• Drug use among the general population and young people
• Prevention
• Problem drug use
• Treatment demand
• Drug-related infectious diseases
• Drug-related deaths
• Treatment responses
• Harm reduction responses
• Drug markets and drug-related offences
• National drug laws
• National drug strategy
• Coordination mechanism in the field of drugs
• Drug-related research

Drug use among the general population and young people

The first national survey on drug use among the general population was carried out in Ireland in 2002–03 among persons aged 15–64 years. The results were jointly published by the National Advisory Committee on Drugs (NACD) and the Drug and Alcohol Information and Research Unit (DAIRU) within the Department of Health and Social Services and Public Safety in Northern Ireland. This survey was repeated in 2006–07. Compared to 2002–03, the proportion of respondents who reported the use of any illegal drug during their lifetime increased from 18.5 % to 24 % in 2006–07; the proportion of those who reported use of an illegal drug during the last year increased as well; as regards the use of an illegal drug during the last month, the proportion remained unchanged. The proportion of young adults (15–34 years) who declared using an illegal drug during the last year increased from 10 % to 12.1 %. The proportions reporting cannabis use were similar to the proportions who used any drug.

In 2006–07 lifetime prevalence for cocaine (including crack) and ecstasy increased compared to that reported in 2002–03: cocaine lifetime prevalence was reported at 5.3 %, up from 3.0 %, and ecstasy at 5.4 %, up from 3.7 %.

The latest survey among young people on health (including drug-related questions) was conducted in Ireland in 2006 (‘Health Behaviour in School-aged Children’, HBSC). It included questions on cannabis. Overall, 24 % of 15-and-a-half year olds reported using cannabis during their lifetime, compared with 20 % in 2002; 17 % reported using cannabis in the past 12 months, compared with 19 % in 2002. The overall rates of reported cannabis use are similar to those in the 2002 HBSC study, except that among boys, a decrease is evident and there is an increase among girls.

Data based on the ESPAD surveys, regularly conducted since 1999 in Ireland, among 15–16-year old students revealed that the lifetime prevalence rate of cannabis varied from 32 % in 1999 to 39 % in 2003 and to 20 % in 2007. In 2007, results showed that inhalants lifetime prevalence was reported by 15 % of the students. Lifetime prevalence of ecstasy was reported by 4 % equal proportion to cocaine, amphetamines use was reported by 3 % of the sample, as well as 3 % reported LSD use and 1 % heroin use. Results indicated 15 % for the last year prevalence of cannabis use (31 % in 2003, 26 % in 1999), 9 % for the last month prevalence of cannabis (17 % in 2003, 15 % in 1999). In addition, the reported lifetime prevalence of cannabis use among males was 23 % and 17 % among females.

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Prevention

Drug prevention is one of the pillars in Ireland’s interim National Drugs Strategy 2009–16 (NDS). The strategy states that ‘a tiered or graduated approach to prevention and education measures in relation to drugs and alcohol should be developed with a view to providing a framework for the future design and development of interventions’. It identifies three levels in this framework:

• universal prevention programmes, aimed at the general population such as students in schools, to promote overall health of the population and to prevent the onset of drug and alcohol misuse. Measures often associated with this type of programme include awareness campaigns, school drug/alcohol education programmes and multi-component community initiatives;
• selective prevention programmes, aimed at groups at risk, as well as subsets of the general population including children of drug users, early school leavers and those involved in anti-social behaviour, to reduce the effect of risk factors present in these subgroups by building on strengths and developing resilience and protective factors;
• indicated prevention programmes, for people who have already started using drugs/alcohol, or who are likely/vulnerable to engage in problematic drug/alcohol use (but may not necessarily be drug/alcohol-dependent), or to prevent relapse. These programmes are aimed at individuals or small groups and address specific needs.

In Ireland, young people and their families are the main target groups for drug prevention activities, which consist mainly of universal and selective prevention, with little focus on targeted prevention.

