'Young people and rural areas let down by lack of drug treatment and prevention services'
Rural areas, young people, and marginalised groups are reported as being 'disproportionately affected' by service discrepancies.
Meanwhile, the review found that annual funding arrangements and restrictive hiring policies have contributed to staff shortages and disruptions in service delivery.
The national drug strategy (NDS) is set out as a national framework for addressing substance use through a 'whole-of-Government, person-centred, and health-led' approach that primarily frames substance use as a public health issue.
An independent review of the strategy, published on Monday, has found that several stakeholders also believe prevention efforts are underdeveloped, inconsistent, and lacking national ownership.
The report, compiled by Grant Thornton, notes some progress and achievements, but makes 10 recommendations for the future direction of the strategy.
The 10 strategic recommendations
Improve the right to health for people who use drugs, providing culturally-sensitive and appropriate services for all groups.
Increase community engagement and involvement from people who use these services, ensuring that they are central to policy-making and service design.
Align service delivery with regional priorities, working with Health Regions to ensure that the implementation of a future drugs strategy and allocation of resources are appropriate to the local population needs.
Maintain and strengthen coordination and communication between the oversight structures of the National Drugs Strategy.
Establish mechanisms for interdepartmental collaboration, reflecting the need for systemic alignment across housing, justice and health sectors.
Continue to strengthen alternatives to coercive sanctions for those found in possession of drugs for personal use, such as the Health Diversion Scheme and community liaison roles.
Ensure equitable access to peer-led recovery services and develop national standards for recovery pathways.
Strengthen prevention and early intervention initiatives across sectors.
Strengthen the integration of alcohol within the national drugs strategy, rolling out integrated treatment services to enhance service delivery.
Invest in monitoring, evaluation and research systems to support evidence-based policy and accountability.
The authors consulted with the HSE, the health research board, members of the national oversight committee and strategic implementation groups for the NDS, as well as service users and family members with experience of drug use.
Based on those engagements, it found that equity of access continues to be a concern, particularly for marginalised groups.
Prevention and early intervention efforts were found to be fragmented and inconsistently delivered, while recovery and service-user involvement requires further formalisation and resourcing.
Additionally, the limited integration of alcohol policy and the 'gradual implementation of legal reforms', such as alternative sanctions, were identified as requiring strategic refinement.
Governance structures
Meanwhile, governance structures were found to lack clearly defined roles, mandates, and accountability mechanisms.
Stakeholders highlighted the need for strong national leadership, enhanced co-ordination across departments, and more inclusive decision-making processes that incorporate lived experience of service users.
There were also calls for enhanced data integration and the establishment of a national research and evaluation centre. The report also details claims of inconsistent reporting from all treatment providers, which is further constraining the ability to assess the strategy's effectiveness.
Stakeholders reported that high attrition rates have been observed in different regions due to factors that include limited funding.
Multi-annual funding
There were repeated calls by some stakeholders for multi-annual funding commitments and targeted workforce investment to support more consistent and sustainable service provision.
Prevention efforts were widely viewed as 'under-resourced and lacking strategic focus'.
There was an emphasis on the need for early, community-based interventions that address root causes such as trauma, poverty, and social disadvantage.
Evidence shows that early-life experiences significantly influence later substance use. The social, personal, and health education programme in schools was repeatedly cited for its inconsistent delivery.
Alcohol addiction
Many stakeholders also felt that the NDS lacked clarity and strategic direction regarding alcohol addiction.
Health minister Jennifer Carroll MacNeill said it is 'essential' to assess how the more than €300 million in annual public expenditure on drugs delivers impact. She said:
The establishment of new HSE health regions presents a valuable opportunity to tailor drug treatment services to population needs and to ensure that both existing and new funding is allocated effectively and transparently.
Meanwhile, the minister of State with responsibility for the National Drugs Strategy, Jennifer Murnane O'Connor, said: 'We have made significant progress in implementing the national drugs strategy, and I'm pleased that the independent evaluation documents the many achievements over the last eight years.'
She added: 'The recommendations from the independent evaluation will inform the development of the successor National Drugs Strategy.
"We need to move forward with new policies and better services to address the ever-changing drugs situation.'
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