Apologies have been received from Deputies Devine and Sherlock.

I welcome everyone. I am delighted to open the 15th public meeting of the joint committee. This is our third and final session on treatment, recovery and rehabilitation. I welcome our witnesses. From the Scottish Drugs Forum, SDF, I welcome Ms Kirsten Horsburgh, CEO. From Turas Counselling, I welcome Ms Nicki Jordan, manager, Mr. Alan Duff, clinical manager, and Mr. Peter McKevitt, chairperson of the board of management. From the European Network of People who Use Drugs, EuroNPUD, I welcome Mx. Leo Jefferys, acting executive director, and Dr. Richard Healy, board secretary. Dr. Healy is also the lead researcher with Service Users Rights in Action, SURIA. From the Drug Treatment Court, I welcome Ms Nina Brennan, assistant secretary, head of Circuit Court and District Court operations, and Ms Fiona Wright, principal officer, head of the Dublin civil and family law combined office. They are all very welcome.

I remind witnesses and members of the long-standing parliamentary practice that they should not criticise or make charges against any person or entity by name or in such a way as to make him, her or it identifiable or otherwise engage in speech that might be regarded as damaging to the good name of the person or entity. Therefore, if their statements are potentially defamatory in relation to an identifiable person or entity, they will be directed to discontinue their remarks. It is imperative that they comply with any such direction.

I remind members of the constitutional requirement that in order to participate in public meetings, members must be physically present within the confines of the Leinster House complex. Members of the committee attending remotely must do so from within the precincts of Leinster House. This is due to the constitutional requirement that in order to participate in public meetings, members must be physically present within the confines of the place where the Parliament has chosen to sit.

All opening statements have been circulated among members and will be published on the Oireachtas website after this session. As agreed, all witnesses will have five minutes in which to deliver their opening statements to allow plenty of time for questions from the members.

I am conscious that a wide range of issues will be discussed today. If necessary, further or more detailed information can be sent to the clerk for circulation among members.

Members will be in and out of the committee room over the course of the day, so witnesses should not read more into that.

I invite Ms Kirsten Horsburgh to deliver her opening statement on behalf of the Scottish Drugs Forum. She is joining us remotely. She is very welcome and has five minutes.

I thank the committee for the invitation to speak today. I apologise that I could not be there in person. Regardless, it is a genuine privilege to be contributing, particularly because the conversations happening in Ireland and Scotland often feel closely connected.

SDF is the national, membership-based organisation working to improve Scotland’s approach to drug-related issues. We influence this by striving for compassionate, inclusive, evidence-informed policy and practice. We are grappling with many of the same challenges: deeply concerning levels of drug-related deaths and harms and an urgent need to build systems that genuinely improve people’s lives. Last year, we were grateful to colleagues from Ireland who came to Scotland to speak at our conference. Those exchanges matter because they remind us that none of us are starting from scratch, and none of us should be making these decisions in isolation.

Scotland faces the highest drug-related death rate in Europe. It is no exaggeration to describe this as a preventable humanitarian disaster. While the context is specific, many of the pressures will feel familiar here: poverty, trauma, inequality and long-standing gaps in treatment and support, all compounded by drug laws that are outdated, restrictive and misaligned with a public health approach.

Scotland is often described as progressive in its approach to drugs policy, and in some respects that is fair. We have made important progress in treatment, particularly through the introduction of medication-assisted treatment standards. These standards represent a shift toward person-centred care – faster access, continuity, choice and dignity – and they are helping to move services away from punitive and overly conditional models.

We have also expanded the use of long-acting injectable buprenorphine, and SDF's peer-led research in Scotland is already showing positive experiences for people. This matters because choices for people with opioid dependence are still relatively limited, and additions like this can make a real difference for individuals, while being clear that no single medication is a solution on its own. Methadone, buprenorphine in all its forms, and other options must all remain on the table, with treatment and wider supports shaped around the person, not the drug.

One of the key lessons from Scotland is that having the right policy direction is not the same as delivering real change. Implementation has been uneven, and access still varies significantly depending on where someone lives. We also remain too focused on specific substances, particularly opioids, when the reality for many people is complex, overlapping use involving benzodiazepines, stimulants, alcohol and a range of other substances.

This brings me to one of the most persistent tensions in Scotland, namely, the debate between harm reduction and abstinence-based recovery. There are strong voices advocating for abstinence-based residential rehabilitation as the primary response to drug harms. Residential rehabilitation absolutely has a place, and for some people it can be transformative. The message here is not that abstinence is wrong but that choice matters. Effective systems recognise that people require different forms of support, whether harm reduction, stabilisation, residential rehabilitation or, commonly, a combination of these over time.

It is also important to consider how we talk about recovery. Too often, it is framed as something that begins only after substance use has stopped, or it is tied to the idea that treatment should always end. However, recovery is far broader than that. It is personal, ongoing and shaped by environment, connection, housing, hope and dignity.

At SDF we honour all forms of positive change and the communities that make it possible, whether that is through harm reduction, abstinence or simply creating spaces where people feel they belong.

Systems that force people into a single pathway, based on ideology rather than need, inevitably exclude those most at risk. The same applies to treatment innovation. Scotland has one heroin-assisted treatment programme, based in Glasgow. It has shown clear benefits for a small group of people. However, one service in one city is not equity. If we are serious about treatment choice, then options like heroin-assisted treatment must be available based on need, not postcode.

This is a broader pattern in Scotland. Many interventions that other countries might aspire to do exist, but at limited scale, after long delays and without consistent national access. Safer consumption facilities, drug checking, stabilisation services and specialist prescribing all fall into this category. Successful drug policy must be holistic and human centred. People do not experience problematic substance use separately from housing insecurity, mental ill health, trauma or poverty. Too often, though, systems are designed around substances, thresholds and service boundaries rather than people’s lives. Scotland has produced numerous task forces, strategies and reports, often all saying the same things. What has been missing is urgency, long-term commitment beyond political cycles, and the courage to implement evidence at scale. Ireland has a real opportunity to learn from both Scotland’s progress and its mistakes.

In our manifesto at SDF, we have some key asks that are relevant to this discussion. Evidence-based harm reduction should be expanded, including safer injecting and inhalation spaces, drug checking, naloxone, and flexible treatment that adapts to changing drug trends. Put people and rights first, embedding lived and living experience in decision-making and actively tackling stigma at every level. Support the workforce by ending short-term funding and prioritising staff well-being, retention and effective supervision. Commit to long-term prevention, with cross-Government action that tackles inequality and treats people who use substances as part of every policy area. Finally, decriminalise people, shifting from punishment to health-led responses that save lives and reduce harm. The exchanges between our two countries show how powerful shared learning can be. If Scotland’s experience teaches anything, it is that good intentions are not enough. Systems must work for people as they are, not as we may wish them to be.

I thank the committee for the invitation to be here today. I am presenting on behalf of Turas. We are a community-based addiction organisation in Dundalk. We have been operating for around 20 years and currently support approximately 500 individuals each year. Our successful services include key working, group supports, recovery capital, a gambling specific programme, a GP-led community alcohol detox, and participation in the Louth drug court. We also run an innovative social care pathway for people with co-occurring addiction and mental health difficulties, delivered in collaboration with our local mental health team, which is funded by the HSE. More recently, we have been one of six organisations in Ireland involved in a EU-funded cross-Border project to do with digital transformation in addiction services with a specific focus on dual diagnosis. That is a recent addition.

In Turas, we understand addiction as primarily a survival response to trauma, particularly developmental trauma. For many people, substance use has functioned as a way of coping with overwhelming or intolerable life circumstances. While substances may initially offer relief or escape, the relief is short-lived and comes at significant personal, social and health costs. This understanding informs our trauma-informed and person-centred approach.

I will focus on a few things that are working well, what our challenges are and then make a few recommendations. Obviously, the whole area of treatment rehabilitation and recovery is broad. We have a skilled and experienced workforce. Thankfully, we benefit from a highly skilled, motivated, well-educated and stable staff team. Many staff members have worked in addiction services for decades and they bring exceptional clinical and community knowledge. We actively promote continuous professional development, including training in areas such as eye movement desensitisation and reprocessing, EMDR, trauma-informed practice and any new and emerging interventions we think would be helpful. We will always try something. We place a strong emphasis on staff well-being, manageable caseloads and recognising that burnout is very much a reality.

