Building on Experience

National Drugs Strategy 2001 – 2008D e p a rtment of Tourism, Sport & Recre a t i o n .

Building on Experience

National Drugs Strategy 2001 – 2008D e p a rtment of Tourism, Sport & Recre a t i o n .

DublinPublished by the Stationery Office

To be purchased directly from theGovernment Publications Sales Office,Sun Alliance House, Molesworth Street, Dublin 2or by mail order fromGovernment Publications, Postal Trade Section,4-5 Harcourt Road, Dublin 2or from any bookseller.

Pn: 9729

ISBN: 0-7076-9073-0

£5.00

Baile Átha CliathArna fhoilsiú ag Ofig an tSoláthair

Le ceannach díreach ónOifig Dhíolta Foilseachán RialtaisTeach Sun Alliance,Sráid Theach Laighean,Baile Átha Cliath 2nó tríd an bpost óFoilseachán Rialtais,An Rannóg Post-Tráchta,4-5 Bóthar Fhearchair,Baile Átha Cliath 2nó trí aon díoltóir leabhar.

© Government of Ireland 2001.Designed by Oonagh Young Design.Printed by Cahill Printers.

C O N T E N T S

Foreword 1

Executive Summary 3

Introduction to the Review 111.1 Terms of Reference 121.2 Review Process 131.3 The Report 15

PART I – REVIEW OF THE CURRENT STRATEGY 9

Overview of Drug Misuse in Ireland 172.1 National Data Collection 182.2 Data Collection at European Level 192.3 Drug Misuse in Ireland 202.4 National and Regional Trends 212.5 Types of Drugs Misused 242.6 Drug Misuse In Prisons 262.7 Drug Misuse among Young People 282.8 Other at Risk Groups 342.9 Heroin Misusers in Treatment 372.10 Prevalence Comparisons with other Countries 402.11 Addressing Gaps in Prevalence Data 422.12 Summary 43

State Response to the Drug Problem in Ireland 453.1 Introduction 463.2 Supply Reduction Pillar 513.3 Prevention Pillar 543.4 Treatment Pillar 573.5 Research Pillar 593.6 Co-ordination across the Pillars 603.7 Public expenditure on the Current Drugs Strategy 62

Overview of International Responses to Drug Misuse 654.1 The International Trade in Drugs 664.2 European Union 684.3 Overview of Selected national Drug Policies 704.4 Australia 704.5 The Netherlands 714.6 Portugal 724.7 England 724.8 Scotland 734.9 Spain 744.10 Sweden 754.11 Switzerland 764.12 Substitution Treatments in the European Union 784.13 Final Comments 79

Overview of Issues Emerging from the Public Consultation Process 815.1 Introduction 825.2 Supply Reduction 825.3 Prevention 845.4 Treatment 865.5 Co-Ordination 88

PART II – TOWARDS A NEW STRATEGY 2000 – 2008 91

Conclusions and Action Plan 936.1 Introduction 946.2 Supply 966.3 Prevention 986.4 Treatment 1006.5 Research 1046.6 Co-ordination 1056.7 Framework for the National Drugs Strategy 2001 – 2008 1086.8 Action Plan 112

PART III – APPENDICES 125

Glossary 126

Appendix 1 Membership of Inter-Departmental Committee on Drugs (IDG) 127Membership of the National Drugs Strategy Team 127National Drugs Strategy Review Sub-Group 128

Appendix 2 Responses to the Drug Problem in Ireland 129

Appendix 3 Submissions Received Individuals 130Submissions Received Organisations 130Submissions Received Oral Hearings 132

Appendix 4 Drug Treatment Types 133

Appendix 5 Drug Types 135

Appendix 6 References 133

Eoin Ryan T.D.Minister of State with special re s p o n s i b i l i t yfor the National Drugs Strategy.

F O R E W O R D

Drug misuse is one of the great social illsof our time. It affects individuals, familiesand whole communities. That is why thisreview of our current drugs policy is soimportant. It is the most comprehensiveanalysis and assessment of the drugsproblem ever conducted in Ireland andoutlines the policy framework throughwhich all those involved in addressingthis problem can work for the next seven years.

A striking feature of the consultationsconducted as part of the re v i e w, part i c u l a r l youtside of Dublin, was the seriousconcern expressed about the widespreadabuse of alcohol by young people andthe perception that such abuse may be agateway to illicit drug misuse. I havemade these views known to mycolleague, the Minister for Health andChildren, Micháel Martin T.D., and therecent launch of an Alcohol AwarenessCampaign, aimed particularly at youngpeople, is clearly both timely and critical.In addition, the new strategy containsrecommendations designed to ensureclose liaison between the implementationof the Drugs and Alcohol Strategies.

Many Government Departments andagencies, community and voluntaryorganisations and individuals providedinformation and assistance and madesubmissions during the course of thereview. Their help was greatlyappreciated, particularly for the many

insights into this complex problem whichthey presented from a variety ofperspectives. In particular, I wish toexpress my thanks to the members of theReview Group who gave so generously oftheir time and oversaw the work of thereview. I would also like to thank FarrellGrant Sparks/Dr Michael Farrell/NexusResearch Co-operative Consultants for the assistance they provided. In addition,I would like to thank the staff of myDepartment whose commitment anddedication was so instrumental inmaintaining the pace and scope of thereview and, ultimately, the production of this Report.

While the review has been taking place, progress has also been made inenhancing the current strategy and anumber of landmark initiatives havetaken place. These include thepublication of the Steering Group Reporton Prison-Based Drug Treatment Servicesin June 2000; the establishment of theNational Advisory Committee on Drugs inJuly 2000; the establishment of the pilotDrug Court in the North Inner City ofDublin in January 2001; and thesubstantial increase in the number oftreatment places available (from 4,332 at the end of 1999 to 5,032 at the end of 2000). Meanwhile, preparation of new Action Plans by the Local Drugs TaskForces has continued and the CabinetCommittee on Social Inclusion has, in thepast few months, approved over £5.5m infunding for nine updated plans coveringa wide variety of initiatives in the areasof treatment, rehabilitation, awareness,prevention and education.

I believe that with the implementation of the recommendations set out in thisReport and the active involvement andhard work of all those engaged intackling drug misuse, we can turn thetide on one of the greatest threats facingour young people and society today.

E X E C U T I V E S U M M A RY

In April 2000, the Cabinet Committee onSocial Inclusion requested that a reviewof the current national drugs strategy be undertaken. The overall objective ofthe review was to identify any gaps ordeficiencies in the existing strategy andto develop revised strategies and, ifnecessary, new arrangements throughwhich to deliver them. A sub-group ofthe Inter-Departmental Group on Drugsand the National Drugs Strategy Team –known as the Review Group – managedand oversaw the process.

As part of the review, a study of thelatest available data on the extent andnature of drug misuse in Ireland wasundertaken. This revealed that the most commonly used drug in Ireland iscannabis, followed by ecstasy. However,in terms of harm to the individual andthe community, heroin has the greatestimpact. Both treatment data and datafrom An Garda Síochána indicate thatheroin misuse remains, almost exclusively,a Dublin phenomenon. Research showsthat the majority of those presenting fortreatment are male, are under 30 years ofage and are unemployed while over halfhad already left school by the age of 15.An overview of drug misuse in Ireland isoutlined in Chapter 2.

Ireland’s current approach to tackling the drug problem has developed aroundthe four pillars of supply reduction,prevention, treatment and research.Central to the approach has been thebringing together of key agencies – bothstatutory and community/voluntary – in a planned and co-ordinated manner, todevelop a range of appropriate responsesto tackle drug misuse, not just in relationto the supply of drugs but also inproviding treatment and rehabilitationfor those who are addicted, as well asdeveloping appropriate preventativestrategies. The various elements of thecurrent national drugs strategy areoutlined in Chapter 3.

As part of the review, the drug strategiesof a number of other countries wereexamined. The approach to dealing withdrug misuse in those countries sharedcommon twin characteristics – a focus onthe needs of the drug misuser, coupledwith attempts through various enforc e m e n tmeasures and agencies to cut off thesupply of drugs, with the degree ofemphasis varying according to the country ’sfundamental philosophy on tackling thed rugs issue. An overview of the intern a t i o n a lapproaches is set out in Chapter 4.

An extensive public consultation process was undertaken as part of thereview to give individuals and groups anopportunity to outline their views on theeffectiveness of the current strategy andhow it might be improved/adapted.Approximately 190 written submissionswere received, 34 different groups madeoral presentations and a series of eightconsultation fora were held throughoutthe country at which over 600 peopleattended. An overview of the issues thatemerged during the consultation processis set out in Chapter 5.

N AT I O N A L D R U G S S T R AT E G Y2 0 0 1 - 2 0 0 8

In developing a new strategy for the nextseven years, the Review Group recognisedthat while much remains to be done,there are encouraging signs of progressin recent years which suggests that thecurrent approach to tackling the drugproblem is proving to be effective. TheG roup believes, there f o re, that the pre s e n tapproach provides a solid foundationfrom which all those involved in trying totackle the problem should work for thefuture. Consequently, it is recommendedthat the new strategy should endorse theexisting approach and should expand onand strengthen the pillars and principleswhich underpin it.

The conclusions of the Review Group inrelation to the individual pillars thatconstitute the current strategy are set outin Chapter 6. In light of these conclusionsand the overall strategic objective andstrategic aims set for the Strategy, theReview Group has developed 100individual actions which are designed tobuild on the existing approach and drivethe new strategy forward.

Implementation of the actions will be amatter for the Departments and agenciesinvolved in the delivery of drugs policy.Their implemenation will be overseen bythe Inter-Departmental Group on Drugs,in consultation with the National DrugsStrategy Team. Six monthly progressreports will be made to be CabinetCommittee on Social Inclusion.

The 100 individual actions are set out indetail in Chapter 6.

FR A M E W O R K F O R T H E NAT I O N A LDR U G S ST R AT E G Y 2001 – 2008

Overall Strategic Objective

The overall strategic objective for theNational Drugs Strategy 2001 – 2008 is :

to significantly reduce the harm causedto individuals and society by themisuse of drugs through a concertedfocus on supply reduction, prevention,treatment and research

Overall Strategic Aims

The following are the overall strategicaims of the Strategy :

■ to reduce the availability of illicitdrugs;

■ to promote throughout society agreater awareness, understanding andclarity of the dangers of drug misuse;

■ to enable people with drug misuseproblems to access treatment andother supports in order to re-integrateinto society;

■ to reduce the risk behaviour associatedwith drug misuse;

■ to reduce the harm caused by drugmisuse to individuals, families andcommunities;

■ to have valid, timely and comparabledata on the extent and nature of drugmisuse in Ireland; and

■ to strengthen existing partnerships inand with communities and build newpartnerships to tackle the problems ofdrug misuse.

OB J E C T I V E S A N D KE YPE R F O R M A N C E IN D I C AT O R S

Supply Reduction

Objectives■ To significantly reduce the volume of

illicit drugs available in Ireland, toarrest the dynamic of existing marketsand to curtail new markets as they areidentified; and

■ To significantly reduce access to alldrugs, particularly those drugs thatcause most harm, amongst youngpeople especially in those areas wheremisuse is most prevalent.

Key Performance Indicators■ Increase the volume of opiates and all

other drugs seized by 25% by end 2004and by 50% by end 2008 (using 2000seizures as a base);

■ Establish a co-ordinating framework inrelation to drugs policy in each GardaDistrict by end 2001; and

■ Increase the level of Garda resources inLocal Drugs Task Force areas by end2001, building on lessons emanatingfrom the Community Policing Forummodel;

■ Strengthen and consolidate existingcoastal watch and other ports of entrymeasures designed to restrict theimportation of illicit drugs;

■ Co-operate and collaborate fully, atevery level, with law enforcement andintelligence agencies, in Europe andinternationally, in reducing the amountof drugs coming into Ireland.

P re v e n t i o n

Objective■ To create greater societal awareness

about the dangers and prevalence ofdrug misuse; and

■ To equip young people and othervulnerable groups with the skills andsupports necessary to make informedchoices about their health, personallives and social development.

Key Performance Indicators■ Bring drug misuse by schools-goers to

below the EU average and, as a firststep, reduce the level of substancemisuse reported to ESPAD by school-goers by 15% by 2003 and by 25% by2007 (based on 1999 ESPAD levels asreported in 2001);

■ Develop and launch an ongoingNational Awareness Campaignhighlighting the dangers of drugs, thefirst stage to commence by end 2001;

■ Develop formal links at local, regionaland national levels with the NationalAlcohol Policy, by end 2001 and ensurecomplementarity between the differentmeasures being undertaken;

■ Publish and implement a policystatement specifically relating toeducation supports for Local Drugs TaskForce areas, including an audit of thelevel of current supports, by end 2001;

■ Nominate an official from theDepartment of Education and Scienceto serve as a member of each of theLocal Drugs Task Forces by end 2001;

■ Prioritise Local Drugs Task Force areasduring the establishment andexpansion of the services of theNational Educational Welfare Board;

■ Have comprehensive substance misuseprevention programmes in all schoolsand, as a first step, implement the“Walk Tall” and “On My Own TwoFeet” Programmes in all schools in theLocal Drugs Task Force areas during theacademic year 2001/02;

■ Complete the evaluation of the “WalkTall” and “On My Own Two Feet”Programmes by end 2002; and

■ Deliver the SPHE Programme (Social,Personal & Health Education) in allsecond level schools nation-wide bySeptember 2003.

Tre a t m e n t

Objectives■ To encourage and enable those

dependent on drugs to avail oftreatment with the aim of reducingdependency and improving overallhealth and social well-being, with theultimate aim of leading a drug-freelifestyle; and

■ To minimise the harm to those whocontinue to engage in drug-takingactivities that put them at risk.

Key Performance Indicators■ Have immediate access for drug

misusers to professional assessment andcounselling by health board services,followed by commencement oftreatment as deemed appropriate, notlater than one month after assessment;

■ Have access for under-18s to treatmentfollowing the development of anappropriate protocol for dealing withthis age group;

■ I n c rease the number of treatment placesto 6,000 places by end 2001 and to aminimum of 6,500 places by end 2002;

■ Continue to implement therecommendations of the SteeringGroup on Prison-Based Drug Treatment Services as a priority andimplement proposals designed to endheroin use in prisons during the periodof the Strategy;

■ Have in place, in each Health Board are a ,a service user charter by end 2002;

■ Have in place, in each Health Boardarea, a range of treatment andrehabilitation options as part of aplanned programme of progression foreach drug misuser, by end 2002; and

■ Provide stabilised drug misusers withtraining and employment opport u n i t i e sand, as a first step, increase thenumber of such opportunities by 30%by end 2004.

R e s e a rc h

Objectives■ To have available valid, timely and

comparable data on the extent of drugmisuse amongst the Irish populationand specifically amongst allmarginalised groups; and

■ To gain a greater understanding of thefactors which contribute to Irishpeople, particularly young people,misusing drugs.

Key Performance Indicators■ Eliminate all major research gaps in

drug research by end 2003; and

■ Publish an annual report on the natureand extent of the drug problem inIreland and on progress being made in achieving the objectives set out inthe Strategy.

C o - o rd i n a t i o n

Objective■ To have in place an efficient and

effective framework for implementingthe National Drugs Strategy.

Key Performance Indicators

■ Establish an effective regionalframework to support the measuresoutlined in the Report by end 2001;

■ Complete an independent evaluationthe effectiveness of the overallframework by end 2004.

■ Each agency to prepare and publish acritical implementation path for eachof the actions relevant to their remit byend 2001; and

■ Review the membership, work-load ands u p p o rts re q u i red by the National Dru g sStrategy Team to carry out its terms ofreference, by end September 2001.

P a rt I

Review of the Current Strategy

1 . 1 T E R M S O F R E F E R E N C E

1.1.1 The Cabinet Committee on SocialInclusion, in line with the commitment toreview the current drugs strategycontained in the Review of theGovernment Programme and in theProgramme for Prosperity and Fairness,

1

requested in April 2000 a review to:

■ identify the latest available data on theextent and nature of problem drug usein the country as a whole, anyemerging trends in drug misuse andthe areas with the greatest level ofproblem drug use;

■ outline the current National DrugsStrategy, including the role of thestatutory agencies and the communityand voluntary sectors, in terms of :

■ supply reduction;

■ education, prevention andawareness;

■ risk reduction, treatment andrehabilitation;

■ inter-agency co-ordination andintegration; and

■ community/voluntary sectorparticipation in the design anddelivery of the strategies.

■ examine the impact of the currentNational Drugs Strategy across theheadings listed in the context of theobjectives set for it and the resourcesallocated to date;

■ identify any major gaps and deficienciespresenting across these headings;

■ examine international trends,developments and best practicemodels; and

■ in the light of the foregoing, considerhow the current National DrugsStrategy, including the structuresinvolved in its development anddelivery, can be revised or modified tomeet the gaps and deficienciesidentified.

1.1.2 The Cabinet Committee on SocialInclusion was established in 1997. TheCommittee has, inter alia, responsibilityfor reviewing trends in the area ofproblem drug use, assessing progress inimplementing national drugs strategyand resolving policy or organisationaldifficulties which may inhibit effectiveresponses to the problem. It is chaired bythe Taoiseach and comprises the Tánaisteand the following Ministers – Tourism,Sport & Recreation; Education & Science;Environment & Local Government; Health& Children; Finance; Justice, Equality &Law Reform; Social, Community & FamilyAffairs; the Minister for Housing andUrban Renewal at the Department of theEnvironment and Local Government; theMinister of State for Local Development(with special responsibility for the NationalDrugs Strategy) the Minister of State forChildren; the Minister of State for RuralDevelopment and the Attorney General.

1

1 Action Programme for the Millennium Review, November 1999 and the Programme for Prosperity and Fairness, 2000.

1 . 2 R E V I E W P R O C E S S

1.2.1 Responsibility for conducting of thereview rested with the Inter-Departmental Group (IDG), which reportsto the Cabinet Committee and overseesprogress on the implementation of thedrugs strategy and overall policy. Thefollowing Departments are representedon the IDG: Tourism, Sport & Recreation(Chair); Taoiseach; Finance; Education &Science; Enterprise, Trade & Employment;Environment & Local Government; Health& Children and Justice, Equality & LawReform. The IDG established a sub-group,known as the “Review Group” to managethe process. The Group comprisedrepresentatives of key departments andthe National Drugs Strategy Team (NDST)including a re p resentative of the communityand voluntary sectors. A full list of themembers of the IDG and the ReviewGroup is contained in Appendix I. TheSecretariat to the Review was supplied bythe Drugs Strategy Unit of the Depart m e n tof Tourism, Sport and Recre a t i o n .

1.2.2 The review included an extensiveconsultation process, research ofinternational examples of best practiceand an examination of various relevantevaluation reports and other literature.The Review Group was assisted in itswork by independent consultants (Farrell Grant Sparks, Dr Michael Farrelland NEXUS Research Co-operative) whoreported on the consultation process and prepared draft documents forconsideration by the Review Group.

1.2.3 Advertisements were placed in thenational newspapers in April 2000inviting any interested individuals ororganisations to make submissions. State Agencies such as Health Boards, the Gardaí, VECs, the Prisons Service,Local Authorities etc. were written toseparately, inviting them to make asubmission with a view to assisting theReview Group to identify any gaps ordeficiencies in the Strategy, developrevised strategies and, if necessary, new

arrangements through which to deliver them. In total, 189 submissions

2

were received and each submission was analysed in light of the terms of reference. A small number ofsubmissions, which related to specificproject proposals or issues which felloutside the remit of the review, werereferred to relevant agencies forappropriate consideration.

1.2.4 Public invitations were subsequentlyinserted prominently in all of thenational newspapers inviting interestedparties and members of the public toattend one of eight regional fora aroundthe country. The first of these took placein Cork on Friday 10th June, followed byKilkenny on Monday 12th June; Galwayon the 15th; Limerick on the 16th; Dublinon the 19th; Athlone on the 22nd; Sligoon the 23rd and Dublin, again, on the26th. Some 600 people in all participatedin the fora.

1.2.5 The format of the fora was identicalirrespective of location and facilitatedwide-ranging debate in relation to thedrugs strategy. An overview of currentstrategy was presented by the Minister ofState followed by presentations by eachof the various interests i.e. the HealthBoards, the Gardaí, the Department ofEducation and Science and the voluntaryand community sectors. Following thesepresentations, questions were taken fromthe floor. Each session was then brokenup into 4 workshops, each with aseparate theme, (a) existing riskreduction, treatment and rehabilitationmethods; (b) existing supply reductionmeasures; (c) existing education,prevention and awareness strategies and(d) other issues, including emerg i n gt rends in drug misuse, drugs in prisonsand gaps in existing strategies to dealwith these issues.

1

2 A full list of submissions is contained in Appendix 3.

1.2.6 Analysis of the attendance sheetsindicates that a broad spectrum of peopleattended, including representatives fromthe Health Boards, An Garda Síochána,Local Authorities, Customs and Excise,youth workers, treatment services,schools, individual treatment andrehabilitation centres, community andvoluntary sectors, drug-user groups andmembers of the general public. Responsesheets were also provided to all attendeesat each forum, providing them with afurther opportunity to express opinionsin relation to current drugs strategy.Sixty-six response sheets were returned.

1.2.7 During July and August 2000, followingthe fora, a total of 34 different groups

3

representing Government Departments,Agencies, service providers and otherinterested parties were invited to meetwith and make presentations to theMinister of State, members of the ReviewGroup and the consultants, on theirrespective contributions to overcomingthe drugs problem and to explore howthey might address issues emerging fromthe fora. The consultants also metseparately with the NDST to discuss arange of issues, in particular the Team’scurrent responsibilities, both in relationto Local Drugs Task Forces (LDTFs) andthe broader strategy.

1.2.8 A debate in Seanad Eireann, in June2000, provided an opportunity forSenators to make an input to the review.In addition, towards the end of thereview process, the Minister of State andofficials visited Sweden, Australia andSwitzerland to discuss their experiencesand to look at the range of treatmentand rehabilitation facilities operating inthose countries.

1.2.9 A detailed review of availableepidemiological data was conducted bythe consultants in order to identify, usingthe best available information, the extentand nature of problem drug use in thecountry as a whole, any emerging trendsin drug misuse and the areas with thegreatest levels of drug misuse.Epidemiological data was also sourced for groups identified as engaging in drugmisuse. In order to examine internationaltrends and developments and to identifymodels of good practice, the drugsstrategies of Australia, the Netherlands,Portugal, Spain, Scotland, Sweden,Switzerland and England were analysedin detail. The Embassies of the relevantcountries were a key source ofinformation in this regard.

1

3 A full list of those who made presentations is contained in Appendix 3.

1 . 3 T H E R E P O RT

1.3.1 Once the consultation process wascompleted, the Review Group proceededto analyse all the views and datapresented, before reaching theconclusions and recommended actionsoutlined in Part 2 of the Report. TheReport was adopted by the Governmentin April 2001.

1

2 . 1 N AT I O N A L D ATA C O L L E C T I O N

2.1.1 According to the Health Research Board(HRB), the term drug use “refers to anyaspect of the drug taking process”;however, drug misuse or problem druguse refers to drug use which causes“social, psychological, physical or legaldifficulties as a result of an excessivecompulsion to continue taking drugs”.Indirect methods encompassing the useof numbers of known drug misusers inthe country i.e those registered fortreatment, drug-related arrests anddeaths etc. are currently used toapproximate the numbers of drugmisusers within the Irish population.

2.1.2 The Drug Misuse Research Division(DMRD) of the HRB was established in1989 and is responsible for operating theNational Drug Treatment ReportingSystem (NDTRS) which is the main sourceof information on drug misuse in Ireland.The NDTRS is an epidemiologicaldatabase, which provides data on peoplewho avail of treatment services forproblem drug use, on a nationwide basis.This provides information on the currentpatterns and trends of treated drugmisuse and drug addiction in Ireland.Data are provided to the NDTRS throughcentres or service locations where drugmisuse is treated.

2.1.3 From 1990 to 1994, NDTRS data werecollected in relation to the GreaterDublin area only. In 1995, the datacollected by the NDTRS was extended tothe whole country in response both todomestic demand for national data ontreated drug misuse and, following theestablishment of the EuropeanMonitoring Centre for Drugs and DrugAddiction (EMCDDA) in 1993, when theprovision of national information becamea requirement for each Member State. Atpresent, the NDTRS is the country’s mostdeveloped epidemiological database andone of the key indicators of drug misuse.

2.1.4 Drug treatment data collected by theNDTRS provides a synopsis of the numberof drug misusers availing of drugtreatment services within the country in aparticular year. Although recorded as thenumber of cases presenting for treatmentrather than total the number ofindividuals,

4analysing data on drug

misusers receiving treatment for the firsttime can allow conclusions to be drawnfrom changes in the patterns and trendsof problem drug use over time. TheDMRD publishes an annual report, themost recent being the Statistical Bulletin1997 and 1998, with a more up-to-datedata set to be published in mid-2001. TheDMRD and the Irish College of GeneralPractitioners are now co-operating incollecting data from GPs working underthe Methadone Treatment Protocol.

5They

are also examining the possibility of theinclusion of prison treatment services aspart of their on-going efforts to promote more comprehensive datacollection systems.

2

4 The NDTRS re c o rds the number of total treatment contacts i . e . all cases receiving treatment at any time during the calender year. The term c a s e s rather than

individuals is applied, as there is a possibility of double counting of individual patients who may have been treated more than once.5 D e p a rtment of Health (1993). R e p o rt of the Expert Group on the Establishment of a Protocol for the Prescribing of Methadone.

Dublin: Department of Health.

2.1.5 Other sources of information on drugmisuse in Ireland which the Review Groupdrew on include:

■ Department of Health and Children –statistics on infectious diseases;

■ Central Statistics Office (CSO) – Reporton Vital Statistics (Regional Registrarsof Births and Deaths);

■ Garda Síochána – annual reports ondrug-related arrests and offences; and

■ Forensic Science Laboratory at GardaHQ – drug seizure data.

As well as these sources of information,of which the DMRD and the GardaSíochána are the most developed, manyindividual reports and studies carried outon both a local and national scale byHealth Boards, LDTFs, academicinstitutions and by individualorganisations/authors were referred to.

2 . 2 D ATA C O L L E C T I O N AT E U R O P E A NL E V E L

2.2.1 In addition to the operation of theNDTRS, the DMRD is the designated IrishFocal Point for the EMCDDA’s REITOXNetwork. In 1993, the EMCDDA was setup, by the European Commission,

6in

response to the escalating drug problemin Europe. With 16 Focal Points operatingwithin the REITOX Network, one in each Member State and the EuropeanCommission, the main responsibility of the EMCDDA is to provide valid,comparable and objective information,which accurately reflects the rapidlychanging drug patterns and trends inEurope. In the context of epidemiology,the EMCDDA has identified 5 keyindicators

7of drug misuse in Europe.

These indicators, which are listed below,will be implemented in each MemberState and over time will provideinformation on trends and patterns of drug misuse. The first two are directindicators of drug use/misuse in apopulation, while the remainder give an indirect indication of drug misuse.

■ Extent and pattern of drug use in thegeneral population;

■ Prevalence of problem drug use;

■ Demand for treatment by drug users;

■ Drug-related deaths and mortality ofdrug users; and

■ Drug-related infectious diseases (HIV, hepatitis).

With data based on the above indicators,the EMCDDA publishes an annual report.The most recent report, published in2000, is the fifth annual report theCentre has produced on the state of thedrugs problem in the EU. The EMCDDA isworking closely with the DMRD in Irelandin an attempt to harmonise datacollection across the EU. By synchronisingdata among Member States, comparisonscan be made about emerging trendsacross the EU.

2

6 Council Regulation (EEC) no. 302/93.7 Extended Annual Report on the State of the Drugs Problem in the European Union, 2000. E M C D D A .

2 . 3 D R U G M I S U S E I N I R E L A N D

2.3.1 The DMRD acknowledges the limitationsof current prevalence estimation methodsand the need for on-going investigationof data availability in order to carry outaccurate prevalence estimation work. Asmentioned in paragraph 2.1.2 above,figures from the NDTRS relate only to thepersons who present themselves fortreatment nationwide and, may notinclude private hospitals and clinics, as allinformation submitted to the HRB is doneon a voluntary basis. Drug misuse outsideof treatment is, therefore, not accountedfor in their figures. Accordingly, it shouldbe noted that numbers presenting fortreatment for problem drug use do notrepresent the total number of drug usersin the country. In fact, they may not evenrepresent all those experiencing problemswith their drug use.

2.3.2 A number of attempts have been madeto estimate the number of opiate users inIreland. Dr Catherine Comiskey estimatedthe prevalence figures based on three1996 data sets – the methadonetreatment list, acute hospital dischargesand Garda data.

8This exercise was

confined to residents in the Dublinregion. Her results suggested a roughestimate of the number of opiate users,in Dublin in 1996, was 13,460, aprevalence of over 21 per 1,000, aged 15– 54 years (or 2.1 per cent of thepopulation). However, concerns havebeen expressed about the method used(“capture/re-capture” model), which statethat this figure could be significantlylower or higher.

9The First Report of the

Ministerial Task Force on Measures toReduce the Demand for Drugs (1996) alsoattempted to estimate the number ofopiate users by extrapolating from thetreatment numbers and arrived at anestimate of approximately 8,000 heroinmisusers in the Greater Dublin area.

2.3.3 The number of heroin users onmethadone maintenance programmes atDecember 2000 was 5,032 compared to4,332 at the end of 1999. A further 469users, in the Eastern Regional HealthAuthority (ERHA) area, were on thewaiting lists to receive treatment.

2

8 C o m i s k e y, C. (1998). P revalence Estimate of Opiate Use in Dublin, Ireland during 1996. Dublin: Institute of Technology Tallaght, 28.9 Uhl states that “one has to warn seriously against re g a rding capture - re c a p t u re estimates as reliable scientifically based estimates. As we could demonstrate: the

t rue value may easily be 50% less or 100% more than estimated", “The Prevalence of Problematic Opiate Use in Austria Based on a Capture - R e c a p t u re

Estimation", Uhl, Dr Alfred, Ludwig-Boltzmann Institute for Addiction Research at the Anton-Proksch Institute, Vienna, 2000.

2 . 4 N AT I O N A L A N D R E G I O N A L T R E N D S

2.4.1 Surveys carried out on schools and youngpeople and reports by An Garda Síochánashow clear differences particularly,between the Greater Dublin area and therest of the country, as regards the misuseof drugs and drug types. This disparity inthe pattern of drug misuse throughoutthe country is also indicated in the NDTRS.Of the clients receiving treatment in1998, 85 per cent were resident withinthe ERHA area, while 4 per cent w e ret re a t e d in the Southern Health Board(SHB) area. The small numbers remainingreceived treatment in the other 6 HealthBoard areas (Table 2.1). Details of thetreatment provided, which includes arange of medical approaches (includingd e t o x i f i c a t i o n , methadone substitutionand drug-free programmes) and non-medical therapies (such as addictioncounselling, group therapy andpsychotherapy), is broken down by themain drug of misuse in each HealthBoard area and is given in Table 2.2.

Table 2.1 – Clients (by residence) receivingtreatment for drug misuse by Health BoardArea in 1998*

* NDTRS Statistical Bulletin 1997 and 1998.1 0

Of clients who received treatment in1998, the main drug of misuse was heroinin almost 70 per cent of cases. These weremainly confined to the Dublin area.

Table 2.2 – Treatment by main drugs of misusein Regional Health Board areas in 1998*

* NDTRS Statistical Bulletin 1997 and 1998 (Note – National total contains

those clients of no fixed abode and from outside Ire l a n d ) .

**Others include morphine sulphate tablets, medical and non-medical

methadone and other opiates, amphetamines, benzodiazepines, hypnotics,

inhalants and sedatives and non-LSD hallucinogens.

2

1 0 I n f o rmation from the NDTRS is presented according to the Health Board area in which the client is resident. This may be in contrast to the Health Board where

the treatment was received. In most cases, the Health Board of residence and that of treatment are the same.

Treated in Number %

Eastern Health Board 5,076 85%

Southern Health Board 303 5.1%

North Western Health Board 48 0.8%

Midland Health Board 96 1.6%

Western Health Board 14 0.2%

Mid Western Health Board 96 1.6%

North Eastern Health Board 128 2.1%

South Eastern Health Board 201 3.4%

Total (includes residence not known) 6,043 100%

Data Total No. Heroin Cannabis Ecstasy Cocaine LSD Others**

National 6,043 4,297 71.1% 642 10.6% 196 3.3% 88 1.5% 14 0.2% 806 13.3%

EHB 5,076 4,121 81% 211 4.2% 45 0.9% 58 1.1% 4 0.1% 637 12.7%

SHB 303 14 4.6% 120 39.6% 89 29.4% 12 4% 4 1.3% 64 21.1%

NWHB 48 10 20.8% 21 43.8% 10 20.8% 0 0% 1 2.1% 6 12.5%

MHB 96 23 24% 51 53.1% 5 5.2% 0 0% 2 2.1% 15 15.6%

WHB 14 6 42.9% 2 14.3% 1 7.1% 1 7.1% 0 0% 4 28.6%

MWHB 96 7 7.3% 57 59.4% 11 11.5% 3 3.1% 1 1.0% 17 17.7%

NEHB 128 32 25% 52 40.6% 15 11.7% 2 1.6% 2 1.6% 26 19.5%

SEHB 201 22 10.9% 119 59.2% 19 9.5% 9 4.5% 0 0% 32 15.9%

2.4.2 Socio-demographic information, compiledby the NDTRS and profiles of drugmisusers reporting for drug treatmentindicate that the majority of drugmisusers are male (70 per cent) and in the20 – 24 year age bracket (36 per cent).Over three quarters of the drug misusersreporting for treatment left school by theage of 16 years and over 70 per centwere unemployed. As regards drugmisuse behaviours, over half of the clientsreported injecting their main drug, while34 per cent smoke their main drug.Almost three quarters of those receivingtreatment for drug misuse were under 19years of age when they first tried theirmain drug and over 30 per cent wereregularly using their main drug forbetween 2 to 3 years.

