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Chapter 1: What is the main topic discussed in this episode?
The Clare Byrne Show on Newstalk. With Aviva Insurance.
An Oireachtas committee has recommended the decriminalisation of possession of all drugs for personal use. To discuss this, I'm joined by Professor Colin O'Gara, addiction psychiatrist at St John of God's Hospital and clinical professor of psychiatry at UCD. Professor, you're very welcome to... to the programme.
I know you and many other clinicians and many other people who've worked within this field have recommended this health led approach for some time. But can you just explain to people this morning what the difference is between the decriminalisation of drugs for personal use and the legalisation of drugs for personal use?
Yeah, good morning Ciara.
Chapter 2: What is the recommendation from the Oireachtas committee regarding drug decriminalisation?
Essentially decriminalisation takes away the idea that if you suffer from an addiction primarily that you're going to be treated as a criminal. So up to this point if you were caught in possession of drugs you would go down a criminal route. The proposal here from the committee is that you would be put into a health system as opposed to a criminal system.
So that is a huge change and it's a huge change in terms of stigma A lot of our patients, Ciara, who attend here to see me, for instance, in the outpatient setting, do not want to come into hospital because of the stigma. We've got a massive issue in terms of access to services.
Some of the figures, for instance, are that only one in 10 people with the more rare forms of addiction will actually... attend for treatment because of stigma. So one of the key issues in terms of driving stigma is saying to a person when they're at their lowest ebb, in addition to being an addict, you're also a criminal. And I think that has to stop.
What about those people who take drugs and never end up in front of you or never have to access addiction services? What does a health led approach mean for them and look like for them?
Yeah, so for some people Ciara, they will use drugs in a hedonistic fashion, meaning they will go out They will take drugs and they will go back to work on a Monday morning. The estimates for, say, ecstasy, cocaine, stimulants, probably 1.5 million people.
You know, 20 years ago, we used to use the figure of a million people in the UK, one and a half million people in the UK using these drugs, some of whom will go to work on a Monday morning as if nothing happened. My experience is that people take drugs for a whole host of reasons. They take drugs because they're lonely. They take drugs because they were bullied in school.
They take drugs because they were traumatised, be it physical, emotional or sexual abuse. And they really on one level would not want to be taking drugs. So if you put these people into a health system, some, not all of course, but some will benefit from that. You will have a cohort of people as well.
who will take drugs, go through the health system and get off and won't be criminalised, of course. But I think the big picture here is that we have to move towards supporting people who are using drugs and who can be helped.
I'm just wondering, though, what that approach in really practical terms looks like. Let's say you're at a festival, you are found using cocaine. This health led approach is what's adopted and recommended for you. What do you do? What happens?
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Chapter 3: What is the difference between decriminalisation and legalisation of drugs?
Well, the international model is that you would be in front of what's called a dissuasion committee. So you would essentially enter, instead of going down the route of a court appearance, you would be engaging with a committee, some of whom will be health professionals, and you'll be offered the opportunity to engage in treatment of some sort.
So obviously, if you don't want to engage in that treatment, that would be, you know, that's not going to be useful. But again, it comes back to, you know, this idea that really when people are using, you know, are you going to give somebody a criminal record, for instance, for the future? They're not going to be able to travel because they have been using drugs at this particular time.
I think, you know, often I do see people in that situation. And I think that's pretty futile, actually. So I think we need to look at other mechanisms. And that's just one end of it. At the end that I deal with, which is the addiction piece, it's absolutely clear that we cannot continue to treat people in the way that we have in criminalising them when really what they need is support.
I'm going to bring in Mary Fitzpatrick. She's a Fianna Fáil Senator who was also Deputy Chair of the Committee and she joins me on the line now. Mary, what was the most compelling evidence for you that persuaded the Committee to recommend decriminalisation of all drugs for personal use?
I suppose it was the human lived experience of families of people who had either lost their lives or had suffered greatly through addiction and drug use.
The families and the supporters and I suppose also the youth workers and the teachers and the schools representatives, all of whom spoke of, I suppose, what was, you know, the real impacts of substance use, substance misuse, addiction, all of the mental health issues, all of the social implications, the economic implications, obviously.
