A midterm review of Ireland’s national drugs strategy was published on 17 November 2021, entitled Mid-term review of the national drugs strategy, Reducing Harm, Supporting Recovery and strategic priorities 2021–2025.1 It draws on a range of evidence sources to inform the strategic priorities and delivery structure for the remainder of the strategy’s lifetime.

Context of review

Reducing Harm, Supporting Recovery included an action plan for the period 2017–2020.2 This approach provided the opportunity for stakeholders to assess the progress of the strategy and its action plan at a midterm point. This assessment combined with any new and emerging issues were to be used to inform the development of actions for the second phase of the strategy’s lifetime from 2021 to 2025. This approach was a recommendation of the rapid expert review that was carried out on the National Drugs Strategy 2009–2016.3 It was found that having a longer-term action plan meant the actions could not be reactive to change in the drug situation over time,
which contributed to an overall perception by stakeholders
of a decline in that strategy’s relevance and momentum over
its duration.

Evidence sources

The midterm review presents evidence from five sources:

1. Examination of progress of the actions in the strategy for 2017–2020 (traffic light format)4
2. Stakeholder feedback, including a review of oversight structures (see accompanying Box)
3. Focused policy assessment of expenditure on drug and alcohol services5
4. Data on trends and indicators on drug and alcohol use6
5. Rapid assessment of the impact of the Covid-19 pandemic on drug and alcohol services7,8

These evidence sources are covered individually in articles in this or previous issues of Drugnet Ireland.

Stakeholder feedback on national drugs strategy

As part of the midterm review of the national drugs strategy, the Department of Health collected feedback from stakeholders represented on the National Oversight Committee (NOC) through 10 ‘engagement sessions’ (p. 7).1 Submissions were also received from ‘groups outside the NOC’ but no further information on how this information was collected is provided in the report. The engagement sessions were structured around three questions:

•    How well is the strategy delivering on its goals?

•    Are there specific areas/priorities that the strategy should focus on for the period 2021–2025?

•    Are there ways in which the structures for the delivery of the strategy could be improved/strengthened?

Findings of review

The findings make up a significant part of the midterm review document (pp. 7–21). They are presented thematically and cover a wide range of topics, including those related to the structure of the strategy and its implementation bodies; ongoing and emerging needs; and monitoring, research, and evaluation associated with the strategy. It is beyond the scope of this article to present all of the issues covered; however, a selection of them are featured below.

•    The health-led approach: Having the needs of the individual at the centre of the strategy was seen as key. The health-led approach was perceived to be a success. However, it was seen to be linked to the work of law enforcement to reduce the supply and availability of illicit drugs.

•    Evolving drug markets: Stakeholders recognised that drug markets and drugs are continuously evolving and that keeping on top of new substances is an ongoing requirement. Resources such as the Early Warning and Emerging Trends subcommittee are seen as useful in this context. There was support for sustaining and increasing cooperation at an international level.

•    Alternative approaches to imprisonment: There was support for the implementation of the Health Diversion Programme and the ongoing operation of the Drug Treatment Court. Progress on the Health Diversion Programme was seen as slow, while it was suggested that the Drug Treatment Court should undergo an independent review.

•    Alcohol: Reducing Harm, Supporting Recovery is the first national drugs strategy to cover both alcohol and other drugs. However, there was criticism that alcohol did not receive adequate attention in the action plan for the period 2017–2020 and that this should be addressed in the remainder of the strategy’s lifetime.

•    Alignment with other strategies: The needs of a person who uses drugs tend to be complex and multifaceted. Government policies have been developing since 2017 and the report argues that the associated strategies need to be aligned as much as possible to meet these complex needs. These include national and international strategies across the range of sectors.

•    Collaboration: Overall, the strategy was seen to have facilitated improved collaboration between relevant departments, agencies, and services. However, opportunities for improvement included the formation of a ‘real partnership’ (p. 12) between state agencies and affected communities, which in turn increases cooperation between youth services and drug services to meet the needs of 14–18-year-olds.

