Decriminalisation: Are we ready to treat addiction as an illness?

Decriminalisation has been something of an international hot topic in recent months with even Minister Aodhan Ó Ríordáin voicing his approval.

The Minister of State backed decriminalisation in November during a speech at the London School of Economics.

This would be a further step towards addressing the drug problem in Ireland after the introduction of supervised injection centres in Dublin was announced last year.

These initiatives could see Ireland move towards regarding drug addiction as a medical rather than a criminal issue, a move which Ó Ríordáin has called “a radical cultural shift.”

Ireland is not leading the way with this initiative. Injection centres, or drug consumption rooms, are prevalent across Europe with 55 centres between The Netherlands and Germany alone according to statistics from The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA).

Drug addiction is a major problem pervading Irish society according to Tony Duffin director of The Ana Liffey centre in Dublin.

"We know there is very, very difficult problem because people are witnessed injecting themselves and also we find drug paraphernalia in every alleyway of Dublin at some point during the week and in the parks."

Duffin believes that the public may not be aware of the seriousness of the issue saying that he believes that users often shy away from public due to the “furtive” nature of the act and the stigma attached to substance abuse.

"In Dublin city centre we have a significant level of public injecting and we would estimate that in any previous month around 400 individuals have injected in the public domain, in the city centre, multiple times. But that is a very conservative estimate."

He believes that the injection centres are a positive way of reducing overdose related deaths on Irish streets.

In May of last year it emerged that there are approximately 365 cases of fatal overdoses every year in Ireland, almost twice that of fatal road crashes. In 2013, the number of deaths from overdose eclipsed that mark, more than doubling deaths on the road, including those of pedestrians and cyclists as well as drivers and passengers.

The drug consumption rooms across Europe typically provide users with clean injecting equipment, advice on safe use, emergency care in the event of an overdose and referral to appropriate social healthcare and treatment centres. These centres are not just facilitating drug use, but offering addicts ‘a way out’.

Duffin believes that the introduction of the centres can only be a good thing for those using in less than ideal locations as well as those who encounter them in public.

A report from The Health Research Board (HRB) shows that 17 per cent of those who died from injecting heroin were in a public place, while 21 per cent were in homeless accommodation. Suzi Lyons, co-author of the report, said that two out of five were not alone while they overdosed.

There is also an economic argument for the introduction of the injecting centres. The strain on mainstream medicine system is reduced, saving the sector a lot of money. According to Duffin, since the medically supervised injection centre opened in King’s Cross in Sydney, ambulance callouts for drug-related incidents were reduced by 80 per cent.

The introduction of these centres in Dublin could go a long way towards the “cultural shift” which Minister Ó Ríordáin spoke of, one which sees the public view drug addiction as an illness rather than a criminal matter.

As well as the introduction of the injecting centres, Ó Ríordáin hopes that the decriminalisation of small amounts of drugs for personal use will also come into effect in the near future.

The Oireachtas Joint Committee on Justice, Defence and Equality published a report last November called ‘Report on a Harm Reducing and Rehabilitative approach to possession of small amounts of illegal drugs.’ The committee has called for a “harm-reduction structure” which would involve treating possession of small amounts of drugs as an administrative matter rather than a criminal one.

While there would be no moves towards legalising any of the drugs, the criminal justice system would scale down its response to minor drug offences.

Ireland would be following in the footsteps of some countries in Europe who already have a similar policy. One such country is Portugal where decriminalisation has seen a marked decrease in drug-induced deaths.

Since drugs were decriminalised in 2001, those caught in possession of small amounts are referred to a commission which operate under the health ministry and comprises of a lawyer, a doctor and a social worker. The system is designed to dissuade further drug use.

Despite Portugal’s success, the system of decriminalisation has often been criticised as being ‘the worst of both worlds’. Drug sales would still be illegal, which would leave production and distribution of drugs to criminals, and illegal drug use would be encouraged by removing the criminal penalties that might otherwise have dissuaded the user.

Trinity College Dublin’s Prof Catherine Comiskey, Chairperson of the National Advisory Committee on Drugs and Alcohol (NACDA), said that she is in favour of the decriminalisation of possession of small amounts of drugs for personal use. She added that research proves that offering treatment and support is the best form of action.

"When people go into treatment, even if they drop out, crime reduces."

Prof Comiskey says that offering support rather than applying criminal punishment is an important step towards society treating drug addiction as a health matter rather than a criminal matter.

"I think we have already started changing as a society, the fact that we can even have these conversations and that ministers can debate these ideas and be able to hear both sides, I think is definitely an indication that we as a society are ready to debate this."

She believes that the criminal branding often associated with minor drug offences can ruin lives and destroy potential, a sentiment echoed by Lord Mayor Críona Ní Dhálaigh last year.

Prof Comiskey asserts that as a nation, Ireland needs to help its citizens, all of its citizens.

"We need to help people, that’s what we’re supposed to be, a family orientated type constitution. […] If that’s what we believe then we need to carry this belief through to all people in society not just those that we’re happy with."