Professor Eamon Edward Keenan

Prescription drugs are often strong medications, which is why they require a prescription and are not available over the counter. There is increasing concern about the misuse of certain prescription drugs, for example opioids (prescribed for pain relief), and benzodiazepines, a group of medicines often used in the shortterm to treat anxiety or sleeping problems. Misuse of prescription drugs generally refers to taking a prescribed drug in a way other than how it was prescribed, for example taking someone else's medication or taking more than the prescribed dose to create a feeling of euphoria or to get "high". It also refers to taking illegally sourced prescription drugs, which is high risk as the drugs may be fake and/or contain harmful substances. The Health Research Board and the Department of Health in Ireland have identified the misuse of prescription drugs as a research priority in Ireland. As there is no single source of information that fully describes the situation in Ireland, we are proposing to examine many different Irish data sources to provide a detailed analysis of the supply, patterns of use and harms associated with prescription drugs with potential for misuse (PDPM).

Over the past decade there has been an increase in the number of adolescents using cannabis worldwide. This is concerning because cannabis is increasing in strength with more serious long term effects on health such as psychosis and depression. The adverse effects of using cannabis are particularly pronounced in those who start to use cannabis in adolescence. However despite the evidence for harmful effects, young people are less likely likely to view cannabis as a harmful substance. In this project we aim to investigate two key issues in relation to cannabis use in youth. Firstly we will examine what factors increase the chances of a young person beginning to use cannabis. We will also examine what factors influence a young person not to use cannabis. Secondly we will investigate what effect early use of cannabis has on the structure of the brain and on cognition.

While opioid substitution treatment (OST) is the most effective treatment for opioid dependence, it is heavily dependent on regular face-to-face health care delivery placing both clients and treatment providers at risk of COVID-19. Policies were rapidly changed with the introduction of Page 18 of 44 national contingency guidelines by the HSE National Social Inclusion Office, where Addiction services are coordinated, beginning in March 2020 to ensure rapid and uninterrupted access to OST while balancing efforts to mitigate COVID-19 risk. The Programme for Government 2020 states they will retain many of the measures introduced during COVID-19 to reduce waiting times in accessing treatment services and reduce overdose mortality. It is therefore essential to examine the impacts, benefits and unintended consequences of the special measures introduced during COVID-19 at a national level, thus informing which measures can and should be sustained throughout and beyond COVID-19 to support effective, safe and patient-centred care promoting the health and welling being of all people with opioid dependence. The aim of this project is to evaluate the impact of the national contingency guidelines, developed in response to COVID-19, on the quality of OST care delivered in Ireland, and to identify priorities for quality and safety improvements which will inform clinical decision making throughout and beyond the pandemic. This will be achieved through evaluating the impact of contingency guidelines on numbers entering OST, numbers on waiting list, waiting times, patient dropout and mortality using an interrupted time series analysis of data from the national OST treatment register (Central Treatment List) from June 2019 to December 2020, alongside a Delphi consensus study of quality indicators for the safe delivery of OST in Ireland throughout and beyond COVID-19. Evidence generated from these studies will inform national policy decisions in relation to improving quality of care in OST.This offers a real opportunity for changes identified within the research and recommendations arising from the research to be translated into meaningful actions for Addiction services in Ireland and possibly Europe in the coming years.

Despite evidence supporting methadone substitution treatment (MST), methadone itself has been associated with drug-related deaths. A recent external review of methadone services in Ireland concluded that Ireland is currently lacking a systematic approach of data linkage which is essential to determine the quality of care delivered to drug users in treatment, particularly in relation to mortality. The National Drug Strategy 2009-2016 also concluded that clinical research is underdeveloped. Understanding progression pathways in treatment and qualitative research regarding service users' experiences were identified as research priorities. The proposed study aims to inform evidence-based treatment guidelines to reduce the risk of mortality associated with MST and to provide a better understanding of progression pathways within the addiction services. Using a sequential mixed methods study design, the project will involve a record linkage cohort study of approximately 3,000 patients attending specialist addiction outpatient services in Dublin South West between 2010 and 2015. The primary objectives of this cohort study are: (1) to investigate the extent to which the impact of MST on mortality (all cause and drug-related) is influenced by modifiable treatment related factors such as treatment modality, dose, treatment duration, co-prescriptions including benzodiazepines and dispensing arrangements including supervised methadone consumption; (2) to identify determinants of time to progression to treatment in primary care or detoxification; and (3) determinants of time to discontinuation in MST. This will be combined with in-depth qualitative interviews with 40 drug users in relation to their treatment pathways or journey to-date, experiences of non-fatal overdose, poly-drug use and supervised methadone consumption. Evidence generated from this study will inform both national and international policy decisions in relation to improving quality of care in MST and reducing mortality. This study will also inform evidence based initiatives around progression pathways, taking the service users perspective into account. The overall aim of this project is to generate evidence based standards for the quality of clinical care in methadone substitution treatment (MST) in addiction services, which will inform future policy decisions on initiatives to reduce the risk of mortality associated with MST and to provide a better understanding of progression pathways within the addiction services. This will be achieved through a sequential mixed method study design which will involve a record-linkage study of approximately 3,000 patients attending specialist addiction outpatient services in Dublin South West, followed by a qualitative study of drug users' experiences of treatment and non-fatal overdose.

Recovery coaching is an innovative psychosocial form of strengths-based support for individuals in addiction. Recovery Coaches are experts-by-experience. They support any positive change, helping individuals as they enter and exit treatment to avoid relapse, build community support, formulate goals regarding work, enter education, and build and sustain relationships (i.e. developing recovery capital). There is an emerging body of research primarily in Australia, the US and the UK showing support for recovery coaching. While the role of the Recovery Coach is relatively new in addiction recovery, peer support has been hugely successful in the mental health field and, more recently, homeless services. Developing an intervention that will assist individuals to build resources and reduce the potential for relapse will be hugely beneficial at an individual, community and health service.