Drug Misuse Statistics Scotland

Transcription

1 Drug Misuse Statistics Scotland 2002 Information and Statistics Division Edinburgh 2003

2 Common Services Agency/Crown Copyright 2003 Brief extracts from this publication may be reproduced provided the source is fully acknowledged. Proposals for the reproduction of large extracts should be addressed to: ISD Publications Trinity Park House Edinburgh EH5 3SQ Price The web version of Drug Misuse Statistics Scotland 2002 is on the national website : Enquiries For enquiries or comments about this publication please contact : Customer Support Desk Information & Statistics Division Trinity Park House Edinburgh, EH5 3SQ Phone Fax ii Drug Misuse Statistics Scotland 2002

3 Contents National Statistics releases from ISD... iv Conventions... iv Addendum ( for Section B1)... v General introduction... 1 A Health impact of drug misuse... 2 A1 General acute hospital inpatient statistics... 3 A2 Psychiatric inpatient statistics A3 Information from general practice A4 Drug misuse in pregnancy A5 Blood-borne viruses A6 Drug-related deaths in Scotland B Services and treatment for drug misusers B1 Scottish Drug Misuse Database Demographics Referral source & presenting issues Drug profiles Age profiles Routes of use & sharing behaviour Social information Forms received B2 GB Regional Drug Misuse Databases B3 Prescription Statistics B4 Criminal Justice interventions C Drug education in schools, 2000/ C1 Drug education in schools, 2000/ D Prevalence of drug misuse D1 Scottish schools adolescent lifestyle and substance use survey, E Drugs and criminal justice E1 Drug-related offences and court proceedings E2 Seizures of controlled drugs E3 Drug misuse and treatment in Scottish prisons F Contacts Drug Misuse Statistics Scotland 2002 iii

4 National Statistics National Statistics releases from ISD Information presented in this publication from ISD is derived from data sources which are classed as National Statistics releases. These include: General acute hospital inpatient statistics (SMR01) Psychiatric inpatient statistics (SMR04) Information from general practice (CMR) Drug misuse in pregnancy (SMR02, SMR11) Scottish drug misuse database (SMR24) Prescriptions relating to drug misuse (PIS) National Statistics are produced to high professional standards, and adhere to commitments relating to integrity, confidentiality, data collection, liaison and consultation, openness, access and timeliness. National Statistics undergo regular quality assurance reviews to ensure that they meet customer needs, and they are produced free from political interference. National Statistics releases are grouped under one of 13 broad subject headings (themes); this publication belongs to the Health and Care theme. Further details on National Statistics are contained at the National Statistics website further information in relation to National Statistics and ISD Scotland is available from National_statistics/index.htm. For further information please contact: Philip Johnston Tel For further information on the non-isd data please contact the appropriate organisation directly (see page 167) for contact details. Conventions The following symbols and abbreviations have been used : editorial comment (appears below footnotes) - nil or negligible. not applicable ** not available Percentages are shown in italics Rates per population are shown in italics iv Drug Misuse Statistics Scotland 2002

5 Addendum Warning Section B1 Scottish Drug Misuse Database The figures shown for 2001/02 relating to Ayrshire and Arran NHS board area and North, South and East Ayrshire Council areas are incorrect, and relate to only six rather than 12 months. This problem affects all tables and related text in Section B1. All other sections of the bulletin are unaffected. Implications The effect of this data shortfall is to invalidate trends for Ayrshire & Arran NHS board and the relevant council areas up to 2001/02. Comparison between Ayrshire and Arran authority figures and other areas would also be inappropriate for 2001/02. This also affects the 2001/02 totals shown for Scotland. The incomplete record for Ayrshire & Arran is, however, a relatively small percentage of total database returns (6 per cent). It is therefore legitimate for the reader to accept the main findings of the report whilst also being aware of this shortfall. Remedial action In September 2003 ISD will publish an update of the Database section of the Bulletin containing revised figures for 2001/2 and new data relating to 2002/3. Please accept our apologies for this inaccuracy. ISD Drug Misuse Information Strategy Team April 2003 Drug Misuse Statistics Scotland 2002 v

