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The national drugs and alcohol strategy Reducing harm, supporting recovery: a health-led response to drug and alcohol use in Ireland 2017‒2025¹ follows through on the commitment made by the Government in May 2016 to pursue a health-led rather than a criminal justice approach to drug use.² Seeing drug use as a health issue rather than a criminal one is an important step towards reducing the stigma experienced by people who use drugs. Activities that aim to raise awareness of the issue and set out to reduce the stigma are ongoing in Ireland.

UISCE and the Press Ombudsman

In October 2017, the Press Ombudsman of Ireland issued an advisory notice³ to all national and local newspaper editors.
The letter was sent following an approach made to the Ombudsman by the Union for Improved Services, Communication and Education (UISCE). In their submission, UISCE made a number of key points that are echoed in the report by the Global Commission on Drug Policy which is covered in the next article and explores the negative perceptions of drugs and the people who use them.⁴

We were deeply saddened to learn of the death of Trutz Haase at Easter. Those involved with the preparation of the current drugs strategy will be familiar with Trutz’s work on the performance measurement framework for Drug and Alcohol Task Forces.

Reducing harm, supporting recovery: a health-led response to drug and alcohol use in Ireland 2017—2025 underlined the shift in Irish drugs policy over the last few years towards a health-led approach. It was made very clear at the launch of the strategy last year and in most official commentary around it that the Irish government viewed drugs as a public health rather than a criminal justice issue.

Because of concerns about the negative impact that alcohol can have on individuals and communities, licensing statutes generally include a right for community members to object to the grant of a new licence or a renewal of a licence. The National Community Action on Alcohol Network, convened and supported by the Alcohol Forum, was formed in early 2017 to support community action on alcohol in Ireland and to facilitate collective working on issues of common concern. It approached the Public Interest Law Alliance (PILA) to develop a legal guide on the licensing process in Ireland, as it is recognised that there is a link between the licensing of alcohol and its consumption. The guide,¹ published in May 2017, was compiled amid growing concerns about the widespread availability of alcohol in communities. It is intended to be a practical guide to the when, where and how of objecting to a proposed grant or renewal of a licence.

The Pompidou Group of the Council of Europe has published a new report, Costs and unintended consequences of drug control policies.¹ The overall aim of the report is to define and identify costs and unintended negative effects of drug control policies, borne by individuals and society (p. 9). The findings are based on a wider study carried out by the Pompidou Group in cooperation with the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA).

The world drug perception problem: countering prejudices about people who use drugs¹ challenges common public perceptions of addiction, drugs, and the people who use them. It highlights the importance of language in creating and reducing stigma and discrimination. The report is by the Global Commission on Drug Policy (GCDP), which describes itself as made up of political leaders and leading thinkers from across the political spectrum. It sets out to ‘bring to the international level an informed, science-based discussion about humane and effective ways to reduce the harm caused by drugs to people and societies’.² Since its inception, the GCDP has published a series of reports that are ‘technical and political reports to ground evidence-based policy recommendations in human rights, health and development’.² The current report was published in January 2018.

Activities of Irish psychiatric units and hospitals 2016,¹ the annual report published by the Mental Health Information Systems Unit of the Health Research Board, shows that the number of new admissions to inpatient care for alcohol disorders has stabilised.

In 2016, some 1,260 cases were admitted to psychiatric facilities with an alcohol disorder, of whom 445 were treated for the first time. Figure 1 presents the rates of first admission between 1996 and 2016 for cases with a diagnosis of an alcohol disorder. The admission rate in 2016 was similar to the previous year, while trends over time indicate an overall decline in first admissions. Just under one-third of cases hospitalised for an alcohol disorder in 2016 stayed just under one week, while 28% of cases were hospitalised for between one and three months, similar to previous years.

Recent research conducted in 2014 by the National Advisory Committee on Drugs and Alcohol suggests that there are 18,988 opiate users in the Republic of Ireland (rate 6.18 per 1,000 population), indicating that Ireland has one of the highest estimated rates of problem opiate use across 17 countries in the European Union.¹ Opiate use disorder is an increasingly common condition in healthcare systems in Ireland, with over 200 opiate overdose deaths occurring annually.²

Naloxone is an antidote for opioid overdose that reverses the depressant effects of opiates such as heroin. Naloxone has been shown to reduce mortality among people who use opioids and its distribution to trained lay users is effective for reducing fatal overdose.³ The Naloxone Demonstration Project was initiated in the Republic of Ireland in 2015, and in that year 600 individuals were trained in how to use naloxone.⁴ To date, more than 400 drug users have been prescribed naloxone⁵ and there have been five recorded ‘overdose reversals’ that may have contributed to lives being saved.

