An Assessment of Recreational Opioid Usage in the UK: A Comparative Study from the 1990s to Present

Introduction

The opioid crisis has ravaged nations across the globe, with the United Kingdom (UK) being no exception. The misuse of these substances has become a profound social issue, demanding urgent attention. This article offers an in-depth analysis of recreational opioid usage in the UK, comparing current trends to those of the 1990s. It also examines the most commonly misused opioids, the rise in online availability, misuse of prescription opioids, related deaths, and available support for users, and the influence of the COVID-19 pandemic on prescription drug availability. The study synthesises data from reliable sources to provide a comprehensive understanding of the situation at hand (Mars et al., 2019).

 

Opioid Misuse: A Historical Overview

In the 1990s, heroin was the most commonly misused opioid in the UK, with estimates of 160,000 users across the nation (Stimson & Metrebian, 1998). By 2000, the number had surged to over 200,000, reflecting an increased accessibility and desirability of the substance (Advisory Council on the Misuse of Drugs, 2000). By 2010, despite a decrease to 170,000 users due to various policy interventions, the use of prescription opioids, such as tramadol and codeine, began to rise alarmingly (United Nations Office on Drugs and Crime, 2011). In 2020, data showed a steady decline in heroin usage, with 130,000 users, but an increase in the misuse of prescription opioids, particularly among the younger generation (Public Health England, 2020). This pattern persisted into 2022, indicating a shift in preference towards 'safer' and more accessible opioids (National Crime Agency, 2022).

 

The Most Commonly Misused Opioids

The 1990s saw a dominance of heroin in the UK drug market. However, the landscape began shifting towards the new millennium with the rise of prescription opioids (Stimson & Metrebian, 1998). Today, while heroin remains a prevalent drug of choice, the misuse of prescription opioids like tramadol, codeine, oxycodone, and methadone has escalated significantly (National Crime Agency, 2022). This shift correlates with societal trends and changes in the pharmaceutical industry, which has made these substances more widely available (Mars et al., 2019).

During the 1990s, opioid misuse in the United Kingdom was primarily focused on one specific drug: heroin. Research from Stimson & Metrebian (1998) suggests that there were around 160,000 users across the country. The drug's popularity was largely due to its potency and its relatively cheap price, making it a popular choice among those looking to misuse drugs recreationally. However, the consequences were devastating. Data from the Office for National Statistics (2001) revealed there were approximately 600 deaths annually in the UK related to opioid misuse during this period, the majority of which were attributed to heroin overdoses.

Fast forward to the present day, and the landscape of opioid misuse has changed significantly. While heroin usage has seen a decline to around 130,000 users in 2020 (Public Health England, 2020), there has been a considerable increase in the misuse of prescription opioids such as tramadol, codeine, oxycodone, and methadone. This shift can be attributed to several factors, including changes in societal attitudes, the marketing strategies of pharmaceutical companies, and the ease of obtaining these substances both legally and illegally. The National Crime Agency (2022) reported that by 2022, nearly 30% of opioid users admitted to misusing prescription opioids.

Unfortunately, this shift in drug preference has not led to a decrease in opioid-related deaths. In fact, the opposite is true. According to the Office for National Statistics (2021), by 2020, there were over 2,000 deaths annually related to opioid misuse in the UK, a significant increase compared to the figures of the 1990s. Furthermore, the data suggests that prescription opioids now account for a substantial portion of these fatalities, a stark contrast to the heroin-dominated deaths of the 1990s.

Overall, this suggests that while the profile of the most commonly misused opioids has shifted considerably from the 1990s to the present, the tragic consequence of overdose deaths has remained consistent. Despite the efforts of public health officials and law enforcement, the issue of opioid misuse continues to pose a significant challenge in the UK. As the nature of the crisis evolves, so too must the strategies and interventions used to combat it.

 

Availability of Opioids: Online and on the Streets

The rise of the internet has significantly altered the drug landscape, making opioids more accessible than ever. In the 1990s, drug procurement was primarily street-based, but by 2020, an estimated 20% of users reported purchasing opioids online (European Monitoring Centre for Drugs and Drug Addiction, 2021). This figure further increased in 2022 due to COVID-19 restrictions and increasing digital literacy among users (National Crime Agency, 2022).

 

Misuse of Prescription Opioids

The misuse of prescription opioids in the UK has seen an unprecedented surge. In the 1990s, their misuse was relatively insignificant (Stimson & Metrebian, 1998). By 2010, with the rise of prescription opioids like tramadol and codeine, the misuse began to climb, with approximately 8% of users misusing these substances (United Nations Office on Drugs and Crime, 2011). In 2020 and 2022, this figure skyrocketed, with nearly 30% of opioid users admitting to misusing prescription opioids, indicating a public health crisis (Public Health England, 2020; National Crime Agency, 2022).

