Róisín Shortall (Dublin North West, Social Democrats) | Oireachtas source

I am pleased to speak on this Bill but it is regrettable that the attendance is so poor, which reflects the general attitude of the political establishment towards issues associated with drug misuse. I welcome the new Minister in her new role. I had the opportunity to meet and greet her in Ballymun in my own constituency last week and we appreciated her visit to the area. I know she has a very keen interest in substance misuse and other issues associated with disadvantaged areas and I am sure she will be a big success in the job.

As a previous occupant of the position, though I shared it with a number of other responsibilities, I very much welcome the fact that we now have a Minister of State who is dedicated and has sole responsibility for substance misuse. I encourage the Minister to be as vocal as possible within Government on the issues associated with drug misuse which ravage so many of our constituencies and our communities across the country. I also strongly encourage her to meet on a regular basis with those involved in the local drugs task forces and in regional drugs task forces. They are a sounding board for what is actually happening on the ground and if she builds up a good relationship with them she will be very well informed about not only the scale of the problem and what is and is not working but emerging trends too. That is important because the drug problem changes all the time and the substances involved change on a regular basis.

Some of the Minister of State's previous party colleagues did not place any great value on the role of the drugs task forces or their valuable role in combatting the drug problem in Ireland. There have been various attempts in recent years to contain local community groups, including drugs task forces, but despite the attempts of Ministers the task forces remained outside their control and I am very glad about that. Many other community organisations were closed down, however, and communities are paying a big price for that. There have been huge cutbacks in community funding compared to what was available in previous years. This may have been seen as an economising measure but will not turn out to be so in the medium and long term. The funding withdrawn from disadvantaged communities was the glue that kept many of them together, and we will pay a price for the cutbacks.

I very much welcome the publication of this Bill. It has been a very long time coming. In August 2002 the local drugs task force in Ballymun and YAP, the organisation the Minister of State met last week, produced a report called Mother's Little Helpers, and this was already identified as an emerging problem. There was a tendency to over-prescribe benzodiazepines and Z drugs, a practice that was replicated across many disadvantaged communities, with women, often young mothers, going to GPs and public health nurses showing all the signs of stress associated with social disadvantage and having to cope with rearing families in very poor conditions.

It was often the case that the general practitioner took out the pad and wrote a prescription. Certainly, there was a significant problem with over-prescribing of benzodiazepines going back that far.

In the past seven or eight years the local drugs task forces became aware of this as a very significant problem and the profile of the problem had changed somewhat. It was still associated with over-prescribing but it was also associated with the widespread availability of prescription drugs. Some of those were finding their way onto the streets through leakage from over-prescribing but other amounts were being brought in at the ports and airports. Increasingly in recent years we have seen where large quantities were brought in by ordering them on the Internet.

Over the past four years or so there seemed to be very little political leadership on this issue in the Department. That is regrettable. For whatever reason it seems to have slipped down the political agenda. It certainly did under the previous Government, along with the need to prioritise the whole area of drug abuse, drug treatment and rehabilitation. It is very much welcome that it is finally back on the agenda. It is unfortunate that it took very serious incidents and a high escalation in gangland crime, particularly in the north inner city, to get it back on the agenda because some of us in this House have been raising it over a number of years. It was not taken to be a serious issue, mainly because it predominantly affected working class areas, and there had not been much interest on the part of the previous Government in issues affecting such areas. It took the explosion in gangland crime in the north inner city and public opinion demanding that something be done. When this blew up, a number of Ministers suddenly discovered that there was a very serious problem and it does not just affect the north and south inner city. It has now taken a hold throughout the country. Second only to the problem of alcohol misuse is the problem of prescription drug misuse. A problem that was confined to disadvantaged areas a number of years ago has become a scourge throughout the entire country. Prescription drugs, benzodiazepines and Z drugs seem to be the drugs of choice for vast numbers of people and they are freely available in every city and town. As a result of largely neglect at an official level, we now have a major problem that has to be tackled and it is very regrettable that it has got to this point before any serious action has been taken.

Front-line workers across several different disciplines have been calling for this measure for years. My local drugs task force in Ballymun, of which I am a member as are other public representatives in the area - I was also a member of the Finglas drugs task force - called for it but it is coming back from all of the drugs task forces, and has been for several years, that this is the second biggest problem in regard to substance abuse, second only to alcohol misuse.

What was identified a number of years ago during my short time in the Department of Health was the need to introduce regulations to tackle this area. We thought we were in a situation where primary legislation was required and, as a result of a Supreme Court ruling last week, we do not need that primary legislation but I am glad that we are at least having an opportunity to discuss this issue here.

It is very difficult to discuss the issue in the absence of regulations. We have heard various Members in this House and in the other House talking critically about these proposals and, on the face of it, it does appear that this is an attempt to criminalise people who have addiction problems with prescription drugs. I do not believe that is the intention of it. If the kind of regulations that will come forward shortly are like those that were produced in draft form four or five years ago, I would be very confident that that is definitely not the intention of this legislation. The intention of this legislation is clearly to tackle the problem of the street dealing of prescription drugs, which is widespread. Various people, including the Garda and the customs service, have been calling for urgent action in this area for several years.

