Some of the most interesting things about alcohol and other drugs in 2015

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Some of the most interesting things about alcohol and other drugs in 2015 Andrew Brown @andrewbrown365

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Estimated rate of high risk drug users in Great Britain, per 1,000 population aged 15 to 64 Nearly 1 in 100 people between ages of 15 - 64 in Great Britain is thought to be a high risk drug user Definition of a high risk drug use: “injecting drug use or long-duration/regular use of opioids, cocaine and/or amphetamines” Source: http://www.nta.nhs.uk/uploads/uk-focal-point-report-2014.pdf

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In 2013-14 there were 47,900 assessments for children in need where alcohol or other drugs were a factor at initial assessment. In 2013-14 435 children ran away from foster care because of substance misuse Source: https://www.gov.uk/government/statistics/characteristics-of-children-in-need-2013-to-2014 Source: https://www.gov.uk/government/statistics/fostering-in-england-1-april-2013-to-31-march-2014

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Substance use by prisoners and links to offending The results demonstrate that drugs are a problem among prisoners, regardless of age, in contrast to general population figures (although older prisoners who had used drugs were more likely to link their offending with their drug use). They also show that older adult prisoners were more likely to have taken Class A drugs before custody. This suggests that older adults and young adult drug users may require different types of intervention focused on their particular patterns of drug use. Source: https://www.gov.uk/government/publications/needs-and-characteristics-of-young-adults-in-custody

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Substance misuse and mental health in prison Prisoners with drug and/or alcohol problems tend to have even higher levels of mental health problems than the rest of the prison population. RAPt service users present with an average of 3.4 mental health problems. Source: http://bit.ly/1ArNoan

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Substance misuse issues for adults and children in prison Adult prisoners Children in the secure estate Source: Service specification No. 29: public health services for people in prison Source: https://www.justiceinspectorates.gov.uk/hmiprisons/wp-content/uploads/sites/4/2015/07/HMIP-AR_2014-15_TSO_Final1.pdf

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When do people with substance use problems turn up at hospital in acute need? “We found that access to, and the quality of, services after 5pm was not good enough. Commissioners and providers should make sure that they have the most appropriate services with the staff that have the right skills working at the times when people with mental health needs are more likely to access them.” CQC - “Right here, right now – help, care and support during a mental health crisis” Source: http://www.cqc.org.uk/sites/default/files/20150611_righthere_mhcrisiscare_full_3b.pdf

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Proportion of drug and alcohol clients in concurrent contact with mental health services Source: http://fingertips.phe.org.uk/profile-group/mental-health/profile/drugsandmentalhealth

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“There is still a struggle with the dual needs of people with alcohol and mental health issues; this becomes very frustrating as people seem to fall into a gap between services. It seems that services can only work with a person either with mental health or addiction - not with the whole person.” Are there appropriate care pathways for people with both mental health and alcohol problems? Source: The Recovery Partnership Review of Alcohol Treatment Services

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Number of current drug injectors admitted to first drug treatment, by country “A total of 12,909 current drug injectors were admitted to first drug treatment in 2011, with the United Kingdom (34.8 %) accounting for the largest proportion of reported cases, followed by the Czech Republic (16.6 %), Italy (13.7 %), Greece (6.6 %), Spain (5.7 %) and Germany (5.0 %).” Source: http://www.emcdda.europa.eu/publications/technical-reports/trends-in-injecting-drug-use

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Merseyside Annual Drug Intervention Programme report 2014/15 Just over half of all successful drug tests carried out in Merseyside in 2014/15 were positive (51.0%). Of the 4,923 positive tests the highest proportion was seen among those testing positive for opiates (51.8%) often in combination with cocaine (38.8%). Source: Merseyside Annual DIP report 14/15

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The number and proportion of stop and searches carried out by police relating to suspicion of drug offences While the number of stop and searches carried out on suspicion of drug offences have halved since 2010/11, the proportion that they make of all stop and searches has risen by 9% points over the same period. Source: Police powers and procedures England and Wales year ending 31 March 2015

