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Welcome
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Alcohol findings from Healthy Ireland Survey 2023
by Anne Doyle
The ninth wave of the Healthy Ireland Survey, commissioned by the Department of Health and carried
out by Ipsos B&A, involves a representative sample from the general population aged 15 years and
over to increase knowledge of the population’s health and health behaviours.1 The survey is in
accordance with Ireland’s Well-being Framework 2023, which seeks to measure the current status of
Ireland’s performance as a nation based on a set of indicators. These focus collectively not only on
economic standing but also equality issues and sustainability.2 A number of these indicators are
incorporated into the survey.









Minister for Public Health, Wellbeing and the National Drugs Strategy, Hildegarde Naughton TD,
speaking at the National Drugs Forum 2023 in Croke Park, Dublin





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In brief
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In brief
by Brian Galvin
A special supplement of this issue of Drugnet Ireland presents an overview of the Citizens’ Assembly
on Drugs Use, which completed its work in late 2023 and published a final report in January 2024.
Ireland’s experience with citizens’ assemblies is recognised internationally as a bold experiment in
deliberative democracy and an example of pluralism and inclusion in the policy decision-making
process. Unlike some of the previous assemblies, the members of the Citizens’ Assembly on Drugs Use
were not offered a binary choice and they completed their work with a detailed and nuanced series of
recommendations on all aspects of the topic that had been discussed. The members demonstrated
exemplary commitment and a remarkable capacity to learn and absorb great detail on the topic. The
citizens’ assemblies are evidence of a robust democratic process, an engaged citizenry, and a
political environment that allows expression of opposing views and political opinion.



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Policy and legislation
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Drug policy evaluation in Europe
by Lucy Dillon
Since the early 2000s, the evaluation of drug policies and strategies has increasingly featured as
part of the drugs landscape at European Union (EU) and member state levels. Evaluation is a critical
part of the policymaking process. It supports effective policymaking by helping it adapt to changes
over time, ensure lessons are learnt from previous successes and failures, and therefore strengthens
value for money in the approach taken by the EU and member states to dealing with the drugs issue.



The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) considers policy evaluation a
priority (see Box 1). In December 2023, it updated its online content for the topic overview on drug
policy evaluation in Europe.1 Stakeholders can find links to sources to support policy evaluation,
as well as examples of EU and member state outputs on the topic. The overview presents the state of
play at the end of 2023 on the focus of national drug strategies and their evaluations.

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Advancing alcohol research in Ireland
by Anne Doyle
Background



The first Health Research Board (HRB) conference solely dedicated to alcohol research was held on 14
September 2023 in partnership with the Department of Health. The event was opened by the HRB CEO, Dr
Mairéad O’Driscoll, who welcomed the support of the Department of Health, which, along with the HRB,
recognises the importance of and is committed to progressing alcohol-related research.



One of the objectives of the HRB Strategy 2021–2025 is to collect and report alcohol-related data
for policy and service planning purposes, and the event included speakers from across the
organisation presenting the work of the HRB.1 The strategy (key action 3.4) also promotes primary
research and secondary data analysis to support drug and alcohol strategies at a national and
European level. The HRB also has a responsibility to ‘assist the Department of Health to monitor the
Public Health Alcohol Act through data collection, validation, analysis and dissemination’
(implementation action 3.4.4). This important obligation is achieved through the work of the team in
the HRB Evidence Centre and through the alcohol overviews published periodically. Dr O’Driscoll
acknowledged the work of the HRB, particularly that of the evidence team and the drugs and alcohol
policy team, whose work has been instrumental in providing evidence to influence policy. An
important example given was of collating key evidence of alcohol-related harm directly influential
in the eventual passing of the Public Health (Alcohol) Act in 2018.2





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Recent research
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Review of efficacy and safety of medicinal cannabis, 2024
by Kathryn Lambe
The Medical Cannabis Access Programme in Ireland1 currently provides access to cannabis to patients
with one of three conditions when other treatments have been unsuccessful. The three conditions are
spasticity (stiff and/or rigid muscles) associated with multiple sclerosis, nausea and vomiting
associated with chemotherapy, and severe epilepsy.



An evidence review was conducted by the Health Research Board (HRB) to inform a Department of Health
review of the current Medicinal Cannabis Access Programme on the suitability of cannabis-based
products for medical conditions.



