Title page
Contents
Acknowledgements 7
List of abbreviations 17
Technical Notes 21
Accompanying Tables 21
Cut-off for updates 21
Executive summary 22
1. Overview of illicit drug use in the United Kingdom 25
1.1. Introduction 25
1.2. Overall prevalence of drug use 25
1.3. Cannabis 29
1.4. Stimulants 33
1.5. Heroin and other opioids 42
1.6. New psychoactive substances 46
1.7. Other substances of interest 49
2. Drug policy 52
2.1. Introduction 52
2.2. Current national drug strategies and action plans 52
2.3. Themes in drug policy 55
2.4. Policy Evaluations 62
2.5. Drug-related public expenditure 64
2.6. New developments 65
3. Prevention 69
3.1. Introduction 69
3.2. The evolution of prevention approaches 69
3.3. Universal prevention 70
3.4. Environmental prevention 74
3.5. Selective prevention in at-risk groups and settings 80
3.6. Organisational structures and funding systems 85
3.7. New developments 87
4. Treatment 90
4.1. Introduction 90
4.2. Provision of drug treatment in the United Kingdom 90
4.3. Key treatment data for 2016 92
4.4. English treatment demand indicator trends 98
4.5. Treatment outcomes 106
4.6. Opioid substitution treatment 109
4.7. Guidelines for treatment 112
4.8. Quality standards 114
4.9. New developments 116
5. Drug users in prison and the broader criminal justice system 118
5.1. Introduction 118
5.2. Prison service overview 118
5.3. Drug use in the prison population 120
5.4. Drug-related problems among prisoners 126
5.5. Drug-related health responses 130
5.6. Guidelines and quality assurance of drug-related prison health responses 135
5.7. Co-ordination of drug-related prison health responses 136
5.8. Drug interventions in the broader criminal justice system 138
5.9. New developments 140
6. Drug-related deaths 144
6.1. Introduction 144
6.2. Main drug-related deaths data sources and definitions 144
6.3. Numbers of drug-related deaths 145
6.4. Profiling of drug-related deaths 145
6.5. Drug-related deaths by drugs reported 146
6.6. Trends in drug-related deaths 149
6.7. Complementary sources of data 159
6.8. Naloxone 160
6.9. New developments 162
7. Drug-related infectious diseases and other harms 165
7.1. Introduction 165
7.2. Blood-borne viral infections among people who inject psychoactive drugs 165
7.3. Blood-borne viral infections amongst people who inject image and performance enhancing drugs 169
7.4. Other drug-related infectious diseases 170
7.5. Infection-related risk behaviours 172
7.6. Prevention and control of drug-related infectious diseases: harm reduction services 175
7.7. Drug testing at events 180
7.8. New developments 181
8. Drug laws and offences 183
8.1. Introduction 183
8.2. Drugs legislation 183
8.3. Drug law offences 185
8.4. New developments 192
9. Drug markets 193
9.1. Introduction 193
9.2. Supply to and within the United Kingdom 193
9.3. Price and purity 196
9.4. Drug seizures 200
9.5. New developments 204
10. Bibliography 206
Table 1.1. Estimated number of problem drug users in Great Britain, and rate per 1,000 population aged 15 to 64, by country 29
Table 1.2. Estimated number of problem opioid users, and rate per 1,000 population aged 15 to 64 in England, 2004/05 to 2014/15 42
Table 1.3. Number of clients presenting to treatment for 'other' opioids in the United Kingdom, by country, 2016 45
Table 4.1. Percentage of clients presenting to treatment in the United Kingdom in 2016 citing injecting as their primary route of administration, those reporting that they are current injectors... 98
Table 4.2. Self-reported drug use by treatment outcome profiles at treatment start and six month review, and the percentage of abstinent clients at six month review, in England, 2016/17 108
Table 4.3. Self-reported drug use by treatment outcome profiles at treatment start and exit, and the percentage of abstinent clients at treatment exit in Wales, for clients referred to treatment... 108
Table 5.1. Proportion of prisoners self-reporting or testing positive for use of selected drugs prior to imprisonment, England & Wales and Scotland 121
Table 5.2. Proportion of prisoners self-reporting or testing positive for use of selected drugs during imprisonment, England & Wales and Scotland 122
Table 5.3. Incidents of drugs found in prisons in England and Wales, by weight, October 2015 to December 2016 124
Table 5.4. Seizures reported by the ten prisons participating in the North West 'Through the Gate Substance Misuse Services' Drug Testing Project 125
Table 5.5. Number of drug seizures made in Scottish prisons in 2010/11 to 2017/18 125
Table 5.6. Quantity of drugs seized in Scottish prisons subjected to presumptive testing, 2010/11 to 2017/18 126
Table 5.7. Number and rate per 1,000 prisoners of incidents where an inmate was disciplined for administering, or allowing to be administered, a controlled drug to oneself in Scottish prisons, 2012/13 to 2016/17 126
Table 6.1. Number of drug-related deaths in the United Kingdom occurring under the EMCDDA definition, by age and gender, 2015 146
Table 6.2. Number of drug-related deaths where the class of drugs involved were known, occurring under the EMCDDA definition, 2015 146
