United Kingdom (England, Wales, Scotland, and Northern Ireland)

"The UK 2017 Drug Strategy addresses illicit drug problems with two overarching aims: to reduce illicit and other harmful drug use and to increase the rates of people recovering from dependency. These aims are supported by four key themes: (i) reducing demand; (ii) restricting supply; (iii) building recovery; and (iv) global action. Within the strategy, policies concerning health, education, housing and social care apply to England, those concerning policing and the criminal justice system cover both England and Wales, while the tasks of the Department for Work and Pensions relate to England, Scotland and Wales. A number of powers are devolved to Northern Ireland, Scotland and Wales, and each of these countries has its own strategy and action plans. Both the current Welsh strategy, Working Together to Reduce Harm: The Substance Misuse Strategy for Wales 2008-18, and Scotland’s strategy, The Road to Recovery: A New Approach to Tackling Scotland’s Drug Problem, were adopted in 2008. In 2018, Scotland launched a new drug and alcohol strategy. Northern Ireland’s policy, New Strategic Direction for Alcohol and Drugs Phase 2: 2011-16, was launched in 2011, and had a final review in 2018. The strategies in Scotland, Northern Ireland and Wales address both illicit drugs and alcohol.

"All European countries evaluate their drug policies and strategies through ongoing indicator monitoring and specific research projects. In 2017, the Home Office published an evaluation of the actions in the Drug Strategy 2010, a multi-criterion assessment looking at the effectiveness of the responses, their costs and value for money; the evaluation focused on England. In 2018, the Welsh Assembly published an evaluation of the Substance Misuse Strategy for Wales 2008-18 as part of the process of developing a new strategy."

"This study provides evidence of a rapidly evolving and active online marketplace from which SCRA vaping products seem to be easily obtainable, but also difficult to identify as controlled substances. Using simple search terms on a widely used search engine, we identified 62 websites selling SCRA vaping products, with 1225 individual listings and 128 unique brands. Although not a direct comparison, a survey of SCRA availability on the “dark web” in 2016 and 2017 which used different methodology to this study [15] found 32 individual SCRA branded vape products, which may suggest that this market has grown in the interim and/or that suppliers are increasingly marketing these on the surface web rather than the dark web.

"There was evidence of both UK-based and international production and trade of these products. There was also evidence of companies competing for custom by offering incentives and discounts, including a wide variety of payment methods, measures to evade detection by law enforcement, and methods of ensuring anonymity in both payment and delivery.

"As found in previous SCRA studies [31], products were heavily marketised, with colourful branding and abstract names that gave little or no hint of the contents of the product. Several SCRA vaping product brand names found in this survey have been listed in a previous survey of SCRA vaping products, such as “Bizarro”, “Diablo” and “Green Giant” [15], and in a survey of non-vape SCRA products, such as “K2” and “Mr Nice Guy” [31]. However, many previously common SCRA brand names were not found and many new brand names had appeared. This suggests a rapidly changing marketplace with ongoing product development and marketing."

"The Misuse of Drugs Act 1971, with amendments, is the main law regulating drug control in the United Kingdom. It divides controlled substances into three classes (A, B and C), which provide a basis for attributing penalties for offences. Maximum penalties vary according to whether the conviction is made at a magistrates’ court for a summary offence or made on indictment following a trial at a Crown Court, with mitigating and aggravating factors determining which type of court is the most appropriate for a given case. Detailed guidance for sentencing in each case is published by the Sentencing Council. A distinction is made between possession of controlled drugs and possession with intent to supply; the latter effectively refers to drug trafficking offences.

"Drug use per se is not an offence under the Misuse of Drugs Act 1971; it is the possession of the drug that constitutes an offence. Summary convictions for the unlawful possession of Class A drugs, such as heroin or cocaine, involve penalties of up to 6 months’ imprisonment and/or a fine; on indictment, penalties may reach 7 years’ imprisonment. Possession of Class B drugs, such as cannabis and amphetamines, incurs a penalty of up to 3 months’ imprisonment and/or a fine at a magistrates’ court; on indictment, the penalty is up to 5 years’ imprisonment and/or an unlimited fine. Possession of most Class C drugs, such as benzodiazepines, attracts a penalty of up to 3 months’ imprisonment and/or a fine by a magistrate, or up to 2 years’ imprisonment and/or an unlimited fine on indictment. There are also a number of alternative responses, such as cannabis warnings and cautions from the police, who have some powers of discretion.

"The Drug Trafficking Act 1994 defines drug trafficking as transporting or storing, importing or exporting, manufacturing or supplying drugs covered by the Misuse of Drugs Act 1971. For trafficking in Class A drugs, the maximum penalty on indictment is ‘life’ imprisonment (which is 25 years in the United Kingdom), while trafficking in Class B or Class C drugs can incur a penalty of up to 14 years in prison. Under Section 110 of the Powers of Criminal Courts (Sentencing) Act 2000, a minimum sentence of 7 years was introduced for a third conviction for trafficking in Class A drugs.

"Temporary class drug orders were introduced through the Police Reform and Social Responsibility Act 2011 to allow a faster legislative response to new psychoactive substances (NPS) supply offences. In 2016, the Psychoactive Substances Act criminalised the production, supply or possession with intent to supply of any psychoactive substance (with some exemptions) if it is known that it is to be used for its psychoactive effects. Supply offences are aggravated by proximity to a school, using a minor as a courier or being carried out in a custodial institution. Simple possession of NPS does not constitute an offence unless it takes place within a custodial institution. Maximum penalties are 7 years’ imprisonment on indictment or 1 year’s imprisonment on summary conviction."

"SCRA vaping products were almost exclusively on sale as liquid formulations for refilling EVDs. It therefore does not appear that the rise in popularity of disposable nicotine e-cigarettes [17] has so far impacted on the online SCRA vaping product market. The most common bottle size on sale was 5mL. Given the lack of data on the concentration of SCRA in these liquids, it is difficult to quantify how many SCRA doses this may constitute. However, this volume of liquid is likely to provide at least several hundred puffs and, given the potency of known SCRAs, this is likely to represent several hundred psychoactive “doses”. For reference, since 2020 UK e-cigarette tanks are limited to a maximum volume of 2mL.

"SCRA vaping products were offered both in small volumes consistent with supply for personal use, and large volumes suggestive of supply for further distribution. Prices varied significantly by brand, website and by the size of the purchase, however average prices by volume were similar to those found in a previous survey [15].

"Of the minority (4.5%) of SCRA vaping products in which an active compound was listed, the most common was 5 F-AKB48. This fourth generation SCRA [32] was also a common compound found in a previous Europe-wide SCRA snapshot survey performed in 2017 [16] and in serum analyses of patients presenting with drug toxicity to an emergency department in London in 2015 [33]. Of the other SCRA compounds listed in this study, they were a combination of first generation (e.g. JWH-018) and later generation SCRA compounds. It is likely that 5 F-MDMB-PINACA and 5 F-ADB refer to the same compound as each other, as do 5 F-CUMYL-PINACA and SGT-25 [34]. Interestingly, there was no advertising of AB-CHMINACA or MDMB-CHMICA, two SCRA compounds which have become relatively well-known for being associated with significant toxicity [35–37].

"Several factors raise concerns that SCRA vaping products could be purchased and consumed by undiscerning customers, or misused even by experienced consumers. Websites were easily accessed and products were available at a range of prices. Products were generally sold with minimal or no explanation of their contents or how to use them. Where descriptions of ingredients or psychoactive effects were provided, they tended to be abstract, vague or incorrect. There was generally no information on the chemical make-up of active ingredients or solvents, conditions of preservation, expiry date or EVD settings necessary for use. SCRA vaping products were often sold alongside legal products such as nicotine-containing EVDs or CBD products and, concerningly, many websites stated their products were legal."

"The 2018/19 CSEW shows that around 1 in 11 (9.4%) adults aged 16 to 59 had taken a drug in the last year, which equates to around 3.2 million people. The trend in the proportion of 16 to 59 year olds taking a drug in the last year was relatively flat between 1996 and 2003/04, followed by small year-onyear decreases until 2007/08. Since the 2009/10 survey, the proportion taking a drug in the last year has remained relatively flat, with the prevalence estimate remaining between 8.2 and 9.4 per cent. The 2018/19 estimate is similar to a decade ago in the 2008/09 CSEW (9.9%) and the 2007/08 CSEW (9.4%), but it is lower than all survey years before 2007/08. For further details see Appendix Tables 1.02 and 1.04.

"Figure 1.2 below shows the trend in Class A drug use in the last year among 16 to 59 year olds. According to the 2018/19 CSEW, 3.7 per cent of adults aged 16 to 59 had taken a Class A drug in the last year, equating to around 1.3 million people. There was a general upward trend in Class A drug use from 1996 (when the series began) until the 2008/09 survey which was then followed by a general downward trend until the 2011/12 survey (2.9%). Since 2011/12, the trend has reversed and has generally been upward, although the 2018/19 estimate was at a similar level to 2017/18 (3.5%). The increase in Class A drug use has been primarily driven by increases in powder cocaine and ecstasy use among 16 to 24 year olds. Trends in this broader age group tend to be driven by the 16 to 24 year old population where levels of drug use were substantially higher than among older adults (see Chapter 3)."

"Overall prevalence of drug use reported in general population surveys in England and Wales is similar to a decade ago, with almost 1 out of 10 adults aged 16-59 years reporting illicit drug use in the last year. In Scotland, there was a decline in last year illicit drug use between 2008/09 and 2014/15.

"In the early 2000s, prevalence of last year cannabis use reported by the Crime Survey for England and Wales was among the highest reported by European countries; however, this is now at a level that is fairly typical to that seen elsewhere in Europe. Following a decrease in prevalence between 2003/04 and 2009/10, the trend in cannabis use in the general population has since been relatively stable. The prevalence rate in 2017/18 was the highest reported since 2008/09; however, the increase from 2016/17 was not statistically significant.

"Prevalence of new psychoactive substances (NPS) use in general population surveys is generally low in comparison with the main traditional drugs. Mephedrone was the only stimulant NPS to show signs of becoming established alongside traditional substances among recreational drug users in these surveys. However, prevalence of use of this drug has fallen since the 2010/11 Crime Survey for England and Wales, when questions were first asked about its use.

"There was a steady decline in lifetime prevalence of drug use among school children (11- to 15-year-olds) in England between 2004 and 2014; however, an increase was reported in 2016. Drug use prevalence among young people in Scotland has declined since 2004 but remained stable between 2013 and 2015. Cannabis is the most commonly used drug among school children, and there has been a long-term downward trend in reported use with a more recent levelling off that is similar to the trend for the general population. A similar trend is also seen for other illicit drug use, as well as for alcohol and tobacco use.

"London and Bristol participate in the Europe-wide annual wastewater campaigns undertaken by the Sewage Analysis Core Group Europe (SCORE). This study provides data on drug use at a municipal level, based on the levels of illicit drugs and their metabolites found in sources of wastewater. For 2018, only data for Bristol were available. The results pointed to a possible increase in cocaine use in Bristol since the initiation of the study (2014). Furthermore, higher levels of cocaine metabolites were detected at the weekends."

