National Mission on Drugs: annual monitoring report 2022-2023

5. Outcome 1: Fewer people develop problem drug use

5.1 Summary

Outcome 1: Fewer people develop problem drug use

Prevalence data for problem drug use is not yet available

• Data will become available in spring 2024

Less than 1% of people reported having a current problem with their drug use in 2021.

• This is the first year for which data is available

Progress towards fewer people developing problem drug use cannot be determined at this stage. New prevalence data in 2024 will be a valuable development

5.2 Background

Preventing people from developing problem drug use is crucial in tackling drug related harms and deaths. To understand prevention and the efficacy of prevention-type initiatives over time it is important to explore, where feasible, population prevalence of problem drug use, both at a local level and for specific demographics (e.g. children and young people). It is also important to address inequalities and the wider social determinants of health. This includes working with young people, providing early access to support and understanding the supply of harmful drugs.

5.3 Headline metrics

5.3.1 Headline metric: Prevalence of problem drug use

No current data are available on the prevalence of problem drug use in Scotland. The most recent data from 2015/16 estimated that there were 57,300 people aged 15 to 64 years with problem opiate and/or benzodiazepine use in Scotland, approximately 1.6% of the population.^[8]

As a hidden population, measuring how many people use drugs problematically is challenging. The Scottish Government is funding a collaborative project between PHS and the University of Bristol to produce a new estimate of the prevalence of problematic drug use in Scotland. The project will use routinely collected linked data and statistical modelling to estimate and monitor the number of people in Scotland who use opioids problematically. Initial findings from the project are expected in the spring of 2024.

5.3.2 Headline metric: Percentage of people who have a current problem with their drug use

In the 2021 Scottish Health Survey (the most recent data available), less than 1% of people reported having a current problem with their drug use. Males were more likely to report currently having a problem with drug use (1%) compared to females (less than 0.5%).

5.4 Supporting metrics

5.4.1 Supporting metric: Prevalence of problem drug use among young people

No current data are available on the prevalence of problem drug use among young people in Scotland. The most recent data available are from 2015/16, when 5,900 people aged between 15 and 24 years were estimated to have problem opiate and/or benzodiazepine use in Scotland.^[9] The prevalence estimate of problematic drug use currently being developed by PHS and the University of Bristol (see section 5.3.1) is expected to provide some insight into more recent trends in the prevalence of problem opioid use amongst young people. Initial findings from this project are expected in the spring of 2024.

5.4.2 Supporting metric: Percentage of young people who have a current problem with their drug use

In the 2021 Scottish Health Survey (the most recent data available), 1% of young people (aged 16 to 24) reported having a current problem with their drug use.^[10] Males were more likely to report having a current problem with their drug use (3%) compared to females (less than 0.5%).

5.4.3 Supporting metric: Percentage of S4 pupils who have ever taken illegal drugs

In 2021/22, the Health and Wellbeing Census found that 9.6% of S4 pupils reported having ever taken illegal drugs.^[11],[12] Of those pupils who have ever taken illegal drugs, one in five (19.4%) reported that they take drugs at least once a week or more. Where pupils reported ever having taken illegal drugs, and having taken drugs in the last month, the drug that pupils most reported taking in the last year was cannabis (95%), followed by cocaine (46%) and ketamine (36%). A quarter of these pupils (24%) reported using benzodiazepines in the last year, while one in five (20%) reported they had used heroin in the last year. It should be noted that these data are the aggregated results for the 16 local authorities^[13] that collected Health and Wellbeing Census data and are not weighted to population totals.

The first Health and Wellbeing Census was undertaken by local authorities in Scotland in 2021/22, therefore no historical time-series data are available. However, findings from similar surveys undertaken in the past do provide some additional context. In 2018, the Scottish Schools Adolescent Lifestyle and Substance Use Survey (SALSUS)^[14] asked young people about their drug use and found that 21% of 15-year-olds reported ever having used drugs. The Health Behaviour in School-Aged Children (HBSC) Scotland study focuses only on cannabis use. In 2022, 19% of 15-year-olds reported they had used cannabis at least once in their lifetime^[15], a slight increase on the previous survey in 2018 when 17% reported having ever used cannabis.^[16]

5.4.4 Supporting metric: Number of school exclusions involving substance use

There were 150 cases of exclusion from local authority schools involving substance misuse in the 2020/21 academic year, 1.8% of all known exclusions.^[17] This is a sharp decline from 2018/19 when there were 410 such exclusions (2.7%).^[18]

