Jack Chambers (Dublin West, Fianna Fail)
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As my party's spokesperson on the national drugs strategy, I am pleased to contribute to the debate on the Bill. I and my party are always open to considering new and innovative ways to tackle drug abuse and help those who suffer with drug addiction. The nature of, and problems associated with, drug-taking are very different today from what was happening over 30 years ago so, as legislators, we have a responsibility to respond and to be open to new and more nuanced approaches as required. Fianna Fáil supports this Bill as we are of the view it will help to reduce the incidence of drug-related deaths. We believe a supervised injecting centre in Dublin should be introduced on a pilot basis, as provided for in the legislation. There should be regular reviews to measure the success of the centre. Input from stakeholders, the Garda and local groups will be important in this regard. How this policy is implemented will be crucial to its success or failure.

I am equally of the view that the introduction of such facilities will not solve or end the scourge of problem drug taking in Ireland. A supervised injecting centre should be viewed as just a part of a range of measures and services to address this problem. It more important that the Government acts to fund and deliver more detoxification centres, more support services for those who want to tackle their addiction, more emphasis on education and prevention and more focus on treatment and rehabilitation. It is disappointing that the programme for Government formally proposes few other measures. This centre is one of the positive measures proposed in the programme but we must outline further measures that could positively assist in addressing many of the issues with drug abuse in Ireland. The national drug strategy is due to be published later this year and I hope the Minister takes on board the submissions made by my party, other parties in the House and the many interest groups to prioritise these measures.

Ireland has the highest rate of intravenous heroin use in Europe. Consequently, the rate of drug-related deaths here is three times the European average, which is shocking. Two people die from drug related deaths every day in Ireland. This is simply unacceptable. Everybody should reflect on those figures.  The Minister referred to the many other morbidities associated with injecting, such as hepatitis C and HIV. There is a direct correlation between those and allowing addicts to be left on our streets, without intervention or harm reduction. The positive aspect of the Bill is that we can provide people with access to a wraparound service when they are in such a vulnerable position.

We must ask how we allowed this situation to develop and, more importantly, what we must do to address it. Since being appointed party spokesperson on drugs I have been visiting and engaging with stakeholders in the area of drug treatment, prevention and rehabilitation. I have met with relevant groups and many of the task forces in Dublin and across the country. We cannot fool ourselves that this is just a Dublin or urban problem. It is a problem for every household on every road across the country. Drug taking is a problem that affects every family. I have visited the Tiglin residential treatment centre in Wicklow and the Rutland Centre and I have met with local and regional drugs and alcohol task forces. I visited the Aiséirí Aislinn centre in County Kilkenny, one of the country’s few adolescent treatment centres, which has struggled to get the proper level of funding to provide its excellent service for vulnerable adolescents. In Dublin city, I visited Merchants Quay Ireland and the Ana Liffey Drug Project, to name just two. All of these groups are doing admirable work, in the most testing of environments with the tightest of budgets. The latter two have recommended the introduction of a supervised injecting facility. Both of the groups see and experience daily how drugs destroy lives and devastate families. They are well placed to offer input in this area.

A supervised injecting facility can only be successful if it is considered the start point for recovery, not the end point for shooting up. Injecting facilities must be a pathway to effective treatment and rehabilitation. That is the constant challenge. The level of services the HSE provides is not enough, and the level of funding is always difficult in the context of the health budget. It is hard for people who do not have a voice to get the funding they deserve. If we enact this legislation, and I hope it will progress quickly through the Oireachtas, we must then discuss how we give hope and proper intervention and treatment to people in such a vulnerable situation. The real challenge is how we match this approach with the services they deserve. The injecting room should be part of a network of services housed in the same centre to facilitate this. If successful, this centre has the potential to become a broader, viable public health measure. At the very least, it has the potential to provide individuals with some dignity and a safe place while we work to help them overcome addiction.

I understand the concerns that have been raised about pursuing this measure. However, we must have an evidence based approach. Injecting facilities are a relatively new development and much of the research is still in the early stages. Studies by the European Monitoring Centre for Drugs and Drug Addiction indicate injecting centres can be successful in reducing drug related deaths and morbidity. There have also been reported decreases in drug related litter in many of the cities where they have been introduced. Overall, the evidence does not support the contention that injecting centres lead to an increase in drug-related crime in an area. We must adhere to an evidence based approach to this discussion, not a mythical approach that is put forward by stakeholders who do not have the interests of the vulnerable people concerned in mind. They must focus on the evidence, not the mythology. There are now approximately 90 injecting centres across Europe and nobody has died in any of them. Staffed by trained health care professionals, the safety of these centres should not be questioned.

