Joint Committee on Drugs Use debate -
Thursday, 4 Jul 2024

Apologies have been received from Senator O'Hara.

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The topic of this meeting is engagement on decriminalisation, depenalisation, diversion and legalisation with international comparisons. Committee members are interested to learn from the experiences of drugs policies in other countries. We welcome all the witnesses, who are joining us by Microsoft Teams. We welcome from UNITE, Dr. Ricardo Baptista Leite, founder and president, and Ms Beatrix Vas, drug policy co-ordinator; from the International Drug Policy Consortium, Ms Marie Nougier, head of research and communications; from the University of Porto, Dr. Marta Pinto, assistant professor; and from the Open Society Foundations, Dr. Kasia Malinowska-Sempruch, programme director of drugs policy.

I invite Dr. Baptista Leite to give his opening statement. I understand he has to leave early and that Ms Vas will take over from him to answer questions.

I thank the Chair and members for their availability and time. The issue of drugs is well known to the UNITE Parliamentarians Network for Global Health, which I represent. I am a member of our network and am honoured to have been invited to speak to the committee on behalf of it. I am a medical doctor trained in infectious diseases and founder and president of the UNITE Parliamentarians Network for Global Health, a non-profit, non-partisan global network of current and former members of parliaments, congresses and senates from more than 110 countries. Our network is committed to the promotion of evidence-based and sustainable policies for improved health systems, including alternative approaches to drug control for better public health, human rights and health outcomes.

As a former four-term member of parliament in Portugal and a physician trained in infectious diseases, the topic of decriminalisation of drug use is of paramount importance to me. My country has gone through major transformations over the past 25 years. In the 1990s, not that long ago, Portugal was facing a heroin epidemic where nearly 1% of the total population were either using or had a problematic use of heroin, which was leading to tremendous social and economic turmoil within our society. No one was left aside. In every fragment of society, be that in high-income or low-income parts of our society, everyone was directly or indirectly affected by the familial tragedies this represented and the criminal impact it had on our day-to-day lives.

Everyone was clamouring for some form of change. There was a need for some level of intervention to change the status quo that was leading to a disruptive moment in our communities. We were seeing families being completely destroyed and disrupted due to the problematic use of drugs. We were seeing the rise of crime related to drug use and drug trafficking. Our communities were completely unstable due to multiple consequences of the problematic use of drugs. The lack of any form of response to this challenge and problem was daunting. We had no responses, be they systemic or involving application of knowledge and science to address the problem. In reality, at the time, there were no good practices to look to as to how to address such a major societal challenge.

In the face of all that, there was a need for legislators in the Portuguese Parliament to be bold. The legislators decided at the time that something had to happen that was different from anything that had happened before, keeping in mind that all the prohibitionists and war on drugs-like approaches, rooted in criminal punishment, had failed completely until that moment. The Portuguese Parliament, through its members, decided to end prohibition of all drugs, decriminalising the use of all drugs and creating a model through which use of drugs was seen as a health matter.

I will highlight two very important points. First, this was a major shift from a criminal perspective on the use of drugs as a criminal issue, a judicial issue, towards seeing it as a health matter. Also, however, it is important to note that decriminalisation did not make the use of drugs legal. It merely stopped it being considered a crime, which meant that it stopped getting people in jail because of the use of drugs. People would not be able to be put in jail for using drugs, although drug trafficking, naturally, would continue to be considered a crime, and that could lead to imprisonment. The personal use of drugs, however, was in no way considered a crime. It was therefore not legal but not a crime.

This decriminalisation model has placed drug use within a five-pillar model of prevention, drug use dissuasion, harm reduction, treatment and reintegration. Treating drug use as a health matter has meant looking at each citizen individually, trying to understand the problematic use of drugs from an addiction and dependence perspective and making sure that the health system is there to support people who want to step away from the problematic use of drugs.

A very important component of this shift was understanding the need for a community-based approach and understanding that putting people's health front and centre means providing health services to all those who need it within the environment in which they feel safe. I emphasise the need to make sure we create a safe environment to address those in need because that is where the role of non-governmental organisations and community-based organisations is so important. We know that formal health services do sometimes push away people in need and people in the most vulnerable situations. They need support but sometimes are afraid to go to the formal institutions where they could find that support today. We needed to look beyond our formal health system, therefore, and reinforce the role of these NGOs and community-based organisations, CBOs, not only as providers of crucial harm reduction services but also as entry points to broader health and social care services. While ensuring that the health system was able to provide adequate support, including treatment and rehabilitation services for those willing to participate, community outreach and involvement were necessary for services to better reach the most marginalised and vulnerable populations.

After the law changed, we saw a drop in the number of HIV infections related to drug use. I come from an infectious diseases background, and a lot of my work involved dealing with people living with HIV. Back in the 1990s, more than 50% of new HIV infections were related to drug use. Today, more than 20 years after we decriminalised drug use, less than 2% of new infections are related to drug use. We have gone from over 50% to less than 2% today. Over the past 20 years, we have seen major transformations, including a drop in the number of crimes related to drugs. There is no one in jail or in prison as a result of the use of drugs, although trafficking is still a criminal offence.

I talked about HIV infections but I highlight that all blood-borne infections, including, for example, viral hepatitis C, are typically transmitted through shared syringes. Through the harm reduction services provided and through this decriminalisation approach, we can use HIV infections as a proxy to understand that all these infections related to drug use have dropped in number.

Many feared that Portugal would become a drug haven with decriminalisation, but what we have seen in reality more than 20 years later is that there is no drug tourism, as many had anticipated would happen, and that the consumption of all drugs in Portugal has consistently stayed below the European Union average. There has been a rise in certain drug tendencies, but Portugal has stayed below the European Union average despite the decriminalisation of drugs. One would expect that if those who were against the law had been right, the consumption of all drugs would be much higher in Portugal than in the European Union generally. We see exactly the opposite by having a health-focused approach and not the criminal approach.

I will highlight, though, as a cautionary note, that no one policy or programme can be copy-pasted to another country. There are certainly lessons to be learned that can be adapted from each context and each country to others. Portugal's decriminalisation approach was successful because of the five-pillar approach, which included proactive engagement with community-based organisations and making sure that harm reduction services, syringe exchange programmes, low-threshold methadone programmes and so forth - and social programmes, including job inclusion programmes - were all integrated. Without that integrated view, decriminalising drugs alone may not be enough in any country. It has to be seen from a holistic perspective.

The main takeaway is that the prohibitionist approach failed, that the criminal approach failed and that this health and human rights-centric approach focusing on each person, on his or her individuality and dignity, is much more impactful towards providing a society in which people who are in need get the help they need, while also making sure that the turmoils related to the problematic use of drugs are overcome. We know that decriminalisation works. We know that putting people in prison because they are using drugs does not work, but we know that decriminalisation is only part of the solution. Our approaches need to be truly human-centric, they need to include all the different components that will address the issues related to the problematic use of drugs, and we need to make sure we are not perpetuating harm but serving the well-being of communities and societies at large.

I thank the committee for its attention and I am happy to take any questions.

Thank you, Dr. Leite. Because you have only ten minutes, I ask all members to ask just one question each if they have any questions they want to put to you. We will not set the timer on the clock. I remind members that Dr. Leite's colleague, Ms Vas, when it comes to the official round of questioning, can answer questions on the statement.

I thank Dr. Leite for being with us and for UNITE's work. I visited Portugal in 2015 with a delegation from the Oireachtas and was highly impressed by what we saw at the time. I met Dr. João Goulão. I am not sure if he still is, but he was a director of SICAD at the time. I met Nadia Simoes as well. They were very impressive. I met many of our people too.

I will ask Dr. Leite just one or two questions, if I may. With respect to decriminalisation, as he has described it and as we have seen it in Portugal, the sale of drugs is still illegal and a criminal offence. Dr. Leite calls it trafficking in the opening statement. That means that the criminal gangs are still operating and still providing the substances we speak about across the board. Am I right in saying that UNITE is coming at this from a human rights and health perspective of the individual user or patient?

That is one question.

As for the second question, it has been said that people have gone to Lisbon and have been offered drugs on the streets. People have approached them on the streets. This seem to be quite prolific, in fact. I asked a question when I was in Lisbon because it happened to me when I was there. I was told by the police they were not actually drugs at all, but other substances. I wish to know the witness' point of view in this regard. It seems to imply that decriminalisation is in some way making it more liberal if these substances are available on the streets in broad daylight with people approaching tourists, visitors and others. Those are my two brief questions.

I have one question. Decriminalisation does not solve the drug problem, the drug crisis or drug trafficking. Rather, it helps the individual and stops him or her from going to prison. If the proper community supports are there, it helps the individual to hopefully progress off drugs or to have a better quality of life. Is that fair to say?

If all drugs have been decriminalised in Portugal, at what point is the intervention to diversion with the individual to provide him or her with support? Dr. Baptista Leite listed the incidence of hepatitis C and HIV. Is there any monitoring of mental health behaviour or trends since decriminalisation? These are my two questions.

I have two quick questions. How important does the witness feel the community-led aspect of service provision is as opposed to a more centralised version? I presume Portugal is like Ireland in that, whenever there is a change in legislation, it is about looking to the next change. I am interested to know what he believes Portugal's next step on its journey will be.

I thank members for the questions. I will try to be brief as I know my time is limited. I will try to address the important questions raised. Mr. João Goulão is still the drugs tsar in Portugal. He has been leading this effort in recent decades. He has been active in this space and is a great point of contact for the committee if it wishes to have additional technical information from the Portuguese Government on this aspect.

As to the question on whether the sale of drugs is illegal, it is illegal. I call it drug trafficking. It is a criminal offence and people can end up in jail as a result of it. The fact that drugs are not legal allows for drugs to be sold on the black market, if you will. This leads to products being sold with no oversight. We do not know what people are buying. It facilitates the gangs and illegal movements related to that. Therefore, organised crime can be put together around these products. This raises another issue, which is not directly related to the criminalisation aspect, about how we address that additional challenge. I am connecting this with the question raised about whether it is fair to say that decriminalisation is mainly focused on a health perspective and on improving the quality of life of the individual and the quality of life and well-being of a society and a community. Decriminalisation is mainly focused on shifting away from that criminal approach to a human-centric approach. It does not focus exclusively on the individual in the sense that as soon as the number of people who are having some level of problematic use of drugs is tremendously lowered, that has a reflection in communities and societies at large. However, the criminal aspect related to the trafficking and selling of drugs continues. To address that, we will have to have a more in-depth conversation. I will get to that in the last question about next steps.

