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Adult Drug Misuse Kerry Anderson – Modernisation Manager, Public Health 23/05/2017 Presentation name 1 Overview • National & local drivers • Local needs – demographics – prevalence • Considerations/complexities • Why the investment? • Treatment model • Challenges/issues 2 23/05/2017 Presentation name 2 5/23/2017 National & Local Drivers Drug Strategy 2010 Outcomes expected from drug treatment: • • • • • • • • Freedom from dependence on drugs or alcohol Prevention of drug-related deaths and blood borne viruses A reduction in crime and re-offending Sustained employment The ability to access and sustain suitable accommodation Improvement in mental and physical health and wellbeing Improved relationships with family members, partners and friends The capacity to be an effective and caring parent 3 23/05/2017 Presentation name 3 National & Local Drivers PH Outcomes Framework Indicator 2:15 “Number of drug users that left drug treatment successfully (free of drugs of dependence) who then do not re-present to treatment again within 6 months as a proportion to the total numbers in treatment” (Performance linked to PH Grant) Joint Health & Wellbeing Strategy 2012-2018 “Improve our drug treatment system to increase the number of people who move out drug free” 4 23/05/2017 Presentation name 4 Drug Treatment Profile • • • • • • • • • • 1364 adults in drug treatment 1128 are Opiate users 236 are non opiate users 1277 adults in effective treatment 1072 opiate (-3%) 205 non opiate (-12.4%) Male - 73% Female - 27% 2% BME 17 ex armed services 78% of those that have injected have been tested for Hep C 5 23/05/2017 Presentation name 5 Drug Treatment – Demographics - AGE Age of service users in treatment (age at mid-year) annual comparison 2008/09 2009/10 35% 2010/11 2011/12 30% 2012/13 Q2 13/14 25% 20% 15% 10% 5% 0% Under 20 20 – 24 6 23/05/2017 25 – 29 30 – 34 35 – 39 40 – 44 Presentation name 45 – 49 50 – 54 55 – 59 6 60 – 64 65+ 5/23/2017 Drug Types – Primary Substance Primary Substances 1000 Q2 2011 900 Q2 2012 800 Q2 2013 700 600 500 400 300 200 100 0 7 23/05/2017 Presentation name 7 5/23/2017 Drug Types – Secondary Substance Secondary Substances 200 Q2 2011 180 Q2 2012 160 Q2 2013 140 120 100 80 60 40 20 0 8 23/05/2017 Presentation name 8 5/23/2017 New Treatment Journeys – Oct 2012 to Sept 2013 • In Sept 2013, we had 409 new treatment journeys in previous 12 months (up 3.2% from 2012/13). • 52 of these completed treatment successfully within 12 weeks • 20% of these were currently injecting on treatment entry • 26% had injected previously • 26 (11%) had a dual diagnosis. • 39 (16%) had some housing problems • 69% of clients were unemployed at the start of treatment (down from 83% 2012/13) 9 23/05/2017 Presentation name 9 5/23/2017 RECOVERY COMMUNITY (DRUG & TREATMENT FREE) Rehab Prison PHARMACOLOGICAL PSYCHO-SOCIAL INTERVENTIONS Disengage Assessment of Need / Recovery Planning Assertive Outreach (where needed) Criminal 23/05/2017 Justice Harm Self Presentation nameReduction Other E.g. 10Rehab RECOVERY SUPPORT AFTERCARE Drug Treatment Profile - complexities • • • • • • • • Dual diagnosis – 58 diagnosed with drug and MH issues 554 living with children of which 505 are opiate users 4 out of 59 new female presentations (YTD) pregnant 65% are poly drug users 351 offenders via CJ (25%) 80% entering treatment unemployed - 33% on JSA 40% completing treatment working In treatment more than 4 years - 51.6% opiate users, 2.4% non opiate • Average time in treatment opiate users 5.1 years; Non opiate 0.6 years 11 23/05/2017 Presentation name 11 Drug Treatment - Complexity 12 23/05/2017 Presentation name 12 5/23/2017 Performance against PHOF Opiate clients Baseline 2010 Latest Local (%) 3.9% 5.1% Completed and did not re-present (n) 47/1213 57/1125 England (%) 6.6% 8.1% 40.1% 42.0% Completed and did not re-present (n) 79/197 105/250 England (%) 37.5% 40.1% Non-opiate clients Local (%) 13 23/05/2017 Presentation name 13 Performance – re-presentations Opiate clients Baseline period Latest period Local (%) 13.2% 16.7% Clients representing/total completions (n) 5/38 4/24 8.2% 2.0% 5/61 1/50 Non-opiate clients Local (%) Clients representing/total completions (n) 14 23/05/2017 Presentation name 14 Invest in drug treatment – Why? • Addiction goes hand in hand with poor health, homelessness, family breakdown, offending • Parental substance misuse - safeguarding • Level of Heroin use in Stockton is higher than Blackburn, Coventry, Southampton, Sunderland & Wolverhampton • Average addict not in treatment commits crime costing average £26,074 per year • Drug misuse causes premature death and disease – Hep B & C; HIV • Drug treatment improves health and reduces drug related deaths – low rates of HIV and Hep C in injectors compared to other European countries • Treatment is cost effective and brings major health savings (NICE) • Improves other outcomes – reduces reoffending, prevents emergency admissions, improves wellbeing, cuts homelessness, safer communities • Every £1 spent on drug treatment saves £2.50 costs to society 15 23/05/2017 Presentation name 15 Investment Locally • PH Grant adult drugs recurrent = £3,746m • PCC = £170k from previous DIP grant of £593k • Commissioned drug treatment service provision £1.9m – a. b. c. d. Birchtree Practice CRI Recovery Service GP enhanced services Specialist Family & Carer Support Service • Recent procurement of services for drug misuse made cost savings of £177,737 per annum 16 23/05/2017 Presentation name 16 Challenges/Issues • • • • • • • • • • Maintain a recovery oriented focus – “Medications in Recovery” Poly drug use and increased alcohol use NDTMS Core Data Set J Early identification and early intervention Identification of treatment naïve Future of arrest referral Future of IOM Development of enhanced GP services for drug misuse Addressing wider health and social care issues – access to GP, sexual health, contraception, safeguarding of children, family focus Emerging drug trends – prescription meds 17 23/05/2017 Presentation name 17