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J Epidemiol Community Health. Sep 2004; 58(9): 766–771.
PMCID: PMC1732885

Injecting drug use in Brighton, Liverpool, and London: best estimates of prevalence and coverage of public health indicators


Study objective: To estimate the prevalence of injecting drug use (IDU) in three cities in England and to measure the coverage of key public health indicators.

Design: Capture-recapture techniques with covariate effects.

Setting: Liverpool, Brighton, and 12 London boroughs, 2000/01.

Participants: IDU collated and matched across five data sources—community recruited survey, specialist drug treatment, arrest referral, syringe exchange, and accident and emergency—896 in Brighton, 1224 in Liverpool, and 6111 in London.

Main results: It is estimated that in 2000/01 the number and prevalence of IDU aged 15–44 was 2300 (95%CI 1500 to 3700) and 2.0% (95%CI% 1.3% to 3.2%) in Brighton; 2900 (95%CI 2500 to 5000) and 1.5% (95%CI 1.3% to 2.6%) in Liverpool; 16 700 (95%CI 13 800 to 21 600) and 1.2% (95%CI 1.0% to 1.6%) in 12 London boroughs; with a prevalence of 1.7% (95%CI 1.2% to 3.3%) in inner London. It is estimated that: less than one in four IDU are in treatment in the three areas; syringe exchange programmes covered about 25% of injections in Brighton and Liverpool and 20% in London; and that the annual opioid mortality rate among IDU was 2% in Brighton compared with less than 1% in Liverpool and London.

Conclusions: Credible estimates of the prevalence of injecting drug use (and key public health indicators) can be determined using covariate capture-recapture techniques. These suggest that: targets to double the number in treatment are possible: syringe distribution should be increased; and further attention, especially in Brighton, given to reducing overdose mortality.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Sudman S, Sirken MG, Cowan CD. Sampling rare and elusive populations. Science. 1988 May 20;240(4855):991–996. [PubMed]
  • Hook EB, Regal RR. Capture-recapture methods in epidemiology: methods and limitations. Epidemiol Rev. 1995;17(2):243–264. [PubMed]
  • Laporte RE. Assessing the human condition: capture-recapture techniques. BMJ. 1994 Jan 1;308(6920):5–6. [PMC free article] [PubMed]
  • Tocque K, Bellis MA, Beeching NJ, Davies PD. Capture recapture as a method of determining the completeness of tuberculosis notifications. Commun Dis Public Health. 2001 Jun;4(2):141–143. [PubMed]
  • Hickman M, Cox S, Harvey J, Howes S, Farrell M, Frischer M, Stimson G, Taylor C, Tilling K. Estimating the prevalence of problem drug use in inner London: a discussion of three capture-recapture studies. Addiction. 1999 Nov;94(11):1653–1662. [PubMed]
  • Frischer M, Leyland A, Cormack R, Goldberg DJ, Bloor M, Green ST, Taylor A, Covell R, McKeganey N, Platt S. Estimating the population prevalence of injection drug use and infection with human immunodeficiency virus among injection drug users in Glasgow, Scotland. Am J Epidemiol. 1993 Aug 1;138(3):170–181. [PubMed]
  • Domingo-Salvany A, Hartnoll RL, Maguire A, Suelves JM, Antó JM. Use of capture-recapture to estimate the prevalence of opiate addiction in Barcelona, Spain, 1989. Am J Epidemiol. 1995 Mar 15;141(6):567–574. [PubMed]
  • Mastro TD, Kitayaporn D, Weniger BG, Vanichseni S, Laosunthorn V, Uneklabh T, Uneklabh C, Choopanya K, Limpakarnjanarat K. Estimating the number of HIV-infected injection drug users in Bangkok: a capture--recapture method. Am J Public Health. 1994 Jul;84(7):1094–1099. [PMC free article] [PubMed]
  • Hser YI. Population estimates of intravenous drug users and HIV infection in Los Angeles County. Int J Addict. 1993 Jun;28(8):695–709. [PubMed]
  • Larson A, Stevens A, Wardlaw G. Indirect estimates of 'hidden' populations: capture-recapture methods to estimate the numbers of heroin users in the Australian Capital Territory. Soc Sci Med. 1994 Sep;39(6):823–831. [PubMed]
  • Beynon C, Bellis MA, Millar T, Meier P, Thomson R, Mackway Jones K. Hidden need for drug treatment services: measuring levels of problematic drug use in the North West of England. J Public Health Med. 2001 Dec;23(4):286–291. [PubMed]
  • Tilling K, Sterne JA. Capture-recapture models including covariate effects. Am J Epidemiol. 1999 Feb 15;149(4):392–400. [PubMed]
  • Tilling K, Sterne JA, Wolfe CD. Estimation of the incidence of stroke using a capture-recapture model including covariates. Int J Epidemiol. 2001 Dec;30(6):1351–1360. [PubMed]
  • Parsons James, Hickman Matthew, Turnbull Paul J, McSweeney Tim, Stimson Gerry V, Judd Ali, Roberts Kay. Over a decade of syringe exchange: results from 1997 UK survey. Addiction. 2002 Jul;97(7):845–850. [PubMed]
  • Hook EB, Regal RR. Validity of methods for model selection, weighting for model uncertainty, and small sample adjustment in capture-recapture estimation. Am J Epidemiol. 1997 Jun 15;145(12):1138–1144. [PubMed]
  • Hook EB, Regal RR. Accuracy of alternative approaches to capture-recapture estimates of disease frequency: internal validity analysis of data from five sources. Am J Epidemiol. 2000 Oct 15;152(8):771–779. [PubMed]
  • Evans MA, Bonett DG. Bias reduction for multiple-recapture estimators of closed population size. Biometrics. 1994 Jun;50(2):388–395. [PubMed]
  • Hunter GM, Stimson GV, Judd A, Jones S, Hickman M. Measuring injecting risk behaviour in the second decade of harm reduction: a survey of injecting drug users in England. Addiction. 2000 Sep;95(9):1351–1361. [PubMed]
  • Hope Vivian D, Rogers Pauline A, Jordan Laura, Paine Thomas C, Barnett Sharon, Parry John V, Gill O Nöel. Sustained increase in the sharing of needles and syringes among drug users in England and Wales. AIDS. 2002 Dec 6;16(18):2494–2496. [PubMed]
  • Hulse GK, English DR, Milne E, Holman CD. The quantification of mortality resulting from the regular use of illicit opiates. Addiction. 1999 Feb;94(2):221–229. [PubMed]
  • White JM, Irvine RJ. Mechanisms of fatal opioid overdose. Addiction. 1999 Jul;94(7):961–972. [PubMed]
  • Bird Sheila M, Hutchinson Sharon J, Goldberg David J. Drug-related deaths by region, sex, and age group per 100 injecting drug users in Scotland, 2000-01. Lancet. 2003 Sep 20;362(9388):941–944. [PubMed]
  • Davies AG, Cormack RM, Richardson AM. Estimation of injecting drug users in the City of Edinburgh, Scotland, and number infected with human immunodeficiency virus. Int J Epidemiol. 1999 Feb;28(1):117–121. [PubMed]
  • Tilling K. Capture-recapture methods--useful or misleading? Int J Epidemiol. 2001 Feb;30(1):12–14. [PubMed]

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