Action in partnership : tackling drugs in Scotland / the Scottish Office.

  • Great Britain. Scottish Office.
Date:
1999
Catalogue details

Licence: Open Government Licence

Credit: Action in partnership : tackling drugs in Scotland / the Scottish Office. Source: Wellcome Collection.

    12/76 (page 10)
    Tackling Drugs in Scotland The sharing of injecting equipment carries a number of serious health risks. Despite a variety of initiatives across Scotland to reduce the practice of sharing, a large number of drug injectors still share their equipment. In 1997/98 around one in ten of new clients/patients at treatment agencies said that they had shared equipment in the previous month (Figure 6). One consequence of sharing injecting equipment is an increased risk of exposure to blood borne viruses. Injecting drug users accounted for 42% of all known cases of HIV infection in Scotland, as at 31 March 1998. There were 25 new notifications of HIV infection among injecting drug users in Scotland in 1998. This is the lowest annual figure of the last 10 years. The figures for new reports of hepatitis B infection among injecting drug users are similarly lower than was once feared. It is thought that the provision of needle exchanges and substitute prescribing accounts for some of the successes in tackling the threats posed by these viruses. However, the threat remains, particularly for some vulnerable sections of the population, and among prisoners. Controlling the spread of hepatitis C among injecting drug-users is one of Scotland's major health challenges, particularly in the context of our current knowledge about the natural history of the virus. Infection is life long, and in two thirds of those infected the virus persists in blood, giving a continuing risk of blood-to-blood transmission. Based on an anonymous hepatitis C testing survey in four Scottish cities during 1995/96, SCIEH estimates that the prevalence of hepatitis C antibodies among current injecting users is, on average, 60%. After twenty years of being infected, 20% of these individuals wil have developed cirrhosis of the liver. This will be a heavy load on general medical services. The spread of hepatitis C infection among injecting drug users in Scotland during the 1990s has not been controlled by interventions such as the existing needle/syringe exchange. There are several possible reasons. With so many injecting users already infected, the novice injector is very likely to share someone else's equipment for the first few times and thus will become infected before the safe injecting messages have had a chance to get through. Also, any infected blood is dangerous - in filters, in bowls, or in spoons - not just in needles or syringes . The lesson is that the health promotion and prevention effort which worked well for HIV and hepatitis B will have to be intensified to make an impact on hepatitis C. Used equipment left lying around is even more of a health hazard and the collection of used equipment has to be particularly efficient to avoid infection of others. Another problem facing treatment services is that of dual diagnosis, where individuals present with both problem drug use and a co-existing psychological or psychiatric disorder. Information about people admitted to psychiatric hospitals in 1997/98 shows that 1231 admissions among people aged 15-44 were related to drug misuse. This accounts for nearly one in ten of all admissions among people aged 15-44, and is itself likely to be subject to a degree of under-reporting. Psychiatric hospitals are not alone in encountering this problem. In general practice, for example, conditions such as anxiety, affective depression and some psychotic disorders are known to be more common amongst people who misuse drugs than those who do not (source: ISD, Continuous Morbidity Recording in General Practice). Recent research shows that as many as 40% of people