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CHAPTER 3: THE SCHEMES IN OPERATION

3.1 This chapter details the activities undertaken in each of the three pilot sites over an 18-month period from June 2007 to the end of November 2008. It presents the data on the numbers of arrestees referred into MDTA, and provides an analysis over time in the main trends of referral activity.

3.2 The period of analysis has been restricted to this 18-month timeframe to meet the reporting timescales of the evaluation. At the time of writing, each of the pilot schemes continues to be operational, but the time required for processing, cleaning and entering the data into local data systems meant that it was not possible to perform a 'real time' analysis of cases in each area.

Summary of Testing, Referral and Treatment Activity

3.3 Table 3.1 provides a summary of the numbers of drugs tests carried out in each of the three pilot sites, as well as the numbers of referrals into assessment, attendance at assessment and people who subsequently went on to engage with drug treatment services as a result of participating in the MDTA scheme.

Table 3.1 Summary of Testing, Referral and Treatment Activity

3.4 The table shows that the number of people tested in Edinburgh was significantly higher than in the other two sites. The numbers of referrals for assessment were broadly similar in all three areas but attendance at assessments was lower in Glasgow than elsewhere. Despite this, the Glasgow pilot had the highest number of people engage with drug treatment services, followed by Aberdeen and Edinburgh.

3.5 The remainder of the chapter provides a more detailed analysis of activity in the three areas to provide a fuller understanding of these figures.

Detailed Analysis of Testing, Referral and Treatment Activity

Arrested and eligible to be tested

3.6 The number of people who were arrested and who were eligible to be tested as part of the MDTA scheme should, in theory, match the total number of tests carried out in each site. All forces pointed out, however, that there would inevitably have been some time periods in which arrestees were brought into custody who met the eligibility criteria, but were not processed for MDTA. This would have occurred at times when dedicated trained MDTA police staff were not at work due to annual leave or illness, or where capacity issues with the numbers of arrestees being held prevented staff from concentrating their time on MDTA.

3.7 In Aberdeen, the total numbers of people arrested and eligible to be tested was 1565. In Edinburgh, this number was 2639.

3.8 In Glasgow, a total figure for the number of people who were eligible to be tested was not provided. With more than 7000 arrestees overall passing through custody in London Road each year, it was felt that keeping a record of those eligible to be tested for MDTA was too difficult to achieve.

Eligible but not tested

3.9 In Aberdeen and Edinburgh, information was provided on the number of people who were eligible to be tested in terms of meeting the trigger offence criteria, but who were not processed. The main reasons for not undertaking the test were that arrestees were excluded on the basis of legislation ie that arrestees had been detained for more than 6 hours, that they had already been tested in the previous three months, they lived outwith the pilot area, or that they were too violent or too intoxicated.

3.10 This information was not available for Glasgow, but Table 3.2 details total numbers for Edinburgh and Aberdeen for the period from 12 June 2007 to the end of November 2008.

Table 3.2 Eligible to be Tested but not Tested

Arrestees refusing to be tested

3.11 The numbers of arrestees refusing to take part in the drugs tests, where the MDTA process had been initiated, was low across all sites.

3.12 In Aberdeen, a total of 26 arrestees refused to be tested while in Edinburgh, a total of 6 arrestees refused to be tested in the period from 12 June 2007 to the end of November 2008. In Glasgow, there were no recorded cases of arrestees refusing to take part in the MDTA drugs test, where offered.

Drug tests conducted

3.13 At the start of the pilot, it was anticipated that 15,000 people a year across the three sites might be tested, that around 50% would test positive and that around 50% of those would go on to engage in treatment.

3.14 Table 3.3 shows the number of drug tests successfully completed in each area broken down by month.

Table 3.3 Number of Drug Tests Carried Out in each Area

3.15 The numbers show that the number of tests performed were significantly below the anticipated numbers, representing around 15% of the numbers predicted in the first 18-months operation.

3.16 Edinburgh carried out more than two times as many tests than Aberdeen or Glasgow, but also had considerably more eligible arrestees to be tested compared with Aberdeen. This might also be explained by the fact that there were more PCSOs in Edinburgh, than there were in either Aberdeen or Glasgow, therefore, a PCSO team was on duty over all time periods covered by the pilot and was available to perform the tests.

