Natalie is a Master of Law candidate at University College Cork with an interest in drug policy reform and harm reduction. Her area of research involves the criminological theory of stigma and its impact on cannabis users. She advocates for decriminalisation as the first step needed in the process of removing such stigma. Twitter: @NatalieORegan1

When did drug policy and harm reduction first catch your interest and why? Well, I think it was Vera Twomey was the first person that kind of sparked my interest in cannabis and the laws surrounding cannabis, and that was even before I studied law. And I remember feeling passionate about her fight to get access to medicinal cannabis for her daughter. And I remember, I think I was living in Wicklow or Dublin at the time and she was walking up to the Dáil and we drove and we stood on the side of the road while she was walking past and I started bawling crying. I didn’t know why I was crying, I didn’t know this woman, I didn’t know her daughter. It kind of resonated with me an awful lot. I think that she made a big impression. Yeah, I think that she kind of turned the tide on the view of cannabis in society, that it wasn’t just a drug anymore. That it is a valid medicine. And I think because she was able to show through her experience that it did help her daughter and that it had more benefits than side-effects, I think that changed a lot of peoples’ attitudes when it comes to cannabis and drug policy in general.

Personally, I have grown up with friends who have used all forms of drugs and I always thought there was a better way that society could respond to them and to respond to drug use in general. And I’ve seen the cycle of drugs, suspended sentences, criminal records, prison sentences, and it just seemed like it was a revolving door. They were going in, they were coming out, they couldn’t get a job, they were going back into prison and I just saw it as a waste of time and a waste of taxpayer’s money. Even where friends did go to treatment for whatever drugs, including cannabis, it was always abstinence-based and it was: “You have to abstain from drug abuse”. And I know a few who it didn’t work for. They’d relapse, they felt shame, they felt guilt, they felt like they were a failure. And it showed, especially in some of my friends, that abstinence is not a measure of your success when you are dealing with drug use. And I just thought the way all of that works is more damaging than helpful, in society.

So that was drug policy. For harm reduction, I left school at sixteen years of age. I went back to college at thirty and I remember the first couple of weeks at UCC [University College Cork] coming across ¹Students for Sensible Drug Policy. And it was the first open conversation that I was witness to for safe consumption, what to expect when you’re taking drugs, what are the side effects, what feelings are you gonna have… And as a thirty year old woman who was around drugs in the community growing up, it was shocking that it was the first time I heard of it. It’s the first time this conversation was being had. And it’s not a very open conversation in Ireland, I think. Everything is very hush hush. Yeah, and even on campus you could see you were getting a couple of funny looks from a few people. But I was shocked, thirty years of age and this was the first time I was actually hearing a conversation about drug use. 

Do you have any particular examples of drug policy or harm reduction that you came across in your studies that would have very strongly formed your views on both?

I suppose the first example of a different drugs policy that shocked me was the typical example of going to Amsterdam. I think it’s a kind of a right of passage at this stage, to go to Amsterdam. And I remember the narrative around cannabis and drug use in general in Ireland was very, very negative. When I went to Amsterdam, it was legally purchased and openly consumed… Before going over there, I had an image in my head that you’d have drug addicts on the street and all the really bad social consequences that you would hear of that surrounds the narrative of the use of drugs in Ireland. But there was none of that, there were no social consequences that you could see. People were openly buying and consuming it. And I think when you look at the laws in Ireland and everywhere else, these social consequences are the grounding of this prohibition. This is why we have to prohibit it.

But when it’s not prohibited, or when it is legally consumed in Amsterdam, there are none of those social consequences that surround the narrative in Ireland, and that really, really was an eye-opener.