2.4.3 In January, 2000 an external review ofthe drug services for the Eastern HealthBoard was published.

11As regards the

provision of services for drug misusers,urine tests were carried out for opiates,benzodiazepines and tricyclics in fiveERHA addiction centres. Overall resultsare presented in Table 2.3. Although thepositivity rates for both opiates andtricyclics were low, the high rates ofbenzodiazepine positivity indicate agrowing problem of poly-drug misuse.

Table 2.3 – Poly-Drug Misuse – Urinalysisresults from 5 ERHA Addiction Centres*

* F a rrell et al., 2000

2.4.4 Data from An Garda Síochána AnnualReports relating to drug possessionoffences and seizures are one indicator ofthe use of non-opiate drugs, such ascannabis etc., throughout the country.Table 2.4 demonstrates the regionalbreakdown of drug possession offencesin Ireland. However, it should be notedthat seizures may not necessarily berelated to usage in that locality as thedrugs may have been in transit. Table 2.5shows the number of possession offencesby region and drug type in 1999.

Table 2.4 – An Garda Síochána Regionalbreakdown of drug possession offences*

* An Garda Síochána Annual Reports 1996, 1997, 1998 and 1999.

Of the number of people prosecuted fordrugs offences in 1999, the Southernregion accounted for 25 per cent, thenext highest after Dublin which haddecreased significantly to 38 per cent. Inall regions the majority of personsprosecuted for drugs offences were maleand over 21 years.

12

2

1 1 F a rrell, M., Gerada, C., Marsden, J. (2000). E x t e rnal Review of Drug Services for The Eastern Health Board . National Addiction Centre, Institute of Psychiatry,

London. 1 2 An Garda Síochána Annual Report 1999.

Drug Type Aggregate Clinic Total

% Positive

Opiates 30

Benzodiazepines 65

Tricyclics 14

Region Number & percentage of offences

1996 1997 1998 1999

E a s t e rn 1 4 9 5 % 3 4 0 9 % 4 1 6 7 % 8 7 4 1 2 %

D u b l i n 1 , 2 4 3 4 3 % 1 , 8 3 9 4 4 %2 , 9 4 1 5 3 % 2 , 7 1 9 3 8 %

N o rt h e rn 9 9 3 % 1 7 0 4 % 1 9 5 4 % 2 7 5 4 %

South Eastern 2 1 5 8 % 3 6 8 9 % 4 6 8 8 % 6 5 2 9 %

S o u t h e rn 8 8 3 3 1 % 1 , 1 6 9 2 8 %1 , 2 8 9 2 2 % 1 , 7 7 0 2 5 %

We s t e rn 2 9 6 1 0 % 2 6 2 6 % 3 2 2 6 % 8 4 7 1 2 %

To t a l 2 , 8 8 5 1 0 0 % 4 , 1 5 61 0 0 %5 , 6 3 1 1 0 0 % 7 , 1 3 71 0 0 %

Table 2.5 – An Garda Síochána Regionalbreakdown of possession offences by drugtype in 1999*

* An Garda Síochána Annual Report 1999.

** Others include morphine sulphate tablets, medical and non-medicalmethadone and other opiates, amphetamines, benzodiazepines, hypnoticsand sedatives and non-LSD hallucinogens as well as possession of forg e dp re s c r i p t i o n s.

2

R e g i o n Number of Off e n c e s / P e rcentage of To t a lC a n n a b i s Cannabis Resin H e ro i n L S D E c s t a s y A m p h e t s C o c a i n e O t h e r * * To t a l

E a s t e rn 9 8 1 1 % 4 4 5 5 1 % 1 9 2 % 3 < 1 % 2 0 0 2 3 % 8 3 1 0 % 9 1 % 1 7 2 % 8 7 4

D u b l i n 4 7 1 1 7 % 7 3 7 2 7 % 8 5 2 3 2 % 2 < 1 % 2 1 1 8 % 7 0 2 % 1 2 6 5 % 2 5 0 9 % 2 , 7 1 9

N o rt h e rn 8 7 3 2 % 1 0 0 3 7 % 0 0 1 < 1 % 6 0 2 2 % 1 6 6 % 4 1 % 7 2 % 2 7 5

South Eastern 8 6 1 3 % 3 5 1 5 4 % 1 < 1 % 1 1 2 % 8 1 1 2 % 9 2 1 4 % 6 1 % 2 4 4 % 6 5 2

S o u t h e rn 8 0 5 % 1 , 1 4 7 6 5 % 1 2 1 % 5 < 1 % 3 6 8 2 1 % 1 0 8 6 % 1 0 < 1 % 4 0 2 % 1 , 7 7 0

We s t e rn 8 2 1 0 % 5 0 1 6 0 % 3 < 1 % 4 < 1 % 1 0 3 1 2 % 9 5 1 1 % 1 4 2 % 4 5 5 % 8 4 7

To t a l 9 0 4 1 3 % 3 , 2 8 1 4 6 % 8 8 7 1 3 % 2 5 < 1 % 1 , 0 2 3 1 4 % 4 6 4 7 % 1 6 9 2 % 3 8 3 5 % 7 , 1 3 6

2 . 5 T Y P E S O F D R U G S M I S U S E D

2.5.1 A number of surveys suggest that themost commonly used illegal drug inIreland is cannabis.

13/14/15Table 2.6 deals

with possession offences and this alsoindicates that cannabis is the illicit drugmost commonly used throughout thecountry, with little change occurring inrecent years. Heroin representsapproximately 13 per cent of all drug-possession offences, almost all (96 percent) of which are recorded in the Dublinregion. Table 2.7 shows the seizures ofselected drugs by year. However, it shouldagain be pointed out that seizures mightnot necessarily be related to usage inIreland as the drugs may have been in transit.

Table 2.6 – Number of possession offences andpercentage of total by year and drug type*

* An Garda Síochána Annual Reports 1996, 1997, 1998 and 1999.

* * Others include morphine sulphate tablets, medical and non-medicalmethadone and other opiates, amphetamines, benzodiazepines, hypnoticsand sedatives and non-LSD hallucinogens as well as possession of forg e dp rescriptions.

2.5.2 Table 2.6 shows that ecstasy is the secondmost commonly cited drug in possessionoffences accounting for 14 per cent ofdrug-possession offences in 1999, onepercentage point ahead of heroinpossession. Ecstasy is the third mostcommonly misused drug after heroin andcannabis for which individuals receivetreatment.

2

1 3 Gleeson, M., Kelliher, K., Haughton, F., Feeney, A., and Dempsey, H. (1989). Teenage smoking, drug and alcohol abuse in the Mid We s t . D e p a rtment of Public

Health, Mid We s t e rn Health Board. 1 4 Jackson, T.M.R. (1997). Smoking, Alcohol and Drug Use in Cork and Kerry. S o u t h e rn Health Board, Department of Public Health.1 5 Moran, R., O’ Brien, M. and Duff, P. (1997). Treated Drug Misuse in Ire l a n d . National Report 1996. Dublin: The Health Research Board .

Drug Type 1996 1997 1998 1999Cannabis (inc.plants) 355 12% 546 13% 441 8% 904 13%Cannabis resin 1,441 51% 2,096 50% 1,749 31% 3,281 46%Heroin 432 15% 564 14% 789 14% 887 13%LSD 24 1% 39 1% 13 <1% 25 <1%Ecstasy 340 12% 475 11% 439 8% 1,023 14%Amphetamines 152 5% 239 8% 273 5% 464 7%Cocaine 42 1% 97 2% 88 2% 169 2%Other** 96 3% 65 2% 1,839 33% 383 5%Morphine 6 <1%Total 2,885 100% 4,156 100% 5,631 100% 7,136 100%

Table 2.7 – Quantities of drugs seized by year*

* An Garda Síochána Annual Reports 1996, 1997,1998 and 1999.

2.5.3 The increase in the use of cocaine, bothnationally and internationally andparticularly among young professionals,was one of the emerging trends in drugmisuse identified during the publicconsultation process and by theEMCDDA.

16A conference held by the

Nurses Addiction Network (NAN)17

in May 2000 identified this trend in Ireland.Garda statistics on the number ofpossession offences for cocaine as shownin Table 2.5 suggest a significant increasein its usage. At present, attempts arebeing made by the DMRD to identifydata on cocaine use for inclusion in a report to be published this year.

2

1 6 Annual Report on the State of the Drugs Problem in the European Union 2000, EMCDDA 2000.1 7 C o n f e rence “Cocaine, An Emerging Pro b l e m ”. Clontarf Castle, May 2000, Nurses Addiction Network.

Drug Type 1996 1997 1998 1999C a n n a b i s 2 . 4 k g 3 4 . 8 k g 4 4 . 5 k g 6 6 k g

Cannabis re s i n 1 , 9 9 3 k g 1 , 2 4 7 k g 2 , 1 5 7 k g 2 , 5 1 1 k g

H e ro i n 1 0 . 8 k g 8 . 2 k g 3 8 . 3 4 k g 1 6 . 9 5 k g

L S D 5,901 Sqs 1,851 Sqs 798 Sqs 577 Sqs

E c s t a s y 19,244 Ta b s 17,516 Ta b s 604,827 Ta b s 229,091 Ta b s

A m p h e t a m i n e s 7 . 6 k g 102.9kg + 3,889 Ta b s 45.4kg + 4,780 Ta b s 13.4kg + 12,051 Ta b s

C o c a i n e 6 4 2 k g 1 1 k g 3 3 1 . 1 7 k g 8 5 . 5 5 k g

2 . 6 D R U G M I S U S E I N P R I S O N S

2.6.1 The primary and most up-to-date sourceof information on current drug misusewithin the Irish prison population is therecent report

18by the Department of

Community Health and General Practice,Trinity College Dublin, on the prevalenceof use and risk to committal

19prisoners in

1999. This report is, in fact, the secondphase of an earlier census survey report

20.

At the time of the census survey, theprison population was approximately2,700 in 15 prisons and the census surveysampled 1,205 of these in 9 prisons. Byconducting a committal survey, the studyincluded everyone who was commitedon that exact day, including prisonerswho had not yet been charged. In thesecircumstances, a lot more non-seriousoffenders are represented in thecommittal survey than in the censussurvey. The committal report surveyed607 prisoners in 7 prisons. In both thecensus and committal surveys there was amix of high and medium risk

21prisons

involved (1 low risk prison was includedin the committal survey). It should benoted that prisons in Dublin, where all ofthe “high risk” prisons are located, havemore drug misuse among the prisonpopulation and higher rates of infectionthan other prisons throughout the country.

2.6.2 The data show that the proportion ofprisoners reporting drug misuse, bothbefore entering and within prison, wassignificantly lower in the committalsurvey than in the census survey. Table 2.8indicates the numbers of prisoners whoreported having smoked heroin in thepast year or having ever injected drugs.

Table 2.8 – Pro p o rtion of Prison re s p o n d e n t swho had smoked heroin or ever injected dru g s *

* Allwright et al., 1999, Long et al., 2000

Most of those prisoners who reportedhaving smoked heroin in the past year(Table 2.9) had also injected drugs andvice versa. Evidence, from both surveys,showed that women prisoners were morelikely to smoke heroin and/or ever injectdrugs than male prisoners.

Table 2.9 – Gender breakdown of re s p o n d e n t swho had smoked heroin or ever injected dru g s *

* Allwright et al., 1999, Long et al., 2000

2.6.3 More than half of the respondents whoreported ever injecting drugs said theyhad commenced injecting before their18th birthday, 92 per cent reportedhaving first injected 3 years ago and over70 per cent had injected in the weekprior to committal. In the light of thisevidence, the survey suggests that mostinjectors were current drug misusers(census survey). Although figures areslightly lower as regards the drug misusebehaviours of committal respondents,evidence also suggests that the majorityof injectors responding to the committalsurvey are also current drug misusers.

2

1 8 Long, J., Allwright, S., Barry, J., Reaper-Reynolds, S., Thornton, L., Bradley, F. (2000). Hepatitis B, Hepatitis C and HIV in Irish Prisoners, Part II :Prevalence and Risk

in Committal Prisoners 1999. P re p a red for the Minister for Justice, Equality and Law Reform by the Department of Community Health and General Practice,

Trinity College, Dublin. 1 9 A committal survey was conducted in order to ensure adequate re p resentation of short - t e rm prisoners, as long-term prisoners are likely to be over- re p resented in

a census surv e y. 2 0 Allwright, S., Barry, J., Bradley, F., Long, J., Thornton, L. (1999). Hepatitis B, Hepatitis C and HIV in Irish Prisoners: Prevalence and Risk. P re p a red for the Minister

for Justice, Equality and Law Reform by the Department of Community Health and General Practice, Trinity College, Dublin. 2 1 Prisons were allocated their status of high, medium and low risk according to the estimated prevalence of dru g - related infectious diseases and the estimated

Census CommittalSmoked heroin in the last 12 months 46% 31%Ever injected drugs 43% 29%

% Wo m e n % M e nC e n s u s / C o m m i t t a l C e n s u s / C o m m i t t a l

Smoked heroin in

the last 12 months 6 0 / 6 5 4 5 / 2 8

Ever injected dru g s 6 0 / 6 0 4 2 / 2 6

2.6.4 Data from both surveys highlighted thelevel of initiation into injecting drug useand the sharing of drug using equipmentwithin prisons. A similar proportion ofinjecting drug users reported startinginjecting while in prison (Table 2.10).However, there are significant differencesin the injecting practices of prisonersbetween the census and committalsurveys, in that a higher proportion inthe census population reported notinjecting in the month prior to thesurvey, which may suggest that someinjectors may have stopped injectingwhile in prison. Moreover, the proportion of prisoners that reportedsharing injecting equipment, bothoutside and within prisons, was higher inthe census population.

2.6.5 There was a greater representation ofyoung people, i . e people younger than 18years, in the committal survey than in thecensus surv e y, as is indicated in Table 2.11.

Table 2.10 – Injecting and equipment-sharingbehaviour of drug misusing prisoners*

* Allwright et al., 1999, Long et al., 2000

Table 2.11 – Number of Under 18 Ye a r srespondents that smoked heroin or ever injected*

* Allwright et al., 1999, Long et al., 2000

A higher percentage of clients, under 18years, reported smoking heroin in thepast year and ever injecting in the censusprison population than in the committalprison population.

2.6.6 In 1998, the Probation and WelfareService (PWS) carried out a survey on thenumber of problem drug misusers amongoffenders in contact with their service inthe Dublin region.

22The survey was based

on the Probation Officers’ assessment ofclients’ drug usage. It included 54community-based service personnel on 12 community-based teams. At the time,there were 2,183 offenders in contact/under supervision with these personnel.Results of the survey indicated that over56 per cent of all surveyed had a knownhistory of problem drug use. Of these, 82 per cent had misused drugs in the tenmonths prior to the survey while only 12 per cent were totally drug free at thetime of the survey. Of those that hadmisused drugs in the ten months prior tothe survey, the primary drugs of misusewere opiates (over two thirds of cases)and cannabis (18 per cent). This highpercentage in the number of offendersmisusing opiates could be explained bythe fact that the survey was conducted in the Dublin region, where the majorityof opiate use is located.

2

2 2 " P roblem Drug Use among offenders in contact with the Probation and We l f a re Service in Dublin", Probation and We l f a re Service, 2000, unpublished surv e y

p resented to the Review Group by the PWS on 14 July 2000.

Drug misuse behaviours Census% Committal% Started injecting in prison 21 17

Injecting in the month

prior to the survey 45 72

Sharing injecting equipment

in month prior to imprisonment 37 33

Sharing injecting equipment

inside prison 58 43

Census CommittalRespondents Under 18 Years 3% 12%Under 18 Yrs. who smoked

heroin in past year 38% 16%Under 18 Yrs. who ever injected 25% 16%

2 . 7 D R U G M I S U S E A M O N G Y O U N GP E O P L E

2.7.1 In recent years, the prevalence of alcohol,tobacco and drug misuse has beengrowing amongst young people both inIreland and throughout the EuropeanUnion. A survey carried out by theNational Youth Council of Irelandindicates that 53 per cent of youngpeople in Ireland have tried an illegaldrug.

23Prevalence among young people

has long been a major concern, not leastbecause of the threat to public health,but also because of the strongrelationship between alcohol and drugmisuse and antisocial and criminalbehaviour. One of the methods used inmeasuring the alcohol and drug habits ofyoung people is to conduct schoolsurveys, as the school populationrepresents the majority of the age groupsof interest and is easily accessible.

2.7.2 The pro p o rtion of young people pre s e n t i n gfor treatment has decreased.

24While in

1995, 2% of those presenting fortreatment were under 15 years of age;this had dropped to 0.6% in 1998. Thep ro p o rtion of 15 to 19 years olds dro p p e dfrom 31 % in 1995 to 22% in 1998.

Table 2.12 – Age Category of Clients who presented for Treatment for ProblemDrug Misuse*

* National Drug Treatment Reporting System, Health Research Board .

2.7.3 Many organisations, particularly theHealth Boards, have carried out a numberof local school surveys throughout thecountry in recent years. In 1999,

25a survey

was conducted on substance misuse inearly adolescents among pupils in theDublin region. The study demonstratedthat just under one third reported use ofat least one illicit substance. Cannabiswas the most commonly used illegalsubstance followed by the use ofinhalants. The reported mean age forfirst time use of cannabis, amongst theDublin pupils who had used the drug,was 12.5 years. Results of a surveyconducted by the Department of PublicHealth of the Mid-Western Health Boardshowed that, other than alcohol,cannabis and inhalants were the maindrugs used by the students in thisregion.

26/27Almost 30 per cent of the

students surveyed had tried at least onedrug in their lifetime, with over 12 percent using at least one drug at the timeof the study. The lifetime

28and current

use of all drugs (except inhalants) werefound to increase systematically with age.The rates for both lifetime and currentdrug misuse were higher in urban areas.

2

2 3 National Youth Council of Ireland, 1998.2 4 National Drug Treatment Reporting System, (NDTRS) Health Research Board. 2 5 B r i n k l e y, Fitzgerald & Green (1999). Substance use in early adolescents. A study of the rates and patterns of substance use among pupils in Dublin.2 6 Gleeson et al. ibid.2 7 K i e rnan, R. (1995). Thesis on substance use among adolescents in the We s t e rn Health Board Area. Unpublished Thesis. Faculty of Public Health Medicine, Royal

College of Physicians of Ireland. 2 8 Lifetime use refers to substance ever taken. Current use refers to substance use within the past month.

Age Category 1 9 9 5 1 9 9 6 1 9 9 7 1 9 9 8

Under 15 Ye a r s 8 4 1 . 9 % 4 3 0 . 9 % 3 6 0 . 7 % 3 9 0 . 6 %

15 to 19 Ye a r s 1 , 3 6 1 3 1 % 1 , 4 4 6 2 9 . 8 % 1 , 2 6 9 2 6 . 0 % 1 , 3 2 7 2 2 . 0 %

1999 ESPAD Report2.7.4 Within the EU, the majority of countries

have conducted national school surveysover recent years, mainly as part of theEuropean School Survey Project onAlcohol and Other Drugs (ESPAD).

29The

most recent ESPAD Report was conductedin 1999 (Report published in 2001). Themain feature of the ESPAD study is theprevalence of drug use, both legal andillegal, among 16 year-old school goers.The study describes the substance usebehaviours, as well as related beliefs andattitudes, among over 80,000 15-16 yearolds in 30 European countries.

30The

methodology involved the use of anidentical questionnaire in each of theparticipating countries, which was thencollected, using the same methods toallow for the collation of acomprehensive and comparable dataset.

Table 2.13 –Proportion of 15-16 year oldstudents using drugs, alcohol and tobaccocompared to the ESPAD average*

* Data taken from the 1995 and 1999 ESPAD Report s .

2.7.5 In Ireland, the study involved 2,277students (the majority born in 1979 andin 5th year) from 98 schools that wererandomly selected nationwide. The mainresults of the study are outlined in Table2.13. Results indicate that the percentageof Irish students who had experimentedwith each of the substances was higherthan that of the EU average, particularlyin relation to the use of cannabisalthough it has declined from the 1995figure. However, further studies need to be conducted that ensure samplerepresentativeness, before any firmconclusions on comparative data aredrawn. Figure 2.1 shows the Irish positionvis-a-vis other ESPAD countries in the EUand the United States in 1995 and 1999as regards the use of cannabis andecstasy by 15-16 year olds.

2

2 9 Hibell et al., (2001). The 1999 ESPAD Report: Alcohol and Other Drug Use Among Students in 30 European Countries. 3 0 The ESPAD Study: Implications for Pre v e n t i o n . D rugs: Education, Prevention and Policy, Vol. 6, No. 2, 1999.

Proportion of Irish students that Irish 1995 % Irish 1999 % ESPAD countries ESPAD countries

avg % 1995 avg % 1999

Had any alcohol in last 12 months 86 89 80 83

Were drunk in the last 12 months 66 69 48 52

Ever smoked 74 73 67 69

Smoked in last 30 days 41 37 32 37

Used cannabis 37 32 12 16

Used any drug but cannabis 16 9 4 6

Used tranquillisers/sedatives 8 5 7 7

Used Solvents n/a 22 n/a 9

Figure 2.1 – Percentage of 15-16 year olds haveused Cannabis and Ecstasy in selected ESPADcountries and the United States in 1995 & 1999

Alcohol and Tobacco Use2.7.6 Throughout the consultation process,

alcohol misuse was identified as a majorproblem within Irish society, particularlyamong young people. The NationalHealth and Lifestyle Surveys published in1999 took account of the consumption of alcohol and tobacco in the population.The surveys are separated into twostudies – SLÁN (Survey of Lifestyles,Attitudes and Nutrition) represents adultsaged 18 years and above and the HBSC(Health Behaviour in School-AgedChildren), which represents school-goingchildren aged 9–17 years.

2.7.7 Research relating to the consumption ofalcohol and tobacco is contained in theHBSC/SLÁN

31report published in February,

1999. The report states that the patternof drinking behaviour among adults inIreland has changed. Data from thereport indicate that a higher percentageof males than females, across all ages,consume alcohol regularly. Consumptionis becoming more regular within youngerage groups. Another report

32suggests

that 59 per cent of school children drinkoccasionally and 16 per cent drinkregularly. As well as drinking moreregularly, the SLÁN report indicates that27 per cent of males and 21 per cent offemales consume more than therecommended weekly limits of “sensible”alcohol consumption.

33

2

3 1 Friel, S., Nic Gabhainn, S. and Kelliher C. (1999) National Health & Lifestyle Surv e y s .3 2 Brinkley et al 1999. op cit.3 3 Sensible alcohol consumption is re g a rded as 21 units for males and 14 units for females per week.

Table 2.14 – Percentage of Males/FemalesConsuming more than the RecommendedLimits of Alcohol*

* The National Health and Lifestyle Surveys, SLÁN Report .

The results indicate that consumption inexcess of the sensible limit of alcohol isgreatest among males in the 18 – 34 yearage bracket, among semi-skilled (SC5)and unskilled (SC6) individuals.

2.7.8 The HBSC survey, conducted in 1998,indicates that 32 per cent of schoolrespondents reported ever having had adrink. Overall 29 per cent admitted tohaving a drink in the past month. Ofthese, boys were more likely to reportcurrent drinking than girls, 34 per centcompared to 24 per cent respectively. Asimilar trend applied to the number ofrespondents who reported having been“really drunk”, with a greater number ofboys than girls more likely to haveconsumed amounts of alcohol whichmade them “really drunk”. For both boysand girls, the majority of those whoreported currently drinking and everbeing “really drunk” were in the 15–17years age bracket.

2.7.9 The progression of use from tobacco andalcohol to cannabis and, then, to otherdrugs is a consistent finding in a numberof studies conducted on young people.Although it is not inevitable thatsomeone who smokes cigarettes or drinksalcohol will progress to the use ofcannabis or other drugs, the risk of usingcannabis and other drugs is much higheramong individuals who smoke or drinkalcohol, than among non-smokers andnon-drinkers.

35The SLÁN survey reports

that 31 per cent of the Irish adultpopulation smoke, with a marginallyhigher percentage of male (32 per cent)than female (31 per cent) smokers. Of the31 per cent who smoke, the majority (39per cent) of smokers are within the 18 –34 year age group, a trend similar to thatof alcohol consumption.

2 . 7 . 1 0 The HBSC report shows that almost halfof school-aged children have had acigarette, which is substantially higherthan the percentage who reportedhaving had a drink (32 per cent). Overall,21 per cent of the children were currentsmokers, with the majority in the 15 –17year age bracket. The data highlightedthat, overall, more girls (36 per cent) thanboys (31 per cent) smoked within thatage bracket.

2

3 4 Social class distribution of SLÁN – SC1: Professional workers, SC2: managerial and technical, SC3: Non-manual, SC4: Skilled manual, SC5: Semi-skilled, SC6:

U n s k i l l e d .3 5 Evaluating Drug Prevention in the European Union. EMCDDA Scientific Monograph Series No 2. EMCDDA.

Age Category SC 1-234

SC 3-4 SC 5-6

% Males/Females % Males/Females% Males/Females

18 – 34 Years 34/27 32/34 40/22

34 –54 Years 23/11 30/16 21/8

55 + Years 23/8 24/15 25/21

D rug Misuse outside the SchoolS y s t e m

2 . 7 . 1 1 Although school surveys may representthe majority of the age groups of interestwhen referring to young people, they donot represent those young people thatare most at risk i.e who are not in theschool system. Treatment data from theNDTRS indicate that, in 1998, just over aquarter of clients (26.8%) had left schoolbefore the official school-leaving age of15 years. Over half (55.4%) had leftschool before the age of 16 years.Seventy nine per cent had left schoolbefore the age of 17 years. Records ofstudents entering the second-level schoolsystem are collected and maintained bythe Department of Education andScience. These records are checkedagainst the number of students takingjunior and senior cycle exams each year,so that the retention rates of each of the26 counties can be ascertained at eachcycle. Data from the 1993 retentionprofiles

36(began post-primary in 1993)

indicate that Dublin South and DublinCounty Borough had the highest rates ofearly school-leaving. For example, of thestudents who began post-primaryeducation in 1993, in those areas, almost30 per cent had left school withoutsitting the Leaving Certificate and 10 percent without sitting the Junior Certificateexaminations. Throughout the rest of the25 counties, figures varied from between14 and 30 per cent for the number ofindividuals that had left school withoutsitting the Leaving Certificate.

2 . 7 . 1 2 As regards drug abuse, data from theNDTRS Statistical Bulletin 1997 and 1998indicate the number of clients whopresented for treatment for problemdrug use during 1997 and 1998 and theage at which these clients had left school(Table 2.15).

Over half (55.4%) had left school beforethe age of 16 years, whereas 3 per centof the individuals receiving treatment forproblem drug use in 1998 were still inschool.

Table 2.15 – Treatment Contacts during 1997 & 1998

National Drug Treatment Reporting System Statistical Bulletin 1997 & 1998.

2

3 6 P o s t - P r i m a ry Pupils’ Database/Examinations System, Department of Education and Science.

School Leaving Age Per cent %1997 1998

Never went to school 0.2 0.1Under 15 Years 26.9 26.815 Years 27.3 28.616 Years 22.4 23.117 Years 12.0 11.418 Years and Over 6.7 7.1Still at school 4.6 3.0Total 100 100Total Number 4,910 6,043

D rug Misuse amongst Third Level Students

2 . 7 . 1 3 Finally, in relation to young people anddrug misuse, there are approximately140,000 full-time and part-time studentscurrently in higher and further educationcolleges in Ireland. In 1998, the Union ofStudents in Ireland (USI) published anational drugs survey of third levelstudents.

37This survey, which was

conducted among students, agedbetween 17-24 years attending higherand further education collegesnationwide, is one of the few sources ofinformation compiled to date on drugmisuse among third level students andwas based on a sample of 1,000 students.

Figure 2.2 – Drugs first used by third level students

Results from the survey indicated that 80per cent of third level students in Irelandhave taken an illegal drug and over halfof these were still taking the same drugat the time of the study. The range ofdrugs taken by students was very broadand is outlined here in Figure 2.2.Overall, the survey suggests a relativelyhigh level of drug misuse within thecurrent student population, although asFigure 2.2 shows, the drugs involved wereoverwhelmingly non-opiates.

2

3 7 USI National Drugs Survey of Third Level Colleges 1997/98. The Union of Students in Ireland (USI), May 1998.

2 . 8 O T H E R AT R I S K G R O U P S

2.8.1 In 1998, the Combat Poverty Agencycommissioned research into thecorrelation between drug misuse andpoverty.

38The findings indicated that;

■ The majority of people being treatedfor drug misuse are unemployed andhave low educational attainment, and the age profile of those intreatment is declining;

■ Opiates and, heroin in particular, werefound to be drugs most likely to beassociated with deprived areas, althoughthere is a marked contrast between thelevel of heroin misuse in Dublin and inthe rest of the country; and

■ Poverty and deprivation are more likelyto encourage, rather than discourage,drug misuse.

The key findings of this research remainvalid in the context of currentepidemiological trends.

The public consultation highlighted anumber of other at risk groups, amongstwhom there is a perceived highprevalence of drug misuse e.g. thehomeless, the Traveller Community andthose involved in prostitution. T h eReview Group looked at availableevidence in relation to these three gro u p s .

The Homeless Population 2.8.2 The prevalence of drug misuse among

homeless people in Ireland is a particularproblem and is extremely difficult toquantify. The latest assessment carriedout by the Department of theEnvironment and Local Government inMarch 1999 estimates that there aresome 5,234 homeless people nationwide.Although the exact percentage of drugmisusers among this population isunknown, a survey carried out by FocusIreland, in June 1999, found that 36 percent of the 762 homeless peopleinterviewed were misusing drugs.

2.8.3 In 1999, the Merchants Quay Projectconducted a study of homeless peopleavailing of treatment for drug misuse. Itfound that drug-taking practicesincreased in risk among homeless drugmisusers, particularly with regard tosharing needles and public usage. Thereport

39stated that:

■ 56 per cent of the respondentsreported an increase in their drugmisuse as a result of being homeless;

■ 92 per cent of rough-sleeping misusersinterviewed reported injecting drugs inpublic places, compared to 37 per centof those who were staying with friends;and

■ 49 per cent reported sharing injectingequipment.

2

3 8 O’ Higgins (1998). Review of Literature and Policy on the links between Poverty and Drug Abuse. Combat Poverty Agency/ESRI. 3 9 Cox, G. and Lawless, M. (1999). W h e rever I Lay My Hat: A Study of Out of Home Drug Users. M e rchants Quay Project: Dublin.

2.8.4 According to Focus Ireland, in 1999Dublin Corporation evicted 30 tenants,under the Housing Acts and an estimated90 per cent of these evictions were drug-related.

40However, a recently published

study41

carried out on the impact of theActs states that they fail to take accountof the difficulty of differentiatingbetween drug misuse and drug dealing,although often the drug misuser willengage in small-time dealing to supporthis/her own habit. That said, it should benoted that the term “anti-socialbehaviour” is tightly defined in theHousing (Miscellaneous Provisions) Act1997, which differentiates between drugdealing and drug use.

2.8.5 The Department of the Environment andLocal Government re p o rted to the ReviewGroup that Dublin Corporation and otherlocal authorities only carry out evictionsin extreme circumstances and only whenall other options have been exhausted.The number of evictions must be viewedin the context of a total local authoritystock of some 100,000 houses. Furt h e rm o re ,the eviction of tenants or exclusion ofindividual family members is contrary tothe ethos of local authorities as socialhousing providers. The Departmentenvisages that the relevant locala u t h o r i t i e s will develop mechanisms inco-operation with the LDTFs thatfacilitate early intervention in drugrelated cases so that such action may beavoided to the greatest extent possible.

The Traveller Community 2.8.6 In general, there is no evidence to

suggest that illicit drug use among theTraveller Community is, at present, amajor issue, although obviously there isalways potential for such a problem todevelop in the future. In 1999, PaveePoint Travellers’ Resource Centreconducted a survey

42on drug misuse

within the Traveller Community usinginformation collated from treatmentcentres via questionnaire, focus groupswith Travellers and a consultativemeeting with Traveller groups. Outcomesfrom the survey indicate that the natureof drug misuse among the Travellerpopulation is similar to drug misusetrends among young people outside theDublin region. In general, it wouldappear that substances most commonlymisused are cigarettes, alcohol andcannabis, followed closely by ecstasy,amphetamines and solvent misuse.Heroin misuse within the TravellerCommunity is still at a relatively lowlevel. Other notable outcomes from thesurvey were that:

■ Of all the Drug Service Providers (21)surveyed, only one third were aware ofwhether or not travellers wereaccessing their services; and

■ Cannabis appears to be the mostcommonly used drug, even more sothan alcohol, as Travellers have easieraccess to cannabis than alcohol,because of the difficulties they face inaccessing pubs and off-licences. The useof cannabis is “normalised” and is notperceived as being an illegal activity bythe majority of the Traveller community.

2

4 0 Focus Ire l a n d ’s Submission to the Review of the National Drugs Strategy. 4 1 M e m e ry, C. and Kerrins, L. (2000). Estate Management and Anti-Social Behaviour in Dublin. A Study of the Impact of the Housing Act 1997. T h reshold Publication. 4 2 Pavee Point Yo u t h s t a rt 1998-9, D rugs and the Traveller Community Pro j e c t , Pavee Point Travellers’ Resource Centre, Dublin, August 1999.

