National Prevalence and Trends in Illicit Drug Use
In 2013-14, 9% of 16-59 year olds in England and Wales used illicit drugs in the last year (Home Office, 2014). Figure 1 shows that illicit drug use has reduced significantly over the last ten years. Despite this downward trend in drug use in the long term, a significant increase in 2013-14 compared to the previous year indicates that illicit drug use continues to be a considerable national challenge. The most commonly used illicit drug type is cannabis, followed by powder cocaine and ecstasy.
Figure 1: Proportion of 16 to 59 year olds reporting use of drugs in the last year (2011-12 to 2013-14)
Notes: 'Any drug' comprises powder cocaine, crack cocaine, ecstasy, LSD, magic mushrooms, ketamine, heroin, methadone, amphetamines, methamphetamine, cannabis, tranquillisers, anabolic steroids, amyl nitrite, any other pills/powders/drugs smoked.
'Any stimulant drug' comprises powder cocaine, crack cocaine, ecstasy, amphetamines, amyl nitrite and methamphetamine.
'Any Class A drug' comprises powder cocaine, crack cocaine, ecstasy, LSD, magic mushrooms, heroin, methadone and methamphetamine.
Frequent use refers to use of any drug more than once a month in the past year.
Source: Home Office (2014).
National Demographic Profile
In the UK, 36% of 16-59 year olds have used an illicit drug at least once during their lifetime (Public Health England, 2014). The use of illicit drugs exists across a broad spectrum of demographic profiles, but there is evidence of higher levels of use in some groups:
Younger adults are more likely to use illicit drugs and to use them on a frequent basis. Frequent drug use is defined as the use of any drug more than once a month in the past year. In 2013-14, 60% of people who used illicit drugs frequently were aged 20-34 years. As shown in Figure 2, adult illicit drug use is most common within the 20-24 age group and consistently depletes thereafter (Home Office, 2014).
Figure 2: Proportion of adults who frequently used illicit drugs by age (England and Wales, 2013-14)
There a number of factors that have been suggested as reasons why drug use is more prevalent in younger people, including:
· Enjoyment: evidence suggests drug misuse is often considered pleasurable by young people;
· Environment: drug production and misuse often thrives in communities suffering from multiple deprivation including high levels of unemployment, low quality housing and poorly resourced local services and infrastructure;
· Curiosity: young people are often keen to experiment and this occasionally manifests in drug misuse;
· Coping mechanism: drug misuse can be used as a mechanism to distract from physical and emotional pain;
· Rebellion: Drug misuse may be used as a mechanism to provoke the attention of others;
· Cost: The price of cannabis, for example, might be considered favourably in comparison to other substances such as alcohol (DrugScope, 2005).
Illicit drug use is not equally distributed by gender either in the UK or internationally, although variations in the magnitude of male to female ratios do exist across different countries within the European Union. Males are more likely to use illicit drugs and to use drugs at a higher frequency, in larger doses and earlier in life compared to females (European Monitoring Centre for Drugs and Drug Addiction, 2005). In 2013-14, 76% of national frequent drug users were male (Home Office, 2014).
Gender differences in risk-taking may provide an explanation for increased prevalence of drug misuse in males. Men appear to be less likely to consider the risks associated with drug misuse. This hypothesis was supported in a survey which found that 27% of men thought it was safe to smoke cannabis compared to 15% of women (Home Office, 2013).
In terms of sexual orientation, the highest levels of use in the last year are reported by people who identify as gay or bisexual. Overall 28.4% report use in the last year, and this is higher in males (33.0% of males compared to 22.9% of females). Overall 8.1% of people who identify as heterosexual report use in the past year, and again this is higher in males (11.1% of males compared to 5.1% of females). Reference:
Factors Associated with Risk of Drug Use
The following factors have been linked to increased risk of drug use (National Institute on Drug Abuse, 2004):
· Troubled family life: The risk of drug misuse is increased in households in which neglect, drug misuse and/ or emotional or physical abuse has taken place;
· Mental health: Mental health problems including depression, anxiety and attention deficit disorder are associated with drug misuse;
· Employment and educational attainment: Unemployment, vocational problems and failures in education are associated with increased risk of drug use;
· Social groups: Socialising with people who use drugs increases an individual’s risk of using drugs themselves;
· Previous drug use: Using drugs early in life has been shown to increase the likelihood of misusing drugs; and
· Biology: Those who report positive effects from drug misuse are more likely to continue using.
Health and Social Consequences of Drug Misuse
Drug misuse is linked to a number of physical and psychological health outcomes. The method of administration, such as inhalation or injection, can also impact on how the drug affects the user. The physical and psychological outcomes associated with misuse are given below:
Physical Health Consequences
Smoking cannabis irritates the lungs and those who smoke cannabis on a frequent basis are likely to develop lung problems that are similar to tobacco smokers. Consequences of frequent cannabis smoking can include coughing, lung illness and increased risk of lung infection (National Institute on Drug Abuse, 2015).
Smoking cannabis increases the heart rate for up to three hours and thereby increases the risk of heart attack (National Institute on Drug Abuse, 2015). Cocaine also leads to increased heart rate and can lead to heart attacks and strokes which may cause sudden death (National Institute on Drug Abuse, 2013). Chronic heroin use can lead to collapsed veins, heart lining infections and pulmonary complications (National Institute on Drug Abuse, 2014).
