inverclyde and drugs - Drug Misuse Information Scotland

Inverclyde Forum About Drugsinverclyde and drugsA SnapshotReview of Drug-related Statistics and other Relevant Data in Inverclyde

contentsiiiiiiivAcknowledgmentsGlossary of TermsExecutive SummaryPreface1 Introduction2 Section One: Demographics and socialdeprivation5 Section Two: Drug prevalence in the area9 Section Three: Drug trends in the area13 Section Four: Services available withinInverclyde19 Section Five: Gaps and omissions in serviceprovision within Inverclyde20 Recommendations and conclusions24 References

acknowledgementsThis report was made possible due to the input ofa number of individuals, groups and agencies, whosecontribution we gratefully acknowledge.In particular we are grateful to our colleagues in thefour Community Forums, without whom IFAD wouldnot exist. We extend our gratitude, also, to our othercolleagues in the community - Open Hands FamilySupport Group, the Habit Group, Mid Oak FamilySupport Group, Haven, Valiant United and Lydia fortheir interest and support.We also acknowledge the support and help we havereceived from workers in our local agencies andexpress our thanks to Inverclyde Council, Argyll andClyde Alcohol and Drug Team and the InverclydeRegeneration Partnership.Our thanks also go to the Scottish Drug Forum fortheir invaluable support, advice and involvementthroughout the lifetime of this project.Finally, we extend our thanks to the agencies for givingus their reports and information - Argyll and ClydeHealth Board, Community Drugs Team, StrathclydePolice and ISD Scotland.Fay Rodgers,Jim Grieve,Isabel Berry andEleanor Robertson,IFAD Working Group, October 2000.i

Inverclyde Forum About Drugsglossary of termsCDTCPNGPIDUsCommunity Drugs Team (CDT is the localsocial work community drug service basedin Greenock and provides a service toindividuals and their families, and to thecommunity as a whole)Community Psychiatric NurseGeneral PractitionerInjecting Drug UsersIFAD Inverclyde Forum About Drugs -Community Group established by localpeople on the Social InclusionPartnership's community Forum to tacklethe problems associated with drugsmisuse.IFAD A sub Group of IFAD which takes forwardWorking project proposals.GroupIRP Inverclyde Regeneration Partnership -Inverclyde's Social Inclusion Partnership.ISDInformation and Statistics Division ('ISDis responsible for the collection, processingand dissemination of statistical informationrequired for planning, management andmonitoring of the Health Service inScotland’)SCIEHSDMDSIPSPSScottish Centre for Infection andEnvironmental ('SCIEH is responsible forthe national surveillance of communicablediseases and environmental health hazardsand the provision of expert operationalsupport on infection and environmentalhealth to health boards and localauthorities in Scotland’).Scottish Drugs Misuse Database (’Thedatabase provides anonymous data aboutnew problem drug users who attendspecialist drug services i.e. statutory andnon-statutory drug agencies and generalpractitioners’).Social Inclusion Partnership (’AGovernment initiative geared to bringtogether the statutory, voluntary,community and private sectors tocollectively find social, environmental andeconomic solutions to complex and deeprooted problems such as unemployment,poor skills, low incomes, poor housing,high crime environments, bad health andfamily breakdown’).Scottish Prison ServicePPAPriority Partnership Area (Areas whichhave been identified for social inclusioninput due to a concentration of multipleproblems)ii

Inverclyde Forum About DrugsexecutivesummaryThis report is a summary of the most currentinformation relating to drugs in the Inverclyde area.It has been commissioned by the Inverclyde Forumabout Drugs (IFAD) in order to help inform debateabout the extent of drug misuse in Inverclyde, whatgaps there are in existing services and whatrecommendations there are to improve services.Inverclyde is one of the poorest local authority areasin Scotland. 14.3% of households in the area couldbe categorised as multiply or severely deprived. OnlyGlasgow and Dundee are worse than Inverclyde.21% of Inverclyde's population live in postcode sectorsamongst the worst 10% in Scotland. 47% of the totalpopulation of Inverclyde are living in or on the marginsof poverty. Inverclyde had the second highest mortalityrate of all local authority areas in Scotland.A survey commissioned by Argyll and Clyde HealthBoard in 1995 estimated that there were 562 injectingdrug users in Inverclyde; this made up 40% of theestimated total for all of Argyll and Clyde at that time.There has been no follow-up survey, but evidencefrom drug agencies and other organisations wouldsuggest that the number of injectors has increasedsince the survey was last carried out.It is estimated from this figure of 562 injectors thatthey will spend a total of just over twelve-and-onequartermillion pounds per year to sustain their drugmisuse. This works out at £420 per week per injectingdrug user. As the overwhelming majority of injectorsare unemployed almost all of the monies to obtainillicit drugs will be obtained by criminal means.Figures about drug misuse in Inverclyde are obtainedfrom a number of sources. These include the localcommunity drug team, 2 needle exchange servicesin the area, a local prescribing service, police data andthe national Scottish Drugs Misuse Database.In 1998-99 4% of all submissions to the drugs misusedatabase came from Inverclyde. Just over a quarterof all submissions to the database from Argyll andClyde came from Inverclyde.The vast majority of new clients, 79%, attending drugservices in Inverclyde are using heroin. This figure issubstantially above the figure for all of Scotland, whichstands at 53% of new clients using heroin and issignificantly greater than that for other areas of Argylland Clyde.50% of new clients attending drug services inInverclyde are injecting which again is higher than theScottish figure of 38%. New clients attendingInverclyde drug services are marginally more likely tobe sharing injecting equipment.63%, or 10 out of 16 drug-related deaths recordedby Strathclyde Police in the divisions serving Argylland Clyde during 1998-99 were in Inverclyde.Inverclyde accounted for 10% of drug-related deathsin the Strathclyde Force area in 1998-99.A survey conducted at Gateside Prison in Greenockduring 1996 reported that 101 out of 115 prisonersinterviewed (88%) had taken drugs in the communitywhile 70 or 68% reported that they had taken drugsboth in prison and the community.There are a wide range of gaps and omissions inservice provision for drug misusers in the area.iii

