Most interesting of 2015

Some of the most interesting
things about alcohol and
other drugs in 2015
Andrew Brown
@andrewbrown365

Estimated rate of high risk drug users in Great Britain,
per 1,000 population aged 15 to 64
Nearly 1 in 100 people between
ages of 15 - 64 in Great Britain is
thought to be a high risk drug user
Definition of a high risk drug use:
“injecting drug use or long-
duration/regular use of opioids,
cocaine and/or amphetamines”
Source: http://www.nta.nhs.uk/uploads/uk-focal-point-report-2014.pdf

In 2013-14 there were
47,900
assessments for children in need
where alcohol or other drugs were a
factor at initial assessment.
In 2013-14
435
children ran away from foster care
because of substance misuse
Source: https://www.gov.uk/government/statistics/characteristics-
of-children-in-need-2013-to-2014
Source: https://www.gov.uk/government/statistics/fostering-in-
england-1-april-2013-to-31-march-2014

Substance use by prisoners and links to offending
The results demonstrate that drugs are
a problem among prisoners, regardless
of age, in contrast to general
population figures (although older
prisoners who had used drugs were
more likely to link their offending with
their drug use). They also show that
older adult prisoners were more likely
to have taken Class A drugs before
custody. This suggests that older adults
and young adult drug users may
require different types of intervention
focused on their particular patterns of
drug use.
Source: https://www.gov.uk/government/publications/needs-and-characteristics-of-young-adults-in-custody

Substance misuse and mental health in prison
Prisoners with drug and/or
alcohol problems tend to have
even higher levels of mental
health problems than the rest
of the prison population.
RAPt service users present
with an average of 3.4 mental
health problems.
Source: http://bit.ly/1ArNoan

Substance misuse issues for adults and children in
prison
Adult prisoners Children in the secure estate
Source: Service specification No. 29: public health services for
people in prison
Source: https://www.justiceinspectorates.gov.uk/hmiprisons/wp-
content/uploads/sites/4/2015/07/HMIP-AR_2014-
15_TSO_Final1.pdf

When do people with substance use problems turn up at
hospital in acute need?
“We found that access to, and the quality of,
services after 5pm was not good enough.
Commissioners and providers should make
sure that they have the most appropriate
services with the staff that have the right
skills working at the times when people with
mental health needs are more likely to access
them.”
CQC - “Right here, right now – help, care and
support during a mental health crisis”Source: http://www.cqc.org.uk/sites/default/files/20150611_righthere_mhcrisiscare_full_3b.pdf

Proportion of drug and alcohol clients in concurrent
contact with mental health services
Source: http://fingertips.phe.org.uk/profile-group/mental-health/profile/drugsandmentalhealth

“There is still a struggle with the dual
needs of people with alcohol and
mental health issues; this becomes
very frustrating as people seem to fall
into a gap between services. It seems
that services can only work with a
person either with mental health or
addiction - not with the whole
person.”
Are there appropriate care pathways for people with
both mental health and alcohol problems?
Source: The Recovery Partnership Review of Alcohol Treatment Services

Number of current drug injectors admitted to first drug
treatment, by country
“A total of 12,909 current
drug injectors were admitted
to first drug treatment in
2011, with the United
Kingdom (34.8 %)
accounting for the largest
proportion of reported
cases, followed by the Czech
Republic (16.6 %), Italy (13.7
%), Greece (6.6 %), Spain (5.7
%) and Germany (5.0 %).”
Source: http://www.emcdda.europa.eu/publications/technical-reports/trends-in-injecting-drug-use

Merseyside Annual Drug Intervention Programme report
2014/15
Just over half of all successful drug tests
carried out in Merseyside in 2014/15 were
positive (51.0%).
Of the 4,923 positive tests the highest
proportion was seen among those testing
positive for opiates (51.8%) often in
combination with cocaine (38.8%).
Source: Merseyside Annual DIP report 14/15

The number and proportion of stop and searches carried out
by police relating to suspicion of drug offences
While the number of stop and
searches carried out on suspicion of
drug offences have halved since
2010/11, the proportion that they
make of all stop and searches has
risen by 9% points over the same
period.
Source: Police powers and procedures England and Wales year ending 31 March 2015

