Home > New drugs strategy published.

Connolly, Johnny and Galvin, Brian and Keane, Martin and Long, Jean and Lyons, Suzi and Mongan, Deirdre and Pike, Brigid (2009) New drugs strategy published. Drugnet Ireland , Issue 31, Autumn 2009 , pp. 1-10.

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On 10 September 2009 the Irish government published its national drugs strategy 2009–2016.1 Noting that the previous drugs strategy had been successful in tackling the heroin problem in Dublin, the Taoiseach, Brian Cowen TD, acknowledges in his foreword to the new strategy that the situation has now changed: ‘problem drug use has spread to other areas and the range of drugs available has increased. The challenge involved is complicated by the fact that drug use can be linked to circumstances of social exclusion as well as to circumstances of economic prosperity.’

 Both the Taoiseach and the Minister for Drugs, John Curran TD, emphasise that partnership both at national and local level, including the drugs task forces, will continue to form the basis of the government’s approach to tackling the problem. Minister Curran confirms that the government will retain the five pillars – supply reduction, prevention, treatment, rehabilitation and research, ‘as these have served us well and still encompass the areas that need to be addressed. This will also facilitate the dovetailing of the Strategy with the provisions of the EU Drugs Action Plan 2009–2013.’
 
Overall strategic objective
To continue to tackle the harm caused to individuals and society by the misuse of drugs through a concerted focus on the five pillars of supply reduction, prevention, treatment, rehabilitation, and research.
 
Overall strategic aims
·       To create a safer society through the reduction of the supply and availability of drugs for illicit use;
·       To minimise problem drug use throughout society;
·       To provide appropriate and timely substance treatment and rehabilitation services (including harm reduction services) tailored to individual needs;
·       To ensure the availability of accurate, timely, relevant and comparable data on the extent and nature of problem substance use in Ireland; and
·       To have in place an efficient and effective framework for implementing the National Substance Misuse Strategy 2009–2016.
 
The new strategy uses the same framework as before, constructed around a hierarchy of aims, objectives, key performance indicators and actions (Figure 1). The pillar construction is accompanied by a co-ordination ‘pillar’, with its own objectives, KPIs and actions. The expectation appears to be that the high-level aspirations will provide an over-arching logic uniting the whole, while, simultaneously, the underpinning actions will drive the new strategy forward.

While the overall strategic approach and framework are the same as before, the contents of the pillars in the NDS 2009–2016 reveal some shifts in emphasis – reflecting either the changing nature of the situation and the problem being faced, the experience gained through implementing the previous drugs strategy, or the insights acquired through the new research and information accumulated during the past seven years. While the overall strategic objective remains broadly the same, there has been a change in the active verb – ‘to significantly reduce the harm’ in the previous strategy has been replaced by ‘to continue to tackle the harm’. 
 
More details on policy initiatives under each of the pillars may be found in the following sections. 
 
Although there was no final evaluation of the previous drugs strategy, the Steering Group that drew up the new strategy assessed progress under each of the pillars. A summary of this assessment is provided on page 8. Furthermore, aware that a combined substance misuse strategy, including both alcohol and illicit drugs, was to be developed over the next 18 months to two years, the Steering Group initiated discussion of alcohol misuse under each of the pillars in the new ‘interim’ strategy. This discussion is summarised on page 9.
 
Supply reduction pillar
Under the supply reduction pillar, the primary aim of reducing the availability of drugs remains. However, there is a greater note of realism evident in the NDS 2009–2016, for example in the way in which the impact of drug supply reduction activities is determined.
 
Acknowledging the significant increase in drug seizures in recent years, the Steering Group states that during the consultation phase ‘the impact of those seizures on reducing the overall supply of drugs was questioned’ (para. 2.22).It goes on to state, ‘Due to the problems associated with estimating the size of the illegal drug market in Ireland, it is difficult to conclude whether increased seizures are actually resulting in a reduction in overall supply – or whether the overall supply of drugs has increased and the percentage of seizures has remained relatively even.’ (para. 2.27) The Steering Group further acknowledges that ‘the figures often quoted in relation to drugs seizures as a percentage of the total drugs market in Ireland are speculative and currently, have no proven basis’ (para. 2.27). Consequently, the Group concludes that there is a need to develop other measurements to determine the effectiveness of supply reduction activities rather than relying on drug seizures.
 