Persons involved in Prostitution 2.8.7 Little information is available as to the

exact extent of drug misuse amongpersons working in prostitution.However, estimates are available fromprojects that have close contact with thisgroup. Figures by outreach workerscoming in contact with women involvedin prostitution show that, since 1997, thenumbers have increased significantly(Table 2.16). In 1999, the Women’s HealthProject of the Eastern Health Board,conducted re s e a rch on drug-using womenworking in prostitution. Over 84 per centof the women reported injecting heroinin the month prior to the study

43and

most women reported taking more thanone drug at the time of the research,highlighting a trend of poly-drug useamongst this group. Results also indicatedthat the main reason 83 per cent of thewomen were working in prostitution wasfinancial, in most cases to “make moneyfor drugs”. Similarly, the outre a c hm a n a g e r of the Ruhama Women’s Projectreports

44that since 1998, some 90 per

cent45

of their contacts are involved inprostitution to fund either their own, ortheir part n e r s ’ d rug habit. The most up todate inform a t i o n, relating to the outreachwork, indicates an increase in the numberof contacts

46with women involved in

prostitution over the past 3 – 4 years. TheProject estimates that there were 402women working in prostitution at theend of 2000, an increase of 139 on theprevious year.

Table 2.16 – Total Contacts from 1997 – 2000*

* Ruhama Wo m e n ’s Project.

2.8.8 According to the Gay Men’s HealthProject’s 1997 pilot study report on Malesin Prostitution, drug misuse is alsoprevalent amongst this group. Twentyseven men involved in prostitution wereinterviewed and the drugs they had usedincluded cannabis (76%), poppers (72%),speed (56%), ecstasy (52%), cocaine(44%) and heroin (20%).

47

2

4 3 D rug Using Women Working In Pro s t i t u t i o n . The Wo m e n ’s Health Project, Eastern Health Board, Dublin, Ireland and European Intervention Project, AIDS

P revention for Prostitutes Supported by the EU DGV under its Programme “Europe against AIDS”, 1999.4 4 The Ruhama Wo m e n ’s Project is a national voluntary organisation working with women in pro s t i t u t i o n .4 5 Based on personal communication between Ruhama Wo m e n ’s Project and contacts of the Pro j e c t .4 6 The number of contacts re p resents the number of women the Project comes in contact with while working on the streets at night.4 7 R e p o rt on Men in Pro s t i t u t i o n, Eastern Health Board/Gay Men’s Health Project, 1997.

Year No of contacts with No of nightswomen working worked byin prostitution the Project

1997 619 461998 1,087 821999 1,932 992000 2,012 126

2 . 9 H E R O I N M I S U S E R S I N T R E AT M E N T

2.9.1 The Central Treatment List, which iscompiled by ERHA, is the only register ofpatients receiving methadonemaintenance within Ireland at present. Asa result of the Methadone TreatmentProtocol, this list now also includes thosepatients receiving methadonemaintenance from GPs working underthe Protocol. According to the CentralTreatment List, at December 2000, therewere 5,032 patients availing ofmethadone maintenance treatmentthroughout Ireland. Table 2.17 shows thebreakdown of patients on the CentralMethadone Treatment List for 1995-2000.This list only covered the Eastern HealthBoard area up to and including 1998.

Table 2.17 – Central Methadone Treatment List*

* Data taken from the Central Treatment List, Eastern Regional Health

A u t h o r i t y.

2

Breakdown of Patients Dec 1995 Dec 1996 Dec 1997 Dec 1998 Dec 1999 Dec 2000

ERHA Clinics 424 616 1,182 1,939 2,502 2,849

Provincial Clinics N/A N/A N/A N/A N/A 41

Trinity Court 305 260 207 504 515 513Attending GeneralPractitioners withinERHA area 629 985 1,470 1,167 1,252 1,574Attending GeneralPractitioners outsideERHA area N/A N/A N/A N/A 63 55

Total number of patients 1,358 1,861 2,859 3,610 4,332 5,032

2.9.2 At the end of 2000, over 56 per cent ofpatients were receiving treatment in 49ERHA clinics and almost one-third fromGPs in the ERHA area. Over 10 per centare receiving treatment in Trinity Court,which is a Dublin-based treatment centre.The remaining patients, which accountfor just under 2 per cent are availing oftreatment in four Provincial Clinics –Athlone, Carlow, Portlaoise andWaterford or from GPs outside the ERHAarea. This highlights the fact that opiate/heroin misuse remains largely confined tothe ERHA area, particularly Dublin.

Figure 2.3 – Methadone Treatment Numbers at end year 1995-2000 from the CentralTreatment List

2.9.3 Figure 2.3 shows the marked increase inthe numbers of drug misusers accessingtreatment; from 1,358 in 1995 to 5,032 atthe end of 2000. This increase is all themore significant when account is taken ofthe strong local opposition to theprovision of treatment centres. This is thecase even in some of the areas worstaffected by the drugs problem. The ERHAis continuing to work in these areas andwith those communities where, atpresent, there are still significant gaps intreatment service provision.

2

4 8 O’ Higgins, K. (1996). Treated drug misuse in the Greater Dublin area. A review of five years 1990 – 1994. The Health Research Board, Baggot St. Dublin, Ireland.

2.9.4 There has been a 16 per cent increase inthe number of patients availing ofmethadone treatment nationwide fromDecember 1999 to December 2000. The2000 data set also includes data fromProvincial Clinics which now offermethadone maintenance treatment,where previously such treatment wasunavailable. Although the figures showthat there has been an increase in thenumber of individuals in treatment, this ismore than likely a reflection of thedevelopment of treatment serviceprovision available for drug misusersthroughout Ireland

48which is

encouraging more users to come forwardand to avail of these services.

2.9.5 Table 2.18 shows the number ofparticipating GPs and pharmacies, both inand outside the ERHA area, for 1998,1999 and 2000.

Table 2.18 – Area Breakdown of ParticipatingPharmacies and GPs*

* Central Treatment List, Eastern Regional Health Authority.

2.9.6 As of December 2000, according to thethe Methadone Waiting List, there wer e469 clients currently waiting to avail ofmethadone treatment in Ireland. Of thisnumber, over three quarters were maleclients of which almost 45 per cent werein the 20 – 24 year age bracket. Almost60 per cent of the female clients were inthe 20 – 24 year age bracket. Table 2.19compares waiting list figures in June 1998and in December 2000.

Table 2.19 – Gender breakdown of theMethadone Treatment Waiting List as in June1998 & December 2000*

* East Coast Area Health Board .

2.9.7 There has been a significant increase inthe number of individuals waiting toavail of methadone maintenancetreatment between June 1998 andDecember 2000. This has been matchedby an increase in the number oftreatment places as demonstrated inFigure 2.3. The most significant increaseoccurred in the number of male clientswaiting to avail of treatment. However, itmust be stated that the increase in thewaiting list may again reflect growth inthe provision of methadone treatmentservices throughout the country which, inturn, encourages more people to comeforward and seek treatment.

2

Area breakdown of

Participating Pharmacies 1998 1999 2000

Pharmacies within

ERHA area 145 154 158

Pharmacies outside

ERHA area 30 49 58

Total 175 203 216

Area breakdown of

Participating GPs

No. of GPs participating

within ERHA area 97 122 130

No. of GPs participating

outside ERHA area 28 32 27

Total 125 154 157

Gender June 1998 December 2000Females 113 113Males 143 356Total 256 469

2 . 1 0 P R E VA L E N C E C O M PA R I S O N S W I T HO T H E R C O U N T R I E S

2 . 1 0 . 1 National prevalence figures for EUcountries are often difficult to obtainand, therefore, difficult to compare. TheEMCDDA Annual Report on the state ofthe drugs problem in the European Unionis based on the collation of data andnational reports provided by each of theNational Focal Points operating withinthe REITOX Network. The DMRD is thedesignated Focal Point within Ireland.Part of each EMCDDA Annual Reportdemonstrates the prevalence, patternsand consequences of drug misuse andprovides updated information onindicators of the prevalence of drugmisuse, health consequences, lawenforcement and illicit drug marketswithin the EU. The EMCDDA has, overrecent years, compiled information fromnational population surveys on drugmisuse in 11 Member States, includingIreland, although, prevalence figures,such as those given below in Figure 2.4should be interpreted as crude estimatesonly. At present, there are an estimated 1to 1.5 million problem drug users (mainlyheroin) in the EU.

49

Figure 2.4 High, mid and low points of theestimates (rates per thousand population) ofnational problem drug prevalence in the EUand Norway*

2 . 1 0 . 2 The evidence from Figure 2.4 highlightsthe wide-ranging scale within whichprevalence estimates must be calculated.The figure refers to the number ofproblem drug users, as defined by theEMCDDA, per thousand in the 15-64 yearold age group. Luxembourg and Italyhave the highest rates, taking intoaccount both the lowest and highestrange of estimates. As regards Ireland,the mid point between these twoestimates is 3.8, putting it just above theEMCDDA country average of 3.68. Heroinhas been identified as the main substanceof problem drug use within the EU. Theoverall prevalence of problem drug use,particularly heroin, appears not to haveincreased in most EU Member States overrecent years.

50

2

4 9 Total EU population of 375 million.5 0 Annual Report on the State of the Drugs Problem in the European Union, EMCDDA, 2000.

D rug-Related Deaths2 . 1 0 . 3 In many countries throughout the EU, the

number of drug-related deaths began tostabilise and even decrease in some cases,in the late 1980s and early 1990s.However, a number of countries are stillexperiencing increases, particularlyIreland. The scale of the number ofdeaths varies dramatically between eachcountry, as can be seen in Figure 2.5.

Figure 2.5 – Number of Acute Drug-RelatedDeaths Recorded 1990-98

Figure 2.5 (contd) – Number of Acute Drug-Related Deaths Recorded 1990-98

However, in the absence of harmoniseddefinitions and methodologies acrossEurope, direct comparisons of drug-related death statistics between countriescan be misleading. Data for Ireland showthat the number of drug-related deathsrose from 7 in 1990 to 90 in 1998. Theincrease between 1994 and 1998,however, may be mainly due to improvedrecording practices as the use ofrestrictive, or more inclusive definitions,of drug-related deaths can lead to verydifferent estimates.

2

2 . 1 1 A D D R E S S I N G G A P S I N P R E VA L E N C ED ATA

2 . 1 1 . 1 Recognising that research andinformation gaps exist about the natureand extent of the drug problem inIreland, the Government, through theCabinet Committee on Social Inclusion,established the Interim AdvisoryCommittee on Drugs in 1999. As part ofits subsequent report,

51the Interim

Committee set out priority policyinformation needs and recommended a 3 year programme of research, whichwould be overseen by a NationalAdvisory Committee on Drugs (NACD).

2 . 1 1 . 2 The Interim Committee also identified arange of research and information gapsunder the headings of prevalence,prevention, treatment and consequences.It concluded that a more focused andintegrated approach was required in thecollection and assimilation of data andthis could be achieved throughestablishing a central database onproblem drug use in Ireland. Thisdatabase should contain all research andinformation relating to problem drug useand addiction and be easily accessible toall the relevant organisations and policy-makers involved in drug-related issues.

2 . 1 1 . 3 On foot of the Interim Committee'srecommendations, the National AdvisoryCommittee on Drugs was established byGovernment in July 2000. The Committeeis overseeing the delivery of a three yearresearch programme aimed at addressingthe priority information gaps anddeficiencies in the area of drug misuse.This programme includes compiling acomprehensive inventory of existingresearch relating to the prevalence,prevention, treatment/rehabilitation andconsequences of problem drug use inIreland. The Committee is also looking athow best to determine the size andnature of the drug problem in Ireland,the effectiveness of existing models andprogrammes in the area of prevention,treatment and rehabilitation and the costto society of the drug problem. In view ofthe large amount of research andinformation which is currently beingproduced by various agencies and groups,the Government also designated the HRBas a central point to which all suchinformation should be channelled.

2

5 1 R e p o rt of the Interim Advisory Committee on Dru g s , D e p a rtment of Tourism, Sport and Recreation, Febru a ry 2000.

2 . 1 2 S U M M A RY

The main points made in this overview ofdrug misuse are:

■ the most commonly used illegal drug inIreland is cannabis, followed by ecstasy;

■ in terms of harm to the individual andthe community, heroin has the greatestimpact;

■ heroin misuse remains, almostexclusively, a Dublin phenomenon;

■ cocaine is seen as an emerging drug ofmisuse though the numbers presentingfor treatment so far remain quite small;

■ the majority of those presenting fortreatment are male, under 30 years ofage and unemployed;

■ over half those presenting fortreatment inject their main drug whilea third smoke it;

■ over half of those presenting fortreatment had left school by the age of 16;

■ in 1999, the highest number of drugpossession offences were in the Dublinregion, followed by the Southernregion;

■ there is clear evidence of a significantlevel of drug use occurring within Irishprisons. Overall, surveys estimate thattwo fifths of the Irish prison populationhave a history of injecting drug use,nearly half of whom continued toinject while in prison;

■ the proportion of young people (under19 years of age) presenting fortreatment has decreased;

■ in 1999, the percentage of Irishstudents who experimented with drugs,alcohol and tobacco was higher thanthe EU average, particularly in relationto the use of cannabis, although it haddeclined since the 1995 ESPAD survey;

■ over 5,000 people are cur rentlyreceiving methadone maintenancetreatment, the majority in the ERHAarea;

■ there are less than 470 people currentlyawaiting treatment, the majority ofwhom are male;

■ there is a serious problem of poly-druguse, including heroin, among men andwomen involved in prostitution;

■ heroin is the main substance ofproblem drug use in the EU;

■ there are an estimated 1m – 1.5mproblem drug users (mainly heroin) inthe EU;

■ the overall prevalence of problem druguse, particularly heroin, appears not tohave increased in most EU countries inrecent years;

■ using the mid-point of nationalprevalence estimates for problem druguse, Ireland is marginally above the EUaverage;

■ while the number of drug-relateddeaths in Ireland is amongst the lowestin the EU, the rate of increase issignificantly higher than in any otherEU country – though this may bemainly due to improved recordingmethods.

2

3 . 1 I N T R O D U C T I O N

Evolution of Current Response3.1.1 During the 1960s and 1970s, the use of

amphetamines and LSD appeared to bethe main drug problem in Ireland. Policyresponses included the formation of theGarda Drug Squad, the establishment ofthe National Advisory and TreatmentC e n t re for Drug Abuse and the enactmentof the Misuse of Drugs Act in 1977.However, the early 1980s witnessed agrowth in heroin use in inner city areasand other deprived communities inDublin. A number of GovernmentCommittees were established, whichrecommended the introduction of aseries of legislative provisions. Inaddition, a number of educational,structural, community and youth servicesand treatment changes were re c o m m e n d e d,including the setting up of the NationalCo-ordinating Committee on Drug Abusein 1985 and the subsequentstrengthening of the co-operationbetween the enforcement agencies, inparticular, An Garda Síochána, Customsand Excise and the Naval Services.Notwithstanding these developments,however, the drug problem continued toincrease in scale and scope, especially indeprived communities.

3.1.2 In order to ensure that services were co-ordinated at the highest level, theNational Co-ordinating Committee wasre-constituted and strengthened in 1990under the aegis of the Department ofHealth. In response to recommendationsfrom the Committee and others to tackledrug misuse and trafficking, a Strategywas put in place based on four pillars ofsupply reduction; demand reduction;manpower training and development andinternational co-operation. Measuresdesigned to implement the Strategyincluded (i) better co-ordination betweenstatutory and voluntary agencies in theprovision of services; (ii) involvement bygeneral practitioners; (iii) increasedpowers for enforcement agencies;(iv) thedevelopment of a Drug Education

Programme for schools and colleges; (v) in-service training for teachers; (vi) theestablishment of Community Drug Teamsunder the auspices of the Health Boardsand (vii) the creation of links betweenthe educational, treatment andcommunity services and the prisons.

First Ministerial Task Force Report3.1.3 Despite these measures, by the mid

1990s, the drug problem, particularly inDublin, was still growing. TheGovernment responded to widespreadpublic disquiet by setting up a MinisterialTask Force on Measures to Reduce theDemand for Drugs in 1996, to deliver an“integrated range of services coveringthe areas of treatment, rehabilitation andeducation/prevention”.

3.1.4 The First Report of the Task Force , whichfocused on heroin misuse, concluded thatsocial and economic disadvantage,unemployment and poor living conditionswere predictors of drug misuse. It alsoconcluded that such misuse hadconsequences which included a severelocalised effect, a life of crime andassociated prison records, ill-health, pooremployment prospects, deterioration inthe quality of life, low educationalattainment, high levels of familybreakdown and the prevalence ofcommunicable diseases. The Reportextrapolated from the treatment statisticsto establish heroin addiction trends andsuggested that there were approximately8,000 heroin addicts in the greater Dublinarea at that time.

3

3.1.5 The First Report emphasised educationand prevention as long-term solutions tothe drugs problem. The Report alsoenvisaged circumstances where“everyone who so wishes should beafforded access to treatment andrehabilitation services”. Achieving thiswould address, inter alia, the waiting listsfor methadone treatment. Critically, theFirst Report proposed administrativestructures to ensure strategic delivery ofthe drugs policy in a coherent,integrated, cost effective manner in areasof the most severe drug misuse. Thestructures proposed included (i) a CabinetCommittee to confer political leadershipon the policy and to resolve inter-organisational barriers to effectiveresponses and (ii) an Inter-DepartmentalGroup (IDG), representing the AssistantSecretaries at those Departments servingon the Cabinet Committee, to addresspolicy issues and review progress. It alsoproposed a National Drugs Strategy Team(NDST) to (i) operate on a cross-departmental basis and ensure effectiveco-ordination, (ii) identify and considerpolicy issues before referring them to theIDG and (iii) co-operate with and overseethe work of the Local Drugs Task Forces(LDTFs) who w e re to co-ordinate deliveryof the pro j e c t s in the areas of highestheroin use.

Local Drugs Task Forces 3.1.6 The LDTFs were set up in areas identified

as having the highest levels of drugmisuse. Originally, 12 LDTFs wereestablished in the Greater Dublin area:North Inner City, South Inner City,Ballymun, Ballyfermot, Finglas/Cabra,Dublin 12 (Crumlin, Drimnagh, Kimmageand Walkinstown), Dublin North East,Canal Communities (Bluebell, Inchicoreand Rialto), Blanchardstown, Clondalkin,Tallaght and Dun Laoghaire-Rathdown.An LDTF was also set up in North CorkCity, where the emphasis is primarily onprevention. Following a review of theLDTFs in 1999, Bray was designated as aTask Force area.

3.1.7 The LDTFs each have a chairperson andemploy a co-ordinator who helps preparelocal action plans which include a rangeof measures in relation to treatment,rehabilitation, education, prevention andcurbing local supply. In addition, theLDTFs provide a mechanism for the co-ordination of services in these areas,while at the same time allowing localcommunities and voluntary organisationsto participate in the planning, design anddelivery of those services. TheGovernment originally allocated £10million to support the implementation of234 separate measures contained in theplans. In July 1999, the CabinetCommittee on Social Inclusion approvedfurther funding of £15 million per annumto enable the LDTFs to update their drugaction plans. The focus of these plans ison the development of community-basedinitiatives to link in with and add value tothe programmes and services alreadybeing delivered or planned by thestatutory agencies in the LDTF areas.Currently, the LDTFs are updating theirplans for the next three years. A sum of£122 million has been provided in theNational Development Plan to supportthe work of the LDTFs up to 2006.

3

Second Ministerial Task Force Report3.1.8 In 1997, the Second Report of the

Ministerial Task Force commented on the progress made since the First Reportwas published. It also focused on thenationwide use of drugs other thanheroin, such as cannabis and ecstasy,drug misuse in prisons and the need for authoratitive research to informthe Government’s policy on drugs. Its recommendations included:

■ the establishment of a Youth ServicesDevelopment Fund with a contributionfrom the Exchequer of £20m, todevelop youth services in disadvantagedareas, where a significant drugproblem exists or has the potential to develop;

■ the training and employment of youth leaders from disadvantagedcommunities under the FÁS CommunityEmployment Programme and othersocial economy measures;

■ the continued development ofeducation/awareness initiatives,including the expansion of substancemisuse prevention/educationprogrammes in primary and secondlevel schools;

■ the development of properly superv i s e dtreatment programmes for “low risk”offenders who misuse drugs and areconvicted of petty crimes, as analternative to prison;

■ the continued development of securitymeasures in Mountjoy to prevent thesmuggling of drugs into the prison;

■ the establishment of an Advisory Bodyto conduct research into the causes,effects, trends etc. of drug misuse and to evaluate the effectiveness ofdifferent models of treatment; and

■ the establishment of an independentExpert Group – containinginternational expertise – to assess howtreatment services inside and outsideprison interact and to makerecommendations for the improved co-ordination/integration of those servicesfor drug misusers coming into contactwith the criminal justice system.

Minister of State3.1.9 In 1997, the Government appointed a

Minister of State for Local Developmentat the newly created Department ofTourism, Sport and Recreation, withspecial responsibility for co-ordination of the National Drugs Strategy.

3

Evaluation of the LDTFs3 . 1 . 1 0 An external evaluation of the LDTF

Initiative was completed in June, 1998 byPA Consulting. The consultantsrecognised that, given the need for anurgent response to the drugs problem,there had been considerable “learning onthe job” with some Task Forces beingoverly project driven. Nevertheless, theTask Forces had provided localcommunities with a focus for their effortsand had improved inter-agency workingrelationships as well as those betweenagencies and local communities.Notwithstanding these positivedevelopments, PA Consulting took theview that there was a need for someDepartments and agencies to show astronger commitment and to make amore effective contribution to theinitiative. It was also felt that theeffectiveness of representation at locallevel could be improved. Specificrecommendations included:

■ the continuation of the LDTFs for twofurther years with updated plans;

■ a greater level of guidance for LDTFs,particularly for planning andevaluation; and

■ a clear project-monitoring andevaluation framework.

In response, the NDST establishedworking groups to examine Task Forceaims and objectives, roles andresponsibilities, the preparation of newplans and monitoring. This led to thepublication of a handbook, Local DrugsTask Forces, A Local Response to the DrugProblem, in 2000. The handbookspecifically addresses many of theoperational recommendations arising inthe PA Consulting Report and providesguidelines which are being overseen bythe NDST, in co-operation with a

facilitator dedicated to work with theTask Forces. Arising from a review of themembership of the LDTFs, local electedrepresentatives were invited toparticipate in their work. Other keyrecommendations, such as theformalisation of links between the TaskForces and Local Area Partnerships andthe roles of the Departments ofEducation and Science and Social,Community and Family Affairs are thesubject of on-going negotiations.

Young People's Facilities andS e rvices Fund

3 . 1 . 1 1 The Young People’s Facilities and ServicesFund (YPFSF) was established in 1998 tosupport the development of youthfacilities, including sport and recreationalfacilities, and services in disadvantagedareas where a significant drug problemexists or has the potential to develop.The overall aim of the Fund is to attractyoung people in disadvantaged areas – atrisk of becoming involved in problemdrug use – into more healthy andproductive pursuits. The target group forthe Fund is youth aged 10 to 21 yearswho traditionally have found themselvesoutside the scope of mainstream youthactivities because of their familybackground, their involvement in crimeor drug misuse or their lack of education.

3

Four Pillars of the G o v e rnment's Response

3 . 1 . 1 3 The main elements of the Government'sresponse to the drug problem havecontinued to evolve, over the past threeyears, around four distinct but inter -linked pillars which, in the process, havebeen refined into:

■ supply reduction;

■ prevention (including education andawareness);

■ treatment (including rehabilitation andrisk reduction); and

■ research

Furthermore, the pillars are nowunderpinned by improved inter-agencyco-operation and co-ordination. Thelocation of principal responsibility foreach of these areas lies amongst theState agencies, as outlined in Table 3.1.The Department of Tourism, Sportand Recreation is responsible for theoverall co-ordination of the NationalDrugs Strategy.

Table 3.1

3 . 1 . 1 4 There is, of course, a necessary sharing ofresponsibility. For example, An GardaSíochána have an important role inprimary prevention and the PrisonsService in rehabilitation, in addition totheir more high profile roles in supplycontrol. The allocation of responsibilityacross functional categories is made morediffuse and, arguably more effective, bythe role in Ireland and elsewhere, of thecommunity and voluntary sectors acrossthe four pillars of the drug strategy.

3P i l l a r Lead Depart m e n t / A g e n c y Other Key Actors

Supply Reduction Dept. of Justice, Dept. of the Enviro n m e n t

Equality & Law Reform & Local Govern m e n t

An Garda Síochána Local Authorities

Customs & Excise Service in the Community & Vo l u n t a ry

O ffice of the Revenue Commissioners S e c t o r s

Prisons Serv i c e

Naval Serv i c e

P revention Dept. of Education & Science An Garda Síochána

Dept. of Health & Children Community & Vo l u n t a ry

Regional Health Board s S e c t o r s

Treatment Dept. of Health and Children Prisons Serv i c e

Regional Health Board s P robation & We l f a re Serv i c e

F Á S Community & Vo l u n t a ry

S e c t o r s

R e s e a rch Health Research Board

National Advisory Committee on Dru g s

3 . 2 S U P P LY R E D U C T I O N P I L L A R

D e p a rtment of Justice, Equality andLaw Reform

3.2.1 The main focus of supply reduction strategyover the past five years has been on:

■ updating legislation to reflect themodern reality of drug trafficking;

■ greater specialisation by enforcementagencies; and

■ a new emphasis on co-ordination andco-operation amongst the mainenforcement agencies.

The Department of Justice, Equality andLaw Reform has administrativeresponsibility for the Courts, Prisons andProbation and Welfare Services and forAn Garda Síochána and also hasresponsibility for policy on the reductionof the supply of drugs. In recent years,several legislative and criminal justicemeasures have been put in place, underthe aegis of the Department, to inhibitthe supply of drugs, as summarised inTable 3.2 below.

Table 3.2 – Legislative and Criminal Justice Measures

A c t E n f o rc e m e n t Ye a r

Criminal Justice Act S e i z u re & confiscation of assets derived 1 9 9 4

f rom the proceeds of drug traff i c k i n g

Money laundering

I n t e rnational mutual assistance

in criminal matters

Criminal Justice Detention of persons suspected of 1 9 9 6

( D rug Tr a fficking) Act d rug trafficking for up to 7 days

Criminal Assets The establishment of the 1 9 9 6

B u reau Act Criminal Assets Bure a u

P roceeds of Crime Act The freezing and forf e i t u re 1 9 9 6

of the proceeds of crime

D i s c l o s u re of Cert a i n Exchange of information between 1 9 9 6

I n f o rmation for Taxation the Revenue Commissioners & the Gard a í

& Other Purposes Act

Bail Act Allows for the refusal of bail to a person 1 9 9 7

who has been charged with a “serious offence”

Criminal Justice M a n d a t o ry minimum 10 year sentences for 1 9 9 9

( D rug Tr a fficking) Act d rug traff i c k i n g

3

An Garda Síochána3.2.2 An Garda Síochána are responsible for

the enforcement of drug laws and are animportant component of the nationaldrugs strategy. A number of specialistGarda Units have been created with theobjective of putting greater focus oncertain key tasks in stemming the supplyof illicit drugs and building up expertisein these areas. In addition, their PolicingPlan 2000 sets requirements for eachGarda District and Sub-District toestablish its own Drug Policing Plan,which would include multi-agencyparticipation in targeting drug dealing atlocal level.

3.2.3 The Criminal Assets Bureau (CAB) was setup in 1996 specifically as a cross-agencyresponse, including An Garda Síochána,the Revenue Commissioners and theDepartment of Social, Community andFamily Affairs, to target the proceeds ofcrime, in particular, drug trafficking. Thesuccess of the Bureau is recognised bothnationally and internationally. The GardaNational Drugs Unit was established in1995 with specific responsibility fortargeting national and international drugtrafficking. The National Crime Council

Table 3.3 – Initiatives of An Garda Síochána

has also been established to informpublic policy on crime, including drug-related crime and drug prevention. Inaddition, Community Policing Fora (CPF)have been introduced on foot of co-operation between the Gardaí and theLDTFs in order to deal with the drugproblem at a local level. At present, CPFoperate in some of the LDTF areas on apilot basis. Once evaluated, it is theintention that best practice will beidentified for the future development ofCPF in other LDTF areas on a needs basis.

3.2.4 As well as the CAB and the GardaNational Drugs Unit, other specialistGarda units include the Garda Bureau ofFraud Investigation, the National Bureauof Criminal Investigation and the localGarda Drugs Units. Moreover, variousinitiatives have been, or are being, takento target drug-related crimes, such asthose described in Table 3.3 below.

3

O p e r a t i o n D e s c r i p t i o n

D ó c h a s Focused patrolling in areas where drug dealing is pre v a l e n t

C l e a n s t re e t U n d e rcover Gardaí targeting suspected dealers in are a s

w h e re drugs are known to be available

M a i n s t re e t Ta rgets drug dealing and use in and around the O’Connell Street are a

N i g h t c a p Ta rgets venues such as nightclubs where drugs are being sold

Customs and Excise Serv i c e3.2.3 The Customs and Excise Service in the

Office of the Revenue Commissioners hasprimary responsibility for the prevention,detection, interception and seizure ofcontrolled drugs, which are smuggledeither at importation or exportation. AMemorandum of Understandingconcerning the relationship between theCustoms and Excise Service and An GardaSíochána, with respect to drugs lawenforcement, was endorsed jointly by theMinisters of Finance and Justice in 1996.Other initiatives to combat the supply ofdrugs have included agreements withtrade associations and individualcompanies in the matter of detection ofillegal drug smuggling and the CustomsDrugs Watch Programme which enliststhe help of coastal communities andmaritime personnel (fishermen andpleasure craft owners) in reportingsuspicious activities.

3.2.4 Following the agreement of theMemorandum of Understanding betweenthe Customs and Excise Service and theGardaí, a number of operational andliaison structures have been developed.These include:

■ a joint task force comprising Customs,Garda and the Naval Services;

■ personnel exchange between therespective organisations at Head Officelevel;

■ liaison between nominated Customsand Garda officers at local level; and

■ an ad-hoc group, comprising a DeputyCommissioner of An Garda Síochána,the Assistant Secretary of the RevenueCommissioners with responsibility forCustoms and the Flag Officer of theNaval Service.

The Customs and Excise Service is alsorepresented on the Multi-disciplinaryGroup on Organised Crime which wasestablished at national level in 1997. ThisGroup feeds into a similar structure atEuropean level which co-ordinates thefight against organised crime. Inaddition, there is on-going liaison withthe Garda National Drugs Unit and theCAB. In response to the challengepresented by the EU Single Market, theCustoms National Drugs Team was set upby the Revenue Commissioners andtargets the illegal importation of drugsinto Ireland.

3.2.5 At international level, the CustomsServices in all EU Member States arelinked electronically to facilitate quickand effective exchanges of informationon the suspicious movement of peopleand goods. In addition, a Customs andFiscal Attaché has been assigned to theIrish Embassy in London with particularresponsibility for liaising with the UKintelligence services and the DrugsLiaison Officer Network. Appointmentsare also being made to Europol in TheHague.

3

Prisons Serv i c e3.2.6 The Prisons Service has responsibility for

the provision and maintenance of asecure, efficient and progressive systemof containment and rehabilitation foroffenders committed to custody. This roleis undertaken in a co-operative and co-ordinated way with prisoners, theirfamilies, the community, otherGovernment Departments and statutoryagencies. However, serious capacityproblems have, in the past, led toovercrowding, particularly in Mountjoyprison, which was, until recently, themain committal prison in the State. Thisseverely undermined the development ofprison-based treatment services in thepast. However, the current prisonbuilding programme will alleviate thissituation and will, accordingly, facilitatethe on-going development of theseservices. In the past year, two new prisonshave come on stream, Cloverhill Prison inClondalkin and the Midlands Prison inPortlaoise. In addition, extensiveredevelopment work is planned for Cork,Limerick and Mountjoy prisons. In thisregard, approx. 1,000 extra prison placeshave been provided and 1,000 more areplanned.

D e p a rtment of the Enviro n m e n tand Local Govern m e n t

3.2.7 Under the 1997 Housing Act, theDepartment of the Environment andLocal Government provides financialsupport to local authorities for housingmanagement activities and otherinitiatives, on local authority estates,which are associated with problems ofdrug-related crime and anti-socialbehaviour.

3 . 3 P R E V E N T I O N P I L L A R

3.3.1 There are a number of GovernmentDepartments and Agencies involved in arange of education, prevention andawareness measures which aim to reducedemand for drugs in Irish society.

D e p a rtment of Education & Science3.3.2 The Department of Education and

Science has a number of initiatives tocombat drugs, all of which are closelylinked with the package of measures ithas to combat educational disadvantagee.g. early intervention with pupils at riskunder programmes such as theDisadvantaged Area Scheme, the Stay inSchool Retention Initiative and theHome-School Liaison Scheme. TheDepartment operates two initiatives inthe context of preventative actions – theSubstance Misuse Prevention Programme(SMPP), “Walk Tall", for primary schoolsand the Substance Abuse PreventionProject (SAPP), “On My Own Two Feet",aimed at second level school pupils. TheDepartment is also co-operating with theDepartment of Health and Children indelivering health promotion programmesin primary and second level schools. Aspart of its effort to increase awarenessamongst young people of drugs anddrug-related issues, the Departmentworks closely with FÁS on joint-fundedinitiatives such as Youthreach and in therunning of workshops aimed atincreasing drug awareness in areas wher eacute drug problems are apparent.

3

3.3.3 The “Walk Tall” Programme – which waslaunched in 1996 – has three main aspects:

■ a substance misuse awarenessprogramme for students, parents andteachers;

■ the development of education resourcematerials and in-service training forteachers; and

■ targeting schools where there is anoticeable incidence of substanceabuse, particularly heroin.

