Drugnet Ireland - Issue 45, Spring 2013

Letter to the Editor: Staff of the National Documentation Centre on Drug Use (NDC) outline how a special alcohol and other drugs (AOD) library may provide considerable added value to those researching and working in this area.

The Irish National Drugs Strategy is unusual as it includes research as one of its five pillars. This recognises the need to have a thorough knowledge of the drugs situation and to respond in an evidence-based way. The NDC was created to facilitate this approach. Through our online repository, we provide access to all relevant Irish news, journal articles, reports, books, theses, conference proceedings and parliamentary debates. The collection has grown from 1,200 bibliographic records in 2002 to more than 10, 000 records in 2012.

Behavioural change in relation to alcohol exposure in early pregnancy and impact on perinatal outcomes – a prospective cohort study
Murphy D, Mullaly A, Cleary B, Fahey T and Barry J
BMC Pregnancy and Childbirth, 2013, 13(8)
www.drugsandalcohol.ie/19224

This study involved 6725 women who booked for antenatal care and delivered in a large urban teaching hospital in 2010–2011. A detailed history of alcohol consumption pre-pregnancy and during early pregnancy was recorded at the first antenatal visit, with follow-up of the mother and infant until discharge following birth. Adverse perinatal outcomes were compared for ‘non-drinkers’, ‘ex drinkers’ and ‘current drinkers’. Factors associated with continuing to drink in early pregnancy were examined.

Of the 6017 (90%) women who reported alcohol consumption prior to pregnancy 3325 (55%) engaged in binge drinking and 266 (4.4%) consumed more than 14 units on average per week. At the time of booking 5649 (94%) women were ex-drinkers and of the 368 women who continued to drink 338 (92%) had a low intake (0–5 units per week), 30 (8%) an excess intake (6-20+ units per week) and 93 (25%) reported at least one episode of binge drinking.

The authors conclude that Public Health campaigns need to emphasise the potential health gains of abstaining from both alcohol and smoking in pregnancy.

The journey into injecting heroin use
Barry D, Syed H and Smyth BP
Heroin Addiction and Related Clinical Problems, 2013, 14(3): 89–100
www.drugsandalcohol.ie/19149

Drug injection carries with it many risks and it is therefore important to understand its origins. We interviewed 104 young opioid users with median age of 22 years. The median age of first opioid use was 16 years, this being heroin chasing in 91% of cases. Friends or sexual partners played an important role in both initial introduction to opiates and in the switch to injecting. Curiosity was the most important factor in first heroin use and the second most important factor, after escalating tolerance, in influencing the decision to first inject.

Avoiding action: Ireland, alcohol, intoxication and workplace safety
Houghton F
Irish Journal of Medical Science, 2012, 29 November, Online first
www.drugsandalcohol.ie/19079

Letter to the Editor: The latest Summary of workplace injury, illness and fatality statistics from the Health and Safety Authority (HSA) makes for sobering reading. As well as 54 fatalities, 6,956 non-fatal injuries were reported to the HAS in 2011. The report also notes that based on CSO data, there were an estimated 666,553 days lost due to injury in 2010.

However, examination of HSA annual reports and summaries of statistics reveals an almost complete absence of the mention of alcohol or intoxicants of any kind. ...

Methadone treatment in Irish general practice: voices of service users
Latham L
Irish Journal of Psychological Medicine, 2012, 29(3): 147–156
www.drugsandalcohol.ie/19006

This study sets out to make a meaningful contribution to the discussion surrounding the treatment of heroin addiction in Ireland. The study took place in nine general practices in Dublin city. Twenty-five service users were interviewed in depth. A phenomenological approach drawing on the psychological research methods of Colazzi for data analysis informed this study.

Four themes were identified: service user’s experiences of attending general practice for methadone treatment; the significance of methadone for the service user; service users’ understanding of the Methadone Treatment Protocol; and the experience of addiction and its effect on families.

This paper reports on the experiences of service users receiving methadone treatment in urban general practice in Dublin and in so doing highlights the influence of the GP in supporting recovery. These accounts provide insight into the harm reduction policy of methadone maintenance and highlight how, from the service users’ experience, the implementation is falling short.

