The use of illicit drugs is a public health issue worldwide with the annual prevalence of drug use increasing over the past decade. International research from Ireland, the United Kingdom, and the United States suggests that approximately one-quarter of students in higher education institutes (HEIs) report using illicit drugs within the last 12 months. However, there is a lack of recent comprehensive data on drug use among students in higher education in the Republic of Ireland.

In 2021, a national survey was carried out among 7,901 students and 3,516 staff to monitor the experiences of students and staff in relation to sexual violence and harassment in higher education institutions (HEIs) in Ireland and their awareness and confidence in HEI policies, processes, and initiatives in the area.^1,2

In Ireland, the Joint Committee on Health scrutinises the work of the Department of Health and its agencies. It is responsible for examining health policy, the future planning of health services, and proposed changes to the way in which healthcare is delivered.¹ Membership includes representation from the Dáil and the Seanad.²

On 19 January 2022, the Minister of State for Public Health, Wellbeing and the National Drugs Strategy, Frank Feighan TD, came before the committee to provide an update on the national drugs strategy. He was supported by Dr Eamon Keenan, the national clinical lead for the Health Services Executive’s (HSE) addiction services, and Jim Walsh, principal officer at the Drugs Policy and Social Inclusion Unit at the Department of Health.

Evidence of the harms caused by alcohol consumption globally, including the three million annual deaths worldwide,¹ has encouraged national governments to commit to strategies to reduce alcohol-related harms. These include those set out in the World Health Organization (WHO) 2010 Global strategy to reduce the harmful use of alcohol² and the 2030 Sustainable Development Goals as well as through the development of the WHO Global alcohol action plan.³ It is well-recognised that policies to control the harms associated with alcohol consumption need to be instituted at national level to be effective; however, national governments face resistance and opposition from the alcohol industry when attempting to implement such policies. Common arguments by the alcohol industry when lobbying against such policies are that they are not required and are expensive to implement. Instead, it proposes alternatives, including information campaigns and a focus on subpopulations only, such as those pregnant, young people, or drink drivers. In its efforts to influence decision-making, the alcohol industry often questions the legality and effectiveness of proposed interventions and the extent of alcohol-related harms, citing the benefits of moderate consumption.

Like many contentious social issues, positions on drug policy are often aligned with political outlooks. While what are described as cultural issues have blurred the traditional dividing line between left and right, we can still speak about coherent political philosophies. Politics, at least in the developed world, can be understood as competition between liberal and conversative world outlooks. Liberals comprise two camps: one libertarian, which is liberal on economic issues and protective of individual liberty; and one which is social democratic, also keen to guard personal freedoms but in favour of an interventionist state to offset the consequences of market failures. Conservatives emphasise the value of stability and see government’s role as supporting societal anchors such as the family, personal responsibility, self-reliance, and respect for tradition. Personal freedom is an essential aspect of conservative philosophy, but the state has the right to intervene to prevent behaviour deemed harmful to the individual or the community.

Drug-related deaths (DRDs) are a growing burden,¹ with limited international evidence of the impact of grief and the lived experience of an affected family. DRDs are associated with moral stigmas, emotional burden, shame, guilt, and complicated grief from ‘a loss that cannot be socially sanctioned, openly acknowledged or publicly mourned’.² Evidence suggests there is a need for targeted interventions in this population to explore the complex grief experienced. A 2021 study investigated the impact of complicated grief on the family system following the DRD of a family member from an Irish context.³

Patients prescribed opioid agonist therapy (OAT) for opioid dependence are known to have increased risk of multiple substance addiction, including alcohol.¹ Benzodiazepines are commonly used to treat alcohol withdrawal syndrome (AWS); however, given their sedative effects, increased risk of misuse, and accidental overdose, an alternative therapy is warranted for OAT patients undergoing alcohol detoxification. Baclofen is an emerging treatment for alcohol detoxification as it can reduce the craving to drink and can suppress AWS symptoms. Currently, there is a lack of evidence for its effectiveness in OAT patients. A 2021 study therefore investigated baclofen’s effectiveness and patient acceptability in treating AWS in OAT patients.²

The prevalence of alcohol use disorder among the general population in Ireland is estimated at 14.8%.¹ In an attempt to reduce alcohol consumption in Ireland and consequently the rate of alcohol-related harms, the Public Health (Alcohol) Act was enacted in 2018.² Several components of the Act have been commenced but a number remain outstanding, such as Section 13. Section 13 of the Act will restrict the content of alcohol advertisements, requiring the marketing of alcohol products to contain facts about the dangers associated with alcohol consumption; how its use is linked to a number of cancers; how unsafe it is to consume during pregnancy; and will include a link to an independent website containing public health information about alcohol.

