Ireland’s Citizens’ Assembly on Drugs Use ran from April to October 2023 and provided the opportunity for an unprecedented in-depth discussion on the drugs situation in Ireland, reflecting all its complexities. Following consideration of the extensive body of evidence presented to them, the assembly members made 36 recommendations to Government. These address legislative, policy, and operational changes that the State should make to reduce the harmful impacts of illicit drugs.

The assembly’s final report was published in two volumes in January 2024.1 It presents a comprehensive record of the assembly’s six meetings and their recommendations. The report is an invaluable resource for those interested in understanding the drugs situation in Ireland.

According to Paul Reid, chairperson of the Citizens’ Assembly on Drugs Use:

Drug use in Irish society is a wide-ranging, complex and multi-faceted issue. Unfortunately, political debate and media coverage far too often tends towards one-dimensional analysis and over-simplification of the issues. In contrast, the Citizens’ Assembly has given extensive time to delving into the complexities and nuances of drug use, examining the evidence and hearing different perspectives. (vol 1, p. 3)1

Background

The Government committed to the Citizens’ Assembly on Drugs Use in its 2020 Programme for Government,2 and in February 2023 gave its approval for the assembly to be established. In Ireland, a Citizens’ Assembly is a democratic structure in which people living in the country are brought together to discuss and consider important and often complex legal and policy issues, independent of the Government and Oireachtas.3

The Citizens’ Assembly on Drugs Use met over six weekends. Membership of the assembly was made up of a selection of 99 Irish residents over the age of 18 years and an appointed independent chair, Paul Reid, former chief executive of the Health Service Executive (HSE). Members did not have to be Irish citizens or on the electoral register. Based on a random selection, a pool of 20,000 households were invited to take part. Of those who agreed to be considered for membership, a selection was made that reflected the age, gender, social class, and regional spread of Irish society. The group was also found to have ‘a diverse range of perspectives and levels of experience in relation to the issue of drug use’ (vol 1, p. 7).1 The assembly set its own rules and procedures, within the confines of nine key principles: openness, balance, transparency, equality of voice, respect, privacy and confidentiality, inclusivity, collegiality, and professionalism (vol 2, p. 205).1 It was supported by a Steering Group, Advisory Support Group, and Lived Experience Group, as well as research support by the Health Research Board and the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA).  

Terms of reference

The remit of the Citizens’ Assembly on Drugs Use was to consider the legislative, policy, and operational changes the State could make to significantly reduce the harmful impacts of illicit drugs on individuals, families, communities, and wider society. It was to consider, among others:

• The drivers, prevalence, attitudes, and trends in relation to drugs use in Irish society
• The harmful impacts of drugs use on individuals, families, communities, and wider society
• Best practice in promoting and supporting rehabilitation and recovery from drug addiction
• The lived experience of young people and adults affected by drugs use, as well as their families and communities
• International, European Union (EU), national, and local perspectives on drugs use
• The efficacy of current strategic, policy, and operational responses to drugs use
• International best practice and practical case studies in relation to reducing supply, demand and harm, and increasing resilience, health and well-being, and
• The opportunities and challenges, in an Irish context, of reforming legislation, strategy, policy, and operational responses to drugs use, taking into consideration the implications for the health, criminal justice, and education systems.4

Building the assembly’s knowledge

Over the course of the six weekends, presentations were made by approximately 130 national and international contributors, including those with lived experience of drug use, policy and research experts, practitioners in the field, service providers, service users, and representatives of lobby groups, among others. Members’ deliberations were further informed by site visits to services for people who use drugs, almost 800 oral or written submissions from the public, and research on young people’s views on the topic.5

The members of the assembly agreed a work programme through which a broad theme would be covered over each of the six weekends, ensuring that they had the information required to meet their terms of reference. Other than when site visits were being made to drug services, the meetings followed a structured format. A set of presentations would be made by contributors or a panel discussion held on a particular topic or theme, then in a roundtable discussion members would discuss what they had heard, followed by a question-and-answer session. The final report provides an account of each of the six meetings. It includes summaries or full transcripts of each of the presentations, an account of themes emerging from the roundtable discussions, as well as the question-and-answer sessions. This makes for valuable reading and captures the depth and complexity of the topics covered in the meetings. Full video recordings of each session are also available to watch online.6

Overview of the six meetings

1. Setting the scene: The first meeting provided an overview of deliberative democracy and tools such as citizens’ assemblies and how they can inform policymaking. This was followed by presentations on drug policy, trends, and patterns of use at the national, international, and European levels.

