Introduction

An evaluation of the national drugs strategy Reducing Harm, Supporting Recovery 2017-2025 was published in July 2025.1 The independent evaluation was commissioned by the Department of Health and carried out over a four-month period by a team of researchers from Grant Thornton Ireland.

From L-R: Antoinette Kinsella, Chair, DRIVE Oversight Committee; Jim O’Callaghan, Minister for Justice; Jennifer Murnane O’Connor, Minister of State at the Department of Health; and Shawna Coxon, Deputy Commissioner, An Garda Síochána at the launch of DRIVE project. Photo by Bryan Brophy, 1IMAGE Photography.

Evaluation goals

As required by the Department of Health’s specification for the evaluation of the national drugs strategy, the findings are reported across four domains that reflect the goals of the evaluation. These four domains are as follows:

1   The impact of the strategy: In relation to the strategy’s goals and strategic priorities, to assess its overall impact in delivering a public health-led and whole-of-government response to drug and alcohol use.

2   Governance and coordination effectiveness: To review the governance and coordination structures involved in the implementation of the strategy, including the contribution of stakeholders (such as civil society and Drug and Alcohol Task Forces), government oversight, and reporting arrangements.

3   Performance against key outcome indicators: To measure the strategy’s performance against key outcome indicators, and to assess the broader impact of substance use on families, communities, and society. Key outcome indicators include:

• Prevalence and patterns of drug use
• Demand for drug and alcohol treatment services, and
• Incidence of drug-related harms, including drug related deaths.

4   Coherence with international drugs strategies: To explore the coherence and synergies between the strategy and relevant international responses. While those listed in the tender document included international responses such as those of the European Union (EU), the European Union Drugs Agency (EUDA), the Pompidou Group, and the British-Irish Council, the evaluation focused on collecting data on the national drugs strategies of seven countries.

The evaluation also aimed to inform Ireland’s next drugs strategy by identifying the accomplishments of the 2017–2025 strategy, areas where improvements could be made, and making recommendations to address drugs use in Ireland into the future.

Methodology

The evaluation used a mixed-methods approach. Data collection included five elements:

1   Context mapping: A mapping of the evolution of drug policy in Ireland, the context in which the 2017–2025 strategy was developed, and any reviews of the strategy carried out to date.

2   Documentation review: A review of documents published since the start of the strategy that explore drug use in Ireland. Sources included: Google Scholar, the Health Research Board’s (HRB’s) National Drugs Library, Lenus, and the Department of Health. Documents were ‘narratively summarised to present the overarching recurring themes, patterns, concepts, and issues raised’ (p. 28).1

3   Data review: A review of some of the national data on drug and alcohol use in Ireland, related to the period 2015–2024.

4   Stakeholder consultations: Collection and analysis of interviews, focus groups, and written submissions from stakeholders to identify the accomplishments in the lifetime of the strategy, areas for improvement, and suggestions for the future focus of Ireland’s national drugs strategy.

5   International review: Ireland’s national drugs strategy was comparatively reviewed against those of seven other countries. The evaluation team reviewed each country’s strategy and policy orientation, as well as any collaborations with Ireland.

The evaluation findings evolved from two main activities that drew on the data collected:

1   Data integration: The team synthesised the data collected above ‘to identify patterns, confirm validity of stakeholder observations and confirm accuracy of emerging conclusions’ (p. 24).1

2   Findings: The findings were identified across the four domains outlined above.

Finally, a set of recommendations was generated, based on the data collection and analysis outlined above.

Evidence review

The findings from the five elements of the evidence review are presented in Chapter 4 of the evaluation report. The chapter provides a summary of each strand of data collection, reflecting the wide-reaching nature of the strategy and the complexity of the data. Two key gaps were identified by the HRB in relation to opioid use. These are discussed in the final section of this article.

Evaluation findings

Chapter 5 of the evaluation report presents a set of key findings. The authors of the evaluation define a key finding as ‘a distinct thematic element or operational component identified through the evaluation process as being of strategic relevance to the implementation and outcomes of the national drugs strategy (2017–2025)’. These emerged through a mixed-methods approach to bring together the quantitative and qualitative data gathered by the team. The process involved:

• ‘Data integration: Consolidating all relevant data to establish a comprehensive and robust foundation.
• Pattern identification: Examining the integrated dataset to identify patterns and trends across data types.
• Validation: Engaging with Strategic Implementation Group 6 to validate emerging findings, ensuring their accuracy, relevance, and alignment with policy objectives.’ (p. 81).1

A set of findings is presented under each of the four domains outlined above. Each finding is categorised under one of three rating levels, which the evaluation’s authors say reflect the status of implementation and progress, based on the strength of evidence, stakeholder feedback and alignment with the strategy. The ratings are:

Accomplishments: The topic of focus is progressing well and demonstrates strong alignment with the goals of the strategy. Implementation is active and positive developments are either emerging or already evident.

