Statistics from the Regional Drug Misuse Databases for six months ending March 2001

Statistics from the Regional Drug Misuse Databases for six months ending March 2001 This bulletin summarises information on people presenting to services with problem drug misuse and relates to the six month period ending 31 March 2001. It is the tenth and final bulletin in the series to be based on more detailed data collected from Regional Drug Misuse Databases; in future, information will be provided from the National Drug Treatment Monitoring System. This bulletin relates to ; some figures for Great Britain are also included. Summary In, during the six month period ending 31 March 2001: About 33,200 users were reported as presenting to drug misuse agencies; this is a marginal increase (0.4%) from the previous six month period (33,100). Half (50%) of those users presenting were in their twenties and around one in seven (13%) were aged under 20, as in previous periods. The ratio of males to females (3:1) was also the same as in previous periods. Heroin was still the most frequently reported main drug of use, accounting for two thirds of users (67%). The next most frequently reported main drugs of misuse were cannabis (9%), methadone (8%), cocaine (7%) and amphetamines (3%). Contents Pages 1. Introduction 2 2. Trends in users and episodes 3. Drugs of misuse 5 4. Injecting and sharing behaviour 5. Agency of treatment 8 6. Regional Office areas and Health Authorities 7. Great Britain tables 10 8. Acknowledgements 10 9. Editorial notes 10 Annexes A Information about the Regional Drug Misuse Databases 3 6 8 13 B Future monitoring 21 C tables 25 D Great Britain tables 75 Bulletin 2002/07 Published February 2002 ISBN:1 84182 508 5 Crown Copyright 2002

1. Introduction 1.1 In 1989, following recommendations from the Advisory Committee on the Misuse of Drugs, the Department of Health (DH) provided funding to the then Regional Health Authorities to set up databases to collect anonymised information about drug misusers attending a range of specialist services, and to return to the Department a six monthly aggregated dataset. Figure 1 Number of episodes per user for the period ending March 2001 Users Number of episodes Number Percentage 1 33,234 94.6 2 1,802 5.1 3 92 0.3 4 3 0.0 Total 35,131 100 1.2 Information on people presenting to services with problem drug misuse for the first time, or for the first time for six months or more, was collected by the drug misuse agencies. Selected personal details and information regarding the drugs misused, together with the type of agency attended, were forwarded to the local Regional Drug Misuse Database (RDMD). RDMDs identified all the records received from agencies which contained attributable data from face to face contacts, counting those people who attended more than one agency in the RDMD area only once as users. A user may be recorded as having several episodes. 1.3 Since 1 April 1996, more detailed data have been submitted to DH. This Statistical Bulletin is the tenth and final publication of the extended dataset, and covers the period 1 October 2000 to 31 March 2001. More detailed information regarding the collection of this data, together with a Glossary of Terms, is included in Annex A. Most of this bulletin relates to, with detailed tables at Annex C. Some information for Great Britain is given at Annex D. Government 10 year Strategy 1.4 The Government s 10-Year Strategy Tackling drugs to build a better Britain was published in April 1998. A key objective is to Increase participation of problem drug misusers, including prisoners, in drug treatment programmes which have a positive impact on health and crime. The UK Anti-Drugs Co-ordinator published a national plan for 2000/01 in July 2000 and a Annual Report for 2000/1 in 2001. The role of the UK Anti- Drugs Co-ordination Unit has now been taken on by the Home Office. National Treatment Agency 1.5 The National Treatment Agency for Substance Misuse has been created by the Government to improve the quality, availability, accessibility and effectiveness of drug treatment in (see Annex B). National Drug Treatment Monitoring System 1.6 Following a strategic review of the structure and operation of the RDMDs, the National Drug Treatment Monitoring System was introduced in from 1 April 2001. A similar system has also been introduced in Wales. This new system will provide more useful information and will contribute fully to the information needs of the Government s drugs strategy and other stakeholders. The new system collects information on clients entering treatment; in addition, further information will be collected on each client at the end of each financial year (starting at 31 March 2002) including whether or not they are still in treatment (see Annex B). 1.7 As a first step, a statistical bulletin "Statistics from the Regional Drug Misuse 2 Statistical Bulletin 2002/07 February 2002

Databases on drug misusers in treatment in, 2000/01" was published in December 2001. It summarises information on the number of drug misusers reported to Regional Drug Misuse Databases by drug treatment agencies and General Practitioners as being in treatment in in 2000/01. Young people and drug misuse 1.8 A Statistical Bulletin Statistics on young people and drug misuse:, 1998 was published in July 2000 by DH. This draws on information from two key sources to monitor the objective of the 10- Year Strategy to help young people resist drug misuse. It includes information such as the proportion of young people offered drugs; the proportion of young people who had used drugs in the last year, the last month and types of drug used. Some later data has now been published "Drug misuse declared in 2000: results from the British Crime Survey" and "Statistics on smoking, drinking and drug use among young people in in 2000" (see Annex A.8). 2. Trends in users and episodes 2.1 During the six month period ending 31 March 2001, there were 33,234 users reported as starting agency episodes, a small increase of 0.4% on the previous period (33,093). However, the number of agency episodes reported decreased by 1.0% to 35,131 (compared to 35,482 in the previous period). As in the previous period, the vast majority of users (95%) had only one episode reported. (Table 1a and Figure 1) 2.2 Although the overall number of users increased marginally compared to the previous period, there was much variation between RDMDs. For example, although there were increases in the number of users reported by Trent (up 14%) and South West (up 16%), there were decreases in the number of users reported by Eastern (down 14%), North West (down 11%) and South East (down 8%). These changes may, at least in part, be due to changes in reporting practice. (Table 1b). 2.3 It is thought that the decrease in reporting seen for some agency types in the period ending September 1997 is likely to have been due to changes in reporting practice following the closure of the Addicts Index (see Annex A1.1). It is important that changes in reporting practice are borne in mind when interpreting the results in this bulletin. (figure 2) Figure 2 Episodes reported by type of agency in the six month periods ending 30 September 1993 to 31 March 2001 20,000 18,000 16,000 Statutory CBDS 14,000 Number of episodes 12,000 10,000 8,000 6,000 4,000 2,000 Non-Statutory CBDS Police Surgeons Other Services GPs 0 Sept 1993 Mar 1994 Sept 1994 Mar 1995 Sept 1995 Mar 1996 Sept 1996 Mar 1997 Sept 1997 Mar 1998 Sept 1998 Mar 1999 Sept 1999 Mar 2000 Sept 2000 Mar 2001 Six month period ending Statistical Bulletin 2002/07 February 2002 3

