Neil Hunt

5-Year Trends in Use of Hallucinogens and Other Adjunct Drugs among UK Dance Drug Users

Aims: To describe and assess trends in the use of hallucinogens and other adjunct drugs over a 5-year period. Design: Repeated-measures cross-sectional survey. Setting and Participants: Annual magazine-based survey targeting people who use drugs in dance contexts. Measurements: Lifetime use prevalence (ever used); age of first use; current use prevalence (any use within the last month), and extent of use within the last month (number of days used) for LSD, psilocybin, ketamine, GHB and nitrates. Findings: Prevalence increases for psilocybin, ketamine, GHB and nitrates use have been detected, with a sharp recent rise in current psilocybin use in 2002–2003 contrasting with more gradual and comprehensive evidence of increased ketamine use throughout the period 1999–2003. The declining prevalence of LSD use in general population surveys is replicated in this sentinel population study. Conclusions: The rise in prevalence of hallucinogen and other adjunct drugs identified among dance drug users may be mirrored by wider prevalence increases among young people with a consequent need to study these trends carefully and to develop effective interventions, where required.

Drug Information Systems, Early Warning, and New Drug Trends: Can Drug Monitoring Systems Become More Sensitive to Emerging Trends in Drug Consumption?

Drug Information Systems (DIS) are called upon to provide an early warning of emerging trends in drug use. However, little theoretical attention is directed toward exploring conceptual issues in this area. In this paper a typology of existing DIS is offered. Among the features that distinguish DIS are their structure (human network or organization systems) and the range of information sources used. Indicators of drug use can be placed on a continuum of sensitivity ranging from leading edge indicators to lagged indicators. Sensitivity implies volatility as sensitive indicators also react to fluctuations that do not become trends. DIS conventionally are largely reliant upon lagged indicators. What is required are DIS that combine a critical information processing function with the ongoing systematic collection of data from a range of data sources. [Translations are provided in the International Abstracts Section of this issue.]

Whose Harm? Harm Reduction and the Shift to Coercion in UK Drug Policy

Building on Stimson’s (2000) analysis, this paper examines the shift from a focus on health towards one of crime within UK drug policy. The increased use of coerced or compulsory treatment of drug users is discussed with reference to harm reduction theory and the question of whose harm is prioritised in shaping drug services. We also identify mechanisms by which the efficacy of treatment approaches based on coercion may be lessened or reduce the efficacy of other existing services. Failure to consider these may be an important omission in any appraisal of the impact of policies that increasingly prioritise crime prevention and coercion over heath and voluntarism.

The Relationship between Legal Status, Perceived Pressure and Motivation in Treatment for Drug Dependence: Results from a European Study of Quasi-Compulsory Treatment

This paper reports on intake data from Quasi-Compulsory Treatment in Europe, a study of quasi-compulsory treatment (QCT) for drug dependent offenders. It explores the link between formal legal coercion, perceived pressure to be in treatment and motivation amongst a sample of 845 people who entered treatment for drug dependence in five European countries, half of them in quasi-compulsory treatment and half ‘voluntarily’. Using both quantitative and qualitative data, it suggests that those who enter treatment under QCT do perceive greater pressure to be in treatment, but that this does not necessarily lead to higher or lower motivation than ‘volunteers’. Many drug-dependent offenders value QCT as an opportunity to get treatment. Motivation is mutable and can be developed or diminished by the quality of support and services offered to drug-dependent offenders.

Early Exit: Estimating and explaining early exit from drug treatment

BackgroundEarly exit (drop-out) from drug treatment can mean that drug users do not derive the full benefits that treatment potentially offers. Additionally, it may mean that scarce treatment resources are used inefficiently. Understanding the factors that lead to early exit from treatment should enable services to operate more effectively and better reduce drug related harm. To date, few studies have focused on drop-out during the initial, engagement phase of treatment. This paper describes a mixed method study of early exit from English drug treatment services.MethodsQuantitative data (n = 2,624) was derived from three English drug action team areas; two metropolitan and one provincial. Hierarchical linear modelling (HLM) was used to investigate predictors of early-exit while controlling for differences between agencies. Qualitative interviews were conducted with 53 ex-clients and 16 members of staff from 10 agencies in these areas to explore their perspectives on early exit, its determinants and, how services could be improved.ResultsAlmost a quarter of the quantitative sample (24.5%) dropped out between assessment and 30 days in treatment. Predictors of early exit were: being younger; being homeless; and not being a current injector. Age and injection status were both consistently associated with exit between assessment and treatment entry. Those who were not in substitution treatment were significantly more likely to leave treatment at this stage. There were substantial variations between agencies, which point to the importance of system factors. Qualitative analysis identified several potential ways to improve services. Perceived problems included: opening hours; the service setting; under-utilisation of motivational enhancement techniques; lack of clarity about expectations; lengthy, repetitive assessment procedures; constrained treatment choices; low initial dosing of opioid substitution treatment; and the routine requirement of supervised consumption of methadone.ConclusionEarly exit diminishes the contribution that treatment may make to the reduction of drug related harm. This paper identifies characteristics of people most likely to drop out of treatment prematurely in English drug treatment services and highlights a range of possibilities for improving services.

