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Drugs

Health and Social Behaviour: The Effects on Health of Drugs and Combating the Issue

Introduction

Drug misuse can refer to the use of illegal drugs or the misuse of prescribed drugs and substances.  This covers a wide range of behaviours from cannabis use to heroine addiction.

The Department of Health work 2001 Drug Action Plan and the subsequent 2007 Drug Action Plan have focused on prevention of drug-related death or contraction of blood-borne virus infections, and the 2008 Drug Strategy focuses on strengthening drug
treatment services.

Epidemiology

Drug misuse often occurs in young people.  It is also common in prisons, in socially deprived groups and the homeless.

Since the Government’s three year Action Plan to reduce drug-related deaths was introduced in 2001, there were consecutive falls in the number of drug-related deaths each year.  However, recent data shows that the level of overdose deaths,
as well as rates of blood-borne virus infections among drug misusers, have both begun to rise again.

Men are more likely to take illicit drugs than women: 13.7% of men compared to 7.4% of women took illicit drugs in 2006.  For Class A drugs the highest use in England is in London.

In 2006, 29% of 15 year olds reported having taken drugs in the last year.  In this age group, similar proportions of boys and girls reported taking drugs in the last year, but boys were more likely to have taken drugs in the last
month.  Cannabis was the drug most commonly taken in this age group; in 2006 10.1% of 15 year olds reported having used this drug.  UK has one of the highest rates of cannabis use among 15 and 16 year olds in Europe.

The number of people who are in contact with structured drug treatment services is increasing.  195,000 people received treatment in 2006/7, 130% more than in 1998.

More men access treatment services than women.  Overall heroine is the main drug for which people receive treatment (64% of all treatment in 2004/5), whereas in the under 18 age group, it was cannabis (67% in 2004/5).

Three out of four people stay in treatment for at least 12 weeks (staying in treatment for 12 weeks has a lasting positive impact and is a measure of successful treatment).  96% of drug users are receiving treatment within three weeks of
being assessed.

Drug related deaths have fallen by 13% since 2001 following sharp increases in the 1990s.

Health Effects of Drug Misuse

Health effects of drug misuse include both physical and psychological effects on the individual, as well as impacts on society.

Psychological effects

Drugs are addictive, and this addiction and dependency can have psychological effects on an individual.  There has also been found to be a link between cannabis and schizophrenia, and cannabis and depression.  Drug misuse is associated
with anxiety and memory loss.

Drug misuse can also lead to lack of control and lack of interactions in society, leading to decreased social capital.

Physical effects

Drug-related deaths are an important aspect of the health burden from drug misuse, including both accidental death from drug misuse and suicide.  In 2005, 1,506 drug users died in England from “overdose” or poisoning, drug abuse or drug
dependence.  Around 15% of these deaths occur in people after release from prison.

Blood-borne virus infections – particularly hepatitis and HIV infection – are also an important aspect in the health effects and wider impacts of drug misuse.  These infections can be transmitted through sharing needles when injecting
drugs.  Blood-borne virus infections can cause chronic poor health and can lead to serious disease and to premature death.   The Health Protection Agency (HPA) estimated in 2006 that almost half of current injecting drug users have
contracted hepatitis C infection.

Severe drug use can also lead to poor nutrition, and can also be linked with alcohol misuse, and tobacco use and the health effects of these.

Societal effects

Health effects also include the harm to society due to antisocial behaviour and crime.

Combating Drug Misuse Using a Wide Range of Approaches (including health service interventions and broader cultural interventions)

Government policy and recommendations

The Government is investing £604 million in drug treatment in 2008/09.  £54.3 million of new funding is being invested to expand inpatient detoxification and residential rehabilitation services.

The new ten-year drug strategy (2008-2018) aims to restrict the supply of illegal drugs and reduce the demand for them. It focuses on protecting families and strengthening communities.  The drug strategy is a cross-government initiative with
the Home Office and the Department of Health.

The Department of Health is responsible for drug treatment aspects of the strategy.  Key drug treatment actions in the Drug Strategy are:

  • Drug treatment services will become even more personalised towards meeting an individual’s needs.  New kinds of treatment will be piloted and delivered through the National Treatment Agency.
  • Treatment agencies will have a new role to work closely with Job Centres and housing services to help drug users re-establish their lives.
  • Drug users claiming benefits will be required to attend a discussion with a specialist treatment provider.
  • Family-based treatment services to protect more young people and families.
  • Piloting pooled budgets to allow local partnerships to bring together funding streams to improve reductions in drug harm.
  • Major improvements to prison drug treatment to ensure better quality and more consistent drug treatment across all prisons.

Cannabis use is also being tackled through the Drug Strategy.

The Department of Health and the National Treatment Agency launched a Harm Reduction Action Plan in May 2007 to further reduce the number of people dying from drug overdoses or contracting blood-borne viruses from contaminated needles.  The
DH and NTA have been working to jointly implement the 2007 Action Plan, which includes activity such as:

  • Improving data on drug-related deaths and blood-borne viruses.
  • Guidance for commissioners including the sharing of good practice on the provision of needle exchange services.
  • Development of training on harm reduction for those working with drug users.
  • Specific funding for hepatitis B vaccinations within prisons.
  • Health promotion campaigns, including work on the hepatitis B immunisation targeted at those most at risk for example service user groups and carers, homeless drug users, heroine and crack injectors, potential new injectors, and those in
    contact with the criminal justice system including prison. 
  • Campaign to include regional service user and carer “engagement projects” to support local campaigns and provide peer education and training.
  • Improving delivery – development and implementation of local action plans to improve harm reduction.
  • Guidance in provision of needle exchange services.
  • Guidance on planning and delivery of services in prison – harm reduction, prevention of drug-related deaths, testing and treating of blood-borne viruses.
  • Training and guidance to service users and carers on how to minimise harm associated with drug use.
  • Guidance on hepatitis C.

