Drug Misuse Statistics Scotland 2006	< Previous | Contents | Next >
A Services and treatment for drugs misusers
A1 Scottish Drug Misuse Database The Scottish Drug Misuse Database (SDMD) offers a profile of drug misusers based on reports at the time of 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. 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 A1.2). Further detail on ‘information available’ is provided within the tables. 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 2001/02 to 2005/06, and are updated versions of statistics that appeared in previous editions of Drug Misuse Statistics Scotland. Key Points 2005/06 Overview In 2005/06, 13,791 ‘new’ individuals were reported to the Scottish Drug Misuse Database (SDMD), a decrease of 1,207 individuals (8%) from 2004/05 (14,998 individuals). This corresponds to a rate of 289 per 100,000 of the Scottish population (Table A1.1). The male attendance rate is more than twice the female attendance rate (396 per 100,000 population for males, 185 per 100,000 population for females) (Tables A1.3 and A1.4). 29% of all individuals reported that they had injected in the month prior to seeking treatment, a decrease from 38% in 2001/02. This fall is reflected in all age groups (Tables A1.26 and A1.27). In 2005/06, 43% of all individuals reported that they had never injected, an increase from 41% in 2001/02. This increase is reflected in most of the age groups with the biggest increase being in the under 20 years age group (66% in 2001/02 rising to 79% in 2005/06) (Table A1.27). 27% of current injectors reported that they had shared needles/syringes in the previous month, the lowest percentage in the last five years (Table A1.33). 42% of current injectors reported that they shared spoons/water/filters/solutions in the previous month, the lowest percentage in the last five years (Tables A1.36, A1.37 and A1.38). Three-quarters (75%) of individuals reported that more than a year elapsed between the onset of problem drug use and treatment first being sought (Table A1.24). Drugs recorded In 2005/06, of those reporting illicit drug use, 68% reported using heroin (7,910 individuals). This is the same percentage that reported heroin use in 2004/05 and a decrease from 77% in 2001/02 (Tables A1.11, A1.12 and A1.14). In 2005/06, of those aged under 25 years reporting illicit drug use, 62% reported using heroin. This is the same percentage as 2004/05 and a decrease from 78% in 2001/02. The percentage of under 25s reporting use of heroin has shown a larger decrease than that for all ages (Tables A1.14 and A1.15). In 2005/06, 11% of those reporting illicit drug use reported cocaine use (1,250 individuals), an increase from 8% (982) in 2004/05 and more than double the percentage reporting cocaine use in 2001/02 (5%, 549 individuals) (Tables A1.11 and A1.12). Use of crack cocaine amongst those reporting illicit drug use increased from 2% (190 individuals) in 2001/02 to 3% (311 individuals) in 2002/03 and then to 4% (484 individuals) in 2005/06 (Tables A1.11 and A1.12). The proportion of illicit drug users reporting use of diazepam was 30% (3,558 individuals), a similar proportion to 2004/05 (32%, 3,891 individuals). The highest proportion of illicit users who reported diazepam use was found in 2002/03 (37%, 3,866 individuals) (Tables A1.11 and A1.12). Geographical profile Between 2004/05 and 2005/06 the percentage of people reporting illicit drug use who reported use of heroin decreased in all areas apart from NHS Borders (increased from 34% to 49%, 62 to 97 individuals), NHS Tayside (increased from 73% to 82%, 374 to 682 individuals), NHS Forth Valley (increased from 73% to 79%, 246 to 379 individuals) and NHS Lothian (increased from 66% to 68%, 1,710 to 1,629 individuals) (Table A1.14). In 2005/06, of those reporting use of cocaine, 35% (433 individuals) were resident in NHS Greater Glasgow, 15% (191 individuals) in NHS Lothian and 11% in both NHS Lanarkshire and NHS Argyll and Clyde (137 individuals in Lanarkshire and 142 individuals in Argyll and Clyde) (Tables A1.11 and A1.12). Of the 484 individuals reporting crack cocaine use in 2005/06, 37% (180 individuals) were resident in NHS Grampian, 25% (119 individuals) in NHS Lothian and 9% (45 individuals) in NHS Greater Glasgow (Tables A1.11 and A1.12). Additional points Profiles of individuals reported to SDMD This section describes the demographic profile of ‘new’ individuals attending services. In the five years since 2001/02, there has been an increase of 18% in the number of ‘new’ individuals reported to SDMD, from 11,685 individuals in 2001/02 to 13,791 in 2005/06. The corresponding rate increase is from 243 per 100,000 population in 2001/02 to 289 per 100,000 