Joint Committee on Drugs Use debate -
Thursday, 20 Jun 2024

We have received apologies from Deputy Murnane O'Connor and our Chairman, Deputy McNamara, whom we congratulate on his election to the European Parliament.

Parliamentary privilege is considered to apply to the utterances of members participating online in a committee hearing when their participation is from the parliamentary precincts. There can be no assurances in respect of participation online from outside the parliamentary precincts and members should be mindful of this when they are contributing.

I welcome our witnesses. The topic of our meeting is drug use policy, the national drugs strategy and a whole-of-government approach. I welcome the following officials from the Department of Health, assistant secretary, Ms Siobhán McArdle, Mr. Tadhg Fallon, Mr. Brian Dowling and Ms Mary-Jane Trimble; Mr. Ben Ryan, head of policy for criminal justice, Department of Justice; and Dr. Eamon Keenan, national clinical lead in addiction services, Ms Martina Queally, regional executive officer, Dublin south and east, and Mr. Joe Doyle, national lead in the national social inclusion office, Health Service Executive.

I inviite Ms McArdle to make her opening statement.

I thank the committee for the opportunity to provide an update on drugs policy, the implementation of the current national drugs strategy, and to outline the plans for the successor strategy as outlined in the recommendations of the Citizens' Assembly on Drug Use.

The Government’s policy on drug use is set out in the national drugs strategy, Reducing Harm, Supporting Recovery, which covers the period 2017 to 2025. The central tenet of the strategy is that drug use should be dealt with as a public health issue. It advocates for a compassionate response to individuals who use drugs. The programme for Government reiterates the health-led approach to drug use.

The shift to a health-led approach to drug use continues to evolve. Drug use is a dynamic situation to which policy must adapt in a flexible manner. It is for this reason the Department undertook a mid-term review of the national drugs strategy in 2021, which identified six strategic priorities for the remaining period of the strategy. A two-year strategic action plan containing 34 actions is now being implemented, which will run to the end of 2024.

The strategic priorities include: prevention of drug use among children and young people; access to and delivery of drug services in the community; harm reduction responses and integrated care pathways for high-risk drug users; the social determinants and consequences of drugs use; alternatives to coercive sanctions for drug offences; and the performance of the strategy.

Underpinning the strategy is public expenditure of in excess of €250 million across all Departments, based on 2022 figures. The bulk of this funding, at more than €160 million was from the Department of Health for the provision of drug services. The Department has allocated a total additional €13.5 million in 2023 and 2024 to support existing services and to develop new services in the community. Approximately one third of this funding is allocated to community and voluntary organisations.

A key strategic priority is to enhance access to and delivery of drugs services in the community. Demand for and access to services has increased during the period of the current strategy. Most recent data indicates that there was a 33% increase in the number of cases entering treatment for problematic drug use. Another measure to improve access is the Department’s recent publication of interactive map of 442 publicly-funded services across Ireland. The next step is to audit current service provision based on treatment demand and population need, to inform the planning of drug services in the new HSE health regions.

A further action in the strategy is the implementation of the health diversion scheme, whereby people found in the possession of drugs for personal use are diverted from the criminal justice system to a health response. The Departments of Health and Justice have agreed the scheme and are now consulting with key stakeholders, including the Director of Public Prosecutions, prior to a national roll-out. The implementation of the scheme will be subject to a formal review after one year, to allow any necessary changes to meet the aims of the scheme.

Implementation of the national drugs strategy is overseen by the national oversight committee and six strategic implementation groups. These groups comprise a wide range of stakeholders, including Departments, civil society, drugs task forces and independent experts. The Minister of State, Deputy Colm Burke, provides political leadership for the strategy, and the Cabinet committee for social affairs and public services, chaired by the Taoiseach, provides government oversight.

Turning now to the successor national drugs strategy, the Department of Health welcomes the comprehensive report from the Citizens' Assembly on Drugs Use, which further develops the health-led approach to drugs use. We acknowledge that full implementation of the recommendations of the citizens' assembly will require a major step-change in how the State responds to drug use.

The report of the citizens' assembly was the focus of Ireland’s Pledge4Action at the recent meeting of the UN Commission on Narcotic Drugs in March 2024. The pledge commits to carefully consider and respond with urgency to the assembly’s recommendations for reform of the legislative, policy and operational approach to drug use, and to indicate the timeframe for implementing the recommendations which it accepts.

It is proposed to prepare a first draft of the new national drugs strategy in quarter 1 of 2025, informed by an evaluation of the current strategic action plan, the Government response to the recommendations of the citizens' assembly, and the 800 submissions made to the citizens' assembly. This timeframe will also allow consideration of the deliberations of this joint committee.

Finally, I highlight the importance of co-ordinating drugs policy in a multilateral manner. Ireland actively contributes to international bodies on drugs policy, including the British-Irish Council, the European Union and the new drugs agency, and the Council of Europe. Indeed, Ireland will have a leading role in promoting a person-centred and human rights approach in EU drugs policy when we assume the Presidency in the second half of 2026.

I thank members for their attention and I am happy to answer any questions that the committee might have.

I thank the committee for inviting me in. I am head of criminal justice policy in the Department of Justice. The Department of Justice is fully committed to helping to significantly reduce the harms caused to families and communities by illicit drug use. The three main policy objectives we are seeking to achieve in this area are: tackling organised crime; minimising the harms caused to those with addiction issues; and diverting people from involvement in crime and illicit drug-related activity.

These areas are complex and often interlinked. For example, a person with an addiction issue may also be involved in the sale and supply of drugs or have close associations with those involved in organised crime. It is well-established that organised criminal groups will exploit vulnerable people and coerce or groom them into being involved in criminality. It is important to recognise that the actions under way in this area must be viewed holistically. There is no single policy solution that can resolve all the harms caused to society by the use of illicit drugs. The stark reality of drug use in Ireland today means this work is a high priority for our Department.

We have a particular focus on targeting the work of organised crime groups, which inflict intimidation and violence on families and communities while grooming and coercing vulnerable young people into drug-related criminal activity. The Minister for Justice has recently brought forward new laws to allow for the prosecution of those involved in grooming and coercing young people into criminal activity. The Criminal Justice (Engagement of Children in Criminal Activity) Act 2024 makes it an offence for an adult to compel, coerce, direct or deceive a child for the purpose of committing crime, with those found guilty potentially liable to face up to five years in prison, and that is in addition to potentially facing a sentence for the actual crime committed by the young person. There is an additional penalty on top of that, recognising the harm done to children in such circumstances.

A programme is currently operating in two trial sites, colloquially known as the Greentown programme, and the trial sites are known as Whitetown and Yellowtown. This targets young people who have been groomed into criminal gangs already and provides them and their families with supports to help them to move away from criminality. This is an innovative intervention that aims to frustrate the grooming of children into network-related criminal activities - for example, drug dealing or drug-related intimidation - by adults, and provide meaningful and practical routes out for network-involved children. The programme was developed in partnership with the University of Limerick and the research evidence into programmes, policy and practice, REPPP, team down there. It is built on four complementary but distinct programme pillars to respond to the problems presented by criminal networks.

The first pillar is the intensive family programme pillar, and the aim of that pillar is to improve family functioning and parenting and to provide the relevant supports to families who want to see their young people move away from being drawn into criminal activities. The second pillar is around pro-social opportunities, and that is to provide young people with viable options other than selling drugs, largely in communities where there is a limited array of options available to young people compared with people in other areas. The third pillar is the community efficacy pillar, and this seeks to build the resources of the community to withstand the criminal influence of organised criminal networks and gangs operating in their areas. The fourth and final pillar is the network disruption pillar, and that is aimed at targeting members of criminal networks themselves who groom children for crime. As I said, the Greentown programme is operating in two trial sites that are anonymised. The reason for anonymising the trial sites is to protect both the young people participating in the programme and also the various staff members, youth workers, social workers and so on who are involved as well, given the extent of the reach of the criminal gangs in these areas.

The community efficacy pillar also includes running a communications campaign to counter the use and sale of illicit drugs, while the network disruption pillar aims to reduce the influence of drug debts and drug-related intimidation on young people and their families. We also have been working very closely with An Garda Síochána to target serious organised criminal groups who have fled the country and we are working closely with international partners on bringing them to justice and intercepting their operations when drugs are moved into or through this country.

On the second aspect of reducing harm, as we all know, many people with addiction issues live chaotic lives, as a result of which they can come into contact with the criminal justice system. Government policy is to adapt a human rights-led approach to policing and penal policy, and that includes considering how to reduce the unintended harms our policies and procedures across the criminal justice system may have on those with addiction issues or other vulnerabilities. There are four recommendations in the report of the citizens' assembly that relate to this dimension of our work. Recommendations Nos. 11, 13, 19 and 23 are the recommendations in question and I am happy to expand on our response to any of those should the committee wish me to do so.

The third strand of our work is on diversion. A significant area of focus in the work of the Department is trying to divert people, in particular young people, away from involvement in crime and illicit drug-related activity. I have mentioned the Greentown programme but we also fund youth diversion programmes throughout the country. We have expanded the number by adding an additional four youth diversion programmes, with two more on the way this year to ensure there is full geographical coverage for any child anywhere in the country who needs assistance in diverting them away from crime. The funding for youth justice and youth diversion programmes has grown substantially. It has effectively trebled since 2014, and was almost €33 million in last year's Estimates. Recommendations Nos. 13, 14 and 17 from the report of the citizens' assembly relate to this dimension of our work, and again, I am able to expand on our response to them should the committee wish me to do so.

I am happy to address any specific questions the committee may have or go into further details on anything I have mentioned.

I thank the Leas-Chathaoirleach and members for the invitation to meet the committee to discuss drugs policy, the national drugs strategy and a whole-of-government approach. I am joined, as introduced earlier, by my colleagues Dr. Eamon Keenan, national clinical lead, HSE addiction services, and Mr. Joe Doyle, national lead for social inclusion services. I am also supported by Ms Sara Maxwell from the office of the CEO of the HSE.

My opening statement will provide information on the HSE addiction services and the work to progress actions identified in our national drug and alcohol strategy, Reducing Harm, Supporting Recovery, particularly as the actions relate to the recommendations that emerged from the report of the Citizens' Assembly on Drugs Use. The HSE welcomes the publication of that report and its recommendations. Many of its actions are aligned with the ongoing work of the HSE as an organisation.

The HSE addiction and social inclusion services are responsible for the delivery of a wide range of treatment interventions nationally for problematic drug use. The services are rolled out across community health organisations, all of which will be incorporated into the six new health regions. They work in partnership with the community and voluntary sector.

HSE addiction services operate across various care groups and divisions within the HSE. The services operate in accordance with the HSE corporate plan and annual service plan, with priorities informed by and aligned with the aforementioned national strategy document.

