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Interesting things about alcohol and other drugs - October 2017

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One in a regular series of slide sets on interesting data about alcohol and other drugs (and the wider issues to do with multiple needs) from a UK perspective.

Published in: Government & Nonprofit

Interesting things about alcohol and other drugs - October 2017

  1. 1. Interesting things about alcohol and other drugs October 2017 Andrew Brown @andrewbrown365
  2. 2. Estimated number of opiate and/or crack cocaine users by age in England in 2011/12 and 2014/15 32,628 109,124 152,127 30,190 91,808 178,785 0 20,000 40,000 60,000 80,000 100,000 120,000 140,000 160,000 180,000 200,000 15 to 24 years 25 to 34 years 35 to 64 years 2011/12 2014/15 Source: Estimates of the Prevalence of Opiate Use and/or Crack Cocaine Use, 2014/15: Sweep 11 report (LJMU 2017)
  3. 3. Estimated number of opiate and crack users in England in 2011/12 and 2014/15 16,935 46,337 36,270 24,085 34,329 21,952 54,985 32,935 26,051 17,675 48,814 36,662 25,057 34,822 25,910 52,487 32,734 26,622 - 10,000 20,000 30,000 40,000 50,000 60,000 North East North West Yorkshire and the Humber East Midlands West Midlands East of England London South East South West 2011/12 2014/15 Source: Estimates of the Prevalence of Opiate Use and/or Crack Cocaine Use, 2014/15: Sweep 11 report (LJMU 2017) Nationally, there was a 2% increase in the estimated number of OCUs, but this change was not statistically significant.The number of OCUs in the East of England increased by 18%, from 21,952 in 2011/12 to 25,910 in 2014/15, and this increase of 3,958 was statistically significant (95% CI: 270 to 7,606). There was an increase in the point estimate in the North West of 2,477 – an increase of 5% - but this was not statistically significant.All other regions saw increases in the point estimate apart from a small fall in the South East and a larger (but still not statistically significant) fall in London.
  4. 4. Estimates of the number of households experiencing core homelessness in Great Britain, by type, in 2011 and 2016 (rounded) 6,100 5,900 7,900 47,100 10,000 42,900 9,100 8,900 12,100 42,200 19,300 68,300 - 10,000 20,000 30,000 40,000 50,000 60,000 70,000 80,000 Rough Sleepers Car, tent, pub transport Squatting Hostels, refuges etc. Unsuitable Temporary Accommodation Sofa Surfers 2011 2016 Source: Homelessness projections: Core homelessness in Great Britain (Crisis/Herriot Watt University 2017) “The scale of core homelessness has increased significantly across Great Britain (33% between 2011 and 2016).” “At any one point in time, core homelessness in 2016 stood at around 160,0002 households in Great Britain (143,000 in England, 5,100 inWales, 11,800 in Scotland).” “We estimate that core homelessness contains 57,000 ‘family’ households (couples or lone parents) containing 82,000 adults and 50,000 children, so that the core homeless ‘population’ is 236,000.”
  5. 5. Projections for the number of people sleeping rough in England, Wales and Scotland - 5,000 10,000 15,000 20,000 25,000 30,000 35,000 40,000 45,000 2011 2016 2021 2026 2031 2036 2041 England Wales Scotland Source: Homelessness projections: Core homelessness in Great Britain (Crisis/Herriot Watt University 2017) “A sub-regional housing market model has been adapted to forecast future levels of homelessness which has modelled 15 additional variables.*The model depends on many assumptions but for the purpose of this analysis it has been fixed on a relatively neutral/ benign scenario for the economy and labour market, and current policy settings including planned welfare reforms.” *The 15 variables used are rough sleeping, hostel residents, unsuitable temporary accommodation, sofa surfers, total core homelessness, homeless acceptances, total homeless applications, total in temporary accommodation, people asked to leave household, evictions, wider homelessness, relative low income poverty after housing costs, crime rates, welfare reform cuts impact (from Beatty & Fothergill), households in financial difficulty.
  6. 6. LGA survey of local authorities about providing naloxone in the community 99% 25% 25% 21% 18% 12% 6% 5% 25% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Drug treatment service Hostels Outreach workers Pharmacy needle and syringe programme Peers (other people who use drugs) Primary care Community pharmacies A&E Other Which services or organisations provide take-home naloxone? Nine in ten respondent local authorities (90 per cent) currently made available take- home naloxone. Six of the fourteen respondents which did not currently make naloxone available subsequently commented that they were either considering, planning or about to make it available. “All service users accessing our local drug treatment services are offered take home Naloxone -We have piloted the distribution of take home naloxone in 3 community pharmacies providing high level of needle exchange and are looking to expand this provision across all needle exchange pharmacies over the coming year subject to ratification” (West Midlands). “Naloxone saves lives and is a very important tool in tackling DRDs in our area” (South East). n = 121 Source Naloxone survey 2017 (LGA 2017)