The main aims of the Programme are togive students the confidence, skills andknowledge to make healthy choices, toseek to avert or delay experimentationand to reduce the demand for legal andillegal drugs. The Programme hasestablished links with the Gardaí, HealthBoards, LDTFs, parents groups andeducation centres. Approximately 2,400schools have participated in the dayseminars of the “Walk Tall” Programmeto date.

3.3.4 The post-primary programme, “On MyOwn Two Feet”, was developed in co-operation with the Department of Healthand Children and the Mater DeiCounselling Centre and was introduced in1995. The Programme consists of anumber of resource materials and in-service training and the approach taken isto enable post-primary pupils to takecontrol over their own health andwelfare. The introduction of the newSocial, Personal and Health Education(SPHE) Programme in second levelschools, from September 2000, willensure that Substance Misuse Prevention,which is a part of SPHE, will become anintegral part of the school curriculum forjunior cycle students.

D e p a rtment of Health and Childre n3.3.5 The Department of Health and Children

also places considerable emphasis on theneed for education and prevention. TheNational Health Promotion Strategy,approved by the Government in 2000, hasa strategic aim “to endeavour to reducethe numbers engaging in drug misuse”.The Health Promotion Unit (HPU)promotes a multi-faceted approach todrug awareness, education andprevention. A range of activities aresupported, for example:

■ the “Substance Abuse PreventionProgramme (SAPP)”;

■ life-skills programmes;

■ award programmes for schools;

■ initiatives in the youth service;

■ the dissemination of resource material;and

■ local campaigns in ERHA areas.

3.3.6 The HPU also formulates preventativepolicies. However, the implementation ofthese policies on the ground is very mucha matter for the regional Health Boards,as the Department’s role – at the policylevel – has been to monitor and overseeimplementation and to provide resources.The Department situates its policyresponses in the context of UN efforts tocombat drugs through establishingtargets to be achieved by 2008.

3

An Garda Síochána3.3.7 The Gardaí also have a role under this

pillar. High priority has been accorded toengaging with young people involved, orat risk of becoming involved in drugs andcrime. The Garda Youth DiversionaryProjects are operated by multi-agencyManagement/Advisory Committees,which encompass the Gardaí, Probationand Welfare Service personnel, youthorganisations, local clergy andrepresentatives of local statutory andcommunity and voluntary groups. As ofApril 2001, there are 51 projects inoperation. The concept of introducing aspecific drug prevention element to theseprojects is currently under review. Othercommunity based Garda initiativesinclude the Drug Awareness Programmefor communities; Garda SchoolsProgrammes; Garda Mobile Anti-DrugsUnit and the Juvenile DiversionProgramme. Moreover, Garda JuvenileLiaison Officers also serve throughout thecountry.

Young People's Facilities andS e rvices Fund

3.3.8 In 1998, the YPFSF was set up to developyouth facilities, including sport andrecreational facilities, and services indisadvantaged areas where a significantdrug problem exists or has the potentialto develop. The primary focus of theFund is on LDTF areas and selected urbanareas (i.e. Galway, Limerick, South CorkCity, Waterford and Carlow) where aserious drug problem exists or has thepotential to develop. A sum of £102million has been provided under theNational Development Plan (2000 – 2006)to support measures under the Fund, ofwhich approx. £46 million has beenallocated to date in the first round offunding.

3.3.9 In establishing the Fund, the CabinetCommittee set up a National AssessmentCommittee to (i) prepare guidelines forthe development of integrated plans inthe target areas, which meet the overallaims and objectives of the Fund; (ii)facilitate the establishment of the localstructures charged with developing plans;(iii) assess the plans emanating from eachof the target areas and (iv) makerecommendations on funding to theCabinet Committee on Social Inclusion.The National Assessment Committee isresponsible for monitoring on-goingprogress in implementing the plans andstrategies approved and addressing anydifficulties or issues arising. It is alsooverseeing an external evaluation of theFund, in conjunction with theDepartment of Education and Science,which will provide a comprehensive andindependent assessment of the Fund,taking account of its overall aims andobjectives. The evaluation of the Fundcommenced in April 2001.

Local Drugs Task Forc e s3 . 3 . 1 0 The LDTFs, in the context of implementing

their Action Plans, are delivering a rangeof measures in the education, preventionand awareness areas. Initiatives includecommunity-based drug awarenessprogrammes in schools, youth clubs andother places where young peoplecongregate; drug awareness programmesfor parents, teachers etc; peer educationprogrammes and projects to preventearly school-leaving.

3

3 . 4 T R E AT M E N T P I L L A R

D e p a rtment of Health and Childre n3.4.1 The Department of Health and Children

has overall policy and legislativeresponsibility for health, social servicesand child welfare in Ireland, as well asvarious responsibilities for aspects of drugpolicy, principally treatment andrehabilitation services. In developing itspolicy on drug misuse, the Departmenthas adopted a health promotionapproach. The Department’s nationalpolicy on the treatment of alcohol anddrug misuse stresses the need forcommunity based interventions ratherthan specialist in-patient approaches.These services include family support andcommunity medical and social services.

3.4.2 Responsibility for the provision oftreatment and rehabilitation services fordrug misusers is vested with the tenRegional Health Boards. The HealthBoards also provide support and trainingfor community groups which are involvedin dru g - related prevention or re h a b i l i t a t i o nactivities, as both the community andvoluntary sectors play a significant part inthe provision of drug related services,especially in the LDTF areas. The HealthBoards have appointed Regional DrugCo-ordinators and many have alsoestablished Regional Drug Co-ordinatingCommittees comprising representatives ofthe relevant Health Board, An GardaSíochána, Education Services and thecommunity and voluntary sectors. Thereis regular contact between the NDST andthe Regional Drug Co-ordinators.

3.4.3 Growth in drug-related problemsthroughout the country has resulted inthe need for many of the Health Boardsto formulate a specific drug strategy fortheir region. This is especially the case inthe area of development of services,which are local and tailored to the needsof particular communities. The majorityof these strategies are being developedat present in accordance with emergingtrends which are specific to the individualregions. Perhaps not surprisingly, theemphasis in many Health Boards outsideof the Eastern region has been oneducation and prevention initiatives.However, because of the nature of thedrug problem in the Eastern catchmentarea, the Eastern Regional HealthAuthority (ERHA) has been involved in asignificant degree of activity andexpansion of treatment services within itsarea.

52The expansion of services in the

ERHA area has been a priority in order toprotect the health of misusersthemselves, to prevent the spread ofinfectious diseases and to reduce theeffect of chaotic behaviour on certainneighbourhoods.

3.4.4 Although waiting lists remain a problemin the successful treatment andrehabilitation of drug misusers in theEastern region, there has, nonethelessbeen an extensive development oftreatment facilities especially in theGreater Dublin area. For example, at theend of 1997 there were 21 treatmentlocations in the Eastern Health Boardarea, while there are now 55. Due todifficulties associated with estimation andresistance amongst some users totreatment, service planners do not alwayshave the opportunity to plan servicesaround accurate prevalence figures.Nevertheless, it is envisaged that over thenext 2-3 years, supply will approachactual demand for treatment andrehabilitation.

3

5 2 F a rrell et al., 2000 op cit.

Prisons Serv i c e3.4.5 In October 2000, the Government

approved in principle the implementationof the recommendations contained in theReport on Prison-Based Drug TreatmentServices which was produced by aSteering Group, established by theDirector General of the Prison Service.

53

These proposals will result in a majoroverhaul of prison-based drug treatmentservices and should make a majorcontribution to breaking the cycle ofdrug dependency, crime andimprisonment which are inextricablylinked at present. Perhaps the mainconclusion of the report is that thePrisons Service must replicate in prison,the level of medical and other supportsavailable in the community for drugdependent people, to the maximumextent possible.

3.4.6 In addition, the report proposes a multi-disciplinary approach to the drugproblem in prisons and the appointmentof a senior figure from the ERHA to co-ordinate the overall treatment service inthe Dublin prisons, as well as drugscounsellors and extra nurses,psychologists and probation service staff.All staff in the relevant institutions willreceive training in drugs-related issuesand refresher courses every yearthereafter. Links are also beingestablished with local community andvoluntary groups, through liaisoncommittees, to enhance the throughcareand aftercare arrangements for prisonersin receipt of drug treatments in custody.Implementation of the recommendationsof the report are progressing at present.

3.4.7 The Probation and Welfare Service,although not a primary drug treatmentagency, co-ordinates a range of drugtreatment initiatives, in co-operation witha number of rehabilitation agencies andthe community.

D rug Court

3.4.8 A Drug Court was established in January2001 in the North Inner City of Dublin. Ithas as its primary aim “the reduction ofcrime through rehabilitation of theo ffender but not excluding punishmentshould the circumstances so warr a n t ” .

5 4

Rehabilitation and structured supervisionwill be used to help participants toescape the cycle of offending with theultimate objective of ending all criminalactivity. It is hoped that best practice willbe identified to allow for expansion, asappropriate.

F Á S3.4.9 FÁS works closely with the voluntary,

community and state sectors on projectsaimed at prevention, treatment andrehabilitation. Specific drug-relatedprogrammes, operated by FÁS, includethe Special Drugs CommunityEmployment Programme, on which 1,000places have been set aside for recoveringdrug misusers.

55Employment Service

Offices, which are based throughout thecountry, provide trained staff to workwith stabilised drug misusers to assistthem to secure employment or furthertraining. Similarly, a number of“advocates”, located in severelydisadvantaged areas, provide amentoring service to young peopleexperiencing drug problems.

D e p a rtment of the Enviro n m e n tand Local Govern m e n t

3 . 4 . 1 0 Special high support hostel accommodationis necessary for homeless people withdrug dependence problems. Under theHomeless Strategy, funding has beenprovided by the Government for theprovision of two high support hostels inDublin for people with drug and alcoholdependence problems. In view of thenumber of people with such problems inDublin, Dublin Corporation and the ERHAare taking the lead role in drawing upand implementing suitable proposals.

3

5 3 First Report of the Steering Group on Prison-Based Drug Treatment Serv i c e s, July 2000, The Prisons Serv i c e .5 4 First Report of the Drug Court Planning Committee, Pilot Pro j e c t, August 1999, Dublin; The Stationery Off i c e .5 5 800 places were taken up on the FÁS programme at end April 2001.

Vo l u n t a ry Drug Treatment Network3 . 4 . 1 1 The Voluntary Drug Treatment Network

56

provides a framework for a number ofvoluntary drug groups working in thearea of treatment to meet, share issues ofconcern and develop morecomprehensive responses to theprevention and treatment of problemdrug use. The Network is an umbrellagroup that aims to challenge drug misuseand related issues in a creative, caringand motivational way. It provides acomprehensive range of drug treatmentmethods that range from harm reductionintervention through to long-termresidential drug-free programmes. Thereare two core strands to the compositionof the Network. These are localisedcommunity-based treatment responses,that have emerged from local residentsand individuals seeking to respond toissues in their areas and regionalresponses that provide treatment atnational and, occasionally, at EU level.

3 . 4 . 1 2 The Network has representatives on theNational Aids Strategy Committee, theNDST and the National AdvisoryCommittee on Drugs (NACD). They arealso members of the Community Platformthat forms part of the Community andVoluntary Pillar of the Social Partnership.However, the Network itself does nothave a national remit to represent all thevoluntary drug treatment organisationsin the country. It is primarily for theDublin based organisations which dealwith drug misuse but some of itsmembers do have a national focus interms of treatment and training. TheNetwork engages with variousGovernment Departments and RegionalHealth Boards who assist in the fundingof its services.

3 . 5 R E S E A R C H P I L L A R

D rug Misuse Research Division ofthe Health Research Board

3.5.1 As set out in Chapter 2, the Drug MisuseResearch Division (DMRD) of the HealthResearch Board was established in 1989and is responsible for operating theNational Drug Treatment ReportingSystem (NDTRS) which is the main sourceof information on drug misuse in Ireland.The NDTRS is an epidemiologicaldatabase, which provides data on peoplewho avail of treatment services forproblem drug use, on a nationwide basis.This provides information on the currentpatterns and trends of treated drug useand drug addiction in Ireland. Data isprovided to the NDTRS through centresor service locations where drug misuse istreated.

3.5.2 The Government has designated theDMRD as the central point to which allresearch data and information should bechannelled. In order to deliver on therole assigned to it, the DMRD isdeveloping a National DocumentationCentre which policy-makers and otherinterested parties can use to access allrelevant and up-to-date information andresearch in the field of drug misuse inIreland and internationally. In addition toexisting data, all future research andinformation will be channelled or, asappropriate, its existence notified andrecorded in a way which facilitates easeof retrieval by policy-makers and otherinterested parties. The DocumentationCentre will build on the existing resourcesof the DMRD and will capitalise on itsposition as the National Focal Point forthe European Monitoring Centre forDrugs and Drug Addiction (EMCDDA).

3

5 6 The Vo l u n t a ry Drug Treatment Network is comprised of Addiction Response Crumlin, Ana Liff e y, CASP, Coolmine Therapeutic Community, Fetterc a i rn DP,

K i l l i n a rden ARP, Mater Dei Counselling, Merchants Quay Project, Saol Womens Project, Ballymun YA P.

National Advisory Committee onD rugs (NACD)

3.5.3 The NACD was established in July 2000 toadvise the Government in relation to theprevalence, prevention, treatment andconsequences of problem drug use inIreland, based on the Committee'sanalysis and interpretation of researchfindings and information available to it.The Committee is overseeing the deliveryof a three year prioritised programme ofresearch and evaluation on the extent,nature, causes and effects of drug misusein Ireland, identifying the contributionwhich can be made by all the relevantinterests. Its membership reflectsstatutory, community, voluntary,academic and research interests as well asrepresentation from the relevantGovernment Departments. TheCommittee operates under the aegis ofthe Department of Tourism, Sport andRecreation.

Health Promotion Unit (HPU) of theD e p a rtment of Health and Childre n

3.5.4 The HPU of the Department of Healthand Children is also involved in thepublication and dissemination ofinformation and literature whichpromotes the avoidance of drug misuse.In this regard, the National HealthPromotion Strategy sets clear aims andobjectives to support best practice modelswhich promote the non-use of drugs and,where they are used, the minimisation ofthe harm done by them.

3 . 6 C O-O R D I N AT I O N A C R O S S T H EP I L L A R S

Cabinet Committee on SocialI n c l u s i o n

3.6.1 The Cabinet Committee on SocialInclusion gives overall political directionto the Government's social inclusionpolicies, including the national drugsstrategy. It has, inter alia, responsibilityfor reviewing trends in the area of drugmisuse, assessing progress inimplementing the national drugs strategyand resolving policy or organisationaldifficulties which may inhibit effectiveresponses to the problem.

D e p a rtment of Tourism, Sport andR e c re a t i o n

3.6.2 The Department of Tourism, Sport andRecreation is responsible for the overallco-ordination of national policy to tackledrug misuse with a Minister of State whoreports to the Cabinet Committee onSocial Inclusion. The Department chairsand provides the secretariat to the IDGand funds both the NDST and the NACD.

3

I n t e r- D e p a rtmental Group on Drugs (IDG)

3.6.3 The IDG oversees progress on theimplementation of the national drugsstrategy and reviews Government policyon issues which may arise, includingsubmissions from the NDST and theNational Assessment Committee for theYPFSF. It meets on a monthly basis and ischaired, at Assistant Secretary level, bythe Department of Tourism, Sport andRecreation which also provides thesecretariat to the Group. The followingDepartments are represented, at SeniorO fficial level, on the IDG: Taoiseach; Finance;Education & Science; Enterprise, Trade &Employment; Environment & LocalGovernment; Health & Children andJustice, Equality & Law Reform. The Chairof the NDST is also a member of the IDG.

National Drugs Strategy Team (NDST)

3.6.4 The NDST, which has joint monthlymeetings with the IDG, is a cross-departmental team comprised o fpersonnel from a number of D e p a rt m e n t sand Agencies. Members have directaccess to their respective Ministers andthe heads of the relevant Departmentson matters relating to the effectiveimplementation of the various pro g r a m m e sand initiatives operating under theiraegis, particularly in so far as they relateto the 14 LDTF areas. Their time isdivided evenly between their parentDepartment/Agency and the Team. Thecommunity and voluntary sectors eachhave a representative on the NDST and,as such, the Team is a partnershipbetween the statutory, community andvoluntary sectors.

3.6.5 The NDST is chaired, at Principal Officerlevel, by the Department of Health andChildren. Full-time secretarial andadministrative support for the NDST isprovided by staff seconded from theDepartment of the Taoiseach and theERHA. The NDST ensures that there iseffective co-ordination betweenDepartments and Agencies, oversees thework of the LDTFs, identifies and considerspolicy issues and, through joint meetingswith the IDG, ensures that policy isi n f o rmed by the work of and lessons fro mthe LDTFs. Each member of the NDST actsas a liaison person for one or more LDTFs.The NDST also meets on a regular basiswith the chairs and co-ordinators of theLDTFs to review progress and identifyissues to be addressed.

3

Local Drugs Task Forces (LDTFs)3.6.6 Membership of the LDTFs include

representatives of all the relevantagencies such as the Health Board, theGardaí, the Probation and WelfareService, the relevant Local Authority,elected public representatives, the YouthService and FÁS. Moreover, LDTFs alsoinclude representation from voluntaryagencies, community representatives, achairperson nominated by the local AreaPartnership and a co-ordinator providedby the relevant Health Board.

3 . 7 P U B L I C E X P E N D I T U R E O N T H EC U R R E N T D R U G S S T R AT E G Y

3.7.1 The cost of drug misuse at a societal levelis extremely difficult to quantify

57as it

encompasses areas like the public healthcosts of disease associated with drugdependence, the cost of acquisitive crimeand associated losses and insurance costswhich are borne by both business andindividuals. The level of State spendingon drugs-related issues is also difficult to estimate and is complicated by the fact that expenditure is spread across a number of Departments, LocalAuthorities, Agencies and other statutoryorganisations. Even within Departmentsand Agencies, it is difficult to arrive at anaccurate estimate of costs associatedspecifically with drug misuse as servicessuch as An Garda Síochána, the Prisons,the Courts and Probation and WelfareServices and the various health agenciesdeal with drugs issues as part of theirwider daily services.

3.7.2 Bearing these limiting factors in mindand using the information supplied tothe Review Group, it is estimated that thedevelopment, co-ordination and deliveryof the four pillars that make up thecurrent National Drugs Strategyapproximated to £144 million in 2000.This is broken down by Departments andAgencies in Table 3.4.

3

5 7 The EMCCDA, in consultation with the Pompidou Group, is currently re s e a rching improved mechanisms for the establishment of costs to society of drug misuse.

Table 3.4 – Direct Expenditure in 2000

* Rounded to one decimal place.

Notes: The expenditure for theDepartment of Education and Scienceincludes the YPFSF. The expenditure forthe Department of Tourism, Sport andRecreation is mainly for theimplementation of the LDTF action plansand is paid through the implementingDepartments and Agencies. Theexpenditure figure for the Department ofEnterprise, Trade and Employmentrepresents funding for the Special DrugsCommunity Employment Programme runby FÁS for recovering drug misusers.Expenditure for the Department ofHealth and Children comprises theadditional funding granted to HealthBoards from 1996 to 2000 plus the 2000funding allocated (from other sources aswell as the Department of Health andChildren) to the DMRD.

3

D e p a rt m e n t / A g e n c y E x p e n d i t u re £

Dept. of Justice, Equality & Law Reform 9 7 . 0 m l

Dept. of Health & Childre n 2 5 . 2 m l

Dept. of Enterprise, Trade & Employment 4 . 7 m l

Dept. of Education & Science 5 . 9 m l

Dept. of Tourism, Sport & Recre a t i o n 9 . 1 m l

Revenue Commissioners (Customs and Excise) 1 . 5 m l

State Laboratory 0 . 4 m l

T O TA L 1 4 3 . 8 m l

4 . 1 T H E I N T E R N AT I O N A L T R A D EI N D R U G S

4.1.1 Drugs are an international problem andthe trade in drugs is worth many billionsof pounds annually. A 1997 report by theUnited Nations Drug Control Programme(UNDCP) estimated that the trade indrugs amounted to 8% of totalinternational trade, that is roughly thesame as textiles, oil, gas or world tourism.There is a marked difference between theprice of drugs sold in Ireland, in thesource country and while in transit. Pricescan vary for a number of reasons, e.g.size of the crop, number of seizures,demand etc. but as an example, a kilo ofheroin is sold in Afghanistan for IR£1,000,in Turkey for IR£8,750, in the Netherlandsfor IR£19,000 and in Ireland forIR£80,000. It can then realise up to fourtimes this figure on the streets,depending on the number of exchangesand the level of purity.

4.1.2 While narcotic crops are cultivatedworldwide and cannabis products, inparticular, are produced in a number ofregions, three areas of the world accountfor the vast majority of cocaine (coca)and heroin (opium) production. Cocaineproduction is concentrated in SouthAmerica (primarily Colombia but bothPeru & Bolivia also produce significantamounts – see figure 4.2). Heroin isprimarily produced in South West Asia(overwhelmingly in Afghanistan) and to alesser degree in South East Asia (theGolden Triangle which straddles Burma,Laos, Thailand and Vietnam – see figure4.1). Colombia and Mexico have alsodeveloped significant potential heroinproduction capability. By 2000, theyaccounted for approx. 2.4% of

world heroin production which istargeted mainly at the U.S. Althoughthere is some limited domesticproduction of cannabis and somesynthetic drugs (mainly ecstasy), Ireland isprimarily an importer of drugs and is alsosometimes used as a transit point forother European destinations. The mainroutes for these drugs into the countryare as follows:

■ Heroin – Heroin mainly originates inAsia and comes through Turkey and theBalkans and arrives in Ireland primarilythrough the UK or the Netherlands.Amounts are generally quite small andare for the home market. Due to thesize of the quantities, they can betransported in a number of differentways and can be difficult to detect.

■ Cocaine – Cocaine is shipped in muchlarger amounts from South America, inmany cases through the Caribbean,arriving in Ireland in most casesthrough other EU countries, inparticular the UK.

■ Cannabis – Cannabis can be producedanywhere but the bulk of cannabis soldin Ireland comes from North Africa,mostly Morocco, via sea-going yachts aswell as articulated trucks using cross-channel ferries. In general, theshipments are quite large in size.

■ Ecstasy – Ecstasy and other syntheticdrugs can also be produced anywherealthough most of the ecstasy that issold in Ireland is believed to be sourcedin the Netherlands and Belgium, butincreasingly drugs are being sourcedfrom Eastern Europe.

4

Figure 4.1 – Estimated Worldwide HeroinProduction in Metric Tonnes by Country in2000* (Total 510 Metric Tonnes)

* “Southwest Asia – Opium Cultivation and Production Estimates 2000”,

publication of the United States Office for National Drug Control Policy,

2 0 0 0 .

Figure 4.2 – Estimated World CocaineProduction in Metric Tonnes by Country 1999(Total 765 Metric Tonnes)*

* “Major Coca & Opium Producing Nations – Cultivation and Pro d u c t i o n

Estimates, 1995-1999”, publication of the United States Office for National

D rug Control Policy, 1999.

4

4 . 2 E U R O P E A N U N I O N

4.2.1 The EU Member States have beenadopting common measures forcombating drug addiction since the mid-1980s. In 1990, the Rome EuropeanCouncil adopted the first European Planto Combat Drugs, which was then revisedand updated by the Edinburgh EuropeanCouncil in 1992. The 1995-1999 EU ActionPlan stressed the need for a multi-disciplinary and integrated response,centred around demand reduction,supply reduction, the fight against illicittrafficking and international co-operationand co-ordination at national and EUlevel. The more recent EU Action Plan2000 – 2004 is based upon theconclusions of the Cardiff and ViennaEuropean Councils. The Strasbourg basedCouncil of Europe also plays a key role ina pan-European response to the drugsproblem, particularly through thePompidou Group which is currentlychaired by Ireland.

4.2.2 The EU Action Plan to Combat Drugs(2000-2004) emphasises the continuingthreat to society posed by illicit drugs.The Plan outlines the need for a balancedapproach between demand and supplyreduction. The main aims and objectivesof the 2000-2004 Plan are:

■ to ensure that the issue of the fightagainst drugs is kept as a major priorityfor EU internal and external action;

■ to continue the EU integrated andbalanced approach to the fight againstdrugs, in which supply and demandreduction are seen as mutuallyreinforcing elements;

■ to ensure collection, analysis anddissemination of objective, reliable andcomparable data on the drugsphenomenon in the EU with thesupport of European MonitoringCommittee on Drugs and DrugAddiction (EMCDDA) and Europol;

■ to promote international co-operation,integration of drug control into EUdevelopment co-operation and tosupport the efforts of the UN and ofthe United Nations Drug ControlProgramme (UNCDP), in particular, todevelop international co-operation,based on the principles adopted atUnited Nations General AssemblySpecial Session on Drugs (UNGASS); and

■ to emphasise that, while not biddingfor new resources, the successfulimplementation of the strategy andactions mentioned in this Action Planwill necessitate appropriate resources.

The Plan emphasises the need to evaluateexperience and identify best practice toensure continuity and consistency inorder to build upon the previous ActionPlan. It identifies many new challengesand re-affirms the Union’s commitmentsto the relevant UN Conventions.

58

Furthermore, it sets targets under its sixkey headings: co-ordination; informationand evaluation; reduction of demand;prevention of drug misuse and of drug-related crime; supply reduction andinternational co-operation.

4

5 8 The 1961 Single Convention of Narcotic Drugs, the 1971 Convention on Psychotropic Substances and the 1988 Convention against Tr a ffic in Narcotic Drugs and

P s y c h o t ropic Substances. Under these Conventions, the parties are obliged to apply specified measures to substances listed in the Conventions and to any

substance subsequently brought within the scope of the Convention by the United Nations Commission on Narcotic Dru g s .

4.2.3 The following are key features of the EUAction Plan:

■ it provides for the EuropeanCommission to organise appropriateevaluations at mid-term and oncompletion of the EU Drugs Strategy(2000 – 2008). Each Member State willhave to account for the actions theyhave taken in accordance with therelevant sections of the Action Plan;

■ including in the EU Annual Report onDrugs an overview of measures takenas follow-up to the Action Plan;

■ completion of a study into thedefinitions, penalties and practicalimplementation of laws by the Courtsand law enforcement agencies for drugtrafficking within the Member States;

■ completion of work on the five keyepidemiological indicators and thedevelopment of indicators on drugsrelated crime, the availability of illicitdrugs and drug-related social exclusion;

■ launch of a study on attitudes to drugsthroughout the EU;

■ establishment of measurable targets sothat assessments can be made onprogress in achieving objectives in theAction Plan; and

■ evaluation of the co-ordinationarrangements that are in place.

4.2.4 The EU has also prioritised the fightagainst drugs in its external relations. Inthis regard, it has applied two categoriesof action. First, is the active support forglobal policy-making, the strengtheningof strategy settings by UN institutionsand the effective functioning of informalbodies. Second, is the need for bilateraland regional actions in the area of tradepolicy, technical assistance and politicaldialogue. It is envisaged that the Unionwill use the full range of measures at itsdisposal in the field of external relations,including enhancement of commonforeign and security policy. In addition,co-operation agreements with thirdcountries regularly feature drugs clauses.

4

4 . 3 O V E RV I E W O F S E L E C T E D N AT I O N A LD R U G P O L I C I E S

4.3.1 The Review Group also looked at nationaldrugs policies in the Netherlands,Portugal, England, Scotland, Spain,Sweden, Australia and Switzerland asbroadly representative of the spectrum ofrecent national strategic responses. Theapproach to dealing with drug misuseacross all these States shared commontwin emphases – a focus on the needs ofthe drug misuser, coupled with attemptsthrough various enforcement measuresand agencies to cut off the supply ofdrugs, with the degree of emphasisvarying according to the country’sfundamental philosophy on tackling thedrugs issue.

4 . 4 A U S T R A L I A

4.4.1 The Australian Drug Strategy is based onthe principle of harm reduction. Harmincludes levels of illness and disease,criminal offences and personal and socialdisruption from drug misuse. It recognisesexplicitly that there is a heavycommitment outside of the Strategy tothe treatment of disease and traumacaused by misuse of drugs and to lawe n f o rcement to restrict the supply of dru g s .In these circumstances, the Strategy, in itsown right, is intended to be a catalyst forchange and innovation. It supports adiverse range of drug and alcohol servicesin the areas of treatment, prevention,supply control and education andtraining. The specific initiatives embracedby the Australian Strategy includepartnerships between variousgovernmental and non-governmentalagencies, media campaigns and theproduction of core educational resources.

4

4 . 5 T H E N E T H E R L A N D S

4.5.1 The main aim of drugs policy in theNetherlands, as in Australia, is to reducethe risks experienced by drug misusers,those in their immediate environmentand Dutch society in general. Formisusers, the central goal is theprotection of their health which isachieved through prevention and caremeasures. Such measures are buttressedby the activities of the police and otherenforcement agencies. Dutch policy isalso formulated on the premises that:

■ t h e re is a distinction to be made between“ h a rd” drug and “soft” drug misuse;

■ processing of misusers through thecriminal justice system is moredamaging to the misuser than the useof drugs; and

■ every effort should be made to inhibitdrug misusers from ending up in anillegal environment where outreachcan be difficult.

Prevention interventions are carried outby local or regional organisations in thefields of education, health, drugs, youthand social work. Information andeducation campaigns can be generic ortargeted at specific high-risk groups. Inthe health sector, the objective includesthe prevention through harm reductionpolicies of further deterioration. Theactions designed to achieve this includesyringe exchange and methadonemaintenance programmes and theprovision of food and shelter to misusers.

4.5.2 An experiment involving the prescriptionof heroin under strict medical supervisionhas also been in place in the Netherlandssince 1998. It involves a group of 750serious misusers whom it is consideredcan no longer be helped by the regularcare system. The experiment involves thecomparison of two different treatments –treatment with methadone andtreatment with methadone incombination with heroin. The aim of thestudy is to examine whether theprescription of heroin has a beneficialeffect on the physical or mental healthand social functioning of drug misusers.Amsterdam and Rotterdam were chosenfor the first phase of the experiment and50 misusers in each area are beingprescribed heroin, in addition tomethadone. An evaluation of theexperiment has not yet been carried out.

4.4.3 Overall, Dutch policy attempts to providedifferentiated care which, insofar as ispossible, is attuned to the wide range ofneeds of the individual drug misuser.

4

4 . 6 P O RT U G A L

4.6.1 The basic principles underpinning thePortuguese Strategy embrace:

■ prevention to minimise demand fordrugs through appropriate educationand information programmes;

■ recognition of the human dignity ofmisusers and the complexity of theissue of drug misuse;

■ an openness to innovative and evidence-based responses to the drugs pro b l e m ;

■ co-ordination between variousgovernmental and non-governmentalagencies; and

■ community mobilisation.

4.6.2 The objectives of Portuguese Strategyinclude effective international co-operation; the provision of good qualityinformation about drug misuse to thePortuguese population; information onthe use of drugs by young people andthe securing of the necessary resourcesfor the treatment and social re-integration of drug misusers.

4.6.3 Portugal aims to deliver a broad range ofstrategic actions, consistent with theharm reduction policies and humanisticphilosophies adopted in other countries.

4 . 7 E N G L A N D

4.7.1 The UK Drugs Strategy “Tackling Drugs toBuild a Better Britain” was launched in1998. Scotland, Wales and NorthernIreland have since developed their owndrug strategies which are aligned withand reflect the key elements of the UKStrategy. The key aim of the 10-yearStrategy is to create a healthy andconfident society, increasingly free fromthe harm caused by the misuse of drugs.There are four main elements:

■ Young People – to help young peopleresist drug misuse in order to achievetheir full potential in society;

■ Communities – to protect communitiesfrom drug-related anti-social andcriminal behaviour;

■ Treatment – to enable people withdrug problems to overcome them andlive healthy and crime-free lives; and

■ Availability – to stifle the availability ofillegal drugs on the streets.

4.7.2 Young people: the Strategy seeks toprepare young people both to resistdrugs and, as necessary, to handle drug-related problems. This is achievedthrough the provision of information,skills and support especially to at riskgroups. The main mode of delivery isthrough the education system startingwith the teaching of broad life-skills atprimary school.

Communities: the Strategy seeks toprotect communities from drug-relatedcrime and anti-social behaviour byidentifying drug misusing offenders atkey points in the criminal justice systemand encouraging them to take upappropriate treatment or other effectiveprogrammes of help. The evaluations ofthe “Arrest Referral Scheme” and the“Drug Treatment” and “Testing Order”pilot schemes indicate significantreductions in drug use and crimecommitted by offenders whilst on theschemes. These schemes are now beingrolled-out nationally.

4

Treatment: the Strategy seeks to improvethe provision of drug treatment toenable all problem drug misusers to haveproper access to support fromappropriate services, including primarycare, when needed, which will have apositive impact on health and crime.

Availability: the Strategy seeks to stiflethe availability of illegal drugs on UKstreets by focusing on disrupting anddismantling the trafficking groups whoare responsible for the bulk of illegaldrugs supplied to and distributed withinthe UK.

4.7.4 The structures put in place to deliver thestrategy is headed by the MinisterialSteering Group on Drug Misuse (MSGD).The UK Anti-Drugs Co-ordinator and hisdeputy, along with the UK Anti-Drugs Co-ordination Unit (UKADCU), have a keyrole in co-ordinating the Strategy andassessing and driving forward progressagainst key targets. Strategic co-ordination of the strategy in England isdriven forward by the Strategic PlanningBoard (SPB) which takes ownership of thestrategy targets, agrees business plans foreach aim of the Strategy and advisesMSGD accordingly. Drug Action Teams(DATs) are responsible for co-ordinatingthe local delivery of the drugs strategy.Representation on DATs is from the coreagencies of education, social services,health, police, prisons, local housingauthority and probation service.