"Similarly to previous surveys, cannabis was the most commonly used drug by respondents in the 2018/19 CSEW, with 7.6 per cent of adults aged 16 to 59 having used it in the last year, equating to around 2.6 million people. As shown in Figure 1.4 below, there was a long-term decline in the proportion of adults who used cannabis in the last year, decreasing from a high of 10.7 per cent in 2002/03 to 6.5 per cent in 2009/10. The trend was then relatively flat until 2016/17 but has since shown a one percentage point increase in last year use of cannabis, to 7.6 per cent in 2018/19.

"Cannabis was also the most commonly used drug by young adults aged 16 to 24, with 17.3 per cent having used it in the last year according to the 2018/19 CSEW (around 1.1 million young adults). The long-term decline in prevalence of cannabis use in the last year was more apparent in this age group, falling from 28.2 per cent in 1998 down to 15.1 per cent in the 2013/14 survey. Since then there has been a general upward trend although the latest estimate is similar to the previous year (2017/18 CSEW, 16.7%)."

"As in recent years, the second most commonly used drug in the last year among adults aged 16 to 59 was powder cocaine (2.9% in the 2018/19 survey, equating to around 976,000 people). Among young adults aged 16 to 24 it was the third most commonly used drug (6.2%, around 395,000 young adults), behind cannabis (17.3%) and nitrous oxide (8.7%). Trends in last year cocaine use are prone to fluctuation from year to year, as can be seen in Figure 1.5, making it difficult to interpret short-term trends in cocaine use.

"Powder cocaine use among 16 to 59 year olds increased between the 1996 and 2000 survey years (0.6% to 2.0%), driven by a sharp increase among the 16 to 24 age group (1.4% to 5.2%). These increases were followed by slower rises to reach a peak in the 2008/09 survey for both 16 to 59 and 16 to 24 year olds (3.0% and 6.5% respectively).

"From 2008/09, last year use of powder cocaine fell before starting to rise again in 2011/12 for both age groups (see Figure 1.5 below) and there has been a general upward trend since. Although there were no statistically significant changes between the 2017/18 and 2018/19 surveys, there has been a statistically significant increase in powder cocaine use for both age groups compared with the 2011/12 CSEW. Last year use of cocaine increased among adults aged 16 to 59 from 2.1 per cent in the 2011/12 CSEW to 2.9 per cent in 2018/19. The comparable figures for those aged 16 to 24 were 4.1 per cent and 6.2 per cent."

"Ecstasy

"The trend in the proportion of 16 to 59 year olds using ecstasy in the last year has been relatively flat throughout the lifetime of the survey, fluctuating between one and two per cent (Figure 1.6). The proportion of last year ecstasy users aged 16 to 59 in the 2018/19 survey (1.6%) was similar to the 2017/18 CSEW (1.7%).

"Among 16 to 24 year olds, the trend shows greater fluctuation between years. Following a generally downward trend from the start of the times series, there was an increase in last year use among this age group between the 2011/12 (3.3%) and 2018/19 (4.7%) surveys. Whilst estimated levels of use have fluctuated between 4.3 and 5.4 per cent in recent years, prevalence of ecstasy use among 16-24 year olds remain below its peak of 6.8 per cent estimated from the 2001/02 survey.

"Other drugs

"The information below presents findings on some of the less commonly used drugs. These can be found in Appendix Table 1.02. Due to the lower number of people using these drugs, even small changes in prevalence can be statistically significant. Changes from one year to the next should be interpreted with caution and greater attention paid to the medium and longer-term trends in these drugs.

"• Use of amphetamines decreased among both 16 to 59 and 16 to 24 year olds. For those aged 16 to 59, prevalence of amphetamine use has followed a general downward trend since a high of 3.3 per cent in 1996 to 0.6 per cent in 2018/19. Use of amphetamines followed a similar trend for those aged 16 to 24, falling from a high of 11.7 per cent in 1996 to 1.0 per cent in 2018/19.

"• Ketamine use has increased from a decade ago across both age groups. For adults aged 16 to 59, use of ketamine has fluctuated in the last decade, with the latest estimate at 0.8 per cent, an increase compared with 2008/09 (0.5%). Use among adults aged 16 to 24 also showed a lot of variation in the last decade, although there was a general increase from 1.9 per cent in 2008/09 to 2.9 per cent in 2018/19, with a particularly large rise between 2016/17 and 2017/18 (1.3% to 3.1% respectively).

"• Nitrous oxide continued to be the second most used drug among 16 to 24 year olds, with 8.7% having used it, a similar proportion (8.8%) to last year’s survey. This equates to around 552,000 young adults who used nitrous oxide in the last year. Use of new psychoactive substances among 16 to 24 year olds in the 2018/19 survey was also at a similar proportion to last year’s survey (1.4% and 1.2% respectively)."

"Studies reporting estimates of high-risk drug use can help to identify the extent of the more entrenched drug use problems, while data on first-time entrants to specialised drug treatment centres, when considered alongside other indicators, can inform an understanding of the nature of and trends in high-risk drug use.

"Opioids, particularly heroin, remain associated with the greatest health and social harms caused by illicit drugs in the United Kingdom. While there has been a decline in the prevalence of injecting among opioid users, around one third of people who seek treatment for heroin use in England report use by injection. There are concerns about changes in the patterns of drug injection in the United Kingdom, in particular the increased injection of crack cocaine and amphetamine-type stimulants, and the emergence in recent years of the injection of NPS. Data from the 2017 Unlinked Anonymous Monitoring survey of people who inject drugs indicate that the injection of crack has increased in recent years in England and Wales, with 51 % of those who had injected during the preceding 4 weeks reporting the injection of crack cocaine.

"Data on the characteristics of those entering treatment in the United Kingdom indicate that heroin is the most commonly reported primary substance among those seeking treatment for drug use problems; however, there has been a long-term reduction in first-time clients seeking treatment for heroin use. Among first-time treatment clients, cannabis is the most commonly reported substance, followed by cocaine. An increase in the number and proportion of first-time treatment entrants for cocaine (both powder and crack) has been reported since 2014. Presentations to community treatment services for primary use of NPS have decreased markedly in England, and problematic NPS use is now found primarily among the adult prison population and street homeless people. Studies among vulnerable populations, such as homeless people, suggest that the use of synthetic cannabinoid receptor agonists is high among this group."

Table: Estimated Prevalence of Last-Year Drug Use Among Young Adults in England and Wales

"Ever used drugs (includes used drugs more than a year ago, in the last year and in the last month).
"Around one in five 15 year olds and a minority of 13 year olds reported ever having used drugs, with boys more likely than girls to have ever used drugs.
"• Eighteen per cent of 15 year olds and 4% of 13 year olds reported ever taking drugs.
"• Boys were more likely than girls to have ever used drugs (5% compared with 3% among 13 year olds and 19% compared with 16% for 15 year olds).

"Used drugs in the last year (includes used drugs in the last month).
"Less than one in five 15 year olds and a minority of 13 year olds reported using drugs in the last year, with boys more likely than girls to have used drugs in the last year.
"• Sixteen per cent of 15 year olds and 3% of 13 year olds said they had used drugs in the last year.
"• Boys were more likely than girls to report drug use in the last year (4% compared with 3% among 13 year olds and 17% compared with 14% among 15 year olds).

"Used drugs in the last month.
"Less than one in ten 15 year olds and a minority of 13 year olds had used drugs in the month prior to the survey, with 15 year old boys more likely than 15 year old girls to have used drugs in the last month.
"• Nine per cent of 15 year olds and 2% of 13 year olds reported taking drugs in the last month.
"• Among 15 year olds, boys were more likely than girls to have used drugs in the last month (11% compared with 8%).

"Never used drugs.
"The majority of pupils reported that they have never taken drugs, with the proportion who had never taken drugs decreasing with age.
"• Eighty-two per cent of 15 year olds and 96% of 13 year olds had never used drugs."

"• Around one in 25 adults (4.0%) aged 16 to 59 said they had taken a drug in the last month. This equates to around 1.3 million people. The proportion is similar to the previous year (4.3% in the 2015/16 CSEW) and is statistically significantly lower than those observed a decade ago in the 2006/07 survey (6.0%) and when CSEW measurements began in 1996 (6.7%) (Appendix Tables 1.03 and 1.04; Figure 1.5).

"• The proportion among young adults aged 16 to 24 followed a similar trend, although the proportion was nine per cent, more than double that of the wider age group. This equates to around 550,000 young people aged 16 to 24 having taken a drug in the month prior to interview. This represents statistically significant falls compared with 14.3 per cent in the 2006/07 survey and 19.2 per cent in the 1996 survey (Appendix Tables 1.07 and 1.08; Figure 1.5).

"• Last month use of Class A drugs was reported by 1.0 per cent of adults aged 16 to 59 and 2.3 per cent of young adults aged 16 to 24. Similarly to any drug use in the last month, these proportions have not changed statistically significantly compared with the previous survey year, but are statistically significantly down compared with a decade ago (Appendix Tables 1.03 and 1.07; Figure 1.5).

"• Among adults aged 16 to 59, the drugs most commonly taken in the last month were cannabis (3.2%, similar to the 2015/16 survey), powder cocaine (0.8%, similar to the 2015/16 survey) and ecstasy (0.3%, similar to the 2015/16 survey).

"• Among adults aged 16 to 24, the drugs most commonly taken in the last month were cannabis (7.6%), powder cocaine (1.6%) and ecstasy (1.1%). The use of these three drugs in the last month by 16 to 24 year olds has not changed statistically significantly compared with the previous survey year.

"• Mephedrone use in the last month was statistically significantly lower in the 2016/17 survey than in the 2015/16 survey among both 16 to 24 year olds and 16 to 59 year olds. For young adults it reduced from 0.4 per cent to zero respondents, and for 16 to 59 year olds it reduced to less than 0.1 per cent of respondents."

"There has been a decline in drug use by 11 to 15 year old pupils since 2001. In 2011, 17% of pupils had ever taken drugs, compared with 29% in 2001. There were similar falls in the proportions of pupils who reported taking drugs in the last year and the last month. The decline in the prevalence of drug use parallels the fall in the proportions of pupils who have ever been offered drugs, from 42% in 2001 to 29% in 2011.
"In 2011, 12% of pupils reported taking drugs in the last year; 6% said they had taken drugs in the last month. The prevalence of drug use increases with age; in 2011, the proportions of pupils who had taken drugs in the last year increased from 3% of 11 year olds to 23% of 15 year olds. There was little difference between the proportions of boys and girls who had taken drugs in the last year. Pupils of Black ethnicity were more likely to have taken drugs than White pupils.
"As in previous years, pupils were most likely to have taken cannabis (7.6% in the last year, down from 13.4% in 2001) or to have sniffed glue, gas or other volatile substances (3.5% in 2011). Other drugs asked about had been taken in the last year by 1% of pupils or less.
"A minority of pupils who take drugs did so frequently. Just over a third (35%) of those who took drugs in the last year said that they usually took them once a month or more (equivalent to 3% of all 11 to 15 year olds). 29% of those who took drugs in the last year had only ever taken drugs once."

