B1 Scottish Drug Misuse Database
The Scottish Drug Misuse Database (SDMD) offers a profile of
drug misusers based on reports submitted on individuals when they
first attend a service for assessment of their drug misuse
problems.
The information presented relates to new patients/clients. A
‘new’ patient/ client is defined as any person who, at
the time of presenting, is not currently in contact with a service
that provides specialist assessment of a client’s drug misuse
care needs.
From April 2006 the new SMR25a form was introduced. Changes to
the data collection mean that trend information cannot be presented
and figures are not directly comparable with those previously
published from the SMR24 form (see background information for
further details on the changes).
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 detail on
‘information available’ is provided within the
tables. |
Key Points 2006/07
Overview
- In 2006/07, 12,222 ‘new’ individuals were reported
to the Scottish Drugs Misuse database (SDMD). This corresponds to a
rate of 253 per 100,000 of the Scottish population (Table
B1.1).
- The male attendance rate was more than twice the female
attendance rate (354 per 100,000 population for males, 156 per
100,000 population for females) (Tables B1.2 and B1.3).
- Of those reporting illicit drug use, 68% reported using heroin
(6,756 individuals) (Tables B1.8 and B1.9).
- Over half (58%) of those under the age of 25 years old
reporting illicit drug use reported using heroin (Table
B1.11).
- Twenty-eight per cent of all individuals (for whom information
is available) reported that they had injected in the month prior to
seeking treatment. Forty-three per cent reported that they had
never injected (Tables B1.21, B1.22 and B1.23).
- Twenty-nine per cent of current injectors reported that they
had shared needles/ syringes in the previous month (Tables B1.27 and B1.28).
- Of current injectors: 61% reported that they had been tested
for Hepatitis B; 63% for Hepatitis C and 58% for HIV prior to
seeking treatment (Table B1.31).
- Sixty-six per cent of individuals reported that more than a
year had elapsed between the onset of problem drug use and
treatment first being sought (Table B1.20).
Geographical
profile
- In 2006/07, of those reporting use of heroin, 24% (1,636
individuals) were resident in NHS Greater Glasgow & Clyde; 18%
(1,186 individuals) were resident in NHS Lothian; 11% (757
individuals) were resident in NHS Fife; and 10% (649 individuals)
were resident in NHS Grampian (Table B1.8).
- Of those reporting cocaine use, 44% (470 individuals) were
resident in NHS Greater Glasgow & Clyde; 14% (151 individuals)
were resident in NHS Lothian; and 9% (97 individuals) were resident
in NHS Lanarkshire (Table B1.8).
- 504 individuals reported crack cocaine use in 2006/07. Of these
individuals 40% (203 individuals) were resident in NHS Grampian;
25% (126 individuals) were resident in NHS Lothian; and 19% (95
individuals) were resident in NHS Greater Glasgow and Clyde (Table
B1.8).
Additional points
Demographic profile
This section describes the demographic profile of
‘new’ individuals attending services.
- The male: female attendance ratio in 2006/07 was 2:1. There was
variation between age groups with the male: female ratio for those
aged under 20 years close to 2:1 and for those aged 35-39 years old
at 3:1 (Tables B1.2 and B1.3).
- The median age of male clients reported to the SDMD was 30
years, whilst the median age of female clients reported was 28
years (Tables B1.1, B1.2, and B1.3).
- Half of clients reported to the SDMD in 2006/07 were aged 30
years or over (Tables B1.1 and B1.4).
- Almost all (96%) of the individuals reported to the SDMD in
2006/07 described their ethnicity as ‘white Scottish’
(Table B1.5).
Social profile
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,
source of funding and average amount spent on their drug use, and
the individual’s current legal status are potentially
relevant factors and are collected by the SDMD.
- Two thirds (67%) of individuals in 2006/07 were unemployed, 14%
of individuals were in paid or unpaid employment (including full
time education and training), and 5% had never been employed (Table
B1.33).
- Two thirds (67%) of individuals said that their drug use was
funded by benefits, 27% reported that they funded their drug use
with crime, and 18% reported that their drug use was funded by debt
(Table B1.34).
- The average daily spend, in a ‘typical’ drug using
day, for individuals who reported using heroin, was
£34 (Table B1.36).
- For individuals using cocaine, the average daily spend, in a
‘typical’ drug using day, was reported as
£87 (Table B1.37).
- Almost four fifths (79%) of individuals (who provided
information) reported that they lived in owned or rented
accommodation at the time of presentation, 14% reported that they
were living in temporary or unstable accommodation and 2% reported
that they were roofless (Table B1.40).
