International - United Kingdom

Basic Data

(Prevalence of Use, England and Wales)
"From the 2011/12 CSEW [Crime Survey for England and Wales]:
"• an estimated one in three adults (36.5%) had ever taken an illicit drug in their lifetime (around 12 million people);
"• 8.9 per cent had done so in the last year (nearly three million people); and
"• 5.2 per cent in the last month (an estimated 1.7 million people).
"Between the 1996 and 2011/12 surveys, last year use of any illicit drug fell (from 11.1% to 8.9%), due in large part to a notable decline in cannabis use (from 9.5% to 6.9%). Any last year drug use remains around the lowest level since measurement began; the last fall was seen between 2008/09 (10.1%) and 2009/10 (8.6%)."

(Prevalence of Use, Scotland) "The SCJS 2010/11 estimated that:
"• Just under one in four (23.7%) adults reported taking one or more illicit drug at some point in their lives (ever), even if it was a long time ago;
"• One in fifteen (6.6%) adults reported using one or more illicit drug in the last year, i.e. the 12 months prior to the survey interview;
"• One in twenty eight (3.5%) adults reported using one or more illicit drug in the last month, i.e. the month prior to the survey interview.
"Cannabis was by far the drug most commonly reported in any of the 3 time periods asked about with around one in seventeen (5.6%) adults reporting cannabis use in the last year. Cocaine and ecstasy were the next most commonly reported drugs used after cannabis in the last year (1.9% and 1.4% respectively)."

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

(Prevalence of Last-Year Drug Use, England and Wales) "In the 2011/12 survey, an estimated 8.9 per cent of adults had used an illicit drug in the last year; this remains around the lowest level since measurement began in 1996 (the last time there was a fall was between 2008/09 (10.1%) and 2009/10 (8.6%)).
"Among 16 to 59 year olds, 3.0 per cent had used a Class A drug in the last year, similar to the levels in the 2010/11 (3.0%) and 2009/10 (3.1%) surveys. The long-term trend in Class A drug use shows no statistically significant difference between 1996 (2.7%) and 2011/12 (3.0%); there was a gradual increase overall between 1996 and 2008/09 (from 2.7% to 3.7%) which has been tempered by a decrease between 2008/09 and 2009/10 (3.7% to 3.1%).
"As in previous years, the 2011/12 survey showed cannabis was the most commonly used type of drug in the last year (6.9% of adults), followed by powder cocaine (2.2%). Cannabis use remains around the lowest level since measurement began; after a rise between 1996 (9.5%) and 2002/03 (10.9%) there was a gradual decline for several years, but levels have steadied since 2009/10 (6.6%). Powder cocaine use has risen in the long term (0.6% in 1996) and in the 2011/12 survey was at a similar level to that in 2010/11 (2.1%)."

(Trends in Prevalence, Scotland) "Self-reported drug use among adults aged 16 or over in Scotland has decreased between 2008/09 and 2010/11. 6.6% of adults reported using drugs in the last year in 2010/11 compared with 7.2% in 2009/10 and 7.6% in 2008/09. Similarly 3.5% of adults reported using drugs in the last month in 2010/11 compared with 4.2% of adults in 2009/10 and 4.4% of adults in 2008/09. These decreases are statistically significant.
"Trends in self-reported drug use compared with England and Wales Fewer 16-59 year olds reported that they had taken any illicit drug at some point in their lives in Scotland than across England and Wales, while the percentages of adults taking any illicit drug in the last year or last month were similar."

(Last Year Drug Use by Drug Type, England and Wales) "As in previous years, in the 2011/12 survey cannabis was the most commonly used type of drug among adults in the last year (6.9%), followed by powder cocaine (2.2%) and ecstasy (1.4%).
"At 6.9 per cent the level of last year cannabis use remains around the lowest level since measurement began; the proportion is notably lower than in 1996 (9.5%). After a rise between 1996 (9.5%) and 2002/03 (10.9%) there was a gradual decline for several years, but levels have steadied since 2009/10 (6.6%).
"Conversely, levels of last year powder cocaine use have increased since 1996 (0.6%) with the sharpest increase occurring between 1996 and 2000 (2.0%) followed by a more gradual increase to 3.0 per cent in 2008/09. Most recently, levels of powder cocaine use were similar in the 2010/11 (2.1%) and 2011/12 (2.2%) surveys. Although there was a fall in last year powder cocaine usage between 2009/10 (2.4%) and 2010/11, levels in 2011/12 are now similar to those in 2009/10.
"Figures for last year use of ecstasy were the same in the 2011/12 and 2010/11 (1.4%) surveys but there has been a statistically significant decline in the long term from 1.8 per cent in 2000 (the comparison with 1996 (1.7%) was not statistically significant).
"The only statistically significant decrease seen between the 2010/11 and 2011/12 surveys was in last year use of amphetamines (from 1.1% to 0.8%). Amphetamine use has fallen markedly over the long term as well (from 3.2% in 1996) with the largest fall taking place between 1998 and 2000 (3.0% and 2.1% respectively)."