These include:• Lengthy waiting lists for prescribing of methadone.• Lack of residential rehabilitation services in thearea.• A total absence of either through-care or aftercareservices for drug users stabilised on methadoneor recovering from drug misuse.• Strains on pharmacies in the area as a result ofthe large numbers of methadone patients gettingtheir methadone on daily supervision, leading totensions between staff and clients.• The need for more services to engage with youngpeople in the area.• There is a need to look at how effective drugtreatment services are within the area.Overall, it is recommended that there be a strategicplan in relation to drugs which is inclusive and involvesall interested parties in Inverclyde including the localauthority, the health board, addiction services, police,service users, community groups (including familysupport groups and carers) and others. Such a planwould seek to look at practical, feasible ways to dealwith the immense social problems surroundingaddiction in Inverclyde and offer the best ways ofworking together to overcome the serious gaps andomissions in service provision in the area.prefacePreface by Dr David Bell Consultant in Public Health Medicine for Argylland Clyde Health BoardAs our research progressed and we realised theenormity of the size and shape of the problemsconfronting us we might readily have abandoned ourproject had we not been reminded of two stories ofelephants recounted to us when our enthusiasm wasflagging.The first is of the elephant and the five blind men.One said 'the elephant was like a wall'; one said 'likea tree trunk'; one said 'like a rope'; one said 'like asnail'; and one said 'like a pipe'.The sighted observer perceived that they had holdof, respectively, the elephant's side, leg, tail ear andtrunk.The other story reminds us not to get daunted bythe enormity of the task ahead.The question is 'How do you eat an elephant?' Andthe answer -'One bite at a time!' Start somewhere: where tostart doesn't matter that much.I wish IFAD the very best in its efforts in this vitalfield.David Belliv

introductionInverclyde Forum About Drugs (IFAD) was launchedin 1998 as an informal and loose grouping ofcommunity forum members in Inverclyde who wereinterested in tackling drugs misuse and related issuesin the area. From initial discussions held by groupmembers it soon became clear that it was difficult toget a handle on local drug problems as there was alack of easily available local information which thecommunity could use as evidence to back their case.IFAD therefore set up a Working Group to look atresearch needs. After much debate and discussion,the Working Group came to the conclusion thatbefore any new research into the subject could becommissioned, there was a need to pull together allavailable local information, collate it and see what thepicture was for Inverclyde.injecting, an estimate of the cost of drug misuse inInverclyde, and numbers attending services in thearea. Section three examines drug trends in the areaand how they compare with elsewhere in Scotland.Section four gives a detailed examination of all drugservices in the area including local authority, healthboard and community groups. Finally section fivelooks at the gaps in services dealing with drug misusein Inverclyde.The purpose of this report is to provide a snapshotof the current situation in Inverclyde as it relates todrugs misuse and to inform a constructive debate onhow best to proceed in attempting to overcome theproblems caused by drugs misuse in the area.A successful bid was made to the Social InclusionPartnership (SIP) for a one-year research and supportworker project in March 1999. The Working Grouptook on the task of managing and delivering theproject which began in May 1999.Five months into the project the Working Group hadto contend with the project worker unexpectedlyleaving. The Scottish Drugs Forum was commissionedto complete the work.This report is a compilation of local informationrelating to drugs in the Inverclyde area. The reportis divided into five sections. Section one looks at theoverall population profile of Inverclyde with a specialemphasis on social deprivation in the area. Sectiontwo looks at the overall levels of drug misuse inInverclyde; the numbers misusing drugs, levels of1

Inverclyde Forum About Drugssection one:demographics andsocial deprivationThe Argyll and Clyde Health Board area, which coversInverclyde, represents the largest geographical areaof any health board in Scotland. Argyll and Clyde alsoincludes the largely rural areas of Argyll and Bute,Cowal Peninsula and islands such as Islay and Mull. Italso has four main urban centres of population, theseare parts of West Dunbartonshire and EastRenfrewshire, Renfrewshire and of course Inverclydewhich represents Port Glasgow, Greenock andGourock. In the year ending 31st March 1999 therewere 1569 submissions to the Scottish Drugs MisuseDatabase (see p8) from the entire Argyll and ClydeHealth Board area (1). Of this 26% were fromInverclyde; thus just over a quarter of all new clientsto services came from this area. We will look in detailat the drug trends and patterns in later sections.Inverclyde comprises the three towns of Greenock,Port Glasgow and Gourock as well as a rural hinterland.According to the 1991 UK population censusInverclyde has a population of 87,268. The numberof households in the area is 37,200 and the rate ofowner occupation is 18,600. The public sector housingstock, i.e. council houses, comprises 13,434 dwellings.In addition there are 2,600 private sector and housingassociation rented properties. Therefore 50% ofhouseholders are in owner occupation, 43% arepublic sector housing or private rentedaccommodation. (2)In 1995 it was estimated by the Social WorkDepartment that there were 2,509 vulnerable childrenliving in Inverclyde or 12% of children aged 15 yearsand younger. (3)Inverclyde is one of the poorest local authority areasin Scotland. Analysis of the 1991 population censuscarried out for the Scottish Office revealed that14.3% of households could be categorised as multiplyor severely deprived. Only Glasgow (16.0%) andDundee (14.5%) are worse than Inverclyde. Morerecent analysis has shown that the poverty map ofScotland has not changed greatly since the 1991census. Research carried out for the Scottish Officein 1998 showed that 21% of Inverclyde's populationlive in postcode sectors amongst the worst 10% inScotland in terms of social deprivation. (4)The 1996 annual report from the Director of PublicHealth for Argyll and Clyde Health Board revealedthat Inverclyde had the second highest mortality rateof all local authority areas in Scotland. Only GlasgowCity had a higher figure. (5)People in Inverclyde also experience poorer healththroughout their lives. Once more, data from the1991 census indicates that over 10% of Inverclyderesidents under the age of 65 reported having a longtermillness; this is twice the rate for the UK widefigure for this age group. (6) An indicator of risk tothe health of infants is low birth weights; theproportion of babies in Inverclyde in this category isaround 20% higher than the Scottish average. Poorhealth is also partly reflected in the use of hospitalservices and referrals to hospital clinics are 35% higherthan the Scottish average. Finally, Inverclyde suffersfrom high levels of alcohol misuse. Figures from theInformation Division of the National Health Servicein Scotland suggest that admissions for alcohol relatedproblems are 62% higher than the national average.2

