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In 2000, the Health Research Board published the results of a nation-wide survey of the public's knowledge, attitudes and beliefs in relation to alcohol and illicit drugs (Bryan et al ., 2000). There was a high level of concern among respondents regarding the extent of the problem generally: 75% believed that the drug situation was "out of control", while almost 95% thought that drug-related crime was a major problem. Despite this, over half of respondents considered that alcohol abuse caused more problems in society than drug abuse and just under half believed that drugs were "not really a problem" in their own neighbourhood. Almost 95% were also of the opinion that illegal drugs were a great threat to young people, while over 50% believed that "it is normal that young people will try drugs at least once" and that "most young people try out cannabis". When asked whether they personally knew someone with a "drugs problem", a quarter of all respondents said they did, with younger people living in urban areas being more likely to have experienced this.

A mid-term review of the National Drugs Strategy was conducted in 2004. Written submissions were received from a wide range of statutory and voluntary organisations around the country, including current perceptions and concerns regarding trends in alcohol and drug misuse. Among the preliminary findings from that review, due to be published in the first quarter of 2005, were the following observations:

• Alcohol continues to be the major problem drug in most areas and is very often used along with illicit drugs.
• The supply of alcohol to under-age young people is particularly problematic and is reported to have escalated, resulting in children as young as 12 having to be pumped out.
• There is widespread misuse of prescription drugs (benzodiazepines in particular), due to inadequate control of supply and illicit street sales.
• There has been a reduction in the age at which young people are being offered and are starting to use cannabis, with children as young as 12 being seen smoking hash.
• The availability and problematic use of cocaine is increasing, particularly among young people. Cocaine is now regarded as a major issue, some regarding it as a growing epidemic that will have a serious impact on services.
• There has been an increase in polydrug use: heroin, cocaine, cannabis, alcohol and benzodiazepines are all taken together in some cases.
• Solvent abuse, mainly by very young people, still occurs and should not be forgotten.

While some of these problems may be local in nature (e.g. specific off-licences consistently breaking the law, or the presence of major drug dealers in certain communities) and are not necessarily typical of the GMR region, no area can be immune and any of these problems could potentially occur if they are not occurring already.

Do these responses reflect the experiences and perceptions of people living in the GMR area, and do they tally with the available data on the region? There have been no region-specific studies of drug and alcohol use since the mid-1990s, and therefore the data from these older studies cannot be taken as reliable guides at this time (although they are useful as reference points). However, there is currently no evidence that, all other things being equal, the GMR region differs substantially from the rest of Ireland (excluding the greater Dublin area) in terms of alcohol and drug use. This is not to say that future research will not reveal local problems or situations meriting particular attention. In the meantime, providing due regard is given to their limitations *, national surveys (and their regional breakdowns where available) can be used as indicators of the current regional situation. The population surveys considered in this report are the European School Survey Project on Alcohol and other Drugs (Hibell et al ., 2000 & 2004), the Survey of Lifestyles, Attitudes and Nutrition and the Health Behaviour in School-aged Children survey (Centre for Health Promotion Studies, 2003), and the 2002/2003 all-Ireland Drug Prevalence Survey (National Advisory Committee on Drugs, 2004). Drug-specific surveys referred to here include Ramstedt & Hope's 2002 study of the Irish drinking culture and the national study of the prevalence of opiate use published by the National Advisory Committee on Drugs in 2003.

* For example, the size and nature of the sample used, random sample variations, the data collection method, the relatively low occurrence of illegal drug use in the population compared to use of legal drugs, the illicit nature of drug use, and other factors may all have a bearing on the reliability of prevalence estimates.

The substance used by most people (around 75%) living in the GMR area is alcohol. For many years, its legality, availability, familiarity and ubiquity have allowed alcohol to be portrayed as "essentially benign" ( Butler , 2002:211). However, because of its widespread use and its inherent potential to cause harm, alcohol must be regarded as being "no ordinary commodity" (Babor et al ., 2003:15).

When considering alcohol consumption in a population, two important points must be understood first:

Total alcohol consumption in a population is an important indicator of the number of individuals who are exposed to high amounts of alcohol. Adult per capita alcohol consumption is, to a considerable extent, related to the prevalence of heavy use, which in turn is associated with the occurrence of negative effects.