Progress underway: Meaningful steps have been taken in the topic of focus, and implementation is in progress. However, further work is required in order to strengthen delivery, embed practices, and ensure consistency across settings.

Areas for improvement: This rating indicates limited progress to date. Strategic intent may be underdeveloped, and significant work is needed in order to initiate or advance implementation.

Twenty-five key findings were identified across the four domains. Of these, seven were rated as accomplishments, eight as progress underway, and 10 were rated as areas for improvement. Set out below is a summary of the evaluation’s findings for each domain, as presented in the evaluation report. 

Domain 1: To assess the overall impact of the strategy, its goals and priorities, in delivering a public health-led and whole-of-government response to drug and alcohol use.

Accomplishments

• The expansion of harm reduction strategies nationwide: Harm reduction initiatives were seen as a central component of the health-centred approach of the strategy. Stakeholders expressed broad support for this approach and the initiatives identified as having progressed in the lifetime of the strategy – the expanded availability of naloxone, the operation of needle exchange programmes, and the introduction of drug-checking services at festivals.
• Strong responses to crisis events and emerging drug threats: The response of drug services to the COVID-19 pandemic and the cluster of overdoses linked to nitazines were highlighted as examples of the structures in place to support the capacity for timely, health-oriented interventions in crisis situations.

Progress underway

• The provision of integrated and holistic care: Services related to addiction, mental health, housing and criminal justice were reported to operate often in isolation, and therefore were not meeting the complex needs of some service users. However, the evaluators noted the launch of the HSE Model of Care for Dual Diagnosis in 2023 as a positive step towards providing more integrated care.
• Equity of access and inclusion: Stakeholders identified geographic and demographic disparities in access to treatment services. While some promising community-led and peer-driven initiatives that promote recovery and reduce stigma were identified, these were described as often being underfunded.

Areas for improvement

• Improve prevention and early intervention: Prevention was described as underdeveloped, inconsistent, and lacking in national ownership.
• Embed lived experience in policy and advancing recovery supports.
• The need for better integration of drug policy with problem alcohol use policy: There were concerns that the strategy only gave limited attention to problematic alcohol use and that a more unified approach to alcohol and other drugs was needed.
• The need for legal reform and alternative sanctions: The implementation of alternative sanctions for drug offences was found to be applied inconsistently across the country.
• Sustainable funding and workforce sustainability: There are staff shortages and disruptions in service delivery due to funding issues and restrictive hiring policies. Stakeholders called for multi-annual funding commitments and investment in the workforce. 

Domain 2: To review the governance and coordination structures underpinning the strategy, alongside evaluating the contributions of stakeholders, government oversight, and reporting arrangements.

Accomplishments

• Strengthened governance structures to support implementation: The introduction of the Strategic Implementation Groups (SIGs) was perceived to have improved coordination in the implementation of the strategy, as well as engagement in the process among stakeholders.
• Interagency involvement at local and regional level: Civil society organisations and the Drug and Alcohol Task Forces were found to play a key role in implementing the strategy at a community level. They were described as well-positioned to respond to local needs and priorities. Interagency collaboration was reported to have strengthened over the course of the strategy.

Progress underway

• Strengthening governance and accountability structures: Despite the accomplishments in this area, stakeholders called for more clearly defined roles, mandates, and oversight mechanisms in key structures.
• Enhanced data collection: Integrating timely and consistent data from multiple sources could support broader surveillance and analysis of emerging drug trends, and improved responses.

Areas for improvement

• Inclusion, communication, and lived experiences in decision-making: A disconnect between policy development and the lived experience of people affected was highlighted. The evaluators argued that inclusive decision-making processes could improve the relevance, responsiveness, and trust in the implementation of the strategy. 

Domain 3: To evaluate the strategy’s performance against the key outcome indicators of drug prevalence, treatment, and drug poisoning deaths.

The evaluators acknowledge the challenge of attribution when considering the indicators – it is not possible to definitively attribute any trends or changes to the implementation of the strategy. Other external factors may have influenced observed outcomes. Only areas for improvement were identified. The HRB found gaps in the data considered in relation to changes in patterns of drug use in this section of the evaluation, specifically in relation to opioid use. These gaps are discussed in the HRB comments section at the end of this article.

