National Profile
Ireland’s current national drugs strategy is structured around cross-cutting goals rather than the pillars of the previous national drugs strategy. Its main aims are to minimise the harms caused by the use and misuse of substances and to promote rehabilitation and recovery. Therefore, there is a focus on the need for a range of treatment, rehabilitation, and recovery services using the four-tier model. The strategy also recognises the need for timely access to appropriate services for clients. The Health Service Executive (HSE) is responsible for the provision of all publicly funded drug treatment in Ireland. Drug treatment is therefore provided not only through a network of HSE services (public), but also through non-statutory/voluntary agencies, many of which are funded by the HSE. Some private organisations also provide treatment.

A range of treatment options is available for people with problem drug use, mainly in outpatient settings, but also in residential settings. Almost all opioid agonist treatment (OAT) provided is methadone; however, since November 2017, buprenorphine-based products have been available nationally for patients where clinically appropriate. In 1998, the first formal methadone treatment protocol (MTP) was introduced in order to ensure that treatment for problem opioid use could be provided wherever the demand existed. Outpatient OAT for people with problem opioid use is provided only through specialised HSE outpatient drug treatment clinics, satellite clinics, or specialised general practitioners (GPs) in the community. The first national comprehensive clinical guidelines for OAT were published in 2016.

Trends
The majority of drug treatment (more than 75%) continues to be provided through publicly funded and voluntary outpatient services. Outpatient services include low-threshold and specialised OAT GPs in the community. Inpatient treatment is mainly provided through residential centres run by voluntary agencies.

In 2022, a total of 11,488 treatment entrants were reported. This is a 10.4% increase from the number of cases reported in 2021, when 10,408 were reported. This is likely to indicate that there has been no residual impact of the public health restrictions due to the COVID-19 pandemic on addiction care. In 2022, cocaine overtook opioids as the most common problem drug reported. The increase in the number of cases presenting for treatment for problem cocaine use continued in 2022. More than one-fifth (21.2%) of cocaine cases were reported to be due to crack cocaine. Opioids (mainly heroin) were the second most common problem illicit drug used by treatment entrants, followed by cocaine and cannabis. The proportion of all treatment entrants reporting an opioid as their main problem drug has decreased year on year since 2004, from a peak of 65% in 2004 to 33% in 2022. Cannabis was the third most common problem drug reported in 2022. From 2004 to 2018, cannabis was consistently reported as the second most common main problem drug. The proportion of cases reporting cannabis as their main problem drug peaked at 28.9% in 2013, with the proportion decreasing almost every year since then. The majority of cases entering treatment have been treated previously. The proportion of new treatment entrants remained relatively unchanged in 2022, at 39%, compared with 2021. The proportion of new treatment entrants has fluctuated, from 39% in 2004 to a peak of 47% in 2009, but the proportion has stabilised at around two-fifths since 2013. In 2022, cocaine was the most common drug reported by new treatment entrants, a continuation of the trend first seen in 2020. On 31 December 2020, 11,667 clients were registered for OAT (including those receiving OAT in prison). In 2022, more than one-half of all OAT clients received OAT in specialist outpatient clinics, two-fifths received it from specialist GPs, and an even smaller proportion (less than 6%) received it in prison.