4 . 8 S C O T L A N D

4.8.1 Four key pillars underpin the ScottishS t r a t e g y. They are social inclusion,partnership, co-ordinated action andevidence-based responses andaccountability.

4.8.2 Effective drug education for all youngpeople lies at the heart of policy onprevention in Scotland. The emphasis ison health education, including drugeducation, within a comprehensiveprogramme of personal and socialdevelopment aimed at providing youngpeople with the necessary knowledgeand skills to choose a healthy lifestyle.The actions taken to reduce drugs withincommunities in Scotland include (i) thetackling of drug misuse within a widersocial programme; (ii) reducing drug-related crime through substituteprescribing regimes; (iii) implementingand evaluating Drug Action Teams; (iv)promoting initiatives to cut drug crimethrough arrest referral and diversion and(v) education programmes for parents.

4.8.3 Treatment in Scotland is designed toimprove the general health of misusers.Aims include stemming the spread ofinfections, the induction of abstinencethrough detoxification and residentialcare programmes. Pharmacy needleexchanges, together with specialist drugservice needle exchanges, have beendeveloped throughout Scotland andmethadone prescription is a major part oftreatment strategy.

4.8.4 The police and other enforcementagencies accord a high priority to drugenforcement in Scotland. The ScottishPrisons Service has mandatory drugtesting, a feature which has led to asubstantial increase in the number ofprisoners seeking support for their drugmisuse problems.

4

4 . 9 S PA I N

4.9.1 The main goals of Spanish policy on dru g sinclude the prioritisation of prevention,demand and harm reduction; thefostering of programmes which promotethe re-integration of drug dependentpersons into Spanish society; and thereduction of supply through concertedaction against drug trafficking, moneylaundering and other related crimes.

4.92 Prevention, which is primarily aimed atyoung people, is considered to be themost important strategy for dealing withthe drug problem in Spain. Prevention isstructured around certain principles,priorities and objectives. These principlesinclude (i) the co-ordination of actions bythe State agencies; (ii) the activeparticipation of communities and (iii) thepromotion of “education for health”,measures aimed at preventing the spreadof disease and a reduction in illness andassociated infectious conditions. Thepriorities for intervention are schools,families, the workplace, communities andthe media. The objectives of the SpanishStrategy buttress these priorities.

4.9.3 Harm reduction in Spain aims to reducethe harm caused by drugs consumption asregards the wider society as well as theindividual user’s health. Harm reductioncovers, amongst other things, syringeexchange and methadone maintenanceprogrammes. Integration of drugmisusers into Spanish society operates onthe premises of equitable treatment forusers throughout the country, the co-ordination of the actions of relevantintervention agencies and the provisionof quality controlled, differentiated,evidence-based and localisedprogrammes.

4.9.4 Another element of Spain's harmreduction programme is the recentprovision of injecting rooms for misusersin the Autonomous Region of Madrid.Although not officially in accordancewith Spain's national strategy on drugs,the injecting rooms opened in Madrid inJune 2000 and approximately 1,200misusers availed of the service in the first3 months.

59The Madrid region has a

population roughly the size of Irelandand has between 14,000 – 15,000 heroinmisusers. Services are divided into twolevels of care – primary care whichincludes a needle exchange programme(2 million needles exchanged last year),methadone maintenance (in 1999, over8,000 drug misusers received methadoneof which over 3,500 were new to theprogramme), as well as psychiatric andemergency care. The injecting rooms areaimed at those intravenous drug takerswho are the highest risk group, arefrequently homeless and the least likelyto come within any of the normal socialservices. No evaluation of theeffectiveness of the Madrid programmehas been carried out to date.

4.9.5 The Strategy on supply control in Spaininvolves co-operation with securityservices across Europe including Europol,combating the internal distribution ofdrugs through the actions of specialisedinvestigation units and reducing streetsupply and dealing.

4

5 9 Personal communication from Cabrera Form e i ro (head of the Autonomous Region of Madrid’s Anti-Drug Agency).

4 . 1 0 S W E D E N

4 . 1 0 . 1 The overriding aim of Swedish policy is a“drug free” society. Consequently, theproblem of drug misuse is treatedprimarily as a matter for the criminaljustice system as distinct from the socialservices. The aim is that drugs shouldnever become an integral part of Swedishsociety and that drug misuse should beregarded as unacceptable behaviour andas a marginal phenomenon.

4 . 1 0 . 2 In Sweden, the overriding aim of thed rugs policy crystallises into three sub-goals:

■ reducing the number of new drug misusers;

■ inducing more misusers to abstain; and

■ reducing the supply of drugs.

Sweden takes the view that the essentialpre-requisite of a successful drugs policyis for people of all ages to disassociatethemselves from drugs and drug misuse.With this objective in mind, the mainpurpose of information provision inSweden is to re-enforce public hostility todrug misuse. In this context, schoolprogrammes have a crucial role to playand the school curriculum requires everyschool to draw up a special action planfor alcohol, narcotic drugs and tobaccoinstruction. School programmes are re-enforced by generic or targetedinformation campaigns.

4 . 1 0 . 3 In Sweden, all non-medical usage ofd rugs is unacceptable. As a result, Swedentakes a restrictive position on methadonemaintenance treatment and needleexchange programmes. For example,methadone maintenance is strictlycontrolled under rules defined by theNational Board of Health and Welfar eand the number of patients may notexceed 600.

60By international standards,

however, Sweden has an unusually smallproportion of heroin misusers, as heavydrug misuse is generally dominated bystimulants such as amphetamines. The2000 EMCDDA Report indicates thatSweden has one of the lowest nationalprevalence estimates for problem druguse in the EU. More specifically, thepercentage of clients admitted fortreatment for opiate use in Sweden isalso among the lowest in the EU.

61

4 . 1 0 . 4Persistent drug misusers, who are likely toharm themselves seriously, can beadmitted into care against their wishes asa form of compulsory restraint.Therapeutic approaches in Sweden coverthe range of psychotherapeutic andsociotherapeutic interventions inresidential and outpatient environments.As Swedish drug policy is primarilyconcerned with preventing the spread ofdrug misuse, supply is looked upon as agrievous offence. Over the years the listof offences and penalties has beenexpanded and augmented.

4

6 0 A Preventive Strategy – Swedish Drug Policy in the 1990’s, The Swedish National Institute for Public Health 1998:21 & Fact Sheet No.4 March 1999, Ministry of

Health and Social Affairs, Sweden.6 1 E u ropean Monitoring Centre for Drugs and Drug Addiction (EMCDDA) (2000) Annual Report on the State of the Drug Problem in the European Union, 2000.

4 . 1 1 S W I T Z E R L A N D

4 . 1 1 . 1 Swiss drugs policy is predicated on a fourpillars model: prevention; therapy and re-integration; harm reduction andrepression and control. Complementarymeasures such as informationdissemination, research and evaluation,epidemiology and co-ordination and co-operation between differing agentssupport these pillars. The goals of Swissdrugs policy are:

■ to decrease initial drug misuse andavoid evolution towards addiction;

■ to help misusers overcome addiction;

■ to improve the living and socialconditions and health of drug misusers;and

■ to inhibit trafficking and supply.

4 . 1 1 . 2 The concept of prevention in Switzerlandis very broad and encompasses bothprimary and secondary prevention. Assuch, it recognises the linkages betweenprevention and treatment and betweenthe consumption of legal and illegaldrugs and considers communityparticipation in prevention activities tobe vital. The Swiss framework forprevention includes schools, localauthorities, sports facilities andorganisations and youth associations. Theexercise of prevention activities is, as arule, delegated to local agencies.

4 . 1 1 . 3 Swiss drug policy, in the fields of therapyand treatment, aims to promoteabstinence where possible and to fosterthe social and psychological health ofthose who remain dependent. Therapiesare differentiated and attuned toindividual needs and are carried out inresidential settings, outpatient facilitiesand prisons. Outpatient treatmentsinclude methadone substitutionprogrammes and the prescription ofheroin under medical supervision. Harmreduction covers activities to improve themedical and social conditions of thosemost heavily addicted. Actions taken touphold this aim include social support,involving the provision of employmentand housing; health care, where needleexchange programmes and sterileinjecting environments play a part andprison projects.

4

4 . 1 1 . 4 In relation to heroin prescription inSwitzerland, evaluations have beenmixed. The results ascribed to thisprogramme include: (i) better retentionand compliance rates when compared toinjectable morphine and methadone; (ii) improvements in physical health; (iii) diminished use of illicit heroin andcocaine; (iv) better housing and fitnessfor work; (v) decline in contact with drugmisusers and the drug scene and (vi) adecrease in income from illegal and semilegal activities.

62A study of the Swiss

programme urged the continuation ofheroin-assisted treatment provided it wasconfined to and directed at, anappropriate target group and wasdelivered in suitably equipped andsupervised outpatient clinics.

4 . 1 1 . 5 However, the report of an externalevaluation

63on the Swiss study was more

sceptical. The Report of the ExternalPanel concluded that:

■ it was medically feasible to provide anintravenous heroin treatmentprogramme under highly controlledconditions where the prescribed drug isinjected on site, in a manner that issafe, clinically responsible andacceptable to the community; and

■ p a rticipants re p o rted impro v e m e n t s inhealth and social functioning and adecrease in criminal behaviour and inreported use of illicit heroin.

Nevertheless, the External Panel felt t h e rewas a need for continued scepticism aboutthe specific benefits of one short actingopioid over others and that there was aneed for further studies to establishobjectively the differences in the effect ofthese different opioids. This scepticismwas predicated on the view that theSwiss studies were not able to determinewhether improvements in health statusor social functioning in the individualstreated were causally related to heroinprescription per se or a result of theimpact of the overall treatment pro g r a m m e . 4

6 2 Uchtenhagen, A., et al. (1999) P rescription of Narcotics for Heroin Addicts: Main Results of the Swiss National Cohort Study.6 3 Ali, R. et al (1999) Report of the External Panel on the Evaluation of the Swiss Scientific Studies of Medically Prescribed Narcotics to Drug Addicts, Executive

S u m m a ry, p. 1.

4 . 1 2 S U B S T I T U T I O N T R E AT M E N T S I N T H EE U R O P E A N U N I O N

4 . 1 2 . 1 While methadone remains the dominanttreatment type in many Europeancountries, including Ireland, Table 4.1indicates the range of alternativetreatment types that are now beingemployed across Europe :

Table 4.1 – Substitution Treatments in the EU*

Notes: Methadone remains the dominant treatment type in most Euro p e a n

c o u n t r i e s .

( a )Dates refer to the year the political decision was taken to prescribe the

s u b s t a n c e .

( b )B u p renorphine is in the form of SubutexR and not Te m g e s i cR as this only

contains small amounts of the substance.

( c ) Trial only.

( d )Date not known.

( e )Consultant Psychiatrists who are responsible for the clinical management

of drug misuse services in the ERHA, where the majority of opiate misusers

reside, are examining the potential of alternative products for use in the

t reatment of drug misusers, bearing in mind the possible side effects of

these pro d u c t s .•S o u rce: EMCDDA 2000 Annual Report on the State of the Drugs Pro b l e m

in the European Union.

4

Country Methadone Treatment Introduction of other Introduced substitution substances (a)

Belgium 1994 Occasional use of buprenorphine(b), dihydrocodeine

Denmark 1970 Buprenorphine (b,c) and LAAM (both 1998) (c)

Germany 1992 D i h y d rocodeine (1985), heroin (1999)(c),LAAM (1999), buprenorphine (2000) (b)

Greece 1993 No other substance prescribedSpain 1983 LAAM (1997)France 1995 Buprenorphine (1996) (b)Ireland 1970 No other substance prescribed (e)Italy 1975 Buprenorphine (1999) (b,c)Luxembourg 1989 Dihydrocodeine (1994) (c),

MephenonR (d)Netherlands 1968 Heroin (1997) (c)Austria 1987 Slow-release morphine (1997),

buprenorphine (1997) (b,c)Portugal 1977 LAAM (1994) (c)Finland 1974 Buprenorphine (1997) (b)Sweden 1967 No other substance prescribedUK 1968 Buprenorphine (1999) (b)

4 . 1 3 O V E R A L L C O M M E N T S

4 . 1 3 . 1 Strategies in the countries reviewed fordealing with drugs issues fall, bro a d l yspeaking, into two camps: Firstly, thosethat focus on the needs of the drugmisuser as a citizen in society with rights,entitlements and responsibilities – the so-called humanistic approach – and, secondly,those that place the primar y, but notexclusive emphasis, on the criminalityassociated with drug importation,trafficking, supply and, in certaincircumstances, use. While internationaldebate has, to some extent, tended to bepolarised around those respectiveextremes, it would be wrong to concludethat they are absolutes. Countries with ahumanistic perspective have vigorouspolicies to combat drug supply at alllevels, while those with a more restrictiveapproach have, in varying degrees,education, prevention and treatment andrehabilitation programmes ascomponents of their national policies. Inboth approaches there is, therefore, arange of interventions employed totackle the problem.

4 . 1 3 . 2 One of the most controversialinterventions in the harm reduction fieldthat arose in the study of the strategiesreviewed was the provision of heroinprescription and/or injecting rooms asdescribed in Switzerland, the Netherlandsand Spain. As outlined in this chapter, theevaluations of these experimentaltreatments have either not yet takenplace (Netherlands and Spain) or aremixed (Switzerland) and, therefore, thereis a need for further evaluation andcontinued research to establishobjectively the benefits of suchtreatments. In this context, the ReviewGroup is also cognisant of the oppositionof the International Narcotics ControlBoard (INCB) – who is responsible foroverseeing and monitoring internationalpolicy in relation to international drugcontrols – to such forms of treatment.The INCB is responsible for overseeingand monitoring international policy inrelation to international drug controls.

4 . 1 3 . 3 Given Ireland's international obligationsin this regard, the Review Group does notconsider that the introduction of suchforms of treatment is warranted at thistime. However, the situation should bekept under review and the results ofresearch, both national and international,should be monitored.

4

6 2 I N C BR e p o rt 1999, Pgs 26, 27 & 60.

5 . 1 I N T R O D U C T I O N

One of the most striking features of theextensive public consultation processcarried out by the Review Group, was themature and deep level of understandingof the nature of the cur rent drugproblem and the burden it places onindividuals, their families, communitiesand society. However, this should not beconfused with any broader acceptance ofdrug misuse. The consultation processwas, by and large, free of moral orethical discussions on the rights andwrongs of drug misuse or associatedissues about freedom of choice. Both thepublic fora and the submissions made bystate agencies, the voluntary andcommunity sectors, individuals, usergroups, families of drug misusers andprofessionals working in the areas ofprevention, treatment and rehabilitationand enforcement, made it very clear thatdrug misuse is a societal ill because itcauses harm, which permeates thro u g h o u tall levels of society. Discussions thro u g h o u tthe public consultation process were verywide-ranging and the main issuesemerging in the context of the terms ofreference for the Review are outlined inthis Chapter under the headings of:

(i) supply reduction;

(ii) prevention (including education andawareness);

(iii) treatment (including rehabilitation, andrisk reduction); and

(iv) co-ordination.

5 . 2 S U P P LY R E D U C T I O N

The main issues raised regarding supply reduction fell under the broadheadings of:

■ Legislative and judicial Issues;

■ Garda Role; and

■ Prisons.

Legislative and Judicial Issues5.2.1 The vast majority of submissions were

supportive of the current legislativeframework, but there was a perceivedleniency in relation to the sentencing ofdrug traffickers. In addition, it was feltthat An Garda Síochána may need todevote additional resources to targetingmedium and larger dealers.

5.2.2 There was strong support for the conceptof a Drug Court and for its potentialextension depending on the outcome ofthe initial pilot phase. There wascommentary on community and voluntarysector involvement in the new structuresand on the dangers of the Drug Courtbeing perceived as a “fast track” tomethadone treatment.

5.2.3 Throughout the consultation process,there was consistent recognition of thesuccess of the CAB and a recurrentsuggestion that consideration be given tointroducing more localised CABs. It wasalso suggested that assets seized by theCAB should be dedicated to the provisionof prevention and rehabilitationprogrammes in the communities in thea reas most affected by the drugs pro b l e m .

5

5.2.4 There was a widespread feeling thatthose aged under 18 should not beprosecuted for drug possession offences,rather they should be referred to therelevant support agency. There were alsoconcerns that, at present, the sentencingregime is inconsistent. At the oppositeend of the spectrum, there were a smallnumber of submissions which advocateda “zero tolerance” approach to all drugsand who argued that the perceivedprimary focus on methadonemaintenance within current policy was anexpression of the State’s tacit acceptanceof drug misuse.

5.2.5 Finally, a small number of submissionsdebated the potential impact ofdecriminalisation for possession of smallamounts of cannabis or the use ofdiscretion by the Gardaí in arrestprocedures. Decriminalisation of thepossession of heroin for personal use wasalso mentioned as a measure that mightenable resources currently allocated toimprisonment to be spent on treatmentand rehabilitation. There were also asmall number of submissions whichreferred to heroin prescription and theprovision of heroin injecting rooms.

An Garda Síochána5.2.6 There was general consensus that those

involved in illicit drug dealing should bethe main focus of Gardaí activities and, inthis regard, it was suggested that knowndealers should be targeted. Furthermore,while there was considerable support forthe Gardaí and recognition of theirsuccesses to date in reducing the supplyof drugs, there was also concern thatdrug dealing was still occurring openly onthe streets, particularly in disadvantagedareas. The need to increase the resourcesdevoted to supply control wasemphasised. The success of CommunityPolicing Fora (CPF), where they are inexistence, was commended and there wasa strong view that this form of co-operation should be extended. In areaswhere there is an emergent drugsproblem, it was suggested that thereshould be dedicated Garda Drug Units inorder to target dealers. In this context,information sharing between the Gardaí,Local Authorities and relevant agencies indifferent areas was regarded as essentialto prevent the movement of dealersthroughout the country and theconsequent establishment of markets fordrugs previously unavailable, or notwidely used, in areas outside of Dublin.

5.2.7 The Garda Youth Diversionary Projectswere regarded as being generallysuccessful. The view was expressed thatthese projects create positive linksbetween young people potentially at riskand the Gardaí, which might eventuallyfacilitate a reduction in supply, crime andmisuse of drugs. The view was alsoexpressed that the enforcement agenciesshould work more closely with localcommunities on collaborative supplycontrol projects.

5

Prisons Serv i c e5.2.8 The role of the Prisons Service as regards

supply control was highlightedthroughout the consultation process.While prison clearly impacts on supplycontrol by providing a sanction againstdrug misuse and drug dealing, it was theperceived under-utilisation of the prisonsystem in the rehabilitation of drugmisusers which was the main focus ofcomment. There was considerableconcern that drugs are so widelyavailable within prisons that someprisoners who formerly had not useddrugs may come into contact with andstart to use drugs for the first time whilein prison. Similarly, there were concernsthat, while in prison, young offenderscome into contact with hardened drugdealers and gain an “education” in drug-related crime which they may use uponrelease. Both of these factors wereregarded as subverting the prisons role insupply control.

5.2.9 There was widespread concern that theprison system is failing to realise itspotential, not only in addressing theneeds of those who are addicted to drugs through the provision of suitabletreatment, but also in the provision ofthe kinds of counselling, education andtraining which would impact on theoffender’s behaviour after release. Arelated factor was the perceivedw i d e s p read availability of drugs in prisonsand the sense that, if prisoners canmaintain drug habits while in prison, thereis neither the opportunity nor the incentiveto engage in rehabilitation programmes.

5 . 2 . 1 0 The issue of more community andvoluntary involvement in prisonstructures in order to ensure that there isa continuity of care within the communityfor the offender post-release also arose.H o w e v e r, there was also acknowledgementof the possible operational implicationsof such involvement.

5 . 3 P R E V E N T I O N

Education 5.3.1 Consolidation of measures to counter

early school-leaving, especially in theLDTF areas, was regarded as a priorityissue. Similarly, the need to provide pre-school supports for children who are atrisk and who may well drop out of theschool system before they can fullybenefit from the existing programmes wasidentified. The imperative to involveparents in school drugs educationp rogrammes was also identified, not with-standing the difficulty of engaging theparents of children who are most at risk.

5.3.2 Overall, there was general support for“Walk Tall” and “On My Own Two Feet”Programmes in schools. However, therewas some concern that the material usedmay need to be reviewed to ensure thatit is still culturally relevant, ageappropriate and it was suggested thatthey should, perhaps, incorporate aspiritual dimension. The need toimplement these programmesimmediately, particularly, in all schools inthe Task Force areas was highlighted in anumber of submissions, as was the needto provide drug prevention materials forthird level students.

5.3.3 It was suggested that the Department ofEducation and Science should have a rolein drafting guidelines to assist schools indeveloping a school drugs policy.

P revention 5.3.4 There was widespread recognition of the

link between disadvantage andproblematic drug misuse and consequentsupport for measures designed to counterdisadvantage. The need for these policymeasures to be targeted – in a concertedmanner – at those communities whereboth disadvantage and drug misuse aremost prevalent, through mechanisms suchas the Integrated Services Process (ISP),was also highlighted.

5

5.3.5 A recurring theme was the role of thefamily in prevention. Parental attitudesand behaviours to alcohol and drugswere regarded as having a significantimpact on their children’s attitude todrug taking. Indeed, there were strongconcerns expressed at many of the fora,p a rticularly those held outside of Dublin,in relation to the amount of alcoholbeing consumed by young people andthe potential that such drinking has tolead young people into drug misuse.Reference was also made to the widerdifficulties experienced by parents whomay not have the necessary time todevote to the supervision of theirc h i l d ren or who do not have the necessaryknowledge and skills to address drug-related issues. Provision of parentingskills, particularly for at risk families andof drug prevention education for childrenwere identified as mechanisms forovercoming these difficulties.

5.3.6 There was significant recognition of therole of sport and recreation in drugprevention and there was quitewidespread support for the YPFSF. Thecontinued need for a wide range ofrecreational activities to be madeavailable was highlighted. There was aneed to provide funding for activitieswhich will appeal particularly to youngpeople who would not typically becomeinvolved in mainstream sportingactivities. Key target groups identifiedincluded Traveller children, early school-leavers and homeless youth.

Aw a re n e s s5.3.7 There was strong support for a national

media awareness campaign, but a degreeof scepticism about the use of shock orscare tactics in such campaigns. As analternative, the potential for usingpopular culture and key media figures toendorse an anti-drugs message washighlighted. It was suggested that, priorto the initiation of an advertisingcampaign, young people, especiallywithin the communities where drugmisuse is most prevalent, should beconsulted about possible content.Moreover, a review of the campaigns,which have been “rolled out” in othercountries, should be conducted. The needfor corresponding ancillary campaigns –using a variety of media and targeted atspecific groups, including existing drugmisusers and other at risk groups – wasalso expressed.

5.3.8 There was a strong sense that alcoholand drug misuse were related in Irishsociety. The view was expressed thatthere needs to be greater awareness,particularly amongst parents and youngpeople of the association between thesetypes of abuse.

5.3.9 At a general level, there was support forthe generation of an easily accessibledata source of all local and nationalsupport services available to those whoare either using or “experimenting” withdrugs. Communities which are currentlyrelatively unaffected should have accessto such a data source which would helpidentify a drugs problem as it emerges.

5

5 . 3 . 1 0 There was considerable concernexpressed about the way in which drugsissues are presented in the nationalmedia. To address this, it was suggestedthat there should be a source of accurate,unbiased information available to themedia and that there should be greaterjournalistic responsibility in the reportingof drugs issues. The stigmatisation ofdrug misusers in some sections of thenational press was regarded as beingunhelpful to the goals of generatingcommunity support for the provision oftreatment and rehabilitation services.

5 . 3 . 1 1 It was felt that there was very limitedinvolvement of the corporate sector inthe consultation process. However, thissector was identified as having a role toplay in the sponsorship of awarenessactivities. There was also a suggestionthat the corporate sector may need tobecome more aware of drug misuseamongst employees and, particularly,amongst young professionals.

5 . 4 T R E AT M E N T

The importance of treatment andrehabilitation, including risk reduction, inthe context of a National Drugs Strategy,was widely acknowledged in theconsultation process.

Tre a t m e n t5.4.1 The need for the provision of a

comprehensive range of drug treatmentoptions was a critical component in anumber of submissions relating totreatment. Throughout the consultationprocess, the need to expand thetreatment options available washighlighted strongly, as was the need toendorse holistic patient care to include awide range of services for the drugmisuser. The continuum of carephilosophy was identified as animportant approach, whereby drugmisusers could eventually attain a drug-free lifestyle. Moreover, providing anadequate treatment service to all drugmisusers, within an acceptable timeperiod, was a consistent demand.

5.4.2 Where the current strategy has focusedon the development of a range ofresponses to the heroin problem in theeastern region of the country, a numberof submissions suggested that there is aneed to consolidate and further developtreatment options aimed at a range ofaddictions and types of drug misuse. Theneed to expand the current response to include all illicit drugs, as well asalcohol and prescribed medication,emerged repeatedly throughout theconsultation process.

5

5.4.3 Methadone maintenance received amixed response in the submissions, aswell as among the participants at theconsultation fora. Those submissions infavour of methadone as a means oftreatment acknowledged its effectivenessin reducing drug misuse, drug-relateddisease and drug-related crime etc.However, the need to clarify the role ofGPs in the provision of drug treatmentwas highlighted, particularly as regardsthe perceived slow growth in GPinvolvement since the introduction of theMethadone Treatment Protocol. Reducingthe current waiting lists to increase theaccessibility of methadone maintenanceemerged as a key issue. On the otherhand, a number of submissions wereopposed to the concept of methadonemaintenance as a means of treatment.The point was made that methadonemaintenance was keeping misusers withinthe user environment, with little focus onattaining a drug-free lifestyle. In thiscontext, treatment as a medical responseand not a behavioural response, wasquestioned. Broadly speaking, there wasa perception expressed at the fora thatthere was a general lack ofunderstanding about the objectives ofmethadone maintenance.

5.4.4 Throughout the submissions, referencewas made to the Methadone TreatmentProtocol which was implemented in 1998,as well as the need now for a protocol onthe prescription of benzodiazipienes. Theperceived emergence of poly-drug usewas a cause for concern in a number ofsubmissions, as was the risk ofmethadone becoming a “street” drug.

5.4.5 Throughout the consultation processthere was consistent agreement aboutthe need for treatment services whichwere aimed specifically at young people,i.e those under 18 years. This wasconsidered to be an important priorityfor the new Strategy. The overallperspective envisaged a comprehensiverange of geographically accessibletreatments targeted directly at youngpeople. The importance of addressing theneeds of young drug misusers, in thecontext of the family, was also highlighted.

R e h a b i l i t a t i o n5.4.6 Local, community-based support systems

were identified as an integral aspect ofrehabilitation, particularly, the role of theFÁS Community Employment Programmefor recovering drug misusers. The generallack of residential care facilities was alsohighlighted in the context of providing amanaged environment of care. The needfor increased funding for existingfacilities, as well as the provision ofadditional aftercare facilities, in the formof half-way houses was outlined in anumber of submissions. The potential toengage Prison Officers in the delivery ofcounselling and rehabilitationprogrammes was identified, as was theneed to adequately resource theProbation and Welfare Service, bothwithin the Prisons Service and in thebroader community.

5.4.7 The development of comprehensiverehabilitation services within prisons wasidentified in the submissions as anopportunity that should be furtherutilised in order to restore misusers to adrug-free lifestyle. The point was madethat, in order to provide such services, an expansion of staff, particularly medical and counselling staff, was anecessary condition.

5

Risk Reduction 5.4.8 The submissions and participants in the

consultation fora expressed repeatedconcern about the need for harmreduction measures in the overallprovision of drug treatment services.Although it was acknowledged that thespread of drug-related diseases has beencontrolled somewhat in Ireland, the needto minimise the spread of such diseases,in particular Hepatitis C, through theincreased use of needle exchangefacilities was identified in a number ofsubmissions. However, the absence of aproper national system for needle andsyringe exchange emerged as a perceivedgap in the treatment services, the overallperception being that a properly plannedand co-ordinated needle exchange servicewould have a positive effect on drugtaking practices. Concern about reducingthe proportion of injecting drug misusersalso emerged in the submissions.

5 . 5 C O-O R D I N AT I O N

C o - o rd i n a t i o n5.5.1 The need for greater co-ordination

within and between agencies was,perhaps, the most common themethroughout the consultation process.There was a perceived lack of clarityabout the structures charged with thedelivery of national drugs policy. In thiscontext, there was significant support forthe need to adopt a more co-ordinatedapproach at Departmental level. Therewas also a recurrent suggestion that theDepartment of Social, Community andFamily Affairs should be represented onthe IDG and the NDST.

5.5.2 The appropriateness of vestingresponsibility for overall co-ordination ofthe National Drugs Strategy in theDepartment of Tourism, Sport andRecreation was questioned. The view wasexpressed in a small number ofsubmissions that responsibility for theStrategy should be vested elsewhere e.g.the Department of the Taoiseach or theDepartment of Health and Children.

5.5.3 As regards mechanisms to improveinteragency co-ordination, it wassuggested that an ISP style approachshould be used to facilitate greater co-ordination between agencies, eventhough increased co-ordination wouldrequire additional time, training of staffand expenditure on the necessaryinformation technology. There was someconcern that statutory representativeswere not receiving the necessary supportfrom their parent Departments orAgencies to enable them to deal with theadditional workload required to ensureco-ordination in the day-to-day deliveryof responses.

5

5.5.4 There was widespread support for therole of the community and voluntarysectors in the delivery of the currentStrategy based on experience in the LDTFareas and for structures which harnessthe activities of these sectors to nationaland strategic goals. Most commentary onthe community and voluntary sectorsrelated to the role of these sectors in theLDTF areas. A key concern was the needto ensure that community and voluntarysectors representatives on LDTFs remaintruly representative of theirconstituencies. In this context, it wassuggested that communityrepresentatives should be elected on toTask Forces by the local community andshould serve for a defined period. Theneed to establish mechanisms throughwhich community opinion can bechannelled on a regular basis to thecommunity representative washighlighted. However, the potentialintimidation of individuals who are seento be involved in efforts to curtail drugdealing was also identified.

5.5.5 During the consultation fora, there wassome discussion about the merits of thevarious approaches which had beenadopted by the community and voluntarysectors outside the Task Force areas.Notwithstanding this, there was concernthat community and voluntary sectorsprojects outside of the LDTF areas areoperating in a policy vacuum and, assuch, are responding to perceived localneeds, rather than complying with theoverall goals of a national policy. As aresult, there was some concern aboutduplication of effort at local level andsome more serious anxieties about thequality of project delivery. It wassuggested that criteria for the delivery oftreatment, rehabilitation, education and

awareness projects be established andthat all projects – while being responsiveto local needs – should also demonstratecompatibility with these criteria prior toreceipt of funding. There was also therelated concern that such criteria shouldbe developed in co-operation with thecommunity and voluntary sectors toensure that they have the necessaryflexibility to enable an appropriateresponse to be delivered locally. It wassuggested that, as a quality controlmechanism, all projects should be subjectto external evaluation after a pre-determined interval.

5.5.6 Finally, many community and voluntaryproject promoters felt that they werededicating disproportionate resources toresearching and accessing fundingsources. It was also felt that the durationof funding cycles should be lengthened inorder to give projects a realisticopportunity to achieve their objectives.

5

P a rt II

Towards a New Strategy 2001 – 2008

6 . 1 I N T R O D U C T I O N

6.1.1 Following the foregoing review ofnational and international drugstrategies, the Review Group has reacheda number of conclusions which are setout in this chapter.

6.1.2 Despite on-going efforts by Governmentsaround the world to deal with problemdrug use, no single universally acceptableeffective response model has emerged. InIreland, the Government's approach totackling the drug problem has developedaround the four pillars of supply,prevention (including education andawareness), treatment (includingrehabilitation and risk reduction) andresearch. This approach incorporates,more or less, the full range of activitieswhich are the hallmarks of modern drugsstrategies in other jurisdictions studied bythe Group. Central to the Irish approachhas been the bringing together of keyagencies, in a planned and co-ordinatedmanner, to develop a range ofappropriate responses to tackle drugmisuse, not just in relation to the supplyof drugs but also in providing treatmentand rehabilitation for those who areaddicted, as well as developingappropriate preventative strategies. Thecurrent strategy has been furtherenhanced by the growing involvement ofthe community and voluntary sectors andby the ever increasing effectiveness ofinternational co-operation in areas suchas supply control and research.

6.1.3 An important element of the overallresponse has been the work carried outby the 14 Local Drugs Task Forces in theareas worst affected by problem druguse. The principal strength of the TaskForces is that they allow local communityand voluntary groups to work hand inhand with the State agencies inresponding to the drug problem in theirareas. The Task Forces provide a range ofdrug programmes and services in theareas of treatment, rehabilitation,awareness, prevention and education andthey are currently updating their localaction plans for the next three years. Thesetting up of the Local Drugs Task Forceshas been a positive development and isgenerally regarded as an effectivemechanism for tackling the drugproblem.

6.1.4 While the Review Group recognises thatmuch remains to be done, there areencouraging signs of progress in recentyears, which suggests that the currentapproach to tackling the drug problem isproving to be effective. Huge strides havebeen made in providing treatment forthose who are dependent on drugs. Inparticular, there has been a verysignificant degree of activity andexpansion in the services provided by theERHA over the past five years – where themajority of heroin users reside – resultingin “probably one of the most innovativecommunity drug service programmes inEurope.”

65This has resulted in a major

expansion in the numbers on methadonemaintenance – from under 1,400 in 1995to over 5,000 at the end of 2000. Thenumber of treatment locations has risenfrom 21 at the end of 1997 to 55 atpresent, a very significant achievementgiven the strong community oppositionto the location of these centres in manyareas. There is also a relatively high levelof provision of in-patient and residentialrehabilitation services in Dublin.

