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Home > Irish drug policy alternatives: a qualitative study.

Dillon, Lucy (2021) Irish drug policy alternatives: a qualitative study. Drugnet Ireland , Issue 76, Winter 2021 , pp. 15-16.

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The voice of people who use drugs (PWUD) is often missing from the debate on drug policy. In an effort to address this gap, Leonard and Windle in 2020 published the findings of a qualitative study carried out in Cork: ‘I could have went down a different path’: talking to people who used drugs problematically and service providers about Irish drug policy alternatives.1 The findings are placed within the broader context of international literature on the topic.

Gap in debate

The authors acknowledge that some effort has been made by policymakers internationally to include the voices of PWUD in discussions on the development of drug policy. The Irish Government’s Working Group to Consider Alternative Approaches to the Possession of Drugs for Personal Use is identified as an example of where this has been attempted, albeit with limitations.2 This view is set within the broader context of a global movement towards including those most affected by policies and practices in their planning, implementation, and evaluation (Nothing About Us Without Us) (p. 2).

Methods

Semi-structured interviews were carried out with eight people who had used drugs problematically. At the time of interview they all had at least one year of abstinence and had been criminalised for their drug use. Seven of the eight had served at least one custodial sentence. Six practitioners who work with PWUD were also interviewed. The interviews set out to explore the relationship between relative deprivation and problematic drug use; decriminalisation of drugs for personal use; depenalisation of cannabis; safe injecting facilities; and heroin-assisted treatment. The authors acknowledge the limitations of their study, including the small sample size and that all participants had undertaken therapy, and therefore acknowledge that they were not representative of the PWUD population more broadly.

Problematic drug use, economic deprivation, and criminalisation

A recurring theme throughout the paper is the link between problematic drug use and economic deprivation. The authors use a subterranean structuration framework to understand this link, which is a focus for study participants. This approach argues that a lack of meaningful employment opportunities for young people results in a situation where drug use and the surrounding activities (including buying and dealing) are perceived to offer an alternative and viable social and economic activity. It allows those living in economically deprived areas to find purpose and company, a sense of identity, excitement and adventure, while also dulling ‘the pains of existence and exclusion’ (p. 45).3

[Subterranean structuration draws attention to] the constraints placed on the choices made by people who have been most affected by the withdrawal of employment in deprived areas. These people are forced to make choices in situations which offer them little hope for pleasure, purpose or respect, no matter how hard they struggle. (p. 10)3

The experiences of those interviewed for this study illustrate the reality of this inextricable link between problematic drug use and economic deprivation.

Penalisation and criminalisation

Study participants argued that criminalising PWUD from economically deprived areas has little deterrent effect, rather it serves to exacerbate the problems that made drugs attractive in the first place. These findings are consistent with international literature. Some participants perceived arrest and incarceration as an ‘occupational hazard’ of problematic drug use. Unintended consequences were noted; for example, moving into heroin use while in prison; the impact on children and partners of their being in prison; and the negative impact of a criminal record on their employment opportunities.

Perceptions on alternative drug policies

Four alternative drug policies were explored: decriminalisation, depenalisation, supervised injecting facilities, and heroin-assisted treatment.

Decriminalisation and depenalisation: The authors used the Dutch and Portuguese models as examples of depenalisation and decriminalisation, respectively. Decriminalisation was defined to participants as ‘the removal of sanctions under the criminal law, with optional use of administrative sanctions (e.g. provision of civil fines or court ordered therapeutic responses)’. Depenalisation was defined as ‘the decision in practice not to criminally penalize offenders, such as non-prosecution or non-arrest’ (p. 999).4 Participants’ views were mixed about the Dutch model. While it was seen as a way to encourage safer cannabis use, some were concerned that it would lead to increased drug use. On the other hand, all of the participants were supportive of the Portuguese model. Much of this support revolved around drug treatment – Irish drug treatment services were perceived to be insufficient and ‘criminalisation without supports leads to a revolving door process for drug offenders’ (p. 20).1 Overall, a model that combines decriminalisation with expansions in drug treatments and the welfare state was deemed to offer the greatest chance of success.

Supervised injecting facilities (SIF): There was overwhelming support for SIF among study participants. Among the benefits identified were a reduction in street litter (drug paraphernalia), safer injecting practices, and an opportunity to offer PWUD additional supports.

Heroin-assisted treatment (HAT): HAT is described as ‘a harm reduction measure for people who have used heroin long-term and have not responded well to other forms of treatment whereby pharmaceutical grade heroin is usually taken under medical supervision’ (p. 24). The aim is not abstinence but stabilisation. None of the PWUD in this study had heard of HAT and were described as surprised that it existed as a policy. While there was some tentative support for its inclusion as part of wider changes, concerns about it were also expressed. Overall, these stemmed from a concern that it might mean people would remain in long-term drug use for longer than necessary and that they might not be offered the opportunity to become abstinent. The possible benefits identified were a reduction in the harms associated with street heroin use – a safer product, a reduction in acquisitive crime, and a reduction in business for street dealers.

Conclusions

Leonard and Windle’s paper provides valuable insights on a variety of topics from the perspective of PWUD and those working with them. They illustrate the complexity of problematic drug use and the policy responses required. No single policy is perceived to offer a silver bullet to addressing the situation. Rather, participants returned to the need for wider structural reforms to address economic inequality and deprivation, alongside improvements in drug treatment services.

 

1  Leonard J and Windle J (2020) ‘I could have went down a different path’: talking to people who used drugs problematically and service providers about Irish drug policy alternatives. Int J Drug Policy, 84: 102891. https://www.drugsandalcohol.ie/32593/

2 Working Group to Consider Alternative Approaches to the Possession of Drugs for Personal Use (2019) Report of the Working Group to Consider Alternative Approaches to the Possession of Drugs for Personal Use. Dublin: Department of Health and Department of Justice and Equality.  https://www.drugsandalcohol.ie/30887

3 Cited in Leonard and Windle: A Stevens (2011) Drugs, crime and public health: The political economy of drug policy. Abingdon: Routledge.

4 Cited in Leonard and Windle: CE Hughes and A Stevens (2010) What can we learn from the Portuguese decriminalization of illicit drugs? Brit J Criminol, 50: 999–1022.

Item Type
Article
Publication Type
Irish-related, Open Access, Article
Drug Type
All substances
Intervention Type
Policy
Issue Title
Issue 76, Winter 2021
Date
March 2021
Page Range
pp. 15-16
Publisher
Health Research Board
Volume
Issue 76, Winter 2021
EndNote

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