It is unfortunate that we do not have the regulations to consider now. It would be helpful from the point of view of the public debate, the debate in this House and in the Seanad if we had the regulations because they would explain what is behind this move to legislate in this area. It would also be helpful if there was input from Members of this House to those regulations. I hope they are sound and robust and that they take into consideration all aspects of the problem, but it would be helpful if we could see them. Bearing in mind that they are secondary legislation the Minister of State is not obliged to debate them. She just lays them before the House, but I ask her to consider allowing some Government time for a discussion on the regulations, ideally prior to them being signed. That is not an excuse for delaying them by any means. If we had sight of the regulations now it would allow for far better scrutiny of the Bill, and it is unfortunate they were not published in advance. I hope there is no further delay.

The substance of the Bill is sound. The primary purpose is to control certain drugs and to try to tackle the street dealing of prescription drugs, especially benzodiazepines and Z drugs.

It is important that people who have spoken against the Bill and those who have raised concerns are clear about its primary purpose. Obviously, it will do very little on its own, and no one is claiming that it will. The country does not just need new laws; we know it needs new drug services. We need to concentrate particularly on rehabilitation. There is a need to update the national drugs strategy and I recognise that is under way. It is critical that the new strategy includes all aspects of alcohol misuse because until recently there was concern that alcohol might be an afterthought or not included at all.

There is a need for many more dual diagnosis places for people with combined mental health and addiction issues. Many people who contributed to this debate in both Houses talked about the reasons people get involved in substance misuse. We have a major problem with it in this country, whether it is alcohol, prescription drugs, heroin or what are called recreational drugs. For some reason there is a basic problem in the Irish psyche. Large numbers of Irish people want to get out of their heads on a very regular basis. Many people spoke about the fact that very significant numbers of people are in serious pain for one reason or another. It is pain caused by abuse, neglect, isolation or alienation. That is very much at the heart of the Irish psyche and we need more study of that area. We talk about responses to substance misuse but we spend very little time researching the root causes of it and the reasons people feel they have to take steps to numb their minds and get out of it. That is not just an issue affecting disadvantaged communities but it is something I believe warrants further research.

I first became aware of this problem in 2002 in Ballymun but also in the past seven, eight, nine or ten years where it was a consistent issue arising at the local drugs task force meetings in Ballymun. The problem was with misuse and over-prescribing. There was a very significant problem of polydrug use and other Members referred to that. There was very high usage of prescribed drugs in comparison to other countries.

That also warranted further investigation.

During my short time in the Department of Health we undertook a study to look at prescribing patterns. We only had access to data as it related to public patients. We looked at prescribing patterns of GPs across the State. There was a wide variation among GPs in the quantities and durations of prescriptions. There were some very serious cases. In one example a person was arrested and in other situations there had to be serious interventions by the HSE with direct approaches to GPs to ensure they changed their prescribing practices. GPs themselves welcomed the information. Many of them are operating on their own in their practice and they welcomed the data showing how they compared to their peers. That basic information is the starting point to changing practice. I do not know if that project is ongoing but it is important that it would continue. We need to investigate and invigilate what is happening in patterns of prescribing. Academic studies and Department of Health studies have over the years shown that Ireland is out of line with other European countries in the high level of prescribing of sedatives and benzos.

It is a long time since the problem of street trading in prescription drugs became apparent, especially in the Dublin area. I recall when I was in the Department of Health four or five years ago, one could actually look out from the Department and see dealing going on directly underneath the windows, all around the Screen cinema and on the Liffey boardwalk. It was public and open and everybody wondered how on earth this was going on under the eye of the Garda, the Department of Health and everybody else. When there was consultation and engagement on this problem by the law enforcement agencies and other players the Garda made it clear that its hands were tied regarding the policing of this problem. The gardaí would stop people who appeared to be dealing on the street and who may have had a few packets of benzos or Z drugs in their pockets. However, because it was not an offence to be in possession of any quantity of benzos, gardaí had to prove not only possession but also intent to supply. That was the difficulty and why it was so hard to police the issue.

With regard to the Customs and Excise, whose job it also was to police the problem, there were people coming in to the State with holdalls full of prescription drugs bought or accessed in Spain, Portugal or elsewhere. The difficulty again, at airports and ports, was proving intent to supply. The law enforcement agencies have been looking for the law to be tightened in this area for many years. It was seen by the establishment as a niche issue and was neglected for far too long.

It is very easy to order supplies of these drugs, in large quantities, over the internet. The regulations a few years ago said that if a person was found in possession of prescription drugs they had to prove they had permission for them in one of two ways: either a prescription from the GP which would entitle a person to have benzos or Z drugs, or a licence to import. I assume that the regulations would be the same in that regard. There are associated problems when the substances being misused are legal and can be prescribed such as steroids. Very large numbers of people are now addicted to steroids which are available on the street, on the black market and are part of the whole poly-drugs scene.