6

6 5 F a rrell et al., op cit.

In addition, there have been significantdevelopments in the delivery of servicesto drug misusers through GP andpharmacy-based services in the past fiveyears. Currently, there are 216 pharmaciesand 157 GPs participating in themethadone protocol, the highest numbersince its introduction in 1998.

6.1.5 The importance of moving drug misuserscurrently in treatment towards fullrehabilitation and re-integration intosociety is widely recognised. In thiscontext, over 800 stabilised drug misusersare currently participating in a speciallydesigned FÁS Community EmploymentProgramme which offers themcounselling, training and other necessarysupports. It is also very encouraging tonote the number of drug misusers onmethadone maintenance who are findingemployment. In 2000, a study found thata number of clinics informally reportedthat around 40% of those on methadoneprogrammes were returning to work. Inthis context, it is worth noting that ratesof 30% are considered remarkable byinternational standards.

66

6.1.6 There have also been a number of othersignificant achievements in recent years :

■ over 120 of the original LDTF projectshave now been mainstreamed and theTask Forces are currently updating theirplans for the next three years;

■ the NACD, which was established inJuly 2000, is overseeing a three yearprioritised programme of research andevaluation on the extent, nature,causes and effects of drug misuse inIreland;

■ over 340 projects are being developedas part of the YPFSF, in recognition ofthe important role that diversionaryactivities, such as involvement in sportand recreation, can have on youngpeople at risk of drug misuse;

■ a joint policy on prison-based drugtreatment services has been agreedbetween the Prisons Service and theERHA and is being implemented atpresent; and

■ a pilot Drug Court has been set up inthe North Inner City of Dublin whichwill provide opportunities to divertpeople away from the criminal justicesystem into alternative and moreeffective treatment and rehabilitationprogrammes.

6.1.7 Given the complex nature of drug misuse,the Review Group recognises that it willtake time for many of these measures tomake a significant impact on theproblem. However, the Review Groupbelieves that the present approachprovides a solid foundation from whichall those involved in trying to tackle theproblem should work for the future. Thenew Strategy should, therefore, endorsethe existing approach and should expandand strengthen the pillars and principleswhich underpin it.

6

6 6 F a rrell et al., op cit.

6.1.8 The Group believes that the currentDrugs Strategy would be furtherstrengthened if all the State Agenciesinvolved in its delivery specify annualtargets in terms of outputs and desiredoutcomes for their respectiveprogrammes and initiatives. This shouldbe agreed with the IDG, in consultationwith the NDST, and used as a benchmarkfor performance review on an annualbasis by the Cabinet Committee on SocialInclusion. Such a development wouldsharpen the focus of the Strategy andbring further clarity to its aims andobjectives for service providers, drugmisusers and the public at large.

6.1.9 The Group welcomes the Government'spositioning of the National DrugsStrategy within the wider social inclusionpolicy and the strong commitment toareas of disadvantage in the NationalDevelopment Plan 2000-2006. The Groupfully recognises that, notwithstanding theobvious benefits for communitiesaffected by the drugs problem of havinga specific drugs strategy, the bestprospects for these communities, in thelonger term, rest with a social inclusionstrategy which delivers much improvedliving standards to areas of disadvantagethroughout the country.

6 . 1 . 1 0 Set out below are the Group's conclusionsfrom its review of the individual pillarsthat constitute the current strategy. Outof these conclusions, the Group havedeveloped 100 individual actions whichare designed to build on the existingapproach and drive the new strategyforward.

6 . 2 S U P P LY

6.2.1 Law enforcement and interdiction arecrucial elements of the national drugsstrategy. The Review Group considersthat law enforcement resources shouldcontinue to be targeted at disrupting theactivities of organised crime groups asthere is ample evidence that the sameorganisational networks involved in drugtrafficking also engage in other forms ofillegal activity. Consequently,interventions that reduce several forms ofcrime are more likely to be cost-effective.

6.2.2 The Review Group found thatinternational co-operation in measures toreduce supply is important particularlyfor the following reasons:

■ as drug dealers are increasingly mobileand drug dealing takes place within aninternational context, co-operativeefforts are critical to the effectivedetection and prosecution of majordealers;

■ it reflects society’s interest in curtailingdrug misuse within national boundariesand also signifies a willingness to assistother countries in their efforts toreduce supply; and

■ parties to international agreements canbenefit from working with each otherto control supply.

6.2.3 Ultimately, individuals involved in thetrafficking of illegal drugs should beaware that there are effective nationaland international sanctions against suchaction and that the Irish enforcementagencies have both the full support oftheir international partners and theappropriate resources to detect andprosecute drug traffickers. Ireland shouldcontinue to work proactively towards theconsolidation and enrichment of existinginternational co-operation mechanisms,with particular emphasis on co-operativeactions with Ireland's EU partners, inparticular through the new EuropeanCrime Prevention Network.

6

6.2.4 As regards legal issues, the Review Groupnoted that substantial progress has beenmade in recent years in terms oflegislation dealing with drug-relatedcrime. In fact, the success of the CriminalAssets Bureau (CAB), in tackling the twinmenaces of drugs and organised crime,has been recognised at a national andinternational level and this washighlighted repeatedly through thepublic consultation process. That said, thepoint was made consistently during thecourse of the review that no matter howgood the legislation, it must continue tobe implemented if it is to be effective.

6.2.5 A principal role of the law enforcementagencies is to dissipate the influence ofcriminal groups. The Review Groupconsiders that community orientedpolicing strategies can play a vital role inthis regard. The criminal justice systemcontributes to a reduction of crime, notonly by reactive policies of detection andpunishment of offenders, but also bypreventative policing policies inpartnership with community groups. TheReview Group also noted that localinformation is an essential component ofthe drug control activities conducted bythe enforcement agencies. Thestrengthening of relationships betweenthe community and law enforcementagencies and the development ofmechanisms for sharing information arecore elements of supply reduction. Overrecent years, successive Garda operations,as well as the development ofprogrammes of estate management, haveinhibited open drug-dealing. The ReviewGroup concluded that thesedevelopments must be sustained and safemechanisms for individuals andcommunities to actively co-operate withthe enforcement agencies must bedeveloped in order to reduce supplyradically. Individuals, families,communities and a range of statutoryand non-statutory agencies each have arole in curtailing the amount of illicitdrugs in circulation.

6.2.6 The Prisons Service is another criticalelement of the supply reduction “pillar”.The threat of imprisonment is both asanction against and a punishment for,involvement in supply activity. Theimprisonment of drug dealers is critical tothe disruption and eventual destructionof established drug markets. Prison canalso play an important role in therehabilitation of offenders, however, theIrish Prisons Service has suffered capacityconstraints which have inhibited thedevelopment of an integrated drugspolicy within the Service. This is beingaddressed by the Department of Justice,Equality and Law Reform, which inaddition to the 1,000 additional placesprovided in recent years has plans for1,000 more.

6.2.7 The Review Group welcomes the Reportof the Steering Group for Prison-BasedDrug Treatment Services, which has beenapproved in principle by Government andis now being implemented. Prisonsshould aim to equip prisoners with thenecessary social and vocational skills toreject drug dealing post-release. Clearly,the success of such initiatives iscontingent on the provision of ancillarysupports in the form of housing, socialwelfare supports and employmentopportunities when the offender returnsto his or her community. In addition, theGroup welcomes the involvement of thecommunity and voluntary sectors inliaison meetings with the Prisons Serviceand feel that this role should beexpanded.

6.2.8 In common with all elements of theNational Drugs Strategy, the activitiesunder the supply reduction pillar shouldbe subject to regular evaluation.

6

6 . 3 P R E V E N T I O N

6.3.1 Reducing the demand for drugs is centralto Irish drugs policy and it is clear thatsuch demand reduction activities must becontinued and reinforced. In this regard,most recent literature points to the needfor comprehensive demand reductionstrategies which include programmesthat:

■ seek to strengthen resilience amongstyoung people in or out of school byfostering positive stable relationshipswith family or key community figuresespecially in the early years, thereby,enhancing their sense of belonging tofamily or social group or locality andi n c reasing their educational and trainingo p p o rtunities and employment pro s p e c t s ;

■ are cognisant of the complexity ofyouth culture and which can effectivelyinfluence young people’s choices inrelation to drug misuse;

■ seek to increase the community’sunderstanding of the antecedents ofdrug misuse and effective interventionsto reduce harm;

■ link drug-specific interventions withinterventions in related areas such asyouth crime prevention and mentalhealth promotion strategies,employment, education and traininginitiatives; and

■ maximise the effectiveness of school-based programmes through efforts tokeep young people engaged in schooland the identification and provision ofs u p p o rts for at-risk children, managementof drug-related incidents and a broad-based curriculum which supports allaspects of the child’s development.

6.3.2 A considerable component of Irish drugpolicy has evolved as a direct response tothe on-going heroin problem. Theopportunity afforded by the Task Forceprocess to address this problem hasfacilitated the implementation of a moreproactive Strategy, of which prevention isa key component. That said, there is

considerable debate on the efficacy ofdifferent preventative approaches and,undoubtedly, current responses will needto be augmented as a greaterunderstanding of the circumstances inwhich people become involved in drugmisuse emerges, particularly the strongcorrelation between early school leavingand drug misuse.

67

6.3.3 As well as effective drug specificprevention strategies, tackling poverty,better housing, access to educationalopportunities, supportive environmentsfor parents and employment prospects,all have a role to play in prevention andmanagement of drug misuse and drug-related harm. In this regard, the efficientand effective implementation of theYPFSF and other targeted localdevelopment initiatives will be critical tothe future success of the National DrugsStrategy. There is a need to develop aninclusive approach which aims to ensurethat young people are affordedopportunities for well-structured leisureactivities and that these activities havegood levels of appropriate adultsupervision included within them.

6.3.4 As regards awareness, while the ReviewGroup's research analysis indicates thatproblematic drug misuse is more closelyassociated with certain groups andcommunities than others, evidence ofgrowth in drug misuse nation-wide, inparticular amongst young people,indicates that throughout Irish society,children, professionals, families,employers and a range of high-riskgroups are increasingly exposed to drugmisuse and drug-related harms. As drugeducation programmes have only beendelivered in schools by the Department ofEducation and Science since 1995, therestill is a large section of the populationwho have never received any formaleducation about drugs.

6

6 7 Data in Chapter 2 show that over half of those presenting for treatment for problem drug use had already left school by the age of 15 years. Over three quart e r s

of the clients presenting for treatment left school by the time they were 16 years old.

6.3.5 Misinformation, or a lack of information,undermine investment in harm reductionmeasures and can also contribute to thestigmatisation of the individual drugmisuser and his or her family. It is,therefore, imperative that Irish peoplebecome more aware of the risksassociated with drug taking, the natureof drug misuse and the supports andservices which must exist to minimiseharm.

6.3.6 A National Awareness Campaign tohighlight the facts about drug misuseshould be put in place, which would aimto facilitate informed, open andconstructive discussion on approaches todrug prevention. A multi-media approachthat will raise visibility of drug misuseamong young people and othervulnerable groups is advocated. Theapproach should take account of previouscampaigns which suggest that youngpeople do not respond positively to asimplistic “Don't Take Drugs” message.Experience in other countries would alsosuggest that awareness campaignsaround drug misuse need to be sustainedover a prolonged period in order to havethe maximum impact on the targetaudience. Other elements ofinternational campaigns have includedtargeting the drugs of first use as a keyto longer-term prevention and demandreduction strategies, information andhelp for parents, teachers, sports coachesetc. and the maintenance of a consistentmessage through the co-ordination ofmedia efforts with other initiatives inschools and communities.

6.3.7 While there is considerable debateevident in the international literatureabout the efficacy of schoolprogrammes,

68there was strong support

throughout the consultation process forthe need to implement school-basedprogrammes as “a first line of defence”as individuals are experimenting with andbecoming addicted to drugs at an earlierage. Initial evaluations of suchprogrammes are favourable butcomprehensive longitudinal studies arerequired. Notwithstanding that, it isessential that current programmes aresupported fully and implementedeffectively in all schools.

6.3.8 The Review Group acknowledges thatissues involved in the design of schoolsdrug policies are complex. On the onehand, schools must minimise the dangerscaused to children by drug misuse anddrug misusers within schools and on theother, neither parents nor studentsshould be afraid to ask schools for help inaddressing drug misuse. Nevertheless, theGroup feels that such policies should bedeveloped and that there should be arange of measures available in caseswhere students are misusing drugs. It isnoted that the ultimate sanction ofexpulsion can have the effect ofalienating a student from mainstreamsources of help and may result in thestudent becoming more involved in theculture of drug misuse.

6.3.9 Finally, there is also a requirement toensure that drug education andawareness programmes are integratedinto broader community-basedapproaches and are reinforced by massmedia responses. Although not a centralpart of the implementation of theNational Drugs Strategy, it is felt themedia can help foster a broaderawareness, which, in particular, can helpgenerate parental understanding of andengagement with, their children aboutapproaches to reducing the risk of druginvolvement.

6

6 8 Handbook on Drug Abuse Prevention: A Comprehensive Strategy to Prevent the Abuse of Alcohol and Other Dru g s, Robert H Coombs and Douglas Ziedonis

(eds) 1995.

6 . 4 T R E AT M E N T

Tre a t m e n t6.4.1 The need to progress towards a more

fully integrated and holistic treatmentservice also emerged as a critical elementof the consultation process. There aretwo related components to theattainment of this goal;

■ the expansion of the range of availabletreatment types; and

■ the provision of additional treatmentplaces.

Similar to other countries, methadone isthe dominant mode of treatment as thecurrent strategic response developedlargely as a reaction to the heroinproblem. Moreover, links between thetreatment and criminal justice fields(including both the courts and prisons)are key priorities to ensure the mosteffective utilisation of existing resourcesand the maximum impact of treatmenton drug-related crime.

6.4.2 The provision of a comprehensive rangeof drug treatments has been a criticalcomponent of national drug policy overthe past decade. Much of this focused onthe development of a broad range ofresponses to the heroin problem in theeastern region of the country and wasaccompanied by a high commitment toinvesting in treatment. By the standardsof other countries, there is a relativelyhigh level of provision in Ireland,

69but at

present, demand for treatment is stilloutstripping supply. However, the ERHA isconfident that with 6,000 treatmentplaces it could manage the demands ons e rvices and significantly reduce or eliminatewaiting lists (at the end of December2000 there were 469 people waiting fortreatment in the Greater Dublin area). Inthis regard, it should be noted that thenumber of people in treatment is amoving population. At any given timepeople will be moving to different phasesof treatment and rehabilitation, somebecoming drug-free. The provision of,say, 6,000 places will cater for a number

of patients well in excess of that number.For example a detoxification programmetakes around 6 weeks. Therefore 1detoxification bed will cater for around 8patients per year. Others can be detoxedon methadone treatment. A proportionof these people will continue to remaindrug-free and no longer require a placewithin treatment services. Some mayrelapse, however and may need to re-enter the system.

6.4.3 It is important that the level of GP andpharmacy involvement in the provision oftreatment programmes is increased. Byproviding a service in the community inwhich the drug misuser lives, the GP andpharmacist can aid the stabilisation andrehabilitation of the misuser. In thisregard, pharmacists need to be moreinvolved in the overall treatmentprogramme for the recovering misuser asthey are in a unique position to identifyearly on any problems the misuser isexperiencing. In addition, increasedcapacity at the primary care level willhave the effect of alleviating the pressureon the secondary care services which arecurrently over-subscribed.

6.4.4 There is also a need for the continuationof treatments which are proven to beeffective and for the broader provision oftreatment, particularly in prisons, where,mainly due to capacity constraints, suchprovision was not previously available.There is also now a need to consolidateand further develop treatmentapproaches which recognise internationalevidence-based responses to drug misuseand drug dependency. In particular, theprovision of treatment for young peoplewho have begun to experiment withdrugs is a matter of urgency. There is alsoa need to ensure that any furtherdevelopment of services is tailored todemand and that resources areappropriately allocated to the mostefficient and effective of these services,based on pre-defined performanceindicators.

6

0 0

6 9 Review of Drug Services in the Eastern Health Board Are a, Farrell, Dr M., Buning, E., 1996 states that “The range and pattern of service provision is consistent

with most and further advanced than many other European Union member states”.

6.4.5 When evaluated by a range of criteria,including outcomes in health, social well-being, economic prosperity and levels ofcrime, drug treatment proves to be cost-effective. Furthermore, experience hasshown that treatment over the longer-term is more cost effective thandetention in prison. Accordingly, peoplewith drug problems should beencouraged at every opportunity to enterdrug treatment, given the benefits thatcan accrue to them as individuals, as wellas to the general community. For thefuture, every effort must be made toensure that treatment is attractive andaccessible to all who need and canbenefit from it. More attention shouldalso be given to ensuring an assertivefollow-up of known users who do notavail of treatment and to supporting thedevelopment and operation of mutualself-aid or self-help organisations andservices. In these circumstances, all effortsto divert individuals from the criminaljustice system into treatment should beexplored and further developed. Thedevelopment of a Drug Court system andthe evaluation of this intervention shouldprovide further information on the costeffectiveness and social impact of thisparticular approach.

6.4.6 In the consultation process it wasrepresented that the use of methadonemay be inhibiting the use of alternativetreatment types. However, it must beacknowledged that methadone isinternationally accepted as one of themost beneficial substitute drugs in thetreatment of heroin addiction and is themost evaluated type of treatment.

70As

part of an overall continuum of care forpeople who are addicted to heroin,methadone has been widely used inIreland and in most other countries.However, as alternative medical and non-medical treatment types gain ground andas new forms of addiction emerge, theremay be a need to expand the range oftreatment types available to the drugmisuser. In this regard, the Consultant

Psychiatrists who are responsible for theclinical management of drug misuseservices in the ERHA area, where themajority of opiate misusers reside, arecurrently examining the potential ofalternative products for use in thetreatment of drug misusers, while alsobearing in mind the possible side effectsof these products.

6.4.7 Throughout the consultation process, themost commonly cited substitutes,recommended for use as alternativetreatment options, included Lofexidine,LAAM (L- Alpha Methadol Hydrochloride)and buprenorphine. Lofexidine is a non-opioid and can be used to detoxifypeople who are dependent on opiates. Itmay be particularly useful in treatingyoung people who are at an early stagein addiction. LAAM is a substitute drugsimilar to methadone in composition andpharmacological effects. It has a muchlonger duration of action thanmethadone (up to 72 hours). However, itshould be noted that the EuropeanAgency for the Evaluation of MedicinalProducts (EMEA) have expressed concernsabout possible side effects from its useand are currently advising prescribers notto introduce any new patients to thistherapy. Buprenorphine is a semisynthetic opiate and is another form oftreatment for heroin and other opiateaddiction. It produces less euphoria thanheroin. As with all substitute treatments,their applicability to the treatment ofheroin misuse in an Irish context shouldbe rigorously evaluated and closelymonitored.

6.4.8 Detoxification programmes followed bydrug-free residential programmes havebeen used with varying degrees ofsuccess in the treatment of opiate andother forms of addiction. However, todate they have been somewhatovershadowed by the demand-ledrequirement to eliminate waiting lists formethadone treatment. Expansion of bothtypes of facilities go hand in hand as

6

1 0

7 0 Marsch, L.A. (1998) The efficacy of methadone maintenance interventions in reducing illicit opiate use, HIV risk behaviour and criminality: A meta-analysis,

Addiction 93, 515-532.

many residential drug-free facilitiesrequire clients to be drug-free onadmission. The expansion of residentialprovision requires a correspondingincrease in detox capacity. Delays inaccessing detox programmes impactnegatively on motivation and the drugmisuser may no longer be willing todetoxify when a detox placementbecomes available. In this context, thereis a clear requirement for increasedprovision of both residential and detoxplaces, although again it should be notedthat by European standards, Ireland has aquite high level of provision. There is alsoa need to incorporate innovative non-medical approaches to the treatment of arange of addictions

71where they are

found to be appropriate.

6.4.9 The apparent younger age of initiationinto drug misuse and dependent drugmisuse

72has created a corresponding

need for the development of treatmenttypes catering specifically for the needsof young people under 18 years of age.Furthermore, as part of the NationalChildren’s Strategy “Our Children – TheirLives”, it is proposed that specialist drugtreatment services for the under – 18swill be expanded. Planning of suchservices should be closely linked to thenational profile of drug misuse amongstyoung people in order to make themrelevant to the needs of the young drugmisuser. To enable family involvement inthe treatment process, ideally, mostservices should be located in the areaswhere the drug misuse is occurring and ismost prevalent.

6 . 4 . 1 0 While services for young people andadolescents should be linked to existingservices, there are strong argumentsagainst services which enable closecontact between habitual andyounger/newer drug misusers. There werealso strong arguments presented in thepublic consultations against the use ofmethadone in the treatment of youngpeople. It is important to point out that

the treatment of under – 18 years oldpresents serious legal and other dilemmasfor professionals working in the area.Family involvement is regarded as acritical component of the treatment ofyoung people and, consequently,treatment should also include familytherapy and community integrationphases.

R e h a b i l i t a t i o n6 . 4 . 1 1 Rehabilitation involves the provision of

the necessary supports to enable arecovering misuser to attain anacceptable quality of life. Given thatpatterns of drug misuse and addiction arefar from homogenous, there is a need todevelop a wide variety of rehabilitationsupports, appropriate to each stage ofrecovery and to the particular needs ofthe client.

6 . 4 . 1 2 To achieve successful reintegration of theuser into his or her community, it is alsoessential that service providers recogniseand attempt to address communityconcerns about the on-goingmanagement of treatment centres andthat local communities acceptresponsibility for ensuring that adequatetreatment facilities are provided for drugmisusers in their own locality.

6 . 4 . 1 3 The need for half-way houses forrecovering drug misusers, who are notalready being treated in the community,was highlighted repeatedly during thepublic consultations and in thesubmissions to the review. An increasedrate of relapse was associated with animmediate return to a drug-takingenvironment and, in this context,consideration should be given toestablishing a network of half-wayhouses throughout the country.

6

0 2

7 1 Transcendental Meditation and Electro - N e u ro Therapy, as well as a variety of religious based approaches, were amongst the treatment types highlighted in the

c o n s u l t a t i o n s .7 2 NDTRS, 1996-1998, Health Research Board .

6 . 4 . 1 4 There is also a need to ensure thatrecovering misusers have access tohousing, training and employmentopportunities. Drug misusers aresometimes forced to leave the familyhome, or otherwise become homeless,through drug misuse. The effectiveness oftreatment and the goals of rehabilitationare often undermined by the failure toensure that recovering misusers haveaccess to accommodation. It is particularlyimportant to ensure that theaccommodation needs of misusersavailing of residential treatment typesare met when the residential phase ofthe programme is complete. There mayneed to be closer liaison betweentreatment providers, counsellors,probation and welfare officers and therelevant local authorities in this regard.

6 . 4 . 1 5 For many drug misusers, the return toemployment is a critical stage in therehabilitation process. However, theoften negative stereotyping of formerdrug misusers can be an impediment totheir employment. Consequently, it isconsidered that FÁS should initiateworthwhile contacts with employers onbehalf of drug misusers. Employerorganisations, trade unions and keyGovernment Departments and Agenciesshould work in partnership to developmechanisms, which would increaseemployment opportunities for formermisusers.

6 . 4 . 1 6 The Labour Inclusion Programme, whichis currently being piloted in the DublinNorth East Task Force area, is designed toassist recovering drug misusers inobtaining and holding downemployment. The Programme issupported by employers and tradeunions, as well as statutory, voluntary andcommunity organisations working in thedrugs area and provides a range ofsupports to former drug misusers at aparticularly difficult stage in theirrecovery. It is proposed to evaluate theProgramme and, if it is successful, toreplicate it in other areas.

6 . 4 . 1 7 Rehabilitation may involve therestoration of important relationships,with family and friends or reintegrationto the work or training environment. Atan ideological level, the successfulrehabilitation of a recovering drugmisuser is also contingent on societalattitudes towards drug misusers.Mechanisms that work towards societaland community acceptance of therecovering drug misuser should bedeveloped.

6 . 4 . 1 8 It is difficult to quantify the level ofexpansion required in currentrehabilitation provision, as much dependson the nature of the client’s drug misuseand individual circumstances.Notwithstanding this, it seems likely thatinvestment in rehabilitation will makeexisting treatment regimes moreattractive to users and will reduceincidences of relapse.

6

1 0

Risk Reduction6 . 4 . 1 9 Traditionally, the dominant trend in

policy has been towards the achievementof a reduction in drug misuse and theultimate attainment of a drug–freesociety.

73However, the recognised link

between drug misuse and the spread ofdisease has resulted in the need to adoptstrategies that reduce the risks posed bysuch behaviour both to the individualmisuser and the wider community. Theimportance of improving existingmechanisms to reduce drug-related harmemerged as a distinctive theme boththroughout the consultation process andin the review of international strategies.In all of the countries surveyed, harmreduction is a considerable component ofnational strategies. The need to developand expand existing harm reductionmeasures and to investigate scientifically-based innovative responses, appropriateto Irish circumstances and consistent withour obligations under internationalconventions while also taking account ofinternational best practice, is vital for theprotection of drug misusers, those theylive with and the wider community.

6 . 4 . 2 0 It is important that a significant reductionin the reported level of injecting drugmisuse and the rates of sharing injectingequipment is achieved. These areessential elements of containing thespread of HIV and Hepatitis C etc. amonginjecting drug misusers and should alsocontribute to a decline in the prevalenceof these diseases amongst the non-usingpopulation. These aims would also beconsistent with the objectives set out inthe National AIDS Strategy published bythe Department of Health and Childrenin June 2000. Such a reduction will becontingent on continued efforts toenhance harm reduction measures suchas needle exchange facilities.

6 . 5 R E S E A R C H

6.5.1 An important element of any strategy isthe knowledge upon which it is based.The provision of good qualityinformation on the extent and nature ofthe problem in Ireland should underpinthe National Drugs Strategy. In doing so,it would support and inform policy-makers and service providers in drug-related sectors. The issue of research ondrug-related issues is one that needs tobe strengthened in terms of acquiringcomprehensive and comparable data.Indeed, the need for improved researchin each of the main themes – supplyreduction, education, prevention andawareness and treatment andrehabilitation, including risk reduction –was a persistent theme of theconsultation process. Research is essentialto enable the dissemination of models ofbest practice in line with EU andGovernment policy.

6.5.2 The NACD will play an important role inthis regard. The Committee's primaryfunction is to advise the Government inrelation to the prevalence, prevention,treatment and consequences of problem drug use in Ireland, based on itsanalysis of research and informationavailable to it.

6.5.3 The Committee is overseeing the deliveryof a three year research programmeaimed at addressing the priorityinformation gaps and deficiencies in thearea of drug misuse. This programmeincludes compiling a comprehensiveinventory of existing research andinformation relating to the prevalence,prevention, treatment/rehabilitation andconsequences of problem drug use inIreland. The Committee is also looking athow best to determine the size andnature of the drug problem in Ireland,the effectiveness of existing models and

6

0 4

7 3 Peter Reuter and Johnathon P. Culkins American Journal of Public Health (1995;851059-1063) Redefining the Goals of National Drug Policy. R e c o m m e n d a t i o n s

f rom a Working Gro u p .

programmes in the area of prevention,treatment and rehabilitation and the costto society of the drug problem. It isessential that the findings of theresearch, commissioned by theCommittee, are disseminated widely in aformat which is accessible to all bodiesand agencies with an interest in thedrugs issue and to the wider community.

6.5.4 The National Drug Treatment ReportingSystem (NDTRS), which is run by the DrugMisuse Research Division (DMRD) of theHealth Research Board (HRB), is the keysource of information and research inrelation to drugs issues. However, toimprove the efficiency and quality of thisflow of information, there is a need forall treatment providers to report problemdrug use to the DMRD. Within treatmentfacilities, this will involve the designationof a staff member with specificresponsibility for ensuring that allrelevant data is returned to the NDTRS.Responsibility for NDTRS data returnsshould be incorporated into the contractsof medical practitioners working intreatment centres, in general practicesand in prisons.

6.5.5 There is also a need to develop anaccurate mechanism for recording thenumber of drug-related deaths in Ireland.At present, drug-related deaths arerecorded by the General MortalityRegister (GMR) of the Central StatisticsOffice, based on the ICD code system.

74

Other countries have developeddedicated systems for recording drug-related deaths and it is important, for thepurposes of comparative analysis, thatthe Irish system is capable of generatingan equivalent level of information. In theshort term, however, there should be afocus on improving the data collectionprocess leading up to the recording of adrug-related death.

6 . 6 C O-O R D I N AT I O N

6.6.1 The public consultation process indicateda lack of clarity in relation to structuresand the respective roles involved in thedevelopment and implementation of ournational drugs policy. Chapter three ofthis Report outlines the current structuresand a number of actions arerecommended, particularly in relation toindividual remits, that would providegreater clarity across structures for serviceproviders and the wider public alike.

6.6.2 Some of the submissions raised, as amatter of some concern, the location oflead responsibility for co-ordination ofthe National Drugs Strategy in theDepartment of Tourism, Sport andRecreation. The Review Group found thatin the countries surveyed, the co-ordination of their drugs strategies fellunder the remit of either the PrimeMinister’s Department or the Departmentof Health. Clearly, from a strategicperspective, both of these Departmentsin Ireland, because of either politicalauthority or budget size, wieldconsiderable influence which could beused to further the Strategy. However, inthe case of the Department of Healthand Children – as it is a service provider –if it were to be accorded overallresponsibility, its ability to drive issuessurrounding supply control and educationand awareness issues would be limited.The Department of Tourism, Sport andRecreation can, however, be objective inrelation to all the thematic areas coveredby the national policy. In addition, theDepartment has overall responsibility forlocal development and for co-ordinationof a number of different programmes topromote social inclusion. Given thecorrelation between drug misuse andsocial exclusion, it is considered that theDepartment is strategically well placed totake the lead role in the co-ordination ofthe National Drugs Strategy. On balance,t h e re f o re, it is proposed that re s p o n s i b i l i t yfor the co-ordination of the Strategy beretained by the Department of Tourism,Sport and Recreation.

6

1 0

7 4 I n t e rnational Classification of Diseases (9th Revision) as set out by the World Health Organisation (WHO). This includes drug dependency and poisoning.

6.6.3 The creation of a post of National Anti-Drugs Co-ordinator, along the lines of the“Drugs Tsar” in the UK and USA, wassuggested in some of the submissions.However, in Ireland, the Minister of Stateat the Department of Tourism, Sport andRecreation is responsible for co-ordinating the National Drugs Strategy.In addition, the Department chairs andprovides the Secretariat to the IDG.Furthermore, through his Department’srole in the IDG, the National AssessmentCommittee for the YPFSF and the NACD,the Minister of State is in a good positionto promote a cross-sectoral approach,which has been an important objective ofthe drugs strategy to date.

6.6.4 A common theme in the consultationswas the need for the creation of astructure which has the capacity to reflectand respond to the drug problem on anational basis. The LDTFs are a specificresponse to the scale of the drugsproblem in specific disadvantaged urbanareas. There was no conclusive evidenceavailable to the Review Group that anyother urban area is currentlyexperiencing a drugs problemcomparable to that experienced withinthe LDTF areas. Consequently, the ReviewGroup considers that it is not appropriateat this time to create Task Forces of thiskind in any other large cities/towns.However, this is not to suggest that drug-related problems do not exist throughoutthe country and, consequently, thesituation should be kept under review.

6.6.5 The Review Group examined whatstructures might be appropriate to tackledrug misuse outside the LDTF areas. Itwas noted that Regional Drug Co-ordinating Committees already exist inmany of the Regional Health Board areasand the Review Group examined howthese Committees might be aligned toany new structures. In this regard, it wasfelt that new Regional Drugs Task Forces(RDTFs) should be developed whichwould incorporate and expand the workof the current Regional Drug Co-ordinating Committees. The secretariat tothe RDTFs should be provided by therelevant Health Boards. Each RDTF wouldbe responsible for putting a strategy inplace specifically for their region andshould have a budget to develop andsupport the implementation of theiraction plans. The Review Grouprecognised that the geographical remit ofthese Task Forces will make it difficult forall the various statutory and non-statutory sectors to have representatives.However, it is considered that every effortshould be made to ensure that there is anequitable regional spread of memberswhich also take account of differinglevels and natures of drug misuse withinany given region.

6.6.6 The Review Group acknowledged that inrelation to the ERHA and SHB (SouthernHealth Board) areas, the existence ofLDTFs raises certain issues for theproposed Regional Drugs Task Forces. Itconcluded, however, that while workingwithin overall regional plans in order tomaximise resources and minimise overlapor duplication, every effort should bemade not to disrupt the work of theLDTFs at this time, given their experienceand their concentrated focus on areas ofhigh opiate abuse. The currentframework should be built on and, asnatural linkages develop, the LDTFsshould feed into regional plans.

6

0 6

6.6.7 The LDTFs are currently updating theirexisting strategies and the CabinetCommittee on Social Inclusion hasapproved many of these plans and hasallocated funding for them. A review ofthe operations of the Task Forces hasbeen commissioned by the NDST and itsrecommendations should be relevant tothe establishment of the proposed RDTFs.

6.6.8 The Department of Education andScience has a key role to play in anyNational Drugs Strategy and, particularly,in regard to the LDTFs. However, ascurrently structured, the Department isnot in a position to providerepresentation on each of the 14 TaskForces. Much attention has focused onthe lack of a direct link betweencommunities and the Department. Therecent Cromien report on the operations,systems and staffing needs of theDepartment reflects the difficulties facedby it in delivering quality services in ahighly challenging environment. A high-level Task Force within the Department ispreparing a blue print for theimplementation of recommendationscontained in the report. The Departmentwill be submitting proposals forsignificant structure and service deliveryreforms, including the establishment oflocal offices, to Government in the nearfuture. In this context, the Department'srepresentation on the LDTFs, which hasbeen an issue since the establishment ofthe Task Forces, will be addressed.