Areas for improvement

• Changes in patterns of drug use: Cocaine use and polydrug use are both increasing in Ireland, and new substances consistently emerge. More targeted interventions and agile responses are required in order to reduce the risk of harm.
• Incidence of drug-related harms, including drug poisoning deaths: There has been an overall upward trend in the number of drug poisoning deaths between 2012 and 2021. However, there was a 20% decrease in the number of drug poisoning deaths between 2020 and 2021.
• Outcome measures: The evaluation identifies ‘a critical need for measurable outcomes to assess the effectiveness of policies, interventions, and government expenditure on drug-related issues. Measuring direct effectiveness is challenging due to the need to integrate multiple data sources, inconsistent data collection, time lags, and other factors’
  (p. 104).1
• Data on drug-related expenditure: The authors of the evaluation identified unlabelled expenditure and productivity costs as being part of the ‘burden of drug and alcohol misuse’ (p. 104).1 The availability and quality of expenditure data severely constrains the evaluation of the strategy’s performance and any assessment of cost-effectiveness.

Domain 4: To explore the alignment of Ireland’s strategy (2017-2025) with relevant international responses.

Accomplishments

• Active engagement with the EU and alignment with broader EU policy frameworks: Ireland actively participates in EU-level working groups, research collaborations, and policy development initiatives. Alignment is illustrated by the emphasis on a health-led and rights-based framework.
• International cooperation: Ireland plays an active role in the British-Irish Council and the Pompidou Group, and is committed to human rights and sustainable development through United Nations (UN) engagement.
• Effective use of data and early warning systems: The HRB submits national data to the EUDA on an annual basis and participates in the European Early Warning System.

Areas for improvement

• Health-led reform: Further integration is needed of a health-led model underpinned by comprehensive services.
• Integrated and accessible care: It is recommended that opioid agonist treatment (OAT) services be expanded through general practitioners (GPs) and that addiction care be integrated into primary care.
• Inclusive, trauma-informed and youth-focused responses to drug use: The evaluators identify a need for trauma-informed and community-based strategies, and ways to address drug use among students through youth-focused, education-led initiatives.
• Promotion of International Overdose Awareness Day: By promoting this day, help to reduce stigma, remember lives lost, and raise awareness.

Recommendations

The evaluation contains 10 recommendations, divided into three broad themes: people, process and systems. The aim of the recommendations is ‘to guide the next phase of strategic development, ensuring a more coordinated, equitable, and outcomes-focused response to drug use in Ireland’ (p. 117).1 Outlined below are the topline recommendations, as they appear in the report (p. 117–123).1

People

1   Embed an equity lens throughout the national drugs strategy, ensuring culturally appropriate services, and strengthening data systems to monitor the impact on populations.

2   Increase community engagement and service user involvement by embedding participatory approaches in policy-making, service design, and provision of community-based services.

3   Align service delivery with regional needs and enhance the capacity of service providers to ensure equitable and consistent implementation.

Process

4   Maintain and strengthen coordination and communication between the National Oversight Committee and the SIGs by clarifying roles, improving information-sharing structures, and enhancing transparency in decision-making.

5   Establish formal mechanisms for interdepartmental collaboration on cross-sectoral issues impacting on drug policy, particularly in areas such as housing, justice, and health.

6   Continue to strengthen the health-led response by placing a focus on justice system reform, community-based responses, and investment in community safety and trust-building initiatives.

Systems

7   Embed recovery as a central aspect of the national drugs strategy by ensuring equitable access to integrated, peer-led, and person-centred recovery services across all regions.

8   Strengthen prevention and early intervention by investing in evidence-based programmes that address social determinants of drug use, support at-risk youth and families, and embed trauma-informed practice across all services.

9   Strengthen the integration of alcohol within the national drugs strategy by clearly defining roles, responsibilities, and service provisions for the prevention, treatment, and recovery of alcohol-related harm, including the national rollout of integrated community alcohol treatment services.

10 Optimise the use of data by further investing in comprehensive monitoring, evaluation, and research systems to inform evidence-based policy, track progress, and support accountability at all levels.

Limitations

The authors of the evaluation identified a set of limitations to their work which they recognised could impact on the overall evaluation and recommendations.

Short time frame of the evaluation: The ‘accelerated time frame’ of the evaluation (i.e. under four months) ‘posed significant constraints’ on the depth and breadth of analysis that could be carried out (p. 26)1,
as well as the team’s ability to identify the nuances of the implementation, outcomes,
and the long-term impact of the strategy.