6 vi Drug Misuse Statistics Scotland 2002

7 Drug misuse in Scotland General introduction About Drug Misuse Statistics Scotland 2002 This publication presents the latest available information on drug misuse drawing from a wide range of national data sources: national surveys; the Home Office; the Scottish Centre for Infection and Environmental Health; the Crime and Criminal Justice Unit at the Scottish Executive and ISD Scotland. The information has been grouped within the following subject headings. Health impact of drug misuse Services and treatment for drug misusers Drug education in schools Prevalence of drug misuse Drugs and criminal justice Health impact Thanks are given to all the organisations supplying the information presented in this publication. Contact details can be found on page 167. Drug Misuse Information Strategy Team The Drug Misuse Information Strategy Team, which produced this publication, are part of the Information and Statistics Division (ISD) Scotland within NHSScotland. The team: provides information support to Drug Action Teams, Local Authorities, NHS boards, specialist drug services, the Scottish Executive, and others; manages the Scottish Drug Misuse Database (SDMD), and ensures the effective and appropriate exploitation of other relevant data collected by ISD, e.g. hospital inpatient data; develops expertise in the use of available data to produce robust performance and activity indicators to monitor the impact of national and local policies; and supports the research and analytical work of other organisations, subject to general strategic priorities and ethical and legal considerations. The team also provides an information service (ad hoc service) to organisations and individuals who wish to use the data relating to drug misuse collected by ISD Scotland. For further information please contact or sdmd@isd.csa.scot.nhs.uk or visit the website at Contact Elaine Parry (Senior Information Officer) phone: elaine.parry@isd.csa.scot.nhs.uk Drug Misuse Statistics Scotland

8 Health impact 2 Drug Misuse Statistics Scotland 2002

9 A Health impact of drug misuse A1 A2 A3 A4 General acute hospital inpatient statistics Psychiatric inpatient statistics Information from general practice Drug misuse in pregnancy Health impact A5 A6 Blood-borne viruses Drug-related deaths in Scotland Drug Misuse Statistics Scotland

10 A1 General acute hospital inpatient statistics Health impact Key Points Between 1997/98 and 2001/02, there was a 62 per cent increase in the number of general acute admissions involving drug misuse. Throughout this period, slightly over two-thirds of such admissions were amongst males. The majority (72 per cent) were aged 25 and over whereas only a small number of admissions (44) were recorded amongst those under 15. (Table A1.1) In 2001/02, nearly 50 per cent of admissions in the under 15 age group related to cannabinoid use and 20 per cent to the use of stimulants other than cocaine (e.g. ecstasy and amphetamines).the majority of admissions amongst those aged 20 years and over involved the use of opiates. (Table A1.2) Just over 10 per cent of drug related admissions were elective in 2000/01, a very similar proportion to that seen in 2000/01. (Table A1.4) Nearly 90 per cent of hospitalisations during 2001/02 involved a stay of less than 1 week, with the majority of the remainder being discharged within a month. Only 58 admissions (1 per cent) were for more than a month. (Table A1.6) Introduction Data for individual patients are collected by ISD Scotland as a series of Scottish Morbidity Records (SMR). The SMR datasets constitute a significant local and national information resource, and are used for epidemiological monitoring, health needs assessment, national and local planning and a range of other applications. SMR01 is an episode based patient record relating to all inpatients and day cases discharged from specialities other than mental health, maternity, neonatal and geriatric long stay specialities in the NHSScotland. A record is generated for each inpatient and day case episode, of which there are about each year. Each individual patient may have more than one episode. The SMR01 basic data set encompasses patient identification and demographic information, episode management information and general clinical information. Items such as waiting time for inpatient or day case admission and length of stay may be derived from the episode management information. The tables and charts presented here are derived from the SMR01, and contain information about patients admitted to general hospitals (mainly for emergency treatment), where drugs misuse is diagnosed as a factor in the patient s treatment. Up to six diagnoses are recorded per admission, and episodes with either a main or a supplementary diagnosis of drugs misuse are included. In the tables of drug type (A1.2, A1.3 and A1.7), there is an element of double counting as episodes may be associated with, for example, diagnoses of both opiate and cocaine misuse. Drugs misuse is recorded on the SMR returns using the codes available in the International Classification of Diseases 10 th Revision (ICD10). The following codes were used in the analysis presented in this section: ICD 10 Code F11 F12 F13 F14 Description Opioids Cannabinoids Sedatives / Hypnotics Cocaine ICD 10 Code F15 F16 F18 F19 Description Other Stimulants Hallucinogens Volatile Solvents Multiple / Other Psychoactive Substances Some caution is necessary when using these data as (a) drug misuse may only be suspected and may not always be recorded by the hospital, and (b) where drug misuse is recorded, it may not be possible to identify which drug(s) may be involved. An initial interpretation of the data is provided along with the tables and charts. Work continues on developing and refining our understanding of these analyses and a more in-depth interpretation will be provided in future publications. 4 Drug Misuse Statistics Scotland 2002

