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: 2015-06-04 10:53:22
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1. What are the key issues?

The prevalence estimate for opiate and crack use in Middlesbrough is the highest in the country.

Fewer opiate and crack users are leaving treatment successfully and there are high rates of re-presentation to treatment following successful completion.

There continues to be a gap of 10 years between the age of the client’s first drug misuse and their presentation into treatment.

There has been a rapid growth in the number of people engaged in effective treatment for the misuse of non-opiates.

Last updated: 04/06/15

2. What commissioning priorities are recommended?

2015/01

Ensure appropriate partnerships/services are in place to look at supply and demand of opiates and crack in Middlesbrough.

2015/02

Improve pathways for early identification of drug use in adults and young people.

2015/03

Look to develop further insight into the misuse of non-opiates locally, and commission appropriate services to meet need.

Last updated: 04/06/15

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: 15/11/12

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

Prevalence

Estimates show that Middlesbrough has the highest rate of illicit drug users in England.

Official prevalence estimates show there are 1,895 opiate and crack users (OCUs) in Middlesbrough (20.8 per 1,000 population). This is much higher than the regional (9.9 per 1,000) and national (8.4 per 1,000) estimates.

The number of clients in Middlesbrough (7.1 per 1,000 population) injecting is also considerable higher than the national (2.5 per 1,000) estimates.

Numbers in treatment

At the start of 2014/15, there were 1,389 OCUs in treatment. Based on an estimated prevalence rate of 21 users per 1,000 in Middlesbrough, approximately 73.3% of those using opiates and/or crack are in treatment at some point in the year.

The numbers of all drug clients in treatment has reduced significantly, as shown below, with a peak of 1,866 in October 2013 compared to 1,707 in July 2014.

Middlesbrough has a high percentage of clients who have been in treatment for more than six years. The local figure is 34% compared to a national average of 29.7%. There were no opiate-only clients in treatment for longer than 2 years, compared to a national average of 8.8%. The average time is 0.3 years for non-opiates compared to 0.9 years nationally.

Successful completions & representations

Middlesbrough has a low percentage of clients who successfully complete drug treatment and do not represent within 6 months. For opiate clients, this was 4.8% in September 2014, compared to 7.7% nationally and 35.8% for non-opiates compared with 38.4% nationally.

Since April 2013, non-opiate successful completions and representations have increased to be more in line with national rates, however for opiate clients, the number of clients who successfully complete has reduced and at a faster rate than the national average.

Last updated: 04/06/15

5. What services are currently provided?

Tier 1

  • Alcohol awareness training
  • GP shared care for alcohol/non-opiates/opiates
  • Volunteer training
  • Drug/recovery training for Tier 1 staff
  • Development and support of recovery community

Tier 2

  • Needle Exchange
  • Advice and information
  • Hospital Interventions and Liaison Team
  • Initial assessment
  • Brief interventions for all substances
  • Assertive Outreach
  • Drop in service
  • Advocacy support
  • Telephone/new media support

Tier 3

  • Care co-ordination of treatment
  • Criminal Justice Interventions
  • Comprehensive assessment
  • Counselling support
  • Evidence based Psychosocial therapies
  • Specialist prescribing
  • Assertive Outreach
  • Community detox
  • 1:1 support
  • Group support

Tier 4

  • Co-ordination of inpatient alcohol/opiate detox pathways
  • Rehab/detox preparation
  • Six supported flats for at risk clients
Last updated: 04/06/15

6. What is the projected level of need?

No projections at present.

Last updated: 04/06/15

7. What needs might be unmet?

There is a lack of information relating to the supply and demand of drugs in Middlesbrough, there is no information sharing between agencies/other localities regarding this.

There is a ten year gap between age of first misuse and presentation to treatment, there is little information available to find out why this is. Current services cater for adults aged 18 and over, however there are few people under the age of 20 in local treatment services.

Clients broader health needs (smoking, diet, sexual health) may not be being addressed across all services. There is a lack of information relating to broader health needs of the substance misusing population of Middlesbrough.

Last updated: 04/06/15

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.

Medications in Recovery - Re-orientating drug dependance treatment; a review from the Recovery Orientated Drug Treatment Expert Group describing how to meet the ambition of the Drug Strategy. (NTA 2012)

Routes To Recovery - Psychosocial Interventions For Drug Misuse; a framework and toolkit for implementing NICE-recommended treatment interventions. (NTA 2009)

The principal publications supporting models of current drug treatment can be sourced from the NTA (now Public Health England) 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).

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:

DfE and ACPO drug advice for schools - Advice for local authorities, headteachers, school staff and governing bodies. (DfE 2012)

The young people’s integrated specialist treatment service (Lifeline Young Peoples Substance Misuse 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: 04/06/15

9. What do people say?

Key findings from the 2014 Client Satisfaction Survey (Carried out with a sample of at least 15% of the local treatment population) were:

  • 89% of clients surveyed were very/fairly satisfied with treatment services overall;
  • 91% of clients were very/fairly satisfied with the range of services available;
  • 44% said that services have improved since re-commissioning in October 2013;
  • 92% said the way staff treat them is excellent or good;
  • In the last five years, 46% feel that drug use locally has got worse; and
  • In the last five years, 58% feel that alcohol use has got worse.
Last updated: 04/06/15

10. What additional needs assessment is required?

  • Further work may be required to investigate the appropriate means of improving aspiration of drug misuse.
  • Little is known about the positive impact that local treatment services have on the wider health system, which could be addressed by cross-referencing treatment and other health data.
  • There appears to be generally high rates of arrest within the treatment population, and further investigation is required into the types of crime committed and detected.
  • There are many references to families within the assessment, but there is no evidence of the impact that specific families (or even small communities) may be having in relation to drug misuse as interventions generally follow behaviours rather than relationships.
  • Further work is required to understand why clients drop out of treatment.
  • Qualitative research may be needed to investigate treatment need for women is appropriately represented in treatment demand.
  • Research is required amongst younger ‘problematic drug users’, with the aim of identifying the triggers for drug and alcohol use, the pattern of escalation, their engagement with services, the effect of any education or interventions and any other prevention lessons (what would have worked).
  • A more detailed needs assessment is required for under-18-year-olds who are in vulnerable groups, to target early interventions more efficiently and effectively.
  • Detailed research is required to find out the effect of adult drug misusing parents on their children’s drug use. This research should focus on the needs of young people and how they can be best met.
Last updated: 15/11/12

Key Contact

Name: Rachel Burns

Job title: Care Coordination Project Manager

Email: Rachel_Burns@middlesbrough.gov.uk

Phone: 01642 728762