Illicit drug use


 

Last updated: 2019-02-26 13:15:13
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1. Summary

Last updated: 26/02/19

2. Introduction

Drug misuse is associated with poor outcomes not just for the individual’s user’s health, but also for their families and local communities. Drug use has a complex relationship with the wider determinants of health; housing, employment, mental health, community and family relationships all influence both the risk and resilience of individuals to drug misuse. Drug misuse and dependence is associated with poor outcomes including:

  • Poor mental and physical health
  • Homelessness
  • Unemployment
  • Family breakdown
  • Criminal activity

Different types of drug misuse have different effects on the health of individuals, both immediate and longer term, for example users of volatile substances can be putting themselves at risk of death by using them once, while illicit drug injecting holds significant risks for the transmission of blood borne infections (HIV, Hepatitis C) and bacterial infections from the use and sharing of injecting equipment. 

Cannabis is the most widely used drug in the UK, and chronic use is associated with psychological dependence, mental health problems, and due to the fact cannabis is primarily smoked when mixed with tobacco, risks of lunch cancer and lung diseases increase with long term use. Cannabis also exposes unborn babies to risk in their development (e.g. reduction in birthweight) (UNDOC 2016).

Heroin and other opiates are highly addictive drugs, and users can rapidly become dependent and build up tolerance levels. Use of these drugs is associated with a range of chronic respiratory problems and other physical and psychological health harms (UNDOC 2019).  The social and economic costs of dependence to heroin are significant, due to a rapid increase in tolerance levels, users can resort to  engagement in acquisitive crime (e.g. shoplifting) to support their drug use.

Cocaine, and specifically crack cocaine is associated with dependence, and long term psychological and physical health harms, crack cocaine particularly is associated with aggression, dependence, mental health problems (DOH 2011).

Substance use (both alcohol and drugs) can independently be a cause for concern for the wellbeing of children; substance use also forms part of the ‘toxic trio’ of substance misuse, domestic violence and mental health problems which are consistently associated with significant harm within families.

Substance misuse (both alcohol and illegal drugs) is not the norm for young people, on a national basis the number of young people drinking alcohol and substance misuse levels are declining. However the UK still has some of the highest rates of young people’s alcohol and substance misuse in Europe (Taylor 2012).  Not all young people who experiment with substances (alcohol, illicit substances/ drugs, tobacco) will go on to experience difficulties or become dependent, problematic substance misuse in young people is closely related, and can indeed by a symptom of other vulnerabilities or problems that they are experiencing including family breakdown, poor mental health and offending (CCQI 2012).

There is strong evidence that the earlier a young person engages in substance misuse; the greater the physical, emotional and social harms are for them.  ‘Risky’ behaviours rarely occur in isolation, binge drinking for young people is associated with a range of other risk taking behaviours including regretted or unprotected sexual activity, self-harm, criminal behaviour and alcohol poisoning (Deluca et al 2015).

The associated costs of drug misuse impact on all aspects of society. The overall cost of illicit drug misuse is estimated to be £10.7 billion, which includes drug related crime, enforcement, health service use and drug related deaths. For Stockton-on-Tees a crude estimate of the costs of drug misuse (which does not take into account level of deprivation, or higher rates of drug users in the local area) the cost is estimated to be £38 million

Figure 1: Estimated associated costs of drug misuse (Home office 2013, taken from PHE Drug Misuse Evidence Review 2017).

Other JSNA topics this topic closely linked to:

Alcohol misuse

Mental and behavioural disorders

Child sexual exploitation

Poverty

Sexual violence victims

 

 

Last updated: 26/02/19

3. Data and Intelligence

Estimated rate of opiate and / or crack use  

Overall, Stockton-on-Tees has a higher estimated rate of opiate and / or crack use (15.1 per 1000 population) compared to regional (10.4) and national (8.6) averages. National prevalence estimates indicates that 1898 individuals are using crack and / or opiates across Stockton-on-Tees.  The majority of this population are opiate users (1657). It is estimated that 917 individuals are crack users.

Estimates of opiate and / or crack use by age range indicate that the 25-34yr age group have the highest estimated prevalence of use for Stockton-on-Tees, and that estimated prevalence is higher that North East and regional averages:

Estimated prevalence of Opiate and / or crack use (per 1,000 population) by age range. Source Liverpool John Moors University.

Age Range

 

Stockton prevalence rate (estimated no.)

