YP specialist treatment services in crisis?

Wed 12th December 2018 |

The Office for National Statistics recently published their annual report on young people (aged under 18 years) in drug and alcohol treatment This release covers the 2017/18 financial year and highlights the concerns felt within the YP treatment sector for some time.

Less accessing treatment? Does this reflect the need?

During the 2017/18 period there were 15,583 young people in specialist substance misuse services. This deomonstrates a 5% decrease from 2016-17 (16,436) and a continuation of a year on year downward trend. There has been a 35% decrease since a peak in 2008-09 when 24,053 young people received treatment.

A number of contributors which have potentially influenced this downward trajectory include the possibility that it reflected the declining prevalence that has been the celebrated and accepted narrative for a number of years.

The point of contention that challenges this often accepted line, is that there is emerging evidence that the number of young people using drugs is increasing. For the first time the ONS accept this within the document by including the important linethe more recent decreases in young people accessing treatment services may not reflect the actual need”.

Nearly a fifth (18%) of pupils said that they had taken drugs in the last year according to the latest NHS Digital survey of school age children conducted in 2016. With the exception of  nitrous oxide (newly added to the drug prevalence measure in 2016) and NPS, 15% of young people said they had taken drugs in the last year, this was an increase from 10% in 2014.

Another source also showed an increase in any class A drug use in the last year among 16-24 year olds, going from 6.8% in 2007-08 to 8.4% in 2017-18. This data was collected by the self reported Crime Survey for England and Wales 2017-18.

Finally, the Department for Education data for 2016-173 demonstrates that school exclusions where alcohol and drug  use is a factor has increased greatly within recent years. Fixed term exclusions have increased  34% since 2012-13 while permanent exclusions have increased by 95% since 2010-11.

What drugs?

Unsurprisingly, Cannabis remained the most common drug by far that young people came to treatment for with the majority (88%) of young people in specialist services reporting that they had an issue with this drug.  Although total numbers have decreased slightly in recent years, the proportion of young people in treatment who have cannabis problems has remained stable in the last 2 years at 77%.

The next most commonly reported problematic substance was alcohol. There were 7,206 young people in treatment for alcohol problems (46%). The number of young people receiving help for alcohol problems continues to steadily decline from the peak in 2008-09 when 16,047 were treated for alcohol.

The number of young people entering treatment for problems with ecstasy in 2017-18 increased by 16% from the previous year (1,815 to 2,112) and has almost doubled since 2013-14. The increase in ecstasy treatment numbers was seen across all age groups.

There was also an 18% increase in young people in treatment for crack problems over the same period, although the numbers were much lower (83 in 2016-17 and 98 in 2017-18).

Benzodiazepine treatment is reported for the first time in this report. Young people who had problems with benzodiazepines at the start of treatment almost doubled from the previous year (161 in 2016-17 and 315 in 2017-18). Alprazolam (most commonly called Xanax) was the benzodiazepine which saw the biggest increase, (8 in 2016-17 to 53 in 2017-18).

Young people entering treatment for problems with new psychoactive substances (NPS) more than halved since the previous year (585 in 2016-17 and 270 in 2017-18) and is 74% lower than 2015-16 when 1,056 reported problematic use. Similar falls were seen in adults starting treatment over the same period, particularly in those under 25. This fall coincides with NPS being made illegal.

Which young people seek help?

Age & gender

Two-thirds of the young people accessing specialist substance misuse services were male (66%). Around three-quarters (74%) were aged 15 or over. The median age for both female and male was 15 years old. Only 43% of females were aged 16 or over compared to nearly half (49%) of males.

While the number of younger children (under 14) in treatment remains relatively low, it has increased from last year (1,342 in 2016-17 to 1,422 in 2017-18).

Any substance misuse among young people – particularly the younger age groups – is concerning because they are likely to be at risk of other harms as well as their alcohol or drug use. Safeguarding needs to be a priority and the other risks and harms need to be addressed.