An issue highlighted during the consultation phase was the possibility of decriminalising or changing the legal status of cases of simple possession of certain drugs, such as cannabis, owing to the Garda resources involved in prosecuting such cases. The Steering Group reports that, according to the gardaí, ‘about 20% of drugs crime relates to supply offences and 80% to possession’ (para. 2.29). Despite this, most members of the Group are not in favour of ‘legalising, decriminalising, or changing/redefining the legal status of certain illicit drugs (cannabis was the focus of most discussion in this context)’ (para. 2.49). The Steering Group notes that the findings of the nationwide drug prevalence surveys conducted in 2002/03 and 2006/07 indicated that approximately 70% of respondents did not think recreational cannabis use should be permitted (support for the medicinal use of cannabis was about 70%). The Group does, however, identify as a priority the ongoing monitoring of legislative and regulatory frameworks with a view to pursuing changes where necessary.
 
Other priorities identified by the Steering Group include developing local partnership approaches through the joint policing committees and local policing fora provided for in the Garda Síochána Act 2005; tackling underage drinking and drug-related intimidation; the development of an integrated system to track the progression of offenders with drug-related offences through the criminal justice system; the continued implementation of measures to curtail the supply of drugs into Irish prisons; and a renewed focus on addressing the use of precursors in the manufacture of illicit synthetic drugs. The last priority calls for increased collaboration with international bodies such as the EMCDDA and the Pompidou Group of the Council of Europe.
 
 
Prevention pillar
In their forewords to the new drugs strategy both the Taoiseach and the Minister for Drugs emphasised the importance of prevention. Minister Curran stated: ‘If we could achieve more in regard to prevention, I believe that the impact on the overall problem would be greatly enhanced.’
 
Having reviewed progress under the previous drugs strategy, the Steering Group concluded that ‘a tiered or graduated approach to prevention and education measures in relation to drugs and alcohol should be developed with a view to providing a framework for the future design and development of interventions’ (para. 3.56). The Steering Group identifies three levels in this framework, which are outlined in the following table. In naming the three levels, the Group combined the current prevention classification framework – universal, selected and indicative – with the old classificatory framework of primary, secondary and tertiary. 
 
Universal (primary) prevention programmes
Aimed at reaching the general population, such as students in schools, to promote overall health of the population and to prevent the onset of drug and alcohol misuse. Measures often associated with this type of programme include awareness campaigns, school drug/alcohol education programmes and multi-component community initiatives;
 
Selected (secondary) prevention programmes
Aimed at groups at risk, as well as subsets of the general population including children of drug users, early school leavers and those involved in anti-social behaviour. These programmes aim to reduce the effect of risk factors present in these subgroups by building on strengths and developing resilience and protective factors.
 
Indicative (tertiary) prevention programmes
Targeted at people who have already started using drugs/alcohol, or who are likely/vulnerable to engage in problematic drug/alcohol use (but may not necessarily be drug/alcohol dependent), or to prevent relapse. These require individual or small group programmes aimed at addressing specific needs.
 
With regard to specific interventions, the Steering Group identifies the following priorities:
°       improved delivery of SPHE in primary and post-primary schools – the Steering Group acknowledges that while the focus of prevention measures in the previous strategy had been on the provision of education services in school settings for the school-going population, their application and delivery had limited their effectiveness.
°       the co-ordination of the activities and funding of youth interventions in out-of-school settings to optimise their impacts – under the previous strategy the provision of education in non-school settings had been fragmented, the provision of alternative recreational facilities for young people had been under-developed, and many young people had not had access to recreational facilities in out-of-school settings.
°       a continued focus on orienting educational and youth services towards early interventions for people and communities most at risk – the Steering Group recommends that actions be developed to further support the families of drugs users, and it acknowledged community development as an important step in building the capacity of local communities to avoid, or respond to and cope with, drug problems.
°       the development of timely awareness campaigns targeted in a way that takes individual social and environmental conditions into account – the Steering Group sees a need to further develop and promote prevention strategies in a number of key areas such as third-level institutions, workplaces, sports and other community and voluntary organisations.
 
