Drug misuse

Drug misuse is a significant issue in Slough negatively impacting levels of ill-health, hospital admissions, mortality rates and crime levels. It is also a significant factor in family breakdown and children being taken into care.

What do we know?

The reasons that people choose to use drugs, and the reasons that for some this use becomes problematic and harmful involves a complex interplay of factors including social, environmental, genetic and biological factors. More than one in three adults say they have used an illicit drug at some time in their life, usually during teenage or young adult life, but less than one in 10 report (8.9%) having done so in the past year. (Source: UKDPC A fresh approach to drugs)

Harms from illicit drug use are wide ranging and extend from effects on the individual, such as risk of overdose and death, mental health risks and risk of blood borne diseases to effects on family including poor child welfare and domestic violence, to effects on the wider community including antisocial behaviour and criminality. These harms are explored further in the ‘Matrix of Drug Related Harms’ as part of the report Moving towards Real Impact Drug Enforcement (2009).

Steroids and image enhancing drugs are a rapidly expanding market and the risks to the, usually young men, using these substances range from the effects of the substance themselves to the risks of injecting i.e. transmission of blood borne viruses (Source: Steroids and Image Enhancing Drugs).

Facts, Figures, Trends

Prevalence

The estimated number of opiate and/or crack users (OCUs) in Slough is 1,066 making Slough one of the highest prevalence areas in the South East. (Source: www.ndtms.net Glasgow Smoothed Estimates 2011/12)

The main drug used by the Slough treatment population in 2013/14 was dual use of opiate and crack, followed closely by sole opiate use; this is in line with the regional and national averages and again this is the same for opiates and other stimulants; however, crack alone is a bigger problem in Slough when compared regionally or nationally. The main method of drug use by clients in treatment is smoking with 77%, which is slightly up from 73% last year (higher than the South East average of 49%). The South East average for injecting is much higher than Slough with 29% vs. 12%.
(Source: NDTMS data analysis provided by SEPHO 13/14 (June 2015)

Client Profile

The profile of clients in treatment mainly White British (at 67.4%) men (77.9%) and are between the ages of 35-64 years old (57.3%). This is a considerable change from the last 4 years where the main group has been 25-34 years of age; this could be due to Slough having an ageing, substance misusing population. The representation of BME (currently 32.6%) groups in treatment has stayed pretty static (33.5% in 12/13) and is also in line with a comparative area (30%) but the figures varies from the overall Census population. Engagement with BME groups and female clients remain a priority for the DAAT, although some social stigma from certain BME groups is an on-going barrier to treatment. (Source: www.ndtms.net Bulls Eye in treatment reports 2013/14)

We have static numbers of younger people in effective treatment with 5.3% of clients under 25 (vs. previous year at 5.2%). Nationally we are seeing an ageing population of drug users, specifically heroin, with our largest age group category being 35-64 years old. Slough’s representation of younger people in treatment is in line with the national average of 6.3% but is slightly lower than a comparative area, which is at 8%. We currently have a young people’s service who engages these clients.

In Slough, 48% of our drug clients and 56% of our alcohol clients are parents. With 19% and 35.1% respectively having children actually living with them. This is in contrast to the South East figures where they have 26% and 25.5% living with them, respectively. The service currently has a specific service to intensively work with families to reduce the harm caused.

Engagement in treatment

Slough has a good number of drug users in effective treatment with approximately 436 of the estimated 1066 OCUs in effective treatment at the end of 2013/14, which is 41% of the estimated drug using population (penetration = 436/1066). (Source: www.ndtms.net Bulls Eye in treatment reports 2013/14)

The proportion of people known to treatment but not attending this year has decreased to 7% from 15% in the previous year. This could be viewed as a positive thing, in that clients may have become drug free and no longer require treatment. Using the Glasgow Smoothed Estimate of 1066, this gives a treatment penetration of 48%. This is down from the previous year, where we were at 57% penetration.

In comparison, a similar area (appears in both of our comparator groups provided by PHE); has a penetration of 48%. This (and we) is below the national figure of 58%.

The average number of treatment episodes for a client in Slough is slightly below the South East average at 1.2 for alcohol clients and 1.1 for drug clients in 2013/2014 (the South East is at 1.5 and 1.6 respectively), which is a slight reduction from last year and is encouraging that your average client only comes through the system once. (Source: NDTMS data analysis provided by SEPHO 13/14 (June 2015).

Blood-borne viruses

Of those starting treatment for blood borne viruses, we estimate that 14% are currently injecting; this has not fluctuated noticeably for the last 3 years (with an additional 10% previously injecting). This, alongside a national focus on blood borne viruses, means that harm reduction is a core component of drug intervention and is incorporated within all four treatment tiers within Slough DAAT.

100% of our clients were offered a Hepatitis B vaccination and of those that accepted, 56% have started or completed the course of vaccinations. 100% of clients were offered a Hep C test and of those that accepted, 82.2% have had the test. BBV is an on-going area of focus for (the services have recently put in place a BBV champion to improve this and have trained staff on BBV oral swab testing).
(Source: www.ndtms.net Quarterly activity reports Q4 14_15)

There are some interesting comparisons to be made in respect of anti-BBV prevalence in the South East versus nationally. There is lower prevalence of anti-HIV positive samples in the South East, but a higher prevalence of anti-BBV positive samples in comparison to the national figure. This is an area of focus for the Public Health teams in Slough and is supported by the good testing/vaccination figures shown above for the South East and Slough specifically.

Figures for those who began injecting in the last 3 years (prior to reporting year) suggest that education surrounding Hep B and Hep C has improved as the prevalence figures are considerably lower. Unfortunately the anti-HIV prevalence is reflective of the sample population as a whole.

