Introduction

The Scottish Drug Misuse Database (SDMD) offers a profile of drug misuse based on non-named data about problem drug users attending services for their drugs problem.

The information presented relates to new patients/clients. The definition of 'new' is any person who is attending the service for (a) the first time ever or (b) it has been at least six months since the last attendance at the service.

This report provides data from the SDMD for 5 years up to year end 31 March 2003.

It is important to note that the percentages quoted below are based on the number of individuals on which data for each specific question are available i.e. they are not based on the total number of individuals reported to the Database. Further information on 'information available' is provided within each table.

Key Points

Profile of individuals reported to SDMD
This section describes the demographic profile of 'new' individuals attending services.

• In 2002/03, 11 472 'new' individuals were reported to the Scottish Drug Misuse Database, an increase from 1998/99 (9 128 individuals) but virtually the same as in 2001/02. The 2002/03 figure corresponds to a rate of 237 per 100 000 population (all ages). (Tables B1.1 and B1.2)
• The male attendance rate is twice that of the female attendance rate (320 per 100 000 population for males, 158 per 100 000 population for females). (Tables B1.3 and B1.4)
• Although overall the male: female attandance ratio is 2.0:1, there is variation between age groups with the under 20's ratio 1.1:1 and for 40 years and over 2.8:1. (Table B1.5)
• Ages ranged from 9 to 69 years, with a median of 27 years. (Table B1.2)
• The age profile of individuals reported to the Database has gradually changed over the past 5 years towards an older population profile - in 1998/99, 14 per cent of individuals reported were under 20 years of age, this has fallen to 11 per cent in 2001/02 and 9 per cent in 2002/03. (Table B1.5)

Where clients are referred from and their presenting issues
This section includes information on the main source of referral and reported issues that have led the person to attend the service for their drug misuse problem.

• Of those individuals being seen by General Practice, the majority (73%) were self referrals i.e. there was no formal referral from another organisation or individual. In Specialist Drug Services 34 per cent were self referrals, with a further 35 per cent being referred from GP/primary care teams. The relatively large percentage of self referrals to GPs probably reflects the role of the GPs as the first point of contact for many drug users. (Tables B1.6a and b)
• Nearly two-thirds (64%) of individuals reported physical health issues, and half (50%) mental health issues in addition to their drug misuse. (Table B1.7)
• Almost half (46%) reported that their purpose in presenting to the service included seeking a prescription related to their addiction, primarily methadone or a similar drug. (Table B1.8)

Types of drugs individuals are using
The Database collects a range of details about the particular drugs which the new patients/clients have used in the past month.

• For new individuals attending services, the percentage who reported using heroin was 77 per cent in 2001/02 (8 168 individuals) and 76 per cent in 2002/03 (7 856 individuals). This compares to 69 per cent in 1998/99 (5 521 individuals). (Table B1.10)
• This slight fall in the percentage who reported using heroin is not reflected in all areas with, for example, a small percentage rise in some of the more rural parts of Scotland (e.g. Dumfries and Galloway, Highland, Fife). (Table B1.12)
• The proportion of people reporting illicit use of diazepam is 37 per cent (3 804 individuals), a slight increase from last year (34%, 3 637 individuals). Of those individuals who reported illicit opiate use, 39 per cent also reported illicit diazepam use (3 229 individuals). (Tables B1.10 and B1.13)
• Twelve per cent of individuals reported illicit use of dihydrocodeine (1 207 individuals) and 8 per cent illicit use of methadone (824 individuals). (Table B1.10)
• Use of cocaine among new individuals attending services has increased from 2 per cent in 1998/99 (190 individuals) to 5 per cent in 2001/02 (548 individuals) and 7 per cent in 2002/03 (739 individuals), a trend reflected in all age groups. Use of crack cocaine among those attending services has also increased from 1 per cent to 2 per cent and then 3 per cent within the same time period (57 to 308 individuals). (Table B1.10)
• For those individuals who reported illicit opiate use, 6 per cent also reported using cocaine (529 individuals), and 3 per cent reported crack cocaine (275 individuals). (Table B1.13)
• There is a growing proportion of alcohol being reported along with drug use by the under 15 age group, with for example, in 1998/99, 23 per cent of under 15s reported alcohol use, 36 per cent in 2001/02 and 48 per cent in 2002/03. Due to the small numbers of people aged under 15 years reported to the Database, caution is recommended when interpreting these data. (Table B1.10)