The rise of Viagra among British illicit drug users: 5-year survey data.

Viagra use among British nightclubbers, a sentinel population of illicit drug users, was first reported in 1999. There has since been little attention paid to the evolution of patterns of non-prescribed use, apart from among men who have sex with men. Beginning in 1999 an annual survey has been conducted with a specialist dance music magazine, permitting cross-sectional comparisons over time. Rising levels of lifetime and current use prevalence and data on patterns of both male and female use are reported, along with elevated prevalence levels among both gay men and women. Experimentation with Viagra appears increasingly to have become established among British nightclubbers who use recreational drugs. Ethnographic and epidemiological study and monitoring of adverse consequences is now needed to fully appreciate reasons for use and the extent of possible harms.

Comparing outcomes of ‘voluntary’ and ‘quasi-compulsory’ treatment of substance dependence in Europe

Aim: This study evaluates quasi-compulsory drug treatment (QCT) arrangements for substance-dependent offenders receiving treatment instead of imprisonment in comparison to voluntary treatment within five European countries. Methods: Participants were interviewed with the European Addiction Severity Index, the ASI-crime module, questions on perception of pressure and self-efficacy, and the Readiness-to-Change Questionnaire at treatment entry and after 6, 12, and 18 months. Results: Reductions in substance use and crime as well as improvements in health and social integration were observed in QCT and voluntary treatment groups. After controlling for various factors, subjects in the QCT and the comparison group showed similar reductions in substance use and crime over time. Study retention was comparable in both groups. Conclusion: QCT is as effective as voluntary treatment provided in the same services in reducing substance use and crime.

Distributing foil from needle and syringe programmes (NSPs) to promote transitions from heroin injecting to chasing: an evaluation.

BackgroundThe report presents evaluation results from an intervention using specially produced foil packs to promote a transition from heroin injecting to inhalation (chasing) with injecting drug users (IDUs) attending four needle and syringe programmes (NSPs) in south west England.MethodsService activity/uptake measures, brief structured interviews.ResultsOut of 320 attenders, 54% took the foil packs when they became available. Over the period of the evaluation, NSP transactions increased by 32.5% from 1,672 to 2,216. Additionally, 32 new clients (non-injecting heroin users) started attending the service to obtain the foil packs. This group would not otherwise have been in contact with the treatment service. More detailed data from one site are reported for 48 recent injectors who took foil within the NSP where the piloting first commenced. Prior to the introduction of the foil packs, 46% of this sub-group reported chasing heroin in the previous four weeks. At follow up, 85% reported using the foil to chase heroin on occasions when they would otherwise have injected. Among the people who took it, client satisfaction with the quality and size of the foil packs was good and respondents viewed its availability as a valuable extension to the NSPs services.ConclusionThese findings suggest that distributing foil packs can be a useful means of engaging NSP attenders in discussions about ways of reducing injecting risks and can reduce injecting in settings where there is a pre-existing culture of heroin chasing. Further research should see whether these findings can be reproduced in other cultural contexts and evaluate whether the observed behavioural changes are sustained and lead to reductions in harm including blood-borne infections and overdose.

Sexual health risk among dance drug users: Cross-sectional comparisons with nationally representative data

AIMS To describe the sexual behaviour and related risk of a sample of dance drug users and compare this with data from the UK National Survey of Sexual Attitudes and Lifestyles 2000 survey. METHODS Cross-sectional purposive sampling using both self-completion postal and web-based questionnaires. FINDINGS This sample of dance drug users are more sexually active and have more concurrent partners than the general population. Rates of anal or vaginal sex within the last year without condom use are high and of concern (men 80 per cent; women 90 per cent). These dance drug users appear also to have higher lifetime prevalence of sexually transmitted infections than the general population and are also more likely to have ever attended a sexual health clinic. CONCLUSIONS Clubbing and dance drug use, as part of a socially active lifestyle, is associated with elevated and pronounced sexual health risk. Future epidemiological studies of sexual health risk should incorporate investigation of both clubbing and recreational drug use in order to confirm the representativeness of these observations. Clubbers should be considered a target for dedicated sexual health promotion interventions, which may also be combined with interventions targeting drug and alcohol use.

The Modelling of Injecting Behaviour and Initiation into Injecting

The modelling of injecting by injecting drug users (IDUs) around non-injecting drug users (NIDUs) is examined as a precursor to NIDUs initiation into injecting. Structured self-report interviews were conducted with 86 IDUs. 86% of the sample had been initiated into injecting by an IDU: 78% of their initiators being either a friend, partner, or sibling. Only 7% of respondents reported being pressured into injecting. 70% of respondents assessed that modelled injecting had been an important influence on their decision to inject by making them curious about injecting. In turn 98% of the respondents had modelled injecting around NIDUs, but 59% reported being unsure, or thought it unlikely, that they had made someone want to try injecting. Of these respondents 90% had talked to an NIDU about injecting, and 77% had injected around an NIDU. The findings suggest the need for interventions that raise awareness about the socially transmitted nature of injecting drug use.