• Drug use among the general population and young people
• Prevention
• Problem drug use
• Treatment demand
• Drug-related infectious diseases
• Drug-related deaths
• Treatment responses
• Harm reduction responses
• Drug markets and drug-related offences
• National drug laws
• National drug strategy
• Coordination mechanism in the field of drugs
• Drug-related research

Drug use among the general population and young people

In the UK, primary sources of information about prevalence of illegal drugs among the adult population are derived from representative household surveys. In England and Wales, the British Crime Survey (BCS) has been a continuous survey since 2002. Surveys comparable to the BCS are carried out in Scotland (the Scottish Crime and Justice Survey, SCJS), and in Northern Ireland (the Northern Ireland Crime Survey, NICS), which last reported for 2008/09 but the drug use module has now been discontinued. In Northern Ireland, a Drug Prevalence Survey (NIDPS), based on the EMCDDA methodology, was conducted for the first time in 2002/03, with a further survey conducted in 2006/07 and 2010/11.

In England and Wales, the 2009/10 BCS, conducted among people aged 16–59, showed that 36.4 % of respondents had tried any illegal drug at least once in their lives (lifetime prevalence rates). Lifetime prevalence of cannabis was 30.6 %; amphetamines, 11.7 %; cocaine, 8.8 %; ecstasy, 8.3 %; and LSD, 5.3 %. In 2009/10, last year prevalence of cannabis use was reported to be 6.6 %, showing a steady decline in cannabis use since 2003/04 (10.8 %). Also, since 1996, there was an increase in cocaine use until the period of 2008/2009. However, the most recent survey shows a decline in last year prevalence down to levels observed between 2003/04 and 2007/08.

In 2008/09, in Scotland the SCJS shows that 33.5 % of people aged 16–59 had tried any illegal drug at least once in their lives. Lower prevalence (27.5 %) was reported in Northern Ireland, based on the 2008/09 NICS among 16–59 year-olds, which might reflect that illegal drug use has been less prevalent in Northern Ireland over the last decade.

Among the school age population, in England, a survey of drug use has been undertaken annually since 1998 among students aged 11–15. The latest available data is from 2009. In Northern Ireland, the Young Person’s Behaviour and Attitude Survey was undertaken in 2000 for the first time among students aged 11–16, and the latest available data is from 2007. In Scotland, the Scottish Schools Adolescent Lifestyle and Substance Use Survey (SALSUS) among students aged 13 and 15 was last carried out in 2008. In Wales, the Health Behaviour in School-aged Children Survey (HBSC) was last conducted in 2006.

In addition, the European Schools Project on Alcohol and other Drugs (ESPAD) survey provides data for students aged 15–16 every four years. In England, based on the school survey, lifetime prevalence of any drug among 11–15-year olds was 22.1 % in 2007.

ESPAD data showed that lifetime use of cannabis decreased from 41 % in 1995 to 35 % in 1999, rose again to 38 % in 2003 and decreased to 29 % in 2007. Last year prevalence of cannabis use was reported by 22 % of the students in 2007, compared to 31 % in 2003 and 35 % in 1995. The same trend was followed, regarding the last month prevalence of cannabis, reported by 11 % in 2007, when figures were higher during the previous years: 20 % in 2003 and 24 % in 1995.

their lifetime in 1995, this proportion decreased to 3 % in 1999, rose to 5 % in 2003 and reached 4 % in 2007. Regarding other substances, cocaine lifetime prevalence varied from 3 % in 1999 to 5 % in 2007; LSD lifetime use was reported by 5 % in 1999 and 3 % in 2007. Lifetime prevalence of inhalants was reported by 15 % of the sample in 1999 and by 9 % in 2007.

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Prevention

Prevention of young people’s drug use is a key element of drug strategies in the United Kingdom. There is a focus on better education and intervention for young people and families, especially those most at risk, and better public information about drugs.