To provide a brief overview of the work of HSE addiction services, it may be useful to highlight some of the key areas that align with the recommendations of the Citizens' Assembly on Drugs Use. Opioid substitution-agonist treatment remains a core component of the HSE harm reduction response to opioid dependence. At the end of April 2024, there were 11,385 people on opioid agonist treatment, OAT, 853 of whom were receiving buprenorphine-based products, including the newly approved injectable buprenorphine. There are 85 HSE opioid substitution clinics, 266 level 1 GP services, 89 level 2 GP services and 759 community pharmacies involved in the scheme. Professor Keenan can give more detail on these services, if required.

Addiction treatment is a key focus for the services. Including those individuals on OAT, it is estimated that circa 23,000 people annually receive treatment for drug-related issues. The HSE has significantly increased availability and training with regard to naloxone, a critical harm reduction measure. In 2023, legislation was amended to allow the HSE to become a recognised trainer, with training modules now incorporated into HSeLanD, which is the HSE’s online learning platform for staff. Since January this year, 977 people have completed module 1 training and 179 have completed module 2. In 2023, naloxone was administered on 461 occasions. That equates, according to international research, to approximately 18 lives saved. The HSE continues to work with An Garda Síochána, including on a pilot programme on naloxone which it is hoped will commence later this year.

Cocaine and crack services are now available in each CHO area as a result of funding initiatives in the national service plan 2022 and 2023. These are undergoing evaluation to identify areas of best practice so they can be sustained and scaled. The HSE recognises the importance of medically supervised injecting facilities as a major harm reduction measure. One such facility is expected to open in quarter 4 of this year at Merchants Quay as a pilot programme. Once operational, the service will be overseen by a monitoring committee and be subject to evaluations at six months and 18 months to determine effectiveness. Stakeholder engagement in this initiative is ongoing and critical to success, as is the participation of UISCE, the national advocacy service for people who use drugs in Ireland.

The recently launched safer nightlife programme 2024 will have a presence at four festivals this year, including back-of-house drug checking and volunteer engagement with attendees. This intervention proved very successful and was a fundamental component of the HSE’s response to synthetic opioid overdoses in late 2023. We can provide more details on that, if required. The HSE diversion programme is progressing with involvement from the Department of Health and Department of Justice. The HSE is recruiting nine practitioners nationally to facilitate brief interventions and onward referrals utilising the SAOR model.

Residential services are critical to addiction treatment and four such services are provided through statutory and community or voluntary services. The HSE received additional funding of €1.125 million through the national service plan in 2021 and €900,000 in 2023, and it is currently purchasing more than 1,000 treatment episodes.

The HSE remains committed to the development of a health-led approach to drug use in Ireland. It recognises that many of the recommendations in the report will support this objective and complement treatment and harm reduction initiatives already in place. However, in recent years the European drug market has become increasingly complex, as referenced in earlier presentations. A concrete example of this has been the emergence of synthetic opioids. HSE addiction services face significant challenges in responding effectively and will require ongoing and sustained investment in treatment services. The HSE will continue to engage with all relevant stakeholders, in particular people with lived experience, to ensure a comprehensive health-led approach is adopted across government and society. At the same time, we are conscious that treatment alone will not address all aspects of the problem.

Go raibh maith agat, a Chathaoirligh Gníomhach. I thank the witnesses for coming in and giving their opening statements. I read them with great interest before coming in. I have worked in front-line addiction services across Dublin and outside of Dublin for many years. I have worked in HSE facilities and in community-based services. I have worked in HSE and statutory methadone clinics and in community-based methadone clinics. The difference between them is vast.

My first questions will be for the HSE. My experience of working in a statutory methadone clinic, as we call it colloquially on the ground, though Ms Queally referred to "opioid substitution-agonist treatment", is that the patients gets in, gets the methadone and gets out, without any wraparound services. The community, despite limited resources, tries to take a holistic approach to helping people on a methadone substitution programme.

Over the years, methadone has turned into a maintenance programme just to keep people where they are. From a harm reduction perspective, it has its place but it has turned into a be-all and end-all. It is difficult for a person to take ownership of their life when they run into a bureaucratic system that is there to maintain them on methadone. They have to be on a certain amount of methadone to go on detox, they cannot have certain drugs in their system to go on detox and so on. If you are trying to start in the community, where the problem probably begins, it makes it even more difficult. People I know well describe it as having liquid handcuffs on. They have to be at a certain place at a certain time and if they step out of line or have a bad day at a clinic, which I have seen happen, they are punished. They may be sent into town - Trinity Court or one of those places - rather than treated in their community. This is regular and it is hard to engage with people on a human level when they face that daily. That is their lived experience.

Of the 11,385 people currently on an opioid substitution programme, how many are on a detox programme or want to be on a detox programme? Has that research been done? In the context of the citizens' assembly recommendations, will the HSE consider a move from a primary maintenance programme of methadone to a recovery-based programme?

I will hand over to Dr. Keenan on some of the detail of the question but we would not condone any punitive approach to the delivery of services. As Ms McArdle said, our values and ethos would say we should be compassionate to people. On the Deputy's point about holistic treatment, it is our ambition to provide holistic treatment to people. I will hand over to Dr. Keenan.

The number of people in this country identified as opioid-dependent in our last prevalence figures is just under 20,000. We have about 11,500 of those people on opioid substitution or opioid agonist treatment, which stacks up well against other European countries. We have a good penetration into the cohort of people using opioids.

I do not have an exact figure for the number of people among those 11,385 who are on detoxification. It is important to note methadone treatment is a means of stabilising somebody's lifestyle. People come into the service in a chaotic manner.

They may have been injecting drugs for a period of time. They may have had family or personal difficulties. They may have viral illnesses, such as hepatitis C or HIV. All of those issues need to be addressed and supported for the individual. The addiction services attempt to do all of this. Part of our remit is to test people for viruses and to get them engaged in treatment. One of our big successes recently has been the establishment of treatment services for hepatitis C right across the addiction services. People need to access treatment.

Moving on is not an easy matter for individuals because sometimes the facilities within the overall structures are not there. While someone can be detoxified off methadone or buprenorphine, they may not have a job, an educational opportunity or a family support, the supports that are wrapped around within the community.

That comes to the Deputy's second point in relation to recovery. Recovery is a whole-of-society approach to the issue of substance use, so that people who wish to come off methadone or buprenorphine have the means whereby they can sustain a drug-free lifestyle. It can be very soul destroying for an individual if they are rushed off a methadone programme or they detoxify too early and relapse. Sometimes, it takes them a while to engage in treatment again because they may feel stigmatised or ashamed that they have not been successful. One example I gave was that a number of years ago we had a pharmacy strike. We had to open our services to people who were engaged in community-based pharmacy programmes. We saw that there was a huge number of people getting on with their lives and holding down jobs who were coming in to our clinics that were open later at night on their way home from work. People can stabilise on methadone, get on with their lives and do jobs to support their families. To view methadone as a bad thing is not a-----

I think Dr. Keenan is misinterpreting me. I said that methadone maintenance has a place in harm reduction - it definitely does - but I emphasised the barriers that people face when they want to come off it at that stage in their lives. Sometimes there might only be a small window of opportunity for a person to be a able to decide this is the right time for them to come off methadone. They find the barriers unbelievably hard to get over.

That is where the recovery supports need to be in place for those people. This year, we have identified funding through the budget that will start to really look at recovery in a sustained manner. If we are looking at recovery we have to have peers involved. We have to have people with lived experience involved. That is all a learning process for the services. That will all be moved forward through the recommendations of the citizens' assembly and any new strategies. If people want to come off methadone then those recovery supports need to be in place. It is not necessarily always a bad thing to remain on methadone. A person in that position has stayed alive, and has got access to treatment and care.

I thank the witnesses for their opening statements and contributions. I will start with Mr. Ryan and the perspective from the Department of Justice. Speaking from the perspective of my community, over the past 20 or 30 years the consensus would be that there has been an abject failure and the approach taken by the State has utterly failed our communities. It fails the victims of drug addiction and it also fails their families and wider communities. The prevalence of drugs, their sale, use and abuse in all forms in public spaces, whether in public housing, on public streets and canals, on buses and trains and in schools and playgrounds, means there is no place left in the country where drugs are not available and are not being used in some form or another. That is a damning indictment of where we are as a State. It is totally unacceptable. I accept the initiatives that have been taken recently and the programme with two trial sites. I have looked at that in detail and I think it is a very promising initiative from the point of view of the concept and the thinking behind it. However, is having only two trial sites anywhere near adequate? What is the proposal to increase the scale of this?

We have heard talk of community efficacy and building the resources of the community to withstand criminal influence. Considering how normalised and pervasive this anti-social criminal activity is, what resources will be required to build community capacity to take it on? I think that individually and collectively communities are taking a position - whether consciously or subconsciously - to defend themselves from it. They do not feel they are being backed up. They do not feel that the support is there. That is a really scary place for individuals, families and communities to be in. I would like to hear what can be said to reassure those communities, individuals and families that the State appreciates the enormity of it and is scaling up to address it in a meaningful way.

I will start with the Greentown programme because the Senator referred to that and the adequacy or otherwise of having two trial sites. We have to test the model as it is very innovative. It was developed by us in conjunction with the University of Limerick. It is not based on a specific programme that had happened anywhere else. It has been recognised internationally as being really innovative. However, an innovative programme has to be tested so that is why we have been testing it in two locations. The intention is to be able to adapt it and use it in other locations as well. Learning has been gathered from the operation to date. We have extended it for another three years. The outcome we hope to achieve after this time is to identify where and how it can be adapted for more mainstream use. The intention is to expand beyond the two trial sites to wherever it is needed. This type of intensive programme is not needed everywhere. There are certain parts of the country where it is more necessary because organised criminal gangs are more embedded. The Senator referred to her own area as one such area. There are already a lot of programmes in that area but this something that could be considered for those areas in the future.

Regarding the community efficacy pillar I mentioned and the resources that will be required to build capacity, again in partnership with the REPPP team and the University of Limerick, a local leadership programme has been developed. It has been drawn down by some of our community safety partnerships that we have piloted in three locations, Longford, Waterford and north inner city Dublin with a view to a national roll-out later this year. The three partnerships have worked very effectively. One of the areas identified by the partnerships - Longford was the first to do this - to try to support communities that want to equip themselves better to be able to deal with organised criminality in their areas is to build up the leadership capacity for local residents and activists who are involved in community-based organisations. It ensures they have the skills and capability to be able to interact effectively, either through structures like community-safety partnerships or just generally within their communities. We have heard back from Longford that it has been really beneficial to those involved.

The north inner city Dublin local community safety partnership is also exploring whether it can utilise the local leadership programme. Funding has been made available to Longford to do that and if the north inner city Dublin local community safety partnership expresses an interest and makes an application to draw down the local leadership programme, which has been piloted by the University of Limerick, we would certainly be interested in that.