11 General acute hospital inpatient statistics Demographics (Table A1.1) During 2001/02, there were admissions for drug misuse to acute general hospitals in Scotland. Just over a third of these (1 729) were in the Greater Glasgow Health Board area, with a further 10 per cent occurring in each of Ayrshire & Arran, and Lothian. There were very few admissions in the, the s, and the Islands, with a total of 87 being recorded for these three Health Boards combined. Between 1997/98 and 2001/02, there was a 62 per cent increase in the number of acute admissions. Increases were particulary seen in Lothian, where numbers had been falling (from 476 in 1997/98 to 422 in 2000/01) but rose by a third in the past year. Increases in excess of 35 per cent were also seen in Ayrshire & Arran and Dumfries & Galloway during 2001/02. chart A Acute admissions for drug misuse 1997/ /02 Health impact Number of admissions / / / / /02 2 Year of admission 2 Figures for 2001/02 are provisional. Throughout the period 1997/98 to 2001/02, slightly over two-thirds of drug misuse admissions were amongst males. The majority (72 per cent) were aged 25 and over, with only a small number of admissions (44) being recorded amongst those under 15. The age at admission has risen over the past five years (see Chart A1.2), with the proportion in the 35+ age group increasing from 19 per cent in 1997/98 to 25 per cent in 2001/02. A corresponding fall has been seen in the proportion under 25 (36 per cent to 28 per cent). chart A1.2 Changes in age distribution 1997/ / /98 Percentage / / / / Under Age Group Drug Misuse Statistics Scotland

12 General acute hospital inpatient statistics Types of drugs misuse (Tables A1.2 and A1.3) Just over half of all admissions for drug misuse explicitly indicated the involvement of opiates, 5 per cent cannabinoids, and 2 per cent cocaine (see table below). Nearly a third of admissions, however, specified problems relating either to multiple drug use or to the use of other, unspecified psychoactive substances. As opioid related admissions are likely to be recorded under multiple drug use, as well as under a specific diagnosis, the proportion of admissions involving opiates may be an underestimate. Health impact Type of Drug No. of Admissions Percentage Opioids Multiple/Other Hallucinogens Other Stimulants Cannabinoids Sedatives/Hypnotics Cocaine Volatile Solvents Note: The above figures include an element of 'double counting' where a patient is recorded as having more than one drug-related diagnosis. Patterns of drug use vary across Scotland with the highest proportion of drug related admissions involving opiates being in Ayrshire & Arran (71 per cent), compared to 21 per cent in Tayside. This is matched, however, by a similarly wide variation in the use of multiple or other drugs which may indicate differences in recording practices. In relation to cocaine, the proportion varies from 0 per cent in the Forth Valley, to 3.6 per cent in Lanarkshire, and 6.1 per cent in the (although the numbers in this last area are small). The types of drugs used are broadly similar for males and females. A slightly higher proportion of admissions amongst females have an explicit diagnosis of opiate misuse (55 per cent to 49 per cent). For males, admissions involving multiple/other drugs, which may include opiates, are more common (32 per cent to 28 per cent). Large differences are seen across the age groups (see Chart A1.3), with the under 15s being unlikely to be admitted for either opioid or cocaine use. Nearly 50 per cent of admissions in this age group relate to cannabinoid use and 20 per cent to the use of stimulants other than cocaine (e.g. ecstasy and amphetamines). Over 50 per cent of admissions in those aged 20+ involve the use of opiates, and the proportion involving multiple/other drugs, possibly including opiates, increases with age (16 per cent in the under 20s, 30 per cent amongst year olds, and 34 per cent in the over 30s). chart A1.3 Type of drugs misuse by age group 2001/02 60 Under Percentage Opioids Hallucinogens Cannabinoids Sedatives Cocaine Other stimulants Solvents Multiple/ Other Type of drug Between 1997/98 and 2001/02, there was a rise of more than 10 per cent in the proportion of admissions involving opiates. In contrast, there was a decline in the proportion associated with the use of multiple/other drugs (36 per cent to 31 per cent), indicating a possible change in recording practices. The proportion involving sedatives fell from 7.4 per cent to 3.9 per cent. Admissions involving cocaine increased, although the overall proportion involved is still low (0.9 per cent to 2.1 per cent). 6 Drug Misuse Statistics Scotland 2002

