We hear from Dr Harry Sumnall — Professor in Substance Use at the School of Psychology, Liverpool John Moores University — on changing trends in young people's drug use, and when and how to talk to children and young people about substances.
Harry is a Professor in Substance Use at the School of Psychology, Liverpool John Moores University. He is interested in all aspects of substance use, particularly young people's health issues. Harry's funded research programmes have examined the evidence base for substance misuse prevention and the mechanisms for implementing evidence-based practice and policy.
Liz is one of the Senior Subject Specialists at the PSHE Association. She has a Masters in Education, focused on policy and the power of language, and has worked with schools in over 20 countries, sharing best practice and collaborating on international, cross-curricular projects.
Note: This interview transcript has been edited for readability with permission from both speakers.
Liz Laming (LL)
Hello and welcome to PSHE Talks. I'm Liz Laming, one of the Senior Subject Specialists at the PSHE Association, and I'm excited to be here today to discuss effective, age-appropriate drug education with Dr. Harry Sumnall. Harry is a Professor in Substance Use in the School of Psychology at Liverpool John Moores University, and he undertakes and collaborates on a wide range of research on drug-related topics, but with a particular specialism in young people's drug use and prevention interventions. We've been working with Harry for a number of years, and he supported our recent work in developing our drugs education lesson pack for the Office for Health Improvement and Disparities. So today we're going to take a look at what the data says around changing trends in drug use amongst young people, the ages at which we should start talking to children and young people about different substances, including ketamine and THC vapes, and the language we should use and be aware of when we deliver drug education, as well as how drug education fits within the wider PSHE curriculum and whole-school approach.
So, Harry, we spoke to you last back in 2021 after launching the previous edition of our drug education pack, and we've recently launched this new edition of the pack, which we'll come on to, but it'll be really interesting just to hear from you first about the current picture in the UK around young people and drug use. Has anything changed?
Dr Harry Sumnall (HS)
Most of the data that we have around school children is from a government survey called the Smoking, drinking and drug use survey. That covers 11- to 15-year-olds, mostly in English schools, but also some Welsh schools; there is data from Northern Ireland and Scotland showing similar results. Now, encouragingly, overall, substance use continues to decline in school-age children (primary school, but mostly secondary school children). In 2023, when the last survey was undertaken, about 13% of pupils reported taking drugs in their lifetime. That's down from 18% in 2021, when I last spoke to you. If we look at some other data, about 10% of pupils will report drug use in the last year and 5% in the last month. Now, that might sound high because obviously, 1 in 10 have reported drug use in the last year. But this is a continued decline. We're seeing some of the lowest levels of drug use since those surveys began, and that reflects levels of drug use in the older population as well.
We think probably this is driven by declines in cannabis use and nitrous oxide use. So nitrous oxide, in particular, was a drug of concern over the last 10 years. But drugs fall in and out of fashion, as with any consumer behaviour, and nitrous oxide seems to have had its day. So that's partly responsible for the declines in use. But with cannabis as well, we sometimes track changes in cannabis use in relation to changes in tobacco smoking, because certainly in the United Kingdom, we tend to mix cannabis with tobacco. So as attitudes and health risk perceptions towards tobacco have changed, and legislation is going to change as well, we also see parallel changes with cannabis use. So that's probably the two drugs which have driven this decline in use, I think.
LL
That's something we definitely touched on in the last iteration of the lessons and certainly the updates. And we still do obviously discuss cannabis use, and we introduce drugs like nitrous oxide. Have there been any particular new drugs that are in vogue now then, the ones that we need to be talking more about because things have kind of moved on, as you say?
HS
It's important, I think, to focus on the most commonly encountered drugs. Broadening the definition of drugs, that will always include cannabis, but of course alcohol as well, and nicotine and tobacco. Something we often forget about, which was relevant back when we last spoke and is still relevant, is so-called 'volatile substances'. That excludes nitrous oxide, but includes things like glues and gases. Those volatile substances, along with cannabis, are the first drugs that young people begin to experiment with. That's probably because they're readily available in the home - it could be deodorants, but also in the garage, in the sheds, glues and gases and things like that.
