New report highlights challenges in street tablet use

April 28, 2020

A report published by Ana Liffey Drug Project today highlights the increase in use and availability of street tablets and an increase in the number of deaths and non-fatal overdoses involving benzodiazepines and other prescribable drugs in recent years in Ireland. It also notes changes in drugs markets, with purchasing online bringing significant regulatory challenges.

The report, ‘Street tablet use in Ireland: A Trendspotter study on use, markets, and harms’, is the result of a collaboration between Ana Liffey Drug Project, the School of Public Health at University College Cork (UCC), the Health Research Board (HRB) and the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) and utilised the EMCDDA’s Trendspotter methodology, drawing on the knowledge of an expert group to provide insights into the street tablet market in Ireland.
Street tablets are prescribable medications in tablet or capsule form which are not obtained from a medical professional and include benzodiazepines, z-drugs and gabapentinoids, three classes of drugs which are routinely used to treat conditions like insomnia, anxiety and neuropathic pain, but which also have a significant potential for misuse.

Tony Duffin, CEO of Ana Liffey Drug Project and one of the report’s authors states:

“Street tablet use is a serious issue for people who use our services, and for people in Ireland generally. For many individuals, they are a cheap, effective and accessible way to self-medicate for how they are feeling and to help them deal with the trauma they have experienced. Perhaps there is also a familiarity with these drugs as they are widely and legitimately used in the healthcare system. Unfortunately, street tablets often come from unregulated sources and you simply cannot tell what’s in them, even if they appear to be in a genuine pharmaceutical blister pack. This is also true for ‘online pharmacies’ which allow purchases without prescription. Remember – unless you get your medications from a doctor or pharmacist you can’t be sure what’s in them.”

The report highlights an increase in the number of non-fatal self-poisoning cases involving benzodiazepines and antiepileptic and sedative-hypnotic drugs between 2015 and 2018 as well as an overall increase in the number of deaths involving alprazolam, zopiclone, and pregabalin as being indicative of the potential serious adverse health consequences of misusing these drugs. It also notes that the landscape of how people access the drug market is changing, with purchasing online bringing significant regulatory challenges.

This landscape presents a number of challenges for policy-makers and practitioners seeking to reduce harms resulting from the street tablet market. For instance, attempts to simply prevent or restrict access poses particular challenges in a market of many small individual level transactions, many of which can involve suppliers based outside the state. Blanket control attempts can have unintended consequences; for example, the imposition of enhanced controls on one category of drug can create an incentive for suppliers to switch to other drugs which are not controlled. Equally, attempts to extinguish the market at a local level through enhanced enforcement can result in other policy challenges as confiscated drugs and money create debts which market actors seek to collect through intimidation of people who use drugs or their families.

This was the first time that an NGO, an academic institution, a national drugs focal point and the EMCDDA collaborated on a study like this in Europe, and work like this may help better inform policy choices. As Paul Griffiths, EMCDDA Scientific Director notes:

“Trendspotter studies are very helpful. They can help us better understand a particularly challenging issue in a timely manner, such that policy makers can have good insights to help in formulating responses. On this occasion, we are very pleased that we were able to work with a civil society organisation and with the national focal point in Ireland to support them in this work – local insights are critical in solid policy formation, and many thanks to the Health Research Board and Ana Liffey Drug Project for bringing this work forward”

The authors make a number of recommendations for policy makers to consider, noting that ‘[t]he reality is that drug markets are not going away – policy-makers can intervene in strategic ways but cannot control illicit markets. In considering interventions, it is important to think systemically, rather than focusing on one discrete area in isolation.’

Dr Austin O’Carroll, an expert participant in the Trendspotter study, is currently the Clinical Lead for Homeless COVID-19 Response in the Dublin Region. Dr O’Carroll noted:

“I welcome the publication of the report at this time. As a General Practitioner that specialises in working with people who are homeless, I have seen the harm caused by street tablet use amongst this cohort increase in recent years. I have known many patients to take many multiples of blister packs of street tablets in a day, far in excess of any therapeutic dose. We need to think differently about how we respond to this problem. During the COVID-19 emergency I have learned that crisis is the mother of innovation, and we are managing to work differently with this cohort. Looking ahead, to when the COVID-19 crisis passes, we need to bring this ‘can-do’ attitude to addiction treatment generally, ensuring that people are not punished for their own personal drug use, but are supported to access services that are individualized for them.”

Download the report ‘Street tablet use in Ireland – A Trendspotter study on use, markets, and harms’ here

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