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Chapter 2: Extent and impact of the psychostimulant use in Scotland
Psychostimulant use in Scotland today
9. There is no one single source of information on psychostimulant use in Scotland. It is possible, however, to build a picture of psychostimulant use among the Scottish population by using information from a number of existing sources, including national surveys, drug seizures and treatment data.
10. Based on survey data cocaine is now the next most commonly used drug in Scotland after cannabis , with a marked increase in its reported use over the last 10 years: 4% of adults in Scotland reported having used cocaine in the past year in 2006, compared with only 1% in 1996 4. The third most commonly reported drug is ecstasy, with 3% of adults reporting they had used it in the past year in 2006, compared with 2% in 1996 5.
11. Methylamphetamine is a synthetic drug related to amphetamine, which produces greater effects on the central nervous system. It appears to have a very low prevalence in Scotland at present; there have been no seizures in the last three years except one very small recovery in the northern isles in 2007 which was handed to the Police anonymously. Very small numbers have presented for treatment. However, the experience from other countries such as North America and Australia demonstrate that it can have a devastating impact on individuals, families and communities.
12. There is a need to remain vigilant as patterns of drug use change. Given this, it is recommended that, where they do not already exist, systems should be put in place at both national and local levels to monitor psychostimulant use to capture data on trends in all drug use, including Methylamphetamine, GHB, Ketamine and other substances. This information should be shared between partners to allow speedy and flexible responses to emerging trends. If cocaine use continues to rise then services may need to be prepared to institute fundamental changes in the way that they operate.
13. Whilst it is recognised that all drugs can be used recreationally, it is wrong to call any substances 'recreational drugs', as all have the potential to cause harm, including dependency and addiction. Used to excess all these substances have the potential to cause serious mental and emotional problems, injury to the body and social problems, including family breakdown, financial and employment difficulties. The current estimation of problem drug users in Scotland (52,000 in 2003) does not include psychostimulants but we know that there has been an increase in the percentage of new clients contacting treatment services whose main illicit drug is cocaine (from 1.3% in 2001-2 to 3.5% in 2005-6) 6.
14. There was also a 0.2% increase in new clients reporting crack cocaine as their main illicit drug from 2003-4 to 2005-6 7. The use of crack cocaine is geographically concentrated in certain parts of Scotland, including Glasgow and Edinburgh, as well as Aberdeen and Aberdeenshire where there is an established crack market within the opiate using population and which is closely linked to prostitution. Crack use, whilst also reported on the 'recreational' scene, appears to be linked to opiate use and problematic psychostimulant use.
15. The mandatory drug testing of arrestees pilots, which are currently underway in Aberdeen, Edinburgh and the east end of Glasgow involve testing for opiates and cocaine/crack cocaine of arrestees for certain trigger offences, principally theft related and Misuse of the Drugs Act 1971. The pilots will run for a 2 year period to June 2010 in the first instance and are likely to provide valuable data on usage in the pilot areas.
16. This picture of increasing cocaine use is supported further by a 46% increase in seizures of cocaine and crack cocaine from 2004-5 to 2005-6, which while not conclusive in itself may be indicative of a growing problem and add to the other existing evidence 8.
17. It is important to ask ' why' there appears to have been a marked increase in the use of cocaine over the last ten years. It is suggested that the advent of the dance scene phenomenon in the late 1980s made the use of psychostimulants more acceptable among those people who were otherwise law-abiding 9. Intelligence from the Scottish Crime and Drug Enforcement Agency suggests that recently the price of cocaine has dropped (from £100 per gram in 2002 to £40-£80 per gram in 2007) makes it more attractive to new users, as well as existing problem drug users. In addition, both Edinburgh and Glasgow have seen cocaine marketed as "tenner" bags, which suggests a deliberate effort on the part of dealers to appeal to heroin users.
18. There is also evidence that cocaine is seen as glamorous, a sociable drug that can be shared without risk. Attitudes towards cocaine are fairly relaxed compared to heroin which, for many people, has a stigma attached to its use 10. Overall, this has resulted in a change in user profile from those with more disposable income to a wider section of the population. This means that psychostimulant users are not a homogenous group. In this respect, the Group felt that the definitions provided in the 2002 SACDM report were still broadly correct but it recommended that 'youthful experimenters' is amended to 'experimenters'. The amended definitions are set out in the box below.
Experimenters - who are likely to use stimulants as part of a pattern of poly-drug experimentation. They are unlikely to be in touch with any Scottish drug service, other than those providing drug information. Their social and demographic profile is mixed and reflects the increased acceptance of drug use within the younger population. Established primary stimulant drug users - These individuals will typically be using stimulant drugs regularly (weekly). Their social and demographic profile matches that of the experimenters. They may have had some contact with drug information services but are unlikely to have used any other drug service. Problematic stimulant users - they will have been regular stimulant users for at least a year. They have a similar social and demographic profile to the first two groups. This is the group that is most likely to be looking for specialist services which do exist in some areas, but not in others and they may then instead present at mental health services. Opiate/stimulant users - primarily opiate users who use stimulants as well. These are the individuals who are most likely to be in touch with existing services but whose needs in relation to the stimulants, may not be well served. It is from this group that the Scottish Drug Misuse Database figures about crack use have come. We could call this group the opiate/stimulant co-users. Their demographic profile is similar to the opiate drug-using group 11 |
19. One of the characteristics of psychostimulant users is the likelihood of other stimulant and other drug use at the same time (known more commonly as poly-drug use). Typically around 2 in 5 current drug users report taking 2 or more different illegal drugs together 12. Consuming alcohol while under the influence of drugs was even more common, with 4 in 5 current drug users having done this 13. This supports expert opinion from the Group that cocaine is being used with a cocktail of drugs and, in particular, alcohol.