(Prevalence of Use Drugs Other Than Cannabis, Scotland) "Looking in more detail at self-reported drug use by composite drug group, i.e. classifying them by shared characteristics, Figure 2.2 shows that:
"• One in eight (12.5%) adults reported that they had taken stimulant drugs (cocaine, crack, crystal meth, ecstasy, amphetamines, poppers) at some point in their lives while 2.8% had taken at least one of these drugs in the last year and 1.2% in the last month;
"• Around one in thirteen (7.5%) adults reported use of psychedelic substances (including LSD, magic mushrooms or ketamine), at some point in their lives. Less than 1% of adults aged 16 or over reported using a drug from this composite drug group either in the last year or the last month (0.6% and 0.2% respectively);
"• Just under one in twenty one (4.6%) adults reported ever using downers or tranquilisers (temazepam or valium), with 1.1% having used either of these in the last year and 0.4% in the last month;
"• Use of opiates (heroin and methadone) was lower. 1.0% of adults reported taking either of these drugs at some point in their lives, and less than 0.5% had taken opiates either in the last year or the last month (0.3% and 0.2% respectively).¹³"

(Last-Year Prevalence of Youth Drug Use, England and Wales) "In the 2011/12 survey, 19.3 per cent of 16 to 24 year olds had used an illicit drug in the last year; this remains around the lowest level since measurement began in 1996 (the last time there was a statistically significant fall was between 2008/09 (22.6%) and 2009/10 (20.0%)).
"Last year Class A drug use among 16 to 24 year olds has fallen in the long term from 9.2 per cent in 1996 to 6.3 per cent in 2011/12 (similar to the 6.6% in 2010/11). The gradual decline is partly a result of falls in last year usage of ecstasy (from 6.6% to 3.3%) and hallucinogens (from 5.3% to 1.4%) which have been partially offset by an increase in powder cocaine use (from 1.3% to 4.2%).
"As in previous years, the 2011/12 survey showed cannabis was the most commonly used type of drug in the last year (15.7%), followed by powder cocaine (4.2%). In the long term cannabis use has fallen (from 26.0% in 1996 and 28.2% in 1998) and has now been stable at the lowest level since 2009/10. Conversely, levels of last year powder cocaine use have increased since 1996 (1.3%) but between 2009/10 (5.5%) and 2011/12 (4.2%) levels have fallen."

(Extent and Trends of Individual Drug Use, England and Wales) "As in previous years, in 2011/12 cannabis was the most commonly used type of drug among young people in the last year (15.7%), followed by powder cocaine (4.2%) and ecstasy (3.3%). There were no statistically significant changes in levels of last year use of any individual drugs between the 2010/11 and 2011/12 surveys.
"In the 2011/12 CSEW the level of last year cannabis use (15.7%) was not statistically significantly different to the 17.1 per cent estimated in 2010/11 or 16.1 per cent in 2009/10; thus levels remain at the lowest since measurement began in 1996. The proportion has fallen notably since 1996 (26.0%) but levels have been stable since 2009/10.
"Conversely, levels of last year powder cocaine use have increased since 1996 (1.3%) but between 2009/10 (5.5%) and 2011/12 (4.2%) there has been a statistically significant fall.
"Although figures for last year use of ecstasy were similar in the 2011/12 (3.3%) and 2010/11 (3.8%) surveys there has been a gradual decline in recent years, with usage being lower in 2011/12 than in 2008/09 (4.4%), continuing the long-term decline since 1996 (6.6%)."

