From [email protected] <[email protected]>
Subject Drugnet Ireland, Issue 74 Summer 2020
Date August 20, 2020 10:15 AM
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Street tablet use in Ireland – results from a Trendspotter study on use, markets, and harms
by Seán Millar
The non-medical use of prescription drugs has become a global health concern. Non-medical usage is
defined as the taking of prescription drugs, whether obtained by prescription or otherwise, except
in the manner or for the reasons or time period prescribed, or by a person for whom the drug was not
prescribed.1 The non-medical use of pharmaceuticals is a unique category of substance misuse in a
number of ways, as the scale of the problem is largely unknown owing to lack of data. This is partly
due to the existence of many gaps in the monitoring of their legal use for medical purposes. In
addition, most studies on, and monitoring instruments for, substance abuse pertain to the use of
illegal drugs or alcohol and tobacco.

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HRB evidence brief on the response of drug services to Covid-19
by Brian Galvin and Deirdre Mongan
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Gender and drug policy
by Lucy Dillon
The mission of the Pompidou Group of the Council of Europe is to contribute to the development of
multidisciplinary, innovative, effective and evidence-based drug policies in its member states.1
Since the late 1980s, it has worked to support the integration of a gender dimension into drug
policies and has delivered on a number of activities in this area of policy.2 The group is currently
running a project on implementing a gender approach in different drug policy areas: from prevention,
care, and treatment services to law enforcement and the criminal justice system. It is based on an
understanding that the gender dimension includes women, men, transgender, and intersex people. The
Irish team taking part in this project is made up of representatives from academia, the Department
of Health, and drug services.3 As part of their work, they published a paper on gender and Irish
drug policy in April 2020.4

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Launch of UBU Your Place Your Space
by Lucy Dillon
UBU Your Place Your Space is a new, targeted youth-funding scheme launched by the then Minister for
Children and Youth Affairs, Dr Katherine Zappone TD, in December 2019.1 It targets young people who
are marginalised, disadvantaged, or vulnerable, and aims to provide services that support them.
These include services that cover health, education, employment, and social connectedness. It
combines four pre-existing overlapping schemes, including the Young People’s Facilities and Services
Fund and the local drug task force projects. The scheme explicitly supports the delivery of action
1.2.8 in the National Drugs Strategy: to improve services for young people at risk of substance
misuse in socially and economically disadvantaged communities.2

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In brief
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Qualitative insights into pregabalin use among individuals in opioid agonist treatment
by Britta Thiemt
Recent research and reports have highlighted the drug pregabalin due to its potential for dependence
and abuse, and an increase in pregabalin-related overdose deaths in several European countries. As a
prescription-only central nervous system (CNS) depressant analogue to gamma-aminobutyric acid
(GABA), it is used for an array of conditions, including neuropathic pain, epilepsy, generalised
anxiety disorder, and fibromyalgia.1 In a 2020 study published in Heroin Addiction and Related
Clinical Problems, Brennan and Van Hout present qualitative insights into the experiences of
patients in opioid agonist treatment (OAT) with pregabalin.2 The authors selected OAT patients as
their study population because of their increased risk for problematic use of pregabalin and
overdose.3 Though related research in Ireland is sparse, international evidence has demonstrated
that using pregabalin leads to the development of tolerance and withdrawal symptoms when ceased. The
combined use of both opiates and pregabalin as two CNS depressants, while highly prevalent, has been
shown to increase the risk of overdose and death.4 The current study was the first in Ireland to
capture the experiences of OAT patients using pregabalin.

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Fostering understanding, empowering change: practice responses to adverse childhood experiences and
intergenerational patterns of domestic violence
by Ciara H Guiney
In November 2019, Dr Sarah Morton and Dr Megan Curran of University College Dublin published the
results of a Tusla-funded study, Fostering understanding, empowering change: practice responses to
adverse childhood experiences (ACEs) and intergenerational patterns of domestic violence.1

The aim of this study was to examine the experiences of women at the Cuan Saor Women’s Refuge, a
domestic violence service in Co Tipperary. The focus was to identify the level of ACEs experienced
by the women who accessed the service. Based on the ACEs routine enquiry process, trauma-informed
responses (TIRs) to women’s childhood experiences and the intergenerational transmission of trauma
were examined as well as the role of ACEs routine enquiry and intervention in relation to infant
mental health (IMH), a key area of work for childcare workers within domestic violence (p. 10).

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Reducing youth crime: role of mentoring
by Ciara H Guiney
In October 2019, Kieran O’Dwyer, a consultant and trainer within the field of criminal justice and
restorative practices, published an article, entitled Reducing youth crime: the role of mentoring.1
The article discussed the results of an evaluation of a La Chéile mentoring programme, which is
delivered to young people aged 12–21 years who come before the criminal courts in Ireland.2

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Inspector of Prisons annual report, 2018
by Ciara H Guiney
In December 2019, the Minister for Justice and Equality published the eight annual report of the
Office of the Inspector of Prisons.1 Under section 32 of the Prisons Act 2007, the Inspector of
Prisons is required to submit a report to the Department of Justice and Equality outlining how the
inspector’s functions were carried out during the preceding 12 months. This was the first annual
report prepared by Ms Patricia Gilheaney who was appointed inspector in May 2018.