"The survey sample represents an estimated population of around 3.0 million young people aged between 11 and 15 in England. Findings from this survey indicate that in England in 2011 around 140,000 young people aged between 11 and 15 were regular smokers, around 360,000 drank alcohol in the last week, and around 180,000 had taken drugs (including glue, gas and other volatile substances) in the last month.
"Pupils aged 11 to 15 were more likely to have drunk alcohol at least once (45%) than to have tried smoking (25%) or taking drugs (17%). The proportion of pupils who had done at least one of these increased with age from 20% of 11 year olds to 80% of 15 year olds.
"Less than half of pupils who had tried smoking, drinking or drug use had done so recently. 12% of 11 to 15 year olds had drunk alcohol in the last week, 8% had smoked in the last week and 6% had taken drugs in the last month.
"Several factors were strongly associated with smoking, drinking and drug use. If a pupil had done one of these, he or she had an increased likelihood of having done one or both of the others. All three became increasingly prevalent with age. Other characteristics, such as sex and ethnicity, were not consistent predictors of whether pupils were more likely to smoke, drink or take drugs."

"As in previous years, the proportion of young adults aged 16 to 24 taking any drug in the last year was more than double the proportion in the 16 to 59 age group, at 19.2 per cent. This proportion equates to 1.2 million young people. It is this younger age group that largely drives the trend seen in the wider group of adults aged 16 to 59.

"Over the last five years there has been some fluctuation in this series. However, the long-term trend is downward; the 2016/17 estimate of 19.2 per cent is statistically significantly lower compared with 10 years ago (24.2% in 2006/07) and with the start of the time series in 1996 (29.7%). The reduction compared with the 2006/07 survey year is accounted for by statistically significant falls in half of drug types.

"The 2016/17 CSEW found that seven per cent of young adults aged 16 to 24 had taken a Class A drug in the last year, equating to around 429,000 young people. The change compared with the 2015/16 CSEW (6.6%) and the 2006/07 CSEW (8.1%) was not statistically significant, but this trend has fallen statistically significantly compared with 1996 (9.2%). As with the trend in any drug use, the trend in Class A drug use has been relatively stable since the 2009/10 survey year, with the exception of the 2012/13 estimate, which looks to be out of line with recent results.

"Each year, OMACs [One-Month Alcohol Abstinence Campaigns] attract an increasing number of participants. For example, even if it still represents less than one percent of the Australian adult population in 2019, 44,000 people officially registered for Dry July [28], while they were 16,787 in 2016 and 9,532 in 2010 [34]. Regarding Dry January, 4,000 people participated in the 2014 campaign while they were 3.9 millions in 2020, that is, approximately 7.5% of the UK adult population [35, 36]. However, for ensuring the continued success of such campaigns, it is important to inform participants whether these programs meet harm reduction objectives. This review thus aimed to determine the profile of participants in the different national one-month abstinence campaigns, to estimate the rates and factors of success, and to explore the associated subjective benefits in participating in or completing the challenge.

"Based on the studies pertaining to Dry January, it seems that those taking part in the challenge were more likely to be heavier drinkers, more concerned about their health, and had higher levels of incomes and education. The latter aspects are consistent with those reported elsewhere: the concern for healthy behaviors is more developed among individuals with higher education and incomes [37, 38]. However, this relationship is probably mediated, at least partially, by the overall level of education received, including during school years, suggesting that sustained and universal health education programs could help to bridge this gap [39]. The finding that females were more attracted in participating in abstinence campaigns is possibly in line with the fact that females are in general more concerned about health-related behaviors [40]. However, being a male led to better chance of successfully complete the abstinence campaign, specifically for campaigns promoting restriction of alcohol use. These results may reflect cultural differences across gender, with respect to alcohol use and alcohol-related representations [41].

"Completing the one-month abstinence challenge was found to be associated with lower drinking patterns and better psychosocial functioning at baseline. Thus, it is interesting to note that those participating in the abstinence campaigns had more elevated drinking patterns compared to the non-participating alcohol users, whereas those achieving the challenge had lower drinking patterns compared to those who did not. Another important factor of success was the registration and active participation in social media communities. This is in line with the overall finding that interactive social media on the Internet can be a very effective tool to change health behaviors in the general population [42]. There may be some biases in this finding as participants who registered on social communities might be the most motivated ones, which could explain a better success in achieving the challenge. However, sharing the experience and the difficulties encountered during of a long time period of alcohol abstinence on a virtual community was designated as the most efficient strategy to successfully reach the abstinence goal during the online HSM program [7]. In this program, other strategies which were reported to be efficient to abstain from alcohol include the engagement in alcohol-free activities, the use of non-alcoholic beverages instead of alcohol, support from family and friends, and anticipation of social events [7]. On the contrary, anxiety, stress, negative emotions, social pressure to drink, loneliness, boredom, and no social support were reported as barriers to maintain alcohol abstinence [7]. Considering those dimensions as potential factors for success or failure in national one-month abstinence campaigns would be relevant in further studies.

"Many participants in OMACs reported subjective improvements in health, including improved sleep, weight loss, an increased “energy”. An important finding is that Dry January participants also reported to have tried to increase their physical activity and to improve their diet, which was also reported by Dry July participants during the mid-year health check. This may suggest that these campaigns are actually not merely alcohol-focused for many participants, and might consist for them to a health-focused month, in particular when it is the first month of the year immediately after the end of year celebrations. This finding might have important implications for the evolution of the communication around these prevention campaigns. Moreover, improvement in health after one-month alcohol abstinence was objectively demonstrated for several parameters in a study with drinkers drinking above national guidelines where one-month alcohol abstinence led to a decrease in blood pressure, decrease in circulating concentrations of cancer-related growth factors, decrease in insulin resistance and weight reduction compared to the non-abstinent group [43]."

"The prevalence of homelessness globally is estimated to be roughly 150 million individuals at any given time (Busch-Geertsema et al., 2016). In the UK, recent data from the Shelter organisation estimated that 320,000 people were homeless in 2019/2020 (Bramley & Fitzpatrick, 2018). Problematic drug use among this population has been extensively documented in the scientific literature (O'Flaherty et al., 2018; Paudyal et al., 2017; Van den Bree et al., 2009; Krupski et al., 2015; Linton et al., 2013; Narendorf et al., 2017). Homelessness and drug misuse often coexist, and the recorded prevalence of drug use among homeless individuals in different countries is consistently above the national average (Doran et al., 2018; Johnson & Chamberlain, 2008; Krupski et al., 2015). Although the high prevalence of traditional drugs has been extensively documented within the homeless population, NPS have become an increasing risk to this population, with particular concern regarding the use of synthetic cannabinoid receptor agonists (SCRAs) due to their underdefined toxic effects, difficulty in treating them and lack of confidence from clinicians (Sulaiman and MP, 2019; Thornton, 2018; Williams, 2017)."

"In 2020 drug related deaths in the United Kingdom (UK) reached the highest rate in over 25 years (ONS, 2021). Data between 2001-2018 evidences a substantial increase in drug poisonings over time for people who use opioids, with risk increasing particularly between the years of 2010-2018, an effect which was not entirely explained by the ageing of this cohort (Lewer et al., 2022). The concentration of drug related deaths are geographically varied in the UK. Areas of high economic deprivation, such as North-East England have more than three times the rate of drug related deaths than London (ONS, 2021). In the North East town of Middlesbrough citizens are statistically more likely to die from a drug related deaths than a car accident (Middlesbrough Council, 2020). Poverty, homelessness, an aging population of opioid users, unemployment, polydrug use and significant funding reductions for drug treatment services have been posited as contributing factors (ACMD, 2017; Lewer et al., 2022; ONS, 2019a, 2019b; Public Health England, 2018). The largest proportion of drug related deaths in the North-East of England are reported among men who are dependent on illicit opioids, such as heroin (ONS, 2022). The high prevalence of opioid usage in Middlesbrough combined with an unregulated and toxic illicit street tablet market (substances such as z-drugs, benzodiazepine and gabapentinoids) provides a potentially fatal risk environment due to interactions between these depressant drugs, which can significantly increase risk of drug related deaths (Akhgari, Sardari-Iravani, & Ghadipasha, 2021; Ford & Law, 2014; ONS, 2021, 2022)."

"These pilots suggest that community-based drug safety testing can provide, first, engagement with more diverse drug–using communities than event-based testing—in terms of demographics, drugs of choice and risk taking behaviours—and therefore potentially can be more inclusive and impactful across drug–using communities including with marginalised groups. Second, there is the potential benefit of issuing proactive alerts for substances of concern in local drug markets ahead of specific leisure events, as happened with a mis-sold ketamine analogue identified in this study. Third, community testing can benefit from accessing fixed site laboratory facilities (in this case, a university chemistry department) to complement the speed and convenience of mobile laboratories with potentially greater analytical capabilities and trialling of new technological developments.

"These benefits cannot be presumed, however. The community pilots highlighted that service design characteristics and operational variations such as venue, day of week, prior publicity and outreach activities all can influence outcomes. Moving to a neutral central building attracted larger numbers and a greater diversity of service users as well as building trust with new service user groups, with drugs outreach staff further enhancing engagement with more marginalised drug using communities."

Prices Per Gram, 2016

United States:
Black tar heroin: range from $17-$400
South American heroin: range from $45-500

Canada:
Heroin: range from $105.70-$452.80

UK, 2016:
Brown heroin: typical price $67.80, range from $54.20-$81.30
Opium: typical price $13.60, range from $13.60-$20.30

"After applying these methods, there is very little remaining evidence of any causal gateway effect. For example, even if soft/medium drugs (cannabis, amphetamines, LSD, magic mushrooms, amyl nitrite) could somehow be abolished completely, the true causal link with hard drugs (crack, heroin, methadone) is found to be very small. For the sort of reduction in soft drug use that might be achievable in practice, the predicted causal effect on the demand for hard drugs would be negligible. Although there is stronger evidence of a gateway between soft drugs and ecstasy/cocaine, it remains small for practical purposes. My interpretation of the results of this study is that true gateway effects are probably very small and that the association between soft and hard drugs found in survey data is largely the result of our inability to observe all the personal characteristics underlying individual drug use. From this viewpoint, the decision to reclassify cannabis seems unlikely to have damaging future consequences."

"The high prevalence of mental health issues among the homeless population has been extensively documented throughout literature, but the consumption of NPS to treat mental health symptoms is of particular concern (Gray et al., 2021; Irving et al., 2015; McLeod et al., 2016; Ralphs et al., 2021). One study demonstrated that the homeless use SCRA to escape from the realities of the streets and provide relief from physical and mental health conditions, similar to the motivations for using cannabis, heroin and crack cocaine within the population (Fountain and Howes 2002; Link, 2014; Peacock et al., 2019)."

