Trends in public attitudes to permitting cannabis for recreational use: analysis of Irish survey data since 2002.

BACKGROUND: There has been considerable debate around the liberalization of cannabis laws in many countries. Given recent changes in cannabis policy, and the current discussion regarding cannabis legalization in Ireland, the aim of this study was to examine changes in attitudes over time towards permitting recreational cannabis use. METHODS: We analyzed data from Ireland's 2002/03 (n = 4918); 2006/07 (n = 4967); 2010/11 (n = 5119); 2014/15 (n = 5937); 2019/20 (n = 3982) National Drug Prevalence Surveys. Multivariable logistic regression analyses were used to examine factors associated with being in favour of the use of cannabis for recreational purposes. RESULTS: The results indicate that there is minority support for permitting recreational cannabis use, which ranged from 19.1% in 2006/07 to 29.9% in 2019/20. In multivariable analysis being male and living in Dublin were significant predictors of agreeing with recreational cannabis use, as were being either a recent or past cannabis user, knowing cannabis users, perceiving cannabis use as not being a great risk, and not disapproving of cannabis use. Subjects aged less than 35 years and those who had completed primary education only were significantly less likely to agree with permitting recreational cannabis use. CONCLUSION: The results from this study indicate that there is minority support for allowing recreational cannabis use. Support was highest among recent cannabis users, consistent with previous studies. The relative lack of support for recreational cannabis use among younger respondents was surprising and warrants further research.

Deterrence effect of penalties upon adolescent cannabis use.

OBJECTIVE: Penalties are used in an effort to curtail drug use by citizens in most societies. There are growing calls for a reduction or elimination of such penalties. Deterrence theory suggests that use should increase if penalties reduce and vice versa. We sought to examine the relationship between changes to penalties for drug possession and adolescent cannabis use. METHOD: Ten instances of penalty change occurred in Europe between 2000 and 2014, seven of which involved penalty reduction and three involved penalty increase. We conducted a secondary analysis of a series of cross-sectional surveys of 15-16-year-old school children, the ESPAD surveys, which are conducted every four years. We focused on past month cannabis use. We anticipated that an eight-year time span before and after each penalty change would yield two data points either side of the change. A simple trend line was fitted to the data points for each country. RESULTS: In eight cases, the trend slope in past month cannabis use was in the direction predicted by deterrence theory, the two exceptions being the UK policy changes. Using the principals of binomial distributions, the likelihood of this happening by chance is 56/1024 = 0.05. The median change in the baseline prevalence rate was by 21%. CONCLUSIONS: The science seems far from settled on this issue. There remains a distinct possibility that reducing penalties could contribute to small increases in adolescent cannabis use and consequently increase cannabis-related harms. This possibility should be considered in any political decision-making influencing drug policy changes.

Changes in HIV incidence in people who inject drugs in Ireland from 2000 to 2018: longitudinal observational study.

BACKGROUND AND AIMS: People who inject drugs (PWID) have a substantial risk of acquiring human immunodeficiency virus (HIV) infection. From 1999 to 2000 in Ireland, there were 115 new HIV cases among PWID, 40% in individuals aged under 22 years. However, over the past two decades, HIV incidence has declined among PWID in western Europe, including Ireland. We investigated secular changes in HIV incidence among PWID in Ireland. Also, new HIV cases in two time-periods 2000-09 and 2010-18 were compared by sex, age group, area of residence and country of birth. DESIGN AND SETTING: Longitudinal observational study in the Republic of Ireland, 2000-18. CASES AND MEASUREMENTS: A total of 753 new cases of HIV in PWID were diagnosed. Diagnosis rates of HIV in PWID were calculated and changes in rates over the period were modelled. FINDINGS: During the period 2000-18, HIV incidence among 15-29-year-old PWID in Ireland declined from 5.69 to 0.11 cases per 100 000, equivalent to a yearly decline of 0.22 [95% confidence interval (CI) = 0.14-0.31, P < 0.001] cases per 100 000. Among PWID aged 30-64 years, HIV incidence declined annually by 0.06 (95% CI = 0.02-0.10, P = 0.007) cases per 100 000 from 1.80 to 0.57 cases per 100 000. Comparing 2000-09 to 2010-18, there was a relative increase in HIV cases among older adults (P < 0.001), and those born outside Ireland accounted for a growing minority of cases (from 14.7 to 28.0%, P < 0.001). Changes by sex (P = 0.10) and area residence (P = 0.39) were not statistically significant. CONCLUSION: Since 2000, Ireland has achieved an ongoing reduction in the incidence of human immunodeficiency virus among PWID, and this is most evident among young adults. The reduction has occurred in the context of a reasonably comprehensive, health-led and harm reduction-orientated national drugs strategy.

