The new National Drug Strategy ignores inequality and pharmacy, writes Dr Des Corrigan
RTE? News recently reported that when it searched the draft National Drug Strategy 2026-30 for the words ‘dis- advantaged’, ‘marginalised’, ‘inequality’, and ‘poverty’, it found only one mention of ‘disadvantage’ in the document.
This gave me the idea to also search the strategy for mentions of pharmacy and, surprise, surprise, I could not find any. There was a mention of the Pharmaceutical Society of Ireland (PSI) as one of the healthcare professional bodies consulted during the drafting process. There is also a paragraph detailing the growing concern about the overprescribing of controlled drugs as a critical issue affecting patient safety and public health.
In addition to the usual suspects such as the benzodiazepines, the gabapentinoids get a mention and it is pointed out
that they are currently not controlled. Strangely then, there is no recommendation or suggestion that they might be scheduled under the Misuse of Drugs Acts.
Two other areas of direct concern to pharmacists are listed under Various Proposed Actions. One (Action 2.6) reads: “Increase the availability of Naloxone and review prescription controls on it.” Action 5.5 states: “Respond to the diversion and misuse of prescribable and over-the-counter drugs.”
Both are highly laudable in their own right, but surely one might expect some mention of ways to harness the unique education and training of society’s ex- perts on drugs and medicines in order to achieve those objectives.
Is it too much to hope that representatives of the profession might make the Department aware of pharmacy’s annoyance at being written out of the Strategy in the same way that various community advocacy groups have expressed their anger at the apparent downgrading of their sector? The City- wide Project, for example, described the new Strategy as fundamentally flawed because it failed to reference the link between poverty/inequality and drug-related harms.
From my experience of chairing a Local Drug Task Force, I have no doubt that deprivation is a huge risk factor for problem drug use and any worthwhile strategy must address it and harness the energy and creativity of the community sector in doing so. Equally, and perhaps controversially, I have always felt that the link between disadvantage and drug use was somewhat overstated.
Now, I realise that I am walking on very thin ice in writing about deprivation, with my appearance of a middle-class background. But while it is true that I do not have a lived experience of poverty and inequality, both of my parents did come from backgrounds where hardship was ever-present in the Dublin of the 1920s and ‘30s.
In my father’s case, his family had to be housed in what was known as ‘The Barracks’, referring to the former Richmond Barracks in Inchicore, Dublin 8, where the most destitute were sent to live. So I do have some idea of the nature and extent of the poverty and despair endemic to Ireland prior to and after Independence and well into the 1960s.
The official statistics on child mortality, disease levels, poverty, and the number of people living in tenement slums with- out sanitation also support my feeling that deprivation was probably worse then than it is now. But despite these levels of disadvantage, there was no heroin or crack cocaine problem in slums described as the worst in Europe, largely because neither drug was readily avail- able at that time. I have no doubt that if they had been around, many would have tried them in their desperation.
So, yes, deprivation is linked to our drug problems, but so too is availability. While recognising that poverty and inequality are overwhelming risk factors for drug use and accepting that areas of socio-economic deprivation are those hardest hit by heroin and crack cocaine, I still maintain that a failure to tackle both disadvantage and drug availability weakens our collective response to this major societal issue.
Let me be clear: I believe that a caring society should seek to eradicate inequality, irrespective of whether it has drugs problems or not. But, in my opinion, even if it were possible to eliminate deprivation, we would still have substance use problems once those drugs are readily available. For example, inequality alone cannot explain the reportedly high levels of middle-class use of cocaine and ‘par- ty drugs’ such as MDMA and ketamine.
What also seems to get lost in this discourse is the role of drug use in perpetuating the very deprivation that has contributed to the problem in the first place. This is partly due to the impact of constant intoxication leading to neglect of self, of family, and of the wider community.
I am also thinking of the considerable cost of maintaining a drug habit. Where- as one can estimate the cost to society as a whole arising from drug-related criminal justice and healthcare expenditure, I am not aware of any in-depth study of the cost of personal drug use to individuals or their families
What also seems to get lost in this discourse
is the role of drug use
in perpetuating the
very deprivation that
has contributed to the problem in the first place
There is some limited information, for example, from a Ballymun Youth Action Project report a few years ago called ‘It’s Only Weed’. This looked at how cannabis use impacted on a group of early school-leavers — one of the findings that fascinated me was that these 16-to-21 year-olds were spending an average of €5,184 a year on their cannabis alone.
Given that the 2023 Healthy Ireland Survey indicated that cannabis users are significantly more likely to smoke tobacco and to drink alcohol heavily, expenditure on those three substances alone must have been a considerable drain on their overall income, especially since their only legitimate income source was the Jobseekers Allowance.
Overall, this means a considerable transfer of wealth from a disadvantaged area into the hands of Organised Crime, in turn further entrenching deprivation.
An effective Drug Strategy must tackle factors such as disadvantage that in- crease the demand for drugs, alongside actions to reduce drug availability. A Strategy that seems to facilitate access to drugs or enhance their acceptability via decriminalisation or legalisation — an approach being heavily promoted by politicians from all parties — will only make things worse. We have only to look at the harmful consequences of our legal, controlled, and highly regulated regimes for alcohol, tobacco, and benzodiazepines to realise that legalisation is not working in terms of the numbers of those addict- ed, dying prematurely, suffering chronic diseases, experiencing violence, or being involved in organised crime.
It has been my experience at both national and European level that drug strategies tend to be long on pious aspirations but short on concrete deliverables. Let us hope that the reverse is true for any Action/Implementation Plans developed for this new Strategy and that the positive role of pharmacists in both treatment and prevention receives proper recognition.
