Journal articles
The following abstracts are cited from recently published journal articles relating to the drugs situation in Ireland.
Onset of cocaine use: associated alcohol intoxication and psychosocial characteristics among adolescents in substance abuse treatment
Apantaku-Olajide T, Darker CD and Smyth BP
Journal of Addiction Medicine, 2013, 7(3): 183–188.
www.drugsandalcohol.ie/20340
Objectives: Cocaine abuse is widespread in Europe, and Ireland ranks among the leading countries for prevalence of cocaine use among adolescents. This study aimed to examine demographic and substance use correlates of lifetime cocaine use among adolescents with substance use disorder, and to explore the relationship between alcohol intoxication and cocaine initiation.Methods: Data from a cross-sectional study of 171 adolescents presenting to an outpatient substance abuse treatment program in the Dublin metropolitan area were analyzed. Bivariate and multivariate analyses were conducted. Results: Approximately 64% of the participants reported ever used cocaine: 70% reported the first use of cocaine was while alcohol intoxicated and 96% reported the onset of cocaine use was preceded by cannabis use. Later age at treatment entry, unstable accommodation, non engagement in educational/vocational functions, and greater frequency of alcohol and cannabis use had robust associations with lifetime cocaine use. Male gender was significantly associated with first use of cocaine while alcohol intoxicated. Conclusions: Alcohol frequently plays a central role in cocaine initiation in Irish adolescents. Efforts to delay, avoid, or reduce adolescent drinking may yield benefits in terms of reducing cocaine use initiation in this population.
A qualitative study of prescribing doctor experiences of methadone maintenance treatment
Van Hout MC and Bingham T
International Journal of Mental Health and Addiction, 2013, 25 April, Early online.
www.drugsandalcohol.ie/20262
Methadone maintenance treatment (MMT) is recognized as an effective treatment for opiate dependence. It is provided in Ireland in addiction clinics and for stabilized patients in primary care. The aim of the study was to explore doctor’s experiences of methadone prescribing, therapeutic alliance and methadone treatment pathways. Semi structured interviews were conducted with a convenience sample of prescribing doctors (n = 16). Thematic analysis of narratives was undertaken. Observations around MMT were positive in reducing harm associated with injecting drug use and opiate dependence, and represented an important turning point for patients. Doctor efforts to assist their patients were grounded in positive, empathic relationships. Some concerns were relayed with regard to prescribing restrictions. Participants commented on the need for policy makers to consider the expansion of MMT provision to include alternative pharmacological approaches, improved interagency, psychosocial and detoxification supports, community based nurse prescribing and adjunct treatment for polydrug and alcohol use.
Miaow miaow: a review of the new psychoactive drug mephedrone
Brennan R and Van Hout MC
Drugs and Alcohol Today, 2012, 12(4): 241–253.
www.drugsandalcohol.ie/20261
Mephedrone is a synthetic stimulant drug causing entactogenic and hallucinogenic effects. A systematic review of all existing empirical research and literature from 2009 to 2012 on this new psychoactive drug was conducted. This paper aims to report on that review. The search was restricted to publications from 2009 to 2012, and produced 702 results; 598 results were discarded, with 104 deemed suitable for inclusion.
The review underscores mephedrone's popularity despite legislative controls. Drug displacement patterns from illicit to licit were observed prior to controls, with blending of mephedrone and other substitute cathinones with street drugs thereafter. User consumptive choices are grounded in availability, perceptions of legality and safety, curiosity and perceived quality of drug outcomes within poly drug taking repertoires. Clinical reports indicate that mephedrone has high abuse potential and toxicity, with several dependence symptoms. Risk assessment, detection, diagnosis and treatment of mephedrone use are difficult due to polydrug use and associated mental health disorders. The review points to the need for further research into the pharmacology and toxicity of mephedrone in order to better equip clinicians with assessment, diagnosis and treatment strategies to reduce morbidity.
Methadone, codeine and acute haemorrhagic necrotising pancreatitis: which came first?
Tormey WP, Sabah M and Moore TM
Forensic Science International, 2013, 226(1–3): e52–53.
www.drugsandalcohol.ie/20240
Acute haemorrhagic necrotising pancreatitis led to the death at home of a young female who was on a methadone maintenance programme. Toxic levels of codeine with potentially lethal levels of methadone and morphine were found at post-mortem. Whether opiates caused the pancreatitis or were the consequence of self-medication for pain is impossible to differentiate. Forensic toxicology may pose the question but be unable to provide the answer.
Teachers' perspectives on their role in school-based alcohol and cannabis prevention
Van Hout MC, Foley M, McCormack A and Tardif E
International Journal of Health Promotion and Education, 2012, 50(6): 328–341.
www.drugsandalcohol.ie/20235
Schools are an important setting for the implementation of health education and harm prevention initiatives.
