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: 2016-01-27 12:00:57
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1. What are the key issues?

The average age of people in treatment is increasing year on year which places a potentially higher demand on health services.

In 2013/14, 48% of all new presentations to drug treatment were, or previously had been, injecting drugs.

Approximately 20% of all new presentations to treatment services in 2013/14 identified that they had housing needs.

Over 80% of people were unemployed at the time of entering drug treatment.

Almost three-quarters of all clients in treatment are parents.

Stockton-On-Tees needs to ensure that the numbers of successful completions increase. This is a key element of the Public Health Outcomes Framework. In particular, we need to address the significant number of clients that have been in treatment for over four years.

The number of non-opiate drug users in treatment is falling in Stockton despite the availability of drugs and ease of access on the street and on-line appearing to be at an all-time high.

The use of social media/smartphones is adding to the ability to access drugs and reduces the visibility of transactions.

The strength, purity and active substance of substances may not be as advertised. This significantly raises the risks associated with recreational consumption.

Only 11% of Stockton’s treatment population are in regular employment.

Last updated: 04/06/15

2. What commissioning priorities are recommended?

2015/01

In order to improve the number of successful completions from treatment, we need to work with service providers to focus on greater engagement in recovery for:

  • Those that have been in stable treatment for over four years; and,
  • Those that continue to lead a chaotic lifestyle with illicit drug use, infrequent engagement with treatment services and offending.

2015/02

Work closely with the Police and Crime Commissioners (PCC) office to ensure that the recently commissioned arrest referral service effectively directs drug misusing offenders into treatment.

2015/03

Research the background of drug-related hospital admissions in order to better understand issues such as accidental and intentional self-harm and the proportion of prescribed and illicit use.

2015/04

Commission further social norms work to monitor local drug and alcohol trends in schools and colleges.

Completed

Stockton-On-Tees re-commissioned a significant proportion of its drug treatment provision following in depth consultation. The re-commissioning was based on four key principles:

  • 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

Those services began delivery in January 2014.

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

Official prevalence estimates show there are 1,739 (20.8 per 1,000 population) opiate and crack users (OCUs) in Stockton-On-Tees. This is higher than the regional (9.9 per 1,000) and national (8.4 per 1,000) estimates. There has been a reduction of 12% OCUs compared to the previous prevalence estimate.

     Numbers in treatment

At the start of 2014/15, there were 1,129 opiate users in treatment. This represents 66% of those using opiates and/or crack in Stockton-On-Tees who have received treatment in 2014/15. This is lower higher than the national rate (54%) of opiates and/or crack users in treatment.

The numbers of opiate clients in treatment is declining.

In Stockton-On-Tees, a higher rate (35%) of clients have been in treatment for more than six years compared to the national average (30%).

In Stockton-On-Tees, there are no “opiate only” clients who have been in treatment for more than 2 years, compared to a national average of 8.8%.

In Stockton-On-Tees, the average length of time a non-opiate using client spends in treatment (0.3 years) is lower than the national average (0.9 years).

Successful completions and re-presentations

In Stockton-On-Tees, a lower rate (4.6%) of opiate using clients have successfully complete drug treatment compared to the national average (7.8%).

In Stockton-On-Tees, a lower rate (28%) of non-opiate using clients have successfully complete drug treatment compared to the national average (37.8%).

The fall in completions of non-opiate using clients since April-2013 reflects the falling number in treatment.

Last updated: 08/06/15

5. What services are currently provided?

Drug treatment services

Stockton Recovery Service: CRi (a registered charity) offers support and interventions for  over 18-year-olds with substance misuse problems.

The Birchtree Practice: A specialist, GP prescribing service for patients living in Stockton-on-Tees.

Cleveland Police Arrest Referral Scheme: Offers access to treatment for those clients who have been arrested and tested positive for heroin, crack and/or cocaine powder.

Bridges: Provides support to anyone who has been directly affected by someone else's substance misuse, including parents, partners, grandparents, brothers and sisters (over 18-years-old).

Lifeline (Young people’s service): Offer a Tier 3 service for young people with drug and or alcohol issues who are under 19-years-old.

Last updated: 04/06/15

6. What is the projected level of need?

There are currently no projections of need.

Last updated: 04/06/15

7. What needs might be unmet?

There is a cohort of clients who repeatedly present within treatment services, whose drug use appears to be linked to offending behaviour. Evidence shows that these individuals often respond positively when in treatment, but retention for any significant length of time remains a challenge.

There is a cohort of clients who have remained in treatment over six years. They are reluctant to engage in treatment to address unmet needs beyond the receipt of prescribed medication.

Both of the cohorts described above often report significant levels of ongoing illicit drug use and/or harmful levels of alcohol consumption. More effective strategies for managing this are required in order to move into more stable and productive recovery based interventions and ultimately successful exits from treatment.

The peak age for drug related hospital admissions is 25-29 years old. A higher proportion of admissions are female compared to the drug treatment population. The most significant factor appears to be opiate based prescription medication misuse. There is an opportunity to examine the need for better harm minimisation advice when prescribing.

The changes to local arrest referral processes have resulted in a significant drop in the number of cocaine users referred to treatment. It is hoped that this is temporary as new procedures are introduced. Monitoring will show whether further work will be required to maximise the number of cocaine users accessing treatment.

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?

No content available

Last updated: 04/06/15

10. What additional needs assessment is required?

Further work is required to better understand how to motivate those who have been in treatment for more than six years into planned recovery, without adversely affecting existing recovery capital.

Further work is required to understand why clients drop out of treatment.

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.

Last updated: 04/06/15

Key contact

 

 

Name: Kerry Anderson

Job title:

e-mail: kerry.anderson@stockton.gov.uk

Phone number: 01642 528455

References

Local strategies and plans

 

 

 

 

National strategies and plans

 

 

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