Irish people now take a combination of legal and illegal drugs - the drugs problem is no longer focused on heroin in Dublin, writes Dr Joe Barry.
The desire to take mind- altering substances is part of the human condition in practically all societies, and previous studies place Ireland near the top of the league for consumption of many substances.
Most drugs are illegal, such as heroin, cocaine, amphetamines and ecstasy, and others are legal but regulated to varying degrees, such as alcohol and prescription drugs e.g. tranquillisers and anti-depressants. Heroin causes dependence and is illegal; alcohol causes dependence in many cases but is legal; whereas ecstasy does not cause dependence but is illegal.
The drug issue arouses strong feelings. This is understandable as the level of drug consumption has been rising in Ireland over the past two decades. For that time, Ireland's drug policy has been concentrated on heroin in Dublin.
However, the use of heroin is now becoming more common outside of Dublin, and evidence from treatment services, voluntary agencies and community groups around Ireland suggests the use of other drugs, including alcohol, is on the increase.
Yesterday's publication on local patterns of drug consumption in Ireland north and south, is the first simultaneous population-based study at local level. Under the National Drug Strategy in the Republic, 10 regional drugs task forces have been set up to determine the level of drug use in their area and identify gaps in services.
In Northern Ireland, a review of drug and alcohol services is due to begin and the data in this report will detail activities in both parts of the island.
There are important NorthSouth differences in these new figures. Whereas illicit drug use is marginally higher in the North than in the Republic, alcohol use is considerably higher in the Republic. Tranquilliser and sedative use rates in the North are about twice those in the Republic. This suggests the prescribing patterns of these drugs in the North need to be addressed.
If one looks at the regional breakdown of sedative use in Northern Ireland, it is almost equal across the four health regions whereas in the Republic, there is a wide range; by far the lowest usage of these substances is in the North Eastern Health Board area. It would be worth examining why this has happened and trying to replicate it across the rest of the country.
A feature of drug use in 21st century Ireland is that most drug users will take a cocktail of drugs. A recent study of people who had died from heroin overdose showed that many had consumed alcohol and tranquillisers as well.
In Northern Ireland, alcohol and drugs services are being reviewed together, and this is a common practice in many countries, but not to date in the Republic. However, the alcohol figures in this report show rates of 'ever use', recent use and current use being substantially higher in the 10 health board regions of the Republic.
Within each jurisdiction, alcohol use is marginally higher in the areas of population density. However, these higher rates in urban areas are only marginal and rates are generally high in all 14 health board areas on the island.
Overall rates for illicit drug use are similar in both parts of the island; 19 per cent, 5.6 per cent and 3 per cent for ever, recent and current in the Republic and 20.4 per cent, 6.2 per cent and 3.3 per cent in the North. In each jurisdiction, rates are higher in health boards with large cities.
There are messages in relation to the impact of legislation and regulation in these figures. The current legal situation in Ireland has resulted in about one in five citizens aged 15-64 ever experimenting with illegal drugs, with current usage rates of about one in every 30 people. The most commonly used illegal drug is cannabis and this is probably a function of supply. Cocaine use is much higher in the Republic than in the North, which again is probably a function of supply.
The alcohol figures are high. There is a consensus among those in the public services and treatment and support agencies that rates should be reduced. In the short term, this can only be done through better regulation.
As sedatives and tranquillisers are not illegal, they don't tend to be the focus of much public debate. However, they contribute substantially to health problems and are often used in combination with illicit drugs. Some of these cocktails can be lethal. Tranquilliser use is more common in older people and women whereas all other substances are most commonly used by young men.
Particularly in the Republic, these figures will be of great benefit to the regional drugs task forces in their attempts to provide a regionally based response to problematic drug use. The publication of the report is also timely at a national level in the Republic as the mid-term review of the National Drug Strategy is due to take place this year.
Dr Joe Barry is a specialist in public health medicine with the Eastern Regional Health Authority and a senior Public Health lecturer in the Department of Public Health and Primary Care, TCD. He is medical adviser to the National Drugs Strategy Team and a member of the National Advisory Committee on Drugs.