There are programmes to try to assist communities in these kinds of situations. The Department of Justice also work very closely with the HSE on the drug-related intimidation and violence programme as well to try to combat drug debt intimidation and related actions that go with that. An Garda Síochána is central to the actions on that. In north inner city Dublin, the drug-related intimidation and associated violence, DRIVE, programme is working well and a co-ordinator has been embedded there. It is a very challenging issue to try to combat because people find it difficult to come forward given the level of pressure and intimidation placed on then. There are drug-related intimidation and violence inspectors in every area in An Garda Síochána around the country as well and they are trying to embed themselves into communities so people within communities can approach them confidentially and with confidence to try to tackle the issue of drug-related intimidation. I have covered the specific points but am happy to come back to give more detail if needed.

I thank everyone for being here. The European Drug Report 2024 shows that Ireland's drug death rate is four times the European average and the highest per capita frequency of drug deaths. This is a shocking figure and demonstrates the complete failure of the Government's drugs strategy and how it is working to reduce harm. These figures outline how serious a problem we have in this State at this moment in time. Will the witnesses give an update on nurse-prescribing of opioid substitutes? The numbers have been met but I have supported people who have struggled either because their GP is not a member of the scheme or because they do not want their family doctor to know. Will the Department of Health or HSE representatives answer?

I agree with the Deputy about the tragedy of drug deaths. Everybody here agrees that any death is one death too many. A lot of the focus of our strategy and the work of all of our organisations is around harm reduction, and addressing and understanding the factors that relate to and underline those drug deaths is really important. It informs the Department of Health in an evidence-based way of the kinds of measures we need to put in place. Access to the range of supports including medication is important. Will Dr. Keenan speak about nurse prescribing?

Sure, and to reiterate, every drug-related death is a tragedy. One caveat about the European Drug Report 2024 is that is that not all countries record deaths in the same manner. Some countries use the general mortality registries of deaths so we are not comparing like with like when we look across European countries. Where we get a very robust-----

Yes, Ireland has high levels of drug-related deaths but other countries also have high drug-related death rates if they use similar methods of recording them. If we are to compare European countries, we need to have a systematic approach to recording deaths across all European countries and that would give a better picture of where Ireland sits. Obviously, Ireland's death rate is high and that is why we are looking at issues such as the supervised injection facilities, the roll-out of naloxone and increasing access to treatment. That is a real priority for the HSE. I absolutely acknowledge that but in a European context if we want to compare countries we have to use the same methodology.

The Deputy asked a specific question around nurse prescribing of OAT. I am not so sure that necessarily will be a big answer to the problems. We do not have huge waiting lists for OAT at the minute. The nurses play an extremely important role throughout addiction services in this country and when talking to anybody who has accessed treatment they will always identify the support the nurse has given them. The HSE is working, through the director of nursing and addiction services and with the chief nursing officer at the Department of Health, to enhance the role of nurses within our service. That is a stepwise progression so it is looking at having a career pathway for nurses within the service to become clinical nurse specialists, nurse managers and up to advanced nurse practitioners who would be the people who could prescribe drugs. It is also to look at other drugs nurses can prescribe within the service such as benzodiazepines and alcohol detoxifications before we need to get legislation around opioid substitution treatments. That might be down the line but-----

I thank Dr. Keenan. The national oversight committee has been charged with overseeing the implementation of the drugs strategy. I understand there are strategic implementation groups, SIGs, for each of the six strategic priorities outlined in the opening statement. Where are the minutes for these meetings published?

They are published on the Government website. We have a quarterly update on the achievement against those targets. There are six interest groups or implementation groups with a number of actions for each of those groups. When the national oversight committee meets on a quarterly basis under the chairpersonship of the Minister for State, the updated-----

I thank Ms McArdle. With regard to methadone as was discussed earlier, maybe the Department of Health or the HSE can answer. People who were given methadone died because they had heart conditions. There seems to be a disconnect between the doctor who prescribes methadone and the family doctor. I know of a tragic case where a young man of 21 years of age with a heart condition who had been with a family doctor all his life joined the Army and had to leave on medical grounds due to the issue with his heart. He was prescribed the minimum level of methadone that is given and died after taking his first prescription. When that doctor who prescribed the methadone rang his GP, he asked the GP what substances the young man was using but never asked the question: is this person suitable for methadone? Why is that question not being answered because, according to studies in America, people who have heart conditions should not take methadone? Why is this not being looked into? Is there stigma around people who are in the throes of addiction? Sometimes I think that a lot of these people have had family GPs who would have had that knowledge. Not every person who is put on methadone has no history or supports behind them. That family was devastated. That person died and should not have. That was a recommendation of the coroner's court a number of years ago - I think eight years ago. Has that recommendation been implemented and if not, will it be implemented now?

I cannot speak about the specific case. The decision to prescribe methadone or any other opioid agonist treatment is not taken lightly by any doctor. A full, comprehensive clinical assessment of any patient who gets a prescription of methadone would be carried out. There is one condition that can be associated with high-dose methadone.

It is in our guidelines now that when people are on higher doses of methadone they receive ECGs to check their cardiac status. The cardiac status of any person who commences methadone is rigorously interrogated by any doctor prescribing it at this point. That is given.

Dr. Keenan made the point that is only for high prescriptions of methadone. This person was on the lowest level of methadone that can be prescribed and died after one prescription. That procedure is not fit for purpose. Will the HSE look at it again? At the time, the doctor cited GDPR. When doctors prescribing methadone can ring the patients' doctors to ask what medication they are on, all they have to do is ask one more question, namely whether patients are suitable for methadone or have had heart issues in the past.

I do not have the number of countries we are comparable with, but the Health Research Board, HRB, is effective in getting robust data on suspicious deaths. It links with the coroners on a regular basis. General mortality rates are much lower in this country and we are in a different scenario. It is important the HRB do the work it does in collating that information because it gives us a true picture of the harms drugs can cause. We see poly-substance abuse as being a significant driver of drug-related deaths.

I have a few more questions, especially for the Department of Health and the HSE. We got some figures in the opening statement on spend in comparison with other European countries. How does that benchmark against others? Some of the key actions being taken were mentioned. Are there inhibitors to good practice in the Misuse of Drugs Act and, if so, what are they?

I will take the question and add to Dr. Keenan's commentary on Ireland's drug deaths and our comparator with other European countries. The type of drug also has an impact. While we do not have the same systems for measuring and collating deaths, we look at the causes of deaths and that also informs us in how to invest the types of treatment or investment that will make a difference. Our budget is approximately €160 million, with additional funding having been provided in the past two years. That has been given to provide a range of interventions, including an increase in the number of drug-support services - the addiction services on the ground - and supports for communities, in addition to the new services for naloxone, the training regime for naloxone and the provision of greater supplies of naloxone to meet the causes of some of the harms in the communities.

I will have to come back to the committee on how we compare with other European countries.

There are various harm reduction initiatives. We have very much embraced and are rolling out naloxone provision. Last year, we delivered more than 6,000 doses of naloxone and it was used more than 400 times. We provide that. The supervised injection facility is one of the significant elements of harm reduction. We have been through a long and tortuous process to get it up and running, but we are nearly there. Building has commenced on the supervised injection facility and we expect it to be open by the end of the year. We are addressing many of the issues for significant harm reduction. We got full support from the Departments of Justice and Health on the establishment of all those initiatives.

I also draw the committee's attention to the initiative we are looking at developing with An Garda Síochána. We are looking at doing a pilot training of members of An Garda Síochána in the identification of overdose and the carrying of naloxone to be able to administer it in the street. There is a clear approach by the Departments in supporting the health-led approach. One of the other areas where we could not have done without the support of An Garda Síochána within the confines of the Misuse of Drugs Act is the back-of-house drug testing we are doing at festivals. An Garda Síochána supports that initiative because it sees it as improving the safety of people attending festivals.

Anyone who commences treatment in our service is captured by the complete national drug reporting service that feeds into the HRB. We collect information about the type of substance they use, their family backgrounds and their ethnicity. With ethnicity we can identify marginalised groups or such cohorts. We also collect information through the central treatment list for people on methadone. We are conscious that getting marginalised groups into treatment needs to be prioritised and we are putting in place effective mechanisms to be able to record that. It is important to note that addiction sits within the social inclusion section of the HSE which looks after vulnerable groups. We have regular contact with people who look after migrant health, Traveller health, LGBTI health and domestic violence. We all work together and as much as possible addiction takes all those parameters into account.

In addition, the national oversight committee monitors that kind of information as well as bespoke research on migrant groups or vulnerable groups. In the past year, we have had a significant piece of research on the impact of drugs use on women and access to services. That has helped us to invest through the women's health action fund and put in additional funding to address it and ensure women who are struggling with problematic drug use are able to access services that are more designed to meet their needs, often with their families.

First, the relationship and co-operation between An Garda Síochána and the PSNI is excellent. Both police services regularly cite the level of co-operation they get on all forms of crime. Tackling organised criminal gangs that operate close to or around the Border is a particular focus of the co-operation between the two services. Despite the fact that different laws are in place in the two jurisdictions, the relationship, operational co-operation and sharing of intelligence are key and that goes on daily. I have heard from colleagues in the Northern Ireland Department of Justice that certain PSNI members stationed near the Border have said they ring their counterparts in Dundalk or Monaghan more often than those in Lisburn or wherever. That is the level of co-operation there is and we want to maintain it and continue to build on it.

The second point the Senator made was relevant. If our approaches diverge further, it will present a policing challenge and there is no doubt about that. At the moment, both jurisdictions have similar enough legislation around the use of drugs. If there is a big divergence, the police services will have to take it into account and adopt practices accordingly.

I am late to the meeting so I apologise if I ask questions that have already been. I attended a briefing last year organised by the Minister of State, Deputy Naughton, at which we heard research statistics. It was a fantastic level of data which showed that while drug use happens across all sectors of society, its effect and devastating impact is felt more particularly in disadvantaged communities. I have the privilege of working with a drug and alcohol task force and seeing first hand the incredible work done by a very small group of people on the ground in delivering recovery, interventions and supports to families through family programmes and outreach workers. I am always in awe of what I hear at the monthly meetings and the sheer work and incredible dedication of people.

The more disadvantaged the community, the more its people are under pressure. They are suffering in the main from poverty. Children need extra interventions. They are the ones who are most deprived of assessments of needs. Access to supports for their children is a steeply uphill battle. In fact, they are climbing a cliff in that regard. When I read the opening statements and look at all of this information, I ask where is the interdepartmental group and where is the Department of children in resourcing youth workers? Where is that co-ordinated approach? When I see the recommendations, I see reference to the need for sharpening up and innovation with respect to policy and delivery. I will come shortly to the issue of the funding of the drug task forces and how that is done. This co-ordinated approach needs an all-of-government response. Where is the Department of Social Protection? Where is the Department of children? Where is this interdepartmental group that co-ordinates? Everybody needs to be fully resourced because we need to tackle these issues, particularly in disadvantaged communities.

Women who may be on maintenance programmes and doing very well can be targeted in their community. I heard a report recently from a specific crack cocaine outreach programme that suggested that within three weeks, women can go from having a lovely home to seeing everything gone and their children left devastated. The situation is that urgent. It is harrowing to listen to the report. The idea that we would talk about pilots or something in the future while people are suffering here and now is appalling, to be perfectly honest.