The research aimed to investigate teachers’ perspectives in Ireland on their role and that of the school in the delivery of school-based alcohol and cannabis education/prevention. Irish school-based drug education–prevention is currently provided within the remit of the Social Personal Health Education (SPHE) module. Thirteen second-level schools took part in the research. A questionnaire collected information on teachers’ experiences of student alcohol and cannabis use, attitudes toward teacher and school prevention roles, and levels of school satisfaction (n = 131). The results indicated that teachers’ experiences of effects of student alcohol and cannabis use in school were rare. Over half of teachers had never taken part in education or prevention activities, with SPHE teachers more likely to do so and report a positive attitude toward such activities. Teacher levels of satisfaction with their school were positively correlated with attitude toward the teacher and school's role in alcohol and cannabis education–prevention. High awareness of school drug and alcohol policies was recorded, along with the need for training, support, and information for all teachers. The findings underscore the need for ‘whole school’ integrated approaches involving a shared organisation-wide approach to student substance education–prevention.
Using chi-Squared Automatic Interaction Detection (CHAID) modelling to identify groups of methadone treatment clients experiencing significantly poorer treatment outcomes
Murphy E and Comiskey C
Journal of Substance Abuse Treatment, 2013, 45(4): 343–349.
www.drugsandalcohol.ie/20187
In times of scarce resources it is important for services to make evidence based decisions when identifying clients with poor outcomes. Chi-Squared Automatic Interaction Detection (CHAID) modelling was used to identify characteristics of clients experiencing statistically significant poor outcomes. A national, longitudinal study recruited and interviewed, using the Maudsley Addiction Profile (MAP), 215 clients starting methadone treatment and 78% were interviewed one year later. Four CHAID analyses were conducted to model the interactions between the primary outcome variable, used heroin in the last 90days prior to one year interview and variables on drug use, treatment history, social functioning and demographics. Results revealed that regardless of these other variables, males over 22 years of age consistently demonstrated significantly poorer outcomes than all other clients. CHAID models can be easily applied by service providers to provide ongoing evidence on clients exhibiting poor outcomes and requiring priority within services.
Problem alcohol use among problem drug users: development and content of clinical guidelines for general practice
Klimas J, Cullen W and Field CA
Irish Journal of Medical Science, 2013, 3 July, Early online.
www.drugsandalcohol.ie/20158
Problem alcohol use is common and associated with considerable adverse outcomes among patients who attend primary care in Ireland and other European countries for opiate substitution treatment. This paper aims to describe the development and content of clinical guidelines for the management of problem alcohol use among this population.
The guidelines were developed in three stages: (1) identification of key stakeholders, (2) development of evidence-based draft guidelines, and (3) determination of a modified ‘Delphi-facilitated’ consensus among the group members. They incorporate advice on all aspects of care, including (1) definition of problem lcohol use among problem drug users, (2) alcohol screening, (3) brief intervention, and (4) subsequent management of patients with alcohol dependence. The researchers concluded that primary care has an important role to play in the care of problem alcohol use among problem drug users, especially opiate substitution patients. Further research on strategies to inform the implementation of these guidelines is a priority.
Problem alcohol use among problem drug users in primary care: a qualitative study of what patients think about screening and treatment
Field CA, Klimas J, Barry J et al.
BMC Family Practice, 2013, 14:98
www.drugsandalcohol.ie/20447
Background: Problem alcohol use is common and associated with considerable adverse outcomes among patients who attend primary care in Ireland and other European countries for opiate substitution treatment. This paper aims to describe patients’ experience of, and attitude towards, screening and therapeutic interventions for problem alcohol use in primary care.
Methods: This qualitative study recruited problem drug users (N = 28) from primary care based methadone programmes in the Ireland’s Eastern region, using a stratified sampling matrix to include size of general practice and geographical area. Semi-structured interviews were conducted and analysed using thematic analysis, and audited by a third reviewer.
Results: We identified three overarching themes relevant to the purpose of this paper: (1) patients’ experience of, and (2) attitude towards, screening and treatment for problem alcohol use in primary care, as well as their (3) views on service improvement. While most patients reported being screened for problem alcohol use at initial assessment, few recalled routine screening or treatment. Among the barriers and enablers to screening and treatment, patients highlighted the importance of the practitioner-patient relationship in helping them address the issue. Nevertheless, patients felt that healthcare professionals should be more proactive in the management of problem alcohol use at a primary care level and that primary care can play an important role in their treatment.
Conclusions: Problem alcohol use is an important challenge in the care of problem drug users. While primary care is well placed to address this issue, little data has reported on this topic. The development of interventions which promote screening and brief interventions in practice are likely to benefit this at-risk group and further research and education, that help achieve this goal, are a priority. Strategies such as dissemination of clinical guidelines, educational videos, academic detailing and practice visits, should be explored.
Substance use in young persons in Ireland, a systematic review
Murphy K, Sahm L, Lambert S and Byrne S
Addictive Behaviors, 2013, 38(8): 2392–2401.
www.drugsandalcohol.ie/19669
Adolescence is a time of physical and mental development when small changes can impact on the rest of a person's life. Substance use in this crucial period can have long-lasting consequences for the individual and for society. The prevalence of substance use in young people is an area of concern for policy makers and health workers. This systematic review looked at prevalence for four substances, alcohol, tobacco, cannabis, and benzodiazepines, across the Republic of Ireland for persons between the ages of 13 and 24, and compared usage between 2000 and 2012. Eighteen articles were included in the review. It was seen that tobacco, alcohol, and cannabis use has fallen in the lifetime and previous month use. The level of benzodiazepine use has remained similar in the period of study. Future work should redress the imbalance in substance use research that sees the majority of researchers looking at a few substances while little work is done on the others.
