David Shewan

Illicit Use of Ketamine in Scotland

Semistructured interviews were carried out with 20 illicit users of ketamine in Scotland. Participants had used a wide range of illegal drugs. Scottish drug agencies reported limited contact with ketamine users; however, subjects were knowledgeable regarding the licit purpose of ketamine, its effects, and its legal status. Ketamine was usually obtained through diversion from legitimate sources. Three participants reported extensive use, indicating the potential for psychological dependence. A standard dose of ketamine was typically 1/8 g, usually taken intranasally. Participants reported the ketamine experience as being extremely intense and dissociative, usually lasting for approximately one hour. All participants reported using ketamine in a carefully preplanned setting, emphasizing comfort, security, and familiarity. Participants identified potential problems arising from using ketamine in a public place, or in unfamiliar surroundings, and also suggested that novice users may encounter problems through lack of knowledge concerning the intense nature of the experience. Accurate information concerning the effects and nature of ketamine as well as the importance of set and setting should be made available. However, publicizing the drug should be avoided as widespread interest could cause greater problems than currently exist.

Prison as a Modifier of Drug Using Behaviour

This study was intended to investigate the nature and dynamics of drug using behaviour in Scottish prisons. Semi-structured interviews were carried out with a purposive sample of 234 prisoners in four major adult male prisons in Scotland. Of this sample, 73% had used cannabis during their current sentence, and 95% of these reported ongoing usage. There was little evidence to suggest that people started to inject in prison. Of this sample, 32% were injecting prior to imprisonment, and 11 % had done so during their current sentence. Of those who were injecting prior to imprisonment, 24% were sharing injecting equipment. Of those who were injecting in prison, 76% were sharing equipment. Factors most closely identified with current sharing of injecting equipment were: having injected a wider range of drugs in prison (during both current and previous sentences); frequency of Temgesic (Buprenorphine) use; being prescribed methadone in the community, then having that prescription discontinued on entry to prison....

Reducing the risks of drug use: The case for set and setting

The central proposition of this article is that if people are thoughtful, well-prepared and aware of the means and best environments for using a particular drug, then the risks associated with the use of a particular drug – any drug – can be minimal. The types of drugs discussed in this context focus on those assumed to be the most ‘addictive’ – heroin and cocaine – to those less well-known but potentially more hazardous to use without prior knowledge and preparation – such as Yage and Fly Agaric. This proposition is discussed in the context of different definitions of relatively non-problematic patterns of drug use, specifically: controlled, recreational and unobtrusive. It is concluded that while the effect of taking a particular drug is a primary motivation to the user, the role of set and setting are of fundamental importance in ensuring that the effects of that drug are as intended for and expected by the user.

Patterns of Heroin use among a Non-Treatment Sample in Glasgow (Scotland)

Semi-struclured interviews were carried out with 74 participants in Glasgow who had used opiates at least twenty times in the previous two years, who had never been in addiction treatment, and who had never served a custodial sentence. Typically, participants were experienced users of a range of non-opiate and of different opiates, with most describing heroin as their “main opiate of use”. Participants tended to have first used opiates at a relatively late age (mean 22.3 years), and a significant minority of the sample are relatively new users of opiates, with some indication that opiate use may be increasing among users of “dance drugs”. Heroin was rated as the most enjoyable opiate to take, and self-ratings of Severity of Dependence for light and moderate heroin users was low by comparison to clinical samples. Participants reported relatively few major drug-related health and social problems. Levels of criminal activity were higher than those reported in the Scottish Crime Survey general population, but...

Fatal Drug Overdose After Liberation From Prison: A Retrospective Study of Female Ex-Prisoners from Strathclyde Region (Scotland)

Aims: this study investigated the role of recent liberation from prison as a contributor to the high level of drug overdose deaths in Strathclyde (Scotland), possibly due to reduced tolerance to opiates. Design and participants: data on all imprisoned female drug users previously resident in Strathclyde were collected from admissions/liberations and medical records of Scotlands only female prison for the time period of October 1993 until September 1995. Records were matched by name and date of birth to the drug death records for Strathclyde. Results: of liberated ex-prisoners, 331/690 (48%) were recorded as known drug users. There were 14 sudden and unexpected deaths matched in the Strathclyde death records. Of these, ten (10/14) were recorded as fatal drug overdoses, which represents approximately 28% of the number of female fatal drug overdoses in Strathclyde over the sample period. Three of ten fatal overdoses occurred within 38 days of liberation, the remainder at least 147 days after liberation (mean 147.3 days, range 15-347 days). There were no significant differences in the drug using, sociodemographic or imprisonment characteristics of dead and surviving known drug users. HIV/AIDS prevalence was low among this sample and was not a contributory factor in the recorded deaths. Morphine/heroin, Temazepam, benzodiazepines and alcohol were in the bodies of the fatal drug overdoses. Conclusions: It was estimated that from one quarter to one third of female drug fatalities in Strathclyde each year the person had been in prison within the previous year. However, the hypothesis that after liberation, individuals typically soon relapse to heroin use and fatally overdose due to reduced tolerance was not supported. Nonetheless, the deaths represent 1.5% of the overall numbers of female Strathclyde prisoners liberated and is an issue which needs to addressed. It is possible that after liberation relapse more often occurs after some months of abstinence or moderation, which then risks fatal overdose. Closer follow-up of liberated drug users is required.