Ethnicity

The majority of young people (76%) in treatment services were white British. This is similar to the general population, where 78% of young people aged 10 to 17 were white British according to the 2011 census. For the remaining clients, 4% were other white and 3% were white and black Caribbean or Caribbean. No more than 2% reported any other ethnic group.

Referral route

Education services was the most common route into specialist treatment services, with 5,178 (31%) young people being referred from these. Mainstream education was the single largest source of referral, accounting for over a quarter of all referrals (26%, or 4,432). The proportion referred by education services has increased over recent years (24% in 2012-13), while referrals from the youth justice system continue to decline (34% in 2012-13 to 22% in 2017-18).

Vulnerabilities

The majority of young people in specialist substance misuse services have other problems or vulnerabilities related to their substance use, the table below shows the range of vulnerabilities identified among young people starting treatment last year.

Conclusion

It is dispiriting to cover yet another report in the social care sphere where the most obvious conclusion is that the public spending cuts associated with austerity have resulted in vulnerable people no longer able to access the services they need. How else can we explain an increase in the number of young people using drugs alongside a decrease in the number seeking help?

There is a double danger here in that with young people unable to receive prompt help for their drug and alcohol problems, the extent of need is under-estimated, potentially making further cuts and reductions in treatment capacity possible in future years.

© Russell Webster

Wed 12th December 2018

Addiction Services are in Crisis

Mon 17th September 2018 |

There has never been a more worrying time within the substance misuse sector. Deaths from drug misuse in England are at the highest level since records began, whilst deaths relating to alcohol consumption are 10% higher than a decade ago. Services are facing a further £34million in reduced funding (on top of  wider cuts to public health worth £800m by 2020/21), while pay plummets and the workforce is struggling to retain highly skilled practitioners that are vital to ensure that organisational memory, skills and competencies survive. The Advisory Council on the Misuse of Drugs described this workforce crisis as “one of the most significant barriers to recovery outcomes.”

New research which finds that the number of people suffering from alcohol addiction has increased over 600,000 while the numbers  receiving treatment in 2016/17 was the lowest level since 2008/09.

  • 97 local authorities are planning on cutting treatment services for drug misuse in adults, whilst 87 local authorities are set to cut adult treatment services for alcohol misuse.
  • 80 councils have budgeted to cut specialist drug and alcohol misuse services for children and young people totalling over £7million.

We should be concerned that this attack on the sector ultimately means a continued funding reduction and will result in the destruction of a once pioneering drug treatment system that has brought huge improvement to the lives of people with drug and alcohol problems.

If resources are spread too thinly, the effectiveness of drug treatment will suffer, which could lead to increased levels of blood-borne viruses, drug-related deaths and drug-driven crime in communities.

The reality of Tory led austerity can no longer be absorbed by well meaning providers and we are seeing the cutting of treatment services for some of the most vulnerable in our society.

The below points demonstrate a need for reinvestment and development of the sector;

  1. We are seeing the highest levels of drug related deaths since records began – in 2017 this numbered 3,756 deaths.
  2. Recovery rates are dropping for opiate users. In 2011/12 treatment completion was 8.59%; in the year ending November 2017, the recovery rate was 6.7% (NDTMS data). This is despite a narrative in procurement exercises that service redesign has resulted in improved outcomes for service users.
  3. The CQC’s recent review of non NHS residential in-patient detox facilities was shocking: 63% of services assessed as not meeting the regulation on ‘safe care and treatment’ (CQC).
  4. Drug use most prevalent in 16-25s (using a wider range of drugs than the over 25s/more poly use) yet disinvestment has been felt greatest in young peoples services.

Image result for cuts to addiction services

Mon 17th September 2018

Deaths related to drug poisoning in England and Wales: 2017 registrations

Tue 7th August 2018 |

ONS: Deaths related to drug poisoning in England and Wales

Yesterday’s statistics, published by the Office for National Statistics (ONS), show that 3,756 people died from drug related causes in England and Wales in 2017.

  • Deaths related to cocaine have increased for the sixth consecutive year
  • Deaths related to fentanyl have increased by 29%
  • Deaths involving heroin declined slightly for the first time since 2012

In the UK, deaths from drugs overtook road traffic accidents as a leading cause of death in 2008, and since 2012 they have risen sharply.