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

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

(Prevalence Among Youth by Type of Drug, Scotland) "Cannabis was by far the most common drug – particularly among 15 year olds. Ten per cent of 15 year olds and 2% of 13 year olds reported that they had used cannabis in the last month. Very few pupils reported using any other drug.
"Due to increased awareness of ‘new’ substances and synthetic drugs, five drugs were added to the 2010 survey (mephedrone, BZP, ketamine, spice and ‘GBL or GBH’). All else being equal, we might expect this change to the questionnaire to increase prevalence rates (because in previous surveys not everyone would have included these drugs in the ‘other’ category). However, the results indicate that use of these drugs is not that common and, despite their inclusion, estimates of prevalence are stable among boys and decreasing among girls. This suggests that they are having little impact on overall levels of drug use."

(Prevalence of Crack Use in England) "Crack use is unusual among socially integrated cocaine users, and occurs mainly among marginalised and disadvantaged groups such as sex workers and problem opioid users. In Europe, it is largely an urban phenomenon (Connolly et al., 2008; Prinzleve et al., 2004), with signs of very low overall prevalence. In London, crack use is considered to be a major component of the city’s drugs problem. Regional crack cocaine estimates are only available for England, where there were an estimated 184 000 problem crack cocaine users in 2009/10, which corresponds to 5.4 (5.2–5.7) cases per 1 000 population aged 15–64. A majority of these crack users were also reported to be opioid users."

(Drug Offenses in the United Kingdom) In 2010/11, authorities in the United Kingdom recorded a total of 270,045 drug offences, of which 39,966 were for trafficking, 228,425 were for possession, and 1,384 were for other drug offences.
Of these, England and Wales accounted for 232,216 drug offences, of which 32,069 were for trafficking, 199,012 were for possession, and 1,135 were for other drug offences; Scotland accounted for 34,347 drug offences, of which 7,138 were for trafficking, 26,690 were for possession, and 249 were for other drug offences; Northern Ireland accounted for a 3,482 drug offences, of which 759 were for trafficking and 2,723 were for possession.

(Trends in Recorded Drug Crime) "Recorded drug crime decreased by three per cent in the United Kingdom between 2009/10 and 2010/11 with a larger decrease in trafficking offences (8%) than possession offences (2%) (Table 9.1). In Scotland, recorded drug offences decreased by 13% in the past year although illegal cultivation of drugs increased by 28% (n=964) (Scottish Government 2011c). There was a one per cent decrease in recorded drug crime in England and Wales between 2009/10 and 2010/11. As in previous years, over two-thirds (69%) of all recorded drug crime in England and Wales was for cannabis possession offences although the number of cannabis possession offences has decreased by one per cent since 2009/10 and by four per cent since 2008/09. The decrease in recorded drug offences since 2008/09 coincides with the end of the national target regime for police (Chaplin et al. 2011). The number of trafficking offences also decreased in England and Wales for the first time since 2004/05.
"In Northern Ireland, recorded drug crime increased by 11% from the previous year with a larger increase in trafficking offences (14%) than possession offences (10%). This continues the trend in year-on-year increases since 2006/07 (Table 9.1)."

(Convictions for Drug Offences) "There were 147,013 drug offences where the person was found guilty at court or cautioned in the United Kingdom during 2009 (ST11). The number has remained stable since 2008 after increases in the previous three years. For the first time since 2001 the number of cocaine powder convictions did not increase and, across all drugs, only cannabis convictions increased in 2009, by six per cent. Ecstasy offences continued to fall with the number in 2009 half of the number in 2007. While the number of heroin offences decreased by nine per cent in 2009, the level is still almost 40% higher than in 2000 (Table 9.3)."

(Convictions for Cannabis Offences) "The increase in cannabis convictions continues the pattern from the previous year when cannabis convictions increased for the first time since the introduction of the cannabis warning in 2004. In addition to the 66,598 offences dealt with through the court or by caution, 89,000 formal warnings for cannabis were issued in England and Wales in 2009, a 15% decrease on the previous year (n=105,000). This decrease is partly due to the introduction, in England and Wales during 2009, of penalty notices for disorder (PNDs) for cannabis possession as part of the three-stage escalation procedure.316 In 2009, 11,500 PNDs were issued for cannabis possession and the total number of cannabis offences dealt with by criminal justice agencies was 154,345, a two per cent decrease since 2008 following large increases since 2004. Figure 9.1 shows that, although there have been decreases since 2003 in cannabis possession offences dealt with by the court or with a caution, the total number of cannabis offences dealt with by all criminal justice agencies has doubled. This contrasts with the trend in cannabis use prevalence, which has been decreasing since 2004 (see section 2.2.2) but may be explained by the increased use of stop and search powers by the police over this period (see above)."

