Drug and Alcohol Trends Monitoring System (DATMS) 2019: Year 4

Research objectives & method

In 2015 we developed our DATMS in Dublin 15. The objective was to establish an evidence base for drug use in Dublin 15 and use this data to inform local service provision. In order to always have current information and to monitor changes over time the study is repeated annually. This report documents the fourth year of our DATMS. Year 1 reporting period began June 2014, Year 2 began June 2015, Year 3 relates to 2017 and Year 4 to 2018. The DATMS employs a mixed-method design comprised of primary and secondary data sources.
 

Trend analysis

As we now have four years of data, it is evident that there are two recurring themes emerging from different data sources over these four years. These themes provide us with a deeper understanding of the nature and consequences of drug and alcohol use in Dublin 15. As these themes have been produced by a range of data sources, the validity of the research findings has been strengthened.

Theme 1: Drug use in Dublin 15 is a community wide issue that crosses all socio-economic boundaries

This theme profiles drug use in Dublin 15 as a community wide issue that crosses all socio-economic boundaries. It has been identified by our treatment demand, untreated drug use, education and family support data. The evidence is as follows:

1. Since Year 2, mapping treatment demand has identified that treated drug users were from every community in Dublin 15, from the affluent to the deprived.
2. Year 1 to 4 reported treated drug users aged under 18 attended secondary schools with and without DEIS status. Since Year 3, the evidence reports that these schools were located in affluent and deprived areas.
3. All four years of the DATMS reported untreated drug use among all socioeconomic groups, ethnicities and in all areas of Dublin 15.
4. Year 1 to 4 reported drug dealing occurred in local secondary schools. Since Year 2, the evidence reports that these schools were located in affluent and deprived areas and included those with and without DEIS status.
5. All four years of the DATMS reported drug use before and during school time in local secondary schools. Since Year 2, the evidence reports that these schools were located in affluent and deprived areas and included those with and without DEIS status.
6. Year 4 mapping treatment demand for BLDATF Family Support Service identified that clients were from every community in Dublin 15, from the affluent to the deprived.

Theme 2: Normalisation of drug and alcohol use in Dublin 15

In all four years of the DATMS the normalisation of drug use has featured prominently. The common perception was that alcohol and drugs were widely used, risk free and socially acceptable. This theme has been identified by the following data sources: treatment demand, untreated drug use, factors that contribute to drug use and gaps in service provision. Alcohol was the most normalised drug in Dublin 15, followed by cannabis, cocaine powder, benzodiazepines and z drugs. Service providers and drug users reported the following consequences of normalisation:

1. From Year 3 to 4, service providers reported an increase in drug use among young people and perceived this increase to be associated with the normalisation of drug use.
2. The normalisation of drug use may be a factor contributing to the reduction in the age of drug users in Dublin 15. Year 3 to 4 reported that untreated drug users were getting younger. This included young people who used cannabis during school time.
3. Since Year 3, data concerning gaps in service provision has reported the need to improve treatment programmes for under 18s and young people aged 18 to 25 years. Research participants reported that these programmes need to proactively attract the most vulnerable and hard-to-reach as most young drug users do not perceive the need for treatment. The normalisation of drug and alcohol use may be a factor that hinders help-seeking for drug and alcohol issues.
4. Since Year 2, an increase in the number of under 18s dealing drugs has been reported. The normalisation of drug use may influence a young person’s decision to become involved in drug dealing as they may not identify the negative consequences of such behaviour. This contributes to the ease of access to drugs in Dublin 15; whereby young people distribute drugs to their peers and friends.
5. All four years of the DATMS reported the family context as a risk factor for the normalisation of drug and alcohol use and the development of intergenerational drug and alcohol dependence. The majority of treated drug users who participated in Year 3 and 4 reported having family members who also had issues with drugs and/or alcohol.
6. Treatment demand data reports the main drugs used were those which were normalised, with the exception of heroin.
   • Treated drug users aged under 18: From Year 1 to 4, cannabis herb was the most commonly used drug followed by alcohol. Since Year 2, an increase in the use of cannabis herb, cocaine powder and alcohol was reported.
   • Treated adult drug users: Since 2011, NDTRS data reports cannabis as the most common reason for new entrants to treatment. From Year 1 to 4, an increase in the use of cannabis herb, alcohol, powder cocaine, benzodiazepines and z drugs was reported.

Socio-demographic profile of Dublin 15, 2006-2016

• Dublin 15 population increased by 20% from 90,974 in 2006 to 109,895 in 2016
• Population has become younger and more ethnically diverse
• Stabilisation of unemployment levels after an increase during the economic downturn
• Increase in educational attainment of population
• Increase in privately rented housing and decrease in owner occupied housing
• Dublin 15 remains categorised as marginally above average; the deprived population decreased from 31% in 2006 to 24% in 2016

Treated drug use

Treated drug users aged under 18

• Treated cases aged under 18 increased from 51 in Year 1 to 97 in Year 4
  • Over the reporting periods, 1% of the Dublin 15 population aged 12 to 17 years has attended treatment for drug and/or alcohol use
• From Year 1 to 4, the profile of treated cases has remained similar:
  • The majority of cases were male and Irish
  • Cannabis herb was the most commonly used drug followed by alcohol
  • The majority of cases were polydrug users
  • An increase in the use of cannabis herb, cocaine powder and alcohol was reported among treated young drug users; Year 4 also reported an increase in the use of benzodiazepines, z drugs, ketamine, MDMA, cannabis oil, lean (syrup) and solvents

