Thursday, 9 March 2017
Misuse of Drugs (Supervised Injecting Facilities) Bill 2017: Second Stage (Resumed)
I welcome this progressive Bill. Anything that prevents deaths and promotes harm reduction in this city is very good. Supervised injecting rooms give people access to treatment, take people off the streets and give them alternative means of gaining access to the drug they take. In addition, they reduce the number of overdoses.
I have seen the social damage that heroin has done to the community I lived in. I saw friends of mine die from heroin abuse. I saw at first hand the absolute tragedy of what heroin does to communities. The Minister of State, Deputy Catherine Byrne, will appreciate that herself. In the area she represents, she will have seen the absolutely appalling damage drugs have done to people. Nobody on this earth grows up wanting to be a heroin addict. It is not of their choosing; it is because of circumstances. We all make mistakes, and sometimes those mistakes are fatal.
It is very good that we are having a debate in this country on the decriminalisation and liberalisation of drug use. We are getting there. It is very important to have the discussion. A number of Deputies will agree that this issue is more about treating people holistically and according to a health-based approach rather than treating them as criminals. Would we lock up a chronic alcoholic in a prison? We would not. We would give him treatment and try to give him a plan to move beyond the circle of chronic abuse. I hope a day will come when a chronic abuser of heroin or another drug will be able to bypass the criminal justice system and be treated according to an holistic, health-based approach. That is very important.
References to the Portuguese model are bandied about a lot. This is important because if we can save one life, it will have been well worth the effort. I was in Portugal last year and asked many people about how the system works for people there. If a person is caught in possession of a certain amount of drugs there, he or she is not criminalised but given an alternative.
The war on drugs has been an abject failure. We must consider completely different approaches. Some of these will be extremely hard for people to understand and some of them will be very radical. I believe those in possession of a small amount of drugs for their own use should not be criminalised. Rather, they should be offered another path. People injecting heroin in this city and others should be given an alternative. Under the supervision of doctors, they can stay away from the street environment.
I welcome this approach.
There were 687 rehabilitation beds and 144 detox beds in Ireland, but over the past eight or nine years, those numbers were vastly reduced because of austerity. Everyone knows that people who are coming off heroin or any other drugs must go through detox. Otherwise, they will go through a full circle of misery. I have friends who have gone through both systems. Some of them have come out the other end but for others it is a constant battle.
Nobody was born to take the worst drug of all, heroin, with the misery and social damage that it causes. Nobody chooses that path. People just take the wrong path in life. This legislation is progressive. It will give people an alternative and it is to be hoped we will see it being implemented in the next six months or so. If it can save one life, then it is well worth it.
Whenever I speak about drugs and addiction in this House I am reminded of my predecessor, the late former Deputy Tony Gregory who, from the time he came into the Dáil in 1982, was a lone voice for many years on drugs and addiction. At that time, officialdom was unaware, ignorant and indifferent to what was happening in our constituency. He used every opportunity to try to ensure these issues would not be forgotten. He highlighted the direct link between disadvantage and hard drug use. At that time, heroin was ravaging Dublin's inner city families, individuals and communities. The response had to be policy driven and it required an inter-agency approach involving the community and voluntary sectors and a co-ordination of services.
His pioneering work eventually led to the establishment of the drugs task forces, the Criminal Assets Bureau, CAB, and the national drugs strategy. We all know the pillars of that strategy.
My own involvement in this area included chairing the north inner city drugs task force and, before that, the young people's facilities and services fund. In that context, I wish to refer to prevention and education because if we could get that right, we would really see a reduction in the numbers who get into addiction. I hope the new strategy will be stronger in that area than previous strategies. I know, from my own work, of many excellent education programmes which develop young people's critical thinking, teach them how to cope with peer pressure and to be assertive and confident in their ability to make decisions about taking drugs or alcohol. We have been doing work in the north inner city on these areas. I have learned about numerous very progressive programmes that are being run by community and youth leaders, as well as local councillors, in different parts of Dublin. Such programmes represent direct, meaningful and appropriate engagement with young people and they are working. We all know of wonderful young people with massive potential who have lost their way through addiction.
