HSE update on patterns and trends

Earlier this week we provided an update at an EMCDDA webinar in relation to patterns and trends that have been reported to us between March - June from national service providers and peer networks.

We would like to thank the National Addiction Advisory Group, UISCE, Merchants Quay Ireland, The HSE National Drug Treatment Centre, Rialto Community Drugs Team, The USI for frequent updates as well as the multiple other professionals and organisations who helped us gather information during this time. By discussing trends and patterns it helped us quickly identify if there was potential areas of concern emerging as a result of COVID-19.

Overall, there has been no one clear national picture in relation to drug patterns or market changes. At present, the situation seems to change frequently in different areas.

Trends highlighted in the media during COVID-19

There has been frequent media attention focusing on the use of nitrous oxide ‘laughing gas’. This has been an increasing trend for some time in Europe as shown by the Global Drug Survey results 2014.
Use has been visible in some Dublin communities for roughly 18 months. Unpublished data from the HSE and Trinity College Dublin shows that a quarter of respondents to a survey they conducted had reported the use of Nitrous Oxide at a festival.
There are known risks associated with nitrous oxide use, particularly frequent or long term use. The HSE shared these risks in the media in January .
There is visible use through the COVID-19 period in communities among young people. Parents are asked to read HSE information in relation to the risks and discuss these with young people, see our feature on nitrous oxide here.
Harm reduction for nitrous oxide can be found here.
Media attention has also discussed the changing benzodiazepine market in relation to ‘fake’ tablets available. The benzodiazepine market has been changing for some time in Ireland,with newer benzodiazepine-type substances emerging which can be potent at low doses.
See the our feature in relation to the changing benzodiazepine market here
We are aware that some tablets currently circulating contain multiple substances or newer substances and ask people to follow harm reduction and overdose awareness information.
The HSE National Clinical Lead for Addiction Services recently issued an advisory notice to addiction services, find it here.
People who use drugs are advised to be aware of the increased risks associated with illicit tablet use. Risks significantly increase if more than one substance is used as some tablets are pressed to could contain multiple substances.

Patterns of use: Service user population

Overall improvements have been reported in relation to mental health, drug patterns and overall well-being of this group. This is said to be as a result of wrap around supports being provided during COVID-19 and people engaging in less ‘street-based activity’.
There is a general perception that there has been a reduction in opioid overdoses, however this needs further investigation. Over 600 new people are now in receipt of opioid substitution treatment as a result of the COVID-19 response which saw a change in legislation, a reduction in waiting times, increased take away allowance and wrap around supports provided.
There has been no one clear national picture in relation to patterns or market reports. Initially a shortage was reported,followed by some areas having large amounts of drugs in circulation.
For the past four weeks, areas are reporting a ‘shortage’ or difficulty accessing illicit tablets, heroin and cannabis. With some areas now saying there is also difficulty obtaining cocaine. Service providers are encouraged to talk to service users about this issue and if other substances are being used as substitutes.
Difficulty obtaining heroin has led people to seek opioid substitution treatment.
Some areas have reported an increase in crack use among existing users, with some in Dublin progressing to injecting. Services are asked to discuss administration patterns and tailor their harm reduction response, injecting crack can lead to more frequent injecting and people may require additional paraphernalia to avoid risky practices– get crack harm reduction here
In relation to new patterns or substances emerging– we have received two reports of non-fatal overdoses in relation to GHB among this cohort and one area noting an increase in synthetic cannabinoid use. Services are encouraged to discuss new patterns with clients. Workers can find information about GHB here and harm reduction in relation to synthetic cannabinoids here.
Some perceptions indicate that heroin quality has decreased in Dublin City and that ‘better quality’ versions are available in Dublin suburbs which could lead to increased drug traffic through some communities.

Patterns of use: Young people/non-dependent/club drug users

This group generally use cannabis, MDMA, cocaine and ketamine.
As expected, club drug use declined among the general population of young people as use was predominantly linked to the night-time economy. However, use continued among smaller niche groups.
This cohort could be susceptible to overdose if use re-starts after a period of absence during COVID-19. Some predications suggest that we may see cheap stimulants available on the market post-COVID which could impact on use patterns among this group. Get harm reduction tailored for this cohort here.
Perceptions are that cannabis use continued or increased among frequent users. Perceptions also suggest that the use of prescription medication such as benzodiazepines became acceptable among this group as a result of additional stress caused by COVID-19 restrictions.
Use among this group appeared to be circumstantial and based on their living situation. Those living with parents are less likely to have used during COVID-19. It appeared that the general population initially found it difficult to obtain drugs as those within closed networks were still able to access supplies. Some young people within closed networks may have become a new link in the supply chain to help others access drugs during COVID-19. Get information in relation to family support and drug related intimidation here.
Difficulty obtaining cannabis was also noted among this cohort due to ‘shortages’. See our advice on cannabis withdrawal can COVID-19 here and the Cannabis and You Booklet.
There are signs of parties re-starting in domestic settings. This raises concerns in relation to COVID-19 transmission and the risks associated with re-starting substance use. People could experience a change in tolerance or mental health which could lead to adverse reactions. A change of set and setting could result in unknown interactions or vulnerabilities. Get COVID-19 drug harm reduction and overdose awareness here
Parties and substance use may be visible in communities due to the cancelation of nightlife activities such as festivals and holidays in which this group frequently engaged in. This could create stigma for young people within certain communities, as we have already seen in some areas. This cohort should be encouraged to medical help if they become unwell and not to be fearful to call emergency services if they or a friend becomes unwell or feels suicidal after using drugs.

Patterns of use: Chemsex community

Engagement in chemsex parties reduced during the initial COVID-19 period. However, we are aware of a small number of parties that continued in Dublin City.
We are aware of additional stigma and divide that developed among this community during COVID-19 between those who abstained and those who continued to engage in chemsex practices.
There was no changes in patterns of use or market changes reported among people who continued to engage. However, a GHB gel emerged which service users reported as difficult to measure when using,therefor impacting on their harm reduction practices. Analysis of one sample showed that this substance contained GHB and no adulterants. As this was one sample, it is not representative of other versions in circulation. People are advised to treat every substance with caution as you cannot be sure of the contents - it is safer not to use any substance at all. It is very easy to overdose on GHB and it has significant long term risks. Learn more here
Get tailored support for GHB use or chemsex practices from Rialto Community Drug Team or HIV Ireland. Find a local drug support service here

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