Amendments Nos. 1 to 4, inclusive, have been ruled out of order as they do not arise out of Committee Stage proceedings.
Misuse of Drugs (Supervised Injecting Facilities) Bill 2017: Report and Final Stages
Amendments Nos. 1 to 4, inclusive, not moved.
I move amendment No. 5:
In page 4, line 29, to delete “and An Garda Síochána” and substitute “, An Garda Síochána and Local Drugs and Alcohol Task Forces.”.
As the Minister of State knows, I am very much in support of medically supervised injecting centres. However, issues have been coming up in the work I am doing in my constituency and also in a number of committees on which I serve. There was a concern that the Garda should be informed if the person who is making use of the injecting centre is no longer eligible to be there as a prescribed user. That is what this amendment addresses. It is a question of keeping in mind the best reputation of these centres, to allow their work to be done in a fair and impartial way and also in a dignified way that respects those who are using them. There would be concerns that if somebody was no longer eligible and this was not known there could be an abuse of the services at the centre.
With all due respect to Deputy O’Sullivan, I do not consider that this amendment is necessary nor that it adds anything further to the Bill, since under this section the Minister is already enabled to consult with local drugs and alcohol task forces when determining whether to grant a licence.
Under section 3(2), as published, the Minister is not restricted to the stakeholders that can be consulted with in determining a licence application. In different areas, and in different circumstances, certain stakeholder groups will be better placed to advise the Minister on a licence application.
I understand where Deputy O'Sullivan is coming from. On Committee Stage, I raised the prescriptive nature of the consultative process that may have to occur. What the Minister of State said then was that there is a proper process of consultation, in the context of the Garda and the various stakeholders, which occurs through the regulations that are published. On Committee Stage, the Minister of State also said that if she prescribed a certain body and excluded others from the consultation process, it could have an adverse effect on the legal interpretation of the Bill. I take her word that this is what the Attorney General has advised her. However, the consultation process is really important and will have to be detailed further when regulations are published.
Fianna Fáil supports this Bill and what it is trying to achieve.
The Minister of State might clarify how it will be determined and known if somebody is no longer eligible to have a service in the centre. This would be in the interests of the other people in addiction using that service. There is a broader issue around the licence and the liability of the person or centre holding it. Aspects of this are not really clear in the Bill. Obviously, the person in addiction takes a certain amount of responsibility; it is not a "Big Brother is watching you" kind of situation. However, if by any chance they contravene the conditions for being in the centre, it would be in their own interests and in the interests of those supporting them that this would be known. How will it be known and what will happen? What is the procedure in those circumstances?
I may have misunderstood what Deputy O'Sullivan said in the beginning. Amendment No. 7 was ruled out of order, even though the Deputy spoke on it.
We are discussing amendment No. 5.
I gave the response to that amendment. It will be down to the people who will be charged with running the centre to determine the use of the centre. That will come out in the consultation process, when there will be an opportunity to make clear how the persons or place will be determined by those who are going to run the centre. They will continue to brief people, in public consultation, on who will be using the centre and who will not be able to use it. There are no restrictions in legislation currently as to who will be using it. They will be identified by An Garda Síochána. There will not be anybody selling drugs within the centre. That will not be allowed anyway. There will be public consultation but it does depend on whoever is going to be given the opportunity to run the centre; that part of the legislation can be interpreted by those who are going to run it.
Is Deputy O'Sullivan pressing the amendment?
Amendment, by leave, withdrawn.
I move amendment No. 6:
In page 6, line 21, to delete “centre” and substitute “facility”.
This amendment will correct a typo in the current version of the Bill where the term supervised injecting centre has been used incorrectly. This should read as supervised injecting facility; the term defined in section 1 of the Bill.
Amendment agreed to.
Amendments Nos. 7 and 8 do not arise out of committee proceedings and have been ruled out of order.
Amendments Nos. 7 and 8 not moved.
I move amendment No. 9:
In page 6, line 39, after “holder” to insert “or any person acting under the direction of the licence holder”.