There are great examples in my constituency of treatment and rehabilitation services that are making a huge difference. Some of these services grew out of initiatives in the community because it was the community that was dealing with the effects of addiction and which saw the need for these services. I must acknowledge all the treatment and rehabilitation services for those in addiction, including the 12 step programmes, the methadone clinics, the harm reduction programmes and the counselling services that are being provided by accredited counsellors. Indeed, I wish to stress the importance of the accreditation of counsellors. There are programmes available that are specific to young people, women and to mothers.
Everyone knows that the road out of addiction into recovery is very difficult, and for many in addiction it involves relapses and hospitalisation. We are all aware of the numbers of people who have lost their lives to addiction. I am very familiar with the Ana Liffey Drug Project. It was set up many years ago by Mara de Lacy and Frank Brady at a time when there were very few services available and very few people reaching out to those in addiction. The project has developed considerably since then in response to emerging needs and it has done much work on proposals for supervised injecting rooms. When those running the Ana Liffey Drug Project realised that drug users were not presenting for services, it increased its use of outreach workers who would go out to those in addiction, bringing them harm reduction and health related material, including freefone numbers and so forth.
The Minister of State has met representatives of the Union for Improved Services Communication and Education, UISCE. UISCE is a service users forum which is rolling out very innovative, peer-led programmes involving users.
Two years ago, staff of the Ana Liffey Drug Project asked me to host an event in the audiovisual room in Leinster House. It was a presentation of the project's position on the concept of medically supervised injecting centres. They showed a film of an injecting room in Australia. To be honest, it was very difficult to watch people injecting themselves. It was obvious from the film that a very particular client group was using the injecting room. They were long-term users of heroin who, for various reasons, had not stopped taking heroin. The heroin addicts in the film were older, articulate and their drug use was such that they were able to wait to get to the rooms before injecting. However, the lives of some of our injecting heroin users are so chaotic, probably due to polydrug use with alcohol, that I would be concerned about their ability to wait to get to injecting room to use the facilities. That said, the project and outreach workers will know the client base who can avail of the rooms.
It was obvious from the film that staff were highly trained. It was also obvious that a number of other services were being offered in the injecting room and that is something we must get right here. I have spoken to people who have either visited or worked in injecting rooms and I know that the Minister of State visited one such facility in Copenhagen. I was told that because other services were available, the addict was in a space where he or she could be engaged with and that some were able to address their drug use. Counsellors saw a reduction in usage, with some clients being supported into recovery. Indeed, we should never lose sight of recovery, and supports must be available to encourage people into recovery.
In that context, I want to mention Recovery Academy Ireland, which grew out of research conducted by the Soilse drug rehabilitation project. Soilse and other projects have been supporting the recovery journey because apart from the obvious benefits to the life of the person in addiction, there is also a payback for communities and an economic payback in terms of our health services. Former addicts are providing a payback themselves by becoming recovery coaches, enabling, facilitating and supporting others into recovery. There are really good examples of recovery academies in England and Scotland which have set up recovery cafés and recovery business centres. The latter are aimed at people who were in addiction and are now in recovery but who cannot get bank loans to set up in business.
We all know that detox programmes are vital for many taking the first step into recovery. We also know of the value of methadone which gives people stability in their lives, but it is not a long-term solution except in a limited number of cases. There must be an exit strategy built into methadone programmes. I would stress that injecting rooms are but one part of a much bigger picture. As we know, addiction services were very badly hit by successive recessionary budgets. I support the provision in this legislation as a harm reduction measure for chronic drug users. It will provide a controlled space for them to inject, but again this is just one programme. We must not lose sight of the other programmes and strategies that form part of the national drugs strategy.
Addicts will have access to clean, sterile injecting equipment in the injecting rooms. Trained staff will be there to supervise the injecting and to act in the event of difficulties arising, including the possibility of people overdosing. I have one question regarding the Title, which is the Misuse of Drugs (Supervised Injecting Facilities) Bill. What exact level of medical supervision will be available?
Why would anybody want to support supervised injecting rooms? The hope is that they will result in fewer deaths from heroin use and overdose. The alternative is to turn a blind eye to public injecting. In the north inner city one will see so many addicts injecting in laneways, side streets, main streets and doorways as well as on the DART and the Luas. That is the reality. Injecting rooms have been operating in Europe for 30 years, with the first one opening in 1986. Evidence from the approximately 90 drug consumption rooms around the world shows their effectiveness in reducing fatal overdoses, decreasing the incidence of public injecting and reducing drug related litter.
