interesting observation on plant-based substances. Is there an argument for considering materials that grow organically in the ground whether mushrooms, as he suggested, a herb or weed, rather than something such as cocaine, amphetamines or ecstasy which are produced chemically or in a lab, where there is an extra degree of processing or layer on top of that?
Is there an argument that perhaps one that is more naturally occurring, a fruit-of-the-ground type of thing, should have greater support or regulatory tolerance as opposed to one created for the purposes of influencing behaviours and chemical reactions?
Mr. Martin Condon:
I have an honours degree in herbal science and have done considerable research into traditional use of plant-based medicines, as they might otherwise be known. When coca was traditionally used in places like Peru at high altitudes, it was very beneficial for people. In the way they used it, it did not impose the harms we associate with cocaine today. That was primarily because they used it in its natural form. They were not extracting it and were not concentrating it. That is a product of prohibition that came somewhat later. In fact, it was a product of Coca-Cola. Coca was being put in Coca-Cola. This became a problem and the coca was then removed. Prohibition came afterwards. The market came first and the prohibition came afterwards. Dana Larsen of the Drug Users Liberation Front in Vancouver has a coca leaf tea café. People who might be regarded as problematic users of cocaine see that as a stepping stone and a way to reduce the harms associated with their overuse of or addiction to cocaine. They drink the tea or a more traditional way is to chew it and keep it in the gums. The harms are drastically reduced when it is used in that form as opposed to the more concentrated forms.
James Lawless (Kildare North, Fianna Fail)
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Members wishing to contribute in the second round will have a shorter time of three minutes.
Lynn Ruane (Independent)
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Many of us have been involved in this field for a long time. I do not underestimate anyone's intentions or how much people care about those they work with it. I am getting more and more disheartened as this conversation goes on. I have been in this conversation not only as a member of the Joint Committee on Justice now, but it is something I have worked towards for a long time. I am becoming increasingly scared for my community because we seem to be having intellectual conversations going back and forth.
The drug user is not responsible for the black-market drug trade. Deputy Gino Kenny and Senator Ward said that the State does not want to be seen to be facilitating a black market, but we facilitate our own pockets because of that black market. The hypocrisy of that is unbelievable. Those involved in the justice system, the legal aid system, probation and prison system are all benefiting and profiting from prohibition. The people at the bottom of the latter are still suffering, are still going to prison and are still being stopped and searched on the street. They still have to tell their child that they cannot go with them on their summer project because they have to be Garda vetted to go on that and they would be too embarrassed to tell the local community centre that they have a charge from 20 years ago. When we talk about saving lives, it is not as simple as taking the immediate view. In the long term, it can save lives because not having a conviction can help lives to flourish.
We should forget about who benefits from the black market in drugs and just talk about who is losing here. We need to help them while we figure out what the harm reduction model is, what the drug policy is and what interventions people need as humans. People in every society in the world seek pleasure through substance use. There lies the problem. We need to look at the human psyche and human development in the context of the need to seek pleasure or the need to medicate. It may be environmental or a human involvement of our psyche.
Can we stop using poor people, mostly as a weapon, in the context of having this conversation? All of us can agree that they are not criminals. Mr. Condon is not a criminal. Mr. Tynan is not a criminal. I am not a criminal. My family are not criminals. All the friends I have buried who overdosed in hospitals because of poverty and their addictions were not criminals. I think we all agree on . Why do we continue to use them as a pawn because of intellectual medical conversations that are actually not serving them?
We need to look at our own prejudices, our own biases and our own understanding of human development and why we seek pleasure seek and self-medicate. We need to look at poverty and marginalisation. We need to stop using the criminal courts and to focus our attention on the people who need our support - the support of everyone in this room. The focus is completely wrong and they need to be separated.
Dr. Hugh Gallagher:
Similar to Dr. McGovern, I have been working in addiction services for more than 20 years. I started work in the HSE addiction services. I have also worked in the Prison Service. The training unit in Mountjoy which was a completely drug-free unit. Unfortunately, it no longer exists. It was a fantastic facility where people who detoxed could enter and stay. They could go to work and so on. It is a major deficit within the criminal justice system that such a facility and the services it offered no longer exist.
Within the addiction clinics, I used to write two or three reports every week for courts. My patients were frequently dying back then from HIV, overdose and so forth. Many of them were simply not living very long. That has changed dramatically in the meantime. I might write one medical report a year for a court these days. While my patients are still going to court and prison, generally it is for theft or other reasons to gain the money to buy the drugs presumably in the majority of cases.