A new study has been published based on Irish data comparing characteristics of suicide to non-suicide drug poisoning deaths (NSDPD), by sex.¹ Both suicide deaths and drug poisoning deaths are dominated by deaths among men; therefore, absence of sex-stratified mortality data can mask important sex-based differences in the data.

In 2020, some 958 cases were admitted to psychiatric facilities with an alcohol disorder, of whom 382 were treated for the first time. Figure 1 presents the rates of first admission between 2000 and 2020 for cases with a diagnosis of an alcohol disorder. The admission rate in 2020 was higher than the previous year, although trends over time indicate an overall decline in first admissions. Approximately one-third (33.3%) of cases hospitalised for an alcohol disorder in 2020 stayed just under 1 week, while 32.7% of cases were hospitalised for between 1 and 3 months, similar to previous years.

The Covid-19 pandemic impeded the delivery of addiction support services to this high-risk group as existing healthcare models were dramatically altered or abolished. The impact of the pandemic negatively affected addiction recovery, with adverse health outcomes and drug-related mortality seen to increase, in turn impacting the wellbeing of practitioners already under pressure.¹ A 2022 study explored the impact that the pandemic had on the wellbeing of Irish healthcare professionals supporting clients with addiction.²

In 2017, the per capita alcohol consumption in Ireland equated to every Irish adult (aged 15 years and over) drinking 13.9 litres of alcohol, considerably higher than the 6.5 litres globally.¹ Alcohol-related harms are associated with this level of alcohol consumption, with the period from 1995 to 2013 seeing an 82% increase in alcohol-related hospital admissions in Ireland.^2,3 Alcoholic liver disease (ALD) is caused by damage to the liver from excessive drinking over a prolonged period, and treatment involves alcohol abstinence, managing complications of liver failure, and/or liver transplantation. ALD is a major cause of both liver cirrhosis and hepatocellular carcinoma (HCC), a type of primary liver cancer.

Internationally, case management (CM) was first adapted in the 1980s to work with people who use drugs; however, the concept had emerged first in the 1920s.¹ In 2010, the Health Service Executive (HSE) published the National Drugs Rehabilitation Framework Document,² in which CM was outlined as a key component. This framework was in response to the earlier policy document, Report of the Working Group on Drugs Rehabilitation,³ which recommended ‘a framework through which service providers will ensure that individuals affected by drug misuse are offered a range of integrated options tailored to meet their needs and create for them an individual rehabilitation pathway.

Chrysalis is a community drug and alcohol service which has been operating for almost 25 years in Dublin’s north inner city.^1,2 The service has grown significantly since then, especially in more recent years; having started as a counselling service it has moved on to provide a range of other services. Its vision is that ‘everyone living with problem substance use should be empowered to fulfil their full potential and have access to the same opportunities and rights as others’.³

In September 2021, Merchants Quay Ireland (MQI) launched a briefing paper calling for governmental support to provide gender-specific services for women experiencing homelessness and addiction, entitled A space of her own: the need for gender specific services for women in homelessness and addiction.¹ The briefing paper draws on the findings of a number of studies, in particular Responding to women with complex needs who use substances, which was published in 2020.²

People who use drugs (PWUD) and are aged 40 years or over experience particular challenges as a cohort. These include social isolation and exclusion as well as poorer physical and mental health outcomes.¹ The Ballyfermot Local Drug and Alcohol Task Force (BLDATF) commissioned a study on the needs of this cohort in their area of Dublin. Entitled It’s like we’re the forgotten...: an exploration of the issues affecting older people in Ballyfermot who are experiencing problematic drug and alcohol use, it was published in March 2021.¹

Merchants Quay Ireland (MQI) is a national voluntary agency providing services for homeless people and those that use drugs. There are 22 MQI locations in 12 counties in the Republic of Ireland (see Figure 1). MQI aims to offer accessible, high-quality, and effective services to people dealing with homelessness and addiction in order to meet their complex needs in a non-judgemental and compassionate way. This article highlights services provided by MQI to people who use drugs in Ireland in 2020.¹

The Ana Liffey Drug Project (ALDP) is a ‘low-threshold, harm reduction’ project working with people who are actively using drugs and experiencing associated problems. ALDP has been offering harm reduction services to people in the north inner-city area of Dublin since 1982, from premises at Middle Abbey Street. ALDP offers a wide variety of low-threshold, harm reduction services that provide pathways for people who use drugs out of their current circumstance, including addiction and homelessness.