Drug misuse in pregnancy
Approximately 70% of infants born to drug dependent mothers are affected in some way (Nottingham Neonatal Service, 2014). Heavy use of cannabis during pregnancy can cause babies to startle more easily (Nottingham Neonatal Service, 2014). Use of amphetamines and ecstasy may lead to decreased birth weight and increased risk of cleft palate and heart defects (Nottingham Neonatal Service, 2014). Cocaine may be associated with placental abruption, prolonged rupture of membranes, intra-uterine growth retardation and differences in organisational responses and interactive behaviour (Nottingham Neonatal Service, 2014). Heroin use in pregnancy can lead to low both weight and premature birth (Nottingham Neonatal Service, 2014). Infants may also show signs of heroin withdrawal which is treated with barbiturates and methadone (Nottingham Neonatal Service, 2014).
Blood borne viruses
Injecting drug users put themselves at risk of a number of blood borne viruses including HIV, Hepatitis C and Hepatitis B. The number of cases of HIV transmitted through injecting drug use in the UK has remained relatively low. In 2011,122,000 HIV diagnoses had been documented in the UK since the beginning of the epidemic over 30 years ago. Approximately 5% of diagnoses (5,600 people) are believed to have been infected through injecting drug use (NAT, 2013). Based on extrapolated data (Public Health England, 2013) it is estimated that there are 20 HIV Positive injecting drug users in Nottingham, two of which may be undiagnosed.
Hepatitis C remains a key area of concern in injecting drug users due to the levels of infection, transmission, the lack of a vaccine, low levels of treatment engagement and the serious effects that it has on health. It is estimated that between 130 and 150 million people globally are infected with chronic hepatitis C (World Health Organisation, 2015).
Injecting drug use remains the main route of hepatitis C infection in the UK, with 90% of those acquiring the infection having done so through injecting drugs. Approximately 50% of injecting drug users in England have been infected with hepatitis C. Around 25% of these will go on to clear their infection naturally, it is therefore estimated that around two in every five injecting drug users in the UK currently have a hepatitis C infection. Furthermore, Public Health England estimates that around half of the injecting drug users in the UK who are infected remain undiagnosed, either because they have not been tested or have been infected since their last negative test.
In England, only 3% of those who have a hepatitis C infection access clinical treatment. It is estimated that in the UK, 215,000 individuals have a chronic hepatitis C infection and hospital admissions and death as a result of hepatitis C are rising. This equates to approximately 2,000 people within Nottingham with a chronic hepatitis C infection. The rate of infection is highest in those aged 25-44 and is higher in males; these characteristics accurately reflect the local opiate using population (Public Health England, 2014).
In 2012 there were 1,613 notifications of drug-related deaths in the UK and Islands (Corkery et al., 2013). In Nottingham between 2011-2013 11 drug-related deaths were recorded. A process for recording and investigating drug-related deaths within Nottingham City continues to be co-ordinated by the Crime & Drugs Partnership. The local investigator receives reports of potential drug-related deaths occurring within the City and liaises with the Coroner’s office to establish the cause of death, and where a death is found to be drug related; investigate the circumstances and background that led to the death.
All deaths are reported to the Confidential Inquiry Review Group; a multi-agency group that receives the investigation reports and identifies any learning points that might arise from them. All learning points are widely circulated across a range of treatment services and partner agencies in order to allow them to be implemented and acted upon to prevent further deaths in future.
Mental health problems directly affect 25% of the population during any given year (Singleton, et al., 2001) which equates to approximately 76,000 Nottingham citizens (according to the Census, 2011). For people dependent on drugs or alcohol, the prevalence of mental health problems is significantly increased to 30% and 45%, respectively (Coulthard, et al., 2002). A known psychiatric condition was also evident in more than half of cases who died a drug-related death in Scotland in 2012 (Hecht, et al., 2014).
A considerable proportion of people with schizophrenia also smoke cannabis, although for many years the temporal relationship was not known, evidence suggests that cannabis consumed in high doses may lead to mental illness and psychosis (McLoughlin, et al., 2014).
Smoking cannabis has been linked to temporary hallucinations which manifest as sensations or images that seem to be real (National Institute on Drug Abuse, 2015). Hallucinations may lead to increased risk of accident or injury.
Cannabis smokers often experience a sense of paranoia which leads sufferers to distrust others (National Institute on Drug Abuse, 2015). Feelings of paranoia may lead to increased risk of injury of both the sufferer and those around them.
Research has shown that the use of cocaine and alcohol is significantly associated with aggression. The causal pathway of cocaine use, alcohol use and violence is currently unclear however; this evidence suggests that people who use these substances are more likely to display aggressive behavior (Macdonald, et al., 2008).
Drug misuse is associated with crime in a number of ways. People who are dependent on drugs may steal in order to fund their addiction, and it is estimated that for this reason up to half of all acquisitive crime is drug-related (DrugScope, 2015). Violent crime is also often associated with drug and alcohol misuse (DrugScope, 2015). Research has shown that effective treatment interventions significantly reduce drug-related offending (Keen, et al., 2000).
Drug misuse is a known cause and consequence of homelessness. The misuse of drugs can be a causal or contributing factor to becoming homeless and drug misuse can also be used as a coping mechanism for dealing with homelessness (Crisis, 2011). The prevalence of drug misuse is considerably increased amongst homeless people; approximately 80% of people who become homeless start using at least one new drug. Furthermore, the misuse of drugs and alcohol accounts for more than a third of deaths amongst homeless people (Crisis, 2011). The lack of stable accommodation is considered a barrier to recovery for many homeless people and this group is recognised as more difficult for intervening services to access (Crisis, 2011).
Drug dependent parents can pose a risk to both themselves and their children. Drug misuse can reduce a parent’s capacity to provide the necessary practical and emotional care to their children and this may result in reduced educational attainment, mental health problems and increased risk of drug misuse in the child (The National Treatment Agency for Substance Misuse, 2012). Whilst living with a child has been considered a preventative factor for developing severe drug misuse problems, drug misuse treatment has been shown to be effective in improving the lives of the families affected (The National Treatment Agency for Substance Misuse, 2012).