The NDS identifies as priorities for Prevention improving the delivery of Social, Personal and Health Education (SPHE) programme in primary and post-primary schools and co-ordinating the activities and funding of youth interventions in out-of-school settings to optimise their impacts. Drug prevention interventions in schools are delivered through the Walk Tall (primary schools) and the SPHE (post-primary schools) programmes. The SPHE programme aims to improve social and personal competencies in students so they can understand and counter the many social influences that are seen as contributing to their use of drugs and alcohol A research carried out in 2010 among a cohort of post-primary school students indicate that almost 90 % of students had received SPHE classes in 2009, and around 83 % respondents noted that alcohol, drug and solvent abuse was the most emphasized theme in the syllabus. In the community, prevention programmes are provided in different settings, such as youth clubs and youth cafés, and by means of diversion activities provided by the statutory, voluntary and community sectors.

The NDS calls for a continued focus on orienting educational and youth services towards early interventions for people and communities most at risk. Actions are being developed to support the families of drugs users, and community development is acknowledged as an important step in building the capacity of local communities to avoid, or respond to and cope with, drug problems. Early school leavers and those outside the formal education are targeted through measures such as the School Completion Programme and embedding the government’s DEIS (Delivering Equality of Opportunity in Schools) Action Plan, which tackles disadvantage among the school-going population in LDTF areas. The DEIS continues to support some 151 000 children in 876 schools. Meanwhile, 46 000 at risk children are directly targeted in schools through the Home School Community Liaison and School Completion programmes.

The Department of Education and Science has also developed a strategy to tackle educational disadvantage and early school leaving in the Traveller community.

The NDS proposes that preference be given to the development of timely awareness campaigns targeted in a way that takes individual, social and environmental conditions into account in key areas such as third-level institutions, workplaces, sports and other community and voluntary organisations. Thus, in 2010 the Health Service Executive (HSE) launched a national drug awareness campaign ‘Legal or Illegal Highs — they’re anything but safe’ (www.drugs.ie) targeting people between 15 and 40 years of age. Apart from outlining the mental and physical health risk related to so-called ‘legal highs’, the campaign provides the information for parents on how to talk about these substances with their children. All material developed for the campaign was made available in the first instance to the service providers and the Local and Regional Drugs Task Forces.

In 2009, the Department of Education and Science found that 84 % of primary schools and 55.1 % of post-secondary schools reported having a substance use policy in place and the presence and effectiveness of the substance use policies is included also in the whole-school evaluation.

Quality standards with practical information on best practice in substance use education in Ireland have been published as a manual. It is based on a substantial review of international research and provides guidelines for the development and enhancement of substance use education in school, youth work and community-based settings.

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Problem drug use

In 2006, the total number of opiate users was estimated to be 7.2 opiate users per 1 000 population, aged 15–64 (20 790 individuals). The estimated rate for Dublin in 2006 was 17.6 users per 1 000 inhabitants, aged 15–64 (14 904 users). For the rest of Ireland, the estimated rate in 2006 was 2.9 users per 1 000 inhabitants, aged 15–64. This study included both injecting and non-injecting opiate users.

The EMCDDA defines problem drug use as intravenous drug use (IDU) or long duration/regular drug use of opiates, cocaine and/or amphetamines. Ecstasy and cannabis are not included in this category.

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Treatment demand

Treatment demand data are collected from agencies in Ireland which report to the National Drug Treatment Reporting System (NDTRS). The system collects data from outpatient, inpatient, low threshold methadone maintenance units, crisis counselling units and general practitioners in Ireland. In 2009, a total of 530 treatment services reported to the NDTRS out of the 686 treatment centres.

In 2009, a total of 7 271 clients entered treatment, of whom 3 430 entered treatment for the first time. Data regarding all treatment clients suggests that 60.5 % of all clients entering treatment reported that an opiate was the primary drug, followed by 21.6 % for cannabis and 11.5 % for cocaine. Among new treatment clients, a similar distribution was identified with 44.4 % for opiates, followed by 32.2 % for cannabis and 15.1 % for cocaine. However, in large proportion of cases poly-substance use is reported. Alcohol, cannabis and cocaine are the most frequent additional substances used by treatment clients.