Age and gender of users 2.4 The gender distribution of users showed a male to female ratio of 3:1, overall, which is similar to previous periods. 2.5 A half of all users (50%) are in their twenties, with one in seven (13%) aged under 20 and around a third (38%) aged 30 and over. For the period ending March 2001, the largest increase in users was in the 30 and over age group (up by 3%) compared with an increase of 0.4% for all ages). (Tables 2a, 2b and Figure 3). Figure 4 Number of drugs of misuse per user for the period ending March 2001 Number of drugs Users misused number Percentage 1 15,449 46 2 9,393 28 3 4,850 15 4 2,379 7 5 1,163 3 Total 33,234 100 7,000 Figure 3 Age and gender of users starting agency episodes in the six months ending 31 March 2001 Number of episodes 6,000 5,000 4,000 3,000 2,000 Male Female 1,000 0 Under 15 15 to 19 20 to 24 25 to 29 30 to 34 35 to 39 Age 40 to 44 45 to 49 50 to 54 55 to 59 60 to 64 65 & Over 4 Statistical Bulletin 2002/07 February 2002

3 Drugs of misuse 3.1 Users must have one drug of misuse recorded and may be recorded as misusing a maximum of five drugs; one drug is recorded as the main drug of misuse, any others are recorded as subsidiary drugs. Just under half (46%) were recorded as misusing only one drug, over one quarter (28%) two drugs, just under one sixth (15%) three drugs, one in fourteen (7%) four drugs and one in twentyfive users (4%) were recorded as having five drugs of misuse. These figures are similar to previous periods. (Figure 4) 3.2 Some of the analysis in the bulletin is based on the "main drug" of misuse and some based on "all drugs" misused. The drugs of misuse have been grouped into drug categories in this bulletin, for ease of presentation and consistency with previous publications. Where a user reported misusing more than one drug in the same category (for example, diazepam and temazepam in the benzodiazepine category), the user has been counted once for this drug category when analysing all drugs misused. Main drug of misuse 3.3 Heroin was the most frequently reported main drug again, accounting for 67% of users. The percentage share has increased from 46% in the period ending September 1993. Conversely, the proportion reporting methadone as a main drug has decreased and was 8% in the period ending March 2001 (Tables 3a and 3b) 3.4 The proportion of GPs, police surgeons and Drug Dependency Units reporting users with methadone as a main drug (at 21%, 13% and 20% respectively) were higher than the figure of 8% for all users. This may have been due to methadone being prescribed for treatment and then being classed as a main drug; this may happen if the main problem drug is heroin, but heroin had not been used in the previous four weeks. The definition of a main problem drug has been changed following the introduction of the new National Drugs Treatment Monitoring System. (see paragraph 1.6) 3.5 The proportion reporting cannabis as a main drug was 9% in the latest period; cocaine use continued to increase and was reported as a main drug by 7% of users (up from 6% in the last reporting period). There has been a decrease in the proportion of users reported misusing amphetamines (from 4% to 3%) since the last reporting period. (Table 3a and figure 5) All drugs of misuse 3.6 Taking all drugs of misuse reported (in first episodes only) into account, heroin remains the drug category with the largest number of users. The proportion of users reported misusing heroin was 74% in the period ending March 2001. Around a quarter of users reported Figure 5 Users starting agency episodes for main drug of misuse by category in the period 1 October 2000 to 31 March 2001 Amphetamines 3% All Others 6% Cocaine 7% Methadone 8% Cannabis 9% Heroin 67% Statistical Bulletin 2002/07 February 2002 5

