Drug-dependent persons seeking treatment
Hospital casualty department visits
Survey of school children
Field studies of young people
Survey of the use of alcohol and tobacco
Author: D. CORRIGAN
Pages: 91 to 97
Creation Date: 1986/01/01
An assessment of the nature and extent of drug abuse , based on the synthesis of different available indicators, shows that since 1979 there has been an alarming increase in drug abuse among young people in Ireland. Surveys of schoolchildren and young people indicate a sixfold increase in drug experimentation. The number of heroin addicts and other opiate addicts seeking treatment increased 5-6 times during the period from 1979 to 1983. The growing drug problem is also reflected in the increasing number of cases of hepatitis B and of drug-related deaths. A recent study carried out in a northern part of Dublin has revealed that 10 per cent of young people in the "15 -24-year" age group were addicted to heroin, while another study has found that only 2.2 per cent of the youth in a southern suburb of Dublin were heroin addicts. Disrupted family life appears to be the major risk factor underlying heroin abuse among young people.
Reporting in 1979 [ 1] on the nature of the drug problem in the Republic of Ireland, the author of this article stated that Ireland had been relatively fortunate in that the more dangerous drugs, such as heroin, were not as widely used there as in some other countries, but the publication of that report has unfortunately been followed by an epidemic of heroin abuse. The large scale of this epidemic has prompted an increase in public concern , which has resulted in an expansion in law enforcement activities, as well as preventive educational and treatment efforts by government and non-governmental organizations [ 2] . Of the 3.4 million inhabitants of the Republic of Ireland, 56 per cent live in urban areas and 48 per cent are under 25 years of age. In 1984, the birth rate was 20.3 per 1 ,000 and youth unemployment was 18.1 per cent. In such circumstances an epidemic of drug abuse may have potentially devastating consequences.
Statistics show the existence of a significant drug abuse problem involving illegal drugs, as well as legal drugs and medicines. This article eviews data on different indicators of drug abuse and associated problems, which are summarized below.
Data of the National Drug Advisory and Treatment Centre [ 3] show that between 1979 and 1983, 2,057 drug-dependent persons sought treatment at the centre for the first time. The majority of them were heroin abusers and under 25 years of age. During the same period, the number of people seeking treatment for addiction to opiates, mainly heroin, increased 5-6 times, and the number of people seeking treatment for addiction to other drugs increased threefold. Many of them were multiple drug abusers. The number of people seeking treatment for drug abuse at the National Drug Clinic, Jervis Saint Hospital, increased from 416 in 1979 to 1,515 in 1983, and since then the number has slightly decreased (3.7 per cent). In 1982, 772 heroin addicts attended the clinic; in 1983, the number increased to 1,006; and in 1984, it decreased to 969.
With regard to other substances, there has been a substantive increase in the number of patients seeking treatment for the abuse of benzodiazepines, while the number of persons seeking treatment for the abuse of synthetic narcotics, such as dipipanone, dextromoramide and methadone , has dramatically decreased. This decrease has been mainly attributed to improved prescribing practices and to improved security in pharmacies.
The abuse of cocaine is a relatively minor problem at this time, as is the abuse of amphetamines. Legislation has played a vital role in reducing the supply of amphetamines and, in turn, the size of the amphetamine problem.
A survey of heroin users in the city of Dublin shows that 8 per cent of them inhale heroin, 18 per cent inject it subcutaneously and 74 per cent inject it intravenously [ 4] . Because of the use of unhygienic needles and syringes, there has been an increase in the number of cases of hepatitis B among those who inject heroin [ 5] , [ 6] . During the first eight months of 1981, 1.58 new cases of hepatitis B were reported [ 7] . The disease subsequently spread to people who had not been abusing drugs but had come in contact with drug abusers infected with hepatitis B [ 8] . There has recently been some concern about the level of acquired immunodeficiency syndrome among intravenous drug abusers in Ireland.
Another indication of the increasing magnitude of the drug problem are seizures made by the Customs and the police. The number of seizures of illicit drugs reached a peak of 2,278 in 1983 and then declined to 1,704 in 1984. The amount of drugs seized followed a similar trend ; for example, the amount of heroin seized rose from 105 grams in 1982 to 1.37 kg in 1983. Recent seizures of cannabis products have shown that the stronger resin form of the drug is the most popular in Ireland ; in 1983, 10 times more cannabis resin (485 kg) was seized than marijuana (44 kg). Seizures of cocaine (97 grams in 1983) seem to reflect the current low level of abuse of this drug, at present [ 9] .
The number of drug offenders dealt with by the criminal justice system has been increasing. The trend is similar to that emerging from the two above-mentioned indicators : a peak was reached in 1983 with 1 ,822 persons charged with drug offences, while in 1984 there was a 25 per cent decrease in such charges. The proportion of cannabis offences has markedly decreased whereas the proportion of heroin offences has increased. The number of cocaine offences declined from 50 in 1980 to 23 in 1984. All parts of Ireland have had cases of drug offences, but the majority of cases have been reported from Dublin and its surroundings [ 9] .
No accurate figures on drug-related deaths are available. The statistics show that the number of deaths related to drug abuse increased from 4 deaths in 1980 to 12 in 1983. By the end of November 1985, 20 such deaths had been recorded for 1985. A considerable number of these were caused by solvent abuse. It is believed that the actual number of drugrelated deaths is higher because some of them may have been listed under other causes, such as hepatitis or asphyxiation.