Inverclyde Forum About DrugsA comparison of parliamentary constituencies in allof Great Britain undertaken by the Townsend Centrefor International Poverty Research published in 1999placed Greenock and Inverclyde 11th in terms ofworst health behind seven constituencies in Glasgow,two in Manchester, and one in Liverpool. This studyclaimed that 59% of deaths in Inverclyde wereavoidable (i.e. they would not have occurred ifInverclyde had the death rate of the 'best health'areas). (8)One report, which looked at Inverclyde's key statisticsand trends, indicated that 42,205 people (or 47% ofthe total population of Inverclyde) are living in or onthe margins of poverty. Almost half the populationof Inverclyde lives in a household with no access toa car - consequently there is a heavy dependence onpublic transport and people are therefore more likelyto feel isolated. (9)The percentage of children in each school receivingfree school meals ranged from 10.8% to 55.6% acrossthe district. The percentages receiving clothing grantsvaried from 10.8% to 80.4%. The entitlement to freeschool meals and clothing grants is dependent onlow income or being in receipt of benefit. Therefore,these levels of take-up of various benefits clearlyindicate wide variations in deprivation across Inverclyde.(10)In 1997 the market research organisation MORI wascommissioned by Inverclyde Regeneration Partnershipto conduct a survey of residents in the InverclydePriority Partnership Area (PPA). (11) Residents wereinterviewed about a range of issues affecting theirlives. A total of 1,033 households were interviewedand key findings were as follows:• Only one quarter of heads of households in thePPA had full time jobs.• Concentrations of poverty exist in the PPA area- three in five households are dependent uponbenefits.• Real unemployment levels are more than 20% insome areas and there is a high degree of pessimism,combined with low expectations of finding work(especially amongst men).• Despite their lower average age, PPA respondentsreported poorer general health. This appearedto reflect poorer life circumstances but also highsmoking rates.• Chief concerns of residents in the PPA relate tocrime, drugs, vandalism and the quality of thephysical environment.This survey was conducted two-and-a-half years agoand many policy developments have occurred sincethen such as New Deal and Social InclusionPartnerships (SIPs). However, anecdotal evidencesuggests that many of the issues highlighted aboveare still of concern.Therefore, on many indicators of social deprivation,Inverclyde has high levels of poverty, unemployment,social destitution and ill health. Research elsewhereindicates a high level of association between socialdeprivation and addiction. It will therefore be nosurprise to find as shown below that Inverclyde doesexperience a high proportion of drug misuse relativeto its population.4

section two: drugprevalence in theareaThere are many difficulties in assessing accurateprevalence figures for drug misuse. Prevalence refersto the numbers of people misusing drugs in anyparticular defined area. As drug misuse is an illicit andhighly frowned upon practice it is difficult to get peopleto voluntarily give information about their drug misuse.There is no national Scottish wide survey that attemptsto estimate the prevalence of drug misuse, thoughthe Scottish Executive will be funding a nation-wideestimate of drug misuse in the near future.During 1995 the Scottish Centre for Infection andEnvironmental Health (SCIEH) was commissioned toproduce a prevalence study for the Argyll and ClydeHealth Board area. The resulting report Estimatingthe Population Prevalence of Drug Use and InjectingDrug Use in Argyll and Clyde in 1995 presented dataon 1,148 current drug users, including 333 currentdrug injectors, resident in Argyll and Clyde. From thisfigure the SCIEH study used various statisticaltechniques to project a total estimate of current drugusers in the area. The results were as follows:• The total number of current drug users in Argylland Clyde was estimated at 5000.• The total number of current drug injectors forArgyll and Clyde was estimated to be 1404.• 40% of current injectors or 562 injectors wereestimated to come from the Inverclyde area. (12)Work conducted in Greater Glasgow has suggesteda total expenditure of £194 million per year by 8445injecting drug users (IDUs) in order to procure a daily'habit'. (13) Using the SCIEH estimate of 562 currentIDUs and assuming an average daily habit of £60 perday this would yield a total yearly expenditure for theInverclyde area of £12,274,080 or £21,840 per yearper IDU or £420 per week per IDU.There are two points to be made about this figure.• The overwhelming majority of clients attendingservices are in receipt of income support, onincapacity benefit or engaged in some kind oftraining or education. Personal income disposal isseverely restricted. Hence when using illicit drugsthe vast majority of clients will obtain money tobuy drugs by acquisitive crime (principally theft),prostitution, small-scale dealing (user-dealing) ora combination of all three. Assuming that thoseIDUs not attending services have similarcharacteristics to those in-service, then we haveto conclude that the greater part of the £12million per year will be derived from these sources.• This prevalence study was conducted in 1995.Evidence from agencies and the national databasesince then indicates that there has been a substantialincrease in the numbers of overall drug users inInverclyde and an increase in the numbers of IDUs.Accordingly the expenditure figure based on the1995 study will be an under-estimate of currentexpenditure on illicit drugs.Apart from the prevalence study, there are severalcurrent sources of information to provide someassessment of people misusing drugs. These include:5

