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. CPH’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
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.
“Once you’ve been there, you’re always recovering”: exploring experiences, outcomes, and benefits of substance misuse recovery
Drugs and Alcohol Today, (2016) Vol. 16 Iss: 1, pp.29 - 38, 2016.
Abstract: Purpose: – Recovery is a central component of UK substance misuse policy, however, relatively little is known about the views and meanings of recovery by those experiencing it. The purpose of this paper is to explore these factors, and understand how service user experiences align to current understandings of “recovery capital”. Design/methodology/approach: – This paper draws on qualitative interviews with 32 individuals from six UK recovery communities, including those commissioned by a statutory service (n=8) and a peer-led recovery community (n=24). Findings: – Meanings of recovery differed between people in abstinence-based communities and those not; however, all had consistent views on their own recovery outcomes and the benefits they believed recovery brought. All viewed recovery as a process; a continuous journey with no end-point. Internal motivation, peer support, social networks and daily structure were integral to supporting individuals achieve and maintain recovery. Key benefits of recovery reflected recovery capital and included positive relationships, sense of belonging, increased self-worth and confidence, employment and education. Research limitations/implications: – This research shows that recovery experiences and outcomes are not centred entirely on the individual but are wider, more holistic. Maintaining recovery involves being connected to themselves and to the wider environment: family, friends, peers and society. Although the recovery capital model has many elements that were discussed by the participants of this research, the discourse they used does not align with the model. To validly measure and quantify recovery outcomes, individuals need to identify with the measures themselves. Practical implications: – From policy and commissioning perspectives, these findings suggest benefits of recovery that were viewed by participants as indicators of success: demonstrate elements which support recovery; and highlight key social value outcomes which people attribute to recovery. Social implications: – These “softer”, qualitative benefits should be considered by policy-makers, commissioners, statutory and non-statutory services in order to evidence outcomes. However, it should also be recognised that a temporally static approach to assessing recovery may be in contradiction to the meaning and perspectives held by those in recovery communities who conceptualise it as a long term and ongoing process. Originality/value: – This paper adds to understandings of experiences and meanings of recovery, with a particular focus on the measurement of outcomes and their meanings, and the role of abstention and continued drug use within the recovery process.
Drugs: Education, Prevention and Policy, Pages 1-8, 2016.
Abstract: Aim: The aim of the paper was to identify changes in the extent and patterns of anabolic steroid use in the United Kingdom to better understand the public health implications within the context of the current health-related evidence base. Methods: Using the two time points between 1995 (prior to legislation changes in the United Kingdom) and 2015, a review of the evidence related to health harms was conducted, in conjunction with needle and syringe programme (NSP) data in Cheshire & Merseyside (UK) relating to anabolic steroid users. Findings: Dramatic increase in the number of anabolic steroid users accessing NSPs, 553 in 1995 to 2446 in 2015, now accounting for 54.9% of clients. With the inclusion of pharmacy NSPs, this rose to 5336 individual anabolic steroid users. Conclusions: Key changes in our knowledge during the 20 years, in particular, in relation to HIV prevalence, changes in the market and patterns of use make anabolic steroid use a public health concern. In the context of increasing numbers of injectors, there is a need for comprehensive interventions.