6.6.9 There is also a perceived need tostrengthen and improve the level ofcommunity representation on Task Forcesin order to ensure their effectiveengagement. While this is necessary andshould be resourced, the need for greaterintegration must be weighed against thethreat that such “formalisation” mayalienate community groups themselvesfrom their constituencies. The NDSTshould commission research to examinethe training and support needs of groupsin order to equip them to participatefully in the process at national, regionaland local levels.

6 . 6 . 1 0 It is essential to the continued credibilityof the LDTF projects and, any newprojects which may emerge via theproposed RDTFs, that they are able toattract suitably qualified staff. Projectorganisers must be able to offeropportunities for professionaldevelopment and reasonable security oft e n u re must be set out clearly in contracts.

6 . 6 . 1 1 The level of seniority of statutoryrepresentatives on the LDTFs washighlighted as a matter of concern in theconsultations. Similar anxieties mightarise in due course with regard to agencyrepresentatives on the RDTFs. However,there is a danger that insistence onseniority may preclude individuals with aparticular understanding of, andenthusiasm for the work, beingnominated to, Drugs Task Forces at localor regional level.

6

1 0

6 . 7 F R A M E W O R K F O R T H E N AT I O N A LD R U G S S T R AT E G Y 2001 -2008

Overall Strategic Objective

The overall strategic objective for theNational Drugs Strategy 2001 – 2008 is :

To significantly reduce the harm causedto individuals and society by themisuse of drugs through a concertedfocus on supply reduction, prevention,treatment and research.

Overall Strategic Aims

The following are the overall strategicaims of the Strategy :

■ to reduce the availability of illicit drugs;

■ to promote throughout society, agreater awareness, understanding andclarity of the dangers of drug misuse;

■ to enable people with drug misuseproblems to access treatment andother supports and to re-integrate intosociety;

■ to reduce the risk behaviour associatedwith drug misuse;

■ to reduce the harm caused by drugmisuse to individuals, families andcommunities;

■ to have valid, timely and comparabledata on the extent and nature of drugmisuse in Ireland; and

■ to strengthen existing partnerships inand with communities and build newpartnerships to tackle the problems ofdrug misuse.

6 . 7 . 1 O B J E C T I V E S A N D K E Y P E R F O R M A N C EI N D I C AT O R S

In light of the analysis in Part 1, theconclusions set out at the beginning ofthis Chapter and the overall strategicobjective and aims set for the NationalDrugs Strategy 2001 – 2008 as set outacross, the Review Group recommendsthat the Government adopts thefollowing objectives and keyperformance indicators (KPIs) under thefour pillars of supply reduction,prevention (including education andawareness), treatment (includingrehabilitation and risk reduction) andresearch. A number of recommendationsin relation to co-ordination are alsomade.

In line with the EU Drugs Strategy, thenew Strategy will run from 2001 to 2008.The objectives and KPIs will be reviewedat the mid-term stage of the Strategy andfollowing this review, the KPIs may needto be amended. These objectives and keyperformance indicators should beincorporated into the Statements ofStrategy of the relevant Departments and Agencies.

6

0 8

Supply Reduction

Objectives■ To significantly reduce the volume of

illicit drugs available in Ireland, toarrest the dynamic of existing marketsand to curtail new markets as they areidentified; and

■ To significantly reduce access to alldrugs, particularly those drugs thatcause most harm, amongst youngpeople especially in those areas wheremisuse is most prevalent.

Key Performance Indicators■ Increase the volume of opiates and all

other drugs seized by 25% by end2004 and by 50% by end 2008 (using2000 seizures as a base);

■ Increase the level of Garda resources inLDTF areas by end 2001, building onlessons emanating from theCommunity Policing Forum model;

■ Strengthen and consolidate existingcoastal watch and other ports of entrymeasures designed to restrict theimportation of illicit drugs;

■ Establish a co-ordinating framework inrelation to drugs policy in each GardaDistrict by end 2001; and

■ Co-operate and collaborate fully, atevery level, with law enforcement andintelligence agencies, in Europe andinternationally, in reducing the amountof drugs coming into Ireland.

P re v e n t i o n

Objective■ To create greater societal awareness

about the dangers and prevalence ofdrug misuse; and

■ To equip young people and othervulnerable groups with the skills andsupports necessary to make informedchoices about their health, personallives and social development.

Key Performance Indicators■ Bring drug misuse by schools-goers to

below the EU average and, as a firststep, reduce the level of substancemisuse reported to ESPAD by school-goers by 15% by 2003 and by 25% by2007 (based on 1999 ESPAD levels asreported in 2001);

■ Develop and launch an ongoingNational Awareness Campaignhighlighting the dangers of drugs, thefirst stage to commence by end 2001;

■ Develop formal links at local, regionaland national levels with the NationalAlcohol Policy, by end 2001 and ensurecomplementarity between thedifferent measures being undertaken;

■ Publish and implement a policystatement specifically relating toeducation supports for LDTF areas,including an audit of the level ofcurrent supports, by end 2001;

■ Nominate an official from theDepartment of Education and Scienceto serve as a member of each of theLDTFs by end 2001;

6

1 0

■ Prioritise LDTF areas during theestablishment and expansion of theservices of the National EducationalWelfare Board;

■ Have comprehensive substance misuseprevention programmes in all schoolsand, as a first step, implement the“Walk Tall” and “On My Own Two Feet”Programmes in all schools in the LDTFareas during the academic year2001/02;

■ Complete the evaluation of the “WalkTall” and “On My Own Two Feet”Programmes by end 2002; and

■ Deliver the SPHE Programme (Social,Personal & Health Education) in allsecond level schools nation-wide bySeptember 2003.

Tre a t m e n t

Objectives■ To encourage and enable those

dependent on drugs to avail oftreatment with the aim of reducingdependency and improving overallhealth and social well-being, with theultimate aim of leading a drug-freelifestyle; and

■ To minimise the harm to those whocontinue to engage in drug-takingactivities that put them at risk.

Key Performance Indicators■ Have immediate access for drug

misusers to professional assessmentand counselling by health boardservices, followed by commencementof treatment as deemed appropriate,not later than one month afterassessment;

■ Have access for under-18s to treatmentfollowing the development of anappropriate protocol for dealing withthis age group;

■ In c rease the number of treatment placesto 6,000 places by end 2001 and to aminimum of 6,500 places by end 2002;

■ Continue to implement therecommendations of the SteeringGroup on Prison-Based Drug TreatmentServices as a priority and implementproposals designed to end heroin usein prisons during the period of theStrategy;

■ Have in place, in each Health Boarda rea, a service user charter by end 2002;

■ Have in place, in each Health Boardarea, a range of treatment andrehabilitation options as part of aplanned programme of progression foreach drug misuser, by end 2002; and

■ Provide stabilised drug misusers withtraining and employmentopportunities and, as a first step,increase the number of suchopportunities by 30% by end 2004.

6

1 0

R e s e a rc h

Objectives■ To have available valid, timely and

comparable data on the extent of drugmisuse amongst the Irish populationand specifically amongst allmarginalised groups; and

■ To gain a greater understanding of thefactors which contribute to Irishpeople, particularly young people,misusing drugs.

Key Performance Indicators■ Eliminate all major research gaps in

drug research by end 2003; and

■ Publish an annual report on the natureand extent of the drug problem inIreland and on progress being made inachieving the objectives set out in theStrategy.

C o - o rd i n a t i o n

Objective■ To have in place an efficient and

effective framework for implementingthe National Drugs Strategy.

Key Performance Indicators■ Establish an effective regional

framework to support the measuresoutlined in the Report by end 2001;

■ Complete an independent evaluationthe effectiveness of the overallframework by end 2004.

■ Each agency to prepare and publish acritical implementation path for eachof the actions relevant to their remitby end 2001; and

■ Review the membership, work-loadand supports required by the NationalDrugs Strategy Team to carry out itsterms of reference, by end September2001.

6

1 1

6 . 8 A C T I O N P L A N

6.8.1 The Review Group recommends a seriesof actions to be taken across the fullrange of Departments and Agenciesinvolved in the delivery of drugs policy,to address specific gaps in the currentstrategy, to strengthen each of the fourpillars which underpin it and to ensurethat the foregoing objectives are met.These actions are listed below and theirimplementation should be overseen bythe IDG, which in consultation with theNDST, should report on progress to theCabinet Committee every six months.

D e p a rtment of Tourism, Sport andR e c re a t i o n

1 The Department, through the IDG andthe NDST, to co-ordinate theimplementation of the National DrugsStrategy in partnership with GovernmentDepartments, State Agencies and thecommunity and voluntary sectors and tobring to the attention of the CabinetCommittee on Social Inclusion anyidentified issues which have adetrimental effect on the implementationof policy.

2 The IDG, in conjunction with the NDST, toestablish an evaluation framework forthe Strategy, incorporating theperformance indicators against whichprogress under the four pillars will beassessed. Annual reports and mid-termevaluations would facilitate progressiontowards key strategic goals. The costeffectiveness of the various elements ofeach pillar of the new Strategy should beestablished to enable priorities to beestablished and a re-focusing, ifnecessary, of strategic objectives from themid-term evaluation stage at 2004.

3 Continued provision of accessible,positive alternatives to drug misuse inareas where such misuse is mostprevalent through the YPFSF and, moregenerally, through arts and culture youthprogrammes, the schemes run by the IrishSports Council and the facilities providedthrough funding under the Sports CapitalProgramme. These should be accessibleand attractive to those most at risk ofdrug misuse and those from socially,educationally and culturally diversebackgrounds. In this regard, the LDTFareas should be prioritised. Specificefforts should also be made to ensurethat the groups who are most at risk ofdrug misuse are actively engaged inrecreational activities at local level.

D e p a rtment of Justice, Equality andLaw Reform

4 To oversee the establishment of aframework to monitor numbers ofsuccessful prosecutions, arrests and thenature of the sentences passed.

5 To establish, in consultation with theGardaí and the community sector, bestpractice guidelines and approaches forcommunity involvement in supply controlactivities with the law enforcementagencies.

6 To review the ongoing effectiveness ofcrime legislation, in tackling drug-relatedactivity.

6

1 2

G a rda Síochána7 To increase the level of Garda resources

in LDTF areas by end 2001, building onlessons emanating from the CommunityPolicing Forum model.

8 To establish a co-ordinating frameworkfor drugs policy in each Garda District, toliaise with the community on drug-related matters and act as a source ofinformation for parents and members ofthe public. Each Garda District and Sub-District be required to produce a DrugPolicing Plan to include multi-agencyparticipation in targeting drug dealers.

9 To target the assets of middle-rankingcriminals involved in drug dealing.

10 To continue to target dealers at locallevel by making additional resourcesavailable to existing drugs units and forthe establishment of similar units in areaswhere they do not currently exist.

11 To extend the Community Policing Fora(CPF) initiative to all LDTF areas, if theevaluation of the pilot proves positive.The proposed RDTFs should be consultedin assessing whether CPFs should beestablished in regional areas of particularneed. Where CPFs do not exist, CPFmethods should be adopted as bestpractice for mainstream policing policy.

12 To ensure that operations similar toDóchas, Nightcap and Cleanstreet areimplemented in urban centresthroughout Ireland, where drug dealingis on-going.

13 To monitor the efficacy of the existingarrest referral schemes and expand them,as appropriate.

G a rda Síochána and Customs andE x c i s e

14 To continue to work more closelytogether in accordance with theprinciples of their Memorandum ofUnderstanding. They should also co-operate and collaborate fully with lawenforcement and intelligence agencies inEurope and internationally in reducingthe amount of drugs coming into Ireland.

15 To strengthen and consolidate existingcoastal watch and other ports of entrymeasures designed to restrict theimportation of illicit drugs by end 2002

16 To develop benchmarks against whichseizures of heroin and other drugs can beevaluated under the EU Action Plan inorder to establish progress on a yearlybasis.

17 To ensure greater integration of Customsand Excise within a European context, anOfficer of the Customs and Excise Divisionshould be appointed to the EuropolNational Unit.

18 To have available to the enforcementagencies detection dogs and otherresources to restrict the importation ofillicit drugs.

6

1 1

G a rda Síochána and Health Board s19 Incidences of early use of alcohol or

drugs by young people coming to Gardaattention to be followed up by theCommunity Police and/or the health andsocial services, in order that problem drugmisuse may be diagnosed/halted early onthrough appropriate early intervention.

C o u rts Serv i c e20 To have in all LDTF areas an early

intervention system, based on the DrugCourt model, if the evaluation of thepilot in the North Inner City of Dublin ispositive. This should be accompanied byappropriate familiarisation for thejudiciary on the role of the Drug Court.

Prison Serv i c e21 To continue to implement the

recommendations of the Steering Groupon Prison-Based Drug Treatment Servicesas a priority and to implement proposalsdesigned to end heroin use in prisonsduring the period of the Strategy.

22 To expand prison-based programmes withthe aim of having treatment andrehabilitation services available to thosewho need them including drug treatmentprogrammes, which specifically deal withthe reintegration of the drug usingoffender into the family/community.

23 To commission and carry out anindependent evaluation of the overalleffectiveness of the Prison Strategy bymid 2004. The review should cover allaspects of drug services in prisonsincluding research on levels and routes ofsupply of drugs in prisons.

24 To expand the involvement of thecommunity and voluntary sectors inprison drug policy via the on-goingdevelopment of Local Prison LiaisonGroups and the formal meetings betweenthe sectors and the Steering Group onPrison-Based Drug Treatment Services.

D e p a rtment of the Enviro n m e n tand Local Govern m e n t

25 To commission an external evaluation ofthe impact of enforcement activity underthe Housing Acts (evictions, excludingorders) on homelessness by end 2001.

26 To monitor and evaluate homelessnessinitiatives in relation to drugs issues inthe context of the Homeless Strategyand, particularly, in relation to the DublinAction Plan.

G a rda Síochána, the Health Board sand Vintner Representative Bodies

27 Representative bodies including theVintners Federation of Ireland (VFI), theLicensed Vintner’s Association (LVA) andthe Irish Hotel Federation (IHF) toprepare guidelines, in association withthe Garda authorities and the HealthBoards, for publicans and night-clubowners regarding drug dealing on, or inthe vicinity of, their premises. Theseguidelines should set out clearly theactions which the owner of the premisesshould take in response to drug dealinge.g. co-operation with the Gardaí etc.

28 Gardaí to object to the renewal oflicences for publicans and night-clubowners where there has been a history ofdrug dealing on the premises.

6

1 4

D e p a rtment of Education andS c i e n c e

29 To publish and implement a policystatement on education supports inLDTFs, including an audit of the level ofcurrent supports by end 2001 andnominate an official to serve as amember of each Task Force. TheDepartment's representatives on the TaskForces will meet to discuss crosscuttingissues, chaired by a senior official. Thiswill be done in the context of structureand service delivery reforms which will beconsidered by Government.

30 To prioritise LDTF areas during theestablishment and expansion of theservices of the National EducationalWelfare Board.

31 To put in place by end 2001 mechanismswhich will support, enhance and ensurethe delivery of school-based educationand prevention programmes in all schoolsnation-wide over the next three years.The ultimate aim of these programmesshould be to ensure that every child hasthe necessary knowledge and life-skills toresist drugs or make informed choicesabout their health, personal lives andsocial development.

32 To implement “Walk Tall” and “On MyOwn Two Feet” Programmes in all schoolsin the LDTF areas, in the context of theSPHE Programme during the academicyear 2001/02.

33 To deliver the SPHE Programme in allsecond-level schools by September 2003.

34 To complete the evaluation of the “WalkTall” and “On My Own Two Feet”Programmes by end 2002 and to continueto evaluate the programmes in order toestablish whether they need to beaugmented or whether there is a needfor alternative programmes to addresskey gaps. Furthermore, schools shouldencourage the participation of parents insuch programmes, where appropriate. Inparticular, mechanisms for engaging theparents of at-risk children in programmesshould be examined with a view toestablishing models of best practice.

35 To ensure parents have access to factualpreventative materials which alsoencourage them to discuss the issues ofcoping with drugs and drug misuse withtheir children.

36 To ensure that every second-level schoolhas an active programme to counter earlyschool-leaving with particular focus onareas with high levels of drug misuse.

37 Recommendations 31-35 to apply equallyto the non-school education sector e.gVTOS, Youthreach and CommunityTraining Workshops operated by FÁS.Such sectors often deal with youngpeople from more disadvantagedbackgrounds who are more at risk ofdrug misuse. For this reason,incorporating a drug element to theeducation provided, as outlined earlier, isimportant.

(The Health Promotion Unit of theDepartment of Health and Children andthe Health Boards are partners in theimplementation of actions 31-35 and 37).

6

1 1

D e p a rtment of Health and Childre n38 To develop and launch an on-going

National Awareness Campaignhighlighting the dangers of drugs, basedon the considerations outlined in theconclusions. The campaign shouldpromote greater awareness andunderstanding of the causes andconsequences of drug misuse, not only tothe individual but also to his/her familyand society in general. The first stageshould commence before the end of 2001.

39 To ensure that adequate training forhealth care and other professionalsengaged in the management of drugdependency is available, including, ifnecessary, arrangements with third levelinstitutions and professional bodies.

40 To consult all treatment and re h a b i l i t a t i o np roviders in order to ensure that perf o rm a n c eindicators, used in the evaluation ofservices, accurately and consistentlyreflect the needs of specific areas i.eperformance indicators should reflect thereality of the drug problem locally.

41 To oversee implementation of therecommendations of the BenzodiazepineWorking Group, which is due to completeits work by end June 2001, as part of theoverall strategy of quality improvementof current services.

D e p a rtments of Education andScience and Health and Childre n

42 To ensure that the design and delivery ofall preventative programmes is informedby on-going research into the factorscontributing to drug misuse by particulargroups. The programmes should alsoinclude the development of initiativesaimed at equipping parents of at riskchildren with the skills to assist theirchildren to resist drug use or makeinformed choices about their health,personal lives and social development.

43 To develop guidelines, in co-operationwith the Health Boards, to assist schoolsin the formation of a drugs policy andensure that all schools have policies inplace by September 2002.

Health Board s44 To have immediate access for drug

misusers to professional assessment andcounselling by health board services,followed by commencement of treatmentas deemed appropriate, not later thanone month after assessment.

45 To increase the number of treatmentplaces for opiate addiction to 6,000 bythe end of 2001 and to a minimum of6,500 by end 2002.

46 To develop and put in place by end 2002a service-user charter specific totreatment and rehabilitation facilitieswhich would lead to a greater balance inthe relationship between the service userand the service provider. Such a charterwould be helpful to drug misuserspresenting for treatment with low levelsof educational attainment and/or lowlevels of self-esteem.

47 To base plans for treatment services on a“continuum of care” model and a “keyworker” approach to provide a seamlesstransition between each different phaseof treatment. This approach will enhancemovement through various treatmentand aftercare forms. In addition, the “key worker” can act a central person forprimary care providers (GPs andPharmacists) to contact in connectionwith the drug misuser in their care.

48 To have in place, in each Health Boardarea, a range of treatment andrehabilitation options as part of aplanned programme of progression foreach drug misuser, by end 2002. Thisapproach will provide a series of optionsfor the drug misuser, appropriate tohis/her needs and circumstances andshould assist in their re-integration backinto society.

6

1 6

49 To develop a protocol, where appro p r i a t e ,for the treatment of under 18 year oldspresenting with serious drug problemsespecially in light of the legal and otherdilemmas which are posed for pro f e s s i o n a l sinvolved in the area. In this context, aWorking Group should be established todevelop the protocol. The Group shouldalso look at issues such as availability ofappropriate residential and daytreatment programmes, education andtraining rehabilitative measures and harmreduction responses for young people.The Group should report by mid 2002.

50 To develop, in consultation with theNACD, criteria to ensure that all State-funded treatment and rehabilitationprogrammes accord with qualitystandards as set out by the HealthBoards.

51 To have a clearly co-ordinated and wellpublicised plan in place for each HealthBoard area by end 2002 for the provisionof a comprehensive and locally accessiblerange of treatments for drug misusers,particularly for young people, theplanning of such services to be linked tothe national profile of drug misuseamongst young people and to the areaswhere usage is most prevalent. Theseplans to be implemented by end 2004.

52 To produce and widely distribute a wellpublicised, short, easily read guide to thedrug treatment services available in eachHealth Board area with contact numbersfor further information and assistance.

53 To require from 2002 that all HealthBoards, in considering the location andestablishment of treatment andrehabilitation facilities, develop amanagement plan in consultation withlocal communities. Existing exampleswhereby Health Boards have establishedmonitoring committees with the localcommunity to oversee the operation ofthe treatment services have provensuccessful and should be replicated,where appropriate.

54 To consider, as a matter of priority, howbest to integrate child-care facilities withtreatment and rehabilitation centres andhow childcare can best be provided in aresidential treatment setting. This shouldbe done in conjunction with theDepartment of Justice, Equality and LawReform.

55 To explore immediately the scope for introducing greater provision ofalternative medical and non-medicaltreatment types, which allow greaterflexibility and choice. This may increasethe number of drug misusers presentingfor treatment as it is evident that a “onesize fits all” approach is not appropriateto the characteristics of Irish drug misuse.

56 To consider as a matter of priority, howto increase the level of GP and pharmacyinvolvement in the provision oftreatment programmes. Increasedcapacity at the primary care level willhave the effect of alleviating the pressureon the secondary care services which arecurrently over-subscribed.

57 To oversee the development ofcomprehensive residential treatmentmodels incorporating detoxification,intervention, pre-treatment counselling,motivational work, therapeutic treatmentand high quality rehabilitation formisusers who wish to become drug-free.Resources should continue to be targetedat the most efficient and effective ofthese services.

58 To report to the NACD on the efficacy ofdifferent forms of treatment and detoxfacilities and residential–drug freeregimes on an on-going basis.

59 To secure easy access to counsellingservices for young people seekingassistance with drug-related problems,especially given the correlation betweensuicide and drug misuse and the growingincidence of suicide amongst youngpeople.

6

1 1

60 To ensure that treatment for youngpeople includes family therapy andcommunity integration phases, in orderto encourage family involvement which isa crucial component in the treatment ofyoung people.

61 To consider developing drop-in centres,respite facilities and half-way houses,where a clear need has been identified,as such facilities have been found to beuseful in the prevention of relapse.

62 To review the existing network of needle-exchange facilities with a view toensuring access for all injecting drugmisusers to sterile injecting equipment.

63 To pursue with the relevant agencies, as amatter of priority, the setting up of aPilot Community Pharmacy Needle andSyringe Exchange Programme in theERHA area and in the event of asuccessful evaluation, the programme tobe extended where required.

64 To continue to develop good-practiceoutreach models, including mechanismsto outreach drug misusers who are not incontact with mainstream treatment orsupport agencies. A reduction in the levelof drug-related deaths, particularly fromopiate abuse through targetedinformation, educational and preventioncampaigns must be a key aspect of theStrategy.

65 All treatment providers should co-operatein returning information on problemdrug use to the DMRD of the HRB.

66 To consider the feasibility of new suitablytrained peer-support groups in thecontext of expanded provision. Peer-support groups are a component of theexisting strategy and are regarded as aneffective rehabilitative support.

C o roners' Service and the CentralStatistics Off i c e

67 To develop an accurate mechanism forrecording the number of drug-relateddeaths in Ireland.

Local Authorities and Health Board s68 To achieve close liaison between

treatment providers, social workers,probation and welfare officers and therelevant local authorities as well as familysupports, so as to ensure that recoveringmisusers should have access to housing.This is very important in ensuring thatthe effectiveness of treatment and thegoals of rehabilitation are not underm i n e d .

69 To develop and implement proposals forthe collection and safe disposal of injectingequipment, in order to ensure that thewider community is not exposed to thedangers associated with unsafe disposal.

70 To consider how the design of housingestates can contribute to the preventionof drug dealing in the context of on-going reviews of the Social HousingDesign Guidelines for Local AuthorityEstates. In this regard, the lessons fromthe ISP may be relevant.

City and County DevelopmentB o a rd s

71 To consider the needs of those areasexperiencing high levels of drug misusewhen drawing up city/countywidestrategies for economic, social andcultural development.

6

1 8

P rofessional Bodies andTraining Institutes

72 To make available to individualsinteracting with groups most at risk ofdrug misuse, such as youth workers,teachers, student welfare officers, GPs,pharmacists, nurses, counsellors, childcare workers, law enforcement agents,members of the judiciary etc. specialistdrug prevention training as part of theirinitial vocational training. The relevantprofessional body or employer shouldensure that training, or up-skilling isavailable on an on-going basis to ensurethat the approach taken reflectschanging attitudes and patterns of drugmisuse.

Public Media73 To encourage the media to play a larger

role in creating a greater understandingof drug misuse throughout society.Informed coverage and analysis anddebate of drugs issues on an on-goingbasis within the public sphere willcontribute to the successfulimplementation of the Strategy. In thisregard, the role of the Department ofTourism, Sport and Recreation, as the co-ordinator of the National Drugs Strategy,as a possible central source ofinformation should be considered.

State Training Agencies74 To increase the number of training and

employment opportunities for drugmisusers by 30% by end 2004, in line with the commitment to provide suchopportunities in the PPF

75and taking on

board best practice from the special FÁSCommunity Employment Programme andthe pilot Labour Inclusion Programme.

75 To examine the potential to involverecovering drug misusers in SocialEconomy projects, and in other forms of vocational training. The ring-fencingof places within the FÁS CommunityEmployment Programme has been animportant element of the existingapproach to rehabilitation.

76 To monitor the participation ofrecovering drug misusers on suchprogrammes and to review their overalleffectiveness. In this context, alternativemodels should be developed whereappropriate.

O i reachtas Committee on Dru g s77 To establish a dedicated drugs sub-

committee of the existing SelectCommittee on Tourism, Sport andRecreation, which would meet at leastthree times a year. 6

1 1

7 5 The commitment in the PPF states that “As the number of drug misusers taking treatment increases, the re q u i rement to provide training and employment

o p p o rtunities to assist them towards a full re c o v e ry will also incre a s e . ”

I n t e r- D e p a rtmental Group on Drugs (IDG)

78 To be chaired by the Minister of State atthe Department of Tourism, Sport andRecreation. This will ensure greater co-ordination between the IDG’sconstituents in the future and will help tomaintain high-level representation andmore effective communication betweenthe IDG and the Cabinet Sub-Committee.

79 To consist, in future, of designatedofficials, at Assistant Secretary level, fromthe following Departments:

■ Tourism, Sport & Recreation;

■ Taoiseach;

■ Finance;

■ Health & Children;

■ Education & Science;

■ Enterprise, Trade and Employment;

■ Environment & Local Government;

■ Justice, Equality & Law Reform; and

■ Social, Community and Family Affairs.

The Chair of the NDST will also be amember.

As has been the practice, regular jointmeetings to continue to be held betweenthe IDG and the NDST to contribute tothe effective and efficient developmentand delivery of the National Drugs Strategy.

80 In conjunction with the NDST and theDepartment of Health and Children, todevelop formal links at local, regionaland national levels with the NationalAlcohol Policy, by end 2001 and ensurecomplementarity between the differentmeasures being undertaken.

81 To seek reports from key serviceproviders, such as the AssistantCommissioner of An Garda Síochána, theDirector General of the Prisons Service,the Chief Executive of the relevant HealthAuthorities, the Revenue Commissionerwith responsibility for Customs and

Excise and the County/City Manager ofrelevant Local Authorities on request and to attend meetings, as appropriate.Representatives from the voluntary,community and professional sectorsshould also asked to attend, asappropriate.

82 The Terms of Reference of the IDG toinclude the following:

■ advising the Cabinet Committee oncritical matters of a public policy naturerelating to the National Drugs Strategy;

■ ensuring the timely and effective inputof relevant Departments and agenciesinto any emerging operationaldifficulties or conflicts in relation toimplementation of national drugspolicy; and

■ approving the plans and initiatives ofthe LDTFs and the proposed RDTFs andmonitoring and evaluating theoutcomes of their implementationthrough joint meetings with the NDST.

83 In conjunction with the NDST:

■ to review the membership of theTeam, immediately and, every twoyears subsequently, in order to ensurethat all relevant interests arerepresented; and

■ to review the workload of the NDSTand satisfy itself that the level ofsupport is adequate to carry out itsnew terms of reference. In particular,to examine, as a priority, the need for aDirector to oversee the day to daymanagement of the Office andadditional technical support workers.The review should be completed byend September 2001.

84 Departments and Agencies participatingon the IDG and the NDST to committhemselves in writing to the process andthe level and extent of representationshould be specified.

6

2 0

National Drugs Strategy Te a m85 The Terms of Reference of the NDST to

include :

■ ensuring effective co-ordinationbetween officials from GovernmentDepartments and State Agenciesrepresented on the Team and membersof the community and voluntary sectorsin delivering local and regional taskforce plans;

■ reviewing on an on-going basis theneed for LDTFs in disadvantaged urbanareas, particularly having regard toevidence of localised heroin misuse;

■ identifying and considering policyissues and ensuring that policy isinformed by the work of and lessonsfrom the LDTFs and the proposedRDTFs, through joint meetings with theIDG;

■ overseeing the establishment of RDTFs;

■ drawing up guidelines for theoperation of Local and Regional DrugsTask Forces and overseeing their work;

■ evaluating the Local and RegionalDrugs Task Forces Action Plans, whensubmitted and makingrecommendations to the IDG regardingthe allocation of funding to supporttheir implementation;

■ ensuring that monies allocated by theDepartment of Tourism, Sport andRecreation to projects overseen by theNDST are properly accounted for; and

■ preparing an annual report andpresenting it to the Department ofTourism, Sport and Recreation.

86 To meet regularly with the co-ordinatorof the National Alcohol Policy and,similarly, a member of the Team shouldbe represented on the body charged withthe co-ordination of the National AlcoholPolicy.

87 To continue to be represented on theYPFSF National Assessment Committeeand to ensure that the LDTFs continue tobe represented on the DevelopmentGroups for the Fund.

88 The NDST to be kept informed byDepartments and Agencies of anyinitiatives being taken which will affectTask Force areas. In addition, membershipof NDST and of the Local and RegionalDrugs Task Forces to be acknowledgedand written into the business plans/workprogrammes of all relevant Departmentsand Agencies.

89 To consider funding on a pilot basis,training initiatives to strengthen effectivecommunity representation andparticipation in Regional and Local DrugsTask Forces.

90 To examine and advise the IDG on thefeasibility of introducing a standards andaccreditation framework for allindividuals, groups and agencies engagedin drugs work. Such a framework shouldaddress issues such as standards, training,qualifications, etc.

91 To continue to identify best practicemodels arising from the work of theLDTFs and the proposed RDTFs anddisseminate them widely.

6

1 2

Regional Drugs Task Forc e s92 Regional Drugs Task Forces (RDTFs) to be

established in each of the currentRegional Health Board areas

76including

each of the three Health Boards77

thatcomprise the ERHA, with the followingterms of reference:

■ to ensure the development of a co-ordinated and integrated response totackling the drugs problem in theirregion;

■ to create and maintain an up-to-datedatabase on the nature and extent ofdrug misuse and to provideinformation on drug-related servicesand resources in the region;

■ to identify and address gaps in serviceprovision having regard to evidenceavailable on the extent and specificlocation of drug misuse in the region;

■ to prepare a development plan torespond to regional drugs issues forassessment by the NDST and approvalby the IDG;

■ to provide information and regularreports to the NDST in the format andfrequency requested by the Team; and

■ to develop regionally relevant policyproposals, in consultation with theNDST.

93 To consist of senior representatives sothat members are capable of decisionmaking and influencing budgets.

94 To include representation from thefollowing sectors:

■ Chair;

■ Regional Drug Co-ordinator of theHealth Board (providingsecretarial/administrative support);

■ Local Authority;

■ VEC;

■ Health Board;

■ Department of Education and Science;

■ Department of Social, Community andFamily Affairs;

■ Gardaí;

■ Probation and Welfare Service;

■ FÁS;

■ Revenue Commissioners – Customs andExcise Division;

■ Voluntary Sector;78

■ Community Sector;

■ Public Representatives (nominated byLocal Authority in accordance withnormal procedures); and

■ Area Based Partnership.6

2 2

7 6 Midland Regional Health Board, Mid-We s t e rn Regional Health Board, Southern Health Board, South-Eastern Health Board, Eastern Regional Health Authority,

N o rth Eastern Regional Health Board, North We s t e rn Regional Health Board, We s t e rn Regional Health Board. 7 7 East Coast Area Health Board, South We s t e rn Area Health Board, Nort h e rn Area Health Board .7 8 The Vo l u n t a ry and Community Sector re p resentatives could be nominees of the Community Development Fora of the relevant City and County Development

B o a rds. However, they should meet the criteria specified in the NDST Handbook for LDTFs and be re p resentative of areas where there are problems of emerg i n g

d rug misuse.

Local and Regional Drugs Ta s kF o rc e s

95 RDTFs to consider the development andimplementation of community-basedinitiatives to raise awareness. The goal ofsuch initiatives would be to develop bestpractice models which send a clear andconsistent message and which ar ecapable of being mainstreamed. In thecommunities where drug misuse is mostprevalent and where there isconsiderable knowledge about all aspectsof the drugs issue, schools could tap intoand use this knowledge as a beneficialaspect of their programmes. By contrast,there are communities that have a verylimited knowledge of the nature ormanifestations of drug misuse. In theseareas, the school, the health promotionofficer, GPs, pharmacists, the Gardaí andothers must take the lead in creating agreater awareness of drug misuse.

96 To enable user groups in Task Force areasto play a role in the generation of agreater societal understanding of drugmisusers and drug misuse issues. Forthose misusers who may not be in contactwith mainstream agencies, these groupscan help foster awareness about supportservices available e.g. treatment options,needle exchanges etc.

