Abstract
The incidence of new persons and repeat attenders presenting for treatment for problem drug misuse in the South West of England more than doubled from 1996-1997 to 2000-2001. During this time there was an increase in the number and severity of chronic cases, both in terms of the prevalence of heroin and crack-cocaine use and in the frequency of injecting and sharing injecting equipment. Growth in the availability of treatment, changes in notification practice and sub-regional variation make it difficult to be confident about real rates of increase, or age, gender and substance misuse changes, but the size of these changes mean they are unlikely to be purely artefactal.
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