"Opioid substitution therapy (OST) is an evidence-based treatment for opioid dependency, with treatment engagement shown to be protective against drug related deaths (Santo et al., 2021). In England, the primary OST medications prescribed are methadone and buprenorphine, with provision ranging from daily supervised consumption at pharmacy services to take-home weekly doses. There were an estimated 261,294 people dependent on opioids in the England in 2017 (Hay, Rael de Santos, Reed, & Hope, 2017) with approximately 140,599 (or 54%) receiving OST (OHID, 2021). Barriers to ‘treatment engagement’ for the 46% of those who are not receiving OST can include concerns regarding disclosure; experiences or fears of stigmatising treatment; geographical isolation; reluctance or inability to engage with often inflexible treatment requirements; poor treatment access/availability and/or dislike of medication effects (ACMD, 2015; Harris & Rhodes, 2013; Marshall, Maina, & Sherstobitoff, 2021). People who are multiply marginalised, including women who use drugs, those who are unstably housed, living with multiple social problems, and/or cycling through the criminal justice system can face additional barriers to treatment access and be at highest risk of a drug related death (Medina-Perucha et al., 2019; Public Health England, 2018). It is crucial therefore, that treatment systems are more responsive and innovative to engage the most vulnerable, reduce health harms and risk of premature mortality."

"Heroin Assisted Treatment (HAT) is an alternate treatment modality for people for whom more traditional forms of OST have been ineffective. HAT is currently delivered in seven countries worldwide (Switzerland, Canada, Germany, Holland, Denmark, Luxembourg and the UK) with the longest standing programme operating in Switzerland. The service usually comprises provision of synthetic medical grade heroin (diacetylmorphine) for supervised self-injection, under medical supervision in a clinical environment. Prior to 2019 in England, clinically supervised HAT had only been provided as part of the Randomised Injecting Opiate Treatment Trial (RIOTT) in 2010 (Strang et al., 2010). Despite a robust international evidence base for the social and health benefits of HAT (Haasen et al., 2007; March, Oviedo-Joekes, Perea-Milla, & Carrasco, 2006; Oviedo-Joekes et al., 2009; Perneger, Giner, del Rio, & Mino, 1998; Strang et al., 2010; van den Brink et al., 2003) and strong results from RIOTT indicating improved outcomes for ‘treatment refractory’ people (i.e. people who have not benefitted from the standard treatment offer), RIOTT did not continue beyond a trial basis. In considering possible reasons for RIOTT discontinuation, Strang et al (2015) drew on concerns about HAT noted in the international literature, such as: 1. public safety and security concerns (concentration of crime in the local area, diversion of medicinal heroin); 2. intervention expense (costs of pharmaceutical product, staff and facilities for supervised consumption); 3. diamorphophobia (anxiety around concept of heroin as medicine); and 4. patient safety (i.e. a 1 in 6000 risk of sudden onset respiratory depression) (Strang et al., 2015).

"The opening of the first UK HAT service in Middlesbrough in 2019 was therefore remarkable. The service in Middlesbrough was initially implemented as a ‘whole systems approach’ i.e. compromising partners from the health and justice sectors. The development of the Middlesbrough service is a novel example of ‘bottom-up’ policy making (i.e. pushed through by the collaboration of localised systems on limited budgets with little formal intervention from the UK government (Poulter, Moore, Crow, Ahmed, & Walker, 2022). The service closed for operation in November 2022 despite client reported benefits in relation to improved social supports and having access to an innovative treatment supporting a wide range of harm-reduction and recovery-oriented goals (Riley et al., 2023)."

"• In 2010/11 use of any illegal drug was highest in the BHSCT [Belfast Health and Social Care Trust]. Adults (15-64 yrs) in the BHSCT reported lifetime (41%), recent (11%) and current (6%) use of an illegal drug.
"• The highest last year prevalence rate for any illegal drugs (BHSCT – 11%) was more than double that of the lowest rate (SHSCT [Southern HSCT] and NHSCT [Northern HSCT] – both 5%) among all adults.
"• Prevalence rates tended to be higher across all time periods in the BHSCT area than in other HSCTs."

"Naltrexone is a long acting opioid receptor antagonist used in drug rehabilitation programmes to maintain opioid abstinence. However, when consumed in conjunction with an opioid substance, prolonged opioid withdrawal will be precipitated resulting in unpredictable and life threatening medical consequences."

"Among the general population, use of powder cocaine is far more common than use of crack cocaine. Although crack cocaine use is relatively rare, it is associated with very problematic use and drug-related crime, predominantly among those also using opioids. Due to the often chaotic nature of users’ lives, it is likely that household surveys underestimate crack use. The last indirect estimate of problematic crack use in England puts the rate at 4.76 per 1000 population aged 15 to 64 years (Hay, Rael dos Santos, & Worsley, 2014). Cocaine (powder) is also the most seized stimulant in the UK, both in terms of number and quantity of seizures (see ST13). Having been 51% in 2003, the purity of domestic resale powder cocaine fell to 20% in 2009. However, it has risen since then and was 36% in 2014."

Click here for complete datatable of Drug Offenses in the UK by Offense Type and Country, 2004-2005 to 2011-2012

Click here for complete data table.

"The number of recorded drug crimes in the UK decreased by one per cent in 2011/12 (Table 9.1). There were variations across the UK with increases in Northern Ireland (8%) and Scotland (2%) and a decrease in England and Wales (-2%). In Scotland the increase was for possession offences with a decrease in trafficking offences while in Northern Ireland there were increases for both possession and trafficking offences. In England and Wales the decrease in possession offences was mainly for drugs other than cannabis while in Northern Ireland the increase in possession offences was mainly accounted for by an increase in cannabis offences. In England and Wales the number of possession offences for both cannabis and other drugs peaked in 2008/09. The decrease in recorded drug offences in England and Wales since 2008/09 coincides with the end of the national target regime for police (Chaplin et al. 2011). This demonstrates the impact of police priorities on recorded drug offences."

"There were 152,451 drug offences where the person was found guilty at court or cautioned in the United Kingdom during 2010 (Table 9.3; ST11). This represents a four per cent increase on the previous year (n=147,013) and resumes the upward trend that was evident between 2005 and 2008. Convictions for almost all drugs apart from cannabis decreased or remained stable with cocaine powder offences decreasing by 11% and ecstasy offences decreasing by 50%. The number of heroin offences remained stable.
"Cannabis offences continued to increase by 13% since the previous year with cannabis offences now accounting for half of all drug cautions and court convictions and wholly responsible for the increase in total drug offences. Cannabis trafficking offences increased by 41% from 11,054 in 2009 to 15,534 in 2010. This is likely to be due to the continued increase in the number of cannabis farm discoveries and related production offences (ACPO 2012; see section 9.2.1 and 10.3.3)."

"While the number of convictions (at court or cautions) for cannabis possession in 2010 (n=59,750) is 26% lower than in 2003 (n=80,656) before the introduction of the formal warning for cannabis²⁷¹ in England and Wales, the number has increased by 24% since 2007 (n=48,299) (ST11). This suggests that more punitive sanctions are being used to deal with cannabis possession offences. Data from England and Wales show that there was a seven per cent increase in cannabis possession offences dealt with by a caution or in court between 2009 and 2010 with a corresponding seven per cent decrease in the use of non-criminal sanctions such as the formal warning for cannabis and the penalty notice for disorder²⁷² (Figure 9.1). Although the total number of cannabis possession offences dealt with by law enforcement (either through criminal or administrative measures) decreased between 2009 and 2010 (from 154,336 to 150,765), the number remains almost twice as high as before the introduction of the formal warning for cannabis (n=77,500). This is despite a decrease in reported cannabis use over the period (see section 2.2 and Trends Analysis section)."

"In 2010/11 there were almost 600,000 stop and searches for drugs carried out by the police in England and Wales accounting for almost half of all police stop and searches for any reason (Home Office 2012e). This is a five per cent increase on the previous year and continues a trend of increased use of this power. Almost half of the drug searches recorded were carried out in London. Overall, a stop and search for drugs resulted in an arrest in seven per cent of cases across England and Wales with the British Transport Police, South-East England, London, and East Midlands below the national average. This compares to a 12% arrest rate for searches for non-drug reasons. The number of arrests as a result of drugs stop and search was 41,961."

"On June 30th 2010 there were 85,002 people in prison custody in England and Wales, 73,305 of whom were adults.³⁴¹ Of those adult prisoners in custody, 15% were on remand and 85% were sentenced. The most common offence was violence against the person (28%) followed by drug offences (16%), sexual offences (14%) and robbery (11%). Of all prisoners in custody, five per cent were female and 14% were foreign nationals (including those held in Immigration Removal Centres). Seven per cent of adult sentenced prisoners were sentenced for six months or less.
"In Scotland during 2010/11 the average daily number of prisoners was 7,853, 19% of whom were on remand. Of those sentenced, 36% were convicted of non-sexual crimes of violence with 14% convicted of drug offences."

"The use of custodial sentences for drug offenders increased substantially between 1994 and 2005. The annual number of people imprisoned rose by 111% and the average length of their sentences increased by 29%. Taking into account the rise in the average sentence length (37 months for drug dealing in 2004), the courts handed out nearly three times as much prison time in 2004 as they did 10 years earlier."

"• There were 216,296 drug seizures by the police and the UK Border Agency (UKBA) in England and Wales in 2011/12, a two per cent increase on 2010/11.
"• Class A seizures decreased by five per cent between 2010/11 and 2011/12, to 33,481. Class B seizures rose by three per cent to 181,011, while class C seizures fell by eight per cent to 6,915.
"• Cocaine was again the most commonly seized class A drug, though there was a one per cent decrease in the number of seizures between 2010/11 and 2011/12, to 17,449. The second highest seized class A drug was heroin with 9,150 seizures, a 15 per cent decrease from 2010/11 and its fourth consecutive fall.
"• The majority of class B seizures were for cannabis. The 173,153 seizures in 2011/12 compared to 167,410 during the previous year, a three per cent increase. This included increases in the number of herbal cannabis and cannabis plants seizures (up 6% and 14% respectively), and a decrease in cannabis resin seizures (down 23%).
"• The most commonly seized class C drug in 2011/12 was benzodiazepine with 2,689 seizures, which was eight per cent higher than the previous year?s 2,489 seizures."

"The 2010 National Profile reported 6,866 offences of commercial cultivation in 2009/10, increasing by 15 per cent over the following two years.³ Based on those forces that provided three years’ data for this profile, there was a 3.7 per cent reduction between 2011/12 and 2012/13 and a 5.6 per cent reduction between 2012/13 and 2013/14. These figures equate to an annual average of five offences recorded per 100,000 population.
"Seasonal trends in reporting were not identified. This is understandable as cannabis production is not driven by external environmental factors.
Of those forces reporting increased offences, some have dedicated dismantling teams and forensic strategies in place to identify farms and recover plants. These specialist teams provide detailed local profiles; identify intelligence links and offenders; and ascertain the source of the equipment used. This is likely to have prompted their increased recording.
"During the three year period, 6,010 offenders were identified as involved in the commercial cultivation of cannabis.⁴ Offenders continue to be predominantly male⁵, accounting for 88.5 per cent of all offenders, and largely white North European (70 per cent of all offenders) 6 most frequently aged between 25 and 34. There has been a decline in the proportion of South East Asian offenders over the last three years, now representing approximately 12 per cent of all offenders recorded⁷.