Universal drug prevention initiatives are an important area of policy in the field of prevention. Communication programmes such as ‘FRANK’ in England and ‘Know the score’ in Scotland, provide information and advice to young people and their families. Throughout most of the United Kingdom, drug prevention is part of the national curriculum and most schools have a drug education policy and guidelines on dealing with drug incidents. Apart from educational activities, since September 2010, head teachers in England are allowed to search school pupils, without consent, for illegal drugs and legal highs. The government has placed the early identification of at-risk children and families and the provision of suitable interventions as a priority and aims to provide a focused approach to the needs of the family as a whole and a tailored support service. A package of interventions is proposed including parenting skills; drugs education for children; family support to help them stay together; addressing other problems; support for kinship carers and in some cases, intensive interventions. Another important element of selective prevention is the focus on vulnerable young people such as young offenders, looked-after children, young homeless people, ethnic and sexual minorities, and youth in deprived neighbourhoods through special programmes. As for indicated prevention, there are early interventions to stop future offenders at the first sign of problems such as truancy, bad behaviour in school or contact with the police. Some brief prevention interventions were piloted and evaluated as beneficial in preventing development of substance abuse problems also for children with attention deficit disorders, and with externalising or internalising disorders.

In the EU context, drug prevention initiatives in the UK are well diversified, balanced and in most occasions also rigorously evaluated, to demonstrate their short-term, and less frequently, also long-term effects.

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Problem drug use

Problem drug use estimates in the UK are available for England, Northern Ireland Scotland and Wales at a regional and local level (including 149 ‘Drug Action Team’ areas in England). Estimates are mostly obtained though the capture–recapture and/or multiple indicator method, as is found to be appropriate for the data concerned.

Latest estimates (2004–07) for the United Kingdom suggest that there are 404 884 problem drug users (with a 95 % CI of 396 267–431 120), a rate of 10.1 (9.9–10.8) per 1 000 population. This estimate is based on different definitions of problem drug use and different time periods. In England (2006/07), case definition is the use of opiates and/or crack cocaine; in Scotland (2006), it is the use of opiates and/or benzodiazepines; in Northern Ireland (2004), it is opiate and/or problem cocaine use and for Wales (2006/07), it is long duration or regular use of opiates and/or cocaine.

The EMCDDA defines problem drug use as intravenous drug use (IDU) or long duration/regular drug use of opiates, cocaine and/or amphetamines.

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Treatment demand

The 2008/2009 treatment demand data for the United Kingdom was based on 1 872 treatment centres comprising of: 1 613 outpatient treatment centres, 122 inpatient treatment centres and 137 general practitioners. In 2008/2009, a total of 139 390 clients entered treatment, out of which 45 048 were first-time treatment clients.

In 2008/2009, opioids were the most reported primary drug among all clients entering treatment at 61.2 %, followed by cannabis at 17.1 % and cocaine at 14.5 %. Treatment demand data among first-time treatment clients indicated that for 41.0 % clients, the  primary substance of use was opioids, followed by cannabis at 28.0 % and cocaine at 21.8 % (¹).

In 2008/2009, 34 % of all clients entering treatment were over 35 years of age. A lower age distribution was reported among new treatment clients with 28 % under the age of 25 years. As far as gender distribution is concerned, 73 % of all clients were male, whereas 27 % were female. The same distribution in gender distribution was reported among first-time treatment clients.

(¹) Cocaine data refers to both cocaine powder and crack cocaine users. In 2008/2009, 15.1 % of the first-time and 8.5 % of all clients entering treatment indicated cocaine powder while 6.7 % of the first-time and 6.0 % of all clients entering treatment indicated crack cocaine as the primary substance.

