Across Europe, the debate on drugs is raging. Especially within Ireland, where the dedicated government minister with responsibility for drugs is facing a certain general election in early spring 2016. Aodhán Ó Ríordáin this week expressed the view that a more liberal and progressive attitude towards illegal drugs was needed in the Republic of Ireland.
He indicated a supervised injecting room was planned for 2016r and that stigma and shame would be removed, with the potential to "decriminalise" small amounts of drugs for personal use.
Within the past week alone, I attended three international meetings on the topics of decriminalisation, safe injecting spaces and heroin assisted treatment. So what would a human rights-based approach look like, and, perhaps more challengingly, how would a universally accepted concept of human rights be implemented and accepted within the care and well-being of people who use drugs?
Some may say we need more research to answer such a question and indeed practice and policy must be continuously informed by research but when is enough, enough? When do we decide to make a decision to move forward on the best available evidence?
Human rights-based approach
Fifty years ago, Vincent Dole and Marie Nyswander trialled the use of methadone substitution treatment to enable a shift in the stigma and criminal-based paradigm surrounding people who used heroin. Essentially, they initiated a human rights-based approach to people who use drugs.
Forty years ago, Leon Gibson Hunt and Carl D Chambers espoused an epidemic, public health-based framework to look at the spread of drug use across the United States. Thirty years ago, the Californians started to follow a cohort of people who used drugs and measure a holistic set of outcomes.
Twenty years ago, similar research was replicated in England and Wales and just over 10 years ago, similar studies were repeated in Australia and Ireland. While all these international studies differed they all found, without exception, that treatment for drug use works.
However, when I was leading the Irish study, which evaluated treatment for drug use (known locally as the ROSIE study), I was challenged to spend time defining and considering how we would measure and know if it worked. Also, for whom did we expect it to work? Does treatment work at the individual, community, societal and economic levels?
The international studies and our Irish ROSIE study looked at the impact of treatment on individual level outcomes in terms of drugs used, risk and health; it looked at family and community-based outcomes in terms of family relationships, parenting and housing, and it looked at societal-based outcomes in terms of crime, health, social and educational service utilisation and employment.
While not all clients remained in their initial treatment, all outcomes at all levels demonstrated improvements one year after treatment and sustained improvements three years after initial treatment entry. There is no debate needed on the research evidence. A public health, human rights-based approach to people who use drugs benefits all.
A lack of dignity
We have the science, but behind all science there is a human story. An office I used within the great Trinity College Dublin was within the basement of a wonderful 1930's art deco building and backed on to an old market lane in the centre of the 1,000 year old Viking city. The office window was at a high level, too high to see in or out of but sufficient to hear the movements of the people outside.
Every day, usually late morning, men, women and parents with children in prams congregated, seeking some miserable modicum of privacy and dignity while they injected and their friends and family looked on. Is this what we would want for our brothers, sisters, children and relatives? Is this a society that reflects a human rights-based approach to healthcare?
Today, I am happy to say I was at yet another meeting. It was the launch of a report from the Irish Government Houses of the Oireachtas, Joint Committee on Justice, Defense and Equality. It was the report of the Committee on a Harm Reducing and Rehabilitative approach to possession of small amounts of illegal drugs. Seven recommendations were proposed. Recommendation six requested more research and as a research professor I completely agree with that. However, what was more exciting was the first of the seven recommendations:
"The Committee strongly recommends the introduction of a harm reducing and rehabilitative approach, whereby the possession of a small amount of illegal drugs for personal use, could be dealt with by way of a civil/administrative response and rather than via the criminal justice route."
As of today, Ireland is leading on a human rights-based approach to healthcare for people who use drugs.
Professor Catherine Comiskey is the Head of School of Nursing and Midwifery at Trinity College Dublin, Ireland, and Chairperson of the National Advisory Committee on Drugs and Alcohol (NACDA).