13 General acute hospital inpatient statistics Hospital episode details (Tables A1.4, A1.5, A1.6, A1.7) Just over 10% of drug related admissions were elective in 2001/02, a very similar proportion to that seen in 2000/ 01 (see Drug Misuse Statistics Scotland 2001). This was broadly the same for both males and females. Some differences were seen by age (see Chart A1.4), with only 2 out of 44 (5 per cent) admissions being elective in the under 15 age group, compared to 18 per cent in the 35 and over group. (Table A1.4) chart A1.4 Percentage Elective admissions for drugs misuse 2001/02 Health impact 5 0 Under Age Group The majority of admissions were within the specialisations of general medicine (53 per cent) and general surgery (17 per cent). A further 19 per cent were split more or less equally between communicable diseases, A&E, and orthopaedics. The reminder were across a range of specialties, including cardiology and plastic surgery. There were some variations across Scotland. Over 10 per cent of admissions were to communicable diseases in, Grampian, Lanarkshire, and Lothian. Admissions to A&E were more common in Ayrshire & Arran (20 per cent), Grampian (25 per cent), and Tayside (18 per cent). These regional variations could reflect a difference in admission policies, for example A&E beds are available in Ayrshire and Arran but not in all areas. Females were more likely to be admitted to general medicine (56 per cent to 52 per cent) and to communicable diseases (6.9 per cent to 5.5 per cent). Amongst males, admissions to A&E (7.0 per cent to 5.2 per cent) and orthopaedics (7.0 per cent to 4.1 per cent) were more common. (Table A1.5) Nearly 90 per cent of hospitalisations involved a stay of less than 1 week, with the majority of the remainder being discharged within a month. Only 58 admissions (1.2 per cent) were for more than a month. A similar pattern was seen for both males and females, but the length of stay did increase steadily with age (see table below). Admissions involving cannabinoids, cocaine, other stimulants, and volatile solvents were generally discharged within a week. Longer periods of hospitalisation occurred amongst those admitted for misuse of opioids, hallucinogens, and multiple/other drugs, with approximately 88 per cent being discharged within a week, and most of the rest being admitted for less than a month. The longest stays were in the group admitted with problems relating to sedative/hypnotic misuse: 81 per cent for less than a week, 16 per cent for less than a month, and 3.3 per cent for greater than a month. (Tables A1.6 and A1.7) Age Group <1 Week 1 Week-1 Month 1-3 Months >3 Months Drug Misuse Statistics Scotland

14 General acute hospital inpatient statistics A1.1 General acute admissions for drug misuse : 1997/ /02 NHS board and council area of residence, age group and gender 1997/98 r 1998/99 r 1999/00 r 2000/01 r 2001/02 p Scotland by NHS board Health impact Argyll & Clyde Ayrshire & Arran Forth Valley Grampian Greater Glasgow Lanarkshire Lothian Tayside Island boards 1 No fixed abode Other / not known 2 by council area Aberdeen City Aberdeenshire Angus Argyll & Bute Ayrshire East Ayrshire North Ayrshire South Clackmannanshire Dunbartonshire East Dunbartonshire West Dundee City Edinburgh City Falkirk Glasgow City Inverclyde Lanarkshire North Lanarkshire South Lothian East Lothian West Midlothian Perth & Kinross Renfrewshire Renfrewshire East Stirling Other council areas 3 No fixed abode Other / not known 2 by age group by gender Males Females Orkney, Shetland and Western Isles NHS boards. 2 Other includes patients resident outwith Scotland or those where NHS board or council area is not known. 3 Eilean Siar, Moray, Orkney and Shetland councils. r p Revised. Provisional. Source: ISD Scotland (SMR01). 8 Drug Misuse Statistics Scotland 2002

15 General acute hospital inpatient statistics A1.2 General acute admissions for drug misuse ; drug type 1 : 2001/02 p NHS board and council area of residence, age group and gender Total Opioids Cannab- Sedatives/ Cocaine Other Halluc- Volatile Multiple / admissions inoids Hypnotics Stimulants 5 inogens solvents Other 6 Scotland by NHS board Argyll & Clyde Ayrshire & Arran Forth Valley Grampian Greater Glasgow Lanarkshire Lothian Tayside Island boards 2 No fixed abode Other / not known Health impact by council area Aberdeen City Aberdeenshire Angus Argyll & Bute Ayrshire East Ayrshire North Ayrshire South Clackmannanshire Dunbartonshire East Dunbartonshire West Dundee City Edinburgh City Falkirk Glasgow City Inverclyde Lanarkshire North Lanarkshire South Lothian East Lothian West Midlothian Perth & Kinross Renfrewshire Renfrewshire East Stirling Other council areas 4 No fixed abode Other / not known 3 by age group by gender Males Females The figures shown include an element of double counting where a patient is recorded as having more than one drug type e.g opioids and cannabinoids. 2 Orkney, Shetland and Western Isles NHS boards. 3 Other includes patients outwith Scotland or those whose NHS board or council area is not known. 4 Eilean Siar, Moray, Orkney and Shetland councils. 5 Including caffeine. 6 Disorders due to multiple drug use and use of other psychoactive substances. p Provisional. Source : ISD Scotland (SMR01). Drug Misuse Statistics Scotland

16 General acute hospital inpatient statistics A1.3 General acute admissions for drug misuse : 1997/98 r /02 p drug type 1 Opioids Cannab- Sedatives/ Cocaine Other Halluc- Volatile Multiple/ Total inoids Hypnotics Stimulants 2 inogens solvents Other 3 admissions 1997/98 r /99 r /00 r /01 r /02 p Health impact 1 The figures shown include an element of double counting where a patient is recorded as having more than one drug type e.g opioids and cannabinoids. 2 Including caffeine. 3 Disorders due to multiple drug use and use of other psychoactive substances. r Revised. p Provisional. Source : ISD Scotland (SMR01). 10 Drug Misuse Statistics Scotland 2002

