cocaine in scotland - the big picture david liddell director

Cocaine in Scotland -Cocaine in Scotland -

The big pictureThe big picture

David Liddell David Liddell DirectorDirector

1.1. The scale and nature The scale and nature of current use.of current use.

2.2. Current response.Current response.

3.3. Policy and Practice issues.Policy and Practice issues.

The Scale of useThe Scale of use

1.1. PricePrice

2.2. Recreational.Recreational.

3.3. Cocaine as main drug problem.Cocaine as main drug problem.

4.4. Cocaine as secondary drug to Cocaine as secondary drug to

primary problem with opiate/ primary problem with opiate/

benzos.benzos.

PricePrice

CocaineCocaine

Five years ago could cost Five years ago could cost

£100 a gram£100 a gram

Now as low as £35Now as low as £35

HeroinHeroin

Currently £100-£50Currently £100-£50

ConclusionConclusion

Cocaine facts and figures (continued)

• Highest levels of recent use among young adults are in Spain + the UK (over 4%, similar to US)

• Around 10% of requests for treatment for drug problems in the EU are linked to cocaine use

• ‘Determining role’ in around 10% of drug deaths; but deaths by cocaine use alone are rare

• New concern: links to cardiovascular problems

• Crack cocaine limited to a few big cities (NL, UK)

• Around 9 million Europeans have tried cocaine in their lifetime (3% of all adults)

• Between 3 and 3.5 million are likely to have tried the drug in the last year (1% of all adults)

• Around 1.5 million are classified as current users (last month) (0.5% of all adults)

• Between 1% and 11.6% of young adults have tried cocaine. Use mainly among young, urban males

Cocaine facts and figures

19931993 19961996 20002000 20032003 20042004 Change 1993-Change 1993-20042004

Last YearLast YearAny DrugAny Drug 6.86.8 9.09.0 6.66.6 9.29.2 7.77.7 +0.9+0.9

CannabisCannabis 6.16.1 8.28.2 5.55.5 8.08.0 6.36.3 +0.2+0.2

AmphetaminesAmphetamines 2.22.2 3.13.1 0.50.5 1.41.4 1.01.0 +1.2**+1.2**

EcstasyEcstasy 1.11.1 2.12.1 1.01.0 1.71.7 1.21.2 +0.1+0.1

CocaineCocaine 0.40.4 1.01.0 0.70.7 1.41.4 1.51.5 +1.1**+1.1**

CrackCrack -- 0.20.2 -- 0.20.2 0.20.2 +0.2**+0.2**

Heroin Heroin -- 0.10.1 0.20.2 0.30.3 0.30.3 +0.3**+0.3**

Recreational use ScotlandTable C-1: Trends in use of specific drugs,

1993-200416-59 age range

Source: Scottish Crime and victimisation survey*significant at the 95 per cent confidence interval; ** significant at the 99 per cent confidence interval

Recreational UseRecreational Use

1.1. Scottish Crime and Victimisation Survey 16-59 Scottish Crime and Victimisation Survey 16-59

year olds use in last year age profile:year olds use in last year age profile:

Cocaine(overall 1.5%): Cocaine(overall 1.5%):

20-24 year olds 3.5%; 30-34 year olds 2.8%20-24 year olds 3.5%; 30-34 year olds 2.8%

Crack(overall 0,2%): 16-19 year olds (peak age) 0.9%Crack(overall 0,2%): 16-19 year olds (peak age) 0.9%

2.2. 45,000 used cocaine in last year? 45,000 used cocaine in last year?

3.3. Under reporting in the 20-24 age range?Under reporting in the 20-24 age range?

Recreational useTable C-1: Trends in use of specific drugs, 1993-2004

*significant at the 95 per cent confidence interval; ** significant at the 99 per cent confidence interval

19931993 19961996 20002000 20032003 20042004 Change 1993-Change 1993-20042004

EverEverAny DrugAny Drug 18.518.5 22.522.5 19.219.2 25.325.3 23.723.7 +5.2**+5.2**

CannabisCannabis 14.514.5 19.019.0 17.417.4 22.822.8 21.921.9 +7.4**+7.4**

AmphetaminesAmphetamines 5.25.2 7.37.3 6.36.3 9.69.6 8.48.4 +3.2**+3.2**

EcstasyEcstasy 2.02.0 4.04.0 3.73.7 6.06.0 5.45.4 +3.4**+3.4**

CocaineCocaine 1.51.5 2.62.6 2.52.5 4.84.8 4.64.6 +3.1**+3.1**

CrackCrack 0.40.4 0.70.7 1.01.0 1.21.2 1.21.2 +.8**+.8**

Heroin Heroin 0.40.4 0.80.8 1.21.2 0.90.9 1.11.1 +0.7**+0.7**

Cocaine as main drug problemCocaine as main drug problem

Very limited data.Very limited data.

Primarily from opiate Primarily from opiate

focused/dominated treatment focused/dominated treatment

and care service.and care service.

