New opiate and crack-cocaine users: characteristics and trends 28 
 
The analysis showed that of the 149 Drug Action Team areas in England, 72 per cent had 
decreases in new OCU treatment numbers in the year to September 2014 compared to the 
previous year. Furthermore, of the 42 areas showing an increase, only 11 also showed a rise for 
the 12 months to September 2010 compared with the 12 months to September 2014, and most 
of these involved small numbers of individuals. 
Overall then, the very recent data on treatment presentations do not currently suggest that the 
number of new OCUs is on the verge of increasing, merely that it flattened for a period.  
A number of factors could explain the flattening. Most importantly, if there was some sort of 
shock that caused a one-off reduction in the lag-time to treatment this could make it appear as if 
incidence was rising when in fact new users may be falling but a greater percentage may simply 
be turning up to treatment faster. Such a shock may have occurred given the reduction in heroin 
supply seen from the end of 2010 through to 2012 (see Ahmad et al,. 2016). If users unable to 
obtain heroin used this enforced abstinence as a spur to seek treatment and hence to present to 
treatment services earlier than they otherwise would have done, this could cause a one-off 
‘concertina effect’ in which treatment numbers initially flatten or even rise but then fall again. 
This would also explain why the downward trend has apparently resumed: evidence suggests 
the reduction in supply has also ended.  
However, further analysis revealed some other possibilities based on the characteristics of 
those attending opiate/crack treatment for the first time in recent years. The Appendix includes a 
series of graphs with age-of-onset distributions for those who first attended treatment in 2013, 
and then 2012, and so on back to 2004. These show that the majority of those who presented to 
treatment in 2004 initiated use in the mid-1990s in line with the likely peak of the epidemic. But 
by 2012 a far greater number of individuals presenting to treatment say they started using 
opiates/crack only a year or two before.23 In other words, there appears to be a shift towards a 
shorter lag between initiation and treatment. This shift looks even more dramatic when using 
proportions rather than absolute numbers, see the Appendix.  
Furthermore, these individuals (those who seem to have both initiated recently and presented to 
treatment within a year or two of initiation) show a notably different age-of-initiation profile 
compared to the established profile in the literature, which peaks around 18–22 (Donmall & 
Jones, 2005). These individuals have a notably older age profile: see figure 11 chart, which 
compares recent initiates who presented to treatment in 2005 with recent initiates who 
presented to treatment in 2013. 
 
23  This shift does not appear to be related to the reduction in heroin supply occurring around 2010/11. As Appendix 1 
demonstrates, the pattern emerges far earlier.