Treatment and Rehabilitation pillars
The Steering Group states that this pillar, which combines the treatment and rehabilitation pillars, has a wider focus than in the previous strategy. It aims to develop a more comprehensive treatment service capable of dealing with all problem substances nationally, rather than focusing mainly on opiate misuse in Dublin. The Group identifies a number of priorities, grouped under four main themes.
 
1. Development of general problem substance use services – develop an integrated national treatment and rehabilitation service for all substances, using a four-tier model approach, underpinned by an appropriate clinical governance regime.
The Steering Group supports the HSE’s reorientation of addiction services towards polydrug use using a four-tiered model approach. The focus of the strategy will be on the development of addiction services, and of pathways between them and other relevant health and social services.
 
The treatment of drug users with hepatitis C is specifically mentioned for the first time in the new strategy. The Group notes that there has been a gradual and consistent decrease in the number of HIV cases reported, while the incidence of hepatitis C among injecting drug users (IDUs) remains a cause of concern. The KPI on the monitoring of the incidence of HIV has been dropped and, for the first time, a KPI for the treatment of hepatitis C in drug users has been included.
 
Data from the National Drug-Related Deaths Index (NDRDI),2 set up in line with Action 67 in the NDS 2001–2008, show an increase in drug-related deaths since 1998, and a new action in the NDS 2009–2016 calls for the development of a National Overdose Prevention Strategy, and also for a response to the increasing numbers of indirectly drug-related deaths.
 
The Steering Group prioritises the expansion of the availability of detox facilities, opiate substitution services, under-18 services and needle-exchange services where required. The KPI relating to provision of services for under-18s remains the same as in the previous strategy, but with a new target of 100% access to treatment within one week (as opposed to one month) of assessment by 2012. While the document states that methadone substitution is the cornerstone of opiate treatment and looks for continued recruitment of Level two GPs, a new action calls for the review of the Methadone Treatment Protocol to maximise the provision of treatment and facilitate appropriate progression pathways. Additionally, the action calls for alternative opiate substitution services.
 
Noting that there was only a small increase in the number of residential places between 2001 and 2006, the Steering Group calls for the development of residential care in the context of the four-tier model. Along with appropriate aftercare services, the Group sees residential care as central to the provision of alternative, drug-free treatment for problem drug users. The NDS 2009–2016 includes a new KPI relating to residential places, which states that there should be a 25% increase in residential rehabilitation places by 2012 based on 2008 figures.
 
The Steering Group calls for the establishment of a drugs intervention programme aimed at young people and young adults, incorporating a treatment referral option, for those who come to the attention of the Garda Síochána because of behaviour caused by substance misuse. While many of the services needed for this programme are already in place, the Group notes that interagency co-ordination needs to be developed. A new KPI specifies that this programme should be in place by 2012.
 
2. Specific groups – further develop engagement with, and the provision of services for specific groups: prisoners, homeless, Travellers, new communities, the lesbian, gay, bisexual and transgender (LGBT) community and sex workers.
These specific groups are listed separately in the NDS 2009–2016. Those with a dual diagnosis (both mental health and substance misuse problems) are also mentioned specifically. These groups have been highlighted in order to differentiate their specific needs and to tailor services for them. New issues for prisoners have also been identified. These include the recognition of the high risk of overdose or relapse immediately following release from custody and the need for the development of an effective and co-ordinated interagency approach to ensure a seamless transition from prison back into the community. The Steering Group notes that not all prisons provide substitution treatment, and identifies this issue as a key gap.
 
3. Quality and standards framework – develop a clinical and organisational governance framework for all treatment and rehabilitation services
The Steering Group states that while progress has been made in introducing standards in treatment and rehabilitation services, further measures are necessary. For example, currently neither counselling nor psychotherapy services are statutorily regulated. New actions are identified in relation to developing a clinical and organisational governance framework for addiction services and developing a regulatory framework on a statutory basis for the provision of counselling.
 