  7. 7. Prevalence of blood borne viruses amongst people who inject drugs in England, Wales and Northern Ireland 44% 43% 43% 47% 47% 43% 43% 47% 49% 50% 53% 28% 20% 18% 17% 16% 16% 17% 16% 14% 13% 14% 1.3% 1.1% 1.6% 1.5% 1.1% 1.2% 1.3% 1.1% 1.0% 1.0% 0.9% 0% 10% 20% 30% 40% 50% 60% 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Hepatitis C Hepatitis B HIV “…data from the main UnlinkedAnonymous Monitoring Survey of PWID, which is targeted at people who inject psychoactive drugs, indicate that the proportion ever infected with hepatitis B has declined and that the prevalence of HIV remains stable and low. Hepatitis C remains the commonest infection among this group and overall prevalence is currently stable…Whilst the vast majority of those with HIV were aware of their status, half of PWID with antibodies to hepatitis C remain unaware of their infection, even though four-fifths reported having been tested for hepatitis C infection. After increasing during the previous decade, the uptake of testing for hepatitis C infection has changed little over the last few years. Services should aim to have testing for blood-borne viruses available for patients at first assessment. Repeat testing of people who inject drugs is recommended, and when risk is assessed as high, testing may be carried out up to once or twice a year.” Source: People who inject drugs: HIV and viral hepatitis monitoring (PHE 2017)
  8. 8. Characteristics of participants in the Unlinked Anonymous Monitoring Survey of people who inject drugs in 2016 70% 91% 68% 75% 13% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Currently in treatment Ever used a needle exchange Ever been in prison Ever been homeless Ever traded sex for money, goods or drugs Source: People who inject drugs: HIV and viral hepatitis monitoring (PHE 2017)
  9. 9. Proportion of participants in the Unlinked Anonymous Monitoring Survey (who had injected in preceding four weeks) who reported injecting crack, powder cocaine and amphetamine 35% 35% 35% 29% 29% 32% 36% 37% 40% 46% 53% 16% 19% 18% 17% 18% 23% 22% 23% 24% 17% 17% 12% 12% 11% 8% 7% 9% 9% 7% 8% 10% 10% 0% 10% 20% 30% 40% 50% 60% 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Crack Amphetamine Cocaine “Injection of crack increased in recent years, with 53% (95% CI, 50%-55%) of those who had injected in the preceding four weeks reporting crack injection as compared to 35% (95%CI, 33%-37%) in 2006.” “Crack injection also increased among the recent initiates, with 50% (95%CI, 40%-59%) of those who had injected in the preceding four weeks reporting crack injection in 2016, vs. 28% (95%CI, 22%-33%) in 2006.” “There was no significant change in the injection of cocaine (10%, 95%CI 9%-12% in 2016 vs 12%, 95%CI, 10%-13% in 2006) or amphetamine (17%,95%CI 15%-19% in 2016 vs 16%, 95%CI, 14%-18% in 2006) among those who had injected in the preceding four weeks.” Source: People who inject drugs: HIV and viral hepatitis monitoring (PHE 2017)
  10. 10. Symptoms of an injection site infection (swelling containing pus (abscess), sore, or open wound at an injection site) among those who injected during the preceding year 15% 20% 25% 30% 35% 40% 45% 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Under 25 25 to 34 35 and over Symptoms of a possible injection site infection are common among PWID across England,Wales and Northern Ireland. In 2016, 36% (95% CI, 34%- 38%) of PWID who had injected during the preceding year reported that they had experienced an abscess, sore or open wound at an injection site – all possible symptoms of an injection site infection - during the preceding year. This is a similar level to 35% (95% CI, 33%-37%) in 2006, but an increase from 28%-29% reported in 2011-2013.The levels of possible injection site infection were particularly high among the under-25 year age group at 43% (95%CI, 30%-58%), which is higher than the 27% reported in 2006 (95%CI, 22%-32%). Source: People who inject drugs: HIV and viral hepatitis monitoring (PHE 2017)
  11. 11. Proportion of participants in the Unlinked Anonymous Monitoring Survey (who had injected in preceding four weeks) who reported injecting in their groin. 35% 32% 32% 35% 34% 35% 35% 38% 38% 38% 40% 25% 27% 29% 31% 33% 35% 37% 39% 41% 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 “Injecting into the groin has been associated with a number of health problems, including damage to the femoral vein and artery, infections and circulatory problems.The proportion of current PWID who reported injecting into their groin during the preceding four weeks varied across England,Wales and Northern Ireland. By country, the proportion injecting into the groin in 2016 was as follows: England 40% (95% CI, 38%-43%);Wales, 39% (95% CI, 31%- 48%); and Northern Ireland 60% (95% CI, 39%- 79%). Across England, there are differences in the proportion reporting injecting into their groin, ranging from 47% (95% CI, 40%-54%) in the SouthWest to 33% in the East of England (95% CI, 25%-42%).” Source: People who inject drugs: HIV and viral hepatitis monitoring (PHE 2017)
