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SCOTTISH ADVISORY COMMITTEE ON DRUG MISUSE: Psychostimulant Working Group Report
CHAPTER 1: INTRODUCTION
1.1 Until recently the known prevalence of psychostimulant use in Scotland has been at a low level compared to other parts of the United Kingdom. However, by 2001 there were increasing anecdotal reports from services which suggested that the use of this group of drugs was on the increase and that current opiate based services were unable to offer an appropriate level of support nor be attractive to potential clients.
1.2 The Scottish Advisory Committee on Drug Misuse (SACDM) agreed, therefore, at its Away Day in June 2001, to set up a Working Group to review the extent of psychostimulant use in Scotland, review current service provision and make recommendations for the future. This is the report of the Working Group, presented to SACDM on 10 June 2002.
The work of the Group will also inform the integrated care report to be published by the Scottish Executive's Effective Interventions Unit later this year.
THE WORKING GROUP AND SCOPE OF REPORT
Remit
1.3 The remit of the Psychostimulants Working Group (PSWG), agreed at its first meeting, was:
to identify the issues around cocaine, crack and amphetamine use in Scotland; to look at the available evidence for best practice in prevention and service provision; and to make recommendations to the SACDM with a view to the Scottish Executive issuing guidance to service providers, users and interested individuals.
Membership
1.4 Membership of the group covered a range of professional expertise and reflected experience across Scotland. The group met on four occasions and took oral and written evidence from a number of experts with a particular interest in this group of drugs. A list of members can be found at the end of this Report.
Scope of report
1.5 The report is based on:
a detailed scrutiny of the relevant scientific literature, including a review undertaken by the Scottish Executive's Effective Interventions Unit (EIU);
the results of a pan-European study to evaluate the current use of psychostimulants - the Study by the Federation of European Professional Associations Working into the Field of Drug Abuse (ERIT);
oral and written evidence; and
a short piece of commissioned, peer research to elicit psychostimulant users' views and experiences with existing services.
WHAT DO WE MEAN BY PSYCHOSTIMULANTS?
1.6 Psychostimulants are chemical substances that excite the central nervous system. There are a number of naturally occurring psychostimulants, such as caffeine, nicotine, ephedrine and cocaine. There are also synthetic stimulants, which are predominantly amphetamines. They have been used as appetite suppressants and have been investigated for their potential to decrease fatigue and increase work output.
1.7 Psychostimulants have the potential to produce feelings of well being and alertness. They are habit forming and can cause dependence. There is evidence to suggest that abrupt discontinuation can result in a characteristic withdrawal syndrome.
1.8 The psychostimulants covered by this report are:
Amphetamines - a group of chemically related synthetic stimulant drugs generally produced illicitly or as tablets legally produced by pharmaceutical firms and subsequently diverted onto the illicit market.
Cocaine - cocaine hydrochloride and cocaine alkaloid which is known as 'freebase' or 'crack'. (
See Glossary)
1.9 The spelling of many drugs has recently been changed by international agreement. 'Amphetamine' is the old British Approved Name spelling and is used throughout this report. 'Amfetamine' is the new International Naming Nomenclature spelling.
THE LEGAL POSITION
1.10 The most important statute relating to drugs in the UK is the Misuse of Drugs Act 1971 which aims to prevent the non-medical use of certain drugs. The Act lists the drugs that are subject to control and classifies them in three categories, Classes A, B and C. Penalties for offences involving controlled drugs depend on this classification, with Class A drugs carrying the greatest penalties. The Act distinguishes, in terms of penalties that can be imposed, between crimes of possession and drug trafficking, the latter attracting the higher sanctions. Class A psychostimulants include cocaine, ecstasy and amphetamines that are prepared for injection; Class B includes the oral forms of amphetamine, dexamphetamine, methylamphetamine and methylphenidate; Class C stimulants include benzphetamine, pemoline, and phentermine. Stimulants therefore fall into all 3 categories under the Act.
1.11 The legislative framework for controlled drugs is a matter that is reserved to Westminster.
Treatment of Attention Deficit Hyperactivity Disorder and Hyperkinetic Disorder
1.12 The use of psychostimulants to treat a number of medical conditions remains controversial and there are concerns about prescribing such medication to children as well as anxieties surrounding the potential for prescription misuse and the inappropriate diversion of these psychostimulants onto the black market. Two psychostimulants available for prescription in the UK are methylphenidate and dexamphetamine. Both are licensed for the treatment of children with Attention Deficit Hyperactivity Disorder (ADHD) and Hyperkinetic Disorder (HKD). The Scottish Intercollegiate Guidance Network recommends that the initiation of pharmacological treatment for children with ADHD and HKD should only be undertaken by a specialist in either child or adolescent psychiatry or paediatrics who has training in the use and monitoring of psychotropic medicines. The Working Group endorses and commends this recommendation.
1.13 Further information on the drugs, the main routes of use and the effects of use can be found in Chapter 5.
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