Ireland
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Legalising drugs will increase their use, Chief Medical Officer tells Citizens' Assembly

Legalising drugs will expand access to them, make drug use more normalised and increase drug use, the Chief Medical Officer has warned.

The view of Professor Breda Smyth was contradicted by Professor Catherine Comiskey of Trinity College, who said the EU drugs agency had examined the laws of European countries and found “no difference” or “no pattern” between a legal system and drug use.

They were both speaking at the fifth and penultimate meeting of the Citizens’ Assembly on Drugs, which this weekend is examining the role of prevention.

Prof Smyth, CMO at the Department of Health, said drug use was implicated in 409 deaths in 2020, 53,000 inpatient bed days and 200 day cases in hospitals.

She said one in five adults that use cannabis were likely to be dependent and that one in three young people were likely to become addicted if they use cannabis weekly or more often.

She said that 45,000 people in Ireland had cannabis use disorders and that almost half of those in treatment in 2022 were parents.

She said a key influencer in drug use was people’s “environment”, whether it was in the home or the community.

Chief Medical Officer, Professor Breda Smyth pointed to Canadian studies that showed legalisation led to increased drug use.
Chief Medical Officer, Professor Breda Smyth pointed to Canadian studies that showed legalisation led to increased drug use.

“Legalising a drug and increasing its access is a form of normalisation and will change the perception of normality," Prof Smyth said. "It decreases the perception of risk associated with drug use. So, legalisation will increase use and the normalisation of drug use.” 

She cited research from Ontario, Canada, where cannabis has been legalised, which, she said, found the prevalence of cannabis use had increased. She said there was a trend towards more daily use and a significant increase in cannabis-related problems, including emergency admissions.

No difference

Prof Comiskey, who is vice-chair of the scientific committee of the European Monitoring Centre for Drugs and Drug Addiction (Emcdda), said that a paper produced by the agency this year “found no difference” between laws on drugs and use of drugs.

She said,

“It found no pattern, it [the laws] doesn’t actually affect drug use.”

She said that “decriminalisation wasn’t the only answer” and that the top three priorities for her were to tackle stigma of drug use, have progressive policies and rely on independent research.

She encouraged the 99 assembly members to “be brave” when it comes to the legal reforms they recommend.

Prof Comiskey said that protective factors against early drug and alcohol use were a positive school environment, positive leisure time and structured evening activities, including participation in sport.

She said adverse childhood experiences (ACE) impact on drug use, with the biggest factor “feeling unloved”.

Professor Catherine Comiskey said that a paper produced by Emcdda  “found no difference” between laws on drugs and use of drugs.
Professor Catherine Comiskey said that a paper produced by Emcdda  “found no difference” between laws on drugs and use of drugs.

After this, the other most important experiences were: family members swearing at you, putting you down; living with a problem drinker/street drug user; being pushed/slapped/grabbed or having something thrown at you; living with a family member who is depressed or with a mental illness.

Adverse childhood experiences

Professor Mary Cannon, a consultant psychiatrist, said that people with more than three ACEs have a 10-fold greater risk of drug use. She said society’s focus should be on “driving down risk factors and enhancing protective factors”.

She said she was “riveted” by the record cocaine seizure in Irish waters this week and that while countries “cannot stop supply” they can “take the handle off the pump” and reduce demand.

She said it was a complex problem and said the assembly had a “mammoth task” ahead of them.

Prof Cannon described the Emcdda report as “interesting” but said it conflated all the age groups. She said analysis of young people indicated that legalisation “does have an effect” and that it was likely that a more lenient legal framework would increase use in the young.

She also cautioned against “conflating” tackling stigma and changing the law.

Professor Mary Cannon a consultant psychiatrist, said that people with more than three ACEs have a 10-fold greater risk of drug use, and cautioned against “conflating” tackling stigma and changing the law.
Professor Mary Cannon a consultant psychiatrist, said that people with more than three ACEs have a 10-fold greater risk of drug use, and cautioned against “conflating” tackling stigma and changing the law.

She said she was supporting a campaign to reduce the significant stigma around mental health, but pointed out that mental illness was not a crime.

Handling the crime

Professor Denis Cusack, director of the Medical Bureau of Road Safety and coroner, asked assembly members if they thought people with drug problems should be punished and to ask if something that is currently a crime could be handled differently.

He said that if resources are not there to implement their recommendations, their report will end up in the same way as many other reports.

Asked by members about what type of public health policy to adopt, Prof Smyth said the covid-19 public health campaigns worked and that they were trying to build on that.

But she said, unlike covid, there was “no simple message” with drugs.

She said any public health message about drugs needs to “meet people where they are” and, for young people, it needs to be on social media with the right visuals and clear language.

Prof Comiskey said that young people are going to experiment and use drugs and that “harm reduction” messages should be part of any public health campaigns.