The relationship between total alcohol consumption and harm is modified by the number of drinkers in a population and by the way in which alcohol is consumed.

International research has shown that when alcohol consumption levels increase in society generally, there tends to be an increase in the prevalence of heavy drinkers, in terms of annual intake (Babor et al ., 2003). Because heavy drinkers account for a significant proportion of total consumption, it is unlikely that the total consumption level would increase without an increase in their drinking. Also of importance is the fact that most drinking is social in nature: people tend to influence each other's drinking behaviour, which implies that "heavier drinkers, along with other drinkers, tend to drink more when [overall] consumption increases" (Babor et al ., 2003:42). An environment where low alcohol consumption is the norm will tend to encourage lighter drinking, whereas an environment in which alcohol is readily available and affordable, and drinking is socially sanctioned or promoted, will tend to encourage heavier drinking (Kypri et al ., 2002). This correlation between 'average' drinking and 'problem' drinking has important implications for the implementation of measures aimed at tackling alcohol-related harm in our communities, and supports the adoption of a public health approach that addresses the total drinking population as well as targeting high-risk groups and individual drinkers (Rose & Day, 1990; Holder, 2003; Strategic Task Force on Alcohol, 2004).

The Strategic Task Force on Alcohol (STFA) has collated and analysed national data on alcohol consumption, drinking patterns and trends, and alcohol-related harm. Although the figures are for the whole country, there is no reason to believe that the GMR area differs substantialy from these. Among the STFA's findings are:

• Ireland continues to have one of the highest levels of per capita alcohol consumption in the world.
• Per capita consumption has increased by nearly 50% since the early 1990s.
• Ireland also has a relatively high number of abstainers, which implies that many drinkers are consuming at risky levels.
• High-risk drinking (bingeing, intoxication, regular heavy drinking) is common, especially among men.
• 30% of male drinkers (22% female) consume more than the recommended upper weekly limit, this figure being substantially higher among young men with lower levels of educational attainment.
• Alcohol-related harm is evident throughout Ireland - in the courts, hospitals, workplaces, schools and homes - and the vast majority of it occurs among the adult population rather than among underage drinkers.
• Rates of alcohol-related diseases and deaths have increased in the last decade or so, in parallel with the increase in alcohol consumption.
• Alcohol is a major cause of Accident & Emergency and Psychiatric admissions, and is involved in 40% of road deaths and 30% of all road accidents.
• Public order offences - especially public intoxication and abusive behaviour - have greatly increased in the last decade.

It is clear that Ireland has "an alcohol problem of world-class proportions", and it is time that this State committed the necessary resources to provide a world-class response to the problem ( Irish College of Psychiatrists, 2005:1). The cost of alcohol-related problems in Ireland - in terms of healthcare, road accidents, crime, absenteeism and other consequences - was conservatively estimated at €2.65 billion in 2003 (STFA, 2004). In 2003, the total consumer spending on alcohol in Ireland was €6 billion, an increase of 60% over 1997 levels. This level of expenditure was 10% greater than the total spent on professional services (including medical goods and services), 13% more than on food (excluding eating out), 27% more than on personal transport (including cars and fuel), and 87% more than on clothing and footwear (CSO, 2004). In the same year the State collected €989 million net in VAT and Excise on alcohol (Revenue Commissioners, 2004).

Given the well-established correlation between the level of alcohol consumption and the hazards referred to above, it can be inferred that the GMR region experiences its fair share of alcohol-related harm. Regional data derived from national surveys suggest that alcohol consumption in the region is not substantially different from the high levels occurring in other parts of Ireland , except for the greater Dublin area where substance use generally tends to be higher.

In 2003 the Centre for Health Promotion Studies at NUI Galway published regional figures, based on a national sample, from the National Health and Lifestyle Surveys of 2002. As the report points out, the aim of the survey was to establish patterns in health and lifestyle at a national level. Therefore the significance of the reported regional figures is to identify potential variations that may merit further investigation (Centre for Health Promotion Studies, 2003).

able 5 shows that the prevalence of regular (at least once a week) alcohol consumption among adults in the Western Health Board/GMR area is comparable to all other regions outside the greater Dublin area (Centre for Health Promotion Studies, 2003). Consumption of alcohol on five or more days in a typical week was also similar to other areas: males 15%, females 10%. The proportion of regular drinkers consuming more than the recommended weekly limit was 28% for males (which was close to the average) and 12% for females (below average).

