The way forward for Irish drugs policy –  Key issues for the next National Drugs Strategy

A dhaoine uaisle,  a hUachtaran, ladies and gentlemen

I want to start by thanking Anna Quigley of Citywide for the invitation to address you this morning on what I see are the key issues for the next National Drugs Strategy.

Since my appointment as Minister of State for the National Drugs Strategy earlier this year, I have been trying to get a better understanding   of the nature and extent of the drug problem.   I have met with a wide range of community groups, service providers, service users and family networks who are of the view that the drugs problem has slipped down the political agenda in recent years. The appointment of a dedicated Minister for Drugs by Government is an important step forward aimed at bringing the drug problem into greater focus.

During the summer I held a “Think Tank on the National Drug Problem” to hear from those who have the knowledge and experience of the drug problem as it impacts on local communities.   I invited members of the Local and Regional Drug Task Forces to attend.    As you know, Anna Quigley was one of the speakers at the event, which also included presentations from Deputy David Staunton who chairs the Oireachtas Committee on Justice, Defence and Equality, the Health Research Board and the Ana Liffey Drug Project.

What emerged from the event was a sense that the nature and extent of the drug problem in Ireland has changed significantly.   While there has been a reduction in the number of people coming into methadone maintenance treatment for the first time, there has been a rise in the demand for services outside Dublin which illustrates the drug problem has spread across the country.  Cannabis use is more widespread, new psychoactive substances present a new threat to public health and polydrug use is endemic among the drug using population.

It is very clear that the drugs problem is far more wide reaching than when CityWide was set up 20 years ago.  It is also very evident that the scale of the challenge is enormous, at a time when there continue to be pressures on available resources.   We will have up-to-date data on drugs prevalence in Ireland when the first results of the National Advisory Committee on Drugs and Alcohol (NACDA) 2014/15 survey come out towards the end of the year.

Drug-related deaths and overdoses

The tragic loss of life as a result of drug-related deaths and the repercussions for the families involved and the wider community are a major cause of concern to Government.  In 2012, there were 633 drug-related deaths in Ireland, which is a small decline in the overall number of drug-related deaths when compared with the 2011 figures.

Each death is a tragedy in its own right.  Unfortunately, the overall trend since records began continues to rise, with one overdose due to poisoning every day of the year.  The Naloxone Demonstration Project which started this year is a tangible step in the right direction.  This pilot project involves providing naloxone,  an anti-dote to a heroin overdose,  to 600 patients.  I understand that already many lives have been saved as a result of this initiative, which I hope will continue to expand in the coming years.

I believe that the introduction of Medically Supervised Injecting Facilities will also help to stem the number of such deaths, particularly among those who inject in the streets and alleyways of Dublin and elsewhere.   These drug users are at increased risk of overdose and blood borne disease infections and the general public is at risk owing to unsafe disposal of syringes and other drug paraphernalia.   As well as providing a safe and hygienic environment for injecting drug users, these facilities provide pathways into higher threshold treatment services such as medical and social interventions.  The Minister for Health and I intend to bring proposals to Government shortly to change our current Misuse of Drugs legislation in order to allow for the operation of these facilities in Ireland.

A medically supervised injecting centre is not the answer to the drug problem, but could form part of a suite of harm reduction measures, as a way of managing the problem.

Under the new Strategy, it will be important to continue to monitor progress in this area and to ensure that the upward trend in drug-related deaths we have witnessed in recent years is reversed.

Drug-related intimidation

The drug market and associated crime has a particularly corrosive impact on Irish communities, whether that is by virtue of gangland crime and related murders or through the intimidation imposed on local communities by those involved in drug crime.   Our criminal justice agencies continue to play a significant role in seeking to address the many challenges faced in tackling such drug-related activity.       Our law enforcement response in targeting those involved in drug trafficking remains an important feature of our overall approach in addressing the drugs issue.    And I would like to commend the Garda Síochána for their ongoing role in targeting those involved in the illicit sale and supply of drugs.

Hidden nature of drug misuse

It is easy to forget that behind every drug user, there is a human being.   Addiction is not a choice; it’s a health care issue.  Yet drug users are often blamed for their own situation.  This can stigmatise those with drug problems and make them less likely to come into treatment, which in turn makes their prospects of recovery more difficult.   The NACDA will provide us with an up-to-date estimate of heroin users by the end of the year.   In the meantime, we know that there are almost 10,000 people currently in receipt of methadone treatment, but there is also a hidden group of heroin users and at the moment the extent of the problem remains unclear.