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Age of first use of people in drug treatment in the UK Source: http://www.emcdda.europa.eu/data/stats2015#displayTable:TDI-0197

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Levels of Blood Borne Viruses amongst people who inject drugs in England, Wales and Northern Ireland “The impact of public health interventions which aim to prevent HIV and hepatitis C infection through injecting drug use, such as needle and syringe programmes and opiate substitution therapy, has been shown to be dependent on their coverage. In addition to these interventions, increasing the treatment of hepatitis C infection in PWID should also reduce the transmission of hepatitis C among PWID.” Source: https://www.gov.uk/government/statistics/people-who-inject-drugs-hiv-and-viral-hepatitis-monitoring

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Less than half of deaths (43%) in opioid users are from overdoses There were more than five and a half times the number of deaths amongst opioid users than would be expected in the general population between 2005 and 2009 Source: National record linkage study of mortality for a large cohort of opioid users ascertained by drug treatment or criminal justice sources in England, 2005–2009, Pierce, Matthias et al., Drug & Alcohol Dependence , Volume 146 , 17 - 23 http://www.drugandalcoholdependence.com/article/S0376-8716(14)01844-4/pdf

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Proportion of females who had been a victim of domestic violence prior to drug related death in Scotland (2013) 13% of all those dying from drug related deaths were reported to have been a victim of domestic violence at some point prior to death. Over four-fifths (81%) were female. 45 in every 100 women who died had experienced domestic violence at some point; this compares to 3 in every 100 men. Therefore women were 14x more likely to have experienced domestic violence. Source: http://www.isdscotland.org/Health-Topics/Drugs-and-Alcohol-Misuse/Publications/data-tables.asp?id=1386#1386

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1,382 children in Scotland lost a parent to a drug related death between 2009 and 2013 Almost half of females (47%) and a third of males (32%) who died a drug-related death in Scotland in 2013 had children aged under 16. Female parents (37%) were more likely to be living with their children at the time of death than male parents (12%). Of those who lived with children at the time of their death, one in three (34%) were known to use drugs intravenously. Source: http://www.isdscotland.org/Health-Topics/Drugs-and-Alcohol-Misuse/Publications/

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The known physical and mental health conditions of those dying from drug related causes in Scotland Physical health conditions experienced in the six months prior to drug related deaths in Scotland Mental health conditions experienced in the six months prior to drug related deaths in Scotland Source: http://www.isdscotland.org/Health-Topics/Drugs-and-Alcohol-Misuse/Publications/data-tables.asp?id=1386#1386

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Regulations to allow wider access to naloxone in England from 1 October 2015 These Regulations will allow drug services to obtain stocks of Naloxone Hydrochloride and supply it to anyone requiring access for use in an emergency involving a heroin overdose. This will include drug users, their family members and carers. It will also include other people likely to come into contact with drug users such as hostel managers. The expected impact on the public sector, charities or voluntary bodies will be an increase in the availability of naloxone and a reduction in fatal opioid overdoses. It is expected that the cost associated with this wider availability, e.g. training and storage, would be minimal. “These Regulations amend the Human Medicines Amendment Regulations 2012 (“the 2012 Regulations”). They do so in order to allow drug treatment services provided by or on behalf of NHS bodies and local authorities (LAs) to supply Naloxone Hydrochloride for administration in emergencies involving a heroin overdose.” Source: http://www.legislation.gov.uk/uksi/2015/1503/memorandum/contents

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Take home naloxone National take home naloxone schemes should aim to issue 20 times as many kits as there are opiate-related deaths per annum; and at least nine times as many. In 2014 there were 1,786 deaths recorded in England and Wales where an opiate was involved, including 952 which mentioned heroin or morphine. Meaning there should be 35,720 (and a minimum of 16,074) naloxone-kits issued issued across England and Wales. Source: Sheila M. Bird , Mahesh K. B. Parmar , John Strang, Take-home naloxone to prevent fatalities from opiate-overdose: Protocol for Scotland’s public health policy evaluation, and a new measure to assess impact, Drugs: Education, Prevention and Policy Vol. 22, Iss. 1, 2015 Source: Deaths related to drug poisoning in England and Wales, 2014 registrations (ONS 2015)

