Problematic use of opioids like heroin three times higher in Dublin than rest of country

Seán McCárthaigh

The proportion of people with problematic use of opioids like heroin is three times higher in Dublin than the rest of Ireland, according to the findings of a new study.

Research on the prevalence of problematic opioid use carried out by the Health Research Board and University College Cork estimated there were approximately 19,460 people nationwide at risk of harm from their use of opioids in 2022.

It represents 5.8 per 1,000 population nationally affected by such drugs, which include morphine, methadone, fentanyl, codeine and tramadol.

The HRB report said the estimate is high compared with the results of comparable international studies which suggests the rates of problematic opioid use in Ireland are among the highest in Europe.

It calculated that Ireland has the 6th highest rate among EU countries behind Denmark, Finland, Italy, Latvia and Portugal.

More than two-thirds of all those affected in the Republic are males, while more than three-quarters are in the older age-group of 35-64-year-olds.

The study found that more than half of all individuals addicted to opioids – 53% of the total – are based in Dublin.

It calculated the prevalence rate of problematic opioid use in Dublin city and county at 11.2 per 1,000 population – more than three times the rate of the rest of Ireland at 3.5 per 1,000 population.

The problem is particularly acute in Dublin city, where the rate is just over 17.0 per 1,000 population.

Outside Dublin, the highest prevalence rates are found in other cities and the midlands, including Limeric,k where problematic opioid use affects 13.7 per 1,000 population.

The rate for Cork is 5.6 per 1,000 population, Galway (4.8) and Waterford (7.5).

Overall, there has been a slight decrease in the number of problematic opioid users between 2020 and 2022, although the reduction is not considered statistically significant.

However, the report said it was notable that the prevalence of problematic opioid use among 15-24-year-olds appears to be decreasing.

Researchers found that a third of all people accessing drug treatment services in the Republic in 2022 were treated for problematic opioid use, with heroin accounting for almost 9 out of every 10 such cases.

The study noted that while synthetic opioids like methadone and fentanyl are used less often than heroin, their misuse may be on the rise.

However, the proportion of people accessing drug treatment services who reported opioids as their main problem has fallen from 47.8 per cent in 2015 to 33.1 per cent in 2022.

The HRB report said measuring the prevalence of problematic opioid use is challenging because of the “hidden” population of at-risk drug users, which can include homeless persons and individuals who may have no contact with service providers.

It was observed that the overall picture in relation to problematic opioid use over the past decade appeared to be relatively stable.

The authors of the study said changes in drug use behaviours are evident with users starting opioid use later in life, reducing injection practices, using opioids less frequently and seeking treatment at later stages.

They added: “Heroin is the primary opioid misused in Ireland, but qualitative research in Dublin indicates that many young people now view heroin extremely negatively. Furthermore, even among adolescents engaged in extensive polydrug use, a significant number avoid heroin.”

“Ongoing research in this area will be crucial for effective service planning and to allow policy-makers to evaluate the impact of strategies aimed at reducing drug-related harms,” they observed.

The report noted that similar trends across Europe suggested younger people may be wary of opioid use after witnessing its harmful effects on previous generations.

However, it stated it was important to consider other findings, which showed a notable increase in the use of stimulant-type drugs like cocaine and ecstasy by young people that indicated a shift towards more accessible and inexpensive drugs that are perceived to be less harmful.