Section 9 provides an exemption for licence holders from a liability in respect of the provision of an injection centre and for any assistance, advice or care provided to an authorised user. This will include any servants or agents of the licence holder. However, in order to adopt a belt-and-braces approach to ensure that a civil action could not be taken against a member of staff acting in a professional capacity, the Office of the Parliamentary Counsel has offered this short clarifying amendment.
Amendment agreed to.
Amendment No. 10 is out of order.
Amendment No. 10 not moved.
I move amendment No. 11:
In page 8, between lines 6 and 7, to insert the following:
“(4) This Act shall be laid before each House of the Oireachtas for renewal every two years so that both Houses are assured that it continues to operate to its most effective, having regard to the highest standards of individual and public health and safety.”.
This amendment seeks to promote the best interests of the centres or facilities and relates to the environment in which they operate. The Minister of State knows there will be great difficulty in regard to location and there are concerns. The constituency I represent has a very high level of hostel-type accommodation, emergency accommodation and addiction services. The fear is not coming from a position of "not in my back yard", however, but from the fact there are so many services in one area and they are attracting people who are dealing in drugs. We want to give the people who will be using these centres every chance that this will help their health and might also encourage them into recovery at some point. We know there are certain areas in this city and outside the city that would not for one second tolerate any kind of addiction centre being anywhere near them. That is why we need to keep a close eye on this. It is the responsibility of the Oireachtas to have a role to ensure the centres are effective and that there are high standards of individual public health and safety. I am not taking from any of the addiction services which may apply to have the injecting rooms in their centre. I accept that this is innovative, inventive and totally new and I want it to work. That is why I want it to have every opportunity to work.
I support Deputy Maureen O'Sullivan in her request for a review of this legislation on a two-yearly basis. I raised this matter on Committee Stage and I thought the Minister of State might have listened and given some sense of comfort in regard to this whole new idea. I wish to state that I support the concept of helping people with drug problems. As I said on Committee Stage, I have lived with a methadone centre just down the road from my constituency office. Despite various pressures I came under over the years, I have supported the retention of that centre.
This is a totally new ball game and it is very questionable in terms of how people get drugs in the first instance. They have to bring illegal drugs, as is made clear in the explanatory memorandum to the Bill. Therefore, there is a whole area of questioning as to the actual operation of this legislation. We are asking people to close an eye to illegal drugs being purchased outside these centres and brought in to be consumed inside. Whatever about relieving the liability on anybody about the consumption of those drugs in one of these centres, it still begs the question about drugs dealers on the streets outside selling drugs to people who are using the facility.
I am a pragmatist and I know that drugs are going to be got, but this is legislation which we are responsible for as legislators. Therefore, I think the very minimum we should do is to have a clause in the legislation to review the situation after a two-year period. I would like to support Deputy Maureen O'Sullivan. I had mentioned this on Committee Stage, including the two-year period. It is not that people want to be heartless or soulless in terms of dealing with this terrible issue but we, as legislators, have a responsibility to be able to answer questions. We cannot put through legislation that has a big question mark over it. There is a huge question mark in respect of this Bill because we cannot, or at least I cannot, answer the question if asked about allowing people to buy illegal drugs from drug dealers out in the street because there is no other way they can get them.
There are serious issues to be addressed. However, if one questions any of these things, one is seen to be unsympathetic to what is sought to be achieved here. My ambition is that these centres would eventually lead to people getting off drugs. Again, however, the legislation does not include anything about the availability of people in these centres to give help and assistance to drug users to get off drugs. Maybe that can be done by way of regulation but it is not in the legislation, and we have to look at what is before us. We need a provision whereby we can review this legislation, whether annually or every two years. To be realistic, I feel we would have to give a reasonable period of, say, two years so that people can then sit and coldly look at how this is working. Information I have received recently suggests that some of the countries - particularly New Zealand - in which these centres are already in place are having a rethink in respect of them.
