Deep End Ireland Policy Document on Drug Services in Ireland
It has been shown in the international literature that people living in deprived circumstances have worse health outcomes and endure more complex multimorbidity than the general population. In Ireland, people from the most deprived socio-economic groups have a mortality rate twice as high as those from the most affluent groups. Alarmingly, Ireland has one of the highest drug-induced mortality rates in Europe, with 97 deaths per million inhabitants, significantly exceeding the EU average of 22.5 deaths per million.
Drug use is a daily reality in our practices. We know that substance use is more prevalent in deprived areas, and the data supports this. A 2023 study found a stark disparity in treatment access: in very and extremely disadvantaged areas, there were 293 treatment episodes per 10,000 people, compared to just 61–66 per 10,000 in areas of above-average affluence.
Accessing appropriate support for addiction is often incredibly difficult. Many of our patients turn to drugs to self-medicate. Drugs are a means to cope with distress and anxiety rooted in significant trauma. However, the severe lack of dual diagnosis services means that those struggling with both addiction and mental health issues are often left without any meaningful care pathways. Even when addiction psychiatry is available it is often confined to patients with cocaine and opiate addiction, and excludes patients with primary benzodiazepine or alcohol addiction despite the high mortality in these patients.
Patients who use drugs are frequently denied access to essential services such as community mental health teams, CIPC, and the Rape Crisis Centre—yet no alternative pathways exist for them. While voluntary sector services provide excellent addiction counselling, their geographic availability is inconsistent, leaving many without access to vital support. For those requiring psychiatric input, options are virtually non-existent, leaving Deep End GPs with few avenues to help these highly vulnerable individuals. This has contributed to avoidable deaths.
The growing prevalence of crack cocaine use has further exacerbated the crisis. Unlike heroin, which can often be managed in the community with opioid substitution therapy, crack cocaine use requires residential detox. Many of our patients who use crack cocaine also have concurrent benzodiazepine dependence, but it is impossible to address benzodiazepine addiction while they are actively using crack. The shortage of residential detox and stabilisation services leaves many with no viable treatment options, deepening their addiction and increasing associated health risks. Most Deep End GPs have experienced deaths of young people which would likely have been avoided if stabilisation beds in particular were available. There are almost no medically supervised stabilisation beds, relative to detox facilities which themselves are insufficient. Parts of the country such as Connacht not only do not have any dual diagnosis service but have no stabilisation beds either, leaving GPs without the necessary resources to provide comprehensive care for patients who use drugs.
Drug use disproportionately affects the most vulnerable members of our society. Yet many services—particularly mental health services—operate on the assumption that people must stop using drugs before they can access support. This is simply not feasible without simultaneously addressing the underlying trauma and mental health conditions driving their substance use. Such policies are inequitable, perpetuating the cycle of disadvantage for those who need help the most.
Multiple studies have demonstrated that a history of childhood trauma significantly increases the risk of drug use later in life. People with five or more adverse childhood experiences (ACEs) are 7 to 10 times more likely to report problems with illicit drug use compared to those with no ACEs. Given this strong link, it is important that trauma informed care is integrated into addiction services to support individuals with a history of trauma. To ensure equitable and effective care, trauma informed care training should be made widely available - not only to staff in HSE and voluntary sector organisations working with people who use drugs but also to all staff in GP practices, particularly in areas of deprivation.
Currently, the waiting list for trauma specific therapy, such as the National Counselling Service or One in Four, is approximately one year. Many of the most vulnerable patients are deemed too complex for these services, yet there is no dual diagnosis service available to meet their needs. Even in areas where a psychiatrist provides dual diagnosis care, there is often no access to psychological support, which is frequently the most essential component of treatment. Trauma specific therapy services must be adequately resourced to support patients with complex needs who fall outside the eligibility criteria for dual diagnosis services.
Addressing the transgenerational nature of trauma and addiction requires a strong focus on early intervention services for vulnerable families, beginning from pregnancy and early childhood. Initiatives such as the Young Ballymun programme and the new North Inner City BEAG (Bonding, Early Attachment and Growth) programme demonstrate the importance of providing structured, early support to break cycles of trauma and addiction. These programmes need to be available more widely, in all at risk areas across the country. Investing in these types of early intervention services can help prevent the development of addiction later in life and support long-term community resilience.
The impact of these systemic barriers is particularly devastating for women in addiction. A recent report by UCD and the Saol project found that “women in addiction perceive that discrimination against them by professionals and services is deserved and should be expected”. This is a damning indictment of the extent of discrimination these women face—so pervasive that they have come to expect mistreatment as inevitable. It underscores the urgent need for a compassionate, trauma-informed approach to addiction care that actively challenges and dismantles these harmful biases.
Deep End Ireland Recommendations for Improving Drug Services in Ireland
Expand dual diagnosis services to provide integrated mental health and addiction support, particularly in deprived areas. Dual diagnosis services need to also expand their remit to include all substances and alcohol.
Increase the availability of residential detox and stabilisation beds to ensure those struggling with complex addictions have a pathway to recovery.
Invest in trauma-informed care within primary care settings, including enhanced funding for services such as the National Counselling Service. These services must be equipped to manage complex dual diagnosis cases and be easily accessible within the most deprived communities. Additionally, trauma-informed care training must be provided for GP teams to ensure they are adequately prepared to support individuals with a history of trauma.
Improve access to a range of psychological therapies within areas of deprivation, including addiction counselling, pain management programs, and a variety of psychological therapies suited to different needs. Given the transgenerational nature of addiction, expanding access to family therapy should also be a priority
Formal recognition and appropriate resourcing for the critical role that GPs play in providing frontline mental health and addiction care.
Addressing drug addiction requires a compassionate, evidence-based approach that acknowledges the intersection of trauma, mental health, and substance use. Without significant investment in appropriate services, the most disadvantaged individuals in our society will continue to be left behind.