4. Training and skills development – develop national training standards for all those involved in the provision of substance misuse services, and co-ordinate training provision within a single national substance misuse framework.
The actions relating to training and skills development are more specific in the new strategy, as they are seen as a key component in the development of a comprehensive addiction service. The new actions call for the development of national training standards, including accreditation, for addiction services (both statutory and voluntary). The need for staff training in the use of naloxone in order to prevent fatal overdose is specifically mentioned.
 
Research and information pillar
The NDS 2009–2016 intends to collect information and complete research projects in order to inform policy formulation and to develop or enhance responses to the drug situation, while the NDS 2001–2008 intended to measure the extent of drug use by person, place and time, and describe the characteristics of drug users, but did not state how the new information would be used (Table 1).
 
The NDS 2001–2008 was based on a low level of information and the information that existed was not collated in a single place or easy to access. The NDS 2001–2008 intended to eliminate all research gaps and funded an extensive programme of research on the drug situation and the responses to it (Table 2).
 
The NACD was established to co-ordinate the programme of research and advise the government on its findings. The information available on the drug situation has increased dramatically since 2001; for example, the NACD published 70 research reports between 2001 and 2008, and the HRB published 35 reports during the same period. All research publications are located in a single web-based library known as the National Documentation Centre on Drug Use (NDC).
 
At the time the NDS 2001–2008 was developed, it was not widely understood by those working in the drugs area that the EMCDDA required all countries to complete an annual national report on the current drug situation and responses to it. Since 2004, these national reports to the EMCDDA have been made available on the NDC website and are used by policy makers to keep abreast of progress.
 
The challenge now is to sustain this level of knowledge and to identify the most efficient ways of updating our knowledge. With this in mind, the title of the research pillar has being changed to the research and information pillar. In the NDS 2009–2016 the emphasis, and investment, will be on the development of a single information system that will consist of existing data sources (such as the CTL, NDTRS, NDRDI, and HPSC) and these sources will be linked using a unique identifier. This will allow us to document the exact number of known problem drug users, and to trace their treatment and rehabilitation pathways and outcomes. Consent and data-protection procedures will be put in place to protect individuals’ identities.
 
The EMCDDA indicators will guide the continuous and periodic data-collection process. Examples of continuous data-collection processes are the CTL, HPSC drug-related infectious diseases, NDTRS, NDRDI and PULSE. Examples of periodic data collection processes are the survey measuring the prevalence of problem drug use among the general population and the estimation of the numbers of problem drug users.
The Minister of State, the OMD and the NACD will develop and prioritise a research programme, revised on an annual baisis.The programme will include projects that could not be achieved through routine data-collection mechanisms, for example exploring new issues, testing new interventions or measuring long-term impact. The development of an annual rather than an eight-year research programme will allow for sudden changes in the situation and prioritising of projects in line with available resources.
 
The seven research-related actions of the NDS 2001–2008 were substantially completed. In the NDS 2009–2016 four priorities have been identified which closely link to the key performance indicators (Table 3).These priorities have been translated into eight associated actions which identify the agency with lead responsibility for implementation, together with all other contributing agencies.   
 
 The critical success factors for Ireland in delivering on the new strategic objectives are that capacity to complete drug-related research is developed further, that there is not duplication of research projects or information systems, and that projects and interventions are planned using the best practice available within Ireland or in other countries.
  
Co-ordination pillar
Compared to the co-ordination arrangements in place for the previous drugs strategy, those to support the implementation of the NDS 2009–2016have been significantly simplified and streamlined (see Figure 2). A new Office of the Minister for Drugs (OMD) will incorporate the work and functions of both the Drugs Strategy Unit (DSU) in DCRGA and the National Drugs Strategy Team (NDST) and will report directly to the Cabinet Committee on Social Inclusion, Children and Integration (CCSICI) (see Table 4).The direct reporting line to the CCSICI and use of a ‘networked organisational’ structure in the OMD will preclude the need for an Interdepartmental Group on Drugs (IDG), which will be reconstituted as an Oversight Forum on Drugs (OFD).
    