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Drug-related infectious diseases

Data on the prevalence of blood-borne infectious diseases among injecting drug users (IDUs) are provided from a number of sources in the UK. The Unlinked Anonymous Prevalence Monitoring Programme (UAPMP) survey of injectors monitors blood-borne virus prevalence among IDUs attending drug services in England and Wales and Northern Ireland. The Centre for Research on Drugs and Health Behaviour (CRDHB) has conducted surveys of IDUs recruited in community settings, and the Scottish Centre for Infection and Environmental Health (SCIEH) surveys prevalence of blood-borne infections among IDUs attending drug services in Glasgow. SCIEH also hold anonymised epidemiological data on all persons who have had a named HIV antibody test in Scotland since 1989. This database provides HIV prevalence data for all persons, including those who indicate that they had injected drugs, undergoing a named HIV test. Another source of information on blood-borne infections are laboratory reports which are collected separately for England, Wales, Scotland and Northern Ireland.

The latest data show that in 2009, there were 149 HIV diagnoses, where infection was thought to have been acquired through injecting drug use. HIV prevalence remains low in the UK, although prevalence amongst recent initiates has been elevated since 2003. In England and Wales, of those participating in the 2009 UAPMP survey, HIV prevalence was 1.5 %, although in London, prevalence was higher at 4.1 %. In Northern Ireland, the HIV prevalence found was 1.3 %. In 2009, 1 547 HIV-infected IDUs were seen for HIV-related treatment or care in the UK.

In 2009, the prevalence of antibodies to the hepatitis C virus (HCV) among IDUs in England and Wales was 44 %, but in London it was at 54 %. In Northern Ireland, prevalence was 26.1 %. The prevalence varies not only according to region, but also other risk factors such as duration of injecting. There has also been evidence of increased incidence, especially among new injectors.

Prevalence of hepatitis B virus antibodies among IDUs declined in the early 1990s, and in 2009 the rates varied between 6.5 % and 23.7 %, the lowest being for Northern Ireland and the highest for London.

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Drug-related deaths

Information on acute deaths in the UK is provided by three General Mortality Registers (England/Wales, Scotland and Northern Ireland) and one Special Mortality Register, and the latest data are for 2009. Based on the Drug Strategy definition, the number of drug-related deaths in the UK rose steadily between 1996 to 2001, fell from 2001 to 2003, but increased subsequently to 2 569 in 2008 (compared to 2 231 in 2007, 2 036 in 2006, 1 980 in 2005 and 1 877 in 2004). In 2009 the number of death fell to 2 481. Males accounted for 79.1 % of deaths and the average age of those dying was 38.9 years.

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Treatment responses

All UK drug strategies give priority to the provision of better access to effective treatment, particularly for vulnerable or excluded groups, and to encourage client retention. Delivery of drug treatment is through local multi-agency partnerships, representing health, criminal justice agencies and social care services. In recent years, increased attention is given to measuring health and social outcomes associated with treatment.

In most parts of the United Kingdom, particularly in England, there is a four-tier system of treatment providing a conceptual framework for treatment provision. Tier 1 refers to generic interventions such as information and advice, screening and referral to more specialist services. Tier 2 refers to open-access interventions, such as drop-in services providing advice, information and some harm reduction services such as syringe exchange. Tier 3 services are specialist community services and include prescribing services, structured day programmes and structured psychosocial interventions, such as counselling and therapy and community-based detoxification. Tier 4 services are inpatient services, including detoxification and residential rehabilitation. The majority of structured treatment is delivered at Tier 3, predominantly through community-based specialist drug treatment services.

Recovery and social reintegration are key elements of drug strategies in the United Kingdom. In England and Wales, the Drug Interventions Programme targeting drug users in the criminal justice system offers a range of treatment and social reintegration responses through Criminal Justice Intervention Teams, based in the community and in the prison system.

Substitution treatment remains the main treatment in the United Kingdom for opiate users mostly offered through specialist outpatient drug services, commonly in shared care with arrangements with general practitioners. Oral methadone is the drug of choice for substitution treatment, but buprenorphine has also been available since 1999. Furthermore, in England prescribed injectable methadone and heroin are also available although this is rare.