But I suppose all of that and what was really, really evident was that We can't police our way out of those problems. They are health problems. We need a public health, you know, response. We need a comprehensive health-led response. We need to recognise that, you know, drugs use and abuse and misuse in Ireland has really evolved over the last, what, 20, 30 years. You know, historically it was...
you know, primarily opioid-based in marginalised communities. Well, now it's polysubstance use, you know, it's population-wide polysubstance use in every community. So, you know, we need to invest very, very heavily in prevention, in supporting young people
in understanding what their challenges are and supporting them to make better decisions, to have more informed decisions, to have more confidence, have more resilience and better coping mechanisms. So that, you know, as is described, like drug use is a symptom. It's a symptom of other pain. So we need to support and prevent and invest in that.
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Chapter 4: How does stigma affect individuals with drug addiction?
I mean, the key issue here is, I mean, the committee has come up with some excellent suggestions. It's wide ranging, it's very well informed, it's evidence-based. Now, the next piece is how do you implement that? And there is a long-term history of diversion of resources away from mental health and addiction services, a vision for change.
2006 would have highlighted the diversion away from mental health services of key resources to the rest of medicine. This really, I agree with Mary, it's a public health issue, but it also strikes at the heart of, is mental health and addiction on par with the rest of medicine? And therefore, you know, is it going to be funded accordingly?
But really, the signals coming from a lot of the literature internationally in terms of the implementation of decriminalisation is one, you know, society needs to be ready for that, but particularly governments need to be ready for it and services on the ground need to be ready for it. If you change...
the attendance and the engagement from one in 10 individuals with an addiction or a severe rare addiction to three or four attending, all of a sudden you have a strain on existing services. And we know, Mary referred there to opioid services, we know that some opioid services across the country have long waiting lists, for instance, for counselling.
So if we're going to implement this harm reduction approach and this health led approach, how exactly are we going to fund it? And this comes back every time to the same thing in a space where there's so many competing and very worthy interests in medicine.
Mary, to bring you in there, we're currently incapable of delivering this health led approach.
Well, we're delivering in a patchy, inconsistent way, I completely agree. And I agree with what has been said. If we were to decriminalise without putting in place the prevention measures without putting in place a comprehensive health-led approach, it would be disastrous. But that's not what the committee is proposing. There's 161 recommendations.
They're wide-ranging, they're comprehensive, and they deal with everything, but primarily focusing on what needs to be done to ensure that we do have adequate prevention so that we avoid and reduce harm in the first instance, that we have treatment available, that we support individuals and communities. But as I say, there's 161 recommendations. The decriminalisation is only one.
And if it was to happen in isolation without the rest, it would be a disaster. And nobody is proposing that. That wasn't the... committee's proposal. And what will happen now is that this report has been launched by the Oireachtas It now goes to the Dáil and to the Sianad. There will be debates there.
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Chapter 5: What does a health-led approach to drug use look like?
We called it out in our report because we share that concern. I mean, I live in Dublin City. I don't think I pass a day through the city that I don't see young people's lives being destroyed through being engaged in drug dealing, drug use, drug distribution. It's heartbreaking, it's alarming and it's unacceptable.
So they have to go in tandem, don't they? Because people will be worried that the decriminalisation comes first and then the years and years spent advocating for further resources to go into this system?
That would be, as I say, disastrous. That just wouldn't work. And I don't think any responsible, reasonable government would oversee such a move. It just would defy any logic or reasonable behaviour. I absolutely believe that in calling for a comprehensive health-led response to our drugs and addiction problem, what we're saying is that we're putting the priority on health, on public health.
We're saying we have to address it as a health issue ever before the criminal issues are... And it is absolutely about... Like, being clear, drug users are separate to drug dealers, drug distributors, drug sellers. It is about pursuing drug dealers, drug sellers, drug traders, you know, aggressively and prosecuting them from a criminal justice perspective.
But people who are in the throes of addiction, criminalising them, only adds to the damage.
All right.
Mary Fitzpatrick, Fianna Fáil Senator and Professor Colin O'Gara, thank you for joining me on that lot.
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