The Cabinet Committee on Social Policy and Public Service Reform in 2015 mandated the Department of Health to develop the new National Drugs Strategy (NDS) to follow on from that which ran from 2009 to 2016. Late in 2015, the then Minister of State with responsibility for the NDS, Aodhán Ó Ríordáin TD, established a Steering Committee to provide him with guidance and advice in the development of the new NDS covering the period 2017-2024. The work of this committee has been informed by a number of inputs, including a report from a group of international experts1 who undertook a high level review of the National Drug Strategy 2009−2016.2,3

The Report of the rapid expert review of the National Drugs Strategy 2009−2016 was completed in August 2016.4 It aimed ‘to inform the development of the next National Drugs Strategy by providing a “helicopter view” of and capturing some key learning points from the experiences of the National Drugs Strategy 2009−2016’ (p. 1). The review highlights the complexities involved in developing a drugs strategy in a landscape that is always evolving and in which ‘articulation between social, criminal, and health policy areas is vital’ (p. 31). The group’s terms of reference were:

• To examine the progress and impact of the 2009−2016 NDS in the context of the objectives, key performance indicators and actions set out in the strategy.
• To identify deficits in the implementation of the strategy.
• To summarise success factors or barriers to success.
• To comment on Ireland’s evolution in tackling the drug problem in the light of international trends.
• To identify key learning points arising from the strategy and to highlight areas to consider for development in the new NDS. 

The review was based on documentary evidence, meetings and site visits held during a week-long visit to Ireland in January 2016. The review team met with a range of stakeholders, including Government officials, statutory and voluntary sector service providers, community members, and service users. It is important to note that this was not an evaluation of the NDS. This article presents just some of the key findings from the review.

National Drugs Strategy 2009−2016

The 2009−2016 NDS was described by Griffiths et al. as a ‘well-crafted and comprehensive version of a contemporary EU drugs strategy’ (p. 2) of its time. Overall, those they consulted considered it to have been ‘a valuable instrument, both in respect to the structures and coordination mechanism it established, and in respect to its content which allowed priorities to be identified and targeted’ (p. 6). It helped ‘facilitate multiagency working, encouraged stakeholder buy-in, and helped galvanise political support for drug issues’ (p. 7). Over the course of the strategy, progress had been made on many of the priority areas. In particular, it had been successful in targeting resources and developing services for opiate users.

However, the review also found that while delivery of the strategy got off to a good start, over time some of the positive changes delivered in the initial phases ‘became less apparent’ (p. 6) and the ‘usefulness and appropriateness of the instrument declined’ (p. 8). Areas that became problematic included: ‘[meeting] changing needs, stakeholder participation, sustaining appropriate coordination mechanisms, and follow up and continuing relevance of actions’ (p. 6). Griffiths et al. argued that it was inevitable that changes would occur over the period of a drugs strategy and it was therefore important that the strategy would adapt to meet these changes. The review discussed a number of areas in which the NDS had lost its momentum over time, including:

• The ‘strong role of community organisations’ in both strategy development and delivery was identified as one of the key features of the Irish context (p. 9). In the course of the review, they found that in some areas of the NDS the coordination between local, regional and the national level became less effective over time. Roles and responsibilities became less clear and lines of communications blurred. This impacted on progress in a number of ways. One of these was that it meant opportunities to identify and adopt effective interventions were sometimes missed: ‘The need for effective engagement with local communities, needs based service provision, and mechanisms to ensure the quality of services delivered across locations, came up repeatedly during discussion on the current strategy’ (p. 10).
• The impact of the strategy appeared to vary across geographical areas – in particular the impact on local structures, services and practice. This was influenced by ‘changes in the location of needs since the drafting of the last strategy; the difficulty of reconfiguring delivery structures in response to these changes; and practical and resource issues related to developing service models suitable for areas where the target population is more geographical dispersed’ (p. 9).
• The policy and operational landscape changed a lot over the course of the strategy. New strategies and structures had been developed across related fields. This had brought about ‘some corresponding lack of clarity on the purpose and/or role of different structures or actors working in the area’ (p. 6).
• The commitment to research, monitoring and evidence-based interventions in the NDS was seen as one of its strengths. However, momentum in this area had faded over time. It was seen as having faced some ‘problematic coordination and structural issues’ (p. 11), including inadequate resourcing, a lack of standardisation for data collection, and a lack of capacity to analyse data collected and use it to inform strategic decisions. 

