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Welcome
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Launch of new Hidden Harm initiative
by Claire O'Dwyer
On 25 January 2019, the Health Service Executive (HSE) and Tusla, the Child and Family Agency
jointly launched the Hidden Harm strategic statement, Seeing through hidden harm to brighter
futures1 and the Hidden Harm practice guide2 in the Plaza Hotel in Tallaght, Dublin. A separate
information leaflet, Opening our eyes to Hidden Harm,3 was also published to support frontline staff
working with children impacted by parental drug or alcohol misuse.



These publications outline how the two State organisations will work together to identify and
support children who are adversely affected by parental substance misuse. Joint training for HSE and
Tusla staff working in this area is due to be developed in 2019.

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In brief
by Brian Galvin
All policy decisions involve a certain amount of anticipation and speculation, informed or
otherwise. It is useful to know the range of possible outcomes so that resources can be allocated
effectively and preparations made for disruptions to established patterns. Policymaking in the drugs
area is sometimes reactive to changes in behaviour in certain populations, some of which may be
predictable but often appear, at least to policymakers, as sudden aberrations from the expected
norm.

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Policy
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HRB evidence review on dual diagnosis treatment service
by Brian Galvin
The Health Research Board (HRB) recently published a review entitled Treatment services for people
with co-occurring substance use and mental health problems: a rapid realist synthesis.1 This report
is part of the HRB Drug and Alcohol Evidence Review series and was undertaken by a team from the
Georgia Health Policy Center. The three initial research questions guiding the review were:



What interventions improve treatment and personal functioning outcomes for people with co-occurring
substance use and mental health problems and in what circumstances do they work?

What aspects of integrative programmes for the treatment of co-occurring substance use and mental
health problems trigger positive system outcomes and in what circumstances do these outcomes occur?

What existing models of care for adults with co-occurring substance use and mental health problems
lead to positive treatment outcomes and successful service integration?

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Medical use of cannabis and cannabinoids: Q&A for policymaking
by Lucy Dillon
The medical use of cannabis and cannabinoids is a complex and challenging field. There is a wide
range of issues to be considered by policymakers and other stakeholders when making decisions about
the best approach to take. In December 2018, the European Monitoring Centre for Drugs and Drug
Addiction (EMCDDA) published a report on the topic to help support this process – Medical use of
cannabis and cannabinoids: questions and answers for policymaking.1 It is supported by a background
paper: A summary of reviews of evidence on the efficacy and safety of medical use of cannabis and
cannabinoids.2

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Civil society involvement in policymaking
by Lucy Dillon
Civil society involvement (CSI) in the development and implementation of drug policy is widely
considered best practice and promoted at both international and national levels. For example, a
focus on the value of CSI is evident in both the EU drugs strategy 2013–20201 and the EU action plan
on drugs 2017–2020.2 One of the 15 objectives of the latter is to ‘ensure the participation of civil
society in drugs policy’. It is also a key part of Ireland’s national drugs strategy, Reducing harm,
supporting recovery: a health-led response to drug and alcohol use in Ireland 2017–2025.3

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Taking stock: a decade of drug policy
by Lucy Dillon
The International Drug Policy Consortium (IDPC) is a global network of 180 non-governmental
organisations.1 It focuses on issues related to drug production; trafficking and use; and promoting
objective and open debate on the effectiveness, direction and content of drug policies at national
and international levels. The network supports evidence-based policies that are effective at
reducing drug-related harm. As part of this work and in the context of the role identified by the
work of the United Nations Office on Drugs and Crime (UNODC) for civil society involvement in drug
policy,2 the IDPC has published Taking stock: a decade of drug policy.3 This report ‘evaluates the
impacts of drug policies implemented across the world over the past decade, using data from the
United Nations (UN), complemented with peer-reviewed academic research and grey literature reports
from civil society’ (p. 7).3

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Prevalence
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Trends in alcohol and drug admissions to psychiatric facilities
by Seán Millar
Activities of Irish psychiatric units and hospitals 2017,1 the annual report published by the Mental
Health Information Systems Unit of the Health Research Board, shows that the number of new
admissions to inpatient care for alcohol disorders has continued to stabilise.

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Global, regional and country level estimates of HCV infection among recent injecting drug users
by Seán Millar
The World Health Organization has set a goal to eliminate hepatitis C virus (HCV) as a global public
health threat by 2030. Targets include reducing new HCV infections by 80% and the number of HCV
deaths by 65%, and increasing HCV diagnoses from 20 to 90% and eligible people receiving HCV
treatment from <5 to 80%.1 Unsafe injecting drug use is the main route of HCV transmission in
developed countries.2 Consequently, people who inject drugs (PWID) represent a priority population
for HCV elimination, given the high prevalence and incidence in this group.

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Rates of reported codeine-related poisonings and codeine prescribing following new national guidance
in Ireland
by Anne Doyle
The risks of misusing opioid medication have been well documented1,2,3 and include a wide range of
problematic consumption outside of medical guidelines. Misuse can include consumption to induce
psychoactive effects, use in combination with other drugs to alter their effects, or self-medication
by increasing or lengthening duration of dosage without or against medical advice. Such risky
behaviour can lead to adverse consequences, including dependence and/or poisoning. Despite the known
risks, many countries, including Ireland, continue to permit codeine (an opiate to treat pain) to be
available without prescription, over-the-counter (OTC).

