Drug Misue in Scotland: Policy, Prevalence, and Public Health
McKeganey, Neil, Journal of Drug Issues
The paper outlines the nature and extent of illegal drug use in Scotland The paper provides a detailed discussion of the impact of SV among injecting drug users in Scotland It is shown that although HIV remains a major public health concern within parts of Scotland, most notably in Edinburgh and Dundee, HIV infection remains low elsewhere within Scotland. Although concern in relation to HIV has receded in light of the continuing low prevalence, there has been growing concern over the marked increase in drug-related deaths among drug users within parts of Scotland. Within the policy sphere greater attention is now being given to topic of drug prevention and the impact of drug use on community well being.
This paper describes key features of the drug misuse scene within Scotland over the last few years. It discusses what is known about the extent and nature of drug misuse within Scotland, the extent of HIV infection and drug-related mortality among injecting drug users, and the evolving policy response, including the increasing importance being given to drug prevention.
The Nature and Extent of Drug Misuse in Scotland
There has never been a national drug misuse prevalence survey conducted within Scotland and there is nothing in Scotland equivalent to the Drug Abuse Warning Network or the Drug Use Forecasting system that monitor changes in drug-using behaviors within the United States. To develop a picture of the extent of drug misuse within Scotland it is necessary to combine a range of official data with the results of recent research, sane of which is national but most of which is specific to particular areas within Scotland. The picture produced by this process is incomplete in a number of key respects; especially because there is less information available on drug misuse within rural as opposed to urban areas within Scotland. In part this results from the fact that most drug misuse services within Scotland are concentrated within urban centers. However, it is also the case that most of the drug misuse research has focused upon a small number of urban areas, most notably Edinburgh, Glasgow, and more recently Dundee. It is not the case, however, that drug misuse is confined to such urban areas. The official data is also limited in relation to individuals using specific drugs (most notably heroin, cocaine, and methadone) who are in contact with one or more of a range of drug-misuse services. As a result we know less about those individuals whose drug use is either less problematic or who are using drugs for which relatively few services are currently available, such as those using Ecstasy. Information on the extent of addictive drug misuse in the United Kingdom was provided by the Home Office Addict Notification System (discontinuted on May 1, 1997). This system related only to individuals judged by medical practitioners to be addicted. The overwhelming majority of notifications relates to three drugs: heroin, methadone, and cocaine. In 1994 there were a total of 33,952 individuals noted in the Addict Index for the United Kingdom as a whole, of which 3,730 were from Scotland. The deficiencies of the Addict Notification System were well known in that not all medical practitioners provide details for patients whom they suspect or know to be addicted Similarly not all addicts presented themselves to medical services. As a result, the figure of 3,730 addicts is undoubtedly an underestimate of the true extent of drug dependence within Scotland. Somewhat more inclusive than the addict notification system are the various Regional Drug Misuse Databases that record details on individuals contacting a wide range of drug services within the United Kingdom. For the United Kingdom as a whole, in the 6-month period ending March 31,1994, there were a total of 17,864 individuals recorded on the database of which 6,359 were resident in Scotland. Both of these systems undoubtedly underestimate the true extent of problematic drug misuse within Scotland. …