CHAPTER 1: Drug Misuse

Drugs whose possession or supply is restricted by law are known as scheduled or, in the UK, as controlled substances. They comprise both licit materials (i.e., those manufactured under licence for clinical use) and the illicit products of clandestine factories. Although many plant-based drugs have been self-administered for thousands of years (e.g., coca leaf, cannabis, opium, and peyote cactus), the imposition of criminal sanctions is mostly a product of the 20th century. Many of the drugs currently misused were once not only on open sale, but often promoted as beneficial products by the food and pharmaceutical industries. A pattern developed whereby initial misuse of pharmaceutical products such as heroin, cocaine and amphetamine led to increasing legal restrictions and the consequent rise of an illicit industry.

The word ‘misuse’ signifies the non-authorised use of medicines that can, in appropriate circumstances, be legally used. That word has carried over into the title of the UK primary drug legislation, i.e., the Misuse of Drugs Act (MDAct), and to the corresponding legislation in a number of Anglophone countries. This was a departure from the earlier use in UK legislation of the title ‘Dangerous Drugs’. According to the WHO,¹  scheduled drugs are ‘abused’. In this book, the term drug misuse is used since it is considered to be less judgemental. However, even the word ‘misuse’ is somewhat misleading since many controlled drugs are not and never have been used therapeutically. This is particularly true of the huge range of, mostly synthetic, psychoactive substances that have appeared in the past 30 years. In many cases, it is appropriate to say that such substances are merely ‘used’. It is equally correct to say that medicinal products both licit and illicit, such as the benzodiazepine tranquillisers and certain analgesic drugs, are ‘misused’. In the following text, and for convenience, the word ‘misuse’ applies to both situations.

Overall drug use in England and Wales has remained fairly stable in the past 20 years but is still predominantly associated with younger members of the population. Data for England and Wales are published, where appropriate, by the HO,²  the ONS,³  and the NHS.⁴  Separate arrangements operate in the devolved administrations in Scotland and Northern Ireland. To a certain extent many of these data collections are limited by various factors. Thus, household surveys can only reach those who live in normal circumstances; some problem drug users are homeless. Drug seizures also depend partly on the level of enforcement. Furthermore, the total quantity of drugs seized can be distorted in any period by unusually large seizures. For this reason, ‘number of seizures’ is a more reliable statistic, and particularly when relative seizures of closely related drugs are examined.

Figure 1.1 shows estimates of the numbers of illicit drug users (16- to 59-year-olds) in England and Wales²  in the period 2001/02 to 2017/18 for any drug broken down by those who have ‘ever taken in lifetime’ and ‘taken in the last year’. On both measures, the number of users has remained fairly stable in the period shown. About 20% of the adult population in England and Wales admits to having used a controlled drug at least once in their lives. Table 1.1 shows data for the same age group in 2017/2018 by drug type and when taken. The most common drug was cannabis while around a third had taken a Class A drug. Apart from cannabis and amphetamine, use of other Class B drugs was much lower. Cocaine in any form, ‘ecstasy’ (probably mostly MDMA) and ‘magic mushrooms’ were the most commonly-used Class A drugs. Heroin and other opiates were far less common. Despite the high level of public interest in new psychoactive substances (NPS), in 2017/2018 they represented only 7% of all users and, furthermore, apart from mephedrone, no data on NPS were collected before 2016. The final column in Table 1.1 gives an estimate of whether use of certain substances is declining/increasing relative to others. ‘Magic mushrooms’ and mephedrone show the lowest value of this index (i.e., greatest negative change) while cannabis, powder cocaine, ketamine and anabolic steroids show the highest values of the index (i.e., greatest increase).

Table 1.2 shows deaths in 2020 in England and Wales associated with specific substances, where those substance were mentioned on the death certificate.³  Some of these deaths involved more than one substance. These data include all substances, but two-thirds involved ‘drug misuse’ which is defined as deaths associated with drug abuse, drug-dependence or those that involved a controlled drug (i.e., listed in the MDAct). Figure 1.2 shows the trend in drug-associated deaths in England and Wales for the period 2001 to 2020. In 2020, heroin and morphine accounted for around 30%, and all opiates/opioids combined accounted for nearly 60%. The total number of deaths in 2020 (4561) was the highest number since recording started in 1993 and represents a rate of 79.5 deaths per million people. Males accounted for two-thirds of those deaths. Long delays can occur in recording some deaths; the data show deaths recorded in the year stated rather than occurring in that year. In 2020, drug-associated deaths in Scotland⁵  reached an all-time high (1339 cases). On a per capita basis, this is over three times the rate in England and Wales. It also the highest rate in Europe although there are some differences in the definition of drug-related deaths used by the Scottish Records Office, the ONS and the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA).

Table 1.3 lists the number of drug seizures by Police in England and Wales in 2018/19.⁶  The data exclude those made by the Border Force. A large proportion of those arrested for drugs offences are drug users, rather than suppliers, manufacturers, or importers, and most of those are for the offence of possession. Cannabis in its various forms represented 74% of all seizures. The trend in police drug seizures since 2006/07 is set out in Figure 1.3.