Barry Cullen

The Citizens Assembly on Drugs Use was established to consider the 'legisltive, policy and operational changes Ireland could make to significantly reduce the harmful impacts of illicit drugs on individuals, families, communities and wider Irish society'. Any individual or organisation is entitled to make a submission to the Assembly (closing date was June 30, 2023). In this personal submission, the Citizens’ Assembly is urged to adopt a common-sense approach to its deliberations on the issue of drugs, to view illegal mood-altering drugs in the same category as alcohol and to propose that prohibition be phased out and replaced, within a decade, with a  comprehensive, highly organised, regulation framework.

 

INTRODUCTION

 In the Assembly’s deliberations to date it has been apprised with comprehensive, up to date research and policy, and with both national and international material, on legislation, treatment and prevention issues, and will draw from these in evaluating and making recommendations. Core issues are highly contested however, and for every well-researched argument in favour of one point of view on any of these matters, there are alternative, equally well-researched, counter arguments. Deciding between competing priorities will be challenging; deciding between contested positions will be even more demanding.

As a random group of Irish citizens, Assembly members are a cross-section of society, and it is assumed they come with open minds. This is their strength and gives credibility. There is, nonetheless, a need for members to have some yardstick in decisions and it is suggested, in this submission, that in addition to appraising the evidence, they should rely also on their own common sense. They should be encouraged to use self-wisdom, and to draw from their own knowledge of life and events to make sensible conclusions.

LIVED EXPERIENCE

The phrase ‘lived experience’ has been used to preface some of the contributions to the proceedings so far. While these have been helpful in explaining the background and context to drug issues, it is important to note that this issue is not owned, exclusively, by any single group: drug users, persons with an addiction, family members, treatment personnel, police, and so forth. As a societal issue, it is non-proprietary with ramifications for us all. Everybody, virtually, has relevant lived or other experiences to bring to the table for reflection and analysis.

Indeed, as a randomly chosen group of Irish citizens, it is reasonable to assume that among  Assembly members, there would be a significant number who are in one or more of the following categories:

• Persons who have used cannabis — or other drugs — recreationally, in their lifetime, or in the past year, or, indeed, recently.
• Persons who have mixed alcohol with legal or illegal drugs in one or more binge episodes, or who have a friend or family member who has done so.
• Persons who live near one or more of thousands of busy street junctions adjacent to village-type retail places (including public houses) that also constitute ‘hot spots’ where drugs — cannabis / cocaine — regularly, if discreetly, change hands having been ordered and paid for by smartphone.
• Persons whose use of drugs has caused them to have a dependency for which they have sought treatment, or who know others who have done so.
• Persons who have used cannabis products to help relieve pain or discomfort arising from serious illness, or who know others who have done so.
• Persons who have been the victims of drug-related crime: break-ins, car theft, car accidents, and violent attack.

 

The list goes on: the issue of drugs is ubiquitous. Assembly members should reflect on their own mixed experiences in reaching conclusions.

 

ALCOHOL – AN EVERYDAY DRUG

 In a common-sense approach, it is suggested that Assembly members consider the case of that most common of drugs, alcohol (ethanol). Although this drug has been excluded from the Assembly’s deliberations in terms of ‘what needs to be done?’ there is every reason to reflect on alcohol in terms of ‘what already has happened?’

As a common, everyday drug, we all know that alcohol is an organic chemical compound, that is naturally produced in a fermentation process using sugars and yeast. It has multiple uses: in medicine, in disinfectant and cleaners and as a fuel. It is a very dangerous, toxic substance, and can easily cause death if taken in high concentrations.

It is noteworthy that nobody goes into a retail outlet and orders a bottle of alcohol, as it’s simply not available in this pure, dangerous form, although historically, it is not so long since highly potent bootleg alcohol products were widely available, illegally.

What is available for legal consumption in a tightly regulated legal market is alcohol beverage. By using various fruits, berries and grains in controlled fermentation and distilling, alcohol is produced, sold and consumed in a variety of drink formats: wine, beer, stout, whiskey, brandy, rum, gin and vodka being the main ones.

These are often stirred with water, lemonade, orange juice, tonic and a variety of fruit and other mixes, before being taken, usually, but not exclusively, in the company of others: at home, in licensed bars and at various private and licensed public events, both indoor and open-air. Sales are time-managed and restricted to over 18s. In most instances minors are not allowed in public venues where alcohol is openly sold or consumed, unless accompanied by adults.