"Data show that there was a large decrease in the average purity of heroin in 2011 (Table 10.8). This follows reports of a reduction in the availability of heroin from late 2010 both within the international supply chain and within the UK. Indeed, the number of seizures the purity data in Table 10.8 is based on decreased by almost one-third in 2011 and seizures data also show a decrease in the quantity of heroin seized in 2010/11 (see section 10.3.2). Despite reports of a reduction in the supply of heroin and an increase in the wholesale price, the street-level price of heroin, as reported by law enforcement agencies, decreased from £45 per gram to £40 per gram. However, when adjusting for purity, the price of heroin increased significantly from £42.16 to £74.32 (Table 10.9). This suggests that dealers are more likely to adulterate their product in times of shortages than increase the price as indicated in research studies (Matrix Knowledge Group 2007). Street-level heroin is commonly adulterated with both caffeine and paracetamol."

"The mean purity of cocaine powder increased for the second year in a row after decreasing since 2005 (Table 10.8). The purity remains far below the levels seen in 2005 and almost half the level of 2003. Cocaine powder is commonly adulterated with benzocaine and levamisole.
"Given that the price of cocaine powder remained stable and purity increased slightly, there was a decrease in the purity-adjusted price of cocaine powder from £86.05 to £78.17 following a peak in 2009 (Table 10.10). Nevertheless, the price remains 42% higher than in 2003."

"Latest national and regional estimates for England are for 2009/10 for opiate and/or crack cocaine use, with separate estimates available for opiate use, crack cocaine use, and injecting drug use. In Scotland, the latest national and regional estimates for problematic opiate and/or benzodiazepine use are also for 2009/10 and were published in 2011. Drug injecting estimates for Scotland are available for 2006. In Wales, local and national estimates for 2009/10 for long duration or regular use of heroin, other opioids, crack cocaine and/or cocaine powder were published in 2011. Estimates for Northern Ireland for 2004 were published in 2006 and cover problem opiate and/or problem cocaine powder use.
"Based on these, it is estimated that there are a total of 383,534 problem drug users in the United Kingdom, and 133,112 people who inject drugs (PWID) (primarily opiates or crack cocaine)."

Problem Drug Use and Its Correlates

"Combining the 2009/10 estimates for England, Scotland, Wales (Hay et al. 2011; ISD Scotland 2011; Welsh Government 2011a) and the most recent estimate for Northern Ireland for 2004 (Centre for Drug Misuse Research 2006) it is possible to derive an estimate for the United Kingdom of 383,534 problem drug users, a rate of 9.38 per 1,000 population aged 15 to 64 (Table 4.2)."

"The most recent estimates of problem drug use in England were published in 2011 (Hay et al. 2011; see UK Focal Point Report 2011) showing that there were an estimated 306,150118 opiate and/or crack cocaine users in 2009/10. New national and local estimates of the prevalence of opiate and/or crack cocaine use (OCU) are being calculated for 2010/11 with separate estimates for opiate use, crack cocaine use and injecting drug use. It is anticipated that the results will be available in 2013."

"National PDU estimates for Wales for the period 2009/10 were published by the Welsh Government in October 2011 (Welsh Government 2011a; see UK Focal Point Report 2011). Regional differences were noted in the report across Health Board areas. The rate (per 1,000 population) ranged from 3.5 (95% CI 2.4 to 9.6) in the rural Powys area to 14.3 (95% CI 11.0 to 19.0) in the Abertawe Bro Morgannwg University (ABMU)123 area."

"The overall prevalence of HIV seen amongst people who inject drugs (PWID) in 2011 was similar to that seen in recent years, and remains higher than that found in the late 1990s. The Unlinked Anonymous Monitoring (UAM)163 survey of current and former PWID in England and Wales indicated an overall HIV prevalence of 1.3% in 2011 (ST09). In 2011, the prevalence was 1.4% amongst men and 0.95% amongst women, with prevalence increasing with age from 0.89% amongst those aged under 25 years to 1.4% amongst those aged 35 years and over (ST09)
"The prevalence of HIV amongst the PWID taking part in the 2011 UAM Survey across England, Wales and Northern Ireland was 1.2%.164 Between 2001 and 2011, prevalence varied between 0.93% and 1.6% (HPA 2012a; HPA 2012b; Figure 6.1).
"In 2011 in England, prevalence was 1.3%165, which is not significantly higher than in 2001 when the prevalence was 1.0%. In Wales in 2011, prevalence was 1.1%166 and in Northern Ireland prevalence was 0.56%167 (HPA 2012b).
"There is also evidence of on-going HIV transmission amongst PWID within the UK. In particular, the HIV prevalence amongst recent initiates to injecting in England, Wales and Northern Ireland (i.e. those who first injected during the preceding three years) has varied over time ranging from 0.36% in 2001 to 1.3% in 2008. The prevalence amongst the recent initiates participating in the UAM Survey in 2011 was 0.47%168 which is similar to the level found in 2001 (HPA 2012a; HPA 2012b; Figure 6.1)."

"The overall prevalence of HIV seen amongst people who inject drugs (PWID) in 2011 was similar to that seen in recent years, and remains higher than that found in the late 1990s. The Unlinked Anonymous Monitoring (UAM)138 survey of current and former PWID in England and Wales indicated an overall HIV prevalence of 1.3% in 2011 (ST09). In 2011, the prevalence was 1.4% amongst men and 0.95% amongst women, with prevalence increasing with age from 0.89% amongst those aged under 25 years to 1.4% amongst those aged 35 years and over (ST09)
"The prevalence of HIV amongst the PWID taking part in the 2011 UAM Survey across England, Wales and Northern Ireland was 1.2%.139 Between 2001 and 2011, prevalence varied between 0.93% and 1.6% (HPA 2012a; HPA 2012b; Figure 6.1).
"In 2011 in England, prevalence was 1.3%140, which is not significantly higher than in 2001 when the prevalence was 1.0%. In Wales in 2011, prevalence was 1.1%141 and in Northern Ireland prevalence was 0.56%142 (HPA 2012b).
"There is also evidence of on-going HIV transmission amongst PWID within the UK. In particular, the HIV prevalence amongst recent initiates to injecting in England, Wales and Northern Ireland (i.e. those who first injected during the preceding three years) has varied over time ranging from 0.36% in 2001 to 1.3% in 2008. The prevalence amongst the recent initiates participating in the UAM Survey in 2011 was 0.47%143 which is similar to the level found in 2001 (HPA 2012a; HPA 2012b; Figure 6.1)."

"The prevalence of hepatitis C infection amongst PWID remains high overall (HPA et al. 2012). In 2011, 44% of the (current and former) PWID participating in the UAM Survey in England and Wales had antibodies to hepatitis C169, which is similar to the level seen in recent years (ST09). However, this is higher than the level found in 2000 when prevalence was 38% (ST09). The prevalence in 2011 was 46% amongst men and 41% amongst women, and increased with age from 22% amongst those aged under 25 years to 53% amongst those aged 35 years and over (ST09).
"In 2011, the overall prevalence of antibodies to hepatitis C amongst the PWID participating in the UAM Survey across England, Wales and Northern Ireland in 2011 was 43%. This is lower than the 47% recorded in 2010, however, it is not significantly different from the prevalence of 39% seen in 2001 (HPA 2012b; Figure 6.2). In England in 2011, the hepatitis C prevalence amongst participants in the UAM Survey was 45%, however, there were very marked regional variations ranging from 33% in the West Midlands, East Midlands and North East to 60% in the North West (HPA 2012a). The prevalence in Wales (39%) and Northern Ireland (29%) was lower than in many of the English regions (HPA 2012a).
"The prevalence of antibodies to hepatitis C amongst recent initiates in England, Wales and Northern Ireland (those injecting for less than three years) is higher than in 2000 (12%) and earlier years. In 2011, amongst those in this group who participated in the UAM Survey from throughout England, Wales and Northern Ireland, the prevalence was 20% and similar to that seen between 2001 and 2010 (Figure 6.2) (HPA 2012b)."

"In 2011 there were 1,605 drug misuse deaths. The number of male deaths decreased by 14 per cent from 1,382 in 2010 to 1,192 in 2011. However over the same period the number of female deaths rose by 3 per cent from 402 to 413 (Table 1).
"Since 1993 there has been an upward trend in the proportion of drug poisoning deaths that were related to drug misuse for both males and females. In males this proportion peaked in 2010 at 73 per cent, but went down to 67 per cent in 2011. In females, this proportion peaked in 2008 at 51 per cent, but has since dropped slightly, and remains stable at around 47 per cent."

"The male mortality rate from drug misuse dropped significantly from it’s peak of 55.8 deaths per million population in 2009 to 43.4 deaths per million population in 2011 – the lowest rate since 2003.
"Despite some annual fluctuations, the female mortality rate from drug misuse has tended to increase since 1993. The mortality rate peaked in 2008 at 15.6 deaths per million population, then dropped significantly in 2009, but increased slightly in 2010 and 2011, reaching 14.4 deaths per million population."

"Over half (57 per cent) of all deaths related to drug poisoning involved an opiate drug. In 2011, as in previous years, the most commonly mentioned opiates were heroin and/or morphine, which were involved in 596 deaths (see Background note 8). For males, heroin/morphine was involved in more deaths than any other substance.
"However, the mortality rate for males has fallen sharply in the last two years, down from 27.9 deaths per million population in 2009 to 17.1 in 2011. This is a 39 per cent fall and is the lowest rate since 1997. The corresponding rate in females was much lower at 4.5 deaths per million population in 2011, and has not changed significantly since 1997, when the rate was 2.2 deaths per million population."

"• In around 11 per cent of drug poisoning deaths only a general description is recorded on the coroner’s death certificate (such as drug overdose or multiple drug toxicity). Deaths where the certificate contains only non-specific information cannot contribute to the counts of deaths involving specific substances.
"• In an additional 34 per cent of all drug poisoning deaths, the death certificate mentions more than one specific drug. Where more than one drug is mentioned, it is not possible to tell which was primarily responsible for the death.
"• Where more than one drug is mentioned on a death certificate the death will be counted in more than one category in Table 3. For example, if both heroin and cannabis are mentioned, the death will be recorded once under heroin and once under cannabis. Therefore the numbers for different substances cannot be added together to give a total number of deaths.
"• Approximately 30 per cent of all drug-related poisoning deaths also contain a mention of alcohol or long-term alcohol abuse (for example, cirrhosis) in addition to a drug."

