Topic Report: Drugs and alcohol

Over one in three adults (35%) aged 16-59 years, an estimated 11.8 million people, have consumed an illicit drug during their lifetime (Any drug comprises powder cocaine, crack cocaine, ecstasy, LSD, magic mushrooms, heroin, methadone, amphetamines, cannabis, tranquillisers, anabolic steroids, plus ketamine since 2006/07, methamphetamine since 2008/09, and mephedrone since 2010/11. Glues are included until 2009/10). This number of people has been stable over the past 10 years (source: Drug misuse in England and Wales, ONS).

Active drug use, that is having consumed an illicit substance in the past year, is higher in the UK than any other country in Western Europe (source: Shooting Up report). According to the Crime Survey of England and Wales, active drug use is reported by nearly one in ten (9%) of the adult population aged 16-59 – an estimated 3.2 million people. The most commonly used drug is cannabis – having been consumed by 2.6 million adults aged 16-59 in the year to March 2020. Reported active cannabis use was previously falling but started to rise again in 2017/18 (Figure 3). Ketamine has seen the greatest relative increase in reported active consumption – rising by 81% in the last 10 years of data.

Amongst adults, active drug use is more common in younger age groups (Figure 4). The most commonly consumed illicit drugs in 16-24 year olds are cannabis (19% of the population), nitrous oxide (9%) and cocaine (5%). Men are also 70% more likely to have consumed an illicit drug in the last year than women. Together this makes young adult men aged 16-24 the most common users of illicit substances – where one in four (25%) consumed an illicit drug in the last year and nearly one in 10 (9%) consumed a class A drug in the last year.

Surveys of school pupils estimate that illicit drug taking is commonly tried before adulthood. Nationally, nearly one in ten (9%) pupils aged 11 reported having ever taken drugs, rising to over one third (38%) by age 15. Boys are more likely to report having used drugs than girls and the biggest risk factor is being a smoker, followed by whether they drink alcohol (source: Smoking, Drinking and Drug Use among Young People).

Nationally, active illicit drug use is reported as over twice as common in 16-59 year olds of mixed ethnicity (23%) than those of white ethnicity (10%), but half or less as common in people of Asian, Black, or other ethnicities (3%, 5%, 5%, respectively). Active illicit drug use is reported as more common in homosexual (21%) or bisexual (31%) adults than heterosexual adults (9%).

Different substances have opposing trends with regards to household income. Cannabis use is reported most commonly among adults in the lowest category of household income (less than £10,400 per year) at 13% of adults, compared to 7% of adults in the highest category of household income. Conversely, powder cocaine use is reported most commonly in the highest category of household income (over £52,000 per year) at 3% of adults, compared to 2% of adults in the lowest category of household income.

Adults who drink alcohol more frequently are more likely to report active consumption of illicit drugs – rising from 5% of those who drink less than once a month to 15% of those who drink on 3 or more days per week. This trend is more marked for class A drugs – rising from 0.8% of those who drink less than once a month to 7% of those who drink on 3 or more days per week.

A 2021 survey of over 3,000 Buckinghamshire young people indicated that 12% of secondary and 33% of sixth form pupils who had responded to this question had been offered something to get high or a drug not prescribed from their doctor. These results are taken from the OxWell Survey which covered a range of health issues running in May-July 2021. In total, 31,490 children and young people aged 9-18 years from 180 schools across Buckinghamshire, Oxfordshire, Berkshire, Milton Keynes and Merseyside participated. Only results specific to Buckinghamshire schools are presented here in this needs assessment. Schools may choose whether to participate and therefore results could be subject to selection bias. There was a higher response rate from less deprived areas and from grammar schools, and therefore results may be less representative for more deprived areas. Nearly one third of respondents (30%) reported not finding it difficult to get illegal drugs. Cannabis was the most common drug young people reported having used.

The Buckinghamshire survey found that secondary pupils were most likely to go to a parent if they wanted information about drugs (48%), whereas sixth formers would most likely consult an internet search engine (64%). In 2021/22, 5% of Buckinghamshire school suspensions (previously referred to as fixed term exclusions) related to drugs and alcohol, up from 4% in 2019/20.