Age of first use, problem recognition and seeking help
The age of the individual at different points of their drug use: age when first used an illicit drug, age at onset of problem and age when (professional) help was sought. The time lags between these ages provides an indication of the length of time between first use, onset of problem and seeking help.

• The majority (82%) of individuals were in their teens when they first started using illicit drugs (which also includes volatile substances and over the counter medicines), were in their teens/early twenties when their drug use became a problem and were in their late teens and early twenties when they sought help. (Tables B1.14 to B1.16)
• As would be expected, the time from when individuals first used illicit drugs until they perceived there to be a problem varied from person to person. Over a third (35%) reported that they did not perceive their drug use as a problem until after 5 years of misuse. On the other hand, 16 per cent reported recognising a problem within one year of misuse. (Table B1.17)
• The time from the onset of problem drug use to seeking treatment also varied markedly. Twenty-six per cent sought treatment within 1 year of onset, 33 per cent in one to two years, and 18 per cent after three to four years of use. The remaining 23 per cent took more than five years to seek treatment for their drug use. This is very similar to the pattern found in previous years. (Table B1.19)

Ways in which people take drugs
All patients/clients are asked whether they have ever injected and if so, whether they have done so in the past month prior to attending the service. Similar questions are asked regarding sharing needles/syringes and sharing spoons/water/filters/solutions.

• In 2002/03, 42 per cent of individuals reported that they had injected in the past month, an increase from the relative stability of previous years (in 1998/99, 39 %, in 2001/02, 38%). This rise is reflected in all age groups but particularly so in the 20-24 age group. (Tables B1.21 and B1.22)
• Individuals in their twenties more frequently reported that they had injected during the previous month than other age groups (46% and 44% of those aged 20-24 and 25-29 years respectively). Compared with other ages relatively few individuals aged under 20 years reported recent injecting behaviour (30%). (Table B1.22)
• Forty per cent of individuals reported that they were in their teens when they first injected. (Table B1.23)
• In 2002/03, 59 per cent of heroin users reported that they injected the drug (52% in 2001/02). This rise in those reporting injecting heroin reverses the recent downward trend and returns the injecting levels of this drug to the levels reported to the SDMD in the late 1990's (59% in 1998/99). (Table B1.26)
• In 2002/03, 32 per cent of current injectors reported that they shared needles/ syringes in the previous month, a fall from previous years (34% in 1998/99 and 36% in 2001/02). Forty-eight per cent of current injectors reported that they shared spoons/water/filters/solutions in the previous month (50% in 2001/02). (Tables B1.29 and B1.32)

Social information
The personal circumstances of the drug user seeking treatment or advice from services can influence the individual's motivation for seeking help and the extent to which the service can contribute to a change in drug taking behaviour. Information on employment status, current living arrangements and accommodation and the individual's current legal status are each potentially relevant factors and are collected by the Database.

• Eighty-six per cent of new individuals reported that they were unemployed. The percentage reporting being unemployed for one year or longer or never employed, at 72 per cent, is slightly higher than in previous years. (Table B1.36)
• Nearly one in five (18%) of individuals reported that they were living with dependent children. It should be noted that this does not include those individuals who have dependent children that live elsewhere. (Table B1.37)
• Just under half (46%) of people reported to the Database in 2002/03 said that they had previously been in prison (44 % in 2001/02). (Table B1.41)