              
Assessing progress under the NDS 2001–2008, the Steering Group that drafted the new NDS found that 20 out of 22 actions to support co-ordination had been implemented, the key performance indicators relating to co-ordination reached, and that the co-ordination arrangements had ‘stimulated and promoted inter-agency working in a difficult cross-cutting policy and service area’ (para. 6.7). However, the Steering Group also found that there were ‘capacity and structural limitations’, which were limiting ability to meet the new challenges, including:
°       accounting for expenditure;
°       governance;
°       mainstreaming;
°       capacity of services to meet client needs; and
°       monitoring/evaluation.
  
The need was identified to establish a structure which would:   
°       support and drive the ongoing implementation of the NDS, while respecting the various lead roles and statutory responsibilities of the Departments/agencies involved;
°       provide a more cohesive and integrated framework that promotes closer co-operation and accountability between the different players, as well as greater transparency for expenditure;
°       provide a clear hierarchy and a greater transparency of the roles from the government and the Cabinet Committee on Social Inclusion, Children and Integration to the local project level.
 
 
The design of the OMD resembles the networking model promoted in a recent OECD review of the Irish public sector.3 The OECD review described the Office of the Minister for Children and Youth Affairs (OMCYA), established in 2005, where staff from different government departments (including Health, Education and Justice) had been brought together in one location (the Department of Health and Children) to work in a networked way on issues of strategic national importance with regard to children. The review’s observations on the OMCYA may be applied equally to the new OMD:
 
Policies that cut across the function responsibility of a number of departments can lead to difficulties in determining who is the overarching ‘owner’ accountable for the service provided. The work to date by the OMC has demonstrated that there is value in ensuring that units, such as the Irish Youth Justice Services, remain connected to their parent department (Department of Justice, Equality and Law Reform). This ensures that they have ongoing interaction with, and input to the development of policies targeted at children while also ensuring that accountability for the services they deliver remains within the remit of their Minister. This guarantees that historical mismatches between children’s policy and youth justice policy can be addressed. (pp. 241–242)
 
To support integration, the Steering Group recommends an Oversight Forum on Drugs (OFD) to replace theInterdepartmental Group on Drugs (IDG). Comprising the same membership, its primary role will be the high-level monitoring of progress being achieved across the strategy and agreeing appropriate ways forward where issues are blocked or progress is being impeded. It will also provide a forum for discussion and feedback on issues relating to problem drug use that arise in EU and international arenas. The Group proposes two additional mechanisms to support the new integrative role of the OMD: (1) an Advisory Group of the OMD, comprising representatives of the statutory, voluntary and community sectors, to advise the Minister on operational and policy matters relating to the NDS; and (2) twice-yearly bilateral meetings between the Minister for Drugs and the ministers for Justice, Education and Health; the Minister and the Director of the OMD and the heads of various departments and state agencies involved in implementing the NDS; the Minister and the Director of the OMD and the chairs and co-ordinators of the DTFs; the Minister and the Director of the OMD and the NACD and the Family Support Network. The Steering Group believes these meetings would help to keep a focus on drug-related issues and the broader implementation of the NDS.
 
This multiplicity of mechanisms raises the question as to whether there is a more efficient and effective means of integrating effort across the statutory, voluntary and community sectors and engaging all stakeholders in the deliberation over and choice of policy options. For example, a study of whole-of-government approaches to cross-cutting policy issues in Ireland in the 21st century4 described how social partnership can perform such an integrating function. Advisory groups such as the National Economic and Social Council (NESC) or the National Economic and Social Forum (NESF), with broad-based representation of all the social partners and reporting to the Department of the Taoiseach, have played and continue to play a critical role in supporting the development and implementation of key national policies.5
 
The National Advisory Committee on Drugs (NACD) is to be co-located with the OMD and the Director of the NACD is to become a member of the senior management team in the OMD. While acknowledging the need for the NACD to be ‘independent’ in regard to research, the Steering Group states that the closer alignment with the OMD will ‘better address the issue of linkages between policy development and research’.
 
