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Middle-aged man using a rolled up dollar bill to snort cocaine off a glass coffee table.  **Dramatization - no illegal drugs were used in the creation of this photo**
Russell Webster

Russell Webster

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

More crack users in prison drug treatment

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The latest trends in alcohol and drug treatment in secure settings.

Last week (17 January 2019), Public Health England published its annual National Drug Treatment Monitoring System (NDTMS) statistics report on specialist treatment interventions for drugs and alcohol misuse in secure settings during 2017 to 2018. The report contains information on adults (aged 18 and over) in contact with treatment services in prisons, including youth offender institutions (YOIs) for 18 to 21 year olds, and immigration removal centres (IRCs).

Numbers in treatment & substances used

In 2017 to 2018, the number of adults (aged 18 and over) accessing treatment in a secure setting was 55,413. Most of those (96%, or 53,109) accessed structured treatment in a prison setting; either in a local, training, high security or open prison. People accessing treatment in prisons and IRCs were primarily treated for opiate use (53%, or 28,246, and 58%, or 318, respectively), while YOIs mostly treated those with non-opiate drug use (77%, or 1,353).

Just over half of all adults in treatment in a secure setting in 2017-18 reported problematic use of opiates (52%, or 28,859). Seven in ten opiate clients (70%, or 20,066) reported problems with crack cocaine and just over a fifth (21%, or 6,150) reported problematic benzodiazepine use. Nearly a third of opiate users also reported problems with alcohol use (31%, or 8,909).

After opiates, alcohol was the next most common substance (25,828, or 47% of adults in treatment). The majority (63%, or 12,674) of people in the non-opiate group were in treatment for problematic cannabis use (68%, or 6,552, of non-opiate only; 58%, or 6,122, of non-opiate and alcohol clients).

The next most common substances were powder cocaine (49%, or 5,126 of non-opiate and alcohol clients and 38%, or 3,646 of non-opiate only clients), followed by amphetamines (8%, or 1,636) and benzodiazepines (6%, or 1,147).

Almost one in ten adults in treatment said they had a problem with new psychoactive substances (NPS) (8.8%, or 4,868). This figure is the proportion of adults entering treatment with problematic NPS use and is not necessarily a reflection of overall NPS use in adult secure settings.

Percentages of people in treatment in secure settings by main substance group 2017 to 2018

Treatment

Almost all people in treatment in secure settings (93%, or 51,559) in 2017 to 2018 received psychosocial interventions. 5% (2,705) received pharmacological interventions only and 2% (1,149) either did not start an intervention or an intervention was not recorded.

The majority of people (94%, or 25,725) were receiving continuous prescribing for less than one year, which reflects the relatively short periods they spent incarcerated. Overall, the average (median) length of continuous prescribing was 48 days but ranged from 8 days for people in the alcohol only group to 59 days for the opiate group.

Dropout rates for people in treatment in secure settings, across all substance groups, were low (5% or less). However, continuity of care between treatment services in prisons and the community remains low; 32.1% of adult prisoners who needed ongoing treatment successfully engaged with community-based treatment within 21 days of release.

Trends

Overall, there was a 4.6% reduction of adults in treatment in 2017 to 2018 compared with the previous year. The majority of the decrease was seen within the non-opiate only (9%) and alcohol only (14%) groups. This reduction should be set in context of the fact that the prison population was 3% lower on 31 March 2018 compared to a year earlier.

The proportion of people entering treatment in 2017 to 2018 who reported problematic crack cocaine use alongside opiate use has risen year on year (from 26% in 2015 to 2016 to 36% in 2017 to 2018), as has the proportion of those starting treatment for crack cocaine without opiates (from 5% in 2015 to 2016 to 7% in 2017 to 2018).

This increase mirrors a similar rise among people starting community treatment for crack cocaine use and opiate use within the same period (from 14% in 2015 to 2016 to 18% in 2017 to 2018) and the rise in the proportion of adults being treated for crack cocaine (but not opiate) problems (an increase of 1% between 2015 to 2016 and 2017 to 2018).

Conversely, the proportion of people entering treatment for opiate problems, who didn’t also have crack problems, has fallen year on year (from 22% in 2015 to 2016, to 14% in 2017 to 2018).

The number and proportion of people starting treatment in prison for new psychoactive substances (NPS) has continued to increase. Almost one in ten adults in treatment stated they had a problem with this in 2017 to 2018 (8.5%). The proportion has increased from 5.7% in 2015 to 2016 where 3,037 individuals reported problematic NPS use. This is the opposite to the trend in community treatment, where numbers in treatment for NPS have decreased from 2,728 in 2015 to 2016, to 2,074 in 2017 to 2018 (only 0.8% of the treatment population), a fall in volume of 24%.

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