Recent publications

OʼCarroll A, Duffin T and Collins J (2020) International Journal of Drug Policy, 87: 102966.https://www.drugsandalcohol.ie/33306/

Dublin appears to have performed very well as compared to various scenarios for Covid-19 mortality amongst homeless and drug using populations. The experience, if borne out by further research, provides important lessons for policy discussions on the pandemic, as well as broader lessons about pragmatic responses to these key client groups irrespective of Covid-19. The overarching lesson seems that when government policy is well coordinated and underpinned by a science-driven and fundamentally pragmatic approach, morbidity and mortality can be reduced. Within this, the importance of strategic clarity and delivery, housing, lowered thresholds to methadone provision, benzodiazepine (BZD) provision and naloxone availability were key determinants of policy success. Further, this paper argues that the rapid collapse in policy barriers to these interventions that Covid-19 produced should be secured and protected while further research is conducted.

Vashishtha R, Pennay A, Dietze P, Marzan MB, Room R and Livingston M (2020) European Journal of Public Health, 31(2): 424–431. https://www.drugsandalcohol.ie/33435/

Evidence suggests adolescent alcohol consumption has declined since the turn of the millennium in almost all high-income countries. However, differences in the timing and magnitude of the decline have not been explored across countries.

Previous analyses of the decline in adolescent drinking have emphasized the wide reach of the changes and their near-coincidence in time. Our analysis points to the other side of the picture that there were limits to the wide reach, and that there was considerable variation in timing. These findings suggest that as well as broader explanations that stretch across countries, efforts to explain recent trends in adolescent drinking should also consider factors specific to countries and regions.

Whelan E, Dockray S, Dick S, Davoren MP, Heavin C, Linehan C and Byrne M (2020) PsyArXiv.
https://www.drugsandalcohol.ie/33446/

The aim of this scoping review was to determine factors that relate to student motivations to reduce or stop their illicit use of substances, and to increase understanding of the factors that may be pertinent in behaviour change interventions for substance use in this population.

Few efforts have been made to identify motivations of third-level students to decrease or cease substance use. Promising avenues for future research on motivations to change in relation to substance use include the social contextual factors, perceptions of effects on social relationships, and actions of friends and family members to prompt contemplations of change.

Devine G and Bergin M (2020) European Journal of Homelessness, 14(2): 193–211.
https://www.drugsandalcohol.ie/33400/ 

Ireland is experiencing a deepening homeless crisis with few sustainable solutions identified. This study explores front-line service providers’ experiences in their engagement with mental health services for adult service users who are homeless within the South-East Region of Ireland. Strauss and Corbin’s Grounded Theory approach was used to guide twenty in-depth interviews with front line service providers.

Five key service gaps emerged: (1) inter-agency communication and collaboration; (2) assertive community recovery-orientated care; (3) training, information sharing and up-skilling; (4) building and sustaining trust, and (5) discharge planning and resource constraints. The findings suggest that the provision of bespoke tailored Mental Health Services, improved inter-agency collaboration and the development of relevant staff educational programmes are required. Further research to inform targeted service provision, policy and practice development is recommended.

Keyes KM, Jager J, Mal-Sarkar T, et al. (2019) Alcoholism, Clinical and Experimental Research, 43(7): 1344-1359. https://www.drugsandalcohol.ie/33359/ 

We review studies using US national data that examined time trends in alcohol consumption and alcohol-related harm since 2008.

Findings suggest that recent trends in gender differences in alcohol outcomes are heterogeneous by developmental stage. Among adolescents and young adults, both males and females are rapidly decreasing alcohol consumption, binge and high-intensity drinking, and alcohol-related outcomes, with gender rates converging because males are decreasing consumption faster than females. This pattern does not hold among adults, however. In middle adulthood, consumption, binge drinking, and alcohol-related harms are increasing, driven largely by increases among women in their 30s and 40s. The trend of increases in consumption that are faster for women than for men appears to continue into older adult years (60 and older) across several studies. We conclude by addressing remaining gaps in the literature and offering directions for future research.

Mayock P and Sheridan S (2020) European Journal of Homelessness, 14(2): 17–47.
https://www.drugsandalcohol.ie/33402/

Using a feminist poststructuralist framework, this paper examines homeless women’s trajectories through and out of homelessness based on data from a qualitative longitudinal study of women’s homelessness in Ireland.

The analysis uncovers women’s agency, mobilised through acts of ‘resistance’ and ‘conformity’, as they navigated a landscape where assumptions about ‘deserving’ and ‘undeserving’ women prevailed and also significantly influenced their housing outcomes.