Local and regional drugs task forces will now report to the OMD for all activities, outputs and expenditures. Priorities for the new OMD with regard to the DTFs will include:
°       considering reporting and accountability arrangements for DTF projects with a view to simplifying the system;
°       examining the feasibility of achieving the optimum structure for the employment arrangements of DTF personnel;
°       reviewing and renewing the commitment and participation of all members of DTFs, including the position of chairperson;
°       updating the handbook for the operation of DTFs to take account of the new structural arrangements and include guidelines on mainstreaming.
 
The NDS notes that the National Drugs Rehabilitation Implementation Committee will also be ‘closely linked’ to the OMD.
 
 
Steering Group’s assessment of the National Drugs Strategy 2001–2008
The Steering Group that managed the preparation of the NDS 2009–2016 assessed the progress that had been made against the key performance indicators (KPIs) under each of the pillars of the 2001–2008 strategy: supply reduction, prevention, treatment, rehabilitation and research.6 The Group’s assessment, as reported in the new strategy document, is summarised below.
 
Supply reduction
All KPIs under this pillar were achieved. The targets of a 50% increase in volume of drugs seized based on 2000 figures and a 20% increase in the number of seizures based on 2004 figures were both exceeded. The 125% increase in supply detections between 2004 and 2008 significantly exceeded the target of 20%. While acknowledging the operational success which this represented for law enforcement, the Steering Group notes that, without a reliable estimate of the size of the illegal drug market in Ireland, the impact of increased seizures on the overall supply could not be measured.
 
Other areas of progress included increases in the Garda Síochána resources in LDTF areas and various initiatives aimed at reducing the supply of drugs, such as the ‘Dial to Stop Drug Dealing’ scheme, undertaken by local and regional DTFs. Less progress was achieved in expanding community policing fora (CPFs) and reducing the availability of drugs in prisons.
  
Prevention                                                      
The KPIs under this pillar related to levels of problem drug use, prevalence, substance use policies in schools and rates of early school leaving. Heroin use stabilised in the Dublin area, with a significant drop in new entrants, but rose substantially outside Dublin. Drug prevalence targets were not achieved and the 2006/07 drug prevalence survey reported increases in recent and current use. The target of having substance use policies in all schools was near completion at the time of a Department of Education and Science survey in 2005. A number of data sources were used to estimate the levels of early school leaving and, while precise figures were not available, it appeared that early school leaving had decreased during the period of the NDS 2001–2008.
 
While many of the actions relating to the implementation of prevention programmes were completed or near completion, the Steering Group questions the effectiveness of a number of the programmes. Despite the high number of schools which reported that they had implemented substance misuse policies, the quality of these policies had not been assessed and there was a need to determine how actively they were being implemented. The Social Personal Health Education (SPHE) programme, the foundation for developing awareness of drugs and alcohol issues in schools, is a mandatory part of the curriculum but its effectiveness as a drug prevention measure was consistently questioned during the consultation process.
 
Treatment and rehabilitation
Three of the KPIs under this pillar specified increased availability of treatment and harm reduction services, and one sought a reduction in the incidence of HIV. The target of a maximum waiting period of one month for treatment for problem drug use was achieved for almost all non-opiate addiction cases. However, there were still difficulties in many areas in providing access to methadone treatment within one month of assessment. No under-18s had had to wait longer than one month to initiate treatment following assessment, but there were still not enough residential places or community supports. There was limited progress in providing harm-reduction services, but the incidence of HIV among injecting drug users had seen a consistent reduction. The incidence of hepatitis C continued to cause concern.
 
While rehabilitation was covered under the treatment pillar in the NDS 2001–2008, the mid-term review (MTR) of the strategy recommended that a separate pillar be established.7 Following a recommendation in the report of the Working Group on drugs rehabilitation,8 a National Drug Rehabilitation Implementation Committee (NDRIC), chaired by the HSE, was set up. The Steering Group notes that there was progress in several areas related to the MTR’s recommendation to strengthen support for families, and that the HSE had significantly developed its family support services.
 