Age of first use of people in drug treatment in the UK
Source: http://www.emcdda.europa.eu/data/stats2015#displayTable:TDI-0197

Levels of Blood Borne Viruses amongst people who
inject drugs in England, Wales and Northern Ireland
“The impact of public health
interventions which aim to prevent
HIV and hepatitis C infection through
injecting drug use, such as needle and
syringe programmes and opiate
substitution therapy, has been shown
to be dependent on their coverage. In
addition to these interventions,
increasing the treatment of hepatitis
C infection in PWID should also
reduce the transmission of hepatitis C
among PWID.”
Source: https://www.gov.uk/government/statistics/people-who-inject-drugs-hiv-and-viral-hepatitis-monitoring

Less than half of deaths (43%) in opioid users are from
overdoses
There were more than
five and a half times the
number of deaths
amongst opioid users
than would be expected
in the general
population between
2005 and 2009
Source: National record linkage study of mortality for a large cohort of opioid users ascertained by drug treatment or criminal justice sources in
England, 2005–2009, Pierce, Matthias et al., Drug & Alcohol Dependence , Volume 146 , 17 - 23
http://www.drugandalcoholdependence.com/article/S0376-8716(14)01844-4/pdf

Proportion of females who had been a victim of domestic
violence prior to drug related death in Scotland (2013)
13% of all those dying from drug related
deaths were reported to have been a
victim of domestic violence at some point
prior to death.
Over four-fifths (81%) were female.
45 in every 100 women who died had
experienced domestic violence at some
point; this compares to 3 in every 100 men.
Therefore women were 14x more likely to
have experienced domestic violence.
Source: http://www.isdscotland.org/Health-Topics/Drugs-and-Alcohol-Misuse/Publications/data-tables.asp?id=1386#1386

1,382 children in Scotland lost a parent to a drug related
death between 2009 and 2013
Almost half of females (47%) and a third of males
(32%) who died a drug-related death in Scotland
in 2013 had children aged under 16.
Female parents (37%) were more likely to be
living with their children at the time of death
than male parents (12%).
Of those who lived with children at the time of
their death, one in three (34%) were known to
use drugs intravenously.
Source: http://www.isdscotland.org/Health-Topics/Drugs-and-Alcohol-
Misuse/Publications/

The known physical and mental health conditions of
those dying from drug related causes in Scotland
Physical health conditions experienced in the six months prior
to drug related deaths in Scotland
Mental health conditions experienced in the six months prior to
drug related deaths in Scotland
Source: http://www.isdscotland.org/Health-Topics/Drugs-and-Alcohol-Misuse/Publications/data-tables.asp?id=1386#1386

Regulations to allow wider access to naloxone in
England from 1 October 2015
These Regulations will allow drug services to obtain
stocks of Naloxone Hydrochloride and supply it to
anyone requiring access for use in an emergency
involving a heroin overdose. This will include drug
users, their family members and carers. It will also
include other people likely to come into contact with
drug users such as hostel managers.
The expected impact on the public sector, charities
or voluntary bodies will be an increase in the
availability of naloxone and a reduction in fatal
opioid overdoses. It is expected that the cost
associated with this wider availability, e.g. training
and storage, would be minimal.
“These Regulations amend the Human
Medicines Amendment Regulations 2012
(“the 2012 Regulations”). They do so in
order to allow drug treatment services
provided by or on behalf of NHS bodies and
local authorities (LAs) to supply Naloxone
Hydrochloride for administration in
emergencies involving a heroin overdose.”
Source: http://www.legislation.gov.uk/uksi/2015/1503/memorandum/contents

Take home naloxone
National take home naloxone
schemes should aim to issue 20
times as many kits as there are
opiate-related deaths per annum;
and at least nine times as many.
In 2014 there were 1,786 deaths
recorded in England and Wales where
an opiate was involved, including 952
which mentioned heroin or morphine.
Meaning there should be 35,720 (and
a minimum of 16,074) naloxone-kits
issued issued across England and
Wales.
Source: Sheila M. Bird , Mahesh K. B. Parmar , John Strang, Take-
home naloxone to prevent fatalities from opiate-overdose:
Protocol for Scotland’s public health policy evaluation, and a new
measure to assess impact, Drugs: Education, Prevention and Policy
Vol. 22, Iss. 1, 2015
Source: Deaths related to drug poisoning in England and Wales,
2014 registrations (ONS 2015)

