Scottish Drugs Forum
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SCOTTISH Drugs Forum’s conference in October highlighted some important issues in relation to the response to the increase in cocaine use. Not least of which was that the subject matter needs to be handled very sensitively so the media, the wider public and, crucially, the politicians, don’t get the impression that cocaine has replaced heroin as Scotland’s main drug problem.
It hasn’t. Scotland’s drug problem remains dominated by problems with depressant drugs. Cocaine use is, however, on the rise and we need to be proactive in our response to problem drug users for whom cocaine is now part of the drugs consumption repertoire, as well as to those who use the drug recreationally.
The number of new clients across Scotland reporting stimulants as their main problem last year climbed to 596, more than double the 2001/2002 figure. This is likely to be an under-estimate of the true proportion of those experiencing difficulties resulting from their cocaine use, for a number of reasons.
Firstly, cocaine users are likely to come from a range of backgrounds while heroin use is very much associated with our deprived communities. Therefore cocaine users - in general - do not relate their experience to others with drug problems and may well feel that there is a stigma attached to attending drug services of any sort.
Cocaine use among people with heroin problems is also beginning to emerge. National statistics suggest this is a relatively small proportion of the 50,000 problem drug users in Scotland but evidence from a number of sources indicates that this type of cocaine use is being under recorded.
There are two likely explanations for this. Users may well feel that services are not equipped to help with cocaine use – which could well be true. They may also be fearful that revealing this use will lead to them receiving sanctions - in some areas this can lead to a removal of prescribed substitute medication for their heroin problem.
timebomb
Meanwhile, cocaine users who do not think they have a problem could also be a timebomb for a range of services. A recent public survey suggested 45,000 adults had used the drug in the last year, and the conference heard a number of important health issues for this potentially overlooked group.
Cocaine, if used with alcohol, has the effect of vastly increasing alcohol consumption – with all the short-term and longer term implications for the health of the liver. Secondly, alcohol and cocaine combine in the liver to form cocaethylene which can have a damaging impact on the heart too. Alarmingly, the effects of combined alcohol and cocaine use are much greater than the impact of each drug alone.
Thirdly, Hepatitis C can be spread through the sharing of banknotes, straws and other equipment for snorting. The newly refocused Scottish Advisory Committee on Drug Misuse (SACDM) is creating a new working group to look at psychostimulants – an opportune moment to look at the issue since it has been four years since a previous working group issued its recommendations on the matter, a number of which have gone ignored. What should happen now?
targeted
We should be looking at more targeted approaches to communication with current users and obvious potential users through trusted sources, rather than potentially expensive campaigns highlighting risks to the wider public. We also need to increase specialist treatment provision in the cocaine hotspots, building on the existing two funded services in Edinburgh and Aberdeen and funding one in Glasgow.
Finally, we need to ensure mainstream drug services are responding appropriately to secondary use. This can be achieved through services reviewing their current practice and through staff training.
The question as usual is who pays. Should funds be allocated from existing Alcohol and Drug Teams budgets or does it require some assistance from the centre? Our guess is that locally competing demands and the pressure on services to deal with the existing opiate population will mean the local response may be too slow. If that’s the case, services may need some cajoling. Or better still, funding from the centre.