2. Lived experiences: The second meeting involved site visits to drug services followed by panel discussions and presentations that explored the lived experiences of people who use drugs, their families, communities, and service providers.

3. Health and community-based perspectives: The third meeting focused on the role of policy and service delivery providers in the health, community, and voluntary sectors. This included consideration of health-led approaches to drug use, including those implemented in Austria and Portugal. Presentations were also made by national contributors who described the landscape of harm reduction, treatment, and recovery services available for people who use drugs, illustrating good practice and innovative ways of working.

4. Criminal justice and Ireland’s legislative framework: The fourth meeting provided an overview of supply-side issues at a national and international level. Members heard about the experiences of those involved in the courts and prisons and the various options available in those settings for people who use drugs. Contributors also reflected on alternative options to dealing with people who come into contact with the criminal justice system because of their drug use. This meeting addressed a core element of the work of the assembly: the exploration of possible alternatives to the current legislative framework in Ireland in relation to drugs use. Models explored ranged from maintaining the status quo to legalisation with regulation (see the section on recommended legislative changes below).

5. Prevention strategies and practice: The fifth meeting focused on prevention strategies and practice across a range of settings. It also included presentations on health-led recovery as well as governance and funding options.

6. Conclusions and recommendations: In the sixth and final meeting members of the assembly voted through a secret ballot to decide on the recommendations of the assembly to Government. Prior to the meeting, draft ballot statements on the issues that had emerged as priorities for assembly members were circulated to them for comment. Through an iterative, democratic process these were amended and then voted on by the assembly. The outcome of this process is discussed in the next section.

Recommendations of the Citizens’ Assembly

The recommendations of the Citizens’ Assembly form the core outcome of the process. As with previous assemblies, technically the recommendations are only advisory in nature and the Oireachtas, Government, and judiciary are not obliged to act on them. The report of the assembly is referred to a committee comprising members of the Oireachtas and Seanad for consideration, with the committee bringing its conclusions to the Houses of the Oireachtas for debate. The Government is obliged to respond to each recommendation of the report in the Oireachtas. For recommendations that it accepts, it is obliged to set out a time-frame for their implementation.

The process of drafting and selecting the recommendations illustrated the democratic and iterative nature of the assembly. Having been presented with a wide range of evidence by contributors, the assembly identified the issues they considered to be the most important. As mentioned above, related ballot statements were drafted, revised, and finalised to reflect feedback from members. Secret ballots were held involving 41 statements in which members voted for those that would form their recommendations.

In line with the assembly’s terms of reference, the recommendations reflect the legislative, policy, and operational changes that it considers the State should make to significantly reduce the harmful impacts of illicit drugs on individuals, families, communities, and wider society. Box 1 lists the 36 recommendations made by the assembly. In the report, each of them is accompanied by an explanatory narrative which, to varying degrees, provides greater detail and specification to the recommendation. It is beyond the scope of this article to provide a detailed account of each of them, and readers are encouraged to examine the relevant section of the report in full (vol 1, pp. 9–18).1 There are some themes that however cut across the recommendations and illustrate the broad consensus among members on many issues. While not an exhaustive list, these include:

1   Drug use is a ‘serious, urgent, complex, escalating and evolving public health issue that causes widespread and significant harm’ (vol 1, p. 9).1

2   Not enough is being done in Ireland to address the drug situation and to meet the needs of those affected – people who use drugs, their families, communities, and wider society. The situation ‘demands a more effective, urgent and ambitious response from the State’ (vol 1, p. 9).1 This includes giving much greater political prominence and priority to drug policy.

3   Given the complex and cross-cutting nature of the issues involved, the assembly’s recommendations argue for a response that invokes effective involvement from all stakeholders, with high-level leadership. Stakeholders include Government Departments, policymakers, State bodies, service providers, service users, the community and voluntary sectors, civic society, and the general public.