misusing cannabis (26%) and cocaine (24%). 3.7 Since the period ending September 1998 there has been an increase in the proportion of users reported misusing heroin (from 64% to 74%) and cocaine (18% to 24%). Conversely, there has been a decrease in the proportion of users reporting methadone (from 21% to 16%) (see paragraph 3.4) and amphetamines (from 16% to 6%). (Table 7a) Subsidiary drugs of misuse 3.8 Looking at all drugs of misuse by category, there were a total of 62,612 reports; note that where a user reported misusing more than one drug in a category, this is counted as one report of the category here. Subsidiary use accounted for around half (29,378 reports or 47%) of all the drugs used. 3.9 Within each drug category, the proportion of all drugs that are reported as subsidiary drugs varies widely. A total of 24,458 users reported misusing heroin, but only 8% of these heroin users (2,027) reported misusing it as a subsidiary drug. However, some drugs were more likely to be reported as a subsidiary drug than as a main drug. Drugs reported mostly as subsidiary drugs include benzodiazepines (89% of the total of 4,837 users), cannabis (66% of the 8,669 users), cocaine (70% of the 7,862 users) and ecstasy (75% of the 1,636 users). Alcohol is, by definition, a subsidiary drug of misuse. See Glossary of terms and data definitions in Annex A.5. (Table 8) Age and gender of users and their main drug of misuse 3.10 The pattern of drug misuse (in terms of main drug used) is similar for males and females. For example, the proportions of males and females reporting heroin as their main drug of misuse were 68% and 67% respectively (65% and 62% in the previous period). The proportion of males and females reporting cannabis as a main drug of misuse remains the same as in the previous period (10% and 6% respectively). (Table 4) 3.11 For some drugs of misuse, for example heroin, there was no clear pattern by age group. However, the use of methadone as a main drug increases with age; for example, 2% of those aged under 20 reported methadone as their main drug compared to 12% of those aged 30 and over (see also paragraph 3.4). Cannabis use was more likely to be reported by those aged under 20, compared to those aged 30 or over (28% and 6% respectively). The majority of solvent users recorded were aged under 20; the under 20s made up 66% of all who reported misusing solvents as their main drug. (Table 5) Drug routes 3.12 Drugs can be misused by a variety of routes, injecting being just one of them. The route recorded for each specific drug determines the classification of the user s injecting behaviour for the corresponding drug category. Users may report misusing more than one drug in the same drug category, but by different routes. Users are classified as "Injecting" for each drug category if they inject any drug in the category and others are classified with an injecting status of "Not known" if any drug route is unknown; the remaining users are classified as "Not injecting". 3.13 The proportion of users injecting their main drug of misuse, of those whose injecting status was known, was broadly unchanged across all drug categories from the previous period. Two-fifths (40%) of users reported injecting their main drug; 55% of heroin users and 41% of amphetamine users were recorded as injecting their main drug. Similarly, for all drugs of misuse, 54% and 39% of heroin and amphetamine users respectively reported injecting their drug. (Tables 6 and 7b) 4. Injecting and sharing behaviour 4.1 Data regarding a user's injecting behaviour are collected in two different ways. The route by which drugs are taken is recorded for each drug of misuse (up to a maximum of five). (See paragraphs 3.1 and 3.12 above.) Other questions are asked to identify user behaviour; has the user injected drugs in the last four weeks, and if so, did the user share injecting equipment in the last four weeks. Users are also asked if they have ever injected drugs and if so, if they have ever shared injecting equipment. 6 Statistical Bulletin 2002/07 February 2002

4.2 Of those whose injecting status was known, 65% of users had ever injected, whereas the corresponding figure for users injecting in the last four weeks was 43%. These are similar to the levels of the previous period. (Tables 9a and 9b) 4.3 Men were more likely to have injected in the last four weeks than women (45% compared to 38%); injecting was also less common among younger users under a third of users (28%) aged under 20 had injected in the last four weeks, compared to nearly half (45%) of those aged 30 and over. (Tables 9e and 9f) 4.4 The percentage of users who had ever shared injecting equipment, of those known to have injected and whose sharing status was known, was 49% compared to 42% in the six months ending September 1996; the equivalent figure for the last four weeks was 20%, compared with 12% in the six months ending September 1996. (Tables 9c and 9d) 4.5 Hunter and Stimson (1998), however, found that a range of detailed questions elicited higher reports of sharing than a single question. As the RDMD information is based on a single question, the RDMD results should be treated with caution; they are likely to underestimate the true rate of sharing compared with the result from Stimson s Injecting Risk Questionnaire (see Annex A.8). 4.6 Further analysis of drug misusers who had injected in the past four weeks indicates that women were more likely to have shared than men (24% compared to 18%), although it should be noted that women were less likely than men to have injected in the last four weeks. Younger users were more likely to have shared than older users (27% of those under 20 compared to 16% of those 30 and over), but again it should be noted that older users were more likely to have injected in the last four weeks. (Tables 9g and 9h) 4.7 This information on injecting and sharing should be treated with some caution since some users were recorded as having an injecting status of "Not known" ever (12%) and in the last four weeks (9%). Of those known to have injected, again some users reported their sharing status as "Not known" ever and in the last four weeks (16% and 12% respectively). (Tables 9a-9d) 5. Agency of treatment 5.1 Over half (51%) of the 35,131 new agency episodes reported were from statutory community based drug services (CBDS). Most others were from non-statutory CBDS (33%), outpatient drug dependency units and NHS funded general practices (5%) and (DDUs) (3%). As discussed earlier (paragraph 2.1 to 2.3), the changes over time may be due, in part, to changes in reporting practice. (Tables 10a and 10b) 6. Regional Office areas and Health Authorities of treatment and residence 6.1 Information by Regional Office (RO) area and Health Authority (HA) of treatment, that is, the HA in which the user presents and is treated, is given in Tables 11-15 and Maps 1 and 2. Tables 16a and 16b compare the HA of treatment with the user's HA of residence. Health Authority of treatment 6.2 Differences at HA of treatment level may be a reflection of the variations in demand for services or the pattern of provision, and not necessarily an indication of drug misuse in the local community. 6.3 Numbers of users at HA level are not comparable with published data up to the period ending March 1996 due to changes in the way in which data were collected and presented after this date (see Annex A.4). 6.4 The gender distribution characteristics displayed by the RO areas follow the pattern of at large, ie a 3:1 male to female ratio. More variation can be seen at HA level. (Table 11a) 6.5 Regional Office areas were restructured from 1 April 1999 and the tables in this bulletin are based on the new regional structure. 6.6 Rates for users per 100,000 population vary widely across the Health Authorities. Northern and Yorkshire RO area had the highest rate for users of all ages and the highest rates for users in Statistical Bulletin 2002/07 February 2002 7

