Big rise in deaths in treatment
Earlier this year, I blogged on the updated figures on drug and alcohol treatment in secure settings for 2015/16.
Last month (18 January 2018), Public Health England published the stats from the National Drug Treatment Monitoring System (NDTMS) on drug and alcohol treatment delivered in secure settings for 2016/17.
The report brings together information on people receiving specialist treatment interventions for drugs and alcohol misuse in all secure settings: prisons, young offender institutions (YOIs), and immigration removal centres (IRCs), with a separate section on young people receiving treatment within the children and young people’s secure estate.
Interestingly, the overall total of adults receiving substance misuse treatment while detained in 2016/17 – 59,258 – fell by almost a thousand (996) on the year before. This is despite the fact that there has been no fall in the prison population and that the number of people receiving treatment in IRCs has jumped from 327 to 522.
It is tempting to speculate that this drop may be related to a reduction in treatment capacity. Several providers of drug and alcohol treatment in prison have commented on the fact that now substance misuse budgets are often wrapped up in general healthcare budgets, their funding has been reduced.
Main findings – adults
Half (50%, 29,626) of all people in contact with treatment in adult settings in 2016-17 presented with problematic opiate use. This is a small decrease on last year (29,146). A further 37% presented with problems with other drugs (non-opiates) and 13% (7,663) presented with alcohol as their only problem substance (a decrease from 8,551 in 2015-16). People accessing treatment in IRCs were mostly opiate users (68%), a lower proportion than in 2015-16 (77%), while YOIs mostly treated those with non-opiate drug use (77%).
Almost two-thirds of the opiate users also presented with crack cocaine use (63%). The next highest adjunctive substances for opiate users were alcohol (32%), benzodiazepines (24%) and cannabis (18%). Overall, there were 3,271 more individuals accessing treatment for crack cocaine than in 2015-16, an increase of 17%. The largest increase was for opiate and crack clients (up 2,942; 19%) and crack only clients were also more prevalent (up 329; 11%).
As in 2015-16, nearly half (49%) of all adults in treatment in 2016-17 presented with problematic alcohol use, either as their only problem substance or alongside opiate or non-opiate drugs. After opiates and alcohol, the next most commonly cited substance was crack cocaine (38%, up from 31% in 2015-16), followed by cannabis (33%), cocaine powder (22%) and benzodiazepines (14%).
There were 4,816 (8.1%) adults presenting to treatment for new psychoactive substances (NPS) use, either as one of their problem substances or their only problem substance. This is up from 6% in 2015-16.
Main findings – adults
Almost two-thirds (63%) of treatment interventions received by adults in treatment in 2016-17 were structured psychosocial interventions. The remaining interventions were pharmacological interventions: 23% to address opiate use, 9% for alcohol and 5% to address other drug misuse.
The majority of people (95%) were receiving continuous prescribing for less than 1 year, which reflects the relatively short periods they spent incarcerated. Overall, the average (median) length of continuous prescribing was 43 days, but ranged from 8 days for alcohol only clients to 54 days for opiate clients.
Over 37,000 adults left treatment in secure settings during 2016-17. Just over a quarter (27%) of those leaving were discharged as having completed treatment. This is 4% higher than in 2015-16. The lowest rate of successful completions was among opiate users (16%), compared with between 36% and 38% for the other 3 substance groups.
The majority of opiate clients discharged from treatment were referred to treatment services in the community on release (65% of discharged opiate clients); while a lower proportion of alcohol only (40%), non-opiate and alcohol (31%) and non-opiate only (27%) clients had the same onward community referral.
However, as last year, only 30.3% of opiate users receiving treatment in prison engaged with community treatment services within three weeks of their release.
Main findings – adults
Alarmingly, the number of adults who died while in contact with treatment services in a secure setting in 2016-17 was 65, an increase of 59% from 41 deaths in 2015-16, and representing 0.1% of all adults accessing treatment in the secure estate. There was an increase of 54 deaths (19%) in the wider prison population in England and Wales between 2015-16 and 2016-17.
Over half (58%) of the 65 deaths were seen in opiate clients (38 deaths, up from 22 in the previous year), and almost a third from the non-opiate client groups (20 deaths, up from 8 in 2015-16). Deaths amongst those in treatment for alcohol only use fell from 11 in 2015-16 to 7 in 2016-17. Females accounted for 11% (7 deaths) of the total deaths amongst adults in treatment.
Main findings – young people
There were 1,362 young people in specialist substance misuse treatment in secure settings in 2016-17. The majority (67%) of young people in treatment in secure settings reside in young offender institutions (YOIs), with a further 18% residing in secure children’s homes (SCHs), 9% in secure training centres (STCs) and 7% in welfare only homes (WOHs).
As in 2015-16, cannabis was the most commonly cited problem substance among young people in treatment in secure settings (91% of all in treatment). Just under half cited problematic alcohol use (48%). Other substances reported by young people included cocaine (21%, up from 19% in 2015-16), nicotine (17%), ecstasy (7%), NPS (5%) and amphetamines (5%).
The proportions of young people citing amphetamines and NPS were lower than in 2015-16 (9% and 8%, respectively). The number of young people in treatment reporting crack cocaine as a problem substance increased from 14 to 26 individuals, which is 2% and twice the proportion compared to 2015-16. The proportion citing opiates increased from 2% to 3% (from 28 to 38 individuals).
Most young people starting treatment received a harm reduction intervention (80%). Motivational interviewing (52%) and relapse prevention (28%) were the next two most common interventions received. One percent of young people in treatment in secure settings received a pharmacological intervention.
Of the 920 young people in secure settings who exited treatment in 2016-17, a third completed treatment in custody, 46% were released from custody and were referred for further treatment in the community, and 14% were transferred to another secure setting establishment with the intention that their treatment would continue. The remaining 6% either dropped out or withdrew from treatment, or declined to participate in treatment. There were no deaths among young people in secure settings while they were in specialist substance misuse treatment.