Evidence Base for Drug Prevention Service Gaps in Rural Areas Professor Mark Bellis Dr Harry Sumnall Yuko M c Grath Karen Hughes Centre for Public Health.

Evidence Base for Drug Prevention Evidence Base for Drug Prevention Service Gaps in Rural AreasService Gaps in Rural Areas

Professor Mark Bellis

Dr Harry Sumnall

Yuko McGrath

Karen Hughes

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Brief OverviewBrief Overview

• Drug Use in England and Wales

– Recreational

– Problematic

• Some Rural Issues in Drug Use

• Rural Issues in Drug Prevention

• Evidence Base to date from the HDA

• Collaborating Centre for Drug Prevention

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0%

5%

10%

15%

20%

25%

30%

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16-2425-3435-59

Prevalence of Drug Use in the Last Year among the Prevalence of Drug Use in the Last Year among the General PopulationGeneral Population

Estimated number of users

(16-59) Thousands

3,357 613 486 642 63 45

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British Crime Survey 2003

• Over 1 in 4 (16-24) used drugs in last year • Around 50% of population ever used illegal drugs

Source: ESPAD survey of 15-16 year olds(1999)

• Levels of lifetime use of any illegal drugs: UK vs Europe (36% vs 16%)

School use of DrugsSchool use of DrugsComparison between UK and EuropeComparison between UK and Europe

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40%

60%

80%

100%

Amphetamine Cannabis Ecstasy Cocaine Heroin

General Population (age 16-24) Nightclubs Techno clubs

BCS 2000; Deehan and Saville 2004; O’Hagan 2000

Lifetime Drug Use among Young PeopleLifetime Drug Use among Young PeopleGeneral Population, Club Goers and Techno-Club GoersGeneral Population, Club Goers and Techno-Club Goers

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Frischer et al, 2004, Hickman et al, 2004

Estimated Prevalence of Problematic Drug UseEstimated Prevalence of Problematic Drug Use

• Problematic drug use– 0.6% Total population – 0.9% 15-64 Year olds

• Injecting drug use– 0.2% Total population – 0.3% for 15- 64 Year olds

• Locality Estimates (Injecting, 15-44 Year olds)– Brighton 2.0%– Liverpool 1.5% – London 1.2%

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Rates/100,000 Numbers

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Estimated rates and numbers of Problematic Drug Use Estimated rates and numbers of Problematic Drug Use per 100,000 population for English DATs (2001)per 100,000 population for English DATs (2001)

Frischer et al 2004

Estimates are generally based on urban studies and relatively little is known about levels in rural communities

Drug Prevention is a mechanism for reducing Inequalities and Social Exclusion

The effects it has on these issues should help prioritise action

Bundles of Rural DisadvantageBundles of Rural Disadvantage• Employment

– Access – Quality – Vulnerability– Low incomes

• Environment– Housing unaffordable

• Transport– Poor– Expensive

• Definition of Rurality unclear • ~ 28% of UK population • Standards generally

– Better health– Higher educational

qualifications– Incomes higher

• Deprivation – 1 in 4 living in low income– Dispersed

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Characteristics of Rural Drug Characteristics of Rural Drug UseUse

• National Surveys too small to measure local variation• Research data:

– Use follows National trends– Cannabis and amphetamine available and cheaper– Access to magic (psilocybin) mushrooms and veterinary

drugs (e.g. ketamine) • Increasing Nationally

– Varies between villages and proximity to urban centres– Dance Drugs availability depends upon cultural

participation • Increased with mobility and youth culture

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1992

1993

1994

1995

McVeigh et al, 2003

Mean year of First Use of Crack Mean year of First Use of Crack NW National Drug Treatment Monitoring SystemNW National Drug Treatment Monitoring System

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Heroin only

Cocaine only

Heroin and Cocaine

Crack only

Heroin and Crack

Cocaine and Crack

All Three

Drugs Use by Drug Treatment Clients by PCTDrugs Use by Drug Treatment Clients by PCTNW National Drug Treatment Monitoring SystemNW National Drug Treatment Monitoring System

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McVeigh et al, 2003

Have a Party in the Country

“Imagine being shacked up in a remote setting, with all your mates, a thumping sound system and a stash of stimulants. The worst that can happen is that you tread in a freshly-laid

cow pat”

Tourism and Festivals• Glastonbury

– Three days– 140,000 people (official

only)– Reported drug offences – 85 – 2C-i –65 (largest seizure)– 4,000 tickets for locals

• BBC 15th August 2004 – Thousands at illegal parties– Neighbours Complain

• Exposure to Drug Culture– Festivals– Tourism– Holiday Work

"I was on E for 2 weeks. On the way back I couldn't find words for things I saw or type on my phone."

