The current national drug strategy, ‘Reducing harm, supporting recovery: a health-led response to drug and alcohol use in Ireland 2017-2025’, was launched in July 2017 and its main aim is to minimise the harms caused by the use and misuse of substances, and to promote rehabilitation and recovery by supporting the development of a range of treatment, rehabilitation and recovery services using the four-tier model. The strategy also recognises the need for timely access to appropriate services for the client. The integrated care pathways model forms the conceptual basis for the National Drug Rehabilitation Framework.
The Health Service Executive (HSE), which manages Ireland’s public health sector, is responsible for the provision of all publicly funded drug treatment. The management of all drug treatment services falls under the remit of the Primary Care Division, which oversees a number of national care groups. Drug treatment is provided through a network of HSE services (public), but also non-statutory/voluntary agencies, many of which are funded by the HSE. Some private organisations also provide treatment.
Most drug treatment is provided through publicly funded outpatient services. These include 314 specialised drug treatment centres, 82 low-threshold agencies and 356 specialised general practitioners, which provide opioid substitution treatment (OST) in the community.
Some outpatient care is provided through mental health services and by private agencies. Inpatient treatment is provided through residential centres run by voluntary agencies or within psychiatric hospitals. There are 51 non-statutory agencies that are based on the principles of residential care or therapeutic communities and two hospital-based detoxification units.
The types of treatment and services offered vary depending on the service. Medication-assisted treatment includes methadone detoxification, methadone maintenance treatment and benzodiazepine detoxification. Alternative therapies, such as acupuncture, are provided through both statutory and community projects. Pregnant opioid users are entitled to immediate access to treatment. For drug users under the age of 18, special interventions, such as family therapy and specially adapted medication-free therapy, are provided. OST is provided by specialised HSE outpatient treatment clinics, by satellite clinics and through specialised general practitioners in the community, as well as in prisons.
In 2017, around 8 500 clients entered drug treatment, almost 40 % of them for the first time. Most clients entered treatment through outpatient settings. Primary opioid users remain the largest group entering treatment in Ireland; however, as a proportion of all treatment entrants, their number has been steadily decreasing over the last few years. In contrast, the proportion of primary cannabis clients entering treatment rose between 2007 and 2013, while a gradual decrease was observed from 2015. In recent years, an increase in the proportion of clients entering treatment for the use of hypnotics and sedatives, mainly benzodiazepines (classified as ‘other drugs’), has been reported. The most notable trend is the continued increase in the number of cases presenting for treatment for problem cocaine use.
The number of clients receiving OST has increased year on year since 2006 (apart from in 2011). Although the proportion of younger clients in OST has decreased since 2010, the proportion of clients aged 45 years or older has increased steadily.