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Alcohol-related emergency department presentations and hospital admissions following minimum unit
pricing in Ireland
by Anne Doyle
Background



In January 2022, Ireland introduced minimum unit pricing (MUP) at EUR 1.00 per 10 grams of alcohol
as per Section 11 of the Public Health (Alcohol) Act 2018.1 The Act was introduced in response to
the high level of alcohol use and related harms in Ireland. Alcohol-related hospital discharges are
collected through the Hospital In-Patient Enquiry (HIPE) Scheme; however, the burden of
alcohol-related harm in emergency departments (ED) in Ireland is largely unknown, as this
information is not routinely collected.2 One study in 2018 estimated that 6% of ED presentations are
alcohol related.3 A study by Maharaj et al. in 2024 sought to determine the impact of alcohol on ED
presentations and hospital admissions and to investigate if the introduction of MUP impacted such
presentations or admissions.4

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Factors associated with suicide in people who use drugs
by Suzi Lyons
Suicide is a complex, major public health issue globally. While people who use drugs (PWUD) are
known to be at increased risk of suicide, there is limited information on the specific candidate
risk factors for this group, which could help to inform targeted interventions to reduce their risk.
To this end, a scoping review was conducted with three aims: (1) to map the extent, range, and
nature of available evidence on factors associated with death by suicide among PWUD; (2) to identify
knowledge gaps and limitations in this body of evidence; and (3) to inform suicide prevention policy
and best practice guidelines for working with PWUD, where appropriate.1



Methods



The aim of scoping reviews is to systematically search for and then map all the evidence in relation
to the research question. Scoping reviews encompass all available literature, both published and
grey, with stakeholder consultation an important component. Unlike systematic reviews, this method
in general does not include a quality appraisal of the literature.

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Prevalence/current situation
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HIV incidence among people who inject drugs in Ireland, 2000–2018
by Seán Millar
Globally, there are an estimated 15.6 million people who inject drugs (PWID).1 Among PWID, the risk
of acquiring HIV is more than 30 times higher than the rest of the population.2 However, HIV
incidence has declined among PWID in Western Europe over the last two decades. In light of this
improved situation, a 2023 study investigated changes in HIV incidence in Ireland among PWID from
2000 to 2018.2



In this study, published in the journal Addiction, data on new diagnoses of HIV among PWID, as
reported by the Health Protection Surveillance Centre, were examined. New HIV cases in two time
periods (2000–2009 and 2010–2018) were compared by sex, age group, area of residence, and country of
birth.

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Drug use during pregnancy in Dublin City, 2010–2019
by Seán Millar
Drug use during pregnancy is a worldwide problem and the consequences of continued drug misuse in
pregnancy can be significant.1 Pregnancy may provide opportunities to engage vulnerable women in
essential healthcare. However, women with an addiction may have poor adherence with prenatal
appointments, presenting late in pregnancy or not until labour. Hence, drug liaison midwives (DLMs)
were appointed to the three Dublin maternity hospitals in 1999.



A 2023 retrospective observational cohort study was conducted at an Irish tertiary maternity unit.2
In this study, published in the European Journal of Obstetrics & Gynecology and Reproductive
Biology, all women with opioid use disorder (OUD) or substance use in pregnancy delivered under this
service between 2010 and 2019 were included. Data were collected by combining electronic and
hand-held patient records, and trends and outcomes were analysed by year of delivery.

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Trends in alcohol and drug admissions to psychiatric facilities
by Seán Millar
The annual report published by the Mental Health Information Systems Unit of the Health Research
Board, National Psychiatric Inpatient Reporting System (NPIRS) annual report on the activities of
Irish psychiatric units and hospitals, 2022,1 shows that the rate of new admissions to inpatient
care for alcohol disorders has decreased.



In 2022, some 806 cases were admitted to psychiatric facilities with an alcohol disorder, of whom
263 were treated for the first time. Figure 1 presents the rates of first admission between 2002 and
2022 for cases with a diagnosis of an alcohol disorder. Trends over time indicate an overall decline
in first admissions. Just over one-third (35.3%) of cases hospitalised for an alcohol disorder in
2022 stayed just under 1 week, while 26.5% of cases were hospitalised for between 1 and 3 months,
similar to previous years.

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Responses
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More Than That Festival – celebrating recovery from addiction
by Anne Doyle
The inaugural More Than That Festival to mark recovery month was held in Naas, Co. Kildare, on 30
September 2023. It was organised by the South Western Regional Drugs and Alcohol Task Force
(SWRDATF) area to celebrate recovery from addiction.1 A series of activities and events were held
throughout the day, beginning with the Recovery Champions 5K Run, which featured famous Kildare
faces such as former Gaelic footballer Anthony Rainbow, leading out a run/walk in support of
addiction recovery.

