Drug and Alcohol Trends Monitoring System (DATMS) Year 9

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. The study is repeated annually to always have current information and monitor changes over time. This report documents the ninth year of our DATMS. The Year 1 reporting period began June 2014, Year 2 began June 2015, Year 3 to 9 is from 2017 to 2023. The DATMS employs a mixed method design comprised of primary and secondary data sources. Years 1 to 5 and 7 to 9 involved a trend report, and Year 6 involved a qualitative longitudinal study that explored clients’ experiences of attending treatment and family support services.

INCREASE IN DRUG-RELATED HARM & LOW-LEVELS OF HELP SEEKING

From 2012, there has been a significant increase in the number of people affected by drug and alcohol use in Dubin 15.

Prevalence and treatment demand data identify that the overall rate of help-seeking is low. This data also identifies factors that contribute to drug use. The most frequently used drugs highlight how the accessibility and normalisation of drugs impacts use. Alcohol’s legal status makes it the most accessible which partly explains why it is the most frequently used. Also, drugs that are normalised are the most frequently used drugs. These drugs are perceived to be widely used, risk free and socially acceptable, and this perception promotes use.

TREND ANALYSIS

A trend analysis from Years 1 to 9 identifies three recurring themes emerging from different data sources. These themes give us a deeper understanding of the nature and consequences of drug and alcohol use in Dublin 15.

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 the following data sources: treatment demand, untreated drug use, factors contributing to drug use, and the consequences of drug and alcohol use. The evidence is as follows:

1. Mapping treatment demand for treated drug users and family members affected by drug and alcohol use, including hidden harm (children aged under 18), has identified that clients were from every community in Dublin 15, from the affluent to the socio-economically deprived.
2. Years 1 to 9 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 a mixture of affluent and socio-economically deprived.
3. All eight years of the DATMS trend data reported untreated drug use among all socio-economic groups, ethnicities and in all areas of Dublin 15.
4. Since Year 1, drug dealing has been reported in local secondary schools. From Years 3 to 9, over 55% of secondary schools had evidence of drug dealing, with Years 5 and 9 reporting dealing in all local secondary schools. Since Year 3, these schools have been a mixture of affluent and socio-economically deprived, including those with and without DEIS status.
5. Year 9 was the first year that drug dealing in local primary schools was reported. These schools include those with and without DEIS status, indicating that drug use is a community wide issue that crosses all socio-economic boundaries.
6. All eight years of the DATMS trend data reported drug use before and during school time in local secondary schools. Since Year 2, the evidence reports that these schools were a mixture of affluent and socio-economically deprived and included those with and without DEIS status. From Year 3, participants reported drug use in at least 80% of local secondary schools, with Years 5, 8 and 9 reporting drug use in all schools.
   • Since Year 1, participants reported that some secondary school students’ education was compromised due to drug use before and during school. Since Year 2, participants reported that these schools were a mixture of affluent and socio-economically deprived and included those with and without DEIS status.
7. Year 9 was the first year that drug use in local primary schools was reported. These schools include those with and without DEIS status, indicating that drug use is a community wide issue that crosses all socio-economic boundaries.

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

In all eight years of the DATMS trend data, the normalisation of drug use has featured prominently. The common perception was that alcohol and drugs were widely used, risk free and socially acceptable. The following data sources have identified this theme: treatment demand, untreated drug use, factors contributing 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. Since Year 3, the normalisation of drug use was reported as a factor contributing to the increase in drug use among treated and untreated drug users in Dublin 15.
2. Since Year 3, participants reported the need to improve treatment programmes for under 18s and young people aged 18 to 25. These programmes must 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.
3. Since Year 2, an increase in the amount of under 18s dealing drugs has been reported. Over the reporting period, participants reported that drug runners were getting younger. The normalisation of drug use may influence a young person’s decision to become involved in the drug market as they may not identify the negative consequences of such behaviour.
4. All eight years of the DATMS trend data 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. Since Year 3, the majority of treated drug users who participated in the DATMS reported having family members who also had issues with drugs and/or alcohol.
5. Treatment demand data reports the main drugs used were those which were normalised, except for heroin:
   • Treated drug users aged under 18: From Years 1 to 9, cannabis herb was the most commonly used drug, followed by alcohol; since Year 2, an increase in the use of cannabis herb and cocaine powder was reported
   • Treated adult drug users: From 2016 to 2023, the NDTRS reports the five main problem drugs were cocaine, alcohol, heroin, cannabis and benzodiazepines; over the reporting period, an increase in the number of cases treated for these drugs was reported, with cocaine becoming the most common main problem drug

