As patterns in drug use and markets change, so too do the techniques used for monitoring and responding to these patterns. Routine monitoring on levels of drug use, treatment demand, and harms is essential for observing trends and planning services, but the unpredictable nature of synthesised drugs requires more immediate responses and a capacity to interpret diffuse information from a wide variety of sources.

A new interactive map has been launched to help people in Ireland quickly find addiction treatment services in their area. Developed by the Health Research Board (HRB) in collaboration with the Department of Health, the map provides a comprehensive overview of all publicly funded addiction treatment and family support services across the country (see Figure 1). 

In July 2024, the Centre for Justice and Innovation published a report, presented by Tony Duffin, the chair of the National Drugs Strategy Strategic Implementation Group 5 (SIG-5), which aimed to map existing alternatives to coercive sanctions (ACS) for individuals found in possession of controlled drugs for personal use in Ireland.¹ The authors explored how ACS are delivered in Ireland, stakeholders’ views on how these could be improved, and the potential for the expansion of ACS in the Irish context.

A ministerial meeting of the drugs and alcohol work sector of the British–Irish Council (BIC) was held in Dublin on 26 January 2024. The Irish Government is the lead administration for this strand of work.

The meeting was chaired by Minister for Public Health, Well-being and the National Drugs Strategy, Hildegarde Naughton TD. It was also attended by ministers from Scotland, Wales, the Isle of Man, and Guernsey.1

In March 2024, the Joint Committee on Drugs Use was established by the Irish Government to consider the recommendations in the report of the Citizens’ Assembly on Drugs Use.¹

Oireachtas Committees

In Ireland, there are mechanisms that Government can use to inform the policy-making process. Oireachtas (Parliamentary) committees advise the Oireachtas on a range of specific areas, including drug policy.

In November 2023, Young Ireland: national policy framework for children and young people was launched by the Department of Children, Equality, Disability, Integration and Youth (DCEDIY).¹ It sets out the policy direction and key priorities in respect of children and young people (aged 0–24 years) in Ireland across all Government Departments and State agencies to the end of 2028.

Background

Young Ireland is the successor strategy to Better Outcomes, Brighter Futures: the national policy framework for children & young people 2014–2020, which was Ireland’s first national policy framework for children and young people.² Overall, Young Ireland reflects a continuation in its aim, focus, and approach when compared with its predecessor.

The Road Traffic Act 2024 was enacted on 17 April 2024.¹ The purpose of the Act is to overcome anomalies evident in the existing legislation. It provides for changes to the penalty points regime (Part 2), speed limits (Part 3), and mandatory roadside testing of drivers involved in serious collisions for intoxicants, which will now include drug testing (Part 4). This article will focus on Part 4, which provides for several amendments to the Road Traffic Act 2010.

An Irish delegation attended the 67^th session of the United Nations Commission on Narcotic Drugs (CND)¹ in Vienna on 14–22 March 2024. The delegation consisted of:

• Jim Walsh, Brian Dowling and Richie Stafford of the Department of Health
• Lisa Fay of the Department of Justice
• Detective Superintendent Sé McCormack of An Garda Síochána
• Ambassador Eoin O’Leary and officials from the Irish Permanent Representation to the United Nations (UN).

CND meets annually and adopts a range of decisions and resolutions.² Intersessional meetings are convened throughout the year. Towards the end of each year, CND meets at a reconvened session to consider budgetary and administrative matters as the governing body of the UN drugs programme.

A feature of an effective drug prevention system is the training of stakeholders.1 Progress in this area in Ireland can be seen through the implementation of the European Prevention Curriculum (EUPC) training programme,
albeit to limited numbers to date.

What is the EUPC?

The EUPC is a training programme whose primary goal is ‘to reduce the health, social and economic problems associated with substance use by building international prevention capacity through the expansion of the European professional prevention workforce’ (p. 10).²

Improving the quality of drug prevention interventions and systems internationally is a focus of the United Nations Office on Drugs and Crime (UNODC). Building on its International Standards on Drug Use Prevention, the UNODC has developed a tool for countries to assess their drug prevention systems and interventions in line with the standards.^1,2 The Review of national prevention systems based on the UNODC/WHO International Standards on Drug Use Prevention: final report of the pilot in Norway was published in September 2023 and a webinar on the project findings held on 19 April 2024.^2,3

In July 2024, the Health Research Board (HRB) published Integrative review on place-based and other geographically defined responses to drug-related threats in communities,¹ the ninth report in the Drug and Alcohol Evidence Review series. On behalf of the Department of Health, the HRB commissioned this report to systematically review and synthesise the international evidence on this topic. Place-based initiatives emerged originally in the field of health, guided by new ideas relating to the social determinants of health, the role of the socioecological context, implementation science, and the importance of community empowerment.