Estimating need for alcohol treatment in Ireland using national treatment surveillance data.

BACKGROUND: International evidence indicates that about 10% of people with alcohol dependence will seek and commence treatment each year. Based upon Irish estimates of prevalence of dependence, a target of 690.0 treated cases per 100,000 population per annum is expected. AIMS: This study analyses routine national surveillance data on alcohol treatment to measure how treatment need is being met. METHODS: National treatment surveillance data on problem alcohol use collected by the National Drug Treatment Reporting System (NDTRS) were analysed. The study included cases resident in Ireland, aged 18-64 years entering treatment for alcohol use disorder (AUD) between 2015 and 2019 (n = 44,079). Treatment rates were calculated per 100,000 of the population. Descriptive and exploratory statistics were used to describe characteristics of cases treated. RESULTS: National rate of treated AUD was 270 cases per 100,000 annually, with a rate of treated alcohol dependence of 165/100,000. There was a fivefold difference between the lowest and highest rates (119 cases per 100,000 in Meath versus 633 in Waterford). Drinking patterns indicate high levels of alcohol consumption and prolonged use prior to treatment. The use of other drugs alongside alcohol was common. CONCLUSIONS: Despite high rates of alcohol consumption and dependence, the rate of treatment entry nationally is sub-optimal, although there are wide geographic variations. There is a need to better understand the reasons for low treatment entry rates in Ireland for people with alcohol dependence. Monitoring and surveillance play a key role in measuring the successful efforts to reduce the harm of alcohol.

Comparing Cannabis Use Disorder in the General Population with Cannabis Treatment Seekers Using Multi-Source National Datasets: Who Receives Treatment?

INTRODUCTION: Given the increased prevalence of cannabis use in Ireland and increase in cannabis potency, this study aimed to estimate the size of the potential population in Ireland that may be in need of cannabis treatment and the percentage of people with cannabis use disorder (CUD) who actually access treatment. We also compared the profile of those with CUD in the general population to those who receive treatment for their cannabis use to explore whether certain subgroups are more or less likely to enter treatment. METHOD: This was a retrospective, multi-source database study. Data were obtained from (1) Ireland's 2014/2015 national general population survey (GPS) on drug use and (2) treatment data from the Irish National Drug Treatment Reporting System (NDTRS) for 2015. The profiles of GPS cases with CUD and NDTRS cases were compared using 2-sided t tests designed for independent samples. RESULTS: The prevalence of last year cannabis use among adults aged 15 and older was 6.5% and the prevalence of CUD was 2.6%, representing 94,515 of the Irish population. A total of 4,761 cases entered treatment for problem cannabis use. NDTRS treatment cases were significantly more likely than GPS cases to be unemployed (63.7% vs. 26.6%) and have no or primary level only educational attainment (56.3% vs. 21.2%). Over half (53.3%) of NDTRS cases first used cannabis before the age of 15 years, compared to 14.7% of CUD cases in the population. DISCUSSION/CONCLUSION: Our findings suggest that earlier users and those with more complex or disadvantaged lives are more likely to seek treatment. A broad population health approach that engages multiple sectors such as health, social welfare, and education is recommended to ensure that there is increased opportunity for people with CUD to be identified and signposted towards treatment.

Relationships between patterns of cannabis use, abuse and dependence and recent stimulant use: Evidence from two national surveys in Ireland.

