Drug Misuse Statistics Scotland 2005	< Previous | Contents | Next >
B Services and treatment for drugs misusers B1 Scottish Drug Misuse Database 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 drug problems. 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 2005. 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. This can result in percentage increases when numbers of individual reports fall (see annex D). Further detail on ‘information available’ is provided within each table. Some of the statistics presented in the text below are not shown in the tables. These figures relate to the number of individuals within specific subgroups for 2000/01 to 2004/05, and are updated versions of statistics that appeared in previous editions of Drug Misuse Statistics Scotland Key Points 2004/05 In 2004/05, 14 322 ‘new’ individuals were reported to the Scottish Drug Misuse Database, an increase of 1 246 individuals (10 per cent) from 2003/04 (13 086 individuals). The 2004/05 figure corresponds to a rate of 302 per 100 000 of the Scottish population (all ages) (Tables B1.1). Individuals attending services who report illicit drug use1 Of those reporting illicit drug use, 68 per cent used heroin in 2004/05 (8 097 individuals). This compares to 71 per cent in 2003/04 (8 036 individuals) (Tables B1.11, B1.12 and B1.14). The proportion of illicit drug users reporting use of diazepam was 32 per cent (3 834 individuals), the same proportion was found in 2003/04 (32%, 3 654 individuals). The highest proportion of illicit users who reported diazepam use was found in 2002/03 (37%, 3868 individuals) (Table B1.11 and B1.12). For the last two years (2003/04 and 2004/05) eight per cent of those reporting illicit drug use have reported cocaine use. In 2000/01 and in 2001/02 this proportion was five per cent (438 individuals in 2000/01 and 549 in 2001/02 individuals). In 2002/03 the proportion using cocaine increased to seven per cent (758 individuals). Of the 949 individuals in 2004/05 reporting using cocaine, 40 per cent (381 individuals) were resident in Greater Glasgow NHS Board, 14 per cent (136 individuals) in Lothian and 13 per cent (123 individuals) in Lanarkshire (Tables B1.11 and B1.12). Of the 348 individuals reporting crack cocaine use in 2004/05, 30 per cent (106 individuals) were resident in Grampian NHS Board and 27 per cent (93 individuals) in Lothian and 12 per cent (42 individuals) in Greater Glasgow (Tables B1.11 and B1.12). Use of crack cocaine amongst those reporting illicit drug use increased from 1 per cent (106 individuals) in 2000/01 to 3 per cent (311 individuals) in 2002/03 and has since remained stable. Injecting In 2004/05, 30 per cent of all individuals reported that they had injected in the month prior to seeking treatment, a fall from previous years (in 2003/04, 37 %, in 2002/03, 41%). This fall is reflected in all age groups. In the under 20 age group, there has been an increase in the percentage of individuals who report that they have never injected, 61 per cent in 2000/01, 72 per cent in 2003/04 and 78 per cent in 2004/05 (Tables B1.25 and B1.26). In 2004/05, 31 per cent of current injectors reported that they had shared needles/ syringes in the previous month (34% in 2003/04 and 33% in 2002/03). Forty seven per cent of current injectors reported that they shared spoons/water/filters/solutions in the previous month (49% in 2003/04) (Tables B1.33 and B1.36). Additional points Profiles of individuals reported to SDMD This section describes the demographic profile of ‘new’ individuals attending services. In the five years since 2000/01, there has been an increase of 35 per cent in the number of ‘new’ individuals reported to SDMD, from 10 581 individuals in 2000/01 to 14 332 in 2004/05. The corresponding rate increase is from 219 per 100 000 population in 2000/01 to 302 per 100 000 population in 2004/05 (Table B1.1). Overall the male: female attendance ratio in 2004/05 is 2.0:1, this has remained relatively stable since 2000/01. However, there is variation between age groups with the under 20’s ratio 1.6:1 and for 40 years and over 2.5:1(Table B1.5). The male attendance rate is twice that of the female attendance rate (408 per 100 000 population for males, 200 per 100 000 population for females) (Tables B1.3 and B1.4). The median age of those reported to the SDMD was 29 years, compared to 28 in 2003/04 and 26 in 2000/01. Nearly half of those reported to SDMD were in their twenties (46 per cent) (Table B1.2) . The age profile of individuals reported to the SDMD has gradually changed over the past 5 years towards an older population profile - in 2000/01, 12 per cent of individuals reported were under 20 years of age, this has fallen to eight per cent in 2004/05 (Table B1.5). In 2004/05, 99 per cent of individuals reported to SDMD described their ethnicity as ‘white’ (Table B1.6). Where clients 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 (76%, data not shown) were self referrals i.e. there was no formal referral from another organisation or individual. In Specialist Drug Services 30 per cent were self referrals, with a further 34 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 (Table B1.7). When undergoing assessment