Regarding responsiveness and local flexibility, we are a small, community-embedded service. We can be highly responsive to emerging trends and local drug patterns and we are able to collaborate with other partners. We see issues as they present at our door and we can adapt quickly. We can pilot new initiatives by just saying "Yes" to trying them. This allows services to develop organically without excessive layers of decision-making. This flexibility is a key strength of the community sector in general and is the path that many of our own services would have taken. We offer a continuum of care and offer services to people when they are in active addiction. People present at different stages. Individuals arrive in the midst of active addiction, receive motivational support and move into a day programme. Later, they can engage in counselling where they can explore the underlying roots of their addiction. Importantly, we do not cap the number of counselling sessions, which allows people to engage in meaningful therapeutic work. Alongside this, our recovery capital programme supports people to build social connection, purpose and community. These programmes often remain a source of support long after formal treatment ends. In our experience, therapy alone is not sufficient for people to sustain recovery. There needs to be far more than that.

We have been approved for a drug rehabilitation community employment, CE, scheme but our building is just so full at the moment that we cannot take anything more on. We have recently started to train in somatic experiencing, which is a trauma-informed nervous system response, because we are increasingly seeing that people in addiction live in a chronic state of fight, flight or freeze and have limited access to a felt sense of safety. We have begun integrating somatic and nervous system-informed approaches, working with a consultant, and are now considering a pilot programme to help people with cocaine addiction. Cocaine has become a significant and growing issue and we believe a body-based approach could be very helpful to deal with the specific impact cocaine has on the brain.

At the core of effective harm reduction, recovery and rehabilitation is that people feel valued, accepted and safe. Recovery is not linear; setbacks are part of the process. The most important intervention is consistent, non-judgmental engagement, which involves being there when people struggle, rather than withdrawing support. To do this well, services need strong leadership and governance, financial stability, safe and welcoming spaces, well-trained and supported staff, and national policy that clearly frames addiction as a health issue, not a criminal one.

To look at some of the challenges, there are obviously many and I am just focusing on these. Funding-----

If Ms Jordan gives us the headings, we will come back in and she can explore them further. We are a little bit over time.

No problem. Funding is obviously a major issue, with funding being received at the end of the year to be spent in three months. If we could get that earlier on, we could at least be more strategic about it. The governance and administrative burden is probably well documented already. I mentioned that workforce sustainability needed to be prioritised in national policy because staff well-being should be at the core of any work in this area. There is also the increasing complexity of addiction. Very few people nowadays present with one addiction. They will either drink and then take cocaine or they will take cocaine and then will start gambling. It may not be clear-cut.

Some suggested recommendations would be to value and protect-----

I am sorry, but we are a minute over. I promise Ms Jordan that she will have a whole load more time. I want to make sure we get all the witnesses in but I will get her back in. I understand Leo Jefferys and Dr. Richard Healy will be sharing time. They can take it away.

Gabhaim buíochas le members of the committee for having us to speak to them today. My name is Leo Jefferys and I work with EuroNPUD. EuroNPUD is the regional network advocating for the health and human rights of people who use drugs in Europe and its neighbouring countries. Drug user rights, self-determination, harm reduction, safer drug use, the right of individuals to take drugs, an end to prohibition, and equality are our network principles.

Self-determination speaks to representation; people with the most recent and relevant experience of an issue determining the policy on that issue. This means engaging people with living experience, namely, people who use drugs, as opposed to people with lived experience, namely, people who have used drugs but no longer do. Initiatives such as wastewater analysis and back-of-house drug checking mean we spend hundreds of thousands of euro to find out information too late to react meaningfully. In order to properly respond and advocate for our communities, policymakers, service providers and people who use drugs need the most recent and relevant experiential knowledge of drug issues. According to the 2024 and 2025 data from the Health Research Board, HRB, and the European Union Drugs Agency, EUDA, cocaine and crack cocaine are some of the widest used illicit substances in the country, yet we hear no discussions of stimulant agonist treatment, nor any consultation with people who are in active use of cocaine or crack cocaine on the new drugs strategy.

Recent cuts to funding and rising populist approaches have resulted in a threat to the existence of harm reduction globally. We must not see harm reduction abandoned in favour of abstinence-based recovery as the only treatment option. We must not prioritise people with lived experience over those with living experience, nor silo one from the other. We must look at full-spectrum harm reduction.

In 2007, the conservative government of Canada at the time removed harm reduction from the national drug strategy. I do not need to explain what is happening there currently with the toxic drug poisoning. We all know by now how history easily repeats itself if we do not learn from it. People who use drugs are full rights-bearing citizens, not criminals, not sick and not sad, but full human beings capable of their own initiative, integrity and intelligence.

I leave members with two asks: that the upcoming national drug strategy will include the traditional pillars of drug policy, including harm reduction, and that the development of the strategy currently under way will include a consultation with people with the most recent and relevant experience of crack cocaine use. Policymakers must be brave and inclusive. I thank the committee again and reiterate our willingness to work with it. I would like to pass to my colleague, Dr. Richard Healy, EuroNPUD board secretary and member of Service Users Rights in Action, SURIA.

I have been a member of EuroNPUD since 2021 and most of my work is predicated on opioid substitution treatment, OST, so methadone use. I wish to clarify what our ethos and values are at EuroNPUD. We do not advocate that drug use is always a rational decision that all should take nor that this can become problematic for individuals, families and communities. Rather, we believe that choice is central, safe supplies essential and that all adults should be sovereign over their own decision to use drugs, have choice in how to maintain their drug use or lack thereof, and that many service models are in need of radical overhaul to meet the complex, continuously evolving needs of the contemporary person who uses drugs.

We are here to discuss treatment and recovery today. The very essence of recovery in Ireland is firmly established. It is usually underpinned by total abstinence, self-denial of identity and, in the case of opioids, frequently follows the traditional route of OST, for which methadone is the principal medication prescribed. The stark choice, if one could call it that, is methadone clinics, CE schemes or medium- to long-term residential care. Many of these are well intentioned and work for a minority of clients. However, tangible success measured and quantified by quality of life is rare. OST, much maligned and stigmatised in Ireland, is arguably considered to be the hegemonic response to problematic opioid use. Current HSE estimates stipulate that over there are approximately 11,000 to 12,000 methadone clients in Ireland, the majority based in Dublin and the immediate surrounding areas.

To give some of the demographics of the contemporary OST client, based on data taken from our own SURIA research: 66% or two thirds are aged over 35 years; 49% or almost half are engaging with OST for more than ten years; one fifth have used MMT for over 20 years and one in ten for over 26 years; and 83% are not engaging in education or employment. It is important to note that I am not critiquing the amount of time service users spend on methadone. What I am critiquing is that people get trapped in these long-term settings where there is low quality of life and poor reintegration, or we could say integration, as some of the people have never been integrated into contemporary society. SURIA research has consistently captured a life in which vulnerable people are regularly dehumanised, disempowered and forgotten by stakeholders who are responsible for their care. As Irish harm reduction services still fall short of the realisation of the highest attainable level of healthcare, our public health sector continues to hurt, punish and blame many service users who are homeless, have experienced trauma and struggle to navigate a world of frenetic competition in a cost-of-living crisis. To continue to do so casts a dark shadow over Irish society. For SURIA and EuroNPUD, the Citizens' Assembly on Drug Use in Ireland will be considered a failure if the pride of the Irish methadone service user continues to be overlooked.

Again, I thank the committee for inviting Mx. Jefferys and me here today. Given the extent of the issue, we urge members to consider the evidence-based points we may have. We will be happy to answer any questions members have, following any remaining contributions. Sorry, it was really difficult to get that into 2.5 minutes.

I thank the committee for the invitation to this meeting to discuss the Drug Treatment Court in Dublin in the context of its module on treatment, recovery and rehabilitation. I am the head of the Circuit and District Court Operations in the Courts Service. I am joined by my colleague, Ms Fiona Wright, principal officer and head of the Dublin Combined Court Office. Responsibility for the operation of the Drug Treatment Court comes under our remit.