A question about drugs being offered on streets was asked. That is a reality in many capital cities across the world, as we know. In certain parts of Lisbon and Porto, for example, this kind of phenomenon happens. Often, the products being sold are actually fake drugs or simulated products. It is a scam, in reality. This phenomenon has been on the rise. We are also seeing a new phenomenon of psychedelic drugs of other natures, such as synthetic drugs, reaching into the European market. Portugal, of course, is no exception. There is a need for us to continually work towards communities building awareness on these issues. The police-enforcement component is also important. This is a lesson that has been learned. It is more than 20 years since we decriminalised drug use in Portugal. The first generation of police officers who were trained for this new law back in the early 2000s were highly committed and a critical factor in making sure the transformation in society and law was enacted in our communities. The truth is that since then, new generations of police officers who did not go through that process have come into the force. They did not go through the time when the problematic use of drugs was related to many health issues. They inherited a situation in which drug use being decriminalised is the norm. We have seen that the comprehensive, compassionate approach of the first generation of police officers who engaged with people who were using drugs and knew how to deal with the balance between the criminal offence of selling drugs and the compassionate human-centric approach in dealing with people who use drugs is missing. There is a need for continued training of the police force and a need to invest more in the different entities involved in making sure the system is effective. We cannot live based on past merits. We need to make sure this is an ongoing process and every generation needs to make sure it adapts the situation to the reality it is in and must continue training all the different components of the system.

The question on how to provide support connects with the question on the importance of community-based initiatives compared with the more centralised approach. We have seen that community-based organisations are much better equipped to reach out to the populations that are classically called “hard to reach”. This includes those who live in the most vulnerable situations and often includes migrant populations and so forth. For many reasons, many of them are afraid to reach out to formal institutions. Others are unaware of how to reach out to formal institutions.

These community-based organisations that actually go into different parts of the city and have organised, multi-disciplinary services, including mental health and psychology services, are critical to support people in engaging and creating a pathway to access rehabilitation and social services. Doing that in a centralised manner will not be as effective in reaching all of those who need the support. That is the reality we see in Portugal and, through the Unite Parliamentarians Network for Global Health, across the globe. There may be centralised directions and guidelines but it is important to have a very local, tailored approach, involving the municipalities and local interventions, to be fully effective.

I was asked about mental health monitoring. The process for ensuring that people get the help they need involves identifying people who are using drugs. We have drug dissuasion committees to which people can be directed. These committees typically include people with mental health training, sociologists and so forth. Community-based organisations also ensure that people get the kind of services they need.

The first goal is, for example, that those have a problematic use of opioid drugs can be put on a programme, be it a low-threshold methadone programme or some other one, that will get them into becoming functional members of society, but also then we must ensure to create a sustainable solution finding social responses to their needs. For example, if they have a family, how are they being provided for? Do they have a job? Are they able to have consistency in their job? Do they have a residence or an address they could share on a job application? There are all the issues that interconnect with ensuring people stay on the programme and eventually, we hope, become free from it. These programmes have been highly effective and that reflects, too, the mental health issue in the sense that they become functioning members of society, they get jobs and become contributing members of their communities. There are challenges. There are people who have been on low-threshold methadone programmes for decades. That is not what the scientific evidence says should be happening. We should find ways to more proactively get people to move from being on these programmes towards being fully autonomous, but this is a step-by-step process where we all have to learn and we all have to grow.

To end, I will speak about next steps. The idea of a criminal approach to drugs since the 1960s and 1970s has proved to be an absolute failure. It is about going beyond the decriminalisation to start the serious discussion of how we address the legalisation of drugs in putting them within a state-regulated programme. This is not full-fledged liberalisation of the drug market, but having a highly regulated market starting with cannabis, for example, is something that is in the pipeline in the Portuguese discussions. If you have been approached in Portugal by someone selling drugs on the street, many times they are cannabis or cannabis-related products. If we were to be able to find a regulated way to approach the cannabis market it would kill more than 50% of drug trafficking across the globe. That would be a huge dent in the drug trafficking gangs and illegal activities and it is money that would be in the state’s coffers that could be used for safety and security enforcement, health services, harm reduction services or to make us more effective at ensuring the state is doing its job of creating societies that are safe for our children and future generations. That is a serious discussion that should be embedded in this more specific conversation around decriminalisation.

I thank Dr. Baptista Leite for his time this morning. We look forward to continuing conversations with Ms Vas in his absence.

I will move to the other witnesses and unlike what just happened there we will hear from the three witnesses one after the other and then go into questions from members. Next up is Ms Nougier, head of research and communications at the International Drug Policy Consortium.

I thank the Vice Chair for the invitation. I am the head of communications at IDPC. For those who do not know us, IDPC is a global network of NGOs that come together to promote drug policies that are grounded in social justice and human rights. In 2023 IDPC produced a shadow report that was directed at the United Nations Commission on Narcotic Drugs. It basically reviewed progress made on global drug policy since 2019. The conclusion we reached was very clear, namely, punitive drug policies have by no means reduced the scale of the illegal market but, rather, have resulted in a major public health crisis that is causing an estimated 500,000 drug-related deaths every year. We know these deaths are preventable. Criminalisation and punishment have also resulted in a severe prison crisis, with one in five people incarcerated globally for a drug offence. The Office of the United Nations High Commissioner for Human Rights and the UN Special Rapporteur on the right to health have both released seminal reports that highlight the devastating impacts of punitive drug policies on human rights. That includes the denial of access to essential medicines, harm reduction and treatment services. It includes arbitrary arrest and detention, police violence and multiple cases of discrimination on the basis of race, gender and class. Importantly, the high commissioner and special rapporteur both reached the conclusion that governments should urgently consider decriminalisation and responsible regulation of all drugs. IDPC’s research has also shown the potential of both policies if they are done right.

First I will say a few words about decriminalisation. When we look at what is happening around the world, approximately 66 jurisdictions and 40 countries have adopted some form of decriminalisation. We have also seen there are as many models of decriminalisation as there are jurisdictions that have decriminalised. As Dr. Baptista Leite said earlier, no policy can be copied and pasted somewhere else, but there are key lessons we can draw from what has or has not really worked and we can draw a set of principles from that. That is what we have done at the IDPC. Based on the evidence of what has been happening around the world we have developed a gold standard of decriminalisation. I will present six of the principles we came up with for what would work best in a decriminalised environment.

The first principle is decriminalisation is most effective when it covers all drugs and focuses on all activities associated with drug use. This is not necessarily just drug use and possession, but it should also cover cultivation for personal use, social sharing and possession of drug use paraphernalia.

The second principle is that decriminalisation should entail the removal of all sanctions, criminal and administrative. That is the conclusion we have reached, because any sort of punishment can negatively impact people’s lives, especially those most marginalised, and the objective here should really be to reduce any sort of contact with the police and the criminal legal system. That is why we are calling for full decriminalisation.

The third principle is decriminalisation should be paired with the scaling-up and funding of systems of care and support for people who use drugs. The Portuguese example is especially important in that regard because that is what happened there.

The fourth principle is decriminalisation should include the expungement of previous convictions for activities that are now decriminalised. That is important. We have seen that in some instances decriminalisation exists on paper, but it is not properly implemented on the ground, so very often decriminalisation policy will require significant training of responsible authorities to ensure it actually materialises on the ground.

The fifth principle is that in addition to that, to avoid any possible backlash against the reform it is very important decriminalisation is accompanied by awareness-raising campaigns among the general public.

Finally and very importantly, people who use drugs have to be involved in all stages of the design, implementation and monitoring of decriminalisation policies. That is to ensure the policy does not have any negative unintended consequences and also because people who use drugs know best what is right for their community.

If we decriminalise all drugs, why should we discuss legal regulation? Conversely, if we legally regulate certain substances like cannabis, why should we even consider decriminalisation? I will address both these points. Legally regulating at least certain drugs in countries that have already decriminalised drugs is critical. This is because decriminalisation policies focus exclusively on activities relating to drug use, but they do not focus on the supply side of the illegal drug market. As a result, people who use drugs continue to rely on an unknown and sometimes highly toxic drug supply, with all the possible harms that are associated with it. Legal regulation would enable public authorities to establish clear rules on the quality and composition of the substance, access, pricing, where it is possible to consume, etc. At the same time, regulating the market means a conversation is now possible on how to address the multiple layers of oppression, violence, vulnerability and exclusion faced by many of those involved in illegal drug supply. That is not possible in an environment that is just decriminalised. The final point is that regulation would help to reduce the huge burden drug control has placed on the criminal legal system.

Why discuss decriminalisation if, say, a country has already legally regulated cannabis or another substance? Even if cannabis or any other substance is now legal, many activities will inevitably continue to operate within the illegal drug market. This includes activities related to the cultivation, production, trade and use of other substances that are not yet regulated.

Even for substances that are regulated, for example, cannabis, there will still be activities within the cannabis market that will operate outside of the legal market. For these, it is absolutely critical that drug use and related activities are decriminalised for all the reasons I already mentioned.

Decriminalisation and legal regulation are complementary policies, both of which have advantages and limitations, which is why I hope both can be considered in drug policing discussions within Ireland. It is important to note as well that regarding decriminalisation, regulatory models vary considerably from one another. That means that it is perfectly possible to avoid the risks that can be associated with highly commercialised models or regulation because that is one policy or regulatory option. There are many more. I am happy to elaborate on this further but for the sake of time I will stop here. I look forward to members' questions and comments. I thank members for their attention.