•    Drug and Alcohol Task Forces (DATFs): There was a call for a strengthening of the role of DATFs. DATFs argued for a more visible role in the actions contained in the strategy. For example, they ‘could bring together the community, family and service users which could have a positive impact on communication and participation and could also assist in identifying emerging needs’ (p. 14).

•    Support for families and communities: Ongoing support is required for building the capacity of communities to respond to the drugs situation. There is an increasing need to strengthen the response on drug-related intimidation and violence, which has such a negative impact on many communities.

There are many other topics covered in this section of the review; for example, research, stigma, diversity and inclusion, prevention and education, and dual diagnosis.

New strategic priorities and delivery structure

The main outcome of the midterm review is the development of six new strategic priorities for the remainder of the strategy. In addition to the five evidence sources listed above, the priorities were informed by an examination of other key strategic documents. These include the European Union (EU) Drugs Strategy 2021–2025; Sláintecare Implementation Strategy and Action Plan 2021–2023; Healthy Ireland Strategic Action Plan 2021–2025; and Programme for Government commitments.

Strategic priorities

The six strategic priorities will be delivered through specific actions, while progress will be measured though outcome indicators. An agreed list of actions and indicators will be developed for each priority. The six priorities are outlined below.

1    To strengthen the prevention of drug and alcohol use and the associated harms among children and young people: This will cover a variety of settings (school, community, and family) and will focus on increasing resilience and strengthening life skills and healthy life choices. Activity under this priority will be informed by the European Prevention Curriculum (EUPC) and the International Standards on Drug Use Prevention.9,10

2    To enhance access to and delivery of drug and alcohol services in the community: Delivery of this priority will be supported through the development of a drug services care plan across the six health regions. Particular focus will be put on ensuring access to services for women, people in rural areas, ethnic minorities, and the LGBTI+ community. This priority will consider models of care for people who use drugs and have comorbidities. It also aims to address the stigma linked to drug use and drug addiction and its impact on access and delivery of health services.

3    To develop integrated care pathways for high-risk drug users to achieve better health outcomes: This group includes people who are homeless, offenders, stimulant users, and people who inject drugs. It is argued that integrated care pathways that connect care settings (general practitioners, primary/community care providers, community specialist teams, and hospital-based specialists) are required to deliver the best outcomes for this cohort. A key outcome indicator will be the reduction in drug-related deaths among these people. The review identifies the experience of the Dublin Covid-19 homeless response as providing a template for the kind of integrated care response required. This priority will also involve strengthening harm reduction responses to high-risk drug use associated with the night-time economy and music festivals, including proposals for drug monitoring.

4    To address the social determinants and consequences of drug use in disadvantaged communities, including the Travelling community: This priority will also tackle the criminality and antisocial behaviour associated with the drug trade and the negative impact it has on the communities in which it is based. To address these issues, action is required across Government to promote community development and community safety. Ensuring synergy with the Sláintecare Healthy Communities programme to address health inequalities will be a key objective.

5    To promote alternatives to coercive sanctions for drug-related offences: This priority will reinforce the health-led approach to people who use drugs, which is at the core of the national drugs strategy. The main focus will be on the rollout of the Health Diversion Programme for people in possession of drugs for personal use. Other initiatives, such as the Drug Treatment Courts, will also be supported. A particular emphasis will be on the exchange of best practice on alternatives to coercive sanctions with EU member states.

6    To strengthen evidence-informed and outcomes-focused practice, services, policies, and strategy implementation: This priority will facilitate the exchange of knowledge and expertise. Learning the lessons of the response to the Covid-19 pandemic will be a key theme. It will strengthen Ireland’s contribution to best practice at EU level, in collaboration with the European Monitoring Centre for
Drugs and Drug Addiction (EMCDDA) and the Health Research Board (HRB) Reitox national focal point. Service innovation will be identified from the network of drug and alcohol task forces.

