Interesting things about alcohol and other drugsNovember 2017Andrew Brown

@andrewbrown365

Number of adults in community drug and alcohol treatment in England, 2013-14 to 2016-17

155,852

25,570

28

,871

91,6

51

152,9

64

25,025

28

,128

89

,107

149

,80

7

25,814

28

,187

85,035

146

,536

24

,561

28

,24

2

80

,454

-

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

180,000

Opiate Non-opiate only Alcohol and non-opiate Alcohol only

2013-14 2014-15 2015-16 2016-17

There has been a fall in the

number of adults in treatment

in the community (3% down

on last year).

This has been particularly steep

in those in treatment for

alcohol alone (5% down from

2015-16), and prevalence

estimates suggest 4 in 5 people

who are alcohol dependent

aren’t having their treatment

needs met.

The number of individuals

presenting with crack cocaine

problems (not being used

alongside opiates) increased

by 23% (2,980 to 3,657).

Source: Substance misuse and treatment in adults: statistics 2016 to 2017 (PHE, 2017)

Change in acute housing problems between start of drug or alcohol treatment and six month review

19%

10%

12%

7%

14%

6%

8%

4%

0%

5%

10%

15%

20%

25%

Opiate Non-opiate Non-opiate and alcohol Alcohol only

Baseline Review

Source: Substance misuse and treatment in adults: statistics 2016 to 2017 (PHE, 2017)

Nineteen per cent of opiate clients reported an acute housing problem at the start of treatment, which fell to 14% by the time of the six-month review. Improvements were also seen in individuals presenting with other substances, ranging from a 4% drop for non-opiate only clients and non-opiate and alcohol clients to 3% for alcohol only clients.

Non-fatal overdoses amongst people who inject drugs

15%

17%18%

19%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

2013 2014 2015 2016

Among the participants who took part in the main Unlinked Anonymous Monitoring Survey across England in 2016 who had injecting during the preceding 12 months (recent injectors), 19% reported overdosing in the preceding year, which has increased significantly from 15% in 2013.

Self-reported overdose in 2016 was lowest among those who were currently in treatment for their drug use (i.e. those being prescribed a detox or maintenance drug regime; 16%). Self-reported overdose was 21% among PWID who had never been in treatment in 2016, and was especially high among those who had previously been in treatment but were not currently (31%).

Source: Non-fatal overdose among people who inject drugs in England: 2017 report (PHE, 2017)

Reduction in re-offending in the two-years following the start of treatment, by substance group

-31%

-59%

-44% -44% -44%

-21%

-49%

-36% -35%-33%

-70%

-60%

-50%

-40%

-30%

-20%

-10%

0%

Opiates Alcohol onlyAlcohol & non-

opiates Non-opiates only Total

Offenders Offences

44% of clients did not reoffend in this period [two years following the start of treatment], and this resulted in the number of recorded offences decreasing by 33%. Opiate clients had the lowest percentage change in recorded offenders and offences (31% and 21%, respectively), while the alcohol only client group experienced the greatest reduction in both offenders and offences (59% and 49%, respectively).

There was a 55% reduction in clients with one offence recorded against them, a 45% reduction in clients with two offences recorded against them, and this decreasing trend generally continues. There was a reduction of only 0.3% in the number of clients with 15 or more offences recorded against them.

Source: The impact of community-based drug and alcohol treatment on re-offending (MoJ and PHE, 2017)

Number of offenders recalled to prison in England and Wales for a reason reported as drugs and/or alcohol, by sex

530

585

665

604

438482

429

342

277

31

50

54

58

4035

33

32

24

0

100

200

300

400

500

600

700

800

Jan-Mar2015

Apr-Jun2015

Jul-Sep 2015 Oct-Dec2015

Jan-Mar2016

Apr-Jun2016

Jul-Sep 2016 Oct-Dec2016

Jan-Mar2017

Male Female

Source: Offender Management Statistics Quarterly (MoJ, 2016 and 2017)

There are various reasons why offenders are recalled to custody for breaching their licence conditions. For example, an offender may be recalled if there is any deterioration in his behaviour which leads the Probation Service to conclude that there is an increased risk of the offender committing further offences. If an offender is no longer in touch with his Offender Manager or if he has resumed a drug habit or alcohol abuse or has been spotted entering an exclusion zone – all such breaches are likely to lead to the offender being recalled to custody.

