Aims of Pompidou project

• The overall aims of the Pompidou Group’s project are to:

• Carry out an analysis of needs and draw up proposals for feasible actions and interventions to be undertaken by different stakeholders (including government and non-governmental agencies) to effectively integrate different gender perspectives of persons who use drugs in planning, service delivery, and professional practice.
• Identify obstacles and barriers for accessing care and treatment and for introducing a gender dimension in drug policy, as well as ways to overcome them.
• Identify obstacles and barriers for the integration of gender approaches in drug law enforcement and the criminal justice system, as well as ways to overcome them.
• Provide a better understanding of when best to apply gender-neutral approaches, and when applying gender-specific responses would be more appropriate.

Irish contribution

Morton et al.’s paper outlines the Irish situation in relation to five topics linked to these aims: gender in current drug policy; transgender and/or intersex persons within service delivery; stakeholders at national level; obstacles to the integration of a gender-sensitive approach; and benefits to society and health and wellbeing of target groups of adapting and implementing a gender-sensitive approach. Some of the findings are outlined below.

Gender and drug policy

Ireland’s current national drugs strategy, Reducing harm, supporting recovery (2017–2025),⁵ is described in the paper as marking a shift in Irish drug policy away from previous strategies that were ‘relatively gender-neutral’ (p. 3)⁴ to one which ‘attends extensively to the issue of women and substance use’ (p. 3).⁴ Morton et al. outline the elements of the strategy that deal with gender, specifically noting four of the 50 strategic actions contained in the document – three relate to women specifically, while a fourth refers to the needs of the LGBTQI community.

1    There is a strategic action to ‘respond to the needs of women who are using drugs and/or alcohol in a harmful manner’, by increasing the range of wraparound community and residential services equipped to meet their needs and by developing interventions to address gender and cultural-specific risk factors for not taking up treatment (p. 42).⁵

2    There is a commitment to ‘expand addiction services for pregnant and postnatal women’ through seven developments, including strengthening links between addiction and maternity services (p. 43).⁵

3    Under the strategic action ‘to improve the range of problem substance use services and rehabilitation supports for people with high support needs who are homeless’, mention is made specifically of developing the provision of gender-specific stepdown services for women and their children progressing from residential rehabilitation treatment who are at risk of discharge into homelessness (p. 48).⁵

4    There is a strategic action that sets out to improve the capacity of services to accommodate the needs of people who use drugs and alcohol from specific communities. (p. 49).⁵

The authors note that there are neither gender-specific actions within the current drugs strategy in regard to prevention nor any specific considerations of transgender or intersex populations or risks for these populations. They describe any consideration of the needs and specialist supports for those who are transgender and/or intersex in Ireland as being in ‘relative infancy’ (p. 5).

Gender and treatment

Drug treatment and intervention in Ireland is described as having evolved over the previous 15 years to a more gender role focus. The authors identify some changes made: including women in substance use treatment and intervention; developing gender-specific services and interventions for women; and developing resources and responses within relevant ancillary services to meet the needs of women who use drugs. Table 1 outlines the gender-specific treatment and interventions for women in Ireland identified in the paper.

Table 1: Gender-specific treatment and interventions for women in Ireland

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Source: Morton et al. (2020)

Gender and the criminal justice system

The Pompidou Group is also interested in how gender is addressed within the criminal justice system. While this does not feature in Ireland’s national drugs strategy, Morton et al. note that the needs of women are identified in other related policy documents.^6,7 They also identify issues arising within the courts and the prison system for women. For example, there are ‘specific risks for women involved within the criminal justice system, including a lack of housing supports on exit from prison, substance misuse within the prison itself, separation from children, and lack of integration supports on exit from prison’ (p. 5).

Obstacles to gender-sensitive approach

The authors outline a series of obstacles facing the adoption of a gender-sensitive approach to drug policy and interventions in Ireland. These exist at societal, policy, community, organisational, practitioner, and individual levels. For example:

• At a community level, women who use drugs experience stigma within their communities, which presents a major barrier to accessing supports.
• At an organisational level, funding streams can prevent the integration of a gender-sensitive approach either by not providing funding for gender-specific services or the services of the broader range of agencies that would be needed to meet the complex needs of women who use drugs.
• At the practitioner level, practitioners may not have been trained in ‘specialist responses that take account of gender within substance use patterns or trajectories, or in responding to women where there are complex issues and trauma histories’ (p. 10).

Gender mainstreaming

The authors offer support for the adoption of a gender-mainstreaming approach to policy development in Ireland. This approach would mean each ‘drug policy proposal is assessed for its potential (unintended) positive and negative impacts across genders’ (p. 10), as well as a critical examination of the gendered norms and assumptions that underpin the proposals. The authors also report there is evidence in Ireland of an increasing focus on inclusion health and a patient and public involvement (PPI) approach to health issues. These along with other factors suggest an environment that might be more conducive to a fully gender-sensitive approach to policy and service development evolving in Ireland. The authors conclude:

Key within the Irish context will be the leveraging off the current developments within social inclusion based health, PPI, participative [national drugs strategy] structures and existing innovation in gender responsive intervention and treatments in order to further advance gender mainstreaming within drug policy, which may ultimately address some of the key individual issues such as stigma and shame in regard to gender and substance use. (p. 10)

Project output

Morton et al.’s paper is an output of the first phase of this broader project by the Pompidou Group. The final output of the project is expected to be a handbook for practitioners and decision-makers. It will contain a set of principles and practical examples that provide concrete guidance for implementing a gender approach in planning and delivering prevention, care, and treatment services for people who use drugs. It will also provide guidance for law enforcement agencies on the practical integration of gender approaches in their work. The project is in its early stages and due for completion in October 2021.

1  For more information on the activities of the Pompidou Group, visit: https://www.coe.int/en/web/pompidou/about

2  For more information on the gender-related activities of the Pompidou Group, visit:
https://www.coe.int/en/web/pompidou/activities/gender

3  The team members are: Sarah Morton, director of the Community Drugs Programme, University College Dublin; Eva Devaney, National Voluntary Drug and Alcohol Sector; Karen O’Connor, Drugs Policy and Social Inclusion Unit, Department of Health; Pauline McKeown, chief executive officer, Coolmine Therapeutic Community; and Anita Harris, residential services manager, Coolmine Therapeutic Community.

4  Morton S, Devaney E, O’Connor K, McKeown P and Harris A (2020) Gender and Irish drug policy: report submitted to the working group as part of the ‘Implementing a gender approach in different drug policy areas: from prevention, care and treatment service to law enforcement’ project. Dublin: University College Dublin and Department of Health. https://www.drugsandalcohol.ie/31888/

5  Department of Health (2017) Reducing harm, supporting recovery: a health-led response to drug and alcohol use in Ireland 2017–2025. Dublin: Department of Health.
https://www.drugsandalcohol.ie/27603/

6  Department of Justice and Equality (2017) National Strategy for Women and Girls 2017–2020: creating a better society for all. Dublin: Department of Justice and Equality.

7  Department of Justice and Equality (2018) Irish Prison Service and Probation Service: strategic plan 2018–2020. Dublin: Department of Justice and Equality. https://www.drugsandalcohol.ie/29241/