Table 8.1. Maximum penalties for drug possession, supply, intent to supply and production in the United Kingdom under the Misuse of Drugs Act 1971 and the Psychoactive Substances Act 2016 (PSA), by drug classification 186
Table 8.2. Out-of-court disposals issued for drug offences in England and Wales, 2009 to 2016 191
Table 8.3. Number and percentage of offenders receiving each disposal at court for drug offences recorded in England and Wales, by offence type, 2016 191
Table 8.4. Changes made to drug misuse legislation in 2017 192
Table 9.1. Common wholesale prices of selected drugs in the United Kingdom, 2016 197
Table 9.2. Common street-level prices of certain illicit drugs in the United Kingdom, 2007 to 2016 198
Table 9.3. Number of drug seizures made by police forces and Border Force in the United Kingdom, 2010/11 to 2015/16 201
Table 9.4. Quantity of individual drugs seized by police forces and Border Force in the United Kingdom, 2010/11 to 2015/16 202
Figure 1.1. Percentage of adult respondents to prevalence surveys across the United Kingdom reporting lifetime, last year or last month use of illicit drugs, by country, 2006/07 to 2016/17 26
Figure 1.2. Percentage of 15-year-olds reporting lifetime, last year and last month use of drugs in the Smoking, Drinking and Drug Use among Young People in England survey, 2001 to 2016, and the... 28
Figure 1.3. Percentage of adult respondents to prevalence surveys across the United Kingdom reporting last year use of cannabis, by country, 2006/07 to 2016/17 30
Figure 1.4. Proportion of 15-year-old pupils who reported having used cannabis in their lifetime and in the last year in England and Scotland, 2004 to 2016 31
Figure 1.5. Number of herbal cannabis and cannabis resin seizures made by police forces in England and Wales, 2000 to 2015/16 32
Figure 1.6. Proportion of the number of police cannabis seizures made up by cannabis resin, in England & Wales and Scotland, 2000/01 to 2015/16 32
Figure 1.7. Percentage of respondents to prevalence surveys in England & Wales and Scotland reporting last year use of all stimulants, powder cocaine, ecstasy and amphetamine, 2006/07 to 2016/17 34
Figure 1.8. Prevalence of last year cocaine use in England and Wales, by age group, 2006/07 to 2016/17 35
Figure 1.9. Proportion of all individuals and recent initiates that had injected drugs in the past four weeks participating in the Unlinked Anonymous Monitoring Survey in England, Wales and Northern... 37
Figure 1.10. Prevalence of last year ecstasy use in England and Wales, by age group, 2006/07 to 2016/17 39
Figure 3.1. Number of individuals aged under 18 entering treatment in England for cannabis use, and all young drug treatment entrants, 2005/06 to 2016/17 81
Figure 3.2. Number of individuals aged under 18 in treatment for the primary problematic use of certain Class A drugs or solvents, in England, 2005/06 to 2016/17 82
Figure 4.1. Proportion of clients presenting to treatment in the United Kingdom in 2016, by country and primary drug 93
Figure 4.2. Proportion of clients presenting to treatment in the United Kingdom in 2016 reporting primary or adjunctive use of crack cocaine, by country 94
Figure 4.3. Proportion of clients presenting to treatment in the United Kingdom in 2016 reporting primary or adjunctive use of benzodiazepines, by country 95
Figure 4.4. Proportion of clients presenting to treatment in the United Kingdom in 2016 citing primary use of certain substances, by age group 96
Figure 4.5. Proportion of all clients in treatment in England and Wales in 2016 citing primary use of certain substances, by age group 97
Figure 4.6. Number of clients presenting to treatment in the calendar year, and those recorded as being in treatment at the start of each calendar year, in England, 2005 to 2016 99
Figure 4.7. Total number of primary heroin clients in treatment, and number of clients presenting to treatment reporting primary heroin use, in England, 2005 to 2016 100
Figure 4.8. Total number of clients in treatment, and number of clients presenting to treatment, reporting primary cannabis, powder cocaine, crack cocaine and amphetamine use, in England, 2005 to 2016 101
Figure 4.9. Number of clients presenting to treatment in England within the calendar year, by selected primary drugs, 2005 to 2016 102
Figure 4.10. Proportion of all primary heroin clients in treatment in England in the calendar year, by age group, 2005 to 2016 103
Figure 4.11. Mean age of clients presenting to treatment for primary use of heroin or crack cocaine in England in the calendar year, by previous treatment status, 2005 to 2016 104
Figure 4.12. Proportion of all primary cannabis clients in treatment in England in the calendar year, by age group, 2005 to 2016 105
Figure 4.13. Proportion of primary heroin clients presenting to treatment in England within the calendar year reporting adjunctive use of crack cocaine or benzodiazepines, 2005 to 2016 106
Figure 4.14. Proportion of clients leaving treatment free from dependency in England, 2009/10 to 2016/17 107