for treatment, 58 per cent of individuals reported physical health issues, and half (50%) mental health issues in addition to their drug misuse (Table B1.8). In 2004/05, 43 per cent reported that their purpose in presenting to the service included seeking a prescription related to their addiction, primarily methadone or a similar drug (Table B1.10). Types of drugs individuals are using The SDMD collects a range of details about the particular drugs that the new patients/clients have used in the past month. Between 2003/04 and 2000/05 the percentage of people reporting illicit drug use who used heroin decreased in all NHS board areas apart from Ayrshire and Arran (increased from 67 per cent to 72 per cent, 835 to 794 individuals) Forth Valley (increased from 71 per cent to 74 per cent, 240 to 246 individuals), Tayside (increased from 66 per cent to 74 per cent, 336 to 366 individuals) and Orkney (increased from 0 to 13 per cent, 0 to 1 individual) (Table B1.11, B1.14). Of the 8 097 individuals who reported heroin use, 92 per cent reported it as their main drug of misuse (7 526 individuals) (Table B1.11 and B1.13). Nine per cent of individuals who reported illicit drug use had used dihydrocodeine (1 112 individuals) and eight per cent illicit use of methadone (944 individuals) (Tables B1.11 and B1.12). Of those individuals who reported heroin as a main drug of use, 33 per cent also reported illicit diazepam use (2 450 individuals) (Table B1.15). For those individuals who report heroin as their main drug of use, six per cent also reported using cocaine (448 individuals), and four per cent reported crack cocaine (265 individuals) (Table B1.15). Although overall reports of ecstasy use have remained stable at around five per cent of those reporting illicit drug use, there has been increased use within the 15-19 age group, 12 per cent in 2000/01 (137 individuals) to 20 per cent in 2004/05 (192 individuals) (Table B1.12). Reports of solvent abuse are highest within the under 15 age group2 who report illicit drug misuse, 17 per cent in 2004/05 (33 individuals). Since 2001/02 the proportion of those aged under 15 who report solvent abuse has decreased from 37 per cent (Table B1.12). Age of first use, problem recognition and seeking help The time lags between the age when individuals first used an illicit drug, age at onset of problem and age when (professional) help was sought provides an indication of the pathways through drug misuse. The majority of individuals reported to SDMD 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 twenties when they sought help. This is a similar pattern to that presented in previous years (Tables B1.18 to B1.20). 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 (37%) 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, a similar pattern to previous years (Table B1.21). The time from the onset of problem drug use to seeking treatment also varied. Twenty-five per cent sought treatment within one year of onset, 34 per cent in one to two years, and 16 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 a similar pattern to that found in previous years (Table B1.23). 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. Most of the NHS Boards show a fall in the percentage who have injected in the month prior to seeking treatment, the exceptions being Ayrshire and Arran and the Western Isles. (Table B1.25). For all age groups there has been a fall in the percentage of people injecting in the month prior to seeking treatment and a rise in the percentage of people who have never injected (Table B1.26). Individuals in their twenties more frequently reported that they had injected during the month prior to seeking treatment than other age groups (36 per cent and 34 per cent of those aged 20-24 and 25-29 years respectively). Compared with other age groups relatively few individuals aged under 20 years reported recent injecting behaviour (16 per cent) (Table B1.26). Forty per cent of individuals reported that they were in their teens when they first injected. This remains unchanged from 40 per cent in 2000/01 (Table B1.28). In 2004/05, 51 per cent of heroin users reported that they injected the drug (57% in 2003/04 and 54 per cent in 2000/01) (Table B1.30). For those individuals who have reported using heroin in the last month there has been a gradual reduction in the percentage taking the drug through injection only, 42 per cent in 2000/01 to 33 per cent in 2003/04. There has been a corresponding increase in the percentage who either administer the drug by injection and another method (e.g. smoking) (12 per cent in 2000/01 to 18 per cent in 2004/05), or those who have not injected the drug in the past month (46 per cent in 2000/01 to 49 per cent in 2004/05) (Table B1.31). 