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Report highlights increase in deaths involving street tablets in Ireland

The purchasing of drugs online brings significant regulatory challenges.

A NEW REPORT has highlighted the increase in deaths and non-fatal overdoses involving prescribable drugs in recent years in Ireland.

The report from the Ana Liffey Drug Project also looks at the increase in the availability of benzodiazepines and other ‘street tablets’ and changes in drug markets such as purchasing online.

Street tablets are prescribable medications in tablet or capsule form that are not obtained from a medical professional.

This includes 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.

The study examines deaths and non-fatal overdose numbers from a variety of sources, with the most recent data from 2018. 

Tony Duffin, CEO of the Anna Liffey Drug Project said street tablet use is a serious issue for many people who use the service.

“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,” he said.

“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.”

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.

It also shows 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.

In particular, pregabalin-related deaths have risen year on year between 2012 and 2016, with an increase of 33% between 2015 and 2016 and an overall increase of 364% between 2013 and 2016. This drug is used to treat epilepsy, neuropathic pain, fibromyalgia and generalised anxiety disorder. 

The report 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.”

The report 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.

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.

Continued collaboration such as this may help better inform policy choices, Paul Griffiths, EMCDDA scientific director said:

“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.”

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