Inverclyde Forum About DrugsScottish Drug Misuse Database (SDMD)This is a national database administered by theInformation and Statistics Division (ISD) of theNational Health Service in Scotland. In most drugservices in Scotland all new clients or clients representingto the agency after a gap of six monthshave basic information on their drug misuse recordedon a form known as the SMR23. These forms aresent to ISD for entry onto the national database.Patients attending GP surgeries for drug misuseproblems will also have information recorded onthem on an SMR22 form also processed by ISD. Thisgives a Scotland wide profile of new and re-presentingcases attending treatment agencies. This profile includesinformation on up to 4 main drugs of misuse; methodby which drugs are taken; whether drugs are beingprescribed or used illicitly; injecting behaviour i.e. sharingof needles and equipment, and age and sex of clients.In Inverclyde the Community Drugs Team, the hospitaladdiction unit and several GP's participate with thedatabase. Please note that SDMD does not includeneedle exchanges, Social Work Departments orprisons but is restricted to addiction agencies and GPsurgeries. Attempts are being made to providerecording systems for the services that are notpresently covered by the SDMD.The last year for which figures are available from theSDMD was 1998/99. Broken down by local authorityarea the SDMD data for new clients and patients byarea of residence indicate that Inverclyde andAberdeen City have the highest rate of return forScotland in terms of numbers per 1,000 populationas shown in Table 1.Table 1: Scottish Drug Misuse Database patients/clientsby area of residenceSource: ISD Scotland 1999It is important to note that these figures refer to those attending servicesand is not an indication of drug prevalence in each local authority area.Nearly five people in every thousand in the Inverclydearea attend a drug agency in Inverclyde compared tofour per thousand in Glasgow.Addiction Agencies, Needle Exchanges andPrescribing ServicesAll have their own internal monitoring systems thatinclude information on ongoing clients as well as newand re-presenting clients. This information can beutilised to look at local trends of drug misuse and torecord improvements in client behaviour (e.g.movement from illicit use to prescribed use and morestable less chaotic behaviour). All addiction agenciesand needle exchanges in Inverclyde provide annualreports based on these internal monitoring systems,these will be examined as part of this report.6

Inverclyde Forum About DrugsPoliceFigures that are available from Strathclyde Police relateto possession and/ or supply of drugs under theprovision of the Misuse of Drugs Act (1971).Strathclyde Police also record information on drugrelated deaths that are defined as non-accidental,overdoses or sudden death. Inverclyde, until themiddle of 1999, was covered by 'X' Division ofStrathclyde Police (from that date 'X' and 'K' Divisionswere joined together and Inverclyde is now coveredby 'K' Division) and information from 'K' Division willbe included in this report.All of the above sources are limited in that they arebased exclusively on people using services or cominginto contact with police or criminal justice agenciesand cannot be said to reflect the entire profile of thedrug misusing population in the area. As a consequenceof the way information is gathered there are seriousunderestimates and deficiencies relating to levels ofcannabis misuse and so called recreational drug usein general.We can now look in detail at what information isavailable in the area.Scottish Drug Misuse DatabaseAs noted above, entries to the SDMD are submittedvia the SMR23 and SMR22 forms that are filled outon all new and re-presenting clients. In year ending31 March 1999 413 entries were recorded on thedatabase from Inverclyde. (14) Of these the largestpercentage, 35% (N=145) came from PA16 that isthe Greenock South-West/Inverkip/Esplanade andFinnart areas. The next highest percentage at 33%(N= 135) was from the Greenock East/South-East/Central areas (PA15). This was followed by 23%(N=94) from Port Glasgow (PA14) with 6% comingfrom other areas.Chart One: Gender Distribution of New ClientsThis illustrates that two thirds of new clients weremale (68%). This is typical of gender distribution atdrug agencies throughout Scotland. This eitherindicates a true reflection of the actual male to femaleratio of drug misusers in the wider community orindicates perhaps that females are less willing to attendservices. Several possible explanations for this mayinclude• Fears of social work department interventionaround issues such as childcare and drug misuse.• A possible 'double-stigma' attached to being bothan illicit drug misuser and female.In the absence of detailed research it is difficult toascertain whether attendees at services accuratelyreflect the sex distribution in the wider drug misusingcommunity. However, from a statistical viewpoint thefact that this two-thirds to one-third-genderdistribution is consistent throughout Scotland is highlysignificant. Services do attempt to engage with femaledrug misusers to persuade them to attend services.In total 4% of all submissions to SDMD were fromInverclyde, this compares to 33% from Glasgow, 22%from Lothian and 12% from Grampian. In proportionto its population size Inverclyde is over-representedon the database indicating a high severity of drugmisuse.Addiction agencies, Needle exchange andPrescribing ServicesThere is a limited range of addiction agencies in theInverclyde area these include:• Community Drug Team (CDT)• Needle exchange Boglestone and NicholsonStreet• Gryffe Unit Methadone Unit/ Prescribing• GP Clinics68%32%MaleFemaleThe client profile of these agencies will be detailed inSection Four.Source: Drug Misuse Statistics in Scotland 1998 Bulletin8

section three: drugtrends in the areaAs referred to earlier, data derived from the ScottishDrugs Misuse Database (SDMD) recorded 413 newcontacts with clients in Inverclyde during 1998/99.The primary drug being used by new clients is shownin Chart Two.As can be seen from Chart Three the percentage useof heroin as a primary drug in Inverclyde is significantlygreater than that for Argyll and Clyde as a whole orindeed for Scotland.This is further emphasised when the rate of heroinuse as a primary drug per thousand of the populationis examined as shown in Table 2.Table 2: Heroin as main drugChart Two: Distribution of Primary Drug80%70%60%50%40%30%20%10%0%79%10% 3% 2% 2% 4%Heroin Methadone Cannabis Temazepam DF118 OthersSource: Drug Misuse Statistics in Scotland 1998 BulletinOver three-quarters of new and re-presenting clientswere using heroin (n=327). The next most popularprimary drug was prescribed methadone.Chart Three: % of Heroin Used as a Primary Drug80%70%60%50%40%30%20%10%0%50%Scotland64% 65%Argtll & Clyde DunbartonshireWest51%RenfrewshireSource: Drug Misuse Statistics in Scotland 1998 Bulletin80%InverclydeSource: ISD Scotland 1999Inverclyde has the highest rate of primary heroin useper thousand of the population, higher than Aberdeenand Glasgow.Chart Four: Age Distribution of New Clients inInverclyde40%35%30%25%20%15%10%5%0%1%20%36%24%14%Under 15 15-19 20-24 25-29 30-34 35-39 40-44 45 yrs & overSource: Drug Misuse Statistics in Scotland 1998 Bulletin3% 1% 1%9