"Tetrahydrocannabinol is a very safe drug. Laboratory animals (rats, mice, dogs, monkeys) can tolerate doses of up to 1,000 mg/kg (milligrams per kilogram). This would be equivalent to a 70 kg person swallowing 70 grams of the drug—about 5,000 times more than is required to produce a high. Despite the widespread illicit use of cannabis there are very few if any instances of people dying from an overdose. In Britain, official government statistics listed five deaths from cannabis in the period 1993-1995 but on closer examination these proved to have been deaths due to inhalation of vomit that could not be directly attributed to cannabis (House of Lords Report, 1998). By comparison with other commonly used recreational drugs these statistics are impressive."

"Uniquely in the United Kingdom, methadone ampoules can also be prescribed. Historically, they have at times been a substantial part of opiate substitution treatment in the United Kingdom (e.g. around 30 % in the 1970s and approximately 10 % in the early 1990s), but they now account for approximately 2 % of all methadone prescriptions in England and Wales (Strang et al., 2007). Injectable heroin can also be prescribed in the United Kingdom to heroin addicts as an opiate treatment and has been a treatment option for over 80 years, and this has historically been important. However, over the last 30 years, this practice has become progressively rarer and now comprises less than 1 % of all opiate substitution treatment in the United Kingdom. The established method of heroin prescription in the United Kingdom has been as a ‘take-away’ supply, which is then injected in an unsupervised context. In practice, few doctors have prescribed it and few patients have received it (Metrebian et al., 2002)."

Treatment

"— Of the 197,110 clients aged 18 and over in treatment contact during 2011-12, 185,428 were in treatment for 12 weeks or more or completed treatment free of dependency before 12 weeks (94%)
"— 29,855 (47%) of clients exiting treatment in 2011-12 completed treatment, defined as having overcome their dependency; a further 8,524 (14%) were transferred for further treatment within the community, while 7,123 (11%) were transferred into structured treatment while in custody
"— Of those opiate only clients with a six month review in 2011-12, 51% achieved abstinence from illicit opiates and a further 23% were classified as reliably improved. A further 3% had deteriorated
"— 63% of crack only clients with a six month review in 2011-12 achieved abstinence from crack cocaine and a further 8% were classified as reliably improved. 2% had deteriorated"

"81% of clients were opiates users, of which two thirds reported adjunctive crack cocaine use. The majority of remaining drug users were in treatment for powder cocaine (5%), cannabis (8%) or crack cocaine (3%) problems (excluding those also citing opiates). Among those aged 18 and over, opiates users in treatment had an average (median) age of 36, while adults in treatment for cocaine had a much lower average (median) age of 29 and those in treatment for cannabis use had an average (median) age of 26. Adults in treatment for benzodiazepines had the same median age as opiates users (36)."

"These pilot study findings showed that opiate-dependent injecting drug users with long injecting careers (most started between 1970 and 1982) and for whom opiate treatment had failed multiple times previously were attracted into and retained by therapy with injectable opiates."

"— 20,688 young people accessed specialist substance misuse services in 2011-12. This is a decrease of 1,267 individuals (5.8%) since 2010-11 and a decrease of 2,840 individuals (12.1%) since 2009-10
"— The most common routes into specialist substance misuse services were from youth offending teams (34%) and mainstream education (15%)"

"— The majority of young people accessing specialist services did so with problems for cannabis (64%) or alcohol (29%) as their primary substance
"— 80% of young people accessing specialist services stated they were living with their family or other relatives. 7% stated they had an accommodation status of either living in care or living independently as a looked after child
"— Of those entering services in 2011-12 almost half (49%) were in mainstream education. 20% stated they were not in education or employment.
"— The majority of those entering specialist substance misuse services did so reporting multiple vulnerabilities (76%)"

"During 2009/10:
"• A total of 576 individuals were in contact with Substitute Prescribing treatment services, compared to 550 in 2008/09.
"• 89 individuals discontinued from the scheme – the main reasons given were ‘failed to present for Substitute Prescribing’, ‘managed discontinuation of Substitute Prescribing’ and ‘unmanaged discontinuation of Substitute Prescribing’."

"In Northern Ireland on 1st March 2012:
"• There were 5916 individuals in treatment for drug and/or alcohol misuse. Of all those in treatment on 1st March 2012:
"— Just over one half (53%) were in treatment for alcohol misuse;
"— Approximately one quarter (26%) were in treatment for drug misuse; and
"— Just over one fifth (22%) were in treatment for both drug and alcohol misuse."

"Drugs only
"5.1 There were 1514 individuals in treatment for drug misuse. Of these, 1042 (69%) were male and 472 (31%) were female (Table 3). The largest proportion of those in treatment for drug misuse were aged 18 years or over (94%; 1417 individuals), whilst 6% (97 individuals) were aged under 18 years (Figure 3; Table 4).
"Alcohol only
"5.2 There were 3111 individuals in treatment for alcohol misuse. Of these, 2056 (66%) were male and 1055 (34%) were female (Table 3). The majority of those in treatment for alcohol misuse were aged 18 years or over (97%; 3020 individuals), whilst 3% (91 individuals) were aged under 18 years (Figure 3; Table 4).
"Drugs and Alcohol
"5.3 There were 1291 individuals in treatment for both drug and alcohol misuse. Of these, 968 (75%) were male and 323 (25%) were female (Table 3). The majority of individuals in treatment for both drugs and alcohol were aged 18 years or over (84%; 1081 individuals), while 16% (210 individuals) were aged under 18 years (Figure 3; Table 4)."

"On 31 March 2010:
"• 466 individuals were receiving substitute medication. This is compared to 429 individuals on 31 March 2009, an increase of 9%.
"• 457 of those individuals had been stabilised. Just over half (52%) of clients were stabilised on methadone, and a further 47% were stabilised on buprenorphine.
"• 423 of those individuals had been stabilised and had been subject to at least one review.
"• At review stage, 22% reported heroin as their main problem drug, compared to 75% when first assessed for substitute prescribing treatment.
"• Of those individuals who had injected, 17% reported injecting in the four weeks prior to review, compared to 55% who had injected in the four weeks prior to their first assessment."

Effectiveness

"The overriding finding from this study is that treatment is associated with a reduction in harmful behaviours that are associated with problem drug use. The majority of treatment seekers received care-coordinated treatment, expressed satisfaction with their care, were retained in treatment beyond three months, reported significant and substantial reductions in drug use and offending, and improvements in mental well-being and social functioning."

"During the course of treatment, many treatment seekers stopped using the drugs that they reported using at entry to the study. Lower rates of drug use were recorded at each follow-up. Furthermore, those that continued to use tended to use less. Most of the changes observed occurred by first follow-up. For most forms of drug use, no particular treatment modality was more associated with cessation than any other and the route into treatment (CJS or non-CJS) did not influence drug-use outcomes.

"The proportion using each drug reduced significantly between baseline and follow-up (Figure 5). Most of this change occurred by first follow-up; indeed use of some drug types increased marginally, and levels of abstinence from all drugs decreased between first and second follow-up.

"The proportion of treatment seekers using heroin, crack, cocaine, amphetamine or benzodiazepines decreased between baseline and follow-up by around 50 per cent; the proportion using non-prescribed methadone or other opiates such as morphine, decreased by considerably more; but the proportion using cannabis or alcohol decreased by considerably less.The proportion who reported each drug to be causing problems fell substantially for all drug types, suggesting that continued use was often, in the client’s view, non-problematic."

"There is evidence from published and unpublished observational studies that opiate substitution treatment is associated with an average 54% reduction in the risk of new HIV infection among people who inject drugs. There is weak evidence to suggest that greater benefit might be associated with longer measured duration of exposure to opiate substitution treatment. All of the eligible studies examined the impact of methadone maintenance treatment, indicating that there are few data regarding the impact of buprenorphine or other forms of non-methadone opiate substitution treatment in relation to HIV transmission. We found no evidence that methadone detoxification is associated with a reduction in the risk of HIV transmission."

"Overall, lower levels of acquisitive offending and high-cost offending were recorded at follow-up. Among those who continued to offend, improvements in offending behaviour at follow-up, in terms of a decrease in its volume and/ or the costs associated with it, were observed. Crack users, injecting users, users with high SDS [Severity of Dependence Scores] scores, and those with previous treatment experience were more likely to offend than others at any point. However, neither referral source nor the type of treatment modalities received, were significantly associated with the level of acquisitive offending at any point (within the adjusted model)."

"We have shown that treatment with supervised injectable heroin leads to significantly lower use of street heroin than does supervised injectable methadone or optimised oral methadone. Furthermore, this difference was evident within the first 6 weeks of treatment."

Prevention & Education

"Policies have been embedded in, or complemented by, a much wider framework of social action to create the capacity of both individuals and communities to resist drugs, including policies for children and young people aimed at enabling them to reach their full potential. In England, the Children's Plan aims to facilitate this (DCSF 2007). The devolved administrations take a similar approach, in Wales through Rights of Children and Young Persons (Wales) Measure 2011(Welsh Government 2011a). The GIRFEC (Getting It Right For Every Child) programme⁴⁸ provides the methodology for delivering the Scottish Government’s three social policy frameworks: the Early Years Framework; Achieving our Potential; and Equally Well (Scottish Government 2008b;c;d), which aim to develop the prevention and early intervention agenda. In Northern Ireland, Our Children and Young People – Our Pledge: A 10 year strategy for children and young people in Northern Ireland, 2006-2016 (OFMDFMNI 2006) sets a framework for addressing the needs of young people. Improved education and early interventions for young people and families (especially those most at risk) and improved public information about drugs are priority areas."

Harm Reduction

"The level of needle and syringe (direct) sharing reported by participants in the UAM Survey in England, Wales and Northern Ireland has declined from 33% in 2001 to 17% in 2011 (HPA 2012a; HPA 2012b). Direct sharing was reported by 17% of the participants in England (regional range: 11% to 23%), 11% of those in Wales, and 29% of those in Northern Ireland in 2010 (HPA 2012a; HPA 2012b). Throughout the period 2001 to 2011, direct sharing levels were consistently higher amongst those aged under 25 years than amongst older participants; in 2011, 24% of those aged under 25 years reported direct sharing compared with 17% of those aged 25 to 34 years and 16% of those aged 35 years and over (HPA 2012a; HPA 2012b).
"Sharing of any of the injecting equipment asked about the in the UAM Survey (i.e. needles, syringes, mixing containers, water or filters; direct and indirect sharing) was reported by 37% of those participating in the survey in 2011. Sharing of any of this equipment was reported by 38% of the participants in England (regional range: 31% to 49%), by 32% in Wales, and by 37% in Northern Ireland in 2009 (HPA 2012a).
"In Scotland, data from the Scottish Drug Misuse Database indicates that 7% of PWID reported current needle and syringe sharing in 2010/11, this is a decline from 12% during 2006/07 (ISD Scotland 2012a)."

