health profile 2015 drug misuse profile for halton€¦ · admissions, drug treatment and deaths...
TRANSCRIPT
701
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47%
44%
20th
best
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deaths
Public Health England estimate that every year drug addiction costs society £15.4 billion in England. This includes the £448 million of drug misuse costs the NHS. An estimated 2.7 million adults have used an illegal drug in the past year, with 1.2 million affected by drug addiction within their family. Health problems from drug abuse can include cardiovascular disease, mental health problems, lung damage. It can also have a significant impact on gaining/maintaining employment and secure housing, and can lead to some to criminal activities to fund their addiction. In England during 2013/14, there were 7,104 admissions to hospital with a primary diagnosis of a drug-related mental health and behavioural disorder. There were also 13,917 admissions with a primary diagnosis of poisoning by illicit drugs. Admissions for these reasons both saw an increase from the previous year (2012/13). During 2013, there were also 1,957 deaths related to misuse of illicit drugs. This is an increase from 1,636 in 2012, which prior to 2013 has been decreasing. This drug profile for Halton has been written to help monitor progress and highlight areas where further action is required. It includes data on estimated prevalence, hospital admissions, drug treatment and deaths due to drug misuse.
Headline Facts
in Halton who are opiate and/or crack cocaine users aged 15 to 64 years (2011/12)
of emergency drug-related admissions in Halton were due to opioids (e.g. codeine, morphine, heroin,) (2012/13 to 2014/15)
of emergency drug-related admissions in Halton were men aged 20 to 49 years (2012/13 to 2014/15) for successful completion of treatment for opiate users in Halton (out of 149 local authorities) (2014/15)
due to drug misuse, average per year in Halton (2006-14)
Health Profile 2015
Drug Misuse Profile for Halton
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15-24 yrs 25-34 yrs 35-64 yrs Overall
Halton 3.92 10.95 8.95 8.37
Knowsley 3.61 7.45 12.27 9.60
Liverpool 4.92 15.22 22.80 16.52
Sefton 1.78 11.34 13.56 10.97
St Helens 2.90 17.94 11.18 10.83
North West 3.79 14.64 10.58 9.99
England 4.71 15.18 7.28 8.40
2011/12
Estimated prevalence of opiate and/or crack cocaine use (crude rate per 1,000 population aged 15 to 64 years) (table 1)
The overall estimate for 15-64 year olds suggests that Halton has the lowest rate of opiate and/or crack cocaine use (OCUs) within Merseyside, and is also very similar to the England average.
Hospital admissions due to substance misuse – 15 to 24 year olds (directly standardised rate per 100,000 population aged 15 to 24 years) (figure 1)
The rate of admissions due to substance misuse in 15 to 24 year olds in Halton has fluctuated during recent years; but remains statistically significantly higher than the England average due to an increase since 2010/11 to 2012/13.
The Halton rate is the 2nd highest in Merseyside, but during 2012/13 to 2014/15, the gap with St Helens (who have the highest rate in Merseyside) narrowed.
Contents
Estimated prevalence of opiate and/or crack cocaine use 2
Hospital admissions due to substance misuse – 15 to 24 year olds 2
Emergency drug-related admissions 3 – 10
Hospital admissions - primary diagnosis of poisoning by illicit drugs 10
Hospital admissions - drug related mental and behavioural disorders 11
Treatment data 11 - 13
Drug related deaths 14
Data sources 15
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Emergency drug-related admissions The data used below was extracted from the full hospital admissions dataset for the period 1
st April
2012 to 31st
March 2015. (Source: EIS LIVE Inpatient Universe). Data was extracted using the ICD 10 codes shown in the table below, where they were listed in any admission field. Records were extracted for all persons resident in Halton from patient’s postcode of residence. Records are a count of admissions not patients, so a person may be counted more than once if they have been readmitted or are repeat/regular admissions. Care must be taken when interpreting data/results as small numbers may lead to misleading results and affect the validity of the statistics.
ICD 10 codes used in the extraction of the drug-related admissions data (table 2)
ICD 10 Code Definition
F11 Mental and behavioural disorders due to use of opioids
F12 Mental and behavioural disorders due to use of cannabinoids
F13 Mental and behavioural disorders due to use of sedatives or hypnotics
F14 Mental and behavioural disorders due to use of cocaine
F15 Mental and behavioural disorders due to use of other stimulants, including caffeine
F16 Mental and behavioural disorders due to use of hallucinogens
F18 Mental and behavioural disorders due to use of volatile solvents
F19 Mental and behavioural disorders due to use of multiple drug use and use of other psychoactive substances
T38.7 Poisoning by androgens and anabolic congeners
T40 Poisoning by narcotics and psychodysleptics
T41.2 Poisoning by anaesthetics
T42.4 Poisoning by benzodiazepines
T43.6 Poisoning by psychotropic drugs: Psychostimulants with abuse potential
T59.8 Toxic effect of other gases, fumes and vapours
X42 Accidental poisoning by and exposure to narcotics and hallucinogens
X62 Intentional self-poisoning by and exposure to narcotics and hallucinogens
Y120 Poisoning by and exposure to narcotics and hallucinogens, not elsewhere classified
Z503 Drug rehabilitation
Z715 Drug abuse counselling and surveillance
Findings In Halton, during 2012/13 to 2014/15, the following can be summarised from drug-related hospital admissions:
There were 944 admissions to hospital related to drugs.
348 of these were repeat admissions by 128 individuals
53.7% (507) of the admissions were male.
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The average length of stay for those admitted was 1.9 days, and 436 (46.2%) resulted in a length of stay in hospital of 0 days.
More admissions (406, 43.0%) were related to Poisoning by narcotics and psychodysleptics (ICD-10 code T40) than any other diagnosis codes.