In Ireland, only one attempt has been made so far to use hospital casualty departments as a source of information [ 10] . For the purpose of this study, a survey of 14 hospitals with accident and emergency departments in the Dublin area was conducted in September 1982 ; 80 drug abusers, 69 per cent of whom were heroin abusers, visited the casualty departments during that period. In view of those findings, it would seem necessary to monitor such figures on a continuous basis.
Two national surveys of the use of illegal drugs among secondary school children were undertaken : one in 1970 and the other in 1980 [ 11-14] . The results show that those living in the city of Dublin were more involved in illicit drugs than their rural counterparts. In 1980, 22 per cent of the respondents in the Dublin area reported that they had been offered addictive drugs. Though this figure was twice that reported for the rural children, the figure foreach group had doubled or tripled since 1970. The number of boys under 16 who in 1980 said they had used an illicit drug was 8-10 times higher than the number of boys in 1970 who had said they had done so. The corresponding figure for boys over 16 showed a fourfold increase. In all cases, the rate of reported drug use for rural areas was between one half and one third lower than that for Dublin, but the rate of increase was similar in the two groups. The proportion of Irish secondary-school children who reported drug use in. 1980 was 8.3 per cent. This finding for schoolchildren is similar to that reported by Parfrey in 1977 for a group of undergraduate students at Cork [ 15] . He found that 19 per cent of the respondents had experimented with cannabis, 3 per cent with lysergic acid diethylamide (LSD) and 3 per cent with barbiturates or amphetamines.
In 1984, a survey of drug use was carried out among Irish youth in the "15-24-year" age group. The survey was sponsored by the National Youth Policy Committee established by the Government [ 16] . Approximately 10 per cent of the respondents said that they had tried drugs, in most cases cannabis. The highest proportion of reported drug use was found in the following groups : those living away from home or in the city of Dublin (17 per cent) ; those in their late teens or early twenties (14 per cent) ; males (16 per cent) ; and young working class people (13 per cent).Approximately 62 per cent of the young people surveyed considered drugs a major health risk.
An overall assessment of the results of different surveys shows that drug experimentation has increased from five to six times since 1979.
Two field studies of heroin use among young Irish people have been carried out. One study covered an area of the north inner city of Dublin [ 4] and the other covered two electoral wards of a suburb in the south of Dublin [ 17] . Approximately 10 per cent of youth in the "15-24-year" age group in the north inner city had used heroin. A subsequent study of the heroin users and non-users in the same area, matched according to age and sex [ 18] , revealed that the heroin users smoked twice as many tobacco cigarettes as the non-users. The heroin users also drank less alcohol than the non-users, but the number of heroin users who had come from homes where one or both parents had had a history of alcohol problems was twice that found among the non-users. A higher proportion of the heroin users had parents who had separated or who had died at an early age. Very few of the heroin users were employed, but the unemployment rate among the non-users was also high (approximately 50 per cent). It is encouraging that 90 per cent of young people in the area of the study, which is one of the most deprived areas of Ireland, had chosen not to use heroin even though they were living in the same conditions as heroin abusers and half of them were unemployed and exposed to the drug.
The second field study [ 17] found only 29, or 2.2 per cent, of a population of 1,327 young people to be heroin users. It showed that disrupted marriage, premature parental death and family alcoholism were the major risk factors leading a young person to become involved in heroin.
In a recent survey of alcohol consumption among young people in the "15-24-year" age group, almost 60 per cent of the respondents described themselves as current drinkers [ 16] . In other surveys, approximately 90 per cent of the young people were alcohol drinkers, many reporting that they drank at least three times a week [ 19] .
With regard to cigarette smoking, the percentage of adult smokers declined from 41 per cent in 1974 to 32 per cent in 1984, while an unacceptably high level of young people were regular smokers. In a survey of schoolchildren, 33 per cent of the boys and 25 per cent of the girls were regular smokers [ 20] . The highest level of smoking (48 per cent) was reported in the "20-24-year" age group [ 16] . The use of alcohol and tobacco are of concern not only because of their inherent health risks but also because of the link between early involvement with these two legal drugs and subsequent involvement with illegal drugs [ 21] .
Although each of the foregoing indicators may not precisely reflect the drug problem, the synthesis of all the indicators clearly shows that there has been a rapid increase in drug abuse in Ireland since the 1970s. The increase in the abuse of heroin has been the most marked and disturbing development. Although the survey data should take into account some possible "under-reporting" inherent in this approach, they show that the majority of young Irish people do not use or even experiment with illegal drugs. Unfortunately, the same statement does not apply to legal drugs, particularly tobacco and alcohol, which are used by many young people.
With regard to the overall situation since 1979, it appears that drug abuse reached a peak in 1983. It is hoped that the decreasing trend observed since 1983 will continue. This trend is considered to be a result of law enforcement, educational and treatment measures and the concerted efforts of the local community. Hope for the future is provided by the fact that most young people are aware of the risks of drug abuse and that their experimentation with illegal drugs is still at a relatively low level compared with the situation in some other countries. Those involved in preventing drug abuse are encouraged by the fact that efforts to date have had a positive impact. There is an opportunity to maintain the drug-free status of many young people. There is also an urgent need to help young people recognize the potential destructiveness of tobacco and alcohol, as well as that of illegal drugs.
Further promotion of preventive measures requires concurrent efforts to assess accurately the incidence and prevalence of drug abuse and the problems associated with it and to facilitate the exchange of experience between countries in this area [ 22] .
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