North East prevalence rate

National prevalence rate

15-24

7.52 (183)

4.97

4.42

25-34

36.04 (917)

20.86

12.36

35-54

10.55  (798)

8.96

8.53

 

Opiate users within Stockton-on-Tees are predominately male, and the estimated rate of male opiate users for the borough is substantially higher than north east and national estimated averages. While significantly lower than male estimates, the rate of female opiate users within the borough is higher than North East and National estimated average rates.

Estimated prevalence of opiate use by gender (per 1,000 15-64 year population).

Gender

 

Stockton prevalence rate (estimated no.)

North East prevalence rate

National prevalence rate

Male

21.03 (1303)

13.86

11.18

Female

5.58 (354)

4.44

3.51

 

Unmet Need

Out of the cohort estimated to be using opiates and / or crack (1898) 46% are estimated to not be engaged with specialist treatment.  Breaking this down further:

  • 39% of the cohort estimated to be using opiates (1657) are estimated as not engaged with specialist treatment
  • 54% of the cohort estimated to be using crack (917) are estimated as not engaged with specialist treatment. 

Although the prevalence rate is higher in Stockton-on-Tees for opiate and / or crack use than north east and national averages, the proportion of unmet need (those individuals not engaged with specialist treatment) for opiate and / or crack use is lower.

Proportion of unmet need for opiate and / or crack use (2014-15). Stockton-on-Tees compared to national averages. (Source PHE 2018).

Use

% unmet need – Stockton-on-Tees Average

% unmet need – National Average

Opiate and / or crack

46%

51%

Opiate

39%

46%

Crack

54%

62%

 

Young People Receiving Specialist Treatment

During 2017-2018, 70 young people under 18 received support from specialist drug and alcohol misuse services Young people are primarily in treatment due to cannabis use (82%). Poly use is common between alcohol and cannabis use for 47% of the cohort in specialist support. The proportion of individuals in treatment are male (74%).

The cohort of young people receiving specialist support for drug and alcohol misuse experience multiple vulnerabilities, the majority of young people in treatment (82%) began using problematic substance before the age of 15, and self-harm, offending / antisocial behaviour, experience of domestic abuse an experience of others substance misuse are common vulnerabilities experienced by young people engaged with treatment .

Adults in specialist treatment

During 2017-18, 1,204 individuals were engaged with specialist drug treatment, out of this number 409 were new to treatment in 2017/18. The largest proportion of individuals in treatment were male (73%), which reflects the national gender split in treatment. The largest proportion of individuals in treatment were aged 30-39 years, with a substantial proportion aged 40-49years. Individuals in drug treatment are predominately White British (92%).

Age profile of adults in treatment. Source PHE 2018

Age

% in treatment (number)

Male (%)

Female (%)

18-29yrs

 16% (192)

16%

17%

30-39yrs

50% (606)

48%

56%

40-49yrs

28% (340)

30%

23%

50-59yrs

5% (56)

5%

4%

60-69yrs

1% (10)

1%

1%

 

A higher proportion of individuals in specialist treatment have problems with misuse of over the counter medications or prescription medications when compared to the national average. During 2017/18 22% of individuals in treatment reported problems with these medications, which is higher than the national average of 11%.

Treatment Outcomes

For a number of years the rate of successful completions of drug treatment by opiate users within Stockton-on-Tees has been significantly lower than the national average.

The proportion of young people successfully completing treatment and leaving in a planned way has been increasing since 2015 and is currently at 96% (N=52) for 2017-18, which is higher than the national average of 80%.

The proportion of young people spending between 13weeks – 52weeks in treatment is substantially higher than the national average.

Length of time in treatment

Stockton-on-Tees % (no.)

National (%)

0-12 weeks

17% (12)

43%

13-26 weeks

41% (29)

32%

27-52 weeks

33% (23)

18%

52 + weeks

9% (6)

7%

 

Drug related deaths

The rate of drug related deaths for Stockton-on-Tees is significantly higher than the national average (10.5 compared to 4.2), the period of 2015-17 has seen a substantial increase in the number of deaths which is likely to have been influenced by a number of factors including:

  • An ageing population of long term heroin users with poor general health, who are more susceptible to death from misuse
  • Access in the local drugs market to high strength opioids such as fentanyl

Figure 13: Rate of deaths from drug misuse. Stockton-on-Tees compared to England average

A review of drug related deaths for Stockton-on-Tees occurring during 2014-15 highlighted that:

Polysubstance use was present in the majority of drug related deaths (Alcohol, benzodiazepine, morphine, methadone, cocaine the main substances involved where death was related to poly use).