Inverclyde Forum About DrugsMost new clients presented in the age-range 20-24with an average age of 25. Very few clients presentedover the age of 35. Equally, few presented under theage of 15. This may be due as much to agencies thathave no policy of working with young people under15 as the fact that very few young people presentto drug services.Chart Six: Sharing of Injecting Equipment AmongNew Clients in Inverclyde30%25%20%15%10%27%25%27%20%Chart Five: Injecting Rate Among New Clients inInverclyde5%0%Shared in Past Month Ever Shared Never Shared Not Recorded50%45%40%35%30%25%20%15%10%5%0%50%19%29%Injected in Past Month Injected Ever Never Injected Not RecordedSource: Drug Misuse Statistics in Scotland 1998 Bulletin2%Half of all new clients in Inverclyde had injected withinthe previous month prior to presenting at a service.19% had injected at some point in the past, but notin the past month. In other words 79%, over threequarters,were injecting now or had been in the past.These figures for injecting rates are high in comparisonwith elsewhere in Scotland. For instance ISD figuresfor injecting rates throughout Scotland for new clientspresenting to services for 1997/98 show that 38%had injected in the previous month, 18% had injectedbut not in the previous month and 44% reportednever injecting, which compares to 29% reportingnever injecting in Inverclyde. Therefore rates ofinjecting among new clients in Inverclyde are significantlyhigher than in Scotland overall.Source: Drug Misuse Statistics in Scotland 1998 BulletinJust over a quarter of new clients who were injectingwere sharing injecting equipment. 25% had shared atsome point in the past while 27% had never shared.For 20% there was no record of their status regardingsharing. These compare to Scotland wide figures of24% who had shared in the past month; 22% whohad ever shared and 16% for which no data wasavailable. While there was not a significant differencebetween current and past sharing figures for Inverclydecompared to Scotland as a whole, there was asignificant difference for the rates of those injectorswho had never shared. Just over a quarter ofInverclyde's current new injectors had never sharedcompared to 39% Scotland wide, indicatingproportionally more sharing of injecting equipmentwithin Inverclyde.In the period from 1996 to June 1999 there were82 reported cases of hepatitis in Inverclyde, of whom51 were acute confirmed cases of the blood bornevirus hepatitis B. A virus introduced into the body bycontaminated blood products or infected needlesand syringes causes Hepatitis B. Hepatitis B is a verygood indicator of a large amount of needle sharingin a community and 89% of those infected by it wereinjecting drug users.10

Inverclyde Forum About DrugsAs was noted earlier, the vast majority of drug usersin Inverclyde, as reported to treatment agencies, areunemployed. Accordingly, they will have to financetheir drug misuse through a variety of means principallytheft, prostitution and small time 'user-dealing'. Druguse is, therefore, normally associated with a high levelof acquisitive crime i.e. theft, housebreaking, shopliftingetc.Table Three below illustrates the high level of drugsrelated offences committed in Inverclyde per thousandof the population.Table Three: Drug related offences recorded byScottish Police ForcesChart Seven: Deaths in Argyll & Clyde Police Divisions1998-991098765432102Source: Annual Report of the Chief Constable of Strathclyde 1998/9910As can be seen from Chart Seven, of the 16 deathsattributed to drug overdose in the Argyll and ClydeHealth Board area in 1998/99, 10 or 63% were inInverclyde compared to 2 or 13% in Dumbartonand Argyll and 4 or 24% in Paisley/Renfrew. ThusInverclyde has a disproportionately high incidence ofdrug related deaths. Inverclyde accounted for 10%of all drug related deaths in the Strathclyde Forcearea in 1998/99 and was the joint third highest policedivision for drug deaths. The two highest divisionswere both within Glasgow City.4Dumbarton/Argyll Inverclyde Paisley/RenfrewSource: ISD Scotland 1999It is important to note that these figures refer tonumbers of offences and not individuals. For instanceone individual could have committed up to onehundred drug related offences.There is evidence, despite the relatively low rate ofacquisitive and directly drug related crime withinInverclyde, that a high proportion of offenders workwithin the Criminal Justice System is drug related.An analysis of Breach of Probation applications withinInverclyde in 1998/99 revealed that '83% involvedcurrent drug users.' Similarly, 'Supervising officersconsidered that in 72% of the Breaches, drug addictionwas a contributing factor.' (15)Inverclyde is second only to Glasgow in the numberof drug related offences committed per thousand ofthe population and is higher than Aberdeen, Edinburghand Dundee.12

section four:services availablewithin inverclydeCommunity Drug Team25%20%15%10%5%0%Chart Nine: Age Range of Clients20% 22% 18%14%10%7%3%3% 1% 1%0-15 16-18 19-21 22-24 25-27 28-30 31-33 34-36 37-39 40+Inverclyde Community Drug Team (CDT) providesa one to one counselling and support service fordrug users and their families. The agency also providesa monitoring and support service for GP prescribingclinics principally prescribing methadone. In additionthe CDT gives harm reduction assessment and advice,offers group activities and support and supplies accessto information on other treatment programmes suchas residential detoxification and rehabilitation.CDT Statistics:In the period April 1998/99 the CDT dealt with 211new referrals of whom 140 (66%) were male. Therewere 185 ongoing cases from the previous yearmaking a total caseload of 396.Chart Eight: Postal Areas of Referral26%65% 5%4%Port GlasgowGourockElsewhereGreenockSource: Inverclyde Community Drug Team Annual Report 1998/99Source: Inverclyde Community Drug Team Annual Report 1998/99A total of 70% of clients presented in the age-range19-30; those under 19 and those over 30 representvery few clients at the service. The average agewas 26.Chart Ten: Primary Drugs New Clients90%80%70%60%50%40%30%20%10%0%81%5% 5% 4% 5%Heroin Cannabis Methadone Temazepam Other DrugsSource: Inverclyde Community Drug Team Annual Report 1998/99The overwhelming bulk of new clients were usingheroin as their primary substance. Relatively few newclients had access to methadone prior to presentingto the service.The characteristics of new clients presenting to CDTare in line with those attending addiction serviceselsewhere in Scotland. These are:The overwhelming majority of CDT's clients camefrom Greenock, just over a quarter came from PortGlasgow. Very few came from Gourock.13