At no time was the everyday, ‘normative’ use of alcohol more evident than by the way it was discussed by government, in the media and in other public fora during the COVID 19 pandemic, as pressure mounted in late 2021 for the re-opening of pubs and bars, representing the long-awaited re-opening of society. At times major media announcements were accompanied with vox pops from people inside or outside pubs, as meanwhile, several health managers struggled to have their voices heard about the likely negative impact of the change on over-stretched health care facilities.

One wonders, if, during the COVID re-opening debate, had the choice of places to be re-opened included specialist cafes for cannabis, or society clubs where members could safely consume cocaine or opiates, would the debate have been more evenly balanced, and less dominated by the success and failure of a single industry that was built around the relatively uncontrolled consumption of one commodity? Any objective assessment of the relative social distancing involved, is paradoxically, more likely to conclude that the latter, irrespective of other non-COVID risks, is less harmful.

 

GETTING HIGH

All the drugs that are currently illegal, notwithstanding their toxicity, and variable strengths and formulations, can potentially also be prepared in similar ways to alcohol, and imbibed in flavoured beverage or other forms through smoking, solid food (sweet and savoury) and inhalants. The choice is endless.

Yet, the common perception of illegal drug use is that it is far from normal, more often described as ‘evil’. Most people indeed, irrespective of their general attitudes towards drug use and misuse, would be appalled and distressed to visualise a young person injecting street-bought heroin, with all the risks entailed in terms of drug adulteration and contaminated injection equipment.

Many might be further distressed, or at least surprised, to realise that by taking heroin the drug taker would most likely experience a high level of pleasure and euphoria, and that they might not be as feckless as they otherwise appear.

Less distressing, however, is that addictive over-the-counter pharmacy opiate is relatively easily available and regularly used, alongside alcohol, for non-medical, pleasure inducing purposes. The drug is sold as a short-acting analgesic for mild to medium pain management. Those who use it can experience pleasure and perhaps some euphoria, depending on the quantities taken. Over the pharmacy counter codeine is taken orally and its use with a glass or cup of water does not draw the attention of others in the way drug injecting would.

This form of drug-taking, however, is not referenced as a health or social problem in the same manner as cannabis, cocaine or heroin. In some instances, concerns are expressed about its easy availability and that it causes problems of dependence for certain individuals who use it in a prolonged manner, or as an enhancement with other drugs or alcohol.

It is often speculated that when some visitors arrive in Ireland, they buy a codeine supply from pharmacies, as over-the-counter codeine may not be so easily available in their home countries. When purchasing codeine in pharmacies, there is a requirement that customers be routinely asked 'why do you need it?' There is a lax approach to this requirement, however with many pharmacies not operating the rule at all. Nonetheless, having been tutored not to mention headaches or hangovers many people quietly murmur something about arthritic or back pain, while to themselves they think 'Ahem! To help me get high, of course. Why else?'

Like it or not, and as was evident from COVID, getting high is a universally accepted form of celebration and of bringing pleasure into the everyday experience of life, work, family, sport and relationships. It can happen quite naturally, as for example through meditation, yoga, mindfulness, spirituality, or simply through reading, cinema, theatre or exercise, or time spent immersed in outdoor pursuits or settings — hills, seas, forests and so on. Getting high frequently happens with the assistance of alcohol, a practice that is deeply embedded in faith observance and in marking personal, family and community milestones, particularly in western societies and for sure in Ireland.

If society dedicates so much time and resources to facilitating people to get high, then surely it needs to discuss why this should continue to be the case. A debate is needed about how the options for getting high can be best facilitated, and their harms best minimised. Such debate needs to avoid the 'drugs is an evil’ narrative, a narrative indeed, that can make sense only when the drug alcohol — which carries a much higher global burden of disease than illegal drugs — is also included.

 

DEBATES

In addition to the Citizens’ Assembly, an open, meaningful societal debate about drugs — including alcohol — is needed, at all levels: in the Oireachtais, in county councils, within civil and public institutions, within all industries and within communities. The Assembly indeed could potentially, among its recommendations, include a proposal to establish a statutory body to facilitate ongoing research, policy debate and discussion on these topics.

The Assembly will have heard submissions that advocate decriminalisation as a necessary outcome from its deliberative process, especially considering that disadvantaged young people have been mostly affected. However, the fact that the criminalising of drugs perpetuates peoples’ poverties, does not mean that decriminalising drugs reduces these poverties and indeed, it can potentially reinforce inequalities.

