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Executive Summary
In 1999, the Scottish Executive set out its plans for tackling drug misuse in Scotland - Tackling Drugs in Scotland: Action in Partnership. A core strand of the strategy focuses specifically on young people, actions to be taken and the messages that need to be conveyed to ensure that young people make healthy lifestyle choices, free from drugs.
The subsequently published Drugs Action Plan: Protecting our Future (2000) , set out the need for a joined up approach to tackling drug misuse, including effective education, better understanding of the epidemiology of drug misuse and provision of appropriate treatment and interventions. Key to the plan is the need to develop the evidence base on what is known about the nature and prevalence of drug misuse in Scotland so that effective interventions can be appropriately targeted.
This report presents the findings of a review of the evidence that is currently available regarding volatile substance abuse ( VSA) in Scotland, with a particular focus on young people aged under 18. The review included analysis of existing statistical data relating to the prevalence and nature of VSA in Scotland and elsewhere. It also included a review of research carried out to explore user profiles, the causes, consequences and nature of VSA, representations of solvent abuse in public media and the educational and other resources that have been developed to raise awareness of VSA among young people, their carers and professionals.
The research shows that the abuse of volatile substances has, in the last 20 years, become a secondary research agenda and is often poorly understood as a drug misuse problem among care professionals. A lack of contemporary research is coupled with low levels of media reporting on the issue, and a lack of obvious presence of VSA in drug education programmes, professional training packages and treatment services. Instead, the evidence suggests that 'glue sniffing' is often portrayed as a historical problem (tied to the 1970s and 1980s) and that illegal drugs, such as ecstasy and heroin, have become the favoured focus of research and care professionals working in the drug misuse field.
Whilst the statistical evidence does show a decline in the prevalence of solvent abuse in Scotland and other parts of the UK over the last 35 years, the abuse of volatile substances continues to be practised by a significant minority of young people and adults in Scotland.
Estimates of the prevalence of VSA come, in the main, from school based self-report surveys of secondary school children. In Scotland, the main survey that collects information on use of solvents in the last year, and in the past month, is the Scottish Schools Adolescent Lifestyle and Substance Use Survey ( SALSUS), a biennial survey of 13 and 15 year olds that collects data on smoking, drinking and drug use. In 2004, 2% of 13 year olds and 4% of 15 year olds reported use of gas, glue or other solvents in the last year. This reduces to 1% in both age groups for use in the last month.
The main European survey that monitors solvent abuse among young people - the European School Survey Project on Alcohol and Other Drugs ( ESPAD) - shows that the UK prevalence for lifetime use of inhalants is 12%, slightly higher than the average for Europe (10%).
The main data relating to adults in Scotland come from the Scottish Crime (and Victimisation) Survey. Data from the latest survey in 2003 showed a prevalence of 3% for lifetime use of glue, gas or aerosols, (an increase from 1% in 2000 and 2% in 1996).
In general, surveys show no gender differences in prevalence of solvent abuse and, relative to other drugs (especially cannabis and stimulants, including cocaine, ecstasy and amphetamines), abuse of glues, gases and aerosols is low.
The reliance on self-report survey data has been criticised in the research literature and schools surveys, in particular, have been criticised for failing to capture those who are often most vulnerable or at risk of engaging in VSA, because they are often not present in the school environment. Indeed, research suggests that VSA is more prevalent among young people who are housed in young offenders institutions and among looked after and accommodated children. It is also difficult to make comparisons between school based surveys in different jurisdictions due to lack of consistency in survey approaches, survey design and different definitions of solvent abuse.
Whilst the practice of glue sniffing, specifically, has declined, there is evidence to suggest that this has been replaced by abuse of an array of alternative products, including aerosols and other household products, and, in particular, gas lighter refills. The evidence suggests that the range of products that can be used, the availability of products, the low cost and ease of hiding products and the short term visible effects of use, make VSA easy to engage in and easy to hide. This makes it difficult to identify and adds to the problems associated with self-report measures of solvent use in achieving accurate estimates of solvent or inhalant abuse.
A number of scientific texts exist that provide coverage of psychological and physiological risks associated with solvent abuse, but much of this work stems from the US and other countries, rather than being UK based.