In 2009, 36 % of all clients entering treatment were aged less than 25 years. A higher percentage in age distribution was reported among clients entering treatment for the first time, with 48 % under the age of 25 years. In 2009, the proportion of males to females for all clients entering treatment was 77 % for male and 24 % for female. A similar gender ratio was also reported among clients entering treatment for the first time, with 80 % for male and 20 % for female.

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Drug-related infectious diseases

Data from the Health Protection Surveillance Centre (HPSC) indicate that in 2009, 29 newly diagnosed cases of HIV among injecting drug users were reported, indicating a decrease when the number is compared with the previous year (36 newly diagnosed cases in 2008 and 54 newly diagnosed cases in 2007).

According to the data from HPSC, there were 1 255 cases of hepatitis C reported in 2009, compared to 1 527 cases in 200. Only 40 % of all newly diagnosed cases reported a risk factor, and of these, 71% reported injecting drug use as their main risk factor. The results of blood-borne viral prevalence studies indicate that around 70 % of injecting drug users attending drug treatment tested positive for antibodies to the hepatitis C virus. High-risk injecting practices and increased time spent in prison have been associated with a positive hepatitis C status among injecting drug users in Ireland. In total, 820 hepatitis B cases were reported in 2009. Injecting drug use was indicated as a main risk factor for 10 out of 358 hepatitis B cases with a known risk factor.

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Drug-related deaths

Direct-drug-related deaths are those occurring as a result of overdose.

For the first time in 2007, Ireland was able to provide data for Selection D. The number of cases in Selection D has fluctuated between 1998 (104 cases) and 2003 (109 cases); however, since 2003 the number of cases (mainly due to opiates, frequency as polysubstance poisoning) has risen from 109 cases to 173 cases in 2005 to 208 cases in 2008. Almost four-fifths of cases were male (78.8 %) and the mean age was 34.0 years. Among those with known toxicology results (84.6 % of total DRD cases in 2008), the majority (86.9 %) were found to have opiates and other substances present.

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Treatment responses

In Ireland, the Department of Health and Children is responsible for developing and reviewing drug treatment policy and strategy, while the Health Service Executive (HSE) is responsible for implementing this treatment strategy. Drug treatment is provided through four HSE regions and 32 local health offices. On 1 January 2005, the 10 health boards managing the health services in Ireland were replaced by a single entity, the Health Service Executive (HSE), which manages Ireland’s public health sector. The management of all addiction services falls under the remit of ‘Primary, community and continuing care’, who oversees a number of national care groups. Funding for treatment is generally provided by the statutory sector through the HSE, however, in some cases individuals are obliged to contribute to the cost of drug treatment (excluding methadone maintenance treatment) usually through private medical care plans.

Treatment is provided through a network of statutory and non-statutory agencies. Medication-assisted treatment includes opiate detoxification and substitution therapies, alcohol and benzodiazepine detoxification, and psychiatric treatment. Various types of counselling are provided through both philosophies of treatment and independent of either type of treatment.

Alternative therapies, such as acupuncture, are provided through both statutory and community projects in Dublin. Furthermore, pregnant female opiate users and their partners are entitled to immediate access to treatment. There are also specific initiatives available for drug users under the age of 18 years. These include psychiatric therapy, family therapy, specially adapted medication-free therapy and guidelines around the use of medication. The total number of drug treatment services available in Ireland showed a strong increase between 1998 and 2004, with the largest expansion in the outpatient sector.

Three inpatient units and a number of outpatient treatment centres provide detoxification for problem opiate users and treatment centres, satellite clinics and specialised general practitioners provide substitution treatment. Methadone, introduced in 1992, is the most commonly-used agent for opiate detoxification and substitution treatment. In 2009, a total of 10 668 clients enrolled in the opioid substitution treatment received methadone. 

In July 2009 a feasibility study on the use of buprenorphine/naloxone treatment as an alternative to methadone in Ireland commenced. It was conducted at several specialist addiction centres in Dublin and a number of Level II GP practices in Dublin and around the country. The aim was to enrol up to 80 problem opiate users who agree to treatment and are suitable (40 in specialist centres and 40 in the community). In 2010, the Department of Health commissioned an independent agency to evaluate the feasibility study. This evaluation is expected to make further recommendations in relation to which circumstances and client groups the drug would be most suitable for and the appropriate regulatory framework needed.

