Supporting evidence based drugs policy through epidemiology, monitoring, evidence review, intervention evaluation and primary research.
Public Health Institute (PHI) has established itself as one of the UK’s leading applied research groups. Research in this area began with the development of local monitoring systems for drug treatment and needle exchanges, and this early work informed the sophisticated national monitoring systems we see today.
In parallel streams of work, PHI’s realistic evaluation approach has helped a variety of stakeholders understand the impact that their work is having and how best to improve services. Primary research has provided insights into a variety of substance related topics, particularly in priority groups such as young people, drug injectors, and families affected by drugs.
Research undertaken by the Public Health Institute has contributed to the development of two successive UK National Drug Strategies and a number national and international guidance. PHI’s systematic reviews of evidence for the effectiveness of drug prevention interventions, and optimal provision of needle and syringe exchange programmes underpinned National Institute for Health and Clinical Excellence (NICE) guidance in these areas. Public Health Institute also coordinates the UK arm of the EMCDDA’s early warning system on psychoactive drugs and this intelligence also feeds into to UK monitoring systems.
PHI is responsible for producing estimates of the prevalence of opiate and / or crack cocaine use in England. Information about the number of people who use these drugs is key to formulating effective policies for tackling drug-related harm and also helps inform service provision at the local level. PHI also takes the lead in the EMCDDA’s problem drug use indicator, collating opiate use prevalence estimates across the four nations within the UK.
Public Health Institute has also developed research specialisms in novel psychoactive drugs (‘legal highs’). As well as coordinating the UK arm of the EU Early Warning System on Novel Psychoactive Drugs, PHI’s policy critiques, forensic analyses, and evidence reviews have contributed to international discussions on this emerging public health priority.
Drugs Case Studies
Adverse Childhood Experiences (ACEs)
A growing body of research is revealing the long-term impacts that experiences and events during childhood have on individuals’ life chances. Adverse Childhood Experiences (ACEs) such as abuse, neglect and dysfunctional home environments have been shown to be associated with …
Publications for Drugs
Papers for Drugs
The extent of and factors associated with self-reported overdose and self-reported receipt of naloxone among people who inject drugs (PWID) in England, Wales and Northern Ireland
Katelyn Cullen, Charlotte O'Halloran, Jaquelyn Njoroge, Lucy Jessop, Josie Smith, Professor Vivian Hope, Fortune Ncube
Int J Drug Policy, 46 :34-40, 2017.
Abstract BACKGROUND: Overdose is a major cause of death among PWID, and for opioid overdoses naloxone administration can reduce harm. However, globally there is limited national level data on the extent of non-fatal overdose and naloxone uptake. The first national level data on the extent of self-reported overdose and self-reported receipt of naloxone among UK PWID, providing a baseline to monitor the impact of the recent policy change regarding naloxone availability, is presented. METHODS: Data on self-reported overdose and receipt of naloxone during the preceding year for 2013-2014 from a national survey of PWID was analysed. Participants who reported injecting during the preceding year were included. RESULTS: Participants (3850) were predominantly male (75%); mean age was 36 years. The most commonly injected drugs were: heroin (91%), crack (45%) and amphetamine (29%). 15% (591) reported overdosing during the preceding year. There were no differences in the proportion reporting overdose by age or gender, but overdose was more common among those who: injected multiple drugs; recently ceased addiction treatment; injected with used needles/syringes; ever had transactional sex; had used a sexual health clinic or emergency department and lived in Wales or Northern Ireland. Among those reporting an overdose during the preceding year, a third reported two to four overdoses and 7.5% five or more overdoses; half reported receiving naloxone. Those reporting naloxone receipt in the preceding year were more likely to: live in Wales or Northern Ireland; ever received used needles/syringes; ever been imprisoned; and less likely to have injected two drug types. CONCLUSION: These data provide a baseline for monitoring the impact of the 2015 UK policy change to improve take-home naloxone access. Interventions tackling overdose should promote naloxone awareness and access, and target those who; are poly-drug injectors, have ceased treatment, share needles/syringes and whose drug use links to sexual activity.