"In Northern Ireland during 2009/10:
"• There were 15,828 visits to participating services by users of the scheme. This is an increase of 18% (2,439 visits) on the 2008/09 figure (13,389 visits).
"• A cin bin is a sealed container which is used to safely dispose of used needles and syringes: 51% of cin bins issued to users of the scheme were returned in 2009/10 compared to 53% returned in 2008/09.
"• 153,625 syringes were issued in 2009/10, compared to 135,700 in 2008/09. This is an increase of 13%."

"• Twenty-three Police Forces in England and Wales participated in the study. Forces were requested to submit samples confiscated from street-level users. In early 2008, they submitted 2,921 samples for analysis to either the Forensic Science Service Ltd (FSS) or LGC Forensics at Culham (LGC F).
"• Initial laboratory examination showed that 80.8% were herbal cannabis and 15.3% were cannabis resin. The remaining 3.9% were either indeterminate or not cannabis.
"• Microscopic examination of around two-thirds of the samples showed that over 97% of the herbal cannabis had been grown by intensive methods (sinsemilla). The remainder was classed as traditional imported herbal cannabis.
"• Regional variations were found in the market share of herbal cannabis. Thus North Wales, South Wales, Cleveland and Devon and Cornwall submitted proportionately fewer herbal cannabis samples, whereas Essex, Metropolitan and Avon and Somerset submitted proportionately more. These differences were statistically significant at the 0.1% confidence interval.
"• The mean THC concentration (potency) of the sinsemilla samples was 16.2% (range = 4.1 to 46%). The median potency was 15.0%, close to values reported by others in the past few years.
"• The mean THC concentration (potency) of the traditional imported herbal cannabis samples was 8.4% (range = 0.3 to 22%); median = 9.0%. Only a very small number of samples were received and analysed.
"• The mean potency of cannabis resin was 5.9% (range = 1.3 to 27.8%). The median = 5.0% was typical of values reported by others over many years.
"• Cannabis resin had a mean CBD content of 3.5% (range = 0.1 to 7.3%), but the CBD content of herbal cannabis was less than 0.1% in nearly all cases.
"• There was a weak, but statistically-significant, correlation (r = 0.48; N = 112; P < 0.001) between the THC and the CBD content of resin."

Economics

"Labelled public expenditure on drugs is estimated at around £1.1 billion per annum. Data on labelled public expenditure on drugs have been provided to the UK Focal Point annually from government departments and the devolved administrations but changes to drug funding in England makes the identification of drug-specific expenditure increasingly difficult. A recent estimate of the economic and social costs of drug supply in the UK for 2010/11 put the cost at around £10.7 billion (Mills et al. 2013). Using a similar methodology to a social and economic costs study in England and Wales for 2003/04 (Gordon et al. 2006), it was estimated that the economic and social costs of illicit drug use in Scotland were £3.5 billion in 2006 (Casey et al. 2009)."

"On 1st April 2013, local authorities became responsible for public health in England supported by a ring-fenced public health grant of £2.66 billion in 2013/14 and £2.79 billion in 2014/15. Historically, 34% of national spend on public health has been on substance misuse. Activity and performance on drug treatment influenced how much money local areas received in 2013-14 and will continue to be recognised in the target formula for the public health grants. This funding is no longer ring-fenced for the provision of drug treatment services (see section 5.2.2). In addition, there is no longer central funding for the routing of offenders into treatment, historically called the Drug Interventions Programme (DIP), which provided funding of £32 million for England and £5.1 million for Wales in 2012/13.24 Alongside other crime, community and drugs grants, funding ended in March 2013. The Community Safety Fund is providing £90 million to Police and Crime Commissioners in 2013/14 for them to decide what to fund at a local level.
"Previously, Focal Point estimates of drug-related expenditure have assumed that funding allocations equate to expenditure since these were primarily ring-fenced grants. With the removal of this ring-fence, collecting data on drug-related expenditure will require reports of actual expenditure. From 2013/14 onwards, local authorities will be required to report on spending from the Public Health Grant on an annual basis. There are categories for adult drugs, adult alcohol and young people’s drug and alcohol spending. Estimated expenditure on drug misuse services for adults by local authorities is £569.1m for 2013/14, with a further £55.0m projected to be spent on drug and alcohol services for young people (DCLG 2013).25 These two elements of planned expenditure account for almost one-quarter (23%) of projected public health expenditure by local authorities. There are no requirements to report centrally on other income streams such as the Community Safety Fund."

"From April 2013, the allocation of both the revenue and capital elements of the Substance Misuse Action Fund (SMAF) was made at a regional rather than local level with Area Planning Boards receiving the funding instead of Community Safety Partnerships. Substance misuse funding in Wales is shown in Table 1.1. It shows an increase in overall funding since 2006/07, with a doubling of funding for the Substance Misuse Action Fund over this period. Reductions since 2010/11 are principally due to funding decreases for the Drug Interventions Programme (DIP)."

Click here for complete datatable of Substance Misuse Funding In Wales, 2006-07 - 2013-14

"The majority of the funding for the New Strategic Direction for Alcohol and Drugs was devolved to the Public Health Agency (PHA) in 2009. Given that the Strategy is combined, it is difficult to provide data for ‘drugs only’ expenditure. In 2012/13, the PHA allocated just under £7 million to alcohol and drug-related services. In addition, almost £8 million is allocated to the provision of alcohol and drug treatment services within the Health and Social Care Trust. The Department retains a small amount of funding (£518,000 in 2012/13) for the provision of regional functions such as research and evaluation. Total substance misuse funding in 2012/13 was therefore in the region of £15,518,000, similar to previous years. Figures for 2013/14 are not available at this stage."

"It is disturbing that the sensitivities of the cannabis and cocaine tests were all quite low, although further testing of the cocaine tests is desirable due to the low prevalences and the low concentrations encountered in this study. There are several countries in Central and Southern Europe for which these two substance classes are of special interest. On the other hand, it seems the sensitivities of the devices are generally better for amphetamines, a frequently encountered drug class among the DUI drivers in the Nordic countries. The suitability of the device for the intended national DUI population should also be considered, for example, PCP is rarely, if ever, found in Europe, therefore at the current time utilising a PCP test is unnecessary. Since the on-site tests are relatively expensive the suitability of all the individual substance tests incorporated in the device should be considered.
"The evaluation showed that none of the evaluated tests is on a desirable level (>80% for sensitivity, specificity and accuracy) for all of the separate tests that they comprised. However, there were tests that performed already on a promising level for one or more substance classes. The DrugTest 5000 had the best overall results. The next best device was Rapid STAT, which performed at a similar level, except for the cocaine test which was somewhat less sensitive. Clearly the best device in terms of sensitivity for amphetamines was the DrugWipe 5+."

Laws and Policies

"The United Kingdom Government is responsible for setting the overall strategy and for its delivery in the devolved administrations only in matters where it has reserved power (SQ32). A new drug strategy was launched in December 2010 (HM Government 2010) replacing that of the previous Government, which was published in 2008 (HM Government 2008). The 2010 Strategy places a much greater emphasis on supporting those who are drug dependent to achieve recovery – and also widens the focus on dependence to prescription and over-the-counter medicines and tackling emerging new psychoactive substances (NPS). Within the strategy, policies concerning health, education, housing and social care are confined to England; those for policing and the criminal justice system cover England and Wales.
"The Scottish Government and Welsh Government’s national drug strategies were published in 2008, (Scottish Government 2008a; WAG 2008a) the latter combining drugs, alcohol and addiction to prescription drugs and over-the-counter medicines. Each strategy aims to make further progress on reducing harm and helping individuals recover from their drug problems. The Scottish and Welsh strategy documents are also accompanied by an action or implementation plan, providing a detailed set of objectives; actions and responsibilities; expected outcomes; and a corresponding timescale for delivery (Scottish Government 2008a; WAG 2008b; Welsh Government 2013a). Each plan reflects the devolution of responsibilities to the national Government.
"Northern Ireland’s strategy for reducing the harm related to alcohol and drug misuse, the New Strategic Direction for Alcohol and Drugs (NSD), was launched in 2006. The NSD contained actions and outcomes, at both the regional and local level, to achieve its overarching aims (DHSSPSNI 2006). A review of the NSD was conducted in 2010, and, after consultation, a revised strategy, the New Strategic Direction for Alcohol and Drugs Phase 2, 2011-2016, was launched in January 2012 (DHSSPSNI 2011)."

"The United Kingdom (UK) consists of England, Wales, Scotland and Northern Ireland. England accounts for 84% of the UK population. A number of powers have been devolved from the United Kingdom Parliament to Wales, Scotland, and Northern Ireland, but each has different levels of devolved responsibilities.
"The Misuse of Drugs Act 1971 is the principal legislation in the United Kingdom for the control and supply of drugs that are considered dangerous or otherwise harmful when misused. This Act divides such drugs into three Classes (A, B and C) to broadly reflect their relative harms and sets maximum criminal penalties for possession, supply and production in relation to each class.
"Drugs in Class A include cocaine, ecstasy, LSD, magic mushrooms, heroin, methadone, methylamphetamine and injectable amphetamines. Class B drugs include amphetamine, cannabis and synthetic cannabinoids, synthetic cathinone derivatives including mephedrone, as well as, since 2012, pipradrol related compounds including desoxypipradrol (2-DPMP) and diphenylprolinol (D2PM) and, since 2013, methoxetamine and related compounds. Class C drugs include anabolic steroids, tranquillisers, ketamine, benzodiazepines and piperazines (such as BZP).
"Most drugs controlled under the Act are place in one of five schedules to the Misuse of Drugs Regulations 2001 based on an assessment of their medicinal or therapeutic usefulness and the need for legitimate access and their potential harms when misused.¹
"The Drugs Act 2005 amended sections of The Misuse of Drugs Act 1971 and The Police and Criminal Evidence Act 1984, strengthening police powers in relation to the supply of drugs. The Police Reform and Social Responsibility Act 2011 added provisions for 12-month temporary class drug orders (TCDOs) enabling law enforcement activity against those trafficking and supplying temporary class drugs. Methoxetamine became the first drug subject to a TCDO in the UK in 2012 and, in June 2013, two groups of substances, known as 'NBOMe' and 'Benzofury' compounds (14 in total), were also placed under a TCDO."

"The Scottish Government and Welsh Government’s national drug strategies were published in 2008, the latter combining drugs, alcohol and addiction to prescription drugs and over-the-counter medicines. All three strategies aim to make further progress on reducing harm and each focuses on recovery. The Scottish and Welsh strategy documents are also accompanied by an action or implementation plan, providing a detailed set of objectives; actions and responsibilities; expected outcomes; and a corresponding time scale (Scottish Government 2008a; WAG 2008a; WAG 2008b). Each plan reflects the devolution of responsibilities to the national government.
"Northern Ireland’s strategy for reducing the harm related to alcohol and drug misuse, the New Strategic Direction for Alcohol and Drugs (NSD), was launched in 2006. The NSD contains actions and outcomes, at both the regional and local level, to achieve its overarching aims (DHSSPSNI 2006). A review of the NSD was conducted in 2010, and a revised document was issued for public consultation in March 2011. It is anticipated that the revised document, entitled The New Strategic Direction for Alcohol and Drugs Phase 2 – 2011-2016 will be published later in 2011."