Section 7.3(a) of the Misuse of Drugs Act 1971 allows for prescription and administering of controlled drugs by medical practitioners and Section 10.2(g)–(i) allows for the development of regulations on the control and monitoring of prescriptions of controlled drugs. The enabling legislation for substitution treatment is the Misuse of Drugs Regulations 2001 and treatment can be initiated and provided by medical doctors, specialised medical doctors and treatment centres. The latest available estimates on the total number of clients in substitution treatment were 487 in Northern Ireland in 2008/09, 22 224 received methadone treatment in Scotland in 2006 and 143 219 received a prescribing intervention in England in 2008/09.

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Harm reduction responses

Drug-related deaths, infectious diseases, co-morbidity and other health consequences are key policy issues within the United Kingdom’s drug strategies. Interventions include information campaigns of the risks associated with drug use, as well as information on safer injecting and safer sex, needle exchange schemes, infection counselling, support and testing, vaccinations against hepatitis B. Provision of take-home naloxone and training of drug users and their family members on its application is currently piloted across the UK. In May 2007, the Department for Health (DH) and the National Treatment Agency (NTA) published a document entitled ‘Reducing drug-related harm: an action plan’. One of its aims is to improve delivery, by issuing guidance on reducing drug-related harm to commissioners, service users, carers and those working with drug users. This includes guidance on hepatitis C, the provision of needle exchange services and testing, and treatment for blood-borne virus infections in prisons and the community. The action plan also contains plans for a health promotion campaign, which will be targeted at risk groups such as homeless drug users, speedballers (i.e. those injecting heroin and crack together) and potential or new injectors. Separate action plans, with an aim to control spread of viral hepatitis, increase testing rates and access to treatment, primarily focusing on hepatitis C infection, are adopted for England, Scotland, Northern Ireland and in Wales.

In 2009–10, the UK experienced an anthrax outbreak among heroin users. As a result, a dedicated web page providing epidemiological updates and also guidance for professionals (clinicians, drug workers, etc.) was established and anthrax anti-toxin was distributed among health practitioners to complement classical treatment protocols for those affected.

Syringe exchange is offered by a wide range of services, including specialist syringe exchange services, detached outreach and mobile units, pharmacies, and accident and emergency services. Reliable data on syringes distributed in England and Wales are not available. A report from the Advisory Council on the Misuse of Drugs (The primary prevention of hepatitis C among injecting drug users, Home Office, February 2009) mentions an estimate of 23 million for 2005 in England and Wales. Latest available estimate for Northern Ireland is 154 000 syringes distributed in 2009. In Scotland in 2008/09, 4.38 million needles/syringes were distributed. Consumption rooms are not available in the UK. In England, trials are being conducted to establish the potential role that increased availability of injectable opiates can play in reducing the harms associated with drug use. In 2003, the Misuse of Drugs Act 1971 (see section on national drug laws) was amended to allow doctors, pharmacists, and drug workers to legally supply swabs, sterile water, certain mixing utensils and citric acid to drug users who obtained controlled drugs without a prescription.

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Drug markets and drug-related offences

The overall picture of United Kingdom drugs distribution appears increasingly complex and diverse. Many traffickers in the United Kingdom, particularly white British criminals, import and distribute more than one type of drug. London, Birmingham and Liverpool continue to be important centres for drugs distribution but other smaller cities and towns are also involved.

Heroin from Afghanistan and the Golden Triangle enters the UK via Northern Cyprus and Turkey in freight vehicles. Trafficking of heroin also occurs via flights with a connection to Turkey and Pakistan. Cocaine from South and Central America, in particular Colombia, Peru and Bolivia, arrives in the UK mainly via Spain, the Netherlands and recently also through the Balkans, but also by air courier, either directly from South America or via the Caribbean. Morocco is the primary source of cannabis resin for the UK market. Main routes for transhipment are by road through the Iberian Peninsula, France and Belgium. In addition, large commercial cannabis cultivation operations, run by South-East Asian criminal gangs and recently by white British criminals, have been discovered in the UK. Ecstasy and other synthetic drugs enter the UK from the Netherlands and Belgium, through ferry boats and the Channel Tunnel. However, Lithuania and Poland are emerging as smaller-scale centres of synthetic drug suppliers for the UK, and some synthetic drugs are produced in the UK, including amphetamines.