5.4.5 Supporting metric: Number of drug supply crimes

In 2022/23, 4,087 crimes related to drugs supply were recorded in Scotland (Figure 3). This is an increase of 111 crimes (3%) compared to 2021/22 when there were 3,976 such crimes. The general decreasing trend in the number of recorded drug supply crimes predates the start of the National Mission and caution must be exercised when interpreting these data. The COVID-19 pandemic and associated measures to limit physical contact affected both the type and volume of crime recorded since March 2020. The largest effect was seen in 2020/21 and to a lesser extent in 2021/22, which may in part explain these trends. Furthermore, these data underestimate the scale of drug supply crimes because not all crimes are reported to the police. The number of recorded crimes may also be affected by police activity and operational decisions.

Figure 3: Following a decrease during COVID-19, drug supply crimes increased slightly in 2022/23

Number of drug supply crimes recorded in Scotland, 2019/20 to 2022/23

Source: Recorded Crime in Scotland 2022-23, Scottish Government, June 2023

5.4.6 Supporting metric: Quantity of (a) heroin, (b) benzodiazepines, and (c) cocaine seized

In 2021/22 (the most recent data available, Table 1):

• 127kg of heroin were seized by Police Scotland, an increase of 17kg (15%) compared to 2020/21.
• 4.82 million benzodiazepine tablets were seized by Police Scotland, an increase of 1.585 million tablets (49%) compared to 2020/21.
• 75kg of cocaine (total powder and crack cocaine) were seized by Police Scotland, a decrease of 338kg (82%) compared to 2020/21.

Table 1: The quantity of drugs seized from supply crimes fluctuates considerably between years

Quantity of heroin, benzodiazepines, and cocaine (powder and crack cocaine combined) seized from supply crimes in Scotland, 2018/19 to 2021/22

Source: Drug Seizures and Offender Characteristics, Scottish Government, March 2023

While drug seizure data provide insights on the quantity of illegal drugs removed from illicit markets each year, the quantity of drugs seized can fluctuate considerably between years. Moreover, the totals are not necessarily correlated with the number of seizures made. While most drug seizures consist of relatively small quantities (usually possession-related crimes), annual quantities of drugs seized can be greatly influenced by a small number of large seizures (usually from supply-related crimes).

5.5 Discussion

Progress towards fewer people developing problem drug use cannot be determined at this stage. New prevalence data in 2024 will be a valuable development.

It is not currently possible to determine trends in the prevalence of problem drug use, for either the general population or young people. The latest data available from the Scottish Health Survey suggests that the percentage of people in Scotland who self-report having a current problem with their drug use is fairly low. However, it is generally accepted that people who use drugs are in part a hidden population and are often not well represented in population level surveys. Between the survey data and the most recent prevalence estimates (from 2015/16), it would be reasonable to conclude that there is still a sizable population of people with problem drug use in Scotland.

Supporting metrics provide some evidence that illegal drug use among young people may be declining. While the latest data from the Health and Wellbeing Census indicate a lower figure for S4 pupils who reported ever taking illegal drugs compared to findings from SALSUS in 2018, the data are not directly comparable due to differing methodologies and associated limitations. This apparent decrease should therefore be interpreted with caution. There has been a notable decrease in the number of school exclusions involving substance use, however this may be at least partially attributable to the COVID-19 pandemic limiting the amount of time pupils were in school during this period.

The supply of drugs is linked to demand, however only limited conclusions can be inferred from these data. This figure increased slightly in 2022/23, following a substantial drop in the number of drugs supply crimes recorded in 2021/22. Again, these trends may have been affected by the public health measures (e.g. lockdowns, social distancing, etc) associated with COVID-19. The amount of heroin, benzodiazepines and cocaine seized by Police Scotland has also been variable over the last several years, with no clear upward or downward trajectory. Reported drug supply crimes increased slightly in 2022/23, following a decrease during COVID-19. However, these data must be interpreted with caution because not all crimes are reported to Police Scotland, and the amount of drugs seized does not necessarily correspond with the amount of drugs in illicit drugs markets at any given time.

Taken together, these data cannot provide a definitive answer on whether fewer people have developed problem drug use since the start of the National Mission. The work by PHS and the University of Bristol to estimate the prevalence of regular drug use, and future iterations of the Health and Wellbeing Census will be valuable developments in informing an understanding of problem drug use in Scotland. Moreover, future work could explore the potential of new or existing data sources (for example the Alcohol and Drug Partnerships survey, the Drug and Alcohol Information System, data linkage) to provide supplementary insight in monitoring the progress towards outcome 1.