The Drug Treatment Court is presided over by a District Court judge, currently Judge Patricia McNamara. As members are aware, the administration of justice is a matter for the Judiciary. In accordance with the constitutional independence of the Judiciary and the provisions of the Courts Service Act, the administration of justice is not a function of the Courts Service. The Courts Service is responsible for the management and administration of the courts. This means I am precluded from commenting on any matter relating to the exercise by a judge of his or her judicial functions. I am also precluded from commenting on matters of Government policy.

The Drug Treatment Court began its work in 2001 as an innovative pilot programme offering participants an alternative to custodial sentences. It provides supervised treatment, education and rehabilitation. The Courts Service provides some useful information on the Drug Treatment Court on our website courts.ie. Today, I want to share some insights into the Drug Treatment Court. The justice sector is increasingly recognising that traditional, punitive measures are ineffective for individuals struggling with substance abuse. Instead, a more trauma-informed supportive approach, like the Drug Treatment Court, aims to address their needs and encourage rehabilitation. This alternative framework emphasises that engagement with the criminal justice system can provide pathways to recovery, education and health services, fostering hope for individuals and their families. The Drug Treatment Court has shown us that addressing drivers of criminal behaviour, such as substance abuse, can lead to transformative change. What we see is not just an individual facing charges but a complex story of struggle, where the individual has had many challenges in life which have led them to being brought before the courts. The support and guidance provided encourage participants to write a new chapter in their lives.

One of the notable aspects is its multidisciplinary approach. We have been fortunate to have a dedicated team led by presiding judges. Each has shown imagination and an interest in finding out about people taking part in the programme and what constitutes success for them. Our team is made up of the Health Service Executive, An Garda Síochána, the Probation Service, the City of Dublin Education and Training Board and ourselves, the Courts Service. By meeting weekly to discuss each participant’s progress, we reduce fragmentation and maintain a collaborative focus on treatment goals, whether it is reducing drug use, pursuing education or improving housing stability. Our team has recently been joined by the Anna Liffey project, funded by the Department of Health, which offers additional support on site and assists with securing treatment for participants on the programme.

Individuals referred from other Dublin District Courts are assessed for their suitability for the programme. Participants engage in a structured treatment plan that progresses through three phases, bronze, silver and gold, with the goal of lasting change over 18 to 24 months. This journey begins with eliminating their primary substance use and engaging in educational or training programmes. Each phase builds on the last, encouraging participants to make prosocial choices and empowering them to work towards sustainable, drug-free lives. Our programme is designed to be supportive and incentivising, recognising that everyone’s journey is different and often complicated. We understand that success is subjective. Progress might mean reducing heroin use to cannabis use for one person, while for another it could mean achieving QQI certificates in maths or computer literacy through our education programme.

Our goal is not just to avoid incarceration but to foster a sense of responsibility, accountability and trust between participants and the court. This approach helps participants to understand that they are not defined by their offences. They are individuals facing complex challenges but they have potential to change. Our insight from the ground is that the programme works for those who take part in it. They can have many positive experiences and outcomes. We look forward to working with our partners to implement any relevant recommendations arising out of the recent review conducted by the Department of Justice, Home Affairs and Migration. This review was one of the actions arising from the mid-term review of the national drugs strategy, Reducing Harm, Supporting Recovery 2017-2025.

The Drug Treatment Court represents a compassionate and effective alternative within our justice system. It empowers individuals to take charge of their lives, reconnect with their families and reintegrate into their communities. Led by our judge and with the agencies working together, we are making a meaningful difference in the lives of those we serve. I thank members for their time. I am happy to answer any questions they may have. Some members of the committee visited the Drug Treatment Court yesterday. We can also extend that invitation to anybody who did not have the opportunity to come.

On behalf of the committee I thank Ms Brennan for extending the invitation yesterday. I know that the members who were present had a really worthwhile experience. I am sure she will hear about that shortly. We now move to members.

Apologies for having to leave in the room. There was a vote in the Chamber on residential tenancies which is not actually too far from some of the conversations I will be having in relation to drugs policy and how we treat people who use drugs.

I do not know how many people have had time to read the draft national drugs strategy. It was published only recently. The draft, which will go for public consultation, removes recovery from the continuum of care and sets it apart as a stand-alone pillar. Some might ask why we should not do that, saying recovery is great and that it is what we are all aiming for. To me, this is a misconception. It fails to understand that recovery incorporates all parts of the continuum of care. We risk doing a disservice to many services that are harm reduction led, preventative or interventionist, whatever it may be. We have noted the gutting of harm-reduction services in the US if they are not recovery led, and this is really affecting people’s access to safe supply, for example. There are now executive orders and people have to be forced into treatment. A service engaging in harm reduction provision has to report it, because those engaging with it may be involved in illegal activity because they are buying an illegal substance. My concerns arise from asking what is happening in the conversation elsewhere in the world and how we can ensure we stay on top of things here.

I am aware of the recovery agenda in Scotland, which I believe is called The Road to Recovery. Could Ms Horsburgh refer to how it is working in Scotland and its impact? Maybe Mx. Jefferys or Dr. Healy could speak to what recovery is and why it is important that we ensure the continuum of care is really protected within our own national drugs strategy. That is an open question, so I will leave it to the witnesses to answer in the way they want.

I thank the Senator very much for the question. The 2008 strategy in Scotland was The Road to Recovery. At that time, I was working as a mental health nurse in drug treatment services and I remember specifically the switch towards abstinence-focused work with people attending our services. National policy can really direct the way services operate because it determines where resources should be directed. This can be particularly problematic when we say any one approach is the right step to take. We should never be telling people what they should be doing about their drug use.

Our vision is to work with people on the goals they see as most important for them. We have moved away from the strategy. In the recent national mission on drugs in Scotland, which is now concluding its fifth year, there has been much more of a focus on an holistic, whole-person approach. It has had harm reduction at its core, which has been extremely positive, but it also recognises abstinence-based models as part of the whole picture for the person. Focusing on any one approach is dangerous for strategy and for how funding streams are then applied. It is also dangerous because of the messages services give to people in their care, because ultimately what happens is that conversations are more directed towards one particular route. In 2008, the route was towards a drug-free society. Having to work with people with that in mind is very damaging to a therapeutic relationship in which you are trying to work with a person.

I thank Ms Horsburgh. I did not want to leave the issue hanging. My next point is for Mx. Jefferys. I am specifically talking about the idea of recovery focusing on a type of drug or drug user rather than gaining an holistic societal picture of people’s lives and what they need to improve their situations.

I echo what Ms Horsburgh was saying. Abstinence-based recovery must be seen as one part of a multi-tier approach to the improvement of quality of life, including the understanding that some citizens may not or may never be substance free. We also have to look at the drivers that affect people, such as poverty and housing, with a view to improvements in that regard and people who use drugs having access to services that respect their right and are informed by the idea of health being determined by the people accessing services.

Harm reduction cannot be lost as a pillar of our drugs strategy and approach. We fought for a very long time in this country for needle syringe programmes, safer injecting, naloxone access, opiate agonist treatment, safer inhalation devices and, most recently, supervised injection sites. We have seen how quickly these can be taken away, so we have to keep harm reduction at our core and continue to fight for it.

The reason I made my point is that the draft strategy speaks to those things. Instead of referring to safe injection facilities, it should refer to consumption sites. We should not refer to safe injection facilities as stand-alone things in our new strategy. I am worried that separating things out now sets a warning tone for the future. Even though we might still be talking about harm reduction, if recovery is a pillar in its own right, it is as if it is a destination separate from all the other elements. While I wish to put on the record that the strategy mentions harm reduction, it is a slippery slope to start pulling the elements apart.

I agree with my two colleagues. We have to ask ourselves what recovery means, and we also need to unpack the common assumption that all drug users are the same and require the same treatment models. In Ireland, we ostensibly have a health-led approach to drug use that is underpinned by harm reduction. I do not believe we are using harm reduction properly in Ireland. It was introduced in the Rabbitte report of 1996, if I remember correctly. I still do not believe we are doing it properly. If you go to a clinic or on to opioid substitution therapy, it is all based on abstinence and the test. If the test shows a person to be drug free or, to use the language used by the clinic, clean rather than dirty, it is called rehabilitation. I would not call it rehabilitation. I would call it coercive confinement or a model of control, all based on achieving abstinence and nothing else.