8 Statistical Bulletin 2002/07 February 2002

all age bands under 30. London has the highest rates for users over 30. (see also Annex A.5.5 and tables 12a, 12b, 12c and Map 1). 6.7 Heroin was the most frequently reported main drug in all RO areas and most HAs. (Table 13) 6.8 The injecting and sharing statuses of users in the last four weeks varied across the RO areas. These figures on injecting and sharing need to be interpreted with care because some HAs of treatment had a relatively high proportion of users with no information recorded on injecting or sharing status in last 4 weeks. (Tables 14a, 14b and Map 2) Health Authority of residence 6.9 Information on HA of residence was collected by the Department of Health from the RDMDs for the first time for the period April to September 1996. This bulletin includes information on HA of residence in relation to HA of treatment. It should be noted that information on HA of residence was not available for 6% of users in the period ending March 2001 (Tables 16a and 16b). 6.10 The tables show the number and percentage of users who have the same HA of residence as HA of treatment (that is, users resident in their HA of treatment); same RO of residence as HA of treatment, but different HA of residence (that is users resident in the same RO area as their HA of treatment, but not the same HA); different RO of residence to HA of treatment (that is, users resident in a different RO area from that of their HA of treatment); HA of residence not known (that is, users where the HA of residence has not been recorded). 6.11 These tables show that the majority of users were treated in the HA in which they were resident. 6.12 There is still wide variation in the amount of data on HAs of residence that is missing and this must be borne in mind when interpreting the data in the tables. 7. Great Britain tables 7.1 Information for users treated in, Wales and Scotland is given in Annex D, Tables D1 to D8.s given in Annex C, Tables C1 to C8 7.2 Some caution is needed in interpreting these tables. Differences between, Wales and Scotland may reflect variations in demand for services or the pattern of provision. In addition, there may be variations in reporting practice. 8. Acknowledgements 8.1 The Department would like to thank all the people involved in collecting the data presented in this bulletin - the Database Managers and their staff, and of course, all the agencies who have collected and sent in their data. The success of these bulletins (and in future those based on the NDTMS) depends on the continued cooperation of all these people. 9. Editorial notes 9.1 Data were first collected centrally for the period ending 31 March 1993. However, these data are not directly comparable with later data. In this bulletin the data in the majority of the tables are given from the period ending 30 September 1993 and for the periods ending 30 September 1998 to 31 March 2001. The data for the periods ending 31 March 1994 to 31 March 1998 have already been published in previous bulletins in this series. Note that some comparisons between data for the periods ending September 1996 onwards, with earlier periods, are not valid - see Annex A.4.6 for further details. 9.2 For the purposes of clarity, figures in the bulletin are shown in accordance with the Department of Health's publication conventions. These are as follows:. not applicable.. not available - zero 0 less than 0.5 numbers greater than or equal to 0.5 are rounded to the nearest integer. Statistical Bulletin 2002/07 February 2002 9

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9.3 Percentages do not always add to 100 due to rounding. 9.4 Constructive comments on the content of this bulletin would be welcomed. Any comments or questions concerning the data contained in this publication, or requests for further information, should be addressed to: information about sources, publications and contact points on the full range of government statistics. This website may be found at http://www.statistics.gov.uk/ statbase/mainmenu.asp Patsy Bailey (Room 437B) Department of Health Skipton House 80 London Road London SE1 6LH Tel. 020 7972 5551 Fax. 020 7972 5662 e-mail patsy.bailey@doh.gsi.gov.uk 9.5 Further copies of this publication can be obtained from: Department of Health PO Box 777 London SE1 6XH Tel. 08701 555 455 Fax. 01623 724 524 9.6 A list of references is given at Annex A.8. 9.7 Information about the Department of Health s statistics and surveys is available on the Internet at www.doh.gov.uk/public/stats1.htm. The website includes a full list of the DH s drug misuse statistical publications. Many of the publications (including this one) are available for viewing on-line. 9.8 The Government Statistical Service also offers an Internet site called StatBase. Statbase has been set up to provide Statistical Bulletin 2002/07 February 2002 11

12 Statistical Bulletin 2002/07 February 2002

Annex A Information about the Regional Drug Misuse Databases Contents A.1. A.2. A.3. A.4. A.5. A.6. A.7. A.8. Background The origins of the collection of drug misuse data The Department of Health and the Regional Drug Misuse Databases Treatment of multiple episodes and comparability with previous bulletin Glossary of terms and data definitions National Drug Treatment Monitoring System Regional Centres Other Contacts References Statistical Bulletin 2002/07 February 2002 13

