MRCPsych seminar series Epidemiology of addictive disorders: a brief review Dr Stuart McLaren March 2010

consumption /use dependence problems/harms Epidemiology of substance use

Sources of data Drug seizures Persons dealt with for drug offences Drug-related crime Prescription audit

Sources of data ONSGeneral Household Survey -smoking -alcohol Surveys of psychiatric disorders Deaths British Crime Survey –illicit drugs Crime and Justice Survey National drug treatment database (NDTMS)

Prevalence of psychiatric disorders /1000 adult population Neurotic disordersAll164 PsychosisM 5 F 6 Alcohol dependenceM119 F 29 Drug dependenceAll ONS

Lifetime prevalence of drug use Overall35.5% Cannabis30% Amphetamines12% Cocaine 7.7% Ecstasy 7.3% Opiates<1% -heroin 0.7% -methadone 0.4% 2006/2007 BCS

Prevalence rates of problem drug users in England 2005/06 per 1000 population aged 15 to 64 Rate95% CI Total Opiates Crack Injecting Hay et al. 2007

Prevalence rate of problem drug users in England per 1000 population aged 15 to 64 by gender Rate95% CI Male Female Hay et al. 2007

Prevalence rate of problem drug users in England per 1000 population aged 15 to 64 by age Rate95% CI years years years Hay et al. 2007

Drug use in last year General population (16-59 years) 10% taken illicit drug 3% used class A drug Prison populations 73% used illicit drugs 50% heroin/cocaine 2006/2007 BCS & 2003 HO

Prevalence of drug dependence All3.7% Cases per 1000 population Cannabis only25 Ecstasy6 Amphetamines4 Cocaine2 Opiates/cocaine ONS

Injecting –England & Wales Whole population (age years) -ever injected4/1000 -regular injector2/1000 -past month1/ ONS

Main drug in adult treatment populations (n=174250) Heroin66% Crack 6% Cocaine 6% Methadone 8% Cannabis 7% NDTMS 2007/8

Main drug in treatment population under 18 (n=14725) Cannabis78% Heroin 5% Crack 1% Cocaine 5%

Individual clients receiving specific treatment modalities 2007/8 England198, 254 Inpatient 6,742 (3%) Specialist prescribing 99,963 (50%) GP prescribing 47,036 Day programmes 20,537 Residential rehab 4, /08 NDTMS

Illicit drug trends Drug dependence has doubled over the last decade (now c. 4.2%) Increasing multiple drug use Opiate use stable, male mortality increasing Use of opiates correlates with deprivation Stimulant use has increased Cannabis use may be falling Use shows no class gradient

Comorbidity-70% of opiate users have another current psychiatric disorder Anxiety disorder28% Affective disorder26% Antisocial personality disorder18% Schizophrenia 7% ECA, Regier, 1990

Substance related harms and risks ‘with drugs nothing is always. Their use does not carry a guarantee of danger, but neither is their safety guaranteed.What one needs to ask about any substance is not whether in absolute terms it is safe, but rather the degree of risk which may attach to its use.’

Harms of drug use: Physical health, including death Mental health Social circumstances Educational & employment status Criminal justice status Safety & welfare of others, including children

Factors in drug harms Contaminants Route -BBVs -accidental overdose -smoking and lung damage -drinking and gut cancers Addiction or dependence

Harm to others Transmission of blood-borne viruses Violence Driving Family disruption Damage to children Community dislocation

Drug-related deaths Tobacco(UK, approx.)500,000 Alcohol (approx.)25, ,000 Opiates6,194 Cocaine 508 Amphetamines 436 Solvents (UK) 361 Ecstasy 200

Problem drug users - all cause mortality X 12 (SMR 1244, 95% CI ) time higher than in general population aged years [ DORIS cohort, 2008] In cohort studies 1-2 % die every year

Demographics of drug-related deaths Mostly male (74%) Most under 45 years (71%) Causes – accidental poisoning (64%), intentional self-poisoning (13%) Opioids +/- other drugs (69%) (np-SAD 2009)

UK AIDS cases- total to 2005 total% Gay sex M/F sex IDU12276 M. to I.5943 Blood8714 Other2622 HPA

UK HIV infections total% Gay sex M/F sex IDU42736 Blood1798- Other4615- HPA

Hepatitis C infection General population0.5% Chronic infection0.4% Prison populations7% IDUs30-80%

Hepatitis C transmission – England IDU91% Blood transfusion2.5 Blood products2.3 Sexual exposure1.8 Renal failure0.9 Other0.8 Vertical0.6 HPA

Epidemiology of drinking and alcohol-related harm

consumption /use dependence problems/harms Epidemiology of substance use

Consumption and risk – units/week MenWomen Low risk<21<14 Hazardous drinking Harmful drinking>50>35

Alcohol consumption Weekly alcohol consumption above recommended limits M 28% F17% F aged years 33% [doubled since 1992] 2002 GHS

Hazardous drinking AUDIT score 8 or more: Overall 25% M38% F15% 2000 ONS

Prevalence of alcohol dependence SADQ – rate per 1000 population (7% dependent, 1% severely dependent) AllMF Mild Moderate471 Severe ONS

Prevalence of alcohol dependence Peaks at years M24% F 7% 2000 ONS

Comorbidity – 37% of those with alcohol disorder have another mental disorder Anxiety disorder19% Antisocial personality disorder14% Affective disorder13% Schizophrenia 4% ECA, Regier, 1990

Alcohol trends CAGE scores increasing between generations of men Dependence and hazardous drinking peak in middle occupations Heavy drinking shows no clear class gradient Younger people and women at particular risk

Smoking prevalence 16 years and above:M. 27% F. 25% years: F. 29% M. 22% years9% (2006) 2002 GHS

Young people Aged ~10,000 sample Regular smokingF 10%M 7% Alcohol last week23% F=M 5.3u/week in u/week in 2000 Drugs last year18%