4   Significant additional funding resources need to be allocated to implement the wide range of responses identified in the recommendations, for example, in supply reduction, community safety, prevention, treatment, and harm reduction.

5   The assembly would like those with responsibility for addressing drugs issues to be held to account, for example, when implementing the Citizens’ Assembly’s recommendations and the National Drugs Strategy. It advocates for rigorous monitoring of progress and spend across all areas.

6   The assembly considered drugs use to be predominantly a health issue. For example, it would like health-led options to be formally adopted and resourced as an alternative for people experiencing drug addiction who are in contact with the criminal justice system. None of the changes recommended involve stricter penalties on people who use drugs, in fact, the contrary.

7   The assembly recognised the value of rigorous evidence. For example, it is essential to inform best practice and remove barriers when evidence-based approaches are identified.

8   More treatment and other service places are needed across the settings where people who use drugs present for support.

9   The skills and knowledge of those working in a role that involves addressing the drugs issue at any level need to be supported and developed.

The explanatory narrative of Recommendation 1, for example, states:

While there are good examples of effective evidence-based operational and policy responses to drugs issues, there is clear evidence that the State’s response continues to be hindered by delays, inaction, lack of policy innovation, under-investment, policy incoherence and the need for more effective leadership at all levels. (vol 1, p. 9)1

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Box 1: Recommendations of the Citizens’ Assembly on Drugs Use

1       The State should take urgent, decisive and ambitious action to improve its response to the harmful impacts of drugs use, including implementing necessary legislative changes.

2       Government should prioritise drugs misuse as a policy priority, as part of an overall socio-economic strategy.

3       Government should give greater political priority and prominence to drugs policy and related issues. A dedicated Cabinet Committee chaired by the Taoiseach, supported by a Senior Officials Group, should consider and publish a detailed annual report on drug trends and emerging risks. The Department of Health must be supported in providing effective leadership and coordination of the work of the National Oversight Committee for the National Drugs Strategy.

4       Government should recognise that an effective national response to drugs-related issues requires whole of government policy coherence, operational cohesion and effective leadership.

5       The Government must assign accountability, at the highest level, for the State’s response to problematic drug use, including for the implementation and tracking of the progress of the Citizens’ Assembly recommendations.

6       The Government should introduce a ‘Health in all Policies’ approach to policy development.

7       Government should publish a new iteration of the National Drugs Strategy as a matter of urgency. A first draft should be published by June 2024 for consultation, with the recommendations of the Citizens’ Assembly as a key input. The [next] Strategy should contain annual action plans with measurable targets and objectives, clear designation of responsibilities, and regular reporting on implementation and expenditure.

8       Government should ensure effective stakeholder involvement in implementing the [next iteration of the] National Drugs Strategy.

9       Government should work with key stakeholders to build an effective whole of society response to drugs-related issues.

10     Drugs policy design and implementation should be informed by service users and people who use drugs as well as family members of people affected by drugs, with provision of appropriate supports to enable this involvement.

11     The State should formalise, adopt and resource alternative, health-led options for people with a drug addiction within the criminal justice system.

12     The Government should allocate additional resources to fund community-based and residential treatment and recovery services as an alternative to custodial sentences for people with problematic drugs use.

13     The Department of Justice and the Irish Prison Service should develop and fund enhanced prison-based addiction treatment services.

14     The Government should develop and expand the use of alternative pathways for young people engaged in low-level sale and distribution of drugs. The Assembly recommends that the criminal justice system adopts the widespread use of restorative justice and diversion initiatives in these cases, with enhanced investment in community-based youth work and community development projects and initiatives.

15     Drugs policy should prioritise the needs of vulnerable and marginalised groups and disadvantaged communities.

16     The National Drugs Strategy should seek to optimise services to ensure continuity of care and joined-up care for all service users, including people with complex and/or specific needs.

17     The State should introduce a comprehensive health-led response to possession of drugs for personal use.

18     Government should allocate significant additional funding on a multi-annual basis to drugs services across the statutory, community and voluntary sectors, to address existing service gaps, including in the provision of community-based and residential treatment services, to support the implementation of the recommendations of the Citizens’ Assembly. This funding should ensure geographic equitability in terms of access to statutory services, as well as providing for accountability, transparency and traceability of allocations.