2004/5 data available 2005/6 2004/5 data available 2005/6

released in Decemberreleased in December

Primary problem with Cocaine/CrackMain illicit drug: year ending 31 March 2005

NHS board area of residenceNEW INDIVIDUAL PATIENTS/CLIENTS

Source ISD Scotland

NewNewindividuindividu

alalpatientspatientsclientsclients

AmphetaminAmphetaminee

CocaineCocaine CrackCrack

CocaineCocaine

ScotlandScotland 1433214332 270270 278278

(1.9%)(1.9%)(249)(249)

4848

(0.3%)(0.3%)(35)(35)

Greater Greater GlasgowGlasgow 31653165 5151 118118 1111

LanarkshirLanarkshiree

15891589 1818 4545 66

LothianLothian 30683068 6262 4343 1212

All illicit drugs: year ending 31 March 2005number of new individuals reporting using each drug of misuse;

Source: ISD Scotland

NewNewindividuaindividua

llpatientspatientsclientsclients

AmphetamineAmphetaminess

CocaineCocaine CrackCrack

CocaineCocaine ScotlandScotland 1433214332 670670 949949 348348

Argyll & Argyll & ClydeClyde

13901390 5858 8080 3030

Ayrshire & Ayrshire & ArranArran

12871287 6464 4545 1515

GrampianGrampian 30683068 6262 4343 1212

Greater Greater GlasgowGlasgow

31653165 9090 381381 4242

LanarkshireLanarkshire 15891589 4141 123123 3131

LothianLothian 30683068 138138 136136 9393

Secondary use of Cocaine/Crack Secondary use of Cocaine/Crack among opiate populationamong opiate population

All drug useAll drug use All drug use – All drug use – primary usersprimary users

CocaineCocaine 949 (6.6%)949 (6.6%) 671 (4.7%)671 (4.7%)

CrackCrack 348 (2.4%)348 (2.4%) 300 (2.1%)300 (2.1%)

Other data such as DORIS and new attenders at Other data such as DORIS and new attenders at

the Glasgow Drug Crisis Centre show much the Glasgow Drug Crisis Centre show much

higher levels of cocaine use 25%-30% among higher levels of cocaine use 25%-30% among

opiate usersopiate users

Secondary use to Alcohol Secondary use to Alcohol

Drug related deaths 2005

Source: SDCEA

Number of cases(%) Number of cases(%) where no other where no other substance was substance was

implicatedimplicated

Number of cases(%) where Number of cases(%) where drug was implicated drug was implicated

ScotlandScotland 242(100.00)242(100.00) 242(100.0)242(100.0)

CocaineCocaine 12(5%)12(5%) 22(9.1%)22(9.1%)

AmphetamineAmphetamine 3(1.2)3(1.2) 5(2.1)5(2.1)

Current responseCurrent response

1. Recreational users:1. Recreational users:

- Few services. Crew 2000.- Few services. Crew 2000.

2. Special provision for Cocaine/Psycho stimulant2. Special provision for Cocaine/Psycho stimulant as main drug problem:as main drug problem:

ESUS – Edinburgh, INCITE – Aberdeen, Cocaine ESUS – Edinburgh, INCITE – Aberdeen, Cocaine AnonymousAnonymous

3. Specialist drug services responding primarily 3. Specialist drug services responding primarily to secondary useto secondary use

Some training reach so far fairly limitedSome training reach so far fairly limited

4.4. Know the Score/website helplineKnow the Score/website helpline

Key policy issues - Recreational usersKey policy issues - Recreational users

More coherent response to recreational More coherent response to recreational users required users required

** CREW 2000 type servicesCREW 2000 type services

** Better use of Helplines/websites Better use of Helplines/websites

** Better targeting of information Better targeting of information campaignscampaigns

For example little information provided on For example little information provided on risks of Blood Borne Virus transmission risks of Blood Borne Virus transmission through sharing banknotes for snortingthrough sharing banknotes for snorting

Key policy issues - Provision for problem Key policy issues - Provision for problem Psycho stimulant usersPsycho stimulant users

Do we need to develop existing services or create specialist Do we need to develop existing services or create specialist Psycho stimulant services?Psycho stimulant services?

The answer likely to be that we need to do both.The answer likely to be that we need to do both.

Existing specialist services have been slow to react to a new Existing specialist services have been slow to react to a new population?population?

Workload?Workload?Service rather than needs led?Service rather than needs led?

Need specialist provision in areas where major problems Need specialist provision in areas where major problems exist until mainstream provision has adapted?exist until mainstream provision has adapted?

Mental Health and alcohol agencies role?Mental Health and alcohol agencies role?

Pillar to post scenario – integrated servicesPillar to post scenario – integrated services

Key policy issues - Response to use among existing Key policy issues - Response to use among existing opiate populationopiate population

Cocaine impacting on ‘stability’ of those on Cocaine impacting on ‘stability’ of those on substitute programmes?substitute programmes?E.g. increases in:-E.g. increases in:-

benzo use?benzo use?Alcohol?Alcohol?Aggression?Aggression?Mental health?Mental health?

Under reporting of cocaine use to services – why?Under reporting of cocaine use to services – why?

Training for frontline staffTraining for frontline staff


Need to retain a perspective: cocaine Need to retain a perspective: cocaine problems small compared to opiatesproblems small compared to opiates

But need to proactively respond in order But need to proactively respond in order that problems do not escalatethat problems do not escalate

Improved response to the three groups; Improved response to the three groups; recreational; primary problem users and recreational; primary problem users and opiate users using cocaineopiate users using cocaine


Recreational useRecreational useMore Crew 2000 type provisionMore Crew 2000 type provision

Cocaine as main drug problemCocaine as main drug problemChanges to existing services and retain and Changes to existing services and retain and develop specialist provisiondevelop specialist provision

Cocaine use among opiate populationCocaine use among opiate populationImprove service responses, more user led Improve service responses, more user led focusfocus


ResourcingResourcing

Need some specific resources devoted to the Need some specific resources devoted to the problems of cocaineproblems of cocaine

£66.5 million for direct responses to drugs per £66.5 million for direct responses to drugs per year(including £34 million for drug treatment year(including £34 million for drug treatment and care)and care)

2% of treatment monies would be £680,0002% of treatment monies would be £680,000

Currently spending - £300,000 for 2 services Currently spending - £300,000 for 2 services

cocaine in scotland - the big picture david liddell director

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