New National Drug and Alcohol Strategy launched

Reducing harm, supporting recovery: a health-led approach to drug and alcohol use in Ireland 2017— 2025¹ was launched on 17 July 2017 by An Taoiseach Leo Varadkar, alongside the Minister for Health Simon Harris TD, and the Minister for Health Promotion and the National Drugs Strategy, Catherine Byrne TD.

A health-led approach

The strategy follows through on the commitment made by Government in May 2016 ‘to pursue a health-led rather than a criminal justice approach to drug use’.² At the launch of the strategy, all of the speakers emphasised the importance of this shift in approach.^3,4,5 The Taoiseach said that ‘treating substance abuse and drug addiction as a public health issue, rather than a criminal justice issue, helps individuals, helps families, and helps communities. It reduces crime because it rebuilds lives’.³ Compassion has been identified internationally as an ‘essential ingredient’⁶ of a health-led approach to drug policy and is a recurring theme both in the strategy document and in what was said at the launch. In her speech, Minister Byrne said ‘there is one word that runs like a thread throughout the strategy, and that word is “compassion” — compassion is the basis for a health-led approach to addiction’.⁴

The Government launched Ireland’s third national drugs strategy in July. While there are a number of consistent themes linking all three strategies, the shift towards a health-led approach, already apparent in previous strategies, is explicitly made in Reducing harm, supporting recovery: a health-led response to drug and alcohol use in Ireland 2017—2025.

A number of stakeholder agencies have published statements on the new national drug and alcohol strategy. These include: CityWide,¹ Gay Health Network,² Simon Communities³ and UISCE (Union for Improved Services, Communication and Education).⁴ The more health-led approach and the inclusion of alcohol in the strategy were widely welcomed. There were concerns, however, about how the strategy would be implemented in practice and the need for additional funding to do so. The statements are summarised below.

The new national drug and alcohol strategy (NDS), Reducing harm, supporting recovery: a health-led approach to drug and alcohol use in Ireland 2017—2025,¹ was informed by a number of inputs, including a public consultation process. The public were invited to provide feedback on what they thought of the 2009—2016 strategy and what issues should be considered in the development of the new strategy. They could provide this by making a written or oral submission to the Department of Health, completing a questionnaire, or attending one of six regional events. Submissions and questionnaires could be made or submitted over the phone, by email, by post, or through the Department of Health’s website. Furthermore, there was an event and questionnaire that specifically targeted young people. Report on public consultation undertaken to inform the new national drugs strategy was subsequently published in May 2017.²

In preparing Reducing harm, supporting recovery,¹ the Department of Health commissioned a performance measurement system to help determine the impact of the strategy on problem substance use at a population level. A performance measurement framework for Drug and Alcohol Task Forces² (DAFT) aims to capture how successful task forces are at reducing problem substance use within their own areas. This will help to identify both good practice and weaknesses in local responses and help to guide the allocation of resources to bring about better local services and systemic improvements.

In May 2017, CityWide Drugs Crisis Campaign launched a new area on its website dedicated to the evidence base for the decriminalisation of possession of drugs for personal use.¹ Decriminalisation in Ireland would involve changing the current law that defines possession of drugs for personal use as a criminal offence. This does not mean that possession for personal use would be legal, as non-criminal penalties may still be applied. Furthermore, it would not affect the law that makes the possession of drugs for sale or supply a criminal offence.

Internationally, there has been a growing focus on adopting a human-rights-based approach to drug policy. This topic has been covered in previous editions of Drugnet Ireland both in the national and international context.^1,2,3,4 With these articles in mind, there are a number of features of the new strategy that would suggest a more human-rights-based approach than in previous strategies:

• It takes a health-led approach to drug use.
• It is underpinned by the values of compassion, respect, equity, inclusion, partnership and evidence-informed.
• It incorporates human rights in some elements, for example introducing supervised injecting facilities and exploring approaches to the possession of small quantities of drugs.

In 2015, the Health Research Board (HRB) commissioned the Public Health Institute at Liverpool John Moores University to prepare a report on the most recent international evidence on responses to problem drug use. This was to support the steering committee working on a new drugs strategy. Incorporating evidence into policy has been a concern of several countries developing drugs strategies in recent years. Part of this process is identifying responses that have been shown to work but, just as importantly, identifying what evidence is relevant to the national situation, where the gaps in evidence are, and what interventions are shown not to be effective or produce harmful results.

The Health Research Board commissioned the Public Health Institute at Liverpool John Moores University to prepare a trends analysis on the drugs situation in Ireland. The drugs situation in Ireland: an overview of trends from 2005 to 2015¹ reviews the current drug situation in Ireland, analysing 10 years of data up to the most recent data available, with respect to the five European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) key indicators (prevalence of drug use, high risk drug use, treatment demand, drug-related deaths, and mortality and drug-related infectious diseases) as well as drug-related crime and supply.

The 10th Club Health International Conference on Nightlife, Substance Use and Related Health Issues took place in the Printworks in Dublin Castle on 24—26 May 2017.¹ It marked 20 years of Club Health conferences and was the first time the conference was held in Ireland. Club Health conferences enable researchers, practitioners and experts from a wide range of fields to meet, present and exchange on current and emerging evidence, policy and practice relating to protecting and promoting health in urban night-time settings as well as music festivals and holiday destinations with a clubbing or nightlife emphasis.

