Drug use and misuse is a major concern for Londoners and is high on the political agenda, but behind the rhetoric and newspaper headlines, it is very difficult to gain an accurate picture of drug use and its impact in London. Information on drug use is not available from a single source, but must be obtained and put together from multiple sources. Our aim is to collate and analyse information about drug use in London and disseminate it in a useful way. We hope to create an authoritative virtual information centre for policy-makers, practitioners, Drug Action Teams and others concerned with reducing the harm caused by drugs in the capital. The virtual information centre will be regularly updated as new and more accurate data becomes available.

It is important to note that problems associated with smoking tobacco and drinking alcohol far outnumber the problems associated with illicit drug use. Nonetheless, tackling illicit drug use is a key priority for the Mayor of London, the Department of Health and the Home Office. Problem drug use and its consequences are of major concern to London, as highlighted in Drug Use In London (1) and the Public Health Report For London (2).

Information on the number of drug users and trends in drug use is required for strategic planning and performance management by policy-makers in health and criminal justice, including Drug Action Teams, Crime and Disorder Partnerships and others involved in regeneration, community development, health and social care. The members of the Greater London Alcohol and Drug Alliance (GLADA) made a commitment to basing all policy and practice decisions about drug use in London on evidence rather than anecdote or rhetoric.

GLADA has also produced a report into drug use in London, 'London the Highs and the Lows'.

Here we present data on prevalence, Misuse of Drugs Act Offences, blood borne viruses, arrest referral and specialist drug treatment statistics, and drug related mortality, ambulance call outs and hospital admissions. Information on this site will be updated regularly (when new data comes to light) and new indicators added. Where possible, time series data will be presented in order to provide the best available evidence on drug use and problem drug use in London.

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• In London in 2001-2003, 78% of all deaths due to drug misuse occurred in males; 68% of admissions to hospital for drug misuse were among males in 2002/03; 72% of those in treatment were male in 2003/04 and over 80% of arrestees assessed were male in 2003/04.
• 90% of people in specialist drug treatment in London are aged between 15 and 44; 36% of arrestees assessed were under 25; 40% of deaths due to drug misuse occurred to those aged 25-34, along with 42% of hospital admissions.

• There is considerable variation in the number of arrest referral assessments by borough from 1% to 6% of all arrestees in 2003/04.
• There is variation in the reported number of people aged 15-44 receiving treatment by borough of residence from 2.3 per 1,000 to 10.0 in 2003/04. In part borough differences are due to under-reporting from local drug agencies, and therefore the data must be treated cautiously. Inner London boroughs tended to have higher rates than outer London with Camden and Islington having the highest.
• Again, inner London boroughs tended to have higher age standardised death rates for drug misuse with Camden, Hammersmith and Fulham, and Lambeth having the highest in 1999-2003.
• Ambulance call outs for drug overdose were highest in Inner London boroughs in 2003.

• In London, among arrestees assessed 64% used crack in the last month, and among those seeking treatment 15% reported using crack-cocaine.
• 58% of arrestees reported using heroin within the last 30 days. Heroin was also the most commonly recorded main drug in treatment with 50% of individuals citing it in 03/04. 17% of death certificates where death was due to drug poisoning mentioned heroin/methadone in 2000-2002.

• In London, in 2003/04, sixty-six percent of those in contact with treatment services were from the White ethnic group (White British, White Irish, and White other), 10% from the Black ethnic group (Black African, Black Caribbean, Black other), 6% from the Asian ethnic group (Indian, Pakistani, Bangladeshi and Asian Other), 4% each from the Other (Chinese and other) and Mixed ethnic group (White and Black Caribbean, White and Black African, White and Asian and other mixed) and 10% of records had missing ethnicities or ethnicities which were not stated.
• In London, among arrestees assessed in 2003/04, approximately 61% from the White ethnic groups, 24% from Black ethnic groups, 9% from the Asian ethnic group, 4% from Mixed ethnic group, and 2% from other ethnic groups

• There are a number of explanations for the differences in London compared to the rest of England, including the pattern of drug use, prevalence of problem drug use, risk behaviour and coverage of harm minimisation programmes, and under-reporting.
• It is likely that the pattern of problem drug use in London is different from the rest of the country, with a higher proportion of problem drug users using crack-cocaine.
• The indicators suggest that the prevalence of problem drug use is higher in London than the rest of the country.
• The higher prevalence of blood borne viruses among London IDU could reflect differences in the historical epidemic and injecting risk behaviour. Further work is required to test whether differences also could be due to differences in the level of coverage of syringe exchange distribution.
• Under-reporting and differences in practise also has a bearing on some differences between boroughs e.g. in number of people reported in specialist drug treatment or number of arrest referral assessments.
• There are a number of competing explanations for these discrepancies in the ethnic breakdown between treatment and criminal justice populations which merit urgent investigation. Alone these data may suggest but in no way provide conclusive evidence of inequity of access to treatment and/or inequity of arrest by ethnic group. Since, we do not know the true ethnic breakdown of heroin and crack-cocaine users in London we need further evidence to indicate which population - problem drug users in treatment or arrested - is under or over represented by Black minority ethnic groups. The following LHO presentation explores these issues in detail.

