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.

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.

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

BACKGROUND: Literature identifies older people who use opioids as a neglected population. Little is known about temporal changes, or about treatment demand among this population. METHODS: The EU Treatment Demand Indicator (TDI) for Ireland (1996-2014) was analyzed for trends in new opioid treatment admissions, ageing and drug using behaviors. A Joinpoint analysis was conducted. RESULTS: Data from 18,692 individuals entering treatment for the first time showed that while the trend of age-adjusted incidence declined between 1996 and 2014, incidence among older age groups increased, with a rising incidence not previously observed among those aged 50 years and older. Subgroups of early and late treatment entries, and early and late opioid onset were observed. The median age commencing opioid use increased by three years from 18 to 21 years (U = 326141.5, p < 0.001). The median age entering treatment increased by 11 years (from age 20 to age 31) (U = 145465.5, p < 0.001). The median opioid-using duration prior to treatment increased by 5 years (from 2 to 7 years) (U = 170807.5, p < 0.001). Half of the individuals started injecting within one year of first using opioids. The median time between first injecting and commencing treatment increased by 6 years for men and 2 years for women. CONCLUSIONS: The study utilizes European TDI data and finds that those entering treatment in Ireland is older, are injecting longer and are taking longer to enter treatment. These findings highlight how TDI data can be used to identify hidden groups at risk of chronic harm which may require prioritizing in policy and practice.

Treatment for opioid use and outcomes in older adults: a systematic literature review.

BACKGROUND: Historically, issues relating to problem substance use among older people have received little attention, and have only recently been recognised. METHODS: A literature review of relevant material was conducted in November 2015 to assess current outcome research among older adults treated for opioid dependence. Multiple electronic databases were searched and results were supplemented by grey literature, library and online searches, and relevant references within selected articles. Retrieved articles were assessed for relevance against the inclusion and exclusion criteria. Results were reviewed to identify major findings and recommendations. RESULTS: A total of 76 titles were included in the review. Most research conducted on older adults involves alcohol and prescription medications. Older drug users are growing in number and have a unique profile, with many presenting for treatment for the first time aged 50-70 years. Findings reveal (1) opioid treatment numbers are decreasing, however the average age of treatment admissions is increasing, (2) there is no consensus on what old is (3) two distinct types of older opioid substance users exist (early/late onset), (4) older clients achieve better treatment outcomes than younger counterparts, and (5) older women achieve better treatment outcomes than men. CONCLUSIONS: Findings suggest that little is known about treatment outcomes among older people. Problematic drug use (of which opioids make up the largest proportion) had been incorrectly assumed to end as patients age. Defining an age limit for 'older' is important. Addiction and healthcare services must anticipate and prepare for increased demand by this group.

Incidence of hepatitis C among people who inject drugs in Ireland.

BACKGROUND: Comprehensive information on the incidence and duration of hepatitis C virus (HCV) infection for people who inject drugs (PWID) in Ireland is not available. We created an incidence curve of injecting drug use in Ireland and subsequently estimated incidence of hepatitis C virus (HCV) infection. METHODS: Anonymised data from the National Drug Treatment Reporting System (NDTRS) were used to identify all people who inject drugs (PWIDs) and who entered drug treatment for the first time between 1991 and 2014. A curve, estimating the incidence of injecting, was created to plot PWIDs by year of commencing injecting. The curve was adjusted for missing data on PWIDs in treatment and for PWIDs who were never treated. An adjustment was made to account for injectors who had never shared injecting equipment. The incidence of HCV infection and chronic infection in PWIDs was estimated by applying published rates. RESULTS: Between 1991 and 2014, 14,320 injectors were registered on NDTRS. The majority were young (median age 25 years), male (74%), lived in Dublin (73%) and injected an opiate (e.g. heroin) (94%). The estimated total number of injectors up to the end of 2014 was 16,382. An estimated 12,423 (95% CI 10,799-13,161) were infected with HCV, and 9,317 (95% CI 8,022-9,996) became chronically infected. The estimated annual number of new HCV infections among PWIDs increased steeply from the late 1970s and peaked in 1998. By 2014, almost 30% of injectors were estimated to have been infected for over 20 years. CONCLUSIONS: This is the first comprehensive national estimate of the incidence of HCV in PWIDs in Ireland and will inform planning and developing appropriate health care services.

Travellers accessing addiction services in Ireland (2007 to 2010): analysis of routine surveillance data.

By accessing addiction treatment services recorded in routine national drug treatment data, the characteristics of Irish Travellers were analyzed to understand their needs and develop policies to tackle issues faced by this community. The number of Traveller cases accessing services increased by 163% between 2007 and 2010. Alcohol and opiates were the most common problem substances reported. Traveller women reported high rates of problem opiate use and risky injecting behaviors, contrary to the perception that problem substance use is a predominantly male issue. This presents a challenge to services to provide targeted, effective services to Travellers with problem substance use.