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Mean percentage purity of cocaine and heroin seized by police in England and Wales, 2003 to 2013 Source: http://www.nta.nhs.uk/uploads/uk-focal-point-report-2014.pdf

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Mental health patients who die by suicide with known history of drug or alcohol misuse Of those suicides in England where a patient had been in touch with mental health services in the previous 12 months over half (54%) had a history of drug and/or alcohol misuse. On average there were 671 deaths a year in this group. In Scotland 69% of mental health patient suicides, had a known history of drug and/or alcohol misuse, an average of 168 deaths per year. In Wales an average of 41 deaths per year were to patients, 57% of suicides in mental health patients. Source: http://www.bbmh.manchester.ac.uk/cmhs/research/centreforsuicideprevention/nci/

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Injection of NPS in Wales “Injection of cathinones, particularly in the groin area has led to an increase in physical impacts: granular/gritty lumps under the skin, profound bruising, abscesses, deep vein thrombosis, long-term stays in intensive care units of up to 3 months, amputations, severe weight loss and requirement for major reconstructive surgery to femoral veins. Increased injection rates were also noted, going from approximately 3 up to 15–20 times per day.” Source: http://www.emcdda.europa.eu/publications/rapid/2015/drug-related-infectious-diseases-in-europe

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What do people in receipt of opioid substitution therapy think about services? Source: How can opioid substitution therapy (and drug treatment and recovery systems) be optimised to maximise recovery outcomes for service users?

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Kilos of cocaine and heroin seizures in England and Wales Three quarters of cocaine (65%) and heroin (66%) seized in 2014/15 was in quantities under 1g. 3% of cocaine and 2% of heroin seized weighed more than 500g. Source: Seizures of drugs in England and Wales, financial year ending 2015

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Rates of Drugs-related Death Rates Soon After Hospital-discharge for People in the Treatment System in Scotland For the cohort of over 98,000 drug treatment clients in Scotland, there is a high drugs-related death [DRD] risk in the 28 days after hospital-discharge. Length of hospital-stay had no effect on DRD-rate, discharge-diagnosis had an effect (as did reported misuse of alcohol) but neither was as discriminatory as the behavioral risk-factor of having ever injected. Source: White SR, Bird SM, Merrall ELC, Hutchinson SJ (2015) Drugs-Related Death Soon after Hospital-Discharge among Drug Treatment Clients in Scotland: Record Linkage, Validation, and Investigation of Risk-Factors. PLoS ONE 10(11): e0141073. doi:10.1371/journal.pone.0141073 http://journals.plos.org/plosone/article?id=info:doi/10.1371/journal.pone.0141073

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Short-term outcomes for opiate and crack users accessing treatment in England (1 of 2) “Significant, and substantive, improvements in most behavioural measures were recorded, and were achieved within a relatively short period of time following enrolment in treatment. The study demonstrates that these successful outcomes continued to be the norm for the English opiate- and/or crack-user treatment population, despite a doubling in the number of drug users treated, and changes in referral patterns and drug use profiles.” Source: Short-term outcomes for opiate and crack users accessing treatment: the effects of criminal justice referral and crack use.

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Short-term outcomes for opiate and crack users accessing treatment in England (2 of 2) “The results observed here demonstrate that, in the face of marked changes in the English drug treatment population, the positive improvement in behavioural outcomes observed in previous studies has been sustained. Positive changes were observed in the short term but did not necessarily equate to abstention from all drug taking and offending behaviour.” Source: Short-term outcomes for opiate and crack users accessing treatment: the effects of criminal justice referral and crack use.

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Reported purity of brown heroin in Europe in 2013 Source: http://www.emcdda.europa.eu/data/stats2015#displayTable:PPP-77-0

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Substance misuse in older people The proportion of high-risk older people (over 60 years of age) with substance misuse problems that don’t receive the treatment that they require. Source: Substance misuse in older people: an information guide, Royal College of Psychiatrists