I thank the Chair and members for the invitation to appear before the committee. I am a professor of the psychology of justice at the University of Porto and a board member of the European Society for Social Drug Research. I have worked in the field of drug use for 28 years now, combining academic activities with clinical and outreach intervention. My statement is therefore informed by both my scientific knowledge and my experience as a psychologist and a citizen of a country, which, as Dr. Baptista Leite said, that has radically improved its drug-related profile in the past two decades. Before the reform, the country had one of the worst scenarios in Europe in terms of drug-related problems. We faced a high prevalence of problematic drug use, high rates of drug-induced deaths, overcrowded prisons because of drug-related crimes, a high prevalence of drug-related infections such as HIV, viral hepatitis and tuberculosis and drug use was classified by the population as one of the three most disturbing phenomena they faced.

The Portuguese reform came in 2000. As we already discussed, Portugal decriminalised the civil possession of all types of drugs and drug use was defined as a healthcare issue, while drug trafficking has remained a topic for the criminal justice system. The Commissions for Dissuasion of Drug Addiction - not drug use - were created to adopt a comprehensive approach aiming to describe drug abuse and its related harms. As Dr. Baptista Leite said, using drugs is still prohibited and may be sanctioned with administrative measures, such as fees, community service and so on. The commissions can also make a referral for treatment. The reform went far beyond the decriminalisation, which I wish to make clear in this statement. Harm reduction was legally allowed in 2001, including services such as low-threshold methadone programmes, needle exchange programmes and drug consumption rooms. Apart from that, there was a considerable renewal in political and financial investment, the network of specialised services was expanded, as was the funding for research and an inter-ministerial organisation, known as IDT at that time, was created. Efforts were made to offer good coverage and accessibility of harm reduction treatment and reinsertion programmes of multiple types. The highly complex and territorial strategy tries to address, in an integrated humanistic format, all the needs of people who use psychoactive substances, as well as their families and communities.

What we could learn from this? The Portuguese scenario changed dramatically. There was a discreet growth in illicit drug use among adults. However, the European Monitoring Centre for Drugs and Drug Addiction, EMCDDA, itself said in 2011 that Portugal's drug situation is characterised by a level of drug use in the general population that is, on the whole, below the European average and much lower than its only European neighbour, Spain. What makes the Portuguese case special is that decriminalisation was not associated with an increase in the prevalence of cannabis use among young people, as it was in other countries. There was a decrease in illicit drug use among adolescents, in the prevalence of injective drug use, in blood-borne infections, in the stigmatisation of people who use drugs and of the weight represented by people who use drugs in the judicial system. To reinforce what Ms Nougier said, my team and I did a scoping review in 2020 and in a literature review of 69 scientific articles that address decriminalisation policies, we found they do not seem to result in a significant increase of drug use prevalence, nor in greater markets, larger supplies or lower prices. It tends to save money on law enforcement and criminal justice systems, they seem to decrease drug related crimes. They are associated with an increase in arrest rates for selling and trafficking, a reduction in the incidence and prevalence of rates of infection and increased numbers of people undergoing treatment. They are associated - this is important also - with an increased support from the public opinion for decriminalisation as people tend to become supportive of legislation that does not criminally prosecute people who use drugs, but redirects them to health and social care.

To conclude, Portugal has had a very good performance in all the usual indicators to evaluate drug policy, but decriminalisation alone would most probably not be capable of reducing drugs effects. I reinforce what has been said until now at this meeting. Recent policy innovations have consistently showed us that the potential of more humanistic, comprehensive, user-friendly and ethical interventions have great potential. While they may sometimes look counterintuitive, such as making syringes and drug consumption rooms available for those who use drugs, they seem to be more effective than the punitive approaches used before. I thank members for their time and attention. I look forward to discussing this topic with them.

I thank the Chair. That pronunciation was almost perfect. Perhaps she has Polish blood.

I work for Open Society Foundations and we support efforts to rethink drug policy across the globe. Since this is an international panel, I will share some of those experiences. To start, even though we see drug use as a public health issue, legally, it continues to constitute a criminal offence. It constitutes a criminal offence that law enforcement pursues quite vigorously, albeit not equally as vigorous in every country in the world. For example, this is often where people in police enforcement make their overtime and this needs to be acknowledged in some way. From a human rights perspective, the criminalisation of drugs is problematic because it infringes on people's right to autonomy and on the privacy of private behaviour. Criminalisation is even more inappropriate in the context of the overdose crisis the world is experiencing right now. It is essential that people who use drugs feel safe contacting the authorities to seek help, report an overdose and alert them to dangerous batches of drugs. All of that becomes highly difficult when a person is criminalised, as we heard earlier. What Portugal has taught us over and over again is, when drugs were decriminalised, people were more ready to access services. With the decreased number of people in prison and with criminal charges, the number of people willing to go into treatment and engage with public authorities has grown impressively.

Particularly at the time of an overdose crisis and adulterated powerful synthetic opioids, we should aim for that increase in the number of people voluntarily in treatment.

I visited China while it was rolling out its methadone programmes, and it was experiencing a different phenomenon. Its methadone programmes were at 30% capacity. I had conversations with officials who were responsible for those programmes and with drug users, and the story was very simple. Public health officials were concerned that even though services were available, people were not using them, and drug-using people asked us why they would self-identify as a drug user if, around the corner, there could be a police officer who could arrest them entering or leaving the programme, because drug use is a criminal offence in that country. That connection was made clear to me when I had those conversations on my visit to China.

In the US, where I live, women are extremely reluctant to walk into harm-reduction services because, again, self-identifying as a drug user runs multiple risks for them. For example, a very real one is that their children could be taken away if they are charged with drug possession. Conversely, when I visited Zurich, Switzerland, a number of years ago and talked to police officers, it was a police officer who took me to a heroin maintenance programme, which was not on my agenda because I did not want to feel like a voyeur of drug use. He said I had to see it because this public health measure had helped Zurich resolve its heroin trafficking problem. Most heroin was used by people who were the most dependent on it. Approximately 80% of illicit heroin was used by those who were the most dependent. The police officer said they had naturally decreased the rate of heroin trafficked into Zurich by opening the heroin maintenance programme, and data on this was shared with me by police officers in the city.

As long as drug use is a criminal offence, the threat of arrest or criminal charges will continue to hang over the heads of people who use drugs and will push them away from health and social services that can save their lives, especially now, during the overdose epidemic. Research has repeatedly found that the criminalisation of drug users makes people who use drugs less likely to seek treatment or other health services or to report a suspected overdose. Decriminalising possession for personal use is an important step towards creating trust between communities, law enforcement and health authorities and is is essential to address the health harms of drug use and reducing overdose deaths.

We know that decriminalisation works. In the 1990s, Switzerland faced a major problem with illicit drugs and a growing HIV epidemic. Instead of doubling down on its criminal justice response, it decriminalised drug use, expanded harm reduction and opened injection sites. Today, Switzerland has among the lowest levels of drug-related deaths and new HIV infections in Europe. Of course, we have heard repeatedly about the similar experience of Portugal.

Increased availability of naloxone, good Samaritan laws and greater access to drug and other medical treatment are all important and are all key parts of a rights-based response to the overdose crisis, but the decriminalisation of drug possession for personal use must lie at the heart of that response.

I thank the witnesses for their presentations and for the work they are doing in this area. Why is the use of certain drugs criminalised? I understand that the Marihuana Tax Act of 1937 criminalised cannabis at a federal level in the United States. Is it the case that these drugs are criminalised to protect people from being harmed by them? As we all know, it is not working, because people are being harmed anyway. When we go back to the genesis of criminalisation, why and when did it happen in various jurisdictions?

When we talk about the decriminalisation of dealing or trafficking, how do we draw the line between that and possession for personal use? We had this question last week. Previously, Portugal had a scale of weights for various drugs and if someone possessed more than a specified weight, they were deemed to be a dealer, but we were told last week that this is no longer the case and that there is now a far more fluid mechanism for distinguishing between personal use and dealing.

We regulate prescription drugs for good reason, because if people who should not take them do so, they can cause harm. We also regulate them because some of them are scarce and expensive and should be targeted at people who need them. I asked at last week's meeting how, if we were to go down the road of regulating drug use, people foresaw that working. Where would people buy them, who would supply the retailers and how would that mechanism work? Would the witnesses be in favour of going down that route?

I am happy to come in first. I am speaking to the committee, somewhat awkwardly, from a hotel room in Geneva because I have just attended a meeting of the Global Commission on Drug Policy. I think I am free to recount the incredible frustration that former presidents and other high-level individuals shared regarding the failure of the drug control system. If we look at the data on whether people are using drugs more or less often, it is clear people are using more drugs today than ever before. Whatever it is we are doing in using the criminal justice approach, it is simply not working. Moreover, it is producing incredible violence and producing corruption.

The system we put in place had good intentions. To the question as to why drugs were criminalised, it is because we tried an approach and hoped criminalisation would deter people from use, and we learned that it is not working. Is there anything wrong with trying an approach? That is what the world chose to do as the first idea, but it is now decades later and we continue to do the same thing. The intention was that it would deter, but it does not, so let us change that approach.

I wanted to say that because it spoke quite clearly to me that where we criminalise drugs, people who are recipients of that approach are petty sellers and drug users. We are mad. These are the people at the bottom of the pyramid. We do nothing, however, to get to the top of the pyramid, which is the drug cartels where people are incredibly powerful as well as financially powerful. On the top of that pyramid is where violence and corruption is generated and we have completely failed to address this issue. It is time to say that we are doing it incredibly incompetently even though our intentions were good. There is really enough data to say that criminalisation has not worked and let us take a different approach.

I will stop here because, again, from the global perspective, it is not only that the drug policy and control is not effective, it is in fact harmful if one looks at all of the harms it creates at the global and local level, including the overdose epidemic. There is a reason why beer was not popular during prohibition. That was because one would not want to risk the punishment from having huge barrels of beer. People only made incredibly powerful alcohol and this is what happened with drugs today. We have basically incentivised drug traffic organisations to create powerful dangerous drugs. The system is incredibly ineffective and harmful and it is time for a change. The only way that change can happen is for countries to be brave and to take care of their citizens in a way that they deserve to be taken care of.