3.17 As the total number of eligible arrestees in Glasgow is not known, it is not possible to provide an estimate of the number of tests carried out as a proportion of all those eligible to be tested. For Aberdeen and Edinburgh, however, the proportions were 54% and 77% respectively. This suggests that, in addition to having the highest potential workload of the two sites, Edinburgh managed to provide a more comprehensive regime of testing than their Grampian counterparts.

3.18 In general, the number of tests carried out in each area fluctuated over time. In Aberdeen, there were no discernable trends in the testing data, with only a slight decline in the number of tests in Aberdeen towards the end of the evaluation period.

3.19 Edinburgh saw a gradual rise in the number of tests performed in the first six months of pilots, before plateauing as the pilot progressed. The Edinburgh pilot showed a drop in testing activity in the summer of 2008, before rising sharply at the end of the evaluation period (November 2008). The police provided no explanation for this rise, but it may have been linked to an increase in evaluation activity, and extra impetus put behind the scheme at that time.

3.20 In Glasgow, there was some fluctuation in the number of tests carried out at the start of the pilot, which may be linked to changes in staff in that period, but once the two PCSOs were in place, the number of tests appears to have been relatively stable over time.

Positive and negative tests

3.21 In total, there were 334 positive tests in Aberdeen (39% of total tests undertaken), 471 in Edinburgh (26% of total tests undertaken) and 301 positive test results in Glasgow (51% of all tests undertaken), over the 18-month period.

3.22 In both Glasgow and Edinburgh, heroin/opiates accounted for the largest proportion of positive tests (n=125; 42% in Glasgow and n=296; 63% in Edinburgh). In Aberdeen, heroin alone was found in 33% of positive tests (n=110).

3.23 The proportion of positive tests in which cocaine was the sole drug present was 26% in Aberdeen (n=88), 24% in Edinburgh (n=111) and 31% in Glasgow (n=94).

3.24 In Aberdeen, traces of both heroin and cocaine were found in the greatest proportion of positive drug tests (n=136; 41%). Combined heroin and cocaine use accounted for the fewest cases of positive tests in both Edinburgh (n=64; 13%) and Glasgow (n=82; 27%).

3.25 The total number of people disputing a test result was 19 in Aberdeen and 144 in Edinburgh for the period from 12th June 2007 to the end of November 2008. The figure is not known for Glasgow.

Confirmatory Testing

3.26 Oral fluid samples from each of the pilot sites are sent to the Scottish Police Services Authority ( SPSA) for confirmatory testing, for one of three reasons: for quality assurance, as part of a random 2% of all tests taken (both positive and negative); following a dispute by the person tested; and to test for medication, where a client declares that they have taken medication which may affect the test result.

3.27 Table 3.4 details the number of tests sent for confirmatory testing in each area, and the reason for the test.

Table 3.4 Number of tests sent for confirmatory testing, by area and reason.

3.28 The total number of confirmatory tests carried out for the Glasgow pilot (n=59) was considerably lower than for either Aberdeen (n=126) or Edinburgh (n=173). When looking at these numbers as a proportion of all tests carried out, Aberdeen had 15% of all tests sent for confirmatory testing, compared to around 9% in both Edinburgh and Glasgow.

3.29 While the proportion of tests sent for confirmatory testing was much higher in Aberdeen, Table 3.5 shows that a large number of these were sent in the first two months of the pilot when the Aberdeen staff were encountering problems with the testing equipment. The monthly pattern of testing in Edinburgh seemed to fluctuate the most whilst in Glasgow, numbers sent for testing were relatively stable over the course of the pilot, with only one peak in August 2007 which cannot be explained.

Table 3.5 Number of Tests sent for confirmatory testing by area and by month

3.30 In Aberdeen, 24 tests were overturned, 95 tests were confirmed, and 7 tests were unable to be confirmatory tested. In Edinburgh 38 tests were overturned, 92 tests were confirmed, and 43 tests were unable to be confirmatory tested. In Glasgow, 17 tests were overturned, 35 tests were confirmed, and 7 tests were unable to be confirmatory tested. There were no notable trends over time in the numbers of tests that were overturned.

3.31 Reasons for the SPSA not being able to carry out a confirmatory test included result printout not enclosed in bag, packaging not signed, bag not sealed, result printout not enclosed in bag, and accused details on printout.

Attendance at Assessments

3.32 The total number of referrals for assessment in each area was broadly comparable with 310 in Aberdeen, 381 in Edinburgh, and 301 in Glasgow.