In 2008, there were 146 909 convictions or cautions for drug offences reported by the United Kingdom, which is an increase when compared to 2007 (135 655). Of those offences where a drug was known, 50.2 % were cannabis related, 18.2 % cocaine-related and 14.3 % heroin-related.

In general, the quantity of seizures has been rising in the United Kingdom, cannabis being the most seized drug. In 2009, 12 690 kg of cannabis resin, 18 162 kg of herbal cannabis and 764 184 cannabis plants were seized across the UK (²). The number of herbal cannabis seizures (74 575 in 2005/06 to  145 662 in 2009 (²)) has increased since the introduction of cannabis warnings and there have been increasing seizures of cannabis plants (4 331 in 2005/06 to 13 059 in 2009 (²)). Until 2008 (²), when 25 004 cocaine seizures were reported in the UK, a steady increase in cocaine seizures was noted. At the same time, quantities of seized cocaine have been on the decline since 2003 (7 773 kg in 2003 and 2 669 kg in 2009 (²)), which reflects the high proportion of smaller quantity seizures performed by police. In recent years, the proportion of larger quantity heroin seizures has increased, and despite a decline in the overall number of heroin seizures, the amounts of seized drug is rising following a drop in 2006 (²). While the quantities of ecstasy tables seized is on the decline since 2006 (²), the quantity of seized amphetamine reached 2 945 kg in 2008 (²), which is the highest in the past decade followed by a decline to 1 421 kg in 2009 (²).

(²) After 2007, data for Scotland are not available. Since 2006, seizures data are published on a financial year basis (data reported in 2006 is for 2006/2007, data reported in 2007 is for 2007/2008, data reported in 2008 is for 2008/09 and data reported in 2009 is for 2009/10).

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National drug laws

The Misuse of Drugs Act 1971, with amendments, is the main law regulating drug control in the UK. It divides controlled substances into 3 Classes (A, B, C) based on harm, with Class A being the most harmful. These Classes provide a basis for attributing penalties for offences. Maximum penalties vary not only according to the Class of substance but also whether the conviction is a summary one made at the Magistrate Court or one made on indictment following a trial at Crown Court.

Drug use per se is not an offence under the Misuse of Drugs Act 1971: it is the possession of the drug which constitutes an offence. Summary convictions for the unlawful possession of Class A drugs such as heroin or cocaine involve penalties of up to six months’ imprisonment or a fine; on indictment, penalties may reach seven years’ imprisonment. Class B drugs such as cannabis and amphetamines attract penalties at magistrate level of up to three months’ imprisonment and/or a fine; on indictment up to five years’ imprisonment and/or an unlimited fine. Possession of most Class C drugs, such as barbiturates attracts penalties up to three months’ imprisonment and/or a fine at magistrate level, or up to two years’ imprisonment and/or unlimited fine on indictment. There are also a number of alternative responses, such as cannabis warnings and cautions from the police, who have considerable powers of discretion. Synthetic cannabinoids receptor agonists, 1-benzylpiperazine and related piperazines, and gamma-butyrolactone are controlled under the Act since December 2009, but cathinone derivates — since April 2010.

Under the Misuse of Drugs Act, a distinction is made between the possession of controlled drugs, and possession with intent to supply to another; this latter is effectively for drug trafficking offences. The Drug Trafficking Act 1994 defines drug trafficking as transporting or storing; importing or exporting; manufacturing or supplying drugs covered by the Misuse of Drugs Act 1971. The penalties applied depend again on the classification of the drug and on the penal procedure (Magistrate level or Crown Court level). For trafficking in Class A drugs, the maximum penalty on indictment is life imprisonment, while trafficking of Class B and C drugs can attract a penalty of up to 14 years in prison. In 2000, a minimum sentence of seven years was introduced for a third conviction for trafficking in Class A drugs.