I thank Dr. Kasia Malinowska-Sempruchand and we have gone slightly over time. I ask Ms Nougier to be brief in her response, if possible. Dr. Pinto might perhaps come in during the next round if she has something which she wishes to come back on. We will then move on to Deputy McNamara next after Ms Nougier has spoken.

I thank the Leas-Chathaoirleach. I will also try to be brief and will address the other two questions which have not been addressed by Dr. Kasia Malinowska-Sempruch yet. As to drawing the line between use, muling and trafficking, there are various ways of doing this. In practice, many governments have used threshold quantities to define that this is the minimum or maximum amount of drugs that one has at one's disposal. If one is beyond that, then one will be considered a dealer. If one is under that, then one will be considered a consumer. The very important thing about threshold quantities is chiefly that they need to first of all reflect the realities of the market because if the threshold quantities are too low, then one is ending up criminalising more people who use drugs than before the reform. That is what has happened, for example, in Mexico or in Russia, where Russia has decriminalised but it has such low threshold quantities that it is basically abused as a system.

Second, again, we need to have the engagement of people who use drugs. The threshold quantities need to be flexible because, for example, many people at the time of Covid-19 were buying more drugs because they could not go out that much or they did not want to have that many interactions with the police, or they would buy for their friends or other people as a social sharing approach. One needs to be very flexible on the threshold quantities.

Other things one can consider are, for example, the use of a case-by-case basis. For example, one could ask whether the person is attending harm-reduction services regularly and there are a number of factors one can use. As for our gold standard, we usually recommend flexible threshold quantities where people are also able to identify other factors because threshold quantities are problematic in some ways.

On regulation, I think we can talk about this for hours so I am not going to go into tonnes of details but there are many mechanisms we can use for this. Kasia has already mentioned the heroin-assisted treatment in Switzerland. That is a model of regulation that enables people who are sometimes extremely marginalised and highly dependent on heroin to access a safe supply of heroin. That is an approach which has worked incredibly well and all of the trials and the research that has been done on heroin-assisted drug therapy have shown the benefits of this approach.

For coca, there are some mechanisms, for example, in Latin America which show that coca is actually not harmful as a substance. It can be sold as tea, as leaves, as powder and can be sold with very minimum levels of regulation in shops.

I thank the Leas-Chathaoirleach very much. I would like, probably, to give Ms Nougier the opportunity to come back in now because I find it interesting.

Is it fair to say that for most of the speakers - Dr. Kasia Malinowska-Sempruch was perhaps less emphatic - the preference is to move towards a legalisation and regulation model, to go beyond decriminalisation, and if so, what would it look like? Do I understand correctly that the hope in doing so would obviously be that one regulates the substances with regard to toxins which may not be added in terms of strengths, etc., so as to make overdosing and the worst effects of drug use less likely? To do so, also has the added benefit of taking criminal gangs out of the equation.

However, is that the experience from the limited knowledge we have of countries that have legalised? As a committee, we have not heard from witnesses in that regard yet. We are hoping to do so and despite our best efforts we have not managed to hear from people yet. To repeat, in countries where some degree of legalisation has occurred, is that the experience or are criminal gangs still operating in tandem with more legal sources? The sale of tobacco products is legal and regulated in Ireland, as in most countries, but there is still a thriving black market in it. There is still a relatively small market, or I think it is relatively small, in selling alcohol on the black market, even though we have a fairly large legal alcohol sector in Ireland. Those are my questions.

Yes, fine. The Deputy's question is a very good one because obviously one of the key advantages of legal regulation is to send the market back into the hands of governments to ensure that organised crime no longer operate within these markets. One has to be realistic. Legal regulation will not end all illegal activities and that is very clear. Criminal gangs will continue to operate and it just depends on the level of regulation we put together. It is a matter of balance. It is also a matter of adapting to the realities of each country. For example, in the United States, one had these huge markets already operating selling medicinal cannabis legally. The medicinal cannabis market that was legal then got converted into a legalised market for recreational drugs. In these markets, organised crime was not that prominent because most of the market was already legal.

In countries like Uruguay, for example, there has been a fairly big proportion of the market which has been withdrawn from organised crime. However, some of the market remains illegal because the level of restrictions on the market were so strong that it did not manage to counterbalance the entirety of the illegal market. We need to be very careful and it is a learning process. It is new and we need to be very mindful that there will be some trial and error there. The idea is to ensure that we retain as much of the market in the legal environment and that will require some adaptation to ensure that, for example, the pricing is not too high because otherwise people will continue to go into the illegal drug market if the price is lower there, or that people who have been traditionally cultivating cannabis, for example, in the illegal environment have a chance to continue cultivating in the legal environment.

Making that position and having a social justice approach to legal regulation will be incredibly important to make sure that we counter organised crime. I do not know if Dr. Malinowska-Sempruch, Dr. Pinto or Ms Vas have other elements they want to add.

The only piece I would add on the regulated market is that it needs to be really well thought-through. The assumption that we should all make is that handing it over, for example, to a large cannabis business is not the smartest idea and that people who have been most impacted by criminalisation can find work in that market. We see a lot of efforts in the United States where small dispensaries hire people who, for example, had criminal records and are creating job opportunities for folks who otherwise would continue to be disenfranchised. I was a little surprised when I was in Massachusetts that if I wanted to order cannabis to be delivered to my hotel, the person who would bring it to me was someone who had been in prison for cannabis crimes. That was a way to include folks who would likely end up on the fringes and continue acting in ways that were illicit because it was incredibly difficult for them to find work.

If the Irish Government chooses to regulate cannabis in the future, Ireland would benefit from engaging in a lot of thoughtful effort on how to do so in a way that is most effective, helps the affected communities benefit from that process and, as a result, limits their engagement in further illicit activity.

I agree totally with Ms Nougier and Dr. Malinowska-Sempruch about this. I would like to highlight the intervention of Dr. Malinowska-Sempruch. Social justice must be taken into consideration while regulation is being put in place because we have already learned how these processes might be perverted if we do not take that into consideration.

I will make a comment on what Deputy Stanton asked me about because it is important to bring this to the discussion. I will only take a minute to say it. While the user system of drugs has been criminalised, I would just like to highlight that we cannot look at the drug use problem without doing the necessary contextualisation of the historical and cultural background that these issues always bring with them. If we look to the history of drug use since the last decades of the 19th century, we see that criminalisation and demonisation of the use of certain substances always have much more to do with cultural and social dynamics related to the groups of people who use those substances than with the harms they can bring - the damage caused by their pharmacological properties and so on. Alcohol, for example, is a very dangerous substance which, except for a period that we all know very well, has not been as problematised as many other substances. There are several studies already done on this subject that show very clearly that there is a strong gap between the United Nations conventions on the substances and their classification regarding their levels of danger, and the classifications made by independent experts. This means that many substances are not as dangerous as they seem in the international conventions from a rational, scientific point of view. The contrary argument can also be made. I would just like to bring to the discussion the importance and the relevance of taking into consideration that when we are talking about drug use, we are not only talking about the pharmacological properties of the substances, but we are dealing with complex social and psychological dynamics that in the history of revisionism have made the prohibition to act upon those in the most vulnerable situations in a very unproportionate way. I would like the committee to take that into consideration because if not, the problems will not be solved.

I thank Dr. Pinto. Before I move to the next member, I apologise for interrupting speakers but there is a set amount of time of seven minutes, and the witnesses online are not able to see the clock. The approach facilitates members to ask questions and get answers. I am reluctant to interrupt responses because we are here to get responses. I apologise for that. I will try to make sure that latitude is given, while making sure that every member gets his or her allotted time.

On that note, I will go straight into the questions rather than give a preamble. The first question is to Ms Vas, in Dr. Baptista Leite's absence. Portugal ended prohibition and moved to a decriminalisation model. Is there anything that Portugal would have done differently or were there any unintended consequences? We heard from a previous speaker about unintended consequences in the United States and China. Was there anything in the early stages that Portugal might have done differently or anything that was learned that we could use in an Irish context if we were to move that way?

I thank the Deputy very much for the question. I will not start on the historical element because perhaps Dr. Pinto can jump in and comment on what could have been done differently at the time.

If the Chair allows me, I will pick up on a point raised earlier about what are the next steps for Portugal and what it is doing currently. I will highlight the example that was mentioned about recent reforms that were taken in Portugal to look at the decriminalisation system and see how to make it more effective. That happened last year. The reforms took place 20 years ago. We have been experiencing a lot of changes in the job market also as a consequence of continued prohibition globally. For example, in the 1990s when decriminalisation was defined in Portugal, thresholds were set for the most commonly used substances that were then included under decriminalisation. They were calculated on the basis of amounts for personal possession for ten days under the decriminalisation framework. In recent years we have seen a big rise globally in the use of novel psychoactive substances and other synthetic drugs, which were not covered under Portuguese decriminalisation. For example, the drug dissuasion committees that we have mentioned as a form of diversion were not available for people charged with possession of novel psychoactive substances. The Parliament in Portugal also highlighted that not including these substances has created a discrepancy. The most vulnerable people in society are using these substances more and they are exposed to more contact with the criminal justice system and are more at risk of arrest and receiving sentences because of that.

Parliament has also highlighted in the discussion on reform the difficulties to some extent with distinguishing between people who use drugs and people who sell drugs based on the amounts that people carry for their personal possession. It was argued during the reform process that to determine whether people are selling drugs for bigger financial gains which would require the attention of law enforcement, the possession amounts are not enough.

The decision was to remove the thresholds for possession and instead look at different ways for the police and prosecution to prove intent to supply. While this point has been raised before, it is also a part of this reform and this discussion that there is very significant overlap between people who use soft drugs and people who get into complex medical emergencies, including in Portugal.

