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Opinion It's time to get real about heroin addiction. It's time to decriminalise this drug

Dr Austin O’Carroll says decriminalisation would be a way of taking responsibility for the vicious effects of inequality.

I CAN SAY without a shred of doubt that the most stigmatised people in our society are those who use illicit drugs.

‘Junkies’, ‘dopeheads’ and ‘crackheads’ are some of the words that capture the general public’s loathing for this group.

Sadly, it has been demonstrated that this antipathy to illicit drug users exists in spades among the public services, including the health service.

The public attitudes focus on blaming the drug user for their fecklessness and lack of character. This is ironic considering that the evidence demonstrates that the precursors to drug use are childhood trauma and poverty.

A class issue

I often ask classes from middle-class schools and colleges for everyone who knows a heroin user to identify themselves -  a small number of people might put their hands up. I then ask how many know someone who has died from heroin use. Occasionally one or two will raise their hands.

If I ask the same questions in an inner-city primary school almost all the class will have their arms in the air.

Blaming individuals for the results of societal ills is surely one of the gravest injustices.

There is an overdose of moralising about addiction. I believe there is nothing wrong with addiction in and of itself. All the problems lie with the consequences of addiction.

Addiction itself is a complex human experience and although rarely a positive one, it can impact the person’s quality of life in a multitude of ways. If I were addicted to exercise, for example, the consequences would not be seen as particularly destructive. But the everyday effects of heroin addiction are horrific.

More people die from drug-related deaths – in terms of overdose and death from HIV or hepatitis – than road-traffic accidents or suicide.

The deleterious effects of heroin use on physical health, which include the spread of HIV/hepatitis, abscesses, leg and lung clots, loss of limbs due to blood vessel complications and heart infections are myriad.

The mental health consequences are equally severe with extremely high rates of depression, anxiety and psychosis associated with drug addiction.

The impact of drug addiction on society can be devastating including unemployment, family breakdown, loss of contact with friends and community, involvement in thievery and crime, homelessness, begging and social rejection.

Let’s talk legalisation

Challengingly, many of these consequences would be diminished or disappear if heroin was legalised. One could sell heroin in the corner shop either in smoking or injection form with clean needles and in regulated amounts. 

This would reduce the risk of overdose, which in turn could be further reduced by including a naloxone opioid blocking injection in the pack. Users would use it together socially so they could watch out for each other. HIV and hepatitis infection would more or less disappear.

As commercial heroin would be cheaper than illicit versions, addicts would not have to turn to crime. As it would be socially acceptable, one could maintain contact with the family, hold down a job and avoid homelessness and street begging or injecting.

Lastly, drug-associated crime would disappear. Al Capone and the Chicago gangs made their money because alcohol was illicit. When it was legalised such crime evaporated.

The downside would that be like when alcohol was legalised, while many of the negative effects disappeared, more people became addicted to alcohol as it was freely available.

This is why I am against legalisation but I am pro-decriminalisation.

Decriminalisation does not mean illicit drugs would suddenly be legally sold; it would mean that those found in possession for personal use would not be criminalised but would be offered health and social supports to help them escape their addiction and find a path to a socially fulfilling life.

The evidence from Portugal is clear that decriminalisation does get rid of many of the negative elements of illicit drug use while preventing the widespread use of drugs that full legalisation would produce.

Since Portugal adopted this policy, the number of new illicit drug users, drug-related overdoses, cases of HIV/hepatitis spread via dirty needles and drug-related crime have all reduced significantly.

As an example, the rate of new cases of HIV-related infection dropped from 104.2 per million in 2000 to 4.2 per million in 2015 post decriminalisation.

The evidence is clear that drug decriminalisation is a no brainer. Any other response to drug addiction has to be soaked in morality and blame to ignore the blatant facts supporting decriminalisation.

The Irish public has led the way in de-criminalising and de-stigmatising homosexuality almost 30 years ago. Let us display the same humanity to those addicted to illicit drugs.

In doing such, in truth, we would be accepting responsibility for the vicious effects of inequality and poverty.

Dr Austin O Carroll is an inner-city GP. He is founder of Safetynet and the North Dublin City GP training scheme and co-founder of GMQ Medical Services for Homeless People and GPCareForAll. 


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Dr Austin O'Carroll
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