Be that as it may, we are dealing with our situation. I do not think we would damage the legislation in any way by allowing the House to review matters after two years in order to see how it is working. Therefore, without creating any difficulties, I think it is reasonable that we should agree to a review after two years.
I have supported this legislation from the start. Although I have not been engaged with it in committee, I remember the furore that arose and the upset that was caused to some people when methadone clinics were first proposed throughout the city. However, the world did not stop. Nonetheless, there were teething problems and some of the latter will again arise in respect of this initiative. One teething problem was that people were coming from outside an area to avail of a service that was offered to them. Unless these supervised facilities are rolled out across the country, there will be people who will come from outside, along with the baggage they sometimes bring with them. That is one of the concerns and, obviously, it is a concern that can be dealt with when the regulations are put in place for the licence, in that whoever gets the licence can start to address who exactly the facility is targeted at.
The point the previous speaker made in terms of support services is very valid. I presume that any facility which applied for a licence would have to be one that has all of those support services available.
If somebody who is using a facility decides at that stage that he or she wants additional supports, that must be available as near as possible to the injecting facility.
I do not think we should be afraid, as I have argued in respect of much legislation in the House, of having a review or referring it at the very least to the Dáil committee that has expertise on it. While the Dáil committee can do that anyway, it would be reasonable for the matter to arise there. There will be consequences to these measures and hopefully they will have the desired effects, are successful and can be rolled out. At the end of the day, this is aimed at protecting the health of the public in general and in particular those who are availing, whether we like it or not, of illegal drugs and injecting them. A variety of different concoctions are being injected at this very moment and it is not just what most people presume is heroin. We saw that in particular when the head shops existed. People were mixing every single type of chemical possible and we saw the effects that had in the accident and emergency rooms across the country. The doctors did not understand how to treat them because they were not aware of what was going into the person. At least if there are supervised injecting centres, they might have quicker information as to what may have been injected in order that they can address some of the side effects of these drugs if people present in accidents and emergency departments.
I think the amendment is reasonable enough. It is not a repeal of the Act every two years. In some cases, that is what people want. This is just to try to strengthen it. It might be just a once-off, but in two years' time we will have the first two years' experience. From that, we will have learned a lot and will be able to tighten up the legislation and the regulations and licence that pertain to it. The main thing is that we learn. Whichever are the pilot facilities, the ones that are granted a licence thereafter will be able to learn from the first ones into the breach.
I hear the points Deputies Maureen O'Sullivan and Ó Snodaigh have made. The Minister of State should justify her opposition to this. I do not think we should fear the Dáil discussing this every two years or having a report come before it with regard to how it is working, what the issues might be and how we can make it work better in the context of rehabilitation and harm reduction. I am not sure why there is an attempt to exclude from this legislation the opportunity for the Dáil to make the regulations that underpin it more effective for the people this Bill is trying to help. We all know there are a lot of legislative items on which a Minister must report to the Dáil on an annual basis or every two years with regard to various health matters. It is recorded in the Dáil. Sometimes there is a debate and sometimes there is not. The amendment is worthy of consideration. We are not changing the thrust of this Bill; we are just saying that the Dáil could potentially make it better. Without leaving executive control completely in the Bill, we are saying that the Dáil could have a discussion every two years to make it work better and see how it is doing. It would also be an opportunity to improve the legislation and regulations for the very people we are trying to help. I think it is a very reasoned and fair amendment. I am not sure why the Government is opposing it.
I will speak in a similar vein. I have not been a participant in the debates on this Bill to date but I am very supportive of the legislation. I believe it is a significant step forward in a progressive direction to have supervised injecting facilities and to try to create a safer environment for people with addiction problems in which to inject. I would not support any amendment that would cast doubt over the value of moving in this direction rather than having things driven underground into parks, alleyways, subways or wherever it is. However, I do not think that is the purpose of this amendment. The purpose of this amendment is to ensure that we discuss this on a regular basis, see how it is going, monitor it closely and try to improve things as we go along. We are entering, for this country at least, into new territory, and it is good territory as far as I am concerned. It is territory that brings something out of the shadows, acknowledges the reality of it and tries to address it. I believe it is a sensible amendment.