I thank the Deputy for the question. I also thank Ms Vas, who has said many of the things I was going to say. One of the good practices in designing the policy was the creation of a commission of experts. This commission tried to analyse all evidence available at that time. A very positive format for creating the national strategy was also assumed. This included auscultation of people who use drugs, their families, the communities, people working in the field and so on. The ten days came from that general auscultation of the population and the people who use drugs and from consideration of harm-reduction and treatment responses in other countries. I do not know if that answers the question. The idea was to ensure the law did not have a very low threshold that would make it possible for people who were not selling drugs to come into contact with the criminal justice system. Many people need or choose to buy enough of these substances for several days. This may be because they do not want to be in contact with the dealers or traffickers very often and try to avoid those environments. Some people who live outside of the big cities also do not have access to these substances and so have to buy for long periods of time. Ms Nougier has also talked about the example of the Covid pandemic. Some contexts make it necessary or preferable to buy doses for more than one day. The period established was ten days. That was an attempt to establish an objective measure to distinguish drug trafficking or dealing from drug use.

Deputy McNamara asked what I thought could be improved. There were some problems putting these measures into practice. For example, drug consumption rose. The value and effectiveness of the measures have consistently and scientifically been shown. The thresholds have existed in Portugal for 20 years. The laws establishing them have been reviewed since 2001. When the thresholds were set, there was a void in the law as regards people who were not trafficking drugs but who had with them more than the threshold amount established for that particular substance. The law has different thresholds for different substances. The law did not say what should be done if a person had more than was allowed for personal use but was not trafficking drugs. The courts decided that such a person must be punished. That decision opened the doors for future sentences of this type.

I have one more thing to say. The Portuguese model has changed over the two decades, mostly as a result of external factors. As I said in my presentation, the support of this network of specialised services given to people who use drugs and their families is absolutely crucial if good results are to be achieved. The problem is that the financial crisis in 2008, the subsequent austerity measures and the crisis we are now leaving have had a great impact on the social and healthcare support given to those people. I fear that the results will not be the same over time. Once again, I will highlight that decriminalisation does not solve the problem by itself.

There is one more thing I would love to say if I may have one minute. I always use qualitative participative approaches in my methodologies when I do my research. I would like to bring the voices of people who use drugs, people who I always listen to, to the discussion. One of the things they systematically say has been failing since the beginning of the reform is the reinsertion component of our interventions. People's health indicators and so on are cared about but working to give them a sense of usefulness and integration into society is always secondary and they would love for that to change.

I thank all of the witnesses for their time. This is really helpful. My understanding is that no jurisdiction has legalised all drugs. I ask the witnesses to correct me if I am wrong on that. I believe it is broadly accepted in Ireland that the approach of criminalisation has utterly failed. Drug dealing and drug use are undermining and damaging individuals and communities all over our country. We are coming at it from that approach. I believe there is broad support for greater support and the resourcing of a health-led approach. Elderly people, children, young adults, adults and communities are really under siege. This manifests in people living in parts of our capital city closing their doors. Elderly people cannot go to the post office or the shops because they feel so intimidated and oppressed by the presence of drug dealing and drug use. Young adults' lives are being limited because of the intimidation, coercion and abuse experienced in their situations. The big question is how far we should go. The changes we make need to be meaningful and successful so that we can not only promote more sustainable communities, but ensure them.

My question is on decriminalisation. From the evidence of the witnesses, it is just not clear to me how drugs are distributed and sold in a decriminalised environment. I am talking about all drugs. I really want to understand how that takes place. To remove drug dealers and the street activity we are talking about and that we all too familiar with, do we need a model of full legalisation? Is that the only way to remove that activity? That is a big imperative. It is a broader societal imperative. To address the individual and remove the stigma, damage and shame, that has to be addressed. I would like to hear the witnesses' views on that.

I will start with a very brief statement. I hope that others can continue from there. The only way to remove the illicit market, the dealers the Senator has described, is for a government to take ownership of the market and to regulate. No country has regulated all drugs. The country of Bolivia has regulated the coca production market and allows some growing.

Governments in Canada, Uruguay, states in the US and, increasingly, Europe are regulating the cannabis market. Heroin is regulated by Switzerland and other countries, making it available to people who are most dependent and for whom other forms of treatment have failed. We are in the early days of regulation, and it is only in those instances where people buy or receive drugs from a legal market where government took responsibility for how it is being regulated. We are in the early days, but data from those examples is quite positive. If you want to truly make sure you get rid of the illicit market, the only way to go is to regulate. What Ireland is considering now is decriminalisation, which will not get rid of illicit markets. You want to decriminalise for people to access services that will let them know what substances are on the street and if they are dangerous. Information can be shared in order that it all comes out of the shadows and people are not afraid to engage with public health and social services.

I will continue the line Dr. Malinowska-Sempruch was taking, which is substantively correct. It is more acceptable for the general public to start with decriminalisation. That results in solving many issues relating to drug use. If you want a model whereby you know where and how drugs are distributed, and can manage it, then that means you need legal regulation. You can start with one substance, build on that and learn from the experience. If, for example, you start with cannabis, you can see how that can be adapted with more or less stringent controls on other drugs. When you look at the experience of control, in particular in Europe, many countries are putting emphasis on the model of cannabis social clubs. That enables cultivation and use to be done in co-operatives, which are small and not for profit. That enables people who use drugs to have contact with one another and share information. It is a way for them to build a level of trust with the products they are using, but also to share information on how to reduce the possible harms associated with their use. That is a model Germany, Luxembourg, Malta, Uruguay and other countries are adopting. That model could remove the issue of coercion and intimidation, for the cannabis market at least. We know cannabis is by far the most widely used substance across Europe and the world.

I agree with everything said on this topic, but I say again that if we look at the history of drug use, it is something which is part of human behaviour in all societies and at all times. I do not think we will manage to end drug use. On the other hand, crime, black markets, infection epidemics and so on are much more the products of bad drug policy than of drug use. If we go for good, science-based and rational drug policies, complementing them with holistic and user-friendly services, and care for the people who use drugs and their families, that will be the best path to follow. I have a practical example of how user-friendly responses can have good results. In drug consumption rooms, I have learned that a clinical format makes a contrast, is more user friendly and is appropriated by the people who use drugs. I am evaluating drug consumption rooms in Porto. Users say repeatedly that they feel so well inside that they tend to use fewer drugs over time. If we understand what they need and give them the responses they need, we are contributing to reach what we are aiming for.

I thank the witnesses for presenting. The information they are giving us is important and interesting. We often discuss poverty as the root cause of addiction. Does anyone have a comment to make on the impact of the welfare state and poverty prevention measures, and how these interact with decriminalisation?

I agree with the Deputy's point of view. Portugal has made a serious investment to try to deal with the social disadvantages of people who use drugs. We have had several programmes of integration. As I said, however, that is because of both structural problems in the country and the series of crises we faced. There was investment to respond to those social disadvantages with a relative power of intervention because the country has problems at a more general level. I agree that is one of the biggest structural factors for drug addiction. The studies show that, even when people develop problems using drugs, those in a situation of social disadvantage face cumulative factors that make it hard to leave the situation.

I agree with Dr. Pinto. Studies show that problematic drug use might be higher among people who are in situations of poverty because they are facing difficult circumstances and the impacts of criminalisation have really focused on those most vulnerable and marginalised. We should also not underestimate the impact of drug policies on levels of vulnerability to the harms that could be associated with drug use. What is interesting is that many governments and civil society colleagues have recognised that already. What is important about harm reduction is that a harm reduction response not only focuses on addressing the health issues of drug us, but also increasingly focuses on the social issues people might face. like providing housing first, food or showers or dealing with issues of gender-based violence. Harm reduction addresses all of this. As Dr. Pinto said at the beginning, it is important that decriminalisation is associated with harm reduction. Harm reduction encompasses many more things than addressing the limited health harms people might be facing. If Ireland moves in this direction, addressing the social issues is also incredibly important. That can be done through harm reduction.

I very much agree with my colleagues. The Deputy asked a great question and I thank him for it. When we think about people who are unhoused it is really not that surprising that drug use becomes an issue because in some sense it is a rational response to a terrible situation that people are in.

I will make one additional point. If folks then become criminalised, it will become that much harder for them to return to society. In the United States, for example, people with a criminal record cannot access public housing and many jobs are unavailable to them. In addition, I invite the members to think about of the cost of criminalisation once people want to or are able to return to society and are being kept out.

I will give an example of a problem that existed in Portugal after the reform was implemented. To improve the employability of people using drugs in treatment, under the programme, those offering care to people using drugs in the treatment centres would work closely with the labour market. During the period in which people were integrated in the labour force and employment, the government gave tax benefits to enterprises that welcomed these employees. The results were very positive but then the austerity measures were introduced and the programme was ended. We had a very good experience with this. User-friendly measures are once again to be implemented with the help of people using drugs telling us at all times what are the best responses to put in place.

I cannot answer necessarily on the Portuguese case but there is a variety of jurisdictions that have allowed for the expungement of criminal records of people who have been previously convicted of drug use-related activities. This is definitely happening around the world. I will let the experts respond on the situation in Portugal.

I have two questions. One is short and specifically directed to Ms Nougier. The second may be for everybody.

In her opening statement, Ms Nougier referred to six areas she would like to see covered in this kind of work. I want to go back to the involvement of drug users in the development of policy. Witnesses from the Departments of Health and Justice have been before the committee discussing this issue in previous sessions. In their description of policy development most of the advocates from the sector who could be categorised as those experiencing the issues, in other words, drug users, are often in the category of problematic drug use, that is, addiction, and those representing families of those who are in addiction. In Ms Nougier's experience is it important or are there examples of both problematic and non-problematic users, possibly casual users of drugs, being brought into the development of policy?

I thank the Deputy. That is a great question. At the International Drug Policy Consortium network, the key thing we promote is the involvement of affected populations in the development and implementation of policy. As many people who use drugs as possible should be included, and that definitely includes people who are casual users, people who have a major criminal record and people who have problematic use. A variety of perspectives is needed because there are so many different perspectives in drug use and people do not necessarily agree. People use different substances and use them in different ways and in different settings. There are people who use drugs at festivals and older people who use at home. The more different perspectives you can get in the development of the decriminalisation policy, the better the model and the least negative the consequences in its implementation afterwards. Please involve as many people as possible.