Number of arrest occasions pre- and post-positive drug test for for Class A drugs in Merseyside between April and September 2015

29

8

156

102

65

32 27

14 6

15 15

235

144

82

43

40

22 14 15

5 7

0

50

100

150

200

250

300

350

1 2 3 4 5 6 7 8 9 10+

Nu

mb

er o

f in

div

idu

als

Number of arrest occasions

Pre-positive drug test Post-positive drug testOverall, both the volume of offending and the number of individuals offending reduced post-positive drug test when compared to pre-test. Individuals were arrested a total of 1,951 times during the 12 months prior to their positive drug test, compared to 1,626 arrest occasions during the 12 months following the drug test. This represents a 16.7% reduction in the number of offences following the positive drug test.

Almost three in five of the positive drug test cohort who reoffended following the drug test were not tested at subsequent arrests. This shows us that a substantial proportion of Class A drug using offenders are not being drug tested under the targeted testing process, thus highlighting missed opportunities to identify and engage them in treatment to reduce their drug use and offending behaviour.

The value of drug testing by Merseyside Police should not be underestimated as it is a key stage in the process of identifying drug using offenders and helping them to engage with local drug treatment services.

Source: Drug Interventions Programme – Re-offending of clients testing positive for class A drugs across Merseyside (LJMU 2017)

Percentage of suspected drug driving saliva tests collected by police giving positive results, by age group

57%60%

58%55% 55%

47%

33%

0%

10%

20%

30%

40%

50%

60%

70%

16-19 20-24 25-29 30-34 35-39 40-49 50+

Data on saliva tests presented here is from primary data collected by the 24 police... The data is based on the results from 4,292 preliminary drug screening tests… 93% of preliminary drug screening (saliva) tests were carried out at the roadside, after a driver had been stopped, with only 7% of the tests being undertaken at a station.

…the percentage of saliva tests giving positive results varies by age group, with the peak percentage for those aged 20 to 24. Those stopped are also predominantly male, with approximately 94% of those stopped and saliva tested being men. For men, 61% of tests were positive (base 3,200) while for women, 51% of tests were positive (base 200).

Of these positive tests, 75% were positive for cannabis only, 14% for cocaine only, while 11% indicated the presence of both cannabis and cocaine.

Source: Evaluation of the new drug driving legislation, one year after its introduction (Risksol Consulting Ltd 2017)

Number and rate (per 100,000 registered patients) of emergency admissions to hospitals in England for alcohol related liver disease in adults aged 19 years and older

10,361 10,644 10,879 10,696

11,79412,402 12,50823.6

24.3 24.9 24.4

26.727.7 27.7

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

0.0

5.0

10.0

15.0

20.0

25.0

30.0

2010-11 2011-12 2012-13 2013-14 2014-15 2015-16 2016-17(provisional)

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Source: Clinical Commissioning Group Outcomes Indicator Set (NHS Digital, 2017)

Provisional rate (per 100,000 registered patients) of emergency admissions to hospitals for alcohol related liver disease in 2016-17, by CCG

NHS Tower Hamlets CCG, 4.2

All registered patients in England, 27.7

NHS South Sefton CCG, 93.3

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

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Source: Clinical Commissioning Group Outcomes Indicator Set (NHS Digital, 2017)

Number of people diagnosed with HIV in the UK where probable route of exposure is injecting drug use

180

170

150 150

130 130 130

150

190

130

0

20

40

60

80

100

120

140

160

180

200

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Source: HIV: annual data tables (PHE, 2017)

Number of people seen for HIV care in the UK and receiving antiretroviral therapy (ART) where probable route of exposure is through injecting drug use

1,5271,609 1,648

1,729 1,736

0

200

400

600

800

1,000

1,200

1,400

1,600

1,800

2,000

2012 2013 2014 2015 2016

Source: HIV: annual data tables (PHE, 2017)

