Scottish Government

SCOTTISH ADVISORY COMMITTEE ON DRUG MISUSE: Psychostimulant Working Group Report

CHAPTER 3: THE EXTENT OF THE PROBLEM

3.1 In England there is clear evidence from survey and drug treatment data of an increase in the use of cocaine in the second half of the 1990s. The British Crime Survey (BCS) found that the proportion of young people aged 16-29 years reporting recent cocaine use in the last 12 months rose from 1% to 5% between 1996 and 2000. In the same time period there was a small fall in reported use of amphetamine. The proportion of new referrals to English drug treatment services reporting any cocaine use also rose from 7% to 24% between 1998 and 2001, while the proportion reporting cocaine as their main drug of use rose from 3% to 8%.

3.2 Information about the use of psychostimulants in Scotland comes from a variety of sources including:

• population surveys of self-reported drug use;

• drug seizures data from police and customs;

• drug treatment data from the drug misuse databases.

Trends in the Scottish data are less marked and less consistent than in the English data but used in combination the different data sources available allow conclusions to be drawn both about the scale of use and the profile of cocaine users in Scotland.

Survey data

3.3 The Scottish Crime Survey (SCS) found that cocaine use in the last 12 months amongst 16-29 year olds fell slightly from 2.9% in 1996 to 2.5% in 2000. In the 2000 SCS recent cocaine use was most common amongst men and women aged 20 to 24 years with 5.4% and 3.8% respectively reporting use in the last 12 months. Interestingly while lifetime use of cocaine was more common amongst men, levels of recent use were similar in men and women across all age groups. Between 1996 and 2000 use of amphetamine amongst 16 to 29 year olds fell sharply from 9.2% to 2.8%. The fall in amphetamine use amongst young adults was also evident in data from the Health Education Population Survey (HEPS), a survey commissioned by the Health Education Board for Scotland (HEBS). However, the HEPS survey found that recent use of cocaine amongst respondents aged 16-34 years increased from 0.9% to 4.1% between 1996 and 2001. The smaller sample size used in the HEPS survey suggests that we should be cautious about drawing firm conclusions from these data, nevertheless the findings are consistent with a marked increase in cocaine seizures reported by police forces in Scotland

Drug seizure data

3.4 Between 1997 and 2001 cocaine seizures in Scotland rose from less than 0.25kgs to 25kgs. The sharp increase suggests [that this reflects] a real increase in the availability of cocaine in Scotland rather than changes in police operational policy. There have also been a small number of seizures of 'crack cocaine'.

3.5 Cocaine seizures in Strathclyde account for a large proportion of the total seizures for Scotland as a whole. Significant quantities of cocaine have also been seized in Lothian & Borders, Fife and Grampian police force areas (Annex A). In contrast seizures of amphetamine have decreased across Scotland, particularly since 2000. For example, amphetamine seizures by Lothian and Borders police fell by 81% in 2001 and in some areas it is believed that supplies of amphetamine are now being replaced by cocaine.

3.6 Available intelligence indicates that Liverpool, London, the West Midlands and direct importation from overseas are major routes of cocaine into Scotland. The primary means for exporting cocaine from South America to Europe is by sea and it is estimated that between 25 and 40 tonnes are imported into the UK per year via this route. Cocaine hydrochloride is the primary form in which cocaine is imported and it is believed that the majority of crack cocaine in Scotland is prepared in the UK from imported cocaine hydrochloride. The amount of cocaine smuggled by air, particularly from Jamaica, to the UK by drug couriers has increased since September 2001.

Scottish Drug Misuse Database data

3.7 The increase in availability of cocaine is reflected in the numbers of new referrals to the Scottish Drug Misuse Database (SDMD) who mention cocaine use (including crack cocaine). The proportion of individuals reporting any use of cocaine has risen steadily from 2% in 1996/97 to 5% in 2000/01. However, the proportion reporting cocaine as their main drug reached only 1% in 2000/01. At present the number of individuals who seek help because of cocaine use is extremely small. It should be borne in mind of course that drug treatment services have been set up almost exclusively to cater for opiate users who have quite different profiles and service needs.

3.8 From the 2000/01 SDMD data it can be seen that the demographic profile of drug users reporting cocaine use alone is markedly different from those who are also using opiates either as a primary or secondary drug. The cocaine only group were more likely to be employed and to be living with a partner than cocaine users who also used other drugs. As a group, with the exception of one case, they were all male.

3.9 The SDMD data also suggest marked geographical variation in the extent of use of both cocaine and crack cocaine. The following table gives a more detailed breakdown of SDMD data by area between 1996 and 2001.

New Referrals to Drug Treatment Services with Mention of Use of Cocaine or 'Crack' Cocaine

3.10 The level of use of 'crack' cocaine in Aberdeen and the surrounding area is particularly high. Police intelligence suggests that this reflects an established crack cocaine market in the area. Police intelligence also suggests that prostitutes from Wolverhampton in the West Midlands have established themselves in Aberdeen and may have stimulated demand. In Edinburgh, prostitutes have been known to sell crack cocaine to heroin addicts. There has been no significant incidence of crack cocaine in the 'red light' district of Glasgow. That may be because local crack users buy cocaine hydrochloride and self-manufacture crack. This is the preferred method in the north of the city. (See unpublished report The Impact of Cocaine and Crack Cocaine Use in Scotland - Strategic Assessment by Scottish Drug Enforcement Agency and the national Criminal Intelligence Service, page 16).

Additional Information

3.11 There are other sources of information that provide a more up to date picture of the use of psychostimulants than is available from routine monitoring data. However, some provide only anecdotal evidence and therefore should be interpreted with caution.