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

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

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

(Cannabis Cultivation Sites Identified)
"• The number of commercial cultivation of cannabis farms continues to rise although this increase has stabilised. A total of 7,865 were identified in 2011/12 compared to 6,866 in 2009/10, an increase of 15 per cent. A total of 7,660 cannabis farms were identified in 2010/11, 4,951 in 2008/09 whilst 3,032 were recorded in 2007/08.
"• Over the two year period forces seized a total of 1,096,797 plants. Based on the average street price of £134 per ounce this provides an estimated value of £207,368,447.
"• The size and scale of commercial cultivation sites are reducing. There is an emergence of the “multiple site” model whereby a large number of gardeners are employed to manage small scale factories across multiple residential areas. This spreads the risk and minimises the potential for detection and financial loss."

(Price of Heroin) "The purity-adjusted price of heroin had been relatively stable over the last three years after large decreases after the start of the war in Afghanistan in 2003. However, in 2010 purity-adjusted prices increased to €50 (£42), the highest level since 2004, which is wholly attributable to a decrease in purity (Table 10.8).
"Most areas of the United Kingdom reported heroin shortages from April 2010 onwards, experiencing low purity at street level and high wholesale prices (Figure 10.3). Data from SOCA [Serious and Organized Crime Agency] ENDORSE³⁴⁰ show that street purity fell from 46% in September 2009 to 32% in September 2010, with suppliers adding more cutting agents to maintain levels of profit. Annually between 18 and 23 tonnes of adulterated and unadulterated heroin is imported in order to supply the UK market. A consequence of this reported shortage has been an increase in wholesale prices; prior to late 2010 UK wholesale prices were commonly up to £19,000 per kilo, however since late 2010 these have increased, commonly up to £25,000 per kilo (personal communication – SOCA)."

(Purity-Adjusted Price of Cocaine) "Due to stable prices and an increase in average purity in 2010, the purity-adjusted price of cocaine powder (indexed to 2003) decreased from €113 (£101) to €101 (£86) (Table 10.7). As seen in Figure 10.2, purity has fallen at a faster rate than price, although the trend was downwards for both indicators until 2008. Since 2008, price has stagnated and despite an increase in purity during 2010, it has not increased enough to compensate for the large decrease in purity witnessed in 2009."

(Estimated Number of Problem Drug Users) "Combining the new estimates for England (Hay et al. 2011a) and Wales (Welsh Government 2011b) and the most recent estimates for Northern Ireland (Centre for Drug Misuse Research 2006) and Scotland (Hay et al. 2009) it is estimated that there are 379,262 problem drug users in the United Kingdom, a rate of 9.31 per thousand population aged 15 to 64 (Table 4.5).
"The latest available estimate for the number of injecting¹⁰⁶ PDUs (predominantly of opiates and crack cocaine) in the UK is 133,112, a rate of 3.27 per thousand population aged 15 to 64 (Table 4.6)."

(Prevalence of Problem Drug Use, Scotland)
"• The estimated number of individuals with problem drug use in Scotland in 2009/10, aged 15 to 64 years old, was 59,600 (95% CI = 58,300 - 61,000). This represents an increase in estimated numbers of over 4,000 (in 2006 there were estimated to be 55,300 individuals with problem drug use (95% CI = 54,500 – 57,200)) since 2006 (Table 1 and Table 7).
"• The prevalence rate of problem drug use in Scotland in 2009/10 amongst individuals aged between 15 and 64 years was estimated to be 1.71% (95% CI = 1.67% – 1.75%). This figure was estimated to be 1.62% (95% CI 1.59% - 1.67%) in 2006 (Table 1 and Table 7). Although the estimate of problem drug use prevalence was higher in 2009/10 compared to 2006, it cannot be said conclusively that actual prevalence has increased. However, we can be reasonably sure that actual problem drug use prevalence has not declined since 2006.
"• Around 71% of individuals aged between 15 and 64 years old with problem drug use in mainland Scotland in 2009/10 were male. The estimated prevalence rate of problem drug use for males was 2.49% compared to 1.00% for females (Table 2).
"• There are apparent decreases in the estimated prevalence rate in both the 15 to 24 and 25 to 34 year old age groups (from 1.75% in 2006 to 1.63% in 2009/10 for 15 to 24 year olds and from 3.90% in 2006 to 3.60% in 2009/10 for 25 to 34 year olds. However, for the 35 to 64 years old age group the estimated prevalence rate appears to have increased from 0.89% in 2006 to 1.18% in 2009/10 (Table 8)."

