Tackling Drugs in Scotland. Page :3

Tackling Drugs in Scotland: Action in Partnership

Treatment

Evidence of problems arising from drug misuse is available from the Scottish Drug Misuse Database (SDMD) which is the main source of data from treatment agencies (including GPs) throughout Scotland. During 1997/98 reports on nearly nine thousand new clients/patients were received.

The treatment agency reports provide a number of insights (Figure 4), including:

the growing presence of heroin in Scotland with sixty per cent of new clients/patients in 1997/98 reporting misuse of the drug - in 1995/96 the proportion was 44 per cent;
evidence of the sharp decline in temazepam misuse following the prescribing restrictions placed on this drug (although there has been some recent evidence of increased use of illegal supplies of temazepam);
the coincident rise in reports of the misuse of other drugs such as diazepam;
and the extremely small proportion of people seen at agencies in Scotland reporting misuse of cocaine/crack (2% in 1997/98) - in marked contrast to reports from agencies in England (16%).

Figure 4 - Reported drug use by new clients/patients attending treatment agencies 1995 - 1998

Fig 6

Source : SDMD, 1997/98 data are provisional

Individuals often report that they misuse a number of different drugs. The use of any particular drug is likely to be the result of a number of different factors, including availability. It is known that combinations of drugs are often taken, including alcohol and this practice carries additional risks, particularly of overdose.

The pervasive extent of heroin misuse among young people in Scotland is illustrated by the rapid increase in the proportion of younger new clients/patients at treatment agencies reporting use of heroin (Figure 5). This increase is most marked in young people aged 15 to 19: for this age group, the proportion of the young people attending treatment agencies who reported using the drug has risen from 37% in 1995/96 to 63% in 1997/98.

Figure 5 - Reported heroin use among young clients/patients attending treatment agencies

Fig 5

Source : SDMD, 1997/98 data are provisional

Based on information obtained from people attending treatment agencies, there are worrying trends regarding the practice of injecting drugs. Between 1992/93 and 1995/96 the proportion reporting injecting drugs was falling year on year. However, this decline has stabilised in recent years with a rise in the percentage injecting in the year ending March 1998 (Figure 6).

Figure 6 - Injecting and sharing behaviour of new clients/patients attending treatment agencies

Fig 6

Source : SDMD, 1997/98 data are provisional

The sharing of injecting equipment carries a number of serious health risks. Despite a variety of initiatives across Scotland to reduce the practice of sharing, a large number of drug injectors still share their equipment. In 1997/98 around one in ten of new clients/patients at treatment agencies said that they had shared equipment in the previous month (Figure 6).

One consequence of sharing injecting equipment is an increased risk of exposure to blood borne viruses. Injecting drug users accounted for 42% of all known cases of HIV infection in Scotland, as at 31 March 1998. There were 25 new notifications of HIV infection among injecting drug users in Scotland in 1998. This is the lowest annual figure of the last 10 years. The figures for new reports of hepatitis B infection among injecting drug users are similarly lower than was once feared. It is thought that the provision of needle exchanges and substitute prescribing accounts for some of the successes in tackling the threats posed by these viruses. However, the threat remains, particularly for some vulnerable sections of the population, and among prisoners.

Controlling the spread of hepatitis C among injecting drug-users is one of Scotland's major health challenges, particularly in the context of our current knowledge about the natural history of the virus. Infection is life long, and in two thirds of those infected the virus persists in blood, giving a continuing risk of blood-to-blood transmission. Based on an anonymous hepatitis C testing survey in four Scottish cities during 1995/96, SCIEH estimates that the prevalence of hepatitis C antibodies among current injecting users is, on average, 60%. After twenty years of being infected, 20% of these individuals wil have developed cirrhosis of the liver. This will be a heavy load on general medical services.