Now, looking at other changes in drug use - the data in 11- to 15-year-olds doesn't really reflect this, but certainly for older young people, aged 16-plus, there's increased attention paid towards a drug called ketamine. That's a dissociative drug - in small quantities it can produce euphoria, but in larger quantities can produce feelings of depersonalisation, derealisation, feeling separate from the body. Ketamine prevalence has increased quite substantially over the last 10 years or so. And there's certainly concerns around that in relation to some of the extreme harmful effects associated. It can cause damage to the bladder, and it's a drug of dependence as well - still rare, but when we're talking about a drug like ketamine, as with other drugs, we need to focus on encouraging help-seeking, thinking about the frequency of use and some of those potential long-term effects. There's been lots of media attention on ketamine, rightly so. But let's not forget other drugs as well. So, powder cocaine remains popular with older young people, but also psychedelic drugs, in particular magic mushrooms. Again, that tends to be a drug which people begin to start using age 16-plus, but we've seen some sharp increases in use of magic mushrooms as well.
LL
I think teachers in particular will be very aware of, obviously incidents in their school and local area, but also what we see in the news and what's really discussed by the media. I know one of the other things that we've talked about that's included in the lessons is this rise in synthetic substances. How much of an issue do you think that's become or is becoming?
HS
There's many different synthetic substances, but one key issue, I think, relates to the rise in popularity of vaping, and we might talk about that a bit later on. As well as regular nicotine vapes - and of course, the government is going to introduce landmark legislation this year about controlling the sale of those disposable vapes - some of the vaping equipment allows for the use of different types of canisters, different types of vaping liquid. We know there's been a rise in incidents in schools around so-called THC vapes. THC is the active chemical in cannabis; it's what gets you high, in very simple terms. So there's concerns around that; that can be bought illicitly - it's produced in the UK, but can also be imported from North America. But there's been analysis by scientists as well, where there's been incidents in schools related to THC vapes; where those vapes have been analysed they contain what we call 'synthetic cannabinoid receptor agonists'. This is often more popularly known as 'spice', and it causes big issues in some of our most vulnerable populations. Now, THC in and of itself can be harmful, and of course, we need to be concerned about that. But spice is particularly harmful for young people. It can have effects that THC and cannabis don't have - increased risks on the heart, concentration, mental health; it can cause damage to, for example, the kidneys as well. But what we tend to have found where there's been incidents around spice, is young people have collapsed in school, for example, and then the vape has been seized by teachers and then analysed and shown to contain this substance.
LL
You mentioned a couple of those substances being particularly prevalent in the older age groups, and you mentioned some of the ones seen more frequently among younger children. At what sort of ages do you think we should be talking to young people about these particular substances then, to make sure we are delivering preventative education and not just responding to those issues that you've just mentioned in schools?
HS
It's never too early to talk about drugs, medicines, alcohol, tobacco - that's good drugs education, health education in general. But if we want to think about preventing use and preventing escalation of use - so that's a slightly different issue from education in itself, which has its own inherent value - looking at that schools data from the government, we see a sharp increase particularly between the ages of 14 and 15. There's also an increase between the ages of 12 and 13, which is when we first begin to notice that increase, but then there's a real rapid increase from the ages of 14 to 15 as young people become more independent, they socialise outside of the family, outside of school... So they're key years. We know from the international research evidence around prevention programmes and education that targeting young people as they begin to get potentially interested in substances, the age of 13 or 14 is a key age. Although, of course, there's absolutely no harm in talking about these issues before then.
LL
We made sure that was built into the lessons previously, but certainly in the updated lesson pack as well. For the older students, we're talking about very specific drugs and scenarios and things, but certainly the year 9 lessons are introducing drugs in a much more detailed way, thinking about peer influence, social influences, pressure and all those factors as well. I think often primary colleagues are not quite sure how we should be talking about this with pupils who are 4 to 11 years old - it's really interesting and great that you said that it's never too early to start. Obviously, the approach we're going to take for those younger years is going to be slightly different. I know for our primary lessons, for example, we start by introducing household products, how to seek help if you're unwell or what medicines are safe, what a medicine is and what's it used for; and then as we get to upper key stage 2 we start introducing substances like tobacco and more specific drugs before they start moving into secondary schools. The other thing that I know we've done with this new pack is have a greater range of lessons for key stage 5, so we've produced some new lessons for this post-16 age group. Do you think there are particular things to be aware of in that age range, 16 to 18, that they really need to be prepared for - thinking about the fact they're going to leave education and be out potentially in the big wide world by themselves for the first time?
