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: 2017-07-04 10:23:36
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1. What are the key issues?

The proportions of people accessing drug treatment are increasingly from an aging cohort of the population (30 years+), often with multiple treatment journeys and entrenched patterns for drug misuse.  

52% of opiate clients within Redcar & Cleveland are retained in treatment 2 or more years, significantly decreasing the likelihood of successfully completing drug treatment. (ref PHE Recovery Diagnostic Toolkit -RDT, PHE JSNA support pack 2015-16)  

The number of people successfully exiting treatment within Redcar and Cleveland is lower than the national average. Furthermore reporting a significant reduction in actual growth in comparison to nationally reported statistics

Significant proportion of people accessing harm reduction service(s) within the borough do so citing ‘Steroids’ as the problem substance. Denoting a significant cohort of injecting drug users that are not engaging in structured recovery orientated treatment.  

The proportion of people citing problematic use of prescription only medicines / over the counter medicines is significantly higher than the national average (PHE JSNA support pack 2015-15)

NPS use is rising nationally, but remains largely an unknown within the borough representing a significant risk to the wellbeing of the local population and a gap in the provision of treatment   engagement strategy/pathway, to pre-empt and safeguard the locality against the national increase in NPS use. (PHE JSNA support pack 2015-16, AND…

Last updated: 04/06/15

2. What commissioning priorities are recommended?

2015/01

Ensure the treatment provision adequately reflects the need(s) of an older client base, with specific focus on pathways designed to address treatment stagnation.

2015/02

Support service users to exit drug treatment successfully. However, specific strategies for those clients that have been in service for greater than two years should be developed to assist these people in living a life free from substance misuse. 

2015/03

Consider innovative approaches to enhance engagement and treatment, targeted specifically towards those clients with multiple treatment journeys.

2015/04

Consideration to be given to developing coordinated partnership approach to increase awareness of POM/OTC (prescription only medicines / over the counter medicines) utilisation of appropriate intervention(s).

2015/05

Consider innovative engagement methods to access users of PIED (performance and image enhancing drugs). To enhance effectiveness of harm minimization activity for this cohort of injecting drug users.

2015/06

Consideration should be given to the development of comprehensive NPS harm reduction strategy.

Last updated: 21/08/15

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: 21/08/15

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

Level of need in the population

Prevalence

Official prevalence estimates for 2011/12 show there are 1054 opiate and crack users (OCUs) in Redcar and Cleveland or 12.21 per  1,000 population. Prevalence within the borough is higher than the regional estimate (9.89) and the estimate for England (8.4).

 

 

 

Within the region, the number of people per thousand who are estimated to be injecting (3.7) is significantly higher than the rate for England (2.49), and higher still within Redcar and Cleveland (4.48), however the estimated number of people in total has reduced by 154 showing a substantial improvement since 2010/11. 

Opiate use is also high in comparison to both regional and national estimates, while crack use within the borough is lower than England but higher than the regional figure.  

Numbers in Treatment and Successful Completions[i]

 

The below line graphs provide a breakdown by each Substance Misuse Category  showing the number of clients in treatment since April 2013 and the % of successful completions with national performance included for comparison purposes.

 

All Drugs

Since April 2013 the number of drug users receiving treatment has fluctuated over time from 854 clients at the highest point to 792 at the lowest. As at May 2015 there were 821 clients engaged in treatment with an upward trend in performance since March 15.

 

 

Since April 2013 both the number and % of successful completions among all drug users was at its highest in April 2015. Performance within the Borough remains lower than the national average, although this gap has narrowed markedly over recent months.

 

 

 

Opiates

Since April 2013 the number of opiate users within the borough has decreased by 29 people.

 

 

Likewise the proportion of clients successfully completing treatment declined from April 2013 to June 2014 but has steadily increased over the last financial year.

 

 

Non-Opiates

The number of non-opiate users in treatment has varied over the last two years; however, overall, the number of users in treatment has remained relatively stable over time.