Do I believe recovery should be set out separately? Potentially, yes. When we look at the raw statistics, we see that at any given time, one in 12 will achieve lifelong recovery. When dealing with statistics like that, we have to consider the 11 who will not achieve lifelong recovery. We should still have recovery avenues for people who want to take them, but we must not send everyone down those avenues. I heard Senator Ruane saying before that we cannot arrest our way out of this problem. We cannot shove people into rehabilitation to find a way out of this problem either. We need to address the complex needs of people in different ways and respond to changing trends in drug use and patterns. A really good example is the crack cocaine epidemic right now. We were not ready for it and do not know what to do.

The witnesses are all very welcome. I want to pick up on what Senator Ruane said and what Dr. Healy just said about crack cocaine. Research from British Columbia shows that stimulant agonist therapy improved stability and functionality and reduced illicit use, even where abstinence was not achieved. That research questions whether abstinence-based randomised controlled trial outcomes accurately measure what works from the user’s perspective. Do the witnesses believe our model in Ireland is too focused on abstinence rather than quality of life? As they said, what might work for me would be abstinence and what might work for someone else could be reducing use, or maybe switching from heroin to cannabis. That might be their path to recovery. Is the model too abstinence focused? It was touched on that recovery is apparently the end goal for everybody, but that does not always work.

I would not say it is too abstinence focused but that it is only abstinence focused in most cases. There are a few good examples of harm reduction in Ireland, but as you go further into the journey, it all points towards total abstinence and no alternatives, at least according to my experience. I was sent to a well-known rehabilitation centre at the age of 19. I was dipping my toe into drug use. I am giving some lived experience. I spoke to a few guys who had been in the centre for a long time. I remember speaking to one guy who said he had been on drugs for a certain number of years. He said he had been in the centre for six months and did not think he would ever take drugs again. My answer, in my head, was that I hoped that would not happen to me. I was not ready. We do not have the resources to send to these places people who are not ready, but we do of course have to have avenues into them if people decide to take those. I would not say we are too focused on abstinence but that it is all we focus on.

Peer-to-peer naloxone models have been shown to have increased reach and saturation as take-home naloxone, particularly in hidden populations. We know that exists.

What are the barriers in law or in practice that prevent Ireland from scaling peer-to-peer model or even having it properly?

The current legislation around naloxone could very much be pushed to change by the Irish State. I know there are EU laws that govern medications but each state has an impetus to change to the legislation. In Italy and France naloxone can be dispensed over the counter. Other European states are implementing this and we could easily move towards that. The new national drugs strategy talks about widening access but we need that done in a timely manner and the same with peer-to-peer distribution. The privileged access of peer distribution cannot be understated when it comes to these types of lifesaving medications.

Absolutely. As we have repeatedly seen, if strategies, especially on drug use, are not enacted then they are just words on paper.

On the Drug Treatment Court, and my apologies for not visiting yesterday but I had work in the Chamber, given the court's trauma-informed multidisciplinary model, why has it not been expanded beyond Dublin for the last 25 years?

The Drug Treatment Court will be in existence 25 years this year but it is still only in a pilot phase. I suppose any expansion requires funding.

Has there been no indication for 25 years?

The issue has been reviewed a number of times.

Yes. It has been reviewed a number of times and recommendations made, which have been implemented within our control. We cannot implement a certain number of the recommendations for various reasons. Following those reviews, a decision was made to continue the court in its current format. The next review has further recommendations and will be published very soon. The court has not been considered to be expanded outside of Dublin. It is very much judge-dependent. A bit of it is done in County Louth. In County Cork, a judge has dipped his toe into doing a bit in relation to that but the court has not been expanded outside of Dublin. Facilities is one reason but there are various reasons.

Would the witnesses like to see the court's work expanded? I am sure it would be beneficial across the board to expand the court to other sentences. If it is judge-dependent then it is like the discretion whereby it is up to the Garda to decide whether to convict someone or give a warning. If a judge does not like a person or if the person is in and out of court all the time, what is to say that the judge will throw that person into jail and not give him or her the chance to go to or access the Drug Treatment Court?

Ideally, it would be nice to see the court expanded around the country but we do not have the resources or facilities to accommodate that at the moment. The court is very much contained in Dublin. It is for people who are within the Dublin metropolitan district only. We have a multi-agency team working in Dublin and a similar team has not been set up outside of Dublin yet. It would be nice to have expansion but we just do not have the resources or funding for that at the moment.

Is it up to the Department of justice to fund and scale this?

To be considered.

The review has been done by or led by the Department, which is our parent Department. In terms of rolling out the model nationwide, the numbers that go through Dublin are low. We run District Courts throughout the country at over 100 locations but is there enough volume? Expansion of the model would 100% need all the full wraparound supports and requires the right people. The model is people-centred. People may not be ready to voluntarily enter a Drug Treatment Court but they are already before the courts, are in the criminal justice system and have charges against them at that point. It is not just a money thing. There are the logistics of whether there would be enough throughput because the model has to be physically located. I do not think that the current model can be rolled out virtually.

No.

With the current model, participants would need to see a nurse as there are things that need to be done.

I thank the witnesses for their presentations and for the work that they do. Ms Horsburgh, in her statement, said, "Scotland faces the highest drug-related death rate in Europe." I realise that she may not have the up-to-date figures but how many deaths have there been over the most recent three-year period for which there are records? Why does Scotland stand out? I understand that one of the reasons is that a lot of European countries do not necessarily record the cause of death where drugs are involved and, therefore, we may get a distorted view as a result.

Since 1996, when the recording of similar deaths started in Scotland, and remember that we only record the number of overdose deaths, over 18,000 people have lost their lives from preventable and accidental overdose deaths. Every year, for the last few years, there has been over 1,000 people. The comment by the Deputy that this is the tip of the iceberg is relevant because while these deaths are overdose deaths only, we are not recording deaths from blood-borne viruses, infections and other health-related conditions that are drug-related. We record the number of preventable overdose deaths, which is very shocking in itself. We have described this in Scotland as a public health emergency.

Ireland has a similar system for recording deaths. We have a coroner system the same as in Scotland whereas other European countries do not have the same system. For instance, I understand that in Germany if, say, someone is found dead on the side of the street, there is not necessarily an investigation into the cause of death as long as the authorities are clearly satisfied that it was not as a result of an assault or the involvement of a third party. Therefore, while Ms Horsburgh has said that Scotland has the highest drug-related death rate, that claim may not be correct in overall terms. I think it is because of the system both in Ireland and Scotland-----

It is not a league table. People are missing the fact that the statistics represent real people who have died. It is not about us having a better recording system.

I did not interrupt the Senator.

Senator Ruane will have a chance to come back in.

The numbers in Ireland and Scotland are very real if not an underestimation. I am saying that the comparison is not to be made and for people to say, "Oh well, we are just good at recording".

Cathaoirleach, can I have my time back?

Deputy Burke can have his time.

I am sorry.

I think it is important information.

That we are great at recording?

No.

We still have those deaths.

We are not going to talk to each other. I ask Deputy Burke to direct his questions to the witnesses.

First, I am trying to make a point about the death rate across Europe. Second, the policy in Scotland is very proactive as regards assisting people. Are there other areas highlighted that the witnesses would prefer to have delivered at this stage but which have not been delivered and would be helpful to reduce the death rate?

I will quickly respond to the earlier comment. While there may be differences in the ways that deaths are recorded across European countries, we are most similar to the Scandinavian countries. Regardless of how these deaths are rated, and in response to the points being discussed, we have over 1,000 people every year dying from accidental preventable deaths, which is shocking. The other thing that we could do better in Scotland is, rather than tinkering around the edges with pilot projects and waiting years to see if there is any effect, to be led by the international evidence base and introduce things at scale. We have described this as a public health emergency in Scotland but our response has been far from an emergency response. There are lots of things such as drug checking, safer injecting and safer inhalation facilities, and a broad range of other things that we could do at scale and at pace if we really were serious about making a difference.

Is there one central agency in Scotland that works with different units around the country? Is it a case that a number of different organisations provide support in different areas around Scotland?

Each council area in Scotland has an alcohol and drug partnership, which is a health and social care set-up. They all get funding. They commission their services depending on their locality and what is required. There are also national resources available and that is done through the national mission but that is very postcode-based.

