Adult drug misuse

Introduction

Drug misuse is the excessive consumption and/or reliance on psychoactive substances. Drug misuse can lead to social, psychological or legal problems for the user and have negative consequences for their wider family and children.

NICE guidance states that illicit drugs use in the UK is most prevalent among young people and associates substance misuse with significant health risks including anxiety, memory or cognitive loss, accidental injury, hepatitis, HIV infection, coma and death. It may also lead to an increased risk of sexually transmitted infections.

People with a history of drug problems are heavily stigmatised and are seen as both blameworthy and to be feared. As a result they are subject to exclusion and discrimination in many areas which prevents them accessing support, treatment and recovery programmes.

Drug misusers have the same entitlement as other patients to the services provided by the National Health Service.  Engagement with effective treatment and preventative measures reduces the impact to society and results in savings due to a reduction in crime, an increase in productivity, and better contributions to society and cost saving to the NHS in the form of improved health, reduction in drug related deaths and a reduction in blood-borne diseases.

Key inequalities and risk factors

Social and environmental factors influencing substance misuse include:

  • previous experience of using substances
  • environment (for example, availability of drugs)
  • family influences, parents or other family members who misuse substances
  • mental health issues
  • poor educational attainment
  • having been looked after by local authorities, fostered or homeless, or who move frequently
  • experience of being in the criminal justice system
  • involvement in commercial sex work

Crime Survey for England and Wales 2014 to 2015 statistics show:

  • Younger people are more likely to take drugs than older people
  • Men are more likely to take drugs than women - around one in eight (11.9%) men aged 16 to 59 had taken an illicit drug in the last year, compared with around one in eighteen (5.4%) women. There were no statistically significant changes between the 2013/14 and 2014/15 surveys for both men and women
  • People living in urban areas reported higher levels of drug use than those living in rural areas - just under a tenth (9.1%) of people living in urban areas had used any drug compared with 6.5 per cent of those living in rural areas
  • Higher levels of drug use are associated with increased frequency of visits to pubs, bars and nightclubs

A previously published regression analysis of Crime Survey demographic characteristics and lifestyle factors found that age, sex, frequency of alcohol consumption and marital status were the most important factors associated with drug use (Hoare and Moon, 2010).

Facts, figures and trends

The 2012 NICE quality standard for treatment of adults who misuse opioids, cannabis, stimulants or other drugs states that:

  • Among people aged between 16 and 59 years, the most commonly used psychoactive substance is cannabis, followed by cocaine and ecstasy
  • Opioids are used less commonly, but present the most significant health problems
  • People with drug use disorders may have a range of health and social care problems
  • Drug misuse is more prevalent in areas characterised by social deprivation, which in turn is associated with poorer health
  • Many people with drug use disorders have lifestyles that are not conducive to good health. Injecting drug users are particularly vulnerable to contracting blood-borne viruses and other infections

The table below summarises detailed analysis of facts and figures on drug use drawn from Drug misuse: findings from the 2014 to 2015 Crime Survey for England and Wales (Home Office, 2015):

 

Younger adults (16-24)

All adults (16-59)

Ever taken

36.5 per cent of young adults aged 16 to 24 had used an illicit drug at some point in their lives, while 19.4 per cent had done so in the last year.

Just over one-third (34.7%) of adults aged 16 to 59 had taken drugs at some point during their lifetime. This is similar to the 2013/14 survey estimate (35.7%).

Taken in last year

Around 1 in 5 (19.4%) young adults aged 16 to 24 had taken an illicit drug in the last year. This proportion was more than double that of the wider age group, and equated to around 1.2 million people. This level of drug use was similar to the 2013/14 survey (19.0%), but significantly lower compared with a decade ago (26.5% in the 2004/05 survey).

Around 1 in 12 (8.6%) adults aged 16 to 59 had taken an illicit drug in the last year. This equated to around 2.8 million people. This level of drug use was similar to the 2013/14 survey (8.8%), but significantly lower than a decade ago (11.2% in the 2004/05 survey).

Taken in last month - indicator of very recent drug use

Among adults aged 16 to 24, the drugs most commonly taken in the last month were cannabis (8.4%), ecstasy (2.1%) and powder cocaine (1.7%).

Among adults aged 16 to 59, the drugs most commonly taken in the last month were cannabis (3.7%), powder cocaine (0.9%) and ecstasy (0.7%).

Drug type

Among younger adults aged 16 to 24, cannabis was also the most commonly used drug, with 16.3 per cent having used it in the last year. This was not statistically significantly different from the level in 2013/14 (15.1%), but was a significant fall compared with the 1996 survey (25.8%).