- A fifth (22%) of individuals had previously been in prison
(Table B1.42).
- A third (31%) of individuals reported that they had dependent
children under the age of 16 years (Table B1.39).
Clients’ sources of referral and co-occurring health
issues
This section includes information on the main source of
referral and reports issues that have led patients/clients to
attend the service for their drug misuse problem.
- A third (31%) of individuals in 2006/07 self-referred to
services. A further 27% were referred by a general practitioner
(Table B1.6).
- Fifty-five per cent of individuals reported that drug-related
physical health issues had led them to present to a service, in
addition to their drug use. Forty-two per cent reported mental
health problems as a co-occurring health issue, and 23% reported
alcohol problems as a co-occurring health issue (Table B1.7).
Types of drugs individuals are using
The SDMD collects a range of information about the drugs that
the patients/ clients have used in the past month.
- Of those reporting illicit drug use, 68% reported using heroin
(6,756 individuals), 32% reported using cannabis (3,231
individuals), 31% reported using diazepam (3,140 individuals), 11%
reported using cocaine (1,076 individuals) and 5% reported using
crack cocaine (504 individuals) (Tables B1.8 and B1.9).
- Of the 6,756 individuals who reported heroin use, 94% (6,339
individuals) reported it as their main drug of misuse (Tables B1.8 and B1.10).
- Of those individuals who reported heroin as their main drug of
misuse, 33% reported additional illicit diazepam use, 20% reported
using cannabis, 6% reported using crack cocaine, and 5% reported
using cocaine (Table B1.12).
- Seven per cent of individuals who reported illicit drug use had
used dihydrocodeine (675 individuals) and the same proportion of
individuals reporting illicit drug use had used methadone (7%, 718
individuals) (this figure does not include those receiving a
prescription for methadone) (Tables B1.8 and B1.9).
- Reports of ecstasy use were most common amongst those aged
under 20 years old with 20% of this group (176 individuals)
reporting the use of ecstasy in 2006/07. Cannabis and solvent use
were more common in the under 15 years old age group; 81% of this
age group reported cannabis use and 14% reported solvent use.
Caution is advised in interpreting these figures because the number
of individuals in the 15 years old and under age group reported to
the database is relatively small. (Table B1.9).
Age at first use, problem recognition and seeking
help
The time lags between the age when an individual first used
an illicit drug, age at onset of problem, and age when
(professional) help was sought provide an indication of the
pathways through drug misuse.
- The majority of individuals reported to the SDMD were in their
teens when they first started using illicit drugs (including
volatile substances and over the counter medicines),in their
teens/early twenties when their drug use became a problem and in
their twenties when they sought help (Tables B1.15, B1.16 and
B1.17).
- The length of time between the first use of illicit drugs and
the onset of a problem varies from person to person. Two fifths
(42%) reported that they did not perceive their drug use to be a
problem until after five years of misuse. Fourteen per cent of
individuals perceived it as a problem after less than one year
(Table B1.18).
- The time from the onset of the problem drug use until help was
first sought also varied amongst individuals. A third (34%) of
individuals reported that they first sought help less than a year
after they perceived there to be a problem, 27% sought help after
one to two years, 14% sought help after three to four years, whilst
the remaining 25% waited five years or more before seeking help
(Table B1.20).
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 also asked
about sharing needles/syringes and sharing
spoons/water/filters/solutions. These questions provide information
about the numbers of individuals who have either used equipment
previously used by someone else or lent to someone else equipment
that they have already used.
- The highest proportions of individuals reporting injecting in
the previous month were found in the 20 to 29 years old age range;
33% of 20 to 24 year olds and 34% of 25 to 29 year olds reported
injecting in the month prior to attending a service (Table
B1.22).
- Only 14% of individuals aged under 20 years old reported
injecting in the previous month (Table B1.22).
- Almost two fifths (37%) of the individuals who had injected
reported that they were under 20 years old when they first
injected. The youngest reported age for first injecting was 12
years old, the median age was 21 years old (Table B1.23).
- Half of individuals reporting heroin use also reported that
they injected the drug (Table B1.25).
- Thirty-five per cent of individuals reporting heroin use
reported taking it through injection only. Fifteen per cent
reported administering the drug both by injection and by another
method (e.g. smoking) (Table B1.24).
Alcohol profile
Patients/clients who present at a service for drug misuse are
also asked to give details of their alcohol consumption, although
it should be noted that this section is only completed for clients
who have presented to a service for drug misuse.
- Forty-four per cent of individuals reported having consumed
alcohol in the past month (5,411 individuals) (Table B1.32).
