Dr. Sharon Lambert:

Substance dependence represents a significant public health challenge globally, affecting millions of individuals, their families and communities. People use drugs and they always have. Archaeological evidence has identified drug use by humans dating back tens of thousands of years. Drug use tends to emerge during adolescence, a developmental stage marked by experimentation and sensation-seeking. Most young people who use drugs stop or engage in less risky drug use as they move into adulthood, but some young people develop problematic relationships with drug use which leads to them interacting with other systems, such as child welfare and justice.

The majority of adults who use drugs do so recreationally and, depending on the substance they use and the route of transmission of that substance, they may not experience any harm. Harm can be viewed as physical, psychological and social. Physical and psychological harm within recreational drug use primarily occurs when there are contaminated and synthetic substances within unregulated markets or in the way in which people use substances. For example, smoking cannabis comes with the risks associated with smoking, whereas ingesting cannabis in other ways has reduced risk.

Social harm occurs when drug use is criminalised. In these situations, contact with the criminal justice system can be viewed as a social harm. A criminal conviction carries with it a stigma, with consequent barriers to education, employment and housing. This places individuals at further risk of social exclusion, which is detrimental for both physical and mental health. There is often an attempt to view these issues as a simple linear process, that drug use leads to negative outcomes. There can be a failure to see how a range of systems interact with one other. For example, a minor conviction for drug possession limits a person's future opportunities and prevents that person reaching his or her full potential. This can generate cycles of problem use.

When we speak about drug use in public domains, we focus on the people who are experiencing chronic substance dependence, estimated to be between 10% to 25% of people who use drugs. This will also be the focus of my submission but it should be noted that people who use drugs in a non-problematic way are at risk of harm from a system that punishes them and increases their risk of social exclusion. The UN Human Rights Office in 2022 stated:

Data and experience accumulated by UN experts have shown that the “war on drugs” undermines health and social well-being and wastes public resources while failing to eradicate the demand for illegal drugs and the illegal drug market. Worse, this “war” has engendered narco-economies at the local, national and regional levels in several instances to the detriment of national development. Such policies have far-reaching negative implications for the widest range of human rights, including the right to personal liberty, freedom from forced labour, from ill-treatment and torture, fair trial rights, the rights to health, including palliative treatment and care, right to adequate housing, freedom from discrimination, right to clean and healthy environment, right to culture and freedoms of expression, religion, assembly and association and the right to equal treatment before the law.

In my current role and my previous role in the community, the focus of my work has been with people who are involved in chronic problem drug use and understanding why a cohort of people develop a different relationship with drugs. People take drugs because of the effect it generates. Mostly, people take drugs and it generates pleasure, but for some people the purpose of their drug use is to medicate overwhelming emotional pain. The way in which we understand the trajectory of this use has evolved. Traditionally, there was a view that drug dependence was a moral failure and a choice. Research data, however, now indicates the majority of people engaged in substance dependence had a pre-existing mental health difficulty, experienced social exclusion and-or had experienced traumatic events. The Health Research Board has identified that while drug use exists at similar levels in affluent areas and areas of economic deprivation, the harm experienced by people who already experience social disadvantage is greater. Financial and social resources are, therefore, a protective factor in preventing drug dependence. Our research in applied psychology has indicated that people who have experienced traumatic events are at increased risk for problem use and there is a cumulative effect to this risk. The more trauma an individual experiences, the greater the risk of problem use. Other findings of note from our work show that people with the highest levels of trauma histories are more likely to self-report their mental health difficulties and do not have an objective diagnosis. This group struggle to access services and are frequently viewed as difficult instead of traumatised. People with substance dependence have frequently experienced a range of social and psychological harms and have co-occurring mental health difficulties. I believe drug dependence is a mental health issue and should be managed by health services.

We know from decades of research that people use drugs, people will continue to use drugs and punitive approaches have not decreased this, yet we continue to follow a policy that generates no effective results. Measures such as incarceration have been shown to be largely ineffective in reducing drug use and they exacerbate health problems. These measures fail to address the underlying issues that lead to substance dependence, such as mental health disorders, trauma and social disadvantage. Further, the stigma associated with criminalisation can prevent individuals from seeking help, leading to increased health risks. Understanding drug use as a mental health issue shifts the focus from punishment to treatment and recovery. This perspective acknowledges the complex interplay between substance use and mental health disorders and underscores the need for integrated treatment approaches. By addressing the root causes and providing comprehensive care, we can improve outcomes for individuals struggling with addiction and promote better mental health across populations.

Ireland has the highest level of drug-related deaths in the EU and it stays in the top three. I will go back to the train station today and I will see young people there who are drug dependent. Sometimes I talk to them. A lot of them have care histories and have experienced trauma. I know some of those young people will be dead before Christmas.