Main points

  • There were 3,756 deaths relating to drug poisoning in England and Wales in 2017, a rate of 66.1 deaths per 1 million population, and similar to levels seen in 2016.
  • Two-thirds of drug-related deaths were related to drug misuse, accounting for 43.7 deaths per 1 million in 2017.
  • Males’ mortality rate decreased from 91.4 deaths per 1 million population in 2016 to 89.6 in 2017, while the female rate increased for the eighth consecutive year to 42.9 deaths per 1 million population; neither changes were significant.
  • The North East had a significantly higher rate of deaths relating to drug-misuse than all other English regions; London had a significantly lower rate.
  • Deaths involving cocaine and fentanyl continued to rise while deaths related to new psychoactive substances halved in 2017.

 

The full statistical release can be found here: ONS – DRD-2017

Tue 7th August 2018

National Statistics on illicit drug use in England and Wales

Wed 1st August 2018 |

The latest National Statistics on illicit drug use in England and Wales were released last Thursday (26 July 2018) by the Home Office and Office for National Statistics, based on self reported responses from the 2017/18 Crime Survey for England and Wales (CSEW).

To add some useful context it’s important to remember that the CSEW figures are a often only a measure of ‘mainstream recreational’ drug use, rather than problematic and dependent use. For a more accurate view of this use the NDTMS treatment service collection will provide a more focused and useful data set.

The CSEW is a household survey and as a result does not include those who are homeless or in prison.

However; even with these often cited limitations the CSEW drug module has been operating since 1996 and as a result provides an excellent and consistent longitudinal comparison of drug use over 22 years.

Key findings

  • Around 1 in 11 (9.0%) adults aged 16 to 59 had taken a drug in the last year. This equated to around 3.0 million people, and was similar to 2016/17 (8.5%). The trend in last year drug use among 16 to 59 year olds has been relatively flat since the 2009/10 survey and the latest estimate was similar to the 2007/08 survey (9.4%). However, the 2017/18 prevalence estimate is lower than in 1996 (11.1%), when the time series began.

 

  • Around 1 in 5 (19.8%) adults aged 16 to 24 had taken a drug in the last year. This proportion was more than double that of the wider age group, and equates to around 1.2 million people. This was similar to the 2016/17 survey (19.2%), but there was a decrease from 1996 (29.7%). There was no significant change compared with a decade ago (21.4% in 2007/08 CSEW).

 

  • Around 1 in 23 (4.3%) adults aged 16 to 59 had taken a drug in the last month, while around 1 in 11 (9.5%) young adults aged 16 to 24 had done so. There was no significant change compared with the 2016/17 survey. However, both have decreased compared with a decade ago, where 5.4 per cent of 16 to 59 year olds reported taking a drug in the last month and 12.5 per cent of 16 to 24 year olds had done so.

 

  • Around one-third (34.6%) of adults aged 16 to 59 had taken drugs at some point during their lifetime. There has been a decrease in levels of lifetime use estimated by the 2017/18 survey compared with a decade ago (36.0% in the 2007/08 CSEW), but this remains higher than the 1996 survey (30.4%).

 

  • Around 1 in 29 (3.5%) of adults aged 16 to 59 had taken a Class A drug in the last year, equivalent to around 1.1 million people. This has increased compared with the previous year and a decade ago (2007/08; both 3.0%). Among young adults aged 16 to 24, 8.4 per cent had taken a Class A drug in the last year. This has increased compared with the 2007/08 CSEW (6.8%), but there was no significant change compared with the 2016/17 survey (7.0%).

 

  • Class A drug use among 16 to 24 year olds has been increasing since 2011/12: While not statistically significant from year to year, there is an upward trend apparent in the use of Class A drugs, particularly among 16 to 24 year olds. Although there was no significant change from the 2016/17 estimate among this age group, there was an increase from the 2011/12 estimate (6.2% to 8.4%). This is mainly driven by an increase in powder cocaine and ecstasy use.