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National drug strategy

In early 2008, the UK Government published a 10-year drug strategy called ‘Drugs: protecting families and communities’. The strategy focused mainly on illicit drugs and covered four broad fields: law enforcement; prevention; treatment and social re-integration; and communication. Following a change in the UK Government in May 2010, a new drug strategy for England (to replace the 2008 document) was published in December 2010. A number of powers are devolved to Northern Ireland, Scotland and Wales, and each of these countries has its own strategy (New Strategic Direction for Alcohol and Drugs in Northern Ireland 2006–2011; The Road to Recovery: A New Approach to Tackling Scotland’s Drug problem (2008); Working Together to Reduce Harm: The Substance Misuse Strategy for Wales 2008–2018).

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Coordination mechanism in the field of drugs

The United Kingdom Government is responsible for setting the overall strategy and for its delivery in the devolved administrations only in areas where it has reserved power. In the 2010 UK Drugs Strategy, policies concerning health, education, housing and social care are confined to England; those for policing and the criminal justice system cover England and Wales. The 2010 strategy is a cross-Government strategy, although secretariat and programme management responsibilities fall to the Home Office.

Overall, the strategy is governed by the Home Affairs, Public Health and Social Justice Committees. Implementation of the strategy is governed by three overarching groups:

• The Inter-Ministerial Group on Drugs (IMG)
• The Drug Strategy Group (DSG)
• The Drug Strategy Implementation Group (DSIG).

The Strategy has been designed to align policy development and planning across Government Departments and agencies and to support a cohesive, joined-up approach to delivery at a local level.

The Scottish Government has devolved responsibility for health and education and much of the justice agenda in Scotland. Consequently, the Scottish Government launched its Drug Strategy in 2008, the ‘Road to Recovery’. This strategy focuses on person-centred care, treatment and recovery, prevention, enforcement and children affected by parental drug misuse.

Implementation is led locally by 30 Alcohol and Drug Partnerships (ADPs) in Scotland, accountable within local arrangements for community planning. ADPs are responsible for directing the funding allocated to them in alignment with outcome-focused local alcohol and drug strategies, based on an assessment of needs in their area.   

The Scottish Drug Strategy Delivery Commission, consisting of experts with a wide range of expertise, provides independent expert advice and challenge to Scottish Ministers on the delivery of the national drug strategy.

In Wales, the National Substance Misuse Strategy Implementation Board oversees the implementation of the 10-year Welsh substance misuse strategy ‘Working Together to Reduce Harm’ and associated implementation plan. Seven Substance Misuse Area Planning Boards have been established to support the planning, commissioning and performance management of substance misuse services in Wales. These Boards are co-terminous with Local Health Boards and bring existing members of Community Safety Partnerships together with Probation services, the Drug Interventions Programme, Public Health Wales and the voluntary service.

In Northern Ireland, the Drugs and Alcohol Implementation Steering Group coordinates implementation of the Northern Ireland Substance Misuse Strategy at the governmental level. In addition, several working groups have been established to support development of action in specific areas.

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Drug-related research

In February 2010, a Cross-Government Drugs Research Strategy for England was published and identified six key priorities:

• Strengthen understanding of drug use: œtiology, incidence, prevalence and patterns of use.
• Strengthen knowledge of drug use and needs amongst a number of groups, including young people, Black and Minority Ethnic (BME) groups, families, and drug-using offenders.
• Review knowledge and measures of drug-related harms.
• Develop understanding of treatment, prevention and other demand side interventions.
• Review and strengthen understanding of UK drug markets, and interventions to tackle them.
• Strengthen understanding of public confidence, perceptions and behaviour.

The strategy makes a commitment to refresh the list of priorities annually.

Funding for research comes mainly from governmental sources. The main organisations involved in conducting drug-related research are university departments, although non-governmental and governmental organisations are also relevant partners. Several channels for disseminating drug-related research findings are available in the United Kingdom, ranging from scientific journals, to dedicated websites, reports, guidance and conferences. Recent drug-related studies mentioned in the 2010 UK National report mainly focused on aspects related to consequences of drug use, though research on responses to the drug situation and on drug use prevalence was also widely used.

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