Characteristics of patients who died by suicide and had been in touch with mental health services in the 12 months over the last 10 years

68%

22%

45%

33%

73%

27%

63%

43%

68%

25%

58%

46%

70%

25%

49%

38%

0%

10%

20%

30%

40%

50%

60%

70%

80%

History of self-harm History of violence History of alcohol misuse History of drug misuse

England Northern Ireland Scotland Walesn = 13,576 n = 778 n = 2,652 n = 817

Source: National Confidential Inquiry into Suicide and Homicide by People with Mental Illness Annual Report 2017

Patients in contact with mental health services in the 12 months, prior to death by suicide in England, by primary psychiatric diagnoses

6,021

2,275

1,234 1,033

765 645 576 547

-

1,000

2,000

3,000

4,000

5,000

6,000

7,000

Affective disorders Schizophrenia Personalitydisorder

Alcoholdependence

Adjustmentdisorder

Anxiety disorders Drug dependence Other

Source: National Confidential Inquiry into Suicide and Homicide by People with Mental Illness Annual Report 2017

Number of patients in contact with mental health services, in the 12 months prior to death by suicide, with a history of alcohol or drug misuse, in England

544

466501

561524

560

624598

575

515486

375356

337

391357

377

475

431 442413

389

0

100

200

300

400

500

600

700

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Alcohol DrugThe number of suicides in patients with a history of alcohol or drug misuse has fallen since a peak in 2011. Between 2011-2015, 375 (7%) patients who died were under drug services, 389 (7%) were under alcohol services, and 612 (11%) were under either drug or alcohol services.

The most common substances misused in the 3 months prior to suicide were alcohol (59%), cannabis (21%), stimulants (15%) and heroin (13%). The number of patients misusing alcohol or heroin fell between 2011 and 2014.

Source: National Confidential Inquiry into Suicide and Homicide by People with Mental Illness Annual Report 2017

Number of homicides by patients with mental ill health with a history of alcohol or drug misuse

58

52

42

47

3335

47

35

41

37

28

58 59

4953

3639

42

41

47

31

34

0

10

20

30

40

50

60

70

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Alcohol Drugs555 patients [in the last decade] (88%, excluding unknowns) had a history of either alcohol or drug misuse or both, an average of 50 homicides per year. Therefore, only 12% of patients who committed a homicide had no history of alcohol and/or drug misuse.

167 (27%) patients [who committed homicide in the last decade] had “dual diagnosis”, defined as severe mental illness (schizophrenia or affective disorders) and co-morbid alcohol or drug dependence/misuse, an average of 15 per year. The number of patient homicides with “dual diagnosis” fell after a peak in 2005 but has risen since 2010.

Source: National Confidential Inquiry into Suicide and Homicide by People with Mental Illness Annual Report 2017

Behavioural characteristics of patients with mental ill health homicide offenders in England (2005-2015)

50%53%

77%73%

78%71%

80%

88%

100%

89%

58% 58%

86%91% 92%

61%

46%

75% 74% 74%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

History of self-harm History of violence Any previous convictions History of alcohol misuse History of drug misuse

England Northern Ireland Scotland Walesn = 641 n = 18 n = 137 n = 39

Source: National Confidential Inquiry into Suicide and Homicide by People with Mental Illness Annual Report 2017

Multiple needs of people entering domestic abuse services and captured by the SafeLives database between April 2014 to March 2017

6%

12%

45%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Drug misuse Alcohol misuse Mental health problems

Needs experienced within the last 12 months In the period April 2014 to March 2017, caseworkers submitted 974 intake forms for clients entering 11 health services across England and Wales which used the SafeLives Insights outcome measurement service.

Where a referral route was recorded(n = 811), 1% (6 cases) were from drug and alcohol services, and 6% (47 cases) were by mental health services.

Of clients accessing support (n = 515) 28% (143) engaged with mental health services, 9% (48) with drug services, and 14% (72) with alcohol services.