Where do you think cannabis users face the most stigmatisation in their lives, we’ll say in Ireland, for example? In my opinion, it goes through every aspect of a cannabis user’s life. And in a way it almost has been weaponised in the war on drugs. It’s been used to shame people, to tell people that it’s wrong. For external stigma, you have the general public’s attitude towards drug users and cannabis users. “It’s your own fault”, there’s blame-worthiness attached. They don’t want drug users living in their community. It’s a major barrier to employment with the criminal records and Garda vetting. It even affects accessing health. You’re going to hide your cannabis use from health professionals for fear of shame, for fear of stigma. And research has shown that health professionals, nurses, Doctors – they are very prejudicial and stigmatising toward drug users. 

Another thing that was surprising in my research was that, while training or practising, education on drug use is key to removing this stigma. That attitudes of health professionals changed dramatically once they were educated on drug use. Do you think that’s more of a systemic thing with third level education for people studying medicine, that the problem mainly lies there? Or that it’s more a case of what your parents and other authority figures would have said as you’re growing up?

I think education is something that’s not being utilised enough in all areas. From Doctors, GPs, nurses… Educating the young, the public in general.. I think education is a key that’s not being utilised properly. And when you’re talking about nurses and Doctors training… During their training in third level education, and qualifying to be a nurse or a Doctor, there is no training whatsoever on substance use. That’s astonishing, really. Even GPs have to get specialised training to be able to prescribe methadone to their patients. Unless a GP is going to specialise in it.. It’s disgraceful, why are you not getting trained in it, if you’re going to come across it in everyday life? There’s a lot of drug users in Ireland. And the fact that you get people addicted to drugs who arrive in the emergency room on a pretty regular basis from overdoses. It’s amazing that they’re not given that training by default. You’d think even in an emergency setting they’d get a little bit of training ‘cause they’re going to come across it but there’s nothing! It’s quite shocking.

Have you personally become aware of, or witnessed, examples of cannabis user stigma? If you look at the world it’s everywhere. From movies, to TV, to the language that people use like your stoners, your unproductive, your undesired, your lazy, like Cheech & Chong. It’s the typical example of “That’s what stoners are, that’s what cannabis users are.” And even in media portrayals, the use of the language and the way that they frame cannabis users is often in a very bad light and that reinforces the negative perception that the public holds. So people think: “Oh, I’m legitimised in holding my bad opinion of cannabis users.” Personally, I’ve witnessed friends who have smoked cannabis that have been rejected by their family, kicked out of home, rejected by the whole community. And friends who have been convicted of personal possession that wouldn’t have been able to work in their chosen fields because of their Garda vetting and their criminal records.

I think it is everywhere if you look for it and I think I wouldn’t have noticed how much of it was there until I started my research. Yeah. I think a lot of people would be surprised how much that can affect someone’s life, even if they’re caught with a small amount of cannabis. Like, caught with a joint you get a suspended sentence, but you still have a criminal record. Yeah. Why do you believe that decriminalisation is a crucial part of removing the stigma faced by users? I don’t think it is the final solution, I don’t think that it’s the absolute solution. But it is the first step. Ideally, I’d love to see full legalisation but I think we’re a good few years away from that yet in Ireland. If you remove the criminality that’s associated with cannabis use and remove the criminal label, you remove the legitimised stigma that the public holds. So, once the public perception is no longer legitimised, they feel that their opinion is no longer accepted so it may allow people to think again and have another look at cannabis users in general and maybe change their opinion. ²Portugal’s main aim of their decriminalisation was to remove the stigma, so by removing this, they changed the public perception which is very slow to change, but it is changing. They’ve increased the uptake in health and treatment options. They have increased the public perception of cannabis users in general. The public, as I said, it is very slow to change. But I think once everything around the public changes, it’s like a default that the public will have to change eventually.

It’s been said that racist fear-mongering in relation to immigrant minorities and their use of cannabis was a core deciding factor behind the original prohibition of cannabis. Would you agree that that was the case? It can be said. There have been articles on the original prohibition in America and how it was targeted at the jazz scene, that they were all marijuana smokers. But I think besides racist fear-mongering.. I think in general, society needs to label those that they do not want in their society. And they need to label them as outsiders, as undesirables. That creates a kind of “Them Vs. Us” attitude. “We are not like them, we don’t want them in our community, we are better than them”. By labelling people as undesirables, those that feel that they are at the higher end of society are able to legitimise their feelings towards the lower end of society.