Evidence suggests that among men who have sex with men (MSM) and who use drugs, there is a preference for ‘sex drugs’, including alkyl nitrites (‘poppers’), crystal methamphetamine (‘crystal meth’), club drugs (including ketamine and ecstasy) and new psychoactive substances.¹ Drug use for or during sex (‘chemsex’) among MSM has caused concern because of the direct effects of the drugs themselves in addition to an increased risk of transmission of sexually transmitted infections (STIs).

Alcohol misuse and alcohol consumption are significant risk factors for suicidal behaviour. Persons diagnosed with alcohol use disorder have been shown to be at increased risk of suicide in a meta-analysis of cohort studies,¹ and the lifetime risk of suicide among those with alcohol use disorder has been estimated at 7%.² In addition, subjects admitted with alcohol use disorder are more likely to present with self-harm during a 12-month follow-up period.³ However, although numerous studies have demonstrated an association between alcohol consumption and suicidal behaviour, very little attention has been paid to the factors associated with alcohol involvement in suicide and self-harm. A recent study conducted in Ireland sought to identify factors associated with alcohol consumption in cases of suicide and non-fatal self-harm presentations.⁴

In October 2016, the Union for Improved Services, Communication and Education (UISCE) was invited to be part of the working group formed to discuss the proposed supervised injecting facility (SIF) that is planned to open in Dublin in 2018. UISCE provides an independent representative voice for people who use drugs and helps to ensure the sharing of accurate, up-to-date information. In order to identify the most important features of the proposed facility to the community of end-users, UISCE developed a short survey that included aspects identified by the working group as necessary to fully represent the opinions, thoughts and concerns of people who use drugs in public places.

In Europe, concerns about the potential risk for misuse of or dependence on the prescription drugs pregabalin and gabapentin have been raised for at least a decade. This article brings together a brief overview of some of the main international and national literature to date. In 2009, pregabalin and its potential involvement in drug-related deaths in Finland, Sweden and the United Kingdom (UK) was reported to the EMCDDA Early Warning System.¹ A retrospective analysis of German data showed that as early as 2008 cases of pregabalin misuse/dependence were reported in that country.² However, several years earlier in 2005, the United States (US) made pregabalin a controlled drug due to the recognition of the potential risk of misuse and/or dependence.³

Two-thirds of sales on darknet markets are drug related. These anonymous online markets enable transactions with neither buyer nor seller having to reveal anything about their identify. So-called ‘cryptomarkets’ are a relatively new phenomenon but the opportunity they present to undermine conventional law-enforcement approaches inevitably means that they will be a driver of significant growth in criminal activities over the next few years. A recent EMCDDA publication, Drugs and the darknet: perspectives for enforcement, research and policy¹ presents an analysis of drug-related activity on darknet markets, focusing on specific European countries and also looking at the phenomenon from the perspective of law enforcement agencies required to monitor and counter the operation of these markets.

A recent systematic review examining treatment for opioid use and outcomes among older adults was published in the journal, Drug and Alcohol Dependence.¹ The review aim was first to identify and distil key literature on ageing among people treated for opioid use, and secondly to investigate immediate treatment outcomes such as retention and abstinence.

The review consisted of targeted databases searches, supplemented by manual grey literature searches. Only articles explicitly involving individuals who received addiction treatment for opioid use were included in the study. The review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and 76 papers were included in the review synthesis. The study lists a number of factors why large numbers of opioid users are living longer.

This study looked at intentional drug overdoses (IDOs) involving pregabalin and gabapentin that were treated in emergency departments (ED) in Ireland, from 2007 to 2015, as recorded by the National Self-Harm Registry Ireland.¹ For more in-depth information on pregabalin and gabapentin (gabapentinoids), see the overview on page 11.

The dearth of literature examining the relationship between economic recessions and drug markets has indicated that economic recessions mainly result in higher drug consumption and drug dealing. A recent study carried out by James Windle at University College Cork examined this relationship from an Irish perspective.¹ Although the trends presented here have already been presented in the Irish national report on drug markets and crime (2016),² Windle extended the findings by putting forward explanations as to why these trends have occurred.

 On 13 February 2017, Dr Sean Redmond, adjunct professor of youth justice at the School of Law in University of Limerick, launched the Lifting the lid on Greentown report, which examined the effect of a criminal network on the offending behaviour of children between 2010 and 2011 in a regional Garda sub-district outside Dublin referred to as Greentown.^1,2

The following abstracts are cited from published journal articles recently added to the repository of the HRB National Drugs Library at www.drugsandalcohol.ie