19     The Government should examine the potential of novel funding sources to support increased drug services within the health and criminal justice systems, and in the community and voluntary sectors. Any novel funding should be secured, tracked and ringfenced for drug services expenditure.

20     Key stakeholders should publish a joint report on an annual basis detailing total and disaggregated expenditure and channels of funding provided for drug-related services in Ireland, audited by the Comptroller and Auditor General.

21     The Government should recognise, value and adequately resource the role of family members and extended support network in supporting people affected by drugs use, and their children. Kinship carers and children should have the same rights as foster carers and foster children, and this should include legal rights and monetary rights on a non means-tested basis.

22     The [next iteration of the] National Drugs Strategy should include a strategic workforce development plan.

23     A minimum, mandatory basic training should be implemented for personnel across education, health, criminal justice, prison and social care services on trauma-informed and problem-solving responses to addiction, and health-led response options for those presenting with problematic drug use or addiction.

24     The National Drugs Strategy should continue to prioritise the objective of reducing illicit drugs supply and associated structures, at international, national and local level within communities.

25     The National Drugs Strategy should focus on building resilient, sustainable communities though local partnerships in both urban and rural settings, and stronger community policing.

26     The National Drugs Strategy [should] continue to prioritise the objective of tackling the source and impact of drugs-related intimidation and violence, and take a zero-tolerance approach.

27     The National Drugs Strategy should include a detailed action plan to enhance Ireland’s approach to prevention of drugs use.

28     The Departments of Health and Education, in conjunction with the HSE, should design and implement a comprehensive, age-appropriate school-based drug prevention strategy for primary school children, junior and senior cycle secondary students, and wider community settings, as well as their parents/guardians and teachers. Prevention programmes should utilise external experts to deliver to classrooms, supporting teachers, with regular updating by the experts to the schools.

29     The Department of Health should roll out regular national public health information campaigns, focusing on reducing shame and stigmatisation of people who use drugs, prevention, risk mitigation and advertising services.

30     The National Drugs Strategy should prioritise a systemic approach to recovery.

31     The Department of Health should develop a strategy to enhance resilience, mental health, well-being and prevention capital across the population, including a focus on providing therapeutic supports for children and young people, and for people dealing with trauma and adverse childhood experiences and dual diagnosis.

32     The [next] National Drugs Strategy should incentivise and promote evidence-based innovations in service design and delivery, prioritise the evaluation of pilot projects and emphasise the timely mainstreaming of best practice nationally and internationally.

33     The National Drugs Strategy should include a plan to strengthen the national research and data collection systems for drugs to inform evidence-based decision-making.

34     Referral of submissions received by the Citizens’ Assembly from the general public and stakeholders on drugs use to inform the development and implementation of the National Drugs Strategy.

35     Referral of certain submissions received by the Citizens’ Assembly on Drugs Use, in relation to the potential therapeutic benefits of certain substances, to the appropriate authorities for consideration.

36     The National Drugs Strategy should use evidence-based approaches to harm reduction, and take measures to reduce the barriers to implementing harm-reduction approaches without undue delay.

          See vol 1, pp. 9–18.

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Recommended legislative change

The assembly was asked to consider legislative changes that the State could make to reduce the harms of illicit drugs use. This issue attracted a lot of debate within the assembly and illustrated how divided opinion is on the topic. It is worth exploring this recommendation in more detail.

Preparing for the ballot

Choosing a legislative approach is a technically complex issue for which the Secretariat prepared a background paper to support the members in their deliberations ahead of their fourth meeting.7 Among the topics covered were key terms and concepts such as decriminalisation, diversion, legalisation, etc.; the current legislative framework at national, EU, and international levels (including that related to human rights); the interplay between legislation, policy, and practice; and an overview of the harms caused by drug use in Ireland.