There is also an economic argument for injecting centres. When drug users are using the same facilities, it frees up health and other resources considerably. When an injecting centre opened in Australia, there was an 80% drop in ambulance call outs. Paramedics were no longer having to deal with overdoses or related incidents, which meant they were better able to respond to emergencies and ultimately save lives. When considering other areas of health care, including community based health care, we are focusing on primary care and making interventions before people end up in an acute situation. The same should apply for the vulnerable addicts who are on our streets. They should have a place where they can access harm reduction, so an acute situation does not arise for them and they do not overdose and end up in hospital for a period of time. A wraparound intervention and treatment for them is what this Bill seeks to provide.

To return to the programme for Government, I am pleased there is now a recognition of the need to promote the health aspect of dealing with drug addiction. As I said in my party’s submission to the national drugs strategy, tackling the country’s crippling drug problem requires major reform in our overall approach. Every day we hear stories of individuals, families and communities around the country that have been devastated by drugs. The renewed focus on this area is welcome, as is the development of the new national drug strategy which will shape our policies in trying to tackle this problem in the coming years. The passing of the Misuse of Drugs (Amendment) Act last year highlighted clearly how legislators must stay on top of a constantly evolving environment where clever and ruthless drug dealers use every loophole, grey area and opportunity they can to intimidate and prey on vulnerable people and make profits from the victims of drugs.

Drug-related harm consistently clusters in communities marked by poverty and social inequality. Research shows that this situation was allowed to develop by the policies of many Governments and year-on-year funding cuts. We must be mindful of this. The economy is growing at present but if it should decline, we must ensure that the core services for the most vulnerable people are maintained and that there is a proper funding model for the services to continue the level of intervention they are currently providing. That is the importance of harm reduction. Equally important is the need to develop proper treatment, rehabilitation, therapeutic and aftercare services. In this regard, we have proposed in our submission the roll-out, on a pilot basis, of therapeutic communities within prisons to help offenders overcome drug addiction. The Joint Committee on Justice and Equality, under its Chairman, Deputy Caoimhghín Ó Caoláin, is trying to engage in a better way on penal reform and on how to provide the level of intervention in our prison system that is not currently being provided.

As work gets under way on the new national drugs strategy, more emphasis should be placed on prevention and education. This should start with our younger people. Greater emphasis must be placed on the teaching of social, personal and health education, SPHE, in schools and informing children about the dangers of drugs.

Former users, as well as health care professionals and gardaí and inter-agency collaboration, are crucial in this regard and can play an important role in educating and preventing young people from going down the road of using drugs.

Ultimately, I am trying to highlight the need for a multifaceted, multi-agency approach which is properly resourced to tackle drug addiction. The injecting centres in this legislation, if correctly introduced and managed, can be an important step on the road to tackling this problem once and for all.

Jonathan O'Brien (Cork North Central, Sinn Fein)
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I warmly welcome the introduction of this Bill. I have been calling for this legislation for a number of years and, at the outset, it is only appropriate to mention Senator Aodhán Ó Ríordáin, the predecessor of the Minister of State, Deputy Catherine Byrne, because he was a champion of this legislation in the previous Dáil and faced some stiff opposition to it. Had it not been for his doggedness in trying to get this issue moved on, I do not think we would be here today.

I will get to the Bill in a minute but I want to touch on some of the falsities that are being put about, and also some of the negative press and commentary around the provision of an injecting centre. People will ask if there is a need for one. We should consider in that context that 13 million people worldwide inject drugs every single day. In this State alone, the latest figures we can work off, which are old figures from 2014, show nearly 10,000 people receiving treatment for opiate use. In 2014, more than 16,500 people entered treatment for a drug problem. Of those, 4,500 were opiate users or opiates were their main choice of drugs. There were 943 new cases in 2014.

What Deputy Chambers said is interesting, that this is not a Dublin issue, and the figures bear that out. Of the 4,500 opiate users to whom I referred, only 2,100 were resident in Dublin. The rest were outside Dublin. Almost 3,000 of them were men. Only five are registered as being under 18, but we all know that there are many more people under the age of 18 who are using heroin and other opiate-based drugs. Only five are captured in this particular research. More than 2,500 of them were aged between 18 and 34, and in excess of 2,500 used opiates with other drugs, so they were multi-drug users. Some 640 people used it between two and six days per week, 294 used it once a week and, what is astonishing, in excess of 2,000 people in this State were using heroin every single day. If that does not highlight the need to provide an injecting centre, even if only one on a pilot basis, then I do not know what does.