(Trends in Problem Drug Use, Scotland)
"• The estimated prevalence of problem drug use amongst 15 to 64 year olds in Scotland has increased from 1.62% (95% CI = 1.59% - 1.67%) in 2006 to 1.71% (95% CI = 1.67% - 1.75%) in 2009/10. Although the estimate of problem drug use prevalence was higher in 2009/10 compared to 2006, it cannot be said conclusively that actual prevalence has increased. This is due to the fact that the confidence limits shown are very close and do not take into account potential data and methodological differences between the years being compared. However, we can be reasonably sure that actual problem drug use prevalence has not declined since 2006 (Table 7).
"• Looking at the change between 2006 and 2009/10 by age group there are apparent decreases in the estimated prevalence rate in both the 15 to 24 and 25 to 34 year old age groups (from 1.75% in 2006 to 1.63% in 2009/10 for 15 to 24 year olds and from 3.90% in 2006 to 3.60% in 2009/10 for 25 to 34 year olds. However, for the 35 to 64 years old age group the estimated prevalence rate appears to have increased from 0.89% in 2006 to 1.18% in 2009/10 (Table 8). This pattern seems to be reflected in data sources such as Scottish Drug Misuse Database (SDMD), hospital discharges and drug related deaths which have seen increases in older age groups and decreases in younger age groups. The percentage of new patients/clients attending drug treatment services on the SDMD aged 35 and over increased from 30% in 2006/7 to 35% in 2009/10 (Drug Misuse Statistics Scotland 2010, Table A1.3). The number of known individuals with problem drug use in treatment in 2009/10 as a percentage of the estimated prevalence of problem drug misuse is virtually unchanged from 2006 at 42%."

(Prevalence of HIV Among Injection Drug Users) "The overall prevalence of HIV seen among IDUs in 2010 was similar to that seen in recent years, and remains higher than that found in the late 1990s. The Unlinked Anonymous Monitoring (UAM)161 survey of current and former IDUs in England and Wales indicated an overall HIV prevalence of 1.1% in 2010 (ST09). In 2010 the prevalence was 1.2% among men and 0.8% among women, with prevalence increasing with age from 0.6% among those aged under 25 years to 1.6% among those aged 35 years and over (ST09).
"The 2010 prevalence of HIV among the IDUs taking part in the UAM survey across England, Wales and Northern Ireland was 1.1%.162 Between 2000 and 2010, prevalence varied between 0.76% and 1.6% (HPA 2011a; HPA 2011b). In 2010, no HIV infections were detected in Wales (0%)163 or Northern Ireland (0%).164
"In England the HIV prevalence was 1.2%165 in 2010; this is significantly higher than in 2000 when the prevalence was 0.78%. HIV prevalence among the IDUs taking part in the survey in England was also significantly higher in 2005, 2008 and 2009 than in 2000 (HPA 2011b).
"There is also evidence of ongoing HIV transmission amongst IDUs within the UK, and that this might be higher than a decade ago. In particular, the HIV prevalence amongst recent initiates to injecting in England, Wales and Northern Ireland (i.e. those who first injected during the preceding three years) has been elevated since 2003. The prevalence among the recent initiates participating in the UAM Survey in 2010 was 0.5% compared with no infections found among this group in 2000 (HPA 2011a; HPA 2011b; Figure 6.1).
"In Scotland, the prevalence of HIV among IDUs is monitored through the surveillance of people undergoing voluntary confidential HIV testing. A HIV prevalence of 0.4% was found amongst IDUs undergoing testing in Scotland during 2009. This compares with a prevalence of 1.4% to 3.2% in the early to mid-1990s and 0.3% to 0.9% during the period 1998 to 2008 (HPA et al. 2011; ST09)."

