How have changing patterns of drug use impacted on individuals, communities and treatment services in recent years? In a seminar hosted by the Dales centre in co-operation with CityWide Drugs Crisis Campaign in December 2011, several speakers addressed this question. Declan Andrews, chairperson of the Dales centre, stated that the shift in Dublin from what had been essentially a heroin problem to what was now an increasingly complex problem of multiple substance use had put a lot of pressure on services. He said that this was a serious challenge for all addiction treatment providers, especially in a context where funding cuts were having a dramatic impact on the delivery of such services.
Presenting the results of a survey done in Darndale, Samantha Parkes of the Dales centre described a change in the drug of choice among users in that small community. In the years 2004–2007, a huge increase in cocaine use had led to the implementation of a specific cocaine support service at the centre. Interviews conducted in 2011 with drug users in that area revealed an increase in the use of cocaine and crack cocaine, particularly in cocaine used with other substances such as alcohol, benzodiazepines and head shop drugs. Heroin, now often ranked as a fourth or fifth drug of choice, had not come back to the level of popularity it had prior to the heroin drought in 2010. Many drug users had replaced heroin with crack cocaine or benzodiazepines, the latter more common among women.
The wide availability of, and easy access to, substances contributed to some degree of acceptance within the community, facilitated by the legal status of some of those substances (alcohol, benzodiazepines, and head shop substances prior to the 2010 ban). In the last four years, cannabis had become so widely available and relatively cheap that its use, sometimes in conjunction with mephedrone, had increased dramatically. The cannabis strains currently available were far more potent than those in recent years; it was noted that the reduced availability of hash, the resin form of cannabis, had led to the promotion of stronger herbal forms of cannabis on the market, with ‘skunk’ now commonplace. In 2011, methylamphetamine, known as ‘crystal meth’, appeared to be increasingly present on the drug scene and was now being used instead of crack cocaine in some areas.
The Darndale survey also showed that substances such as cocaine, head shop products and benzodiazepines did not carry the same stigma as that associated with heroin, and that drug users, and indeed the wider community, did not view the use of such substances as a serious problem that required intervention. Addiction treatment was still often viewed by service users as a response to heroin use. Dermot King, director of Ballymun Youth Action Project, outlined the difficulty faced by services in addressing the normalisation and the social acceptance of benzodiazepine use in the Ballymun area. The increased use of benzodiazepines among young people who had never used opiates reflected a perception that benzodiazepines were safer and better to use than stimulants or opiates. Mr King described an initiative in Ballymun involving a close partnership between addiction counsellors and general practitioners in order to illustrate the positive outcome that some community responses have had in the area.
Johnny Connolly of the Health Research Board spoke of the value of local surveys and small-scale research projects in revealing what can be hidden in national data or surveys. He said that, while levels of crack cocaine use in Ireland remained low, increased use in the last few years had tended to be hidden behind an overall decrease in the reporting of cocaine powder use in national figures. He said that because the drug problem differs from one area to another, and within local areas, the community approach was complementary to policies, monitoring and interventions implemented at national level, and was a key element of any adequate and efficient response to the drug problem.
Drugs are changing, they are more toxic, there is easy access to a wider range of substances and therefore more opportunities for potentially lethal combinations. Gary Broderick, director of the Saol project, said that there was a growing population of stable ex-opiate users who were returning to treatment for misuse of cocaine or other substances. Multiple substance use, now the norm, increases the complexity of drug interventions and is associated with poorer treatment outcome and the need for repeated episodes of treatment. This is a huge challenge for services in a context where already stretched resources are being further reduced.