It might set a precedent for other debates of a similar nature that we are going to have in the next few weeks on the question of medicinal cannabis. I know that in that area, the Government and possibly some others in the Opposition are going to express concern about potential implications and knock-on and spill-over effects, as they might see it, of decriminalising medicinal cannabis. I do not share those concerns, but if, as I hope, the medicinal cannabis Bill passes, I suspect that the Government and those who have those concerns will propose an amendment just like this one and state that the House will need to constantly review matters to see what the impact, efficacy, benefits and shortcomings of it are. I think that is a sensible approach. It would therefore be inconsistent for the Government to oppose this amendment and to then, very likely, make the opposite argument in a few weeks' time when we come to debate another area of decriminalisation around particular drugs, during which the Government will argue for caution, monitoring and so on and so forth.
I think the Minister should seriously consider this amendment and accept it. There is nothing to lose. There are no dangers in this. It is just a sensible measure to ensure that this issue stays in focus and that we move from this positive step on a trajectory of making things better over time to address the reality of what is a fact of our society, that is, the injection of these drugs. I hope the Government will accept the amendment. Aside from the Government's concerns, everybody else in the House seems to share that view.
I wish to pick up on one or two points that have been made. I share Deputy Maureen O'Sullivan's concerns about communities that have been loaded in the past with facilities compared with other communities. The direction of this supervised injection centre is all about where the need is greater. That is why the HSE and the Department are engaged in a mapping process to try to identify where people are injecting and where people have left litter. When the legislation comes into force, that will help to identify where exactly the location should be and will give those who are going to provide the service a real insight into where the centre should be located. I certainly share some of Deputy O'Sullivan's concerns. I hope that when the legislation is approved and when the people are ready to provide the service, it will be possible to consider many of these concerns during the consultation. Where the need is greater, the services will be allocated.
I wish to pick up on something that Deputy Ó Snodaigh said. Deputy Ó Snodaigh knows a lot about this Bill, like a lot of Members here.
We do not anticipate there being a honey pot effect. It does not happen in other countries and we are taking on board the experiences of other countries. People are not attracted from far and wide but rather it deals with people in the location of the facility.
The supervised needle injection facility is all about a health-lead approach. It has to be, for those chronic people who are coming in off the street. They are probably not in any other service, but as part of the service there will be doctors, nurses and clinical staff there, and there will be people able to forward users into other services. That is the whole idea of this service. It gives an opportunity to chronic users to be able to build up trust in the centre with the staff and to be able then if they wish to go further into their recovery. That is what we all want as legislators. A crucial part of the supervised injection service is that we have a wraparound service around it. Otherwise I do not believe it will work.
Regarding the amendment, I am advised that the amendment offered would not achieve what the Deputy intends. The two yearly review of the legislation, rather than the outcomes of the centre, would be overly burdensome and could ultimately prevent the Bill achieving its goals. I know this is not the intention of Deputy O’Sullivan, who has been an advocate for injecting centres for many years and spoke so favourably about the Bill some weeks ago.
I am advised that there is no similar provision on the Statute Book. I understand that it may be the Deputy’s intention to provide what is known as a sunset clause, where the law shall cease to have effect unless further legislative action is taken to extend it. However, I have been advised that the amendment in this section does not achieve this and I cannot accept it. I do not consider this measure to be necessary given that the Bill clearly sets out that any licence issued will be for a defined period of time. The Minister is not obliged to grant a licence under the Bill. Similarly the Minister is not obliged to renew a licence either. However, under section 5 the Minister is empowered to suspend or revoke a licence. This includes where the Minister is satisfied that the licence holder is no longer eligible to hold the licence or is breach of the conditions of the licence or any regulations made under the Act. The Minister will consult with the HSE and the Garda and may bring issues to the attention of the Minister in this respect.
