‘Medical model’ for illegal drugs is absurd


Sir, – It was interesting to see another small success this week for those who seek to “medicalise” the issue of illegal drug possession in Ireland, with the usual (indirect) references to the “Portuguese model” (“First-time drug offenders to be referred to HSE in policy overhaul”, News, August 2nd), wherein “personal” drug use is treated by default as a “medical” difficulty, and approached accordingly, with “incredible” reported successes, in reducing disease, death and destructive-criminality due to the “drug trade”.

Five fundamental concerns arise, however, that must be addressed in this jurisdiction, before we again import another “international best practice” model, just as it is seen to fail.

First, the approach in Portugal is distinctly questionable: I was in Lisbon relatively recently (speaking at a conference discussing substance misuse), and the extent of aggressive and open drug dealing on its streets was astounding, and profoundly depressing, and of course likely to affect tourism eventually. The “medical science” behind the “model” is also dubious (there have been bizarrely few papers in the Anglophone medical literature analysing the research “conclusions”, eg in terms of autopsy figures, or standardised international comparisons, etc).

Second, the paramount problem with “drugs” is not dealing but drug-taking, and its biological effects (intoxication, challenging behaviour, violence, sudden illness and death), which are not amenable to legislation.

The fact is that the overwhelming majority of reported cases of violence related to “drugs” in this country are perpetrated by intoxicated (eg “coked-up”, “psychotic”) individuals, not members of drug-dealing cartels (as with alcohol, the vendors don’t usually wreak havoc, unless they are siphoning-off some of the product).

Third, most severely drug-damaged people end up in a police cell, mortuary or hospital emergency department. Now, it is being argued that the custodial option should significantly shrink, so yet more is to be asked of bursting emergency departments or GP surgeries. It would be difficult to overstate the effect of this idea on the morale of the heroic staff in these facilities.

Fourth, services for the spiralling numbers of mentally ill young people are grossly inadequate and it will be years before that is remedied (particularly with the financially voracious new children’s hospital).

So establishing a “medical model” for drug consumption in the current Irish context is absurd, without an immediate-quadrupling of such support; even then, the absence of the “deterrent” effect of the only “real” sanction left (“you won’t be able to go to the United States if you have a drug conviction”) could remove the final “impediment” to turbo-charged drug-taking.

The fifth concern is the arguably “de facto” decriminalisation of drug-taking here, already, with the Garda Síochána having to carefully husband their resources, and focus on major dealers, drug-related deaths and massive shipments. The frequently reported huge seizures of illegal and counterfeit drugs, tobacco and alcohol are widely seen as the “tip of the (drug-consuming) iceberg” (just 10 per cent of illegal drug shipments are intercepted); they are a crude but striking metric of our national appetites, while drugs are cheaply and swiftly available, with “door-to-door delivery” in minutes, in 32 counties.

If I hadn’t personally been so affected in a long career in emergency healthcare by countless cases of drug-induced violence, quickly forgotten drug-deaths of friends and celebrities, and the grotesque injustice of drug-culture in the poorest parts of our nation (with resulting personal and societal disintegration, and homelessness), I might join in the enthusiasm for “obvious” overseas solutions for our epidemic of “self-medication”.

But the truth is that, while the Irish are “top-ranking” in almost every aspect of global drug (including alcohol) consumption figures, with all that that implies, the “solution”, as we have found so often in our recent healthcare policymaking, will not be Dutch, Canadian, or Portuguese, but Irish (ie infuriatingly incremental, idiosyncratic and indigenous).

And, given that drug-induced violence by so many individuals is the current gravest personal threat to the population (in their homes, hospitals, prisons, and elsewhere), the response must also inevitably involve some State-sanctioned “restraints”, rather than mythical medical panaceas. – Yours, etc,


Consultant in

Emergency Medicine,

Adjunct Senior Lecturer

in Public Health,

University College Cork.