Although there are considerable variations, it is possible to identify an underlying model which focuses on providing universal, structural interventions that seek to improve health and well-being by modifying the social context in which health-related behaviour occurs.

The key findings of the review are set out below under the five research questions.

Background and methods

The overall prevalence of recreational drug use (RDU) has risen in Ireland from 5.6% in 2002/2003 to 7.4% in 2019/2020; and males report a higher prevalence of RDU in comparison to females (12.3% and 5.7%, respectively).¹ International evidence suggests that gay, bisexual, and other men who have sex with men (gbMSM) have a higher prevalence of drug use versus age-comparable non-gbMSM.² Previously cited reasons for this drug use disparity may include ‘minority stress’, as well as the perceived ‘normalisation’ of drug use within the gbMSM community, including sexualised drug use (SDU).^3,4,5 However, in Ireland, there is a paucity of literature regarding the prevalence of drug use and its determinants among gbMSM.

The Criminal Justice (Engagement of Children in Criminal Activity) Act 2024 was enacted on 11 March 2024.¹ The purpose of the Act is to provide for offences relating to the engagement of a child in criminal activity. Section 2 of the Act addresses engagement of children in criminal activity, while Section 3 makes amendments to the Schedule of the Bail Act, 1997.

Published in June 2024, the latest report from the National Drug Treatment Reporting System (NDTRS) presents data on treated problem drug use (excluding alcohol) for the year 2023, as well as trends for the seven-year period from 2017 to 2023.¹

Key findings, 2023

In 2022, some 12,009 cases were treated for problem drug use.² This is the highest annual number of cases recorded by the NDTRS to date. Almost 4 in 10 (37.1%) of those cases were never treated before, while almost 7 in 10 (68.9%) cases were treated in outpatient facilities.

A recent study by Kelly et al.¹ aimed to understand how different factors within community-based opiate-prescribing services affect the overall work environment. The study examines how clear each organisation’s goals are, how well the team works together, how much freedom staff have, and how open each organisation is to change. The goal was to identify what makes a good work environment in these services and how to improve it.

The Health Research Board (HRB) has published its second report on deaths among people who were homeless at the time of death.¹ The report describes deaths that occurred in 2020 and contains updated figures for deaths in 2019.² The report follows on from research originally commissioned by the Department of Health, which examined deaths in 2019 among people who were homeless.³

Background

The HRB collects data on all deaths among people who were homeless at the time of death in order to better understand and prevent premature death among people who are homeless. The data are extracted from closed coronial files nationwide using the methodology of the National Drug-Related Deaths Index (NDRDI), even if the deaths do not meet the standard NDRDI inclusion criteria.⁴ The NDRDI validates these data with the Dublin Regional Homeless Executive through its Pathway Accommodation and Support System (PASS).

The HIPE (Hospital In-Patient Enquiry) scheme is a computer-based health information system, managed by the Economic and Social Research Institute (ESRI) in association with the Department of Health and the Health Service Executive. It collects demographic, medical, and administrative data on all admissions, discharges, and deaths from acute general hospitals in Ireland. Each HIPE discharge record represents one episode of care; each discharge of a patient, whether from the same or a different hospital, with the same or a different diagnosis, gives rise to a separate HIPE record. The scheme therefore facilitates analysis of hospital activity rather than of the incidence of disease. HIPE does not record information on individuals who attend emergency departments but are not admitted as inpatients. Monitoring of drug-related acute emergencies in the Irish context refers to all admissions for non-fatal overdoses to acute general hospitals in Ireland.