The first international conference in Ireland on recovery from drug addiction, Mainstreaming Recovery in Irish Drug Policy and Practice: the Challenge of Change, took place in Trinity College Dublin (TCD) on 8 September 2017. Organised by the Recovery Academy of Ireland, it was one of a number of events held during International Recovery Month to recognise, promote and celebrate recovery from addiction.

The International Drug Policy Consortium (IDPC) is a global network of 163 non-governmental organisations (NGOs).¹ It focuses on issues related to drug production, trafficking and use, promoting objective and open debate on the effectiveness, direction and content of drug policies at national and international levels. The network supports evidence-based policies that are effective at reducing drug-related harm. In collaboration with their NGO partners, in July 2015, the IDPC launched an e-tool designed to map out the models of decriminalisation for drug use or possession of drugs for personal use globally. The IDPC identified 21 countries and jurisdictions that had adopted this legal position. There is also a link to the tool through the recently launched CityWide Drugs Crisis Campaign website area on decriminalisation discussed in another article in this issue of Drugnet.²

On 18 May 2017, Blanchardstown Local Drug and Alcohol Task Force (BLDATF) launched its report Drug and alcohol trends monitoring system (DATMS) 2017: Year 2.¹ BLADTF started the DATMS in 2015 to ensure they had a ‘thorough, comprehensive and deep knowledge of the problems of the [Dublin 15] area’ (p. 3) upon which to base decisions about service provision. This is the second annual report from the system.^2,3 The system was designed to identify trends in patterns of drug use, and the authors caution that this requires three years of data. Therefore, any changes identified in the current report will require further investigation in the next rounds of data collection.

Cannabis is the most widely used illicit drug in Europe and worldwide.¹ While increased mortality rates are not associated with cannabis use, a number of very serious and long-term negative health problems are correlated with regular and long-term cannabis use. These include dependence, mental illness, cognitive impairment, cardiovascular disease and pulmonary disorders, including lung cancer and chronic obstructive pulmonary disease.²

This article examines trends in drug law offences between 2003 and 2016. Crime data, which are collated on the PULSE system by An Garda Síochána, are provided to the Central Statistics Office (CSO) for analysis. An incident may consist of more than one criminal offence. A primary offence or detection may refer to one offence within an incident. Sometimes, a charged offence may be different from the offence originally identified in the incident. Nevertheless, incidents are a useful indicator of the level of particular types of criminal activities.¹ Figure 1 shows the available statistics for recorded incidents of drug offences between 2003 and 2016, as entered on the PULSE system by Gardaí.

In September 2016, An Garda Síochána (AGS) and the Police Service of Northern Ireland (PSNI) published their biannual cross-border organised crime threat assessment.¹ The aim of the report was to provide insight into how criminal activity orchestrated by organised crime groups (OCGs), North and South of the border, is disrupted by the work of the Cross Border Joint Agency Task Force (CBJATF). The CBJATF involves interagency engagement between the PSNI, AGS, Revenue, HM Revenue & Customs and other agencies, such as the National Crime Agency and the Criminal Assets Bureau.

People who inject drugs (PWID) represent the majority of the hepatitis C virus (HCV) epidemic in the developed world.¹ The majority of new infections develop in active PWID, with this group accounting for more than 80% of new infections in high-income countries.² Furthermore, an additional large reservoir of infection exists among former PWID who remain undiagnosed.

The first Health Behaviour in School-Aged Children (HBSC) survey was conducted in Ireland in 1998 and has been repeated every four years since then. In 2014, the study was conducted in Ireland for the fifth time. This survey included 13,611 children drawn from 3rd class in primary school through to 5th year in post-primary school; 230 primary and post-primary schools across Ireland participated. Data were collected on general health, social class, smoking, use of alcohol and other substances, food and dietary behaviour, exercise and physical activity, self-care, injuries, bullying and sexual health behaviours. This article presents findings from a 2017 report which examined trends in alcohol, tobacco and cannabis use among 10—17-year-old children between 1998 and 2014.¹

According to the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) annual report for 2017 on estimates of drug use in the European Union (EU),¹ cocaine is the most commonly used illicit stimulant drug in Europe. It is estimated that 17.5 million European adults (aged 15—64 years), or 5.2% of this age group, have experimented with cocaine at some time in their lives. Among these are about 2.3 million young adults aged 15 to 34 years (1.9% of this age group) who have used the drug in the last year. Only Ireland, Spain, the Netherlands and the United Kingdom (UK) report last-year prevalence of cocaine use among young adults of 2.5% or more.¹ The 2014/15 general population survey reported that 2.9% of young Irish adults had used cocaine in the last year.² Around one million seizures of illicit drugs are reported annually in Europe. Cocaine is the second most commonly seized drug (after cannabis). In total, around 87,000 seizures of cocaine were reported in the EU in 2015. Both the number of cocaine seizures and the quantity seized increased between 2014 and 2015 in Europe.¹

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