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FactFind: What is the relationship between social inequality, drug use and drug-related harms?

A survey shows consequences of drugs differ across socio-economic levels, even as the prevalence of use doesn’t.

LAST WEEKEND, THE Citizens’ Assembly on Drugs Use heard from people who had been impacted by drugs recounting their personal experiences.

The assembly also heard claims that people from deprived areas face tougher consequences for using drugs.

Some of the arguments put forth during that debate echoed a recent back-and-forth on Twitter about how inequality affects drug use and addiction, between Labour TD Aodhán Ó Ríordáin and TCD Professor Bobby Smyth, an expert in adolescent addiction. 

It began when Smyth shared an article on drivers who were caught speeding, with the professor also referencing arguments used by advocates for the decriminalisation of drugs: “’War on speeding’ is clearly not working. Must be time to legalise speeding. (Or is that type of moronic logic only used when discussing drug policy)”.

Ó Ríordáin responded: “This analogy really does you no favours. Speeding isn’t a medical condition. Speeding isn’t funding criminal gangs. Speeding isn’t a result of inequality.”

The exchange escalated into an argument over how drug use or drug addiction (the two terms quickly became conflated), relate to inequality.

The Labour TD claimed that “addiction absolutely is disproportionately a result of inequality”, while Smyth claimed that “drug use is not a result of inequality”.

Other activists and political groups have linked inequality to addiction, as calls to decriminalise drug use in Ireland grow louder.

Given the arguments put forth by politicians, experts and activists, as well as testimony given in the Citizens’ Assembly, let’s take a look: what is the relationship between inequality, drug use, and its consequences?

Drug use, addiction and harms

It is important first to distinguish between drug use and drug addiction.

Drug use is simply where people take drugs, and is unrelated to short- or long-term consequences.

Drug addiction is considered a chronic disease which is characterised by drug use that is compulsive and difficult to control, despite harmful consequences to the individual who takes the drug.

And although not mentioned by either Ó Ríordáin or Smyth, both drug use and drug addiction can feed into harms, in terms of individually (e.g. on a person’s health) and in society (e.g. through criminal activity).

In an email to The Journal, Smyth said his point was that there is no law or regulation that “eliminates the behaviour which it targets” – in other words, drug use and addiction will continue regardless of whether drugs are legal or illegal.

“Some who push for legalisation make arguments along the lines that ‘(1) Drug use is prohibited. (2) In spite of this a sizeable minority of people use drugs. (3) Therefore the laws aren’t working and should be removed.’ The conclusion is erroneous and simplistic as the speeding example highlights,” he said.

Ó Ríordáin did not respond to requests for comment.

Irish data

First, let’s take a look at data relating to drug use, addiction and inequality from Ireland. Irish-specific studies in the area appear to be based on limited data, but some surveys do show similar trends to what is seen internationally (which we’ll get to later).

“The prevalence of the use of illegal drugs (percentage of the population using drugs) is similar across different socio-economic levels,” the Health Research Board (HRB), a state agency that compiles statistical evidence on drug use, told The Journal in a statement.

“But the harmful consequences of this use are more pronounced in areas of higher deprivation.”

In terms of drug use, the 2019-20 Irish National Drugs and Alcohol Survey, published by the HRB, shows that the rate of drug use was about the same in the most and least-deprived groups.

The survey included cannabis, ecstasy, cocaine powder, magic mushrooms, amphetamines, LSD, new psychoactive substances (NPS), crack, and heroin, as well as legal substances: poppers and solvents. 

Those in the second-most privileged group were most likely to use drugs.

The study found that, in the year leading up to the survey, almost 6% of people who responded had used cannabis, making it the most-commonly used drug.

It was followed by ecstasy (2.2%), cocaine (1.9%), poppers (1.4%), LSD (0.9%), and amphetamines (0.8%). 

Men aged 25 to 34 had the highest level of recent illegal drug use at 25.8%.

A European-wide web survey in 2021 received higher rates of self-reported drug use by respondents, though cannabis, cocaine and ecstasy still ranked as the most-used drugs in Ireland. 

An analysis by the HRB into the use of cannabis, ecstasy and cocaine by socio-economic status also found that use of these drugs is prevalent across all levels of deprivation.