A.1 Background A.1.1 Before the development of the Regional Drug Misuse Databases very little information was held centrally regarding users of drug misuse services and the types of services used. Much of the difficulty in obtaining information lies with the illegal nature of drug misuse. Some data were available regarding hospital in-patients with drug related diagnoses. General Practitioners and other doctors provided the Home Office with details of patients who were addicted to drugs in accordance with the Misuse of Drugs Act 1971 (1973 Regulations); details were published annually in the Home Office Addicts Index until its closure in March 1997. The last publication was the Home Office Statistical Bulletin: Statistics of drug addicts notified to the Home Office, United Kingdom, 1996, published in October 1997. The data from the RDMDs/NDTMS are now the only routinely collected information about drug misuse services. A.1.2 The Department of Health collects drug misuse information from a range of drug treatment agencies. This information assists in the understanding of both national and local drug misuse problems. It is used for the planning and development of services, ensuring wherever possible that appropriate services are developed and that they respond effectively to changing trends in drug misuse. Data on injecting behaviour is particularly important because of its potential as a transmission route for HIV and hepatitis C. A.1.3 Drug users presenting to services for problem drug misuse only constitute a small proportion of all drug users. For a broader picture of patterns of drug misuse, surveys of selfreported drug use can be helpful, for example, the British Crime Survey (see Annex A.8). A.2 The origins of the collection of drug misuse data A.2.1 In 1982 the Advisory Council on the Misuse of Drugs (ACMD) published a report: "Treatment and Rehabilitation", which recommended that local drug teams be set up to collect information. Responding to this recommendation, the Department of Health issued circular HC(84)14 to the NHS requesting a review of the prevalence of drug misuse. In 1986 a drug misuse database was developed by the Drug Research Unit at the University of Manchester. In 1989 the Department commissioned the Unit to adapt the database for use by the NHS Regional Health Authorities (RHAs), and issued circular HC(89)30 requesting the RHAs to set up databases to monitor trends in drug misuse and the use of drug misuse services, and to introduce a system for providing this information to the Department by way of the KO71 Statistical Return. A.2.2 RHAs subsequently submitted one KO71 paper form for each of its District Health Authorities (DHAs) and Special Health Authorities (SHAs) within its geographical boundary, together with an overall KO71R form for the whole region with identifiable multiple counting of users across DHAs removed, biannually for each six month period 1 April to 30 September, and 1 October to 31 March respectively. The information provided on the forms comprised details of the relevant DHA, SHA or RHA of treatment; the numbers, by age and by sex, of users starting an agency episode, that is for the first time ever or for the first time after a gap of at least six months, during the period being monitored; the numbers of users by types of drugs being misused and whether these were being injected; and the numbers of episodes recorded at each type of drug misuse agency. Only data from face-to-face contacts where the initials, date of birth and sex were given (attributable data) were included. Data from certain agencies were excluded (probation services, social services, needle exchange schemes, outreach work and penal establishments) as the methods of collection utilised were not consistent. A.2.3 In July 1996 the Department issued an executive letter EL(96)54: Regional Drug Misuse Databases: Core Contract Specification, which sets out the current requirements of the extended national dataset. Beginning with the period 1 April to 30 September 1996 the Regional databases now submit anonymised details of individual users in electronic form. This includes age, sex and other personal information, details of up to five drugs misused, information regarding injecting/ 14 Statistical Bulletin 2002/07 February 2002

sharing equipment behaviour, treatment profiles, together with the type of agency attended and Health Authority (HA) of treatment. A.2.4 Some information was collected by the Department of Health from RDMDs for the first time for the period April to September 1996, but has not been included in this Statistical Bulletin. This includes ethnic group and employment status. There is a considerable amount of missing information, for example, details of ethnicity were missing for 13% of episodes. It was felt that analysis of these data might be misleading. It is hoped that the completeness of all data items collected by the Department of Health will improve over time and that further analyses will be included in future Statistical Bulletins. A.3 The Department of Health and Regional Drug Misuse Databases A.3.1 The Drug Misuse Database has changed little since its inception and development in the late 1980s. Information needs and the services have, however, changed substantially since that time and it was vital that changes be made to enable the Regional Drug Misuse Databases (RDMDs) to contribute to monitoring the Government's Drug Strategy. A.3.2 Although the data collected by the RDMDs were useful in identifying trends in drug misuse among people newly attending services, they gave no information on the numbers of drug users in treatment or the treatment received. Following a strategic review of the databases a new collection, the National Drug Treatment Monitoring System (NDTMS) was introduced in and Wales from 1 April 2001 (see Annex B). A.4 Treatment of multiple episodes and comparability with previous bulletin A.4.1 Only those people who present to a contributing drug agency for the first time ever, or for the first time after an interval of at least six months, providing attributable details including information concerning at least one drug of misuse (other than alcohol) are counted as users. (See Glossary of terms, at A.5.1, for definition of a User). A.4.2 An episode occurs each time a user presents to a particular agency for the first time, or returns to an agency after an interval of six months or more, and a report is made to the Regional Database. Every user must therefore have at least one episode and some may have several in one six month period (if they present to more than one agency within the same RDMD area in one six month period). A.4.3 During a reporting period users may commence several episodes, though not necessarily with the same HA, or even within the same Regional Office (RO) area. However, the way in which information about users with multiple episodes is treated in this Bulletin differs in some respects from the way in which data were collected and presented prior to March 1996. A.4.4 Up to March 1996, data were collected on an aggregate return, the KO71; this collected total numbers, rather than information about individuals. The KO71 was completed for each HA and recorded users and episodes; where a user had more than one episode starting in the HA, these episodes were linked to ensure that users were counted no more than once. A.4.5 At RDMD level an additional return, the KO71R was completed in which any counting of users more than once across the RDMD area was removed, since on the KO71R a user might have several episodes in the RDMD area, in one or more HAs. The totals for users were calculated by the Department of Health using the information from the KO71R returns, that is, they eliminated the counting of users more than once within each RDMD area (but not between RDMD areas). A.4.6 From April 1996 onwards, the RDMDs have supplied individual records to the Department of Health. Where a user has more than one episode in the RDMD area in a period, these episodes are linked when reported to DH as several episodes of one user. In Bulletins since the period April to September 1996, the analysis of users is based on the first (or only) episode of each user. Thus a user is counted at HA level, if and only if, their first episode was in that HA. A.4.7 Therefore, comparisons of users at HA level between the Statistical Bulletin 2002/07 February 2002 15