The second most commonly used drug among young adults aged 16 to 24 was ecstasy (4.2%)

As in previous years, cannabis was the most commonly used drug in the last year, with 6.7 per cent of adults aged 16 to 59 using it in the last year, similar to the 2013/14 survey (6.6%)

The next most commonly used drug in the last year by adults aged 16 to 59 was powder cocaine (2.3% in the 2014/15 survey).

Frequent drug use - having taken any illicit drug more than once a month on average in the past year 

Over twice as many young adults aged 16 to 24 were classed as frequent drug users (5.1%) compared with older adults.

 

2.2 per cent of all adults aged 16 to 59 were classed as frequent drug users

There is a similarity to the most common source of other illicit drugs, as they were also frequently obtained from a friend, neighbour or colleague (42% of 16 to 59 year olds who had used illicit drugs in the last year), or from a known dealer (11%).

New psychoactive substances (NPS)

The use of generic, rather than specific, new psychoactive substances was measured by the 2014/15 Crime Survey for the first time.  Use of NPS was more concentrated in young adults aged 16 to 24 (around 1 in 40 (2.8%) compared to 1 in 100 (0.9%) of 16 to 59 year olds). In particular, use of NPS in the last year was concentrated among young men aged 16 to 24.

Eighty-four per cent of young adults aged 16 to 24 who had used an NPS, had also used another illicit drug in the last year. This proportion was similar (83.0%) for 16 to 59 year olds.

There is also a link with alcohol consumption: People who had visited a pub or a nightclub in the last month were significantly more likely to have used an NPS in the last year than those who had not. People who had consumed alcohol once or more in the last month were significantly more likely to have used an NPS in the last year, in both age groups.

Prevention, care and support

There is no commonly accepted definition of ‘drug prevention’ or precisely what type of activities it describes. At a simple level, drug prevention may include any policy, programme, or activity that is (at least partially) directly or indirectly aimed at preventing, delaying or reducing drug use, and/or its negative consequences such as health and social harm, or the development of problematic drug use. NICE guidance on drug misuse prevention is expected in 2017. Register for updates on progress here.

A long-term study of people with an addiction to heroin showed they had a mortality risk 12 times greater than the general population. The aim of drug treatment is to reduce such inequalities by helping people overcome their addiction and improve their quality of life.

Specialist drug and alcohol services are available in the borough from the Bracknell Forest Drug and Alcohol Team which provides Parenting early intervention programmes, advice and information for young people, support for friends and families affected by drug and alcohol misuse, screening and referral services, a needle exchange service, vaccination and advice on accidental overdose.

Quality care and care outcomes

Markers of high-quality, cost-effective care that, when delivered collectively, should contribute to improving the effectiveness, safety and experience of care for people with drug use disorders in the following ways:

  • Preventing people from dying prematurely.
  • Enhancing quality of life for people with long-term conditions.
  • Helping people to recover from episodes of ill health or following injury.
  • Ensuring that people have a positive experience of care.

Treating and caring for people in a safe environment and protecting them from avoidable harm.

Outcomes in all these areas are valid for drug misusers and are set out in the NHS Outcomes Framework.

In 2014/15, there were 255 people in specialist drug misuse services  in Bracknell Forest and no one was waiting 3 weeks or more for treatment services. 

The successful treatment rate for non-opiate users who left treatment and did not re-present within 6 months was 54%.  This was statistically higher than the national average and represents a year on year improvement since 2012:

The successful treatment rate for opiate users who left treatment and did not re-present within 6 months was 14.9%.  This figure remains statistically higher than the national average and represents a year on year improvement since 2012:

Individuals achieving this outcome demonstrate a significant improvement in health and well-being in terms of increased longevity, reduced blood-borne virus transmission, improved parenting skills and improved physical and psychological health.

Liver disease is one of the top causes of death in England and people are dying from it at younger ages. Most liver disease is preventable and much is influenced by the prevalence of hepatitis B and hepatitis C infections, which are both amenable to public health interventions. Persons who inject drugs are at higher risk of contracting hepatitis B and C infections. In Bracknell Forest in 2014/15, of the people entering substance misuse treatment the percentage of eligible persons offered and completing a course of hepatitis B vaccination was 16.7% and 82% received a hepatitis C vaccination, both rates compare favourably with the England averages.

Mortality

In 2014, there were 2,297 registered drug related deaths in England and Wales where opiates, cocaine, amphetamine, cannabinoids or NPS were mentioned on the death certificate.