(New HIV Diagnoses Associated with Injection Drug Use) "The number of new HIV diagnoses in the UK associated with exposure through injecting drug use has been low and relatively stable in recent years, averaging 161 reports each year from 2000 to 2009. Up to the end of June 2011, 141 new HIV diagnoses had been reported in this group for 2010 (43 in London, 18 in Scotland and 80 elsewhere in the UK; HPA et al. 2011)."

(Hepatitis C Prevalence and Injection Drug Use) "The prevalence of hepatitis C infection amongst IDUs remains high overall (HPA et al. 2010). In 2010, 48% of the (current and former) IDUs participating in the UAM Survey in England and Wales had antibodies to hepatitis C,166 which is similar to the level seen in recent years (ST09). However, this is higher than the level found in 2000 when prevalence was 38% (ST09). The prevalence in 2010 was 49% among men and 43% among women, and increased with age from 27% among those aged under 25 years to 60% among those aged 35 years and over (ST09).
"In 2010, the overall prevalence of antibodies to hepatitis C amongst the IDUs participating in the UAM Survey across England, Wales and Northern Ireland was 47%, this compares to 38% in 2000 (HPA 2011b). In England in 2010 the hepatitis C prevalence amongst the participants in the UAM survey was 49%, however, there were very marked regional variations from 28% in the West Midlands and 29% in the North East to 64% in London and 65% in the North West (HPA 2011b). The prevalence in Wales and Northern Ireland was lower than in many of the English regions; hepatitis C prevalence among the UAM survey participants in Wales was 26%, and in Northern Ireland it was 31% (HPA 2011a).
"The prevalence of antibodies to hepatitis C amongst recent initiates in England, Wales and Northern Ireland (those injecting for less than three years) has been elevated in recent years. In 2010, the prevalence amongst recent initiates participating in the UAM Survey from England, Wales and Northern Ireland was 23%, similar to that seen between 2001 and 2009 (HPA 2011b). However, the prevalence among this group remains higher than found was in 2000 and earlier years; it was 12% in 2000 (HPA 2011a; Figure 6.2)."

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

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

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

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

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

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

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

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

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

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

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

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

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

(Syringe/Needle Sharing) "The level of needle and syringe (direct) sharing reported by participants in the UAM Survey (see section 6.2.1) in England, Wales and Northern Ireland has declined from 31% in 2000 to 21% in 2010 (HPA 2011a; HPA 2011b). Direct sharing was reported by 21% of the participants in England (regional range: 12% to 31%), 20% of those in Wales, and 23% of those in Northern Ireland in 2010 (HPA 2011a).
"Sharing of any of the injecting equipment asked about in the UAM Survey (i.e. needles, syringes, mixing containers, water or filters; direct and indirect sharing) was reported by 40% of those participating in the survey in 2010. Sharing of any of this equipment was reported by 40% of the participants in England (regional range: 27% to 51%), by 41% in Wales, and by 39% in Northern Ireland in 2010 (HPA et al 2011).
"In Scotland, data from the Scottish Drug Misuse Database indicates that 18% of IDUs reported needle and syringe sharing in 2009/10 (HPA et al. 2011).
"The vast majority of participants in the UAM Survey from across England, Wales and Northern Ireland reported that they had used a needle or syringe exchange, with 91% reporting having ever done so in 2010 (HPA 2011a).

(Syringe Exchange Programs in Scotland) "A total of 269 Injecting Equipment Provision (IEP) outlets responded to the 2010/11 survey. This was an increase from 255 for the 2009/10 survey.
"Approximately 234,000 contacts were reported across IEP outlets in Scotland in 2010/11. This was a decrease of 11% from approximately 263,000 contacts in 2009/10.
"There are, however, a number of factors that are likely to have contributed to this drop in reported contacts. Amongst these are a reduction in the percentage of IEP outlets reporting that their service limits the number of needles/syringes distributed in a single transaction and an increased provision of supplies for the purposes of secondary distribution both in line with national guidelines.
"Where gender of the client was reported, 78% of contacts were made by males. A total of 4.51 million needles/syringes were reported to have been distributed in 2010/11. This was a decrease of 3.7% from 2009/10, when 4.68 million needles/syringes were distributed. NHS Greater Glasgow and Clyde reported the highest number of needles/syringes distributed (1.27 million).
"In terms of injecting paraphernalia distribution, there have been increases in, in particular, the numbers of filters and spoons reported to have been distributed by services from the 2008/09 to 2010/11 surveys. Whilst an increase in the number of services reporting this information goes some way to explaining the rise, the size of the increase points to an ’actual’ rise in the numbers of items distributed.
"The majority of IEP outlets have policies that follow the national guidelines for services providing injecting equipment in respect of both secondary distribution (96%) and the return of used needles/syringes (99%)."

