An Analysis of UK Drug Policy

2007

2013

2003

PsycEXTRA Dataset

The Research, Development and Statistics Directorate exists to improve policy making, decision taking and practice in support of the Home Office purpose and aims, to provide the public and Parliament with i n f o r mat io n necessar y for i n f o rmed debate and t o publish information for future use. Stat istical Bul let ins are p roduced by the Researc h , Development and Statistics Directorate. For further copies contact: p u b l i c a t i o n s . rd s @ h o m e o ff i c e . g s i . g o v. u k h t t p : / / w w w. h o m e o ff i c e . g o v. u k / rd s

The Politics of Drugs

During the New Labour years (1997-2010), significant redirection of drugs policy took place, especially in the area of treatment: new institutions and policies were developed under the guidance of the National Treatment Agency. However in 2010, when the Coalition (Conservative and Liberal Democrat) government was formed, with its goal to prioritise 'recovery', there were still an estimated 400,000 problematic heroin and crack cocaine users in the UK. The consensus then among drug treatment experts was that the priority should be to build on what had been achieved but develop better links between different health, social care and other services to support recovery. The new direction of policy towards recovery was accepted but the challenges had to be recognised: many of the people who were using drug services arrived at the door with multiple problems and needs. Often their drug use was linked to experiences of childhood abuse or adult trauma, to mental health problems, homelessness, family breakdown and other problems. 1 Under Coalition and Conservative administrations since, the emphasis in drug treatment policy has been on 'recovery' but the wider context has

2005

to improve policy making, decision taking and practice in support of the Home Office purpose and aims, to provide the public and Parliament with i n f o rmat ion necessar y for i n f o rmed debate and to publish information for future use. Sta t i st ica l Bu l le t ins are p roduced by the Researc h,

2000

Addiction Research & Theory, 2013

Using Bayesian capture-recapture analysis, we estimated the number of current injecting drug users (IDUs) in Scotland in 2006 from the cross-counts of 5670 IDUs listed on four data-sources: social enquiry reports (901 IDUs listed), hospital records (953), drug treatment agencies (3504), and recent Hepatitis C virus (HCV) diagnoses (827 listed as IDU-risk). Further, we accessed exact numbers of opiate-related drugs-related deaths (DRDs) in 2006 and 2007 to improve estimation of Scotland's DRD rates per 100 current IDUs. Using all four data-sources, and model-averaging of standard hierarchical log-linear models to allow for pairwise interactions between data-sources and/or demographic classifications, Scotland had an estimated 31700 IDUs in 2006 (95% credible interval: 24900-38700); but 25000 IDUs (95% CI: 20700-35000) by excluding recent HCV diagnoses whose IDU-risk can refer to past injecting. Only in the younger age-group (15-34 years) were Scotland's opiate-related DRD rates significantly lower for females than males. Older males' opiaterelated DRD rate was 1.9 (1.24-2.40) per 100 current IDUs without or 1.3 (0.94-1.64) with inclusion of recent HCV diagnoses. If, indeed, Scotland had only 25000 current IDUs in 2006, with only 8200 of them aged 35þ years, the opiate-related DRD rate is higher among this older age group than has been appreciated hitherto. There is counter-balancing good news for the public health: the hitherto sharp increase in older current IDUs had stalled by 2006.

