Drug use and Associated Problems in Ireland
There are a range of data sources recording data about drug use in Ireland and its health correlates. These sources indicate:
- There has been an increase in drug use in the Irish population since regular population surveying began in 2002, with males and young people being the most common users.
- Illicit drug use contributes to a range of health problems. These include drug-related health problems, the spread of infectious diseases such as HIV/AIDS and hepatitis C, drug overdoses and drug-related deaths.
While the social problems arising from the operation of the illicit drug market do not lend themselves to quantitative data-gathering, the link between socio-economic deprivation and the illegal drug market has been recognised in Ireland since the 1990s. Recent qualitative studies have revealed just how the illicit drug economy can impact on individuals.
Every year the Irish Focal Point to the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), based in the Health Research Board (HRB) in Dublin, compiles an annual report on the drug situation in Ireland. This report contains the latest information available on drug use and health-related problems in Ireland, with data drawn principally from the following sources:
Drug prevalence survey of households in Ireland and Northern Ireland, first administered in 2002/3, has been repeated at 4-yearly intervals, in 2006/7, 2010/11, 2014/15 and 2019/2020. The main focus of the survey is to obtain prevalence rates for (i.e. discover what proportion of the population is using) key illegal drugs such as cannabis, ecstasy, cocaine and heroin, and also alcohol, tobacco, and other drugs such as sedatives, tranquillisers and anti-depressants. The results are jointly published by the Health Research Board (HRB) in Ireland, and the Public Health Information and Research Branch (PHIRB) of the Department of Health in Northern Ireland.
National Drug Treatment Reporting System (NDTRS) is an epidemiological database on treated drug and alcohol misuse in Ireland, established in 1990 in the Greater Dublin Area and extended in 1995 to cover all areas of the country.
Health Protection Surveillance Centre (HPSC) collects, collates and analyses data on communicable diseases in Ireland, including HIV and hepatitis.
HIPE (Hospital In-Patient Enquiry) is a computer-based health information system, managed by the Economic and Social Research Institute (ESRI). It collects demographic, medical and administrative data on all admissions, discharges and deaths from acute general hospitals in Ireland. It was first piloted in 1969.
National Drug-Related Deaths Index (NDRDI) is a census of drug-related (including alcohol) deaths (such as those due to accidental or intentional overdose) and deaths among drug users (such as those due to hepatitis C and HIV) in Ireland, established in 2005.
Use of controlled or illicit drugs in Ireland has been growing ever since data were first collected, almost twenty years ago. According to the fifth, and most recent, all-Ireland general population survey of drug use in 2019/2020, the proportion of respondents aged 15 to 64 years who have reported using any illegal drug in their lifetime has risen from 18% in 2002/3 to 31% in 2019/20. ‘Any illegal drug’ could mean cannabis, ecstasy, cocaine power, magic mushrooms, amphetamines, poppers, LSD, new psychoactive substances (NPS), solvents, crack and heroin.
Cocaine use has increased across all age groups. Men aged 25–34 are most likely to report cocaine use in the last year, rising from 2% in 2002–03 to 9% in 2019–20. Nine-in-ten people support the use of cannabis for medical purposes, while less than three-in-ten support recreational use
In areas that are most and least deprived there is little difference in the prevalence of drug use, while communities with high levels of deprivation are disproportionately impacted by the negative effects of drug use activities in their local area
- In 2019 opiates (mainly heroin) were the main problem drug reported by the majority of people entering treatment for problem drug use, followed by cocaine and then cannabis . Since 2004, the proportion reporting opiates as their main problem drug has been dropping while the proportion reporting cocaineand cannabis has been increasing.
- With regard to infectious diseases, since June 2015 there has been a decrease in notifications of recently acquired HIV in people who inject drugs (PWID) in Dublin. While the overall incidence of hepatitis C has decreased in the last 10 years, among the 49% of reported cases for whom risk factor data were available in 2016, for 66% of cases injecting drug use was the main risk factor.
- The number of overdose cases admitted to Irish hospitals show a general decrease, falling from 5,012 cases in 2005 to 3,956 cases in 2015
- Between 2004 and 2016 the number of drug-related deaths in Ireland increased by 71%., from 431 in 2004 to 736 in 2016. Opiates are the main drug associated with drug-induced deaths. Males have accounted for the majority of deaths in each year.
Opiates (mainly heroin) are the main problem drug used by entrants to treatment, followed by cannabis and cocaine. The proportion of all entrants to treatment reporting an opiate as their main problem drug has decreased year-on-year since 2004, from a peak of 65% in 2004 to 48% in 2015.
Over the period, cannabis has been consistently reported as the second most common main problem drug, with the proportion increasing from 21% in 2004 to 28% in 2015 The numbers presenting for treatment for problem cocaine use was highest in 2007 at 13%, dropping steadily until 2012, but increasing again in 2015 to 10%. The numbers presenting for treatment of benzodiazepine use has increased from 4% in 2010 to 9% in 2015. For new clients to treatment, cannabis has been the main problem drug since 2010, replacing opiates (mainly heroin).
- HIV: In 2016, 508 people were newly diagnosed with HIV in Ireland. The total number of HIV diagnoses increased by 5% between 2015 and 2016. However, excluding those with a previous HIV diagnosis, the number of diagnoses decreased by 6%. There were 21 diagnoses among people who inject drugs (PWID), a decrease from the numbers in 2014 and 2015 when there was an outbreak of HIV in Dublin among homeless drug users
- Hepatitis C (HCV): There were 645 notifications of hepatitis C in 2016. Risk factor data were available for 49% (313) of these cases: for 66% (206) injecting was the main risk factor.Overall, there has been a downward trend in hepatitis C notifications since peak numbers (1,541) were recorded in 2007. The median age at notification has increased steadily since notification began in 2004, from 32 to 39 years among males and from 29 to 36 years among females. Decreasing HCV notifications and increasing median age are indicative of a reduced incidence of HCV in the population.