The funding of drugs task forces seems to me to be the unbelievable Cinderella of the Department of Health. They do not have a voice at the table as far as I can see. They went for an awfully long time without any increase to their funding. They are an inconvenience. I am not saying that about the task force with which I am involved because they do not feel that at all but I know from going to meetings and sitting with the chairs' network that they are totally voiceless. Given how urgent their work is, they should be properly resourced. The idea of giving them programme funding that lasts for a year or nine months for a specific piece of work when the funding should be for a multiannual piece of work shows a complete disconnect between the experience on the ground and in some ivory tower where funding decisions are made. There is a complete disconnect there.

I should stop speaking and leave it to the witnesses to say something. I want to know where we are in changing a cultural attitude. A person with a drug addiction is a mother and daughter, and was once a child brought home from a hospital, celebrated and dressed up beautifully. The idea that people reach a point in their lives where they are held in contempt by society and branded as drug addicts or whatever else is appalling and heartbreaking for communities. We need an urgent upsurge in getting on with it and not just talking about it. I will stop there.

I will take that question. I agree with the Senator and think that compassion is at the heart of our national drugs strategy. It is about compassion and not punishment. The intention is to reduce the stigma and to ensure that people live the fulfilled lives they deserve and to which they are entitled.

One of the big strategic priorities in the national drugs strategy and in our strategic action plan is to address the social determinants of health and those communities that are experiencing the consequences of drug use. That is about supporting the drugs and alcohol task forces and community-based services. As I said in my opening statement, one third of the funding that goes to our drugs services nationally is directed towards our community services. Many of those funds go through the 24 drugs and alcohol task forces and they support approximately 280 separate initiatives. In addition, those organisations are also in receipt of funding from the HSE. The Senator pointed to something that has changed in recent years, which has been the move towards the provision of recurring funding. We have heard the issues in respect of once-off funding or pilot projects that can leave people with a lack of certainty. It is hard to recruit people to continue to work in those sorts of services. There has been an increase in recurring funding or in the proportion of funding that is now given on a recurring basis. That gives greater certainty to the communities and to the people who work in those services. It creates a better connection between those who work in the services and those who receive those services so they build trust in each other.

The Senator asked about a cross-governmental approach and what we are doing in that regard. The national oversight committee for the national drugs strategy has a cross-governmental lens. Our colleagues from the Departments of Education and Justice and other Government Departments are involved. They are specifically involved in actions relating to the management of drugs services and looking at prevention. The Department of Education is working with our colleagues in the Department of Justice on harm reduction measures and addressing those coercive pieces. As my colleague, Mr. Ryan, said, there is a requirement and recognition that communities themselves, independent of the drugs element, need to be supported. We have local area boards, which are cross-governmental boards under the governance of the Department of the Taoiseach and the Cabinet committee on social affairs and public services, to hold that lens. They work on the community safety partnerships. They are forming part of the learning about how government at local level and organisations such as sports partnerships, health services or the Garda, which are funded and provide support, can work with local communities to address these kinds of issues and make communities strong and vibrant, and places in which people are proud to live. We also want them to be able to address any of the issues that arise and make these areas more disadvantaged.

I will come in to give the HSE perspective. We fund the community and voluntary sector and many of our services are delivered through that sector. I agree that it is critically important because they are close to and part of the communities they serve. The drug task forces are also important to mobilising support for the strategy. I completely agree.

There is a particular project that Dr. Keenan may wish to talk about in respect of the crack cocaine issue the Senator mentioned. It is, of course, devastating.

I acknowledge Ms McArdle's point about multiannual and sustained funding. That is really important. We are nurturing these programmes and want them to strengthen, which means they need to be sustained. That effort needs to be sustained. A community connector project under the health and well-being division is working closely with local authorities and playing an important role in community connection and building the community and voluntary sector.

Does Dr. Keenan wish to say something about the women's programme?

We run some crack cocaine-specific women’s programmes in Tallaght that look to address the issues the Senator mentioned. There was a recognition that many women were running into difficulties with crack cocaine and that they needed support. Through funding provided by the Department, we have introduced initiatives in Tallaght and the south inner city specifically focused on crack cocaine and supporting people in respect of that horrendous drug.

It is important to note that, year on year, we have been increasing the number of people able to access treatment for cocaine. We expect treatment figures to be released again next week. It will be interesting to see whether the impact of the funding we have received for cocaine treatment over the past two years will be reflected in those.

I will pick up on Ms McArdle’s point about the co-ordination of approaches at local level. She mentioned what was happening in the Department of the Taoiseach to try to pull together all of the various strands. We have community safety partnerships and the Department of children has children and young people’s services committees, CYPSCs. There are the Sláintecare healthy communities and a range of other strands. The Department of the Taoiseach is trying to pull them all together and target areas of particular disadvantage where considerable money has already been invested but we have not yet seen the type of change we want. The Senator is familiar with the Cherry Orchard implementation board and was instrumental in the work leading up to it. That is an example of the 12 areas we are trying to identify where a more targeted approach is needed. The Senator is familiar with that model.

Having listened to the contributions, we could spend several meetings going through the flaws in the system and the challenges we believe exist. The establishment of this dedicated committee is a once-in-a-generation opportunity for us to get to grips with making this better. There are many flaws in the system and I accept that the witnesses know that, too. We can try to try to improve them through this process. I accept the witnesses’ bona fides in appearing before us. They want to improve the system.

The main societal challenge in this regard is that people are not in full agreement about how to improve matters. There are many who want to make changes because they know the system is not working but who are terrified of making matters worse. Many are taking that approach to this discussion, including the citizens’ assembly.

I wish to discuss the citizens’ assembly, whose report has been laid before us for debate. Given the national drugs strategy and the assembly’s recommendations, where does the Department of Justice stand on the development of policy and what is the way forward for us in terms of making recommendations, the Government adopting them and so on? What is the pathway as opposed to the position?

We are working closely with the Department of Health on the pathway forward. It is the policy lead on drugs. We have been progressing the health diversion programme. Actually, it is called the “health diversion scheme”. It changed title recently and I still have not caught up with it. The scheme tries to provide people caught in possession of drugs additional opportunities to avoid going into the criminal justice system. We already have the adult caution scheme for-----

Yes. We are introducing another opportunity for people to engage with health services instead of ending up going down the criminal justice route. People going to prison for short sentences is not rehabilitative and does them no good, so our focus is on doing anything we can to keep people out of prison for minor offences.

That was the last time the Oireachtas took a position on the matter, so the Department is taking its lead from that with the health diversion system. The citizens’ assembly appeared to go further than that. Mr. Reid made clear the assembly’s view when he was before us. It is an advisory body and its opinion is not law, so I accept the Department cannot take a lead from it, but does Mr. Ryan accept that there will be a hiatus between us making recommendations – I am not assuming what our recommendations will be – and the strategy that the Department is currently implementing? Is the Department building into the strategy future changes and the types of initiative that the citizens’ assembly considered or is it sticking to the 2017 point until we make a different decision?

No, we are conscious of what the citizens’ assembly recommended, although it is not yet Government policy. The health diversion scheme goes in the exact same direction as the assembly’s recommendation, although it does not go as far. As Ms McArdle mentioned, we will evaluate the scheme after 12 months. This committee will deliberate and produce its report and recommendations, which will be considered by the Government. In the meantime, we will have been working on and evaluating the scheme and we will know its impact. If it is working well, there will be evidence for us to say, “Let us expand it”.

Much of this will lie with the Department of Justice, given the way we have criminalised addiction and so on. One of the challenges is trying to operationalise the citizens’ assembly’s recommendations, assuming that is what we decide to do. How can the Department assist us? Perhaps it would be as micro as assisting us in drafting the wording of policies around the Misuse of Drugs Act and so on. I would like us to work with the Department during this process rather than it be a case of us presenting bullet points that then sit in a Minister’s office before being developed. How can we work together on whatever strategy we choose to ensure that the legal proposals we make are robust and stand up?

We would be happy to engage further with the committee at any point in its deliberations. We will be involved with the Department of Health because this is its legislation. We will be involved in the operational agencies as well, for example, the HSE, An Garda Síochána and, if there is an impact on it, the DPP.

I might make a recommendation after the meeting, but as we go through this process, perhaps a liaison to the committee from each Department would be useful for private sessions when we could have additional discussions on drafting and so forth.

Much of this revolves around the legal and policy approaches, but a great deal relies on what Senator Seery Kearney discussed. Addiction often has to do with poverty, disadvantage, the medication of trauma and so on and becomes concentrated in certain areas. Like those in addiction, people who are not involved end up experiencing the negative impacts as well. Mr. Ryan and I worked hard on the implementation board for Ballymun. In essence, that was a political choice because we lobbied and pushed hard. Some areas were included while other areas were not, but I accept that that is our system. Cherry Orchard was included for a reason, as were other areas. We need to look at a data-driven system. Let us take the top 100 most disadvantaged EDs in the whole country and not leave it up to politicians to lobby good, bad or whatever. When somewhere falls below a certain level of disadvantage, then X happens and a whole range of packages are triggered. These would involve the respective local authority, Tusla, the HSE, etc. It would almost be like having a crack team going into an area until we improved outcomes there. For 30 or 40 years, we have had partnerships, implementation boards and inner city task forces. The policy approach has been far too fragmented, but it is right to say that this is a multidepartmental issue. This is my suggestion and is something that I will push throughout the process because I have seen how difficult it is to establish an implementation board for just one area.

The community safety partnerships are what we have. They have been passed and are important because we will have to use them. However, all of the previous interventions that I have seen fail - I am referring to area-based partnerships, which are in many ways the same as what we are discussing now - did so because two particular agencies were absent from them, those being, the HSE and Tusla.

I have to call that out. Consistently, over time, senior officials come to the first few meetings, then a different official comes, and then they stop coming altogether. I am talking about decades here and I am not naming anybody.

The HSE has to be involved in these area based structures because you are spending billions of euro and sometimes that voice is not at the table. Joint policing committees are a good example as well. I say that as advice rather than criticism. When the CSPs are up and running, the HSE and Tusla cannot drift away from them. I thank the Chair.

I might start with the Department of Health. These are relatively quick fire questions. One of the recommendations from the citizens' assembly was around stakeholder engagement with the work the Department does. Could the officials outline what engagement they envisage and what engagement they currently undertake?

Part of the work we will be doing in 2024 is an evaluation of our current national drugs strategy, taking on board the learning from our EU partners. It is that piece around looking at how we are doing against what we said we would do and looking at how we are doing against the European model using European data where available.

That is very useful but it was not quite my question. My question was not about what our policy is and how it fares against EU trends, norms or changes, it was on whether an active piece of work was being done in the Department to keep tabs on and to analyse data on what is happening across Europe, in and of itself and not in relation to ourselves.

