Journal articles
The following abstracts are cited from recently published journal articles relating to the drugs situation in Ireland.

Availability of HIV prevention and treatment services for people who inject drugs: findings from 21 countries
Petersen Z, Myers B, Van Hout MC et al.
Harm Reduction Journal, 2013, 19 August, Vol.10, Article no.13
www.drugsandalcohol.ie/20531

This paper is a response to the need to monitor the state of the HIV epidemic as it relates to IDU and the availability of HIV treatment and harm reduction services in 21 high epidemic countries.

The overall proportion of HIV positive PWID in the selected countries ranged from 3% in Kazakhstan to 58% in Vietnam. While IDU is relatively rare in sub-Saharan Africa, it is the main driver of HIV in Mauritius and Kenya, with roughly 47% and 36% of PWID respectively being HIV positive. All countries had antiretroviral treatment  available to PWID, but data on service coverage were mainly missing. By the end of 2010, uptake of needle and syringe programmes (NSP) in Bangladesh, India and Slovakia reached the internationally recommended target of 200 syringes per person, while uptake in Kazakhstan, Vietnam and Tajikistan reached between 100-200 syringes per person. The proportion of PWID receiving opioid substitution therapy ranged from 0.1% in Kazakhstan to 32.8% in Mauritius, with coverage of less than 3% for most countries.

The authors conclude that In order to be able to monitor the impact of HIV treatment and harm reduction services for PWID on the epidemic, epidemiological data on IDU and harm reduction service provision to PWID needs to be regularly collected using standardised indicators.

A qualitative study of Irish postgraduate students’ alcohol consumption
Hogan G and O'Loughlin D
Journal of Substance Use, 2013, 3 September, Early online.
www.drugsandalcohol.ie/20504

This exploratory qualitative study investigated Irish postgraduate students’ experiences of alcohol consumption and the motives that work to encourage their engagement in the consumption practice. Utilising a non-probability purposive sampling method, seven semi-structured in-depth interviews were conducted with postgraduate university students from a range of academic disciplines. The findings of the research indicate that, during their studies, these young people underwent an important transition regarding the manner in which they engage in alcohol consumption. The excessiveness that characterised their initial behaviour as undergraduates has given way to a more restrained approach to alcohol consumption as postgraduates. A number of factors sustain this desire to adopt a more controlled approach to alcohol consumption, including an increasing sense of responsibility, critical self-reflection and experience gained. The research also provides valuable insight into the motives that continue to underlie engagement by this more mature group in the consumption practice, namely pleasure-seeking and the belief that drinking represents a form of expected behaviour.

 

The relationship between subjective life expectancy and self-reported alcohol use in Northern Irish adolescents
McKay, MT
Drugs: education, prevention and policy, 2013, 5 September, Early online.
www.drugsandalcohol.ie/20523

Aims: This study examined the relationship between subjective life expectancy (the subjective probability of living to age 75 years) and sex, type of school attended, year in school and self-reported adolescent drinking behaviours.
Methods: Participants were school children (aged 11–16 years) from post-primary (high) schools in Northern Ireland. Participants completed a questionnaire, including an assessment of subjective life expectancy, alcohol use and demographic measures.
Results: In bivariate analyses, there were significant differences in subjective life expectancy and sex, year in school, type of school attended and selfreported relationship with alcohol. Results of multinomial logistic regression, controlling for clustering at school level and socio-demographic measures, showed that more problematic drinking was significantly associated with a reduced life expectancy. Therefore, individual perceptions of subjective life expectancy accounted for some of the variance in problematic drinking above and beyond that predicted by socio-demographic factors.
Conclusion: Although there was an observed association between subjective life expectancy and selfreported alcohol use, future longitudinal research could assess the degree to which future time perspective predicts initiation into alcohol use and escalation into more problematic use among adolescents.

Surfing the Silk Road: a study of users’ experiences
Van Hout MC and Bingham T
International Journal of Drug Policy, 2013, 24(5): 385–391.
www.drugsandalcohol.ie/20545

The online drug marketplace, called ‘Silk Road’, has operated anonymously since 2011. It is accessible through computer encrypting software (Tor) and is supported by online transactions using peer-to-peer anonymous and untraceable crypto-currency (bitcoins). The study aimed to describe user motives and realities of accessing, navigating and purchasing on the Silk Road marketplace.

Results: The majority of participants were male, in professional employment or in tertiary education. Drug trajectories ranged from 18 months to 25 years, with favourite drugs including MDMA, 2C-B, mephedrone, nitrous oxide, ketamine, cannabis and cocaine. Few reported prior experience of online drug sourcing. Reasons for using Silk Road included curiosity, concerns for street drug quality and personal safety, variety of products, anonymous transactioning, and ease of product delivery. Vendor selection appeared to be based on trust, speed of transaction, stealth modes and quality of product. Forums on the site provided user advice, trip reports, product and transaction reviews. Some users reported solitary drug use for psychonautic and introspective purposes. A minority reported customs seizures, and in general a displacement away from traditional drug sourcing (street and closed markets) was described. Several reported intentions to commence vending on the site.
 