Dutch Person returning from Spain (IREFREA)

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<1 day perweek

1 day per week 2-4 days =>5 daysfrequency of use

% o

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UK Ibiza

Frequency of Ecstasy Use in UK and IbizaFrequency of Ecstasy Use in UK and Ibiza(1999 & 2002 Users only)(1999 & 2002 Users only)

Hughes et al, 2004; Hennink et al 1999

Seasonal staff in Holiday ResortsSeasonal staff in Holiday ResortsDrug use among British Casual workers in Bars and Clubs in IbizaDrug use among British Casual workers in Bars and Clubs in Ibiza

%

0

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Drug

Workers Holidaymakers

• Seasonal workers Abroad see increased drug and sexual activity

• Seasonal workers in UK holiday centres see significant increases in sexual activity whilst at holiday centre

• Initiation into Drug Use

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Holiday Work

No. of tablets taken in a usual night

3.0 4.75

Greatest no. of tablets ever taken in one night

4.0 8.0

No. of tablets safe to take in one night

2.0 5.0

No. of tablets safe to take in one week

5.0 18.5

• Casual Workers are ideally placed to influence holidaymakers• Health messages should target Casual Workers

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Ecstasy use - Casual Workers vs. HolidaymakersEcstasy use - Casual Workers vs. Holidaymakers

Drug PreventionDrug Prevention

“Speak to someone you trust, who knows about

drugs, whenever you feel you need to speak to

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RuralRuralGoldfish Goldfish

BowlBowl

• Access to Services

– High Visibility

– Low Confidentiality

– Low Confidence – High Self Reliance

• Community Involvement

– Everyone Knows

• Distant Services

– Difficult to Access

• Deprivation Dispersed

• Generation Gap Bubble

– Schools

– Media

– Community

Rural Drug Use – Added ImpactRural Drug Use – Added Impact• Urban schools

– Higher deprivation, lower achievement but– Not reflected in life-time drug use

• Rural heroin users– Higher injecting

• Health Service– Non Specialist – Limited Options (Stimulants)– Staff recruitment poor but wide skills required– Isolated Services and Workers (Progress)– Variation in Services (Syringe Exchange)

(Forsyth & Barnard, 1999)

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Major Review

(Category 1 White & Pitts, 1998)

Evidence Base for School Based PreventionEvidence Base for School Based Prevention• School based drugs education accounts for

0.14% of the variance in drug use– i.e. 3.7% of young people who would use drugs

delay onset or never use • Methodologically strongest

– alcohol, tobacco and cannabis• Targeting hard to reach

– Poorly evaluated – Need peer recruitment and outreach (Rural Issue)

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Best Evidence for Drug PreventionBest Evidence for Drug Prevention• Interactive Teaching Techniques

– Facilitators- training/support from programme developers • Rural – initial support difficult

• Positive effects Short Lived– Decline with time without booster sessions

• Rural - continued support stretched• Multiple Joined up components for health education

– Involve schools, communities, health initiatives, media, and take into account cultural sensitivities• Rural - may be better as community often better integrated?• Parish councils, local business involvement, District councils,

Countryside Agency• Generational Bubble and Communications Issues

Health Development Agency - Canning et al., 2004

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FRANK

Countryside Agency, 2003

BT exchanges ADSL enabled, August 2004 Internet AccessInternet Access

• Availability of affordable rural broadband (2003):– Urban population: 95%– Rural villages: 7%– Remote rural areas: 1%

• Regular personal internet use:– Urban areas: 47%– Rural areas: 45%– Deprivation Gradient

• Television Coverage

Qualities of Best ProgrammesQualities of Best Programmes• Young People’s Perspective

– Including the most marginalized - Dispersed– Ways back when off track – Special Support

• Planned, focused and persistent– Early intervention, intensive, sustained – Long term management difficult

• Understanding risk and protective factors – Why start, What stops some, How some exit– Poor Local Research

• Use data and local knowledge – Target action and monitor their success– University Support

Coomber et al., in press

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Quarterly Report     

April to September 2004 rapid summary report oneffective drug prevention evidence

  Yuko McGrath

Dr Harry SumnallProfessor Mark Bellis

 ContactNCCDP,

Centre for Public Health,Liverpool JMU,8 Marybone,

Liverpool,L3 2AP

[email protected] 231 5818

Technical Updates Generic Communications

Collaborating Centre Collaborating Centre for Drug Preventionfor Drug Prevention

• Information Service– Provides answers to questions

on drug prevention evidence base

– Frequently Asked Questions System

– National 2005• Effective Action Briefing

– Evidence into Action – May 2005

SummarySummary• Missing– Scale and Nature of Rural Drug Use

• Very Large and Dispersed• Could glean some picture from National Data

– Likely to be changing rapidly• Internet, Parties, Tourism• May even lead in some recreational areas

• Problematic– Tendency to follow urban but little use made– NDTMS routinely examine this

• Goldfish Bowl– Kept out – Generic National messages?– Isolated within

• Drug Users• Service Access & Confidentiality• Movement to distant services difficult

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SummarySummary• Prevention Issues– School Services

• Specialist Support – Training, Availability and Sustainability• Generation Difference – Better understood

– Other Prevention • Stimulant services poor even in urban areas• Syringe Exchange needed and cost effective• Long Term Management an issue with individuals multi-tasking

• Rural Possibilities– Good Community Development– Link Media, School, Police, Council, Parish, DAAT– Peer-led and social/familial work effective and suited to rural setting– Mobile Services and Support needs examining

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National Collaborating Centre for Drug Prevention

Centre for Public Health

Marybone 8,

Liverpool JMU,

Liverpool

L3 2AP

UK

www.cph.org.uk/nccdp

[email protected]

Professor Mark Bellis