The survey found that people were more likely to have used drugs if they were unemployed.

The effects of education were mixed, though 15-34 year-olds who had stopped education after lower secondary school (i.e. the Junior Cert) were significantly more likely to have recently used drugs.

Drug-related harms

The HRB’s survey also measured the impact of drug-related harms – a wider consequence of drug use that affects communities and society, including children taking drugs, or violent crimes related to drug use or dealing.

Responses on this subject showed much starker trends, with those in the most-deprived areas more than twice as likely to say that people using or dealing drugs are a big problem in their local area.

In addition, more than 17% of people in the most-deprived areas said they either had personal experience of debts to drug dealers, or knew someone who had been intimidated because of drug-related debt – more than double the rate than those from least-deprived areas.

A recent analysis of the relationship between addiction treatment data and geographic deprivation in Ireland showed that people from disadvantaged areas were also much more likely to have been treated for drug or alcohol.

The study also showed that people who are ‘ranked’ as being from a lower or more disadvantaged socio-economic background (who comprise about 14% of the population) made up more than 35% of all drug treatment cases and 42% of opioid treatment cases.

International data

International literature, which relies on broader research, shows similar trends to the impacts of deprivation on drug use, drug addiction and drug-related harms.

For example, one study by epidemiologists, which included data from Ireland and cited by the HRB, found that “the more unequal a society, the higher the level of drug use”.

An analysis of data from the United States between 2002 and 2013 showed that those in the poorest group used heroin more at a rate that was three times higher than those in the richest group.

A further analysis showed that, among those who reported ever using illicit drugs in their lifetime in the US, those who were in the lowest annual family income category (earning less than $20,000 per year) were “34% more likely to report having substance abuse-related problems in the past year”.

Another American study found that prescription opioid overdoses were elevated in economically disadvantaged areas.

In Europe, a Swedish study tracking drug use among people with different trajectories of childhood poverty (e.g. those who moved out of poverty in childhood, or who moved into poverty in adolescence) found that those who had never experienced poverty (almost 70% of the participants) had the lowest risk of drug-use problems.

The highest risks of drug crime convictions were among males “moving into poverty in adolescence”, followed by those “chronically poor”.

The study also references a Swedish-language paper which found that, in wealthier districts, young people were less frequently suspected of drug use than in lower–middle-income areas, despite reporting higher drug consumption.

“It is also six times more common for boys to be suspected of drug-related crimes compared with girls, although self-reported consumption does not differ greatly,” its synopsis reads.

However, one Norwegian study conversely found that chronically poor children were “less prone to have potential alcohol- or drug-related problems compared to all other groups”.

A low proportion of respondents from that deprived group also said that they had never tried drugs — about the same as the responses by those in the “never poor” group.

However, drug use disorders were particularly high among people who moved into poverty in adolescence.

There is yet more international data from the UK, which has an abundance of papers on the interactions between inequality and the effects of drug use, often centered on Scottish studies.

One oft-cited statistic from the National Records of Scotland, which tallies deaths among other statistics, found that, in 2020, after adjusting for age, people living in the most-deprived areas were 18 times more likely to have a drug-related death than those living in the least-deprived areas (68.2 per 100,000 population compared with 3.7).

A Scottish committee also found that the “single biggest structural driver” of problem drug use is “poverty and deprivation”.

It found that drug use disorders are “17 times more prevalent in Scotland’s most-deprived areas, compared with the least-deprived”.

The committee also noted that deprivation made it much less likely to overcome drug problems, in some cases due to a lack of housing or unemployment.

In the UK as a whole, a similar (though less extreme) relationship between inequality and drugs was also noted, with some analyses showing that the highest rate of deaths due to drugs was among the most deprived people, while the lowest rates were among the most privileged.

Moreover, the use of crack and opiates – drugs which are responsible for highest number of deaths – is much more common in deprived areas of the UK. 

However, it is important to note that most of these studies cited look at drug harms, not drug use, where an association with deprivation is weaker.

“The vast majority of people who use drugs will do for a short time without any harm,” Dr Emily Tweed, University of Glasgow told a Scottish committee.