97 To include local publicity about thenature of their work and the type ofmeasures/initiatives being put in place bythem as a key element of the work ofTask Forces and as part of their actionplans. This information should bedisseminated as widely as possible.

National Advisory Committee onD ru g sTo examine their current three yearresearch programme to establish if thefollowing actions could beaccommodated within it:

98 To carry out studies on drug misuseamongst the at-risk groups identified inthis Report e.g. Travellers, prostitutes, thehomeless, early school leavers etc.including de-segregation of data onthese groups. It is essential that theindividuals and groups most affected bydrug misuse and those involved inworking to reduce, treat and preventdrug misuse have immediate access torelevant statistical information.

99 To commission further outcome studieswithin the Irish setting to establish thecurrent impact of methadone treatmenton both individual health and onoffending behaviour. Such studies shouldbe an important tool in determining thelong-term value of this treatment.

100 To conduct research into the effectivenessof new mechanisms to minimise thesharing of equipment e.g. non-reusablesyringes, mobile syringe exchangefacilities etc. to establish the potentialapplication of new options withinparticular cohorts of the drug usingpopulation i.e amongst younger drugmisusers, within prisons etc.

6

1 2

P a rt III

Appendices

G L O S S A RY

CDP Community Development Programme

CE Community Employment

CNDT Customs National Drug Team

CPF Community Policing Forum

DLO Drugs Liaison Officer

DMRD Drug Misuse Research Division

EMCDDA European Monitoring Centre on

Drugs and Drug Addiction

ERHA Eastern Regional Health Authority

ESPAD European Schools Survey Project on Alcohol

and other Drugs

EU European Union

FÁS Foras Áiseanna Saothairi

HBSC Health Behaviour in Schools Aged

Children Survey

HRB Health Research Board

HPU Health Promotion Unit

IDG Inter-Departmental Group on Drugs

INCB International Narcotics Control Board

ISP Integrated Services Process

IV Intravenous

LAAM L-Alpha Acetyl Methadol

LDTF Local Drugs Task Force

LSD Lysergic Acid Diethylamide

NACD National Advisory Committee on Drugs

NAPS National Anti Poverty Strategy

NDP National Development Plan

NDS National Drugs Strategy

NDST National Drugs Strategy Team

NDTRS National Drug Treatment

Reporting System

RDTF Regional Drugs Task Force

SMI Strategic Management Initiative

SAPP Substance Abuse Prevention Pro g r a m m e

SMPP Substance Misuse Prevention Pro g r a m m e

UN United Nations

UNDCP United Nations Drug Control Pro g r a m m e

UNGASS United Nations General Assembly

Special Session on Drugs

USI Union of Students in Ireland

VEC Vocational Educational Committee

VFM Value for Money

YPFSF Young Peoples Facilities & Services Fund

2 6

A P P E N D I X 1 – K E Y S T R U C T U R E S O F T H E N AT I O N A L D R U G S S T R AT E G Y

Membership of Inter- D e p a rtmental Committee on Drugs (IDG)The review was conducted under the auspices of the Inter-departmental Committee on Drugs (IDG) which

consists of high level representatives of key Government departments with a role to play in addressing issues

related to illicit drug use. Membership of the IDG at the time of publication is:-

■ Mr. Con Haugh (Chairperson) Department of Tourism, Sport & Recreation

■ Mr. Eddie Arthurs (Secretary) Department of Tourism, Sport & Recreation

■ Ms Eileen Kehoe Department of the Taoiseach

■ Mr. Tom Corcoran Department of Environment & Local Government

■ Mr. Jimmy Duggan Chair – National Drugs Strategy Team /

Department of Health & Children

■ Mr. John Fitzpatrick Department of Finance

■ Mr. Tom Mooney Department of Health & Children

■ Vacancy Department of Education & Science

■ Mr. Seamus O’Moráin Department of Enterprise & Employment

■ Mr. Brian Purcell Department of Justice, Equality & Law Reform

■ Ms. Kathleen Stack Chair – YPFSF National Assessment Committee/

Department of Tourism, Sport & Recreation

■ Mr. John Kelly Department of Tourism, Sport & Recreation

Membership of the National Drugs Strategy Team (NDST)Membership of the NDST at the time of publication is:-

■ Mr. Jimmy Duggan (Chairperson) Department of Health and Children

■ Mr. Ray Henry Department of the Taoiseach

■ Ms. Eileen Hughes Department of Environment & Local Government

■ Superintendent Barry O'Brien Garda National Drugs Unit

■ Mr. John Harkin FÁS

■ Ms. Mary O'Sullivan D e p a rtment of Social, Community and Family Aff a i r s

■ Mr. Stephen Falvey Department of Education & Science

■ Ms. Lylia Crossan Department of Justice, Equality & Law Reform

■ Fr. Sean Cassin Voluntary Representative

■ Mr. Fergus Mc Cabe Community Representative

■ Dr. Derval Howley ERHA

■ Dr Joe Barry ERHA

1 2

National Drugs Strategy Review Sub-Gro u pThe IDG were assisted in the preparation of the review by a sub-group, comprised of representatives from

Government Departments and the National Drugs Strategy Team (NDST) consisting of the following members;

■ Mr Con Haugh (Chairperson) Assistant Secretary Department of Tourism,

Chair of the IDG Sport & Recreation

■ Ms Kathleen Stack Principal Officer – Department of Tourism

Drugs Strategy Unit, Sport & Recreation

■ Mr. Stephen Falvey Assistant Principal Officer – Department of Education

Social Inclusion Unit & Science

■ Mr. Brian Purcell Principal Officer – Department of Justice,

Crime Division Equality & Law Reform

■ Superintendent Barry O’Brien An Garda Síochána NDST Member

■ Mr. Jimmy Duggan Principal Officer – Department of Health &

Chairperson of the NDST Children

■ Mr. Fergus McCabe Community Worker NDST Member

■ Mr. John Kelly Secretary to the National Department of Tourism,

Drugs Strategy Review Sport & Recreation

The Secretariat to the review was supplied by the staff of the Drugs Strategy Unit of the Department of Tourism,

Sport & Recreation and consisted of Mr. John Kelly (Secretary); Mr Caoimhín Ó Ciaruáin, Ms. Sharon Gleeson; Ms.

Patricia Kenna and Mr. Anthony McCarthy. Mr. John Kelly succeeded Mr. Tony Bass as Secretary to the review in

November 2000.

2 8

1 2

A P P E N D I X 2 – R E S P O N S E S T O T H E D R U G P R O B L E M I N I R E L A N D

Time Period Developments

1966-1979 Working Party on Drug Abuse established December 1968

Report of Working Party completed in 1971

Committee on Drug Education established in 1972

Report of the Committee on Drug Education in 1974

Health Education Bureau established in 1974

Health Education Bureau established in 1974

Misuse of Drugs Act 1977

1980-1985 Prevalence study conducted by Medico Social Research Board in 1983

Inter-Ministerial Task Force established in 1983

Report of the Inter-Ministerial Task Force in 1983

Misuse of Drugs Act 1984

National Coordinating Committee on Drug Abuse 1985

1986-1991 Health Research Board established in 1986

Health Promotion Unit established in 1987

National Coordinating Committee on Drug Abuse reconstituted in 1990

Government Strategy to Prevent Drug Misuse 1991

1992-Present Time Criminal Justice Act 1994

Criminal Justice (Drug Trafficking) Act 1996

Criminal Assets Bureau Act 1996

Proceeds of Crime Act 1996

Disclosure of Certain Information for Taxation and Other

Purposes Act 1996

Bail Act 1997

Housing Act 1997

Ministerial Task Force on Measures to Reduce the Demand

for Drugs established in 1996

First Report of the Ministerial Task Force 1996

Establishment of National Drugs Strategy Team 1996

Second Report of the Ministerial Task Force 1997

Establishment of Cabinet Drugs Committee

Establishment of Local Drugs Task Forces 1997

Cabinet Drugs Committee reconstituted into wider

Committee on Social Inclusion and Drugs 1997

Young People’s Facilities and Services Fund 1998

Criminal Justice (Drug Trafficking) Act 1999

National Advisory Committee on Drugs 2000

A P P E N D I X 3 – S U B M I S S I O N S R E C E I V E D

I n d i v i d u a l s

O rg a n i s a t i o n sAddiction Resource Centre, Rooskey

ADHD – The Irish National Council of Supports Gro u p s

A I S É I R Í

AISLING – Group Cavan Branch

Aisling Gro u p

AISLINN – Adolescent Addiction Treatment Centre Limited

An Garda Síochána

A rea Development Management (ADM) Ltd

Association of Secondary Teachers in Ireland (ASTI)

Athlone Drug Aw a reness Gro u p

Balbriggan Aw a reness of Dru g s

B a l l y f e rmot Local Drugs Task Forc e

Ballymun Youth Action Project (BYA P )

B a rn a rdos – Southern Region

Beg Borrow and Steal Theatre Company

C A I R D E

Campaign against Bullying (CAB)

Canal Communities Local Drugs Task Forc e

Carlow Regional Youth Serv i c e

Carlow Urban District Council

Catholic Primary School Managers' Association

Catholic Youth Council (CYC)

Cavan County Council

Clonmel Community Based Drugs Initiative

We x f o rd Community Based Drug Initiative

C O A I M

Coalition of Communities Against Drugs (COCAD)

Combat Poverty Agency

Combined Tallaght Community Treatment Pro g r a m m e s

Community Aw a reness of Drugs (CAD)

Coolmine House

Cork Local Drugs Task Forc e

County Kilkenny VEC

County Louth VEC

C PA D

CREW Network

C ross Border Anti-Drugs Initiative Committee

C R S A

Cuan Mhuire

Cumann Lúthchleas Gael

D a rndale/Belcamp Resource Centre

D e p a rtment of Education and Science

D e p a rtment of Health & Childre n

D e p a rtment of Justice, Equality & Law Reform

D e p a rtment of the Environment and Local Govern m e n t

D rug Prevention Alliance

D rug Treatment Centre Board

D rugs Education Workers Forum

Dublin City University

Dublin City Wide Drugs Crisis Campaign

Dublin Corporation

Dún Laoghaire Business Association

3 0

■ Mr. Max Brohan

■ Dr. Gerard Bury

■ Dr. Fergus O'Kelly

■ Mr. Adrian Carolan

■ Cllr. Sheila Casey

■ Fr. Sean Cassin

■ Prof. Paul Connon

■ Mr. Con Doherty

■ Dr. Pat Fanning

■ Dr. Michael Ffrench-O'Carroll

■ Mr. John Fitzgibbon

■ Mr. Michael Fox

■ Mr. Hugh Greaves

■ Mr. Paul Gregory

■ Ms. Roslyn Hurley

■ Mrs. R. Leech

■ Mr. Fergus McCabe

■ Ms. Maria McCully

■ Ms. Nancy O’Flynn

■ Ms. Siobhan O'Donnell

■ Mr. Richard Parker

■ Mr. Lorne Patterson

■ Mr. Ciaran Perry

■ Dep. Pat RabbitteT.D.

■ Mr. Paul Sheehan

■ Mr. C. Skelton

■ Mr. Eamonn White

Dún Laoghaire/Rathdown Local Drugs Task Forc e

East Coast Area Health Board

East Wall Drugs Committee

E a s t e rn Regional Health Authority (ERHA) (form e r l y

E a s t e rn Health Board )

E U R A D

F Á S

Fatima Young Person Project Focus Ire l a n d

FORÓIGE – National Youth Development Org a n i s a t i o n

General Practitioners Specialising in Substance Abuse

( G P S S A )

Haddington Clinic

Health Research Board (HRB)

Institute of Technology Tr a l e e

Irish Association of Univeristy and College Counsellors

Irish Bishops' Drugs Initiative

Irish College of General Practitioners

Irish Congress of Trade Unions (ICTU)

Irish Medical Organisation (IMO)

Irish Prison Serv i c e

Irish Sports Council

K e rry County Council

K e rry Diocesan Youth Serv i c e

Kilkenny Drugs Initiative

K i l l a rney Urban District Council

Labour Part y

Lake Isle Relaxation Centre

L e i s u re Point

L I N K S

Local Bishops Network Committee

Local Drugs Task Forces Repre s e n t a t i v e s

Marist Rehabilitation Centre

Mater Dei Counselling Centre

Matt Talbot Community Tru s t

Mayo County Council

Meath County Council

M e rchants Quay Pro j e c t

Mid We s t e rn Health Board

Midland Health Board

Midland Regional Youth Serv i c e

Mountview/Blakestown Community Drug Te a m

National Adult Literacy Agency (NALA)

National Council for Curriculum and Assessment (NCCA)

National Parents Council – Post Primary

National Parents Council – Primary

National Youth Council of Ire l a n d

Natural Law Part y

N o rth Clondalkin Community Development Association

N o rth Eastern Health Board

N o rth Inner City Drugs Task Forc e

N o rth We s t e rn Health Board

N o rt h e rn Area Health Board

Nurses Addiction Network

O ffice of the Revenue Commissioners

One Parent Exchange and Network

PA C E

Pavee Point Travellers Centre

P h a rmaceutical Society of Ire l a n d

P o rtarlington Drug Aw a reness Group

P revention Project Group, Department of Education,

NUI Maynooth

Prison Officers' Association (POA)

P robation and We l f a re Service (PWS)

Ranelagh, Rathmines Drug Aw a reness Pro j e c t

Rathmines Drug Aw a reness Gro u p

Rialto Community Drugs Te a m

Ringsend Action Project Limited

Ringsend and District Response to Dru g s

Rinn Development Initiative Limited

Rutland Centre Limited

SAOL Pro j e c t

S e c retariat of Secondary Schools

Sligo County Council

Sligo Northside Community Resource Centre

South East Regional Drug Helpline

South Eastern Health Board

South Inner City Community Development Association

South Kerry Development Part n e r s h i p

S o u t h e rn Health Board

1 3

Southhill Community Development Pro j e c t

Southill Young Men's Pro j e c t

St. Michael's CBS

Tallaght Community Drug Te a m

Teachers Union of Ire l a n d

Teen Challenge Ire l a n d

Thomas Mullins and Company

Ti p p e r a ry S.R. Vocational Education Committee

T R U S T

UISCE

Union of Students in Ireland (USI)

University of Limerick

U R R U S

Vincentian Partnership for Justice

Wa t e rf o rd Community Drugs Network

We s t e rn Health Board

We x f o rd Area Part n e r s h i p

Wicklow County Council

3 2

Oral HearingsDuring July and August 2000, the Minister of State, the Chairperson of the IDG, members of the Review Group,

representatives of the consultants and the Secretary to the review met the following 34 groups. Each session

consisted of a short presentation by the group concerned and then a lengthy discussion around issues raised.

ADM Ltd.

An Garda Síochána

Citywide

COCAD

Combat Poverty Agency

County & City Managers Association

Custom and Excise Division, Revenue Commissioners

Dept. of Education & Science

Dept. of Enterprise, Trade & Employment

Dept. of Health & Children

Dept. of Justice, Equality & Law Reform

Dept. of Social, Community & Family Affairs

Dept. of the Environment & Local Government

Dept. of the Taoiseach

Eastern Regional Health Authority

FÁS

Health Research Board (Drug Misuse Research Division)

Irish Bishops Conference on Drugs

Irish College of General Practitioners

Irish Courts Service

Irish Prisons Service

LDTF Reps

Merchant Quay Project

National Council for Curriculum & Assessment

National Parents Council (Post-primary)

National Youth Council of Ireland

Pharmaceutical Society of Ireland

Policy Research Centre, National College of Ireland

Prison Officers Association

Probation & Welfare Service

Regional Drugs Co-ordinators (excl. ERHA)

UISCE

Union of Students in Ireland

Voluntary Drug Treatment Network

A P P E N D I X 4 – D R U G T R E AT M E N T T Y P E S

The following is a sample of drug treatment types,

some of which are mentioned throughout the

Report.

Needle/Syringe Exchange SchemesNeedle/syringe exchange schemes provide injectors

with clean injecting equipment to prevent them

from using needles more than once or sharing

with other people. Moreover, they facilitate the

safe disposal of injecting equipment reducing the

harm associated with unsafe drug using behaviour.

The overall concept of needle/syringe exchange

facilities is to reduce needle sharing and

unhygienic practices so that the threat of

transmission of disease, in particular hepatitis and

HIV, is reduced. Exchange schemes may make

contact with injectors who are not in contact with

other services and the international literature

consistently reports evidence of reduced sharing

frequency amongst those attending exchange

schemes. Although it is argued that the presence

of such a service encourages injecting, research

indicates lower HIV rates among drug injectors,

where there are good services available.

Needle/syringe facilities are now recognised

internationally as a central part of a harm

reduction strategy.

Detoxification Pro g r a m m e sThe aim of detoxification is to eliminate opiate

and other drugs from the body. Detoxification is

carried out for a range of drugs, particularly

opiate drugs or substitutes to opiate drugs

(opioids) and is conducted by either gradually

reducing the dosage or abruptly stopping the

dosage until the individual is drug free. Treatment

generally continues until all withdrawal symptoms

have subsided. Detox programmes can be accessed

in hospitals (in-patient) or on a community basis.

Methadone Reduction Pro g r a m m e sMethadone maintenance programmes apply to

individuals who are using prescribed methadone

as a means of reducing withdrawal symptoms

from coming off opiate drugs. The aim is to

prescribe a gradually tapering dose over time,

with the ultimate aim of the individual achieving

abstinence in the medium term. The time in which

abstinence is reached can vary significantly

between different individuals. Such interventions

provide immediate benefit in reducing in drug

misuse and injecting behaviour.

Methadone MaintenanceP ro g r a m m e sThe aim of methadone maintenance programmes

is to stabilise the user by prescribing methadone as

a substitute for heroin and other opiate drugs.

Methadone maintenance is the most evaluated

form of treatment in the treatment of heroin

addiction and is the most common substitute of

choice for those treating opiate addiction. In some

cases, individuals can be prescribed methadone for

a number of years. International evidence

surrounding methadone indicates that methadone

maintenance significantly reduces heroin use, drug

related crime and the spread of drug-related

diseases through injecting drug misuse

H e roin Pre s c r i p t i o nExperiments involving the prescription of heroin,

under strict medical supervision are in place in the

Netherlands and Switzerland. Only those serious

misusers whom it is considered can no longer be

helped by the regular care system are allowed

participate in the experiments. The INCB opposes

such experiments.

1 3

In-Patient Treatment Serv i c e sIn-patient treatment services generally provide

detoxification and early rehabilitation, on a short-

term basis (2 –12 weeks). On completion of in-

patient detoxification a significant number of

patients generally go on to residential

rehabilitation facilities.

Residential Serv i c e sResidential treatment services provide a managed

environment for heavily dependent drug misusers

who are trying to become drug-free.

Internationally, residential treatment programmes

are generally divided into three broad categories:

1. Therapeutic Communities, where residents attend

intense therapy sessions.

2. Twelve step models based on Alcoholics/Narcotics

Anonymous. The aim is for long-term abstinence

and the approach is based on spiritual, as well as

practical guidance.

3. More general houses, some of which have a

religious-based philosophy. The approach used is

based on group and individual therapy.

R e h a b i l i t a t i o nRehabilitation involves assisting a drug misuser in

achieving a drug-free lifestyle, as well as enabling

the individual to cope with all aspects of daily life.

Individuals availing of rehabilitation can either be

stabilised on medication, detoxing or already drug

free.

C o u n s e l l i n gCounselling plays a central role in drug treatment

therapy and can include psychological therapy,

group therapy, as well as advice on how to deal

with issues such as housing and social problems,

criminal justice problems and health problems etc.

A l t e rnative Forms of Tre a t m e n tSelf-Help Networks

Narcotics Anonymous (NA), which is an

international self-help organisation, co-ordinates

local support groups for drug misusers and is

similar to Alcoholics Anonymous. Similar groups

are run which place specific emphasis on the

family of the drug misuser (Family Anonymous).

Both groups are based on the 12-step abstinence

model.

NeuroElectric Therapy (NET)79

NET is a form of electro-medicine used in

detoxification. Special adhesive electrodes are

placed behind the ear and continuous stimulation

is applied for between 6 to 10 days (significantly

less for nicotine addiction). NET is used for both

drug and alcohol addiction. It utilises minute

amounts of electricity transcranially to re-establish

or stabilise the natural levels of neuropeptides

intractably disrupted by chronic substance use and

misuse.

Transcendental Meditation (TM)

Transcendental Meditation is a simple form of

meditation which has documented benefits for

health and well being.80

It is taught using a shor t

programme based on a standard seven-step course

and is practiced for 15-20 minutes twice daily.

Transcendental Meditation settles mental activity

while maintaining (and enhancing) alertness. The

health and personal benefits arising from this

practice has been researched worldwide, in over

27 countries.

3 4

7 9 Patterson et al. (1996) Electrostimulation: Addiction Treatment for the Coming Millennium. The Journal of Alternative and Complementary Medicine,

Volume 2, No. 4. 8 0 Transcendental Meditation, Introduction and Overview of Researc h – January 1998. Scientific Research on Maharishi’s Vedic Approach to Health: Part 1.

A P P E N D I X 5–D R U G T Y P E S

Types of Dru g sThe following is a sample of drug types mentioned

throughout the course of this Report.

There are four main categories of drugs:

■ Depressants, such as alcohol and cannabis,

depress or slow down mental and physical

activity.

■ Stimulants, such as amphetamine and cocaine,

stimulate mental and physical activity.

■ Hallucinogens, such as LSD and magic

mushrooms, create hallucinations and delusions

and may alter sense of smell, taste, time etc

■ Opiates, such as heroin and methadone, have

pain killing properties and produce feelings of

well-being. Opiates are derived from the opium

poppy. Opium is the dried milk of the opium

poppy and it contains morphine and codeine,

which are both effective pain-killers.

Amphetamines are stimulant drugs, also called

speed, whiz or base. They come in the form of a

white powder, and can be snorted up the nose,

mixed in drink or prepared for injection.

Benzodiazepines are synthetic drugs manufactured

for medical use and are a form of tranquilliser.

Benzodiazepines can be used in the same way as

street drugs.

Buprenorphine is a semi synthetic opiate

possessing both narcotic agonist and antagonist

activity, which is being studied as another

alternative form of medication as a treatment for

heroin and other opiate addiction. Buprenorphine

produces less euphoria than morphine and heroin.

Cannabis is usually smoked when rolled into a

cigarette or joint, often with tobacco, or can also

be smoked using a pipe. Other common names for

cannabis include hash, weed, dope, etc. Smoking

cannabis generally has a number of physical

effects, including decreased blood pressure,

bloodshot eyes, increased appetite and occasional

dizziness.

Cocaine is made from the leaves of the coca shrub

and is a white crystalline powder in its most

common form. It is generally sniffed up the nose,

but it can also be made into a solution and

injected.

Crack is a smokeable form of cocaine made into

small lumps or “rocks”. It is usually smoked. Crack

can also be prepared for injection.

Ecstasy often known as E is both a stimulant and

an hallucinogen. Sold in tablet or capsule form, it

can be any shape or colour. Tablets are often

referred to after the image printed on it, for e.g.

doves, apples etc.

Heroin is an opiate drug from the opium poppy. It

is made from morphine and is a white powder in

its pure form. Heroin is a sedative drug which

depresses the nervous system.

LAAM (L-Alpha Acetyl Methadol Hydrochloride) is

a substitute drug similar to methadone in

composition and pharmacological effects. It has a

much longer duration of action than methadone

(up to 72 hours).

Lofexidine is a non-opioid and can be used to

detoxify people who are dependent on opiates. It

may be particularly useful in treating young

people who are at an early stage in addiction.

LSD (Lysergic Acid Diethylamide) is a powerful

hallucinogenic drug also known as acid, trips or

tabs. It comes on small squares of coloured

blotting paper or tiny pills (‘microdots’). A tiny

dose produces a non-stop ‘trip’ which can last 8-12

hours.

Methadone is one of a number of synthetic

opiates (called opioids) which is manufactured for

medical use and has a similar effect to heroin. It is

mostly prescribed as a substitute drug in the

treatment of heroin addiction.

Morphine is an opiate drug derived from the

opium poppy. It is one of the most powerful

analgesics known and it acts as an anesthetic

without decreasing consciousness.

Tricyclics, otherwise known as antidepressants, are

generally used in the treatment of depression and

depressive conditions.

1 3

A P P E N D I X 6–R E F E R E N C E S

Action Programme for the Millennium Review,November 1999

Ali, R. et al. (1999) Report of the External Panel on the Evaluation ofthe Swiss Scientific Studies of Medically PrescribedNarcotics to Drug Addicts.

Allwright, S., Barry, J., Bradley, F., Long, J. andThornton, L. (1999) Hepatitis B, Hepatitis C and HIV in Irish Prisoners:P revalence and Risk. Prepared for the Minister for Justice, Equality andLaw Reform by the Department of CommunityHealth and General Practice, Trinity College, Dublin.

An Garda Síochána Annual Reports 1996 -1999.

Aware (1998). Suicide in Ireland: A Global Perspective and ANational Strategy.

Brinkley, A., Fitzgerald and Green (1999) Substance use in early adolescents. A study of therates and patterns of substance use among pupils inDublin.

Bryan, A., Moran, R., Farrell, E. and O’ Brien, M.(2000) Drug-Related Knowledge, Attitudes and Beliefs inIreland. A Report of a Nation-Wide Survey. DrugMisuse Research Division.

Caulkins, J.P., et al. (1999) An Ounce of Prevention, a Pound of Uncertainty:The Cost-Effectiveness of School-Based Prevention Programmes, Rand Corporation p.85.

Comiskey, C. (1998) Prevalence estimate of opiate use in Dublin Ireland during 1996. Dublin: Institute of Technology Tallaght, 28.

Coombs, R.H. and Ziedonis, D. (eds) (1995). Handbook on Drug Abuse Prevention: AComprehensive Strategy to Prevent the Abuse ofAlcohol and Other Drugs.

Cox, G. and Lawless, M. (1999) Wherever I Lay My Hat: A Study of Out of Home Drug Users. Merchants Quay Project: Dublin.

Department of Health (1993) Report of the Expert Group on the Establishment ofa Protocol for the Prescribing of Methadone.Dublin: Department of Health.

Department of Justice, Equality and Law Reform. Drug misuse and drug treatment in the prisonsystem – draft action plan. Dublin: Department of Justice, Equality and LawReform, 1999.

Department of Tourism, Sport and Recreation (2000) Report of the Interim Advisory Committee on Drugs, February 2000.

Eastern Health Board/Gay Men's Health Project,1997, Report on Men in Prostitution.

ESPAD Study: Implications for Prevention. Drugs: education, prevention and policy,Vol. 6, No. 2, 1999.

European Monitoring Centre for Drugs and DrugAddiction (EMCDDA) (1999) Annual Report on the State of the Drugs Problem inthe European Union, 1999.

European Monitoring Centre for Drugs and DrugAddiction (EMCDDA) (1999) Extended Annual Report on the State of the DrugsProblem in the European Union.

European Monitoring Centre for Drugs and DrugAddiction (EMCDDA) (2000) Annual Report on the State of the Drugs Problem inthe European Union, 2000.

European Monitoring Centre for Drugs and DrugAddiction (EMCDDA) (1999) Evaluating Drug Prevention in the European Union. Scientific Monograph Series No 2.

European Union Action Plan on Drugs, 1999.

Farrell, Dr M., Buning, E., (1996) Review of Drug Services in the Eastern Board.

3 6

Farrell, M., Gerada, C. and Marsden, J. (2000) External Review of Drug Services for The Eastern Health Board. National Addiction Centre, Institute of Psychiatry, London.

Faughan, Pauline, Refugees and asylum seekers in Ireland: social policy dimensions, Social Science Research Centre, University CollegeDublin, 1999.

First Report of the Drug Court Planning Committee, Pilot Project,August 1999.

Freeman, K., Lawrence, R., Karski and Doak, P.,(April 2000) New South Wales Drug Court Evaluation: Program and Participant Profiles Turning Point Alcohol and Drug Centre Inc.

Friel, S., Nic Gabhainn, S. and Kelliher C. (1999) National Health & Lifestyle Surveys.

Gleeson, M., Kelliher, K., Haughton, F., Feeney, A.and Dempsey, H. (1989). Teenage smoking, drug and alcohol abuse in the Mid West. Department of Public Health, Mid Western Health Board.

Hibell, B., Anderson, B., Bjarnason, T., Kokkevi, A.,Morgan, M. and Narusk, A. (1997) The 1995 ESPAD Report: Alcohol and Other DrugUse Among Students in 26 European Countries.Stockholm: The Swedish Council for Information onAlcohol and other Drugs (CAN), Council of Europeand the Pompidou Group.

Hibell, B., Anderson, B., Ahlstrom, S., Bjarnason, T. ,B a l a k i reva, O., Kokkevi, A., and Morgan, M. (2001) The 1999 ESPAD Report: Alcohol and Other DrugUse Among Students in 30 European Countries. Stockholm: The Swedish Council for Information onAlcohol and other Drugs (CAN), Council of Europeand the Pompidou Group.

International Narcotics Control Board Report 1999.

Jackson, T.M.R. (1997). Smoking, Alcohol and Drug Use in Cork and Kerry.Southern Health Board, Department of PublicHealth.

Kiernan, R. (1995). Thesis on substance use among adolescents in theWestern Health Board Area.Unpublished Thesis. Faculty of Public HealthMedicine, Royal College of Physicians of Ireland.

Long, J., Allwright, S., Barry, J., Reaper-Reynolds, S.,Thornton, L. and Bradley, F. (2000). Hepatitis B, Hepatitis C and HIV in Irish Prisoners, Part1 1 : Prevalence and Risk in Committal Prisoners 1999. Prepared for the Minister for Justice, Equality andLaw Reform by the Department of CommunityHealth and General Practice, Trinity College, Dublin.

Marsch, L.A. (1998) The efficacy of methadone maintenanceinterventions in reducing illicit opiate use, HIV riskbehaviour and criminality: a meta-analysis. Addiction, 93.

Memery, C. and Kerrins, L. (2000). Estate Management and Anti-Social Behaviour inDublin. A Study of the Impact of the Housing Act 1997.Threshold Publication.

Ministry of Health and Social Affairs, Sweden. A Preventative Strategy – Swedish Drug Policy in the 1990s, The Swedish National Institute for Public Health1998:21 & Fact Sheet No 4 March 1999.

Monitoring Poverty Trends(1999) Data from the 1997 Living in Ireland Survey.Conducted by ERSI for Combat Poverty Agency andD e p t a rtment of Social, Community and Family Aff a i r s .

Moran, R., O’ Brien, M. and Duff, P. (1997). Treated Drug Misuse in Ireland. National Report 1996. Dublin: The Health Research Board.

Nadelman, E (1998). “Challenging the global prohibition régime”, TheInternational Journal of Drug Policy.

National College of Ireland, (PRC) Evaluation of Local Drugs Task Force Projects, September 2000

1 3

National Drug Treatment Reporting System (2000) Statistical Bulletin 1997 and 1998. Drug Misuse Research Division, The Health Research Board.

National Institute of Justice, Washington, DC, (1993). Miami’s Drug Court: A different Approach:

National Youth Council of Ireland. (1998). Youth and drugs – The NYCI drugs policy.Dublin: NYCI.

Nexus Research Co-operative, June 2000. Poverty, Drug Use and Policy Grants Scheme –Evaluation Report.

Nurses Addiction Network (2000). Conference “Cocaine, an emerging problem”.Clontarf Castle, May 2000.

O’ Higgins, K. (1996). Treated drug misuse in the greater Dublin area. A review of five years 1990 – 1994. The Health Research Board, Baggot St., Dublin, Ireland.

O’ Higgins (1998). Review of Literature and Policy on the linksbetween Poverty and Drug Abuse. Combat Poverty Agency/ESRI.

O’ Mahony, P. (1993). Crime and Punishment in Ireland. Dublin: The Round Hall Press.

O’ Mahony, P. (1997) Mountjoy Prisoners. A Sociological andCriminological Profile. Dublin: Department of Justice, Equality and Law Reform.

Paterson, M.A., Patterson, L. and Patterson, S. (1996) Electrostimulation: Addiction Treatment for the Coming Millennium. The Journal of Alternative and ComplementaryMedicine, Volume 2, No. 4.

Pavee Point Youthstart 1998-9 (1999). Drugs and the Traveller Community Project, Pavee Point Travellers’ Resource Centre, Dublin,August 1999.

Programme for Prosperity and Fairness, 1999.

Reuter, P. and Culkins, J.P. (1995) Redefining the Goals of National Drug PolicyRecommendations from a Working Group. American Journal of Public Health; 85.

Ruddle, H., Prizeman, G. and Jaffro, G. (2000) Evaluation of Local Drugs Task Force Projects.National College of Ireland, Policy Research Centre.

Steering Group for Prison-Based Drug TreatmentServices Report (July 2000) Prison-Based Drug Treatment Services in the EasternRegional Health Authority Area.

Transcendental Meditation, Introduction andOverview of Research – January 1998. Scientific Research on Maharishi’s Vedic Approach to Health: Part 1

Uchtenhagen, A., et al. (1999) Prescription of Narcotics for Heroin Addicts: MainResults of the Swiss National Cohort Study.Executive Summary.

Uhl, Dr. Alfred Ludwig-Boltzman Institute forAddiction Research at the Anton-Proksh Institute,The Prevalence of Problematic Opiate Use in AustriaBased on a Capture Recapture EstimationVienna, 2000.

Union of Students in Ireland (USI) (1998). USI National Drugs Survey of Third Level Colleges1997/98.

Women’s Health Project, Eastern Health Board,Dublin, Ireland and European Intervention ProjectDrug Using Women Working In Prostitution. Dublin:1999.

3 8