There are mostly NHS health-led treatment services across the country. We would like to see much more third sector involvement in that. There are variations in each local authority across Scotland in terms of how services are provided, but it is mostly delivered through alcohol and drug partnerships and the NHS.

Mx. Jefferys referred to the change in Canada. What change contributed to the adverse outcome there with the higher death rate, etc.?

There are multiple drivers when we are talking about preventable overdose deaths. As I mentioned in my opening statement, in 2007, there was a very real move by the Conservative Government to remove harm reduction from the drug strategy. There was then a bit of a domino effect. The safe-injection sites had to go to the Supreme Court to stay open. Luckily, they were able to stay open. We then had heroin-assisted treatment being trialled but then stopped. We had all of these harm-reduction initiatives try to get off the ground but were then shut down. It is almost 20 years since 2007 and Canada is now in a place that we can learn from.

What did the Canadians do that we need to be careful not to do here?

They removed harm reduction from the strategy. We need to be very careful that we do not let go of harm reduction and that we do not silo it from the idea of improvement of quality of life and we only link that to recovery and abstinence. We need to look at the whole picture, including housing and access to health, connection to community, and engagement with people who are in active use of drugs rather than excluding them just because of their drug use. We need to give them spaces where they can talk about their drug use. People coming into the safe-injection site in Merchants Quay can talk about their drug use in a strength-based and positive way. Some of them have said their injection patterns have changed a bit because they have a safe place to use. We need to look at that strength-based approach.

Is Mx. Jefferys saying that Canada does not have supervised injection facilities?

It does, but a lot of them are closing now. They are closing in Ontario and in-----

They are actually going in the opposite direction; they are closing.

I will return to Deputy Burke, as his time is up.

Two minutes were basically taken off my time.

I will allow him to take 30 seconds.

How long were those supervised injection facilities running before being closed? Were they running for a number of years?

There are still some existing but they are being closed down. Different provinces are moving to involuntary treatment. Saskatchewan has moved back to one-for-one needle exchange. We are seeing a rowing back in the harm-reduction processes that have been proven to work and are evidence based.

I thank Mx. Jefferys.

I wish to ask Ms Horsburgh-----

I am sorry. I have been strict on everybody's time. I already gave the Deputy back 30 seconds.

I thank the witnesses for coming in today. I know time for questions is short, but we have read all their submissions.

I know Ms Jordan was cut short. I agree with the recommendation in her submission that the national drug strategy protect community-based flexibility and responsiveness. How can that be achieved? What is the role of the task forces? If she has read the strategy, she will understand where I am coming from.

In our experience working with community organisations, there is a move towards bigger organisations taking over some of the work of smaller organisations. That is not to knock bigger organisations, which have a value and purpose. However, smaller organisations are less well able to fight than bigger organisations and have fewer resources. Often, the work they are doing is even more vital on the ground and they have more of a vested interest in a community. I have seen it in our own area where there have been tenders for work that had been done by a community organisation and a bigger organisation that had not been doing the work got the tender, with the community organisation then not doing that work any more. If we do not make a conscious decision to protect smaller grassroots community organisations, they will all inadvertently be subsumed by larger organisations. It is systemic and institutional. I do not know if there is an agenda or if these things are just happening by chance. Obviously, larger organisations are able to have better economies of scale. They may have people who are able to do grant writing for them or policy people. I have worked in large organisations; I am not knocking them at all. There is value in having a conversation about this ongoing issue. If nothing is done, community organisations will be gone.

I agree. The strategy document makes it clear that there is a proposal to push everything back into the big machine that is the HSE. When it comes to funding, the person who holds the purse strings takes the lead.

I thank Ms Brennan for hosting us yesterday. It was very good and really eye-opening. I know Senator Nicole Ryan raised the question of rolling out the pilot further afield, which would be a great idea. Did that come up as a recommendation from the reports that were done previously? I am thinking of bigger cities such as Limerick and Cork that could really do with it. It is a great service.

I raised the issue of gender yesterday. When we were in the court, it was predominantly men. Is it the case that women either do not opt to plead guilty and get access to the programme or do not tie in for some reason? Is it just that there are more men going through the court system than women?

Any of the reviews that have been done heretofore have solely concentrated on the Dublin Drug Treatment Court, so any of the recommendations have been for Dublin. There has been nothing to recommend it going further beyond that. There may be something in the new review that is taking place. Again, there is multi-agency and multidepartment involvement, so it will have to be a joint mission on that.

Regarding the Deputy's question about gender, unfortunately, those present yesterday afternoon were predominantly male. There were women at the morning session. As it happened, one lady actually graduated. We missed that. She was supposed to be there in the afternoon but unfortunately was there in the morning. The supports are there for women. As my colleague mentioned to the Deputy and her colleagues yesterday, there are more opportunities for women to come along and get involved in the Drug Treatment Court. There is more opportunity for them to lead a family life and support their children and families while they are involved in the drug treatment programme. From that point of view, it is very beneficial for women to be involved.

I was very interested to hear Mx. Jefferys and Dr. Healy talking about people with not just lived experience but living experience being involved in the processes that impact on people. Regarding the likes of the national drug strategy, the delivery of services, etc., how can people with living experienced be involved and have an impact on those services?

Not only should they be involved, but they should be central to the entire process. I certainly would not get involved in making recommendations for any strategy that I was not well informed on. I am not saying that people who are in the process are not well-intentioned, but the training is poor. I go back to my own expertise, which is in OST. I have spoken to doctors who have told me they have been trained poorly. Why are these people writing strategies about our lives? We should not just be consulted; we should be central to the entire process.

The drug strategy is topical at the moment. Could somebody with living experience have oversight of that process rather than just going through a consultation process?

It has to do with looking at parts of the strategy and going back to what I said about self-determination. If we are looking at the part of the strategy that includes abstinence-based recovery, it is about getting somebody who has gone through that process to feed into that part of the consultation. If we are talking about a safe inhalation space or drug consumption space, it would be somebody who is in active use. It is about the most recent and relevant experience of the issue. The way that can be done is to engage people by their strengths but also in spaces, as I said, such as the safe injection site, where people feel open and okay to talk about being in active use. In the safe injection site, you could have people doing safer injecting training to become peer trainers. By that, they are given a bit of motivation and empowerment to speak in front of other people and use their expertise as a power. In that way, people can get training to be a part of these consultations.

Paul Butler's book traces the sociological history of our response to drug use. In the eighties, peer-led was done. Drug users were trained to speak to other drug users and it worked remarkably well. I am not sure why it was removed but it worked remarkably well. This was in the 1980s, so we are talking 50 years ago.

That is how a lot of the community-based services grew. They grew from people living that experience. That is why they are so important.

I do not think people realise that we have been prescribing methadone in Ireland since 1969 at Jervis Street. That is over 50 years, so the progression we have made needs to be questioned. Again, I am speaking directly to OST, which is something I have researched for 15 years. That is why I am speaking about it. We first started in Jervis Street Hospital in 1969.

I will come back in just to go on record on the Deputy's point about community-based organisations, funding and this risk of centralisation. Where we engage with people with active experience who are mostly at the coalface, or on the ground at the front line, is in these community-based services because those are the services that are creating relationships with people, where they walk in the door and see a friendly face. We need to be fostering these community-led and community-based organisations, and their funding, and really enshrining them.

I will add to that point in relation to recovery capital. Recovery capital is where people are able to engage in extra activities beyond therapeutic support. It is something that is very important in the community as well. If you are at the grassroots within that community, it is from that that good recovery capital can be built. Time and again in our organisation, we have seen people come into the service who are actively using, are really struggling and are not sure where to go, but they come on board and go through the therapeutic process. Within that therapeutic process and following on from that, they decide they want to give back. They want to become a volunteer or staff member and they want to grow. That is the grassroots I believe is so important within the community.

I thank the Deputy. She is over time and I am conscious Deputy Ó Murchú is waiting.

Fadhb ar bith. I was only too delighted. I always like when a Chair shows an element of flexibility.