Decriminalising possession for personal use, does not remove the black market for drugs. With personal users no longer a target for police intelligence gathering, the focus intensifies on street dealers. In the event of decriminalisation, recreational drug-takers — whose sole involvement in the market is that of consumers — will continue to source illegal drugs. By so doing not only to they continue to buttress that market, but they also expose their street suppliers — mainly young, disaffected and often unemployed young people — to further risks from both the police authorities and from the criminal drug gangs in which they are embedded, and which generate fear and intimidation within communities and families.

It should be noted furthermore that decriminalisation diminishes the State’s authority to dissuade people from using drugs, while continuing to lack control over the quality of drugs and their systems of supply. Common sense suggests that Assembly members reject decriminalisation proposals.

 

ALTERNATIVE FRAMEWORK

In a post-Assembly framework, there is a need to envisage, within a decade, a new legal system that caters for a wider range of mood-altering products other than just alcohol, and in which possession and use of these products is not prohibited but legal and regulated.

Within such a system, those whose ongoing use of these products has little or no bearing on either their own or other people’s welfare or safety, should not, as with the use of alcohol currently, unnecessarily come to the attention of either law enforcement or specialist, health services. In this regard, health diversion should be applied only in circumstances where criminality has been associated with alcohol or drugs, but not drug use per se.

In addition, those who use these substances in a problematic manner should be perceived, as with alcohol, as individuals needing help and treatment. Comprehensive treatment systems should be available, and their different domains should be based primarily on the task of helping people to gain individual control of their problems: through harm reduction, overcoming dependence, where this arises, and towards social integration. Public funding of treatment systems should be based on evidence of best practice and should not be available for treatments that are based primarily on belief systems, ideology or wishful thinking.

Alongside, an envisaged removal of prohibition, there is also, obviously, a need to develop more effective regulatory constraints over all industries — big and small — that proffer products which lend to habitual, uncontrolled use, and that contribute to dependencies. In much the same way that tobacco and alcohol policies are concerned with commodity control, market regulation and public health guidance, a similar, but more rigorous, and stringent approach needs to be put into practice in relation to all drugs, including alcohol.

Current failures to properly regulate the alcohol industry — as in the case of brand marketing with 0.0 products — and the inability to minimise the industry ‘s power of political lobbying is a poor harbinger of a restrained cannabis, cocaine or opiate market. We can, as a result, expect that aggressive lobbying will come soon from these latter industries.

For some observers, such a prospect provides even deeper reasons for continuing to prohibit other drugs to avoid adding further to the problems caused by alcohol, and not to rely on the political system to maintain a public health stand against newly regulated drug industries. In this regard the counter arguments are avoided: that making alcohol illegal, within an overall prohibition mindset, would potentially result in better societal outcomes, and better politics.

Neither argument has merit, although it is important to note that drugs, including alcohol are highly dangerous commodities and society needs to have exceptional measures in place, short of outright prohibition, to protect its citizens from these dangers, and that political institutions need more priority around these aims. Ultimately, the best outcomes are achieved not by conceptualising drugs as an ‘evil' or, at the other extreme, viewing individual drug-use as representing ‘personal freedom’. Just as prohibition has accentuated health and social harms, so too would unbridled access, and strict laws around access and availability would be required.

Previously, US alcohol prohibition was abolished because it didn’t work, and because it fuelled massive criminal empires, and prohibition enforcement failed to suppress demand. The failure has been repeated with drugs, so that there are now 192 million individuals worldwide using illegal cannabis in a market valued at 142 billion US dollars.

This is unsustainable and has huge, immeasurable impacts on international, national and local violent criminality, and unending spirals of lawlessness for the violent resolution of disputes between and within criminal organisations.

 

NO ORDINARY COMMODITIES

 It was succinctly stated in the title of a seminal WHO publication, that alcohol is No Ordinary Commodity and should not therefore be treated in public discourse in the same manner, for example, as confectionery, savoury foods or non-alcohol beverages. The same goes with other mood-altering drugs. As with gambling and tobacco-smoking, these fall into a category that requires governments to take extraordinary actions to reduce and mitigate their negative consequences, to prevent an escalation of problems, to protect people from becoming dependent, and to offer them treatment when this is indicated.

