A harm-reduction approach to drug use

• The variety of drugs used recently, ‘in the last month’, has increased and recent use was most common among 15 to 24 year olds (Figure 1).
• Drug use in Ireland has gradually increased since 2003.
• Polydrug use increased from one-third of drug users in 2002 to nearly half in 2019 (Figure 2).
• Ireland has high levels of drug use in comparison to European Countries (Ecstasy 2nd, Cocaine 4th & Cannabis 8th).
• The European Union Drugs Agency (EUDA) Drugs Report 2024 showbthat Ireland had the highest proportion of drug induced deaths (97 per million of population aged 15 to 64) among EU countries (EU27 corresponding average was 22.5).
• A 2021 assessment of all Irish data sources found that there was over 23,000 people ‘in treatment’ for drug problems.
• The EUDA 2024 report also highlights the trend overall of greater drug use society-wide, including variety of drug types, ways to consume drugs, and that risks associated with some substances may be growing among those experiencing social and economic deprivation.

The move to HR from previous criminal justice-led responses to drug use reflects an acceptance that such policies on drug use, as opposed to drug supply, have not had the impact anticipated. Evidence shows that prohibitionist policies lead to negative consequences for drug users such as:

• prolonging risky behaviours;
• delaying access to supports;
• criminalisation of those who use drugs for personal use; and
• penalising and stigmatising problematic drug users.

Criminal justice-led policies have also had disproportionally negative consequences for disadvantaged communities and social groups.

While HR is now recommended as the primary response to problems related to drug use, it has faced criticism over the years. A key argument against HR is that it is a step towards legalisation of currently illegal drugs, and in-effect, condones drug use instead of seeking solutions. Reviewing earlier HR efforts in Ireland, Butler and Mayock (2005, 2021) concluded that HR activities had been framed loosely and introduced cautiously to minimise critiques from opponents.

In Ireland, the shift to HR was first evident under the current National Drugs Strategy (2019). Momentum towards HR has been significantly enhanced by the 2024 Report of the Citizens’ Assembly on Drug Use. As the most comprehensive and inclusive overview of drug use undertaken to date, the work of the Citizens’ Assembly is of central importance in any consideration of drug policy and legislation. The central message of its recommendations is that the State should pivot to a comprehensive health-led response to drug use.

Following the report of the Citizen’s Assembly, the Oireachtas Joint Committee on Drug Use was established to consider its recommendations. The Interim Report of the Oireachtas Joint Committee on Drugs (2024) agreed with all the Citizens’ Assembly recommendations considered by the Joint Committee, including recommending the pursuit of a harm-reduction approach.

What are harm-reduction responses to drug use in Ireland?

There are multiple approaches to HR in Ireland (see Figure 3). A core principle of HR is implementing pragmatic responses to problematic drug use. The most prominent HR intervention in Ireland is Opioid Substitution Treatment (OST), which involves medical prescription of Buprenorphine or Methadone to address opioid dependence, such as heroin addiction. Often referred to as Ireland’s ‘Methadone programme’, OST has been effective in reducing HIV and Hepatitis C virus transmission and reducing drug-related illnesses. It has also been shown to reduce crime, minimise risky behaviours and improve the health and well-being of individuals.

The Citizens’ Assembly on Drug Use described Ireland’s roll-out of HR as partial and inconsistent. This section outlines key policy issues arising on foot of their recommendations. These will be relevant for Members of the Oireachtas when they consider future legislation and policy on drug use.

Recognising the diversity and reality of drug use

• Drug users vary from those using less potent drugs for personal use to those who are problematic drug users.
• Problem-related drug use represents a minority of the population of drug users.
• A one-size-fits-all approach to drugs legislation and policy has generally not been effective. Effective responses require a series of measured supports and interventions.
• Future policy would benefit from considering the varied lived experiences of people who use drugs and how these interact with public and private services.

Decriminalisation

• The Citizens’ Assembly called for a clear decriminalisation model and a pivoting from a reliance on criminal justice-led responses. The legal situation remains that possession of drugs for personal use is a criminal offence.
• The Irish legal system does not presently allow for criminal offences to carry administrative or civil sanctions instead of criminal penalties.
• There are insights to be gained from the experiences of decriminalisation in other jurisdictions including Portugal, Oregon (USA), British Columbia (Canada) and Switzerland.

The need for policy coherence

• The Citizens’ Assembly Report states that there is evidence that Irish drug policy and legislation has been compartmentalised, siloed and is as a result ‘incoherent’.
• Submissions to the Citizens’ Assembly and the Oireachtas Joint Committee on Drug Use demonstrate a lack of consensus on the nature of drug use, associated problems, and appropriate responses. This fragmentation poses a significant challenge to the effectiveness of future policy and legislative initiatives.
• Both the Citizens’ Assembly and the Oireachtas Joint Committee emphasise that HR-led responses require a broad and sustainable range of services and supports. These must cohere across departmental, agency, service, and policy boundaries to ensure long-term success.

Creating the space for policy innovation

• The nature of drug use trends and drug related problems continues to evolve. This highlights the importance of drug policy and legislation adapting and innovating in parallel with societal trends in drug use.

While there have been incremental advances over the course of three National Drug Strategies, there has been no fundamental change to the general legislative and policy framework for drug use. The extent of the changes required by the implementation of a HR-led response are considerable. If these changes are to prove successful, they will require careful consideration and sustained implementation.