A feasibility study undertaken by Frischer, Heatlie, and Hickman attempted to estimate the prevelance of problematic and injecting drug use for Drug Action Team Areas in England.

A Multiple Indicator Method (MIM) was used to produce prevalence estimates for problematic and injecting drug use for Drug Action Teams (DATs) in England in 2001. The MIM required drug indicators for all DATs and information on drug prevalence in selected DATs. For the purposes of the project, problematic drug use was defined as current use of illicit opiates, crack-cocaine or benzodiazepines. Injecting drug use covers all drug use where injecting was the method of drug administration.

Eight quantitative drug indicators were obtained from the DAT template (information collated by the Home Office) and other sources. [1: episodes of possession of controlled drugs, 2: episodes of supply of controlled drugs, 3: adults entering drug treatment services, 4: people arrested and referred for drug treatment, 5: drug abuse related deaths, 6: methadone prescriptions, 7: episodes of hospitalisation for drug abuse, 8: material deprivation measured by Townsend score].

Findings

From the model developed the estimated prevalence rate of problematic drug use in the 149 DATs varied from 0.2 per cent to 1.5 per cent of the population. The estimated rate of injecting drug use varied from nought to one per cent of population. Overall, the estimates for England in 2001 based on the model were:

• Rate of problematic drug use – 0.6 per cent for the total population (or 0.9% for 15- to 64-yearolds).
• Rate of injecting drug use – 0.2 per cent for the total population (or 0.3% for 15- to 64-year-olds).

Although this was a pilot project, it was large-scale in the sense that it provided estimates for all English DATs. The study’s authors suggested that DATs be given the opportunity to critically evaluate the estimates for their area and provide feedback. The feedback will help in the process of developing robust estimates in future years.

Further details can be found by clicking here.

This study by Hickman et al compared and developed existing indirect estimation techniques, here we report on the capture-recapture technique, in order to estimate the prevalence of injecting in three areas of England (Liverpool, Brighton and part of London). Estimates of the prevalence of problem opiate use also were generated for London (and Liverpool, and in London for problem drug and crack-cocaine use.

The estimation exercise involved collecting data about problem drug users in contact with specialist drug treatment, arrest referral, needle exchange, and Accident and Emergency departments, and conducting a community-recruited survey in the three areas.

Findings

The "best" estimates for London are summarised below and were obtained using covariate capture-recapture techniques - further details in main report.

Best estimates of the prevalence of injecting drug use using capture-recapture in London, including the 95 per cent confidence intervals are shown below.

Table 1

*Boroughs of Brent, Camden, City of Westminster, Ealing, Hammersmith and Fulham, Harrow, Hounslow, Islington, Kensington and Chelsea, Lambeth, Lewisham, Southwark

Overall, the study estimated that the prevalence of injecting drug use in those aged 15 to 44 years was 1.2 per cent in 12 London boroughs, and 1.7 per cent in the eight inner London boroughs.

The study’s authors note that prevalence is high and clearly a cause for concern, but state that the estimates are credible, consistent with each other and fit with the available evidence from some other public health indicators.

Table 2 shows the study’s current estimates for the number and prevalence of problem opiate users and problem drug use and crack or cocaine use in London.

Overall, the study estimated that the prevalence of problem opiate use was 2.1 per cent in London, and the prevalence of problem drug use and crack or cocaine use was 3.4 per cent and 0.8 per cent respectively.

The authors state that the estimates for crack/cocaine should be treated cautiously and perhaps as minimum estimates, but that, the estimates are still an important step forward in measuring the spread of crack cocaine use and the first for this substance in the United Kingdom

Table 2: Summary of the capture-recapture estimates for opiate, crack/cocaine and problem drug use: 2000/01

* Boroughs of Brent, Camden, City of Westminster, Ealing, Hammersmith and Fulham, Harrow, Hounslow, Islington, Kensington and Chelsea, Lambeth, Lewisham, Southwark

Further details can be found by clicking here.

• Centre for research on drugs and health behaviour. Department of Social Science and Medicine, Division of Primary Care and Population Health Sciences, Imperial College, Reynolds Building, Charing Cross Campus, St Dunstan's Road, London W6 8RP. Telephone: 020 7594 0811 Fax: 020 7594 0866
• The Home Office. Research, Development and Statistics Directorate, Home Office, 50 Queen Anne's Gate, London SW1H 9AT. Telephone enquiries: 0870 000 1585
• The Metropolitan Police. New Scotland Yard, Broadway, London, SW1H 0BG. Tel: 020 7230 1212
• London Ambulance Service NHS Trust. London Ambulance Service NHS Trust, 220 Waterloo Road, London SE1 8SD.
• Greater London Authority. City Hall, The Queen's Walk London SE1 2AA
• HDA Collaborating Centre: Drugs

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