  

Responsible vendors, intelligent consumers: Silk Road, the online revolution in drug trading
Van Hout MC and Bingham T
International Journal of Drug Policy, 2013, 7 November, Early online.
www.drugsandalcohol.ie/20888

Silk Road is located on the Deep Web and provides an anonymous transacting infrastructure for the retail of drugs and pharmaceuticals. Members are attracted to the site due to protection of identity by screen pseudonyms, variety and quality of product listings, selection of vendors based on reviews, reduced personal risks, stealth of product delivery, development of personal connections with vendors in stealth modes and forum activity. The study aimed to explore vendor accounts of Silk Road as retail infrastructure.

Vendors described themselves as ‘intelligent and responsible’ consumers of drugs. Decisions to commence vending operations on the site centred on simplicity in setting up vendor accounts, and opportunity to operate within a low risk, high traffic, high mark-up, secure and anonymous Deep Web infrastructure. The embedded online culture of harm reduction ethos appealed to them in terms of the responsible vending and use of personally tested high quality products. The professional approach to running their Silk Road businesses and dedication to providing a quality service was characterised by professional advertising of quality products, professional communication and visibility on forum pages, speedy dispatch of slightly overweight products, competitive pricing, good stealth techniques and efforts to avoid customer disputes. Vendors appeared content with a fairly constant buyer demand and described a relatively competitive market between small and big time market players. Concerns were evident with regard to Bitcoin instability.

Conclusion:The greatest threat to Silk Road and other sites operating on the Deep Web is not law enforcement or market dynamics, it is technology itself.

 

Characteristics of patients admitted to the intensive care unit following self-poisoning and their impact on resource utilisation
McMahon A, Brohan J, Donnelly M and Fitzpatrick GJ
Irish Journal of Medical Science, 2013, 8 October, Early online.
www.drugsandalcohol.ie/20696

Self-poisoning accounts for up to 10 % of hospital admissions, some of whom require admission to ICU. Few studies have looked at the epidemiology of these patients in an Irish setting. This study aimed to quantify the proportion of ICU admissions attributable to self-poisoning, to examine the characteristics and outcomes of these patients, and to assess their ICU resource utilisation.

ICU admissions from 2006 to 2010 were reviewed. Data were collected on patient age, sex, admission diagnosis, substances involved, APACHE II score, length of stay, organ support, and outcome. There were 80 admissions to ICU following self-poisoning, accounting for 3.8% of ICU admissions and 13% of all hospital admissions for self-poisoning. M:F ratio was 0.9:1. Mean age 35 (range 16–75), APACHE II score 14 (2–36). Commonest substances involved were benzodiazepines, opioids, tricycle antidepressants. Median ICU stay was 2 days, 84% of patients were ventilated, 27.5% required inotropic support, and 14% renal replacement therapy. When opioids were involved requirement for inotropes and CRRT were higher. ICU mortality was 6.3 %. These patients consumed 280 bed days.

Results: Self-poisoning accounted for 3.8 % of ICU admissions. Patients tend to require a short period of ventilation, with a minority requiring additional organ support. The cost of ICU care is calculated based on previously published methodology to be €7,717 per patient. Extrapolated nationally the annual cost for ICU care for self-poisoning is estimated to be in the order of €5 million.

The recovery ethos: towards a shared understanding
McDaid S
Irish Journal of Psychological Medicine, 2013, 8 October, Early online.
www.drugsandalcohol.ie/20681

This article presents Mental Health Reform’s perspective on the recovery ethos for mental health service delivery derived from Irish stakeholders’ perspectives. It arose out of a project to develop Mental Health Reform’s agenda for advocacy to implement A Vision for Change. The article describes five core components of a recovery-orientated service: hope, listening, choice, partnership and social inclusion. The article also describes briefly how each component can be reflected in mental health service delivery. The recovery ethos can provide a way forward for service delivery within the current economic crisis and may be viewed as a tool for responding positively to the crisis rather than an additional burden.

Smoking cessation: a new approach
World of Irish Nursing & Midwifery, 2013, 21(7): 27.
www.drugsandalcohol.ie/20903

A new campaign is delivering real motivation and change for smokers based on an evidence-based digital coaching platform. Clinical intervention can be more successful if smokers can regard their smoking as preventing them from living a full life, rather than being the potential cause of their inevitable death. In response to this need, and in order to find a way to reach the 28 million smokers within the 25–34-year age group across Europe, the ‘Ex- Smokers Are Unstoppable’ campaign (www.exsmokers.eu) was developed to provide smokers with positive motivation to quit smoking for good. The campaign shifts the focus of smoking cessation from avoiding illness to the positive benefits of a smoke-free life: the ability to play sport and feel healthy, have more confidence and money, and hassle-free air travel. The campaign is underpinned by the scientific, evidence-based tool ‘iCoach’ – a free and clinically proven digital health coaching platform. Approximately 5,000 people in Ireland are registered on iCoach, with a self-reported quit rate of 40.1% after three months, compared to the average European self-reported quit rate of 36.8%.