There are diverging opinions in Ireland on injecting rooms and all sides can present facts to support their arguments. I am not so naive as to think that this will be plain sailing. We cannot expect injecting rooms to prevent drug use, to divert all drug users from risky behaviour or to solve the wider issues of drug dealing. However, there is no evidence that the rooms recruit drug users into injecting. Rather, they are there for those who have been injecting long-term. This cohort of drug users needs encouragement, support and treatment towards recovery, but while they are injecting, they are deserving of our compassion and are deserving of dignity in their consumption and the rooms will give them that.
I know the relief it will give their loved ones because they are constantly waiting for the knock on the door to say that the addict has been found in a laneway or a doorway with needles all around them.
For the consumption rooms to have a chance of working, location is important. They have to be easily accessible and the opening hours have to be flexible. I know the concerns in Dublin regarding location. However, addiction services and consumption rooms in other cities do not attract the same attention as they do in Dublin. It is vital that there is engagement with the residents and with the Garda. It comes down to management and staff.
There are two ironies. First, how cool and trendy it is for a certain cohort of drug users to do their lines of cocaine in the nightclub or in the hotel and yet at the same time, people who are injecting are looked down on. However, the same drug dealer is providing the drugs for both cohorts. Another irony is that we do not want them located near schools but in Dublin's north inner city schoolchildren going to school every day are watching people injecting.
I wish to make a point about the licenceholder's and his or her responsibility. There is another concern about section 19(1)(e) of the 1977 Act. There is a need to amend the provision regarding immediate personal consumption to be limited to small amounts of the drugs. We need to keep this under review as we go along. There also is an insurance element. Those places in Dublin involved in the needle exchange programme are experiencing huge increases in insurance premiums. Insurance premiums have gone from €2,000 in 2016 to nearly €15,000 in some areas now.
I support the legislation on supervised injecting facilities introduced by the Minister of State, Deputy Catherine Byrne. There has been a demand from the Ana Liffey drugs project and other groups and the drugs task forces, including the one in which I am involved, the canal communities drugs and alcohol task force. They feel it is part of an overall intervention for people who use drugs.
There have been many representations from members of the public in my area, not in any way hostile to the people using heroin, but mainly because in areas such as at the back of the Viking centre, Dublinia, and the green section beside the flats and the school, there is open heroin injection. People are so desperate they literally just drop their trousers and inject themselves. Then the needles are left around the area. There has been huge concern about this for some time. A security officer in the Dublin civic offices who lives in my area has told me about tragic cases of trying to care for people who have overdosed and ambulances having to be called.
This is a pilot scheme. It is certainly worth introducing the legislation and setting up the facility to see how it operates. How will the Garda deal with the issue of carrying drugs to the centre? I expect it will need to establish some sort of policy with the Department of Health and the facility as to how to deal with that. Drug pushers could try to target the area but I think that can be dealt with and obviously that will need to be continually reviewed.
For those who want to inject heroin in a safe confined area, this is worthwhile legislation. We have a big problem with public injection. A recently published report by the UCD school of medicine on urban overdose hotspots found that over a 12-month period, ambulance services attended 469 overdoses in Dublin. The vast majority were concentrated in the city centre and 45% occurred on the street. Just under 90% were taken to hospital and 30 people who overdosed did not make it that far. There is a real need.
I have read articles by journalists who have spoken to heroin users in the centre. Some of them did not know what a medical centre would be - they had not heard about it, while others had. It can play a role as part of an overall strategy that I hope will be supported as regards the national drugs strategy in co-operation with the communities and the task forces. It has been successful in other parts of Europe and elsewhere. I read an article that indicated that in Australia in certain areas they brought in sniffer dogs to try to deal with some issues.
We have to give it a chance to see how it develops. If it is successful hopefully those heroin users will come into the centre and will make contact with other services in the area. I have contact with people involved in a hospital in Ballyfermot where there was a rehabilitation centre. It was closed down and moved to the Simon Communities on the quays. It plays a role in assisting people getting some stability back in their lives. Along with that has to be the long-term hope and vision those people have for themselves of getting a job and becoming responsible in their own right for their own future.
I give the Minister of State my full endorsement for the legislation and will be voting for it. It will be well supported by the drugs task forces.