3.12 Preliminary results from the Drug Outcome Research In Scotland (DORIS) study point to a relatively large minority of treatment-seeking drug users using either crack or cocaine in the previous 3 months. However, this group considered their crack or cocaine use as less problematic than their other drug use (predominately opiates). It should be noted that these are early results from this study and may not be based on a representative sample.

3.13 In a short survey of needle exchange attenders in Aberdeen, 62 out of 337 (18%) reported using stimulants. The majority of these clients were males aged 25-30 and used crack regularly - most by smoking though about a quarter injected. Heroin was the primary drug of use amongst those surveyed.

3.14 The Conference of Cocaine and Crack (COCA) is a national organisation that supports agencies which work with people with crack and cocaine addiction. COCA Scotland provided the Working Group with anecdotal evidence of the pattern of stimulant use across Scotland. In the north, agencies reported that cocaine use had increased in recent months. Speed/snowball injecting was reported to be common in both Aberdeen and Inverness. COCA Scotland report some doubt about the "Wolverhampton connection" with Aberdeen. In the East, agencies reported that cocaine has been present for some years. More crack is now being seen. This is mainly produced by the ammonia wash method as extraction with sodium bicarbonate is considered to be wasteful. Smoking is more common than injecting. In the Borders, there is a history of amphetamine use. There are no reports of cocaine or crack being available in any quantity. What is available appears to originate from Edinburgh or Glasgow.

3.15 Figures from ISD for Glasgow and West of Scotland show a rise between 1996 and 2001 in the numbers using:

• cocaine as the main drug from 20 to 63

• crack as the main drug from 3 to 4

• any use of cocaine from 62 to 257

• any use of crack from 7 to 32.

3.16 Because ISD statistics are for new presentations to services (or re referrals after an interval of six months or more), local addiction service workers in Glasgow, East Renfrewshire and Renfrewshire were contacted to ascertain a broader picture of the levels of use among existing service users. Across the area workers reported a significant increase in crack use among known opiate using clients. The crack use was generally recreational or occasional and was not seen as problematic by the clients. Workers estimated that 20% to 40% of their existing client caseload were reporting crack use. There were some differences in the profile of users between areas.

• Barrhead - mainly young males purchasing crack rocks at 15-20 to smoke.

• Paisley - widespread use across age groups, higher levels of use among sex workers and mostly home produced crack (cocaine hydrochloride @ 40 per gram). Some freebase use, always home made. No reports of intravenous use.

• Renfrew - widespread across age groups, high levels of use among sex workers and more often purchased as rocks. Some intravenous use as 'snowballs'.

• North Glasgow - mainly crack bought as rocks, mainly smoked.

• East Glasgow - very widespread use, home made and ready rocked, (40 per gram cocaine, 10-15 per rock) IV 'snowballing' fairly common. More freebase than elsewhere.

• South Glasgow - as for North Glasgow, very occasional intravenous use.

• West Glasgow - as for South Glasgow.

3.17 The above evidence is of course anecdotal, however workers are consistently reporting increasing numbers of recreational crack users. These figures will not be recorded by ISD as they are from existing service users. The introduction of re-reporting may overcome this problem for those stimulant users already in touch with opiate-based services. The introduction of re-reporting may overcome this problem for those stimulant clients already in touch with opiate based services. Workers stated that although clients often report crack use when directly asked, they often failed to mention it during a general enquiry because it is not perceived as problematic. Presentations at dual diagnosis clinics were also increasingly reporting crack and cocaine use. The Glasgow Drugs Court Team treatment providers, Glasgow Drug Problem Service (GDPS), routinely screen urine samples for cocaine - over 50% are positive. A more in-depth mapping exercise of cocaine and crack use in Scotland is about to be undertaken by COCA. We await the results with interest.

3.18 The cross-national ERIT survey on psychostimulant use aimed to assess the current national situation and any changes in psychostimulant use. Three extensive questionnaires were circulated to key practitioners and policy makers in six European countries. The recipients of the questionnaires were asked to include the views of users in their responses. Fifteen organisations in Scotland were contacted including Drugs Action Aberdeen, Glasgow City Council, and CREW 2000 in Edinburgh. In addition the ERIT researcher visited Scotland and interviewed representatives on the Scottish Executive, Scottish Drugs Forum, Greater Glasgow NHS Board and Strathclyde Police.

3.19 Apart from identifying a widespread use of ecstasy and a few pockets of amphetamine use, the ERIT study appeared to demonstrate that the use of other psychostimulants such as crack and cocaine is at a low but emerging level in Scotland. This finding was in sharp contrast to the findings from the other participating countries where there is already widespread use of both crack and cocaine. Although the ERIT study provided evidence of low crack and cocaine use in Scotland, there was some indication of an increase in use in the previous twelve months and some evidence that crack/cocaine was being used by primary opiate users to aid functioning and conversely that ecstasy users may be using opiates such as heroin to come down from a "high". In addition the ERIT study found that both local and national strategies in Scotland were focused on opiate use, service provision was predominately targeted at opiate users and stimulant users felt marginalised and reluctant to access existing services.

Conclusion

3.20 In combination, the available monitoring data from population surveys, drug treatment and drug seizure data provide some evidence of an increase in the use of cocaine and 'crack cocaine' in Scotland over the last five years. Concurrent with this there appears to have been a decline both in the availability and recent use of amphetamine. Nevertheless, in comparison with England the level of use of cocaine both in general and drug treatment populations appears to be lower. More recent anecdotal and provisional data from a number of surveys provide further supporting evidence of an emerging problem with cocaine and 'crack cocaine'. If the availability of cocaine continues to increase then it is anticipated that the number of Scots in need of drug treatment for cocaine dependence will also increase sharply.