period April - September 1996 and later with previous bulletins are not valid; although comparisons of episodes at this level are. Comparison of numbers of users and episodes at RDMD level and with earlier data are valid. A.4.8 If an RO area consists of more than one RDMD, then despite users being counted only once within each RDMD, they may be counted more than once in the RO area because they are counted in each RDMD area. Thus the totals for RO areas are only true for those areas covered by one RDMD. In this bulletin, no attempt has been made to eliminate double counting across two RDMDs in the same RO area. A.5 Glossary of terms and data definitions A.5.1 User A person who experiences social, psychological, physical or legal problems related to intoxication and/or regular excessive consumption and/or dependence as a consequence of his/her own use of drugs or other chemical substances. A.5.2 Agency A separately identifiable facility which provides a service to drug misusers. In practice some organisations may have more than one kind of facility each offering a different kind of service for different stages of treatment. A new episode should be recorded for each such facility rather than just one for the parent organisation. For example, if a particular organisation runs a residential facility and a day care facility and a user attends both, both facilities should make a return to the database for that user when a new episode starts. This information should then be carried forward to the central return treating the two facilities as two separate agencies. A.5.3 Classification of agencies When deciding which agency type should be used to describe a new episode it is important to consider the service offered rather than the role of the worker who sees the client. For example, if a client sees his General Practitioner at his GP's surgery, this counts as a General Practice agency episode. If the client sees a GP, even the same GP, at a Community Drug Team this counts as a Community Based Drug Service episode. A.5.4 All agency episodes starting during the period should be counted for the HA in which the agency is located and against the appropriate agency type. A.5.5 Agency types to be included in submission to DH In general, all agencies which lie within the geographical boundary of the area covered by the RDMD, whether they are private, voluntary, local authority or other should be included. In the interests of achieving good quality local and national statistics only fully attributable data should be included, that is, data for clients whose initials (forename and surname), date of birth and sex have been recorded by the agencies. A.5.6 In the interests of achieving good quality data comparable across the country, some agency types listed should be excluded from the return to DH. Regions are, of course, free to collect data from these agencies on their own databases as long as the data can be filtered out when submitting the central return. A.5.7 The agency types to be excluded from the submission to DH are: Needle exchange schemes Outreach work (Outreach workers who are working in other areas where a report would normally be made should be included. Actual outreach work should be excluded.) Probation service Social Services Penal establishments (prisons and young offenders institutions) Telephone and letter contacts Third party contacts A.5.8 Up to the period ending September 1999, some RDMDs included in their submission to DH episodes relating to the work of specialist community agencies in prison. For the six month period ending March 2000 RDMDs were, for the first time, specifically asked to exclude episodes for users treated for drug misuse in prison from the data sent to DH. This change in reporting practice affects comparisons between the periods ending September 1999 and March 2000; it is estimated that the numbers of users increased by 8% in this period (though the reported increase was 4%). 16 Statistical Bulletin 2002/07 February 2002

A.5.9 Agency Episode An agency episode starts when a user goes to a particular agency for the first time, or returns to an agency after an interval of 6 months or more. Whenever a new episode starts, a report is made by the agency to the regional database. One user can have several concurrent episodes. A.5.10 Drug Any drug of misuse, including solvents and tranquillisers but excluding tobacco; alcohol as the sole drug of misuse should be excluded. Where alcohol is part of the drug profile it should be included but always as a subsidiary drug, that is, second or subsequent drug, not the main drug. Note that in bulletins prior to the period ending March 1999 a few misusers were recorded as "Drug free". These users were drug free when they presented to services and no information on previous drug misuse was recorded. In bulletins prior to period ending September 1996 such users were shown as "Not known". In this period information was obtained on previous drug misuse for all users. Non-mandatory fields may be left blank if the information is not available. A.5.12 Other information collected Information was also collected on the following: Ethnic group Employment status Referral from Dependent children (living with client, elsewhere, in care or unspecified residence) Living with relationship Whether drug of misuse prescribed How often taken Duration of episode Age of first use Intent on prescribing However, the data were not well supplied for all these fields. Where a large proportion of the data was missing, it was felt that any analysis upon this data would be misleading. A.5.11 Mandatory fields The following fields are mandatory; a valid code must be given, the fields must not be left blank: Database Number Episode Number Age Sex Drug Code (Main Drug only) Agency Type Agency HA Code Statistical Bulletin 2002/07 February 2002 17

