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Russell Webster

Russell Webster

Criminal Justice & substance misuse expert and author of this blog.

Heroin users stuck in the treatment system

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Less than one quarter (24%) of the 273,898 opiate clients who have been in contact with treatment services since 2005/6 had completed treatment and not returned by 31 March 2015.

Latest treatment statistics

The latest drug and alcohol treatment figures (published together for the first time in one report, on 3 December 2015) cover everyone in treatment in 2014/15.

The figures cover very nearly 300,000 people who were in contact with drug and alcohol services in the last financial year. As you can see, over half (51.8%) are opiate users and well over a quarter (30.2%) only misuse alcohol.

numbers in drug treatment

The treatment population is getting older

The age profile of people in treatment is rising. Just under half (44%) of the 152,964 people in treatment for opiates are now 40 and over. Since 2009-10, the number of opiate users aged 40 and over starting treatment has risen by 21% (12,761 to 15,487). This ageing cohort is often in poor health, with a range of vulnerabilities associated with long-term drug use. These people require a wide range of support, including social care.

There is a similar picture for those seeking help for their alcohol problem.

Since 2009-10, the number aged 40 and over accessing services has risen by 21% and the number aged 50 and over by 44%. Many of these people will have been drinking at high-risk levels for some time and are likely to be experiencing health harm such as liver disease and hypertension.

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Younger people not using treatment services

The majority of younger people (18-24) presenting to treatment in 2014-15 cited problems with either cannabis or cocaine (7,369 – 52% of the total, and 3,272, 23%). Most presentations for new psychoactive substances (NPS) are also in the younger age groups, though the total number accessing treatment for NPS remains very low (1,370, 0.5%).

Overall, the number of under-25s accessing treatment has fallen by 33% since 2009-10, with the largest decrease in opiates (mainly heroin) where the numbers presenting to treatment have fallen by 60%. This reflects a shift in the type of drug use among young adults.

It appears that the large number of young people using NPS, MDMA (now more commonly known as Molly or Mandy rather than ecstasy) and cocaine do not see drug treatment agencies as providing a service to them, despite the latest epidemic of media stories about the prevalence of chemsex.

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Success rates falling

Since 2013 the overall rate of people exiting treatment successfully has slowed. This is mainly because the rate of opiate clients successfully completing treatment has fallen (from 37% in 2011/12 to 30% last year), which is likely to be a result of those now in treatment having more entrenched drug use and long-standing and complex problems.

In all, 130,609 people exited the drug and alcohol treatment system in 2014-15, with 52% (67,788) being recorded as having successfully completed their treatment free of dependence. We will have to wait for future years’ figures to see how many relapse and return to treatment.

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Increase in death rates

The number of people who died while in contact with services in 2014-15 was 2,360. Most of these (61%, 1,428) were opiate clients who tended to be over 40 (median age 43) and were likely to have been using heroin for a long time.

While not all deaths in treatment will be attributable to an individual’s substance use, the use of drugs is a significant cause of premature mortality in the UK.

Drug misuse deaths registered in England and Wales between 2012 and 2014 increased by 42%, with the number now 2,120 per year, the highest since records began in 1993. The number of deaths involving heroin in 2014 increased by 64% from 2012.

Among those accessing treatment for alcohol only problems, there were 792 deaths. Again the majority were aged 40 and over, (median age 49).

Users of other substances made up the remaining deaths, with the lowest number of deaths seen among users of non-opiates (39 deaths), the lowest median age (35 years) was also seen in this population.

It’s important to note that the drug-related death rate among people in treatment is significantly lower than among those who are not in treatment.

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Conclusion

This is a rather dispiriting set of figures, especially when you consider that the funding cuts which other social care sectors have had to contend with for the last five-six years are only just beginning to hit drug and alcohol services.

An ageing treatment population with fewer young people accessing services are clear causes for concern.

However, the most worrying statistic of all in this report is the very high failure rate for opiate users:

Less than one quarter (24%) of the 273,898 opiate clients who have been in contact with treatment services since 2005/6 had completed treatment and not returned by 31 March 2015.

 

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8 Responses

  1. “Less than one quarter (24%) of the 273,898 opiate clients who have been in contact with treatment services since 2005/6 had completed treatment and not returned by 31 March 2015.”

    Have we no idea how many of these people are actually working or thriving in some way in what remains of our MMT services. MMT seems like a dirty word in these days of recovery but they can’t all be ‘parked’ on methadone. I have been on MMT for some time now and am currently working and doing alright, the only time I do screw up is when I’ve left treatment for some reason, guilt or by suggestion or attempting a detox.
    The point is that MMT is now viewed as somehow ‘bad’ and recovery as somehow ‘good’. One evidence based and the other based on belief. How many people who have left treatment are in employment or education, how many are discharged as drug free only as that seems to be the driver behind all these charities who now deliver drug treatment as the NHS are priced out. Does anyone know what happens to people once they have left, being drug free is just the start of it…believe me I know.

  2. Without any qualitative assessment of peoples lives either after leaving treatment or staying on methadone this is a pretty useless conclusion. Many do well on long term methadone with minimal intervention. The way NDTMS is designed and the PHE metric which says that all those on methadone prescriptions must be in structured treatment gives this entirely misleading outcome. If people receiving GP care for long term conditions such as diabetes, hypertension or depression were regarded as ‘failures’ there would be an outcry. These figures don’t capture those who have left treatment ‘successfully’ and have then continued to use alcohol, benzodiazepines, prescribed analgesics and not returned to treatment in 12 months. These numbers only tell a partial story.