Inverclyde Forum About Drugs• A ratio of two-thirds male to one-third female• An average age of 26• Overwhelmingly opiate usersRavenscraig Hospital Drug ClinicThe hospital provides a Consultant Psychiatrist ledservice that works with three doctors who operatefive clinical sessions per week. Two CommunityPsychiatric Nurses and one Community Nurse deliverssupport for clients at home. The clinic provides longtermmethadone detoxification and stabilisationprogrammes. It also provides other short-termprogrammes when needed.Chart Eleven: Attendance at Drug Clinic 1996-9920001800160014001200100080060040020007641996-97 1997-98 1998-99Source: Ravenscraig HospitalAs can be seen, numbers of client contacts presentingat the clinic have more than doubled since 1996-97.There was a particularly sharp increase in contactnumbers between 1996-97 and 1997-98.There are approximately 170 patients on methadoneas of June 1999 (the last period for which figures areavailable). There appear to be roughly 120 otherpatients receiving methadone via their GP.Needle Exchanges17211815There are currently two needle exchanges withinInverclyde. Both operate two sessions weekly. Onewas located until November 1999 at Shaw Place, butsince then has moved to Nicholson Street along withthe Community Drug Team. The other is at theBoglestone Clinic in Port Glasgow. The service ismanaged on a day-to-day basis by the NeedleExchange Development Group and is formally runby the Needle Exchange Management group thatmeets on a two monthly basis and oversees anymajor development or management problems.The clinic at Nicholson Street runs from 2-5pm everyMonday and Thursday afternoon and is staffed byone Needle Exchange Community Psychiatric Nurse.The clinic at the Boglestone Clinic runs between6.30-8pm every Tuesday and Friday evening and isstaffed by the needle exchange CPN and a sessionalnurse.Both clinics run a new for old scheme, however, if noneedles are returned a minimal amount (three) is stillgiven.Amongst developments over the past year at theExchanges: funding was given to undertake HepatitisB immunisations for drug injectors at both clinics.Another development has been the availability ofclean filters for the exchange users. The Inverclydeneedle exchanges are the first in Scotland to undertakeboth these initiatives with other members of theScottish Needle Exchange Workers Forum followingsuit.In addition to this women are able to have aconfidential pregnancy test and are given specialistinformation regarding pregnancy and addiction.Patients are also able to access some basic woundcare advice at the exchanges. Also with theemployment of a full time G graded nurse theexchanges have been able to give an expanded service.14

Needle Exchange StatisticsNicholson Street• During 1998-99 a total of 2277 contacts weremade to the exchange. In addition, a total of 1614visits were made by exchange staff out of hours.• 196 contacts were new to the exchange.• 20507 syringes were returned and 23715 givenout which is an overall return rate of 86% for theyear.• 20% of contacts were female.• Over half (55%) of contacts were aged 25 or over.Boglestone Clinic• During 1998-99 a total of 683 contacts weremade to the exchange.• 108 contacts were new to the exchange.• 6605 syringes were returned and 7303 given outwhich is overall return rate of 91% for the year.• 16% of contacts were female.• 84% of contacts were aged 25 or over.The total number of contacts at the two exchangeswas 2960 and the total number of new contacts was304.Gateside PrisonGateside Prison has over the past few years had aspate of suicides, some of which were related toprisoners undergoing withdrawal from drugs. Thenumbers of prisoners entering Gateside who haddrug-related problems or who were sentenced fordrug-related offences has also increased enormouslyover the last several years. In response the prison,in line with Scottish Prison Service (SPS)recommendations, has established a dedicated DrugUnit to help monitor, supervise and rehabilitateprisoners with identified drug problems.Currently the prison employs two drug workers andhas recently started a drug throughcare worker. Theprison also has Programme Officers who devise andrun various courses for prisoners.Upon admission to the prison all prisoners are testedfor illicit substances. Drug workers attached to thePrison Drug Unit will interview those providing apositive result. The purpose of the interviews is toidentify 'vulnerable' prisoners', i.e. those at risk ofsuicide or self-harm or any other problem, and alsoto assess potential throughcare issues andarrangements. During these interviews prisoners areoffered a range of advice and information. Prisonersare also offered Hepatitis B immunisation and generalhepatitis counselling.Staff at the Drug Unit participate in the inductionprocess for prisoners in order to raise awarenessabout services available within the prison. Amongthe programmes currently available for prisoners are:• Drug Education Programme (available to 6 remandprisoners each week). There are two basiccomponents to this programme. One sessiondeals with basic drug awareness and blood-borneviruses such as Hepatitis C and HIV. The othersession teaches 'heart start' basic first aid.• Relapse Prevention - a course that is a twelveweekprogramme for six long-term, convictedprisoners at any one time.• Stress Management course.• Cognitive skills.• Anger Management.• 'Breaking the Cycle' which involves participantslooking at coping strategies and parental skills.15

