Illicit drug use

Drug misuse refers to the use of a drug for purposes for which it was not intended or using a drug in excessive quantities.

‘Drug addiction is a chronic condition characterised by the risk of repeated relapse and remission. It can take an individual several attempts over a number of years to finally overcome his or her dependency and lead an addiction-free life. There is no quick solution and what may work for one person will not necessarily work for another’ (Drug Treatment & Recovery in 2010/11, National Treatment Agency for Substance Misuse, October 2011).

All sorts of different drugs can be misused, including illegal drugs (such as heroin or cannabis), prescription medicines (such as tranquilisers or painkillers) and other medicines that can be bought off the supermarket shelf (such as cough mixtures or herbal remedies).

In the UK there are high levels of drug misuse, including high rates of heroin and crack cocaine use.

People who misuse drugs often have a range of health and social problems, which may have lead them to misuse drugs or may be a consequence of their addiction.

The 2009/10 British Crime Survey estimates that 8.6% of 16 to 59-year-olds living in England and Wales had tried illegal drugs in the last year.

Among young people, this figure is more than twice as high, with an estimated 20% of 16 to 24-year-olds having used illegal drugs in the last year.

For the people who take them, illegal drugs can be a serious problem. They're responsible for between 1,300 and 1,600 deaths a year in the UK, and destroy thousands of relationships, families and careers.

This topic links with the following JSNA topics:

Alcohol misuse

Crime

Offenders

Housing

Employment

Last updated: 2017-09-29 10:47:03
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1. What are the key issues?

Numbers in treatment

The rate of people dependant on drugs in Hartlepool (18.6 per 1,000 population) is more than double the national average (8.7 per 1,000 population). More than half of those users (63.7%) are currently accessing treatment services for support and this is higher than the England average (53.4%).

The total number of individuals in Hartlepool accessing treatment in 2012/13 was 861 (5.5% increase from the previous year). Nationally, the number of people accessing drug treatment has fallen by 1.1%.

Changing drug trends, poly drug use

In Hartlepool, heroin is the primary drug for 74% of service users; many of them are also using other substances (including cannabis, alcohol and prescription drugs). The number of users of crack cocaine and benzodiazepines has reduced by 85% and 28% respectively.

Successful completions & length of time in treatment

The proportion of successful completions for opiate and non-opiate clients in Hartlepool is below the national average. Within this group, one-third are retained in treatment for more than six years.

Offending

Drug-related offences in Hartlepool have reduced by 6.5%. However, drug use and drug dealing remains a community concern (particularly in the most disadvantaged communities).

Young people

It has been identified that there is a change in trends for the younger generation of drug users and these changes present challenges for treatment providers. Therefore, methods of engagement and support may need to change accordingly.

Last updated: 04/06/14

2. What commissioning priorities are recommended?

2012/01

Ensure that the four principles for commissioning a drug treatment system that promotes successful recovery journeys are thoroughly embedded in Hartlepool. These four principles are:

  • Recovery is initiated by maintaining (and where necessary improving) access to early and preventative interventions and to treatment;
  • Treatment is recovery-orientated, high quality and effective;
  • Treatment delivers continued benefit and achieves appropriate recovery-orientated outcomes (including successful completions);
  • Treatment supports people to achieve sustained recovery.

2012/02

Ensure that all strategies and services continue to develop an outcome-based focus in line with the outcomes described in the HM Government Drug Strategy 2010.

Last updated: 06/10/14

3. Who is at risk and why?

Age

Fewer drug users under 30-years-old are coming into treatment for heroin and/or crack dependency.

Younger age groups are using illicit substances (cannabis) and this may create new or additional demands upon the treatment system.

Older, entrenched drug users find it difficult to make progress through the treatment system.

Larger proportions of those admitted into hospital for drug-related reasons are in the younger age groups.

The young people most at risk of escalating to problematic substance misuse are those in vulnerable groups, including:

  • looked after children;
  • sexually exploited children;
  • adolescents with mental health problems;
  • those persistently missing from home;
  •  not in education employment or training (NEETS);
  • excluded from school;
  •  persistent truants;
  • on alternative education for attendance and behavioural issues; and
  • those young people living with adult drug/alcohol users.

Gender

The gender split of those in treatment is male (73%) and female (27%).

By contrast, 46% of people admitted to hospital for drug-related reasons were female. It appears that some women may still be prevented from gaining access to treatment.

Socioeconomic status

Deprivation is associated with the problematic use of particular drugs such as heroin and crack cocaine.

Deprivation is linked most strongly with the extremes of problematic use and least with casual, recreational or intermittent use of drugs.

The more deprived the user is, the less likely they will access care and treatment.

The chances of overcoming drug problems are less among people who are disadvantaged.

Deprived areas often suffer from greater and more visible public nuisance from drug taking and supplying.