 

 

Wed 1st August 2018

Homeless adults with complex needs: evidence review

Sun 11th February 2018 |

Last Friday Public Health England released their evidence review around ‘Homeless adults with complex needs’

The review is an overview of the homeless situation across England and aims to provide a perspective around the up to date evidence base and to support action to prevent and reduce homelessness.

The document is a really useful wide angle view of the current issue and examines key themes such as;

  • Definitions of homelessness
  • National profile of people who street beg and/or street sleep
  • What factors may be driving increases in homelessness?
  • Why do people street beg and/or street sleep?

More importantly the document reviews what works to prevent/ reduce street begging and rough sleeping and examines a matter close to our hearts here at Higher Learning; the impact of enforcement on street begging/street sleeping.

The review does not claim to be the definitive catch all guide to end homelessness but instead acts as a really useful first point of call and sense checking document (particularly for local authorities).

It unsurprisingly points to integrated and multi-agency working as a vital component to tackling the issue and advises that the most effective approach is for services to work together to provide support and seamless transitions for those leaving prisons and acute settings with the aim of  preventing those with vulnerabilities falling through the gaps and into rough sleeping. None of this is groundbreaking innovation and for those of us with a long enough memory and who can remember the halcyon days of functional prisons and probation services, properly funded substance misuse services with prison liaison workers and designated vulnerable peoples teams it will all sound fairly familiar.

Thankfully it also finds (and recommends) that prevention in all its forms (and not enforcement!) is essential – and that focusing on the individual at the point of homelessness is often too late.

The review captures the voice of many out in the front line and their evident frustrations, particularly around enforcement actions such as Public Space Protection Orders (PSPOs);

“PSPOs don’t alleviate hardship on any level. They are blunt instruments which fast-track so-called ‘offenders’ into the criminal justice system…handing hefty fines to homeless people … is obviously absurd, counterproductive and downright cruel”

It is made clear that the using of punitive powers only further serves to marginalise and criminalise the homeless and that there is no evidence hat banning people from geographical areas or fining individuals in any way solves the underlying issues that lead to and contribute homelessness or ‘street begging’.

The paper also states that vulnerable individuals are pushed further away from the services they need by PSPOs and describe enforcement as a ‘high risk strategy’ for those who were least likely to respond i.e those involved in substance misuse, a long history of street living, mental health and crime. Essentially the bulk of the cohort.

The full document can be found HERE

 

 

 

Sun 11th February 2018

Statistics on Drug Misuse: England, 2018

Thu 8th February 2018 |

The data contained within ‘Statistics on Drug Misuse: England, 2018’ is largely made up of data that has previously been published such as the Crime Survey, Office for National Statistics, deaths related to drug poisoning, National Drug Treatment Monitoring System (NDTMS) data, Adult Psychiatric Morbidity Survey (APMS) and the school based Smoking, Drinking and Drug use.

However; there is some newer additional data from Hospital Episode Statistics (HES) relating to drug-related hospital admissions.

Of particular interest are the hospital admissions with a primary diagnosis of drug-related mental and behavioural disorders which are reported as down 12% from 2015-16 (but still 12% higher than 2006-07). When you add secondary diagnosis to the statistics you get 82,134 admissions which is a similar number to the previous period of 2015-16 but this is still more than double the number captured in 2006-07

Hospital admissions with a primary diagnosis of poisoning by illicit drugs were 7% lower than 2015-16 but were 40% higher than those in 2006-07.

As we are all aware drug-related deaths are the highest since records began and we must focus all of our efforts to prioritise and address this issue. It is widely acknowledged that to reduce the numbers of drug-related deaths services must prioritise the engagement and retention of more individuals in quality treatment as half of the people who die each year are not in treatment. Perhaps services need to reflect on what the offer for those not yet ready to engage in the utopia of long term recovery is and make committing to treatment a worthwhile and suitable endeavour.

