Alcohol
There are particular emerging challenges both nationally and locally.
Liver disease kills more people than diabetes or many other conditions such as:
- heart disease
- Cancer
- Stoke/Brian trauma
and kills more people than diabetes and road deaths combined, but is largely preventable.
While about five per cent of liver disease is attributable to autoimmune disorders, most liver disease is due to three main risk factors: alcohol, obesity and viral hepatitis. But most people at risk of developing serious liver disease, or who have early liver damage, are not aware of this.
Alcohol-related liver disease deaths in Britain have increased more than four fold since 1970. In 2010-12, 7.5 people in every 100,000 died early from alcohol-related liver disease, which was about 922 deaths.
Alcohol habits across Bournemouth, Poole and Dorset:
- 14% do not drink alcohol
- 63% drink at low risk levels
- 17% drink at risky levels
- 6% drink at very risky levels
Across Bournemouth, Poole and Dorset about 6% of people aged 16 or over are drinking at higher risk levels; a total of over 37,000 people. Encouraging everyone who drinks in the area to do so in a safe and social way is a significant challenge.
Drinking patterns are different across Bournemouth, Poole and Dorset and research has shown that the harm from drinking is not evenly distributed across the population, and is closely tied to other factors of health and social inequality.
Any action we take locally will need to be targeted to make sure that services are accessible to, and used by, those who need them the most, and looks at the needs of the whole person, not simply their alcohol use in isolation.
In Bournemouth, Poole and Dorset nearly twice as many men are admitted to hospital with an alcohol related condition than women.
Local data that allows us to split our population into groups with similar characteristics based on where they live, along with government and commercial information, suggests that:
- levels of drinking among young people have dropped over the past 10 years, but some areas locally have relatively high levels of use compared to the England average
- people who are older and economically well off tend to drink the most in our society; but this group also has the overall best health outcomes. They are also less likely to access the local commissioned drug and alcohol treatment services
- although as a group they drink less, all age groups in areas of social and economic deprivation have a greater complexity of need and are much more likely to use services. People in the most deprived 20% of the population are 4.9 times more likely to die from alcohol-related liver disease than those in the least deprived 20%
For every two people in the most affluent areas that die of an alcohol related condition, three people in the poorest areas die.
When people engage with local support services, successful outcomes of treatment are comparable to England averages.
But there are many people drinking at high risk levels who do not currently access support.
This is a challenge for areas across the country as patterns of substance use change. In 2015, more people entered local treatment services for support with their alcohol use than for any other drug.
This has changed significantly from 10 years ago when the main drug to present to services was heroin.
While this is a positive development, showing that services are responsive to changes in need, further progress can be made, including adapting service design.
Other alcohol statistics
From data In 2015 there were:
- 222 deaths due to alcohol related conditions
- 62 is the median age of death
- 96% were known to primary care
- 77% were known to secondary care
- 4 is the average admissions prior to death
- 22% were known to specialist treatment services
- younger people are more likely to engage in treatment
Heroin and crack cocaine
Although there are significant issues associated with the use of heroin and crack, most people who use illicit drugs tend not to use these substances.
National estimates suggest 8.8% of adults aged 16-59 have taken an illicit drug in last year, compared to just 0.82% of people who use opiates or crack locally.
Four years ago, just one in six opiate users had been in treatment for six years or longer.
Today, although the overall number of people accessing services has not changed, as many as one in three of these have been in treatment for 6 years or more.
These local figures reflect a national trend, and it should be acknowledged that long-term treatment can provide substantial benefits to the service user and wider community.
This development poses definite challenges for all those involved in supporting opiate users locally.
There is evidence that these long-term users, as well as having lower chances of completing treatment successfully, are likely to be facing wider health and social challenges that are not being addressed through treatment.
Almost half of injecting drug users who have Hepatitis C are unaware they are infected9 and therefore cannot access treatment for this condition, and smoking causes many more deaths among service users than heroin or alcohol.