It was estimated that 1,482 adults were using opiates and crack cocaine in Buckinghamshire and might therefore benefit from specialist treatment in 2016/17. This equated to 4.5 per 1,000 population – a lower rate than nationally (8.9 per 1,000) and regionally (6.2 per 1,000). The estimated number of people using opiates and crack cocaine in Buckinghamshire has not changed significantly from 2010/2011 to the most recent data in 2016/17. Using the current drug treatment figures (2020/21) this corresponds to over half (55%) of estimated users not receiving specialist treatment in Buckinghamshire (unmet need) which is in line with the figure nationally (53%).

The estimated rate of opiate and crack cocaine use in Buckinghamshire was 2.0 times as high in younger adults (aged 25-34) than older adults (aged 35-64) in 2016/17. National data show less of an age discrepancy, with younger adults only being 1.2 times more likely than older adults to be estimated as using opiates and/or crack cocaine (source: Estimates of opiate use and/or crack cocaine use).

Research (source: International Journal of Drug Policy) indicates children who start drinking early are more likely to become more frequent drinkers and binge drinkers. Underage drinking is also associated with school and educational problems, risky behaviours and consumption of illegal drugs (source: BMC Public Health) (source: Addictive Behaviours). The Public Health England (PHE) National Diet and Nutrition Survey found that 7% of young people aged 11-18 years reported consuming alcohol on at least one day out of the four days they recorded their intake for over a two to three week period (source: National Diet and Nutrition Survey).

Reported alcohol consumption was falling nationally prior to the COVID-19 pandemic (source: Health Survey for England).

Alcohol units consumed per adult per week fell on average by 9% from 13.4 in 2011 to 12.2 in 2019. However, while units consumed fell by 24% in 16-24 year olds, they rose by 23% in 65-74 year olds during this period. By 2019, those aged 65-74 were nearly twice as likely to drink alcohol at least once a week compared to 16-24 year olds (58% versus 30%) (Figure 5). While one in seven adults aged 65 and over reported consuming alcohol nearly every day, fewer than one in 100 16-34 year olds reported drinking that frequently (source: Health Survey for England).

Men are more likely to drink alcohol than women (83% versus 77%), and also twice as likely to consume alcohol at increasing or higher risk (30% versus 15%).

Adults with lower household income are more likely to abstain from alcohol – one in three adults (33%) are abstinent in the most deprived quintile, compared to one in ten adults (10%) in the least deprived quintile. These abstinence rates may partially be driven by different ethnic compositions between the most and least deprived quintiles (source: Understanding the Relationship Between Poverty and Alcohol Misuse, Jones, L., and H. Sumnall).

Adults with higher household income are more likely to drink above the level recommended by the Chief Medical Officers. Nearly one in three adults (35%) reported drinking more than 14 units per week in the least deprived quintile, compared to one in ten adults (15%) in the most deprived quintile (source: Statistics on Alcohol England).

Data indicate that patterns of alcohol consumption changed during the COVID-19 pandemic. The volume of alcohol purchased by consumers for home consumption rather than on licensed premises rose by 25% between 2019 and 2020. This increase was not uniform across the population – those who had previously been the heaviest buyers saw the greatest increases (source: Monitoring alcohol consumption and harm during the COVID-19 pandemic). The National Diet and Nutrition Survey study during the COVID-19 pandemic in 2020 found that the percentage of participants reporting that they consumed alcohol was higher than pre-pandemic in young people (those aged 11-18 years) and in adult men (source: National Diet and Nutrition Survey). The proportion of the population reporting drinking at increasing and higher risk based on the Alcohol Use Disorders Identification Test (AUDIT) demonstrated a step increase during the first national lockdown which has subsequently been maintained (Figure 6) (source: The Alcohol Toolkit Study 2022).

Modelling suggests that the increase in alcohol consumption during the COVID-19 pandemic is likely to result in an additional 42,677 alcohol-related hospital admissions over the next 20 years even if drinking behaviour returns to pre-pandemic levels in 2022, but if these drinking levels are sustained there will be an additional 972,382 admissions over the next 20 years (source: Institute of Alcohol Studies).

The same 2021 survey of Buckinghamshire young people indicated that 43% of secondary and 66% of sixth form pupils had alcohol in the previous week. 19% of secondary and 23% of sixth form pupils reported having been drunk in the preceding week. 6% of secondary and 34% of sixth form pupils reported having an alcohol drink quite often or most days.

A greater proportion of Buckinghamshire adults are estimated to drink above low risk levels than nationally (25.1% versus 22.8%). A lower proportion of Buckinghamshire adults are abstinent (14.4% versus 16.2%). The prevalence of binge drinking (men consuming 8 units or women consuming 6 units of alcohol on a single occasion) is higher in Buckinghamshire than nationally (16.4% versus 15.4%) (source: Local Alcohol Profiles for England).