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

(National Naloxone Program, Scotland) "The ‘take-home’ naloxone kits issued in the community may be issued to either: the person at risk of opioid overdose, to family/friends (with the recorded consent of the person at risk) or to a service worker. Figure 1.5 shows, for the total 2,730 kits issued in the community in Scotland in 2011/12, who received the kit. The majority of kits (2,370 or 87% of the total) were issued to persons at risk, 295 (11%) to a service worker, 60 (2%) to family/friends and <1% ‘unknown’ who distributed to (note: the latter will include cases where the recipient was recorded as ‘unknown’ as well as cases where recipient details were missing). Table 1.4 provides a quarterly breakdown of kits issued, by who distributed to (Scotland level in 2011/12), whilst table 1.5 shows the numbers at NHS board level for the whole year. The latter shows that for three of the 13 participating boards kits were distributed only to ‘persons at risk’."

(Provision of Naloxone to Prisoners on Release) "Naloxone is issued to prisoners only on release. Prison statistics show that in 2011/12 there were 19,792 liberations from Scottish prisons (Scottish Government, 2012 7). Combined with results from the 2010/11 Addiction Prevalence Testing in Scottish prisons, where opioids were detected in 36% of prisoners tested on reception (ISD Scotland, 2012⁸), this produces an estimate of 7,125 liberations in 2011/12 of prisoners using opioids on admission to custody. When compared with the 715 ‘take home’ naloxone kits issued by prisons in Scotland in 2011/12 as part of the National Naloxone Programme, this gives an estimate of approximately 100 kits issued per 1,000 such liberations, in 2011/12.
"2.2 Whom kits were issued to
"Whilst the ‘take home’ naloxone issued in the community may be issued to either: the person at risk of opioid overdose, to family/friends or to a service worker, all 715 kits issued by prisons in Scotland in 2011/12 were issued to ‘a person at risk’."

(Economics of Drug Policy) "Labelled public expenditure on drugs is about €1.3 billion (£1.1 billion) per annum. The economic and social costs of Class A drug use in England and Wales combined are estimated to have been around €22.2 billion (£15.4 billion) in 2003/04 (Gordon et al. 2006). Using a similar methodology, it is estimated that the economic and social costs of illicit drug use in Scotland was €5.1 billion (£3.5 billion) in 2006 (Casey et al. 2009)."

(Drug Control Spending, England) "Labelled public expenditure in England during 2010/11 was €1.1 billion (£971 million), a five per cent reduction on the previous year (Table 1.1). This reflects a decrease across all COFOG categories except for social protection. For general public services, the decrease is predominantly in overseas assistance and drug-related capacity building projects with a 23% reduction in funding for Afghanistan counter narcotics work. For public order and safety, there was a decrease of €16.5 million (£14 million) for the Drug Interventions Programme (DIP) and a €7.1 million (£6 million) increase in prison clinical services funding. The remaining difference is due to an inability to separate expenditure on drug supply reduction in prisons and regional support for substance misuse services in prisons from wider budgets during 2010/11. The reduction in total DIP funding is a result of several changes. Changes to the DIP Main Grant were due to a new funding model being introduced in 2010/11 and, in addition, the costs for Prolific and Priority offenders (PP0), integrated offender management and administration costs were removed from the overall DIP Programme budget. For health, the pooled treatment budget (PTB) remained stable but there was a reduction in funding for capital development of drug misuse services after large investment in the previous two years. The reduction in education spending was due to a large decrease in the FRANK budget borne out of a government-wide freeze on communications spend."

(Drug Control Spending, Wales) "The amount of labelled expenditure continued to increase in Wales with an 18% increase between 2009/10 and 2010/11 and a 68% increase since 2006/07. The majority of the increase came from Local Health Board allocations from their general health budget but there were also increases in the Substance Misuse Action Fund, which funds local Community Safety Partnerships (CSPs) and in the amount allocated for various policy initiatives (Table 1.3)."