As the Misuse of Drugs Acts currently stand, it is illegal to operate and use an injecting centre of any sort. This Government has made a commitment to maintaining a health-lead rather than criminal justice approach to drug use. It is our intention to open an injecting centre on a pilot basis in Dublin city centre where, as many Members have agreed, there is a problem of street injection and the related challenges such behaviour gives rise to. We know the evidence internationally is very much in favour of injecting centres. However, this pilot centre will be subject to a thorough evaluation in order to assess it in an Irish context and the ability of the centre to meet the needs of people who inject drugs in Ireland. It will be evaluated to determine its safety, cost-effectiveness and benefits. The results of this pilot project will inform decisions about any further injecting centres, including whether or not the pilot facility should continue to stay open. These decisions will be based on the evidence. The pilot centre will be subject to ongoing monitoring and review, with input from the Garda, the HSE and others. While I expect the pilot centre to be a success, if for some reason it is not, then the Minister is not obliged to renew the licence or grant any other licence. If the evidence does not support the pilot service continuing, or the ongoing monitoring process suggests that the centre is not operating as intended, then the Bill enables the Minister to revoke the licence. In this way I do not see the need for any form of review clause in this Bill. Licences and centres will be subject to regular and ongoing reviews and structured evaluation.
We have witnessed this in other countries where a review of this nature became a hurdle to the work of the centre and was ultimately removed from the legislation. This was despite the fact there was a huge amount of evidence to support the injecting centre there.
There is no injection facility in New Zealand at the moment. However, an injection centre will shortly be opening in Glasgow and one opened in Paris just before Christmas. In Sydney, where there is an injection centre, authorities are returning to Parliament to look for another injection centre to be opened because the Bill at that time only sought one centre. In this Bill we are looking at having facilities so that we will not have to come back seeking further legislation.
When I hear the Oireachtas is not going to have any role in reviewing this it rings alarm bells, because we all know how little debate there has been here and how little discussion there has been about addiction, whether it is drugs, alcohol or gambling. It is good that we are having this particular discussion today. I do not remember too many debates. There have been periods since I have been here that we did not have a Minister with specific responsibility for the drugs strategy, and there was a long gap before Senator Ó Ríordáin took up the mantle in the last Dáil. Despite the Minister of State saying that she will have the power to suspend the licence, I have a fear that unless we have somebody who is particularly interested and dedicated to this area, someone who understands the issues, we could have a situation where any unintended consequences might go on for much longer than they would. To me that would be detrimental to the work of the injecting centres.
One thing I would love to see beside every injecting centre - I hope there will be more than one if the need is there - is a recovery café. Great work is being undertaken by the recovery academy, and they are not on the agenda at all. We have to show the examples and let it be visible that people are in recovery and that there are opportunities for people to go into recovery and to stay in recovery. In other countries they have recovery business centres and recovery cafés. That would be very good. It is not a "Big Brother is watching" type thing. This is to make it better, and other people in the House, whoever they may be, at other stages who have an interest in this and who are concerned about it should have a continuous input.
Deputy Ó Snodaigh mentioned the methadone clinics. There were unintended consequences and they are still going on. People are spending far too long on methadone and they are not having the opportunity to reduce their use or to come off methadone completely. We still have a lack of dignity for people who are visibly queueing up for methadone on the streets. I would hate to see something like that happening at the injection centres. I am disappointed that we are not considering this more.
The Minister of State said that such clauses are not contained within other legislation. I know of several pieces of legislation that have a clause where a report goes to a committee of the House or the Dáil. For example, any of the Ombudsman Acts facilitate an ombudsman making a report to the Dáil. It is laid before the House. In some instances they are to report to relevant committees. I would not go down the road of a sunset clause because I do not believe that this should be repealed. It should be reviewed by the Committee on Health. It can be done without it being in the legislation. It would be nice if it was contained within the legislation because that is a guarantee that it will happen, whether in the next Dáil or the one after it. At least then they are discussing the drugs issue and whether this pilot is successful or not.