On the number of people who have lost their lives as a result of drug use, again the figures are slightly behind where we are. Between 2004 and 2014, more than 6,600 people lost their lives through drug use. Nearly 4,000 of those deaths were due to overdose. Over 40% of them were due to non-poisoning, which is non-overdose, causes. A quarter of all deaths from overdose were as a result of heroin or involved heroin. Of those who lost their lives, 87% were male and 81% of such cases involved more than one drug, so it was heroin plus another. Of the number of people who lost their lives from using heroin, 48% were injecting the drug at the time of death. I stress that figure because it indicates that more than half the drug related deaths due to heroin were down to non-injecting reasons - people smoking it, basically. While this legislation is welcome and is going to address the issue of intravenous use, it does not address the issue of the 52% of people who lost their lives from smoking heroin. We need to be cognisant of that.

What we are providing here will help a number of people. There is no doubt about that and I welcome it, but it is not going to address the issue of drug use in this State. Unfortunately, we are behind the times compared with other European states. We need to look at the evidence available. I saw one local councillor, whom I will not name, debating with the Minister of State on a television show recently. He said there was no evidence to suggest that injecting centres save lives.

I want to read into the record the number of people who have had their lives saved because of these injecting centres. The European Monitoring Centre for Drugs and Drug Addiction has calculated that in Germany, ten people are saved every year because of these centres. In Canada, up to 12 deaths have been prevented every single year. A 2011 study went into more detail. It tracked the number of fatal overdoses in the 32 months before a centre was opened and the 27 months after the centre was opened. It found that the rate of overdose deaths fell by 35% in the first two years of the centre's operation, while it fell by less than 10% in other areas of the city where they were not providing a supervised injecting centre. That same report went on to say that not only did it prevent deaths, it probably prevented 35 HIV infections every year since opening. While there is a lot of research in Australia, it does not go into the number of people who have potentially been saved, but it enables the data to be analysed and for the figures to be worked out. They reckon that 25 overdose deaths are prevented every single year by providing these centres.

The evidence is available, and I agree with Deputy Chambers that when we are dealing with this type of issue, the scaremongering has to go out the window and we have to rely on the evidence. I know personally, and the Minister of State knows why, that there is a lot of stigma around people who use heroin. We can pass this legislation, but for me that is only half the battle. We have to open one of these facilities. Let us be very clear that it is not going to be an easy job. There will be many people with many issues. There will be NIMBYism. People will not want it in their backyard. Those people need to take their heads out of the sand. I have seen it in my city of Cork, where for years I was raising the issue of heroin use and people were saying not to mention it, that it was bad for tourism and bad for publicity. The reality is people were dying on our streets. No matter how few media articles there are about it or how quiet it is kept, the reality is people are still dying, and we can either bury our heads in the sand or do something about it.

I would love to see one of these centres in my community and my constituency, because I have lost friends who have died from heroin overdoses. I have almost lost family members to heroin overdoses. There are many people whom I grew up and went to school with who, unfortunately, are not here today because they became addicted to heroin and lost their lives. I could probably name six close friends of mine who, unfortunately, lost their lives because of overdoses, nearly all of which were down to heroin.

I would love to have one of these in my city. I am quite jealous that we are planning a pilot project in Dublin. I understand why we are doing that given that nearly half of those who inject heroin reside in Dublin. However, more than 2,000 people outside Dublin also inject heroin and their lives are just as important. I know people will have a battle on their hands to get this facility open. I implore communities to recognise that such a facility does not stigmatise their community but is trying to save the lives of people who reside within that community. They can be our neighbours, family members or people we have grown up with. I encourage people to approach the debate with a very open mind.

I said we are probably behind other international models because the injecting centre we are now looking at is what other countries were looking at ten or 15 years ago. Many European countries are now moving beyond the injecting-centre model to a drug-consumption model, which is where we need to go eventually. I outlined the figures. Given that 52% of all heroin-related deaths are for non-injection reasons, the evidence is there to suggest we should move to that. We are not just talking about heroin. People who will be able to access these facilities could be injecting cocaine or amphetamines; although I acknowledge heroin is the predominant drug.

