Drug-related deaths in Ireland: key patterns and trends 2008-2017

New HSE report on drug-related deaths offers insight on emerging trends of concern and recommended actions. 

To initiate a series of reports, the Dr David Evans has conducted a review of drug-related death data for the period 2008-2017. The report utilises the Health Research Board (HRB) National Drug-related Death Index (NDRDI) publications to stimulant discussion on the Irish situation and makes key recommendations to inform policymakers to support the implementation of the National Drug and Alcohol Strategy with an aim to reduce drug-related deaths through evidence-based practice

Drug-related deaths are a significant source of mortality in Ireland. It is important that patterns and trends are monitored, to facilitate the development of policy and initiatives to tackle the issue. 

Overall patterns

• There were 786 deaths in 2017 which represents a 24% increase since 2008.
• There was a 9% decline in poisoning rates since 2008.
• There was a 37% increase in non-poisoning rates since 2008 which were 10% higher than poisonings since 2017.

Poisonings (overdose)

• 70% of poisonings were men in 2017
• 38% involved illicit drugs in 2017; of these 52% were for heroin, 38% cocaine, 10% MDMA
• There has been a 15% decline in heroin deaths
• There has been a 13% decline in cocaine deaths (but have increased by 26% between 2016 and 2017)
• There has been a 75% increase in MDMA deaths since 2016 and a doubling since 2008

Non-poisonings (someone with history of drug use)

• 76% of non-poisonings were men in 2017
• 48% were trauma deaths in 2017 with the main cause being hanging (28%) and cardiac events (14%)
• There has been a 67% increase in medical deaths
• There has ben a 70% increase in trauma deaths
• Female non-poisonings have increased by 113%, with males increasing by 58%
• There has been a 56% increase in female hangings since 2016 (25 in 2017)

Key recommendations

1. The National Drug and Alcohol Strategy should be fully implemented, to help maintain and improve the progress made on reducing drug deaths. An added emphasis on the area of Drug Related Deaths in the second half of the strategy is warranted, including the establishment of a pilot medically supervised injecting facility. 
2. Prevention and treatment programmes should incorporate gendered specific responses and be designed to meet the differing needs of men and women.
3. The needs of older drug users in Ireland should be recognised and tailored interventions developed for this cohort, similar to interventions for other vulnerable cohorts.
4. Initiatives that have been developed to address crack cocaine use should be reviewed to determine their effectiveness.
5. A multifaceted evidence based approach to addressing polydrug use should be developed.
6. Naloxone availability for opioid users should be prioritised and its impact monitored on an ongoing basis.
7. Consideration should be given to undertaking a comprehensive health needs assessment of long term drug users receiving treatment, with referral pathways developed to supporting physical and mental health services.
8. Recovery programmes need to be strengthened as this may have the potential to reduce the number of people in long term treatment for substance use.
9. The HSE Clinical Programme on Dual Diagnosis needs to be supported into the future as this may have a significant impact of rates of self harm/suicide in this population. The programme will require regular monitoring and evaluation to assess impact in this area.
10. Best practice guidelines when prescribing more than one drug, particularly for those with drug dependency disorders should be employed.
11. The Public Health Alcohol Bill (2018) should be fully enacted and its implementation monitored.

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