BACKGROUND AND OBJECTIVES: Epidemiological studies show that the use of cannabis is related to the use of other illicit drugs, including stimulants such as cocaine and ecstasy. However, few studies have examined how patterns of cannabis use relate to the use of stimulants. In this research we determined relationships between patterns of cannabis use and recent stimulant use, drawing on data from two large nationally representative surveys. We also explored how frequency of cannabis use relates to stimulant use and whether subjects with a cannabis use disorder (CUD)-defined as cannabis abuse or dependence-are more likely to be recent users of cocaine or ecstasy. MATERIALS AND METHODS: We analysed data from Ireland's 2010/11 and 2014/15 National Drug Prevalence Surveys,which recruited 5,134 and 7,005 individuals respectively, aged 15 years and over, living in private households. We included only those people who reported some past cannabis use. Multivariable logistic regression analysis was used to examine associations between patterns of cannabis use and recent stimulant use. RESULTS: Among survey participants who had used cannabis in the last month, 17.9% reported recent cocaine use, while almost one-quarter (23.6%) reported recent ecstasy use. There was a significant linear relationship between patterns of cannabis use and recent use of cocaine, ecstasy or any stimulant, with last month cannabis users displaying greater odds (OR = 12.03, 95% CI: 8.15-17.78) of having recent stimulant use compared to last year (OR = 4.48, 95% CI: 2.91-6.91) and former (reference) cannabis users. Greater frequency of cannabis use in the last 30 days was also significantly related to the use of stimulants. In addition, results demonstrated an association between CUD and recent use of cocaine or ecstasy (OR = 2.28, 95% CI: 1.55-3.35). CONCLUSIONS: Findings from this study suggest a relationship between patterns and frequency of cannabis use and recent use of stimulants and an association between CUD and stimulant use. As the use of cannabis with stimulants may increase the risk of negative health consequences, education in community and medical settings about polydrug use and its increased risks may be warranted.

Relationships between age at first substance use and persistence of cannabis use and cannabis use disorder.

BACKGROUND: From a secondary prevention perspective, it is useful to know who is at greatest risk of progressing from substance initiation to riskier patterns of future use. Therefore, the aim of this study was to determine relationships between age at first use of alcohol, tobacco and cannabis and patterns of cannabis use, frequency of use and whether age of substance use onset is related to having a cannabis use disorder (CUD). METHODS: We analysed data from Ireland's 2010/11 and 2014/15 National Drug Prevalence Surveys, which recruited 5134 and 7005 individuals respectively, aged 15 years and over, living in private households. We included only those people who reported lifetime cannabis use. Multinomial, linear and binary logistic regression analyses were used to determine relationships between age of substance use onset and patterns of cannabis use, frequency of use and having a CUD. RESULTS: When compared to former users, the odds of being a current cannabis user were found to be reduced by 11% (OR = 0.89; 95% CI: 0.83, 0.95) and 4% (OR = 0.96; 95% CI: 0.92, 1.00) for each year of delayed alcohol and cannabis use onset, respectively. Among current users, significant inverse linear relationships were noted, with increasing age of first use of tobacco (ß = - 0.547; P < .001) and cannabis (ß = - 0.634; P < .001) being associated with a decreased frequency of cannabis use within the last 30 days. The odds of having a CUD were found to be reduced by 14% (OR = 0.86; 95% CI: 0.78, 0.94) and 11% (OR = 0.89; 95% CI: 0.82, 0.98) for each year of delayed tobacco and cannabis use onset respectively in analyses which examined survey participants aged 15-34 years. CONCLUSIONS: Among people who report past cannabis use, it is those with a more precocious pattern of early use of substances, including alcohol, and especially tobacco and cannabis, who are more likely to report ongoing, heavy and problematic cannabis use. Secondary prevention initiatives should prioritise people with a pattern of very early onset substance use.

Correlates of patterns of cannabis use, abuse and dependence: evidence from two national surveys in Ireland.