On 9 November 2023, Ireland’s Health Service Executive (HSE) was made aware of an overdose cluster in Dublin, with 24 cases notified throughout the day and another 10 cases the following morning. This triggered an urgent review across a number of information sources to identify possible signals of change on the Dublin drug market.¹ Data were monitored by the HSE on 9–12 November, and a total of 57 non-fatal overdoses were recorded during this period. Analysis by Forensic Science Ireland of a sample obtained by An Garda Síochána on the evening of 10 November confirmed the emergence of nitazenes in a light brown/sandy-coloured powder on the Dublin heroin market, which resulted in the HSE issuing a Red Alert for the city. The nitazene was later confirmed as N-pyrrolidino protonitazene (protonitazepyne), which was a first identification for Ireland and a substance under intensive monitoring by the European Union Drugs Agency (EUDA). Samples were also found to contain caffeine, paracetamol, benzoic acid, and mannitol.²

Pharmacy needle exchange in Republic of Ireland

The current national drugs strategy (2017–2025) aims to reduce harms arising from substance misuse and to reduce the prevalence of blood-borne viruses among people who inject drugs (PWID) through the expansion of needle exchange provision to include community pharmacy-based programmes. In October 2011, the HSE rolled out the national Pharmacy Needle Exchange Programme, which is a partnership initiative between the Elton John AIDS Foundation, the Irish Pharmacy Union, and the HSE. Once pharmacies have signed a service level agreement with the HSE, their contact details are passed on to the relevant HSE services so they can promote access to sterile injecting equipment at the participating pharmacies and accept referrals for investigation and treatment. There are pharmacies providing needle exchange in each Regional Drugs and Alcohol Task Force (RDATF) area, apart from those covering Counties Dublin, Kildare, and Wicklow, which are served by a mix of static and outreach needle exchange programmes.

In January 2024, addiction services warned of a concerning increase in the use of ketamine in Ireland. In 2023, Revenue seized 41.2 kg of ketamine, valued at €2.47m. The drug, known for its use as a horse tranquiliser, has become popular among revellers at festivals and parties. In 2022, Revenue seized 7.86 kg of ketamine, while in 2021 officers seized 25.19 kg of the drug.¹ A letter to the editor of the Irish Journal of Medical Science (IJMS) by the HSE National Social Inclusion Office noted that ketamine has become a prominent feature of recreational drug repertories in Ireland, often used in combination with other ‘club drugs’ for stimulant and euphoric effects when socialising.²

Background

In 2022, the HSE, in partnership with Merchants Quay Ireland, collected 165 used syringes from the Dublin and Midlands regions during September and October. Residual drugs were extracted from these syringes and the data obtained were used to compare drug trends from the two regions.

The Syringe Analysis Programme is the first of its kind in Ireland and enables the HSE to identify temporal and geographical trends annually as part of its emerging drug trend monitoring. Analysis of 235 drugs and metabolites was performed using liquid chromatography–mass spectrometry.

These analyses spanned a wide range of substances, such as opiates (including new synthetic opioids), benzodiazepines, amphetamines, cocaine, new psychoactive substances (NPS), Z-drugs, gabapentinoids, ketamine, and various cutting agents. In 2023, the HSE published a report¹ detailing the findings from the 2022 analysis programme; it also compared 2022 programme results to findings from a syringe analysis programme conducted in 2021. The main findings are discussed below.

Background

Serious human rights and equality concerns emerged regarding the lived experience of service users in Dublin’s North-East Inner City. In 2009, drug service users, their representatives, and community activists formed a coalition after concerns were raised about the practice of and over-reliance on urine testing and the lack of information and choice on pathways to health for each service user. A study was conducted¹ to identify issues experienced by service users of drug treatment projects and to review the key monitoring points and changes arising from the Health Service Executive (HSE) Action Plan. A great emphasis of this study was on peer-led processes, as the voice of the service user is rarely heard.

Background

The Health Service Executive (HSE) Integrated Alcohol Service (IAS) began operating on North Great Clarence Street, Dublin 1 in 2022, following the growing recognition of and concern regarding widespread problem alcohol use in the area, particularly during the COVID-19 pandemic. The IAS is based on the recommendations outlined in the National Drugs Rehabilitation Framework Document, and provides a coordinated response to address both prevention and the provision of services and support to those who require it.¹

Prevalence and current situation

Kelly P, Searby A and Goodwin J (2024) Journal of Substance Use and Addiction Treatment, 162, 209362.
https://www.drugsandalcohol.ie/40901/

Dempsey S and O’Grady MJ (2024) Archives of disease in childhood. Fetal and neonatal edition, 109, (3), pp. 261-264.
https://www.drugsandalcohol.ie/40884/