The distribution of Naloxone needs to be improved as evidenced by the recent national survey conducted by Release that highlighted that only an average of 12 take-home naloxone kits were given out for every 100 people using opiates – equivalent to just 12% coverage; the evidence is clear that naloxone saves lives by reversing the effects of an overdose and increased provision of take-home naloxone kits, especially for those at risk of greater of harm i.e prison leavers.

In 2017 the UK made up 31% of European drug related deaths. With further reductions to the public health grant and local authority budgets the treatment system looks to be in further peril of catastrophic and life threatening budget cuts.

Another point of note within the statistical release was around young people. The report highlights that in 2016, 24% of pupils reported they had ever taken drugs. Compared to 15% in 2014.

The likelihood of having ever taken drugs increased with age, from 11% of 11 year olds to 37 per cent of 15 year olds.

We can most likely attribute this rise to the inclusion of a question about nitrous oxide within the most recent school survey on smoking, drinking and drug use. However, and as the report highlights “this still represents a large increase which has not been observed in other data sources. Therefore an estimate from the next survey in 2018 is required before we can be confident that these survey results reflect a genuine trend in the wider population”.

The full release can be viewed here: http://digital.nhs.uk/catalogue/PUB30210

 

Thu 8th February 2018

Homelessness set to surge

Sun 4th February 2018 |

Recently released figures show that for the seventh consecutive year the numbers or rough sleepers in England has once again risen, and the grim reality is that this current data most likely does not show the true level of street homeless on our streets today.

These figures make depressing reading, and only account for the individuals sleeping rough for one night and it is estimated that there are thousands more who are ‘hidden’ and not captured within these official statistics; young people for example, sofa-surfing, sleeping on public transport or staying wherever they can to avoid sleeping on the streets.

The “Rough Sleeping Statistics Autumn 2017, England” published by the Ministry of Housing, Communities and Local Government back last month show that an estimated 4,751 people slept outside overnight in 2017. This is an  15% increase on the previous years statistics and are up 169% since 2010.

The reasons behind this sharp increase are complex and while they cannot be attributed to one single cause we cannot ignore the actions and policy of the current government who’s austerity driven manifesto has reduced local authority funding, failed to investment in affordable homes and made cuts to housing benefit that can only be seen as a huge contributor to what we are all too regularly seeing in towns and cities across the country.

Reductions to the public health grant has also led to huge disinvestment and reduced funding for substance misuse, mental health, school nursing, health visiting and other services aimed at reducing inequalities and preventing ill health.

Homeless charity Crisis have issued a warning about the consequences of failing to address the issues at the root of the problem.

Their recently released report predicts that the core homeless population (now at 236,000 people) is set to increase by more than a quarter over the next ten years, with those sleeping rough in the United Kingdom due to swell by 76 per cent should current harmful policies not be halted.

 

Sun 4th February 2018

Preventing Prevention?

Thu 31st August 2017 |

Following the release of the 2017 UK drug strategy there was much criticism of the lack of bravery or willingness on behalf of the Conservative Government to try any more sensible, evidence based or honest approaches to tackling the issues associated with problematic drug use. As gnarly old public health practitioner and former substance misuse worker with a background in both adult and under 18’s services it was no great surprise that the strategy only gave the most tertiary and fleeting mention to young people; after all; we are used to being an afterthought despite it being my longstanding belief that the spend is weighted the wrong way round and much greater gains would be made by spending the bulk of drug budgets on young peoples services. Recreational and non-problematic drug use is also given little attention and the one mention of ‘harm reduction’ is used in relation to the use of tobacco. It would appear that ‘recovery’ is still the one and only goal despite the alarming (yet predictable) increase in drug related death rates published just last month.

The one welcome addition to the strategy was the reference to a commitment around a preventative approach across the life course that utilises the Healthy Child Programme as a framework for delivery. The funding of Mentor-Adepis as a source of evidence-based information and tools for alcohol and drug education and prevention for schools is to be celebrated as for those of us who have worked with schools around substance misuse education and prevention have all too often seen the delivery of the ‘scare tactics’ and potentially harmful programmes that the 2017 strategy makes reference to and seeks to guide education settings away from.

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Thu 31st August 2017