Prisons have a comprehensive drug treatment framework in place to address the different needs of drug misusers, and to reduce the supply of drugs coming into prison.  The Department of Health and the Ministry of Justice fund the Integrated
Drug Treatment System for prisons (IDTS). Drug treatment involves interventions, such as detoxification, prescription of substitute drugs (e.g. methadone), and psychological support.  Extra money has been allocated for 2008/9 which aims to
ensure better quality and more consistent drug treatment across all prisons and a chance for offenders to break free from a cycle of drugs and crime.

The Department of Health has invested additional funding of £54.3 million to increase the availability of drug and alcohol inpatient detoxification and residential rehabilitation services. These services help drug users beat their addiction and
support abstinence from drug use.

Treatment guidance:

To support improvements in the quality of drug treatment, in 2007 the Department of Health together with the other UK administrations published updated Guidelines on the Clinical Management of Drug Dependence.  The 2007 Guidelines are
intended for all clinicians providing treatment of drug misuse in the UK.  They are based on the most up-to-date evidence on how to provide drug treatment for patients.

The National Treatment Agency (NTA) has published best practice guidelines on the commissioning and delivery of drug treatment in Models of Care for Treatment of Adult Drug Misusers: Update 2006.

The National Institute for Health and Clinical Excellence (NICE) has published guidance on the treatment and care of drug misusers.

The 2007 Guidelines on Clinical Management of Drug Dependence is for use by all clinicians providing treatment of drug misuse in the UK.

NICE has produced two guidelines on drug misuse – ‘Drug misuse: psychosocial interventions’ (NICE clinical guideline 51) and ‘Drug misuse: opioid detoxification’ (NICE clinical guideline 52). These guidelines cover: 

  • The support and treatment people can expect to be offered if they have a problem with or are dependent on opioids, stimulants or cannabis
  • How families and carers may be able to support a person with a drug problem and get help for themselves.

NICE have also produced public health guidance on community-based interventions to reduce substance misuse among vulnerable and disadvantaged children and young people.

Interventions

The Frank Campaign:

The Department of Health’s campaign, the FRANK campaign, provides information and support for young people to ensure they understand the risks and dangers of drugs and their use and that they know where to go for help and advice. FRANK also aims
to give parents the confidence and knowledge to talk to their children about drugs.  FRANK is jointly delivered by the Department of Health, the Home Office and the Department for Children, Schools and Families.

Since launching in 2003, FRANK has established itself as an informed and trusted source of help and information. FRANK has received over 739,000 telephone calls, responded to over 48,000 emails and received over 5.7 million hits to talktofrank.com. 
83% of young people are aware of FRANK.  The number of 15-18 year olds agreeing that smoking cannabis can damage the mind went up from 45% to 61% as a result of this campaign.

NICE has produced public health guidance on community-based interventions to reduce substance misuse among vulnerable and disadvantaged children and young people.  It is aimed at those who have a role in and responsibility for reducing
substance misuse, including those working in local authorities and the education, voluntary, community, social care, youth and criminal justice sectors.

Recommendations from this document, for application at a local level, include: 

  • Developing and implementing a strategy at a local level to reduce substance misuse, based on local profile and supported by local services
  • Using existing screening tools to identify vulnerable and disadvantaged children and young people who are misusing or at risk of misusing substances
  • Offering a family-based programme of structured support over 2 or more years
  • Offering group-based behavioural therapy
  • Offering motivational interviews

Another example of a local intervention to prevent drug misuse is the installation of ultraviolet light in public areas or toilets.

The NICE guidance on psychosocial interventions for drug misuse recommend that treatment should take into account service-users’ needs and preferences; that informed decisions should be taken in partnership between the service-user and the
healthcare professional.

Harm reduction is commonly implemented as a way of reducing drug-related deaths.  The UK Harm Reduction Alliance (UKHRA) defines harm reduction as a term that defines policies, programmes, services and actions that work to reduce the health,
social, and economic harms to individuals, communities, and society that are associated with the use of drugs.  An example of harm reduction is the use of needle exchange to encourage safe use of needles.

The Department of Health and the National Treatment Agency’s Harm Reduction Action Plan highlights other recommended interventions.  This is described in more detail above.

References

  • The Department of Health and the National Treatment Agency for Drug Misuse. Reducing drug-Related harm: An action plan. May 2007 http://www.dh.gov.uk/en/Publicationsandstatistics
    (Accessed August 2008)
  • The Information Centre.  Statistics on Drug Misuse: England.  2007 http://www.ic.nhs.uk (Accessed August 2008)
  • The Department of Health Website: Drug Misuse http://www.dh.gov.uk/en/Publichealth (Accessed August 2008)
  • National Institute for Health and Clinical Excellence.  Community-based interventions to reduce substance misuse among vulnerable and disadvantaged children and young people. March 2007. http://www.nice.org.uk
    (Accessed August 2008)
  • National Institute for health and Clinical Excellence.  Drug Misuse: Psychosocial interventions.  July 2007.  http://www.nice.org.uk (Accessed August
    2008)
  • National Institute for health and Clinical Excellence.  http://www.nice.org.uk (Accessed August 2008)

© Sally Cartwright 2008