Perhaps the case of Mexico could be interesting. In Mexico in the lead-up to the UN General Assembly special session on drugs in 2016, there was a big deal in terms of engagement with civil society. Mexico decided to put together a series of hearings with civil society to get its perspective on what it was expecting the government to bring to that big UN meeting. The government released a public call for expressions of interest from civil society. Civil society could respond to that. If Ireland first reached out to all the civil society organisations that work on drug policy and reform, it will get a lot of contact from people in very different environments. Students for Sensible Drug Policy and Youth RISE are two youth-led organisations working on drug policy reform and harm reduction. The committee could reach out to them. There are also global and regional networks of people who use drugs and the European Network of People who Use Drugs, EuroNPUD. There are a variety of different avenues available. I am sure all of us will be happy to help the committee identify a few of these colleagues. As a ripple effect, the committee will be able to identify many people would be willing to engage, both casual and problematic users.

I thank Ms Nougier for that. It is incredibly helpful. I will stay on that theme but broaden it out to our other witnesses as well. There is a complexity with navigating policy between problematic and non-problematic drug users. This seems to be an issue particularly when we have either a criminalisation system or a decriminalisation system. Obviously under legalisation, people self-identify if they require addiction support but under both of the other models - criminalisation and decriminalisation - we are likely to see diversion programmes, which complicates the issue of how we navigate and make a differentiation between people who are truly problematic users of drugs and those who are not problematic. In previous sessions, the committee has discussed incentivising people who are not problematic to take up space within the health system because there may be a legal benefit to them doing so. I have a concern that we could incentivise non-problematic users to go for treatment that they may not need and then take a place from somebody who needs it.

That is an excellent and really important question. The reason my institution is advocating for decriminalising rather than diversion is that decriminalisation removes involvement with police from people's lives. Diversion actually continues police engagement.

Police, who are not qualified to make decisions on who is drug-dependent and who is not, often end up arbiters and referral points to treatment for people. That is not where we want to be. Switzerland, Czechia and Portugal show clearly that people will come forward for treatment when they are ready. That is when treatment is most effective. If people are pushed or forced into treatment, it is often not helpful to them.

On the question of 90% of drug users not needing to be in treatment and being forced into treatment, that is a complete waste of public resources. I stress that people know when they are able for and want treatment. We should, rather than being frustrated they do not want it sooner, honour that. That approach is the best in terms of using public resources and honouring people's autonomy.

I will complement what Dr. Malinowska-Sempruch said. It is important to understand not everybody requires treatment. Many people will require some element of support and harm reduction. However, in every case, criminalisation has a severely negative impact on people who use drugs, whether they are dependent or face problematic or occasional use. Decriminalisation is critical for everyone. We want to remove interactions with police because they lead to negative interactions, harassment, discrimination and violence. The idea is to get this out of the criminal legal system, out of the hands of the police and into the hands of people who use drugs themselves. They should be able to access the health and social services they need. For example, for a woman who uses drugs occasionally and needs to go to sexual reproductive health services, using drugs or identifying as a person who uses drugs will be detrimental to her health and that of her unborn child. Do members want her to continue to be criminalised even for occasional use or to have access to health services? It is not just access to treatment services but to the whole range of services that they are denied.

I will be slightly different. I thank the witnesses for taking the time to be with us. This has been highly educational. I am old enough to remember a time when being gay was illegal in Ireland. We have seen such societal change regarding human rights in my lifetime that I can now stand up and argue for same-sex couple parenting rights. That is a welcome and fantastic growth in inclusion in our society. That shows societal change is possible in Ireland; it can be argued for and brought in. I approach this topic with the same view but find myself in very conservative territory. I am challenging my own conservatism.

The Health Research Board produces figures demonstrating that drug use is the same across all sectors of society, though maybe different drugs are used. At the more affluent end, it is probably cocaine use. Problematic usage can be better covered up and private treatment can be paid for. It is more socially acceptable. In deprived areas, the drugs used are less socially palatable, including opioids, and there is the association with high levels of crime. I am 100% already there that we need to decriminalise the individual and steer people on a pathway of health over anything else. I see in vulnerable communities that the instant criminalisation of possession is of no use. It is an absolute failure.

I am wondering about a future where we take the brave step of regulation. I am curious and want to push myself towards regulation. What would it look like? How would we get there? I do not want to say all our social services, youth work and investment in socially deprived areas have to reach a certain bar and have certain outcomes before we could consider regulation, although the fear of communities being exploited puts me in that place of saying we need to show a reduction in poverty. In those communities, vulnerable families are exploited and single parents have their children exploited as drug mules. The correct attitude of our criminal justice system is those under 18 should not carry a criminal record into adulthood and that is exploited by drug gangs to use children in the dissemination of drugs.

I am trying to get my head around it. I am sorry I am not as eloquent or as far down the road as my colleagues on the committee. What stages would bring us to a place where we would regulate? The authorities in New York have regulated. The latter was a place I once enjoyed going to but my most recent experience there was one I would never want to repeat. It was one where a father, mother and eight-year-old child were constantly approached on the streets to buy cannabis. The smell of cannabis on the streets is incredible. That makes me think I do not want us to go down that route. Help me move to that place. I am sorry I have talked too long but I am just trying to articulate my view.

I raised my hand because New York is my home at the moment and I am happy to speak to that. There is a reason cannabis goes first. The reason is it is the most frequently used drug. If you look at the scale of drug use in countries across the world, cannabis has primacy. We can learn from the experiences of others. I would look at Canada and a couple of states in the United States. For cannabis, there are many examples. As Ms Nougier mentioned, members may want to consider social clubs rather than a fully regulated market. There is also a reason heroin is made available by the Governments of Switzerland, Germany and other countries. It is because it is a drug that causes overdoses and potentially death. The two drugs to start with are cannabis and heroin through medical prescribing for those reasons.

I am a little concerned that this is how people see New York. If people went to San Francisco, Oregon or a couple of other states, they would probably have a somewhat similar experience.

I am not sure that New York is really the worst but perhaps that is my hopeful perception because it is my home. New York has struggled with the fact that it tried to regulate cannabis in a very specific way. First, it took a long time to set up models of regulation that are social justice-aware and, second, New York made a conscious effort to stop arrests. Even if people are selling illegally, they made a choice as a city to stop arrests and stop harassment of people. I think the committee should ask those questions of New York and state regulators. Why did they make that choice? Perhaps Ireland would not make that choice. Perhaps Ireland would have dispensaries and shops and continue arresting people outside. However, for numerous reasons, some of them having to do with social justice and race, New York made that choice. There are two ways to understand that.

There is now a lot of fantastic experience. If Ireland takes that path, we at OSF are happy to host members in the US. We will invite them to a couple of states with different approaches, and members could make a judgment that would work for Ireland.

-----so we can be fair and we can redeem New York’s reputation. I think that would be good.

Does anyone else wish to come in on that? We do not have much time.

I wish to make two points. First, legal regulation will not solve poverty issues. We should be very clear about what decriminalisation and legal regulation can achieve. I refer to state services, funding, access to education and access to services. Legal regulation will operate within these, and policing as well. Legal regulation will not be able to sort out all poverty but it will be able to remove certain layers of criminalisation and vulnerabilities that are faced by some of the most marginalised populations.

Second, a market already exists. It is illegal, but a market exists. We need to face that reality. It is important to also consider the power dynamics that operate within these illegal markets and see how we can redress some of the violence, oppression or inequalities - whether it is class, gender or race inequality – and make sure we address these within the legal market. That is not a given; it requires serious thinking. That is what Dr. Malinkowska-Sempruch was saying with regard to New York, Massachusetts, Oregon and other examples. We need understanding and to see how to not perpetuate these problems and issues in a legal environment. This requires much thinking. It is complicated. That is where you need to engage with the affected communities to understand where their issues are and how the State can redress them adequately.

We will have time for a smaller second round of questions. I will ask some questions before we move on. A few things have come to mind, as they always do when listening to a conservation. It is hard not to want to come back in on every single thing.

One of the things I want to get to the heart of has also been a trajectory of my own evolution of thought on drug policy. Even though I had very early involvement with drug policy for many years, my thinking has evolved, which is always a positive thing. Landscapes change and different countries try different things, so we start to see what works and what does not. One of the main things over the past number of years that I have begun to integrate into my own understanding is a rights-based approach to drug policy. Where I have come to that now is that it is different from a health-based approach. Unless the health-based approach has a full rights-based approach built into it, it is not actually a health-based approach. Previously, I had been looking at diversion very early on and then was looking at Portugal and dissuasion.

I wish to talk about dissuasion. Dr. Pinto underlined in her contribution a point on dissuasion of drug misuse rather than dissuasion of drug use. I would like to tease that out. What is happening in that area? There are fears we will not be able to meet the need. It goes back to Deputy Hourigan’s contribution where she talked about people who do not need any treatment using the system and availing of treatment to evade legal sanction. There is then the piece around dissuasion of somebody in the misuse of drugs. That is still a target on the most vulnerable that we all talk about. They will be the ones targeted in most systems that we look at, even if we are just looking at the dissuasion of misuse.

I think we can all agree that we would like to make sure that people are offered all the supports necessary for drugs misuse. I want to get to the heart of what that looks like in terms of a rights-based approach. Are people sanctioned for not availing of any supports or attending meetings? My fear is that any dissuasion that has sanction in any shape or form associated with at any stage it is not actually a rights-based approach. I ask Dr. Pinto to come in. If anyone else has a contribution to add onto that, that would be great.

I thank the Leas-Chathaoirleach for that excellent question. I am happy to answer it. We have learned - because we have already tried it - that mandatory treatment is not effective. It is not a good solution. People should not be forced to go to treatment. I agree with the Leas-Chathaoirleach. I do not appreciate the term “dissuasion”, nor the background, although I like that it is not targeting drug use but drug misuse. I agree that sanctions would not be the best way to approach the problem. We should help those who have a drug addiction and want help to deal with it. As Dr. Malinkowska-Sempruch said, the majority of people using drugs do not have a problem with them. Those people should be approached by harm reduction, user-friendly and non-judgmental approaches and services, which are often, by definition, outreach teams that go to people where they are and where they live. They are open to addressing drug use, taking into consideration what Ms Nougier also said, that is, the personal relationship that any adult constructs with a substance. That is an idiosyncratic thing.