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GYDP young people: response to Covid-19 public health measures
by Ciara H Guiney
On May 2020, the then Minister of State with responsibility for Youth Justice, David Stanton TD,
launched a report that examined the response of young people participating in Garda Youth Diversion
Projects (GYDPs) to the Covid-19 public health measures.1 The report was a collaboration between the
Research Evidence into Policy, Programmes and Practice (REPPP) project based in the School of Law at
the University of Limerick and the Department of Justice and Equality.1,2 The design of the report
allows for rapid assessment by policymakers.1

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Strategy and intervention framework for Planet Youth
by Lucy Dillon
In February 2020, President Michael D Higgins launched the Planet Youth strategy and implementation
framework: Galway, Mayo and Roscommon.1 Planet Youth was established in Ireland in 2018 by the
Western Region Drug and Alcohol Task Force (WRDATF). In May 2019, the first tranche of survey data
was published from pupils in schools across the three participating areas in the region (Galway,
Mayo, and Roscommon).2,3,4

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Experiences of teenagers in treatment for cannabis use
by Lucy Dillon
Cannabis continues to be the most common ‘main problem drug’ for new cases accessing treatment in
Ireland. In 2018, it was reported as the main problem drug for 38% of new cases, followed by cocaine
(31.1%) and opioids (18.1%).1 A new Irish study explores the experiences of a sample of teenagers
(n=8) attending treatment for their cannabis use, entitled ‘Debt on me head’: a qualitative study of
the experience of teenage cannabis users in treatment.2

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Hepatitis C screening and care for opioid substitution patients in Ireland
by Britta Thiemt
Hepatitis C virus (HCV) is now among the most common causes of cirrhosis and primary liver cancer in
Europe.1 As HCV is a blood-borne virus, people who inject drugs are the primary risk group for
contracting HCV, making up 80% of new infections.2 With opioid substitution increasingly being
provided in primary care settings, they have an important role in HCV screening and treatment. In a
2018 study published in the Interactive Journal of Medical Research, Murtagh et al. investigated
compliance in Irish primary care practices with guidelines on screening for HCV, other blood-borne
viruses, and alcohol use disorder.3

About 74% of patients contracting HCV will become chronically infected, which is associated with
considerable morbidity and mortality.4 As symptom onset can be delayed by decades and result in
considerable damage to the liver, screening for HCV is vital among opioid substitution patients, who
are often at increased risk of HCV infection due to a history of drug injection. Additionally,
opioid substitution patients often present with problem alcohol use, which can exacerbate the risk
of liver disease. Hence, guidelines from the World Health Organization and Health Service Executive
advise on addressing alcohol use with HCV patients.

Effective diagnostic technology (e.g. FibroScan) and treatment for HCV (direct-acting antiviral
(DAA) treatment) are now available, but due to the high cost of treatment, guidelines prescribe
prioritising patients with the highest clinical need.5 Additionally, scarce time and resources can
complicate treatment within primary care. Given new options and plans to expand HCV interventions,
the study’s aim was to investigate whether opioid substitution patients were receiving HCV screening
and care in line with best practice guidelines.

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DOVE Service, Rotunda Maternity Hospital annual report, 2018
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 drug
use. Figures from the service for 2018 were published in the hospital’s annual report in 2019.1

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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, Activities of Irish psychiatric units and hospitals 2018,1 shows that the rate of new
admissions to inpatient care for alcohol disorders has decreased.

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National Self-Harm Registry annual report, 2018
by Seán Millar
The 17th annual report from National Self-Harm Registry Ireland was published in 2019.1 The report
contains information relating to every recorded presentation of deliberate self-harm to acute
hospital emergency departments in Ireland in 2018 and complete national coverage of cases treated.
All individuals who were alive on admission to hospital following deliberate self-harm were
included, along with the methods of deliberate self-harm that were used. Accidental overdoses of
medication, street drugs, or alcohol were not included.

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New clinical guidelines for management of opioid substitution in hospital setting
by Vivion McGuire
In December 2016, the Health Service Executive (HSE) launched its clinical guidelines for opioid
substitution treatment (OST)1 in conjunction with the College of Psychiatrists of Ireland, the Irish
College of General Practitioners, and the Pharmaceutical Society of Ireland. Appropriate policies
and standard operating procedures for the delivery of inpatient OST are essential for patient safety
when treating a person with an opioid dependency.

Following the publication of those guidelines, it became apparent that there was a need for a
specific set of guidelines covering inpatient aspects for the prescribing and dispensing of OST
within the hospital setting.2

Having identified the specific need for guidance within the hospital setting, the new document is an
adjunct to Clinical guidelines for opioid substitution treatment. It is divided into seven sections,
each covering the different aspects of OST treatment: the guiding principles; rehabilitation and
psychosocial components of OST; principles and key operational stages of pharmacological
interventions of OST; assessment of dependence and management of OST; drug testing; OST and
associated health considerations; and specific treatment situations and populations.3,4

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