And I think through prohibition, this label became formalised through the criminal justice approach and the prohibition of cannabis users. So I wouldn’t break it down to race or minorities or ethnicities, but I think it can be said in every society that there is a labelling process of undesirables and that’s where it came from. It just grows in society.

Do you believe that there is a high level of ethnic profiling in Europe, in terms of stop and search procedures by police checking for cannabis possession? I don’t think that it can be broken down to ethnicity alone. I don’t think that is the underlying reason for profiling. I’d say the stigma and negative perception of cannabis users can attach to a whole community as well as the individual. So anyone from a certain area will be under suspicion for drug use if there’s high drug use in the area. Like, here in Cork you can drive through certain areas and you’re stopped and you get searched ‘cause the Gardaí will use the excuse that there’s drug dealing in the area. Again, I think it comes down to labelling and stereotypes where you need to label the undesirables and this is what the undesirables look like. This is where they live, this is how they act, and that’s why it came, I think. In my opinion anyway.

What are some of the more promising examples of drug laws around the world, from your perspective? I think the increase in legalisation across the world is taking strides in the last number of years. There’s more and more countries legalising, whether it’s for medicinal purposes or recreational purposes. Even in the recent New Zealand referendum, although they didn’t vote for recreational cannabis, it was surprising that almost 49% of the country voted ‘Yes’. So, even that shows that a good campaign of information and education to the public has merits and can be beneficial. The example that comes up all the time for promising drug laws is Portugal’s decriminalisation. As I said, it’s not the be all and end all, it is not the final solution or the brilliant solution that everyone may think it is, but it has shown success. And it means that a generation of cannabis users will no longer be criminalised. From there, you can step up. That will have knock-on consequences, they won’t be criminalised. We’ll say, if it was in Ireland, they wouldn’t have a Garda vetting problem, they wouldn’t have a criminal record. And that little thing of removing criminalisation can have knock-on consequences far beyond anything you would originally think of. 

What is your opinion on the implementation of MCAP [Medicinal Cannabis Access Programme] in Ireland so far? I’m not really very up to speed on the medicinal aspect of it legal-wise, because I just steered away from it in my research. But, just in general, it needs to be expanded to more illnesses and more issues. You were talking to Alicia Maher recently. An amazing girl, an absolutely fantastic woman. Incredible. She stopped taking thirty tablets a day, I think she was taking? And it’s all cured by a plant you can grow yourself, and that is cheap as chips when you grow it yourself! In Ireland, she wouldn’t qualify for that programme. So, I do think it needs to be expanded to more illnesses. I also think that access to the programme needs to be a valid first option when you do go to the Doctor, where a patient can choose their treatment. Currently, it’s available only when all other options are exhausted. And I don’t think that’s right, I think it should be available as a valid first option. Also, in terms of access to filling your prescriptions in Ireland… There’s a lot of issues around it. People have to travel, they’re finding it hard to get their prescription filled… You shouldn’t have to travel to get your prescription filled. If you are legally entitled to it, you should be able to get it in a pharmacy, where you get everything else. And also it needs to be available on the medical card. 

You need to make it a viable option for people, you need to make it a viable choice for people. And when you don’t include it under the medical card scheme, or have a reimbursement for it, it is a barrier to a lot of people who would benefit from it. Yeah, and even the amount you have to pay up front to access it when you do qualify.… I think it needs to be made open to a lot more people. How do you envision drug policy, and in particular cannabis policy, taking shape in Ireland in the next decade? Well thankfully my name isn’t Mystic Meg, so I’m not very good at prediction! Laughter But I do think the first step of what we were promised when people were voting in the general election was a ³Citizens Assembly. That will at least guide the Oireachtas on what is the general public opinion and the general attitude towards cannabis in Ireland. I think without the Citizens Assembly, it’s gonna be the blind leading the blind in terms of making legislation for any form of cannabis policy in the future. Without some form of engagement with the public of Ireland on what the attitudes are, and what the issues are, through a Citizens Assembly, the Oireachtas are not going to do right, in my opinion. I think they’re probably gonna mess it up more than they will fix it, if they don’t. The Irish government’s current drug policy claims that it’s health led and health approached and health focused, but it’s still administered through the criminal justice approach. 