Horizontal themes

The review also identifies five horizontal themes that will support delivery of the strategic priorities:

1. Involvement of service users in the design and delivery of services based on a human rights perspective and the promotion of health literacy
2. Active and meaningful participation of civil society in the development, implementation, and evaluation of policies and services
3. Good governance, accountability, and mutual respect by all partners
4. Cross-sectoral funding and the targeting of additional resources
5. Public sector equality and human rights duty11

Revised delivery structure

The findings of the review have led to changes being made to the structures supporting the implementation of the strategy (see Figure 1). The standing subcommittee and other subcommittees in place up until this midpoint in the strategy will be replaced by a strategic implementation group (SIG) for each of the priorities as well as a research subcommittee. The research subcommittee will oversee the research outputs of the strategy, including the national drug and alcohol survey, in conjunction with the HRB. The SIGs will reinforce cross-agency working and have an independent chair who will be a member of and report back to the National Oversight Committee. A service user and a nominee from both civil society and the task force network will be included in each SIG’s membership. The Early Warning and Emerging Trends subcommittee will remain in place in keeping with the previous structure.

Figure 1: Coordination of bodies for the implementation of the national drugs strategy, 2021–2025 (p. 37)1

1  Drugs Policy and Social Inclusion Unit (2021) Mid-term review of the national drugs strategy, Reducing Harm, Supporting Recovery and strategic priorities 2021–2025. Dublin: Department of Health. https://www.drugsandalcohol.ie/35183/

2  Department of Health (2017) Reducing Harm, Supporting Recovery: a health-led response to drug and alcohol use in Ireland 2017–2025. Dublin: Department of Health. https://www.drugsandalcohol.ie/27603/

3  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/

4  Drugs Policy and Social Inclusion Unit (2020) Reducing Harm, Supporting Recovery: progress report 2020. Dublin: Department of Health. https://www.drugsandalcohol.ie/34857/

5  Bruton L, Gibney S, Hynes T, Collins D and Moran P (2021) Spending review 2021. Focused policy assessment of Reducing Harm, Supporting Recovery: an analysis of expenditure and performance in the area of drug and alcohol misuse. Dublin: Government of Ireland. https://www.drugsandalcohol.ie/34729/

6  Mongan D, Millar SR and Galvin B (2021) The 2019–20 Irish National Drug and Alcohol Survey: main findings. Dublin: Health Research Board. https://www.drugsandalcohol.ie/34287/

7  Bruton L, Featherstone T, Gibney S and Department of Health (2021) Impact of COVID-19 on drug and alcohol services and people who use drugs in Ireland: a report of survey findings. Dublin: Government of Ireland.
https://www.drugsandalcohol.ie/34128/

8  Galvin B (2021) Impact of Covid-19 on drug and alcohol services and people who use drugs in Ireland: a report of survey findings. Drugnet Ireland, 78 (Summer): 14–15. https://www.drugsandalcohol.ie/34742/

9  European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) (2019) European prevention curriculum: a handbook for decision-makers, opinion-makers and policy-makers in science-based prevention of substance use. Luxembourg: Publications Office of the European Union. https://www.drugsandalcohol.ie/31119/

10 United Nations Office on Drugs and Crime (UNODC)/World Health Organization (WHO) (2018) International standards on drug use prevention. 2nd updated edn. Vienna: United Nations Office on Drugs and Crime. https://www.drugsandalcohol.ie/30048/

11 All public bodies in Ireland have a responsibility to promote equality, prevent discrimination, and protect the human rights of their employees, customers, service users, and everyone affected by their policies and plans. This is a legal obligation, called the public sector equality and human rights duty, and it originated in Section 42 of the Irish Human Rights and Equality Commission Act 2014. For further information, visit: https://www.ihrec.ie/our-work/public-sector-duty/­