population in 2005/06. However, there has been a decrease in the last year of 8% in the number of ‘new’ individuals reporting to SDMD (from 14,998 individuals in 2004/05 to 13,791 individuals in 2005/06). The corresponding rate decreased from 315 per 100,000 population in 2004/05 to 289 per 100,000 population in 2005/06 (Table A1.1). Overall the male:female attendance ratio in 2005/06 is 2.1:1. This has remained relatively stable since 2001/02. However, there is variation between age groups with the male:female ratio for those aged under 20 years old at 1.6:1 and for those aged 40 years and over at 2.8:1(Table A1.5). The median age of those reported to the SDMD was 29 years, the same as in 2004/05. The median age was 28 year in 2003/04 and 27 years in 2001/02, as reported in previous publications. Nearly half of those reported to SDMD were in their twenties (43%) (Table A1.2). The age profile of individuals reported to the SDMD has gradually changed over the past five years towards an older population profile. In 2001/02 11% of individuals reported were under 20 years of age. This has fallen to 8% in 2005/06 (Table A1.5). In 2005/06, 99% of individuals reported to the SDMD described their ethnicity as ‘white’ (Table A1.6). 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. In specialist drug services the majority of individuals (66%) were referred from another organisation or individual, with only 33% attending as self referrals. For individuals being seen by General Practice for drug misuse, the majority (73%, data not shown) were self referrals i.e. there was no formal referral from another organisation or individual. This is a similar pattern to that found in previous years (Table A1.7). When undergoing assessment for treatment, 56% of individuals reported physical health issues and 52% mental health issues in addition to their drug misuse. This is a similar pattern to that found in previous years (Table A1.8). 13% of females reported pregnancy as an issue when undergoing assessment (Table A1.9). In 2005/06, 39% reported that their purpose in presenting to the service included seeking a prescription related to their addiction, primarily methadone or a similar drug (Table A1.10). 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. Of the 7,910 individuals who reported heroin use, 93% reported it as their main drug of misuse (7,372 individuals) (Table A1.11 and A1.13). Of those individuals who reported heroin as a main drug of use, 32% reported additional illicit diazepam use, 26% cannabis, 6% reported using cocaine, and 5% reported using crack cocaine (Table A1.16). 8% of individuals who reported illicit drug use had used dihydrocodeine (982 individuals) and roughly the same proportion of people who reported illicit drug use had used methadone (this figure does not include those receiving a prescription for methadone) (8%, 965 individuals) (Tables A1.11 and A1.12). Overall reports of ecstasy use have remained stable at around 4 to 5% of those reporting illicit drug use (4% in 2005/06, 431 individuals) (Table A1.12). Reports of solvent abuse were most common within the age group 15 years and under, with 21% of this group (36 individuals) reporting it in 2005/06. Next were 15 to 19 year olds, with 3% reporting solvent abuse. The percentage of those aged under 15 years reporting solvent abuse decreased each year between 2001/02 and 2004/05 (from 33% to 15%) but rose between 2004/05 and 2005/06 (15% to 21%). Note that the overall number of individuals in the 15 years and under age group reported to the database is small therefore caution should be used in interpreting the data (Table A1.12). 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 found in previous years (Tables A1.19, A1.20 and A1.21). 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 (41%) reported that they did not perceive their drug use as a problem until after five years of misuse. On the other hand, 15% reported recognising a problem within one year of misuse, a similar pattern to that found in previous years (Table A1.22). The time from the onset of problem drug use to seeking treatment also varied. 26% sought treatment within one year of onset, 32% in one to two years, and 16% after three to four years of use. The remaining 27% took more than five years to seek treatment for their problem drug use. This is a similar pattern to that found in previous years (Table A1.24). 