HS
Yes. I spoke before about that sharp increase in use between the ages of 11 to 15. But again, in terms of prevalence of drug use and frequency of drug use, that does escalate even more from the age of 16-plus. It's understandable - young people testing boundaries, experimenting, etc. Here, I think education is still important - facts and figures, that's still important, effects of drug use, what drugs do, what they look like, all of that's important. But I think it's also useful to discuss drug use in the context of wider risk-taking behaviour, and wider what we call 'risk environments' as well, because where young people will begin to take drugs and why they take drugs might also change. Not in all cases, but in general. For example, they might be socialising in nightlife, and drugs are obviously going to be involved in some environments there, including alcohol, of course. But we also find, looking at other types of research, that, for example, young people who are beginning to struggle - and by that I mean with mental health and wellbeing - that we find that 16 is a critical age if they begin to develop a more unhealthy relationship with substances, because they might be using those substances to make sense of themselves and the world around them, and to cope with mental health and wellbeing problems. Some of the discussion around ketamine use and why that might have increased, for example, that's very much been centred on, well, what effects does ketamine produce? It helps people to deal with negative thoughts and emotions. So people are perhaps self-medicating in a way that, to be honest, they might find will work initially - but if they continue to rely on those substances to help with mental issues, that's when use can escalate, and of course, it doesn't deal with the underlying problems. Other risk behaviours can include of course relationships, sexual behaviours as well, but even just social relationships, friendships, thinking about exams, family relationships, thinking about the world of work. Drug use could interfere with those issues as well, and it's important to discuss a wide range of implications and a wide range of scenarios. It's not just about the direct health effects of drug use.
LL
I know in our key stage 5, our post-16 lessons, we are looking very much at those more independent contexts. We look at what it's like to be travelling independently, leaving home, joining a new workplace, all of those situations where they might be encountering new opportunities, but new challenges as well - there might be new substances they're being offered, it might be being used as something to help them mental health-wise to navigate their way through these quite scary, sometimes, new situations they find themselves in. And I think it touches on this point that we always talk about, the fact that we should be teaching about drug education as part of this comprehensive PSHE education programme, where we are looking at mental health, we're exploring relationships, and it all links in with these other subject areas. And yes, we need to be doing these focused lessons on drugs and alcohol, but actually this should be part of making connections with how it impacts relationships or how relationships impact drug and alcohol use, and ditto with mental health and other topics too.
LL
Is there anything in particular you think we do need to be aware of, or the teacher should be careful or cautious about, when teaching about this topic? Because it can be quite sensitive, I suppose, for those reasons we've just spoken about, that it links so intricately with relationships, mental health and so on.
HS
It does. Particularly links with other PSHE or RSHE areas can be quite controversial, of course. But I think there's similar concerns about sometimes the age-appropriateness, the developmental appropriateness. Some of the conversations I often have with teachers are about, well, what should be the objective? What should be the intention of drug education? Because many of their pupils, many of their young people will be using drugs already. Some might be contemplating drug use. So they need to understand or be really clear about what stage young people are at. Where can that benefit be provided that supports those people to develop healthily? That might include some tricky and tough conversations about the realities of drug use, accepting that some young people will be using drugs. And the education there might be slightly different from a more preventative perspective, where you're trying to persuade, you're trying to steer people away from initiating use. That can sometimes be tricky, but there is lots of guidance out there as well.
I think it's really important not to be too critical, but a lot of our understanding about drugs and their effects come through the media. Media can be a good resource, an informative resource, but I think we also know it can be quite sensationalist as well, sensationalist in many different ways. In terms of describing the drug use situation, I think sometimes there's a danger that media can normalise drug use, perhaps give the impression that more young people are using drugs than is the case. Sometimes there's also a focus on really extreme outcomes - so, although we don't use the term clinically, addiction. So a focus on addiction, extreme outcomes, deaths, or if we're focusing on ketamine, for example, there's been a lot of discussion on bladder harms. That does happen; it's important to acknowledge that, but that's not the type of harms that most people who are using drugs are most likely to be exposed to. So it has an important educational component, but is maybe not too relevant to most young people and their own experiences with drugs.
It's important to get that balance. I think sometimes perhaps teachers feel they have to focus on the more extreme consequences because they feel that is the right thing to do, they feel that that will scare people away from drug use. But we know that those approaches don't work. Focus on those issues and consequences that are most relevant to young people. Health effects, yes, short term health effects, but also, as we've spoken about, relationships, wider risk behaviours, plans for the future, thinking about university, college, all of those sorts of things.
LL
You've mentioned a couple of points there related to a whole-school approach to drug education. So yes, obviously, PSHE or RSHE has a really important role here in delivering lessons and dedicated time to actually explore these issues. But this is part of a wider school effort, and actually, there might be pastoral intervention needed for particular students or groups of students who are engaging in drug-taking behaviours and things. And that's not all down to the PSHE teachers or PSHE lead, that's part of a bigger picture.
