Leo Varadkar (Dublin West, Fine Gael)
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I wish to speak very briefly about the Bill. I do not have a lot to say that has not been said. This is a Bill in which I have a particular interest having followed it in my previous ministry - the Department of Health.

When it was first proposed as an idea I was somewhat sceptical because I was concerned that it might encourage drug use, encourage more people to use heroin and other illegal drugs. Having looked at the matter and studied it, this really falls into the category of harm reduction. It is about reducing harm and ensuring that people who are going to inject anyway have a safe place to do so. They can use needles that are safe, thus reducing the transmission of blood-borne infections such as HIV.

In addition, if something goes wrong, medical help is nearby to ensure that the user does not overdose. I understand from the contributions of the Minister of State, Deputy Catherine Byrne, that no one has ever died in a supervised injecting facility, probably because these facilities are available.

The project does something else that is important and valuable. People who are hard to reach and who are not likely to engage with addiction services are at least registered. In this way, they become exposed to and begin to interact with services that might be available. This increases the chances that they might someday get into a rehabilitation or maintenance programme.

For all these reasons this is timely legislation. I welcome it and recognise the work of the officials in the Department of Health in bringing it forward. The former Minister of State, Senator Aodhán Ó Ríordáin, started the process and the Minister of State, Deputy Catherine Byrne, has brought it to this Stage. That is important and I express my support for it. I hope the Bill has speedy passage through this House and the Seanad.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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I call Deputy Billy Kelleher.

Billy Kelleher (Cork North Central, Fianna Fail)
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I did not realise that I was able to get in. I also welcome the Bill. It is a positive step in addressing the issues faced on a daily basis by drug addicts on the streets of the capital city. I realise it is based on a pilot. Mr. Tony Duffin and others have been before the Joint Committee on Health in recent years to explain the concept.

Like many others, I did not have a great understanding of the concept or what it did in terms of harm reduction. It ensures people have a safe place to inject or consume drugs that otherwise would be consumed in back-street alleys or on sidewalks or boardwalks in our capital city. The concept is good in terms of the practical health implications for individuals. They can be monitored in order that there is no potential to overdose. Needles can be exchanged. There is a concept of taking care of people in a vulnerable state, especially when they are addicted to substances.

Equally, it gives an opportunity to ensure this is not seen in an open environment throughout our cities. That is not to suggest that once it is behind closed doors and hidden from public view, all is well. However, people are being monitored and a clean needle exchange is available. We can ensure that if any harm comes to them, they have access to medical services quickly and effectively.

Of course, all of this is predicated on the understanding of An Garda Síochána with regard to this concept. We need to ensure positive buy-in from An Garda Síochána. There is an obligation on the force to enforce laws. There is a grey area around this concept in terms of a person going to the premises knowing full well that he is carrying an illegal substance. We have to impress upon An Garda Síochána that this is being done on a pilot basis. There should be an embracing of the concept. We have to ensure that there is an understanding of what we are trying to achieve, that is to say, people who are addicted to substances will be able to inject in a safe environment with clean needles. They can be monitored and observed in the context of health in an immediate sense to prevent overdoses. They can also be monitored for the longer term health implications that come about because of heavy drug usage, in particular with heroin and other opiates.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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Deputy Kelleher, sorry for interrupting you. Did you speak on this matter earlier?

Billy Kelleher (Cork North Central, Fianna Fail)
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No.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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That is fine. We had no indication of who had spoken earlier.

Billy Kelleher (Cork North Central, Fianna Fail)
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I thought you were implying that I had some knowledge of it already.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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No, we are absolutely enraptured by what you are saying. Carry on.

Billy Kelleher (Cork North Central, Fianna Fail)
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I will take the hint from the Ceann Comhairle.

While it is a pilot scheme, I believe we should examine the international evidence and embrace the concept more widely to ensure we can assist more people who are chronically addicted to substances and who inject. There are such people in many of our major cities and towns throughout the country.

There are always objections and the view that it should not happen in my backyard. However, as public representatives with a broader agenda in terms of the public good, we must be forceful in seeing how this works. We must ensure it is embraced by the community and An Garda Síochána. We must ensure it benefits those using it. We must ensure those who have oversight of it in terms of health outcomes are resourced to enable them to secure health requirements in the short term, medium term and longer term.

I welcome the Bill and compliment those who brought it forward. I know that it has broad support in the House. I hope it will have a meaningful impact on the lives of many people.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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Thank you, Deputy Kelleher. I assure you I was not trying to cut you short. I was just uncertain about who had contributed previously. Deputy Mattie McGrath is next.