THEME 3: Increase in drug and alcohol use in Dublin 15

Since Year 2, an increase in the use of drugs and alcohol has been reported by treated and untreated drug users. The data identifies how an increase in the availability of drugs and alcohol and the normalisation of drugs and alcohol contributes to this trend. The increase in drug and alcohol use has been identified by the following data sources: treated drug use, untreated drug use, factors contributing to drug use, and the consequences of drug and alcohol use.

1. Treatment demand data reported an increase in the number of cases seeking support which may be associated with an increase in drug use:
   • Treated drug users aged under 18 increased by 51% from 51 in Year 1 to 77 in Year 9
   • NDTRS data reports treated adult cases increased by 152% from 244 in 2016 to 616 in 2023
   • From 2017 to 2023, the number of family members receiving support increased by 448% from 149 in 2017 to 817 in 2023
2. Since Year 2, treated and untreated drug users reported an increase in the use of the following drugs:

Year 9 treated and untreated drug users also reported an increase in the use of the following drugs:

3. Each year the DATMS has reported an increase in the availability of drugs in Dublin 15. This increase is associated with an increase in drug and alcohol use which identifies how demand influences the local drug market. This increase in demand has also increased the number of drug distributors. The majority of the drugs that have increased in availability are the most commonly used:
   • Since Year 1, an increase in the availability of benzodiazepines and z drugs has been reported; since Year 4, synthetic (NPS) benzodiazepines and z drugs were reported to be more commonly available than authentic tablets
   • Since Year 3, an increase in the availability of cannabis herb, powder and crack cocaine has been reported
   • Since Year 7, an increase in the availability of ketamine, methamphetamine and nitrous oxide has been reported
   • Since Year 8, an increase in the availability of cannabis oil has been reported
   • Year 9 reported an increase in the availability of MDMA and alcohol
4. The increase in drug use is also associated with an increase in the types of drugs available, which identifies new trends in drug use. The table below reports the new drugs that have entered the local market, the year they were first reported to the DATMS, and the current status of use.

• In addition, with the use of cannabis cakes, the re-emergence of an old trend has been reported by treated and untreated drug users since Year 5
• Since Year 5, the use of alcohol-free drinks by untreated drug users has been reported

5. Year 9 reported changes in the profile of drug use during school time, to include drug use in primary schools and an increase in drug use in secondary schools in Dublin 15. Young people reported an increase in the use of cannabis oil and edibles during school due to the potential ability to use them without discovery. Cannabis oil used in vaping equipment can be odourless when smoked. Cannabis edibles in the form of sweets can hide their psychoactive nature.
6. As reported above, since Year 3, the normalisation of drug use was reported as a factor contributing to the increase in drug use among treated and untreated drug users in Dublin 15.

TREATED DRUG & ALCOHOL USE

Treated drug users aged under 18

• Treated cases aged under 18 increased by 51% from 51 in Year 1 to 77 in Year 9, though fluctuations in this trend were reported during this period
• From Years 1 to 9, the majority of cases were male, white Irish and aged from 15 years, cannabis herb was the most commonly used drug, followed by alcohol
• Changes in the profile of treated cases: 
  • From Years 1 to 9, an increase in the use of cannabis herb and cocaine powder were reported
  • From Years 3 to 9, a change in the profile of polydrug use was reported, with a decrease in polydrug use from Years 3 to 5 and an increase from Year 6
  • From Years 3 to 9, the majority of cases were in education. There has been an increase in the number of secondary schools and training centres attended by treated cases aged under 18, from 54% (7) in Year 1 to 64% (9) in Year 9
  • New trends are emerging in Dublin 15 among treated young drug users: A reduction in alcohol use and increase in drug use; also reported by untreated young drug users
    • The increasing use of vaping devices to consume cannabis oil to such an extent that it is now a common mode of administration; demand associated with increasing availability in local shops; also reported by treated adult drug users and untreated drug users
    • The availability and use of two new drugs: a pink powder comprised of stimulant and hallucinogenic drug types (ketamine, MDMA and cocaine), names include barbie, pink and pink lemonade; hexahydrocannabinol (HHC) oil, a synthetic cannabinoid; both drugs also reported by treated adult drug users and untreated drug users