17 General acute hospital inpatient statistics A1.4 General acute admissions for drug misuse ; type of admission : 2001/02 p NHS board and council area of residence, age group and gender Total Admissions Elective 4 Emergency Scotland by NHS board Argyll & Clyde Ayrshire & Arran Forth Valley Grampian Greater Glasgow Lanarkshire Lothian Tayside Island boards 1 No fixed abode Other / not known Health impact by council area Aberdeen City Aberdeenshire Angus Argyll & Bute Ayrshire East Ayrshire North Ayrshire South Clackmannanshire Dunbartonshire East Dunbartonshire West Dundee City Edinburgh City Falkirk Glasgow City Inverclyde Lanarkshire North Lanarkshire South Lothian East Lothian West Midlothian Perth & Kinross Renfrewshire Renfrewshire East Stirling Other council areas 3 No fixed abode Other / not known 2 by age group by gender Males Females Orkney, Shetland and Western Isles NHS boards. 2 Other includes patients resident outwith Scotland or those where NHS board or council area of residence is not known. 3 Eilean Siar, Moray, Orkney and Shetland councils. 4 Includes deferred, waiting list, repeat admissions and booked cases. p Provisional. Source : ISD Scotland (SMR01). Drug Misuse Statistics Scotland

18 General acute hospital inpatient statistics A1.5 General acute admissions for drug misuse ; speciality : 2001/02 p NHS board and council area of residence, age group and gender Total General Cardio- Commun- Respir- General General A & E Anaes- Ortho- Plastic Gynae- Other admissions Medicine logy icable atory Surgery Surgery thetics paedics Surgery cology Diseases Medicine (excl Vascular) Scotland by NHS board Health impact Argyll & Clyde Ayrshire & Arran Forth Valley Grampian Greater Glasgow Lanarkshire Lothian Tayside Island boards 1 No fixed abode Other / not known by council area Aberdeen City Aberdeenshire Angus Argyll & Bute Ayrshire East Ayrshire North Ayrshire South Clackmannanshire Dunbartonshire East Dunbartonshire West Dundee City Edinburgh City Falkirk Glasgow City Inverclyde Lanarkshire North Lanarkshire South Lothian East Lothian West Midlothian Perth & Kinross Renfrewshire Renfrewshire East Stirling Other council areas 3 No fixed abode Other / not known 2 by age group by gender Males Females Orkney, Shetland and Western Isles NHS boards. 2 Other includes patients resident outwith Scotland or those where NHS board or council area of residence is not known. 3 Eilean Siar, Moray, Orkney and Shetland councils. p Provisional. Source : ISD Scotland (SMR01). 12 Drug Misuse Statistics Scotland 2002

19 General acute hospital inpatient statistics A1.6 General acute admissions for drug misuse ; length of stay : 2001/02 p NHS board and council area of residence, age group and gender Total less than between 1 week between 1 month more than admissions 1 week and 1 month and 3 months 3 months Scotland by NHS board Argyll & Clyde Ayrshire & Arran Forth Valley Grampian Greater Glasgow Lanarkshire Lothian Tayside Island boards 1 No fixed abode Other / not known Health impact by council area Aberdeen City Aberdeenshire Angus Argyll & Bute Ayrshire East Ayrshire North Ayrshire South Clackmannanshire Dunbartonshire East Dunbartonshire West Dundee City Edinburgh City Falkirk Glasgow City Inverclyde Lanarkshire North Lanarkshire South Lothian East Lothian West Midlothian Perth & Kinross Renfrewshire Renfrewshire East Stirling Other council areas 3 No fixed abode Other / not known 2 by age group by gender Males Females Orkney, Shetland and Western Isles NHS boards. 2 Other includes patients resident outwith Scotland or those where NHS board or council area of residence is not known. 3 Eilean Siar, Moray, Orkney and Shetland councils. p Provisional. Source : ISD Scotland (SMR01). Drug Misuse Statistics Scotland

20 General acute hospital inpatient statistics A1.7 General acute admissions for drug misuse; length of stay : 2001/02 p drug type Total Less than Between 1 week Between 1 month More than Admissions 1 week and 1 month and 3 months 3 months Health impact Opioids Cannabinoids Sedatives/hypnotics Cocaine Other stimulants Hallucinogens Volatile solvents Multiple/Other Including caffeine. 2 Disorders due to multiple drug use and use of other psychoactive substances. p Provisional. Source : ISD Scotland (SMR01). 14 Drug Misuse Statistics Scotland 2002

