The characteristics of people who inject drugs in the United Kingdom: changes in age, duration, and incidence of injecting, 1980–2019, using evidence from repeated cross-sectional surveys

Dan Lewer*, Sara Croxford, Monica Desai, Eva Emanuel, Vivian D. Hope, Andrew McAuley, Emily Phipps, Emily J. Tweed

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background and aims: Mortality and drug treatment data suggest that the median age of people who inject drugs is increasing. We aimed to describe changes in the characteristics of people injecting drugs in the United Kingdom (UK). Design: Repeat cross-sectional surveys and modelling. Setting: Low-threshold services in the United Kingdom such as needle and syringe programmes. Participants: A total of 79 900 people who recently injected psychoactive drugs in the United Kingdom, recruited as part of the Unlinked Anonymous Monitoring Survey (England, Wales, Northern Ireland, 1990–2019) and Needle Exchange Surveillance Initiative (Scotland, 2008–2019). Measurements: Age of people currently injecting, age at first injection, duration of injecting (each 1990–2019) and estimates of new people who started injecting (1980–2019). Findings: In England, Wales and Northern Ireland between 1990 and 2019, the median age of people injecting increased from 27 (interquartile range [IQR], 24–31) to 40 (IQR, 34–46); median age at first injection increased from 22 (IQR, 19–25) to 33 (IQR, 28–39); and median years of injecting increased from 7 (IQR, 3–11) to 18 (IQR, 9–23). Values in Scotland and England were similar after 2008. The estimated number that started injecting annually in England increased from 5470 (95% prediction interval [PrI] 3120-6940) in 1980 to a peak of 10 270 (95% PrI, 8980-12 780) in 1998, and then decreased to 2420 (95% PrI, 1320-5580) in 2019. The number in Scotland followed a similar pattern, increasing from 1220 (95% PrI, 740–2430) in 1980 to a peak of 3080 (95% PrI, 2160–3350) in 1998, then decreased to a 270 (95% PrI, 130–600) in 2018. The timing of the peak differed between regions, with earlier peaks in London and the North West of England. Conclusions: In the United Kingdom, large cohorts started injecting psychoactive drugs in the 1980s and 1990s and many still inject today. Relatively few people started in more recent years. This has led to changes in the population injecting drugs, including an older average age and longer injecting histories.

Original languageEnglish
Pages (from-to)2471-2480
Number of pages10
Issue number9
Publication statusPublished - Sep 2022

Bibliographical note

Funding Information:
National Records of Scotland provided data on the age of death for opioid‐related deaths. We thank the staff at the services that have facilitated delivery of UAM/NESI surveys and the participants recruited for giving their time to take part. Dr Thomas Brothers (Dalhousie University and UCL) and Professor Sharon Hutchinson (Glasgow Caledonian University) provided feedback on drafts of this research article. D.L. is funded by the National Institute for Health Research (NIHR; Doctoral Research Fellowship DRF‐2018‐11‐ST2–016). E.J.T. is funded by the Chief Scientist Office (CAF/17/11; SPHSU17) and Medical Research Council (MC_UU_00022/2). This paper presents independent research. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, the UK Department of Health and Social Care, the UK Health Security Agency, or Public Health Scotland.

Publisher Copyright:
© 2022 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.


  • Ageing
  • United Kingdom
  • demography
  • epidemiology
  • heroin
  • injecting
  • modelling


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