I wish also to address the following issue. Senator Seery Kearney said that drug use is across all levels of society. However, as I said, we know that socially deprived sectors are disproportionately affected by drug addiction. Therefore, we must put in place rights-based approaches for those people, taking into consideration the social deprivations and making a serious investment in addressing the structural interventions that are absolutely necessarily to take these people out of poverty or at least apply protective measures to protect them from the effects of the disadvantaged conditions in which they live.

I agree that dissuasion, sanction and so on would not be the best way to approach drug use. That is not a health-based approach. Although, from our studies, we know that many of the people who go to the dissuasion commissions say they have had a good experience and they thought about their relationship with drugs. However, we do not have to address those issues with penalties, sanctions or so on. We must adopt a harm-reduction approach that is syntonic with the way people deal with their substance use.

I do not know if I was clear.

No, that is good. It captures that many people can have a positive experience with dissuasion, but it is uncoupled from sanction, so it is very much that they were willing to engage, or the supports were there for them to engage.

I will go to Dr. Malinowska-Sempruch next. Along with the answer she is going to give now, I just want to pick up on the good Samaritan law within her contribution. I looked at good Samaritan laws previously in Canada with regard to overdose. I am aware of a number of people throughout my lifetime who left the scene of an overdose out of fear of being arrested and not realising that the person was going to die, and they did. With regard to that good Samaritan piece, is that the legislation to which Dr. Malinowska-Sempruch is referring or is there a much more expansive understanding of what that is?

I will answer that first. I am sure many of us have seen in the US dramatic movies where someone drops a person who has overdosed in front of the emergency room and runs away because otherwise, if they stay with them, they will be charged with possession, or even in some instances with murder, if they were the ones who provided medicine. Therefore, the good Samaritan law allows for people who called to actually stay with the person and not be charged. That is an incredibly important law but again, that law is put in the context of a criminalised environment because if possession was not criminalised then that would not have happened and there would be no need for it. Therefore, it is incredibly important to understand it within the very punitive system that functions in the US.

I do not mean to get nostalgic, but I want to share one thing. In my process of supporting harm reduction programmes throughout the world, I travelled to Tomsk in Russia where it is -30°C. It is always amazing to me that drug users get on a bus, pay the ticket and travel in this terrible cold to make it to the harm reduction programme because there is someone there who is non-judgmental and who offers the services they need. When we think about that, it takes a lot of effort in the most remote parts of the world for drug users to come and seek help in an environment that is not judging them. My plea to everyone in Ireland would be to trust drug users to come and ask for the help they need and that they are able to accept once possession is decriminalised. People know what they want. Forcing them simply does not work.

On Portugal, I am sorry; I hope it does not sound unkind. I am a big fan. Let us keep in mind that law in Portugal was set up 20 years ago. We should learn from it and set up a decriminalisation law for the current century. I really hope and trust that Ireland will lead us there.

That is a very interesting question. As was said before, people can buy it in the street. They can also buy it by telephone. They may ask for it. They can buy it from their informal social networks. Usually, the people who only use cannabis or, for example, amphetamines or drugs like that do not usually go to the most marginalised locals of the city. They usually do that to get heroin or cocaine products. I do not know if I have answered the question.

That is fine; Dr. Pinto has confirmed the impression I have. I have not been to Portugal recently. I just wanted to get that clarified. I have not been able to find the information. Dr. Pinto has confirmed what I thought was the situation. Why did Portugal not put in place a formal regulated process for the sale and supply of cannabis at least, if not all drugs, when it was decriminalising cannabis?

That is a very good question. At the time, the commission that did this work was studying all the possibilities and maybe thought that was a very huge step and so it should try a more conservative strategy. As the Senator knows, however, we are evolving on the regulation of cannabis use for therapeutic terms. It is already happening for recreational use.

For a very long time, legal regulation was just not something that governments would consider because it is against international drug control treaties, which are currently actually creating huge barriers to governments responding to realities of their populations on the ground and moving towards legal regulation. However, the direct control regime does currently create significant obstacles in terms of what governments can and cannot do. There are already some discussions at the highest levels in countries that have legally regulated it in terms of how to overcome these challenges with different sets of agreements internationally among the countries that have legally regulated and seeing how cannabis could be removed from the drug control treaties or make reservations on the treaties. That is definitely something that has hampered the progress towards legal regulation. Obviously, I am sure these discussions will come up in Ireland when people start discussing legal regulation more, but they are definitely questions that need to be asked and there needs to be an answer to that.

I agree with everything. On the question of why Portugal did not also consider regulating cannabis, as was highlighted previously, early or from the beginning, one of the primary reasons was that they were primarily focusing on addressing more problematic use of other types of substances. However, that is also to the point others mentioned that the Portuguese system also needs to be revised continuously. It is in that framework that the discussions have been going on for more than ten years regarding what to do about cannabis and manage the harms of cannabis that are understood to come primarily from it currently being illegal. Therefore, giving the motivation for revising now is exactly that harm reduction piece to manage those factors that were not accounted for 20 years ago.

If we look at the drug policy regime, law enforcement has been put in place where officers have no choice but to arrest. When we have conversations with police officers, many of them actually express frustration about that because they book someone and take him or her to jail, there is a conversation with the prosecutor and the person is out on the street three days later and then they book him or her again. Very often, law enforcement officers will tell us it is a complicated process and they do not necessarily like it and that it is a waste of resources because often, Portuguese law enforcement officers say they are not able to focus on more serious crimes.

It is putting a police officer in a position where he or she can be helpful to a person who may be confused, angry and under the influence of substances rather than arresting them. I have seen a situation in the Netherlands where a very confused person who was coming out of a coffee shop went to a police officer for help because they did not know how to get to their hotel. That is potentially a role law enforcement can play. They actually can be helpful to people. Currently, drug possession and use are criminal offences. The same police officer would have no choice but to arrest the person. There is a reality in which police officers can be helpful and can help someone access services if that person asks for it or can point him or her to his or her hotel, rather than this continuously hostile relationship they have at the moment. There is a very quiet displeasure among some people in law enforcement and they do not want to take on that role but they really have no choice. Law enforcement in its proper role, community organisations and harm reduction and treatment services can function in a way that is supportive to people rather than in a punitive way and a way that takes agency from people to take care of their own health.

That is okay. I wanted to reinforce what Dr. Malinowska-Sempruch was saying, that we have to trust people who use drugs that they will take care of themselves. That is the biggest lesson from harm reduction, that when people have the resources to do so they take care of themselves. We have to make the resources available and accessible. Decriminalisation also helps a lot with that and people will come to us for help. For example, that is why the HIV epidemic among people who inject drugs has gone away because we made the syringes available, we helped people to know how to inject safely and they adhered to it. That is a very important message we have to give.

On another thing Senator Ruane mentioned, I would like to share that a health-based approach can be somehow perverse because if we only focus on the health indicators we will take care of people in that dimension and forget all of the other human rights we have to address. In the end, it silences and neutralises those people in the community. They become people who do not harm others with infectious diseases, for example, and live for longer but many of the people I have interviewed and worked with have told me many times about lives that, in their words, are senseless. We must take that into consideration so I totally agree with a human rights-based approach.

Regarding the introduction of decriminalisation in Portugal but not the regulation of cannabis, now it is easy to talk about it but I remember at that moment I was a young girl of around ten and there was a very hard public discussion and no consensus, so introducing decriminalisation was really a big thing. Now we need to go further.

I want to stay on the issue Dr. Pinto spoke about because we have spoken a lot about cannabis today but I want to return to helping people who are in addiction, or drug users, to take care of themselves. We are currently on the edge of opening our first injection facility in Dublin, which will be the first one in the country. I welcome it and am absolutely delighted about it. However, in future I would like to see it broadened to being a consumption facility that would have an expanded remit. At the moment it is taking quite a constrained approach that is specifically around an injection facility. If any of the witnesses have thoughts on this issue will they speak to the importance of facilitating a broader sense of consumption, particularly in view of the changes in potency to some drugs, the emergence of synthetic opioids and how variable the potency of those can be?

Also, from a gender and diversity point of view, I am from an area that has a high level of drug use and it can often be women with children or who are put into situations where there is threat of sexual violence through their purchase of drugs. We also have a high population of new communities in Ireland so there are those from migrant communities, who we very much welcome. They are also in more precarious positions and do not find it so easy to engage with policing services where they may feel threatened and particularly where drugs are criminalised. Will the witnesses expand on how consumption facilities might support marginalised groups?

I thank the Deputy. Congratulations, it is very exciting and we have been following this for a long time. There are many ways in which safe injection can be facilitated. Ireland is at the beginning so it will take some time to adapt. In many different contexts it is important to ensure the drug consumption room is adapted to needs of local communities. Obviously, drug use patterns change over time and the ways in which people want to use also changes. In terms of women, and any other group as well, safe injection rooms are very often a point where people gather together so they are a point of contact with some of the most marginalised people who use drugs. Very often, they come there to use drugs but also to do laundry, have breakfast or seek people's support. It is very important all of this is being incorporated in the drug consumption room when it is being designed and that there is flexibility so that when people provide feedback on what they need, the services that are available can be adapted to the needs of the people who are coming to the room.

In some contexts, women have specific opening hours where it is women-only and in other contexts, for example in Barcelona in Spain, there are harm reduction services specifically tailored to women and there is a space for women to consume within the harm reduction space. It is not a safe injection room dedicated to just that, it is becoming much more incorporated in the usual harm reduction spaces. That is important in terms of offering flexibility as well because women who are highly stigmatised might not want to go to the drug consumption room but they might go to a harm reduction service they are used to and where they can use safely. That is something to consider, that not everything needs to be incorporated within the drug consumption room. We can also be a bit more flexible about how we can incorporate safe injection or safe drug consumption in the harm reduction services you currently have in the country. That is also important for outreach because there will be one drug consumption room in one place but there are many people who use drugs everywhere so it is something to consider.

