1. Differences in drug use by ethnicity: Do they suggest inequity in access to drug treatment? March 2005 Peter Madden Senior Analyst, Matthew Hickman Senior Lecturer, Charlotte Fellows, Analyst © Imperial College London

2. Equity of access to treatment Defined as “equal access for equal need” Access to treatment affected by –Gender, Age, Socio-economic group, Ethnicity Minimum requirement to assess equity –High quality ethnic group data –Measure of treatment need/ Prevalence of problematic drug use by ethnicity –Treatment access Focus on heroin and crack use

3. Prevalence by ethnicity / treatment need British Crime Survey (BCS) – 2001/2002 Used to estimate the prevalence of drug use in the general population Representative random sample across England and Wales The 2001/02 sample included an ethnic minority booster Total sample of 24,127 respondents aged <60 completed the drugs component

4. Prevalence by ethnicity / treatment need Last month drug use by ethnicity – BCS 2001/02 White (84%) 20,322 Black (5%) 1184 Asian (8%) 1832 Crack<0.500 Heroin<0.50 Cannabis772 Any Drug883

5. Prevalence by ethnicity / treatment need ONS Survey of Psychiatric Morbidity - 2000 Survey among private households (16-74) Focused on tobacco, alcohol and other drug use and their relationship to psychiatric morbidity Approached 12,792 addresses and analysis are based on 8,580 interviews

6. Prevalence by ethnicity / treatment need Last year drug use (dependency) by ethnicity - ONS 2000 White (94%) Black (2%) Indian, Pakistani or Bangladeshi (2%) Crack0.30.6- Heroin/methadone0.1-0.3 Cannabis2.62.31.4 Any illicit Drug3.83.41.7

7. Prevalence by ethnicity / treatment need Summary – Household surveys Limitations : –Excludes homeless, those living in institutions Under-estimate of heroin and crack use No suggestion that the level of under-estimation differs by ethnicity Little evidence to suggest prevalence of crack and heroin varies substantially by ethnicity (less than 1%) –Verify findings using Capture-recapture

8. Treatment access National Drug Treatment Monitoring System NDTMS - 2003/04 (Treated) A "public health surveillance system” for monitoring trends in problem drug users presenting for treatment Focuses on problem drug users presenting to specialist drug agencies and GPs offering structured care. Collects data at contact and then at the end of the fiscal year "client review"

9. Treatment access Arrest Referral Monitoring Database: data for 2000- 2004 combined (Arrested) Crime reduction initiative seeks to identify drug users at the point of arrest, encourage them to address their drug problem and obtain appropriate treatment. Offered to all arrestees by a custody officer as part of the booking-in process Data presented for arrestees who choose to be assessed and possibly referred through the AR scheme

10. Treatment access: treated, arrested and general population (census 2001) data Data available Data collated but not currently available Wales, Scotland, Northern Ireland outside scope

11. What we would expect to see assuming equality of access & similar prevalence of drug use across ethnic groups Hypothetical General Population Assuming drug use is equal in each ethnic group @ 50% Assuming Equality of access i.e. 10% of each group receives treatment % in treatment (or arrested) * White Black Asian Other No: 700 (70%) 100 (10%) 1000 No of drug users: 350 50 500 35 5 50 70 10 100 * So under these assumptions the % treated by ethnicity matches the % of each ethnic group in the general population

12. Treatment access Asian ethnic group - treated, arrested and general population comparisons

14. Treatment access Black ethnic group - treated, arrested and general population comparisons

15. No significant differences seen for the White or Mixed ethnic group Treatment access Black ethnic group - treated, arrested and general population comparisons

16. TreatedArrested Heroin48%17% Heroin and Crack24%43% Crack10%15% Other17%24% 21,34923,598 Treatment access Drug profile by data source (London)

17. ArrestedTreated AsianHeroin77%85% Crack50%27% Crack only5% BlackHeroin37%41% Crack61% Crack only32%39% WhiteHeroin67%77% Crack59%33% Crack only10%6% Treatment access Drug profile by ethnicity and data source (London)

18. Conclusion Little evidence (in household surveys) for ethnic differences in the prevalence of crack or heroin use by ethnicity Differences observed by drug use and ethnic group –Asian ethnic group under represented in treated population –Black ethnic group over represented in arrested population –Crack users being arrested, heroin users treated Difficult to say that these differences relate to inequity in treatment without improved prevalence data Recommendations Obtain additional prevalence estimates Improve quality of ethnicity data in some data sources Further explore differences observed in crack and heroin