Exploration of attitudes towards interventions to reduce opioid drug-related deaths on the island of Ireland and recommendations for social and policy change
: a mixed methods inquiry

  • Nicole Miller

Student thesis: Doctoral Thesis


Background: Opioid drug-related deaths is a health issue experienced in the Republic
of Ireland (ROI) and Northern Ireland (NI). Both jurisdictions use an evidenced informed approach to policy making. The evidenced-based intervention of naloxone is used in both jurisdictions, and a supervised injection facility (SIF) has been placed into policy in ROI. Other evidence-based interventions exist but have not been implemented suggesting a research-to-practice gap. This thesis aimed to examine how public attitudes and the social and policy environment are related to the implementation of these policies in order to recommend how to place evidence based interventions into practice
to reduce opioid drug-related deaths.

Design: A mixed-methods design was employed. It included a survey study (study 2) with an open-ended question and a Single Implicit Association Test (study 3) to investigate how explicit and implicit stigma, prejudice, contact, and opinions on drug use relate to support for evidenced-based interventions. The fourth study explored the environmental barriers and facilitators to naloxone and SIF implementation using one-to-one interviews and codebook reliability Thematic Analysis.

Results: The results of the second study found that unsympathetic attitudes predicted less support for policies (e.g., non-prescription naloxone, making a SIF legal) and disagreeing with criminalizing drug users predicted more support. Results of a mediation analysis found that medium to high levels of familiarity indirectly predicted policy support through less stigma and prejudice (avoidance, disgust, and lack of sympathy). The open-ended question further explained the role of stigma in policy
support. The results of the third study found that social stigma predicted policy support beyond implicit stigma. Study four outlined four major themes. Notably, stigma in the health and criminal justice sector and community were a barrier to naloxone carriage and support for an SIF. Heavy policing, community intimidation in ROI, and paramilitary violence in NI were barriers to SIF support. In addition, apathy of policy
makers to help with challenges implementing a SIF in ROI. Naloxone was perceived as a community asset. A SIF was perceived as an environment that reduced stigma and mobile sites were thought to be an important type of SIF to escape community intimidation and violence.

Conclusion: Cross environmental (social and policy) multi-level (macro and micro) stigma reduction programs incorporating sympathetic messaging and contact methods (either indirect or direct) may reduce negative attitudes. This in turn maybe alter the environment and reduce the research-to-practice gap to place available evidence-based interventions into policy to reduce drug-related deaths on the island of Ireland.
Date of AwardOct 2022
Original languageEnglish
SupervisorOrla McBride (Supervisor), Bethany Waterhouse-Bradley (Supervisor), Claire Campbell (Supervisor) & Gillian Shorter (Supervisor)


  • Drug-related deaths
  • Stigma
  • Contact theory
  • Mixed methods

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