The face of addiction in Ireland is changing and we are witnessing the most significant shift in our drug landscape since the heroin epidemic of the 1980s. The sedative effects of heroin use are slowly shifting towards a more intense and restless energy that is commonly associated with a drug with very different effects but ravaging the same communities. Social inequality remains at the heart of the problem. If we don’t take steps to provide adequate social support we could end up looking back at this time as our next epidemic, the crack cocaine crisis. The victims remain the same and the consequences could be just as devastating. At Merchants Quay Ireland our frontline staff are reporting that many people who use crack cocaine are presenting in shocking conditions, showing significant weight loss, poor nutrition and declining overall physical health. Crack cocaine suppresses a person’s appetite and its short-lived effects alongside its low cost drives repeated use throughout the day. People who use the drug describe spending much of their time focused on obtaining and using the drug, while eating, sleeping and self-care become secondary concerns. People’s lived experience as well as statistics confirm our concerns. The Health Research Board’s (HRB) drug treatment report for 2025 shows cocaine became the most common drug for which people sought treatment in Ireland last year. Crack cocaine accounted for 26.6 per cent of all cocaine cases (1,741), the highest figure ever recorded in Ireland. Treatment demand for crack cocaine increased by more than 900 per cent between 2017 and 2025, while rising by 31 per cent last year alone. The growing impact on women is another important factor that deserves attention. Recent findings from Coolmine Therapeutic Community show that more than half of those presenting for crack cocaine treatment are women. We know from both research and the stories women tell us that they often experience stigma, struggle with caregiving responsibilities, have a fear of child welfare involvement and have past or current experiences of gender-based violence or trauma as additional barriers to treatment. Any effective national response must acknowledge these realities and ensure services are designed to meet women’s specific needs. While public attention often focuses on drug seizures, crime, or visible drug use, the rapid rise of crack cocaine reveals a deeper and more uncomfortable reality exposing the consequences of homelessness, trauma, poverty and social exclusion. It demands a response that goes beyond treatment alone. Importantly, unlike powder cocaine, Ireland’s crack cocaine problem is not distributed evenly across society. [ Dublin’s crack cocaine epidemic: ‘You get a rush. You come down. And then you have to go again’Opens in new window ]The profile of people most affected points to a wider social crisis. The HRB data shows that almost a quarter (24 per cent) of people entering treatment for crack cocaine last year were experiencing homelessness compared with 5 per cent for those using powder cocaine. Similarly, nearly 80 per cent of crack cocaine users were unemployed compared with just more than 54 per cent for powder cocaine users. This reality challenges a common misconception that addiction is primarily a matter of personal choice. Drug use spans all social groups but the harms are often concentrated among those who have experienced childhood adversity, family instability, homelessness, poverty and involvement with the care or justice systems. Having worked in the Irish Prison Service for more than 30 years I’ve seen the challenges facing people who are living on the margins of society. Crack cocaine has been quietly growing as a problem but it’s now very much moving into plain sight. Mental health concerns are equally alarming. We are increasingly seeing people with significant paranoia and agitation. Although crack cocaine itself can contribute to these symptoms, the reality is often far more complex. What people often do not see is that many of these people are already coping with significant trauma, living in unstable housing, experiencing poor physical health and dealing with existing mental health difficulties. Crack cocaine can intensify the challenges people are seeing in their day-to-day life, which creates a vicious cycle where distress drives drug use and drug use worsens distress. We need integrated mental health and addiction services so we can address both issues simultaneously. The response to Ireland’s crack cocaine crisis cannot be limited to emergency measures and enforcement actions that focus on victim-blaming or over-stretched treatment services. Expanded access to evidence-based addiction treatment is essential but not exhaustive. Increased investment in dual diagnosis services that address addiction and mental health difficulties together with harm reduction measures, including low-threshold services and supervised consumption facilities, all have an important role to play. But if we focus only on the drug itself, we risk missing the source of the problem. The rise in crack cocaine use is not simply evidence of a changing drug market but also of growing social vulnerability. The same conditions that drive homelessness, unemployment and untreated trauma create fertile ground for problematic drug use. Addressing one without addressing the others will not work. We can start to tackle this issue on the front line by supporting an end to stigma, strengthening existing homelessness and addiction services, and delivering gender-specific services for women but crucially this support must be built upon a stable foundation of government interventions that prioritise areas such as community development, housing provisions and early trauma interventions. Four decades ago heroin exposed inequalities within Irish society. Today crack cocaine is exposing them once again. The question is whether we are prepared to respond not only to the drug but also to the circumstances that leave people vulnerable to its harms before it’s too late. Eddie Mullins is CEO of Merchants Quay Ireland and former governor of Mountjoy Prison