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.