Related to your point there as well about addressing those misconceptions, we always talk about the importance of baseline assessments and finding out what pupils already know, what they think they know, just to unpick some of that because there are a lot of misconceptions around drug use - ideas like, "all drugs will kill you", or "this drug is going to cause this particular damage to the body based on what the media said" and so on. I know you've briefly touched on it there, but I know we've talked before about the language teachers are using, which I think is something they're quite conscious of, and this idea about whether we should be talking about addiction or problematic substance use. I wonder if you could just give any advice about the kind of language and terminology we should be using with young people.
HS
We have an accurate set of terms and language that is sometimes different from the language and phrases which are commonly used to describe drug use and drug use issues, the lay terminology. You can understand why people might use particular phrases and terminology. But within PSHE, within RSHE, we want to make sure we use accurate language and precise language. Just using the example of addiction, for example, addiction doesn't have any clinical definition. It's used popularly to refer to, what in scientific language we might refer to as, dependence or substance use disorders, which are a very, very particular set of behaviours with acknowledged consequences and a set of social behaviours. And the term by itself, 'addiction', doesn't really mean anything. It also has a moral dimension as well. It's open to interpretation, and people's interpretation might be different depending upon who you ask. It's understandable why people use that term because that's the phrasing that's used in popular discussions. But I think it can be helpful to focus on using language of 'use', simply to refer to patterns of use, frequency of use, focusing on specific consequences of use. Be specific, because that means you can begin to talk about the consequences of those outcomes - if you use vague phrasing and terminology like addiction, what are you really talking about? What kind of messages are you giving? But if you focus on specific use behaviours, patterns and specific outcomes, you can be precise. You provide young people with relevant knowledge and accurate language as well.
LL
I know you've obviously supported us for the production of these lessons, and all this stuff is written within the teacher guidance. I think it really comes down to teacher training, and making sure teachers have adequate support to know what these things are that they should be aware of before they deliver the lessons.
LL
Are there any top tips you can give teachers, or if there are a couple of takeaways you'd want all teachers to know about teaching about drugs or drug education, what might they be?
HS
You've mentioned a couple of times the whole-school approach - that is really important. Good drugs education is not just what happens in the classroom, although that's critical. It's also about making sure you have up-to-date school policies around drugs and alcohol. But I think increasingly, and this reflects wider changes and wider initiatives in the sector, it's making sure that your school has good links with other community organisations as well. Drug use can be a complex topic, it can be a controversial topic, and it can be a topic which significantly impacts on young people and their families, of course. And let's not forget that young people might be affected by other people's drug use as well. So making sure schools have good links with a range of community organisations is important as well. Indeed, the government, through its National Drug Strategy, is trying to promote this partnership approach. Teachers in schools shouldn't think they have to deal with this on their own.
There is an increasing number of good resources available. Of course, the PSHE Association guidance, but even other resources like Talk to Frank - when I speak to teachers, they find that valuable. It includes some good, accurate information and it includes other resources and sources of support.
Lastly, all schools and teachers have an obligation and a duty to deliver drugs and alcohol education, but this shouldn't be seen as a one-off event. We still find that sometimes this is dealt with in an assembly or an end-of-term event, or getting in a guest speaker. And I understand, with time constraints and curriculum constraints, why schools may feel they have to do this. But this is a topic that needs to be developed across time, to build upon skills and knowledge across year groups but also across the school year as well. That can be within PSHE - that's important, of course - but some schools, in an innovative way, take what we call an 'infused approach', where they're talking about drugs and alcohol education not just within PSHE, but also in other lessons as well. Take maths, for example, where they might consider the costs of alcohol or the costs of tobacco, yearly expenditure on alcohol use, as an example. There's some international evidence that broadening the lessons in which drug and alcohol education is delivered could actually have additional impact and additional benefits, because it's something that cuts across different types of understanding and different types of learning - it's not just something which is located solely within the PSHE lesson.
LL
That's a really good point. We speak to a lot of schools, a lot of colleagues, who talk about those cross-curricular links, actually, and what they're trying to do to enhance the PSHE curriculum throughout the school and in other subjects. It's really interesting how you can do that, and great to hear it's had some really interesting results. Obviously, teachers can go and check out our lessons, but thanks very much for signposting those great additional sources of support as well. We really appreciate your time today - thank you very much, it's been lovely to have you with us.
HS
Pleasure to be here.