1. Cocaine in Scotland - The big picture David Liddell Director

2. 1. The scale and nature of current use. 2. Current response. 3. Policy and Practice issues.

3. The Scale of use 1.Price 2.Recreational. 3.Cocaine as main drug problem. 4.Cocaine as secondary drug to primary problem with opiate/ benzos.

4. PriceCocaine Five years ago could cost £100 a gram Now as low as £35 Heroin Currently £100-£50

5. Conclusion

6. Conclusion

7. 19931996200020032004 Change 1993- 2004 Last Year Any Drug 6.89.06.69.27.7+0.9 Cannabis6.18.25.58.06.3+0.2 Amphetamines2.23.10.51.41.0+1.2** Ecstasy1.12.11.01.71.2+0.1 Cocaine0.41.00.71.41.5+1.1** Crack-0.2-0.20.2+0.2** Heroin-0.10.20.30.3+0.3** Recreational use Scotland Table C-1: Trends in use of specific drugs, 1993-2004 16-59 age range Source: Scottish Crime and victimisation survey *significant at the 95 per cent confidence interval; ** significant at the 99 per cent confidence interval

8. Recreational Use 1. Scottish Crime and Victimisation Survey 16-59 year olds use in last year age profile: year olds use in last year age profile: Cocaine(overall 1.5%): Cocaine(overall 1.5%): 20-24 year olds 3.5%; 30-34 year olds 2.8% Crack(overall 0,2%): 16-19 year olds (peak age) 0.9% Crack(overall 0,2%): 16-19 year olds (peak age) 0.9% 2. 45,000 used cocaine in last year? 3. Under reporting in the 20-24 age range?

9. Recreational use Table C-1: Trends in use of specific drugs, 1993-2004 * significant at the 95 per cent confidence interval; ** significant at the 99 per cent confidence interval 19931996200020032004 Change 1993- 2004 Ever Any Drug 18.522.519.225.323.7+5.2** Cannabis14.519.017.422.821.9+7.4** Amphetamines5.27.36.39.68.4+3.2** Ecstasy2.04.03.76.05.4+3.4** Cocaine1.52.62.54.84.6+3.1** Crack0.40.71.01.21.2+.8** Heroin0.40.81.20.91.1+0.7**

10. Cocaine as main drug problem  Very limited data.  Primarily from opiate focused/dominated treatment and care service.  2004/5 data available 2005/6 released in December

11. Primary problem with Cocaine/Crack Main illicit drug: year ending 31 March 2005 NHS board area of residence NEW INDIVIDUAL PATIENTS/CLIENTS Source ISD Scotland New individual patients clients AmphetamineCocaineCrackCocaine Scotland14332270278(1.9%)(249)48(0.3%)(35) Greater Glasgow 31655111811 Lanarkshire158918456 Lothian3068624312

12. All illicit drugs: year ending 31 March 2005 number of new individuals reporting using each drug of misuse; Source: ISD Scotland New individual patients clients AmphetaminesCocaineCrackCocaine Scotland14332670949348 Argyll & Clyde 1390588030 Ayrshire & Arran 1287644515 Grampian3068624312 Greater Glasgow 31659038142 Lanarkshire15894112331 Lothian306813813693

13. Secondary use of Cocaine/Crack among opiate population All drug useAll drug use – primary users Cocaine949 (6.6%)671 (4.7%) Crack 348 (2.4%)300 (2.1%) Crack 348 (2.4%)300 (2.1%) Other data such as DORIS and new attenders at the Glasgow Drug Crisis Centre show much higher levels of cocaine use 25%-30% among opiate users  Secondary use to Alcohol

14. Drug related deaths 2005 Source: SDCEA Number of cases(%) where no other substance was implicated Number of cases(%) where drug was implicated Scotland242(100.00)242(100.0) Cocaine Cocaine12(5%)22(9.1%) Amphetamine3(1.2)5(2.1)

15. Current response 1. Recreational users: - Few services. Crew 2000. - Few services. Crew 2000. 2. Special provision for Cocaine/Psycho stimulant as main drug problem: as main drug problem: ESUS – Edinburgh, INCITE – Aberdeen, Cocaine Anonymous ESUS – Edinburgh, INCITE – Aberdeen, Cocaine Anonymous 3. Specialist drug services responding primarily to secondary use Some training reach so far fairly limited Some training reach so far fairly limited 4. Know the Score/website helpline

16. Key policy issues - Recreational users More coherent response to recreational users required More coherent response to recreational users required *CREW 2000 type services *Better use of Helplines/websites *Better targeting of information campaigns For example little information provided on risks of Blood Borne Virus transmission through sharing banknotes for snorting

17. Conclusion

18. Key policy issues - Provision for problem Psycho stimulant users Do we need to develop existing services or create specialist Psycho stimulant services? The answer likely to be that we need to do both. Existing specialist services have been slow to react to a new population? Workload? Service rather than needs led? Need specialist provision in areas where major problems exist until mainstream provision has adapted? Mental Health and alcohol agencies role? Pillar to post scenario – integrated services

19. Key policy issues - Response to use among existing opiate population Cocaine impacting on ‘stability’ of those on substitute programmes? E.g. increases in:- benzo use? benzo use?Alcohol?Aggression? Mental health? Under reporting of cocaine use to services – why? Training for frontline staff

20. Conclusion Need to retain a perspective: cocaine problems small compared to opiates But need to proactively respond in order that problems do not escalate Improved response to the three groups; recreational; primary problem users and opiate users using cocaine

21. Conclusion Recreational use More Crew 2000 type provision Cocaine as main drug problem Changes to existing services and retain and develop specialist provision Cocaine use among opiate population Improve service responses, more user led focus

22. ConclusionResourcing Need some specific resources devoted to the problems of cocaine £66.5 million for direct responses to drugs per year(including £34 million for drug treatment and care) 2% of treatment monies would be £680,000 Currently spending - £300,000 for 2 services