3.33 Attendance at assessments amongst those referred was variable between the sites. A total of 263 assessments were completed in Aberdeen (85%), 247 in Edinburgh (65%) (4 arrestees will have been referred for assessment to attend the following week) and 152 in Glasgow (50%).

3.34 The total number of people who did not attend their assessment for the period from 12 June 2007 to the end of November 2008 was 47 in Aberdeen (15%), 130 (34%) in Edinburgh and 149 (50%) in Glasgow. Four cases in Edinburgh cannot be accounted for because the arrestees had been given an assessment time in the period outwith the evaluation period, and so their attendance was not known.

3.35 Interestingly, Glasgow also kept a record of the reasons for non-attendance. Whilst it would not be reliable to generalise the findings to the other pilot sites, this may be cited as an example of good practice to emerge from the pilots, since it enables learning about some of the practical and logistical barriers affecting engagement potential among arrestees.

3.36 Of the 149 people who did not attend in Glasgow, reasons for non-attendance were traced for 46 clients. Of these 33 were in prison, 2 were at court at the time of the assessment, one was in hospital and one was in police custody. In the remaining nine cases, mistakes were made with setting up the appointments.

3.37 Across all sites, assessors reported that no-one left their assessment early (ie before it was complete).

Assessments over Time

3.38 Figure 3.1 shows the number of people who were referred for assessment for the period from 12 June 2007 to the end of November 2008. This data is presented in table form in Appendix G.

Figure 3.1 Number of People Referred for Assessment by Area and Month

3.39 In each area, the number of referrals from June to July 2007 went up considerably, but in both Aberdeen, and later in Glasgow, this dropped again significantly, perhaps due to the fall in the number of drug tests being carried out. The number of referrals seemed to stabilise in all sites between September 2007 and January 2008, at which point, the number of referrals in Edinburgh showed a large increase and the number in Aberdeen dropped once more. From March 2008, the number of referrals in both Aberdeen and Glasgow showed a slow decline. This was also mirrored in Edinburgh until the latter months of the evaluation (October and November 2008).

3.40 The trend in the number of referrals in Edinburgh and Aberdeen seems to simply reflect the trends in numbers tested, particularly the downward trend in Aberdeen. This is not the case in Glasgow where the number of tests seems to have remained stable, and the number of referrals decreased.

3.41 It is interesting, however, that in both Aberdeen and Glasgow there was a downward trend towards the end of the pilots, something that might be explained by a decrease in motivation to undertake MDTA activity as the pilot was coming to an end.

Characteristics of Those Attending Assessments

3.42 The evaluation sought to explore in detail the profile of those referred into MDTA, focussing specifically on the extent to which it met the needs of those most vulnerable and at risk drugs users.

3.43 While a great deal of qualitative data were generated from interviews with stakeholders (which is presented in Chapter Four), the level of demographic data held on the profile of people referred to or attending assessments in each area was restricted mostly to age, gender and ethnicity information. This was not collected consistently across the three sites.

3.44 In Aberdeen, a breakdown of those referred for assessment was provided, but not for those attending assessments. The majority of referrals were for males (79%). Most males were between 21 and 35. Most women referred in Aberdeen were also between the ages of 21 and 35. An analysis of the data that is held shows that the majority of arrestees were of White Scottish ethnicity, with a small number of mixed ethnicity, or 'Other British'.

3.45 In Edinburgh, the majority of people attending assessments were male (74%). Most males were between 26 and 45. Most women attending assessments in Edinburgh were between the ages of 26 and 35. Information on ethnicity is recorded on Turning Point Scotland's database, however, at this time the information cannot be extracted in a report.

3.46 In Glasgow, just under two thirds of people attending assessments were male (63%). Most males were between 25 and 39. Most women attending assessments in Glasgow were between the ages of 25 and 34. All but 22 of those who attended assessments were classified as White Scottish. Of the remaining 22, two were White Other British, one was White Irish, one from a mixed background and one was Other South Asian. In 17 cases, ethnicity information was unspecified/unknown.

Engagement with Drug Treatment Services

3.47 The primary aim of the Mandatory Drug Testing of Arrestees is to encourage problem drug users to engage in treatment services as a means of addressing the individuals' drug misuse problem and associated offending behaviour. Data were therefore requested from each of the pilot sites regarding the total numbers of clients engaging with treatment services for the duration of the MDTA pilot to the end of November 2008.

