Why does Northern Ireland have one of the highest rates of drug-related deaths in Europe?

The figures were stark, but came as no surprise.

The grim reality – as outlined in a report published last week by Queen’s University Belfast – is that Northern Ireland has one of the highest rates of drug-related deaths in Europe, more than five times the EU average; the number of deaths due to the misuse of illicit drugs has almost trebled in 10 years.

“Unfortunately, it didn’t come as a huge shock, which tells its own story,” says Tommy Canning, head of treatment at Northlands Addiction Treatment Centre in Derry.

“We know that over the past 10 years, the rate of people dying from both alcohol use and drug use has been constantly increasing.”

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According to the report, young people are the worst affected; not only are there more drug-related deaths among those aged 25-34 than any other age group, but the number has risen “significantly”, from 13.4 per 100,000 in 2011 to 27 per 100,000 in 2021.

It is likely that we will see an increase in overdoses and drug-related deaths across all age groups

—   Drug Overdoses and Drug Related Deaths in NI report

Ambulance personnel in the North are called to about 2,000 overdoses per quarter; in 2021-22, the emergency services saw 466 people aged 10-19 with an overdose, and the highest number of hospital admissions due to overdoses was in that age group.

According to the report, Drug Overdoses and Drug Related Deaths in NI, the rate of deaths in Northern Ireland stands at 11.5 per 100,000 of population, compared with 1.8 per 100,000 in the EU.

For the first time, researchers compared a decade’s worth of data from multiple sources – including the Northern Ireland Statistics and Research Agency (Nisra), the emergency services and health trusts – in order to provide an evidence base to inform efforts to tackle the problem.

It is, says Anne Campbell, professor of substance use at Queen’s and the report’s lead author, “the foundation for our next steps, but they will be stymied by the fact that there is no resourcing, there’s no money”.

The report’s warning was clear: “If this trajectory continues, it is likely that we will see an increase in overdoses and drug-related deaths across all age groups.”

“That’s what the research is telling us,” says Canning. “I don’t see anything coming down the track that’s going to reduce the amount of consumption, reduce the amount of availability, reduce the amount of people using.”

Why is there such a problem in Northern Ireland? Part of it is undoubtedly the legacy of the Troubles, and the ongoing impact of intergenerational trauma, especially when combined with the effects of socio-economic deprivation.

A 2022 report by Nisra found that the most deprived 20 per cent of areas in Northern Ireland had the highest rate of drug-related deaths, and people living in those areas were “almost five times more likely to die from a drug-related death than those in the least deprived areas”.

These factors have also contributed to a crisis in mental health – which worsened as a result of the Covid-19 pandemic – and have been exacerbated by the cost-of-living crisis, says Campbell.

“In areas of social-economic disadvantage we see those problems just spiral out of control.”

Post-conflict, she says, the nature of the drug market in Northern Ireland changed; previously controlled by paramilitaries, international gangs moved in. “That’s when we saw our heroin start to increase.”

Canning describes it as “a change in the landscape” – an increase in the sheer amount of drugs being used, the access to them – and he cites the growth in illicit prescription drugs bought online and an increase in the nature and composition of drugs, with synthetic opioids and the mixing of multiple drugs also on the rise.

“Maybe 10, 15 years ago, people were just taking one drug like heroin, injecting heroin, that was it. Now the cocktail of drugs is just phenomenal,” says Campbell; in this, she says, greater collaboration and sharing of expertise with cross-Border colleagues would be beneficial.

Canning also points to societal attitudes, another legacy of the Troubles; the report noted that the substance most implicated in emergency admissions to hospital in 2017-2022 was paracetamol, and Northern Ireland prescribes more diazepam than anywhere else in the UK, and 3½ times as much as England.

“We are a big prescribing society,” he says. “We do seem to have an unhealthy relationship with all types of substances, in terms of taking them to make ourselves feel better.

“We’re feeling something, so let’s take something, whether that’s paracetamol, diazepam, whether that’s illegal drugs, whether that’s alcohol – that’s a prime example.

“That is part of our psyche, and I think some of that does come from our relationship with alcohol but also from our way of dealing with the trauma that was going on here for so long.”

All of this, says Campbell, results in “more complex presentations”. In 2021, 10,000 young people were referred to drug treatment services in Northern Ireland, and staff were seeing “mental health problems, trauma, adverse childhood experiences, family breakdown; it was the complexity of the problems that people were reporting on, rather than the size or the numbers”.

The simple fact is that no Assembly equals no allocation of resources

—  Tommy Canning, Northlands Addiction Treatment Centre

It is all exacerbated by the crisis facing the North’s health service, which is struggling with spiralling waiting lists, long-term underinvestment and a need for reform.

A total of 218 people died of drug-related causes in Northern Ireland in 2020, and 213 in 2021. “The prevention of each of these deaths is possible,” the report concluded, “making it essential for the Department of Health, the Northern Ireland Executive and society to prioritise this issue.”

But as the Stormont stalemate which has left the North without a fully functioning government – and without ministers to make decisions – drags on, there is little hope that this will happen, nor that the necessary funding can be provided given the multimillion pound “black hole” in its finances.

The most recent, 10-year strategic framework to tackle the harm from substance abuse in Northern Ireland, published in 2021, noted that the Department of Health had invested about £16 million (€18.3 million) a year in the delivery of the previous strategy, and estimated it would need “in excess of £6 million per annum of additional expenditure” in order to achieve its outcomes.

“It’s quite straightforward, we don’t have the resources or the funding that should have been made available as a result of the substance abuse strategy. We have nothing to spend,” says Campbell. “At the moment, the simple fact is that no Assembly equals no allocation of resources.”

At Northlands, additional funding for its treatment centre was a commitment in the New Decade, New Approach document which restored the Northern Executive in 2020, but remains undelivered; at the beginning of this month, its core funding grant was cut by £120,000 per year.

“That will ask huge questions about our ability to continue to function, to deliver the service that we deliver,” says Canning.

In Belfast, Campbell is now involved in grassroots efforts to provide advice and support within local communities; it is, she says, “a response that’s been borne out of the critical situation, and they’re beginning to look at themselves and what they can do to help themselves”.

What keeps her going is when she sees a young person, “particularly a young woman, actually getting out of the situation and turning her life around”.

“What we do, does have an effect. It can be very unfulfilling at times and you can be very down about it, but there are occasions when you see people come out of it, and that’s mind-blowing.”