BACKGROUND: Knowledge of factors relating to patterns of cannabis use is important for informing drug policy. This study determined factors associated with recent and current cannabis use. In addition, we explored factors related to having a cannabis use disorder (CUD)-defined using the Diagnostic and Statistical Manual of Psychiatric Disorders-among current users. METHODS: We analyzed data from Ireland's 2010-11 and 2014-15 National Drug Prevalence Surveys, which recruited 5134 and 7005 individuals respectively, aged 15 years or more, living in private households. Multinomial logistic regression was used to identify factors associated with recent (last year) and current (last month) cannabis use compared to experiential use. Binary logistic regression was used to determine factors related to CUD among current users. RESULTS: The weighted prevalence of experiential cannabis use was 18.3%, with 3.0% and 3.3% of participants indicating recent or current use, respectively; 41.3% of current users indicated having a CUD. Factors associated with both recent or current cannabis use included younger age, not being married or cohabiting, having no dependent children and current use of tobacco or alcohol. Male gender, younger age and lower educational levels were significantly related to CUD among current users. CONCLUSIONS: Males, adolescents/young adults and individuals with lower educational levels are more likely to be current users of cannabis and are at a greater risk of having a CUD. Health professionals should be aware of these factors to improve detection and prevention of CUD.

Drug-related medical hospital admissions during and after a period of head shop expansion.

BACKGROUND: New psychoactive substance (NPS) use can negatively impact health and may result in drug-related hospital admissions (DRHAs). Irish youth reported very high rates of NPS use by international standards, the most common being synthetic cannabinoids and cathinones. There was a rapid expansion in specialist shops, called head shops, selling NPS in 2010. Government responded to public protests about head shops by enacting legislation in May and August 2010 to end this trade. Many academics argued that such actions would prove futile. We sought to determine if changes in head shop activity coincided with changes in DRHA. METHODS: The national database on admissions to general hospitals hospital in-patient enquiry was examined focusing on young adults admitted from 2008 to 2012, and all emergency admissions with an International Classification of Diseases-10 diagnosis of mental disorder related to any drug (F11-F19) were identified. Joinpoint regression analysis was utilized to explore for the presence of trend changes in DRHA. RESULTS: Joinpoint regression analysis identified a significant downward trend change which occurred in June 2010 (95% CI February 2010 to January 2011). DRHA increased by 0.5% (95% CI 0.1-0.9) per month prior to this and then fell by 2.6% (95% CI -1.4 to -3.8) per month over the next 16 months. CONCLUSIONS: Cessation of NPS sale by head shops coincided with a reversal in the upward trend of emergency hospital admissions related to drugs. Although correlation does not confirm causation, legislation which successfully curtails the commercial sale of NPS may result in reduced hospitalizations.

Legislation targeting head shops selling new psychoactive substances and changes in drug-related psychiatric admissions: A national database study.

AIM: New psychoactive substance (NPS) use can negatively impact mental health and may result in drug-related psychiatric admissions (DRPA). Irish youth reported very high rates of NPS use by international standards, the most common being synthetic cannabinoids and cathinones. This occurred in the context of a rapid expansion in specialist high street shops, called head shops, selling NPS in 2010. Government responded to public protests about head shops by enacting legislation in May and August 2010 to end this trade. Many academics argued that such actions were futile. We sought to determine if changes in head shop activity coincided with changes in DRPA. METHOD: The national database on psychiatric admissions was examined focusing on young adults admitted from 2008 to 2012. Joinpoint regression analysis was utilized to examine for the presence of trend changes in DRPA. RESULTS: The monthly rate of DRPA was higher in 2010 than 2008, 2009 and 2012 (P < 0.01). Joinpoint regression analysis identified a significant downward trend change which occurred in July 2010 (95% CI Feb 2010 to April 2011). Young males aged 18 to 24 years showed evidence of greatest change, DRPA falling by 1.4% per month (95% CI 0.7 to 3.7% decline) from May 2010 to December 2012. CONCLUSIONS: Cessation of NPS sale by head shops coincided with a reversal in the upward trend of DRPA, this change being most evident in young men. While correlation does not imply causation, legislation which successfully targets the sale of NPS may result in reduced drug-related mental disorders.

"Debt on Me Head": A Qualitative Study of the Experience of Teenage Cannabis Users in Treatment.