Injection into the jugular vein among people who inject drugs in the United Kingdom: Prevalence, associated factors and harms
Professor Vivian Hope, Jenny Iverson, Katelyn Cullen, John V. Parry, Lisa Maher, Fortune Ncube
Int J Drug Policy, 46 :28-33, 2017.
Abstract BACKGROUND: While people who inject drugs (PWID) typically use peripheral veins, some inject into their central veins, including the femoral and jugular veins. Injection into the jugular vein can have serious adverse health consequences, including jugular vein thrombosis, deep neck infections, pneumothorax, endocarditis and sepsis. This study examined the prevalence of, and factors associated with, jugular vein injection among a large sample of PWID in the United Kingdom. METHOD: Unlinked anonymous surveys (2011-14) recruited PWID from agencies providing services to this population. Self-reported demographic and injection-related data were collected from consenting respondents using a brief questionnaire and dried blood spot samples were tested for exposure to HIV, hepatitis C virus (HCV) and hepatitis B virus (HBV). Univariate and multivariable logistic regression were used to examine factors associated with jugular vein injection. RESULTS: Among 5261 PWID, one third had injected into a central vein in the previous 28 days, including 6% (n=339) who had injected into their jugular vein and 1% (n=52) who had used this site exclusively for recent injections. Factors independently associated with recent jugular vein injection in multivariable analysis included female gender, a lifetime history of imprisonment, sharing needles and syringes, poly-drug injection and injection into multiple body sites. Jugular vein injection was also associated with experiencing injection-related injuries, although no associations were identified with respect to exposure to blood borne viral infections. CONCLUSION: A significant minority of PWID inject into the jugular vein in the United Kingdom. Public health responses should investigate ways to support and promote good injection site management in order to minimise vascular damage and reduce problems with peripheral venous access. Women who inject drugs, PWID with a history of imprisonment and those people who are experiencing early signs of injection-related skin and soft tissue injuries are priority sub-populations for interventions.
Low levels of hepatitis C diagnosis and testing uptake among people who inject image and performance enhancing drugs in England and Wales, 2012-15
Drug and Alcohol Dependence Volume 179, 1 October 2017, Pages 83-86, 2017.
Abstract: Introduction: People injecting image and performance enhancing drugs (IPEDs) have traditionally not been perceived as being at high risk of hepatitis C virus (HCV) infection. However, recent studies indicate the HCV antibody (anti-HCV) prevalence in this group is 10-times that in the general population. HCV testing uptake and undiagnosed infections are examined using data from a voluntary unlinked-anonymous survey. Method: People injecting IPEDs across England and Wales completed a short bio-behavioural survey (2012–15). Anti-HCV status and self-reports of HCV testing were used in the analysis. Results: The participants median age was 31 years, 98% were men, 14% had also injected psychoactive drugs and the anti-HCV prevalence was 4.8% (N = 564). Among those who had never injected psychoactive drugs the anti-HCV prevalence was 1.4%; among those who had recently injected psychoactive drugs (preceding 12 months) prevalence was 39% and among those who had done this previously 14% (p < 0.001). Overall, 37% had been tested for HCV: among those who had recently injected psychoactive drugs 78% had been tested, as had 56% of those who had injected psychoactive drugs previously; 33% of those never injecting psychoactive drugs were tested (p < 0.001). Overall, 44% of those with anti-HCV were aware of this; however, only 14% of those who had never injected psychoactive drugs were aware. Conclusions: One-in-twenty people who inject IPEDs have anti-HCV. HCV infections among those who had never injected psychoactive drugs were mostly undiagnosed, though this group had a lower prevalence. Targeted HCV testing interventions are also needed for those injecting IPEDs.