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Harm reduction responses

Needle and syringe exchange services were first provided in Ireland in 1989, when five exchanges were established. There are now 34 exchanges in the country, operating two models of service: fixed-site exchanges (28), and home visit exchanges, or backpacking (6). In 2009, a project was announced by the Health Service Executive in cooperation with the Irish Pharmacy Foundation to provide needle –syringe exchange through community-based pharmacies in 65 new locations across Ireland; the terms and conditions of this project are still being negotiated. The latest estimate (2007) indicates that nearly 1.1 million syringes were distributed through needle exchange programmes.

Services provided a range of sterile injecting equipment and materials. All existing services provided different sizes and types of needle and syringe, as well as alcohol swabs and citric or acetic acid. Condoms, stericups or cookers and sterile water, non-toxic foil (for smoking heroin); syringe identifiers; and tourniquets are available through the needle and syringe programmes. However, no service provides single-use injecting packs, crack pipes or straws.

In Ireland, the hepatitis B vaccine is recommended for several high-risk groups. Prisoners and injecting drug users are two of the high-risk groups. A national hepatitis C working group, established in early 2007, has examined how the country can respond to hepatitis C in the areas of surveillance, education and treatment. The experts’ recommendations were presented to HSE senior management in 2008.

On 9 August 2005, the Minister of State at the Department of Health and Children introduced a new statutory instrument known as ‘the Medical Products (prescription and control of supply) (Amendment) Regulations 2005’. This permits the supply and administration of a number of medicinal products (including naloxone, for the management of respiratory depression secondary to a known or suspected narcotic overdose) by pre-hospital emergency care providers in specific conditions.

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Drug markets and drug-related offences

The main source of information on Irish drug offences is the Annual report of An Garda Síochána (the Irish police) up to 2006 and the Central Statistics Office since. The reports contain information on the number and quantity of drug seizures made by the Garda Síochána and the Irish Customs Drug Law Enforcement.

Between 2001–07, the number of cocaine seizures has shown a strong upward trend, increasing from 300 seizures in 2001 to 1 749 in 2007. The volume of cocaine seized has increased steadily since 2001, increasing from 5 kg in 2001 to 1 752 kg in 2007. However in 2008 and in 2009, the quantities of seized cocaine dropped to 167 kg and 118 kg respectively. Significant decline in the number of seizures was also reported for the same period. The number of heroin seizures increased from 209 in 1995 to a peak of 1 698 in 2007, and declined in 2008 and 2009 (1 611 and 1 455 respectively). The volume of heroin seized has fluctuated from year to year. Between 1995 and 2008, the volume of heroin seized increased significantly from 6 kg to 207 kg, with 79 kg seized in 2009.

The vast majority of drug-related offences reported in the Garda annual reports come under one of three sections of the Misuse of Drugs Act 1977: Section 3 — possession of any controlled drug without due authorisation; Section 15 — possession of a controlled drug for the purpose of unlawful sale or supply; and Section 21 — obstructing the lawful exercise of a power conferred by the Act. Other offences regularly reported relate to the unlawful importation into the State of controlled drugs contrary to Section 5; the use of forged prescriptions (Section 18); and the cultivation of cannabis plants (Section 17). Data complied by the Irish Central Statistics Office regarding drug-related offences in 2008 reported that there were a total of 14 374 drug-related offences. Out of which, 75 % were possession-related offences.

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National drug laws

Possession of any controlled substance without due authorisation is an offence under the Misuse of Drugs Acts, 1977 and 1984. The drugs to which the acts apply are listed in the schedules to the acts, together with some generic definitions of families of substances. The legislation makes a distinction between possession for personal use and possession for sale or supply.

Penalties for possession for personal use depend on the type of drug (cannabis or other drugs) and on the penal proceedings, i.e. whether a summary conviction or a conviction on indictment. Possession of cannabis or cannabis resin for personal use is punishable by a fine on first or second conviction but from a third offence onwards it incurs a fine and/or a term of imprisonment up to one year for summary conviction and up to three years for conviction on indictment. Possession in any other case incurs a penalty of imprisonment for up to one year and/or a fine on summary conviction and up to seven years on conviction on indictment. With regards to drug trafficking, the law establishes different penalties according to the type of offender, the type of drugs and the quantity. Possession for sale or supply can attract penalties up to life imprisonment, with a mandatory minimum sentence of 10 years for the possession of drugs with a market value of at least EUR 12 700.