As the Minister of State will be aware, the committee carried out the pre-legislative scrutiny. The Library and Research Service produced a fine document on it. Page 39 of that publication covers the main issues raised during the pre-legislative scrutiny and how well the Bill addresses those concerns. It found that the majority of observations fell into three main areas. Unfortunately, two of the three have not been addressed in the Bill, which is disappointing. The one area that has been addressed is the issue of an authorised user; the committee was concerned as to what is an authorised user. I believe the Minister of State has addressed that in the legislation and I agree completely with the definition.

According to section 7(1), "A licence holder, or the person in charge of a supervised injecting centre for the time being, may authorise a person, not being a person prescribed as being ineligible to be an authorised user". I ask the Minister of State to explain how a person becomes ineligible. I do not know whether that is just a legal term. I presume the only way for a person to become ineligible is by no longer injecting and by looking to smoke or consume drugs by methods other than injection.

Section 5 deals with the revocation or suspension of licence and section 5(5) refers to "Where the Minister considers that there is a serious and immediate risk to the life, health or welfare of an authorised user, or to the well-being of the staff of that facility". I am not happy with that wording. By their very nature, authorised users who are injecting heroin are in serious risk of their lives. That is the reality of drug use. I do not want the legislation to contain any caveat that would allow any future Minister to revoke a licence on the basis that there is a risk to an authorised user's life or health. We need to get real. The user is in a centre and is injecting heroin; of course there will be a risk to his or her life.

At the committee I raised concerns over section 11, which gives members of An Garda Síochána permission to enter these centres. In order for this pilot project to be successful, in addition to getting the buy-in of local communities, the Garda and the Health Service Executive, we also need to get the buy-in of the drug users themselves. If they do not buy into this pilot project, it will fail with devastating consequences for those individuals.

I do not know how many drug users who plan to inject themselves with heroin will actually do so if there is a member of An Garda Síochána standing beside them in the facility. I do not know how practical that is. I can understand the Minister of State's reasons for inserting that provision. It is obviously to prevent people from using the centre for profit through dealing and preying on vulnerable drug users. However, we need to look at this. At the pre-legislative scrutiny it was mooted that a code of practice could be put in place with An Garda Síochána. That will not happen; the law is the law. Gardaí do not work off codes of practice; they work off what is legal and what is not legal.

A heroin user in possession of heroin who is ten yards away from an injecting facility will be committing an offence. If a garda stops that person, we will be relying on the goodwill of that garda to say, "It's all right. Off you go. I know where you're off to." Many gardaí will do that but it will still be illegal. We need to address the issue of decriminalisation. While we will not do so in this legislation, we need to do it in the context of the national drugs strategy. If we are serious about moving to a public health model we need to look at decriminalisation, which will be a very difficult conversation but we need to have it.

The Bill provides that if a person is caught in possession of a controlled substance within the facility, we will "disapply" the law to them. We need to put people's minds at ease. A number of people have said to me that passing this legislation actually legalises heroin within certain facilities. That is not the case. My understanding is that even within a supervised injection centre, a person in possession of a controlled substance is still breaking the law. However, we are saying that we will "disapply" that to individuals who are in there for the purpose of using that controlled substance. We need to knock that myth on the head immediately. Irrespective of whether we agree with the argument on decriminalisation, nobody in this House is proposing to legalise any controlled substance that is currently illegal.

The second myth we need to knock on the head relates to drug crime. In all the research that has been done, there is absolutely no evidence that suggests the establishment of a drug injecting centre increases drug crime in the locality. On the contrary all the evidence suggests it decreases drug crime.

I hope we can progress the legislation quickly. When it is passed the Minister of State will have a job of work regarding the regulations for providing a licence. It cannot be too restrictive. We cannot allow the regulations on providing a licence to become a stick that people opposed to this legislation can use to beat us. We need to provide this centre because it is the right thing to do. There is no such thing as a good decision or a bad decision when it comes to providing an injecting centre, only the right decision or the wrong decision.

It is the right decision to provide these types of facilities. The facilities in question are not just about allowing somebody to walk in off the street and inject himself or herself with an illegal substance and walk back out. That is not their purpose. Their primary purpose is to save lives and their secondary purpose is to try to address the drug problem the individual has. We will do that by providing all the ancillary services at the facility. From my experience, if we have the right facility and services in place, we will not only save lives, we will save people from a lifetime of drug addiction. If the facility is there that can actually provide the services when somebody is at their lowest point, they will grab it with both hands and take it. They will do everything in their power to beat their drug addiction and become functioning people in society again.

I wish the Minister of State well with the legislation.