BACKGROUND: Cannabis is the most commonly used illicit drug in most western countries. In Ireland, it now accounts for most new presentations to substance use treatment services. Cannabis use for most of these people commenced during adolescence. Although a significant amount of research has been conducted on the effects of cannabis on physical and mental health, less is known about the experiences of young cannabis users. OBJECTIVE: The aim of this study was to understand more about the experience of young, treatment-seeking, cannabis users. METHODS: This descriptive qualitative study interviewed eight adolescents who were attending outpatient treatment services for cannabis misuse in Dublin, Ireland. Data were analyzed using thematic analysis. RESULTS: Six themes were identified incorporating the early onset of cannabis and heavy use, involvement in criminality including drug dealing to pay for cannabis, ambivalence, experience of treatment, and damage to relationships. These themes are discussed in light of emerging literature. CONCLUSION: Young cannabis users in treatment can clearly identify many negative aspects of their cannabis use but are particularly ambivalent toward cannabis. Reluctance to aim for abstinence is common.

Opioid substitution treatment and heroin dependent adolescents: reductions in heroin use and treatment retention over twelve months.

BACKGROUND: Opioid dependence is a major health concern across the world and does also occur in adolescents. While opioid substitution treatment (OST) has been thoroughly evaluated in adult populations, very few studies have examined its use in adolescents. There are concerns that OST is underutilised in adolescents with heroin dependence. We sought to measure changes in drug use among adolescents receiving OST and also to examine treatment attrition during the first 12 months of this treatment. METHODS: We included all heroin dependent patients aged under 18.5 years commencing OST at one outpatient multidisciplinary adolescent addiction treatment service in Dublin, Ireland. Psycho-social needs were also addressed during treatment. Drug use was monitored by twice weekly urine drugs screens (UDS). Change in the proportion of UDS negative for heroin was examined using the Wilcoxon signed rank test. Attrition was explored via a Cox Regression multivariate analysis. RESULTS: OST was commenced by 120 patients (51% female and mean age 17.3 years). Among the 39 patients who persisted with OST until month 12, heroin abstinence was 21% (95% confidence interval [CI] = 9-36%) at month three and it was 46% (95% CI = 30-63%) at month 12. Heroin use declined significantly from baseline to month three (p < 0.001) and from month three to month 12 (p = 0.01). Use of other drugs did not change significantly. People using cocaine during month 12 were more likely to be also using heroin (p = 0.02). Unplanned exit occurred in 25% patients by 120 days. The independent predictors of attrition were having children, single parent family of origin, not being in an intimate relationship with another heroin user and evidence of cocaine use just before treatment entry. CONCLUSIONS: We found that heroin dependent adolescent patients achieved significant reductions in heroin use within three months of starting OST and this improved further after a year of treatment, about half being heroin abstinent at that stage. Patient drop out from treatment remains a challenge, as it is in adults. Cocaine use before and during treatment may be a negative prognostic factor.

A naturalistic longitudinal analysis of post-detoxification outcomes in opioid-dependent patients.

INTRODUCTION AND AIMS: To provide an assessment of outcomes in a cohort of opioid-dependent patients post-detoxification. DESIGN AND METHODS: This study employed an observational longitudinal cohort design. Patients who completed detoxification in the three major Drug Dependency Units in Ireland during a 14-month period were included in the study (n = 143). Patients opting for one of the three pathways post-detoxification (inpatient aftercare, outpatient aftercare or no formal aftercare) were assessed in the final week of detoxification and followed up after 3, 6 and 9 months. The primary outcome was abstinence following detoxification. RESULTS: A Cox (adjusted) model indicated participants who opted for outpatient aftercare treatment lapsed/relapsed at a rate of 52% higher than the inpatient aftercare group (hazard ratio = 1.52, 95% confidence interval 0.75-3.08, P = 0.24). Moreover, time to lapse/relapse was considerably shorter for the no formal aftercare group (hazard ratio = 7.68, 95% confidence interval 4.30-13.73, P = 5.75 × 10-12 ). Abstinence rates for outpatient aftercare and inpatient aftercare are about equal after 9 months. DISCUSSION AND CONCLUSION: Patients who opt for aftercare post-detoxification have significantly better outcomes at follow up when compared to no formal aftercare. In addition, patients' intention to attend aftercare affected their outcomes regardless of eventual treatment path.