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HSE AskAboutAlcohol website analyses, 2022–2023
by Anne Doyle
Background



The Alcohol Programme in the Health Service Executive (HSE) was established in 2016 to address the
impact of alcohol-related harm on individuals, families, and children. The programme aims to
decrease per capita alcohol use to 9.1% (10.2 litres in 2022), in accordance with the Healthy
Ireland Framework 2013–2025.1,2 The work of the HSE Alcohol Programme involves collaborating with
the Department of Health, Alcohol Health Alliance Ireland, and other stakeholders to actively
support the Public Health (Alcohol) Act 2018. This involves identifying national priority areas,
supporting effective policies, and advocating for evidence-based interventions and community action
as well as informing and supporting the public in reducing alcohol use and signposting to support
services through the AskAboutAlcohol campaign and website.3

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Scenarios development workshop at National Drugs Forum, 2023
by Brian Galvin
Purpose of scenario development in drug policy



All foresight work involves developing a capacity to identify weak signals, considering how they may
react within a specified environment, and determining the level of attention they deserve.
Epidemiologists and drug policy experts anticipate greater diversity in patterns of drug use as the
plant-based drugs that have dominated the picture in recent decades are partially replaced by
synthetic drugs and polydrug use becomes increasingly common. Geopolitical changes, the emergence of
new trafficking routes, and other supply-related factors add further complexity. As with any complex
system, it is problematic to assign significance to a particular variable in the drugs field,
especially if it is difficult to discern. We can easily overlook signals or fail to recognise their
potential significance or predict what signals will become trends. There are cognitive as well as
imaginative factors that can impede a thoughtful consideration of possible future events, but
foresight helps us to identify what these barriers are and allows us to be more playful and open in
considering signals. It is a valuable tool for developing anticipatory capacity and considering the
range of possible outcomes from currently observable trends.

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Merchants Quay Ireland annual review, 2021
by Seán Millar
Merchants Quay Ireland (MQI) is a national voluntary agency providing services for homeless people
and those that use drugs. There are 22 MQI locations in 13 counties in the Republic of Ireland (see
Figure 1). MQI aims to offer accessible, high-quality, and effective services to people dealing with
homelessness and addiction in order to meet their complex needs in a non-judgemental and
compassionate way. This article highlights services provided by MQI to people who use drugs in
Ireland in 2021.1



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Prison visiting committees annual reports, 2021
by Seán Millar
A visiting committee is appointed to each Irish prison under the Prisons (Visiting Committees) Act
1925 and the Prisons (Visiting Committees) Order 1925. Members of the 12 visiting committees are
appointed by the Minister for Justice for a term not exceeding three years. The function of prison
visiting committees is to visit, at frequent intervals, the prison to which they are appointed and
hear any complaints that may be made to them by any prisoner. They report to the Minister for
Justice regarding any abuses observed or found, and any repairs which they think are urgently
needed. Prison visiting committee members have free access, either collectively or individually, to
every part of the prison to which their committee is appointed. Information from prison visiting
committee reports relating to drug use in prisons for 2021 (n=8) is summarised below.1

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Ana Liffey Drug Project annual report, 2022
by Seán Millar
The Ana Liffey Drug Project (ALDP) is a ‘low-threshold, harm reduction’ project working with people
who are actively using drugs and experiencing associated problems. ALDP has been offering harm
reduction services to people in the north inner city area of Dublin since 1982, from premises at
Middle Abbey Street. ALDP offers a wide variety of low-threshold, harm reduction services that
provide pathways for people who use drugs out of their current circumstance, including addiction and
homelessness.

The services offered in Dublin include:

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An Garda Síochána annual report, 2022
by Ciara H Guiney
In October 2023, An Garda Síochána (AGS) published its annual report for 2022.1 This article first
reports on activities related to national policing, followed by national security and intelligence,
community safety, and finally statistics for detections of incidents related to the sale and supply
of drugs and Garda drug seizures for 2022.



National policing



Gardaí work in various units to fight crime across Ireland. What follows is a brief outline of a
selection of the work undertaken by some of these units.

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EWODOR Conference, 2023
by Lucy Dillon
The European Working Group on Drugs Orientated Research (EWODOR) Conference took place on 23–24
October 2023 in Trinity College Dublin, in partnership with Coolmine Therapeutic Community. EWODOR
was established in 1983 as a forum for researchers in the drug and alcohol field to share their work
and learnings, with a particular focus on drug-free therapeutic communities. It is the oldest
European network of researchers working in the sector. Its work has expanded with practitioners
becoming members of the group; while maintaining a focus on recovery pathways, EWODOR also explores
drug treatment more broadly.