The key to minimising individual and social harms, therefore, is the pragmatic, dual approach of legal regulation, and rigorous enforcement at societal levels. In this regard, it is important to acknowledge, as did No Ordinary Commodity, that neither education/prevention nor addiction treatment are the most important componenst of the overall effort to manage alcohol problems and that at a societal level, effective regulation and enforcement should be paramount. So too, should it be with drugs, post-prohibition.

NEGOTIATED OUTCOMES

In recent years, the whole debate about cannabis law — criminalisation, decriminalisation and regulation — has entered a new phase, especially because of changes in some US States, Uruguay, Canada and developments and proposed changes in Europe also: Austria, the Netherlands, Portugal, Malta, and Germany. While the pace of change is slow, inevitably the ending of prohibition, will cascade, suggesting it might be better for governments to embrace and negotiate large, comprehensive changes now. It will need to establish a whole new system for controlling cultivation, supply, sales and possession, as currently happens with alcohol, before these are imposed from without through EU competition and other laws.

In addition to legislation, there is a need to address the issue of how existing criminal gangs can be disrupted, particularly taking account of their devastating impact — through drug-related debt intimidation — on poorer communities. There is the need for more effective methods to deal with the everyday violence caused by drug criminality.

It should be clear that despite reported successes, policing has not worked, and the effective dismantling of one criminal empire simply creates openings for replacements. A lot of policing work relies on using secretive sanctions to turn poor mid- and lower-level criminal gang members as informants.

It’s a dangerous game and few young criminals have the wherewithal to manage the inherent conflicts. Whatever positive intentions they acquire around turning a new leaf, it is virtually impossible for most such persons to escape criminality. A better approach to turning young couriers and dealers would be to openly declare and pursue large scale amnesties for those who can demonstrate a capacity to cease their activities and who are willing to contemplate a career or lifestyle change.

Negotiated outcomes indeed have been applied at the respectable, 'white collar' end of the drug market, as internationally, some banks have been spared the prospect of prosecution for laundering drug cartel money in return for paying substantial fines and issuing apologies. Such developments undermine laws that criminalise possession and underscore the validity of claims that certain corporate entities are too big to fail, too big to prosecute.

While marginalised young people face further ostracization and the prospect of jail for carrying relatively small drug supplies, the owners of large corporations, such as the pharmaceutical companies that fuelled the USA’s opioid crisis, get to negotiate alternative compromises for their criminal activities. How big, one wonders, how respectable, must drug dealers become before sensible, realistic aims are pursued?

Most governments, often because they fear the backlash from perceived conservative societal attitudes, as well as vested interests, are slow to address and lead out on the pragmatic debates required to get on top of the drug issue, as indeed, previously, successive Irish governments failed to lead out on debating other issues in which individual behaviours and individuals’ health were at stake.

In this regard, it is noteworthy that the significant 2013 pioneering change in Uruguayan policy on cannabis did not happen because of popular demand, but despite it. The unrelenting damage caused to individuals, families, communities and society requires a major change of governmental attitude to say enough is enough and that society will no longer be held hostage to this futile and destructive mindset.

Comprehensive pragmatic solutions, however, will inevitably require wider global support and agreement, especially as issues of legality are tied up with a succession of international laws, which are often referred to as 'unchangeable' laws. What would be the point indeed of making drug production for domestic consumption legal in a producer country — as proposed by some governments — if vast illegal supplies are still required in a consumption country, where such drugs remain prohibited?

CHANGING THE UNCHANGEABLE

Debate of course starts at home, which is one if the reasons the work of the Assembly is so important. Irish society is not like it was forty-five years ago when the problem of heroin was first manifested in poor communities: when condoms could be bought but ludicrously, only through pharmacies on prescriptions issued for bona fide family planning purposes, when divorce was prohibited, when abortion was a crime and exported to the UK, when homosexual behaviour between consenting males was legally disallowed, when the tsunami of revelations of child sex abuse in families, institutions and in other places was yet to be unleashed, and when the first Pope to step on Irish soil received a whole-of-society turnout and tumultuous welcome, in sharp contrast to a successor’s lukewarm reception, almost 40 years later.

Times have changed; people have over four decades experience of the drug problem behind them either directly or through their parents and grandparents, and they have debated, protested and changed other things. People can have a mature debate about drugs and alcohol, and they should be facilitated and helped to get on with it, to bring common sense to the debate — to make the so-called ‘unchangeable’ laws changeable.

 

ENDS/……