Treated drug users aged 18 and over

• NDTRS data reports an increase in the number of treated cases from 292 in 2016 to 348 in 2018
  • From Year 1 to 4, an estimate of less than 1% of the Dublin 15 population aged 18 to 64 years has attended treatment for drug and/or alcohol use
  • From 2016 to 2018, the profile of treated cases has remained similar:
    • The majority of treated cases were Irish, male, aged 35 to 44 years
    • A third of cases were in treatment for drugs for the first time
    • The three main problem drugs were alcohol, heroin and cocaine
    • A fifth of treated cases reported injecting drug use
    • The majority of cases were treated for polydrug use
• Changes in the profile of treated adult drug use included:
  • From Year 1 to 4, treated adult drug users reported an increase in the use of cannabis herb, alcohol, powder and crack cocaine, benzodiazepines and z drugs
  • Year 4 also reported an increase in the use of pregabalin (lyrica), heroin and cannabis oil
  • The use of cannabis concentrates by treated adult drug users was first reported to the DATMS in Year 4

Untreated drug use

• All four years of the DATMS reported similar profiles of untreated drug use by young people and adults:
  • Alcohol, cannabis herb, MDMA and cocaine powder were the main drugs used
  • Polydrug use was the norm with alcohol being an integral part of it
  • Changes in the profile of untreated drug use included:
    • Untreated drug users were getting younger
    • An increase in the use of alcohol, cannabis herb and oil, powder and crack cocaine, benzodiazepines, z drugs, ketamine and lean (syrup) was reported
    • The use of the nitrous oxide and GHB by untreated drug users was first reported to the DATMS in Year 4
  • Prevalence rates estimated 24,630 (80%) Dublin 15 residents aged 15 to 34 years used alcohol in the last year compared with 40,440 (80%) aged from 35 years; and 4,926 (16%) Dublin 15 residents aged 15 to 34 years used illegal drugs in the last year compared with 2,022 (4%) aged from 35 years

Factors contributing to drug use

Easy access to drugs and alcohol

• Factors contributing to the ease of access to drugs included an increase in the number of people dealing drugs in Dublin 15
• Changes in the availability of drugs in Dublin 15 included:
  • Since Year 1, an increase in the availability of benzodiazepines and z drugs has been reported
  • Since Year 3, an increase in the availability of powder and crack cocaine, cannabis herb and heroin has been reported
  • Year 4 reported an increase in the availability of cannabis oil

Normalisation of drug and alcohol use

• As reported above in the trend analysis section

Family context

• All four years of the DATMS reported the family context as a risk factor for the normalisation of drug and alcohol use and the development of inter-generational drug and alcohol dependence
• Prevalence rates estimate 15%-24%% (4,907 to 7,852) of children were impacted by parental illicit drug use in Dublin 15, and an estimate of 14%-37% (4,580 to 12,105) children were impacted by parental alcohol dependency in Dublin 15

Mental health

• From Year 1 to 4, service providers reported an increase in the incidence of mental health issues among children and young people
• Poor mental health is a risk factor for drug use which identifies the importance of early intervention

Consequences of drug and alcohol use

Health consequences

• Data suggests the use of GHB/GBL has increased which may suggest that the prevalence of chemsex has also increased
• HIPE data from 2012 to 2018 reported the following:
  • From 2012 to 2017, the number of treatment episodes for mental health and behavioural disorders due to drug use among Dublin 15 residents increased though in 2018, this upward trend decreased
  • From 2012 to 2017, the number of treatment episodes for drug-related poisonings (overdoses) among people living in Dublin 15 increased though in 2018, this upward trend decreased
• NDRDI data reports drug-related deaths due to poisoning (overdose) increased by 33% from 266 in 2004 to 354 in 2016:
  • Alcohol was implicated in 1 in 3 poisoning deaths
  • Prescription drugs were implicated in 7 out of 10 poisoning deaths
  • Polydrug use was involved in 3 in 5 poisoning deaths

Social consequences

• All four DATMS years reported the negative impact drug use has on family relationships, employment, finances, housing and education
• In 2018, the BLDATF developed a Family Support Service that provides a range of evidence-based programmes and practices for adults; 115 people attended the service in 2018
  • A case study of the 5 Step Method reported that the service had a positive and empowering impact

Drug-related crime

• All four years of the DATMS reported the existence of drug-related crime in Dublin 15
• Year 3 and 4 reported drug-debt intimidation was the most frequently occurring crime with an increase in its frequency from Year 2 to 4

Service provision strengths & gaps identified by research participants

Strengths of addiction services

• The Dublin 15 addiction services offer a continuum of care from low threshold to stabilisation, drug free to rehabilitation programmes for adults
• The service provision for under 18s has been improved with the development of the new community drug team D15 CAT
• The service provision for family members affected by drug use has been improved with the development of BLDATF Family Support Service and D15 CAT
• Peer-led family support groups provide supportive and non-judgemental environments for family members affected by drug use

Gaps in service provision

Education & prevention

• Improve drug prevention programmes for under 18s
• Funding for public awareness campaign ‘Think before you buy’
• Increase access to skills based mental health wellbeing programmes for young people and adults
• Increase knowledge of local service provision on a local and targeted basis
• Education and information for family members about latest drug trends

Treatment

• Improve treatment programmes for under 18s and young people
• Improve access to naloxone, the antidote to opioid overdoses
• Improve access to childcare to increase access to treatment and rehabilitation services
• Develop a stabilisation programme for non-opioid polydrug users
• Integrate counselling and rehabilitation services into methadone maintenance treatment
• Improve access to detoxification programmes
• Improve access to peer-led support services
• Increase access to mental health services for children, young people and adults

Rehabilitation

• Improve access to aftercare services, training, employment and housing