  • Prescription medication was present in over half of drug related death cases, while not attributed to the cause of death, this highlights that the majority of people were taking prescription medication at the time of death.
  • Over half of cases had a diagnosed mental illness, most commonly depression and anxiety
  • A large proportion of cases had a history of previous arrest (73%), most commonly for theft, robbery or burglary.
  • The largest proportion of drug related deaths were from the Boroughs most deprived wards (Stockton, Newtown, Hardwick and Salters Lane, Roseworth, Billingham East).
Last updated: 26/02/19

4. Which population groups are at risk and why?

Last updated: 26/02/19

5. Consultation and engagement

Last updated: 26/02/19

6. Strategic issues

Last updated: 26/02/19

7. Evidence base

Last updated: 26/02/19

8. What is being done and why?

Primary Care

GP practices provide support and advice and onward referral to specialist support to their registered population about drug misuse.

Six GP practices offer specialised shared care support to individuals in treatment for drug misuse, where the GP works in partnership with drug treatment services to prescribe medication for and oversee treatment for drug misuse. 

Community Pharmacies

Nine community pharmacies are commissioned to provide needle and syringe exchange programmes. Needle exchange programmes delivered across communities encourage improved hygiene and the use of clean equipment, and also hold benefits for communities by providing safe disposal of used injecting equipment.

26 community pharmacies are commissioned to provide supervised consumption of prescribed medications from drug treatment services, pharmacists work with individuals to provide supervision for the self-administration of prescribed drugs.

CGL: Change Grow Live

CGL are commissioned to deliver drug treatment and recovery programmes through evidence based psychosocial treatment and the prescribing and dispensing of medication. Family support is offered both through case work and through the delivery of evidence based programmes to reduce the impact of drug use on children (e.g. MPact programme). Harm minimisation programmes are delivered across treatment settings to promote needle exchange for those individuals who are injecting drugs.

CGL also offer specialist young people’s substance misuse support, working with under 18 year olds, offering psychosocial support, 1-1 case work and routes to pharmacological support for individuals with problematic drug or alcohol use.

Secondary Care and TEWV (Tees Esk and Wear Valley NHS Trust)

Secondary care services provide treatment for the associated long term health conditions of people who misuse drugs, which include respiratory problems or infected injecting sites. TEWV (Tees Esk and Wear Valley) provide treatment and support to individuals with mental health problems, and work in partnership with treatment services to provide support to individuals with coexisting mental health and drug misuse problems.

Schools & Colleges and the VCSE sector - prevention

Schools, the VCSE sector and local authority services all support different elements of the prevention agenda around drugs, this approach is currently embedded within a risk taking behaviour approach and includes:

  • Resources and training to support secondary schools to deliver educational messages to young people about drugs, alcohol, sexual health, relationships, risk and choice as part of a comprehensive Personal, Social, Health and Economic education (PSHEe) programme.
  • Direct delivery of risk taking behaviour education to young people in primary, secondary, further / higher education settings and youth settings by a range of partner organisations

Youth Direction

Stockton on Tees Youth Direction Preventions service offer targeted group work 1-1 advice & support through individual case work.

Voluntary Sector

A range of VCSE sector organisations offer mutual aid and recovery support for individuals recovering from drug addiction and their families including:

  • The Moses Project: provides guidance, monitoring and support to adult males with current and past addiction
  • A Way Out: provide one to one support, group work and outreach support vulnerable women across the borough
  • Eastern Ravens: is commissioned to provide support to young carers and their families
  • Bridges: is commissioned to deliver specialist support to families of individuals misusing drugs and alcohol

Residential Rehabilitation

Access to residential rehabilitation is provided through CGL and other voluntary sector partners to support individuals with additional treatment needs

Last updated: 26/02/19

9. What needs are unmet?

Last updated: 26/02/19

10. What needs to be done and why?

Last updated: 26/02/19

11. What additional needs assessment is required?

There is a gap in recent consultation that has taken place locally about drug misuse. Local research and consultation is currently taking place as part of the strategic review of drug and alcohol misuse prevention and the results of this consultation should be added to the JSNA when complete.

Last updated: 26/02/19

12. References

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Last updated: 26/02/19

13. Key contact

Name: Gemma Mann

Job title: Health Improvement Specialist

Organisation: Public Health

Phone number: 01642 524293

Contributor/s:

Safer Stockton Partnership – members of the Reducing Harm and Reoffending Group

Tom le Ruez

Beverley Bearne

Gillian Small

Last updated: 26/02/19

Email: gemma.mann@stockton.gov.uk