Tá fáilte roimhaibh go léir. I thank Ms Brennan, Ms Wright and the rest of the team. It was worthwhile getting to the drug treatment court. I get the idea that, at some level, we are looking on at what are people's lives, only that I saw and heard it. I could not commend the judge any more on what looked to me like caring, being utterly humane and a real engagement with those who were obviously going through what was not exactly a perfect set of circumstances. They could quite easily have been written off and the regular court system could have just kicked in. On that basis, we know they are stuck in the criminal justice system, and on and on it goes. Whatever about abstinence and perfect settings for recovery, we would not even be necessarily looking at anything from a harm reduction point of view or anything like that.

It is very Irish in the sense that we are talking about a 25-year pilot project. That just says it all. It is fair to say, and a number of the witnesses said it, we have enough evidence in relation to what works and about delivery on scale, but we are not doing it. Will the witnesses very quickly give a review? I saw a number of things, including 1,774 referrals and then 107 getting through. Is that called the gold-----

All right. I get that it is not always going to be a Hollywood story, and everyone is starting and ending in a different place, but it is a case of making the arguments in relation to what I saw, even from a numbers point of view. The big thing I thought is the project could probably do with a hell of a lot more resources but the reason it is getting by is that there are not enough referrals in. Beyond that, as was said, we need to expand this throughout the State.

I will start and then Ms Wright will come in. On the referrals piece, the judge is doing a webinar today with her colleagues in the District Court where she will present on the drug treatment court and answer any questions. That is one of the ways the judge is proactive in trying to get colleagues to think of the programme when somebody suitable is before them. From listening to all the colleagues, people have to be ready for it. We can see there are different people at different points in their lives who may get referred. The Deputy is right that over the 25 years, only 1,774 people have ever been referred to the court at all in Dublin. If we are then talking about expanding that nationwide, and I will pick Letterkenny in Donegal, which has a much smaller population, what would that look like there? Again, if you are saying to people they have to be referred and will have to come to a centre or somewhere else, it makes it very difficult.

It is what was spoken about, which is a sort of ad hoc scenario happening in places like Louth. Obviously, Dundalk and Drogheda would be big enough for this.

We have it in Cork.

We just need to see that happen properly.

On the Cork one in particular, that was an individual judge who has now retired. He had a focus because how he referred people for treatment rather than send them to prison meant something to him. Those things are the administration of justice. They are decisions of courts.

The Deputy asked about what I call "throughput", which sounds horrible because we are talking about humans. The Deputy is right that the figure of 1,774, to the perfect gold standard, has only translated to 107 people. We have a few people at the moment who are nearly there or getting towards it. I would like to think the Deputy saw, when he was in the room, that it does make a difference to those individuals. It might not be perfect and you might not get a perfect, or gold star, result for everybody, but there will be interventions that will make a difference. It has been truly transformational for some people and has made a huge difference but I would not underestimate-----

It might only be the first step on a journey.

-----what might appear smaller pieces, whether it is a woman who is able to not go to jail and stay with her family and her children, and maybe move into education. There may be people who are getting a Quality and Qualifications Ireland, QQI, level educational certificate and making decisions about maybe doing some work or different things like that. There is a certain value in it, but this is not large scale. Even the pilot itself, over 25 years, has not been large scale. Again, we are talking people who are before the courts. They have to be suitable. We have a set of eligibility requirements. They have to meet all those as well and have to want to do it. Nobody can be forced to interact with the programme in its current state. Does Ms Wright want to add anything to that?

There is a lot of focus sometimes on the statistics. The statistics are numbers but in behind those numbers there are people, as the Deputy saw. People may not complete the individual phases but they have achieved a huge amount by even getting involved in the programme in the first instance. They have done the QQI courses, as Ms Brennan said. They have participated and they want to participate. It may not have worked out for them for various reasons, but behind those figures there are more figures for people who have taken that first step to making an improvement in their lives. Even if it is all very subjective, we cannot-----

I get that, but if you are improving your life, you are improving your family's life-----

Exactly.

-----and are even reducing the harm that is being done to wider society. It is all a win. You can make the gold standard at some other point in your life, but you are definitely on the road.

I will come in on that. We have had a drug court in Louth for the last eight years. It was set up by a judge there at the time who had an interest in it. He retired, another sitting judge came along and she continued it. It has worked very well. It diverts people from criminal justice to ourselves or a similar project, such as Red Door in Drogheda. They then come to us for support. A lot of the conversation ties in with the whole conversation around what recovery is. One of the challenges of it was that the gold standard and the graduation was abstinence but not everybody can achieve that. Somebody could come off 13 benzos a day, plus, plus, plus, but still want to smoke some cannabis every night.

In the eyes of the law, it just was not enough.

But in the real world, it is phenomenal.

Exactly. It ties into the bigger picture, but the drug court has been very successful in Louth. I echo what the Deputy says about the small interventions and changes because whatever intervention is made, it is better than someone not coming at all.

I thank Ms Jordan.

Did I take the Deputy's time?

No. I was going to ask for an example. I know Ms Jordan and Mr. Duff and I am aware of some of the work that they do. I wanted to talk about the sort of people they deal with. I have seen the feedback they have got from multiple people who have been through their service and some who have gone on to do really great things with the service and in the wider community, which would not have been the case when they started on their journey. Could they just go through a bit of that because, in fairness, I would be stuck if it was not for the witnesses and others who we can deal with.

While it might sound dramatic, this kind of work can be a case of life or death. People do come and say that, if it was not for Turas, they would be dead. That comes back to the whole community ethos and the fact that we have so many different elements to our service and different things that we can do. We had a sober socialising night recently. We had 25 people at that, which is quite a success. They are people who would have come to our service and people who are no longer linked in with our service but who still feel part of the wider work that we do. Mr. Duff might have some other points to add.

It is just the fact that we work across the continuum of care, which is so important. If harm reduction is where the person is at when they present, that is something that is very important to the person right there and then. There are other people who want to become abstinent and that is their goal. It is about taking the person when they present, however they present, and providing the support, however little or big it is. There is an old saying that you can bring a horse to water but you cannot make him drink. At least they know where the water is for future reference, so they can come back to you. They have that familiar experience of meeting someone that listened to them and respected them. It is about seeing people come in and not being afraid to present and take the first step of walking in the door. They do not know what it is going to be like. We have developed the recovery cafés from that. It is not just a case of coming into a clinical setting, where you walk in, sit on the chair and say how you feel. It is about doing walks and talks, nature therapy, bodywork, recovery cafés and Sailing into Wellness. It is about having all of these other options whereby you meet the person where they present, not where you feel they have to be.

Gabhaim buíochas le Mr. Duff. It is my speaking slot now. I apologise, as I had to go to vote. I thank all of the witnesses for being here today. I specifically thank them for the visit to the Drug Treatment Court. It was impressive to see it in action, and to see a court operate in a trauma-informed, human-centric but individualised way. I was struck by the lack of presence of legal representation. People are there participating in a collaborative way. I was impressed by the fact that it had not just the garda but the educational officer, the probation officer and the representative from teh law engagement and assisted recovery, LEAR, project. That is powerful. I thought the judge herself demonstrated great respect and humanity. That is not an easy balance to find when you are in that position. As a consequence, everybody who was in front of her responded with respect as well.

I think of the 1,174 individuals who signed up for it or committed to start it. They are 1,174 people who were not sent to prison. That is a success in and of itself. The recovery journey is at a different pace for everyone. I was impressed by seeing in practice how the judge went through people's various indicators. You can see that there are statistics, a structure and a format behind this, and that there is a measurement taking place. At the same time, the system recognises human frailties and challenges. That is incredibly powerful.

It is great to hear that Louth has been operating a drug court. I get the point Ms Brennan makes about there not being as many cases in more rural areas so that it may not be appropriate to dedicate resources to having a drug court in every jurisdiction, but we need more in Dublin than we have. I appreciate that criteria have to be met and not every individual will be a candidate for the Drug Treatment Court. What is needed to get us to a point whereby we would have them at least in the major centres – Cork, Limerick, Galway and Waterford? Is that the model we should be looking to get, namely, having a drug treatment court operating in those big centres, or is it just a case of promoting and instructing the model to judges who are operating in satellite courts?

The once-a-week frequency is very important in terms of the individual's engagement, in particular during the first phase. I would like to hear what needs to be done to take it from a pilot and put it on streamlined funding and have it available more widely. Access to services locally is important.

