Country overview: United Kingdom
- Situation summary
- Data sheet
- Barometer
Contents
- 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
| Year | United Kingdom | EU (27 countries) | Source | ||
|---|---|---|---|---|---|
| Population | 2008 | 61 185 981 | 497 455 033 | Eurostat | |
| Population by age classes | 15–24 | 2008 | 13.4 % | 12.6 % 1 | Eurostat |
| 25–49 | 35.1 % | 36.3 % 1 | |||
| 50–64 | 17.9 % | 18.4 % 1 | |||
| GDP per capita in PPS (Purchasing Power Standards) 2 | 2007 | 119.2 | 100 | Eurostat | |
| Total expenditure on social protection (% of GDP) 3 | 2006 | 26.4 % p | 26.9 % p | Eurostat | |
| Unemployment rate 4 | 2008 | 5.3 % | 7 % | Eurostat | |
| Unemployment rate of population agends under 25 years | 2008 | 14.3 % | 15.5 % | Eurostat | |
| Prison population rate (per 100 000 of national population) 5 | 2006 | 145.1 | Council of Europe, SPACE 2006.1 | ||
| At risk of poverty rate 6 | 2006 | 19 % | 16 % 7 | SILC, 2007 | |
p Eurostat provisional value.
1 2007 figures.
2 Gross domestic product (GDP) is a measure of economic activity. It is defined as the value of all goods and services produced less the value of any goods or services used in their creation. The volume index of GDP per capita in Purchasing Power Standards (PPS) is expressed in relation to the European Union (EU-27) average set to equal 100. If the index of a country is higher than 100, this country's level of GDP per head is higher than the EU average and vice versa.
3 Expenditure on social protection contains: benefits, which consist of transfers, in cash or in kind to households and individuals to relieve them of the burden of a defined set of risks or needs.
4 Unemployment rates represent unemployed persons as a percentage of the labour force. Unemployed persons comprise persons aged 15 to 74 who were: (a) without work during the reference week; (b) currently available for work; (c) actively seeking work.
5 Situation of penal institutions on 1 September, 2006.
6 Share of persons aged 0+ with an equivalent disposable income below the at-risk-of-poverty threshold in the current year and in at least two of the preceding three years.
7 EU-25 countries.
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 Victimisation Survey, SCVS), and in Northern Ireland (the Northern Ireland Crime Survey, NICS). 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.
In England and Wales, the 2007–08 BCS, conducted among people aged 16–59, showed that 35.8 % of respondents had tried any illegal drug at least once in their lives (lifetime prevalence rates). Lifetime prevalence of cannabis was 30 %; amphetamines, 11.7 %; ecstasy, 7.5 %; cocaine powder, 7.6 %; and LSD, 5.2 %. In 2007–08, last year prevalence of cannabis use was reported to be 7.4 %, showing a steady decline in cannabis use since 2003 (10.8 %). Also, since 1996, there has been an increase in cocaine use, but a corresponding decrease in amphetamine use.
Reported drug use in Scotland is slightly higher than England and Wales. The 2006 SCVS shows that 36.6 % of people aged 16–59 had tried any illegal drug at least once in their lives. Lower prevalence (28 %) was reported in Northern Ireland based on the 2006/07 NIDPS among 15–64 year-olds, which might reflect that illegal drug use has been less prevalent in Northern Ireland over the last decade. The NICS results lead to the same conclusion. Use at least once during lifetime among younger adults was higher: 30.6 % of those aged 16–34 years in Northern Ireland reported lifetime prevalence of cannabis use. However, this compares to a figure of 40.1 % for those aged 16–34 in England and Wales and 49.6 % in Scotland.
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 2007. 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 2006. In Wales, the Health Behaviour in School-aged Children Survey (HBSC) was last conducted in 2006 but results are not yet available.
In addition, the European Schools Project on Alcohol and other Drugs (ESPAD) survey provides data for students aged 15–16 every four years. In the UK, drug use among schoolchildren increased markedly between 1998 and 2002, though in recent years use has stabilised or even decreased for some substances. In England, based on the school survey, lifetime prevalence of any drug among 11–15-year olds was 25.2 % in 2007. In Scotland, lifetime prevalence of any drug was 26.4 % among 15-year olds.
