Bobby P. Smyth

Background: Mental health presentations are common in general practice, particularly in socially deprived areas, yet standard consultation times often limit GPs’ ability to comprehensively assess and manage patients presenting with diverse emotional concerns. Such work is also difficult to capture in research, which often relies on coded diagnoses or prescribing data. This study aimed to describe the nature, management, and outcomes of extended mental health consultations in a deprived urban Irish practice. Methods: A retrospective descriptive secondary analysis was conducted on clinical charts for 195 patients who attended 30-minute extended mental health consultations between March 2021 and March 2023. Quantitative data on demographics, presenting complaints, prescriptions, and referrals were analysed descriptively, while clinical notes were systematically categorised to explore the spectrum of emotional concerns. Results: The median patient age was 29.0 years; 63.1% were female, and 69.8% lived in areas below the national average for social deprivation. Anxiety (47.7%) and low mood (42.1%) were the most common presenting complaints. Psychotropic prescriptions were initiated or modified for 37.9% of patients, with SSRIs the most prescribed. Of all patients, 26.7% were referred to psychiatric services and 57.4% were signposted to community mental health supports. Conclusion: The study demonstrated GPs in this deprived urban practice encountered wide range of mental health concerns across all ages and managed substantial proportion entirely within the community. These findings highlight the potential for delivering mental health care in general practice when time and resources are sufficient and underscore the need for better access to comprehensive primary care mental health supports.

Background: Substances, such as cannabis, alcohol, and nicotine, have each been associated with an increased risk of mental health concerns in adolescence. These substances are often taken concurrently and less is known about the effects of polysubstance use. We investigated the relationship between polysubstance use and psychopathology in adolescence including internalising, externalising behaviours, and psychotic experiences (PE). As a secondary analysis, we examined gender differences. Methods: A sample of 4,404 15–16-year-old adolescents in 40 schools in Ireland was examined. Our exposure was single substance use (cannabis, alcohol, and nicotine) and polysubstance use within the past month. The outcome of interest was psychopathology, measured using the Strengths & Difficulties Questionnaire, and the Adolescent Psychotic Symptoms Scale. Associations were explored using mixed-effects logistic models. Results: Adjusted odds ratios were calculated to examine the associations between polysubstance use and each outcome, compared to substance-naive participants. A significant dose response relationship was observed, with increasing substance use associated with higher odds of general psychopathology (aOR range: 1.65–5.09), internalising behaviours (aOR range: 1.18–2.06), externalising behaviours (aOR range: 1.68–5.79), and PE (aOR range: 1.60–3.13). Females engaging in polysubstance use exhibited the poorest mental health outcomes. Conclusion: This study highlights the strong associations between adolescent polysubstance use and emerging mental health problems. The findings reinforce the need for mental health services to take polysubstance use into consideration during intervention. Tailored public health messaging is required, acknowledging polysubstance use as a marker for poor mental health among adolescents and young adults.

Polysubstance use is increasingly the norm among adolescents who use substances, yet research and clinical frameworks remain concentrated in single-substance models. This narrative conceptual editorial highlights key emerging literature on the conceptual inconsistencies and methodological challenges in polysubstance use research, particularly in the context of shifting cannabis legislation and adolescent vulnerability. A lack of definitional consensus, regarding the number of substances, timing of engagement, and intent of substances used, undermines the comparability of findings and the effectiveness of interventions. Adolescent polysubstance use is shaped by developmental, social, and structural factors, with cannabis and nicotine frequently overlooked despite their prevalence. This editorial addresses three linked gaps: definitional inconsistencies, insufficient attention to timing and intent of co-use, and the continued dominance of single-substance research frameworks. Therefore, we argue for clearer definitions, inclusive research designs, and interdisciplinary approaches.