I would love to speak English the way you do. I love that question and thank the Deputy for the opportunity to say this. The evidence shows very clearly that harm reduction is a fundamental strategy to deal with drug use in any national strategy. The evidence also shows we should not apply unique strategies, we have to combine them. The benefits from harm reduction are potentialised when several responses are combined. Clearly, a drug consumption room or an injection facility must combine different harm reduction interventions besides that. For example, it is important to help people to get in contact with their families if they ask, to try to help with their social inclusion. It is important to work with people if they are willing to, for instance, in respect of labour inclusion.

Evidence is showing more and more that we should not expect someone coming off drugs to try to start working, even if it is not a full-time position. We have done many experiments in this area that show starting to work is not always the best option. For those who want to do so, however, it reinforces their capacity to manage drug consumption. In my opinion, evaluation is a very powerful tool to mould and shape the interventions. We were talking about the health-based approach, and if we look at all the evidence being produced on drug consumption rules, we can see that health indicators are the most common in the evaluation and sometimes things like public nuisance and crime are also considered. There is usually nothing related to a human rights-based approach. If drug consumption rules are created with an evaluation that has indicators related to the human rights dimension, it would be very important to shape the rule in order to avoid it becoming a very constrained approach.

For the needs evaluation and the design of the drug consumption rules, and for the evaluation of the impact of the drug consumption rules and so on, it is very important to listen to people who use drugs on how the drug consumption rules should be. Diverse groups - women, people with disabilities and so on - should be included in order to hear what they have to say about services specifically designed for them.

I want to finish with a couple of things people who use the drug consumption room in Porto said to me while doing the evaluation. These represent the most common opinions expressed there. One person told me they came to the drug consumption room for the people, not the drugs, and that every time they came, they wanted to stay longer. Another person said they found the family there that they had never had before. This is the kind of service we must provide to people and it is the kind of service that attracts people to us. If we have services like this, we will not need mandatory responses, because those are not effective.

My question is a very quick one arising from the previous round. Dr. Pinto speaks about law enforcement as hostile and I do not deny that there are certain communities here in which law enforcement is hostile, with stop-and-search policies and the risks these entail, that are not ideal. However, there is a chink of light because members of our police force are on drugs task forces and they work very well with youth workers and drug outreach workers, where the atmosphere is not hostile. Rather, it is supportive and the members speak about things like drug-debt intimidation and how we can co-operate to support families and to assist. Does Ireland have something that is not present in other countries and could we make sure we enhance that? We have challenges at present with police resources and numbers of personnel but we need to have a vision for the future of enhancing these good points. Our police force is called An Garda Síochána which means "guardians of the peace", because we have a different model of policing here. They do not carry arms. I wonder if we are missing something by not focusing on what is good in our model and how we could enhance it.

That is a good question. I do a lot of training of police officers so that they can understand concepts like harm reduction, drug use, drug dependence, etc. However, in no circumstances should the police be the first point of contact for people who use drugs. The experience from every single country, all around the world, shows that this does more harm than good. We need to acknowledge that. Of course, I am not saying that the police are all bad but in the context of drug use, it is just not helpful and is actually harmful. We need to acknowledge that and move on. Criminalisation does not work, punishment does not work and the role of the police, quite often, unfortunately, is to enforce punitive measures. We have to move on and acknowledge that the police should not be the first point at which people seek help. They should be able to seek help when they need to from the services that are directed towards them and not from the police.

I need to interject here because that is not what I am referring to at all. There is no question that we need to move to a health model. I am not for one moment suggesting that the police would be the first point of contact, but the fact is that the police in Ireland already engage very constructively. While they enforce the law, they already engage constructively in communities, community policing and youth diversion, working with youth clubs and young people to provide positive role modelling. There are many positives here. It is not as black and white as it appears in some of the narrative that I hear from Ms Nougier. I want to ensure that in this discussion and when we come to write the report, that we do not write off a resource that we already have that could be enhanced and supported.

I will return to my example from the Netherlands. If a person, whoever they are, a bypasser, a sex worker or a person who is under the influence of drugs, makes a choice to engage with a police officer, then the police officer should be competent to engage in a way that is non-punitive. Of course, if someone is overdosing, the police should have naloxone and be able to intervene. In a situation where a person makes a choice to engage with the police, the police should be competent to do so. They should be educated in and know a lot about drug use and its consequences and how to help an individual. I think we want to promote that, of course we do.

I would love to be able to tell my 20-year old daughter in college in Massachusetts that if she is in trouble to go to the police. Unfortunately, if possession is criminalised, that is not what I am going to advise her because if she goes to the police she is in trouble. Instead, I am going to tell her to look for friends or social services. If a person makes that choice, it would be fantastic if the police were responsive in supportive ways. There are ways to do that. Training can ensure that police feel competent to engage with people. If we criminalise possession, we are making that impossible. I appreciate the Senator's experience with police officers and it is fantastic to hear. Maybe one day we could be working with them and helping others understand the positive role they could play. For that, we need to remove criminal sanctions.

This is an important point to think about. Given the fact that many young people are from communities that might not have a positive perception or experience of gardaí, removing the criminal sanction would go a long way to repairing historically fraught relationships. I think it is an important discussion.

I will move on to my questions. As so much was covered already, I do not need to go into too much. I sound a little naive sometimes regarding what is possible but I will continue my life in that vein. Regulation is obviously a massively important step. I get somewhat anxious that people will say we need regulation and, therefore, decriminalisation should not happen. I always want to make sure that the decriminalisation piece happens because that is about the individual. The regulation piece is a question of supply. They should often be seen as separate but, of course, they intersect in various ways. They are related but can maybe be unrelated in how we think about things. In thinking about being from a community, working within communities, and all the work I do within the prison system, drug dealing is often the activity that people are focused on. When we grind down into it, however, it is the violence and intimidation that wreaks the most havoc in the community. It is about how we begin to think about this, if we do not have a regulated market but still want to address the most problematic elephant in the room. Drug dealing has layers but to my mind it is about whether an ethical framework can be created for the selling of drugs in one's community that avoids violence. It is hard for policymakers to think about that because they are then acknowledging there is an illegal activity about which they are trying to have a discussion around how it can be done ethically. Many people will not be able to engage in that conversation.

When I imagine a scenario or think of these ideas, I am speaking more from my community work background, the work I have done with drug dealers in the past, and the research I have done on drug dealers. It seems that violence is causing the most destruction but, in many ways, that cannot be uncoupled from the fact that debt, the black market and so on are created, or from the way these are interconnected. I worked with drug dealers who started drug dealing in the 1970s and 1980s and, forgetting the 2000s for a minute, up to the 1990s. There was very much the feeling that drug dealers, even the local drug dealers who may have been at the top of the rung in that regard, were more likely, when they saw their next-door neighbour struggle out of the local shop with his or bags would take the bags off that person and carry them home. Something has changed whereby there is a trend that even the very presence of certain drug dealers or young men in communities brings around a certain perception or reality of threat.

Is there an issue with violence? If we look at regulation, and it does not happen this year but does in future and is something we are going for, is there something we can do in the interim that is about alternatives to violence in the illicit drug trade in order to reduce deaths? As Senator Seery Kearney said, drug use exists across all communities but it is poor young men who are killing each other for the drug use of more well-off people. How do we make sure we reduce male-on-male violence, even if drug dealing is in the background, in the absence of a regulated market? I do not know whether that is slightly outside the witnesses' policy brief. Are they aware of any work being done, and Dr. Malinowska-Sempruch has travelled a lot on this issue, on the illicit drug trade that is about reducing violence rather than looking at the illicit drug trade itself?

I will answer at least part of that question. I am very much agree with the Vice Chair that decriminalisation needs to be pursued. My advice is that once that is in place, cannabis regulation should be considered - one should not undermine the other - and potentially heroin maintenance, if opioid use is the problem and overdose becomes a problem.

The question of violence is very important. If you talk to colleagues in Mexico who look at Switzerland, they will say that they are not interested in getting rid of drug trafficking. Rather, they want it to happen in the way it happens in Switzerland - that no one dies. The committee needs to think about what the goal is. If there is a clear commitment to getting rid of trafficking, then the activities related to that will create risks of violence. The Government needs to think very clearly about what the primary, secondary and tertiary goals are. If the goal is to reduce violence, then it needs to work with its own law enforcement to understand that is the goal rather than going after petty drug trafficking. All of this is incredibly connected. A lot of studies state that the more expensive the drugs, the less are available. That increases violence because people are able to make a larger amount of money from trafficking that they are willing to kill each other for.

There are multiple ways to think about this. I am not an expert in it but I am thinking of an institution in Newark, New Jersey, which is a city close to where I live. It has a community safety effort where the focus is on reducing violence rather the number of illicit substances that are on the street. That may be an interesting connection for the committee. I will make an additional point. The reason I met and engaged with members of that group is they came to us to ask for naloxone. I was a little surprised that a community safety initiative would engage on public health. The person who runs that initiative, Aqueela Sherrills, works with and helps gangs achieve ceasefires. He said that he did not want people to die in his community, whether because of knives, gun violence or overdose. All of this falls under one goal for him: keeping people alive. It is a very interesting intervention that has both public health and community safety working together. I am happy to put the committee in touch with that initiative because it will be instructive.

Again, there needs to be clarity of messaging to law enforcement, and also to people who sell drugs, that petty sales of cannabis will be overlooked but violence will not be overlooked. Those networks are able to hear if the messaging is clear and the activity from law enforcement is consistent with that. You cannot say it but then go after small sellers at the same time.

I would appreciate the contact. It definitely sounds as if it is down the street where my mind is moving on a number of things.

We have finished our questions. I thank our witnesses Dr. Baptista Leite, Ms Vas, Ms Nougier, Dr. Pinto and Dr. Malinowska-Sempruch for engaging with the committee. Their contributions and answers have given everyone a huge amount to think about and many more questions to ask as we move forward. We appreciate the insight into the knowledge and experience they have domestically and internationally. It is much appreciated. We will adjourn until Tuesday, 9 July.