As with drug use in the adult population, cannabis is the most commonly used drug among young people. In England, 27 % of 15 year olds had taken cannabis at least once in their lifetime, 25 % among 15-year olds in Scotland and 17 % among 15 to 16 year olds in Northern Ireland. Among younger students (aged 11 years) the recent use of volatile substances (at 4.4 %) in England is more common than cannabis (at 0.8 %). Among 15 year olds, lifetime prevalence rates for amphetamines range from 3.0% in England to 3.4 % in Scotland while lifetime ecstasy use is similar across all countries at around 5.3 %.. A decreasing trend is noticed especially for cannabis (34% in 2005 to 27 % in 2007 in England).
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.
Lifetime use of amphetamines decreased from 13 % in 1995 to 8 % in 1999, 3 % in 2003 and 2 % in 2007. While 8 % reported the use of ecstasy at least once in 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.
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. 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 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 by way of enforcement and support utilising Individual support orders (ISOs) (1) alongside Anti-social behaviour orders (ASBOs (2)).
(1) ISOs can be attached to an ASBO on a young person and contain positive obligations which are designed to tackle the underlying causes of a young person’s antisocial behaviour. ISOs can last for up to six months.
(2) An ASBO is a civil order that is placed upon an individual in order to protect the public from harassment, alarm or distress. They usually contain conditions that prohibit an individual from entering a defined area and/or acting in a specified antisocial manner and are effective for at least two years. See: http://www.crimereduction.homeoffice.gov.uk/antisocialbehaviour/antisocialbehaviour55.pdf
Problem drug use
Problem drug use estimates in the UK are available for England, Northern Ireland, and Scotland, at a regional and local level (including 149 ‘Drug Action Team’ areas in England). Estimates for Wales are extrapolated from England estimates. 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 for the United Kingdom suggest that there are 400 469 problem drug users (with a 95 % CI of 393 247–417 861), a rate of 9.97 (9.79–10.40) per 1 000 population. This estimate is based on different definitions of problem drug use and different time periods.
In England, case definition is the use of opiates and/or crack cocaine; in Scotland, it is the use of opiates and/or benzodiazepines. The UK excludes powder cocaine users from the case definition due to the characteristics of the available data sources which would probably cause the inclusion of a potentially large number of occasional users into the estimates. However, estimates from Northern Ireland do include powder cocaine, as the nature and extent of drug use differs from the rest of the UK.
The EMCDDA defines problem drug use as intravenous drug use (IDU) or long duration/regular drug use of opiates, cocaine and/or amphetamines. Ecstasy and cannabis are not included in this category. The UK excludes powder cocaine users from the case definition due to the characteristics of the available data sources which would probably cause the inclusion of a potentially large number of occasional users into the estimates.
Treatment demand
The 2007, treatment demand data for the United Kingdom was based on 2 869 treatment centres comprising of: 2 535 outpatient treatment centres, 99 inpatient treatment centres and 235 general practitioners. In 2006–07, a total of 128 208 clients entered treatment, out of which 47 165 were first-time treatment clients.
In 2006–07, opioids were the most reported primary drug among all clients entering treatment at 63.7 %, followed by cannabis at 15.6 % and cocaine at 12.7 %. Treatment demand data among first-time treatment clients indicated a similar distribution with the primary substance of use being opioids at 47.7 %, followed by cannabis at 25.1 % and cocaine (including crack) at 17.4 %.
In 2006–07, 31 % of all clients entering treatment were over 35 years of age. A lower age distribution was reported among new treatment clients with 38 % under the age of 25 years. As far as gender distribution is concerned, 73 % of all clients were male whereas, 28 % were female. A similar distribution in gender distribution was reported among first time treatment clients.
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 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 2007, there were 152 HIV diagnoses, where infection was thought to have been acquired through injecting drug use. HIV prevalence remains low in the UK, although there is evidence of increased transmission amongst recent initiates: 1.0 % of those participating in the 2007 UAPMP survey compared to 0.25 % in 2002. However, in London prevalence is higher at, or near, 4 %. In 2007, 1 429 HIV-infected IDUs were seen for HIV-related treatment or care in the UK.
The prevalence of antibodies to the hepatitis C virus (HCV) among IDUs in England and Wales is between 29–60 %, but this varies according to region and, also, other risk factors such as duration of injecting. The overall prevalence rate in Wales and Northern Ireland in 2006 and 2007 was 21 % and 29 % respectively, with prevalence rates being higher in London in 2007 (58 %). There has also been evidence of increased incidence, especially among new injectors.
Overall about one in five IDUs have had a hepatitis B infection. Prevalence of anti HBc among IDUs declined in the early 1990s, levelling off at around 20 %.