On an average month the Prison Drug Unit staff willsee 40 prisoners who have tested positive and, asmentioned above, they will be given advice andinformation. Of those 40, on average, 10 will havethrough-care issues and 8 will be followed up withother interventions.The prison is seeking to establish closer liaison withvarious community agencies such as social work andaddiction services. A throughcare worker has beenemployed to develop these links.The main drugs prisoners have been using prior tocoming into prison are heroin, a reported increase in'crack' cocaine and temazepam use. The main routeof administration by which people were using theirdrugs was by smoking rather than injecting. In general,anecdotal evidence from prison staff indicates thatprisoners continue to smoke drugs within the prisonrather than resort to injecting.A drug prevalence and needs assessment study wasconducted in Gateside Prison during 1996. The studyfound that 44% of Argyll and Clyde residents in theprison were from Inverclyde. Out of 115 prisonersinterviewed, 101 reported that they had taken drugs.Seventy prisoners reported they had used drugs bothin prison and in the community. 15% of the prisonersbegan using illicit drugs (other than opiates) in prison.(16)There are no plans to repeat the survey; it is thereforedifficult to assess the accuracy of the results in relationto current trends within the prison.Other Relevant Agencies (The) Habit GroupHabit is a campaigning group that advocates for familysupport facilities. The group meets monthly for BusinessMeetings at the Craigend Resource Centre.Referral to the group is by self-referral. The group canbe contacted c/o Highholm Community EducationCentre, Port Glasgow.Open HandsOpen Hands is a voluntary organisation that providesfamily support services every Wednesday eveningsfrom 7pm-9pm in the Blairmore Centre. Method ofreferral is by self-referral. The group can be contactedc/o Highholm Community Education Centre.Valiant UnitedValiant United is a voluntary organisation that providesa range of services and activities including leisureactivities, football training, self-defence, complimentarytherapy, cafe area and line dancing. Advice andinformation is also provided. Referral is by word ofmouth, telephone, advertising and self-referral.The group can be contacted at the Health and FitnessRecovery/Family Support Group c/o Octavia Halls,99 Sinclair Street Greenock.MidoakMidoak is a voluntary organisation that providessupport for mothers of drug users who have becomeinvolved in the criminal justice system. The group isopen every second Wednesday from 7pm-9pm. Thegroup can be contacted via the Family Support Group,c/o Social Work Department, Nichol Street, BowFarm, Greenock PA16 7EN.17

Inverclyde Forum About DrugsLydia TrustLydia Trust is a voluntary organisation offering support,counselling and rehabilitation to people with lifecontrolling problems, mainly drug users and theirfamilies. Lydia Trust offers residential care for thosewho need a more intensive way of dealing with theirproblems. Referral is through social work, familymember, self or church leader etc. Can be contactedby telephoning 07775 755554 (Jean McGhee) or01475 530271 (Residential Centre).HavenThe Haven is a residential centre where studentsfollow a christian based programme of study andwork that enables them to overcome a life ofaddiction to drugs. The eighteen month programmeis highly structured and very disciplined. Entrance isby application and interview. Can be contacted on01505 872099/328055 (Mr Black).18

section five: gapsand ommissions inservice provisionin inverclydeThe foregoing report has illustrated the range ofservices for drug users within Inverclyde. However,there are serious deficiencies in the range and provisionof services.• There are problems for clients experiencing drugproblems in outlying areas of the district, particularlyin outlying areas such as Kilmacolm. This is especiallyso with regard to transport costs in accessingprescribing services, pharmacies and the CDT.There is also a lack of services based in PortGlasgow, Gourock, Wemyss Bay and Inverkip.• There has been concern expressed at the lack ofa residential rehabilitation service or of ease ofaccess to one for people in Inverclyde. This maybe due to lack of available beds, inadequate fundinglevels or the need for such a service to beestablished within the district.• According to the Inverclyde Joint Community CarePlan section on drugs for 1998-2001: 'A consistentconcern expressed by service users and carers isthat Inverclyde has no specific in-patient provisionat local hospitals for dealing with drug relatedemergencies apart from physical problems suchas septicaemia, blood clotting and overdose'.(17)There is a clear need for more services to caterfor drug users in crisis. At present the nearestprovision for crisis intervention for drug users isat the Glasgow Drug Crisis Centre.• Waiting lists for substitute prescribing and sharedcare schemes are long and lengthy; on averagethere are 80-100 patients waiting with waitingtimes of 4-6 months. This is clearly inadequategiven the importance of retaining drug misuserswith services in order to stabilise their drug use.• There is evidence, albeit anecdotal, of strains onpharmacies in providing supervised methadone.This ranges from tensions between staff and clientsover supervision, large numbers of drug misusersin pharmacies acting as a deterrent to othercustomers, equally a lack of privacy and dignity fordrug misusers who have to take their prescriptionof methadone in front of other customers.• There are two needle exchanges currentlyoperating in the district, one of which operates inthe evenings. However, the CDT needle exchangeemergency service was withdrawn; this hadpreviously accounted for over half of all needleexchange contacts. Again there is the recurringproblem of clients from outlying districts trying toaccess exchanges. There is also the problem ofno out-of-hours provision for injecting equipment.The adequate and accessible provision of injectingequipment is particularly important given therecent (1997-98) outbreak of Hepatitis B and theincreasing incidence of Hepatitis C.• The aforementioned Community Care Planspecifically identified 'the lack of after care centreresources as a key shortfall in current serviceprovision'. The avoidance of relapsing back intodrug misuse can be bolstered by an effectiveaftercare service. This can provide both alternativesto drug misuse and build upon skills' deficits inorder to move people to a position where theymay be able to commence training and/or go backto the labour market. These considerations applyequally to the provision of through-care servicesfor drug misusers who are stabilising on substitute19