Since 31 January 2006, any kind of fungus which contains psilocin or an ester of psilocin is a controlled drug under the Act. The Criminal Justice Act 2006 included:

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National drug strategy

The new ‘Irish National Drugs Strategy (Interim) 2009–16’ was launched on 10 September 2009. In November 2009, in line with Action 1 of the new National Drugs Strategy, a Steering Group was established to develop proposals and make recommendations on a National Substance Misuse Strategy, that would combine illicit drugs and alcohol and incorporate the interim strategy. The Steering Group was due to submit its proposals to the Minister for Health and Children and the Minister for Drugs by the end of 2010, after which the combined strategy is due to be presented to the Government for consideration.

The 2009–16 (interim) Drugs Strategy is comprehensive and built on five pillars (supply reduction, prevention, treatment, rehabilitation and research). It is constructed around a hierarchy of aims, objectives and key performance indicators, and comprises 63 different actions. The overall strategic aims of the new strategy are to create a safer society through the reduction of the supply and availability of drugs for illicit use; to minimise problem drug use throughout society; to provide appropriate and timely substance treatment and rehabilitation services (including harm reduction services) tailored to individual needs; to ensure the availability of accurate, timely, relevant and comparable data on the extent and nature of problem substance use in Ireland; and to have in place an efficient and effective framework for implementing the National Drugs Strategy 2009–16.

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Coordination mechanism in the field of drugs

The Cabinet Committee on Social Inclusion is responsible for, among other things, reviewing trends in problem drug use, assessing progress in implementing the national drugs strategy, and resolving policy or organisational difficulties.

The Department of Health is responsible for national coordination of the national drugs strategy, policy development, supporting the work of drugs task forces, supporting the work of the NACD, supporting the community and voluntary sectors, and coordinating Ireland’s input to the EU, UN and other international for a regarding the drugs issue rests with.

The Oversight Forum on Drugs (OFD), which meets every quarter, comprises officials of government departments with responsibility for implementing the national drugs strategy, together with representatives of state agencies and of the voluntary and community sectors. Its primary role is the high-level monitoring of progress being achieved across the strategy and agreeing appropriate ways forward where issues are blocked or progress is being impeded. It also provides a forum for discussion and feedback on issues relating to problem drug use that arise in EU and international arenas.

The National Advisory Committee on Drugs (NACD) advises the government in relation to prevalence, prevention, treatment/rehabilitation and consequences of problem drug use in Ireland based on its analysis of research findings and information available to it.

Ten regional drugs task forces (RDTFs) bring together all the statutory agencies as well as the voluntary and community sectors. Their role is to develop a coordinated response to drug misuse at regional through the development of a single, integrated plan. Fourteen local drugs task forces (LDTFs) in Dublin, Cork and Wicklow, a partnership between the statutory, voluntary and community sectors, are established in the areas experiencing the worst levels of opiate misuse to develop local action plans. The DTFs report to the Department of Health for all activities, outputs and expenditures.

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Drug-related research

Research is one of the four pillars of Ireland’s national drug strategy, and has two main objectives: to make data available on the extent of drug misuse amongst all marginalised groups; and to gain greater understanding of the factors which contribute to the misuse of drugs. The areas of prevalence, prevention, treatment and consequences of problem drug use were listed as priorities and account for most of the main projects in this area. Funding is mainly made available by governmental sources, while research in this area is mainly undertaken by the national focal point (Health Research Board), the National Advisory Committee on Drugs, and some university departments. The national focal point coordinates two main reporting systems, a documentation centre, a newsletter and a website where a database on research projects is available. Several national scientific journals contribute to disseminating drug-related research findings. Recent drug-related studies mentioned in the 2010 Irish National report mainly focused on aspects related to consequences of drug use, research on drug use prevalence and on responses to the drug situation.

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