Journal of Drug Issues

This paper gives an overview of some of the most recent research surrounding the use of prohibited or illicit drugs by young people in Britain. Current research on the prevalence of illicit drug use identifies an unprecedented rise in such use by increasingly diverse groups of young people of all socioeconomic backgrounds. Presenting here for the first time 4 years of data from the University of Manchester northwest longitudinal study of English adolescent drug use, the paper looks at patterns of use of different drugs, differential experiences with these drugs, and characteristics of use and non-use throughout the mid-teens. Along with this transformation in adolescent drug use has been a similar rise in the prevalence of drug use by young adults, which is located in the context of the dance party or ‘rave’ scene in Britain, linked to the ‘dance revolution’ and to a wider youth culture that reflects an acceptance of drug use both by users and non-users as a part of young people's leisure. This has led the authors to identify a process of ‘normalization’ of recreational drug use among young people with resulting legal, education, employment, and health implications.

Amphetamine sulphate has been a popular drug choice for British youth since the 1960s. The reasons for its persistence are explored in this paper, highlighting the alluring nature of its psychoactive effects that can influence social development in the adolescent years. The potential hazards in using the drug are identified and an attempt made to anticipate future trends. The 1960s saw the start of a strong association with music that continues today, and the rave scene has adopted Ecstasy, an amphetamine-type stimulant, as its drug of choice, yet the use of amphetamine sulphate shows no sign of decreasing. Recent international developments in production and trafficking suggest that this is a growing market. The idea that we are faced with an epidemic that could burn itself out is challenged. Support for these arguments derives from several research projects on drug misuse conducted in the northwest of England and the accounts of respondents are used to illustrate key points.

This paper uses qualitative methods to examine the social contextual use of alkyl nitrites among targeted groups: young recreational drug users (students), polysubstance users receiving treatment in a methadone program, homosexual men, and homeless people. Nitrites were a popular recreational and social drug, most commonly taken in nightclubs to enhance both music and the effects of other recreational drugs or taken to enhance sexual experience. Its legal status, low cost, and easy availability added to its popularity, particularly among younger people.

Nitrites appeared to be commonplace in mainstream night clubs, having previously been confined to night clubs catering to a more homosexual clientele. Despite this fact, nitrites were still associated with gay culture. There was no evidence that nitrite use led directly to use of illicit drugs.

Participant observation was used to study the lifestyles of female drug injectors in Glasgow. Twenty-six women were interviewed in-depth at the end of the observation period. The results reveal how women become involved in drug use, the ways in which they finance their drug use, and their relationships with friends, partners and children. The efforts the women made to give up their use of drugs is discussed along with the difficulties involved in their attempts to do so. Overall, the findings refute the stereotypical view of women drug users as inadequate individuals. The evidence provided indicates that the lifestyle which evolves from the use of drugs offers an arena in which the women are able to find a degree of independence and purpose otherwise missing from their lives and which makes their drug-using lifestyle attractive even when disadvantages become apparent.

The paper outlines the nature and extent of illegal drug use in Scotland. The paper provides a detailed discussion of the impact of HIV among injecting drug users in Scotland. It is shown that although HIV remains a major public health concern within parts of Scotland, most notably in Edinburgh and Dundee, HIV infection remains low elsewhere within Scotland. Although concern in relation to HIV has receded in light of the continuing low prevalence, there has been growing concern over the marked increase in drug-related deaths among drug users within parts of Scotland. Within the policy sphere greater attention is now being given to topic of drug prevention and the impact of drug use on community well being.

This paper describes the evolution of responses to drug related problems in Wales, from the first National Health Service in-patient admissions in the late 1960's until the publication of Forward Together, the Welsh Office strategy for drug and alcohol problems, in May 1996. Service developments are placed in the context of the available data about the nature and extent of drug use across Wales, the particular challenges faced, and the strategies adopted in Britain, in Wales, and at the local level.