We are very heavily involved in the Horizontal Working Proup on Drugs, which is a European group. We are also involved in the Pompidou Group, which is a cross-European group. Part of our involvement in that is to be both a participant sharing information from the Irish context but also hearing the information from other countries and jurisdictions and taking that learning back to-----

We are involved in a number of ongoing EU projects. The Health Research Board, HRB, is a key player in the web survey of drug use across Europe. Ireland is a key member of the European Syringe Collection and Analysis Project, ESCAPE, which is looking at syringe analysis across eight different European states. We are involved in the waste water analysis, the SCORE project, which looks at predictors and prevalence of drug use across 20 European countries. We very clearly see the benefit of linking with European colleagues in relation to ongoing research. In fact in the last European drug survey, Ireland had the second highest number of respondents for people who use drugs in the night-time economy of any European country behind Hungary. A key element of our work is that cross-European research.

That is fascinating. I might move to the HSE and its safer nightlife programme, the social inclusion aspect and how it was dealt with by the citizens' assembly. There was a suggestion the HSE needs more funding and expansion. Could someone put some bones on that? What exactly does it need for that to work better?

That was a gas chromatography-mass spectrometry, GC-MS, machine which is able to analyse these new drugs. The benefit of that was shown last Friday when we got a tablet from Limerick, which had a synthetic opioid in it, and we were able to analyse that and put an alert out on Friday night. That was really important.

It is a bit scary and a big part of our work now is to look at that. We do need additional resources in terms of us being able to keep a close eye on what is emerging because it happens it so quickly and we need staff on the ground. We have proposals in with the Department to expand the emerging trends analysis work that we do and we would be delighted with any support we get.

I know I am over time but I have just one quick question, or maybe two. A witness talked about children being coerced into the drug trade, which is I suppose more accurate than drug taking, and these are young children. What is the youngest Mr. Ryan is aware of in that cohort of children who are being asked to do look-out duties or whatever it might be?

On the issue of referrals or the health-led scheme, one person who is a recovered addict said to me a couple of years ago, and it really stuck with me, that they were worried about any change in policy because they see the criminal system as the gateway to service provision. As in, you get your health services when you get a conviction. That really shocked and surprised me. While I very much welcome a health-led approach, it does strike me that perhaps funnelling people through a health-led scheme means that those people who are in active addiction might not get places.

When people are directed towards a health-led scheme, which is a good thing, is there a framework of discretion so it can be ensured that the few places we have, and we know we are tight on funding and resources in the health-led sector, are taken up by people in active crisis or active addiction and not by people who are attempting to escape a conviction?

I do take the point. In relation to the programmes that they are going to have access to, Dr. Keenan or Ms Queally might be able to talk about that a bit better, but there are different programmes for different levels. Obviously for people in active addiction, it is very different from people who are more casually using drugs. They are directed towards whatever the appropriate-----

I thank the Chair. I appreciate the witnesses attendance here. I want to ask a few questions of the HSE but before I do, I want to put a comment on the record to add further to our previous meeting when were talking about the number of vulnerable people in addiction who are being criminalised for possession. Somebody sent me a note to outline that young professionals are also being charged with possession and are being criminalised. Their names are appearing in newspapers, which is having a significant affect on their professional career prospects and to their relationships. I wanted to note that.

I will talk to the HSE for a few minutes about a number of the initiatives outlined, one of which was the naloxone one. It was stated that 977 people have completed the module 1 training, while 179 have completed module 2. Who are those people? Where are they based? In terms of the pilot programme with gardaí, why are we waiting for this? This is common in other security services across the EU.

The people who are engaged are service providers. We are actively targeting homeless service providers, so people who are working in private emergency accommodation, PEA, in hostels and in front-line services are accessing that. One thing we are doing in relation to naloxone is that we are training peers around how to identify an overdose. At this stage, we have 128 peers right across the country trained in the circle programme. These are the people who will come across overdoses and see people, so that is a big initiative. It is called the circle programme. Peers, front-line service providers and people working in hostels as well as family members can be trained in provision of naloxone. If somebody gets naloxone home and they overdose, they are not going to necessarily give it to themselves. Their family members need to be trained.

I cannot speak for the Garda Síochána but I do know we have had engagement with it and it is supportive of the idea of developing these two pilots. It is looking at two Dublin metropolitan areas where gardaí would be trained. We are ready to give the training to An Garda Síochána and I have met with the chief medical officer in An Garda Síochána to whom I have offered my support on an ongoing basis. We have invited An Garda Síochána to join our quality assurance group, which oversees naloxone, so I am hopeful that we are going to be able to provide naloxone. The gardaí will be carrying the nasal spray as opposed to the injectable, so there will be no needles involved.

I refer to the medically supervised injecting facilities. We talk about Merchant's Quay, and this has been spoken about for a number of years. Dr. Keenan has stated he wants to do a six-month evaluation and a final evaluation at 18 months. Again, these are being used across other countries. What are we going to evaluate in Ireland that has not been evaluated elsewhere? Why are we waiting so long to get this project off the ground and to try to have further ones around the country?

We are waiting so long because we have been through a planning process involving An Bord Pleanála and a judicial review. We are at the end of that. Over the course of that five years, the cost of construction increased and we had to get additional funding. Regarding the supervised injecting facility, we are very clear that evaluations across Europe and North America have identified that there has been a reduction in drug-related litter, there has been an increase in access to services and there has been a reduction in overdoses. We clearly see these as having an evidence base.

We have been granted planning permission for 18 months from the opening of the facility. We plan an evaluation at six months so we can put the results of that evaluation into the planning process in order that it can continue at the end of 18 months. We do not want to have 18 months for it then to stop. However, we are going to need something to persuade Dublin City Council and the planning board to continue with it. That is why the evaluation at six months will feed into that. We also have committed, along with the Children's Ombudsman, to do an evaluation of the impact it would have on children in the local school.

I thank Dr. Keenan.

I will go on to the safe nightlife programme. A presence at festivals was talked about. I know the Department of Justice has been involved in terms of the gardaí and that is helpful. What is the HSE doing on the ground in terms of trying to educate kids that are coming in, having popped pills at festivals and so on? Hopefully they get fixed up quickly but they may get sick or have a bad experience and that might be the best thing under supervision. Hopefully, it will put them off. However, is there a danger that by having this apparent at festivals, we are giving credence to informal drug use at music festivals as something that is a part of life?

This is a pragmatic approach. The reality is that people at some of these events do use drugs, whether we like to admit to it or not. As well as the back-of-house testing at these festivals, we will have volunteers who are out and about going around the campsites and talking to attendees. That, in conjunction with us being able to identify harmful substances and put out communications, is getting the message across. We are working with the festival promoters and the people attending these events will be given information, prior to attending the event, around harm reduction and the risks associated with drugs, so that everybody there will be able to get access to that information. Festival promoters and safety promoters have bought into this. We will have volunteers onsite who will be able to talk to attendees about the harms and risks and if they are having any difficulties. We have pragmatic advice such as saying do not go away into a corner and use alone. Tell your friends if you do use drugs and tell the medics if you have taken drugs. This is the practical advice that we are giving in this programme as well as sort of a headline thing where we are testing the drugs.

It is a very positive initiative. It will be well-supported. The emergence of synthetic opioids was mentioned. What trends is Dr. Keenan seeing? The likes of MDMA was mentioned. Crystal meth is on the way, and fentanyl is definitely on the way. I know we are not seeing them but they are all coming.

Does Dr. Keenan have any awareness of these drugs being manufactured in Ireland as opposed to being imported? In terms of the greater addiction these drugs cause, what further pressure is this putting on the system in terms of people being able to get off drugs, get maintenance and to get into recovery?

Synthetic opioids is a trend that we are seeing across Europe. From a geopolitical point of view, you have to be aware that since the Taliban banned the production of opium in Afghanistan, there has been a 95% reduction in heroin production from Afghanistan and that is what feeds Europe. What is happening now is that the stocks of heroin are reducing and we are seeing increased number of synthetic opioids being produced. These are being generally produced in the Far East, in China, and are coming into Europe. I am not aware of any production in Ireland of synthetic opioids.

A trend we are seeing across Europe is the increasing potency of drugs. MDMA tablets are getting stronger. Cocaine potency is increasing, but I suppose our big worry at the minute is the synthetic opioids because we have had now four incidents that the committee is aware of, where synthetic opioids have been a problem. We had the overdose cluster in Dublin in November and in Cork in December. We had a small cluster of overdoses associated with nitazenes in prisons in March. This weekend, and I am dealing with it now, we had yellow tablets being sold as counterfeit benzodiazepines. We have identified that they contained nitazene drugs.

We have had a number of cases where we are looking at the analysis around that. We have had a number of overdoses. That is not just in one area; it is around the country. That trend is a big worry and concern at the moment.

Yes, since 1977. I accept and acknowledge that in recent years there has been a policy shift in the HSE and the Department of Health as regards this issue, and I think there has been a public shift, which is more important, that criminalising or marginalising people for drug use has been an abject failure. I do accept, as I said, this health-led approach of harm reduction, but my criticism of that is that it is largely lip service. If we do not talk about the elephant in the room, we could be in this position in the coming decades as to why people take drugs and trying to police our way out of it. Trying to police our way out of the proliferation of drugs is absolutely impossible. In those terms, we have to look at different approaches, and that is what this committee has been trying to do. I would argue that you have to look at the Misuse of Drugs Act, forms of regulation, forms of legalisation and decriminalisation of the person. With all that, probably a good example of what lip service accumulates is the adult caution scheme around cannabis. I ask the witnesses to correct me if I am wrong. It was introduced in late 2021. Cannabis was part of the adult caution scheme. Is that correct?

The figures are startling. Since 2021, 5,000 people have been issued with a caution for simple possession of cannabis, but in the same period, for simple possession, the figure for charges or summonses is 17,500. It is extraordinary, and that is why I am hugely critical of the lip service paid to harm reduction and so forth.

Getting back to the nub of this issue, we are talking about controlled drugs - heroin, crack cocaine and cannabis. These are all controlled drugs, but can somebody tell me who actually controls them? I know who controls them. It is not the HSE or the Department of Health and it is not the State; it is criminal gangs. As long as these drugs are controlled by criminal gangs, we will have a problem because there is no regulation and these people do not care. They just profiteer from misery in some cases. As long as that exists, we will have the same conversations constantly. There has to be a paradigm shift as to who actually controls these drugs. There will always be a demand for drugs, regardless of whether we agree with it. These are controlled drugs. Who actually controls these drugs? Can somebody answer that question?

It is a difficult question to answer. Obviously, the people who manufacture and distribute illegal drugs are criminal gangs, and it is an illegal activity. If the Deputy is talking about drugs such as heroin and cocaine, as Dr. Keenan has said, most of the heroin production in the world comes from Afghanistan when the Taliban was facilitating it and then after it stepped down. If the suggestion is that the State take over the production of drugs in some form of legalisation, we would have to engage with the countries and entities that are in regions where those drugs can be produced. These are plants, essentially, that do not grow everywhere. As regards opium production and coca leaves, we would have to engage with the Taliban and narcoterrorists in Colombia, so it is not as simple as saying the State should just take over production. That is just not practical, if that is the suggestion.

