Misuse of prescription sedatives is a significant problem for addiction treatment services. The aim of this study was to examine the prescribing of diazepam in disadvantaged Irish communities, and to identify factors which may predict diazepam consumption in that population. We examined prescribing trends for those aged 16–69 years in 2002 in a region of the state-funded General Medical Services Scheme. Material deprivation was based on the 2002 Small Area Health Research Unit (SAHRU) deprivation index. The average defined daily dose (DDD) was calculated and logistic regression analysis was used to predict diazepam use by age, gender and deprivation index. Results showed that patients living in the most-deprived areas were more likely to receive diazepam than patients living in the least-deprived areas (OR = 1.21, 95% CI 1.15–1.27). Female patients living in the most-deprived areas were also more likely to receive diazepam than those living in the least-deprived areas (OR = 1.36, 95% CI 1.18–1.57). It is concluded that there is a pattern of higher diazepam prescribing in areas of greatest deprivation, where prescription sedatives play a complex role within troubled families.

The study aimed to examine demographic and psychosocia l features of clients presenting to a new community addiction service in Dublin by retrospective collection of data from the National Drug Treatment Reporting System and from case records on site. The setting was Ballymun Addictions Service, where adequate records were available for three-quarters of all cases seen to date. Findings included a mean age of injecting commencement of 18 years, a 7-year period of injecting before treatment entry, 80% hepatitis C infection rate, 39% prevalence of heroin-addicted siblings, 73% within-family substance misuse, 80% male previous conviction rate and universal early school leaving. Psychosocial problems included domestic violence, sexual assault, homelessness, self-harm, teenage sex work and homicide history. It is concluded that the caseload of the communitybased addiction service includes many complex problems and that prognosis for most clients must be guarded. Community-based treatment services need to address the endemic and collective nature of addiction processes in the poverty context.

AB S T R A C T Benzodiazepines have been described historically as the latest and safest of a long list of popular sedative compounds. Despite well-known problems of dependence and misuse, they continue to be widely prescribed, even on an unlicensed long-term repeat basis, particularly to women, the elderly, the chronically ill and other groups of people who suffer social and educational disadvantage. Guidelines discouraging such prescribing have been relatively ineffective, and may not be based on a grounded assessment of the balance of risk in the management of community mental health problems. Effective benzodiazepine regulation is a complex multilevel process, requiring a grasp of the dynamics of drug prescribing, consumption and diversion. The urgent need for further quantitative and qualitative research is starkly illustrated in the deteriorating social environment of the modern inner-city ghetto.

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