  3. Drug & alcohol treatment has developed into such a car crash. Highly emotive language is used like ‘stuck in the system’ or ‘parked on methadone’ without checking how many people are just ‘in’ the system getting on with their lives. Recovery is such a saturated concept that most people on methadone know that reduction or abstinence is an option. Services are so preoccupied with recovery monitoring, abstinence and commissioner pleasing that they have forgotten how to engage people and offer a recovery pathway that is both individualised to need and therapeutic. When are the commissioners and the sector going to truly embrace medicated assisted recovery as a valid treatment outcome and celebrate the positive life changes that are there for all to see?

  4. For myself I would of loved to of had a job now I am clean but alas I am 47years of age and it as ruined my health, the heroin might not be the thing that finishes me off on the day but it is the thing that as ruined my body and given me legs of a 90year old and the veins to, my mind is as sharp as ever, my generation are what I call the lost boys and girls it ruined us, it does not surprise me one bit that alot of service users die in their 35ish-40 something years that was my generation, it came and it might as well of raped all those families were I lived back then, it took something like 8 weeks and the whole of my estate was taking heroin and within 3 months we all had full blown habits to heroin. I am serious nearly every single young person there ended up on it, all over that same estate, now there are not many people taking it these days but personally I know that to be because the majority have died now all in their late 30’s early 40’s or like me they moved away and got clean but if I had carried on i would be dead already, I really don’t see myself being around n another 5 years time and that’s not me looking for any sympathy it’s the truth, i have to be matter of fact about it, I do my best to keep well, i see my doctor regularly, but I have now got post thrombotic lymphedema in both legs, I also have cellulitis in both legs, I have chronic hyperension in both legs and I also have chronic ulcers all down the shin area of my right leg, all of it caused my intravenous injecting into the groin area, my right leg as been in compression bandages for the last 2 years and has had ulcers for the last 4years, my veins poke up out of my skin as if there is to much blood in them and it makes them bend and the bend is what stick up out the skin, i have like a gazzilion of these little viens all over my legs, and huge varicose veins as well, I cannot sit for long periods of time because it makes the edema i have in both legs worse for some reason, and my variose veins on the underside of my legs hurt if i sit for to long as well, I also have these varicose veins all over my body luckily it s not gone to my arms neck area and face so i can at least hide that aspect from view I do get pain killers called pregablin and they do help the pain but i am only on a low dose, i was on a higher dose and it did stop the pain but it also made me stutter quite badly and my hair start to fall and i was quite spaced out as well and I stopped taking drugs because i didn’t want that feeling anymore, so i had to drop it, I would be very surprised if they ever have as many people join the drugs service’s for help with heroin again as they did in my generation, the only good thing to come out of it all was that our children and their friends did not touch the drugs they had already seen what it does not in terms of making the user high off said drug but in terms of how much they lost out as kids and suffered because the parents were junkie’s and were not able o see to them as we should of done, luckily my parents took my 2 children on so I am lucky eough to have a good relationship with them today but many users don’t have this option and their kids were adopted , heroin users and d=drug users in general usually have something underlying that brought them to using heroin in the first place and it is really those issue’s that people need help with, things like abuse, prostitution etc these are all things that play with a persons mind and when you feel you have no choice because you need the money it does not bode well and i’d definitely say the service needs to up it’s game because they’ve been doing the same old tired thing to junkies and heroin addicts as long as i can remember and it does not work, in my mind the only thing that ever came near to calming things down in my town when heroin usage was at it’s worst was the Diamorphine ampules and methadone ampules I saw junkies who had used for years change their whole lifestyles on these ampules and withdraw from the drug community only seeing them occasionally at the chemists and their local community drug team, I know they are of no use to the people who don’t use intravenously but for those that do the pin(needle) is also part of the problem you don’t only have to bring the habit down of that user but also the needle use to because that’s another habit alltogether because the majority will be happy to stop the drug and take that on head on and try and beat it but if they inject then they have two addictions to fight, it’s no use trying to fix one habit without fixing the other. this is just my opinion though. I do know quite a few people who have managed to beat it though and are doing well and working etc…. The time as come for the powers that be to stop mucking about making better decisions and working with the users instead of just giving them choice A or choice B and for some drug councillors to get rid of the Hitler Complex and stop lording it over the service users because for me I found alot of drugs centre staff” who I had dealings with were prone to using a service users script like a bribe over their heads and they know you can’t tell them to shove it and so when they do this resentment sets in and right there that can stop a person progressing in their recovery, I don’t know what the answers is I just know for sure things need to change, I find it refreshing that it is debated here and by the look of things in a lot of other places to thanks to some of you guys in here but I have to say this, if you have never used heroin then you will ever know as much as a user does, you will never have insight the way a user does, maybe it is time to start listening to what the user thinks or wants and I don’t mean by giving in and giving them loads of the sleeping tablets they like best that kind of thing but by giving them more options and being prepared to listen to what they have to say properly and maybe just letting them try out some of their own idea’s on their recovery occasionally they might be surprised by it……..just putting it out there…. 😀

  5. I’ve been on methadone for 19 years on and off but can’t stay clean more than 10 days at most.I desperately want a chance on HAT but I’m from Doncaster.I would up sticks an move anywhere in the country for a chance at HAT treatment.Methadone just isn’t for me plus I’ve done subutex at least 3times Whitchurch also don’t agree with.I even did detox 5 years back which didn’t work.If there’s someone who can help me get on this treatment I’d be happy to pay wotever.I think it would change my life if I got a chance at it.Im also a regular offender in out of prison I just want a chance please anyone I will not let u down it cud save my life

    1. Hi Matthew
      The only HAT scheme I know at the moment is the one just starting in Middlesbrough I’m afraid and that is targeted at local people, I think.
      Please don’t give up, lots of people have managed to turn their lives around even after as many years as you.
      Good luck.
      Russell

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