Source: Insights National Dataset Health 2016-17 (SafeLives, 2017)

First time entrants to the criminal justice system in England and Wales between 2003/04 and 2012/13

9.8%

0.9%

3.8%

1.6%

29.5%

1.1%

4.6%

7.2%

2.2%

10.0%

38.2%

0.9%

0% 20% 40% 60%

Violence against the person

Sexual offences

Burglary

Robbery

Theft and handling stolen goods

Fraud and forgery

Criminal damage

Drug offences

Other indictable offences

Indictable motoring offences

Summary offences excluding…

Summary motoring offences

Proven first offence characteristics of first time entrants to the criminal justice system

7,344

6,151

3,654

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

Number of FTEs by proven drug offence, by year

Source: An analysis of trends in first time entrants to the youth justice system (MoJ, 2017)

n= 757,231

Kilos of cocaine (including crack) and heroin seized by the police and Boarder Force

3,249 3,468

2,949 2,702

2,437

3,495

3,079

3,463 3,419

4,282

5,555

1,003 1,041

1,552 1,516

732

1,849

752 642

1,113 806 783

-00

1,000

2,000

3,000

4,000

5,000

6,000

2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17

Cocaine (including crack) Heroin

Source: Seizures of drugs in England and Wales, financial year ending 2017 (Home Office)

In 2016/17, 5,516 kilograms of cocaine were seized by the police and Border Force, a 30% increase on the previous year (4,240 kg), and the largest quantity since 2003.

There were 39 kilograms of crack seized in 2016/17, 3 kilograms less than in 2015/16.

In 2016/17, 783 kilograms of heroin were seized, a 3% decrease on 2015/16 when 806 kilograms were seized.

Quantity of cannabis seized, 2006/07 to 2016/17, police forces and Border Force

-00

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000

-00

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

Nu

mb

er o

f p

lan

ts

Kilo

gra

ms

Herbal cannabis Cannabis resin Cannabis plants The total quantity of herbal cannabis seized in 2016/17 fell by 61% from the previous year, from 30,493 kilograms to 11,861 kilograms. However, the quantity of herbal cannabis seized in 2015/16 was the largest since 2008/09, largely due to seizures made by Border Force. The fall in the last year should therefore be seen in the context of the longer term trend. Over the last year, the total quantity of herbal cannabis seized by Border Force decreased by 69%, from 27,132 kilograms to 8,370 kilograms. At the same time, the quantity of herbal cannabis seized by police forces increased by 4% from 3,361 kilograms in 2015/16 to 3,492 kilograms in 2016/17.

Over the same time period, the quantity of cannabis resin seized decreased from 7,035 kilograms in 2015/16 to 5,838 kilograms in 2016/17 (down by 17%).

Source: Seizures of drugs in England and Wales, financial year ending 2017 (Home Office)

Proportion of drug seizure quantities by drug type and authority, 2016/17

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Police Boarder Force

Source: Seizures of drugs in England and Wales, financial year ending 2017 (Home Office)

Proportion of cases where the outcome of the stop was linked to the reason for the stop and search, by reason for stop and ethnicity

0%

5%

10%

15%

20%

25%

30%

Drugs Stolenproperty

Firearms Offensiveweapons

Criminaldamage

Goingequipped

Other

White BMEIn the year ending March 2017 around 1 in 5 stop and searches resulted in an outcome that was linked to the reason for the search, i.e. the officer found what they were searching for. This proportion varied considerably depending on the reason for the stop. While around 1 in 4drug stops led to an outcome related to ‘Drugs’, this figure was around 1 in 10 for searches relating to ‘Criminal damage’ and ‘Going equipped’.

The figures cover all searches, including those that resulted in an outcome of ‘No furtheraction’. Given that ‘No further action’ outcomes will rarely be linked to the initial reason for the search, it is helpful to consider the picture when these cases are excluded. When this is done, 65% of outcomes were linked to the initial reason for the search. This proportion varied by outcome type. For example… 82% of cannabis/khat warnings were linked to the reason for the search…

Source: Police powers and procedures England and Wales year ending 31 March 2017 second edition (Home Office)