In the all-Ireland Drug Prevalence Survey, 89% of all respondents aged 15-64 in the GMR area reported that they had consumed alcohol at least once in their lifetime, 78% in the previous 12 months, and 68% in the previous 30 days (National Advisory Committee on Drugs, 2004). Assuming these figures can be applied to the general GMR population, this means that around 220,000 people consumed alcohol at least once in their lifetime, 195,000 in the last year, and 170,000 in the last month.

Ramstedt and Hope's national study of drinking habits showed that around two thirds of all men and around a half of all women aged 18-64 go drinking at least once a week. In this study, "binge drinking" was defined as "at least one bottle of wine, 25 centilitres of spirits or 4 pints of beer, or more, during one drinking occasion" (Ramstedt & Hope, 2003:2). Nearly half of all men in the study, and 16% of women, reported that they go drinking in this fashion at least once a week. These rates were higher in the younger age groups: 59% of men and 26% of women aged 18-29.

In 2002, the second Health Behaviour in School-aged Children study (HBSC) surveyed the self-reported health behaviours of a national sample of Irish school-goers aged 10-17 years. Regional figures were also published (Centre for Health Promotion Studies, 2003). The HBSC data in Table 6 were standardised by age and sex to allow for comparisons between health boards, and show that the rates in the GMR region for this group are close to the average. In general, boys tended to be more likely than girls to report having ever taken alcohol or having been drunk.

The European School Survey Project on Alcohol and Other Drugs was first conducted in 1995 and covered 26 countries including Ireland . The second ESPAD survey was in 1999 (30 countries) and the third in 2003 (35 countries). The survey uses a standardised method and a common questionnaire for direct comparability, and only students who reach 16 years of age during the survey year are eligible to participate.

Table 7 shows the figures from all three ESPAD surveys for five selected variables. For most categories there was a noticeable increase in prevalence between 1995 and 1999, with relatively little change between 1999 and 2003. Lifetime prevalence of having been drunk twenty times or more has escalated since 1995, however, rising 10 points for boys (a 45% relative increase) and 14 points for girls (a 93% relative increase). The prevalence of binge drinking (defined in this study as five or more drinks in a row) has also markedly risen, especially among girls. Girls were 5 points behind boys in 1995, but in 2003 had gone two points ahead, a relative increase of 65%.

This phenomenon of both a high prevalence and gender parity in heavy alcohol use is only seen in a small number of countries in the ESPAD survey, mainly Ireland , the UK and the Nordic countries. Ireland is consistently at the top of the scale for binge drinking, and is one of only three countries where the prevalence of this variable is higher for girls than for boys (the other two countries being the Isle of Man and the UK ). This trend merits closer attention and further investigation. While risky drinking in any population group is a matter of serious concern, it is important to remember the physiological reality that, given similar levels of alcohol consumption, a majority of females will get drunk faster and will be more vulnerable to alcohol-related problems than males (Corrigan, 2003).

Table 7: Trends in alcohol use among 16-year-old Irish schoolgoers 1995-2003 (ESPAD)

* Binge drinking defined as 5 drinks or more in a row.

Heavy and hazardous drinking is also occurring to a notable degree among third level students. The College Lifestyles and Attitudes Survey, which involved a nationally representative sample of 3250 students in 21 third level institutions, found that binge drinking rates are higher in this cohort than in the general population, particularly among females (Hope et al ., 2005). There is a large student population in the GMR area (20,000+ including full-time and part-time students) and so a high prevalence of risky or problem drinking in this group is a cause for concern.

2.2.2 Tobacco

Although fewer people smoke tobacco than drink alcohol, the impact of tobacco in terms of disease and death is far higher. Tobacco kills more people than the combined total attributable to alcohol, cocaine, heroin, homicide, suicide, car accidents, fire and AIDS (US National Institute on Drug Abuse, 2001).