Structure of the NDS

To take learning from the experience of the NDS, the review discussed the effects of three elements of the NDS structure:

• The topic areas of the five pillars were described as ‘well chosen’, as they contained all the main elements of a ‘modern balanced drug strategy’ (p. 8). There were pros and cons to structuring the NDS around the pillars. By keeping similar areas together, it gave clarity to the main tenets of the strategy. Having a ‘point of focus’ (p. 7) encouraged joined up working in some areas. However, it also impeded cross-pillar coordination at times, in particular when resources were limited or reduced. Where issues cut across more than one pillar, they sometimes lacked ownership and failed to be addressed. However, the overall view was that the benefits of the pillar approach outweighed the costs of it. Griffiths et al. suggest that the new strategy could be designed in a way to maintain the clarity that comes from keeping similar areas together but also facilitates better cross-area working.
• Actions were embedded in the seven-year strategy. Doing so was found to have particular limitations. The actions could not be reactive to change in the drug situation over time, and this contributed to an overall perception of a decline in the NDS’s ‘relevance and momentum’ (p. 6) over its timeframe.
• The NDS included a set of key performance indicators (KPIs). These were to be used to measure progress over time. Their appropriateness as measures for both changes over time and the strategic goals they were linked to was not always clear. Furthermore, the data needed to measure them were not always available and investment in monitoring the KPIs ‘appeared to decline’ (p. 6) over the course of the strategy. They therefore did not fulfil their intended role. The authors suggested that the objectives, actions and KPIs need to be more clearly linked together and better sequenced to ensure they are achievable. 

New NDS

Based on their findings, the authors made a number of suggestions for the development of the new NDS. These included:

• Separate the actions from the strategy: Given the relatively long period of time covered by Ireland’s current and forthcoming strategies, Griffiths et al. argued strongly for separating the strategy from the actions. The strategy document could lay out the vision, objectives and structure for the seven years; and a separate time-bound (e.g. three years) action plan to support the strategy. This approach would allow for an opportunity to reflect on progress and changes in the landscape at a midpoint in the strategy’s timeframe and to make appropriate changes to the action plan.
• Synergise with other strategies: To minimise duplication, the waste of scarce resources and to maximise the impact of strategies, the authors emphasised the importance of having clear ‘synergy and complementarity’ (p. 31) between the new NDS and other related strategies. This would include strategies dealing with other substances (in particular alcohol), the needs of specific populations, areas, or social issues where drug use is an issue.
• Ensure equality of access to provision according to need: They argued that this is a concept that should cut across the strategy. High-quality interventions, of proven effectiveness, need to be universally available, irrespective of the types of drugs being used, where the user lives, or which community the user belongs to.
• Identify and roll out good practice: In the course of the review, the authors were presented with numerous examples of good practice, but it appeared there were barriers to them being implemented nationally. They argued for ‘a clear mechanism for identifying good practice, supporting programme evaluation, and encouraging wider implementation where this is appropriate’ (p. 10). They suggested drawing on national and international practice and programmes to develop a suite of approved interventions that have been proven to work and from which partners could draw.
• Monitor, research and evaluate: These are considered ‘an essential element of any strategic response in this area’ (p. 31). This would help ensure that the strategy is responsive to changing needs and will deliver on the goals. Following on from this, there needs to be mechanisms in place to facilitate the analysis of what is found and the provision of advice based on this evidence to relevant stakeholders. Stakeholders would therefore be able to spread good practice and identify problem areas.
• Clarity of structural functions for implementation and delivery: The strategy should have a clear focus on how it is to be implemented and delivered, including the organisational structure and roles and responsibilities of the various stakeholders. To facilitate the delivery of the strategy, they highlight the importance of leadership (ideally at a ministerial level with the support of a committee) to provide drive, direction/prioritisation and to ensure resources are made available.
• Alcohol: The authors gave special mention to alcohol as a theme that recurred throughout the review – the high prevalence of problems associated with it, the ‘interactions’ (p. 6) between alcohol and other drug problems, and its place in the forthcoming strategy. While Griffiths et al. do not identify a specific model to follow, they note that what is important in areas like prevention and treatment, where a ‘cross-substance approach is essential’ (p. 12), is that they are adequately supported. 

Specific issues for new NDS

Section 4 of the review identified a long list of specific issues that the team considered important for inclusion in the new strategy. Replicating the full list is beyond the scope of this article. However, current issues in Ireland that reflect those in other EU states included: meeting the needs of an ageing cohort of opiate users; new psychoactive substances; concern about cannabis in its various forms, in particular high potency products; and, the negative impact of criminalising users, especially young cannabis users. Issues that appeared to be of particular relevance to Ireland were problematic prescription drug use, the spread of opiate use to rural areas, drug-related intimidation, and homelessness and housing insecurity.

As mentioned above, this report is not an evaluation of the NDS, rather it sets out to take lessons from its delivery to inform the new NDS. This article presents just some of its key findings with far more detail available in the full report.

1    The expert review group included: Paul Griffiths, scientific director of the European Monitoring Centre on Drugs and Drug Addiction (EMCDDA), who chaired the group; Nicola Singleton, scientific analyst with the EMCDDA; and Professor John Strang, director of the National Addiction Centre, King’s College London.

2    Department of Community, Rural and Gaeltacht Affairs (2009) National Drugs Strategy (interim) 2009−2016. Dublin: Department of Community, Rural and Gaeltacht Affairs. https://www.drugsandalcohol.ie/12388/

3    Throughout this article, the National Drugs Strategy 2009−2016 will be referred to as the NDS. The National Drug Strategy 2017−2025 will be referred to as the ‘new NDS’. https://www.drugsandalcohol.ie/27603/

4    Griffiths P, Strang J and Singleton N (2016) Report of the rapid expert review of the National Drugs Strategy 2009−2016. Dublin: Department of Health. https://www.drugsandalcohol.ie/27289/