Published in June 2022, the latest National Drug Treatment Reporting System (NDTRS) report presents trends in treated problem drug use (excluding alcohol) for the seven-year period from 2015 to 2021.1,2

Key findings

Over the period, some 69,450 cases treated for problem drug use (excluding alcohol) were reported to the NDTRS.3 The number of treated cases recorded increased from 9,892 in 2015 to 10,769 in 2021 (see Table 1). Between 2019 and 2020, the number of treated cases decreased by 9%, from 10,664 cases to 9,702 cases, increasing to 10,769 cases in 2021.

The overall drop in the number of cases entering drug treatment in 2020 is in part the result of temporary service closures and measures introduced to comply with Covid-19 restrictions and does not necessarily indicate a real decline in demand for treatment.4,5

New cases (never previously treated) accounted for 37.8% of cases in 2015 and 39.1% in 2021. Previously treated cases accounted for 59.2% of cases in 2015 and 56.6% in 2021.

In 2021, the majority of cases (70.3%) were treated in outpatient facilities as in previous years, while 12.9% of cases were treated in inpatient facilities, 8.5% in low-threshold services, 6.1% in prisons, and 2.2% by general practitioners (GPs) (see Table 2).6

Between 2019 and 2020, the number of cases treated in residential settings decreased by 24.3%, from 1,571 cases to 1,190 cases, rising to 1,394 cases in 2021. The reduction in residential case numbers in 2020 can in part be attributed to temporary closures and measures introduced to comply with Covid-19 restrictions.

Main problem drug

Opioids, mainly heroin, remain the main problem drug reported over the period. As a proportion of all cases treated, opioids decreased year-on-year from 47.8% in 2015 to 33.7% in 2021 (see Table 3).

Cocaine was the second most common main problem drug reported in 2021. There was a threefold increase in the proportion of cases treated for cocaine as a main problem, rising from 10.4% in 2015 to 30.2% in 2021. In 2021, for the first time, the NDTRS recorded more cocaine (n=3248) than heroin (n=3168) cases among those treated for drugs as a main problem.

Cannabis was the third most common main problem drug reported in 2021. The proportion of cases treated for cannabis as a main problem decreased from 28.2% in 2015 to 21.3% in 2021.

In 2021, as in 2020, cocaine remained the most common main problem drug among new entrants to treatment (see Table 3). Cocaine replaced cannabis as the most common main problem drug among new entrants in 2020. In 2021, cocaine accounted for 38.4% of new cases, followed by cannabis (35.2%) and opioids (12.6%). Among new cases, cocaine increased from 13.7% in 2015 to 38.4% in 2021.

Polydrug use

Over the period, the majority of cases (57.8%) reported polydrug use, i.e. problem use of more than one substance. The proportion of cases that reported polydrug use decreased from 60.9% in 2015 to 53.4% in 2018, then increased to 58.2% in 2021 (see Table 4).

In 2021, cannabis (42%) was the most common additional substance reported by cases with polydrug use, followed by cocaine (35.9%), benzodiazepines (35.8%), and alcohol (35.8%). 

Table 1: Number of cases treated for drugs as a main problem, by treatment status, NDTRS 2015–2021

Table 2: Number of cases treated for drugs as a main problem, by type of service provider, NDTRS 2015–2021

* Includes any service where the client stays overnight, e.g. inpatient detoxification, therapeutic communities, respite, and step-down.

Table 3: Main problem drug excluding alcohol reported in 30 days prior to treatment, NDTRS 2015–2021

* Z-drugs are non-benzodiazepine hypnotic sedative drugs, e.g. zolpidem and zopiclone.

** NPS: New psychoactive substances.

~ Cells with five cases or fewer. 

Table 4: Polydrug use in cases treated for drugs as a main problem, NDTRS 2015–2021

Risk behaviour

The proportion of all cases that had ever injected decreased from 33.7% in 2015 to 21% in 2021. Among cases that had ever injected, the proportion currently injecting, i.e. in the 30 days prior to treatment, decreased from 36.7% in 2015 to 32.7% in 2021.

Sociodemographic characteristics

The following sociodemographic characteristics of the cases were noted:

• Seven in 10 cases (73.0%) reported over the period were male.
• The median age of cases when entering treatment increased from 30 years in 2015 to 32 in 2021.
• Under 18s accounted for 5.5% of cases in 2021.
• Cases recorded as homeless increased in proportion from 9.2% in 2015 to 12.5% in 2021.
• The proportion of cases with an Irish Traveller ethnicity increased from 2.9% in 2015 to 3.4% in 2021.
• A large proportion of cases (58.8%) were unemployed in 2021, as in previous years.
• The proportion of cases in paid employment increased from 8.9% in 2015 to 20.5% in 2021.
• In 2021, 1 in 6 cases (15.8%) treated for problem drug use were residing with children aged 17 or younger.

Sociodemographic characteristics – cocaine as main problem

The following sociodemographic characteristics of cases with cocaine as a main problem were noted:

• Eight in 10 cases (78.4%) reported over the period were male.
• The proportion of female cases increased from 1 in 5 cases (19.2%) in 2015 to 1 in 4 cases (25.2%) in 2021.
• The median age of cases when entering treatment rose from 30 years in 2015 to 31 years in 2021.
• Under 18s accounted for 1.9% of cocaine cases in 2015 and 0.9% in 2021.
• The proportion of cases in paid employment increased from 24.3% in 2015 to 34.2% in 2021.
• Cases with polydrug use decreased in proportion, from 70.9% in 2015 to 62.7% in 2021.
• In 2021, the most common additional substances were cannabis (53.3%), alcohol (52.1%), and benzodiazepines (30.5%).

1    The NDTRS is the national epidemiological surveillance system that reports on treated problem drug and alcohol use in Ireland. Established in 1990, the NDTRS is maintained by the National Health Information Systems (NHIS) of the Health Research Board (HRB) on behalf of the Department of Health.

2    Kelleher C, Condron I and Lyons S (2022) National Drug Treatment Reporting System: 2015–2021 drug treatment data. HRB StatLink Series 8. Dublin: Health Research Board. https://www.drugsandalcohol.ie/36071

3    The data reflect the number of entries into treatment in a calendar year, rather than the number of persons treated in that year.

4    The capacity and functionality of treatment services were impacted by Covid-19 restrictions. The NDTRS surveyed participating services to estimate the impact of the restrictions on treatment data for 2020, with a response rate of 80%. Around 40% of services surveyed expressed some impact on their ability to provide returns, while around 50% expected some impact on numbers (unpublished data).

5    To comply with European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) requirements and enable services to accurately reflect their activities in response to Covid-19 restrictions, the NDTRS added functionality to the LINK database to record treatment provided over the telephone or internet (teleworking).

6    Coverage of services was 70% for 2021. The number of services participating in the NDTRS varies annually, making small fluctuations in the numbers of cases difficult to interpret. Coverage for most service types ranges between 86% and 100%; the main reason for the shortfall is the poor participation of GPs who provide opioid substitution treatment (OST). In 2021, only 45% of eligible GPs participated in the NDTRS. In addition, the NDTRS receives counselling data but no OST data from the Irish Prison Service. This means that the number of OST cases are underrepresented in the NDTRS.