An important aspect of tobacco use, in the context of drug misuse generally, is its role as a 'gateway drug' and its prominent role in the common phenomenon of polydrug use. Research has shown that, for example, adolescent users of tobacco are much more likely to progress to use of illicit drugs than are nonusers of tobacco. Clearly, not all adolescent cigarette smokers progress to using illicit drugs, but tobacco has proved a strong and consistent predictor of subsequent illegal drug use. Learned smoking behaviours facilitate progression to other drugs that are self-administered by the same method, while smoking as a social activity normalises substance use (Lindsay & Rainey, 1997). Smoking provides "exposure opportunities" where young smokers are more likely to encounter and use other substances (Wagner & Anthony, 2002).

There is a very strong association between tobacco and alcohol use: up to 95% of alcoholics smoke cigarettes and approximately 70% of alcoholics are classified as heavy smokers, while adolescents who begin smoking are three times more likely to begin using alcohol (US National Institute on Alcohol Abuse & Alcoholism, 1998). In addition to the psychological and social processes involved, there is also evidence from pharmacological studies that nicotine alters brain chemistry in a way that enhances the influence of other drugs, an effect that may be reciprocal. For example, alcohol use seems to promote continued smoking and smoking promotes continued drinking (Anthony & Wagner, 2000). In a major scientific review, the US Surgeon-General concluded that the pharmacologic and behavioural processes that determine tobacco addiction are similar to those that determine addiction to drugs such as heroin and cocaine (US Department of Health and Human Services, 1988). Of all drugs, whether used together or individually, tobacco is one of the most addictive. In the US National Comorbidity Survey, the estimated proportion of recent tobacco users who had developed clinical syndromes of drug dependence was 32%, compared to 9% for cannabis, 15% for alcohol, 17% for cocaine and 23% for heroin (Anthony & Wagner, 2000).

In the 2002 SLÁN survey, the prevalence of regular/occasional smoking among adults aged 18+ in the Western Health Board/GMR region was 28% for men and 22% for women. Males also smoked more cigarettes than females. In the all-Ireland Drug Prevalence Survey, 62% of respondents in the GMR area reported ever smoking tobacco, 36% in the previous year and 31% in the previous month. Rates among young adults were lower than the corresponding national figures: 32% vs 37%. The prevalence rate for current tobacco use among females (33%) was higher than that for males (30%), a difference which was not seen in the national figures. In the HBSC survey, 33% of boys and 35% of girls aged 10-17 in the WHB/GMR region reported ever smoking, while 19% of boys and 16% of girls reported that they were current smokers; these rates did not differ markedly from other health boards outside the Eastern region. The 2003 ESPAD survey showed a continued decrease since 1995 in the 30-day prevalence of smoking among both boys and girls, although girls' rates remain higher than boys'. The boys' rate was 28% in 2003 (down from 37% in 1995), while the girls' rate was 37% (45% in 1995).

The workplace smoking ban introduced in 2004 was widely supported, even among smokers, and led to a drop of 18% in cigarette consumption (and a decline in tax revenue of €128 million) in six months. This legislation was a good example of an effective public health policy, and future research can be expected to reveal its benefits. Nonetheless, it may be the case that committed smokers are also adapting in ways other than by reducing their smoking or by continuing to go to pubs and smoking outside. While tobacco sales have decreased, and around 8% of smokers have quit since the ban, off-licence sales of alcohol for home consumption have increased. Although a move towards home drinking had already been occurring, the smoking ban may have accelerated the trend. Research into the effects of the smoking ban on consumption patterns of both tobacco and alcohol, as well as health outcomes, will be a useful line of enquiry.

Although it is anticipated that smoking prevalence will decline following the smoking ban, smoking rates will remain relatively high in disadvantaged groups without more targeted interventions. In Ireland , as in other countries, there is a marked difference in the prevalence of smoking between social classes and according to level of educational attainment, with manual workers being more than twice as likely to smoke as those in the professional or managerial classes (Layte & Whelan, 2004). Smoking rates are higher among people living in council housing (Office of Tobacco Control, 2004) and there is also some evidence that the prevalence could be much higher among Travellers than in the general population (Mid-Western Health Board, 2002) although targeted health research in this community has been relatively sparse to date.

