THE NUMBER OF drug poisoning deaths – commonly known as overdoses – has risen in recent years, the Citizens’ Assembly on Drugs Use heard this morning, with chairperson and former HSE CEO Paul Reid describing the findings as “quite grim and quite stark”. 

The Citizens’ Assembly heard from a panel of expert speakers this morning who presented statistics, suggestions and policy examples from other countries in relation to the impact of drugs on people’s health, and about the benefits of an integrated, health-led approach to drug policy.  

The assembly heard first from Dr Suzi Lyons of the Health Research Board (HRB), the government’s main funding agency for health research, who outlined the key figures when it comes to drug-related deaths in Ireland in recent years, with particular reference to 2020.  

Her presentation showed that the number of poisoning deaths (excluding those attributable to alcohol alone) rose that year and that the vast majority of them involved more than one drug. 

Lyons said that since 2017 there has been a “sustained increase” in poisoning deaths, which is not attributable to factors such as population growth. The figures were compiled as part of the National Drug-Related Deaths Index (NDRDI). 

In total, there were 409 poisoning deaths in 2020 and 8 in 10 of them involved a mix, or cocktail, of different drugs. There were also 397 non-poisoning drug-related deaths, with hanging and cardiac events being the most common causes and cannabis and cocaine being the most common drugs in the deceased person’s system.  

“Using more than one drug increases a person’s risk of overdose and makes them more likely to succumb to a poisoning death,” said Lyons. “In 2020, there was an average of four different drugs implicated in each poisoning death.”

Among the key findings in Lyons’ report were that 7 out of 10 poisoning deaths involved opioids, with methadone, a replacement drug for people trying to get off heroin, implicated in 3 in 10 of those deaths. Heroin accounted for 2 in 10 poisoning cases. 

Opioids, as a number of panellists explained, are so common in poisoning deaths because they affect the part of the brain that controls breathing. 

However, Lyons and others expressed concern that cocaine and cannabis were on the rise as problem drugs for which people seek treatment, with heroin in particular on the decline in that respect.

Lyons also said that there had been a more than fourfold increase in cocaine-related deaths since 2011. 

The Journal recently reported that cocaine has become Ireland’s most common problem drug. 

“If more people are using cocaine in the general population, we can’t be surprised to see them appearing in poisoning deaths,” she said. 

Additionally, almost 6 in 10 poisoning deaths involved benzodiazepines, sedatives such as valium or Xanax. 3 in 10 involved cocaine, 2 in 20 involved alcohol (as part of a mixture of substances) and almost 6 in 10 involved prescription drugs, most often antidepressants and antiepileptics, which are used to treat people who suffer seizures. 

In demographic terms, the majority of those who died from poisoning in 2020 were male (6 in 10), although Lyons did say that the number of women had increased. More than half of men were under the age of 42 and more than half of women were under the age of 45. 

Half of those who died from drug poisoning had a history of mental health issues, according to the NDRDI research.  

When it comes to the circumstances in which people died from drug poisoning, 1 in 8 were homeless, 1 in 5 had injected drugs before and in 40% of cases the person died alone, which Lyons said represented “a missed opportunity for prevention”. 

“There was no one there to call 999 or 112. There was no one there, for example, to administer naloxone, which is a reversal agent for opioids.” 

Those who died while in homeless accommodation made up 11% while 9% died in a public place or building. 

“If ever we needed a wake-up call, I think that information is compelling,” said Reid following Lyons’ presentation.  

Department of Health suggestions

Jim Walsh of the Department of Health gave a brief overview of a list of suggestions his department would like the assembly to adopt. Among the recommendations Walsh made was the implementation of a rights-based approach that centres around the right to health and children’s right to protection. 

He also recommended involving people with lived experience in the process, making prevention a key point in dealing with drug problems, more alignment of services to get away from the “patchwork quilt” that is currently in place, specific services for women among others. 

He also said that people found in possession of drugs should be diverted to the health system rather than the criminal justice system, a common theme throughout the meeting which did not have decriminalisation on its agenda today but nevertheless found the topic coming up repeatedly. 

Finally, he added that in order to target a reduction in drug-related deaths, “we need to make this a policy priority”. 

Outside perspective

The Assembly also heard from Nuno Capaz of the Portuguese Ministry of Health’s Drug Dissuasion Commission, who described Portugal’s transition from a criminal justice oriented approach towards drug use to a health-led approach that included decriminalisation and investment in treatment services.  

Alfred Uhl, an addiction treatment expert from Austria also presented the history of his country’s treatment-led approach to tackling the harms of drug use. 

Both speakers pointed to the depoliticisation of the issue as a necessary step in making positive, fact-based and scientific changes to the ways their societies approach the issue. 

“Keep it out of the media and out of politics,” said Uhl. He recommended that the Assembly take the issue out of the hands of populist politics.

Capaz similarly suggested that the Assembly get an assurance from political leaders from across the spectrum to follow expert advice and not let it be used as a political issue, but instead a health one. 

Capaz also added that a judicial approach, involving the court system, “is trying to win a war that is not winnable”. 

A health-led approach, he said, accepts that “there will never be a drug-free society,” something he said has never existed anyway.

Courts “disconnect people from society” while the Portuguese system now attempts to connect people who have drug problems with structures and institutions that can offer them help, he explained. 

Similarly, Austria’s ‘treatment instead of punishment’ philosophy, which has been in place since 1971, has led to positive results, according to Uhl. He also said that such a system would still involve “good cooperation with police”.