Clinical & Policy Updates:
SMMGP Policy Update July-August 2013
|Download the PDF version of this Update here! (PDF*, 74K)|
Two sets of national statistics showing prevalence of drug use among adults and school children in the population were published during July 2013. The main relevance of highlighting substance misuse trends is in indicating possible nature of future treatment demand. However, as household surveys, the prevalence figures do not capture data from key groups e.g. students or homeless people.
"Drug Misuse: Findings from the 2012/13 Crime Survey for England and Wales" (Home Office) (age 16-59)www.gov.uk
Highlights from the survey show that:
- Numbers of people using any illicit drug last year fell.
- Last year Class A drug use is also down.
- Young people are more likely to take drugs than adults, but their drug use has fallen.
- Cannabis was the mostly commonly used drug, but again has fallen.
- Powder cocaine and ecstasy remain popular, but use has fallen.
- Adult mephedrone use has halved in a year.
"Smoking, drinking and drug use among young people (aged 11-15) in 2012" (Health and Social Care Information Centre)
Overall, the survey shows that:
- Fewer school children in England are smoking, drinking or taking drugs.
- Estimates from this survey indicate that in England in 2012, around 120,000 pupils aged between 11 and 15 were regular smokers, around 320,000 had drunk alcohol in the past week, 200,000 had taken drugs in the last month and 370,000 had taken drugs in the last year.
- Boys and girls were equally as likely to drink, smoke and take drugs in 2012.
Drug related deaths statistics for 2012 were published in late August followed by a wave of media and press reporting which focussed on the fact that deaths from novel psychoactive substances such as PMA "had soared".
Key findings include:
- There were 1,706 male drug poisoning deaths (involving both legal and illegal drugs) registered in 2012, a 4% decrease since 2011.
- Female drug poisoning deaths have increased every year since 2009, reaching 891 in 2012.
- The number of male drug misuse deaths (involving illegal drugs) decreased by 9% from 1,192 in 2011 to 1,086 in 2012; female deaths decreased by 1% from 413 in 2011 to 410 in 2012.
- The highest mortality rate from drug misuse was in 30 to 39-year-olds, at 97.8 and 28.9 deaths per million population for males and females respectively in 2012.
- The number of deaths involving heroin/morphine fell slightly in 2012 to 579 deaths, but these remain the substances most commonly involved in drug poisoning deaths.
- The number of deaths involving tramadol have continued to rise, with 175 deaths in 2012 - more than double the number seen in 2008 (83 deaths).
- Mortality rates from drug misuse were significantly higher in Wales than in England in 2012, at 45.8 and 25.4 deaths per million population respectively.
- In England, the North West had the highest mortality rate from drug misuse in 2012 (41.0 deaths per million population).
The statistics of drug-related deaths in 2012 in Scotland, broken down by age, sex, selected drugs reported, underlying cause of death and NHS Board and Council areas is also available this month.
Whist it is good news that the trend is towards an overall reduction in drug related deaths, there remains 50 drug related poisonings a week, 11 of these from heroin/morphine. These figures support the continuing spread of the provision of naloxone, together with sound harm reduction advice, to people in drug treatment. We echo concerns from others in the field about the increase in deaths from tramadol and novel psychoactive substances.
The guest blog post on our website by David Henderson, Head of Substance Misuse Services, South Tyneside NHS Foundation Trust, is a heartening example of how Gateshead tackled the problem of drug related deaths in their local community in a practical and meaningful way. Congratulations to the team on their award.
The independent expert group report on Opioid Replacement Therapies (ORT) was published on the Scottish Government's website during August 2013:
It concluded that ORT, in particular methadone, is supported by a strong evidence base, that local services are largely providing it in accordance with national guidance and its use should continue in Scotland. However, it also concluded that ORT must be one of a full range of treatment options across the country ranging from community to residential rehabilitation, and services should become more aspirational in relation to supporting individuals' recovery. Other key recommendations are:
- Consideration should be given to how to better address the link between health inequalities and problem substance use.
- Fit for purpose, local information systems should be in place and be able to identify people on ORT and demonstrate their progress towards recovery.
- A national specification for pharmacy services for drug users should be developed to ensure high quality provision, supported by a nationally agreed guideline for supervised, self- administration of ORT.
- Discussions should take place on how substance misuse treatment can best be provided through GPs and community pharmacists, with action to reduce variations in practice.
- The arrangements for reimbursing pharmacists for methadone prescriptions should be reviewed to ensure they provide best value for the public purse, while also meeting individuals' needs.
- Care providers should publish plans to ensure they can demonstrate that individuals are making progress towards recovery and all their staff should be trained in care that is geared towards recovery.
- The Scottish Government should reconsider how to facilitate effective local partnerships. In particular the role of Alcohol and Drug Partnerships should be reviewed and clear improvement measures developed and monitored.
The PHE alcohol and drugs team is developing a number of tools and resources to support improvement of effective local responses to alcohol and drugs-related ill-health.
Routes to Recovery - mapping manual
Public Health England has published a new mapping manual for drugs workers called "Routes to Recovery via the community".
This manual is "a user-friendly, client-focused tool, designed for busy community service based key workers, responsible for large case loads of people". It includes elements of effective interventions, such as Motivational Interviewing and cognitive behavioural approaches. Node-Link Mapping is used as a unifying element, presenting clinical tools in a simple to use map format. It is designed to be a practical tool to support effective recovery focussed interventions for people who use drugs problematically.
Printed copies of the manual have been distributed to providers and other partners in the treatment sector by PHE's Centre teams or the PDF can be downloaded from the NTA's "legacy" website.
Improving local responses to alcohol ill health
The Alcohol stocktake self-assessment tool is available now and provides a structure for local areas to take a systematic review of their system for responding to alcohol-related harm in the adult population. It explores the integration of activity by all local partners across all levels of prevention and covers the interventions that evidence indicates are most effective.
The tool provides an opportunity to benchmark against evidence-based practice, facilitating the identification of effective practice, any gaps in provision and highlighting possible improvements.
Guidance for Commissioners of Drug and Alcohol Services
"Guidance for Commissioners of Drug and Alcohol Services" is produced by the Joint Commissioning Panel for Mental Health (JCP-MH) and is a collaboration co-chaired by RCGP and RCPsychs and brings together leading organisations and individuals with an interest in commissioning for mental health. It is part of the implementation arm of the government health strategy "No Health Without Mental Health".
Key messages for commissioners from the guidance are:
- Investment in drug and alcohol services gets results. Treatment as part of a co-ordinated public health approach is proven to be cost effective and disinvestment brings with is a risk of reversing gains made in recent years.
- A strong evidence base exists for the range of interventions that are effective in substance misuse, and commissioning should be based on this evidence using NICE Quality Standards.
- The treatment system should be equipped to respond to the full range of complexity of need.
- A skilled workforce, with appropriate supervision and working to their competencies, is key to delivering good outcomes.
- Collaboration and partnership gets results - NHS and voluntary sector have a contribution to make.
- Commissioning of drug and alcohol services should be based upon accurate and up to date information about local needs.
- Commissioners should ensure that local services have clear leadership (clinical and managerial).
- Commissioning of drug and alcohol services should be outcome based and make use of data.
- Services should place recovery at the centre of their approach, central to strategic decision making.
- Treatment is not simply about patients and should address the needs of families and carers and wider social networks.
Within the new commissioning landscape with its emphasis on localism there is an increasing need for practitioners to understand and become involved in the commissioning process. Any guidance and tools we can utilise to do so will help this process.