My point is that if we continue the policy of criminalisation, of no control whatsoever and no regulation, we will continuously have this debate. I would argue that a better approach - and I think the majority of people would agree - would be decriminalisation of the drug user. I think that is a shift in public opinion but I think we need to go even beyond that and look at elements of legalisation and regulation. If we do not have that, what will happen and is happening is that criminal gangs will control the drug market. As long as that happens, we will have the complex issue of our prisons being three quarters full of people who are in the drug industry. We will constantly have these issues that we are trying to resolve and address unless we talk about the elephant in the room. If we do not talk about that, we will be back here in the next ten years talking about the exact same thing.

The state of Oregon is moving in the opposite direction. Canada is considering moving back as well. There are steps being taken by some where they have seen unintended consequences. For example, as regards cannabis production and the Mexican cartels, what the Garda has been hearing from its contacts in the Drug Enforcement Administration in the US is that the cartels are still producing large volumes of it. The people who can afford to go to licensed premises to purchase cannabis are people who are more affluent. The drugs gangs are still targeting people in American inner cities and still supplying them, so they are still involved in-----

There is a black market still for alcohol and tobacco, even though they are regulated and legal. There will always be a black market for these drugs, but as long as the State completely shuns its responsibility around regulation, we will have this conversation in ten years' time and people will die. It is as simple as that. This is the question we have to ask ourselves.

Thank you, Deputy. There is lots in that. I will ask a few questions as well. We do have clinical-grade drugs that hospitals use that do not require engagement with the Taliban, when we look at how all medicines are made, so there may be some questions as to whether that is an accurate representation. There are things like heroin-assisted treatment programmes in other countries, and I am sure they are not engaging with the Taliban on clinical-grade heroin.

I am sure I can be corrected on that but my instinct would tell me that is not the case. There is something I am not understanding that is an undercurrent, which is the resistance to answer Deputy Kenny's very first question about the drugs Act having criminalised people who use drugs and people who experience addiction. Can I put that question back? It is a very simple question. Perhaps the witnesses from each Department and the HSE could answer that. Forgetting prohibition and legalisation, has section 3 of the drugs Act criminalised people who use drugs and people who experience addiction?

Okay. For that to act as the basis, we must also look at this idea of a health diversion. We need to be very honest that the current model being worked on is not decriminalisation. I wonder if there is an objection from any of the Departments to decriminalisation in the repealing of section 3. Is there a departmental objection to decriminalisation?

On the maintenance or otherwise of section 3, the starting point is effectively what we have heard from An Garda Síochána on the ground. Gardaí utilise section 3 and often, as a result of section 3, they find section 15 offences or they may find other offences as well. By removing section 3 completely from the Statute Book, it would greatly reduce their capacity to identify section 15 offences. That is the kind of underlying operation of it by An Garda Síochána.

It is good to have this on record. As legislators we need to work on the idea of stop and search as a barrier to stopping the criminalising of people who experience addiction because the section that exists within the drugs Act is used for a broader purpose of being able to just stop and search carte blanche. It is using people who are in addiction and people who use drugs as a way to find other crime. From that basis I believe this is wrong in and of itself. Obviously there is the legal question about how we still ensure An Garda Síochána is empowered to pursue any other crime it sees fit, but the proposals for decriminalisation should not be put in the bin because of those other questions.

On the health diversion piece and the two strikes, let us consider the mental health aspect. In many cases there will be dual diagnoses and in many cases a lot of people also look at addiction at certain stages as a mental health issue. There are lots of different models in the way people want to look at things but we do not mandate people into care. Addiction is complex. If there is a threat of one caution, then two cautions, and then the person is going to be criminalised, and that this somehow would increase the health interventions to the point where somebody actually leaves addiction, it is disingenuous to see that as a health diversion. Every person should be offered it as an option but they should not be criminalised to access a health support. Obviously someone should be offered a health diversion if stopped and searched, but there is the issue of them being criminalised. We would have a lot of people in our communities who would not now be dead or who would not now be in addiction if the threat of a criminal sanction was the thing that stopped them being an addict, but it is not that simple. Will the representatives from the Department of Health and the HSE speak a little to the evidence for criminalising a person in addiction if they are caught in possession of drugs for their own use? What is the medical evidence and what is the medical rationale for keeping a criminal sanction on the Statute Book that criminalises the person? What is the actual health outcome for that person?

A working group was set up as part of the national drugs strategy to look at the alternative approaches to personal possession. There were policy debates and research was commissioned by the working group. There was also public consultation and, after that, three policy options were recommended to the Government. The Government decided to move forward with the health diversion scheme. In that respect it is a health-led approach that leads to the health diversion scheme. With the arrest it is an opportunity for members of An Garda Síochána to divert that person-----

Yes, but in respect of the actual arrest piece and arresting somebody, will the witnesses tell me what is the evidence and the health rationale? Can the Department of Health say what is the health benefit of arresting someone for possession of drugs for personal use, whether it is the first time or the 12th time, and if they are in addiction, what is the evidence to support this as a good rationale from a health perspective?

The health benefit is that while the referral is made, it is not mandatory for the person to turn up to that referral, and this speaks to a point made by the Leas-Chathaoirleach a moment ago. The person will be connected with the health services and then possibly on to other services for dual diagnosis, homelessness, and other challenges that person might be facing. It is, however, not mandatory that they engage in that respect.

I will have to revert on the evidence base. There is a working group report and a Government decision on that and we will implement-----

I am talking more about the Department of Health. I would imagine the Department of Health would be first for help and that it would see that arrest under the criminal justice system is not a health response, even if a health diversion has been offered once or twice, because addiction obviously is complex. From a health-led perspective, how is criminal justice, even factored into a health Department response, an evidence-based health initiative?

I will keep my questions for the Department Justice. I have zero interest in criminalising people for simple possession who are in addiction. I do have an interest in tackling those in organised crime who are making vast amounts of money from other people's misery. Young people, especially in disadvantaged areas in my area, are attracted by the lifestyle, the flash runners, the fancy cars and the few bob in their pocket. They see it as a way of escaping poverty. CAB was set up to tackle high-level organised crime and take the assets. It is a really welcome tool of the State. There are a cohort of drug dealers whose lifestyles do not match their means. You just need to go onto social media to see this. They are eating out in fancy restaurants. They are constantly going to football matches. They are probably over at the Euros at the moment. They do not have the assets but they have the lifestyle that does not match the means. When the representatives from the citizens' assembly were in here, they mentioned a community, local level type criminal assets bureau as a recommendation. We did not get a chance to tease it out. Has the Department given any consideration to a kind of local CAB? Would that be able to tackle lifestyles as well as assets? This is something that needs to be tackled. I use the GAA analogy when they are trying to attract more young girls into sports: if you cannot see it, you cannot be it. In this case, however, if young people cannot see it, they may not want to be it.

Absolutely. It has been given consideration and, as a result of that, a network of asset profilers exists within An Garda Síochána around the State. People have been specifically trained by CAB to identify that kind of mid-tier range of drug dealers, to look at assets they have, and target them and go after them. As part of that, the threshold levels at which CAB can seize goods or cash has reduced to €5,000 and €1,000 to go after that kind of range. CAB has had a lot of success as a result of those reduced thresholds where they can go after people who do not yet have the mansion with the reinforced windows or whatever but are the mid-level people who have BMWs and-----

What about a form of lifestyle - being able to go across the water to any soccer match they want or eat in any restaurant they want? They are probably not working or if they are working, they are not in a job where their means match their lifestyle. Does the Department of Justice or An Garda Síochána have the ability to go after these people and ask them how they are funding that lifestyle?

It all builds a picture though and it gives An Garda Síochána the evidence to allow it to go after somebody. It is able to build a profile, make its case and decide these are the proceeds of crime and this person cannot finance that kind of lifestyle. All this is of evidential value when An Garda Síochána goes in to make the application to freeze assets and cash

Mr. Ryan stated earlier that the community safety partnerships had had excellent results. Could he send us some documentation outlining how the Department concluded that an excellent outcome has been reached on the part of community safety partnerships, particularly in the north inner city, because what I and others described certainly does not sound like excellence and does not appear to be excellence to the community? I want to understand how this excellence is being measured.

Regarding section 3, there are two sides to this argument. On the one side, An Garda Síochána needs section 3 to be able to intervene in the first instance and this ideally leads to a referral to health support and intervention. The other side is that it immediately introduces a criminalisation element and everything that goes with that for an individual. Has the Department done any work with An Garda Síochána in examining and assessing the impact of doing away with that section 3 power and taking away criminalisation at that point? If simple possession was no longer a criminalising event, how would An Garda Síochána operate in terms of trying to tackle drugs and drug abuse?

We evaluated community safety partnerships all through the process. The initial baseline evaluation report and the interim valuation report were published and the final evaluation report has either been published or will be published in the next couple of weeks. There are documents out there that evaluate the programme and I can send the committee specific examples of any of the partnerships and some of the activities they have done.

Regarding doing away with section 3, Mr. Fallon referred to the work of the group led by Mr. Justice Sheehan that looked at different approaches to drug use. As part of that process, we examined jurisdictions that have done it and looked at how they could apply in an Irish context. There are deliberations in that report about the pros and cons of that. We can furnish the committee with a copy of that if that is useful.

Access to drug services is not just through the route of being referred by An Garda Síochána. We have open access self-referral and there are many channels through which people access services be it through going online on drugs.ie, access through the HSE website or through engagement with healthcare professionals or even family and loved ones. The publication of that map of services is targeted so people can find it on their phones. It could be a family member who is worried about somebody in his or her family with problematic drug or alcohol use. It could be his or her GP or somebody within the health service. I want to make sure people understand that there is not just one channel. In fact, that would be a very minor channel of access and we would encourage anybody who is concerned about problematic drug use to avail of those resources because they are available across the community.

Last week, the citizens' assembly appeared before us. One of the recommendations concerns funding for drug services, recovery services, community services and education. Unless the funding, resources and services are in place, we cannot deliver a new drugs strategy. The sector is chronically underfunded. The Government has failed to support services like drug and alcohol task forces for years. Their funding is shocking for the work they do. They are not given multi-annual funding. If we are serious about a drugs strategy, we must start off with the basics and the basics involve services, funding, community and recovery. This is where we need to put money.

Reference was made earlier to an additional €13.5 million in 2023 and 2024. This is a tiny amount compared to the level of need. How much did the interactive map cost? One third of the money is allocated to community and voluntary groups. Where does the rest go? Why was funding not provided to re-open Keltoi? Was the decision made by the HSE, the Department of Health or the Government?