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Courts Service annual report, 2022
by Ciara H Guiney
The Courts Service annual report 2022was published on 27 September 2023.1 While the report presented
data for all criminal cases arising within the Irish justice system between January and December
2022, this article only reports on statistics of prosecutions for drug offences.1 The data provided
are for overall drug law offences. The Courts Service in Ireland does not distinguish between the
different supply offences and possession/use offences (Courts Service, personal communication,
2017).



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Coolmine Therapeutic Community annual report, 2021
by Seán Millar
Coolmine Therapeutic Community is a drug and alcohol treatment centre providing community, day, and
residential services to men and women with problematic substance use and to their families in
Ireland. Established in 1973, Coolmine was founded on the philosophies of the therapeutic community
approach to addiction treatment. This is primarily a self-help approach in which residents are
responsible for their own recovery, with peers and staff acting as facilitators of change.
Participants are expected to contribute to the general running of the community and to their own
recovery by actively participating in educational activities and in group and individual therapy.
This article highlights services provided by Coolmine in 2021.1

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DOVE Service, Rotunda Hospital annual report, 2022
by Seán Millar
The Danger of Viral Exposure (DOVE) Service in the Rotunda Hospital, Dublin was established to meet
the specific needs of pregnant women who have or are at risk of blood-borne or sexually transmitted
bacterial or viral infections in pregnancy. Exposure may also occur through illicit substance use.
Figures from the service for 2022 were published in the hospital’s annual report in 2023.1

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Tabor Group annual report, 2022
by Seán Millar
The Tabor Group is a provider of residential addiction treatment services in Ireland. It aims to
offer hope, healing, and recovery to clients suffering from addictions through integrated and caring
services. In addition to two residential facilities, the organisation provides a Continuing Care
Programme to clients who have completed treatment to assist with their recovery as well as a
community-based programme. Its Family Support Programme offers counselling to families whose loved
ones are struggling with an addiction. In 2023, the Tabor Group published its annual report for
2022.1 This article highlights services provided by the Tabor Group to individuals with a substance
use addiction in 2022.

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Recent publications
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Recent publications
Responses

Advancing early detection of suicide? A national study examining socio-demographic factors,
antecedent stressors and long-term history of self-harm. McMahon, E M Cully, G Corcoran, P Arensman
E and Griffin Eve (2024) Journal of Affective Disorders, 350, pp. 372-378.
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Prescription drugs with potential for misuse in Irish prisons: analysis of national prison
prescribing trends, by gender and history of opioid use disorder, 2012 to 2020. Durand, L Keenan E
and O'Reilly D et al. (2023) BMC Psychiatry, 23, 725. [link removed] [
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The Citizens’ Assembly on Drugs Use
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Final report of the Citizens’ Assembly on Drugs Use
by Lucy Dillon
Ireland’s Citizens’ Assembly on Drugs Use ran from April to October 2023 and provided the
opportunity for an unprecedented in-depth discussion on the drugs situation in Ireland, reflecting
all its complexities. Following consideration of the extensive body of evidence presented to them,
the assembly members made 36 recommendations to Government. These address legislative, policy, and
operational changes that the State should make to reduce the harmful impacts of illicit drugs.



The assembly’s final report was published in two volumes in January 2024.1 It presents a
comprehensive record of the assembly’s six meetings and their recommendations. The report is an
invaluable resource for those interested in understanding the drugs situation in Ireland.







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Deliberative democracy and citizens’ assemblies
by Brian Galvin
Ireland’s Citizens’ Assembly on Drugs Use, which published its report in January 2024, is the first
time that the topic of illegal drugs use has been considered by a deliberative forum of this type in
any country. This article is a brief introduction to the concept of deliberative democracy and the
ideas from which it developed.



Deliberative and aggregative democracy



Deliberative democracy is a political exercise in which deliberation is the defining feature, and so
differs from aggregative democracy, which primarily involves the counting of votes. Citizens’
assemblies, citizen juries, mini-publics, or other mechanisms for deliberative democracy invariably
focus on topics where there are sharp differences of opinion. Deliberative democracy does not seek
to replace aggregative systems or become the only or even the main form of public policy formation.
Accounts of the origins and development of deliberative democracy emphasise its equally important
epistemic and normative aspects; reasons are weighed and their strength is determined through a
political process that supports equal participation and produces a collective judgement on the
matter being considered. The opportunities for deliberative input into policymaking are limited, but
deliberative democracy can add a further level of legitimacy for policy decisions in that public
justification for a position is built through reasoning among equals.



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