Community collaboration is 'critical' to drug strategy success, report says
The report said that a Health Research Board examination of drug treatment data found that while just 14% of the national population are from areas classified as disadvantaged that 42% of drug treatment cases, where opioids were the primary drug, came from disadvantaged areas. File picture
It is “critical” that communities which are most affected by drugs have a say in designing and implementing policies to address the problem, external experts have said.
The evaluation of the National Drugs Strategy (NDS) 2017-2025 said “funding and staffing constraints” were affecting community projects.
It also argued that former and recovering drugs users should have a presence on national and regional drugs structures.
The Grant Thornton report stressed it was “critical” that an implementation structure be set up involving the relevant government departments to ensure policy actions are delivered.
The review, commissioned by the department of health, will inform the next national drugs strategy, expected to be finalised later this year.
The sprawling 160-page evaluation highlighted positives with the 2017-2015 ‘Reducing Harm, Supporting Recovery’ strategy, such as its emphasis on harm reduction and investment in drug treatment.
It also highlighted successful multi-agency responses during the covid pandemic and to a deadly outbreak of potent nitazene drugs among the heroin-using homeless population at the end of 2023.
The evaluation team stressed the importance of marginalised communities and service users in policy making, through advisory panels and “partnerships” with community organisations. It said this was “high priority” but said it would require “considerable effort”.
Some community organisations have argued this for many years and claim that the bulk of power has gone back to State agencies and departments. They have urged recent governments to revert to the “partnership” philosophy and structure between the State and the community sector explicit in early drug strategies.
The first NDS, 2001-2008, established a powerful National Drug Strategy Team (NDST), which, among other things, was set up to ensure “effective coordination” between government officials and community/voluntary representatives. It fizzled out some 20 years ago.
In one of its findings, the Grant Thornton report said: “Many community and voluntary organisations expressed concern that their perspectives are not sufficiently reflected in national decision-making processes.”
The report said that while community involvement is a “pillar” under the NDS 2017-2025 that community stakeholders reported it was “inconsistent” and concluded that community engagement remained “underdeveloped” in policy.
It further said that service user “advisory panels at national and regional levels” should be set up with representation on the National Oversight Committee (NOC) and relevant strategic implementation groups.
Despite extensive references to the needs of families of drugs users in the 2017-2025 strategy, and a specific action to increase their participation in addressing the problem, the Grant Thornton report said family groups, like peer groups, were “not systematically included” in the planning or delivery of services.
The recently established Families in Addiction Recovery Ireland (FARI) is pushing to get a place in national and regional drug structures.
The report said that a Health Research Board examination of drug treatment data found that while just 14% of the national population are from areas classified as disadvantaged that 42% of drug treatment cases, where opioids were the primary drug, came from disadvantaged areas.
Grant Thornton called on the next strategy to invest in programmes that will address “social determinants” — social and economic factors driving drug use in disadvantaged communities — and projects that recognise and try to address the trauma in the lives of users that contributed to their drug problem.
It recognised that this would require “significant effort”, particularly in marginalised urban and rural areas.
The report said that local groups emphasised the need for early community-based interventions that address root causes, such as “trauma, poverty and social disadvantage”.
In terms of structures, the report said that coordination and information sharing between the NOC and SIGs needs to improve, adding that this did require “significant effort”.
It said the establishment of an “interdepartmental group” — comprising the departments of housing, justice, and health — was needed for joint action plans and to improve communication and governance.
Grant Thornton said that in its meetings with community and voluntary groups and other stakeholders, they pointed to a “growing demand” for drug treatment.
It said many groups pointed out that existing systems were under “increasing pressure” and that this was particularly evident in rural areas and among marginalised groups.
They cited population growth and emerging social and economic pressures as factors.
It said they also identified the “rising prevalence” of drug use “particularly among adolescents”. They expressed concerns about youth interventions and the need for earlier intervention.
These organisations said mental health conditions and trauma disorders were “frequently” combined with substance misuse.
The report said the launch of the Model of Dual Diagnosis Care in May 2023 was a “positive development” but said there was still “limited support” for people with dual diagnosis (mental health condition and problem drug use).
The report recommended “joint oversight” for dual diagnosis implementation to mental health and addiction leads, rather than just one.
Prevention was highlighted as an issue among groups consulted. Stakeholders frequently criticise existing prevention programmes in secondary schools, with some groups suggesting that the SPHE curriculum should be mandatory in all schools.
Groups reported a “rise in drug use”, particularly among young people and said this was linked to social, recreational and nightlife settings.
They said that while cocaine use has increased significantly that “further increases may be likely”. Local groups also referenced the increased use of the powerful hallucinogenic ketamine, which HSE harm reduction experts say is a rising issue as festivals.
The report did praise the HSE ‘Safer Nightlife’ harm reduction strategy at festivals, which includes the piloting of a limited drug-checking service, and the operational beginning of the long-awaited medically supervised injecting facility at Merchants Quay, Dublin, in December 2024.
The report said that community groups and services flagged the difficulties they faced in terms of “funding and staffing constraints”, which were exacerbated by short-term funding cycles and recruitment barriers.
Groups said administrative delays in applying for funding, such as long application processes, were “burdensome” and that this was compounded by “restrictive hiring policies” which added to staff shortages and disruption.
Elsewhere, stakeholders called “for a clearer policy direction on alcohol and behavioural addictions”, with suggestions that these be integrated into the NDS or in a dedicated strategy.
The report recommended that alcohol be integrated into the NDS but added this would require “significant effort”.
The NDS 2017-2025 is supposed to be, at least according to the government, its policy on “drug and alcohol use”.
The department of health told Grant Thornton that alcohol is expected to remain “a strategic priority” in the forthcoming NDS.
The report said stakeholders viewed alternative sanction programmes, such as the adult caution scheme, Dublin drug treatment court and Cork court referral programme as promising responses to drug possession, but said there was inconsistent implementation.
The report the Government’s health diversion scheme, announced in August 2019, illustrated Ireland’s “move toward a health-led approach”.
It said the HSE was “in a position to receive referrals” and that the government has reaffirmed its commitment to diverting individuals found in possession of drugs for personal use to a brief health intervention.
Drug possession would still be illegal under the law.
The Citizens Assembly on Drug Use, which reported in January 2024, recommended what it described as effective decriminalisation, with a potentially unlimited number of referrals possible.
The formal government position on this is due once the Oireachtas Drugs Committee completes its final report.
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