So even in August 2019 I think, they announced that for personal possession of cannabis, for the first and maybe the second time, being caught would not result in a criminal conviction. But yet again, it is still administered through the criminal justice approach, regardless. Yes, you’re staying away from the Courts, but it’s still an adult caution, you still have contact with the Guards, you still have contact with the criminal justice system. And I don’t think that needs to happen, I think that it was just laziness on the part of whoever was writing the drug policy. I’d love to see decriminalisation in Ireland as a first step. Hopefully legalisation in the future, but I think we’re about ten or fifteen years away from that yet I’d say. 

How do you think current Irish government policies in terms of harm reduction practices could be improved? In terms of cannabis, in general, there’s very little direction in the national drug strategy and in documents themselves, in relation to harm reduction. The dominant conversation around harm reduction in cannabis is usually about administration and mixing it with tobacco and mental health issues. So, I think a significant investment in mental health is needed in general in Ireland. Not specifically down to any cannabis side-effects, but investment in treatment, in alternatives, in education are some things that are greatly needed in Ireland. For example, education in the national drug strategy is limited to school settings and youth services, so this excludes a lot of people who are not in an education setting. I left school at sixteen, I didn’t go back to college till I was thirty. The first drug conversation I had was at thirty years of age. 

Health – there’s no discussion around the everyday health of a drug user in the national drug strategy. As I was saying a while ago with the GPs, they’re not trained, they’re not informed on drug uses and that has consequences on a cannabis user’s life. If they don’t feel that their GP is aware enough, they’re going to hide the fact that they use cannabis from their GP, which may have an impact on whatever medical issues they have. And then you may have other prescriptions that you’re using alongside it and you don’t know what you’re doing properly… Yep. I think that stigma is a valid harm of cannabis use. We don’t have the high risk of overdose like heroin users, or of contracting illnesses from sharing drug-taking equipment. We don’t have that risk. And I think there is an overlook of how important stigma is on a cannabis user’s life. It is a valid harm, it needs to be minimised. It needs to be discussed first and foremost. Even in the national drug strategy, decriminalisation is mentioned once, and I don’t think stigma is mentioned at all, at all, throughout the whole strategy. So, without incorporating that into your conversation of harm reduction, you’re not gonna get anywhere. Especially in terms of cannabis use. It’s not compassionate basically, it doesn’t think about it on a human level. No, it doesn’t. It’s very rigid, departmental, focused. There’s no compassionate conversation around it.

In terms of the harder, more dangerous drugs, like heroin, and people who are addicted to those substances… What suggestions would you make for harm reduction with those. Are we severely lacking in safe injection centres and facilities like that? Yes. What would be the first steps to start to deal better with severe addiction issues like that? They promised safe injection zones left, right and centre. But a lot of the backlash and the rhetoric for them is the ‘not in my back garden’ mentality. Nobody wants 200 heroin users turning up on a daily basis in their back garden, I completely understand that. But, if a community has an overwhelming heroin addiction, it needs to be addressed. So, we need safe injection zones, sterile equipment, needle exchanges. But I think one thing that’s not being discussed enough around heroin users is Naxolone. You need training, you need a prescription. It’s not available for the people who are out on the street, who are in the community of heroin users. It’s not available to homeless services, who go out in the evening. The Guards walking down the street, why don’t they have Naxolone on them? You have to get a prescription, you have to get it filled, you have to get training, licences… It’s a life-saving option that’s there, but it’s too difficult to get access to, or to be able to use it effectively.