Patterns of injecting and sharing in a Scottish prison.

Although the potential for prisons to act as the setting for HIV transmission has been recognised, there is an enduring lack of knowledge in this area. Data are presented on patterns of injecting and sharing in Edinburgh prison (Scotland), 1993-1994. There was a relatively low level of injecting in Edinburgh prison during this period, with 13% (8/60) of a sample of drug users having injected at some point during their current sentence. The majority (6/8) of those who had injected had shared injecting equipment. Where sharing took place, the level of HIV risk was variable, but would have been higher had cleaning fluids not been available within the prison, or had they not been used by sharers. The implications of this study for drug service provision in prisons is discussed.

A Qualitative Exploration of the Impact of Cultural and Social Factors on Heroin Use in Shetland (Scotland)

Abstract In order to gain a greater understanding of the impact of social and cultural factors on patterns of heroin use and use-related behaviors, in-depth interviews were carried out with 12 heroin users in Shetland. Analysis revealed the existence of a small, highly organized and highly covert heroin subculture. Within this group, users were predominantly older, and their use was reported as being relatively self-controlled and unproblematic in nature, especially by comparison to the heroin use associated with deprived urban areas. There were indicators, however, that this situation seemed to have entered a phase of change, reflected by descriptions of an increasing number of younger, less controlled heroin users. Within the theoretical framework of drug, set and setting, the importance of drug-using norms and rules among heroin users in both regulating and maintaining patterns of use, even through periods of change, was identified. Shetland, with its relative affluence, small size and geographical isolation constitutes an unusual setting for research into heroin use, which customarily has been viewed as an urban phenomenon. Thus it offers the opportunity to gain insight into the nature of heroin use and associated behaviors from a relatively novel perspective.

Injecting risk behaviour among recently released prisoners in Edinburgh: The impact of in-prison and community drug treatment services

Purpose. Research in the area of injecting risk behaviour among drug users in prison is increasing; this paper attempts to rectify the paucity of research on risk behaviour of prisoners after release. This study also assesses the impact of both in-prison and community drug services on injecting risk behaviour after release. Methods. This longitudinal study looked at the risk behaviour of a cohort of ex-prisoners in Edinburgh, Scotland. Two follow-up interviews were carried out after release from prison, involving 56 and 40 participants respectively. This study built on an in-prison evaluation of a drug reduction programme, and sufficient numbers were recruited to compare an intervention and a control group. Results. There was some evidence of an initial flurry of injecting risk behaviour among participants soon after release, with a minority reporting injecting after release from prison, but over time patterns of injecting were variable. There was a low incidence of sharing injecting equipment. Generally, and perhaps contrary to expectation, post-release risk behaviour among the present sample was relatively low. Neither community-based nor in-prison drug treatment programmes were found to have a major effect on patterns of drug use. Conclusions. Caution should be observed when generalizing from the data obtained in this study. That said, focusing specifically on the period after release as a situational factor in increased injecting risk among drug users has indicated that more enduring local factors may be just as influential on levels of risk behaviour. Contact with neither in-prison nor community drug services was predictive of lower risk behaviour.

Long-Term Heavy Cannabis Use: Implications for Health Education.

There is growing evidence that cannabis can have negative effects on health. While the ongoing debate about the nature and duration of these effects recognizes mild cognitive impairment, the evidence for irreversibility of cognitive impairment and causal links with psychiatric illness is not conclusive. There is undoubtedly potential for impairment of respiratory functioning, but that will depend on lifetime load and in most cases is confounded with tobacco smoking. There is a lack of data that addresses the long-term cannabis users perspective. How do long-term cannabis users perceive the impact of their cannabis use on their own lives and what are the policy implications of their experience and perceptions of cannabis use? A recent study of long-term cannabis users explored a number of issues that have relevance for policy in relation to health education interventions. Quantitative data gathered from 405 long-term cannabis users provide insights into the impact of different levels of cannabis use over ten or more years on a range of issues: health; dependence; cannabis-related beliefs and attitudes; and preferred sources of cannabis-related information. Implications and the need for innovative approaches to cannabis-related health education are discussed.

What Affects Reintegration of Female Drug Users After Prison Release? Results of a European Follow-Up Study

The main objective of this follow-up study is to explore factors influencing the success or failure of women in reintegrating after their release from prison. Female drug users in five European cities were tracked after being released from prison. Out of 234 female prisoners contacted in prisons, 59 were included in the follow-up study. Structured questionnaires were given out and statistical group comparisons were conducted. The authors found that receiving preparation for release significantly supports a successful reintegration. On the other hand, living with a current drug user and initiating regular heroin use at an early age of less than 18 years are major barriers to successful reintegration.