This is a pilot scheme and I welcome it and have no problem with it at all. However, if the pilot goes on for three or four years, when will it be properly reviewed to see whether it will go on beyond the pilot? Sometimes the pilot just continues and it becomes a established mainstream, in drug taskforce language. If it is mainstream is another one piloted somewhere else?
The Minister of State said the international evidence suggests that people do not come from too far away. Dublin and Cork are very small cities and people can travel from one side of the city to the other. That has consequences, and they are good consequences if people's health is improved, but I know it has other consequences in some of the services.
There were suggestions that a service in our own locality was being closed and there was a fear that some of those who would be put into a new facility were from different elements of a feuding gang. Sometimes there are unforeseen consequences and in that context, it is useful to review legislation. Whether such a review would be on a once-off basis or ongoing is not something about which I am too concerned but there should be some review at least.
Again, I just do not understand what difficulty there could be about having a clause in legislation that it would come before the House again after a two-year period. We all learn from experience and things change. Hopefully there will be less and less demand for these sorts of centres because we will get on top of this very sad issue. That is what Parliament is all about; being able to review what it has done. For the life of me, I cannot understand what difficulty there could be with this. I do not think it should be a contentious issue.
I would like to mention to the Minister of State, whose officials gave her a note about New Zealand, that I have a note about New Zealand too. That country is putting through legislation called the Substance Addiction (Compulsory Assessment and Treatment) Bill, which will replace a 1966 Act. That might be of interest to the Department.
The amendment, which seems to be fairly well supported in the House today, provides that we insert a clause that will not cause any difficulty or delay matters. One can word it in whatever way one likes but it is simply that a review would take place every two years to see if the legislation can be improved - perhaps the latter phrase could be included. I just do not understand why it cannot be considered.
The amendment tabled by Deputy Maureen O'Sullivan proposes to review the Act, not to review the centres in terms of their success or failure. I have already made it very clear that reviews will be conducted by An Garda Síochána and the HSE. They will monitor and review the centres. We would expect that there will be a period of time - possibly 18 months to two years - before such a review will take place. We will also have an independent review, which is very important. I will not be accepting the amendment.
I seek clarification. Is the word "review" or "renew"?
It is "review".
The Minister of State has mentioned that An Garda Síochána and the HSE will be involved in the consultation. While gardaí may have local knowledge, I am not too sure that the HSE would have its finger on the pulse in a particular area. One of my other amendments related to the involvement of local drugs task forces and the use of soft knowledge, which is important. When the review or monitoring of this takes place, that monitoring must be done correctly. I am not sure, from what the Minister of State has said today, that it will happen in the way that it should. I say this in the context of the methadone clinics, which were not reviewed, evaluated or monitored enough. While I do not disagree with methadone, which has helped to save many lives, we now have people who are more addicted to methadone than they ever were to heroin. They are possibly in a more difficult situation today than they would have been otherwise.
It is disappointing that the Minister of State is not accepting my amendment. Does this mean that we will never be able to review legislation once it is passed unless that be through a different mechanism?
Just on a point of clarification, the Minister of State made reference to "review" but the amendment refers to "renewal". That is a more positive term than "review", which has negative connotations. The amendment calls for the renewal of the Act, in the context of public safety. That is what is written in the amendment before us. It is quite a positive amendment in the context of what we are trying to do. The amendment provides that "This Act shall be laid before each House of the Oireachtas for renewal every two years" and does not refer to a review.
Yes, the Deputy is correct. The word is "renewal".
Renewal is very different to review in terms of what has been said.
I will allow the Minister of State to provide clarification and then we must move on.
I did say that the pilot centre would be subject to ongoing monitoring and review.
Is Deputy O'Sullivan pressing her amendment?
Amendment put and declared lost.
Bill, as amended, received for final consideration and passed.
The Bill will now be sent to Seanad Éireann.