Trends over time indicate a decrease in overdose cases admitted to Irish hospitals, falling from 5,012 cases in 2005 to 3,956 cases in 2015, a reduction of 1,056 cases. In 63% (2,490) of cases, the overdose was classified as intentional. Non-opioid analgesics (e.g. non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol) were involved in 44% (1098) of cases, benzodiazepines in 21% (532) and Anti-epileptic/sedative/anti-Parkinson agents were indicated in 43.5% (1,331 cases).
- All drug-related deaths: Between 2004–2020 there have been 11,086 drug-related deaths: 5,734 (51%) were due to poisoning 5,352 (49%) were non-poisoning.
- The annual number of deaths increased by 87% during this period, from 431 in 2004 to 806 in 2020. Males have accounted for the majority of deaths in each year; more than 6 in 10 of all deaths in 2020 were male.
- More than half of the men who died in 2020 were aged 42 years or younger; more than half of women who died ere aged 45 years or younger.
- Poisoning deaths: Between 2004–2020 a total of 5,734 of all drug-related deaths were due to poisoning (overdose). In 2020 more than three quarters (78%) of poisoning deaths involved poly-drug use, with an average of four different drugs involved; benzodiazepines being the most common prescribable drug group involved. The number of deaths where heroin was implicated increased from 106 in 2019 to 113 in 2020. There was a 23% increase in cocaine related deaths from 105 reported in 2019 to 130 in 2020. Methadone related deaths increased by 13% from 123 in 2019 to 139 in 2020.
- Non-poisoning deaths: Between 2004 and 2020, 49% (5,352) of all drug-related deaths were non-poisoning (i.e. non-overdose). The number of non‐poisoning deaths decreased from 474 in 2019 to 397 in 2020*. The number of deaths due to hanging decreased by 21% from 137 deaths in 2019 to 108 in 2020.
*The NDRDI collects data from closed Coronial files, which usually means reporting data in arrears. This has been exacerbated in recent years because of limited access coroner’s offices because of Covid-19 related public health restrictions. While these are preliminary figures, they aim to have a full report, including 2021 data, published in Q4 2023.
Drug Misuse and Disadvantage
The link between drug misuse and social and economic disadvantage was first recognised by the Irish government over 20 years ago, when the first report of the Ministerial Task Force on Measures to Reduce the Demand for Drugs concluded: ...in view of the link between economic and social deprivation and drug misuse, strategies to deal with the problem need to be focused on these areas. (p.28).
Subsequent research has sought to explore how this dual concentration of drug misuse and economic and social deprivation affects communities. Described here are two recent studies suggesting how the criminalisation of possession of drugs for personal use may exacerbate the negative impacts of illicit drug use on individuals and communities.
A 2016 research study in the Clondalkin Local Drugs Task Force area in west Dublin provides an in-depth understanding of current patterns of drug use, drug-related harms and emerging needs of individuals, families and a local community in 2015. The researchers found that the drugs most commonly taken by young people were alcohol, cannabis, cocaine, ecstasy and new psychoactive substances, and rates of ‘any illegal drug’ use had almost doubled in the previous five years. Among the four groups identified by the researchers as being at high risk of drug-related harms were ‘socially-excluded young people engaging in drug risk behaviours and the drugs economy but out of touch with services’:
For many young people living in the Clondalkin DATF area, making the transition from childhood to adulthood in a high-risk environment brings an increasing array of challenges, yet there is a decreasing level of resources to address their needs – notably in relation to educational, social development and psychological difficulties. The high level of suicides among young people in the area is of immense concern (p. 7).
Although not explicitly mentioned by the researchers, a criminal conviction for possession of drugs would appear to be one of the ‘increasing array of challenges’ these young people would have to overcome as they make the transition to adulthood.
Drug Related Intimidation
Drug-related intimidation of individuals and/or their families, frequently for failure to settle a drug debt, has been identified as a serious problem in areas experiencing economic disadvantage and social exclusion where illicit drug markets have taken hold. It was reported in the Clondalkin study described above. And according to the Citywide 2016 study of drug related intimidation in drugs task force areas, based on data collected in 2014/15, those being intimidated are reluctant to report the matter. If people do report incidents, they feel most comfortable reporting to community organisations, with the Gardaí being approached by smaller numbers. The main reason given for not reporting intimidation to the Gardaí was the fear of reprisals.
Given that the possession of drugs for personal use is a criminal offence, it seems probable that this is an additional reason why victims of intimidation are reluctant to report such problems to law enforcement agencies. Moreover, it was widely reported in focus groups held as part of this intimidation study that young people who get into debt over weed are coerced into ‘working the debt off’ by engaging in illegal activities such as holding drugs, money or weapons, and transporting and/or selling drugs.
Outcomes: Drug harms, policy harms, poverty and inequality. O’Gorman, A., Driscoll, A., Moore, K. and Roantree, D. (2016) Dublin: Clondalkin Drug and Alcohol Task Force.
Demanding money with menace: drug-related intimidation and community violence in Ireland. Connolly J and Buckley L (2016) Dublin, Citywide Drugs Crisis Campaign