Background: The COVID-19 pandemic and associated lockdowns raised concerns about their impact on substance use among young people. Objectives/Aims: The aim of this study is to investigate the potential changes in alcohol and drug-related medical hospital admissions during the pandemic compared to pre and post pandemic years among individuals aged 15–24 in Ireland. Methods: Data from the Hospital Inpatient Enquiry (HIPE) database, covering emergency hospital admissions from 2017 to 2022, were analysed. Lockdown and control periods were identified, and admission rates for drug-related hospital admissions (DRHA) were calculated per population and per 100 all-cause admissions. The study also examined changes in alcohol-related hospital admissions (ARHA) and explored the contribution of different drug categories to DRHA during lockdowns. Results: We found that there was an increase in drug-related hospital admissions (DRHA) among individuals aged 15–24 years during the periods of hard lockdowns, comparing the three periods of hard lockdown from 2020 to 2021 with corresponding weeks in control years. The median rate of DRHA per million per week during the lockdowns was 23.8 (inter-quartile range [IQR] 19.0 – 29.9) while it was 18.2 (IQR 13.7–22.2) during the control weeks (p<0.001). DRHA accounted for a median 3.81% of admissions during lockdown weeks while they comprised 2.16% during the control weeks. Conclusions: Our findings suggest that an adverse effect of pandemic restrictions appears to be increased acute drug-related problems requiring medical management among youth aged 15–24 years.

Background and aims: Alcohol and other drug use is common in early adulthood; however, research on contemporary polysubstance use patterns—defined as use of multiple psychoactive substances—and their associated factors is limited. This study aimed to identify groups with differing polysubstance use patterns and to examine associations with individual, family and socio‐environmental factors. Design: This is a cohort study based on data from the Growing Up in Ireland (GUI) study. GUI employed a two‐stage clustered sampling design, using the national primary school system as the initial sampling frame. Sampling was stratified by county, sex, disadvantaged status, religious denomination and total number of nine‐year‐old pupils. Setting: GUI is a nationally representative cohort of young people in the Republic of Ireland. Participants: This study includes 4695 participants (49.5% female) who completed all four waves of GUI. Wave 1 took place in 2007/2008 when participants were aged nine, followed by wave 2 at age 13 in 2011/2012, wave 3 at age 17/18 in 2015/2016 and wave 4 at age 20 in 2018/2019. Measurements: We used eight indicators of substance use at age 20: Alcohol Use Disorders Identification Test (AUDIT) scores, e‐cigarette, tobacco, cannabis, cocaine, ecstasy, ketamine and other drug use in a latent class analysis, and examined associations with age, sex, age at first alcohol, emotional and behavioural difficulties, socioeconomic status, household structure, non‐parental address, region, familial, peer and neighbourhood substance use using survey‐weighted multinomial regression. Findings: Four latent classes were identified: limited use (33.8%), alcohol, tobacco and cannabis use (43.0%), polysubstance use (16.2%) and heavy polysubstance use (7.0%). Both polysubstance classes, which together accounted for 23.2% of the cohort, had elevated probabilities of using five or more substances, including risky alcohol use, tobacco, cannabis, cocaine and ecstasy, with individual substance use probabilities ( P ) ranging from 0.63 to 0.99. The heavy polysubstance class was characterised by more frequent and diverse substance use, notably including ketamine ( P = 0.90). Male sex [adjusted odds ratio (aOR) 2.7, 95% confidence interval (CI) = 1.7–4.2], familial (aOR 3.8, 95% CI = 1.9–7.6) and peer substance use (aOR 13.5, 95% CI = 6.3–29.2), a non‐parental address (aOR 2.3, 95% CI = 1.4–3.8) and living in the Dublin region (aOR 1.9, 95% CI = 1.1–3.3) were associated with heavy polysubstance use, relative to the limited use class. Conclusions: Nearly one in four 20‐year‐olds in Ireland appears to engage in polysubstance use, representing a significant public health concern. Polysubstance use among 20‐year‐olds in Ireland appears to be associated with being male, having family members and peers who use substances, not living with parents and living in or near Dublin.

Background: Cannabis is the most commonly used illicit substance in Ireland and globally. It is most likely to be used in adolescence, a period of biopsychosocial vulnerability to maladaptive behaviours. This study aims to investigate the risk and protective factors for cannabis use among adolescents.Methods: This study is a secondary analysis of the cross-sectional Planet Youth survey (2021). The sample comprised 4,404 adolescents aged 15–16 from one urban and two rural areas in Ireland. The outcome of interest was current cannabis use, defined as cannabis use within the last 30 days. Independent variables i.e., risk and protective factors, were selected a priori following a literature review. Associations between cannabis use and the independent variables were explored using mixed-effects logistic regressions.Results: The prevalence of current cannabis use was 7.3% and did not differ significantly between males and females. In fully-adjusted models, significant risk factors for cannabis use were: Having peers that used cannabis (Adjusted Odds Ration (aOR) 10.17, 95% CI: 5.96–17.35); Parental ambivalence towards cannabis use (aOR 3.69, 95% CI: 2.41–5.66); Perception of cannabis as non-harmful (aOR 2.32,95% CI 1.56–£.45): Other substance use (aORs ranging from 2-67–3.15); Peer pressure to use cannabis (aOR 1.85,95% CI 1.05–3.26), and Low parental supervision (aOR 1.11, 95% CI: 1.01–1.22).Conclusions: This study identified key individual, peer-to-peer and parental risk factors associated with adolescent cannabis use, several of which have the potential to be modified through drug prevention strategies.