OʼHare G and Luney P (2020) Irish Probation Journal, 17: 43-62.
https://www.drugsandalcohol.ie/33454/

Organisations within the criminal justice system have been involved in a number of projects to tackle substance misuse, including the Substance Misuse Court (SMC) initiative. This initiative has its origins in ’problem-solving justice’, which is an approach that seeks to tackle the root causes of offending behaviour. While the SMC is still in its infancy and evolving, early results are encouraging, with a sustained participant engagement in supervision and treatment rate of 87.5% recorded. This paper sets out the findings of an evaluation of the SMC conducted in 2019, and looks at the next steps in the development of this innovative project.

McGregor IS, Cairns EA, Abelev S, Cohen R, Henderson M, Couch D, et al. (2020) International Journal of Drug Policy, 85: 102935. https://www.drugsandalcohol.ie/33370/

In this study, we compared the availability of CBD [cannabidiol] products and the associated legislative and regulatory background in nine selected countries.

There are a variety of approaches in how countries manage access to CBD products. Many countries appear to permit OTC [over-the-counter] and online availability of CBD products but often without legislative clarity. As consumer demand for CBD escalates, improved legislation, guidelines and quality control of CBD products would seem prudent together with clinical trials exploring the therapeutic benefits of lower-dose CBD formulations.

Daly C, Griffin E, McMahon E, Corcoran P, Webb RT, Ashcroft DM and Arensman E (2020) Social Psychiatry and Psychiatric Epidemiology, 56: 773–781. https://www.drugsandalcohol.ie/33297/

This study aimed to describe the characteristics, incidence, and temporal trends in paracetamol-related IDO [intentional drug overdose] among young people.

The increase in paracetamol-related IDO among specific groups of young people, particularly young females is an issue of growing concern. Interventions targeting IDO among young people are needed, incorporating measures to address the availability of paracetamol and aftercare following IDO.

Dillon CB, Saab MM, Meehan E, Goodwin J, Murphy M, Heffernan S, et al. (2020) Journal of Affective Disorders, 276: 898-906. https://www.drugsandalcohol.ie/33301/

This mixed-method systematic review aimed to appraise and synthesise evidence from studies that explored and promoted healthcare staffʼs knowledge and awareness of suicide and self-harm risk in healthcare settings.

Long-term, routine face-to-face group training programmes should be established to educate healthcare staff about suicide risk across all professions and in specific patient groups.

Hill M, Farrelly N, Clarke C and Cannon M (2020) Irish Journal of Psychological Medicine, Early online, 1-8. https://www.drugsandalcohol.ie/33451/

This paper, by members of the Youth and Student Special Interest Group of the College of Psychiatrists of Ireland, contextualises student mental health currently and describes future directions for this emerging field. It is a call to action to develop a structure that supports the needs of students with mental health problems across the full range of the spectrum from mild to severe.

Murray SA, Lyne SJ, Cryan MD, Mullin M, McGrath D and Hayes CB (2020) Irish Journal of Psychological Medicine, Early online. https://www.drugsandalcohol.ie/33449/

This study aimed (1) to determine prevalence of occasional/social smoking among third level students in an Irish university; (2) to evaluate students’ attitudes to occasional/social smoking, including perceived benefits and harm; (3) to explore when students commenced occasional/social smoking, their reasons and continued smoking habits; and (4) to determine any influence of other factors, e.g. alcohol consumption, on occasional/social smoking.

Prevalence of self-reported occasional smoking among university students was higher than daily smoking. Most occasional smokers primarily smoked in social contexts. All current smokers reported that alcohol increased cigarette intake. Effective intervention campaigns tailored to determinants of occasional/social smoking are needed as part of induction to third level.

Mayock P and Butler S (2021) International Journal of Drug Policy, 90: 103092.
https://www.drugsandalcohol.ie/33604/

This paper examines the experiences of long-term clients of methadone maintenance treatment (MMT) in one area of Dublin in the context of a recent emphasis on rehabilitation and recovery in Irish drug policy.

The findings highlight a disconnect between policies that ostensibly aim to promote social reintegration and recovery and the experiences of individuals who are long-term clients of MMT. Irish policy aspirations of facilitating opiate-dependent clients to progress along a pathway to recovery are difficult, if not impossible, to realise given the marginal status of addiction services within the health system and the difficulties involved in securing ongoing cooperation from other public service sectors.

Power E, Sabherwal S, Healy C, OʼNeill A, Cotter D and Cannon M (2021) Psychological Medicine,
51(2), 194–200. https://www.drugsandalcohol.ie/33710/

This study is a systematic review and meta-analysis. We preregistered our review with PROSPERO (ID no. CRD42019125624). We found seven cohort studies including 808 cases and 5308 controls. We found a significant effect for the association between frequent or dependent cannabis use in youth and IQ change, Cohenʼs d=-0.132 (95% CI -0.198 to -0.066) p<0.001. Statistical heterogeneity between studies was also low at I²=0.2%. Study quality was moderate to high. This translates to an average decline of approximately 2 IQ points following exposure to cannabis in youth. Future studies should have longer periods of follow up to assess the magnitude of developmental impact.

