Drug use appears to be changing in England - both in the types of drugs people take and their potency, according to our latest survey of adult mental health and wellbeing .
Authors
- Sally McManus
Professor of Social Epidemiology, City St George's, University of London
- Sarah Morris
Research Director, National Centre for Social Research
The Adult Psychiatric Morbidity Survey (APMS) began in 1993 and is the longest running mental health survey series in the world. This national study gives us one of the clearest pictures of mental health in England. Because it includes people from all walks of life, not just those using NHS services, it shows how mental health is changing across the population.
In the latest survey , a random sample of around 7,000 adults aged 16 to 100 living in England took part in detailed interviews at home, each lasting about an hour and an half. Participants were asked questions about their mental health, whether they used any of a range of illicit drugs, and if they had experienced signs of dependence, such as symptoms of withdrawal or increased tolerance.
Although the Crime Survey for England and Wales (CSEW) is the government's official source of statistics on illicit drug use in England, it is a survey about crime. As such, those surveyed may not be comfortable disclosing their illegal activities - meaning the CSEW might not fully capture the extent of drug use across the population.
Because our survey is of the population's health and wellbeing, participants may be more willing to disclose their drug use. This gives us a valuable alternative lens on drug use and an opportunity to cross-check against official figures.
Our report has highlighted important shifts in what we know about the extent of drug use in England, the types of drugs adults take and the degree to which people may be dependent on those drugs.
Drug use may be more widespread
Our findings suggest a higher proportion of adults in England use drugs than official figures have shown.
We found that around 18.1% of 16- to 24-year-olds reported using an illicit drug in the past year. This is higher than the 16.5% reported by the CESW for the same age group and time period.
A few factors could be at play here.
Our survey doesn't include Wales - so the geographic coverage isn't identical between the two surveys - and we also asked participants about substances which aren't covered in the CSEW. This included amyl nitrites, prescription opioids, synthetic cannabinoids and volatile substances. This broader scope may contribute to a more complete picture of drug use in the population - and account, to some extent, for the higher prevalence we found.
But even when we compared just one drug type, differences are evident: 4.3% of 16- to 24-year-old participants reported using ketamine in the past 12 months, compared with 2.9% of 16- to 24-year-olds in the CSEW.
This suggests that surveys framed around crime might lead to under-reporting, as people may be less willing to disclose illegal behaviour in that context. Approaching drug use through the context of mental health may offer a more accurate picture of what's really going on.
Non-medical use of prescription opioids
Until now, due to a lack of data little was known about what proportion of people in England use prescription opioids without a prescription. So our survey asked people whether they had ever used opioid medications such as buprenorphine, fentanyl, morphine, oxycodone and tramadol that hadn't been prescribed to them.
Around 3% of participants reported that they had - much higher than the proportion reporting use of another opioid, heroin (which was below 1%). This suggests that non-medical use of prescription opioids may be a distinct and more widespread problem.
Men and women were equally likely to report using prescription opioids that had not been prescribed to them. Prevalence was highest in 25- to 34-year-olds. This indicates that usage probably can't be explained solely by self-medication for medical conditions and physical pain, which tend to be more common in older age groups.
Gender profile of drug dependence
Among 25- to 34-year-olds, men were twice as likely as women to report signs of dependence - possibly reflecting gender differences in family responsibilities or life stage. But in 16- to 24-year-olds, signs of drug dependence were similarly common in men and women.
This is a noticeable shift. In earlier waves of the survey series, young men consistently showed the highest levels of drug use and dependence . It appears this is no longer the case.
These results suggest that young women may be engaging in similar levels of risk-taking - or that young men are starting to use drugs at a later age, with problems emerging later down the line.
But given the relatively small number of 16- to 24-year-olds in the sample, it's too early to say for sure.
Cannabis dependence rising
The proportion of adults reporting signs of cannabis dependence nearly doubled this decade - from 2.8% in 2014 to 5.4% in 2023-2024. Yet this rise doesn't appear to be explained by an increase in the number of people using cannabis. In 2014, 7.2% of people reported having used cannabis in the past year. In 2024, this figure only rose to 8.7%.
So it's likely this increase in cannabis dependence is due to changing potency or other factors.
A 2018 analysis of drug seizures indicated that the UK's cannabis market is increasingly populated by high-potency varieties . Stronger cannabis potency has been linked to higher risk of addiction . The growing range of cannabis products, such as cannabinoid vapes, may also be making it easier to access and use cannabis more frequently.
Lack of specialist support
Only about one adult in every five who showed signs of drug dependence reported they'd ever received support or treatment for their drug use.
The survey also revealed a strong overlap between dependence and depression or anxiety.
This can present further challenges for mental health services in terms of engagement and recovery.
Patterns of drug use and dependence in England appear to be shifting. It's important that there's awareness of these changing trends so that support can be targeted effectively.
This chapter was produced by a team of researchers: Maxineanu, I., Roop,S., Morris, S., McManus, S., Roberts, E., Strang, J. (2025) Drug use and dependence. In Morris, S., Hill, S., Brugha, T., McManus, S. (Eds.), Adult Psychiatric Morbidity Survey: Survey of Mental Health and Wellbeing, England, 2023/4. NHS England. Sally McManus led the 2007 and 2014 Adult Psychiatric Morbidity Surveys and is part of the team running the 2023/4 survey. She is Professor of Social Epidemiology and Director of the Violence and Society Centre at City St George's, University of London. She is a deputy director of the VISION consortium, which is funded by UKRI.
Sarah Morris leads the Adult Psychiatric Morbidity Survey and works on the Health Survey for England at the National Centre for Social Research, which is commissioned by NHS England, with funding from England's Department of Health and Social Care.