Treated drug users aged 18 and over

• NDTRS data reports treated cases increased by 152% from 244 in 2016 to 616 in 2023. From 2016 to 2023: 
  • The majority of treated cases were Irish, male, aged 35 to 44 years
  • About a third of cases were in treatment for the first time
  • The five main problem drugs were cocaine, alcohol, heroin, cannabis and benzodiazepines
  • Over the reporting period, there has been a 644% increase in cases treated for cocaine with this drug becoming the most common main problem drug
  • From 2016 to 2023, the majority of cases were treated for polydrug use, with the exception of 2019
  • From Years 1 to 9, treated adult drug users reported an increase in the use of cannabis herb, alcohol, powder and crack cocaine, benzodiazepines and z drugs
  • New trends may be emerging in Dublin 15 among treated adult drug users:
    • An increase in the use of cocaine powder without the use of alcohol (dry sniffing)
    • Changing patterns of drug injecting, with an increase in injecting of opioid and stimulant drugs and polydrug injecting
      • Since Year 8, treated drug users reported an increase in the injection of cocaine powder
      • Year 9 reported an increase in the injection of crack cocaine, and polydrug injecting of heroin and cocaine (powder or crack), heroin and methamphetamine, ketamine and cocaine powder
      • The injection of ketamine was first reported to the DATMS in Year 9, it is not a common mode of administration
    • Changes in cannabis oil use and the emergence of new drugs reported above in ‘Treated drug users aged under 18’ section

UNTREATED DRUG & ALCOHOL USE

• All eight years of the DATMS trend data reported similar profiles of untreated drug use by young people and adults: 
  • Alcohol, cannabis herb, MDMA, cocaine powder, benzodiazepines and z drugs were the main drugs used
  • Polydrug use was the norm, and alcohol was an integral part of it
  • Changes in the profile of untreated drug use included: 
    • From Years 1 to 9, untreated young and adult drug users have continued to report an increase in the use of cannabis herb, cocaine powder and ketamine; over this reporting period, untreated adult drug users also reported an increase in alcohol use
    • Since Year 3, an increase in the use of benzodiazepines and z drugs has been reported
    • Since Year 5, an increase in the use of nitrous oxide has been reported; and since Year 7, nitrous oxide has become an integral part of polydrug use for young people
    • Since Year 7, an increase in the use of cannabis edibles has been reported
  • New trends may be emerging in Dublin 15 among untreated drug users: 
    • Since Year 8 it has been reported that young people have reduced their alcohol consumption while increasing their consumption of other drugs (also reported by treated young drug users)
    • Changes in cannabis oil use and the emergence of new drugs reported above in ‘Treated drug users aged under 18’ section
  • Prevalence rates estimated 24,753 (77%) of Dublin 15 residents aged 15 to 34 years used alcohol in the last year and 48,234 (78%) aged from 35 years; and 5,786 (18%) of Dublin 15 residents aged 15 to 34 years used illegal drugs in the last year and 2,474 (4%) aged from 35 years
  • Prevalence rates of cannabis and alcohol dependence among the general population and treatment demand data identify low levels of help-seeking among cannabis and alcohol dependent people in Dublin 15; 1% (144) of people with alcohol dependence and 5% (131) of people with cannabis dependence sought treatment in 2023

FACTORS CONTRIBUTING TO DRUG USE

ACCESSIBILITY OF 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, this includes young people aged under 18. Since Year 3, drug runners have become younger, and drug dealers have become older. The norm age for drug runners is 12 and the youngest age is 7 years. The norm age for drug dealers is 15 and the youngest age is 12 years.
• Other changes are reported above in the ‘Trend Analysis’ section