Other established drugs
Statistics
- four years ago, 1 in 6 opiate users have been in treatment for 6 years or more
- today, 1 in 3 opiate users have been in treatment for 6 years or more
Compared to the 0.82% of people who use opiates or crack locally, national estimates suggest 8.8% of adults aged 16-59 have taken an illicit drug in last year. Although there are significant issues associated with the use of heroin and crack, most people who use illicit drugs tend not to use these substances.
The most commonly used illicit substance is cannabis, with 6.6% of adults reporting some use in the past year. There are also notable numbers of users of other substances, with 2.4% reporting use of powder cocaine and 1.6% ecstasy.
While these substances are relatively familiar to professionals and users alike, comparatively few people who use them will require treatment to manage their drug use, unlike those who use opiates.
Many individuals access support services locally. In 2014-15, 591 people reporting use of a non-opiate drug accessed a structured programme of support across Bournemouth, Poole and Dorset.
But we must ensure that all those who might benefit from support for their substance misuse can access the services they need.
Emerging substances
The number of young people taking illicit substances continues to drop, but there is some concern that individuals using emerging substances are unaware of associated risks and are not accessing the support available to them.
New psychoactive substances (NPS), over-the counter and prescription drugs, and image and performance enhancing drugs (IPEDs) have challenged established approaches to enforcement and, to a lesser extent, treatment.
New psychoactive substances, also known as ‘legal highs’, tend to mimic the effects of illegal drugs such as ecstasy, cocaine and cannabis, but many are not currently controlled under the UK’s Misuse of Drugs Act 1971.
Their effects on humans are often unknown, and there have been reports of cases causing paranoia, psychosis, seizures, hospitalisation and even death after ingestion.
These substances are generally sold online or on the high street in ‘head shops’, and there are some reports of them being sold in outlets such as newsagents, petrol stations, sex shops and market stalls.
The issues relating to both supply of and demand for these substances involve a range of partner agencies including some that have not generally dealt with drug policy in the past, such as local council regulatory services departments.
These drugs reflect a change in patterns of drug supply and use, but they are not currently used as much as alcohol, cannabis, cocaine or opiates.
Under one per cent of adults aged 16 to 59 report using NPS in the past year.
There is considerable overlap between users of NPS and more established drugs, with 83% of NPS users reporting use of an illicit substance in the past year.
Although the guidance for addressing problematic use of such substances does not differ considerably from that for more established issues, we must ensure that the support available is accessible and viewed positively by all those who could potentially benefit.
Numbers of people accessing local treatment systems for new psychoactive substances are relatively low, though there are people using such substances who do not currently access support, particularly as there are specific sub-groups where use is more common.
For example, four per cent of young men between 16 and 24 report using NPS in the past year, and HM Inspectorate of Prisons has referred to NPS use amongst prisoners as a significant growing problem.
Use of needle exchange facilities by steroid users, for example, is increasing, but these people do not currently access structured support.
The illicit trade in substances produces crime in local neighbourhoods and international organised crime with wide-reaching effects.
In a year across Bournemouth, Poole and Dorset about 1,600 recorded crimes were drug possession or supply offences, with implications for a range of public services from the police, probation services and prisons through to treatment services.
Only a small number of users with addictions to prescription drugs are accessing support services; but anecdotal evidence suggests that drugs such as oramorph – a prescribed opiate painkiller – are increasingly implicated in drug-related deaths locally.
Therefore, monitoring patterns in prescribing and harm related to these drugs remains vitally important to ensure we are providing the support that is needed.
Drug misuse features significantly in Child Sexual Exploitation (CSE) and where there are issues regarding the safeguarding of children and vulnerable adults, including incidents of domestic abuse.
National data suggest that parental drug use is a factor in 29% of all serious case reviews and alcohol is involved in half of violent assaults.
One of the priorities for this strategy is to make sure that effective pathways of treatment and evidence-based therapies are available to those adults and young people adversely affected by substance misuse.
Statistics
Of every 100 residents 16-59:
- 8.6% of people have used an illicit drug in the past year
- 6.7% of people have used cannabis in the past year
- 2.3% have used cocaine in the past year
- 1.7% have used ecstasy in the past year
- 0.9% have used NPS in the past year
