Rising incidence of ageing opioid users within the EU wide treatment demand indicator; The Irish opioid epidemic from 1996 to 2014

Gambling in Ireland: profile of treatment episodes from a national treatment reporting system

OBJECTIVES

Globally, problem gambling prevalence is estimated at between 0.1% and 5.8%. Problem gambling can have many negative consequences; including on physical, and psychological health, and social functioning. There is a need to better understand treatment uptake as only a small proportion seek treatment. This is the first Irish national study using routinely gathered health surveillance data to describe treated problem gambling. Results will inform service policy and planning.

METHODS

An analysis of episodes treated for problem gambling collected by the National Drug Treatment Reporting System was undertaken. Included were episodes entering treatment between 2008 and 2019 (n = 2999). Variables of interest included service types accessed, demographics, socioeconomic information, referral and assessment details, current problems (up to five) and treatment history.

RESULTS

The majority (93.8%) were male. One fifth (20.9%) lived with dependent children, 7.4% were homeless. There were high levels of employment (35.4%) and formal education qualifications; half (53.8%) had completed second or third level education. Problem gambling frequently co-occurred with problem use of other substances (47.3%), which was most commonly alcohol (85.6%), followed by cannabis (32.3%), cocaine (28.0%) and benzodiazepines (10.9%). The majority were treated at inpatient settings (56.1%) with many self-referrals (46.3%).

CONCLUSIONS

This study provides insights into treated problem gambling nationally. Monitoring and surveillance can play a crucial role in measuring the successful efforts and help inform planning and treatment. The findings may have implications for treatment pathways.

Opioid agonist treatment in transition: A cross-country comparison between Austria, Germany and Switzerland

BACKGROUND AND AIMS

OAT is a well developed and successful treatment strategy for opioid dependent patients in Europe. It has significantly contributed to the fight against the HIV and HCV pandemics, leading to an increased life expectancy in this population. Building on the OAT experiences in Austria, Germany, and Switzerland and their models of care, the objective of this study is to analyse experiences and changes in patient structures to identify necessary adaptations for the system of care.

METHODS

We analysed national register-based data from patients receiving OAT during the period spanning from 2010 to 2020 in Austria, Germany (cases), and Switzerland. We examined and compared OAT policies and practice at national levels through a review of literature and publicly available policy documents.

RESULTS

Across these three countries, the life expectancy of OAT patients increased substantially. The mean age increased from 33.0 in 2010 to 39.1 in 2020 in Austria, from 35.6 years to 41.5 years in Germany (cases), and from 39.6 to 47.1 in Switzerland, respectively. In all three countries, the percentage of patients/cases aged 60 years and older increased more than tenfold between 2010 and 2020.

CONCLUSIONS

Integrated support models, reliable care structures, internationally comparable high treatment coverage, flexible prescribing practices, and a wide range of available OAT medications are successful strategies. The experiences in these countries indicate that it is possible to address the complex and chronic nature of opioid dependence and its concurrent mental and physical health challenges, resulting in an increasing life expectancy of OAT patients.

Cause-Specific Mortality among Patients in Treatment for Opioid Use Disorder in Multiple Settings: A Prospective Comparative Cohort Study

INTRODUCTION

Among people receiving current or previous opioid maintenance treatment (OMT), the leading cause of premature death is an opioid overdose. However, other causes of mortality remain high in this group. An understanding of causes of deaths across multiple settings can be useful in informing more comprehensive prevention responses. The aim of this study was to describe all non-overdose causes of death in three national cohorts (Czechia, Denmark, and Norway) among OMT patients and to explore associations of non-overdose mortality with age and gender.

METHODS

This prospective comparative cohort study used national mortality registry databases for OMT patients from Czechia (2000-2019), Denmark (2000-2018), and Norway (2010-2019). Crude mortality rates and age-standardized mortality rates (ASMRs) were calculated as deaths per 1,000 person years for cause-specific mortality.

RESULTS

In total, 29,486 patients were included, with 5,322 deaths recorded (18%). We found variations in causes of death among the cohorts and within gender and age groups. The leading non-overdose causes of death were accidents in Czechia and Denmark, and neoplasms in Norway. Cardiovascular deaths were highest in Czechia, particularly for women in OMT (ASMR 3.59 vs. 1.24 in Norway and 1.87 in Denmark).

CONCLUSION

This study found high rates of preventable death among both genders and all age groups. Different demographic structures, variations in risk exposure, as well as variations in coding practices can explain the differences. The findings support increased efforts towards screening and preventative health initiatives among OMT patients specific to the demographic characteristics in different settings.

The role of substance use in the lives of incarcerated older adults: A qualitative study

Background

The prevalence of drug abuse among older adults has grown over the last decade. Despite the expanding development of a body of research dedicated to studying this phenomenon, drug abuse by incarcerated older adults has been marginalized. Thus, the aim of the present study was to explore drug abuse patterns in the lives of incarcerated older adults.

Method

Semi-structured interviews were conducted with 28 incarcerated older adults, and an interpretive analysis was used to analyze the participants’ narratives.

Findings

Four themes emerged: (1) Growing up around drugs; (2) Prison onset; (3) Professionals, and (4) Lifelong substance abuse.

Conclusion

The study findings reveal a unique typology of drug-related themes in the lives of incarcerated older adults. This typology sheds light on the interplay between aging, drug use, and incarceration and the way these three socially marginalized positions may intersect.

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.

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.