Poor areas with high unemployment levels can provide an environment where drug dealing becomes an established way of earning money.

Deprived people living in overcrowded and sub-standard accommodation are more likely to share injecting equipment and more likely to get hepatitis, HIV and tuberculosis.

Mental health

In the Co-morbidity of Substance Misuse and Mental Illness Collaborative Study (COSMIC) (quoted in the DrugScope response to the ‘New Horizons’ consultation) the NTA found that:

  • Nearly 75% of drug service users have a mental health problem;
  • 30% of drug service users have ‘multiple morbidity’ (or complex need);
  • Over one-third of drug users have a psychiatric disorder.

In 2011, the Mental Health Network updated their factsheet ‘Key facts and trends in mental health’ and it recognised that ‘the dual problem of mental ill health and substance misuse remains a challenge for mental health services’. It continues that ‘between 22-44% of adult psychiatric inpatients in England also have a substance misuse problem’. ‘Research indicates that urban areas have higher rates of dual diagnosis than rural areas’.

Housing

Three-quarters of single homeless people have a history of problematic substance misuse (rising to more than 80% of rough sleepers).

More than 40% of single homeless people cite drug use as the main reason for homelessness, while two-thirds report increasing problem substance misuse after becoming homeless.

Addaction (2005) found that 83% of substance misusers felt that having appropriate housing was one of the most important support services required to help them stay free of drugs.

Employment

The Department for Work and Pensions study ‘Problem Drug Users’ (2010) describing experiences of employment and the benefit system, included the following extract:

‘Studies have found that users of ‘hard’ drugs such as heroin and crack cocaine are significantly less likely to be in employment than other adults of working age’ (MacDonald and Pudney, 2001, 2002). Research has also found that duration of unemployment is associated with the number of drugs an individual has used (Plant and Plant, 1986).

Parenting

There are approximately 250,000 to 350,000 children who may be exposed to the consequences of problem drug use.

Children of drug misusers are more likely to:

  • Come to the attention of social services for either abuse or neglect (neglect is the most common);
  • Enter the care of relatives who themselves may require support;
  • Experience behavioural and/or psychiatric problems;
  • Engage in substance misuse; and
  • Be vulnerable to physical, emotional and educational problems.

The lifestyle of families with a substance-misusing parent can also be characterised by chaos and lack of routine, as well as social isolation.

Crime

There are strong links between drug use and crime.

Ethnicity

There are higher proportions of cannabis users in treatment from ‘Asian/Asian British’ and ‘Black/Black British’ communities than those from white ethnic backgrounds.

Last updated: 04/06/14

4. What is the level of need in the population?

Information for 2012/13 shows that in Hartlepool:

  • The estimated prevalence of drug users is 1,101.
  • The number of people currently in treatment is 563.
  • The gender split for those in treatment is 72% male and 28% female.
  • The population of treatment naive for 12/13 was at 294.

Successful completions & length of time in treatment

Successful completions for opiate and non-opiate clients in Hartlepool are below the national average. Within this group a third are retained in treatment for more than six years.

Proportion of clients still in treatment in years

 

 

Under 2 years

2 - 4

years

4 – 6 years

6 years & over

Average (years)

Opiate Clients

38.0%

18.8%

10.9%

32.3%

4.3

Non-Opiate Clients

87.7%

5.5%

4.1%

2.7%

1.0

 

SHP Strategic assessment

The SHP Strategic assessment states that:

  • There is an increase in the number of those accessing treatment;
  • Less than two thirds of drug users are known to treatment services;
  • Heroin continues to be a primary drug for adults in Hartlepool;
  • Cannabis and alcohol are the primary drugs for young people; and
  • There is a clear relationship between the misuse of drugs and acquisitive crime.
Last updated: 04/06/14

5. What services are currently provided?

Adults

Developing Initiatives for Support in the Community (DISC) deliver the following services in Hartlepool:

  • Structured psychosocial interventions, relapse prevention and aftercare;
  • Harm reduction and needle exchange; and 
  • Recovery and reintegration.

Lifeline deliver the following services in Hartlepool:

  • Service user and family support; and
  • Education, training and employment.

Addaction deliver the following service in Hartlepool:

  • Specialist drug & alcohol clinical Service.

Tier 4 Rehabilitation is delivered depending on individual need.

Young people

HYPED deliver drug & alcohol treatment services in Hartlepool for under 18-year-olds.

Last updated: 04/06/14

6. What is the projected level of need?

Although the former North East Public Health Observatory (NEPHO) have reported a marked change in treatment demand regionally, caution should be used in translating recent trends into future demand.

Last updated: 04/06/14

7. What needs might be unmet?

Drug users who repeatedly re-present within treatment services have multiple needs that are currently unmet.

There isn’t any targeted work for those who remain in treatment for long periods of time.