 

 

 

The percentage of clients who have successfully completed treatment has increased significantly since April 2013 to 41% in May 2015 which exceeds performance nationally.

 

 

 

Non Opiates & Alcohol

The number of non-opiate and alcohol users in treatment has doubled since April 2013 to 123 clients in May 2015.

 

 

 

The percentage of successful completions is lower than the national average however performance has increased over the last few months despite the increases in demand for treatment.

 

 

 

 



[i] Adult Successful Completions and Re-presentations Partnership Report.

 

Last updated: 21/08/15

5. What services are currently provided?

Support services available to 18-year-olds and older:

Lifeline:

  • Lifeline provide information, advice and support to overcome drug or alcohol issues is provided to adults (aged 18 and over) living in Redcar and Cleveland.
  • Lifeline provide an integrated drug and alcohol treatment system through Prevention, Recovery Coordination and Through & Aftercare services. They promote safer injecting practices, provide needle exchange facilities, blood borne virus screening and immunisation, information and advice around drug or alcohol misuse and support to overcome problematic drug or alcohol use which can include the provision of clinical support. They operate from a number of premises across Redcar and Cleveland so that support can be delivered locally within communities affected by substance misuse.

Support services available to under 18-year-olds:

CREST:

  • CREST provide information, advice and support to young people from Redcar and Cleveland who use drugs or alcohol.
  • CREST also supports young people whose lives are affected by their parents, carers or siblings drug or alcohol use. The service is for under 19s only. CREST is a confidential service which can offer advice, support and guidance. They also aim to support young people who have drug or alcohol problems with housing, employment, education and training as well as offering support to parents and carers.
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?

The present Treatment Outcome Profile (TOPS) reporting system although providing significant insight into client treatment progress, should be considered as one tool in many to fully support a person into sustained recovery. A comprehensive and rounded approach is therefore the preferential starting point to ensure people receive the best possible outcome to treatment.  Understanding all aspects of a person’s life and focusing on positive change to support lasting recovery.  Future consideration should be given to the introduction of tool(s) such as ‘the outcome star’ to enhance the present treatment offer.

Harm minimisation and Needle Exchange services although well-established amongst traditional drug user, are being increasingly accessed by individuals using performance and enhancing or image enhancing drugs. Greater exposure into this area of non-traditional, alternative drug culture would enhance the current harm reduction provision.

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?

Service user questionnaire (Adult Drug and Alcohol Joint Commissioning Team, 2010)

Key Findings:

  • Most service users felt that the length of time they had to wait to access services was reasonable
  • Most service users felt that if they needed information in relation to mental and physical health, housing issues or debt management then the information provided would be delivered effectively;
  • There was evidence to suggest that the relationship between service users and staff was usually positive, however consideration should be given to how this can be improved;
  • Strong and positive relationships between staff and service users contributed to service users being more aware of their treatment goals and how they would be achieved;
  • Most service users were happy with the overall service delivered, but almost 40% had issues with the service to varying degrees;
  • The majority of service users felt there had been at least some minor improvement in their life since engaging with drug treatment;
  • The Adult Drug and Alcohol Joint Commissioning Team plan to enhance the level of service user and carer consultation by introducing a number of new research projects and consultation events.
Last updated: 15/11/12

10. What additional needs assessment is required?

Consideration should be given to the Intelligence provision pertaining to NPS use in the borough, strengthening local intelligence in this area could provide the foundations for future commissioning intentions.

Last updated: 19/08/15

Key Contact

Name: Mark Fox

Job Title: Health Improvement Commissioner (Substance Misuse)

Email: mark.fox@redcar-cleveland.gov.uk

Phone: 01642 771632

 

References

PHE, NDTMS, NICE, LIFELINE, ClevelaND POLICE, CRIME SURVEY OF ENGLAND AND WALES (csew), mental health network,