Mattie McGrath (Tipperary, Independent)
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I assure you I have not spoken on this matter before.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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If you had, we would not let you speak now.

Mattie McGrath (Tipperary, Independent)
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I know you would not. You have declared that. However, as you said you did not know, I could have pulled a fast one. I am not as keen as you think to have a microphone in front of me full-time.

While I will support the Bill and I can see where the Minister of State is coming from, I am not fully in favour of it. I believe the concept is fine. I know it is a pilot project. I know that it would be good for health reasons and so on to have clean needles and a safe area for this method of injection.

However, we are talking about illicit and illegal substances and the carrying of them to and from the place. So many pressures are on our authorities. I have the greatest sympathy for people who are addicts and those who become addicts. We do not put half enough menacing pressure on the suppliers and those peddling. This is a problem in every town and village in Ireland. Certain people are known to An Garda Síochána. I cannot understand why more pressure cannot be put on them. It is ruining families and the lives of people. It is damaging.

It is not a question of NIMBY syndrome. I realise it is a pilot project. However, from the point of view of the concept of setting up these programmes I am unsure whether this is the right methodology. Have we exhausted any other reasons and assessments?

Deputy Billy Kelleher has suggested we are duty bound or that it is incumbent on us to embrace things like this. I am unsure about that. We almost seem to be on a wave of embracing things. We were here this night last week and embraced things. Many people here were not in favour of it and yet they were standing up clapping for it. What is wrong with people? This is the Chamber to which we are elected to pronounce our views.

I am here almost ten years, thankfully. That was the first time I was unable to say and do what I wanted to do on the night. That is not good or healthy in a democracy. We had it again this evening. People could not get in or out. If a person holds a certain view, that person is demonised as some kind of racist or bigot or whatever. Thankfully, we live in a democracy. I thank the gardaí for their help in getting me in and out, as well for helping others later. People were restricted from getting in or out.

All kinds of charges are made if one does not go with the flow. People are being encouraged to strike and leave their workplace and everything else. It is reckless. We are elected to the Chamber to make these decisions.

I am not in favour of it. I would like to see how it is going to work. I would like to see it teased out better. Are we going to have a situation whereby the State is paying moneys to cover for illicit substances and injecting facilities while, on the other hand, trying to prohibit people who have addictions and those who do not from using drugs? What about those who are taking recreational drugs and then going on to harder drugs? The jury is out as far as I am concerned and, therefore, I cannot say that I wish the Minister of State well on it; I do not.

I hope I will not be portrayed as backward, a caveman or any other type of man. I am simply making known my view that I am not in favour of this. The matter must be teased out and the community must be involved. There should be more public consultation.

We cannot just say that we hope the Garda will be able to understand. Gardaí are too scarce and busy. There is enough pressure on them at present. There must be a serious assessment of the impact of any legislative initiatives undertaken in the House. Is there a review clause in this legislation? Perhaps there is a timeline for reviews of the functionality of this and to assess whether it is dysfunctional or not working. If it is found to be a bad, retrograde step, are we stuck with it or is there a timeline for amending the legislation or, indeed, scrapping it?

Jonathan O'Brien (Cork North Central, Sinn Fein)
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It is a pilot project.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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Deputy Danny Healy Rae will give the view from Kilgarvan.

Jonathan O'Brien (Cork North Central, Sinn Fein)
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I suggest that the Deputy read the legislation. It would be a help.

Michael Harty (Clare, Independent)
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Tonight, the House is witnessing a split in the Rural Independent Group because I will speak in favour of the Bill.

Mattie McGrath (Tipperary, Independent)
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We have no problem with that.

Michael Harty (Clare, Independent)
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The Bill appears to be counter-intuitive and perhaps my colleagues see it that way in that it appears to be encouraging drug misuse but, in fact, it has the opposite intention. The intent of the Bill is not in any way to condone intravenous drug abuse or to encourage illegal activity. Its intent is to reduce health risk for intravenous drug abusers. Such drug abuse is very high risk behaviour and this is an attempt to reduce the risk. It is not intended to encourage them to use intravenous drugs in any way. This country already has a needle exchange programme and it is accepted that it has reduced the incidence of intravenous infections such as hepatitis C, HIV and septicaemia. It certainly has reduced the number of deaths related to intravenous drug abuse. If it is accepted that one would give somebody a clean needle to inject, it is a natural progression to move on to giving them a facility where they can inject safely and be supervised. That is the intention of the Bill.

