Executive summary

• Overall drug prevalence in the general population is lower now than ten years ago, with cannabis being the main driver of that reduction; however, there has been little change in recent years (section 1.2.1).
• The order of drugs most commonly reported by respondents to general population surveys has not changed much over this time, with cannabis most prevalent (last year prevalence of 6.6%) followed by powder cocaine (2.3%) and ecstasy/MDMA (1.3%), according to the most recent Crime Survey for England and Wales (section 1.3.1 and section 1.4.1).
• Lifetime prevalence of drug use among schoolchildren has previously showed a steady long-term decline; however, data from the most surveys of schoolchildren in both England and Scotland reported increases in drug use. Future surveys will need to be monitored to determine if this is a genuine changing trend in this population (section 1.2.2).
• The most recent available estimates have suggested that there was a ten per cent increase in crack cocaine use in England between 2011/12 and 2014/15. Other indicators support this general picture, with increases seen in the number of those presenting to treatment for crack use in 2016 and in the proportion of injecting drug users using this substance surveyed in the Unlinked Anonymous Monitoring (UAM) survey of people who inject drugs (PWID) (section 1.4.3).
• The UK government published the 2017 Drug Strategy in July 2017, outlining the overall strategic approach to responding to the drug situation. This strategy, in line with the previous version, aims to reduce demand, restrict supply, and build recovery, with a new aim of global action, and was accompanied by an evaluation of the 2010 drug strategy (section 2.6.1).
• In April 2017 the Department for Work and Pensions published Improving lives: Helping workless families, a policy paper which proposed a trial of individual placement and support (IPS) approaches to aid drug users enter or continue to work. The Department for Work and Pensions and Department of Health and Social Care Work and Health Unit have funded a randomised controlled trial of IPS in seven areas, which Public Health England is currently in the process of conducting (section 2.6.3 and section 4.9.6).
• A new NICE guideline, Drug misuse prevention: targeted interventions (NG64), was published in February 2017, replacing the previous guideline PH4 (section 3.7.1).
• The Children and Social Work Act 2017 came into force in April 2017. In addition to aiming to improve local joint working, the act provides the Education Secretary with powers to make personal, social and health education (PSHE) mandatory in all schools (section 3.7.2).
• There were 119,973 treatment presentations in the UK in 2016. In England and Wales, there were 244,971 individuals recorded as being in drug treatment during 2016. Of all those in treatment in England and Wales, 138,422 were receiving prescribing treatment for opioid use (section 4.3.1).
• Two-fifths (42%) of treatment presentations in the UK were for primary heroin use, with 25% of all service users presenting for treatment of cannabis use. Among those who had never previously been in treatment, 45% of clients presented for primary cannabis use, whereas 16% presented for primary heroin use, representing a five per cent decrease in the proportion of first-time primary heroin clients from 2015 (section 4.3.2).
• As with the previous year, the primary drugs cited by those presenting to treatment services varied notably between the four countries of the UK. While almost half of treatment entrants cited heroin as their primary substance in England, Scotland and Wales, seven per cent of clients in Northern Ireland had this as their primary substance (section 4.3.2).
• Benzodiazepines were cited by a much larger proportion of treatment entrants in Scotland and Northern Ireland than in the rest of the UK, while primary crack cocaine use was more common in England, and amphetamine/methamphetamine use was more common in Wales (section 4.3.2).
• In July 2017, the then Department of Health published an update of the Drug misuse and dependence: UK guidelines on clinical management, based on the results of a review of the evidence on drug treatment since 2007 (section 4.7.1).
• Treatment data showed that 29,886 of the clients that presented to treatment in the UK in 2016 did so within a prison setting, made up of 27,575 individuals in England, 1,778 in Scotland, and 533 in Northern Ireland (section 5.5.1).
• Use of synthetic cannabinoid receptor agonists (SCRAs) in prisons remains a problem. Testing data published this year suggested that SCRAs are the most commonly used substance in prisons, with 16% of prisoners testing positive for these substances on release from prison, compared to nine per cent on arrival (section 5.3.2).
• The Prisons and Probation Ombudsman reported that between June 2013 and September 2016 there were 79 deaths in prisons in England and Wales where the deceased was known or strongly suspected to have taken new psychoactive substances (NPS) before death, or where NPS use was a key issue during their time in prison. Of the 79 deaths, 56 were self-inflicted (section 5.4.2).
• National take-home naloxone programmes continue to supply naloxone to those exiting prison in Scotland and Wales: there were 720 kits issued by NHS staff in prisons in Scotland, and 655 in Wales, in 2016/17 (section 5.5.3).
• Using the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) definition, the total number of drug-related deaths (DRDs) that occurred in the UK during 2015 was 3,070, a 13% increase from 2014 and the highest number reported to date (section 6.3).
• Due to delays between occurrence and registration of DRDs in England and Wales, UK-wide DRD figures are not yet available covering deaths occurring beyond 2015. However, published statistics for DRDs occurring in Scotland during 2016 showed a 23% increase on 2015, and deaths registered in England & Wales in 2016 showed a four per cent increase. It is therefore likely that the figure for UK DRDs occurring in 2016 will again show an increase on the previous year (section 6.3).
• Across the UK there were 2,656 deaths reported which featured an opioid (87% of UK cases) (section 6.5.1). As in previous years, the substance with the largest number of associated deaths was heroin. In contrast to the UK as a whole, tramadol was the most commonly mentioned opioid in Northern Ireland (section 6.5.2). 
• The proportion of deaths involving cocaine has continued to rise. Many of these deaths are believed to be heroin users who also use crack cocaine (section 6.5.2).
• There was a substantial increase in the number of deaths registered in Scotland in 2016 that involved a benzodiazepine, rising from 191 deaths in 2015 to 426 in 2016. Etizolam, classified as an NPS, was implicated in, or contributed to, the largest proportion of these cases (n=225, up from 43 cases in 2015) (section 6.5.2).
• There was a spate of deaths related to fentanyls (particularly carfentanyl) in the first half of 2017. This particular incident abated; however, concern remains that there is demand for these drugs if supply were to be re-established (section 6.9.3).
• Over the last decade the average age at death has increased from 37.6 years in 2004 to 42.1 in 2015, with males being younger than females (41.3 years and 44.5 years respectively) (section 6.6.4).