Family Practice Vol. 21, No. 4, 370-371
Family Practice Vol. 21, No. 4 © Oxford University Press 2004, all rights reserved.
Stimulant use: an investigation into population characteristics and service provision
The University of Sheffield, Institute of General Practice and Primary Care, ScHARR, Community Sciences Centre, Northern General Hospital, Herries Road, Sheffield S5 7AU, UK
E-mail: j.foers{at}sheffield.ac.uk
Received 19 May 2003; Revised 19 November 2003; Accepted 10 March 2004.
Foers J, Mathers N, Glendenning R and Keen J. Stimulant use: an investigation into population characteristics and service provision. Family Practice 2004; 21: 370–371.
Keywords. Population characteristics, service provision, stimulants, support.
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Introduction |
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The use of cocaine has become an increasing problem in the UK, and there are substantial gaps in our knowledge about the use of stimulant drugs.1 In addition, more established drug-using areas have reported a rise in the availability and use of crack cocaine,2 yet most users do not access available services or advice.3
The aims of this study were to develop a profile of the stimulant user population, to determine the views of users and providers on current support, and determine what kind of services might better meet the health needs of the stimulant user.
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Methods |
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A survey of stimulant users and service providers was conducted during a 6 month period in 2002. Discussion centred on current stimulant use, service needs and suggested improvements. The support services were also asked to provide information about the number of clients presenting with substance misuse problems in 2001. However, the data collection systems used by the different services and the variety of data collected made it difficult to establish the extent of the problem.
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Results |
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Seventy-eight stimulant users were interviewed, of whom 60% were male. Seventy-seven percent of respondents had used drugs in the month prior to interview, and 63% reported themselves to be current stimulant users (51% crack cocaine, and 23% cocaine powder and amphetamines). Most respondents were resident in deprived areas, and 64% reported using crime to fund their habit. Polydrug use was more prevalent than single drug use amongst current users, and the most common combination was crack cocaine and heroin (47%). The majority (81%) of respondents used cannabis as part of their polydrug use (see Table 1). Fifty-four percent of stimulant users thought that current services were focused on opiates and were "totally inadequate". There was a "lack of knowledge" about stimulants by the service providers.
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Sixteen interviews were conducted with 21 drug support/agency workers who recognized the need for more expertise in working with stimulant users and the need to develop existing services to include outreach.
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Discussion |
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In this group of self-declared stimulant users, there was a high prevalence of the combination use of heroin and crack cocaine. A study of crack cocaine users in the North of England found that many of the more seriously problematic users were co-dependent on opiates, and attending treatment services.5 Other studies have also found similar patterns of polydrug use and it has been recommended that more attention is paid to the multidimensional nature of drug use patterns.1 However, most users in our survey did not perceive their stimulant use as problematic and were in any case unlikely to present to services because they do not perceive them to be useful.4 Both users and drug workers in this study and others1,4 thought that existing services were primarily for opiate users.
Methadone maintenance treatment can be effective in reducing crime and providing improvements on a range of harm minimization outcomes.6 It has also been found that patients retained in methadone treatment have a significantly lower rate of criminal convictions than before initiation of treatment.7 However, the effectiveness of such treatment may be limited since 71% of respondents on a methadone maintenance programme (n = 24) in this study reported concurrent use of cocaine for which they were not receiving specific help.
From the interviews with the users and drug agency/support service workers, our study identified a consensus view that the scope and quality of existing services should be broadened to address the issues and needs arising from stimulant and polydrug use rather than their current preoccupation with opiate use. Most drug workers agreed with the users that there was a need for a better understanding of stimulant use and a development of the skills required for support. These issues could be addressed through training, which should be extended to include GPs and other members of primary health care teams who may provide a first point of contact with stimulant users. Primary care services in particular should avoid ‘labelling’, particularly of women.
Since the sampling of the population of stimulant users in the city was of necessity opportunistic, it is unclear to what extent these data are representative of the wider population. Although the records of the different agencies were examined to determine the number of stimulant users accessing the service, there were marked differences in the recording systems and the quality of the data extracted. The only other point of reference was the Trent Drug Misuse Database Annual Report for Sheffield (1 April 2000–31 March 2001) which identified 933 individuals seeking support of which only 1% reported using cocaine powder, 14.8% crack cocaine and 4.1% amphetamines. All of the 78 respondents in our study reported using stimulant drugs at some point, and a large majority had not confined their usage to one particular drug. Extrapolating from these results, the database may have underestimated the number of people in the city engaged in stimulant use, although in the intervening period patterns of substance misuse may have changed.
Traditionally, drug services as a whole have been structured towards support for opiate users and been slow to adapt to the new trends and patterns of drug use. Clearly intervention strategies might be more effective if they reflected the changing nature of drug use within a particular area. An agreed common approach to the recording of accurate information about substance misusers seeking treatment and support by the different agencies would be of considerable help in monitoring trends of substance misuse, targeting resources and providing data for strategic planning in an area of limited resource. Current services do not have a common policy and to a certain extent operate in isolation with their own particular guidelines and service aims. Services are also fragmented further by the varied nature of their funding, and there is no agreed commitment to a common policy or protocol. The development of such a policy between the agencies would enable the formulation of a basic working standard against which agencies could measure their service improvements.
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References |
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1 Gossop M, Marsden J, Stewart D. Treatment outcomes of stimulant misusers: one-year follow-up results from the national treatment outcome research study (NTORS). Addict Behav 2000; 25: 509–522.[CrossRef][Web of Science][Medline]
2 Eggington R, Parker H. Hidden Heroin Users: Young People's Unchallenged Journeys to Problematic Drug Use. London: Drugscope; 2000.
3 ISDD Audit Report. National Audit of Drug Misuse in Britain. London: London Institute for the Study of Drug Dependence; 1992.
4 Robson R, Bruce M. A comparison of ‘visible’ and ‘invisible’ users of amphetamine, cocaine and heroin: two distinct populations? Addiction 1997; 92: 1729–1736.[Medline]
5 Carmworth T, Jeacock J, Wibberley C, Smith M. Crack cocaine—tailoring services to users' need. Addict Res 1997; 5: 223–234.
6 Keen J, Oliver P, Mathers N. Does methadone maintenance treatment based on the new national guidelines work in a primary care setting? Br J Gen Pract 2003; 53: 461–467.[Web of Science][Medline]
7 Keen J, Rowse G, Mathers N, Campbell M, Seivewright N. Can methadone maintenance for heroin dependent patients retained in general practice reduce criminal conviction rates and time spent in prison? Br J Gen Pract 2000; 50: 48–49.[Web of Science][Medline]
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