ON THE SAME day that Jennifer Murnane O’Connor, Minister of State for Public Health, Wellbeing and the National Drugs Strategy, opens a collaborative process focused on planning and delivering drug services, the Joint Committee on Drug Use (JCODU) has published its final report.
It sets out 161 recommendations advising the government on how to address drug use, addiction and associated harms. As I prepare to engage in the minister’s collaborative process and reflect on the report’s key messages, I am optimistic about the sentiments being echoed by both the Department of Health and the JCODU. At the same time, I feel an unease that we will move too far away from our partners in justice and, unintentionally, lose valuable opportunities for people who are struggling to engage and recover.
Informed by the recommendations of the Citizens’ Assembly on Drug Use, the overarching message of the JCODU report is the strong recommendation to address personal possession of drug use solely by offering voluntary health supports to any person who comes to the attention of gardaí for being in possession of illicit drugs for personal use.
The report also outlines detailed recommendations focused on harm reduction, geographical equity in service provision and improving our prevention strategies. A similar and clear commitment to a health-led approach to drug use is reflected in Ireland’s draft National Drugs Strategy, which builds on the approach first established in the 2017–2025 strategy, Reducing Harm, Supporting Recovery (Reducing Harm, Supporting Recovery 2017-2025).
It is even more heartening to know that many initiatives recommended in the report are already in action, such as the delivery of tailored programmes to serve women in addiction, the LGBTQ+ community and Ireland’s new communities, and an emerging drug trends response led by the HSE National Social Inclusion Office.
Recovery – we must be ambitious
While the JCODU report champions recovery and places it as a central tenet of the response to addiction, its depiction of recovery falls significantly short of what we should be aiming for.
For years, the addiction sector has been hampered by the concern that, by focusing on an ambitious and life-changing vision of recovery for those who seek our help, we will leave others behind. As a leader of a harm reduction organisation, I have proudly watched harm reduction evolve, improve and become mainstream in the last two decades.
While services can always develop and expand, it is more than evident that the government wholeheartedly supports the harm reduction approach. It has been the dominant approach since the response to drug use commenced over four decades ago.
The JCODU report is correct in saying that recovery is a spectrum and does not always need to be synonymous with sobriety. However, it comes dangerously close to watering recovery down, reducing it to being another step in a treatment plan. In reality, recovery is a journey, not an end point. It is a transformational experience that flourishes in peer relationships, in empowered communities and in people being given real opportunities outside of the treatment system.
We cannot lower our hopes and ambitions for our service users by reframing recovery as being less at risk than they were before receiving an addiction intervention. Medically assisted recovery, where a person remains on opioid substitute therapies to manage their addiction and live fulfilled and wonderful lives, abstinence-based recovery and recovery characterised as a person leading a healthy, integrated and hopeful life… these are all the lives we should strive to help anyone in addiction to achieve.
In my 19 years of working in a harm reduction organisation, I have never met a single service user who has not wanted some form of recovery and has not pleaded with us to help them get there. I am surrounded by recovery every day. It is life-changing, inspiring and exceptionally good for society. Evidence tells us that those in recovery contribute back to society more than citizens who never had an addiction do.
For too long, the addiction system has been so focused on saving lives, treating problems and making sure everyone is safe, that we have lost sight of the bigger picture – making life-changing recovery possible and accessible for everyone.
We have been fighting fires. We have been doing our best. And as a consequence, perhaps we have lowered the bar of what success looks like. Saving lives through harm reduction strategies is essential. But it’s not enough. Our draft National Drug Strategy recognises this, and plans for the type of recovery you would want your loved one to experience if they came to Ana Liffey for help.
Justice partners – a pathway to support
Moving towards a health-led approach to drug use naturally means that people who use drugs and need either information, intervention or intense supports will less frequently, or potentially never, come into contact with justice structures. They will be more likely to engage with health structures. This is an undeniably positive move for individuals and society. However, the positive models of collaboration between health and justice partners, which are currently benefiting people who use drugs in Ireland, must not be lost in the move.
The JCODU is clear in its recommendation that the Drug Treatment Court programme be supported to roll out nationally. This court-supervised treatment programme, led by Judge Karen Dowling, is an example of positive collaboration between justice, health and Drug Court participants to divert their lives away from crime and into recovery. So too is the Law Engagement Assisted Recovery model operated by our teams in Ana Liffey, which enables our frontline addiction workers and An Garda Siochána to co-work cases collaboratively, offering those entrenched in crime and addiction a voluntary support programme, again aimed at diverting them from prison and into their recovery.
There are many more models operating successfully between justice and health nationally and globally, operating as part of the Law Enforcement and Public Health (LEPH) movement. All of these models are able to engage and support vulnerable people because they came into contact, multiple times, with criminal justice structures. As our approach in Ireland evolves, we must be cautious not to make it harder for those in entrenched addiction and criminality to avail of these bespoke supports and, potentially, become lost in an overburdened health system.
A whole-of-government approach is urgently required
The JOCD report, and the composition of the committee itself, highlight a key, significant shift which is acutely required to push Ireland forward in addressing drug use – a cohesive whole-of-government approach.
A meaningful cross-government commitment to prevention, treatment and recovery is an urgent priority.
In order to reduce the prevalence of social determinants of drug use – such as poverty, and intergenerational exposure to harmful substance use and trauma, government policies even wider than the National Drug Strategy must be aligned and focused on the reduction of drug use and associated harms.
Dawn Russell is the CEO of Ana Liffey, a charity working across Dublin, Midwest and Louth to support people experiencing social harms such as addiction, homelessness and criminal activity. Dawn began her career as a frontline addiction worker in 2007 working through the principles of Harm Reduction. Since then, Dawn has completed a Masters in Addiction Recovery and is now a PhD candidate in Trinity College Dublin researching recovery capital.