Expenditure on drugs services is broken down across a number of major categories. HSE addiction service account for about 45%. Services provided by the community and voluntary sector account for about 39% or 40%. GPs and pharmacies represent about 15%. This is based on 2022 data. The Health Research Board, which gathers all this information and does the underlying research, accounted in 2022 for about 1% of that funding. Since 2022, there has been a 12% increase in funding for drugs services. I welcome this committee, particularly the attention of the citizens' assembly, attending to what is a really important topic. There is a significant stigma around accessing services. As Professor Keenan said, we do not see very long waiting lists for many of our drug services. This tells us that we need to increase awareness if there are people out there who are struggling with problematic drug use and do not know where to go. When we see things within our health services like increased waiting lists or higher demands in one part of the country-----

My apologies for interrupting but I wish to correct something. We have figures about people trying to access detox, rehab beds and residential beds. There is a significant shortage there so for it is not correct to say there is none. These are figures I received from the Department or Minister. We need a massive roll-out of beds in that sector. People have to pay a fee to access treatment. In many cases, the fee is €90, €100 or €120. These are vulnerable people. Access should be free. We need more beds. I do not accept the point that there is no backlog.

What I mean is that when we see areas that are under pressure in terms of higher demand, we put the increased funding towards those.

For instance, in the current year we have increased the funding to dual diagnosis services because we know there is an underdelivery of services for people who are coping with both addiction and mental health issues. We now have a model of care, which tells us what "good" will look like and we are now rolling out the provision of those services for both adults and adolescents in different hubs around the country. When the evidence tells us there is an increased demand or a growing need for something, that is how the funding is also being allocated. I welcome the Deputy's proposal around the need increasing.

Ms McArdle has mentioned the national dual diagnosis programme. Keltoi is proposed to be the HSE national dual diagnosis rehabilitation centre. That centre was recommended in the model of care that was launched in May 2023 and it is going to be used to rehabilitate people with serious and significant mental health and substance use disorders. It is going to be a national service and accept referrals from across the country. This is planned as a partnership between HSE social inclusion in CHO 9 or Dublin north city and the dual diagnosis clinical programme for the HSE mental health services. The staff who were employed in Keltoi previously are going to be working in the new dual diagnosis clinical programme. There was a meeting with the Minister of State, Deputy Butler, and the national dual diagnosis clinical programme in the Department where proposals were put forward for a day service or residential service.

I thank the Leas-Chathaoirleach. I want to use my four minutes to talk about potency of drugs. Before I do, I wish to return to the issue of Oregon reversing some of its work on drug decriminalisation. It is important we put on record that when it took that action three years ago it interacted with a thirteenfold increase in drug overdose due to fentanyl, which nobody who engaged in that lawmaking could have envisaged. Also, the legislators themselves said there is an interaction with homelessness. One of the problems for Oregon is it has rampant homelessness and one of the ways it dealt with that was effectively by putting people into the system and without relying on drugs and drug possession to do that it had no way to effectively move people on within communities if they were homeless. I wanted to say that because I have been following the Oregon thing very closely.

One of my interests here is the change in potency. We have talked a little about the change in the type of drugs we are seeing and in synthetic drugs. In the past few decades we have also seen an increase in potency in drugs we are more familiar with, like cannabis, which can be seven to eight times more potent. That is before we start looking at the addition of more psychoactive substances. I think it is called polysubstance use where people are adding bits together. The HSE is doing work on monitoring potency of all sorts of substances, but with a justice-led approach, when the Garda is stopping and searching for standard possession, what is the approach to understanding and documenting the potency of particular substances? What is the communication and interaction between these two groups?

It would be very helpful to have representatives from An Garda Síochána here to talk through that because they are the operational people on the ground. Essentially, if gardaí seize drugs from somebody they will be sent to Forensic Science Ireland. Forensic Science Ireland will analyse the drug and report back. There is good engagement with the HSE, particularly on-----

What Ms McArdle means by that is if there is a new drug the HSE puts it onto the list of controlled substances and it is now something that would be recognised. I am asking how the HSE's current policies are addressing situations where is an existing drug the nature of which is changing out of all recognition.

The policy itself is broad enough. I will give the example of the synthetic opioids. That change around naloxone and broadening the training role of the HSE is an example of how working with colleagues in the HSE and other agencies we use the broader lens of the policy to be able to adapt. The policy itself does not preclude us from being able to respond in a more agile way to that change in drugs at the moment.

Mainly our concern is providing people with the services, giving them access to the services and responding to the needs as they are presenting. As we said at the outset it is a very complex and fast-changing environment. Dr. Keenan might want to come in as some of the initiatives that have been outlined have facilitated that adaptability in addressing what are very changing issues within society.

Throughout the early part of the discussion today, we talked about the upstream factors and having a comprehensive, holistic approach to addressing substance misuse, particularly as it interacts with environments in which there is poverty, poor education and environmental factors. A lot of the contributions this morning discussed the importance of upstream work in prevention. Even at the recovery point, Dr. Keenan made the point that it is important that options are available for people during their recovery in education, employment and support for families. That is where we come at this-----

On the potency issue, it is a factor for the HSE because with higher-potency substances, we get more referrals. If one looks at what is happening for those aged under 25, the substance causing the most referrals is cannabis. Some 40% of our referrals relate to cannabis. That has increased year on year as a result of the increase in potency. It has a knock-on effect for health. We have to respond to that because we are the treatment providers.

On the labs, I wish to mention our national red alert group. For the first time, the labs have sat down with us around the table and we are working collaboratively on responses around nitazenes. The Deputy is right in that previously, analyses of drugs were done on the basis of a prosecution but we need greater emphasis on the analysis of the content of drugs to see the potency and if there are other contaminants. That is what the national red alert group chaired by the HSE does. The laboratories, An Garda Síochána, HSE emergency management, the ambulance service and the emergency departments are sitting around the table looking at these emerging trends. The Deputy is right - these new substances create lots of difficulties and we need to know what they are.

I wish to address a question to Mr. Ryan of the Department of Justice. On the inner city programme which Senator Fitzpatrick discussed, I would be interested to get the information she requested when that is possible. Will Mr. Ryan provide exactly what is happening there? He said there were excellent outcomes. I have some knowledge of community safety partnerships. A former Secretary General of the Department of Justice, Sean Aylward, led out on this in Waterford. I noted Mr. Ryan's comment that the Department will, he hopes, look for a local leadership programme and for people to step forward. That is not very easy to do in terms of community involvement, particularly where drug dealing is rife. There are significant personal safety issues for anybody, particularly a member of the public, in trying to combat any of that. I am not quite sure what that will look like. I will wait to see.

What is the Department's opinion on trying to deal with the issue of drug supply into the country? Others spoke about the difficulty of trying to tackle organised crime. Obviously, supply is interdependent on price. We saw in past years that when the price of drugs rose, it had an effect on consumption. The witnesses will be aware of recent talk of our defence situation and the navy in particular. We have no ability to interdict drugs being landed on the south coast, which we have seen a number of times. What does the Department of Justice think about that in terms of our defence budget? We have not done anything. Three ships have been tied up in Cork Harbour in the past months, unable to go out to sea because of a lack of recruitment and workers. The same is true of An Garda Síochána and its recruitment programme. We hear about the churn of new gardaí passing out and not staying in position because of that. Where is the Department of Justice speaking to Government on this issue?

I wish to also ask about CAB activity. We all remember Fachtna Murphy and Barry Galvin at the time when the CAB was set up and the stellar victories they had against organised crime. It appears the situation has now changed. Organised crime is much more organised now, unfortunately. There are very effective telecommunications and IT systems at play. There is a long-running saga of a crime family overseas who cannot seem to be apprehended or brought to justice for their involvement in drug dealing. I think the Department has an important role to play. In fact, I do not think it, I know it. Obviously, its statute is that as well. Will the witnesses speak to a few of those points?

On drug seizures and large seizures of drugs transiting through the country and through the south coast in particular, I will not comment on anything to do with defence, with respect, or defence budgets. An Garda Síochána has seen significant seizures and successes as recently as, I think, February, when there was a joint operation between An Garda Síochána and Revenue in County Cork. There was a seizure with an estimated value of €32.8 million of synthetic opioids. It is seeing successes. We would like to see more people in An Garda Síochána. We have been assisting it with attempts to increase recruitment and throughput through Templemore. There is a challenging recruitment environment at the moment, not just for An Garda Síochána but for any employer. There is much more fluidity and mobility. People pick a job for a couple of years and then decide they want to broaden their horizons and do other jobs. That is not unique to An Garda Síochána. It is the case across the board. We have it in our Department; I am sure every other Department has it as well. The job for life career attitude seems to have disappeared, largely. Despite that, we are doing everything we can to support An Garda Síochána to increase recruitment and a budget has been provided to do that.

CAB has continued to expand its efforts and we continue to support it in adapting to the changing model of organised crime. In my response to Deputy Ward's question, I was not clear on one point. The thresholds have been reduced to assets of €5,000 and cash of €1,000 since the Proceeds of Crime (Amendment) Act 2016. That is to target the mid-level foot soldiers as well. The Deputy spoke about people operating and controlling things from other jurisdictions. We have collaborated with other jurisdictions to try to formalise extradition treaties and mutual legal assistance treaties. We are getting good co-operation. We are happy with the level of co-operation. These processes take a significant amount of time. There are different legal systems and languages and translation issues and so on. We have to make sure that if someone is to be formally sought to be extradited back to this country, the case is watertight and legally robust and there are no technicalities that someone can get away with. Extensive work is going on in that regard between us, An Garda Síochána, the Director of Public Prosecution's office and the Department of Foreign Affairs. There are concerted efforts on international co-operation to target drug dealers operating abroad. I think those were the three points the Deputy asked me to comment on.

I am not au fait with the latest initiatives from the Department. While we are talking about how we might solve things at the consumer end, what is happening in the drug space, unfortunately, is that it appears that the volume of drugs coming into the country is increasing. Mr. Ryan mentioned a high-profile drug seizure. It was said that was the fourth of those. Three previous ones of that scale had come into the country. How much of it comes through here and transits on to other countries is another question. A significant amount of it is obviously destined for the Irish market, unfortunately. Mr. Ryan does not wish to comment on what our naval assets can do but if drugs are being dumped at sea, which is what is happening, and we do not have a way of interdicting that, it is a significant policy deficit which needs to be addressed.

I will have to find it but there is good research on drug markets and that no matter how many interventions or seizures happen, it is such an intelligent market that they never interrupt the market, because it is so big.

What we sometimes see when a seizure happens is that the market corrects itself so quickly that is not really felt on the ground or it does not remove the substances, although it can do that for a little while. There has sometimes been a scarcity of certain types of drugs but it is an intelligent market. John Collins has done research on that, and it might be beneficial for the committee to read it.

I have two questions for Mr. Ryan and two for Dr. Keenan. We will then go to a final round of brief comments because we have until 12.30 p.m. I may need to leave within that time. If I do, Deputy Ward will take the Chair for the final ten minutes.

