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Reducing harm associated with illicit drug use

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Doctors are concerned about the use of illegal drugs, which is a widespread problem throughout the UK.

Around 8% of adults have taken an illegal drug in the last year (2015-16), and 4% have used them frequently, with use most common among young adults (16-24). The most frequently used illicit drug is cannabis, followed by powder cocaine, ecstasy, and amphetamine/methamphetamine.

UK Governments tend to prioritise a criminal justice approach to tackling illicit drug use.

The BMA believes in prioritising treatment and support and a new briefing, Evidence-based interventions for managing illicit drug use (PDF), highlights some of the available treatment options.

Key facts

  • Short-term harms can range from unpleasant side-effects such as vomiting and fainting, to more serious impacts such as seizures, tissue and neural damage, or death. Repeated use can lead to chronic physical and psychological health effects, as well as dependence
  • Individuals who become dependent are at increased risk of harm because of chronic use
  • Although heroin use is relatively uncommon, it can cause substantial harm to users and others (eg through drug-related crime), and is therefore a key focus for policy makers
  • The number of drug-related deaths in the UK was 2,655 in 2014, with the vast majority associated with heroin use
  • People who inject illicit drugs are at particular risk of secondary health harms such as acquiring HIV, hepatitis B and hepatitis C. Although many drugs can be injected, this occurs most commonly with heroin, methamphetamines and cocaine
  • Read a detailed overview of the health harms of illicit drugs (PDF) developed by the Department of Health in 2011.
  • Drug misuse

    Individuals with an illicit drug problem commonly access treatment services through self-referral, or referral via the criminal justice system. In 2015, there were over 120,000 treatment presentations in the UK, half of which were for opioid use (predominantly heroin), and over a quarter for cannabis use.

    Since the 1990s, despite illegal drug use declining in the UK overall (mainly driven by the decline in cannabis use), the level of Class A drug use has remained steady. In particular, cocaine use has increased significantly, and attempts to curb heroin and ecstasy use have seen limited progress.

    You can find out more about the trends in illicit drug use and treatment via the UK Focal Point on Drugs

    Novel psychoactive substances

    NPS (novel psychoactive substances) are compounds designed to mimic established recreational drugs. These are usually grouped into four main categories: stimulants, cannabinoids, hallucinogens and depressants.

    Robust data on the prevalence of NPS use are limited, as is evidence on long-term harms. The most recent data for 2015-16 show 0.7% of adults had used an NPS in the last year, and 2.7% of adults in their lifetime. There is increasing evidence that NPS are being used by increasingly diverse groups, many of whom are from vulnerable groups (including the homeless, people with coexisting mental health problems and increasingly the prison population).

    Synthetic cannabinoids are increasingly prevalent, with widespread reports of severe mental and physical health problems associated with their use. There is some evidence that they are increasingly used by vulnerable groups, particularly the homeless and prison populations.

    The Psychoactive Substances Act 2016 banned trading, but not possession, of all current and future NPS. While this is a welcome development, there is a need to ensure that in response to the Act, effective evidence-based treatment services are routinely available for those NPS users with acute problems and dependency.

  • Taking a health-based approach to tackling illicit drug use

    Successive governments have prioritised a criminal justice approach to tackling illicit drug use in the UK.

    In light of the significant health harms, the BMA believes this should be refocused to prioritise treatment and support over criminalisation and punishment of drug users. Such an approach should be coordinated and led by the relevant health departments across the UK, helping to align illicit drug policy with tobacco and alcohol strategies. This will provide a set of common principles in order to address cross-cutting issues of addiction and substance use.

    Support for this approach is reflected in a growing consensus about the need to review drug policy in the UK, as set out in reports from the Home Affairs Select Committee, the RSA (Royal Society for the Encouragement of Arts, Manufactures and Commerce) Commission on Illegal Drugs, Communities and Public Policy and the UK Drug Policy Commission. Most recently, the Royal Society for Public Health, set out a new vision for a holistic public health-led approach to drugs policy at a UK-wide level.