NORMALISATION OF DRUG AND ALCOHOL USE

As reported above in the ‘Trend Analysis’ section

FAMILY CONTEXT

• All eight years of the DATMS trend data 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
• Since Year 7 we have quantified the extent of hidden harm within the community; hidden harm relates to treated drug use and family support cases with children aged under 18. From Year 7 to 9, there has been a 6% increase in the incidence of children affected by familial drug or alcohol use, from 385 to 409 of treated drug use and family support cases 
  • Prevalence rates estimate from 15% to 24% (5,053-8,053) of children were impacted by parental illicit drug use in Dublin 15, and from 14% to 37% (4,698- 12,416) were impacted by parental alcohol dependency in Dublin 15
  • The number of family support cases from 2021 to 2023 accounts for between 3% and 9% of these estimates which identifies that our data underrepresents the extent of hidden harm in Dublin 15

MENTAL HEALTH

• Poor mental health is a risk factor for drug use which identifies the importance of early intervention
• From Years 1 to 9, service providers reported an increase in the incidence of mental health issues among children, young people and treated adult drug users
• The negative impact of inter-generational drug use and deprivation on young people’s mental health was reported

CONSEQUENCES OF DRUG AND ALCOHOL USE

HEALTH CONSEQUENCES

• HIPE data from 2012 to 2023 reported the following:
  • Overall, the number of treatment episodes for mental health and behavioural disorders associated with drug and alcohol use increased by 123% from 169 in 2012 to 377 in 2023
  • Overall, the number of treatment episodes for poisonings increased by 229% from 17 in 2021 to 56 in 2023

SOCIAL CONSEQUENCES

• All eight years of the DATMS trend data reported the negative impact drug use has on family relationships, employment, finances, housing and education
• Family
  • From 2017 to 2023, the number of family members receiving support increased by 448% from 149 in 2017 to 817 in 2023
  • Over the reporting period, there has been a significant increase in the number of family members who attended evidence-based/informed programmes
• Education
  • Impact of drug use on primary and secondary education reported above in the ‘Trend Analysis’ section
• Drug-related crime
  • All eight years of the DATMS trend data reported the existence of drug-related crime in Dublin 15
  • From Years 3 to 5, drug-related intimidation was the most frequently occurring crime, this changed to anti-social behaviour in Year 7 and from Year 8 visible drug use
• Since Year 3, participants reported an increase in most drug-related crimes

EDUCATION PREVENTION

• The BLDATF D15 Family Support service coordinates a limited number of educational assessments/interventions which complement the Department of Education’s provision
• The programmes primary focus is to reduce risk factors for drug and alcohol use, and ensure best outcomes for primary school children living in Dublin 15
• The number of children who received support for psychological issues increased by 165% from 17 in Year 5 to 45 in Year 9

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, to drug free and rehabilitation programmes for young people and adults
• Treatment, rehabilitation, and family support services provide supportive and non-judgemental environments for people affected by alcohol or drug use: 
  • Engagement with evidence-based programmes empowers people to improve coping strategies, increase resilience and prioritise wellbeing
  • The shared experience of peer support reduces isolation, fosters a sense of belonging and improves wellbeing
  • Rehabilitation services including education and training programmes, and pro-social activities assist the development of recovery capital

GAPS IN SERVICE PROVISION

Education & prevention

• Improve drug prevention programmes for under 18s
• Increase knowledge of local service provision on a local and targeted basis

Treatment

• Improve treatment programmes for adolescents, young people and adults
• Increase effectiveness of treatment services by maintaining fidelity to evidence-based programmes
• Improve capacity of stabilisation programmes, and drug-free day programmes
• Improve access to childcare for people attending day and residential programmes
• Increase out-of-hours service provision
• Improve access to detoxification programmes
• •Increase access to mental health services for children, young people and adults

Family support

• Increase access to family support services for under 18s

Community safety

• Increase Gardai relationship with communities to potentially increase the effectiveness of drug-related intimidation initiative DRIVE

Rehabilitation

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

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