21 A2 Psychiatric inpatient statistics Key Points There were psychiatric discharges during 2000/01, (3.3 per cent) of which had a main diagnosis of drugs misuse, making it the 9 th most common condition. (Tables A2.1 and A2.2) Just over two-thirds of drugs misuse discharges were amongst males. The majority were in those aged 25 and over, with 62 per cent of main diagnoses, and 67 per cent of all diagnoses, being made in these age groups. Only a handful (3 main, 4 all) were under 15 years old. (Table A2.5) Over the five-year period 1996/97 to 2000/01, the number of psychiatric discharges for drugs misuse increased by 12 per cent for the main diagnosis, and by 28 per cent for all diagnosis. (Table A2.1) In the under 20's, cannabinoid-related diagnoses are more likely (13 per cent in the under 20s, 4.4 per cent amongst the year olds, and 6.1 per cent in the over 30s), and problems with opiates are less common (27 per cent, 34 per cent, 31 per cent). (Table A2.5) Health impact Periods of hospitalisation are generally longer for psychiatric admissions, with the proportion of patients being discharged in less than a week being 42 per cent compared to 89 per cent for general acute admissions. (Table A2.6) Introduction Tables A2.1 to A2.6 contain information on admissions to and discharges from mental illness specialties. These statistics are derived from data collected through the mental health inpatient and day case return (SMR04) which records information at admission and discharge. On the SMR04 form, up to six separate diagnoses can be recorded on discharge. A diagnosis in the first position is the principal diagnosis on discharge. A diagnosis in any position, refers to the occurrence of a diagnosis in any of the six positions (including first and supplementary). Figures for all admissions, re-admissions and discharges relate to the number of episodes not to the number of individual patients admitted or discharged. Each individual may have more than one episode. First admissions relate to first ever admissions to a mental illness specialty, and therefore approximate to the number of people. It is also important to note that re-admissions will include patients who have returned for treatment after a long period of time, as well as those who have been diagnosed after a short interval. Diagnosis is recorded on both the admission and the discharge part of the record and diagnosis on discharge may differ from diagnosis on admission. The tables presented here are based on diagnosis on discharge. Drugs misuse is defined using the same group of ICD 10 codes outlined in section A1 (page 4). In Tables A2.2 - A2.4 diagnoses have been grouped together into the following short list of conditions based on the International Classification of Diseases 10 th Revision (ICD10): ICD10 Code Description F00 F03 Dementia F10.1 F10.9 Alcohol Misuse F11.1 F19.9 Drug Misuse F20 Schizophrenia F30-F39 Mood (Affective) Disorders F31 Bipolar Affective Disorders F32 Depressive Episode F33 Recurrent Depressive Disorder F04, F05, F22, F23, F24, F25 Other Psychotic Disorders F80, F81, F82, F84, F88, F89, F90, F93, F94 Disorders of Childhood F40 F48 Neurotic, Stress-related and Somatoform Disorders F60 Personality Disorders F70 F79 Mental Handicap All other codes from chapter 5 Other Conditions Drug Misuse Statistics Scotland

22 Psychiatric inpatient statistics Differences between the figures published here, and those published in the previous (2001) edition of Drugs Misuse Statistics Scotland will reflect an increased completeness of records received from a number of NHS Board areas. An inital interpretation of the data is provided along with the tables. Work continues on developing and refining our understanding of these analyses and a more in-depth interpretation will be provided in future publications. Health impact Demographics (Tables A2.1, A2.2, A2.3, A2.4) There were psychiatric discharges during 2000/01, (3.3 per cent) of which had a main diagnosis of drugs misuse, making it the 9 th most common condition (see Chart A2.1). It was the primary diagnosis for slightly more first admissions (4.8 per cent) than readmissions (2.8 per cent), but one possible explanation may be the high proportion of patients with chronic conditions involving repeat admissions, for example schizophrenia. Only 30 per cent of discharges with a main drugs misuse diagnosis also listed supplementary diagnoses, the most common being mood affective disorders (18 per cent of discharges with a main diagnosis of drugs misuse) and disorders due to alcohol use (13 per cent). In the 584 cases where drugs misuse was given as the second diagnosis on discharge, schizophrenia (27 per cent), mood affective disorders (20 per cent), and disorders due to alcohol use (17 per cent) were the most common primary diagnoses. chart A2.1 Main diagnosis relating to psychiatric discharge 2001/ Percentage Mood Dementia (Affective) Personality Schizophrenia Alcohol Learning Misuse Disability Other Neurotic Other Drugs Psychotic Misuse Childhood Diagnosis As with both SMR01 (see section A1), just over two-thirds of drugs misuse discharges were amongst males. The majority were in those aged 25 and over, with 62 per cent of main diagnoses, and 67 per cent of all diagnoses, being made in these age groups. Only a handful (3 main, 4 all) were under 15 years old. Drug-related discharges most commonly occurred in the Greater Glasgow NHS Board (25 per cent of the total), and very few were seen in the, the s, and the Islands (5 per cent combined). (Table A2.1) Over the five-year period 1996/97 to 2000/01, the number of psychiatric discharges for drugs misuse increased by 12 per cent for the main diagnosis, and by 28 per cent for all diagnoses. For first admissions alone, the number with a main diagnosis of drugs misuse actually fell by 3.8 per cent, and only a modest increase (2.0 per cent) was seen in all diagnoses, suggesting that much of the rise is due to an increase in the number of readmissions. A more detailed examination of the trend (see Chart A2.2) shows that, whilst discharges did increase up to 1999/00, there has been a sizeable decrease over the past year. It should be noted, however, that the figures for the last available year (2000/01) are provisional, and it is possible that the number of discharges may increase slightly for this year. (Table A2.1) Note: Figures for 2000/01 are provisional 16 Drug Misuse Statistics Scotland 2002