Fatal overdose in intravenous users is very frequent. When one combines intravenous drug abuse with methadone and benzodiazepine use, as well as other illegal drugs, one compounds the effects and one is more likely to have an overdose and a fatal outcome. The provision of an injecting site is to prevent that, which is the primary objective of the Bill. In addition, international experience shows that supervised injection sites reduce the incidence of public order offences and anti-social behaviour and do not increase drug related crime. They do not increase the incidence of intravenous drug abuse. The centre is targeted at a specific, highly vulnerable group that engages in high risk activity. In that regard, it is a positive proposal.

Injection centres are safe zones for drug abusers. Unfortunately, there have been overdoses but there has not been a fatality in supervised sites for intravenous drug injecting. That is to be welcomed. They reduce the incidence of fatal overdose because people are supervised for a certain period of time after they have injected, which is the time when a fatal overdose is most likely to occur. Medication can be administered to them, which I will mention later. There is international experience with supervised injection sites. There are more than 90 such sites throughout the world and they have been tried and tested. This approach is not new, therefore, and it has been found to be safe and effective.

We must remember that intravenous drug abusers are a very vulnerable group. Many are homeless and have multiple health problems such as mental health issues, intravenous drug abuse issues and physical illness related to their intravenous drug abuse. They are vulnerable and need to be supported. We must not dehumanise drug users. We must treat them humanely. They are members of our society and if they are not given every support, they will die on our streets. There have been 5,000 drug related deaths in the past ten years in Ireland, which is an unbelievable figure. It is 500 per year. Of them, 200 die on our streets from intravenous drug overdose, which is one on every second day. The introduction of this injection site will address that and, hopefully, will save many lives.

Supervised injecting sites will also offer supports to intravenous drug abusers. It is not simply bringing them into a room where they can inject safely. They will be offered medical, dental and psychological services. There will be detoxification and rehabilitation programmes. They will have social services and social support and they will be offered accommodation. This group of people should be at top of the list for housing. We must get these people off the streets and then wrap services around them. There is no point in shoving them away or not giving them support.

10 o’clock

If we do that, they are going to die on our streets. This is about offering harm reduction and integrating with other services. That is what the health service should be about - integrating and helping the most vulnerable.

This is not only a Dublin issue. It is an issue in every city and town in Ireland, in Galway, Limerick, Cork, Ennis and probably in Clonmel and Killarney too.

Mattie McGrath (Tipperary, Independent)
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Yes, it is.

Michael Harty (Clare, Independent)
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It is a nationwide issue., not just a Dublin problem. The principle underlying this legislation is better outcomes for patients. It is primarily about saving their lives. Remember, we cannot rehabilitate someone who is dead. We must give them every support that we can.

In terms of the policing aspect of this issue, it requires common sense policing. It requires a sensitive approach from An Garda Síochána and this is challenging. There must be an acceptance that intravenous drug users who are approaching these supervised centres are in need of a different type of policing. There is a difference between an intravenous drug user in possession of drugs going into an injection centre and someone who is selling or supplying drugs in the vicinity. Certainly, there is no intention that the injection facilities will be in any way related to the sale and supply of intravenous drugs. Gardaí need to play a very supportive role and should protect rather than victimise the intravenous drug users. After all, drug users are the victims in this situation. They are not the criminals or the people supplying the drugs. They, unfortunately, have been abused by criminals who have gotten them hooked on these drugs. They are victims more than anything else. We must have a health-led approach to drug users, rather than criminalising them. This is not a criminal justice matter, but a health matter. It requires co-operation from the health services, the police and the local authorities.

I draw the attention of the Minister of State to the testimony of one of the witnesses who appeared before the Oireachtas Joint Committee on Health when we discussed this issue, Professor Gerard Bury. He is a Professor of General Practice in Dublin and is very involved in the provision of medical services for intravenous drug users in the city. He offers his services voluntarily, as do many others, in looking after intravenous drug abusers. He is deeply frustrated about the availability of Naloxone. This is a drug that is used to reverse the side effects, particularly the respiratory failure side effects, of intravenous drug overdose. It has saved many lives but Professor Bury is very frustrated at the lack of availability of this drug for GPs who want to provide a service to counteract the side effects of overdose. He feels that the drug is a potential life saver and argues that if it is made more widely available, it will save lives on our streets. He wants to drive that message home as strongly as possible and I am assisting him now in doing that. I would be grateful if the Minister of State would consider making that drug more widely available in order to save lives.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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Deputy Kate O'Connell is next but I will be asking her to adjourn the debate at 10.15 p.m.

Kate O'Connell (Dublin Bay South, Fine Gael)
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I hope I will not be still speaking at 10.15 p.m.

