Advisory Council on the Misuse of Drugs (ACMD): Evidence for a report on young people’s drug use and treatment
NeuroSight has provided ACMD with written evidence on young people’s drug behaviour based on the survey conducted during Lockdown in April 2020. Evidence outlines prevalence and nature of drug use, descriptions of interventions used, and how responses to interventions can be improved.
Section 1: Prevalence and nature of drug use among young people
Drugs and Me and NeuroSight (formerly Adec) are sibling brands that deliver harm reduction interventions for individuals and organisations respectively. Both brands carry out projects that collect data from drug users, who are primarily young people, for various purposes such as designing campaigns, creating educational tools, delivering workshops and writing drug policies for organisations.
The figures mentioned in this document are drawn from two online surveys: one was conducted at University of Leeds in January 2019 and the other was conducted globally in April 2020. Both surveys aimed to understand recreational, non-problematic drug use. The first survey was the largest survey conducted at a UK university, with 2,548 complete responses. 94.9% of respondents were between 18-23 years old and the demographic was largely representative of the whole university. The second survey, which explored changes in drug use during the COVID-19 outbreak, had 479 participants who were from the UK and 18-25 years old. Because the respondents were not representative of the general population, the insights from this survey will only be used to understand the nature of and trends in drug use.
Prevalence of drug use
The results show that drug use among university students was commonplace with 56.4% having ever used a drug recreationally. This was in line with the research by Release and NUS which found the prevalence to be 56%.[1] Furthermore, most drug use (79.1%) is found to start before university, while drug use increased at university for 66% of the students who had already tried drugs.
Cannabis, MDMA, ketamine, nitrous oxide, and cocaine were the most commonly used drugs (Figure 1). Interestingly, ketamine was the most frequently used drug overall with 61% of its users consuming it regularly, when regular use was defined as “once a month” or “more” (Figure 2). Cannabis and MDMA followed ketamine with 52.6% and 37.4% of its users being regular user respectively (Figure 2).
Cannabis was most likely to be used daily or multiple times a week than any other drug (15.8%). Surprisingly, modafinil also had a few (5.6%) daily/almost daily users and it might be worth comparing the trends of its recreational use with its prescription numbers. Ketamine was mostly used 2-3 times a month (25.5%) whereas for MDMA, this was every 2-6 months (33.3%). Magic mushrooms and LSD were the least frequently used drugs with 96.3% and 91.8% taking it less than once a month respectively.
Figure 1. Breakdown of drug use for those who had ever used drugs
Figure 2. Frequency of drug use of those who had ever used drugs
Nature of drug use
The most common reasons for drug use were not associated with problematic use (Figure 3). For instance, 84% of drug users consumed drugs “to have fun”, compared to 24.6% and 12% who used drugs “to escape reality” and “manage a mental health issue” respectively. This finding was in agreement with the survey conducted by Release and NUS.[1]
Figure 3. Reasons for drug use of those who had ever used drugs
This is further supported by other self-reported data. Only 0.8% of drug users said they couldn’t control their drug use (legal or illegal) every day, or almost every day. 1.4% needed a drug almost every morning to get going for the rest of the day and 1.2% needed to use a drug every week. Additionally, only 0.4% of students failed to do something expected of them because of their drug use almost every day.
1 in 10 (10.6%) drug users reported using drugs for self-medication, which suggests an unmet need to treat certain conditions. According to our findings these included anxiety, depression and insomnia (Figure 4).
Figure 4. Reasons for self-medication of those who had ever used drugs
A considerable number of young people took drugs without any awareness or knowledge on the drug they were taking. 27.2% of drug users took a drug that they were unsure what it was in the last year. Moreover, only 59.5% of drug users researched the effects and risks every time they tried a new drug. This is highly concerning as this behaviour greatly increases the risk of harm.
Polydrug use
Alcohol was the most popular drug to combine with other drugs with 78.3% of drug users reporting this combination. Moreover, 60.6% of those who drink and take drugs, also reported consuming a lot less alcohol than they usually would. The most common drugs students mix with alcohol were cannabis (61.2%), ketamine (54%), cocaine (50%), MDMA (47.4%) and nitrous oxide (43.4%).
When the polydrug use behaviour is analysed for specific groups of drug users for which the combination is known to be especially harmful, a more concerning drug use behaviour is observed. 78.2% of cocaine users and 71% of ketamine users consumed these drugs with alcohol. Moreover, 31.3% of benzodiazepine users and 22.7% of opioid users combined their use with alcohol.
Students were also asked to report their most common drug combinations up to four drugs, excluding when a drug was combined only with alcohol. The results show that ketamine and MDMA were the most commonly combined drugs either as a pair (28.9%) or in combination with other drugs such as alcohol (10.1%) (Figure 5). Concerningly, 47.7% of those who combine drugs knew a little about how the drugs they took interacted while 13.9% didn’t know anything.
Figure 5. Common drug combinations.
Drug use during the COVID-19 outbreak
70.9% of young people who had ever used drugs consumed drugs during the outbreak (n=388). The most commonly used drug was cannabis (80%) by a large margin.
Figure 6. Breakdown of drug use for those who took drugs during the COVID-19 outbreak
As it can be seen in Figure 7, the use of party drugs such as ketamine, cocaine and MDMA has decreased while drugs that are more likely to be taken at home such as cannabis, LSD and benzodiazepine have increased.
Figure 7. Change in drug use during the COVID-19 outbreak
Figure 8 shows the reasons for drug use during the outbreak. While the most common reason is “to have fun”, the other common reasons include reasons which signal a more problematic use such as “to cope with boredom”, “to escape reality”, “to cope with stress” and “to cope with anxiety”. Although the samples are different, a comparison of Figure 8 with Figure 3 shows how the COVID-19 outbreak changed why people take drugs and how this change reflects a more problematic drug use during the outbreak.