Mean percentage purity of cocaine and heroin seized by
police in England and Wales, 2003 to 2013
Source: http://www.nta.nhs.uk/uploads/uk-focal-point-report-2014.pdf

Mental health patients who die by suicide with known
history of drug or alcohol misuse
Of those suicides in England where a patient had been in
touch with mental health services in the previous 12
months over half (54%) had a history of drug and/or
alcohol misuse. On average there were 671 deaths a
year in this group.
In Scotland 69% of mental health patient suicides, had a
known history of drug and/or alcohol misuse, an
average of 168 deaths per year.
In Wales an average of 41 deaths per year were to
patients, 57% of suicides in mental health patients.
Source:
http://www.bbmh.manchester.ac.uk/cmhs/research/centreforsuicidepre
vention/nci/

Injection of NPS in Wales
“Injection of cathinones, particularly
in the groin area has led to an increase
in physical impacts: granular/gritty
lumps under the skin, profound
bruising, abscesses, deep vein
thrombosis, long-term stays in
intensive care units of up to 3 months,
amputations, severe weight loss and
requirement for major reconstructive
surgery to femoral veins. Increased
injection rates were also noted, going
from approximately 3 up to 15–20
times per day.”
Source: http://www.emcdda.europa.eu/publications/rapid/2015/drug-related-infectious-
diseases-in-europe

What do people in receipt of opioid substitution therapy
think about services?
Source: How can opioidsubstitutiontherapy (and drug treatment and recovery systems) be optimisedto maximise recovery outcomes for service users?

Kilos of cocaine and heroin seizures in England and
Wales
Three quarters of
cocaine (65%) and heroin
(66%) seized in 2014/15
was in quantities under
1g.
3% of cocaine and 2% of
heroin seized weighed
more than 500g.
Source: Seizures of drugs in England and Wales, financial year ending 2015

Rates of Drugs-related Death Rates Soon After Hospital-
discharge for People in the Treatment System in
Scotland
For the cohort of over 98,000 drug
treatment clients in Scotland, there is a
high drugs-related death [DRD] risk in the
28 days after hospital-discharge. Length of
hospital-stay had no effect on DRD-rate,
discharge-diagnosis had an effect (as did
reported misuse of alcohol) but neither was
as discriminatory as the behavioral risk-
factor of having ever injected.
Source: White SR, Bird SM, Merrall ELC, Hutchinson SJ (2015) Drugs-RelatedDeath Soonafter Hospital-Dischargeamong Drug Treatment Clients in Scotland: Record Linkage,
Validation,and Investigationof Risk-Factors. PLoS ONE 10(11): e0141073.doi:10.1371/journal.pone.0141073
http://journals.plos.org/plosone/article?id=info:doi/10.1371/journal.pone.0141073

Short-term outcomes for opiate and crack users
accessing treatment in England (1 of 2)
“Significant, and substantive,
improvements in most behavioural
measures were recorded, and were
achieved within a relatively short period
of time following enrolment in treatment.
The study demonstrates that these
successful outcomes continued to be the
norm for the English opiate- and/or crack-
user treatment population, despite a
doubling in the number of drug users
treated, and changes in referral patterns
and drug use profiles.”Source: Short-term outcomes for opiate and crack users accessing treatment: the
effects of criminal justice referral and crack use.

Short-term outcomes for opiate and crack users
accessing treatment in England (2 of 2)
“The results observed here
demonstrate that, in the face of
marked changes in the English drug
treatment population, the positive
improvement in behavioural
outcomes observed in previous
studies has been sustained. Positive
changes were observed in the short
term but did not necessarily equate to
abstention from all drug taking and
offending behaviour.”
Source: Short-term outcomes for opiate and crack users accessing treatment: the
effects of criminal justice referral and crack use.

Reported purity of brown heroin in Europe in 2013
Source: http://www.emcdda.europa.eu/data/stats2015#displayTable:PPP-77-0

Substance misuse in older people
The proportion of high-risk older
people (over 60 years of age) with
substance misuse problems that
don’t receive the treatment that
they require.
Source: Substance misuse in older people: an information guide, Royal College of
Psychiatrists

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