I can see clear parallels between our attitudes towards drug users and other vulnerable groups in society, such as Travellers, Roma and the homeless – due to the prevalence of a victim blaming culture.    These attitudes compound the social exclusion experienced by people in this situation and undermine their human rights.   I believe there needs to be a cultural shift in attitudes to drug and alcohol addiction in Ireland.  As a society, we need to face up to the fact that addiction affects people from all social backgrounds, every family and every corner of Ireland.

It is against this background that there is now an emerging debate in Ireland on whether an alternative approach to the possession of small quantities of illicit drugs should be considered.

Decriminalisation model

The Oireachtas Committee on Justice, Defence and Equality visited Portugal in May this year to see at first hand the strategies in place for dealing with drug use.    The Committee initiated a drugs policy review and consulted with a diverse range of interest groups to get their views on the current approach in Ireland to this issue.

I very much welcome the report published by the Committee last week. This report recommends the introduction of a harm reduction and rehabilitative approach, whereby the possession of a small amount of illegal drugs for personal use could be dealt with through a civil/administrative response, rather than through the criminal justice route.

I believe that the development of the new Strategy will provide a forum for a national conversation on this topic.    I am confident that we can learn from the Portuguese experience and develop a model that suits the Irish context.

Education and Prevention

As many of you know, I worked as a teacher and school principal here in the north inner city for a number of years. That experience has given me my own sense of the kind of challenges that we face as a society in tackling the drug problem.  I am aware that there is a very well developed SPHE programme in schools which aims to strengthen lifeskills so that young people are better equipped to make sensible choices.   However, I don’t believe the problem can be addressed solely within the school walls.   Parents, families and local communities have a very important role to play in the prevention of substance misuse in young people.   I am keen to ensure that their voices are heard as the new drugs policy is being developed.  We must be realistic in our approach.  “Just say no” does not work.  Young people need to understand the issues in all their complexity, including the risks and harms associated with the use of particular substances.  In this way they can make informed and hopefully sensible choices.

Ireland is entering a new and exciting phase, as we embark on developing a new drugs strategy to meet the challenges ahead.  In order to get the best possible sense of what the issues are and how to address them, I intend to have comprehensive consultations to encourage the general public, as well as those with knowledge and expertise in the area, to participate in a wide-ranging debate.  I want to see an inclusive process that takes on board the perspectives of families, communities and service users – from the ground up.

One of the key challenges we face is to ensure that those who enter treatment have a real chance of rehabilitation, reintegration into society and recovery.   Many of these individuals have multiple, complex, interlocking needs such as poverty, housing, poor health and education.   A holistic and integrated response is needed to address their needs.

A further challenge for our services – a legacy of earlier decades – relates to the ageing group of methadone users who have spent years on opiate substitution treatment and who have complex needs and poor physical health.  Of the 10,000 in treatment, 1 in 3 has been in treatment for more than 10 years and 1 in 5 is over the age of 45.

Achieving better outcomes for those in treatment is vital if we are to improve their quality of life.      Every recovering drug user should have a care plan, which provides a definite framework for addressing their needs.   This means all the agencies working together with a common vision on recovery.  Local and Regional Drug and Alcohol Task Forces need to work in partnership with the HSE to ensure that the National Drugs Rehabilitation Framework is rolled out in all areas.  The new Strategy must be firmly focused on recovery.

While I have described some of the issues that should be considered as we start to develop a new Strategy, without strong leadership we are unlikely to see the kind of change that will make an impact on the drugs problem. The new Strategy will provide an opportunity for Government departments and agencies, the community and voluntary sector and elected representatives to re-commit to the partnership approach which has been the cornerstone of our drugs policy up to now. This commitment must be evident through genuine participation by all concerned in the partnership structures of the National Drugs Strategy.

In  this  context,  the  next  National  Drugs  Strategy  will be of vital importance  and  I am delighted today to announce that I will be appointing John  Carr  as the Independent Chairperson of the Steering Group which will oversee the development of the new  strategy.

John  is  a  former  General  Secretary  of  the  Irish  National Teachers Organisation  and  is  involved  with  the  Northside  Partnership  and the Preparing  for  Life  programme  in Darndale. I know he will bring a lot of experience to the role and that he has the negotiating and mediation skills for the work ahead.

I also wish to announce the appointment of an international Expert Review Group to carry out an independent high level review of the current Strategy in order to highlight areas for consideration in the development of the new Strategy.  Paul Griffiths, Scientific Director with the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) will chair this group and will be joined by Ms Nicola Singleton, also of the EMCDDA, and Professor John Strang of the National Addictions Centre, Kings College in London.

I want to congratulate Citywide on the tremendous work they have done in the past 20 years to build the capacity of local communities to have a say in how the drug problem is tackled in their areas.   A strong community voice is essential to the democratic process.

I wish you a very enjoyable and fruitful day in your deliberations and I look forward to hearing the outcome of this conference in due course.