20. Overall, the use of psychostimulants and, in particular, cocaine has increased in Scotland over the last five years.
21. However, it is likely that the prevalence may, in actual fact, be considerably higher than survey and statistics show as there may be a 'hidden population' which is not being picked up through the existing data collection methods. This includes those people who:
- are using psychostimulants on a 'recreational' basis who do not see themselves as having a problem. Their use is unlikely to be accompanied by any criminal behaviour other than the possession/supply of controlled drugs.
- think they might have a problem but are reluctant to contact existing opiate based drug services. This is because they do not think treatment for psychostimulants is available or effective; feel that there is a stigma attached to attending these services; and are concerned about confidentiality issues ie their employer might find out. The opening hours may also be a barrier to people attending services as many will be in full time employment and can not attend during the day.
- are receiving treatment for opiates, but as the focus of the service is on their opiate use rather than their psychostimulant problem, the latter is not picked up; or the psychostimulant use is not disclosed for fear of having their methadone prescription withdrawn 14.
22. It is recommended that the Government develops a more accurate picture of psychostimulant use in Scotland which attempts to capture data on the 'hidden population'. The National Evidence Group should consider how this might be done most effectively and whether it should be widened to include poly-drug use, if there is currently a gap in this area.
Impact of psychostimulant use
23. The impact of psychostimulant use can be on the individual, their family and wider society. Individuals who take psychostimulants generally do so orally (swallowing or smoking) or by snorting. Psychostimulants can cause a variety of cardiovascular problems. These include rapid heart rate, irregular heartbeat, increased blood pressure, and irreversible, stroke-producing damage to small blood vessels in the brain. Methods of ingestion such as snorting and smoking (especially the use of pipes) can damage soft tissue in the nasal passages, affecting breathing and causing burns to the throat and lips etc, and can also reduce appetite 15.
24. Some people take psychostimulants intravenously. Intravenous use can result in cellulitis, abscesses, septicaemia, arterial thrombosis, endocarditis (a chronic infection of the inner lining of the heart and heart valves), renal infarction, and thrombophlebitis. Sharing of injecting equipment raises the risks of contracting hepatitis B and C, HIV and ultimately AIDS. A recent report demonstrated that over 85% of hepatitis C sufferers in Scotland contracted the disease from sharing needles, syringes or other paraphernalia. 16 Psychostimulant injectors are also likely to inject more frequently than heroin injectors which has implications for needle exchange provision.
25. Heightened libido and increased sexual activity through psychostimulant use can also lead to higher risks of unplanned sexual activity, increased sexually transmitted infections and pregnancy (particularly when psychostimulants are used in conjunction with Viagra or alcohol) and also abrasions and damage to the genitals 17.
26. Taking cocaine alongside alcohol can have a more dangerous effect on the brain, producing another compound in the liver, cocaethylene, which is more harmful than using either drug alone. Cocaethylene exacerbates the cardiovascular effects. There is also a possibility that the culture of binge drinking (which is especially prevalent in Scotland) on an empty stomach and taking cocaine at the same time will be even more dangerous due to the potential optimisation of cocaethylene levels as the alcohol consumed reaches the bloodstream more quickly 18.These are important issues for Scotland given the prevalence of cardiovascular problems 19. In addition, the numbers of drug-related deaths where cocaine was present (sometimes with alcohol or with other drugs) have doubled over the past 5 years whilst deaths where ecstasy was present have halved. 20
27. There are psychiatric problems associated with psychostimulant use such as anxiety, panic attacks, depression and paranoia, and methylamphetamine, in particular is linked to episodes of psychosis. Often users do not associate these problems with their drug taking. There are also links between substance misuse and Attention Deficit Hyperactivity Disorder ( ADHD) 21.
28. While there is no figure for the social and economic cost of drug use in Scotland (Scotland specific research has been commissioned and will be published later this year) research has been carried out in England and Wales. It shows that the average economic and social cost per problem drug user in England and Wales is around £50,000 per year 22 which if applied to Scotland using the 2003 prevalence rates of 52,000 problem drug users would suggest economic and social costs of problem drug use at £2.6bn per annum.
29. People with psychostimulant problems are not included in the 52,000 estimated problem drug users in Scotland. However, it is assumed that a proportion of the £2.6bn per annum can be attributed to those people experiencing problems with primary psychostimulant use or using it in conjunction with other drugs such as heroin.
30. There is also likely to be wider costs of 'recreational' psychostimulant use, for example lost labour productivity due to absence from work or poor performance following drug misuse which affects economic growth. However, it has been suggested that amphetamine use enhances productivity as it allows people who work in the trucking, building or service industry to work longer hours. It is also used to aid study by reported increased concentration and long period of revising.
31. Demand for drugs in Scotland can also have an impact at a global level as it often relies on the exploitation of the poorest people in the producer and transit countries. For example, Colombia remains by far the largest source of illicit coca in the world, followed by Peru and Bolivia 23. The 'Shared Responsibility' is a Colombia-led initiative to highlight in other countries the social and environmental effects that their cocaine use is having on people and communities in Colombia 24.
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