The paper also introduced five examples of different legislative models to illustrate plausible alternative approaches that the assembly may consider recommending for the Irish legislature to adopt to deal with possession for personal use. The fourth assembly meeting was structured as a workshop that explored the models. It facilitated an extensive opportunity for members to draw on the knowledge of an expert panel, have additional time for roundtable discussions, and to report their comments back to the Secretariat. Participants were asked to reflect on the different models and what effects they may have on stakeholders; how effective the model would be in reducing the various harms of drug use; and the advantages and disadvantages of each model and possible improvements. They were also invited to suggest any alternative models they would like considered. The main objective of the workshop was for members to develop a methodology that they could use for the remainder of their deliberations to assess the pros and cons of alternative systems that might be considered in relation to dealing with illicit drugs in Ireland.

Ballot options

Five models were on the ballot, including the text of the recommendation (in italics below). Some of the key elements of the accompanying explanatory narrative are also outlined; the full text for each model can be found in Appendix H of volume 2 of the report (pp. 216–218).1

A   The status quo/options within the current legal framework: To retain the current legislative approach to possession of drugs for personal use, including offences specified under S3 of the 1977 Misuse of Drugs Act, and sentencing as specified under S28 of the Act. Under this approach, possession for personal use can result in a criminal conviction and a prison sentence. There is also no legal basis for direct referrals by Gardaí to health-led services.

B   Limited health diversion: The Government should introduce the planned Health Diversion legislation as an urgent legislative priority. Under this approach, the offence of possession of drugs for personal use and the related sentences would be retained as per the status quo model. However, new legislation would provide for leniency in the treatment of people found in possession of drugs for personal use for the first time. First-time offenders would be referred for a brief intervention. They would avoid an appearance in court, with the prospect of a criminal conviction, fine, and possible prison sentence.

C   Comprehensive health-led approach: The State should introduce a comprehensive health-led approach to possession of drugs for personal use. Under this approach, the State would respond to drug use primarily as a health rather than a criminal justice issue. While possession of drugs would remain illegal, those found in possession would be afforded extensive opportunities to engage voluntarily with health-led services. This would minimise or potentially completely remove the possibility of criminal conviction and prison sentences for simple possession. At its core, this model combines diversion, decriminalisation, and dissuasion (see Box 2 for definitions of the first two of these).

D   Tolerance of possession of drugs for personal use: The State should take a more tolerant approach to people found in possession of drugs for personal use. Under this approach, possession of drugs for personal use would remain illegal but an approach combining decriminalisation and depenalisation would be adopted (see Box 2 for definitions). People found in possession would have their drugs confiscated with no further consequences or charges to follow, and no required referral to health or other support services.

E   Legalisation and regulation of drugs: Drugs should be legalised and made available to adults on a regulated basis. This is a significantly different proposal to the previous approaches and would have implications for the production, sale, and distribution of drugs, as well as possession for personal use. People who use drugs would be able to purchase and consume drugs without fear of prosecution, among other potential benefits. The Exchequer would also be impacted with a new revenue stream from taxation of drugs sales.

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Box 2: Decriminalisation and diversion

The comprehensive health-led approach recommended by the Citizens’ Assembly is structured around a combination of decriminalisation, diversion, and dissuasion. There is sometimes a lack of clarity about the meaning of the first two of these terms. Definitions that are provided in the report are consistent with those of the EMCDDA.

Decriminalisation refers to the removal of criminal status from a certain behaviour or action. However, it does not mean that the behaviour becomes legal, nor does it mean the elimination of sanctions or penalties for the commission of an offence. It generally means that the nature of penalties and sanctions change from criminal to non-criminal. Therefore, the likelihood of an offender receiving a criminal record and custodial sentence can be significantly reduced, or indeed entirely eliminated following decriminalisation. However, other sanctions and penalties can still be applied. For example, drugs can be confiscated and non-criminal penalties such as fines may still be applied. In debates about drugs policy, ‘decriminalisation’ is usually used to describe laws related to personal possession or use (typically of small amounts without any intent or attempt to supply) rather than drug supply.