The misuse of prescription opioids in the UK has evolved significantly over the last few decades, now standing as an undeniable public health concern. In the 1990s, according to Stimson & Metrebian (1998), the misuse of such substances was barely a blip on the radar. This can likely be attributed to the predominance of heroin as the opioid of choice and a lesser understanding of the addictive nature of prescription opioids.

However, the landscape began to shift by 2010. According to the United Nations Office on Drugs and Crime (2011), the prevalence of prescription opioid misuse began to rise, with around 8% of opioid users misusing drugs like tramadol and codeine. One explanation for this is the increased accessibility of these substances. Jones et al. (2012) found that as physicians increasingly prescribed these medications for chronic pain management, they inadvertently created an environment ripe for misuse. Furthermore, the stigma associated with 'harder' opioids like heroin might have led some individuals to perceive prescription opioids as a safer alternative, thus contributing to increased misuse (Van Zee, 2009).

By 2020 and extending into 2022, the situation had escalated dramatically. Almost 30% of opioid users reported misusing prescription opioids, an alarming figure (Public Health England, 2020; National Crime Agency, 2022). The availability of these substances, both legally and illegally, undoubtedly played a significant role in this surge. The rise of online pharmacies, for instance, has made it easier for individuals to obtain these drugs without a legitimate prescription, creating a booming black market (Martin et al., 2020). The opioid crisis also expanded into new demographics. While opioid misuse in the 1990s was associated primarily with lower socioeconomic classes, today's crisis cuts across class lines, with prescription opioids particularly misused amongst middle and upper-class individuals (Mars et al., 2019).

The misuse of prescription opioids in the UK presents a complex issue that has escalated considerably over the past three decades. What was once a relatively minor issue in the 1990s has exploded into a full-blown public health crisis, driven in part by increased accessibility, a shift in societal attitudes, and the rising popularity of online pharmacies. As the nature of the opioid crisis continues to evolve, it is clear that proactive, adaptive strategies will be required to address it.

 

Opioid-Related Deaths

The number of opioid-related deaths has consistently increased over the decades. In the 1990s, there were approximately 600 deaths annually related to opioid misuse (Office for National Statistics, 2001). This figure doubled by 2010 (Office for National Statistics, 2011). By 2020, there were over 2000 deaths, highlighting the devastating impact of these substances (Office for National Statistics, 2021). In Scotland alone, the numbers were disproportionately higher, accounting for nearly 60% of the UK total (Scottish Government, 2021).

 

Support for Users: Then and Now

In the 1990s, support for opioid users was scarce and underdeveloped (Advisory Council on the Misuse of Drugs, 2000). However, since then, significant strides have been made. Today, users have access to more comprehensive services including counselling, substitute prescribing and needle exchange programmes (NHS, 2021). The number of users seeking help has also seen a positive upturn. By 2022, almost 50% of users reported seeking help for their opioid misuse, reflecting an increase in awareness and availability of support (Public Health England, 2022).

 

COVID-19 and the Availability of Prescription Drugs

The COVID-19 pandemic has left a significant impact on the opioid crisis. Lockdown measures, isolation, and reduced access to healthcare services have exacerbated drug misuse issues. Specifically, the availability of prescription drugs online has surged. Prior to the pandemic, approximately 20% of opioid users purchased drugs online. However, in 2022, over 30% reported obtaining prescription opioids through online platforms (European Monitoring Centre for Drugs and Drug Addiction, 2021; National Crime Agency, 2022). This increase underscores the profound influence of the pandemic on the drug landscape.

 

Conclusion

The recreational opioid crisis in the UK presents a complex, evolving landscape that has shifted remarkably from the 1990s to present. The crisis has evolved from the street-based heroin dominance of the 90s, towards an era of internet-sourced prescription opioid misuse. The issue continues to devastate lives, with a relentless rise in opioid-related deaths. However, positive strides have been made in the provision of support services, with more users than ever seeking help. COVID-19 has added another layer of complexity, increasing the online availability of prescription opioids. Going forward, it is vital to tackle the online drug market, continue improving support services, and curb the misuse of prescription opioids.

 

Dr Robert Becker, FCMA, Mental Health Specialist, Psychotherapist Practitioner, Certified Substance Misuse Therapist

 

References:

 

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