Costs

The Drug Strategy 2010 Evaluation Framework (2010) presents a framework for effectiveness and value for money of the strategy, specifically ‘Early Intervention’ and ‘Education and Information approaches’.

Drug use contributes to crime and the fear of crime. Home Office estimates (2006) suggested people addicted to drugs committed between a third and a half of all acquisitive crime and crimes committed by people dependent on heroin and/or crack cocaine to fund their drug use cost society an estimated £13.9 billion a year.

Treatment can help people control and, eventually, overcome their addiction, resulting in a reduction in such crimes. The Estimating the crime reduction benefits of drug treatment and recovery report (Public Health England, 2012) estimated drug treatment and recovery systems in England may have prevented approximately 4.9 million crimes in 2010/11, saving society an estimated £960 million in costs to the public, businesses, the criminal justice system and the NHS.   An evaluation by NICE in 2007 assessed the cost of cost of providing health services to someone who injects drugs costs an estimated £35,000 or more over their lifetime.

Overall, between 2002/3 and 2012/13 admissions decreased by 15 per cent (1142) from 7,691 to 6,549.  In 2014-15 there were 6,646 hospital admissions with a primary diagnosis of mental or behavioural disorder due to opioids, cannabinoids, sedatives, cocaine, stimulants, hallucinogens and other psychoactive substances of which 71% were emergency admissions compared to 7,432 (73%) in 2013-14

Want to know more?

2010 to 2015 government policy: drug misuse and dependency (Home Office, 2015) - sets out government agenda to reduce the number of people misusing illegal drugs and other harmful drugs and increase the number of people who successfully recover from dependence on these drugs. Includes policy on restricting the supply of drugs and identify and prosecute those involved in the drug trade.  Progress against the strategy outcomes is set out in the Drug strategy review 2013.

Adults Drug and Alcohol Health Needs Assessment (Berkshire Public Health Team, 2015) - identified treatment demand and service provision for substance misuse which draws upon comparisons between local authorities (LAs) across Berkshire to support service commissioning.

Drug misuse and dependency (Home Office) – Portal area for all government guidance, policy, advice, and data relating to drug misuse.

Drug misuse in over 16s: psychosocial interventions (NICE, 2007) -  guidance on support and treatment people can expect to be offered if they have a problem with or are dependent on opioids, stimulants or cannabis and how families and carers may be able to support a person with a drug problem and get help for themselves.

Drug Misuse and Dependence: UK Guidelines on Clinical Management (Department of Health, 2007) –  updates and replaces Drug Misuse and Dependence – Guidelines on Clinical Management (UK health departments 1999) and provides guidance on the treatment of drug misuse in the UK based on evidence and professional consensus on how to provide drug treatment for patients.

Drug misuse statistics (Home Office, 2016) - facts and figures on extent and trends in illicit drug use among samples of 16 to 59 year olds.

Drug Strategy 2010 Evaluation Framework – evaluating costs and benefits (HM Government, 2013) – a framework for evaluating early interventions to prevent future adverse outcomes, education and information approaches to increase awareness of the dangers associated with drugs, treatment, rehabilitative activity and enforcement.

Families and carers of people with drug use disorders are often in need of support for themselves. An assessment is important to identify their needs and determine appropriate interventions for those needs that are unmet and the 2014 NICE quality standard sets out the rationale for assessing and improving carers’ personal, social and mental health needs.

New Psychoactive Substances in England: A review of the evidence (Home Office, 2014) – sets out evidence on prevalence, motivation, demand, supply and harm caused by NPS. It also supported by a resource pack for  informal educators and practitioners.

Substance misuse interventions for vulnerable under 25s (NICE, 2007) – guidance for anyone involved in reducing substance misuse among vulnerable and disadvantaged children and young people under the age of 25. With a focuses on community-based activities taking place in, for example, schools and youth services, recommendations cover strategy development, identifying children and young people who are existing users or at high risk, whole family and holistic support approaches to support, referring and signposting and interview techniques. Guidance is also supported by a 2014 Evidence update.

Tackling drug use (NICE, 2014) - recommendations for local authorities and partner organisations on tackling drug use. Includes preventing drug use, minimising the harm caused by drugs and helping people to stop taking them. It is particularly relevant to health and wellbeing boards, police and crime commissioners and community safety partnerships.

 

This page was created on 27 February 2014 and updated on 22 June 2016.  Next review date July 2016.

Cite this page:

Bracknell Forest Council. (2016). JSNA – Adult drug misuse. Available at: http://jsna.bracknell-forest.gov.uk/living-working-well/healthy-lifestyl... (Accessed: dd Mmmm yyyy)

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