Download Marion Lyons and Josie Smith - All Wales Sexual Health Network

Sex, drugs and alcohol –
impact on health services
Dr Marion Lyons
Josie Smith
NPHS
Consequences of alcohol misuse
• key factors associated with young people committing offences
• more specifically, drinking by young people is associated with
violence
• young people who drink are significantly more likely to take drugs of
all kinds than young people who do not drink.
• Among 15-year-olds who first drank alcohol at 10 years or
younger,17% had taken Class A drugs at the age of 14, compared
with 2 % of those who first drank when they were 14 years or older
• teenagers are significantly less likely to use contraception when
drunk and, therefore, risk pregnancy or sexually transmitted
infections.
• Also much more likely to regret having sex in the first place
Consequences of sex
• Not all negative!
• What can be painful:
–
–
–
–
–
–
–
–
Acute infection
Long term sequelae
Inability to conceive
Inability to maintain relationships
Unwanted pregnancy
Ectopic pregnancy
Chronic disease
Sexual assault / rape
Consequences of drug use
• Not all negative!
• Depends on type of drugs (stimulants, depressants, legal
and illegal) and how they are taken
• Use of alcohol in combination with drugs (e.g. benzodiazepine)
• Range of consequences dependent on level of drug use
– Disorientation / Disinhibition – sexual contact
– Drug/drink driving
– Dependence – harms inc physical, psychological
– Chronic – including non-fatal overdose, infection with
blood borne viruses
Healthcare implications of clubbing
– sex, drugs and alcohol
• Physical assault – lacerations most
common injury
• Alcohol intoxication
• Drug overdoses
• Sexual assault
Alcohol – impact on health services
•Over 15,000 referrals to alcohol treatment services in 2007/08,
representing 0.5% of total population of Wales. 31% were under 30
years old, 1.8% were under 15 years
•Strong association between alcohol consumption and accidents
•Hospital admission for alcohol related liver disease rose by over
25% from 2000-2006
Hospital discharges with an alcohol related diagnosis in Males and Females
aged under 15 and 15-19 years 2000 – 2007
600
500
Male under 15
years
400
Female under 15
years
300
Male 15 - 19
years old
200
Female 15 - 19
years old
100
0
2000
2001
2002
2003
2004
2005
2006
2007
Alcohol – impact on health services
1200
Number of hospital admissions
Alcoholic
hepatitis
1000
Alcoholic
cirrhosis of
liver
800
Alcoholic
hepatic failure
600
400
Alcoholic
liver disease,
unspecified
200
Total hospital
admissions
for alcohol
liver disease
0
1999/00
2000/01
2001/02
2002/03
2003/04
2004/05
2005/06
Sex – impact on health services
• Pregnancy:
3500
Number of conceptions and abortions in young women aged under 18
1998 - 2006
Number of cases
3000
Number of
teenage
pregnancies
2500
2000
Number of
abortions
1500
1000
500
0
1998
1999
2000
2001
2002
2003
2004
2005
2006
• Maternal alcohol consumption during pregnancy appears to be
associated with conduct problems in children, independent of
other risk factors
• Methadone does not damage the unborn child, but the baby may
experience withdrawals – impact on health services
Sex – impact on health services
• Sexually Transmitted Infections
Incidence and rates of chlamydia in Wales: 1991-2007
Sex – impact on health services
Incidence and rates of gonorrhoea in Wales: 1991-2007
Sex – impact on health services
Cases and rates of infectious syphilis (primary and
secondary stages only) in Wales: 1995-2007
Drugs – impact on health services
• During 2007/08 there were 12,443 referrals to services in Wales for
problematic drug use
• 48.7% (n=6064) of these referrals were for heroin use
• Increased numbers accessing mental health services for stimulant
related psychosis, reported increases in diagnoses of schizophrenia
related to drug use
• Widespread use of steroids and performance and image enhancing
drugs (PIEDS) – impact on health of heavy end users (e.g. heart,
liver function)
• Poly-drug use – NPHS research indicates that the vast majority of
problematic substance misusers use more than one substance over
a given period, with related health implications, and this pattern may
change over time.
Drugs - Impact on health services
Injecting drug users
• estimated to be just under 20,000 problematic drug users in Wales,
of which at least 8,000 are IDUs
• IDUs are at increased risk of infection with both blood borne viral
and bacterial infections
• 42% of IDUs in Wales report having experienced at least one nonfatal overdose
• One third of IDUs in Wales report experiencing recent injectingassociated health problems such as abscesses, deep vein
thromboses and septicaemia
• There are both direct and indirect non-fatal overdose-related
morbidities, including those associated with falling, assaults while
unconscious, peripheral neuropathy and chest infections.
Ambulance call-out and hospital treatment is regularly required in
these cases
Ambulance statistics
Figures from Central and
West regional ambulance
service:
Figure 1 – incidents of
ambulance attendance for
2006/07 by drug.
Complaint at the time of
call was Cardiac Arrest,
Overdose, Poisoning or
Psychiatric/Suicide
Key word
Number of cases
Dead on arrival Heroin
2
Other
20
Cocaine
13
Heroin
122
Drugs
166
Alcohol related
972
Total Number of Arrivals at Scene
7621
Figure 2 - Age range for
cases with keyword
“Heroin”. During 2006/07
30.33% of patients were
aged between 19 and 25
years of age, and a further
20.49% of these cases
were aged between 15
and 18 years of age and
74.6% were Male.
Age Group
15-18
19-25
26-30
31-35
36-40
41-45
46-50
U
Grand Total
Total
25
37
29
9
8
7
2
5
122
% of Total Number
of Arrivals at Scene
0.03%
0.26%
0.17%
1.60%
2.18%
12.75%
100.00%
% of Total Activity
20.49%
30.33%
23.77%
7.38%
6.56%
5.74%
1.64%
4.10%
100.0%
Drug and alcohol related death
Alcohol related deaths 1996 - 2006
Drug related deaths 2000 - 2006
500
120
400
350
300
Male
250
Female
Total
200
150
100
Number of drug related deaths
Number of alcohol related deaths
450
100
80
Male
60
Female
Total
40
20
50
0
0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
2000
2001
2002
2003
2004
2005
2006