    In 2013, the BMA published, Drugs of dependence: the role of the medical profession, seeking to refocus the debate on drug treatment and policy through the eyes of the medical profession.

    The report sets out the debate around the most effective approach to preventing and reducing the harms associated with illegal drug use and drug-control policies, based on an independent and objective review of the evidence. It also examines the doctor’s role in the medical management of drug dependence and the ethical challenges of working within the criminal justice system.

    Read the full report, and watch Professor Averil Mansfield (board of science chair, 2010-2013) discussing it

  • Role of doctors

    There are several ways in which doctors can help reduce the harm associated with illicit drug use.

    1. Recognise when illicit drug use is contributing to health risks in a patient

    All doctors in clinical practice will encounter patients adversely affected by illicit drug use. By acting in a non-judgemental way, they can support accurate diagnosis of drug-related harm, the provision of appropriate advice and referral for specialised support. The use of opportunistic brief interventions, for example providing information and advice when attending a needle and syringe sharing exchange or primary care setting, can support patients in stopping drug use, or using drugs in less harmful ways.

    2. Support the treatment of illicit drug dependence

    Some doctors, particularly GPs and psychiatrists, will often be responsible for supporting the treatment of drug dependency. This includes managing withdrawal and relapse prevention, as well as maintenance prescribing. As the following case study highlights, this can often involve a range of complex care needs.

    Drug misuse and dependence: UK guidelines on clinical management (the ‘orange guidelines’) provide clinical guidance to support this. The guidelines were updated in July 2017 following a review by an expert working group. This reflected developments in the evidence for drug treatment, in the demands on services and in the treatment delivered, including:

    • an ageing cohort of those with heroin dependence in treatment
    • legislative changes to allow non-medical prescribers to assess, diagnose and independently prescribe for the treatment of drug dependence
    • emerging risks from new psychoactive substances and changing patterns of drug use
    • a more explicit focus on individually defined recovery journeys with an enhanced focus on pharmacological and psychosocial interventions, and peer engagement and mutual aid.

    Case study: considering complex care needs not criminal records

    London consultant addiction psychiatrist Emily Finch is treating up to 400 illicit drug users and alcohol-dependent patients in south London at any given time, including prisoners at HMP Brixton. Dr Finch leads the addictions clinical academic group at the South London and Maudsley NHS Foundation Trust and has spent 20 years helping substance users.

    She says: ‘Our treatment services are dominated by complex drug users many of whom are homeless and have substantial psychical health problems. They are high users of healthcare. We also see a group of alcohol users who tend to be resistant to treatment and have dual diagnoses.

    ‘Many of our patients have hepatitis C and have injecting complications. Many are involved with the criminal justice system in a range of different ways.

    ‘As doctors, it is not our place to question the client’s criminal behaviour but to help them access healthcare and provide treatment which gets the best possible benefits for them.

    ‘Prison treatment is much better than it was. But patients in prison are not fully committed to recovery. You are using it as an opportunity but you can’t help them rehabilitate to work, you can’t improve wider aspects of their life such as relationships.

    ‘We know that methadone treatment [for opiate users] is effective and we know that methadone reduces deaths. Helping people recover and live drug-free lives is the objective but there is very little research on the sort of interventions that help achieve that.

    ‘In fact there is some concern in our treatment services that many recovery interventions are being provided without much evidence for their effectiveness.

    ‘We really do need to evaluate alternative interventions more effectively.’

    This case study was taken from Drugs of dependence: the role of healthcare professionals.

    3. Advocate for policies to minimise drug-related harm

    All doctors, particularly those in public health and specialist drug services, can advocate for policies to minimise drug-related harm in their community. This can range from working with professional organisations – including the BMA and medical royal colleges – to lobby for health to be a central feature of drug policy; to encouraging the use of evidence-based harm reduction measures in their local area.

    For the latter, the BMA supports the introduction of a wider range of evidence-based interventions for treating illicit drug dependence – such as heroin assisted treatment and supervised consumption rooms – in areas of high levels of need.

    Download our briefing for further detail about these treatment approaches