Our needle exchange packs have been catered for specific types of use, including our ‘blue pack’ that has been created to provide equipment for those using anabolic steroids or other performance enhancers. In 2013-2014, we dispensed approximately 150 blue needle exchange packs (which each contain 10 needles); equating to approximately 1500 needles and accounting for approximately 30% of our total number of packs dispensed. This is a large amount considering we provide this service alongside provision for our main (opiate using) clientele.
(Source: Analysis of needle exchange packs dispensed 14-15)

National & Local Strategies (Current best practices)

National

Drug Strategy 2010: Reducing demand, restricting supply, building recovery

After a major change to government policy in 2010, a fundamentally different approach to preventing drug use in communities, and in supporting recovery from drug and alcohol dependence was put into practice.
The key points of the strategy are:

  • To place more responsibility on individuals to seek help and overcome dependency
  • Place emphasis on providing a more holistic approach, by addressing issues in addition to treatment, such as offending, employment and housing
  • Aim to reduce demand
  • Take an uncompromising approach when dealing with those involved in drug supply both at home and abroad
  • Place power and accountability in the hands of local communities to tackle drugs and the harms they cause.

A number of National Institute of Health and Care Excellence (NICE) Guidelines, both clinical guidelines and public health guidelines on the topic of drug misuse are available including guidance on opioid detoxification and psychological interventions as well as the delivery of needle and syringe programmes. Currently in development is the guidance on drug misuse prevention.

Local

The Slough Drug and Alcohol Action Team (DAAT) consists of a partnership combining representatives from local authorities (education, social services, health, probation, prison service and the voluntary sector). Working with partner organisations, Slough DAAT commission and monitor locally provided drug and alcohol services, deliver projects and raise awareness of drug and alcohol issues in Slough

The key aims of the Slough DAAT are to provide an effective drug treatment system in order to:

  • minimise the social and health related harms caused by drug misuse
  • increase positive outcomes within effective treatment and to ensure the needs of all drug users are met, regardless of ethnicity, gender, age, drug type and status
  • to help more clients to become drug free and ensure relapse prevention.

What is this telling us?

  • Compared to regional and national averages, there is a high level of drug misuse in Slough. 
  • There are estimated to be 1066 opiate and/or crack users in Slough, making it one of the highest levels of OCUs amongst people aged 15-64 years in the South East.
  • Opiate and Crack use is high in Slough and has increased but is in line with regional and comparator averages.
  • We have evidence (through needle exchange provision) of high prevalence of use of performance enhancers.
  • A good level of opiate and/or crack users are known to treatment (penetration is at 41%- reflective with similar areas of comparison).
  • The percentage of successful opiate completions (and did not re-present in 6 months since exit) in Slough in 14_15 is 11.4%, this is in line with comparators.(Source: www.ndtms.net DOMES reports Q4 14_15)
  • The estimated percentage of users in treatment who currently inject is at 14%.
  • In Slough there are approximately 52% of OCU’s not known to the treatment system in 2013/2014.

What are the key inequalities?

Substance misuse is a significant source of health inequalities in the UK and is itself linked to socioeconomic inequality, social exclusion, lack of a sense of community and disenfranchisement. (Source: UKDPC A fresh approach to drugs)

According to UKDPC: "In general men are more likely to use illicit drugs than women and young adults are more likely to do so than older ones. The extent and nature of drug use also varies by ethnicity. There is considerable diversity within Black and Minority Ethnic (BME) communities although most surveys do not have large enough samples or collect the relevant information to be able to provide robust evidence about drug use in many of these groups."

What are the unmet needs/ service gaps?

  • Successful completions/re presentations: Although the number of successful completions has increased and re-presentations has reduced, work needs to continue to ensure that we no longer have ‘revolving door’ clients and that everyone is supported when they leave treatment (see recovery and reintegration).
  • Accommodation/housing: There is a lack of suitable housing options available for the client group and indeed, while in treatment and on leaving, suitable accommodation is still a priority for a proportion of drug users. This is a big aspect of a client’s stability on leaving treatment; ‘People are more likely to complete their recovery if they have wider support to help them to rebuild their lives. These services include stable homes and employment prospects.’. (Source: http://www.nta.nhs.uk/recovery.aspx)
  • Mental health: There is currently a lack of suitable resources to manage those with mild to moderate mental health conditions. Referrals into the mental health services are on-going; however, this could be a smoother process.
  • Recovery and reintegration: There is a need to highlight what the treatment system is for; recovery and reintegration. Clients need to be aware that they are in treatment with an aim to be reintegrated into a life without substances. Our services should ‘…seek to maximise opportunities as they present in a client’s journey, building on the benefits of being in treatment, with a view to recovery steps being foremost at all times.’.(Source: http://www.nta.nhs.uk/uploads/commissioning_for_recovery_january_2010.pdf)
  • Provision for injecting clients: There is evidence that the use of the above is high in Slough. We do provide for these clients (in relation to both support and needle exchange), however, we need to work with PHE to identify how best to tackle this issue.

Consideration should also be given for self testing HIV kits. The services already take advantage of self-testing kits for Chlamydia and offer services for BBV testing through blood tests, although costly, efficiencies could be gained through encouraging self testing.

Recommendations for consideration by other key organisations

  • Collaborative work is needed to continue improving reintegration into a life without substances and prevent re-presentation.
  • Housing and the availability of suitable accommodation remains a barrier to recovery and reintegration for many service users - opportunities to improve housing availability need to be explored.
  • Better integration between mental health and substance misuse services is needed to improve the patient pathway for those with mild to moderate mental health conditions.
  • Improvements in healthcare provision, particularly with regards infectious diseases, needs to be developed for injecting clients.

Related pages