On 25 January 2019, the Health Service Executive (HSE) and Tusla, the Child and Family Agency jointly launched the Hidden Harm strategic statement, Seeing through hidden harm to brighter futures¹ and the Hidden Harm practice guide² in the Plaza Hotel in Tallaght, Dublin. A separate information leaflet, Opening our eyes to Hidden Harm,³ was also published to support frontline staff working with children impacted by parental drug or alcohol misuse.

These publications outline how the two State organisations will work together to identify and support children who are adversely affected by parental substance misuse. Joint training for HSE and Tusla staff working in this area is due to be developed in 2019.

All policy decisions involve a certain amount of anticipation and speculation, informed or otherwise. It is useful to know the range of possible outcomes so that resources can be allocated effectively and preparations made for disruptions to established patterns. Policymaking in the drugs area is sometimes reactive to changes in behaviour in certain populations, some of which may be predictable but often appear, at least to policymakers, as sudden aberrations from the expected norm.

The Health Research Board (HRB) recently published a review entitled Treatment services for people with co-occurring substance use and mental health problems: a rapid realist synthesis.¹ This report is part of the HRB Drug and Alcohol Evidence Review series and was undertaken by a team from the Georgia Health Policy Center. The three initial research questions guiding the review were:

What interventions improve treatment and personal functioning outcomes for people with co-occurring substance use and mental health problems and in what circumstances do they work?

What aspects of integrative programmes for the treatment of co-occurring substance use and mental health problems trigger positive system outcomes and in what circumstances do these outcomes occur?

What existing models of care for adults with co-occurring substance use and mental health problems lead to positive treatment outcomes and successful service integration?

The medical use of cannabis and cannabinoids is a complex and challenging field. There is a wide range of issues to be considered by policymakers and other stakeholders when making decisions about the best approach to take. In December 2018, the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) published a report on the topic to help support this process – Medical use of cannabis and cannabinoids: questions and answers for policymaking.¹ It is supported by a background paper: A summary of reviews of evidence on the efficacy and safety of medical use of cannabis and cannabinoids.²

Civil society involvement (CSI) in the development and implementation of drug policy is widely considered best practice and promoted at both international and national levels. For example, a focus on the value of CSI is evident in both the EU drugs strategy 2013–2020¹ and the EU action plan on drugs 2017–2020.² One of the 15 objectives of the latter is to ‘ensure the participation of civil society in drugs policy’. It is also a key part of Ireland’s national drugs strategy, Reducing harm, supporting recovery: a health-led response to drug and alcohol use in Ireland 2017–2025.³

The International Drug Policy Consortium (IDPC) is a global network of 180 non-governmental organisations.¹ It focuses on issues related to drug production; trafficking and use; and 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. As part of this work and in the context of the role identified by the work of the United Nations Office on Drugs and Crime (UNODC) for civil society involvement in drug policy,² the IDPC has published Taking stock: a decade of drug policy.³ This report ‘evaluates the impacts of drug policies implemented across the world over the past decade, using data from the United Nations (UN), complemented with peer-reviewed academic research and grey literature reports from civil society’ (p. 7).³

Activities of Irish psychiatric units and hospitals 2017,¹ 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 continued to stabilise.

The World Health Organization has set a goal to eliminate hepatitis C virus (HCV) as a global public health threat by 2030. Targets include reducing new HCV infections by 80% and the number of HCV deaths by 65%, and increasing HCV diagnoses from 20 to 90% and eligible people receiving HCV treatment from <5 to 80%.¹ Unsafe injecting drug use is the main route of HCV transmission in developed countries.² Consequently, people who inject drugs (PWID) represent a priority population for HCV elimination, given the high prevalence and incidence in this group.

The risks of misusing opioid medication have been well documented^1,2,3 and include a wide range of problematic consumption outside of medical guidelines. Misuse can include consumption to induce psychoactive effects, use in combination with other drugs to alter their effects, or self-medication by increasing or lengthening duration of dosage without or against medical advice. Such risky behaviour can lead to adverse consequences, including dependence and/or poisoning. Despite the known risks, many countries, including Ireland, continue to permit codeine (an opiate to treat pain) to be available without prescription, over-the-counter (OTC).

In October 2018, the Parole Board published its annual report.¹ This was the 16th annual report since the board was established in 2001. The aim of the Parole Board is to review the cases of prisoners who have received either ‘determinate’ sentences greater than or equal to eight years or life sentences and to provide guidance on how these sentences are managed. The current report provided an overview of the board’s activities for 2017.

The DOVE Clinic in the Rotunda Hospital, Dublin was established to meet the specific needs of pregnant women who have, or are at risk of, blood-borne or sexually transmitted bacterial or viral infections in pregnancy. Exposure may also occur through illicit drug use. Figures from the clinic for 2017 were published in the hospital’s annual report in 2018.¹

The National Family Support Network (NFSN)¹ is an autonomous self-help organisation that provides support to families and respects the experiences of families affected by substance misuse in a welcoming non-judgemental atmosphere. On Friday, 1 February 2019, the NFSN held its 20th Annual Service of Commemoration and Hope. This spiritual, multidenominational service is held in remembrance of loved ones lost to substance misuse and related causes and to publicly support and offer hope to families living with the devastation that substance misuse causes. The service was preceded by a procession from the ‘Home’ memorial on Sean MacDermott Street, Dublin, to the nearby Church of Our Lady of Lourdes, led by the band of An Garda Síochána.