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 SDMD. Eighty-four 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 similar to previous years (Table B1.40). Nearly one in five (19%) individuals reported that they were living with dependent children. This compares to 18 per cent in 2003/04 and 20 per cent in 2000/01. It should be noted that this does not include those individuals who have dependent children who live elsewhere (Table B1.42). Eighty-two per cent of individuals reported that they lived in owned/rented accommodation and 13 per cent lived in temporary/unstable accommodation (e.g. hostels). Two per cent of new individuals were reported as being roofless. This is a very similar pattern to that presented in previous years (Table B1.43). Just under half (45%) of people reported to the SDMD in 2004/05 said that they had previously been in prison) (Table B1.45). Background information The Scottish Drug Misuse Database offers a profile of drug misuse based on non-named data about problem drug users attending services for their drugs problem. Problem drug user Any person who experiences social, psychological, physical or legal problems related to intoxication and/or regular excessive consumption and/or dependence as a consequence of his/her own use of drugs or chemical substances. - ACMD 1982. Established in 1990 at ISD Scotland on behalf of the Scottish Office, the database gathers information from most specialist drug services in Scotland and from a number of general practitioners, providing a unique source of information on drug misuse in Scotland. Data Collection Information is collected using form SMR24 (introduced April 2001). Annex C includes a sample copy of the form. This collects a variety of information about the user, including demographic, drug profile and injecting and sharing details. Prior to April 2001, the same core data was collected on forms SMR22 and SMR23, there were however some important differences, particularly where data items were not previously collected e.g. sharing injecting equipment (SMR22 & 23), became sharing needles/syringes and sharing spoons/water/filters/solutions. In these cases it is not possible to report accurate trend data. For those trend tables which are included in this publication, it may have been necessary to make certain assumptions about the data. These assumptions are included as footnotes on each table, as required. Understanding the data ‘New’ patients/clients The information presented relates to new patients/clients. As such, statistics do not reflect the total number of drug misusers seen by services during any period. New patient/client 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. The database does not collect information on the non-client work in which most specialist projects are involved, nor measure the number of contacts or amount of time spent with clients. The data is usually recorded at or around the time of the initial assessment and no measure of outcome is included. Misuse of alcohol may be reported to the database only when there are reports of other drugs. It cannot be reported if it is the only substance. From April 2001, alcohol could be reported as the main drug of misuse. Matching new patients/clients By means of matching on certain criteria (initial of first name, initial & 4th character of surname, date of birth and gender), an adjustment is made for the double counting of individuals who may have attended more than one service during the period. The accuracy of these matches cannot be guaranteed. This is however, the most precise method of matching individuals given that full name and address is not provided to ISD. Where the terms `individuals’ and `attendees’ have been used, this refers to new patients/clients who have been through the matching process. Local area analysis and trends Individuals have been included only once within each NHS board and council area of residence. However, they may appear in more than one area and as a result the sum of the NHS board or council areas data will not equal the Scotland figure. Where data are presented at a national level, individuals are also counted only once in any year. This is true for all tables excluding table B1.46 which presents statistics on all valid forms received. Within Ayrshire & Arran NHS Board data were collected through the Ayrshire Common Database using a previous version of SDMD (form SMR22). Since April 2003, Ayrshire & Arran have designed a new local database based on the SMR24 form. However, because the SMR24 form is being introduced gradually (from January 2004) within the region, information is unavailable from some agencies for the SMR24 specific questions. Information received on penal establishment inmates (i.e. including those seen in prison by an external agency) and from needle exchanges have been excluded from most tables presented (except table B1.46), to improve validity of comparisons between NHS board and local authority areas. Definitions of statistical terms and tests can be found in Annex D. Supplementary information for some specific tables can be found in Annex A. For more advice on understanding the data please contact the analytical team at DMIST. Acknowledgements The co-operation and assistance of the staff at all services contributing to the database are gratefully acknowledged. Footnotes 1 The percentages of people reporting the use of various types of drugs are calculated from the number of people reporting illicit drug use - not the total number of people reported to SDMD. 2 Due to small numbers of people aged 15 years reported to the SDMD, caution is recommended when interpreting these data.