Harris J, Shorter GW, Davidson G and Best P (2020) Drug and Alcohol Dependence, 208: 107878.
https://www.drugsandalcohol.ie/33688/

This qualitative study aims to improve understanding of environmental influences preventing people who smoke heroin from transitioning to regular injection.

Findings illuminate environmental influences surrounding and shaping drug consumption practices. Harm reduction strategies should develop and implement safer smoking rooms, community and peer interventions, and improve accessibility to opioid substitution therapy and low threshold outreach services to prevent transitioning to regular heroin injecting.

Matthews E, Van Hout MC, Scheibein F and Cowman M (2021) Heroin Addiction and Related Clinical Problems, Early online. https://www.drugsandalcohol.ie/33648/

This research aimed to explore service user experiences of change with respect to physical activity and dietary practices since entering opioid agonist treatment (OAT). This research also explored barriers and facilitators to positive lifestyle behaviours among those accessing OAT.

Lifestyle behaviours appear to be positively modified during OAT allied to additional health care supports in place for service users and a potential for improved health and social function. A number of barriers, particularly psychological, remain with respect to behaviour change for this population. This research explores these, with learnings for services to support behaviour change.

Haran M, Kelly JR, Kennedy L, Hennigan K, Farid H, Herteu C, et al. (2021) Irish Journal of Medical Science, Early online. https://www.drugsandalcohol.ie/33641/

This study aimed to audit adherence to the National Drug Treatment Centre (NDTC) Cervical Screening guidelines before and after the implementation of an awareness-raising educational intervention.

This completed audit cycle shows that an awareness-raising educational intervention can significantly improve adherence to a cervical screening programme in women with substance use disorders (SUDs).

McAleer A, Daly A, Leary S, Barry J, Mullin M and Ivers J-H (2021) Irish Journal of Medical Science, Early online. https://www.drugsandalcohol.ie/33644/

This study examines Irish undergraduate studentsʼ behaviours and motives regarding alcohol consumption. The study explores both levels and patterns of consumption.

Given the high rates of hazardous drinking, the development of an alcohol intervention may
be justified; given the high response rates to
peer-screening, a peer-led intervention for alcohol-related harms may yield positive results.

Brennan R, Overbye M, Van Hout MC and McVeigh J (2021) Performance Enhancement & Health, 8(4): 100185. https://www.drugsandalcohol.ie/33622/

This scoping review gathers what is currently known on the self injection of body fillers for aesthetic purposes, using Arksey and O’Malley’s (2005) five stage iterative process scoping review methodology.

It was found that the majority of people who inject body fillers are male and do so to grossly increase muscle size. Injection of oils and other materials in the male genitalia was also described, in addition to female self-injection in the breast, hand and leg areas for augmentation. A range of health consequences were reviewed. Recommendations are made for further research into this unique phenomenon, which, although relatively rare, warrants future research attention considering the documented increase in DIY facial fillers and contemporary body image culture.

Durand L, Boland F, OʼDriscoll D, Bennett K, Barry J, Keenan E, et al. (2020) Drug and Alcohol Dependence, 219: 108466. https://www.drugsandalcohol.ie/33611/

This study aims to identify determinants of time to dropout of methadone maintenance treatment (MMT) across multiple treatment episodes in specialist addiction services in Ireland.

Clients with a previous history of treatment dropout and those on low dose methadone should be identified as high risk for both early and later dropout. Inversely, adherence to treatment, not missing methadone doses, is protective.

McLoughlin C, McLoughlin A, Jain S, Abdalla A, Cooney J and MacHale S (2021) Irish Journal of Medical Science, Early online. https://www.drugsandalcohol.ie/33594/

This study aimed to evaluate the characteristics of mental health presentations to the emergency department (ED) in two different hospital settings.

A large proportion of ED referrals to psychiatry constitute patients with unmet social and addiction needs, who are seen out of hours. This prompts consideration of expanding both ED and community services to comprise a more multidisciplinary-resourced, 24/7 care model.

Murphy L, Lyons S, OʼSullivan M and Lynn E (2020) HRB Open Research, 3(45).
https://www.drugsandalcohol.ie/33653/

This paper presents a protocol for a scoping review that aims to systematically map and synthesise the extent and nature of published, unpublished and grey literature related to risk factors for suicide among people who use drugs (PWUD).

