PhD Study : Reducing overdoses and overdose deaths in Ireland: what are the options and how are they perceived?

Summary

Background:

Overdose mortality rates are increasing worldwide. Ireland has the third highest rate of overdose in the European Union with 71 deaths per million (1). Many of these deaths are preventable. Both Department of Health drug strategies in Ireland take an approach incorporating harm reduction, prevention, treatment, and supply reduction, although diverge in how this may be achieved (2, 3). Both drug strategies’ approaches to prevention of overdose are based on principles of evidence based policy. However, policy can be shaped by research (high and low quality), influential individuals/groups, the public, lobbyists, individual or party beliefs, industry, and others (4). Some of this divergence in drug policy strategy is due to perceptions of drug use as a criminal justice or a health issue.

Compared with people who have other mental health problems, those with a history of drug addiction face significantly more negative public attitudes and stigma (5). This is a key barrier to preventing overdose and overdose deaths. The palatability of options to reduce overdose, particularly by the public, tends to favour those such as detoxification units, rather than those available to current/continuing users such as naloxone supply (6). Similarly, it is unclear which options service users may prefer and what determines this preference.

This PhD programme will examine the relationships between policy making, public attitudes, service user attitudes, and stigma to understand how reduction in overdoses (fatal and non-fatal) may be achieved across Ireland. It will draw upon health psychology, social psychology, public health, medicine, and social policy amongst other disciplines.

Objectives and methods:

1) To identify overdose prevention strategies

Conduct a realist review to determines what works, for whom, and in what circumstances.

2) Explore public and service user attitudes to these strategies (or a subset)

Using mixed methods including survey of attitudes towards those who use substances and options for overdose prevention (convenience sample or existing data e.g.(5)). It will include both implicit (subconscious) and explicit (conscious) attitudes. Semi-structured interviews will explore these in more detail, and will be analysed using Framework methods drawing on participants from existing and new networks.

3) Identify ways to incorporate service user perspectives to co-create policy change to improve outcomes for those at risk of overdose

Use political opportunity theory to identify what needs to be in place to facilitate effective service user involvement in policy decision making, understanding who gets listened to, and how views are represented.

Outcomes will include peer-reviewed publications, public engagement events to raise awareness of issues around overdose and the PhD findings, conference or other presentations, and briefings for policy and the public. There will be a strong influence of experts by experience in this work and the student will contribute to research culture at the IMHS.

The right candidate for this opportunity will have a demonstrable interest in overdose prevention and enthusiasm for working in this area.

1. The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). European drug report: trends and developments. Luxembourg: The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA); 2017.

2. Department of Health. New strategic direction for alcohol and drugs phase 2 (2011-16). Stormont, Northern Ireland: Department of Health; 2011.

3. Department of Health. Reducing Harm, Supporting Recovery – a health led response to drug and alcohol use in Ireland 2017-2025. Dublin: Department of Health; 2017.

4. Saltelli A, Giampietro M. What is wrong with evidence based policy, and how can it be improved? Futures. 2017;91:62-71.

5. Singleton N. Attitudes to drug dependence: Results from a survey of people living in private households in the UK. London: UK Drug Policy Commission. 2010.

6. Shorter G, Bingham T. Brief service review, take home Naloxone in Northern Ireland. 2014.

7. Armour C, Shorter GW, Elhai JD, Elklit A, Christoffersen MN. Polydrug use typologies and childhood maltreatment in a nationally representative survey of Danish young adults. J Stud Alc Drug. 2014;75(1):170-8.

8. Wang Z, Du J, Sun H, Wu H, Xiao Z, Zhao M. Patterns of Childhood Trauma and Psychological Distress among Injecting Heroin Users in China. PLOS ONE. 2011;5(12):e15882.

9. Peirce JM, Kolodner K, Brooner RK, Kidorf MS. Traumatic Event Re-exposure in Injecting Drug Users. Journal of Urban Health. 2012;89(1):117-28.

10. Kessler RC, Borges G, Walters EE. Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Survey. Archives of General Psychiatry. 1999;56(7):617-26.

Essential criteria

Applicants should hold, or expect to obtain, a First or Upper Second Class Honours Degree in a subject relevant to the proposed area of study.

We may also consider applications from those who hold equivalent qualifications, for example, a Lower Second Class Honours Degree plus a Master’s Degree with Distinction.

In exceptional circumstances, the University may consider a portfolio of evidence from applicants who have appropriate professional experience which is equivalent to the learning outcomes of an Honours degree in lieu of academic qualifications.

• Experience using research methods or other approaches relevant to the subject domain
• Sound understanding of subject area as evidenced by a comprehensive research proposal
• A comprehensive and articulate personal statement

Desirable Criteria

If the University receives a large number of applicants for the project, the following desirable criteria may be applied to shortlist applicants for interview.

• Sound understanding of subject area as evidenced by a comprehensive research proposal
• Relevant professional qualification and/or a Degree in a Health or Health related area

Funding and eligibility

This project is funded by:

• Institute of Mental Health Sciences

The University offers the following levels of support:

Vice Chancellors Research Studentship (VCRS)

The following scholarship options are available to applicants worldwide:

• Full Award: (full-time tuition fees + £19,000 (tbc))
• Part Award: (full-time tuition fees + £9,500)
• Fees Only Award: (full-time tuition fees)

These scholarships will cover full-time PhD tuition fees for three years (subject to satisfactory academic performance) and will provide a £900 per annum research training support grant (RTSG) to help support the PhD researcher.

Applicants who already hold a doctoral degree or who have been registered on a programme of research leading to the award of a doctoral degree on a full-time basis for more than one year (or part-time equivalent) are NOT eligible to apply for an award.

Please note: you will automatically be entered into the competition for the Full Award, unless you state otherwise in your application.

Due consideration should be given to financing your studies. Further information on cost of living