The spread of hepatitis C infection among injecting drug users in Scotland during the 1990s has not been controlled by interventions such as the existing needle/syringe exchange. There are several possible reasons. With so many injecting users already infected, the novice injector is very likely to share someone else's equipment for the first few times and thus will become infected before the safe injecting messages have had a chance to get through. Also, any infected blood is dangerous - in filters, in bowls, or in spoons - not just in needles or syringes . The lesson is that the health promotion and prevention effort which worked well for HIV and hepatitis B will have to be intensified to make an impact on hepatitis C. Used equipment left lying around is even more of a health hazard and the collection of used equipment has to be particularly efficient to avoid infection of others.

Another problem facing treatment services is that of dual diagnosis, where individuals present with both problem drug use and a co-existing psychological or psychiatric disorder. Information about people admitted to psychiatric hospitals in 1997/98 shows that 1231 admissions among people aged 15-44 were related to drug misuse. This accounts for nearly one in ten of all admissions among people aged 15-44, and is itself likely to be subject to a degree of under-reporting. Psychiatric hospitals are not alone in encountering this problem. In general practice, for example, conditions such as anxiety, affective depression and some psychotic disorders are known to be more common amongst people who misuse drugs than those who do not (source: ISD, Continuous Morbidity Recording in General Practice). Recent research shows that as many as 40% of people presenting with a first episode of a psychotic illness have been misusing substances. Most of these were young males. Twenty per cent were using illicit drugs alone, the rest a mixture of drugs and alcohol. There is evidence of a rising trend (source: Cantwell R et al, Prevalence of Substance Misuse in First-Episode Schizophrenia, The British Journal of Psychiatry, 174 150-153 (1999)).

Finally, the danger of drug taking is perhaps most starkly seen by the death of 263 people in Scotland during 1997 where drugs were formally identified as a factor, with injecting implicated in many deaths. The number of drug related deaths has remained relatively constant in recent years, although there are indications that the figures for 1998 are likely to show a rise (Figure 7).

Figure 7 - Drug related deaths: 1994-1997

Fig 7

Source : General Register Office for Scotland.

Opiates and benzodiazepines commonly feature in such drug related deaths, unlike cannabis or ecstasy. Those who die are typically injecting drug users.

Availability

Action continues by police forces and by Customs and Excise to intercept drugs in bulk either at import or during domestic distribution, in the hands of dealers, or in the possession of drug users themselves. Figure 8 shows the year on year rise in the number of seizures of controlled drugs made by the police in Scotland up to 1998.

Figure 8 - Seizures of controlled drugs by police forces in Scotland: 1990-1998

Fig 8

Source : Home Office, 1997 and 1998 figures are provisional

According to the latest published figures, seizures of heroin have increased in volume by more than eight-fold, from 2.7kg in 1994 to 57.8 kg in 1998 (provisional). Scottish Customs investigation and intelligence activity also translates into significant seizures elsewhere in the UK, and this is instrumental in disrupting the flow of drugs into Scotland. In 1998 Customs and Excise in Scotland seized a total of 11,533 kilos of drugs with an estimated value in excess of Ł40 million.

While the figures reflect to some extent increases in availability they also demonstrate the effort that is being put into tackling the problem by law enforcement agencies through intelligence led initiatives targeted at high level criminals. The scale of this effort is reflected in the increase in the number of offences recorded in recent years. In 1997, 7,005 people were convicted of drug offences in Scottish courts, compared with 6,183 in 1996 and 5,599 in 1995 (source: Home Office).

Anecdotal evidence suggests that availability has been influenced by a number of factors, including a fall in the price of illicit drugs and an increase in their purity.

In conclusion

These figures demonstrate the extent to which drug misuse affects our society. The involvement of children and young people, the recent rise in the availability and misuse of heroin, the spread of hepatitis C, the untimely death of people using drugs and the associations with crime are of particular concern in Scotland. These problems affect individuals, families, communities and every corner of society.

This country, however, is not alone in experiencing a growing drugs problem. Many of the trends described here are common throughout the UK and the rest of the world.

This document sets out the strategic framework for a co-ordinated and effective response to the challenge of drug misuse in Scotland, within this international context.