New members of Alcoholics Anonymous introduce themselves by their name and their admission of addiction. We all get the idea behind it: in order to address a problem, it is first necessary to recognise it. And though I don’t want to rain on anyone’s Christmas party, Ireland has a drug problem.
Last week, the Health Research Board (HRB) published a report on Drug Related Deaths over the last decade. It appears there has been quite a shift in drug-related deaths from 2008-2017. And it is fair to say that deaths represent the thin end of the wedge. It is probably not just a shift in drug-related deaths. Overall drug usage has also risen.
Taxpayers’ money is used to fund health research of this kind. Needless to say, I think it is worth the expense if we use the information to inform health and social policy. But this report has drawn limited comment. It is in danger of being ignored.
We rightly worry about making our roads safe. Tackling driving under the influence has been one element of the challenge of reducing road deaths: in 2018 there were 142 fatalities on Irish roads, in 2017 there were 156, in 2016 , 187. And we have done even better if you look back further – in 1998 there were 458 road deaths.
These figures offer an interesting comparison to drug-related deaths. In 2017 there were 786 drug-related deaths, rising from 772 in 2016. The rise has been year-on-year in since 2008, when there were 630 deaths. Drug-related deaths, compared to road deaths, are a larger problem and continue to rise.
So what does the HRB research tell us? Over the last decade, approximately 350-400 people lost their lives as result of the toxic effects of drugs in Ireland. In at least half of these cases more than one drug was involved, while in about one third, alcohol was implicated. The number of deaths due to illicit drug use has also increased from 2016-2017. This increase was due to cocaine, ecstasy and heroin use. Importantly, prescribed drugs are implicated in two-thirds of all deaths. As they are prescribed, it is possible that a serious proportion of these cases were known to health professionals.
That said, the clearest increase in deaths and the basis for much of the overall increase in drug-related deaths is the rise in deaths that are not linked to poisoning by the drug per se. These deaths have risen a staggering 69 per cent in 10 years, from 243 in 2008 to 410 per annum in 2018.
The two largest causes of death in this category are those due to medical causes, for example cardiac events (56 deaths, or 14 per cent of the total) and deaths due to traumatic cases, such as hanging (114 deaths, or 25 per cent of the total). We know a significant portion of this latter group of people have also had contact with health professionals prior to their death.
Another known factor is the changing age profile of the deceased. The median age of the deceased has risen over the last 10 years. The age of death has risen from 38 to 43 years of age in those affected by overdose, from 41 to 49 years for medical deaths and from 28 to 35 years for trauma deaths.
From this we can see the changing norms around drug use. Psychologists use the concept of social norms to articulate the idea that we have shared ideas about behaviour. Norms have two dimensions. The first relates to how often any particular behaviour occurs. The data the HRB presents is clear.
The last decade has seen a change in use and misuse of drugs. Many of us have memories of drugs circulating in a college bar and so we typify recreational drug use as a high-risk activity young people should avoid, but may occasionally engage with. The HRB report shows us this is a fallacy. Young and old are represented in drug misuse statistics. The longer people sustain drug misuse, the more likely they are to die because of that misuse.
The second dimension of norms is linked to wider social approval of a behaviour. Misuse of drugs is something that is too often seen as occurring on the margins of society, in shadowy places. But we can see from this report and others that those misusing drugs are often known to health professionals and often interact with them in the days prior to their death. Their ultimate undoing could have arisen from a prescription having been filled.
Drug misuse and addiction is a very real problem in Ireland. The AA approach tells us that our first step is to recognise this. We have the HRB to thank for holding up the mirror.
Orla Muldoon is professor of psychology at University of Limerick