  12. 12. Top 10 telephone enquiries to the National Poison Information Service and TOXBASE accesses relating to drugs of misuse 163 140 116 100 76 74 68 67 54 51 0 50 100 150 200 Cocaine (including crack) MDMA (including ecstasy) Cannabis Drug of misuse (not known) Diazepam Branded products Heroin Methadone Amphetamine SCRA Telephone enquiries 11,499 10,281 5,201 3,980 3,904 3,887 3,166 2,593 2,148 2,062 - 4,000 8,000 12,000 Cocaine (including crack) MDMA (including ecstasy) Heroin Amphetamine Methylphenidate hydrochloride Cannabis SCRA GHB and sodium oxybate Ketamine Branded products TOXBASE Accesses Branded produces - These are sold in packages with distinctive branding. Examples (sometimes previously termed ‘legal highs’) include ‘Black Mamba’, ‘Vertex’ and ‘Sweet Leaf’. The constituents of these products are often unknown and may be inconsistent. Although many contain SCRAs, they are listed separately because some may contain other drug types. Source: National Poisons Information Service Report 2016/2017 (PHE, 2017)
  13. 13. Provision of support specifically for women across local authority areas in England, by domain 68.9% 64.2% 53.6% 49.0% 37.7% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% Mental health Offending Complex needs Substance misuse Homelessness N = 151 In England, the majority of local authority areas (n=122; 80.8% of all local authorities) offer support in two or more domains, with the average being 2.8 (mean). Only in nineteen local authority areas in England (12.6% of all local authorities) can women access localised support across all five domains. Source: Holly, J. (2017). Mapping the Maze: Services for women experiencing multiple disadvantage in England and Wales. London: Agenda & AVA.
  14. 14. Types of identified substance misuse support for women in England and Wales 33.7% 33.7% 12.0% 10.8% 9.6% 0.0% 10.0% 20.0% 30.0% 40.0% Women’s group in generic service Substance misuse midwife Women-only residential rehabilitation facility Other type of substance use support Women-only non-residential substance misuse service N = 83 Data from the National DrugTreatment Monitoring System (NDTMS) indicates that currently around a third of people accessing drug treatment services are women, with the figure rising to almost 40% in alcohol only support services. As such, finding that only around half of all local authority areas in England (n=74, 49.0%) and five unitary authorities in Wales (22.7% of all authorities in Wales) are home to localised support specifically for women experiencing substance use problems is disappointing Source: Holly, J. (2017). Mapping the Maze: Services for women experiencing multiple disadvantage in England and Wales. London: Agenda & AVA.
  15. 15. Number of convicted BAME men placed in a high security prison, for every 100 White men convicted of the same types of offence 82 125 142 127 143 126 120 121 0 20 40 60 80 100 120 140 160 Black Asian Mixed ethnic All BAME Drug offences All offence groups Source: Lammy Review (2017) “Many prisoners arrive in custody as damaged individuals. In the youth estate, 33% arrive with mental health problems, whilst a similar proportion presents with learning difficulties. A third of children in prison have spent time in the care system, 45% arrive with substance misuse problems and 61% have a track record of disengagement with education. In the adult estate, an estimated 62% of men and 57% of women prisoners have a personality disorder, while 32% of new prisoners were recorded or self-identified as having a learning difficulty or disability. Many have been both victims and perpetrators of violence, with resulting trauma and psychological damage.”
  16. 16. Deaths by drug poisoning where any opiates were mentioned on the death certificate, English regions, 1993 - 2016. 0 50 100 150 200 250 300 350 400 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Yorkshire and the Humber West Midlands South West South East Outter London North West North East Inner London East of England East Midlands Source: User requested data (ONS, 2017)
  17. 17. Use of Asset Recovery Incentivisation Scheme funds £.0m £10.0m £20.0m £30.0m £40.0m £50.0m £60.0m £70.0m £80.0m £90.0m 2011-12 2012-13 2013-14 2014-15 2015-16 Asset Recovery work Crime Reduction projects Community projects Miscellaneous “Law enforcement agencies allocated the largest amount of monies received from ARIS to fund future asset recovery work8 .This was £73m in 2015/16, representing 88% of available funds. The remaining funds supported crime reduction projects (£3m), community projects (£1.5m) and miscellaneous payments (£6m).” “These figures only account for monies and projects where the Home Office have received a return from the law enforcement partner and does not reflect all theARIS monies that have been distributed in a given year.” Source: Asset recovery statistical bulletin: financial years ending 2012 to 2017 (Home Office, 2017)
  18. 18. Number and proportion of patients who have an emergency alcohol-specific readmission to any hospital within 30 days of discharge following an alcohol-specific admission 21,161 22,016 23,341 24,036 11% 12% 12% 13% 0% 2% 4% 6% 8% 10% 12% 14% 0 5,000 10,000 15,000 20,000 25,000 30,000 April 2011 - March 2014 April 2012 - March 2015 April 2013 - March 2016 April 2014 - March 2017 (Provisional) Source Clinical Commissioning Group Outcomes Indicator Set (NHS Digital 2017)

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