I agree. Local access is really important. If we were to look at our funding model – that is probably a generous word for it – each agency funds the people to go in, so there is not an overall programme of funding that runs the drug treatment courts. If an individual judge wants to do it, he or she would be pulling on local services such as those of counselling services and charities. That is all done much more locally. If we want to mainstream it, it is like anything else, in that we would have to invest and have dedicated people and dedicated funding. Dedicated facilities are very important.

The Leas-Chathaoirleach saw the facilities we were working from at the moment. If we were to replicate the service and provide, let us say, even six services around the country, then to do it properly and try to divert people, we would need to have appropriate facilities in place that people could come to so that we could run a court out of a room that looked less like a court, if that makes sense. For example, we do not run the court out of the Criminal Courts of Justice, which is our flagship in Dublin for criminal cases, and that is to take it away from that location. We might not necessarily want it in the courthouse, which I am sure is what is happening in Louth, if we are trying to take it out of that environment. We can see from the operation of the system that it is still a court, presided over by a judge, and it is court supervised.

Is it at the judge's discretion whether or not to operate it?

It was a pilot programme that was put in place. The Minister for justice set up a working group back in the 1990s. It was probably John O'Donoghue when he was Minister for justice. They did work on it between 1997 and 1999. It was established on a pilot basis. We mentioned in the note that there had been a number of reviews over the years. It is effectively running in Dublin but still on a pilot basis. What would a non-pilot look like? Would it need underpinning so it is not just a case of needing money? There is nothing stopping the Oireachtas putting rules in place that say every whatever that comes before the courts should be diverted into this first. That is what we mean by the judge's discretion. The referral is from another judge. You can ask for it but if a judge has to refer it, then it has to come to our judge in the Drug Treatment Court and she has to look at the eligibility and see if this person is somebody who meets the eligibility.

Does the Senator have views to add to that?

If a young person was arrested, they would be a candidate for the Drug Treatment Court if they were in Dublin, but a judge in Cork cannot refer a person because there is no court to refer them to. How do we unblock that? Is that a decision of the Department of justice or of the judges?

I will put it this way: it is a District Court. We call it the Drug Treatment Court, which is what it was called on the pilot basis, but it is the District Court, which is a court established by legislation.

So, legislation is required.

Yes. You could have the legislation but if you wanted to run it in the way you would want to run it, you would have to back it with funding. That is not just the Courts Service.

It is multi-agency.

Yes. Also, if you are going to run something like that nationally, you would want somebody leading on it, in that it is their day job to deliver this nationwide. That all comes down to funding and they are policy decisions for Government. If law is needed for it, it is a matter for the Oireachtas to do that. We are certainly not funded to say we will do a few more pilots and roll things out at that level. There is no line in our funding for it.

That answers my question. It is what I wanted to get to. The thing that really struck me is that it is not only person-centred but that it has to be way more effective for everyone else who is working with that case to be in one room with the judge and the individual. It entails an objective review of what has happened in the past week, how the person is progressing, what has been good and not so good, where the person can do better or if the person is doing great. That is real feedback in real time and it is individualised. It is not anonymous, abstract and irrelevant.

Ideally, the dream world would be to have a purpose-built facility where all the agencies are located. At the moment, the HSE nurse, gardaí and staff from the City of Dublin Education and Training Board, CDETB, travel to Green Street. The ideal is to have everybody in one facility operating full time around this and also to have the court there as well, not so much in a formal court setting but more of an impersonal setting. That is the ideal situation but that obviously takes implementation, funding, policy and legislation.

We have a second round, with four minutes each. Senator Ruane is first up.

I will make a couple of comments on the conversation. I am sure Deputy Burke was not happy that I interrupted him but how we talk about things is important, as are the questions we ask and the reason we ask them. We had a conversation about Ireland and Scotland only having the highest death rates because deaths are not recorded adequately elsewhere, rather than asking why we have people dying of overdose in our countries. That is the question for me and it is why it bothers me so much when someone asks whether there is a way we can jig this around so we do not have the highest rate, or says that if only the others recorded it better, we would not be in that highest group, as if it is a league table we somehow need to fix, when actually ending preventable deaths in the country should always be the primary goal.

It is great Ms Jordan brought up the community front-facing services. I do not necessarily think we need centralised services in a place. The community services exist right across the country. We need to be able to include communities in the referral processes so that people are able to engage locally in their education services, community employment, CE, schemes or whatever other need they have in relation to housing. The services are there within communities. Perhaps that integration piece could be a little bit better as regards how the referrals are made. That may not necessarily need to be done by the addiction nurses, if they are employed by the HSE. The reason I point that out is the new health regions model written into the national drugs strategy is extremely problematic for community work in this country. The merging of task forces is extremely problematic. It is a centralisation and a pull-back towards the State as regards how close we can get decision-making, autonomy, funding decisions and what programmes we can and cannot run. All of a sudden, they are going to have to be decided by someone higher up in the HSE, rather than having people who are working on the ground in the likes of Turas and the other services deciding what they need and saying, "This is what we are seeing on the ground, this is how we are responding, and we are going to put some of our funding over in that area to respond to that". As a committee, or even as individual politicians, we need to take that more seriously in understanding the role of community work for people and their lives beyond just drug use.

Would the witnesses like to comment or say anything more on the importance of this? It is not about the State saying it has consulted the community, told it what to do and so this is now community-led. Community development itself has been gutted in this country for many years. For me, this is just another extension of the privatisation of community development.

Does anybody want to respond?

I totally agree with everything the Senator said. It is what to do to stop it, as regards what the Senator said about the new strategy, amalgamating task forces and all of that. It becomes so much more difficult because in a lot of the work we have done, we just said, "Yes, let us try it". We did not even have decision-making. We had some funding to do something new with cocaine. We wondered what we would do because there is not a lot of training out there. When Mr. Duff asked, "What about somatics?", I said yes, we would try that. None of us knew what it was but now it turns out that it is actually an amazing way of supporting people with addiction and to help them feel ease, safety and things we often forget about, like what is happening in somebody's body. There is so much research now about how trauma is held in people's bodies. That is just an example of the things you can do and the paths you can go down if you have autonomy to do them. When everything is set out in an annual plan with quarterly targets and key performance indicators, KPIs, that is grand - if you are a robot. It does not really fit in with human beings, and certainly not people with addiction. For people with addiction, relapse is just part of it. Recovery is different for everybody. Recovery for one person could mean they are always going to take some level of drugs, while somebody else will absolutely want abstinence. It is even about having a space to have the conversations and to be able to take these things into account. We definitely need to do something about the community.

I thank Ms Jordan. I understand Ms Horsburgh indicated she wanted to respond.

I am still getting over the shock that a service that is doing good for people is still classed as a pilot after 25 years. I want to talk about the involvement of people with living experience there, particularly in relation to how we always create these strategies and processes and consult with people after. I want to reiterate the point made by Mx. Jefferys and Dr. Healy earlier that people need to be involved at the very start. When we are even thinking about a strategy, we should be incorporating people's views at that very point and helping to guide and shape things going forward. It is not something we do incredibly well in Scotland but over the past few years, we have seen a lot of improvements in how we listen to people who are currently using substances. We support engagement groups across the country in a sort of "you said, we did" type of style with the local authority areas, so that people can get practical responses from local areas about the issues that matter to them.

At the core of everything around that is for over 20 years, we have had a peer research programme. That really helps us get to the reality of people's situations in local communities and what we need to improve going forward. Peer research models are so valuable in getting to the root of the issues and the recommendations for what we need to.

I would like to elaborate on that point about peer-led research projects. As part of SURIA, we traced progressive realisation of the right to health from the International Covenant on Economic, Social and Cultural Rights. We produced five research reports, from 2015 to 2024, tracing that progression. Article 2 is that you cannot regress; there must be progression through the realisation of each one of these rights. Article 12 is the right to health, which is the one I am discussing.

In our fifth research report, we trained service users to collect their own data from their peers, and they were paid for these surveys. This would never pass an ethical committee in a college but we did that. I wrote up the research. We got the most precise and realistic analysis that we ever got, but what followed from that was the empowerment piece. I presented the research to the Irish Human Rights and Equality Commission, IHREC, and many of the men and women who collected the data were in attendance. To see the pride on their faces at actually being included and allowed to share their own voices was something I had never experienced before.

