Irish Research Council Service User Perspectives of Irish Drug Policy: Toward the Development of a Human Rights Based Approach. Richard Healy BA MA Irish Research Scholar. John & Pat Hume Scholar. A thesis submitted for the Degree of Doctor of Philosophy. Department of Sociology. Maynooth University. October 2019. Head Of Department: Professor Sean O’Riain. Research Supervisor: Professor Mary Corcoran. Acknowledgements. It is a strange feeling thanking people for work that has yet to be evaluated, however I am proud of this research and there are many people, groups and institutions without whom this project would have remained in my head and never made it to the page. I will first thank the ‘faceless’ institutions who enabled me to complete this work. The research commenced with the aid of Maynooth University’s John and Pat Hume Scholarship fund, an award that allowed a chancer to get his foot in the door. What followed, with the assistance of Maynooth University’s Sociology Department was an Irish Research Council Award. Both scholarships allowed me to complete my studies without the financial difficulties that inhibit many. Staying in Academia, I owe a debt of gratitude to my Supervisor, Professor Mary P. Corcoran. Straightforward and to the point, her guidance helped me navigate the nonsense and get on with research. In the latter days, her calming influence was invaluable as I fretted over drafts and re-drafts. I must thank the entire Sociology Department; many nuggets were elicited from chance conversations at photocopiers and kettles. My thanks to Professor Jane Gray. The advice to re-order chapters was a relatively simple task but it enhanced my work greatly, insight only an expert can offer. Both are true masters of their trade. My friend and colleague, Doctor Philip Finn. My PhD guinea pig who graciously allowed me to learn from his mistakes. Doctor Phil taught me without realising it. My wife Karen, your understanding, hard work, encouragement and love allowed me to chase my dreams. My ‘mam’ Mary, from day one, a part-time certificate in Liberty College, to the final days of this research, you have been an outlet for frustration and a source of inspiration. In short, I thank you both for putting up with me. The Service Users Right in Action, an amazing group, who do amazing work and will achieve amazing things. Both individually and as a collective, this research would not have been possible without them. I must also thank Cecilia Forrestal and Gerard Ryan for their help and endless knowledge. Most importantly, I must especially thank every participant who allowed me a glimpse into their private life, I hope this research reflects their thoughts, experiences and opinions accurately. Without these interviews, there would be no research. Thanks. I have chased rainbows all my life, I’ve never found any gold. In the end this is where I come. Man, I fxxxxxxg hate this place. -Graffiti on a wall of a methadone clinic. On Raglan Road on an Autumn day I met her first and knew, that her dark hair would weave a snare that I might one day rue. -Patrick Kavanagh, On Raglan Road. List of Tables and Diagrams Fig. 1. A Graphic of the ‘Two-Step’ Methodology… ....................................................... 127 Table of Participants… ................................................................................................ 133-135 Appendix 1. Consent Form. (Given to all Participants.) 2. Information Sheet. (Given to all Participants.) 3. Contract/Consent Form. (Sample of Clinical Contract). 4. Clinic Sign re: Urinalysis, on display in a Clinic. 5. Sanctions. On display in a Clinic. 6. Table of Participants. “Aido” and “Eamonn”. R.I.P. For Karen, Richard, Brandon and Lola Abstract This thesis makes a number of key contributions to contemporary Irish Methadone Maintenance Treatment (MMT) discourse and practice. As a harm reduction modality, the annual number of clients availing of MMT in Ireland has continually increased, (EMCDDA 2017, 2018, 2019). Due to the recurrent absence of positive outcomes in the lives of clients, (Carew & Comiskey 2018, 2018a), human rights have emerged as a valid platform to frame a new approach to this recovery model, (CAN & SURIA 2018, Barrett 2010). Heroin use and MMT embody what is arguably the primary example and hegemonic response to problematic drug use in Ireland, (EMCDDA 2019). Therefore, both are explored as examples of deleterious Irish drug use and the predominant recovery model it employs. A Foucauldian Approach, predominantly underpinned by genealogy and governmentality, informs the tracing of the continual and ephemeral construct of the Irish drug user (and drug service user), (Foucault 1991, 2000, 2008). This advances a cogent overview of the socio- historic trajectory of the service user and the concomitant societal and administrative responses to Irish problematic drug use. An analysis of this trajectory explicates that human rights and methadone use are not sudden manifestations of Late Modernity. Rather, they are the consequence of broader socio-political and economic contexts within which drug policy has always been framed. A ‘two-step’ methodology, a combination of Participatory Action Research and Narrative Analysis, employed over a three-year period, enabled the compilation of rich, in-depth qualitative data from what is traditionally regarded as a vulnerable and hard to reach populace. This research asks important questions of Irish MMT. As a recovery modality, it is delineated as a mode of social control, a harmful harm reduction service and a method of governing and maintaining the docility of a population with little value to a society of frenetic consumerism, (Baumann 2000, Lee 2006, Palese 2013). Human rights-based recovery advances treatment practices that promote dignity, respect and agency. Participation, autonomy, non-discrimination, equality and accountability are also values which should translate as tangible entitlements of rights based care, (Barrett 2010, Vizard 2011). Although Ireland is a signatory of several human rights instruments that ratify the Right to Health and The Public Sector Duty Act, these rights are rarely made manifest in contemporary Irish MMT practice. The findings of this thesis suggest that the methadone apparatus requires an urgent review of policy, governance and practice if the model is to rehabilitate, re-integrate and reduce the harm for those who have difficulties with opioid use. Table of Contents Introduction: I. Overview ....................................................................................................................... 1 II. Irish Drug Use ............................................................................................................... 2 III. Harm reduction in Ireland ............................................................................................. 3 IV. Human Rights and MMT .............................................................................................. 5 V. Rationale, Aims and Objectives: Significance of the Research .................................... 9 VI. Research Structure and Theoretical Frameworks .......................................................... 8 VII. Overview of the Key Research Questions ................................................................... 11 Chapter One: Theorising Irish Drug services, Drug users and Service Users: Foucauldian and Human Rights Based Approaches. • 1.1. A Governmentality Perspective ............................................................................ 16 • 1.2. Foucauldian Approach—Genealogy and Governmentality ................................. 17 • 1.3. A Human Rights Perspective ............................................................................... 24 • 1.4. Human Rights Violations and Dehumanising the Drug User .............................. 28 • 1.5. Economic, Social and Cultural Rights--A Human Rights-Based Approach or “Nonsense on Stilts” .................................................................................................... 31 • 1.6. United Nations Drug Conventions, Human Rights and Harm Reduction ............ 34 • 1.7. Neoliberalism and Human Rights ........................................................................ 38 • 1.8. Advocating for the Rights of the Excluded ---Service Users Rights in Action…42 • 1.9. Conclusion ............................................................................................................ 45 Chapter Two A Foucauldian Approach: Governmentality and The Genealogy of the Drug Service User. • 2.1. Introduction… ...................................................................................................... 48 • 2.2. The History of Problem Drug Use in Ireland: A Genealogy… ............................ 49 • 2.3. Irish Drug Policy and International Drug Policy… .............................................. 52 • 2.4. 1967-1969: The Drug Squad and Jervis Street Clinic…....................................... 54 • 2.5. The Working Party on Drug Abuse--1968-1971… .............................................. 60 • 2.6. Pitied as Opposed to Punished: Early Drug User Constructs. .............................. 63 • 2.7. The Remainder of the 1970s: A Period of Inactivity ........................................... 66 • 2.8. The 1980s: Heroin, Vigilantes and Epidemics… .................................................. 68 • 2.9. The First Heroin Epidemic ....................................................................................72