Another issue which has recently come to light is the widespread availability of tanning pills. Apparently, tanning pills, which can be bought on the street and can be accessed through friends or over the Internet, have the effect of making a person very hyper, they cannot sleep and they become agitated. In order to counteract the impact of tanning pills people are also taking large quantities of benzos, sleeping tablets or Z drugs. This is an emerging phenomenon which has become obvious over the last year or so. This is what happens when a black market exists for prescription drugs which are very dangerous when taken in the wrong way or in large quantities. I hope that tanning pills, or the substances in the tanning pills, will be added to the list and will be covered by the regulations.

There are many statistics that show the scale of the problem in this country regarding the abuse of some prescription drugs. Two fifths of poisonings in 2013 involved

I pay tribute to the excellent work done in the Department five years ago on this issue. The senior people involved there were Marita Kinsella and Siobhan Kenna who did extraordinary work. It is unfortunate that the work came to a standstill and was left to gather dust for the last number of years. When I left the Department in September 2012 I had signed off on draft regulations. I accept that there was a need for primary legislation but in the meantime there has been a huge amount of slippage and very little attention paid by people who have been in the Department in recent times.

As well as restrictions on possession and the intent to supply there are proposed restrictions on prescribing. We know that benzos should only be prescribed for a limited period of time, should be reviewed on a regular basis and there should be no practice of repeat prescriptions. That has been addressed with a number of patient groups and while there were concerns regarding people with epilepsy I believe that special arrangements were made in their case.

There was widespread consultation five years ago with all of the different players, the law enforcement agencies, the drugs task forces, the patient groups, etc. An important development in recent years was the creation of the community national counselling service. We cannot underestimate the demand there is for a national counselling service. It is very welcome that it has been rolled out so far but it is still quite patchy and there are major parts of the country that are not covered.

To those Members in the House and in the Seanad who had concerns about this I would say that the overwhelming feedback from front-line workers is that these provisions are long overdue. That has certainly been the feedback from the gardaí. Their difficulties could be addressed by these measures and they could be much more proactive in tackling this problem. Drug dealers have been flouting the law by carrying relatively small amounts knowing that they could get away with it.

Feedback from front-line medics is that misuse of these substances continues to be a very significant problem and that such use is very disruptive of care plans. It is very demoralising for staff working in drug treatment centres who prepare their care plans, get their clients onto a programme and then their clients are bombarded on the street by offers of benzos and Z drugs. This is what is happening. People are being bombarded and it is very difficult for those who have addiction problems to avoid this. They are given the drugs for free initially in order to get them into taking them.

Very quickly they get caught up in that tangled web. Feedback from client community workers is that the misuse contributes to serious anti-social behaviour and that this law is desperately needed. To those Members who have concerns about this, who balk at the idea of it, it is important to point out this is not a case of criminalising those with addiction problems but those who deal in death, in these substances that are so dangerous. We need to strengthen the law to ensure we can tackle this problem and take control of it.

I have serious concerns about the oversight of drug treatment services. We spend €100 million per annum on drug treatment yet there is little or no accountability, research or examination to see whether we are getting value for money. It is a huge budget to dole out on methadone. That seems to be the problem and there is no review of the value of this treatment. As statistics are not always automatically collected I encourage the Minister of State - if she has not been provided with them to date - to get answers to a number of questions. For example, what do we know about methadone treatment, are we getting value for money, is it making a difference to people’s lives and how long are people in methadone treatment? Many people have been getting this treatment for ten years and more but there has been no intervention to get them to start on a road to recovery. Recovery must be restored to the lexicon of drug treatment. In recent years we have tended to forget about recovery and to concentrate on maintenance. Rehabilitation and recovery must be the by-words in the approach to drug and substance misuse generally.

While we need to tackle these problems and to be much more innovative in ensuring there are proper care plans for all people with addiction problems we must vastly expand the range of drug treatment services available, particularly to the many people who are addicted to prescription drugs. The level of service for such people is very limited. There was an element of turning a blind eye and regarding the problem as minor. We do not have significant drug treatment services for people addicted to prescription drugs.

When the law is changed and the approach to the widespread availability of prescription drugs changes there will be many people desperately looking for treatment. We have to ensure the system is geared for that. The Minister of State should talk to the people working in community addiction services and the drugs task forces because they have a handle on the scale of demand there will be for services. It is important to be geared up for that and that the system can cope with the demand.

While there are very significant problems with substance misuse across the population, we cannot get away from the fact that the problem is most pronounced in areas of severe disadvantage. Providing drug treatment services and awareness is important. Tackling the supply of drugs is critically important and that is where this legislation will play a role. Unless we change the conditions that lead people to self-medicate in an effort to block out the issues that make their lives very difficult we will not get to the root of this.

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