A.6 National Drug Treatment Monitoring System Regional Centres (formerly Regional Drug Misuse Database) - Contacts A.6.1 Contact details for the Database Managers for the National Drug Treatment Monitoring System Regional Centres are given below. The Database Managers can provide further information for their own database on request. Northern & Yorkshire Duncan Easton Database Manager Leeds Addiction Unit 19 Springfield Mount Leeds LS2 9NG Tel: 0113 295 1337 Fax: 0113 295 1310 e-mail: duncanea@lau.co.uk Trent Ian Ball Manager National Drug Treatment Monitoring System-Trent Drury House 50 Leicester Road Narborough Leicester LE9 5DF Tel: 0116 225 6360 Fax: 0116 225 6370 e-mail: DruryHse@freenet.co.uk South East (West) and Eastern Bryony Brown Manager Drugs Treatment Monitoring Unit South East (W) and Eastern Public Health Resource Unit Institute of Health Sciences Old Road Headington Oxford OX3 7LF Tel: 01865 226 734 Fax: 01865 226 652 e-mail: drug.database@phru.anglox.nhs.uk Thames/ Southeast (East) Paul Eastwood National Drug Treatment Monitoring System-Thames/ Southeast (East) The Centre for Research on Drug & Health Behaviour Imperial College School of Medicine Reynolds Building Charing Cross Campus St Dunstan's Road London W6 8RP Tel: 020 7594 0811 Fax: 020 7594 0866 e-mail: p.eastwood@ic.ac.uk South West (including Wessex) Barbara Boulton Manager National Drug Treatment Monitoring System-South West Oakwood House Blackberry Hill Hospital Fishpond Bristol BS16 2EW Tel: 0117 918 6880 Fax: 0117 918 6883 e-mail: Barbara.Boulton@awp.nhs.uk West Midlands Jennie Lowdell National Drug Treatment Monitoring System - West Midlands 3 rd Floor, West House Lombard Street West West Bromwich West Midlands B70 8ER Tel: 0121 580 4331 Fax: 0121 525 7980 e-mail: dmdproj@hsrc.org.uk North West Mersey: Dr Caryl Beynon Public Health Sector School of Health and Human Sciences Liverpool John Moores University 70 Great Crosshall Street Liverpool L3 2AB Tel: 0151 231 4486 Fax: 0151 231 4320 e-mail: C.M.Beynon@livjm.ac.uk North Western: Helen Morey University of Manchester Drug Misuse Research Unit School of Epidemiology & Health Services Kenyon House Bury New Road Manchester M25 3BL Tel: 0161 772 3782 Fax: 0161 772 3445 e-mail: helen.a.morey@man.ac.uk 18 Statistical Bulletin 2002/07 February 2002

A.7 Other Contacts A.7.1 For statistical information for Scotland, please contact: Elaine Parry Scottish Drug Misuse Database Information & Statistics Division Trinity Park House South Trinity Road Edinburgh EH5 3SQ Tel: 0131 551 8715 Fax: 0131 551 1392 e-mail: elaine.parry@isd.csa.scot.nhs.uk http://www.drugmisuse.isdscotland.or g A.7.2 For statistical information for Wales, please contact: Wendy Mohammed National Assembly for Wales Substance Misuse Implementation Branch Cathays Park Cardiff CF10 3NQ Tel: 02920 825 720 Fax: 02920 825 473 e-mail: Wendy.Mohamed@Wales.gsi.gov.uk A.7.3 Northern Ireland set up a Drug Misuse Database in April 2000. Results are expected to be available for the six month period ending September 2001. For further information, please contact: Kieron Moore Information and Analysis Unit Department of Health Social Services and Public Safety Room 6, Annex 2 Castle Buildings Newtonards Road Belfast BT4 3UD Tel: 028 905 25577 e-mail: kieron.moore@ DHSSPSNI.gov.uk A.7.4 For statistical information about the Home Office Addicts Index, please contact: John Corkery Research & Statistics Directorate Home Office 50 Queen Anne's Gate London SW1E 9AT Tel: 020 7273 3266 e-mail: john.corkery@homeoffice.gsi.gov.uk Database system, please contact: Dr Michael Donmall University of Manchester Drug Misuse Research Unit School of Epidemiology & Health Services Kenyon House Bury New Road Manchester M25 3BL Tel: 0161 772 3782 Fax: 0161 772 3445 e-mail: m.donmall@man.ac.uk http://www.medicine.man.ac.uk/epide m/homepage.htm A.7.6 For information about the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), please contact: EMCDDA Rua da Cruz de Santa Apolonia 23/25 PI-1149-045 Lisbon Portugal Tel: 331 21 811 3000 Fax: 351 21 813 1711 e-mail: info@emcdda.org http://www.emcdda.org A.7.5 For information regarding the Drug Misuse Statistical Bulletin 2002/07 February 2002 19