There are five of us in SURIA. We all joined in 2012 as fairly dysfunctional drug service users. One returned to work after being out of work for 20 years. Another got a master's degree, another is now working in addiction services and I completed a PhD through being empowered to allow my voice to be heard and then bringing that into the policy landscape, like we are being invited to do today, to instigate change in policy.

That model was being asked for all over Europe. It is sitting on a shelf somewhere here and no one wants to read it or listen to it.

I have what is more of a statement than a set of questions. While the drugs strategy does not really fall under the remit of this committee, the recommendations of the citizens’ assembly do. Where they intertwine is, of course, of concern to all of us. Everybody on this committee is here because this is our area of interest and related to something we want to do as well as we can. I agree with what was said. I have major concerns because I believe those at the coalface, those with lived experience, those in community services, service providers, etc., were not really included in the drafting of the document, as has been raised on numerous occasions. It is a big mistake. I hope that when the consultation is launched, people get their voices heard and that things are done as clearly as possible. I also have serious concerns about the funding model for the future and how it will impact not only on the task forces but also local service providers.

Missing from the drafting of the strategy and everything else is what all of the guests have spoken about and what we saw in reality yesterday, namely compassion and the accordance of dignity to the people concerned. It should not just be a matter of asking how we can deal with the problem, write the documentation up and provide funding. With funding lying outside the drug task forces, any little step is progress. We do not live in an ideal world where someone will wave a magic wand that cures people just because they go to a service. That does not happen. We have to recognise that whatever steps people make, whether they sign up to go somewhere or get in contact with a service, comprise a step forward that shows willingness to do something about the issue. It will not always work out, but the fact that people take the steps has to be acknowledged. Moving things back into the big Departments – funding is always the key – will have a very negative impact on everybody. We are only at the first draft stage, so maybe there will be chances for everybody. I thank everyone again. I really appreciate their being here.

Does Deputy Ó Murchú want to make any further remarks?

Yes. I have never refused a microphone in my life. I reiterate what everyone else said. The big fear with the national drugs strategy is the hollowing out of the community sector. Ms Jordan summed up what was happening long before the start of the drafting of the strategy. It was said that since drugs are everywhere, we do not see what we need, namely more concentrated resources, particularly in areas of absolute deprivation where drug taking, drug use and the impact of drug crime are sometimes far more impactful than among the middle classes and those who have money. That is not to take away from any case in that there will always be individuals with really bad cases, but it is a very different thing. Generally, if you grow up in a middle-class home, it is less likely that you will be doing runs at 12 or 13 and all the rest that goes with that, and less likely that you will fall into using some of the drugs at a very early stage. That goes without saying.

The big thing that has been said at almost all of these meetings is that while we already know what to do, we just will not do it. We know the issues. What needs to happen from a resource point of view to make real change, whether we are talking about opioids, benzos or crack, which is absolutely everywhere at the minute? That is before we talk about cocaine. There is no bar in Ireland where people are not using the toilets to take it at the minute.

That is a big ask.

I am not asking Ms Jordan to solve it. I am just referring to the big ask that Turas has at this time.

We run our service for €470,000 per year, which is very little. We are always tight for money. The protection of community groups is necessary. If you get extra funding at the end of the year, you have to wait three months and cannot plan. If we could get the extra money in advance, it would help. Staff well-being needs to be promoted and waiting lists must be dealt with. There are so many issues. I do not want to always go back to funding.

You cannot operate without money.

You cannot do anything without money and you cannot operate if you do not have staff feeling good about themselves. Those are the two asks, along with protecting community organisations.

I have the same asks. I very much echo everything Ms Jordan said. One of the challenges we have is that if small pockets of money become available, they do not come with staff. More and more responsibility is being placed on increasingly fewer people to do more and more. People want to be able to help and support people with the money available but, as Ms Jordan implied, people are taking more on for increasingly less. There are fewer additional staff members-----

Sometimes the money comes with constraints that do not make it easy.

Funding a small piece of peer-led research on stimulant agonist treatment is an achievable goal we could consider in Ireland, especially because we are talking about crack cocaine and cocaine as an emerging issue. Obtaining some Irish-based data on it would be an achievable goal.

We should also start thinking about incorporating the idea of harm-reduction capital. We hear a lot about recovery capital, connection and what is important to improving someone’s quality of life. It is a matter of reconnection to something to make the person feel empowered. Maybe we should consider this in the context of training peers on how to be safer injecting trainers or naloxone trainers, for example. It is case of looking more at empowering or capacity-building for the peer workforce in Ireland.

I have two things to say. We have to start realising that not every person who takes drugs needs recovery. The vast majority do not. I am talking about different types of drugs. We are concentrating on everybody, though. We are treating everybody the same, chasing everybody through the courts, and so on. We need to address this very quickly.

Second, although I do not know how we would address this, I believe the treatment of people who use drugs is aligned with the social construction of the drug user. I do not believe there is a TD in this room who does not agree with everything we are saying, but I think they will lose the confidence of their constituents if they say certain radical things that need to be done. It is all about the social construction of the drug user. I have traced this in my own research. I have done a genealogy of the responses of the State to drug users and the social construction of the drug user at the time. They all line up.

We all had simplistic ways of dealing with this years ago. However, it is fair to say that what is being done by the State at the minute is not working.

Yes.

I thank the Deputy for the question. I have three closing points, having listened to everybody today. With regard to the drug treatment court, I hope the Deputy saw that the multidisciplinary approach really works. It did not just involve our colleagues in the Garda, the Probation Service and the justice sector; it also involved those in education, health and so on. That is valuable. The initiative is still a pilot, so we must ask what we can learn and where we can go with it.

Moving it beyond a pilot would be a fair ask.

Mainstream it.

Yes. The second point relates to the person-centred approach. I hope the members saw that was the main approach, including from the judge.

It is about the individuals. One of the things we have worked very hard on in the Courts Service, as civil servants, is to be trauma informed and practice trained. I have done the training and it assists us, at least, in trying to be more understanding. I hope the Deputy saw that in terms of-----

Yes.

-----service my own colleagues in the team who were there from the Courts Service.

On, potentially, the mainstream issue, we are awaiting the publication of the review the Department of justice has undertaken. We are waiting for the outcome of that review. I understand it will have a set of recommendations-----

Ms Brennan does not know when she is going to get it.

We understand it will be soon. The last time I appeared before the committee, we were still talking about that review. That was in the 2023-24 action plan under the national drugs strategy. The normal course, when recommendations are made, is that it is a matter for our parent Department, the Minister and whoever else to tell us what the next steps are. Our job then is to carry out those steps. We look forward to working with the Department and our partners to take forward any of the recommendations that come out.

I agree with what Ms Brennan said. The Deputy saw yesterday first-hand the passion of my colleagues who were involved. I commend them on that. They have really taken this on board. I will point out that it is only a very small part of their job. They are managers in other areas within the Courts Service. It is a minuscule part of their job. The Deputy spoke about and questioned the expansion of the court. Obviously, it comes back to funding and policy, which is a huge issue. We would love to be able to support whatever comes out of the review and the follow-up actions from that. That is key.

We outlined in my opening statement our five key asks for our manifesto. We have an election year in Scotland, but it sounds from the discussion that a lot of the points are relevant to Ireland too. I reiterate that we should be ensuring that our systems meet people unconditionally where they are at, not where any person, service or government expects or wants them to be and ensuring that any drug laws are not restricting us realising a public health response to all this.

I thank Ms Horsburgh for joining us. On that basis, it falls to me to conclude the meeting and engagement this afternoon. On behalf of the committee, I sincerely thank all the witnesses for their participation and I apologise that only Deputy Ó Murchú and I are present at this point. The Dáil is sitting, however.

It is a case of quality over quantity.

It is. As was mentioned, we do not have a specific remit for the drugs strategy but we have a significant interest in it. More important, the witnesses will all have an opportunity to have their say in it when it goes to public consultation. We are expecting that to take place before the end of this month and certainly in the next two months. I encourage them all to make a submission and also use their networks to encourage others to make a submission. We greatly appreciate their contribution to the meeting. One of the questions I asked was on the review. The committee will look for an update from the Department on that review. We have taken on board all of the witnesses' contributions. I sincerely thank them.