Scope of stakeholder engagement: Despite engaging representatives from various Government Departments and service provider and user organisations, the authors identified the scope of stakeholder consultations as a key limitation in the evaluation. Therefore, they note: ‘this section of the report may not fully capture the diverse experiences and perspectives of all service provider and service user organisations involved in the national drugs strategy’. They describe the different groups as having different perspectives and experiences when discussing the strategy. However, they see as a limitation that ‘these varying viewpoints made it challenging to form a comprehensive and unified conclusion’ (p. 26).1 The HRB would consider that the value of carrying out consultations with different groups is the varying perspectives gained. This can provide an opportunity to analyse areas of overlap and agreement, and possible areas of difference, and the implications of these.

Complexity of the data: The data used to evaluate the strategy are ‘highly complex, encompassing various quantitative and qualitative metrics’ (p. 26).1 The authors found that the complexity was compounded by a need to integrate data from multiple sources, and what they considered to be ‘the outdated nature of some of the available data’ (p. 26),1 the impact of the COVID-19 pandemic on data, and a lack of ‘sufficient granularity’ of some data, limiting their ability to carry out detailed analysis (p. 26).1

Additional limitations of the evaluation identified by HRB researchers, stemming from those outlined above, are discussed in the section below.

HRB comments on the evaluation

The evaluation of the strategy provides valuable insights that will inform the development of the next national drugs strategy. The authors of the evaluation identified a set of limitations, including the short time frame given to the evaluation and the complexity of the data. The HRB recognises these limitations and agrees that they are reflected in parts of the report. Among the limitations, the HRB has identified two gaps in the evidence as presented that it considers important to note. Both gaps relate to opioid use. While relatively few young people are starting to use heroin, there continues to be a considerable cohort of ageing opioid users who will need ongoing OAT treatment and also additional care, given the high prevalence of comorbidities within this population. An accurate understanding of the scale and nature of their treatment needs (for their addiction, mental health, and physical comorbidities) is important, in order to inform the deliberations of the development of the new strategy and ensure that these people’s needs are met.

Prevalence of opioid use: The prevalence of opioid use is a central feature of the landscape of drug use in Ireland, particularly in the context of the level of harms caused. While the evaluation considers prevalence data gathered through general population surveys, these do not provide adequate insights when exploring opioid use. In order to fill this gap, three studies have been carried out specifically to estimate the prevalence of problematic opioid use in Ireland covering periods from 2011 to 2022.2, 3, 4 The evaluation does not consider the findings of these studies. The overall message of this body of work is that the prevalence of opioid use significantly declined among young people in Ireland over the 10-year period, and the prevalence of opioid use overall stabilised. While recognising that the estimates do not cover all years of the strategy’s lifetime, the HRB considers the three studies to be an important body of evidence, the findings of which should be considered when exploring changes in Ireland’s drugs situation over the course of the national drugs strategy.

Opioid agonist treatment (OAT) and the Central Treatment List (CTL) data: OAT is a key drug treatment service in Ireland. The Central Treatment List (CLT) is the administrative database to regulate the dispensing of OAT in Ireland and is a complete register of all patients receiving OAT (as treatment for problem opioid use) in Ireland. The evaluation did not explore these data. OAT is considered in the context of the National Drug Treatment Reporting System data, and a report on the impact of OAT on people experiencing homelessness. The omission of the CTL data is problematic. For example, CTL data show that approximately 37% of all OAT is provided by GPs (as of 31 December 2024 - unpublished CTL data). This is not fully reflected in the NDTRS data as GPs have limited levels of participation in this system. As a result, the evaluation is not correct in concluding that GPs have ‘limited participation in the provision of OAT’ (p. 113).1 The HRB recognises that there are difficulties in gaining access to an OAT GP in some areas, but the picture is complex.

1    Grant Thornton. (2025) Evaluation of the National Drug Strategy “Reducing Harm, Supporting Recovery 2017-2025”. Dublin: Department of Health. https://www.drugsandalcohol.ie/43790/

2    Hanrahan MT, Millar SR, Mongan D, Lyons S and Galvin B (2025) Prevalence of problematic opioid use in Ireland, 2020–2022. Dublin: Health Research Board. https://www.drugsandalcohol.ie/42700/

3    Hanrahan MT, Millar SR, Phillips KP, Reed T, Mongan D and Perry IJ (2022) Problematic opioid use in Ireland, 2015–2019. Dublin: Health Research Board. https://www.drugsandalcohol.ie/35856/

4    Hay G, Jaddoa A, Oyston J, Webster J, Van Hout MC and dos Santos RG (2017) Estimating the prevalence of problematic opiate use in Ireland using indirect statistical methods. Dublin: National Advisory Committee on Drugs and Alcohol. https://www.drugsandalcohol.ie/27233/