Potential national drug policy changes debated at psychiatry meeting

The College of Psychiatrists of Ireland Spring Meeting hosted a lively panel discussion highlighting the different perspectives about current drug policy in Ireland and what the alternatives are.

Ahead of the Citizens’ Assembly on Drug Use, the meeting panel looked at the possible consequences on mental health and public health in the event of a change in Ireland’s drug policy.

The Citizens’ Assembly is made up of 99 members of the general public and an independent chairperson, which is examining “the legislative, policy and operational changes Ireland could make to significantly reduce the harmful impacts of illicit drugs on individuals, families, communities, and wider Irish society”. It held its inaugural meeting on the weekend of the 14-16 of April, two weeks after the College held its Spring Meeting.

The Assembly will also be taking submissions from stakeholders, and, according to Prof Eamon Keenan, HSE National Clinical Lead for Addiction Services, “this is something that the College maybe could consider.”

Dr Mike Scully, Consultant Psychiatrist and Clinical Director of Addiction Services in HSE CHO 7, told the meeting that it is potentially “time for a reset” on drug regulation. He highlighted the failed “war on drugs” approach and the option now to reconsider the system of drug control and sanctions.

According to Dr Scully, there are “multiple options” for this reconsideration, including decriminalisation of use and possession of drugs, or legalisation of particular drugs; for example, cannabis.

“Broadly speaking, if you have been polling in recent years there is quite good [public] support for change,” he said in his presentation.

Speaking to the Medical Independent (MI), Dr Scully said: “Nobody’s in disagreement that substances can potentially harm people, but it’s how you regulate them, and the level of harm associated with the regulations that are an issue. And I will continue to suggest that the current system is plainly not working.”

Debating the other side of the coin, Prof Bobby Smyth, Consultant Child and Adolescent Psychiatrist and Clinical Professor with the Department of Public Health and Primary Care in Trinity College Dublin, examined why the American Medical Association is against legalisation of certain drugs, looking at the negative health impacts of legalising cannabis.

Prof Smyth presented data which showed that daily cannabis use among 16-year-olds in the US had increased from 0.8 per cent in 1991 to 4.8 per cent in 2019, whereas in the same timeframe in Europe, daily cannabis use in this age group stayed between 0.5-0.8 per cent.

Prof Smyth also cited a number of studies showing altered neurological development in young cannabis users, including a 2019 Journal of Neuroscience study which showed differing levels of grey matter in the brain associated with adolescent cannabis use, and a 2022 study in the Journal of Translation Psychiatry, which found that “adolescent cannabis use accelerates prefrontal cortical thinning”. Additionally, Prof Smyth maintained that cannabis use has negative effects on mental health.

“I don’t see any model of legalisation that’s going to reduce the health harms associated with cannabis,” Prof Smyth told MI. “And my observation of them is that they all carry a risk or a likelihood of increasing health harms… on the basis of the current evidence.”

Consultant Adult Psychiatrist Prof Matthew Sadlier also spoke on the panel and told delegates: “The concept that making some activity illegal does not change use is bonkers: We know it does.”

He said that legislative bans do affect behaviour and that in the event of decriminalisation or relaxed legalisation, “you would have to have a policy to reduce [drug] use.”