The most recent estimation of alcohol dependence, albeit in 2018 and therefore prior to the COVID-19 pandemic, suggested 3,617 adults in Buckinghamshire (8.7 per 1,000) were dependent on alcohol. This is lower than the estimated national rate of 13.7 per 1,000 (Figure 7). Using the current alcohol treatment figures (2020/21) this corresponds to over in 10 (81%) of estimated dependent drinkers not receiving specialist treatment in Buckinghamshire (unmet need) which is in line with the figure nationally (82%).

Drugs and alcohol are implicated in a substantial amount of crime and disorder, and the effects on victims can be devastating. In 29% of violent crimes in England and Wales in 2019/20 the victim believed the offender(s) to be under the influence of drugs (source: Office of National Statistics). The organised criminality behind the drugs trade also makes neighbourhoods less safe – heroin and crack cocaine addiction are linked to almost half of all acquisitive crime including burglary, robbery and theft (source: Understanding organised crime). Half of all homicides are linked to drugs. One in 3 prison spaces are occupied by individuals with drug addiction (source: Review of drugs part two). 14% of offences committed by first time entrants to the youth justice system were drug offences in 2021 (source: Youth justice statistics).

The victim believed the offender(s) to be under the influence of alcohol in 42% of violent crimes in England and Wales in 2019/20 (source: The nature of violent crime in England and Wales). Alcohol misuse is associated with a fourfold risk of violence from a partner (source: Alcohol and intimate partner violence), and is scored highly in relation to predicting violent reoffending in the Offender Assessment System (the main probation assessment tool used in England and Wales) (source: HM Inspectorate of Probation). Alcohol is also an important factor in road safety – slowing reaction times increasing the stopping distance, impairing judgement of speed, and affecting hazard awareness. Accidents where at least one driver was over the drink-drive limit caused 230 deaths, a further 1,820 serious injuries, and an additional 5,750 casualties in 2019 (source: Department for Transport).

Buckinghamshire is a relatively safe area with a total crime rate of 59.6 per 1,000 residents (2021/22) – lower than the Thames Valley (72.4 per 1,000), South East (78.3 per 1,000) and national (88.7 per 1,000) rates. However, this overall crime rate in Buckinghamshire has been rising for four of the last five years (with an exception during the pandemic in 2020/21). There are differences in crime rates across the county – the community board areas with the highest total crime rates in Buckinghamshire are High Wycombe, Wexham and Ivers, and Aylesbury.

Violent crime levels have been increasing, theft crimes have been decreasing, resulting in violent crime becoming the highest volume crime type in Buckinghamshire (37%), and theft offences becoming the second highest (30%) (Figure 8). This pattern is repeated nationally and not unique to Buckinghamshire.

Drug offences, such as possession, consumption, supply or intent to supply illegal drugs, are responsible for 2.0 recorded crimes per 1,000 residents in Buckinghamshire (2021/22). The drug offences crime rate rose during the pandemic to 2.5 per 1,000 during 2020/21 (unlike total crime which fell during this period) but has since fallen back to pre-pandemic levels. Over three-quarters (78%) of possession offences relate to cannabis. The majority of offenders are male (85%) and under 30 years of age (70%).

The wards with the highest rates were located in Aylesbury, High Wycombe and Chesham. However, while the rate of drug offences has been rising in Aylesbury and Chesham over the past five years, it has been falling in High Wycombe.

The annual community safety survey provides insights into residents’ experiences and perceptions of crime in Buckinghamshire. The majority of respondents (92%) reported feeling safe outside in the daylight alone, dropping to approximately half (53%) feeling safe alone outside after dark in 2021.

Respondents are asked which issues in relation to drugs and alcohol posed the greatest problems where they live or work. In 2020 the issues most likely to be rated as a ‘very big’ or ‘fairly big’ concern were (1) drug use, (2) supply/selling of drugs, and (3) behaviour related to drug use. However, in 2021 there was a marked increase in the proportion of respondents reporting discarded drug canisters as a problem, most likely relating to use of nitrous oxide, with it becoming highest rated as a ‘very big’ or ‘fairly big’ concern.

In Buckinghamshire, 13% of assessments completed by the Youth Offending Service found the young person was using alcohol (source: Alcohol and Us 2019 Report). Almost half of those who used alcohol began drinking by 13 years of age.