Substance Misuse and Illegal Drugs

Key Facts

Illicit drug use is responsible for a great deal of ill health and harm in society. Not only do drug users place their own health at risk, but the activities associated with their drug use can cause widespread distress to others. A high proportion of acquisitive crime is believed to be driven by the need to fund drug purchase and criminality around drug distribution harms communities. Drug use and dealing also exacerbates health inequalities since often the communities most affected by drug activities are those with the fewest resources.

It is not too difficult to obtain information on those drug users who are in treatment or in contact with services, but information on those not in contact with services can only be obtained from surveys and drug users may be difficult to reach. Drug services send an anonymised report on service users and these reports are collated by the drugs database and forwarded to the National Treatment agency.

Problematic Drug Users

Image of needle

Most of the harm from illegal drugs is caused by and to the group of users commonly classified as 'problematic drug users'. These are users who are often dependent on Class A drugs, who live extremely chaotic lives with high levels of risk to their health and that of others, and who are often involved in crime to fund their addiction.

Heavy problematic drug users are at risk of immediate drug-related death caused by the drug itself, or resultant health problems from infections such as Hepatitis C and HIV. The impact of drugs (and alcohol) on the mental health of substance users can be profound

Health Inequalities in Staffordshire

Health Inequalities are relevant to drugs because of the direct health and community safety impact on individuals, families and communities who are at risk of poor health outcomes and health inequalities owing to drug use.
In 2004 the Home Office carried out research to provide estimates of the number of problem drug users across the country. These estimates indicate that there were approximately 4,430-5,080 problematic drug users in Staffordshire (excluding Stoke on Trent) in 2004, although these are only research estimates based on Treatment Service User and Police data, it is difficult to assess the true figure owing to the illegal nature of illicit drug use. The Home Office is currently re-assessing these estimates.
Overall, Staffordshire experiences drug-related mortality rates well below the regional average, although Cannock Chase and Newcastle Under Lyme had elevated rates
Needle finds for Staffordshire highlighted Cannock Chase, East Staffordshire and Stafford districts as hotspots.
There is a changing pattern of drug use which treatment services need to respond to. Traditionally, drug treatment services have treated males for heroin dependency. Poly-drug usage is now more common, including stimulants such as amphetamines and crack cocaine, and ecstasy.

For more local information on local health issues related to drugs and alcohol misuse see:

Substance Misuse & Health Issues in Staffordshire report, October 2007

PDF File Icon Substance Misuse Report 2007

Joint Strategic Needs Assessment Jan 08

National and Local Strategies and Targets

There are a number of key national and local policies and drivers to reduce the harm caused by illegal drugs. These include:

1. The National Drug Strategy (updated 2002)

The Drug Strategy is a cross-Government programme of policies and interventions that concentrate on the most dangerous drugs, the most damaged communities and problematic drug users, whose addiction and chaotic lifestyles are most harmful. The Strategy comprises four strands of work:

preventing young people from becoming drug misusers;
reducing the supply of illegal drugs;
increasing the number of individuals accessing effective drug treatment;
and reducing drug-related crime.

2.Tackling Drugs Changing Lives: Keeping Communities Safe from Drugs (2004)

Sets out progress made in delivering the Drug Strategy and planned action for the period to 2008:

Reduced availability of drugs on our streets
Preventing people from using
Reduce and rehabilitate existing users
Out of crime, in to treatment

3. "Out of crime, into treatment" - The Drug Interventions Programme (2003)

A critical part of the Government's strategy for tackling drugs.

Police Custody - Encouraging offenders in custody to take up treatment for drug misuse
Courts and Probation - Drugs Intervention Programme (DIP) and the Criminal Justice Act
Prison - Offering prisoners access to treatment and counselling
Treatment - The effective treatment interventions that work alongside the programme
Throughcare & Aftercare - Providing a beginning-to-end support system

4. Drug Strategy Public Service Agreement Targets

The Spending Review 2004 saw agreement of a new Public Service Agreement (PSA) for the Government's Drug Strategy. This includes three PSA targets to:

Reduce the harm caused by illegal drugs (as measured by the Drug Harm Index encompassing measures of the availability of Class A drugs and drug related crime) including substantially increasing the number of drug misusing offenders entering treatment through the Criminal Justice System.
Increase the participation of problem drug users in drug treatment programmes by 100% by 2008 and increase year on year the proportion of users successfully sustaining or completing treatment programmes.
Reduce the use of Class A drugs and the frequent use of any illicit drug among all young people under the age of 25, especially by the most vulnerable young people.

