Problems and Purpose

Hopes

• To make informed recommendations that address the causes of societal issues related to drugs use and that make changes for the better

• To improve knowledge of the Assembly and of wider society of drugs use

• To improve service provision for people affected by drug use

• To achieve legislative change

• To see the implementation of the Assembly’s recommendations

• To educate members and others on experience of Assembly

• To be comfortable with the recommendations made by the Assembly

• To see a diverse range of presentations that ensure impartiality and broaden viewpoints Fears

• Recommendations will not be taken seriously or quickly implemented

• Presentations will be overly emotive, impartial, or biased

• Important aspects will not be addressed within the time of the sessions

• Overwhelm or overload due to the volume of information

• Personal beliefs / experiences get in the way of making informed recommendations

• Members are triggered by personal stories and traumatic experiences

• Recommendations have a negative impact on communities and society

• Issue is too divisive

The presentation discussed various aspects of drug use, including the reasons people use drugs, the methods of drug consumption, the types of drugs used, the potential benefits, the risks, and how different groups of drug users are treated. The speaker explained that people use drugs to either avoid negative feelings or to experience positive ones, such as feeling relaxed, relieving stress, or escaping pain. There are four primary ways to consume drugs: orally, through injection, by inhalation, or via absorption. Injection is the quickest but also the most hazardous method.

To understand drug use on a broader scale, the speaker proposed viewing it along a spectrum that ranges from "Beneficial Use" to "Non-problematic Use," "Chronic Dependence," and "Addiction." This spectrum applies to both legal and illegal drugs. Addressing whether all drug use is problematic, the speaker noted that up to 90% of drug users view their use as either beneficial or non-problematic. However, it's important to consider additional risk factors, such as the user's overall health, any existing psychiatric conditions, pregnancy status, the source of the drugs, and whether the drugs have been tampered with or contaminated.

In terms of the broader population, 90% of those who use drugs transition out of that drug use. When we look at risk of dependency, we are generally talking about 10% of the people who use drugs

The HRB survey data shows that 1.4% of the Irish population aged 15 -64, which equates to about 45,000 people, meet the criteria for Cannabis Use Disorder. The HRB data also shows that this is most common among males aged 15-34 which is the group most likely to use cannabis. Of those who reported using cannabis in the last year 1 in 5, or 20%, met the criteria for Cannabis Use Disorder.

The data for 2020 showed 409 poisoning deaths, a significant increase of 38 compared to 2019, and the highest number of deaths per annum reported over the decade. These 409 deaths equate to nearly 12,000 potential life years lost in a single year.

Poisoning deaths involving cocaine had increased from 24 in 2011 to 130 in 2020, representing a more than four-fold increase in the period, which is driven by the greater prevalence of cocaine use in the general population.

Background History and Context

In 2021, Ireland participated for the first time in the European Web Survey on Drugs, which surveyed almost 6,000 people who had used drugs in the past year. Dr Mongan detailed findings from the survey. In 2019, 22% hadn’t used any substance (including alcohol) in the last year, with 9% or 287,000 people (aged 15-64) reporting they had used an illegal drug in the previous year. Ireland is around the European average for cannabis use, however, we are near the top in terms of cocaine and ecstasy use. The 2019 survey indicated an increase in polydrug use, with 34% reporting using 3 or more types of drugs in the last year, an increase from 14% in 2002.

8% of survey respondents reported weekly use of cocaine. Weekly users of cocaine reported using double the amount of cocaine compared to those that reported using less than monthly. In contrast, users of ecstasy reported much less frequent use, with just 1% reporting using ecstasy weekly and 90% reporting using it monthly. Dr Mongan highlighted that the survey was conducted during 2021, at a time when Covid restrictions were still in place, which may impact on findings regarding the use of ecstasy, which is often associated with nightlife and festival settings, which were curtailed at the time.

Ms. Doyle compared figures from 2019 with historical figures from 2002, which show that young people are starting to delay initiating substance use. The age of initiation is important, as the earlier a person starts using substances the more likely they are to experience problems. For example, a person who starts drinking alcohol at 15 years of age or earlier is four times more likely to develop alcohol use disorder than someone who starts drinking at a later age. Similarly, early cannabis use is a predictor for Cannabis Use Disorder, while early cannabis use and early alcohol use are predictors of future use of cocaine.

Organizing, Supporting, and Funding Entities

Some countries have taken the approach of providing drug testing facilities to provide clarity on what is contained in a substance.

Suggestions for the next drugs strategy included: incorporating a rights-based approach obligating a health-led drug strategy to prioritize those with the greatest needs, including people with problematic drug use, children and young people, ensuring that nobody is left outside or left behind and no discrimination takes place for reasons of stigma or otherwise; ensuring the involvement of people with lived experience a core component of the next strategy, both in terms of policy development and service design; prioritising prevention policy and supporting prevention objectives with adequate funding; better integrating drugs services with the healthcare system, with integrated care pathways for people with problematic drug use, in the context of the roll-out of the new HSE Health Regions and the Health Communities Initiative; taking a gendered perspective on drugs policy and services, with an emphasis on services for women; commencing the Health Diversion Programme for people found with the possession of drugs, with Mr. Walsh commenting that this programme had been agreed by Government in 2019 yet still hadn’t been legislated for; and finally, addressing premature drug-related deaths as an urgent public health priority

Participant Recruitment and Selection

The participant recruitment was randomly selected much like a jury to ensure the most fair and accurate representation of the Irish public and ensure fair outcomes of the assembly. There was also one chairperson there to lead the assembly and ensure it didn’t go off course.