3.48 It is important to note that, in Aberdeen and Glasgow, the numbers provided included both MDTA clients who were already engaged with drug treatment services before being referred into MDTA, as well as those who were previously unknown to drug treatment services. Although the focus of the evaluation was on those not already engaged with drug treatment prior to MDTA referral, the data for both categories of client are presented for fullness of coverage.

3.49 Similarly, many more who did not accept the offer of a formal treatment appointment were provided with harm reduction information and other information about services in their area which may be able to offer them assistance and support as part of their initial assessments. Although the numbers cannot be captured, this group represents an important number who will have arguably received at least some small benefit from their time spent with assessors in each area.

3.50 Table 3.7 provides a summary of the numbers of people who engaged with treatment in each of the pilot sites, and provides a breakdown of those who were previously engaged with treatment serves and those who were not.

Table 3.7 Numbers of Arrestees Engaging with Treatment Services

3.51 In Aberdeen, a total of 67 people entered into treatment as a result of MDTA. Of these, 42 people (63%) were not already in existing services. The remaining 25 people (37%) reported that they were already engaging in treatment, but were referred on for further treatment through the MDTA pilot.

3.52 In Edinburgh, 46 people were referred by Turning Point at their initial assessment to a treatment agency. The proportion of these people who were already engaging in treatment is not known.

3.53 In Glasgow, a total of 110 people entered into treatment as a result of MDTA. Of these, 68 (62%) were not registered with Glasgow Addiction Services ( GAS) as being currently engaged with their treatment services. This group represents those who, had it not been for the MDTA pilot, may have remained unknown to Glasgow Addiction Services. The remaining 42 (32%) were already engaging in treatment, but were referred on for further treatment through the MDTA pilot.

3.54 In understanding the extent of engagement in drug treatment services, data were also requested from Information Services Division ( ISD) Scotland on the number of patients/clients resident in Aberdeen City, Edinburgh City of Glasgow City, reporting to the Scottish Drug Misuse Database ( SDMD), with Mandatory Drug Testing as their source of referral.

3.55 At the end of February 2009, 86 clients from Aberdeen and 43 clients from Glasgow were registered on the database with MDTA as their source of referral. There were no cases from Edinburgh.

3.56 Analysis of these numbers presents a somewhat confusing and contradictory picture of the total number of arrestees who engaged with drug treatment services as a result of their referral into MDTA. In Aberdeen, whilst the scheme managers provided a number of 42 people entering treatment for the first time, independent data from ISD suggests that this number was somewhat greater at 86. Conversely, in Glasgow, the number of people recorded on GAS databases as receiving treatment from GAS directly was 68, compared to a figure of 43 from ISD. In this case, the discrepancy may be due to the time period for which analysis was provided by ISD (April 2007 to March 2008) which was not consistent with the pilot evaluation period. Indeed, at the general level some under-reporting to ISD should be expected due to differing and inconsistent recording local practices for information being provided on the SMR25 forms. In some areas, a free text field may have been used to note MDTA as the referral route, whilst in others, a pre-coded Criminal Justice tick box may have been used to indicate the referral route. This may explain why no cases were observed in Edinburgh since the ISD search focussed solely on the free text field and not on the Criminal Justice option.

3.57 Due to the differences in data recording systems and, more importantly, the need to protect the anonymity of clients and the confidentiality of data provided by them, it was not possible to reconcile these figures. For the purposes of the evaluation, and for the costing exercise, therefore, the numbers provided by the assessors in each pilot area have been used as the definitive numbers of people engaging in treatment services as a result of their engagement with the pilot.

Multiple Referrals

3.58 In Aberdeen/Edinburgh data was not available on the number of people being referred into MDTA twice.

3.59 In Glasgow, 21 people were referred into MDTA twice, and no-one was referred three or more times. In Glasgow, information was also kept on the patterns of attendance non-attendance for this sub-sample of arrestees. It showed that, of the 9 clients who did attend their first appointment, 6 went on to attend their second appointment with 3 failing to attend. Of the 12 clients who did not attend their first appointment, 8 went on to attend their second appointment with 4 failing to attend.

People Charged under the Act

3.60 It is an offence under section 88(2)(a) of the 2006 Act for a person not to report to the place at which their drugs assessment will take place to obtain details of their appointment with a drugs assessor.