Figure 4.15. Number of clients receiving prescribing treatment in England, 2005 to 2016 109
Figure 4.16. Number of clients receiving opioid substitution treatment in Wales, by treatment received, 2005 to 2016 110
Figure 4.17. Number of prescriptions for methadone and buprenorphine dispensed in England, 2004 to 2016 111
Figure 4.18. Price per milligram of buprenorphine prescribed in England, 2004 to 2016 112
Figure 5.1. Percentage of clients presenting to treatment in prisons and all other treatment centre types in England, Scotland and Northern Ireland in 2016, by primary drug (where recorded) 130
Figure 6.1. Number of drug-related deaths in the United Kingdom and England under the EMCDDA definition, occurring in 2004 to 2015 149
Figure 6.2. Number of drug-related deaths in Scotland, Wales and Northern Ireland under the EMCDDA definition, occurring in 2004 to 2015 150
Figure 6.3. Mortality rate (deaths per million population) for drug-related deaths occurring under the EMCDDA definition in the United Kingdom, England, Scotland, Wales and Northern Ireland, 2004 to 2015 151
Figure 6.4. Number of drug-related deaths where heroin/morphine or methadone were mentioned on the death certificate in England & Wales, or were implicated, or possibly contributed to the... 152
Figure 6.5. Number of drug-related deaths in Northern Ireland where heroin/morphine, methadone, tramadol, fentanyl or benzodiazepines were mentioned on the death certificate, or were... 153
Figure 6.6. Number of drug-related deaths where selected prescription medications susceptible to misuse were mentioned on the death certificate registered in England and Wales, 2000 to 2016 154
Figure 6.7. Number of drug-related deaths where selected prescription medications susceptible to misuse were implicated in, or contributed to, the cause of death registered in Scotland, 2000 to 2016 154
Figure 6.8. Number of drug-related deaths where amphetamine, MDMA and ecstasy-type drugs, GHB and mephedrone were mentioned on the death certificate registered in England and Wales, 2000 to 2016 155
Figure 6.9. Number of drug-related deaths where amphetamine, ecstasy-type substances and non-benzodiazepine-type new psychoactive substances were implicated in, or potentially contributed to... 156
Figure 6.10. Proportion of all drug-related deaths in the United Kingdom occurring under the EMCDDA definition, by age-group, 2004 to 2015 157
Figure 6.11. Number of drug-related deaths occurring under the EMCDDA definition in England and Scotland, by gender, 2004 to 2015 158
Figure 6.12. Mortality rate (deaths per million population) for drug-related deaths in England, Scotland, Wales and Northern Ireland occurring under the EMCDDA definition, by gender, 2004 to 2015 159
Figure 7.1. Prevalence of anti-HCV among all participants and recent initiates in the Unlinked Anonymous Monitoring survey in England, Wales and Northern Ireland, 2006 to 2016, and the Needle... 166
Figure 7.2. Prevalence of anti-HBc among all participants and recent initiates in the Unlinked Anonymous Monitoring survey in England, Wales and Northern Ireland, 2006 to 2016 167
Figure 7.3. Prevalence of antibodies to HIV among all participants and recent initiates in the Unlinked Anonymous Monitoring survey in England, Wales and Northern Ireland, 2006 to 2016, and in... 168
Figure 7.4. Prevalence of antibodies to HCV, HBc and HIV among all participants in the Unlinked Anonymous Monitoring survey in England, Wales and Northern Ireland, 2015, and the Unlinked... 170
Figure 7.5. Percentage of current injectors participating in the Unlinked Anonymous Monitoring survey reporting needle and syringe sharing in England, Wales and Northern Ireland, 2006 to 2016 173
Figure 7.6. Percentage of current injectors participating in the Unlinked Anonymous Monitoring survey in England, Wales and Northern Ireland that had injected crack cocaine, powder cocaine or... 174
Figure 7.7. Number of needles and syringes distributed in Scotland, by outlet type, 2007/08 to 2015/16 176
Figure 7.8. Percentage of participants reporting having ever undertaken voluntary confidential testing for hepatitis C or HIV in the Unlinked Anonymous Monitoring survey 2006 to 2016, and the... 178
Figure 7.9. Uptake of hepatitis B vaccination among participants in the Unlinked Anonymous Monitoring survey in England, Wales and Northern Ireland, 2006 to 2016, and the Needle Exchange... 179
Figure 8.1. Number of possession drug offences in the United Kingdom by drug, 2006 to 2015 188
Figure 8.2. Number of supply drug offences in the United Kingdom by drug type, 2006 to 2015 189
Figure 8.3. Proportion of possession and supply offences, by drug, recorded in England & Wales and Scotland, 2015 190
Figure 9.1. Mean user-level purity of selected drugs in England and Wales, 2003 to 2016 200
Figure 9.2. Proportion of the number and quantity of seizures made by police forces and Border Force in England and Wales, 2016/17 203
Figure 9.3. Selected drugs seized as a proportion of all police seizures in England & Wales, Scotland and Northern Ireland, 2015/16 204