Methods and Tools Used

The report sets out the totality of the work of the 100-member Assembly over six months, representing the most comprehensive and widespread discussion on drugs policy in the history of the State, which included 130 speakers and panellists, 250 hours of deliberations, and 800 public submissions.

What Went On: Process, Interaction, and Participation

Discussions were held over a sixth month period with

many speakers coming in both professionally and some with personal experiences

of drugs. Hours of deliberating and discussions came down to a ballot in the

end where the 100 members all voted on the recommendations they would suggest to

the Irish government and how they would change the legislation on drugs.

Influence, Outcomes, and Effects

1.    95% agreed the next national drugs strategy should prioritise a systematic

approach to recovery

2.    93% agreed the government should introduce a ‘health in all policies’ approach to policy development

3.    93% agreed the state should formalise, adopt and resource alternative, health-focussed options for people with a drug addiction within the criminal justice system

4.    94% agree the department of justice and the Irish Prison Service should develop and fund enhanced prison-based addiction treatment services

5.    85% do not agree that they should retain the current legislative approach to possession of all drugs for personal use

6.    58.6% preferred the hybrid approach (different approach for different drugs)

7.    96% agree the government should give greater political priority and prominence to drugs policy and related issues

8.    98% agree 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

9.    94% agree the government should prioritise drugs misuse as a policy priority, as part of an overall socio-economic strategy

10. 98% agree the government should recognise that an effective national response to drugs-related issues requires whole government policy coherence, operational cohesion and effective leadership

11. 96% agree the government should publish a new iteration of the national drugs strategy as a matter of urgency

12. 96% agree the government must assign accountability, at the highest level, related to the state’s response to problematic drug use, including the implementation and tracking of the progress of the recommendations of the Citizens’ assembly

13. 93% agree the government should ensure effective stakeholder involvement in implementing the next iteration of the national drugs strategy

14. 88% agree drugs policy should prioritise the needs of vulnerable and marginalised groups and disadvantaged communities

15. 88% agree drugs policy design and implantation 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

16. 93% agree the government should work with key stakeholders to build an effective whole of society response to drugs-related issues

17. 98% agree the 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

18. 93% agree 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 drug use.

19. 93% agree 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. 94% agree 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. 95% agree the national drugs strategy should include a strategic workforce development plan

22. 95% agree 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.

23. 89% agree 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.

24. 93% agree 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

25. 98% agree 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

26. 99% agree 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 judiciary 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.

27. 92% agree the national drugs strategy should focus on building resilient, sustainable communities through local partnerships in both urban and rural settings, and stronger community policing

28. 98% agree the national drugs strategy continue to prioritise the objective of tackling the source and impact of drugs-related intimidation and violence, and take a zero-tolerance approach

29. 96% agree 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

30. 96% agree the national drugs strategy should include a detailed action plan to enhance Ireland’s approach to prevention of drugs use.

31. 98% agree 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. 99% agree 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.

33. 98% agree 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

34. 94% agree 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. 81% agree 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. 93% agree 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

37. 92% agree 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

Analysis of democratic goods and Lessons Learned

Inclusion:

The selection of candidates was at random trying to get the most accurate census of the Irish public including men, women, youth and elderly as well as people who have had drug experience and those who haven’t. Not only this but the self-censorship in this citizen assembly was particularly effective as the ballots at the end were all anonymous meaning people could vote how they truly felt without potential judgement from others.

Considered judgement:

Once again this assembly did especially well in considered judgement both allowing the participants to learn from professionals and those with previous past experiences, growing empathy for those who have struggled from drugs in the past. This is evident through meeting two of the assembly which was solely based on lived experiences of those who have struggles with drugs, those who work on the front line, those who have lived with relatives with drug issues and those who have experience working for committees. This builds up a sense of learning and empathy as the participants gain a greater understanding of how drugs affect everyone, not just those who take them.

Popular control:

Control is given to the people in this assembly through the power of the ballot at the end of the six months of meetings. This is evident as it seems the participants don’t play much of the role in the beginning few meetings, but as the assembly continues to meet the participants play more and more of a role and eventually gain all the power of the assembly as it is their vote that leads to the recommendations that go through to the government.

Transparency:

Initially these assemblies were internal towards the participants with only them being able to attend these assemblies and only them being able to quote on the dilemma’s at hand, much like a jury service. However, as the assembly ended the results became available to the public and became much more outward with the results also being brought to government.

Efficiency:

As of right now the efficiency of this assembly has not been the most effective, due to the lack of change made by the Irish government despite these recommendations. Therefore it can be argued that it was not an effective use of time for the participants or the speakers. But on the other hand it can be argued that this assembly will always be of use as the government can reflect on the results whenever they want and use them to see how the public wanted the laws to be changed.

Transferability:

This citizen assembly will be very transferable overtime due to its use of looking at past laws and how they can be changed to benefit the government, as well as suggesting new laws and new ways to improve how the government looks at drugs. This means that even if the Irish government doesn’t decide to make any significant changes now, they can look at these results int the future and use these as accurate representations on how the public feel towards drugs and how they would react to law changes.

References

https://citizensassembly.ie/wp-content/uploads/CADU_Volume-2.pdf

https://citizensassembly.ie/wp-content/uploads/CADU_Volume1.pdf

https://citizensassembly.ie/launch-of-the-report-of-the-citizens-assembly-on-drugs-use/