Inverclyde Forum About Drugsprescribing. At present there are no effectivethrough-care or after-care services in the area.Allied to the huge waiting lists to commenceprescribing the risks of relapsing back into drugmisuse in the absence of constructive alternativesare particularly acute within this area.• There is a need for more services to engage withyoung people. There is some evidence to indicatethat young people's use of drugs is increasing, butthat the structure and profile of current servicesin Inverclyde is not geared to meet the needs ofyoung people, especially those under 16.• There is a need to look at the effectiveness ofdifferent treatment services within the area tolook at how effective they are in: stabilising druguse, reducing drug-related harm and ceasing druguse.• The drugs prevalence and needs assessment surveyconducted at Gateside Prison in 1996 should berepeated to ascertain current levels of drug misusewithin the prison.• Similarly the survey conducted on residents inthe Priority Partnership Area in 1997 should berepeated to see if levels of poverty, poor health,unemployment and overall poor quality of lifewhich was revealed then still remains the same,or whether any improvements have occurredsince then.recommendationsand conclusionsInverclyde has high levels of both multiple deprivationand drugs misuse as highlighted in this report. Thereis clearly a link between both and attempts to dealwith one will not be as effective unless both are dealtwith. Accordingly, it is important that a long-termstrategic plan be drawn up to deal effectively withthe multitude of problems surrounding drugs misusein the area.Such a plan should be drawn up with all ‘stakeholders’in the area who have an interest in halting and arrestingthe serious levels of drug misuse in Inverclyde. Thesestakeholders would include:• Local authority and it’s constituent departmentssuch as social work and education, as well as electedmembers of the authority• Health Board• Strathclyde Police• Community Drug Team• Prescribing services• Local GPs• Pharmacists• Community groups• Family members and carers• Service usersThis list is not meant to indicate level of importance,but all are equally valid and each has a significant partto play in drawing up and informing a strategic plan.Such a plan to succeed must be inclusive and can onlybe so by involving all ‘players’ to this issue on an equalfooting.There are clearly major gaps, omissions and deficitsin levels of service provision. A process of consultationand active involvement of community and agenciesalike will only overcome these deficits.As part of this process of consultation IFAD held aseminar of community activists to discuss issues arounddrug misuse in the area. The seminar was divided intofour workshops on themes relating to crime, young20

21people, treatment and services, and communities.Below are listed some of the main recommendationsthat arose out of the seminar.Crime• There was a perceived need to tackle a culturewhich that views certain criminal activities as‘normal’ or ‘acceptable’.• Families would like some form of police supportin dealing with crimes that occur, for examplewithin the family home, which does not criminalisefamily members.• There was a perceived mistrust of the police fromcertain sections of the local community that needsto be addressed; there has to be a process ofconfidence building between the police and thesesections of the community.• There should be suitable detoxification facilitiesin the community for people withdrawing fromdrugs so that prison doesn’t seem to be the onlyreasonable detox option. In addition theenhancement of throughcare provision fromprovision might require safe accommodation withinthe community.Young people• Education programmes should be consistent acrossschools; parents and teachers need help to learnabout drugs too.• There should be an emphasis within schools ondeveloping a ‘citizenship’ ethos.• Schools should involve and encourage ‘lowachievers’ more.• Young people need a range of youth services andongoing alternatives as well as access toemployment and training and access to informationabout services.• For those young people using drugs it wasrecognised there could be a need for a serviceto deal with recreational drug users. Such a serviceshould seek to provide a safe environment forcounselling and information giving. It was recognisedthat it would be inappropriate to mix young peoplewith older people who may have a more chaoticlifestyle, within the same service.Treatment and Services• There was perceived to be a need for greateradvertising of local services in the area. There waspoor knowledge of helplines and local servicesgenerally. More strategic thinking was requiredaround advertising of local services.• GPs should be a first line of assistance and referralto other agencies and there should be greater GPinvolvement in services.• Families need greater support and different typesof support e.g. development of self-help groupsand crisis help when needed.• There is a need for local detoxification andresidential facilities, particularly in emergencysituations.• Service providers need to learn about families’experiences of living and coping with drug misuse;compiling family stories could make a start to this.Communities• The infrastructure of the area needs addressedparticularly in relation to jobs, the local economyand the environment. There was felt to be a needfor local training for local jobs and more longtermjobs.• There was felt to be a need for more communityinvolvement needed in regeneration decisionmaking and local authority strategies.• Treatment for drugs misuse should support thereintroduction of the individual back into

Inverclyde Forum About Drugsemployment and not act as a block to it. Forexample the daily supervision of methadone,while acting as a safety check to deter leakage andprevent overdose could, in some circumstances,act as a brake on an individual’s employment ortraining prospects.• There was the need to balance ‘good’ and ‘bad’news about Inverclyde.With respect to this last point, there is need toemphasise that there is also a great deal of communityactivism and involvement in the area as exhibited bythe numerous community groups active in Inverclyde.Equally there is great deal of expertise, both lay andprofessional, about drugs and addiction generally. Itis hoped that this report, by highlighting levels of drugmisuse, social deprivation and gaps in service provision,and also the level of community involvement andexperience, can begin a process of planning andconsultation, which by bringing all parties together,can seek to alleviate what must be the common goalof all: - the alleviation and reduction of harm causedby drugs misuse in Inverclyde.22

Inverclyde Forum About Drugsreferences1) Drug Misuse Statistics in Scotland: 1999 BulletinISD Scotland2) Population Census Report for Scotland 19913) Strathclyde Regional Council Social WorkDepartment 19954) Updated Population Census Report for Scotland19985) Annual Report of Director of Public Health forArgyll and Clyde, 19966) Population census for Scotland 19917) ISD Alcohol Statistics 19978) Comparisons of Parliamentary Constituenciesin Great Britain: Townsend Centre forInternational Poverty Research (1999)9) Inverclyde Joint Community Care Plan 1998-200110) Ibid11) Survey of Residents in Inverclyde PriorityPartnership Area: Market & Opinion ResearchInternational (MORI) 199712) Estimating the Population Prevalence of DrugUse and Injecting Drug Use in Argyll and Clydein 1995 Scottish Centre for Infection andEnvironmental Health (SCIEH)13) Estimated expenditure of injecting drug users inGreater Glasgow. M Frischer, A. Taylor, L.Grueret al 199814) All of the following statistics relating to newclient characteristics presenting to services withinInverclyde are derived from the ISD Bulletin,Drug Misuse Statistics, Scotland 199915) Inverclyde Joint Community Care Plan 1998-200116) Scottish Prison Service, Drug and AlcoholPrevalence and Needs Assessment in HMPGreenock, Scottish Prison Service OccasionalPapers Report No.3/199717) Inverclyde Joint Community Care Plan 1998-200124