3.61 If a person fulfils the requirements of their initial appointment (ie the requirements imposed under section 86(2)(b) of the 2006 Act), but fails to attend their drugs assessment, or does not remain for the duration of a drugs assessment, without reasonable excuse, he or she will be liable to prosecution under section 88(2)(b) or (c) of the 2006 Act.

3.62 In total, the Crown Office and Procurator Fiscal Service received 197 reports under section 88(2) ⁴. Table 3.8 provides a breakdown of the reasons for referral to the COPFS by area.

Table 3.8 Reasons for Referral to the COPFS by area

3.63 For the 20 Aberdeen cases referred under Section 88(2)(a), no action was taken in two cases, a fiscal fine was offered in one case, warnings were offered in three cases, and 14 cases were prosecuted. In Edinburgh, no action was taken in one case, and five cases were prosecuted. In Glasgow, no action was taken in six cases, warnings were offered in 2 cases, 44 cases were prosecuted and six cases were yet to be marked at the time of the evaluation.

3.64 For the 13 Aberdeen cases referred under Section 88(2)(b), no action was taken in three cases and 10 cases were prosecuted. For the Edinburgh cases, no action was taken in 11 cases; a fiscal fine was offered in one case, in two instances the case was proceeded with but this particular charge was not, 61 cases were prosecuted and one was yet to be marked. For the Glasgow cases, no action was taken in six cases; 16 were prosecuted and one has yet to be marked.

3.65 The Crown Office and Procurator Fiscal Service received one report under s88(2)(c). This was a Glasgow case and was prosecuted.

Comparison with Arrest Referral

3.66 A core component of the evaluation was to provide a comparison of the cost effectiveness of Mandatory Drug Testing of Arrestees with the cost effectiveness of Arrest Referral ( AR). To this end, data were requested on the numbers of people referred into the Arrest Referral schemes operating in each of the three geographical areas which match the MDTA pilot sites. For the purposes of comparison, the Arrest Referral areas that were selected were Northern (which includes Aberdeen), Lothian & Borders and Glasgow (east End) areas.

3.67 Table 3.9 details the number of arrestees who were referred into Arrest Referral for the time period of June 2007 to November 2008, to allow direct comparison with the numbers of referrals made into MDTA for the same period.

Table 3.9 Arrestees referred into Arrest Referral, June 2007 to November 2008

*Only quarterly figures were available in Edinburgh, and include April and May in 2007 and December in 2008.

3.68 In Aberdeen, of the 295 people referred into Arrest Referral, 162 attended an assessment. Of these, 32 were referred onto drug and alcohol treatment services. It is worth noting that Arrest Referral was introduced in Aberdeen at roughly the same time as the MDTA pilots were introduced (ie. July 2007).

3.69 In Edinburgh, of 1259 people referred and seen by an Arrest Referral worker and completing an assessment in the court cells, 448 people agreed to treatment options including referral into drug treatment/specialist drug agency, GP liaison, referral into alcohol treatment/specialist alcohol agency, and referral into mental health services as part of Arrest Referral. In particular, of these 448 people, 242 were referred to continue in drug treatment/referral to specialist drug agency.

3.70 In Glasgow, of the 3683 people referred into Arrest Referral, 616 attended an assessment. While data was not available for the number of people who entered treatment for the period June 2007 to March 2008, a total of 251 people in the period April 2008 to the end of November 2008, were referred onto treatment services ⁵.

3.71 Recognising that there are fundamental differences in the referral processes adopted for MDTA and Arrest Referral, and between the various areas in which the schemes operate, Table 3.10 provides an indicative comparison between the numbers of people referred into MDTA and Arrest Referral, those attending and their onward engagement with treatment in each of the three areas.

Table 3.10 Comparison of MDTA and Arrest Referral Throughput Figures

3.72 Whilst the data presented above covers slightly different time periods (and as such, was revised for the cost effectiveness component of the work), the table shows that there were more people referred for assessment, attending assessment and entering drug treatment via MDTA in Aberdeen/Northern compared to Arrest Referral. This may be explained by the later introduction of Arrest Referral in that area. In both Edinburgh and Glasgow, however, the numbers referred, assessed and entering drug treatment via Arrest Referral, was considerably higher than the numbers for MDTA.

3.73 The following chapter uses the throughput data presented above to provide a cost effectiveness analysis of MDTA and Arrest Referral.

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