Collating and thematically categorising the various risk factors for suicide among this high-risk group will hold important implications for future research, policy and practice. The research will be disseminated through publication in a peer-reviewed academic journal and a conference presentation, and by sharing the findings with key stakeholders working within research, policy-making and professional practice contexts.

Orsolini L, Rojnić Palavra I, Duccio Papanti G, Potočan M, Quattrone D, Martens M, et al. (2021) Frontiers in Psychiatry, 11: 1315. https://www.drugsandalcohol.ie/33618/

Although psychoactive substance use disorders (PSUDs) are a domain of mental health, addiction psychiatry is only formally recognized as a subspecialty in a few European countries, and there is no standardized training curriculum.

Despite a growing spread of PSUDs in European countries, addiction psychiatry is a relatively poorly trained field within psychiatry training programs. Further research should investigate reasons for poor training and timings of the educational activities to optimize experiential education training in addiction psychiatry.

McDonnell BP, McCausland R, Keogan S, Clancy L and Regan C (2021) Irish Journal of Medical Science, Early online. https://www.drugsandalcohol.ie/33642/

The purpose of this study was to explore the purchasing habits of pregnant smokers with regard to tobacco expenditure and use of illicit tobacco.

Use of illicit tobacco is low and only a minority of women engaged in tobacco tax avoidance. As the average price of tobacco in Ireland increases, weekly expenditure on tobacco products is a significant financial impact on low-income women. Smoking cessation would deliver significant financial gains in addition to health benefits.

Houghton F and McInerney D (2020) Irish Geography, 53(2): 179-184
https://www.drugsandalcohol.ie/33628/

The negative impact of alcohol on Irish society necessitates that the current opportunity to curtail this problem is not missed, as has happened in the past. Tackling youth and problematic alcohol use and misuse requires a robust response. The current Public Health (Alcohol) Act is a valuable start but contains a number of serious deficiencies that must be remedied. Past examples of equivocation by Government on this issue are unacceptable. Deficits in this legislation must be addressed through amendments as forthcoming sections are brought into force.

Smyth BP (2021) Irish Journal of Psychological Medicine, Early online.
https://www.drugsandalcohol.ie/33687/

In 2010, Ireland found itself at the eye of an international storm as a network of head shops emerged selling new psychoactive substances (NPS) and Irish youth rapidly became the heaviest users of NPS in Europe. Within months, the Irish government enacted novel legislation, which has since been copied by other countries, which effectively stopped the head shops selling NPS. Critics of this policy argued that it could cause harms to escalate. A number of separate studies indicate that a range of drug-related harms increased amongst Irish youth during the period of head shop expansion. Within months of their closure, health harms began to decline. NPS-related addiction treatment episodes reduced and admissions to both psychiatric and general hospitals related to any drug problem began to fall. Population use underwent sustained decline. Consequently, the closure of head shops can be viewed as a success in terms of public health.

Brady M, Shanley A, Hurley C, OʼDonnell K, OʼTuathail M, Fitzgerald M, et al. (2020) Irish Journal of Medical Science, 189(4): 1507-1514. https://www.drugsandalcohol.ie/33304/

Our aim was to pilot and then introduce sustained monitoring of VCBT [voluntary community-based HIV testing] in Ireland, through collaboration between statutory and non-statutory organisations.

Sustained national monitoring in community settings will help inform HIV testing guidelines and will enable assessment of the impact of local and regional community HIV testing strategies.

Griffin E, Gunnell D and Corcoran P (2020) BJPsych Open, 6(6): e145.
https://www.drugsandalcohol.ie/33453/

The aim of this study was to identify the specific hospital and individual factors associated with care pathways following hospital-presenting self-harm.

Characteristics of the presenting hospital and hospital admission rates influence the recommended care pathways following self-harm. Provision of onsite mental health facilities and specialist mental health staff has a strong impact on psychiatric care of these patients.

Strashun S, DʼSa S, Foley D, Hannon J, Murphy A-M and OʼGorman CS (2020) Irish Journal of Medical Science, 189(4): 1331-1336. https://www.drugsandalcohol.ie/33299/

Our aim was to identify and categorize the physical morbidities prevalent in homeless children.

This literature review summarized the physical illnesses prevalent among homeless children and the contributing factors leading to them. Gaps in the literature were also identified and included a dearth of studies focusing on younger children compared with adolescents. Further research into prevention and intervention programs for this vulnerable population is urgently needed.

Drugnet Ireland is the quarterly newsletter of Ireland’s focal point for the EMCDDA and is produced in collaboration with the HRB National Drugs Library. Drugnet Ireland is published by the Health Research Board.

Managing editor:    Brian Galvin
Copy-editing:           O’Hanlon Media

© Health Research Board, 2021

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