2.2.3 Prescription drugs and other medications

A key factor in the misuse of any drug is availability. For this reason, among others, "it is difficult not to agree with the suggestion that most Irish people have more to fear from legal drugs and medicines than from illegal drugs" (Corrigan, 2003:18). The Pharmaceutical Society of Ireland has stated that misuse of over-the-counter (OTC) medicines seems to be "a widespread and intractable problem" (Ledwidge, 2005). Products suspected of being misused include drugs with potential sedative or stimulant properties, such as analgesics (particularly those containing codeine), antihistamines, sleeping aids, cough mixtures and laxatives. OTC medicine abuse has been under-researched and regarded as a low priority.

Commonly abused prescription medicines include sedatives and tranquillisers, particularly the benzodiazepines. Benzodiazepines are broadly divided into anxiolytics (anti-anxiety drugs) and hypnotics (sleep-inducing agents) and are among the most frequently prescribed and widely used of all medicines. It is already known that misuse of benzodiazepines (street diversion) is common among opiate and polydrug users (Benzodiazepine Committee, 2002). However, the relatively low number of such users in the GMR area suggests that if there is a benzodiazepine misuse problem of any notable size it is more likely to be found in the general population. According to the Benzodiazepine Committee (2003:6), "it has been recognised for a considerable period of time that benzodiazepine anxiolytics and hypnotics can cause drug dependence when taken on a long-term basis, even in prescribed therapeutic doses". Tolerance to their effects - one aspect of addiction - may develop within 3 to 14 days of continuous use. Analyses by the Benzodiazepine Committee of prescribing patterns in the General Medical Services (or medical card) Scheme, which covers about a third of the Irish population, have indicated that in this group about 1 in 10 people overall, rising to about 1 in 5 in the over-60s, are prescribed benzodiazepines. Prescribing rates tend to be higher for women. In the Eastern Regional Health Authority area, around 6% of GPs were found to be prescribing at a rate at least 50% higher than that of their colleagues, while up to 70% of GMS patients in this area receiving such prescriptions "would appear to be taking benzodiazepines on an ongoing basis" (Benzodiazepine Committee, 2003:16).

Recent research conducted in Ballymun found that benzodiazepine misuse was very prominent among habitual users of other drugs, that there was a clear gender bias in prescribing, with women receiving almost two thirds of prescriptions, and that " a considerable proportion of patients who are initiated on benzodiazepines continue to take them for many years" (Ballymun Youth Action Project, 2004:8). An audit of dispensing patterns in community pharmacies showed that 90% of prescriptions were issued on the GMS scheme, while 77% of prescription items came from just four doctors. Although Ballymun is in many ways a very different environment to the West of Ireland, this study is a very informative account of why and how benzodiazepine misuse occurs.

The Drug Prevalence Survey reported that 3.7% of all respondents aged 15-64 in the GMR area had used sedatives, tranquillisers or anti-depressants in the previous month, with females being more likely to have used these drugs (5.1% vs 2.4%) as were the older adults (4.6% vs 2.8%). Last year prevalence in this study was 5.5% overall, with the rates for females and the older age group being higher: males 4.5%, females 6.5%, young adults 3.2%, older adults 7.4%. All of these rates were similar to those for the country as a whole. In the SLÁN survey, 1.2% of women and 0.4% of men in the GMR area had used tranquillisers or sedatives without a doctor's prescription in the previous twelve months - a question on prescribed use was not included in the survey.

Benzodiazepines, opiates and cannabis are, in similar proportions, the three most frequently reported secondary problem drugs among users attending treatment for addiction (Drug Misuse Research Division, 2003). The reported experiences of addiction counsellors indicate that, in the treatment of drug addiction, benzodiazepine dependence alone or concurrently with other drugs typically requires a more extended detoxification process. The availability of benzodiazepines, the prevalence of their use and misuse, and the likelihood and severity of dependence, suggest that closer attention should be paid to the possibility that there could potentially be a benzodiazepine problem in the GMR area.