Considerable emphasis has been placed in Northern Ireland as elsewhere upon providing an estimate of the prevalence and pattern of drug misuse, yet despite the importance of this information, a less than adequate picture has emerged. In this paper, divided into three sections, we attempt to layout and explore the assemblage of factors influencing drug misuse in Northern Ireland and subsequently our knowledge of it. In the first section we endeavor to demonstrate that drug use, distribution, and policy cannot be examined in isolation from the politics and practices of the protagonists to the conflict in Northern Ireland. In the second we critically review existing data on drug misuse ranging from the various public health and law enforcement indicators through to the limited emprical research avaliable. The final section makes urgent calls for quality research in Northern Ireland that would be instrumental in influencing effective drug policy and practice.

Problematic drug use, mainly regarding the use of opiates, has been identified as a major social problem in Ireland. Such problematic drug use has been found to be concentrated in Dublin's inner city areas and outer estates where poverty, multi-generational unemployment, high population density (particularly of young adults), and poor facilities are the norm. Policy responses, although acknowledging the environmental context of the drug problem, have tended to focus on the medical treatment of the individual, rather than tackling the wider social and economic issues.

This paper focuses on the issues facing Irish drug users who have migrated to Britain. The main finding is that a number of changes in relation to drug use occur as a result of migration itself. These are both harm increasing and harm reducing, but a majority of respondents self-reported harm-increasing changes in drug use particularly in relation to HIV infection.

Irish drug users have close networks of friends and relatives that they can access when they come to Britain. However, there is evidence that they are reluctant to approach services. When they did so Irish drug users traveled long distances in London to go to services that were known to work with their community.

Together with the multiplicity of problems associated with migration that are described in this paper, the findings show that Irish drug users are a highly vulnerable group within the British drug-using population.

This paper reviews recent trends in drug policy in Britain. It identifies the influence of American perspectives in encouraging greater attention to prevention and a stress on partnership. Receptivity to these influences is explained by reference to restructuring of contemporary cities and to wider developments in British urban policy.

One consistent theme within public debates on the problem of drug misuse is its association with minority ethnic groups (Pearson 1995b). It is, nevertheless, a peculiar feature of the British drug scene that members of black and other minority groups have been significantly underrepresented among known populations of problem drug users. This despite the fact that there has been clear evidence since the early 1980s of a concentration of the most serious drug-related problems in areas of high unemployment and social deprivation, and that ethnic minorities in Britain experience a high degree of social exclusion in terms of poverty, housing deprivation, educational disadvantage, and discrimination in the labor force (Jones 1996). It is entirely possible, of course, that drug users from Britain's black communities are more likely to remain unknown to service agencies—reflecting other aspects of disadvantage in access to health care (Awiah et al. 1992). In what continues to be a rapidly changing drug scene in Britain, this paper sets out to review this perplexing area of drugs, deprivation, and ethnic minority status, while also presenting evidence in Part II from an outreach project among Asian drug injectors in the city of Bradford in the north of England.

Cocaine now occupies an established place in the British illicit drug scene. The available data point to London and several other metropolitan areas as core centers of the problem. Smokable cocaine (crack) represents a notable and worrying new feature of cocaine use in the 1990s. There remain substantial gaps in knowledge about the natural history of cocaine problems in Britain. This review addresses the prevalence and problems associated with cocaine in Britain and includes a brief summary of the effects of the drug and the development and distribution of illicit cocaine products in Britain. Following discussion of the prevalence of cocaine use and associated problems, the orientation of existing services toward cocaine users is described and future challenges for responding effectively to cocaine users in need of treatment services are identified.

Opioid substitution with oral methadone is the most widely implemented treatment for heroin dependence. In Britain, a complex array of specialist and generic health care services have evolved to deliver this treatment modality. Several minority aspects of British substitution practices receive enduring international interest, including the use of heroin itself as a substitute and the prescribing of methadone in an injectable form. This paper focuses on six linked dimensions that characterize substitution services: (1) treatment providers and settings, (2) prescribing regimes and treatment goals, (3) substitute drugs, (4) dose administration, (5) dose levels, and (6) substitute formulations. Against a background of increasing central and local accountability for the quality and efficiency of specialist providers and critical attention toward their effectiveness, the strengths and weaknesses of the British approach are considered and key issues and future directions are discussed.