The service we offered was largely biological or medical initially. People have spoken about the stigma. When I started in the service, I was trained that if a person was not complying with their treatment, we were supposed to reduce their methadone dose. It was barbaric, inhumane and ridiculous. Unfortunately, that prevailed in some circles and did so for some time afterwards in certain services. We have obviously altered that.
I would like to think I have spearheaded increased choice regarding treatments available for people with addiction, particularly opiate addiction. The availability of injectable buprenorphine is significant and provides recovery in injectable form. It provides many benefits and reduces the stigma of having to attend clinics and so on.
I have worked in the voluntary sector and the private sector. In the voluntary sector the real benefit I saw in terms of presentations with drug problems, particularly in those marginalised communities, was in increasing the psychological interventions, which we had been doing all the time but which were very ineffective in many cases if not combined with social interventions. Social intervention as part of treatment is key to success.
In recent decades, the Icelandic model has been successful in reducing drug use and social problems, as well as increasing participation in sports music and so forth. What has happened in Portugal has also worked. We have prevented the deaths of vast numbers of people through the social interventions we have undertaken.
I work in a part of Dublin where there are crack dealers on every corner.
It is very hard to escape it. It is important to give those people something to do and in any areas Senator Ruane talked about as well. Social interventions both in terms of protecting and assisting those using drugs are what is key to success.
Patrick Costello (Dublin South Central, Green Party)
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Again, focusing on demand reduction and why we use drugs can help. Better interventions can help. On Subutex – I will stick with the brand name because it is easier to pronounce – when I was working in Merchants Quay 20 years ago, it was widely used in the UK. Yet it was said it is only coming in here now. We seem to be quite far behind. Better interventions are very important but, again, just like it is not a choice between demand reduction or improving interventions, it is not necessarily a choice between looking at the criminal aspects of it and better interventions. We can do the demand reduction, better interventions and look at the criminal status of it all at the same time. When criminalisation gets in the way of the harm reduction and better interventions, that is where it becomes a problem. I refer to the delay to roll out Naloxone and things such as that. I look at other services where testing of pills for quality and safety is not done in this country because of the issues of criminality around it. Safe injection rooms are on hold essentially because of the criminalisation. Those are two harm reduction things that are being impacted by the criminalisation. The safe access for patients is being impacted by the criminalisation. Again, these are all, in a way, silos. They are all separate. We should be doing better interventions, demand reductions and providing the psychological supports because it is not just a purely chemical reaction and all of that.
I will come back to where I was going with the question. If the criminalisation - the prohibition - is getting in the way of the harm reduction and better interventions, surely we need to be looking at that so that we can ultimately have both better interventions and the demand reduction. We could talk about demand reduction for hours and hours in and of itself. It ties deeply into all the stuff Senator Ruane talked about in relation to poverty, exclusion and inequality. There is a whole host of things we could talk about simply looking at demand reduction. We could spend hours talking about better interventions, but they are not mutually exclusive. I am just conscious that there are many things being mixed up here.
Professor Bobby Smyth:
There is a suggestion that drug use is much more common in deprived communities. Certainly, the evidence from national surveys does not bear that out. Again, the more recent general population survey indicates that rates of drug use are pretty much evenly distributed across the entire economic domain, so that is certainly not the only or even a massive driver of drug use. At the end of the day, our drug laws are a very small but important component of our wider drug policy, which needs to look at prevention, which means looking at the social, family, individual, school and community-based determinants of drug use, which is where Iceland has been particularly strong. We should have optimism about our ability to suppress demand for drug use. It is not all about laws and legislative responses.
We need better treatment but we do not seem to talk about treatment. The whole conversation about drug policy in Ireland for the past ten years has been completely overshadowed by this relatively minor issue, because those intent on drug legalisation will not let it go. It is the only thing we are allowed to talk about within the drug policy domain over the past decade. We do not talk about the big needs in terms of treatment and what we could or should be doing in terms of prevention.
James Lawless (Kildare North, Fianna Fail)
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I will go to Deputy-----
Patrick Costello (Dublin South Central, Green Party)
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As someone who has spoken about both those things quite a lot-----
James Lawless (Kildare North, Fianna Fail)
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I call Deputy Gino Kenny. This is the final-----
Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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I thank the Chair.
James Lawless (Kildare North, Fianna Fail)
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I know a couple of witnesses have their hands up or have indicated. They can come back in as part of this round.
Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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I have a number of very quick questions for Professor Smyth. Does he see any circumstances where cannabis can be used for medical purposes?
Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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Professor Smyth would not support the medical cannabis access programme that is in existence.
Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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Does Professor Smyth see cannabis in a medical form having any benefits?
Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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No. Does Professor Smyth see how it could medically benefit somebody in a different form rather than smoking?
Professor Bobby Smyth:
Perhaps my issue with it is the reference to it as a "medicine". Once you say something is a medicine, it has to have proven effectiveness and a proven safety profile. Unfortunately for the cannabis plant, I do think it will ever reach those criteria. I see cannabis more as an alternative therapy. Many people are passionate about a whole range alternative therapies, such a homoeopathy and crystal therapy, and they will swear by their chosen treatment. I think cannabis falls in that domain. I do not see it as a genuine medicine in and of itself. We currently have Sativex, which is recognised as a medicine and contains THC and CBD, which are obviously cannabinoids derived from the cannabis plant.
Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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I ask the same question to Dr. McGovern.
Dr. Garrett McGovern:
I will not ask Professor Smyth a question, but one of the reasons that the evidence base for medical cannabis is not as strong as it should be is that it is very hard to assess a drug that is illegal. We have not invested. We have pooh-poohed medical cannabis in this country. The medical profession largely has discarded it. Therefore, one would think that because the medical profession is calling for a greater evidence base, that we would support the research around that. However, we are not doing that.
My view on medical cannabis is very straightforward. I refer to the people I have dealt with, met and the stories I have heard in relation to medical cannabis. We need to understand the conventional medical treatments have not worked for those people. The very treatments that have the strong evidence base, generally speaking, and are well researched, have not worked. We have a situation, which I believe is inhumane, where people are forced to either break the law or leave this country to try something to see whether it works for their symptoms. They are criminalised and have to leave the country. My view on medical cannabis is very straightforward.
We talk about its effectiveness, but what about its safety? It seems to be fairly safe in countries that have medical cannabis. I would accept Professor Smyth’s comments about the evidence base in relation to medical cannabis. It needs to be stronger. However, that does not mean we do not use it. There are many examples in the history of medicines when we did not wait for the wonderful evidence base to arrive. Penicillin is probably one example. However, also in the area that I work in, there is methadone maintenance treatment. The evidence base was informed by practice and having to deal with an epidemic. We could not wait around for the absolutely perfect evidence base. I do not think medical cannabis is unsafe and I do not see any evidence that it is unsafe. The people who are trying it have tried every other conventional medicine. I just think in this country we need to show a bit of humanity towards those people. It is not right for people and families to have to leave this country at great expense and face hardship to go to another country to access a treatment they cannot access here.
James Lawless (Kildare North, Fianna Fail)
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I will give the last word to Mr. Minish who has been indicating for a while on the screen.
Mr. Brendan Minish:
I just wanted to comment on something we heard throughout today and remind us why we are here. We are here because the rate of drug deaths in Ireland is very high. We are three times the EU average. We are the fourth worst in Europe for drug deaths. If the policy is working, then goodness me, what else is going wrong? We need to do better. We are not serving these people. Many people, obviously, who are getting into treatment are having reasonable outcomes. However, there are many people who are getting missed, falling through the cracks and are dying from overdoses. The problem here is, of course, in part, contaminated supply and all that goes with it in the black market. It is premature to assume that our policy as is is working; it is not.
James Lawless (Kildare North, Fianna Fail)
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I thank all the witnesses who came before us today. That concludes our examination of this topic. It was a very useful debate with many strong views. It is interesting that it is one of the more vehemently argued topics that we have had, and we have many topics across a range of issues at this committee. Certainly, the strong views are on all sides of the House on this one, which is good, because makes for a more robust meeting.
We will, of course, produce a report. Everything that has been discussed today, the written submissions received and what was received from others who were not present at the meeting but would have sent in their thoughts in advance will be distilled into a report that we will produce, probably in the new term, because we are approaching summer recess. It will be documented by the committee but then produced later in a couple months’ time.
I thank our witnesses. I will just ask members for agreement that we would publish the opening statements on the committee website as per the norm. Is that agreed? Agreed. As there is no other business, the meeting stands adjourned until 3 p.m. tomorrow for a housekeeping meeting in private session so that prior to the recess we get our ducks in a row for the new term. I thank everyone again, particularly our online and in-person witnesses, and all who participated in the debate.