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Parole Board annual report, 2017
by Ciara H Guiney
In October 2018, the Parole Board published its annual report.1 This was the 16th annual report
since the board was established in 2001. The aim of the Parole Board is to review the cases of
prisoners who have received either ‘determinate’ sentences greater than or equal to eight years or
life sentences and to provide guidance on how these sentences are managed. The current report
provided an overview of the board’s activities for 2017.

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Responses
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Updated international standards on drug use prevention
by Lucy Dillon
In 2013, the United Nations Office on Drugs and Crime (UNODC) published the first edition of its
International standards on drug use prevention.1 The standards present an overview of the
international evidence for prevention interventions and policies. A second, updated version produced
in collaboration with the World Health Organization (WHO) is now available.2

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International Nurses Society on Addictions (IntNSA) Europe
by Peter Kelly
On Sunday, 26 August 2018, a special ceremony linked to the 10th International Council of Nurses
(ICN) Nurse Practitioner/Advanced Practice Nurses (NP/APN) conference took place at De Doelen
Congress Centre in Rotterdam, the Netherlands. Addiction nurses from around the world gathered for
the inauguration of the International Nurses Society on Addictions (IntNSA) Europe and the launch of
the new website of the Netherlands Chapter of IntNSA.1

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Evaluation of three J-ARC pilot projects
by Ciara Guiney
The Joint Agency Response to Crime (J-ARC) is a multiagency response to the management and
rehabilitation of offenders. It was established by An Garda Síochána, the Irish Prison Service, the
Probation Service, and the Department of Justice and Equality in 2014. The main aim of J-ARC is to
stop crime and increase safety in society by targeting prolific offenders that are considered guilty
of the majority of crimes. J-ARC presented the findings of an evaluation of the effectiveness of
three pilot initiatives – ACER3, STRIVE, and Change Works – that were developed to reduce offending
behaviour.1 Table 1 provides an overview of the main features of the three programmes.

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Cross-border organised crime: threat assessment 2018
by Ciara H Guiney
In September 2018, An Garda Síochána (AGS) and the Police Service of Northern Ireland (PSNI)
published their biannual cross-border organised crime threat assessment.1 The aim of the report was
to provide insight into criminal activity on the island of Ireland.

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Resilience in the face of trauma: implications for service delivery
by Helen Kennelly
Psychological trauma, such as adverse childhood experiences (ACEs), can have significant effects on
an individual’s physical and emotional health. There is a relationship between exposure to childhood
trauma/ACEs and future negative health outcomes as well as increased risk of alcoholism, drug abuse,
depression, and homelessness.

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Evaluation of Tabor Group addiction services
by Helen Kennelly
The Tabor Group, a provider of residential and community-based addiction treatments in Ireland, has
conducted and published the results of an external evaluation of their services.1 The Tabor Group
comprises three residential units: Tabor Lodge (primary treatment centre), Fellowship House
(secondary treatment centre for males) and Renewal (secondary treatment centre for females) using
the Minnesota Model, as well as supported accommodation in the community. In 2017, some 213 patients
were admitted to their residential unit, Tabor Lodge, for treatment as well as providing structured
support for their families.

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Barriers and enablers to HCV screening and treatment in Irish prisons
by Seán Millar
Hepatitis C infection (HCV) is a major global epidemic with an estimated 399,000 people dying
annually from HCV-related liver failure and cancer.1 Unsafe injecting drug use is the main route of
HCV transmission in developed countries, with an estimated 20 million people who inject drugs (PWID)
infected worldwide.2 Over one-half of Irish prisoners report a history of opiate use, with 43%
reporting a history of injecting.3 A 2000 study estimated the prevalence of HCV infection in the
Irish prison population at 37%, increasing to 81% in those with a history of injecting drug use.4
With recent advances in treatment regimes, HCV is now a curable and preventable disease and prisons
provide an ideal opportunity to engage this hard-to-reach population. However, despite increased
access to primary healthcare while in prison, many HCV-infected prisoners do not engage with
screening or treatment.

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Merchants Quay Ireland annual review, 2017
by Seán Millar
Merchants Quay Ireland (MQI) is a national voluntary agency providing services for homeless people
and drug users. There are 22 MQI locations in 12 counties in the Republic of Ireland (see Figure 1).
In September 2018, MQI published its annual review for 2017.1 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-judgmental and compassionate way. This article highlights services
provided by MQI to drug users in Ireland in 2017.

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New publications
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Recent publications
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DOVE Clinic, Rotunda Maternity Hospital annual report, 2017
by Seán Millar


The DOVE Clinic 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 clinic
for 2017 were published in the hospital’s annual report in 2018.1

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Twentieth Annual Service of Commemoration and Hope
by Ena Lynn
The National Family Support Network (NFSN)1 is an autonomous self-help organisation that provides
support to families and respects the experiences of families affected by substance misuse in a
welcoming non-judgemental atmosphere. On Friday, 1 February 2019, the NFSN held its 20th Annual
Service of Commemoration and Hope. This spiritual, multidenominational service is held in
remembrance of loved ones lost to substance misuse and related causes and to publicly support and
offer hope to families living with the devastation that substance misuse causes. The service was
preceded by a procession from the ‘Home’ memorial on Sean MacDermott Street, Dublin, to the nearby
Church of Our Lady of Lourdes, led by the band of An Garda Síochána.

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