5. National Treatment Agency for Substance Misuse

Models of care sets out a national framework for the commissioning and provision of treatment for adult drug misusers, and the Criminal Justice Intervention Programme, composing of the 4 Tiers of Treatment

Tier 1: Drug Interventions and Generic Services: a range of drug-related interventions that can be provided by generic providers depending on their competence and partnership arrangements (e.g. care provided for in-patient hepatology units for drug-users with Hep C infection)

Tier 2: Open Access Community Interventions: which are not part of structured treatment programmes e.g. harm reduction, brief intervention, non-drug related support, e.g. access to education and training as a part of rehabilitation

Tier 3: Structured Care Plan and Treatment in the Community: e.g. substitute prescribing and GP-shared care.

Tier 4: Inpatient treatment or Residential rehabilitation (including in-patient detoxification) for those with the most severe treatment needs

6. Hidden Harm: Responding to the needs of children of Problem Drug Users (2003)

250,000 - 350,000 children of problem drug users in the UK (1 for every PDU)
parental problem drug use can and does cause serious harm to children at every age from conception to adulthood
reducing the harm to children from parental problem drug use should become a main objective of policy and practice
effective treatment of the parent can have major benefits for the child
by working together, services can take many practical steps to protect and improve the health and well-being of affected children
the number of affected children is only likely to decrease when the number of problem drug users decreases

7. Staffordshire County Council - Strategy for Healthier Communities 2005-2008

Identifies the necessary public health leadership role of SCC and the need to improve health and reduce health inequalities.

Substance Misuse and Alcohol are identified as major priorities:

SCC to lead in the LPSA2 target to reduce alcohol consumption by 11-15 year olds by March 2008.
To assist through implementation of the Drug and Alcohol Action Team's (DAAT) treatment plan in the provision of accessible services for a wide range of substance mis-users, helping them to engage in treatment programmes.
To provide dedicated young people's substance misuse services within the Youth Offending Team, Children and Lifelong Learning, schools, a range of early intervention initiatives.
To support schools prevention work, through the Healthy Schools Programme and the drug education team, and monitor and disseminate evidence base for prevention and education approaches.
Increase support for people with substance misuse issues across the County.

8. Staffordshire Local Area Agreement

The LAA has directly prioritised substance misuse and alcohol in 3 of the 4 LAA blocks:

HCOP1.3.1: Number of individuals in Tier 3 Alcohol/Substance Misuse Treatment Programmes
HCOP 1.3.2:Percentage of individuals retained within Tier 3 Alcohol/Substance Misuse Treatment Programmes for 12 weeks
CYP1.4.1: Percentage of 11-15 year olds who report that they drank alcohol in the last week, as measured by the biennial self reporting questionnaire
CYP1.4.2: Mean alcohol consumption of those who drank in the last week, as measured by the biennial survey
CYP1.5.1: Number of young people accessing substance misuse advice, information or treatment services
SSC 3.1.1: Percentage of residents who believe that people using or dealing is a 'very big' or 'fairly big' problem in their local area

What Works in reducing drug-related harm?

The links below describe effective measures for reducing the harm caused by illegal drugs. In summary, health services, local authorities, education, police, social services must work together to prioritise and commission prevention, treatment and community safety programmes in communities:

Young people need to be educated about illegal drugs and the harm that they cause. More importantly, young people need the confidence to satisfy their need for exploration and excitement in more productive ways and have the assertiveness to refuse if peers and others try to introduce them to drugs.
Harm minimisation through access to needle exchange to reduce cross-infection and reduce needle finds in local communities
Harm minimisation through changing a drug user from illegal supplies to a prescribed drug such as methadone
Increase the numbers of problem drug users in accessing effective treatment services as described above in the 4 Tiers of Treatment services