(Drug Control Budget, Northern Ireland) "Labelled expenditure on drugs increased by nine per cent in 2010/11 to €10.8 million (£9.2 million). The majority of this increase was an increase in the amount allocated for implementation of the national strategy across Drug and Alcohol Co-ordination Teams (DACTs) from €5.8 million (£5.2 million) in 2009/10 to €7.6 million (£6.5 million) in 2010/11 (Table 1.2)."

Laws and Policies

(UK National Strategy) "A new drug strategy, Reducing Demand, Restricting Supply, Building Recovery was published by the Coalition Government in December 2010 (HM Government 2010a). The strategy emphasises recovery and supporting people to become drug free. It also aims to restrict supply by cracking down on internet sales, reducing supply in prisons, developing an approach to stop criminals profiting from the trade in cutting agents and strengthening international partnerships. Some of the key initiatives of the strategy are to:
"introduce a system of temporary bans on new psychoactive substances;
"pilot wing-based, abstinence focused, drug recovery services in prisons;
"pilot Payment by Results (PbR) schemes for drug recovery; and
"develop and evaluate alternative forms of treatment-based accommodation for offenders.
"For the first time, the strategy includes dependence on all drugs including prescription and over-the-counter drugs and, where appropriate, severe alcohol dependency."

(National Drug Control Strategy for England) "The United Kingdom Government is responsible for setting the overall strategy and for its delivery in the devolved administrations only in matters where it has reserved power (SQ32). A new drug strategy was launched in December 2010 (HM Government 2010a) replacing that of the previous Government, which was published in 2008 (HM Government 2008a). Within the strategy, policies concerning health, education, housing and social care are confined to England; those for policing and the criminal justice system cover England and Wales."

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

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

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

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

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

(National Naloxone Program, Scotland) "The aim of the National Naloxone Programme is to contribute to a reduction in fatal opioid overdoses in Scotland. The rate of drug related deaths in Scotland remains higher than the UK average (9.17 drug related deaths per 100,000 population in Scotland in 2010, compared with 3.1 in the UK1). An earlier investigation into drug related deaths in Scotland and more recent information from Scotland’s national drug related deaths database has shown that the majority of these deaths are opioid related, the majority are ‘accidental overdoses’, the majority are ‘witnessed’ and 50% have been in prison (Zador et al, 20052; Graham et al, 2011 and 2012 3 4). As well as monitoring the supply of ‘take-home’ naloxone kits in Scotland, ISD Scotland were tasked by the Scottish Government to measure the impact of increased naloxone availability on the number of (opioid) drug related deaths in Scotland and, in particular, to monitor the number and percentage of these occurring within four weeks of prison release."

(Diverting Offenders to Treatment) "The Ministry of Justice published its Green Paper, Breaking the cycle: Effective punishment, rehabilitation and sentencing of offenders in December 2010 (MOJ 2010c). It sets out the Government’s aims for more effective rehabilitation and sensible sentencing of offenders. It states that the MOJ will work with the Department of Health to divert more of the less serious offenders with drug dependency into treatment rather than prison. Proposed actions include:
"• reducing the availability of illicit drugs in prison and increasing the number of drug free environments;
"• introducing pilots for drug recovery wings in prisons;
"• working with the Department of Health and other government departments to support the design and running of pilots to pay providers by the results they deliver in getting offenders to recover from their drug dependency;
"• testing options for intensive community based treatment; and
"• learning the lessons from the approach to managing women offenders and applying them more broadly."

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

(Providing Naloxone to Prisoners at Risk of Opioid Overdose on Release) "SPS [Scottish Prison Service] developed an intervention to provide naloxone to prisoners at risk of opioid related overdose on release from prison, as part of the National Naloxone Programme, in recognition of the increased risk of overdose in the first four weeks following release from prison custody. The naloxone is packed in with their personal belongings, which are stored at reception, then supplied to the prisoner on release from custody.
"The supply of ‘take-home’ naloxone kits by prisons was introduced, incrementally, from February 2011 and by June 2011 all Scottish prisons were participating in the programme. Approximately 100 prison staff participated in training during the introduction and implementation phase (note: HMP Inverness, along with the Inverness area of NHS Highland, as noted earlier, commenced supply of ‘take home’ naloxone from July 2009)."

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

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

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

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