23 Psychiatric inpatient statistics chart A2.2 Psychiatric discharges for drugs misuse 1996/ / All Adm - All Diag Number of discharges / /98 All Adm - Main Diag 1st Adm - All Diag 1st Adm - Main Diag 1998/ / /01 Year of discharge Health impact Type of drugs misuse (Table A2.5) Nearly a third of all psychiatric discharges for drug misuse explicitly indicated the involvement of opiates, 11 per cent stimulants other than cocaine, and 5.9 per cent cannabinoids. Over 40 per cent of discharges, however, specified problems relating either to multiple drug use or to the use of other, unspecified psychoactive substances. As with SMR01, opioid-related discharges are likely to be recorded under multiple drug use, as well as under a specific diagnosis, and the proportion of psychiatric discharges involving opiates is, therefore, likely to be an underestimate. Cocaine was listed in only 4 (0.4 per cent) discharges (see table below). Type of Drug No. of Discharges Percentage Multiple/Other Opioids Other Stimulants Cannabinoids Sedatives/Hypnotics Hallucinogens Volatile Solvents Cocaine Note:The above figures are based on the main diagnosis alone and hence, unlike the equivalent acute admissions table, each patient is recorded as having only one drug-related diagnosis Wide variations are again seen across Scotland, with the highest proportion of psychiatric discharges involving opiates being in (59 per cent), compared to 15 per cent in. The reverse pattern is, however, seen with respect to multiple/other drug use, suggesting possible differences in recording practices. Although regional variations in relation to cocaine cannot be examined due to very small numbers, differences can be seen in the proportion of discharges involving stimulants of other types (32 per cent Greater Glasgow, 1.2 per cent Ayrshire & Arran). Psychiatric discharges explicitly indicating the involvement of opiates are more likely amongst females (39 per cent to 29 per cent). Diagnoses of multiple/other drug misuse are, however, recorded more often for males (46 per cent to 39 per cent). The actual level of opiate use amongst males is, therefore, likely to be closer to that for females. The types of drugs used are otherwise broadly similar by gender with the exception of sedatives/ hypnotics (11 per cent (female) to 4.8 per cent (male)) and other stimulants (7.5 per cent (female) to 13 per cent (male)). As with general acute admissions, differences are seen across the age groups (see Chart A2.3), although these are not as marked. In the youngest age group, cannabinoid-related diagnoses are more likely (13 per cent in the under 20s, 4.4 per cent amongst the year olds, and 6.1 per cent in the over 30s), and problems with opiates are less common (27 per cent, 34 per cent, 31 per cent). In contrast to SMR01, diagnoses relating to the use of stimulants other than cocaine increase with age, from 5.8 per cent in those under 20 to 14 per cent in the 30+ age group. Drug Misuse Statistics Scotland

24 Psychiatric inpatient statistics chart A2.3 Types of drugs misuse by age group 2001/02 60 Under Percentage Health impact Opioids Hallucinogens Cannabinoids Sedatives Cocaine Other stimulants Type of drug Solvents Multiple/ Other Over the past year, the largest change in the types of drugs recorded has been in relation to multiple/other drugs where the proportion has fallen from 52 per cent, to 44 per cent. This contrasts with a slight increase in the proportion of discharges including the specific drug diagnoses (possibly indicating a change in recording practices), the most notable of which is stimulants other than cocaine (7.2 per cent to 11 per cent), (see Drug Misuse Statistics Scotland 2001). Hospital episode details (Table A2.6) Periods of hospitalisation are generally longer for psychiatric admissions (see Chart A2.4), with the proportion of patients being discharged in less than a week being 42 per cent compared to 89 per cent for acute admissions. Furthermore, longer stays are also seen amongst readmissions (20 per cent >1 month) than amongst first admissions (12 per cent >1 month). Similar patterns are seen for males and females, but there are some differences by age. The proportion of hospitalisations under a week is lowest in the 35+ age group (33.2 per cent to 44 per cent for the other groups combined). Conversely, 45 per cent of the over 35s are admitted for between 1 week and 1 month, compared to 34 per cent of the under 20s. Longer periods of stay (>1 month) are broadly similar across the age groups. chart A2.4 Period of hospitalisation 2001/02 50 Overall 40 Ist admission Readmission Percentage <1 Week 1 Week- 1 Month 1-3 Months >3 Months Period of stay 18 Drug Misuse Statistics Scotland 2002