The harm that recreational drug use can bring to individuals and communities is not being addressed.

Communication between all partners and treatment providers needs to improve.

There needs to be a smoother transition between services, particularly for those young people entering adult treatment from young people’s services.

The needs of young people living with drug using parents or siblings to address hidden harm needs to be addressed.

There needs to be stronger links (by the use of in-reach) to prisoners who are due to be released into community-based treatment provision.

There is a larger cohort of older heroin and/or crack users who have remained in treatment for four years or more and there is a need to work more proactively to address this issue and reduce the number of years in treatment.

Last updated: 04/06/14

8. What evidence is there for effective intervention?

Research For Recovery: A Review of the Drugs Evidence Base ; a recent review commissioned by the Scottish government of the evidence base for treatment and for a recovery approach.

The principal publications supporting models of current drug treatment can be sourced from the NTA and NICE websites:

Professor Michael Gossop, ‘Treating drug misuse problems: evidence of effectiveness’ (2006)

NICE, ‘Drug misuse: Psychosocial interventions’ (CG51, 2007)

NICE, ‘Psychosis with coexisting substance misuse’ (CG120, 2011)

NICE, ‘Drug Misuse and dependence UK Guidelines on Clinical Management’ (2007)

NICE, ‘Drug Misuse: Opioid detoxification NICE Clinical Guideline’ (2007)

NICE, ‘Drug Misuse Psychosocial Interventions NICE Clinical Guideline 51’ (2007)

NICE, ‘Interventions to reduce substance misuse among vulnerable young people’ ( 2007)

NICE, ‘Methadone and buprenorphine for the management of opioid dependence NICE Technology Appraisal 114’ (2007)

NICE, ‘Needle and syringe programmes: providing people who inject drugs with injecting equipment’ (2009)

NTA, ‘Addiction to Medicine’ (2011)  

NTA ‘Models of care for treatment of adult drug misusers: Update 2006’ (2006) 

NTA, ‘Prescribing services for drug misuse’ (2003)

NTA, ‘Treating cocaine/ crack dependence’ (2002)

NTA, ‘Routes to Recovery: Psychosocial Interventions for Drug Misuse’ (2010).

The evidence base for recovery-oriented treatment is as yet much less centralised.

Young people (under 18-years-old)

All schools have been supported by the specialist service to deliver drug education to the guidance contained within the evidenced based-documents: ‘Drugs: Guidance for Schools February 2004 – Curriculum Standards for KS1, KS2, KS3 and KS4 (Ref DfES/0092/2004)’, and ‘Drug Education: an entitlement for all 2008’

The young people’s integrated specialist treatment service is commissioned in line with NTA guidance contained within the evidenced-based documents: ‘Commissioning Young People’s Specialist Substance Misuse Treatment services’ (NTA: 2008: Guidance on commissioning young people’s specialist substance misuse treatment services’ [online] Available at  http://www.nta.nhs.uk/publications/documents/commissioning_yp_final2.pdf) and ‘Young people’s specialist substance misuse treatment’.

The pharmacological interventions for young people are delivered by the specialist service in accordance with the NICE guidance (National Institute for Health and Clinical Excellence (NICE) (2007a). Methadone and Buprenorphine for the Management of Opioid Dependence. London, UK: NICE).

National Institute for Health and Clinical Excellence (NICE) (2007b) Naltrexone for the Management of Opioid Dependence. London, UK: NICE.

National Institute for Health and Clinical Excellence (NICE) (2007c) Community-Based Interventions to Reduce Substance Misuse Among Vulnerable and Disadvantaged Children and Young People. London, UK: NICE.

Last updated: 04/06/14

9. What do people say?

Content under development.

Last updated: 11/10/11

10. What additional needs assessment is required?

  • Investigate the appropriate means of improving aspiration of drug misuse
  • Gather evidence of why people drop out of treatment.
  • Broaden the links with family services; to identify the impact drug use can have on the family unit.
  • More detailed needs assessment for young people to enable targeted early interventions that will deliver more focused education messages.
  • Further research about the use of enhancement drugs due to the significant increase of clients reporting the use of these drugs. It is known that some clients are injectors of anabolic steroids, growth hormones and other peptide hormones that could potentially see an increase in clients seeking help and advice. The longer-term effects are largely unknown therefore it is essential that research and harm minimisation is addressed for these potential clients in Hartlepool.
Last updated: 04/06/14

Key Contact:             Paul Edmondson-Jones

Job Title:                 Director of Public Health

e-mail:                    Paul.edmondson-jones@hartlepool.gov.uk

Phone number:         01429 523773

 

Key contact:             Sharon Robson

Job title:                 Health Improvement Practitioner – Drugs & Alcohol

e-mail:                   sharon.robson@hartlepool.gov.uk

Phone number:         01429 523783