"The Substance Misuse Annual Report 2010 (WAG 2010a) sets out the progress made in implementing the Welsh Assembly’s 10-year substance misuse strategy. An annex to the report sets out progress against the Key Performance Indicators (KPIs).21 Data show a 12% decrease in reported serious acquisitive crime since the previous year and a 19% decrease since baseline. Other achievements include an increase in the proportion of clients waiting no more than 10 working days between treatment referral and assessment, from 55% at baseline to 65% in 2009/10 and the creation of 1,794 additional treatment places in 2009/10. However, drug-related deaths increased from 96 in 2008 to 132 in 2009 and there has been an increase in the proportion of clients waiting more than 10 working days between assessment and the beginning of treatment."

"1.2 In 2000 funding was made available to develop a free needle and syringe exchange scheme in community pharmacies in Northern Ireland. With input from community pharmacists and other expert advisors, and taking account of models of best practice developed elsewhere, the Northern Ireland Needle and Syringe Exchange Scheme (NSES) was introduced in April 2001.
"1.3 Initially five pharmacies were involved in the scheme; by the end of 2009/10 there were twelve pharmacies and one Community Addiction Services clinic offering needle and syringe exchange. These were chosen based on their willingness to participate, their location, and the assessed need for needle exchange in the locality."

"The Misuse of Drugs Act 1971 (Modification) (No. 2) Order 20035 reclassified cannabinol and cannabinol derivatives (previously Class A drugs), and cannabis and cannabis resin (previously Class B) as Class C drugs; effective from January 2004. This followed an assessment of their relative harmfulness (ACMD 2002), and should enable a more effective message to be conveyed about the graded scale of danger of different types of drugs, according to their classification. In addition, it reinforces Government’s priority to tackle those drugs that cause the most harm: Class A drugs.
"With reclassification, the maximum sentence for possession has been reduced from five to two years imprisonment. However, penalties for drug-related offences have been increased; the maximum penalty for trafficking Class C drugs has increased from five to 14 years imprisonment. Under the Cannabis Enforcement Guidance issued by the Association of Chief Police Officers (ACPO 2003) to police forces in September 2003, there is a presumption against arrest for those aged 18 or over found in possession of cannabis⁶. Guidance is directed at ensuring that certain individual offenders are dealt with appropriately. Guidance relates to:
"• those repeatedly dealt with for possession of cannabis (repeat offenders);
"• those whose cannabis use causes or threatens to cause public disorder; and
"• those in possession of cannabis in or near premises where young people are present and vulnerable (e.g. schools, youth clubs and play areas).
"It is expected that for most possession offences, a police warning and confiscation of the drug will be sufficient. The subsequent time saved is intended to allow the police to focus greater resources on priority areas such as tackling Class A drug supply offences."

"1.3 The Substitute Prescribing Implementation Group was created by the DHSSPS and in February 2004 ‘Northern Ireland Guidelines on Substitution Treatment for Opiate Dependence’ were published. The new guidelines, including the arrangements for the monitoring and evaluation of Substitute Prescribing, were introduced on 1 April 2004.
"1.4 Subsequently the Public Health Information and Research Branch (PHIRB) formerly known as Drug and Alcohol Information and Research Unit (DAIRU), in conjunction with the treatment services responsible for delivering Substitute Prescribing, developed a series of monitoring forms. The Northern Ireland Substitute Prescribing Database (SPD) has been developed and is maintained by PHIRB. All data is supplied in an anonymised form to PHIRB for input to the SPD.
"1.5 The Northern Ireland Substitute Prescribing Database (SPD) was developed and, using the SP1, SP2 and SP3 forms, data collection began on 1 April 2004.
"1.6 There are currently thirteen statutory specialist drug services from across Northern Ireland supplying data on problem drug users presenting to be considered for Substitute Prescribing treatment."

"In England the Department of Health, the Ministry of Justice, HM Court Services, the National Offender Management Service and the Home Office are working together to take forward government proposals to invest in liaison and diversion services at police stations and courts to ensure that an individual’s health needs or vulnerabilities are identified and assessed early and that they are linked to appropriate treatment services. Within this wider programme, an 'Alternatives' pilot has been set up to test alternatives to custody at the point of sentencing, i.e. court based activity. The project is restricted to those offenders who have mental health problems, including personality disorder, and/or a substance misuse problem and whose index offence and risk of reoffending is of sufficient seriousness to attract a short prison sentence.
"Four substance misuse pilots commenced in October 2011, focusing on offenders receiving DRRs [Drug Rehabilitation Requirements] as part of a community sentence. A further twelve pilots focusing on offenders receiving Mental Health Treatment Requirements began work in April 2012. The pilot sites bring together treatment (residential and community based provision), rehabilitation and restorative justice. The schemes seek to offer a balance between punitive elements and rehabilitation and include life skills training, gaining qualifications, peer support, and wraparound support services. The Department of Health is conducting an evaluation of the health and criminal justice benefits of these schemes."

South Bank University's Criminal Policy Research Unit conducted a detailed study of the policing of cannabis in England. The study found that:
"One in seven of all known offenders in England and Wales were arrested for the possession of cannabis.
"There has been a tenfold increase in the number of possession offences since the mid-1970s. There is no evidence that this increase has been an intended consequence of specific policy.
"Possession offences most often come to light as a by-product of other investigations.
"A minority of patrol officers ‘specialise’ in cannabis offences: 3 per cent of officers who had made any arrests for possession accounted for 20 per cent of all arrests.
"Arrests for possession very rarely lead to the discovery of serious crimes.
"Officers often turn a blind eye to possession offences, or give informal warnings.
"Of the 69,000 offenders who were cautioned or convicted in 1999, just over half (58 per cent) were cautioned.
"The financial costs of policing cannabis amount to at least £50 million a year (including sentencing costs), and absorb the equivalent of 500 full-time police officers.
"The researchers conclude that:
"- re-classification of cannabis to a Class C drug will yield some financial savings, allowing patrol officers to respond more effectively to other calls on their time;
"- the main benefits of reclassification would be non-financial, in removing a source of friction between the police and young people;
"- there would be a very small decline in detection of serious offences, but this should readily be offset by the savings in police time."

"Recommendation 1. Local service planners need to review local needle and syringe services (and be supported in this work) in order to take steps to increase access and availability to sterile injecting equipment and to increase the proportion of injectors who receive 100 per cent coverage of sterile injecting equipment in relation to their injecting frequency."

"The Drug Rehabilitation Requirement (DRR) within a community order or suspended sentence of imprisonment is an intensive vehicle for tackling the drug misuse and offending of many of the most serious and persistent drug misusing offenders in England and Wales (SQ31). DRRs involve treatment, regular testing and court reviews of progress and are subject to rigorous enforcement.
"There is no longer a DRR commencement target in the National Offender Management Service (NOMS) Performance Metrics but data are collected from probation trusts and published in Offender Management Caseload Statistics. The most recent published data shows that 16,071 DRRs were commenced in 2010, 11,996 as part of a community order and 4,075 as part of a suspended sentence order. This represents a decrease from 16,207 starts in 2009 and 17,457 in 2008. The reduction in DRR commencements was partly due to police initiatives which divert offenders from charge and a change in focus from commencement to completion targets (MOJ 2011b).
"The main performance indicator for DRRs in 2010/11 was the completion rate with the number of completions as a secondary indicator. Fifty-six per cent of DRRs were successfully completed in 2010/11 against a target of 49% with all regions reaching this target. There were 8,392 successful DRR completions which significantly exceeded the aggregated annual target³³² of 6,837 (MOJ 2011b).
"The completion rate has doubled since 2003. This is encouraging because research into DTTOs, the predecessor of the DRR in England and Wales, suggests that offenders who complete orders have much lower reconviction rates (53%) than those who do not (91%), though it is not possible to attribute the difference entirely to the effect of the order (Hough et al. 2003)."

"Our findings raise questions about the validity of the current Misuse of Drugs Act classification, despite the fact that it is nominally based on an assessment of risk to users and society. The discrepancies between our findings and current classifications are especially striking in relation to psychedelic-type drugs. Our results also emphasise that the exclusion of alcohol and tobacco from the Misuse of Drugs Act is, from a scientific perspective, arbitrary. We saw no clear distinction between socially acceptable and illicit substances. The fact that the two most widely used legal drugs lie in the upper half of the ranking of harm is surely important information that should be taken into account in public debate on illegal drug use. Discussions based on a formal assessment of harm rather than on prejudice and assumptions might help society to engage in a more rational debate about the relative risks and harms of drugs."

Law enforcement authorities in the UK conducted an experiment in policing in the London borough of Lambeth, wherein cannabis violations were given a low priority. Researchers for PRS Consultancy Group undertook an evaluation of the program at the request of the Borough Police Commander. The researchers found that:
"The measures of police activity demonstrate that the policy has succeeded in releasing resources, and that activity against more serious offences has increased.
"During the 6 months of the evaluation, Lambeth officers issued 450 warnings. This released at least 1350 hours of officer time (by avoiding custody procedures and interviewing time), equivalent to 1.8 full-time officers. A further 1150 hours of CJU staff time was released by avoiding case file preparation.
"In comparison with the same 6 months in 2000, Lambeth officers recorded 35% more cannabis possession offences and 11% more for trafficking. In adjoining Boroughs possession offences fell by 4% and trafficking fell by 34%.
"Lambeth also increased its activity against Class A drugs relative to adjoining Boroughs."

"One study on the role of closed circuit television in a London police station emphasizes the potential for abuse and discrimination when police officers have discretion to strip search detainees.¹⁷⁴ From May 1999 to September 2000, officers in the station processed over 7000 arrests.¹⁷⁵ The station’s policy allowed officers of the same sex to conduct strip searches only if they felt it was necessary to remove drugs or a harmful object.¹⁷⁶
"For each arrest, the researchers documented the detainee’s age, sex, ethnicity, and offense.¹⁷⁷ A statistical analysis of these factors revealed that, as expected, people arrested for drug offenses were the most likely to be strip searched.¹⁷⁸ The results also showed that while all other variables (age, sex, and offense) were controlled, females were less likely to be strip searched than males, and arrestees who were seventeen to twenty-three years old were more likely to be strip searched than other age groups.¹⁷⁹ In addition, ethnicity influenced whether a strip search was conducted even when all other variables were taken into account. Specifically, compared to white Europeans, African-Caribbeans were twice as likely to be searched while Arabics and Orientals were half as likely.¹⁸⁰ The researchers in the study concluded that the data at least 'raise . . . the spectre of police racism' and reveal that 'policing is unequally experienced,' though it is impossible to determine whether the disproportionate number of strip searches of African-Caribbeans is due to institutional racism or unintentional discrimination.¹⁸¹"