When talking about decriminalisation for possession for personal use, the terms ‘de jure’ and ‘de facto’ are often used. The distinction is explored in-depth in the report of the Citizens’ Assembly (vol 2, pp. 139–140). In its simplest terms, de jure decriminalisation occurs when legislation is changed to explicitly remove a criminal offence from the statute books, as was done in Portugal in 2000 in relation to the possession of drugs for personal use. In contrast, other jurisdictions may pursue the objective of decriminalising, while retaining the criminal status of an act. This approach, which could be described as de facto decriminalisation, can be achieved by introducing such additional diversion and depenalisation measures as to render the act effectively, or to all intents and purposes, decriminalised.

Diversion refers to any mechanism that moves an offender away from the path of punishment by the criminal justice system and towards a health-oriented response such as counselling, treatment or social reintegration.

Based on extracts from vol 2, p. 120 and p. 139.

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Results of the ballot

A universal comprehensive health-led approach is the model recommended by the assembly. This was the most divisive of the recommendations within the assembly. While appearing as number 17 in the list of recommendations, it was the first to the ballot. Six ballots were taken to come to the recommendation of adopting a comprehensive health-led approach for all drugs. Initially members were asked to choose whether they would recommend a universal or a hybrid approach to any legislative model, that is, would the same or a different approach be recommended for different types of drugs. It was agreed by the assembly to take separate ballots for (1) cannabis; (2) DMT, psilocybin/mushrooms, ayahuasca, ibogaine, etc.; (3) cocaine; and (4) all other drugs. Despite the decision to consider a hybrid approach, the comprehensive health-led approach was chosen in each of the ballots, essentially resulting in the recommendation of a universal approach. However, there was variation in the numbers between drugs, with the cannabis vote proving especially divisive. The comprehensive health-led model received only one more vote than the legalisation and regulation model (39 vs 38 votes). In contrast in the cocaine vote, the comprehensive health-led model received 56 votes in the final count, with the status quo being the next most popular model with 22 votes. The ballot results are presented in detail in the final report (vol 2, pp. 180–202).1

Concluding comment

The final report of the Citizens’ Assembly is an invaluable record of the drugs situation in Ireland in 2023 and its complexities. Drug use is often an emotive and divisive topic and both members and contributors sometimes held conflicting views on the best approach to take to address the harms drugs can cause. However, the nature of the process provided an opportunity for all perspectives to be heard, and a comprehensive overview of the evidence base underpinning work in the field to be presented and reflected upon. Furthermore, the comprehensive set of recommendations included in the report indicates an understanding of the complex nature of drugs use and a commitment to reduce the harms caused, through a compassionate, humane, and health-led approach.

If the assembly is to have an impact on policy and bring about legislative change on a par with other citizens’ assemblies, there will need to be a firm commitment from Government and an increase in the resources provided. Furthermore, there will need to be a new sense of urgency at the highest levels, especially where legislative changes are to be made. Developing the new National Drugs Strategy provides an opportunity to harness the learning from the assembly and state a commitment to what is needed to reduce the harms caused. There is an opportunity to build on the innovation, expertise, and commitment of those working across the sector so evident over the course of the assembly.

1    The Citizens’ Assembly (2024) Report of the Citizens’ Assembly on Drugs Use. vols 1 and 2. Dublin: The Citizens’ Assembly. Available from: https://www.drugsandalcohol.ie/40393/

2    Fianna Fáil, Fine Gael, and the Green Party (2020) Programme for Government: our shared future. Dublin: Department of the Taoiseach. Available from: https://www.drugsandalcohol.ie/32212/

3    For more information on the Citizens’ Assembly, visit: https://www.citizensassembly.ie/en/

4    Naughton H (2023) Parliamentary Debates Dáil Éireann. 21 February 2023. Vol. 1033, No. 6. Available from:
https://www.drugsandalcohol.ie/38235/

5    Dillon L (2023) Young people’s consultation for the Citizens’ Assembly on Drugs Use. Drugnet Ireland, 86 (Summer): 13–15. Available from: https://www.drugsandalcohol.ie/39493/

6    A full record of presentations, panel events, and question-and-answer sessions can be viewed on the Citizens’ Assembly website: https://citizensassembly.ie/assembly-on-drugs-use/meetings/

7    Citizens’ Assembly (2023) Workshop on options for legal frameworks in relation to illicit drugs. Dublin: Citizens’ Assembly. Available from: https://www.drugsandalcohol.ie/40395/