Literature relating to professional approaches to VSA, and referral pathways in particular, suggests that there are no dedicated services for the treatment for VSA and that many staff lack knowledge of appropriate referral routes for solvent users.
The Scottish Drug Misuse Database ( SDMD), which collects current drug use data from adults presenting to treatment services for all local authorities and health boards across Scotland, showed that, in 2004/05, a total of 78 people presented to services with current solvent abuse problems, accounting for just over 1% of all adults with presenting drug misuse. The number of people presenting to services for whom solvent abuse was the main drug of abuse was just 32, most of whom were under 18. These comparatively low figures (when compared to other types of drug misuse), are often presented in the literature as being the main reason that additional resources have not been targeted at VSA in recent years.
Given the difficulties of estimating prevalence of solvent abuse, it is unclear if the level of training among professionals, and the provision of dedicated care services, is adequate. In any case, consultation with some of the key stakeholders involved in raising VSA awareness suggests that there may be a need for front-line workers, especially social work services and the police, to receive more routine VSA education and training. What does seem apparent is the lack of empirical research that has tested current levels of understanding and awareness of VSA among professionals.
A wealth of information/guidance documents exist which are, for the most part, produced and distributed by a small number of voluntary agencies working in the field in VSA or drug misuse .
The key message presented in the literature is that there is no safe way to use volatile substances since use can be fatal on first experimentation. Indeed, in the 10 year period from 1995 to 2004 inclusive, there were 78 deaths associated with VSA in Scotland (St George's University, of London, 2006). Although the number may appear low, Scotland has the fourth greatest standard mortality ratio for the last 10 years of all jurisdictions in England, Wales and Northern Ireland, sitting at 134, lower only than the North East of England at 158, the East Midlands at 137 and Northern Ireland at 136. There is evidence in the literature that a proportion of VSA associated deaths may occur in first time users.
The death risks associated with VSA appear to present unique challenges to the drug education agenda. The drug education literature shows that scare tactics do not work well with young people and that stories of first time death risks are often not believed. Fear of raising awareness of VSA methods is also cited in the literature as a reason that VSA has not, in recent years, been targeted specifically as part of drug education in the UK. Whilst some of those working in the field have argued for specific VSA education, including primary school children, traditional drug education debates regarding suggestibility of younger children may continue to act as a barrier to VSA education.
Across all the data sources, the area of VSA receiving the least attention is what works in preventing volatile substance abuse. Whilst fears about encouraging VSA through education may account for a general lack of awareness about what works, it presents an obvious gap in the evidence base that can be used to reduce VSA in the future. Research shows mixed levels of response to public awareness raising campaigns, a resistance among professionals in raising the profile of VSA and logistical difficulties in implementing product modifications to reduce VSA. There is also a lack of fieldwork to test the effectiveness of legislative provisions to ban the sales of age-restricted good to under 18s in Scotland. Despite this, a number of harm minimisation approaches that are based on making VSA more visible can be identified from within the range of documents available.
In general, it is apparent from the existing literature that little direct consultative work has been carried out with those who have previously abused, or are currently abusing solvents. Such consultations may represent a way forward in achieving a better understanding of the reasons for initial experimentation with solvents, and the reasons for transition between solvents and illegal drug use. Cross-jurisdictional work may also be necessary to further explore why the mortality rates associated with VSA for Scotland, and those living in Northern Ireland and the North of England, are higher than for other areas of the UK.
In sum, there appears to be little research that focuses specifically on VSA in the Scottish context and a general tendency in the drugs misuse literature towards illegal drugs including cannabis, ecstasy and heroin. Much of the research work that does exist is quite old with very little work post 2000. A number of core sources of evidence are routinely cited, and some of these appear, prima facie, to be out of date with regards to recent trends in types of products that are used and legislative developments. Variable levels of effectiveness in the different strategies that have been employed to tackle VSA have perhaps acted as a barrier to wider efforts in the area. Whilst a body of guidance is available from a small number of agencies the lack of evaluation of these sources, or at least the hidden nature of this work in the grey literature, makes it difficult to achieve an accurate gauge of the effectiveness of current VSA communications.
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