2.2.4 Cannabis

The most commonly used illicit drug in the GMR area, as elsewhere, is cannabis. The trend internationally has been towards significantly increasing use, particularly among adolescents and young adults. Despite the high prevalence of cannabis use, uncertainty persists about its physical and psychological consequences (Patton et al ., 2002). Consequently, it is also one of the most widely researched and debated of controlled substances. As a comprehensive and wide-ranging review of the literature on cannabis for the National Advisory Committee on Drugs states, "the vast body of research on the consequences of cannabis use does not lend itself to simple and easy conclusions" (Collins et al ., 2004:8). A particularly important issue - one with potentially serious public health implications - is the association of cannabis use, especially among adolescents and young adults, with the later onset of mental disorders, including depression, anxiety and psychosis. Does cannabis cause these conditions, or do people who already have a predisposition for these disorders tend to use cannabis more, perhaps as a form of self-medication?

The lack of irrefutable, conclusive evidence of significant harm to public health, in the context of widespread and persistent use of the drug, has sustained scientific and political debate for many years, allowing scope for the pragmatic (though contentious) easing of restrictions on cannabis use in some jurisdictions. Cannabis use, among young people especially, remains a controversial area, and absence of good data has hindered the development of rational and consistent public health policies (Patton et al ., 2002). Holland has long been perhaps the best-known example of a low-restriction regime, while the UK, following a recommendation from the Advisory Council on the Misuse of Drugs and with the full backing of the Association of Chief Police Officers, reclassified cannabis from Class B to Class C in 2004. Converging evidence from well-designed and carefully controlled epidemiological studies of cannabis use as a potential cause of psychiatric illness, published before and since the reclassification decision was made, has however led the UK government to initiate a reassessment of its position (Home Office, 2005). Holland has also recently 'de-liberalised' its policy.

Henquet et al . (2005), in a prospective four-year study of over 2400 young people aged 14 to 24 with and without a diagnosed predisposition for psychosis at baseline, concluded that "cannabis use moderately increases the risk of psychotic symptoms in young people but has a much stronger effect in those with evidence of predisposition to psychosis". While cannabis use accounted for 6% of psychosis outcomes in the total study population and 14% in the predisposed group, psychosis predisposition did not predict cannabis use, thus countering the self-medication hypothesis. These findings support previous prospective studies that indicated a causal association between cannabis use and certain psychiatric symptoms. Van Os et al . (2002) concluded that "cannabis use increases the risk of both the incidence of psychosis in psychosis-free persons and a poor prognosis for those with an established vulnerability to psychotic disorder". Patton et al . (2002) found a strong association between daily use of cannabis and depression and anxiety among young women; in contrast, depression and anxiety in teenagers did not predict higher cannabis use. These and other similar studies strengthen the argument that use of cannabis increases the risk of psychiatric illness (Rey & Tennant, 2002). Given that this risk rises with level of use, and that nowadays cannabis often contains more of the main active constituent (THC) than ever before, the public health impact of widespread, frequent and increasing use could be considerable (Henry et al ., 2003). Since adolescence and early adulthood is the peak period for both cannabis use and incidence of psychosis, preventing harmful exposure in this high-risk age group is an important public health goal (Verdoux et al ., 2003).

Last year prevalence of cannabis use in the 2002 SLÁN survey was 5% for adults aged 18 and over in the Western Health Board region; this rate was the lowest of all health boards and was significantly lower than those for the Dublin area. Male prevalence rates were consistently higher than those for females in all health board areas, and in the GMR region the male rate was three times higher: 9% vs 3%.

In the all-Ireland Drug Prevalence Survey, self-reported use of cannabis in the last 30 days among all respondents aged 15-64 in the Western Health Board/GMR region was 1.3%, compared to 2.6% for the country as a whole. Last month prevalence was similar for males and females, but higher among older respondents (see Table 8). Males had higher rates than females for both last year and lifetime prevalence: 2.7% vs 1.3% and 16.5% vs 9.7% respectively. These rates were all lower than those for the country as a whole.

Table 8: Cannabis use by age group (NACD 2004)

In the HBSC survey, 10% of boys and 4% of girls aged 10-17 in the Western Health Board region reported using cannabis in the previous year. Rates were similar for lifetime use. These were among the lower rates in the country and were significantly lower than those in the Eastern Regional Health Authority. The 2003 ESPAD survey reported that the lifetime and 30-day prevalence rates for 16-year-old Irish school students were 39% and 17% respectively, on a par with the UK and in the top five of all countries surveyed. Rates were equal for boys and girls. In the 1999 ESPAD survey, 59% of Irish respondents perceived cannabis as being "fairly easy" or "very easy" to obtain, which was the highest percentage of all the European countries in the study.

