Leicester Joint Strategic Needs Assessment (JSNA). Health and social care needs associated with drug use, 2016.
Who’s at risk and why?
Drug misuse is associated with a range of psychological, physical and social issues and addressing these remain a key national and local priority.
Overall, drug use within the adult population is relatively low and illicit drug use has reduced significantly over the last 10 years. Despite this downward trend in drug use in the long term, a significant increase in 2013/14, compared to the previous year, indicates that illicit drug use continues to be a considerable national challenge.
The rates of overall drug use vary across different ethnic groups. Those from Mixed race backgrounds have the highest rates of reported drug use, followed by those from all White backgrounds. All South Asian backgrounds had the lowest rates of drug use.
Sexual orientation appears to be an important factor in drug use. Rates of overall drug use were reported to be significantly higher for those of gay/bisexual orientation than for heterosexual adults (28.4% compared to 8.1%). This was the case for both sexes, although more so for gay/bisexual men.
Frequent drug users were also twice as likely to live in the 20% most deprived output areas, than the 20% least deprived output areas.
The level of need in the population
Based on the 2013/14 British crime survey, drug prevalence rates found around 18,396 of 16-59 year-olds in Leicester took an illegal drug in the last year; it is likely that around two-thirds of these were male. Most drug use would be related to cannabis.
16-24 year-olds are more likely to have a higher rate of drug use and twice as likely to be frequent users. About 3,757 of 16-24 year-olds are likely to be ‘regular users’, which means they are using drugs at least once per month.
In Leicester, those areas with the highest presenting need to local drug services (per 1,000 head of the adult population), are also areas with high levels of deprivation including New Parks, Abbey and Eyres Monsell. However, Spinney Hills and Belgrave areas have high deprivation and low rates of presentation to drug services. These areas have large South Asian communities with a suggested, lower prevalence of drug misuse.
Leicester has a relatively high rate of opiate and crack/cocaine users (OCUs), estimated to be 12.6 per 1,000, compared to a national rate of 8.4 per 1,000. This is equivalent to 2,859 OCUs in Leicester, with 617 who are injecting drug users.
Hospital admission rates in Leicester for both poisoning and for drug related mental health problems are lower than the national rate.
There are around 1,400-1,500 people each year in Leicester’s drug treatment services and the majority of these - over 90% - are OCUs. The numbers of overall opiate users in treatment have remained consistent over the last 3 years – 1,298 (2014/15), 1,304 (2013/14) and 1,281 (2012/13).
In terms of demography for those presenting to local services, between 2010/11 and 2014/15, the male: female ratio was 76:24. White British users have remained consistently high at around 76-79%. The next largest ethnic groups are Indian at 6%, White Other at 3-4%, White/Black Caribbean at 2.5-3%, and Other Asian at 2-3%.
The proportion of White British drug users within the Criminal Justice (CJ) drug service is higher than the White British rate across all local drug services, at around 84%.
Current services in relation to need
Local authorities, in discharging their functions around public health are required to “have regard to the need to improve the take up of, and outcomes from, its drug and alcohol misuse treatment services.” Adult drug services are currently delivered by two services – LIFT, which is for those in the Criminal Justice (CJ) system including those in H.M.P. Leicester; and Leicester Recovery Partnership, which is for those not in the CJ system.
Successful completion (which mainly equates to abstinence) of treatment and non-representation (within 6 months) are key outcomes. The high level Public Health Outcomes Framework (PHOF) indicator for substance misuse, measures levels of successful completions and non-representations (PHOF indicator 2.15), aiming for increasingly high levels of individuals that successfully complete treatment and do not represent within 6 months.
Improvements in the proportion of individuals successfully completing drug treatment in Leicester occurred in 2014/15.
Peer support and mutual aid is an important ingredient of recovery, as it provides opportunities for support and the development of a user’s own capacity to provide support to others. Treatment providers have an important role to play in supporting users into recovery. Beyond the provision of clinical care and psychosocial interventions, they can work to link users to activities and networks that help to grow recovery capital; they can also provide a link to mutual aid and offer opportunities for users to become volunteers and peer mentors.
Projected services use and outcomes in 3-5 years and 5-10 years
By 2017/18 the minimum levels of treatment demand are anticipated as follows:
- Opiates - around 1,200-1,300 individuals per annum.
- Non-opiates - around 170-190 individuals per annum, with this prediction allowing for a small increase in those seeking help with non-opiates only.
However, the demand for non-opiates could be higher than this, if different pathways are developed and promoted effectively.
In addition to treatment, services are required for information and advice around substances, for the existing treatment population, but also for those who do not have a treatment need and for carers and parents.
It is anticipated that there will be 500-600 people requiring a centre-based needle exchange scheme per year – this excludes those who also access pharmacy based schemes.
Unmet needs and service gaps
According to Glasgow University estimates, only around half of OCUs may be in treatment locally. Cannabis use is more widespread than other drugs, yet few users present to services. A relatively small number of primary over the counter (OTC)/prescription drug users are in contact with services. Young adults are under-represented within services, despite their being the most regular users of illegal drugs. There may be unmet need around presenting need for drug users from Black and Minority Ethnic (BME) communities.
Recommendations for consideration by commissioners
Recommendations for commissioners include: better targeting and responsiveness of services for users facing multiple issues; promotion of services for, and engagement of, users of non-opiate substances; joint development of a recovery focused approach and support for communities engaged in such; maintaining reduction of harm as an integral aim of services; and development of a strategy to increase engagement of BME and other under represented groups such as lesbian, gay, bisexual and transgender (LGBT) communities.
- Drugs and Alcohol Joint Specific Needs Assessment
- Public health profiles
- Leicester Health and Wellbeing Survey 2015
- Support pack for drug and alcohol abuse