Source: British Medical Journal (UK)
Contact:  Sat, 15 Aug 1998
Issue: BMJ 1998;317:431 (15 August)
Author: Richard Harling, BMJ

HEROIN USE AMONG YOUNG PEOPLE IS INCREASING IN ENGLAND AND WALES

Heroin use has risen among young people aged under 19 in England and Wales,
according to a report from the Home Office Police Research Group.

Throughout the 1990s several indicators have suggested that adolescents are
increasingly using heroin: the Department of Health's database on regional
drug misuse has been notified of more first episodes of heroin use;
prosecutions for heroin related offences have escalated; and seizures of
the drug have increased.

The use of heroin is also becoming more common in smaller towns. In a
survey of police forces and drug action teams, 80% of areas reported new
outbreaks of heroin use among young people. Most of the new users were
described as "socially excluded," but heroin is also being used as a
recreational drug by adolescents from more affluent families.

An additional UKP1m ($1.6m) is to be made available to health authorities
for drug prevention work. According to the report, drug education campaigns
may have failed the latest generation of teenagers by focusing too heavily
on recreational drugs such as cannabis and ecstasy and failing to
adequately communicate the dangers of heroin. It calls for future public
health messages about drugs to "acknowledge a hierarchy of dangerousness"
in order to "give heroin a bad name."

The report emphasises the importance of providing "caring, high quality
services" for young heroin users. Dr John Merrill, consultant in drug
dependence for the North West NHS region, criticises existing arrangements
because drug action groups do not always have access to advice from a
specialist with experience of working with young drug users. He would like
to see services coordinated at regional level by multiagency partnerships,
including adolescent psychiatry, drug misuse teams, primary care, social
services, and education.

Professor Howard Parker, professor of social work at Manchester University
and one of the authors of the report, would like the government to
re-evaluate its approach to treating young heroin users. Although he sees a
clear place for methadone as a detoxification agent, Professor Parker
believes that it is overused among younger addicts, leading to
overdependence on medical treatment. Instead, he advocates a philosophy of
"tough love," in which the behaviour of young heroin users is challenged in
a sensitive environment.

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Checked-by: Mike Gogulski