Transcript Cocaine as main drug problem

Cocaine in Scotland -
The big picture
David Liddell
Director
1.
The scale and nature
of current use.
2.
Current response.
3.
Policy and Practice issues.
The Scale of use
1. Price
2. Recreational.
3. Cocaine as main drug problem.
4. Cocaine as secondary drug to
primary problem with opiate/
benzos.
Price
Cocaine
Five years ago could cost
£100 a gram
Now as low as £35
Heroin
Currently £100-£50
Conclusion
Conclusion
Recreational use Scotland
Table C-1: Trends in use of specific drugs, 1993-2004
16-59 age range
1993
1996
2000
2003
2004
Change 19932004
Last Year
Any Drug
6.8
9.0
6.6
9.2
7.7
+0.9
Cannabis
6.1
8.2
5.5
8.0
6.3
+0.2
Amphetamines
2.2
3.1
0.5
1.4
1.0
+1.2**
Ecstasy
1.1
2.1
1.0
1.7
1.2
+0.1
Cocaine
0.4
1.0
0.7
1.4
1.5
+1.1**
Crack
-
0.2
-
0.2
0.2
+0.2**
Heroin
-
0.1
0.2
0.3
0.3
+0.3**
Source: Scottish Crime and victimisation survey
*significant at the 95 per cent confidence interval;
** significant at the 99 per cent confidence interval
Recreational Use
1. Scottish Crime and Victimisation Survey 16-59
year olds use in last year age profile:
Cocaine(overall 1.5%):
20-24 year olds 3.5%; 30-34 year olds 2.8%
Crack(overall 0,2%): 16-19 year olds (peak age) 0.9%
2.
45,000 used cocaine in last year?
3.
Under reporting in the 20-24 age range?
Recreational use
Table C-1: Trends in use of specific drugs, 1993-2004
1993
1996
2000
2003
2004
Change 19932004
Ever
Any Drug
18.5
22.5
19.2
25.3
23.7
+5.2**
Cannabis
14.5
19.0
17.4
22.8
21.9
+7.4**
Amphetamines
5.2
7.3
6.3
9.6
8.4
+3.2**
Ecstasy
2.0
4.0
3.7
6.0
5.4
+3.4**
Cocaine
1.5
2.6
2.5
4.8
4.6
+3.1**
Crack
0.4
0.7
1.0
1.2
1.2
+.8**
Heroin
0.4
0.8
1.2
0.9
1.1
+0.7**
*significant
at the 95 per cent confidence interval;
** significant at the 99 per cent confidence interval
Cocaine as main drug problem

Very limited data.

Primarily from opiate
focused/dominated
treatment and care service.

2004/5 data available
2005/6 released in December
Primary problem with Cocaine/Crack
Main illicit drug: year ending 31 March 2005
NHS board area of residence
NEW INDIVIDUAL PATIENTS/CLIENTS
Source ISD Scotland
Scotland
New
individual
patients
clients
Amphetamine
14332
270
Cocaine
Crack
Cocaine
278
(1.9%)
48
(0.3%)
(249)
(35)
Greater
Glasgow
3165
51
118
11
Lanarkshire
1589
18
45
6
Lothian
3068
62
43
12
All illicit drugs: year ending 31 March 2005
number of new individuals reporting using each drug of misuse;
Source: ISD Scotland
New
individual
patients
clients
Amphetamines
Scotland
14332
670
949
348
Argyll & Clyde
1390
58
80
30
Ayrshire &
Arran
1287
64
45
15
Grampian
3068
62
43
12
Greater
Glasgow
3165
90
381
42
Lanarkshire
1589
41
123
31
Lothian
3068
138
136
93
Cocaine
Crack
Cocaine
Secondary use of Cocaine/Crack
among opiate population
All drug use
All drug use –
primary users
Cocaine
949 (6.6%)
671 (4.7%)
Crack
348 (2.4%)
300 (2.1%)
Other data such as DORIS and new
attenders at the Glasgow Drug Crisis
Centre show much higher levels of cocaine
use 25%-30% among opiate users
Secondary
use to Alcohol
Drug related deaths 2005
Source: SDCEA
Scotland
Cocaine
Amphetamine
Number of cases(%)
where no other
substance was
implicated
Number of cases(%) where drug
was implicated
242(100.00)
242(100.0)
12(5%)
22(9.1%)
3(1.2)
5(2.1)
Current response
1.
Recreational users:
- Few services. Crew 2000.
2.
Special provision for Cocaine/Psycho stimulant
as main drug problem:
ESUS – Edinburgh, INCITE – Aberdeen,
Cocaine Anonymous
3.
Specialist drug services responding primarily
to secondary use
Some training reach so far fairly limited
4. Know the Score/website helpline
Key policy issues - Recreational users
More coherent response to recreational
users required
*CREW 2000 type services
*Better use of Helplines/websites
*Better targeting of information
campaigns
For example little information provided
on risks of Blood Borne Virus
transmission through sharing banknotes
for snorting
Conclusion
Key policy issues - Provision for problem
Psycho stimulant users
Do we need to develop existing services or create
specialist Psycho stimulant services?
The answer likely to be that we need to do both.
Existing specialist services have been slow to react to a
new population?
Workload?
Service rather than needs led?
Need specialist provision in areas where major
problems exist until mainstream provision has
adapted?
Mental Health and alcohol agencies role?
Pillar to post scenario – integrated services
Key policy issues - Response to use among existing
opiate population
Cocaine impacting on ‘stability’ of those on
substitute programmes?
E.g. increases in:benzo use?
Alcohol?
Aggression?
Mental health?
Under reporting of cocaine use to services – why?
Training for frontline staff
Conclusion
Need to retain a perspective: cocaine
problems small compared to opiates
But need to proactively respond in order
that problems do not escalate
Improved response to the three groups;
recreational; primary problem users and
opiate users using cocaine
Conclusion
Recreational use
More Crew 2000 type provision
Cocaine as main drug problem
Changes to existing services and retain
and develop specialist provision
Cocaine use among opiate population
Improve service responses, more user
led focus
Conclusion
Resourcing
Need some specific resources devoted to
the problems of cocaine
£66.5 million for direct responses to
drugs per year(including £34 million for
drug treatment and care)
2% of treatment monies would be
£680,000
Currently spending - £300,000 for 2
services