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. - --- Checked-by: Mike Gogulski