- Approximately a quarter of individuals (27%) who provided
information on frequency of consumption reported drinking alcohol
every day, a further 26% reported drinking alcohol one to two days
a week and 14% reported drinking alcohol two to three days a month
(Table B1.32).
Background Information
The Scottish Drugs Misuse Database (SDMD) offers a profile of
drug misusers based on reports submitted on individuals who
attended a service for assessment of their drug misuse problems.
These reports are taken at the time the patient/client initially
attends a service.
Data Collection
The analysis presented in this section is based on data
collected through SMR25a returns. Annex B1.3 includes a sample copy
of the form. In April 2006 ISD introduced the SMR25a assessment
form to replace the SMR24 form which had been in use from 2001. The
revised form 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 was collected using SMR24
but also includes new information, including blood borne virus
testing information, information on dependent children and alcohol
profile. The SMR25a form is completed at the beginning of an
individual’s care episode.
There have been a number of changes which mean that data
submitted through SMR25a forms is not directly comparable with
previously published analysis of SMR24 data. Firstly, services
submit a form only for a client beginning a new episode of care,
and therefore do not submit forms for clients who have been
referred from another service. Also, General Practitioners do not
submit the new SMR25a form but continue to submit SMR24 forms.
General Practitioner data is not included in this analysis. These
changes were required in order to prepare for future data
collection developments (see Data Developments below) These
differences in data collection mean that information is presented
for the financial year 2006/07 only. These figures are not directly
comparable with information previously published from the SDMD.
Data Developments
The SMR25a form currently collects data at the beginning of an
individual’s care episode. Developments are underway to
collect further information at set points in an individuals
treatment and to collect discharge and transfer data. This will
mean that clients can be tracked across time and, if they are
transferred or receive shared care, across drug services. These
developments aim to provide a greater depth of information on
clients’ pathways through treatment.
Understanding the data
‘New’ patients/clients
The information presented relates to new patients/clients. The
statistics do not reflect the total number of drug misusers seen by
services during any period.
New patient/client
Any person who, at the time of presenting, is not currently in
contact with a service that provides specialist assessment of a
client’s drug misuse care needs. |
The database neither collects information on the non-client work
in which most specialist projects are involved nor measures the
number of contacts nor the amount of time spent with clients. The
data are usually recorded at or around the time of the initial
assessment and so no measure of outcome is included.
Misuse of alcohol may be reported to the database but it should
not be reported for clients presenting solely with an alcohol
problem.
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. The terms "individuals"
and "attendees" refer 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 sums of the NHS board and council
area data will not equal the Scotland figure. Where data are
presented at a national level individuals are counted only once in
any year. This is true for all tables except table B1.43, which
presents statistics on all valid forms received.
Within Ayrshire & Arran NHS Board some agencies continued to
collect data using the Ayrshire Common Database based on the SMR24
form after the introduction of the SMR25a form in April 2006. As a
result information is unavailable from some agencies for certain
questions that are specific to SMR25a.
Background notes on client confidentiality and small
numbers
Maintaining patient confidentiality is a fundamental principle
in ISD’s work. We take particular care when providing tabular
information which results in small numbers appearing in table
cells. We are currently reviewing our procedures with the objective
of implementing the confidentiality guidance published by the
Office of National Statistics (ONS) in October 2006. In line with
this review and to protect client confidentiality when publishing
sensitive data we have revised our protocol on the treatment of
small numbers for this year’s publication. The main points
are as follows:
a) Client confidentiality.
- Data tables are classified as sensitive either if the
information within them is in itself sensitive, eg. numbers of
heroin injectors, or of it can be combined with data from other
sensitive tables to obtain information that might be used to
disclose the identity of individuals, eg. age, sex.
- If the data are sensitive and the total number of clients
providing information is less than 40 and any individual category
has a frequency below 5 then all individual entries are replaced by
‘z’. If the total is less than 5 then the total is
replaced by ‘z’.
- If the data are not sensitive and the total number of clients
providing information is less than 40 and any individual categories
has a frequency below 5 then that entry is replaced by
‘z’. If the total is less than 5 then it is presented
but all individual entries must be less than 5 and are replaced by
‘z’s.
b) Small numbers:
- This protocol applies to all data, irrespective of
sensitivity.
- If the total number of clients is very small so that the data
within individual categories are not statistically meaningful then
individual entries are replaced by ‘†’. The
total is reported.
Supplementary information for some specific tables can be found
in Annex B1.1.
Definitions of statistical terms and tests can be found in Annex
B1.2.
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.
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