Methadone dosing and prescribed medication use in a prospective cohort of opioid-dependent pregnant women
Cleary BJ, Reynolds K, Eogan M, O'Connell MP, Fahey T, Gallagher PJ et al.
Addiction, 2012, 7 December, Early online
www.drugsandalcohol.ie/18937

This study aimed i) to describe methadone dosing before, during and after pregnancy, ii) to compare the incidence of neonatal abstinence syndrome (NAS) between those with dose decreases and those with steady or increasing doses, and iii) to describe prescribed medication use among opioid-dependent pregnant women.

Of 89 women treated with MMT throughout pregnancy, 36 (40.4%) had their dose decreased from a mean pre-pregnancy dose of 73.3mg (Standard Deviation 25.5) to a third trimester dose of 58.0mg (SD 26.0). The corresponding figures for those with increased doses (n=31, 34.8%) were 70.7mg (SD 25.3) and 89.7mg (SD 21.0), respectively. The incidence of medically-treated NAS did not differ between dosage groups. Antidepressants were dispensed for 29 women (25.7%) during pregnancy, with the rate decreasing from pre-pregnancy to postpartum. Benzodiazepines were prescribed for 43 women (38.0%).

In the Irish health service, opioid-dependent women frequently have their methadone dose decreased during pregnancy but this does not appear to affect the incidence of neonatal abstinence syndrome in their babies.

The symbolic politics of the Dublin drug court: the complexities of policy transfer
Butler S
Drugs: education, prevention and policy, 2013, 20(1): 5–14
www.drugsandalcohol.ie/18888

This article, based on qualitative interviews with experienced professionals and bureaucrats involved in the management of drug-using offenders in Ireland, looks at the Dublin pilot drug court as an example of policy transfer between countries. Those interviewed were generally unconvinced that the American drug court model was technically more effective than more traditional methods of diverting offenders from custodial sentencing into treatment, and tended to see political support for the initiative in terms of the symbolic value of this liberal, humanistic alternative to imprisonment. They also agreed, however, that the Dublin drug court was not true to the American model in that it did not embody the philosophy of therapeutic jurisprudence which is central to American drug court practice.

Situational and psycho-social factors associated with relapse following residential detoxification in a population of Irish opioid dependent patients
Ducray K, Darker CD and Smyth BP
Irish Journal of Psychological Medicine, 2012, 29(2): 72–79
www.drugsandalcohol.ie/18862

This study aimed to identify and describe the context and factors involved in the opioid lapse process following discharge from an Irish inpatient opioid detoxification treatment programme.

Of 109 people interviewed at follow-up, 102 (94%) reported at least one episode of opioid use after leaving the residential treatment programme. Eighty eight patients (86% of the lapsers) identified more than one major factor contributing to their recidivism. The median number of factors identified as having a major role in the lapse was four. The most frequently reported major contributors to lapse were low mood (62%), difficulties with craving (62%), ease of access to heroin (48%) and missing the support of the treatment centre (43%).

Conclusions: Early lapse was common following inpatient treatment of opioid dependence. Lapse tended to result from a number of common, identifiable, high-risk situations, feelings and cognitions which may assist clinicians and patients develop lapse prevention strategies to anticipate and interrupt this process.

Cognitive behavioural coping skills therapy in cocaine using methadone maintained patients: a pilot randomised controlled trial
Darker CD, Sweeney B, El Hassan HO, Kelly A and Barry J
Heroin Addiction and Related Clinical Problems, 2012, 14(3): 101–110
www.drugsandalcohol.ie/18861

A pilot randomised controlled trial to test the effectiveness of delivering cognitive behavioural coping skills (CBCS) to reduce cocaine usage in methadone maintained patients. Recruitment was stopped after forty-five patients were recruited, with twenty-two randomised to TAU and twenty-three to CBCS. CBCS group significantly reduced their cocaine powder usage compared to the TAU group (DiD = -6.65, p<0.03). There was a significant reduction in both cocaine powder (DiD = -7.66, p<0.002) and crack cocaine (DiD = -4.88, p<0.04) between baseline and follow-up across both groups. However, urine toxicology results indicate a slightly larger drop in the percentage positive urines (relative to baseline) occurred in the TAU group. Attendance at counselling sessions was very low, averaging 25% at CBCS sessions and 13% at TAU sessions. Participants who did attend counselling showed a marked decline in the proportion of cocaine positive urines (during treatment and again at week 52).

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