25 Psychiatric inpatient statistics A2.1 Psychiatric inpatient discharges with a diagnosis of drug misuse 1,2 ; discharge diagnosis : 1996/97 r /01 p previous psychiatric inpatient status, NHS board of residence and council area of residence 1996/97 r 1997/98 r 1998/99 r 1999/00 r 2000/01 p Main All Main All Main All Main All Main All All admissions First admission by NHS board of residence Argyll & Clyde Ayrshire & Arran Forth Valley Grampian Greater Glasgow Lanarkshire Lothian Tayside Island Boards Other/not known Health impact by council area Aberdeen City Aberdeenshire Angus Argyll and Bute Ayreshire East Ayrshire North Ayrshire South Clackmannanshire Dumfries and Galloway Dunbartonshire East Dunbartonshire West Dundee City Edinburgh City Falkirk Glasgow City Inverclyde Lanarkshire North Lanarkshire South Lothian East Lothian West Midlothian Perth and Kinross Renfrewshire Renfrewshire East Stirling Other Council Areas Other/not known Excludes misuse of tobacco or alcohol. 2 Main is the Primary diagnosis; All includes supplementary diagnoses. 3 Orkney, Shetland and Western Isles NHS boards. 4 Other includes patients resident outwith Scotland or those where NHS board or council area of residence is not known. 5 Eilean Siar, Moray, Orkney and Shetland councils. r p Revised. Provisional. Source : ISD Scotland (SMR04). Drug Misuse Statistics Scotland

26 Psychiatric inpatient statistics A2.2 Psychiatric inpatient discharges by main discharge diagnosis : 2000/01 p all discharges by previous psychiatric inpatient status and gender Total Males Females All discharges 1, Health impact Dementia Mental and behavioural disorders due to use of alcohol Mental and behavioural disorders due to drug misuse Schizophrenia Mood (affective) disorders - Bipolar affective disorder - Depressive episode - Recurrent depressive disorder Other psychotic disorders Disorders of Childhood Neurotic, stress related and somatoform disorders Personality disorder Mental handicap Other First admissions 2 Dementia Mental and behavioural disorders due to use of alcohol Mental and behavioural disorders due to drug misuse Schizophrenia Mood (affective) disorders - Bipolar affective disorder - Depressive episode - Recurrent depressive disorder Other psychotic disorders Disorders of Childhood Neurotic, stress related and somatoform disorders Personality disorder Mental handicap Other Re-admissions 2,3 Dementia Mental and behavioural disorders due to use of alcohol Mental and behavioural disorders due to drug misuse Schizophrenia Mood (affective) disorders - Bipolar affective disorder - Depressive episode - Recurrent depressive disorder Other psychotic disorders Disorders of Childhood Neurotic, stress related and somatoform disorders Personality disorder Mental handicap Other Includes type of admission not known. 2 Includes patients with learning disabilities. 3 Includes transfers in from other psychiatric inpatient care. p Provisional. Source : ISD Scotland (SMR04). 20 Drug Misuse Statistics Scotland 2002

27 Psychiatric inpatient statistics A2.3 Psychiatric inpatient discharges with a main discharge diagnosis of drug misuse 1,2 : 2000/01 p supplementary discharge diagnosis 2nd discharge diagnosis 3rd discharge diagnosis 4th discharge diagnosis Total Males Females Total Males Females Total Males Females All discharges Dementia Mental and behavioural disorders due to use of alcohol Mental and behavioural disorders due to drug misuse Schizophrenia Mood (affective) disorders - Bipolar affective disorder - Depressive episode - Recurrent depressive disorder Other psychotic disorders Disorders of childhood Neurotic, stress-related and somatoform disorders Personality disorder Mental handicap Other Health impact No supplementary diagnosis Excludes misuse of tobacco or alcohol in main diagnosis. 2 As an individual may have a number of diagnoses in any discharge record, some individuals may appear in more than one column. p Provisional. Source : ISD Scotland (SMR04). A2.4 Psychiatric inpatient discharges with a supplementary discharge diagnosis of drug misuse 1,2 : 2000/01 p main discharge diagnosis Main discharge diagnosis for discharges with a drug-related diagnosis in the : 2nd position 3rd position 4th position Total Males Females Total Males Females Total Males Females All discharges Dementia Mental and behavioural disorders due to use of alcohol Mental and behavioural disorders due to drug misuse Schizophrenia Mood (affective) disorders - Bipolar affective disorder - Depressive episode - Recurrent depressive disorder Other psychotic disorders Disorders of childhood Neurotic, stress-related and somatoform disorders Personality disorder Mental handicap Other Excludes misuse of tobacco or alcohol as a supplementary diagnosis. 2 As an individual may have a number of diagnoses in any discharge record, some individuals may appear in more than one column. p Provisional. Source : ISD Scotland (SMR04). Drug Misuse Statistics Scotland