2.2.5 Ecstasy
The 2002 SLÁN survey noted an increase in the national 12 month prevalence rate of Ecstasy use among adults aged 18+ compared to the 1998 survey: from 2.9% to 3.9% in men and from 1.5% to 2.4% in women. The 18-34 age group had the highest rate: 6.4% in 2002. The regional (WHB) SLÁN figure for all adults was less than 0.5%, one of the lower rates among the former health boards. Last month prevalence in the Drug Prevalence Survey was 0.3% nationally for all adults aged 15-64 and twice this rate for males and the younger age group (15-34). Last month and lifetime prevalence were 1.1% and 3.8% respectively, and in each case rates were higher for males and the younger age cohort. Figures for the GMR area in this survey were lower (2% lifetime prevalence overall) and the same pattern in age and gender was evident. Lifetime use of Ecstasy was 5% overall in the 2003 ESPAD survey. There was little difference between boys and girls or between 1999 and 2003.

2.2.6 Cocaine
There has been growing concern in recent years over the increasing availability and use of cocaine in Ireland . According to the National Advisory Committee on Drugs, "anecdotal reports suggest that the increase in cocaine use has been across the general population, not just among existing problem drug users or confined to certain urban areas" (NACD, 2003:7). Although research on the scale of the potential problem regionally or nationally has been sparse so far, data from the criminal justice system, drug treatment centres and small research studies indicate that cocaine use is having an increasing impact on services though its prevalence is still small compared to other drugs (NACD, 2003). Drug treatment data are an indirect indicator of drug misuse, and an increased reporting of problem cocaine use has been noted across a number of health boards outside the Dublin region: "though small, the numbers reporting cocaine use increased consistently, indicating the early years of an epidemic" (Drug Misuse Research Division, 2004:1). Small-scale qualitative studies conducted in the Dublin area have reported an increased visibility of cocaine in pubs and clubs and have identified a phenomenon of users injecting the drug (NACD, 2003).

The Drug Prevalence Survey indicated that 3% of the general adult population in Ireland have ever used cocaine and less than one per cent have used crack. Lifetime prevalence was highest among 15-34 year olds at 5%. Last month and last year prevalence rates in the GMR area were less than 1% and tended to be higher in younger males. The 2002 SLÁN survey reported a national increase in last year prevalence among males from 1.8% in 1998 to 3% in 2002 and among females from 0.6% to 1.9%. The corresponding rate for the GMR area was around 1% overall. Rates were generally higher in the 18-24 age group. In the 1998 HBSC and 1999 ESPAD surveys, around 2% of respondents reported that they had ever used cocaine.

In the all-Ireland Drug Prevalence Survey no respondent in the GMR area reported use of heroin. However, as the survey report states, this "does not mean that there was no use of that drug in the area, although it is indicative of low levels of use" (NACD, 2004:3). Rates for the country as a whole were low, with 0.5% of all respondents having ever used the drug. Use of Methadone and other opiates was also infrequent. In the SLÁN survey, regional prevalence of heroin use was similarly low.

In 2002/2003, researchers at Trinity College Dublin conducted a Capture Recapture study of opiate use in Ireland (Kelly et al ., 2003). This was a statistical analysis using three separate data sources: the Central Drug Treatment List, the national Gárda Study on Drugs, Crime and Related Criminal Activity, and the Hospital In-Patient Enquiry (HIPE) database. The statistical model used in this study produced an estimated prevalence of opiate use expressed as the rate per 100,000 persons aged 15-64 for the years 2000 and 2001. The rates for the GMR area were 12.7 in 2000 and 17.9 in 2001, which were among the lower rates in the country.

nhalant or solvent abuse is regarded as being primarily an adolescent phenomenon although it is known to occur among young children and occasionally among adults (Corrigan, 2003). Volatile substances that can be abused are numerous and many are widely available, and their potential harmful effects can be serious and unpredictable. It is therefore a matter of some concern that young people may be continuing to abuse these substances. In the 2003 ESPAD survey, 21% of Irish 16-year-old girls and 14% of boys reported that they had ever used inhalants. These were among the highest rates in the 35 countries surveyed.