Cocaine-related hospital admissions in Ireland from 2005 to 2019, a period of varying national economic performance

Background: Research on the association of cocaine use and varying economic conditions is limited. Using Irish data from a 15-year period of economic fluctuation we hypothesised that harmful cocaine consumption would decline during recession and increase during economic growth.

Methods: A retrospective review of emergency cocaine-related hospital admissions (CRHA) was carried out using Irish Hospital In-Patient Enquiry (HIPE) data from 2005 to 2019. CRHA rates were calculated using population estimates and population affluence was measured using annual median disposable income (MDI) for the same time period. Associations between CRHA and age group, sex, and diagnosis were examined, and the association between CRHA and MDI was modeled using linear regression.

Results: CRHAs were overwhelmingly male (p<0.001) and almost two thirds were under 35 years (p<0.001). Injury and poisoning was the commonest primary admission diagnosis. Only 21.5% of CRHAs involved dependent cocaine use. Almost 35% had an alcohol-related diagnosis. CRHA rates mirrored MDI, increasing until 2007, then declining until 2011, followed by an increase from 2012. Among 15 to 34 year-old males a €1000 increase in MDI was associated with an increase in CRHA rate of 4.10 (95% confidence interval: 3.11, 5.10) per 100,000, with strong although smaller positive associations observed in other age-sex groups. 

Conclusions: While there is a substantial literature pointing to the role of poverty in perpetuating many drug-related harms, this study suggests that economic prosperity is associated with increased acute medical cocaine-related harms. Prevention efforts should prioritise younger males and non-dependent patterns of use and may need to be escalated during periods of economic growth.