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 across Scotland have shown a fall in the percentage who report injecting in the month prior to seeking treatment over the last five years, the exceptions being NHS Fife, NHS Forth Valley, NHS Grampian, NHS Lothian, NHS Orkney, NHS Shetland and NHS Tayside. Where there are increases in injecting this does not always correspond with an increase in reports of heroin use. Likewise, where there are increases in reports of heroin use there will not necessarily be an increase in reports of recent injecting (Tables A1.14 and A1.26). Individuals in their twenties more frequently reported that they had injected during the month prior to seeking treatment than other age groups (35% and 34% of those aged 20 to 24 years and 25 to 29 years Scottish Drug Misuse Database respectively). Compared with other age groups relatively few individuals aged under 20 years reported recent injecting behaviour (16%) (Table A1.27). 37% of individuals reported that they were under 20 years old when they first injected. This is a slight decrease from 40% in 2001/02 (Table A1.29). In 2005/06, 49% of heroin users reported that they injected the drug. The percentage of heroin users reporting injecting has decreased from 59% in 2002/03. The median age of first injecting has remained at 21 years for the last five years (Table A1.29 and A1.31). There has been a reduction since 2001/02 in the percentage of those reporting heroin use in the last month who report taking the drug through injection only (35% in 2001/02 to 30% in 2005/06). The percentage who administer the drug by injection along with another method (e.g. smoking) has been consistent throughout the five year period (17% in 2001/02 and 18% in 2005/06) (Table A1.32). 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 SDMD. In 2005/06 83% of new individuals reported that they were unemployed. The percentage reporting being unemployed for one year or longer or never employed was 71%, similar to figures found in previous years (Table A1.41). Nearly one in five (17%) individuals reported that they were living with dependent children. This compares to 19% in 2004/05 and 20% in 2001/02. It should be noted that this does not include those individuals who have dependent children who live elsewhere (Tables A1.42 and A1.43). 83% of individuals reported that they lived in owned or rented accommodation and 13% lived in temporary or unstable accommodation (e.g. hostels). 2% of new individuals were reported as being roofless. This is a similar pattern to that found in previous years (Table A1.44). Just under half (45%) of people reported that they had previously been in prison (Table A1.46). Background information The Scottish Drug Misuse Database (SDMD) offers a profile of drug misusers based on reports at the time of attending services for their drugs problem. Established in 1990, 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 A1.3 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. Data Developments The data presented in this section is based on analyses of the SMR24 returns. In April 2006 ISD introduced the SMR25 assessment paper form to replace the SMR24. This revised dataset reflects the need for more in-depth and focussed information on clients who present for treatment. The new dataset incorporates most of the information that SMR24 collected, but also includes data items on aspects of a client's situation that were not previously captured in the SDMD. The paper SMR 25 is currently completed at the beginning of an individuals care episode. In 2007 services will be asked to transfer SMR25 data electronically to ISD on individuals at their initial assessment, in addition they will also be asked to transfer data three months after and annually after the initial assessment. Discharge and transfer data will also be collected. The plans are to track clients across time and if they are transferred to or share care with other drug services, across drug services. For information on analysis from the current assessment SMR25 and on the future plans and timescales for collecting follow up SMR25 data contact substancemisuse@isd.csa.scot.nhs.uk. 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 A1.47 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 A1.47), to improve validity of comparisons between NHS board and local authority areas. Information received from General Practitioners is excluded from all tables for these reasons. Supplementary information for some specific tables can be found in Annex A1.1. Definitions of statistical terms and tests can be found in Annex A1.2. Acknowledgements The co-operation and assistance of the staff at all services contributing to the database are gratefully acknowledged. Further information Information on the Scottish Drug Misuse Database is available at: http://www.drugmisuse.isdscotland.org/sdmd/sdmd.htm If you would like further information please contact the Substance Misuse Information Strategy Team at substancemisuse@isd.csa.scot.nhs.uk.