Two of the questions arise from earlier comments. Deputy Kenny gave statistics in regard to possession offences still being at a high level and Assistant Commissioner Kelly noted last week that people were also being prosecuted for other stuff. That is a bit confusing. Does it mean that the people being prosecuted for other stuff are not entitled to the adult caution scheme? If there are other charges against them, they would be up for the other charges, so why are they up for cannabis offences? Why are the two not being uncoupled? It is saying that if someone is being prosecuted for any other thing, they are not entitled to the adult caution. Is that correct?

It is not exactly as cut and dried as that. It will depend on the nature of the other offences. If there are other low-level offences, it is possible that gardaí can use their discretion to allow someone to avail of the adult caution scheme. If they are more serious offences, however, that will be taken into consideration. The adult caution scheme is not aimed at people who are involved in more serious offences. Section 15 would be the main one in this regard. If someone is being charged with possession of a particular drug with intent to supply and may also have a small quantity of a different drug for personal possession, they would not be considered suitable under the public interest test around suitability for adult caution.

My second question is on grooming. I have always had a personal issue with this because, for me, poverty and the environment are why grooming happens, yet we seem to want to target particular groups and say they are responsible for the grooming of those in this or that age group. Within the policy or the legislation, is it possible that an 18-year-old can be charged with grooming a 15-year-old?

That is extremely problematic. When we look at the nature of some communities and their access to youth work, we see young people as being those up to the age of 23. They do not just go from being a child to being an adult. The sequence of grooming is complex in the sense that there are many people who live in the same community who are being given the same access to the same illegitimate resource for making money. I have huge questions about that.

I have a question for the HSE regarding naloxone. We talked about training. I am not sure we discussed the current position in respect of over-the-counter naloxone and what decision needs to be made on that. Training might be important but the nasal naloxone is much easier to use. Where are we at with regard to access to naloxone over the counter? That question is also for the Department.

The HSE is now recognised as an organisation that can do the training. It can then apply to the HPRA to get naloxone onto its premises. That is where we have been working with the private emergency accommodation providers the hostels and so on. For example, Simon and other organisations are trained under the HSE naloxone programme and they can then get a licence from the HPRA to hold it.

On the street about a week and a half ago, I encountered a suspected overdose. I would not be able to tell, but I suspected that it was an overdose. I checked her and she had no naloxone. The experience was difficult because nobody wanted to help me put her in the recovery position. They did not even want to touch the girl. It was a really horrible experience. I am used to overdoses. I have dealt with them many times, but I was definitely not used to the on-street experience. One older lady came to help me keep the girl up straight while I negotiated with a shop to ring for an ambulance. It was a negotiation that she should have an ambulance. In that situation, it is about being able to run into a chemist and access the nasal spray. Obviously, you are taking a risk as to whether it is an overdose or not, and it could have been anything that was wrong with the girl, but it is not going to cause any harm to her in that context. Given that there are so many people on our streets who may not even be in a service, it is important that we can access naloxone.

I apologise for going over my speaking time. When we talk about options for recovery, this goes right back to the very first comment from Dr. Keenan regarding the response when someone is coming off methadone and needs those options and supports, and being able to fill the gap that accessing the service used to fill, whether that be education or employment. When we look at options, is it noted and acknowledged that those options are massively decreased if a person has a criminal conviction for possession of drugs, which cannot come off their vetting forms. That will stay on the vetting form in line with murder, sexual offences and gun crimes. It will remain there so somebody who is looking to access a particular source of education or employment is excluded from full recovery due to a criminal conviction in many cases, although not all. When we talk about options, do we need to acknowledge that, under the current legislation, a criminal conviction reduces the options for recovery?

I have a comment and a question for the Department of Health. I went on the interactive map of addiction services this morning before I came to the meeting. I found it a bit clunky. It is probably still a work in progress, and I am not the best when it comes to IT. There is duplication of some services. I would bring that to the Department's attention.

I had a particular look at residential services. To my surprise, Keltoi was listed as a residential service on the map. As we know, and as Deputy Gould just mentioned, it has not been open for four years. We had debates with the Ministers of State at the Department of Health, Deputies Feighan and Hildegarde Naughton. They both gave commitments that they were going to reopen it. From listening to the interaction between the HSE and Deputy Gould, the buck seems to be stopping with the Department of Health in the context of why it has not reopened. Will the Department comment on that? Is it because the Department did not get the resources from the Government or did the Department prioritise resources elsewhere? I am seeking to discover the reason money has not been prioritised for Keltoi.

I am not aware of the specific referrals to the Department regarding Keltoi, but I can speak to the investment in and the requirements for investments in dual diagnosis services. Part of the Sláintecare theme is to ensure that services are delivered at community level, supporting people to live in their own homes and ensuring they have access, and that is then stepped up all the way to residential services.

Before it became a dual diagnosis service, Keltoi was also open to other people. For example, if someone was doing a methadone detox in Cuan Dara in Cherry Orchard, there was a door-to-door service whereby they could detox in Cuan Dara and then start their rehabilitation journey in Keltoi. That is the piece of the jigsaw that is missing. People finish their detox and, more than likely, they are going back out into the community because that space is not there for rehabilitation. That is another aspect that needs to be looked at outside of dual diagnosis.

I look forward to seeing that note because no excuses are acceptable for the delay in not reopening the Keltoi unit and not having it offering residential care too. I am not looking for a nine-to-five, Monday-to-Friday service because that is not going to run here. I will also be talking to Deputy Cullinane about this issue too. Deputy Ward and I have been commenting on the Keltoi unit for some years now. To be honest, I am shocked the witnesses have come in here today and no one can tell us how much money is required and when the unit will be open again. It is unbelievable.

On naloxone, I agree with what the Leas-Chathaoirleach said. Councillor Daithí Doolan and I have met different groups in Dublin that were sidestepping the systems in place so they could get naloxone to people who needed it. I was impressed by the ingenuity of these addiction service groups in Dublin. We know naloxone saves lives. What is the issue here? We need to get this substance out to a broad swathe of people, including family members and communities, where there is a high risk. I know there needs to be training. The Leas-Chathaoirleach described an experience she had last week. I imagine that if naloxone had been available then, she would have been well capable of being able to deliver it to the person who was potentially at risk of an overdose.

Will the Department of Justice give figures on the number of young people brought through the youth diversion programme for drug possession?

I request that this be done. There are different issues here, but we need more information on young people at risk in relation to drugs. It is all about the data because it will tell us what we can do.

I had a case in Cork where a person was selling these new psychotic drugs. I contacted the local gardaí. They felt they did not have the training to prosecute under the criminal justice laws. I contacted the Minister, who told me that a letter was sent out detailing the relevant Act. As far as I know, gardaí are not even getting the training in Templemore. Is there an issue with red tape? The person I referred to was selling products from her door for months, if not years, and the gardaí could not act because they did not have the training. Has the matter been resolved at this stage?

I am referring to these new synthetic drugs coming onto the market. They used to be sold in head shops. The witnesses might remember there was a gap in the legislation when head shops were selling these materials. The loophole was closed but the normal gardaí on the beat I spoke to in Cork did not have the training. This should certainly be part of the training for gardaí in Templemore and not just the subject of a letter. A letter is not going to run.

I will address the issue of supports for people recovering from addiction, so my question is mainly to the witnesses from the HSE and Department of Health. I represent Dublin 1 and 7. Many addiction supports are available while people are in active addiction. Following on, thankfully, we have a Housing First strategy and people are found placements, often in private accommodation. Sometimes, however, these placements are in places that are effectively being operated by approved housing bodies. Will the witnesses outline the framework and communication between AHBs and their respective organisations in terms of ensuring that people in Housing First are getting supports? I know community workers are going in and checking on certain people. I also know, however, that some of those placements are, in some cases, chaotic. I have people coming into my constituency clinics saying they have a placement like that and it attracts people who may also be in addiction and it becomes a problematic situation in that housing. I am interested in hearing what the live conversation is between AHBs and the Department of Health or the HSE in supporting people who are recovering or are in Housing First programmes and in active addiction.

Not to put too fine a point on it, some parts of the country, like Dublin 1, have a high provision of those places and are increasingly being put under serious pressure. Is the Department of Health tracking the management of all such provision by the Dublin Region Homeless Executive, DRHE, various charities and the HSE directly, so we have a live-action map showing how many people are in Dublin 1, Dublin 8, Kerry or Limerick, for example? I very much believe some communities are bearing a greater burden than others.

I thank the Deputy for her question. We work in partnership, as she knows, with the Department of Housing, Local Government and Heritage, which has given responsibility for oversight to the Housing Agency. That is all co-ordinated in partnership between the Housing Agency and us in the HSE. There are nine housing areas-----

I will stop Mr. Doyle there. I will outline the situation as I understand it. There is the Department of Health, where the money starts. That is point A. We could go back to the Department of Public Expenditure, National Development Plan Delivery and Reform, but we will start at this point A. Point B, then, is the HSE. The HSE then works with the Department of Housing, Local Government and Heritage. That Department then puts the Housing Agency into the mix. The Housing Agency then goes to the AHB.

We have an oversight committee co-chaired by the Department of Housing, Local Government and Heritage and the Department of Health. As part of that, targets are set for the Housing Agency to take up tenancies across the country. These are agreed with the local authority areas. The HSE, in partnership with the local authority areas, develops plans to service and support people in the Housing First tenancies programme around case management and access to health services.

As Mr. Doyle said, representatives of the Department of Health sit on the oversight committee. We have oversight with the HSE of the delivery of the target for any particular year. We have ongoing engagement with our colleagues in the Department of Housing, Local Government and Heritage outside that structure if there are any issues ongoing nationally. Just to say, however, one of the things about the supports is that there are the immediate supports for a person in a tenancy, but there is also the role of the support around mainstreaming and pathwaying people to the services in their local area. For each individual-----

-----but can I just say one thing? Is Ms McArdle telling me then that the Department of Health has a sense of the situation across all the service providers? Let us take Gardiner Street as an example and say there are 320 of these placements on that street. Would the Department of Health have a sense of that and the kind of social impact such a number of placements is going to have on that street? Is anyone in the Department of Health doing this type of analysis?

It is "Yes" and "No", if I can put it that way.

We work closely with the HSE on how it is delivering on those targets for their particular regions or CHOs. However, we have a gap in terms of the data sharing. The Deputy has pointed to an issue whereby we do not have single identifiers for people who-----

Part of the purpose of the review was to identify how well it works and how it serves those communities. This is absolutely a pilot project. We know from other jurisdictions that this kind of harm reduction measure is an important tool in the overall toolbox. If we are seeing the same needs arising in other parts of the country, we will absolutely have to actively consider it.

That is very much appreciated. We will definitely write to the members of the committee to see how we organise that. It is very useful. This has been an extremely informative morning. We got through a lot of different issues and I thank everyone for their patience and for their latitude in terms of time. I thank our witnesses for engaging with the committee today. Their contributions and answers have given us a lot to think about and they have opened up a lot more conversations as we go forward. I thank them for their time.