Research
The KPIs under this pillar dealt with information on prevalence in the general population, problem drug use, demand for drug treatment, drug-related deaths and drug-related infectious diseases. In 2005 the NACD published the findings of a drug prevalence survey carried out in Ireland and Northern Ireland in 2002/03. This survey was repeated in 2006/07 and the results published in 2008. The NACD also commissioned studies on drug prevalence among vulnerable groups, including the homeless, new communities in Ireland and Travellers. Other studies give some insight into alcohol and cannabis use among the youth and school-going populations. While work on the second 3-source capture-recapture study to estimate the prevalence of problematic opiate use has yet to be completed, the Research Outcome Study in Ireland (ROSIE) and the information reported by the NDTRS provide significant insights into the patterns of problem drug use.
 
Improvements in the reporting of problem drug use to the Drug Misuse Research Division (renamed Alcohol and Drug Research Unit (ADRU) in 2007) increased the efficiency of the flow of this data and the quality of the information. The ADRU manages the National Drug Treatment Reporting System (NDTRS). This system collects data on episodes of treatment, rather than on the individual person treated; neither does it provide outcome/exit data for all areas. In 2005 the Health Research Board (HRB) developed a National Drug-Related Deaths Index (NDRDI), which subsequently published data for the period 1998–2005.2 The Health Protection Surveillance Centre (HPSC) introduced an extended surveillance system for hepatitis B in 2004 and for hepatitis C in 2007. The Steering Group notes that there has been no concerted effort to monitor the incidence and prevalence of hepatitis B, hepatitis C or HIV among drug users since the NDS 2001–2008 was launched.
 
Inclusion of alcohol in new substance misuse strategy
Announcing the decision to develop a ‘substance misuse’ strategy, including both illicit drugs and alcohol, Minister of State with responsibility for drugs strategy, John Curran TD, said: ‘A combined strategy will facilitate a more coherent approach to the issues and consequences of alcohol and illicit drug use including addictive behaviours. We cannot continue to look at these problems in isolation.’9 A new steering group will be established in autumn 2009 to develop proposals for a strategy that will incorporate the already-agreed drugs policy element. Membership of the new steering group will reflect the appropriate statutory, community/voluntary and other relevant interests. The group will be jointly chaired by officials from the Department of Health and Children and the Office of the Minister for Drugs and will be asked to report by the end of 2010.
 
The interim drugs strategy contains a number of proposals relating to alcohol. These are summarised below.
 
Supply reduction
During the public consultation process, the issue of underage drinking was consistently raised, both as a problem in its own right and as a gateway to the use of illicit drugs. However, owing to the fundamental legal difference involved in their supply, the focus in the interim drugs strategy is on illicit drugs rather than on alcohol, with the exception of underage drinking.
 
Prevention
Alcohol is referenced under this pillar with regard to developing a prevention strategy to tackle substance misuse, particularly in relation to under-18s. One of the key themes to emerge from the consultation process was the perception that drug and alcohol use are becoming more widespread and that the age profile of those involved is getting younger. Measures to prevent and/or delay drug and alcohol use – especially among young people – are, therefore, particularly important and urgent.
 
The Steering Group is of the view that renewed efforts need to be made to address the issue ofunderage drinking, which is often perceived as the direct, or underlying, cause of many of the problems encountered by individuals and communities. The Group acknowledges the benefits of the enactment of the Intoxicating Liquor Act 2008. However, it also feels that the impact of the legislative measures, and the situation generally, should be monitored to ensure that alcohol is not being supplied to under-18-year-olds in an illegal or irresponsible way.
 
Alcohol advertising and sponsorship (especially in the sporting context) are seen as particular problems, especially as the messages often target the young and impressionable. The Department of Health and Children established a working group to engage with relevant stakeholders and sporting bodies to examine the extent of sports sponsorship by alcohol companies and to consider how the health-related concerns might be addressed. The working group is expected to report in autumn 2009. The Steering Group welcomes these developments.
 
Provision of recreational and other facilities for young people is considered to be important in preventing misuse of drugs and alcohol, and the Steering Group identifies the lack of such facilities and appropriate supporting structures across the country as a key gap. The Group believes that access to school facilities outside school hours should be progressed as a matter of urgency.
 
The Steering Group is of the view that there is a need to further develop and promote prevention strategies in a number of other key areas – third-level institutions, workplaces, sports and other community and voluntary organisations – using brief interventions where appropriate.
 