A.8 References 1. Tackling Drugs to Build a Better Britain. The Government s 10-year Strategy for Tackling Drug Misuse. Cm 3945. London: The Stationery Office, 1998. (ISBN 0 10 1394527) 2. Tackling Drugs to Build a Better Britain UK Anti-Drugs Co-ordinator s National Plan 2000/2001. Cabinet Office 2000. 3. The United Kingdom Anti-drugs Co-ordinators Annual Report 2000/01. London: The Central Office of Information, 2001. Available on the internet at: http://www.homeoffice.gov.uk/dpas/ukadc2000-01.pdf 4. Statistics on young people and drug misuse: 1998. London: Department of Health, Statistical Bulletin 2000/18. Telephone 020 7972 5550. http://www.doh.gov.uk/public/sb0018.htm 5. Ramsay, M. & Percy, A. Drug Misuse Declared in 1994: latest results from the British Crime Survey. London: Home Office, 1996. (Home Office Research Study 151). Telephone 020 7273 3177 6. Ramsay, M. & Spiller, J. Drug Misuse Declared in 1996: latest results from the British Crime Survey. London: Home Office, 1997. (Home Office Research Study 172). Telephone 020 7273 3177 http://www.homeoffice.gov.uk/rds/pdfs/hors172.pdf 7. Ramsay, M. & Partridge, S. Drug Misuse Declared in 1998: latest results from the British Crime Survey. London: Home Office, 1999. (Home Office Research Study 1997). Telephone 020 7273 3177 http://www.homeoffice.gov.uk/rds/pdfs/hors197.pdf 8. Goddard, E. & Higgins, V. Smoking, drinking and drug use among young teenagers in 1998 Volume 1:. London: The Stationery Office, 1999. ISBN 0 11 621263 2 9. Drug use, smoking and drinking among young teenagers in 1999. London: The Stationery Office, November 2000. (ISBN 0 11 621398 1). Statistical press release on http://www.statistics.gov.uk/ssd/surveys/survey_smoking_drinking_drug_use_among_secondary school_children.asp 10. Statistics on Smoking, drinking and drug use among young people in in 2000 - The Stationery Office, November 2001. Tel: 0870 600 5522 http://www.doh.gov.uk/public/sddsurvey.htm 11. Drug misuse declared in 2000: results from the British Crime Survey. London: Home Office Research, Development and Statistics Directorate. http://www.homeoffice.gov.uk/rds/pdfs/hors224.pdf 12. Statistics from the regional drug misuse databases on drug misusers in treatment in, 2000/01 National Statistics, Department of Health. http://www.doh.gov.uk/public/sb0133.htm 13. Hunter, G. and Stimson, G. Survey of prevalence of sharing by injecting drug users not in contact with services. Imperial College School of Medicine, 1997. 14. Statistical Bulletin: Statistics of drug addicts notified to the Home Office, United Kingdom, 1996. London: Home Office, 1997. http://www.homeoffice.gov.uk/rds/pdfs/hosb2297.pdf 20 Statistical Bulletin 2002/07 February 2002

Annex B Future monitoring Contents B.1 The Government 's 10 year Strategy B.2 National Treatment Agency for Substance Misuse B.3 The National Drug Treatment Monitoring System Statistical Bulletin 2002/07 February 2002 21

22 Statistical Bulletin 2002/07 February 2002

B.1 The Government 's 10 year Strategy B.1.1 The Government s 10-Year Strategy Tackling drugs to build a better Britain was published in April 1998 and has four areas: Young People, Communities, Treatment and Availability. The data from the Regional Drug Misuse Databases (and in future from the National Drug Treatment Monitoring System) supports the treatment objective - to Increase participation of problem drug misusers, including prisoners, in drug treatment programmes which have a positive impact on health and crime. B.1.2 The UK Anti-Drugs Co-ordinator published a report for 2000/1 in 2001 - available on the internet at http://www.homeoffice.gov.uk/dpas/ukadc2000-01.pdf. The role of the UK Anti-Drugs Co-ordination Unit has now been taken on by the Home Office. B.1.3 The Drug Action Teams are the local "lead" organisation in ensuring the implementation of the National Drugs Strategy. The DATs are made up of chief executives or senior representatives, from a variety of organisations and professions (Health Authorities, Local Authorities, Police, Probation) who meet four to six times a year. B.2 National Treatment Agency for Substance Misuse B.2.1. The National Treatment Agency for Substance Misuse (NTA) has been created by the Government to improve the quality, availability, accessibility and effectiveness of drug treatment in. To achieve this purpose the NTA will perform two key roles: identifying best practice, and ensuring that this is implemented in ways which respond to the varying needs of the whole population. B.3 The National Drug Treatment Monitoring System B.3.1 The Drug Misuse Database has changed little since its inception and development in the late 1980s. Information needs and the services have, however, changed substantially since that time and it was vital that changes be made to enable the Regional Drug Misuse Databases to contribute to monitoring the Government's Drug Strategy. B.3.2 Although the data collected by the RDMDs were useful in identifying trends in drug misuse among people newly attending services, they gave no information on the numbers of drug users in treatment or the treatment received. Following a strategic review of the databases a new collection, the National Drug Treatment Monitoring System (NDTMS) was introduced from 1 April 2001. In brief, the key differences in the data to be received centrally from the NDTMS are: prevalence information on the numbers in treatment (not just people new to treatment) through reviewing the status of clients at 31 March of each year changes in data collection on each client (some increases, some reduction) focus on data for those entering structure care capacity for modules to collect data for specific areas of interest B.3.3 There are two types of forms for completion by drug treatment agencies, a client contact form and a client review form. Variations of these forms are available for residential agencies and General Practitioners (GPs). The client review forms will be completed on 31 March of each year for anyone in treatment during the year (starting at 31 March 2002). The data collected will include whether the client is still in treatment and if not, why not and information on the treatment received, for example, whether this was a prescribing treatment. B.3.4 A full software system will be developed for the NDTMS compliant with government standards for the exchange of electronic information. This will be consistent across all regional Statistical Bulletin 2002/07 February 2002 23

centres. The full software system will enable sophisticated analysis of data including linking client contact and review data. In the meantime, the NDTMS regional centres are using interim computer systems to store the data received from drug treatment agencies and GPs; these do not have full functionality but are being developed to make basic outputs available until the new system comes on line. 24 Statistical Bulletin 2002/07 February 2002