Risk factors for cannabis use in young people: With cannabis use among young people on the rise, Ronan Fleury, Prof Bobby Smyth and Prof Mary Cannon. discuss the mental and physical impacts and the importance of understanding the risk factors. Cannabis remains the most widely used illegal drug among teenagers. Research indicates that usage typically begins between ages 12 and 17, with this age group making up about two-thirds of new users. (14) According to the European Monitoring Centre for Drugs and Drug Addiction, approximately 23 million people in Europe (8% of those aged 15-64 years) had used cannabis in 2022. (8) Among European 16-year-olds, daily cannabis use has slightly increased from about 0.5% in 1995 to 0.8% in 2019. (9) In the United States, the increase is more striking, with daily use among 16-year-olds rising from 0.8% in 1991 to 4.8% in 2019. (11)

Objective: Penalties are used in an effort to curtail drug use by citizens in most societies. There are growing calls for a reduction or elimination of such penalties. Deterrence theory suggests that use should increase if penalties reduce and vice versa. We sought to examine the relationship between changes to penalties for drug possession and adolescent cannabis use.Method: Ten instances of penalty change occurred in Europe between 2000 and 2014, seven of which involved penalty reduction and three involved penalty increase. We conducted a secondary analysis of a series of cross-sectional surveys of 15–16-year-old school children, the ESPAD surveys, which are conducted every four years. We focused on past month cannabis use. We anticipated that an eight-year time span before and after each penalty change would yield two data points either side of the change. A simple trend line was fitted to the data points for each country.Results: In eight cases, the trend slope in past month cannabis use was in the direction predicted by deterrence theory, the two exceptions being the UK policy changes. Using the principals of binomial distributions, the likelihood of this happening by chance is 56/1024 = 0.05. The median change in the baseline prevalence rate was by 21%.Conclusions: The science seems far from settled on this issue. There remains a distinct possibility that reducing penalties could contribute to small increases in adolescent cannabis use and consequently increase cannabis-related harms. This possibility should be considered in any political decision-making influencing drug policy changes.

Background and AimsPeople who inject drugs (PWID) have a substantial risk of acquiring human immunodeficiency virus (HIV) infection. From 1999 to 2000 in Ireland, there were 115 new HIV cases among PWID, 40% in individuals aged under 22 years. However, over the past two decades, HIV incidence has declined among PWID in western Europe, including Ireland. We investigated secular changes in HIV incidence among PWID in Ireland. Also, new HIV cases in two time-periods 2000-09 and 2010-18 were compared by sex, age group, area of residence and country of birth. Design and SettingLongitudinal observational study in the Republic of Ireland, 2000-18. Cases and MeasurementsA total of 753 new cases of HIV in PWID were diagnosed. Diagnosis rates of HIV in PWID were calculated and changes in rates over the period were modelled. FindingsDuring the period 2000-18, HIV incidence among 15-29-year-old PWID in Ireland declined from 5.69 to 0.11 cases per 100 000, equivalent to a yearly decline of 0.22 [95% confidence interval (CI) = 0.14-0.31, P < 0.001] cases per 100 000. Among PWID aged 30-64 years, HIV incidence declined annually by 0.06 (95% CI = 0.02-0.10, P = 0.007) cases per 100 000 from 1.80 to 0.57 cases per 100 000. Comparing 2000-09 to 2010-18, there was a relative increase in HIV cases among older adults (P < 0.001), and those born outside Ireland accounted for a growing minority of cases (from 14.7 to 28.0%, P < 0.001). Changes by sex (P = 0.10) and area residence (P = 0.39) were not statistically significant. ConclusionSince 2000, Ireland has achieved an ongoing reduction in the incidence of human immunodeficiency virus among PWID, and this is most evident among young adults. The reduction has occurred in the context of a reasonably comprehensive, health-led and harm reduction-orientated national drugs strategy.