Addiction, 1967

British Medical Journal, 2008

Objectives To examine the "Scottish effect"-namely, the growing divergence between mortality in Scotland and England that is not explained by national differences in levels of deprivation-and, more specifically, to examine the extent to which the Scottish effect is explained by cross national differences in the prevalence of problem drug use. Design Secondary analysis of cohort study (the DORIS study). Participants 1033 Scottish drug users recruited to the cohort study in 33 drug treatment facilities across Scotland in 2001-2 and followed up 33 months later in 2004-5. Results 38 deaths occurred in the cohort, giving a standardised mortality ratio for the cohort of 1244 (95% credible interval 876 to 1678). Only 22 of the 38 deaths in drug users were classified as drug related deaths. From estimates of the size of the problem drug using populations in both England and Scotland, the contribution of deaths in drug users to national death rates can be estimated: the attributable risk fraction for Scotland is 17.3% (12.3% to 22.8%) and that for England is 11.1% (7.8% to 14.8%). Excluding estimated numbers of deaths in drug users would bring down age standardised mortality at ages 15-54 years from 196 to 162 per 100 000 in Scotland and from 138 to 122 per 100 000 in England; 32.0% (22.3% to 43.0%) of the excess mortality in Scotland is due to drug use. Conclusion Although problem drug use is a low prevalence risk behaviour, it carries a high mortality; the standardised mortality ratio for Scottish drug users is 12 times as high as for the general population. The higher prevalence of problem drug use in Scotland than in England accounts for a third of Scotland's excess mortality over England. Successful public health efforts to reduce the prevalence of problem drug use in Scotland or deaths in Scottish drug users would have a dramatic impact on overall mortality in Scotland.

The Sociological Review, 2008

This is an early report of data from an on-going, repeated, cross-sectional study of a community sample of Glasgow injecting drug users. Although HIV was first detected among Glasgow's drug injectors in 1985, data from the first two years of our annual samples (1990 and 1991) indicate that HIV prevalence continues to be low in this population, in the order of 1 or 2 per cent. Possible reasons for this apparent continuing low prevalence are examined. It is suggested that substantial risk reduction – reductions in injection equipment-sharing, reductions in numbers of sharing partners and restrictions in social circles of sharing partners – may have been sufficient reasons, in conjunction with limited contributions to near-stabilisation from the disproportionate attrition of the numerator population through death and cessation of injecting.

Journal of Public Health, 2004

The incidence of new persons and repeat attenders presenting for treatment for problem drug misuse in the South West of England more than doubled from 1996-1997 to 2000-2001. During this time there was an increase in the number and severity of chronic cases, both in terms of the prevalence of heroin and crack-cocaine use and in the frequency of injecting and sharing injecting equipment. Growth in the availability of treatment, changes in notification practice and sub-regional variation make it difficult to be confident about real rates of increase, or age, gender and substance misuse changes, but the size of these changes mean they are unlikely to be purely artefactal.

2010

The Annual Report on drug-related deaths in the United Kingdom published by the national programme on Substance Abuse Deaths (np-SAD) is used by the UK Government, national and international agencies, academics, and commissioners and service providers as an indicator of the extent and nature of drug misuse, and makes a contribution towards the prevention of substance abuse problems. The Programme could not achieve its goals and objectives without the invaluable voluntary collaboration and cooperation of coroners and their officers across England, Wales, Northern Ireland, Guernsey, Jersey, and the Isle of Man. Scottish drug-related deaths data is provided by the Scottish Crime and Drug Enforcement Agency. Additional data is provided by the Northern Ireland Statistics and Research Agency on drug-related poisonings from the General Mortality Register. The contributions from all are important as it enables the Programme to maintain a UKwide reporting and surveillance system. We thank them all for their active participation and support. The findings show an increase in deaths in 2009 reported directly to np-SAD by coroners from England, Wales, Northern Ireland and the Islands when compared to the number reported in last year's report. Deaths in Scotland have remained stable. The np-SAD has an ongoing programme of visits to a representative sample of coroner areas to monitor the quality, accuracy and comprehensiveness of the data received on drug-related death. As in previous years, the statistics in this report are intended to inform authorities at the local, regional and national levels, as well as health professionals and the general public, about the serious consequences of drug abuse, especially polydrug use. This year's report provides a more detailed analysis for 'drug misuse' deaths for England and looks in particular at differences between age-groups, the mortality of drug users aged over 40, and polysubstance implication in death. The report also provides a number of indications of changes in patterns of drug abuse, trends over time, and emerging issues from our surveillance activities so that appropriate and timely action can be taken. The Programme would like to express their thanks to the Department of Health for its support for this very important programme.