Key trends in numbers in treatment and substance use

The adult substance misuse treatment statistics for 2016/17 were published last week (10 November 2017) and the headline findings were:

• Overall, 279,793 individuals were in contact with drug and alcohol services in 2016-17; this is a 3% reduction from the previous year (288,843). The number receiving treatment for alcohol alone decreased the most (5%, 85,035 to 80,454) and the number of alcohol only clients in contact with treatment has fallen by 12% from the 91,651 peak in 2013-14.
• Estimates of the number of adults with alcohol dependency in England were published for the first time in March 2017. The findings from this study suggested that there were 595,131 individuals aged 18 and over drinking at dependent levels and potentially in need of specialist treatment. This is 1.4% of the adult population.
• Individuals who had presented with a dependency on opiates made up the largest proportion of the total numbers in treatment in 2016-17 (146,536, 52%). This is a fall of 2% since last year.
• There were 52,803 non-opiate and non-opiate and alcohol clients in contact with treatment in 2016-17, which was a 2% fall since last year.
• Despite this overall fall in numbers in treatment for non-opiate substances, the number of individuals presenting with crack cocaine problems (not being used alongside opiates) increased by 23% (2,980 to 3,657), this follows a smaller increase of 3% in crack cocaine presentations between 2014-15 and 2015-16. The increase over the last 12 months was seen in nearly all age groups.
• There was also a 12% increase in individuals presenting with both crack cocaine and opiate problems (19,485 to 21,854), which was seen primarily in those aged 45 and over.
• Recently published estimates of crack cocaine use in England in 2014-15 reported a 10% increase in the numbers estimated to be using the substance since 2010-11 (166,640 to 182,8281).
• It is likely that the recent increase in the number of people entering treatment for crack problems reflects the rise in the prevalence of the use of the drug. The increase in the number of new users may be in part caused by changes in the purity and affordability of crack cocaine over the last few years.

New psychoactive substances and club drugs

There were 1,450 individuals presenting with problems with the use of one or more new psychoactive substance (NPS) starting treatment in 2016-17, which is a 29% decrease on last year (2,042). This fall was mainly driven by a 49% reduction in those aged under 25 presenting with NPS problems over the last 12 months (627 in 2015-16 to 321 in 2016-17).

Individuals who present to treatment using NPS are more likely to be homeless compared to those not using these substances at the start of treatment (18% vs 7%).

There was a 23% fall in the total number of ecstasy presentations over the last year (1,318 to 1,013), with a much larger decrease of 70% recorded in the number starting treatment citing problematic mephedrone use.

Smoking

Information on the smoking status of individuals starting treatment has been included in this report for the first time. Opiate clients had the highest reported rates of smoking when commencing treatment (59%). This was closely followed by non-opiates, and alcohol and non-opiate users (52% and 49% respectively). Those presenting with problematic alcohol use only had the lowest rates, with 34% smoking at the start of treatment. For all substance groups the rates of smoking at the start of treatment are substantially higher than the national rate of smoking among adults (15.5%)

Demographics

Individuals in treatment for alcohol only and opiate use tend to be older than those who have presented for problems with other substances. The median age of alcohol only problems was 46 years, with 12% (9,274) aged 60 years and older. Opiate clients were younger than alcohol only clients, with a median age of 39.

There were 11,657 individuals aged 18-24 who commenced treatment in 2016-17, of these, the majority cited problems with cannabis, alcohol or cocaine (6,322 – 54%, 5,221 – 45% and 3,113 – 27% respectively). Overall, the number of under-25s accessing treatment has fallen by 45% since 2005-06; this reflects changes in the patterns of drinking and drug use in this age group over the last 11 years.

However, while the numbers are relatively low, there was a 30% increase in young adults (under 25) entering treatment for crack cocaine problems (not used alongside opiates), an increase from 281 to 364. This is the first year that there has been a rise in crack cocaine presentations in this age group since 2007-08.

Males made up 69% of the entire treatment population in 2016-17. The gender split varied depending on the presenting substances. 73% of people using drugs were male compared to 61% presenting with alcohol only.

Individuals recorded as white British made up the largest ethnic group in treatment, (85%, 231,949) with a further 5% from other white groups. No other ethnic group made up more than 1% of the total treatment population.

Substance-related deaths

The total number of people who died while in contact with treatment services in 2016-17 was 2,680 (1.0% of all individuals in treatment). This is similar to 2015-16 when there were 2,689 deaths in treatment (0.9% of all individuals in treatment).

The number of opiate clients who died in treatment increased by 3% over the last year, (1,693 to 1,741) with deaths as a proportion of all opiate clients in treatment increasing slightly from 1.1% to 1.2%. The median age of opiate clients recorded as having died in 2016-17 was 45 and 74% were male.

The number of deaths for users of other drugs fell slightly from 179 in 2015-16 to 172 in 2016-17, a decrease of 4%.

Drug use is a significant cause of premature mortality in the UK. In England, the number of deaths from drug misuse registered in 2016 increased by 3.6% to 2,383, this follows larger increases of 8.5% between 2014 and 2015 and 17.0% between 2013 and 2014.

The number of registered heroin deaths increased by 0.7% between 2015 and 2016 (1,201 to 1,209) and are the highest on record. Treatment has been demonstrated to provide some protection against drug related deaths and these numbers would likely be even higher without the harm reduction it provides.

There were 767 deaths in 2016-17 among individuals accessing treatment for alcohol problems only, which was a 6% decrease on the previous year. Deaths as a proportion of all people in treatment for alcohol only was 1%, which is the same as last year. The median age of these deaths was 50, with 63% being male.

Analysis

Three main facts jump out to me from this statistical update.

Firstly, the number of people in treatment for alcohol alone has dropped 5% despite the fact that this represents only an estimated one in seven of those in need and that many areas have reconfigured services over the last few years to increase the local capacity for alcohol treatment.

Secondly, there has been a substantial jump (23%) in the number of people seeking treatment for crack cocaine, admittedly from quite a small base.

Thirdly, despite huge focus, we are still making no progress in tackling drug-related deaths, the figure of 1,741 opiate using individuals dying last year is an extremely uncomfortable figure when you consider that all these people were in treatment at the time.

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