The United Kingdom Home Office Addicts Index closed in 1997 (leaving only the informal non-identifiable regional drug misuse databases). At that time there were about 40 000 notified opiate addicts in the United Kingdom. Over the previous decade this figure had increased by approximately 20 per cent annually. Although important as a marker of the prevalence of heroin abuse in the United Kingdom, this centralized resource was of limited value since it only provided information on those who presented to doctors. The current prevalence of heroin use in the United Kingdom is thought to be less than 1 per cent (male-to-female ratio of 2:1), with most new addicts seeking treatment being in their 20s. Other indicators of the level of substance misuse include the number of arrests for possession, Customs's seizures, deaths from opiate abuse, uptake of needle-exchange programmes, and household surveys.

Good epidemiological data regarding opiate misuse among younger people are limited, although recent reports from the North of England highlight new outbreaks of heroin use among this group,(6) often through smoking. Concern over the introduction of heroin into the club scene to help the 'come-down' from stimulant drugs is also a potentially worrying new trend. More important perhaps is the relative paucity of treatment services for young people, in terms of both accessibility and the potential consequences of introducing a vulnerable group to adult services where they may meet experienced drug users. The main initiative should be the targeting of individuals who are likely to experience problematic drug use through two main approaches:

1. a better understanding of the interaction between risk factors and developmental processes may allow the development of early identification and intervention;

2. a multidisciplinary skill base to address those issues which may be more pertinent in this group (e.g. family and education).

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