Figure 8. Reasons for drug use of those who had ever used drugs during the COVID-19 outbreak
31.4% of young people who had ever used drugs reported taking drugs to self-medicate during the outbreak (n=283). This is a much higher percentage compared to the data from the University of Leeds (10.6%). Still, the top reasons for self-medication continue to be the same (Figure 9). This suggests that unless these issues are addressed in another way, more young people will progress to dependence due to the extra burden on their mental health caused by the outbreak.
Figure 9. Reasons for self-medication of those who had used drugs during the outbreak
62.5% of drug users used drugs in combination with alcohol during the outbreak (n=275) while 32.7% of these users reported drinking less alcohol than they usually would.
67.6% of people knew about how the drugs they consumed interracted (n=160). This is a much higher number compared to the data from the University of Leeds (38.4%). This large difference in the perception of knowledge is likely to be due to the general decrease in polydrug use. Furthermore, users are more likely to combine drugs they already have at home and are familiar with during the outbreak.
The prevalence of problematic drug use was much higher during the outbreak compared to the student population at University of Leeds. 18.2% of young people said they couldn’t control their drug use (legal or illegal) every day, or almost every day during the outbreak (n=264). 15.5% needed a drug every or every other morning to get going for the rest of the day (n=264). Additionally, 6.9% failed to do something expected of them because of their drug use everyday or every other day (n=260), and 15.5% experienced withdrawal symptoms that they were not expecting (n=220). These are in line with other findings that signal problematic use (15-16).
Section 2: Descriptions of interventions or treatment models being used
Although we don’t provide treatment to young people, we do deliver educational and policy interventions to reduce drug-related harm. Our educational interventions involve workshops, courses and campaigns in settings such as schools and universities. Our interventions are designed to be proactive in preventing drug misuse, and relevant and practical to reduce harm for people who are already using or planning to use drugs. We acknowledge that drug use is a spectrum, and therefore we first try to understand the relationship between our target group and drugs. Depending on their drug behaviour history and knowledge on drugs, we tailor the content of our interventions. For instance, if the target group has less experience with drugs, our interventions focus more on the mental tools and knowledge which would help them make less risky decisions in any drug-related context. In the case of past drug use, we identify the harmful behaviours and include more specific evidence-based harm reduction information.
Our model to educate young people on drugs involves the use of “The Drugs Wheel”2 and the “Drug, Set and Setting”3 model. We supplement these with timely information on drug trends, drug prevalence, and university culture. We also carry out interactive activities for young people to engage with these information in different scenarios in which they learn how to make decisions and what to do in certain situations such as when a friend takes too much drugs.
This model supports young people to be generally knowledgeable on drugs and their effects. It allows them to make the safest decision by gauging the harms and benefits of a certain behaviour in any context such as drinking alcohol while on a prescription drug, going to a university in a country where certain recreational drugs are decriminalised, or trying an illegal drug out of curiosity or for medicinal purposes.
Section 3: How responses could be improved
Interventions for drug use usually focus on drug abuse. However, our results (6-7) show that most drug use is not problematic. Hence, most interventions that aim to prevent use or reduce harm are not relevant to the majority of drug users.
We believe that there should be more focus on proactively preventing unproblematic use progressing into problematic use, which can then turn into dependence and eventually abuse. As our findings regarding drug use during the COVID-19 outbreak shows (15-16), external factors that affect mental health also negatively influence the drug use behaviour of some people. Capturing these vulnerable groups whose drug use is likely to turn into abuse is extremely important to prevent young people requiring treatment in the first place.
Delivering harm reduction interventions for unproblematic drug users is essential because young people engage with drug-related activity despite negative consequences such as criminalisation. Indeed, our findings at University of Leeds show that 63.1% of students would still use illegal drugs despite university policies.
On the other hand, young people are unlikely to seek help regarding their drug use, even if they want to quit using drugs. For instance, 18.6% of students who used legal or illegal drugs wanted to quit, but only 2.3% of legal or illegal drug users had been to the university’s support services. Moreover, 84.2% of users who hadn’t been to support services, still wouldn’t consult their university about their drug use.They were discouraged from seeking support due to fear of punishment (49.9%), police being contacted (37.8%) and judgment (32.9%). Given that 16.5% of people reported feeling dependent on a drug during the outbreak and 28.9% wanted to quit a drug according to our COVID-19 data, a decrease in the number of young people at treatment services after the outbreak would only indicate young people’s unwillingness to seek help, and not a decrease in the number of drug users.
Young people can be encouraged to seek help by reducing the social stigma around drug use. The most effective way to tackle stigma is to have an open and honest conversation about using drugs. Providing harm reduction interventions that is relevant to the way they use drugs stimulates such a conversation. In fact, our data from the University of Leeds show that 63.3% of students who had ever used drugs asked for practical advice on harm reduction and 66.7% requested drug testing kits from their university.
Providing drug testing would allow treatment and support services to engage with young people who wouldn’t otherwise reach out to support services. It could open a conversation in which harm reduction advice can be more effectively communicated,and young people can be better followed up regarding their drug use behaviour. According to our findings at University of Leeds, only 5.2% of drug users reported testing their drugs before taking them while 11.1% sometimes tested them. On the other hand, 88.6% of users who didn’t test their drugs said they would if they were provided with free/cheap testing facilities.
Providing young people with evidence-based harm reduction advice, which might improve their experience while reducing harm, helps authorities gain credibility, legitimacy and trust in the eyes of young people. Once that trust is established, young people take the authorities’ advice more seriously even if that advice includes “not taking drugs”.