Some of what I have written down mirrors what my good colleague, Deputy Michael Harty, said. I am coming at this issue from the perspective of a health professional. Fundamentally, a society is judged by how it treats its weakest and most vulnerable citizens. My experience tells me that substance abusers are just that - vulnerable, weak people who live on the fringes of our society. People do not choose that life. They are usually victims of circumstances far beyond their control. Who knows what might have happened to any of us if we were brought up in different circumstances or were exposed to different things at certain times in our lives. Anyone who has dealt with people with an addiction knows that they are trapped in a cycle of getting a hit, withdrawing, panicking about where they are going to get their next hit and so on. It is a vicious cycle in which they are trapped. The least we can provide for vulnerable people on the fringes of our society is a clean room, with a clean needle and swab, where they can inject themselves.

Public health policy should have harm reduction at its core. I know that it probably does not suit some people to hear this but we sell alcohol legally in this country. How many alcoholics do we have? We allow people to gamble legally. How many families have been destroyed by gambling? I was asked why we will not be giving addicts methadone in injection centres but they do not want methadone. They want heroin. They want to inject drugs. If they wanted methadone they could get it from a community pharmacy or a methadone centre. The core point here is that the legal classification of a drug does not make it any worse or better for a person. That is just the way it is. This is not about schedule 1 drugs or going against the law. It is about trying to sort people out in their most difficult time.

Water is to the fore in my mind these days and this is a bit like shoddy workmanship that results in a leaking pipe. One can say that it is terrible that the pipe is leaking but one still has to fix the pipe. I do not want to get political but we cannot keep going down the usual route. Until now, we have been going down the wrong road. Previous policies have not addressed the issue and have not worked, which is clear from the startling number of intravenous drug users all over the country.

I concur with much of what Deputy Michael Harty said. I will not mention specific towns but I have worked in about 60% of the country, geographically speaking, and can confirm that this is not just an urban issue. Intravenous drug use is rampant in many of our rural and coastal towns and people are turning a blind eye to it in many instances. Injection centres offer an opportunity to engage with substance abusers on a regular basis. Often addicts do not engage with the regular services and injection centres are a way of tapping into a vulnerable group and trying to improve their lives through the provision of various services. I hope it will prove possible to initiate them onto appropriate treatment pathways. Often intravenous drug abusers have slipped through the cracks of social services. They have removed themselves from their GP practice and from other services in their communities and injection centres are a way of engaging with isolated people. The centres can also be beneficial in terms of being gossip hubs. This can be useful if bad batches of drugs come onto the market. The centres can be a very good way of identifying wrong concentrations or contaminated batches of illegal drugs and in that sense, they can be a good way of communicating.

Injection centres are not just for drug users but are also for the wider public and the villages and towns that have been ravaged by drug abuse. In response to those Deputies who find this policy unpalatable and who are struggling to support this legislation, I ask them to consider how bad our society looks when we leave vulnerable people exposed on the streets, suffering in front of strangers who come to our shores to look at our beautiful country. Injection centres mean less drug paraphernalia on the streets. I am talking here about contaminated needles, swabs, bits of foil, blades and all sorts of things. These are all left on the streets now but there is evidence to show that providing adequate injection centres will reduce this.

Deputy Michael Harty has referred to the fact that supervised injection centres reduce the number of unnecessary hospital admissions. People are shown how to inject correctly and they tend to end up with fewer blood-borne diseases, septicaemia and the other complications that arise from intravenous drug use. We are not reinventing the wheel. I have not been qualified for very long but needle exchanges were being piloted when I qualified some years ago and have been shown to improve peoples' lives. My view on this has become more open over the years as I have become more informed and have seen that drug addiction can affect anyone.

I wish to address some of Deputy Danny Healy-Rae's comments. Nobody gets up in the morning and decides to take up injecting heroin. We need to try to improve people's lives to the extent that they do not see that as the option for them. As a society, we can deal with what is in front of us now in the most humane and practical way we know, which I believe is this policy. We also need to work to try to make people's lives better in order that is not the path that is the most opportune. That is not somewhere where my children will end up or the children of anybody else here. That is not the path that is laid out for people in life.

We have done great work in Dublin's north inner city to try to improve people's lives there and stop this continuing into the future. This is about reaching out to people who are more vulnerable than us. I ask anyone who is opposed to the Bill to meet some of us who are involved in this. This is about trying to do the best for society.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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I do not think the Minister of State will have sufficient time to respond and it might be preferable to move the adjournment in order that she will have enough time in which to give her response.