The development of a tiered or graduated approach to prevention and education measures in relation to drugs and alcohol is recommended. This approach would provide a framework for the future design of targeted prevention and education interventions.
 
Treatment and rehabilitation
The Steering Group endorses the view of the Working Group on Alcohol and Drug Synergies that greater coherence and co-ordination of alcohol and drug issues at policy, planning and operational levels are needed. With respect to treatment and rehabilitation, the Steering Group sees the re-orientation of all addiction services towards dealing with problem substance use as a key feature of the new strategy.
 
The Steering Group acknowledges that it is not possible to quantify the number of problem alcohol users requiring treatment. However, the significant difference between the number of alcohol-related hospital discharges and the number of reported cases receiving treatment for alcohol addiction indicates that there is a considerable cohort of problem alcohol users who could benefit from engagement with addiction treatment services.
 
The Steering Group believes that training in brief interventions needs to be rolled out across the healthcare service to maximise the impact of this cost-effective approach. Early interventions, targeted at hazardous and harmful users of alcohol, are designed to reduce alcohol consumption before dependence develops. There is strong evidence to suggest that brief interventions provided within various healthcare settings, including primary care, general hospital wards, mental health services and emergency departments, are effective in reducing hazardous and harmful alcohol use.
 
Research and information
The Steering Group recommends the development of a research management framework in relation to problem substance use in Ireland.  In relation to alcohol, it specifically recommends:
·          the development of appropriate epidemiological indicators of problem alcohol use, and building on existing monitoring systems and prevalence surveys;
·         measuring the impact of alcohol and drugs on the Irish health and justice systems; and
·         monitoring problem substance use (including alcohol) among those presenting to hospital emergency departments.
 
(Johnny Connolly, Brian Galvin, Martin Keane, Jean Long, Suzi Lyons, Deirdre Mongan and Brigid Pike)
 
1. Department of Community, Rural and Gaeltacht Affairs (2009) National Drugs Strategy (interim) 2009–2016. Dublin: Stationery Office.
2. Lyons S, Lynn E, Walsh S and Long J (2008) Trends in drug-related deaths and deaths among drug users in Ireland, 1998–2005. HRB Trends Series 4. Dublin: Health Research Board.
3. Organisation for Economic Co-operation and Development (2008) Ireland: towards an integrated public service. Paris: OECD.
4. Whelan P, Arnold T, Aylward A, Doyle M, Lacey B, Loftus C, McLoughlin N, Molloy E, Payne J and Pine M (2003) Cross-departmental challenges: a whole-of-government approach for the twenty-first century. Dublin: Institute of Public Administration.
5. Pike B (2008) Development of Ireland’s drug strategy 2000–2007. HRB Overview Series 8. Dublin: Health Research Board.
6. The KPIs used to measure progress under the pillars in the NDS 2001–2008 were revised by the Steering Group that undertook the mid-term review of the drugs strategy.
7. Steering Group for the mid-term review of the National Drugs Strategy (2005) Mid-term review of the National Drugs Strategy 2001–2008. Dublin: Department of Community, Rural and Gaeltacht Affairs.
8. Working group on drugs rehabilitation (2007) National Drugs Strategy 2001–2008: rehabilitation. Dublin: Department of Community, Rural and Gaeltacht Affairs.
9. Curran J (2009) Alcohol and drugs to be joined in a National Substance Misuse Strategy. Press release issued 31 March 2009 by the Department of Community, Rural and Gaeltacht Affairs.
Item Type:Article
Issue Title:Issue 31, Autumn 2009
Date:October 2009
Page Range:pp. 1-10
Publisher:Health Research Board
Volume:Issue 31, Autumn 2009
EndNote:View
Accession Number:HRB (Available)
Subjects:VA Geographic area > Europe > Ireland
MP-MR Policy, planning, economics, work and social services > Programme planning, implementation, and evaluation > Programme planning (strategy)
J Health care, prevention and rehabilitation > Health services, substance use research
MP-MR Policy, planning, economics, work and social services > Policy > Policy on substance use
MP-MR Policy, planning, economics, work and social services > Programme planning, implementation, and evaluation

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