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 2007. 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 has risen subsequently to 2 025 in 2006. Males accounted for 79 % of deaths and the average age of those dying was 37.4 years. In 2007, 2 069 direct drug-related deaths were recorded (compared to 2 025 in 2006, 1 987 in 2005 and 1 887 in 2004).
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 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.
Substitution treatment remains the main treatment in the United Kingdom. Most substitution treatment is for opiate dependence, and the majority offered through specialist outpatient drug services, commonly in shared care with general practitioners. Oral methadone is the drug of choice for substitution treatment, but increasingly also buprenorphine, which has been available since 1999. Furthermore, injectable methadone and heroin are also available albeit more rarely, in England.
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 total number of clients in substitution treatment in Northern Ireland in 2006/07 was 463), 22 224 received methadone treatment in Scotland in 2006 and 131 468 received specialist prescribing treatment in England in 2007/08.
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. 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. 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. 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.
Drug markets and drug-related offences
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 and the Netherlands, 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, there are indications of increasing domestic cultivation in the UK. Ecstasy and other synthetic drugs enter the UK from the Netherlands and Belgium, through ferryboats and the Channel Tunnel. However, some synthetic drugs are produced in the UK, including amphetamines.
In 2006, there were 123 132 convictions or cautions for drug offences in the United Kingdom. Of those offences where a drug was known, 51.9 % were cannabis related,14.6 % heroin-related and 14.3 % cocaine-related. In addition, 80 527 cannabis warnings were issued in England and Wales in 2006. The latest information on seizures in the United Kingdom is for 2006/07, and provides data for all law enforcement agencies except for customs data for Scotland and Northern Ireland. Increases are reported for all drugs, the largest being for herbal cannabis with a total of 107 424 seizures, cannabis plants with a total of 5 906 seizures, and cocaine with a total of 18 064 seizures. In 2006, there was a decrease in the quantity of seizures for a number of drugs, namely cannabis resin, heroin and cocaine.
Estimates of drug prices in the United Kingdom come from a number of sources. Law enforcement agencies collect national data on drug prices, while the Independent Drug Monitoring Unit (IDMU) surveys festival-goers. Data from law enforcement agencies show that in 2007 the average price of amphetamines was EUR 13.2/gram, crack EUR 95/ gram, ecstasy EUR 4.4/tablet and heroin EUR 70.2/gram.
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 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.
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 any production or supply transportation import and export of 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. Two drug court pilots were opened in Scotland in 2002 and England in 2005, and four more were announced in April 2008 after an evaluation indicated they could have a positive impact on reoffending, court attendance and compliance by offenders.
National drug strategy
In early 2008, the Government published its second 10-year drug strategy 2008–18 called ‘Drugs: protecting families and communities’. The strategy focuses mainly on illicit drugs, is comprehensive and covers four broad fields: law enforcement; prevention; treatment and social re-integration; and communication. Devolution of certain powers to Northern Ireland, Scotland and Wales means that the devolved administrations are responsible for some of the areas covered by drug policy. Thus, each of the devolved administrations has its own strategy (New strategic direction for alcohol and drugs in Northern Ireland 2006–11; The road to recovery. A new approach to tackling Scotland’s drug problem; Working together to reduce harm: the substance misuse strategy for Wales 2008–18).
Coordination mechanism in the field of drugs
A series of boards has been put in place to ensure that cabinet ministers, junior ministers and senior officials have oversight of the development and delivery of the UK strategy. At Cabinet level, the Domestic Affairs Cabinet Sub-committee (Justice and Crime) is chaired by the Secretary of State for Justice. The National Crime Reduction Board is chaired by the Home Secretary and there is an inter-Ministerial Group on Alcohol and Drugs. At senior official level, there is a strategic board concerned with the delivery of the relevant public service agreements and an Alcohol and Drugs Strategic Delivery Group.
A feature of the Government’s strategy is the strong link between the agreed national policy and programmes and their delivery throughout the country at the local level. Across the UK local partnerships are permanent structures composed of all actors involved in drugs at local level varying according to the local situation (probation services, health services, police, treatment centres, social services and voluntary organisations).
Drug-related research
The current ‘National action plan on drugs’ significantly increased drug-related research and available funding. Priority is given to research involving identification of, and prevention within, high-risk social and demographic groups. The national drug policy also emphasises knowledge and competence in the area of research as a basis for prevention, and places particular importance on findings from research and methodological development studies that can be immediately applied in the field.
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.