Could you give some examples of some of the more shocking or striking examples of data you discovered over the course of your Masters research? I always figured that cannabis use was… not prevalent, but I always presumed that there would be a high level of cannabis use. But, some of the figures I came across in the European report, millions of people in Europe are using cannabis! It is the most widely-used drug and it’s far beyond heroin use, cocaine use, prescription abuse… And, I think, for something that is so prevalent and so widely used there’s not enough focus on it. The focus is always on the lower-use more dangerous drugs. I think it was 92 million in the European Union who use cannabis in their lives. Even when you look at prison numbers in Portugal during my research. They had the highest proportion of drug users in prison in 1999, to having the lowest in 2008. I think they decreased nearly 50% in the first 8-10 years of decriminalisation. The shock of how many people were criminalised for cannabis use. The drop of 50% can show you that that many people did not need to be criminalised. It’s amazing. It’s a bit puzzling why more countries in Europe don’t try to emulate their success. Even if you look at the figures by the ⁴Commission for the Dissuasion of Drug Addiction (Comissões para a Dissuasão da Toxicodependência – CDT) in Portugal… 80-90% of the cases that came before the CDT had no evidence of addiction. They were not addicted to drugs, they were recreational users.

I always had the thought in my head, that usage does not equal addiction. And I think those figures from the CDT really cemented that view of: “Just because you use a drug, does not mean you’re addicted and you need help”. What was the focus of your research paper? What was your main area of interest? The title I ended up with was: “Blunt Trauma – Effective Stigma on Cannabis Users and Why We Need to Decriminalise Personal Possession”. Okay. I wanted a pun title. I was playing around with so many puns, I was absolutely determined to get one in there, to keep my Supervisor happy, ‘cause she begged me: “Please get a pun in the title, I love my puns!” Richard Laughs And she came up with a brilliant one, she called it: “Nip it in the Bud”. And I was like, “Oh that’s so good, but I can’t use it, it’s yours! I really have to come up with my own one now, but you’ve taken the best one!” Natalie laughs Yours is better, but they’re both good! So, I titled it “Blunt Trauma”, which I was proud of. 

Was that research paper focused on Ireland, or was it more international? It was kind of a happy mix of everything. I explained the international overlook of where Ireland is in terms of flexibility and room for manoeuvre in international law. I discussed the changing attitude internationally, from back in the United Nations Special Assembly in 1998 about advocating for a drug-free world, which you’re never going to get, to harm reduction and decriminalisation in 2016. And it has moved away from the fact that we’re never going to achieve a drug-free world. They were probably a bit optimistic! And I think the most striking part was looking at ⁵Kofi Annan. In 1998, he was a real advocate for a drug-free world, and he completely changed his narrative by the time 2016 had come around. He had joined the Global Drugs Policy Commission. He completely changed his view on international drug policy and it was quite refreshing to see that… no offence… even someone at that age can change their mind. You can be educated and you can change your opinion! 

Natalie, it’s been a pleasure, thanks a million for your time. Thanks very much! I’ll leave you with Albert Einstein’s definition of insanity.. Doing the same thing over and over again, and expecting a different result! I think that sums up drug policy perfectly in Ireland!

References:

¹ Information on Students for Sensible Drug Policy (SSDP): https://ssdp.org/ssdp-history/

² A commentary on Portugal’s decriminalisation of drugs, by The New York Times:

https://www.nytimes.com/2020/10/05/upshot/portugal-drug-legalization-treatment.html

³ A piece on the Irish Citizens Assembly on Drugs by The Irish Examiner:

https://www.irishexaminer.com/opinion/commentanalysis/arid-40042595.html

⁴ Dissuasion commissions are mentioned in this BBC article on Portugal’s decriminalisation of drugs:

http://news.bbc.co.uk/2/hi/programmes/from_our_own_correspondent/8106689.stm

⁵ Kofi Annan’s opinion on the illegality of drugs: https://www.drugpolicy.org.au/kofi_annan_time_to_legalize