157 (16.6%) of admissions were related to Mental and behavioural disorders due to use of opioids, and 127 (13.5%) related to Poisoning by benzodiazepines.
Female admissions occurred in greater numbers in the 20 to 24 age group, with male admissions highest in the 25 to 29 age group.
76.0% of emergency admissions were in the most deprived quintile nationally.
52.2% were dealt with by Warrington & Halton hospitals, with a further 43.4% in St Helens and Knowsley hospitals.
Overall, Windmill Hill witnessed the highest rate of drug related admissions of any ward; Daresbury had the lowest.
The table below displays the number of emergency drug related admissions in Halton, during 2012/13 to 2014/15, by the drug related ICD-10 code they are attributed. It shows that T40 (Poisonings by narcotics and psychodysleptics) accounted for more than any other ICD-10 sub category, with other opioids (codeine, morphine) making up the majority.
Number of drug admissions by ICD 10 sub-chapters (table 3) ICD 10 Code
ICD Description No. of admissions
Percent
F11 Mental and behavioural disorders due to use of opioids 157 16.6%
F12 Mental and behavioural disorders due to use of cannabinoids 84 8.9%
F13 Mental and behavioural disorders due to use of sedatives or hypnotics
6 0.6%
F14 Mental and behavioural disorders due to use of cocaine 66 7.0%
F15 Mental and behavioural disorders due to use of other stimulants, including caffeine
16 1.7%
F18 Mental and behavioural disorders due to use of volatile solvents
- < 0.5%
F19 Mental and behavioural disorders due to use of multiple drug use and use of other psychoactive substances
26 2.8%
T40
Poisoning by narcotics and psychodysleptics Of these: Other opioids (codeine, morphine) Other synthetic narcotics (Pethidine) Cocaine Other drugs (cannabis, heroin, methadone and LSD)
406 275 85 30 16
43.0% 29.1% 9.0% 3.2% 1.7%
T41.2 Poisoning by anaesthetics - < 0.5%
T42.4 Poisoning by benzodiazepines 127 13.5%
T43.6 Poisoning by psychotropic drugs: Psychostimulants with abuse potential
28 3.0%
T59.8 Toxic effect of other gases, fumes and vapours 14 1.5%
T38.7, X42, X62
Remaining sub-chapters - < 0.5%
‘-‘ denotes value of less than 5, so data supressed
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Year Male Female
2012/13 54.8% 45.2%
2013/14 52.8% 47.2%
2014/15 53.5% 46.5%
Total 53.7% 46.3%
Drug-related admissions by gender (table 4) There were a higher number of male admissions compared to females for each of the 3 years. However, there wasn’t a large difference in the overall percentage.
Drug-related admissions by gender and 5 year age band (figure 2)
Female admissions were highest between 20 and 24 years old, however, the greatest male admission rate was in the 25 to 29 age band. The majority of male admissions were for males aged 20 to 49. For females, the spread was more even between 15 and 54 years of age.
Drug-related admissions by 2015 National Deprivation Quintile (figure 3)
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No. of admissions 2012/13 2013/14 2014/15
1 admission 236 253 212
2 admissions 28 27 18
3 admissions 7 - 5
4 admissions - - -
5 admissions - -
6 admissions -
7 admissions
8 admissions -
No. of people
Figure 3 shows that the drug-related emergency admission rate was significantly higher for people living within the most deprived quintile nationally (based on LSOA were individual lives). The admission rate in Quintile 2 was also statistically significantly higher than the rates in Quintile 3, 4 and 5. This suggests there is a strong relationship between high levels of deprivation and emergency drug-related admissions to hospital.
Multiple emergency admissions (table 5)
‘-‘ denotes value of less than 5, so data supressed
The number of emergency admissions was similar in 2012/13 to 2013/14, but decreased in 2014/15. The table above shows that the number of multiple admissions decreased from 2012/13 to 2013/14. This may suggest that people are receiving the help they need after the first admission to hospital, and this is reducing the likelihood of them being readmitted to hospital later in the year.
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Emergency admission rates (DSR*) split by males and females, 2012/13 to 2014/15 (figure 4) Figure 4 and table 6 display the rates of drug related admissions in Halton, by ward. The wards with the highest rates of such admissions are highlighted in the darkest blue on the map, with the lowest rates in light blue.
* Directly Standardised Rates: Calculated using the European Standard Population, these express an indicator in terms of the overall rate that would occur in a standard population age-structure if it were to experience the age-specific rates of the observed population. (Care must be taken in interpreting these as small numbers and lack of data can lead to misleading rates).
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It is evident from figure 4 that Windmill Hill has the highest rate of male drug-related admissions in the local area between 2012/13 and 2014/15. Grange ward saw the second highest admission rate for males and, along with Windmill Hill, had a statistically significantly worse rate compared to the Halton average for males. With regards to females, Riverside had the highest emergency admission rate and was significantly worse than the Halton female average, as were Ditton and Norton South wards. Figure 5 below shows the emergency admission rate for males and females combined, for each ward.
Emergency admission rate (DSR), persons, 2012/13 to 2014/15 (figure 5)
When the data is combined for males and females, there were five wards which had an admission rate that was significantly worse than the Halton average (red bars). However, there were seven wards which had a rate that was better than the Halton average (green bars). Below explains how statistical significance is calculated: Significantly worse The lower confidence interval (LCI) for the ward is higher than the Upper confidence interval (UCI) for Halton. Significantly better The upper confidence interval (UCI) for the ward is lower than the Lower confidence interval (LCI) for Halton.
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Highest number of emergency drug-related admissions by ICD 10 code, by ward, 2012/13 to 2014/15 (table 7)
Ward Name (total admissions)
Sub-chapter
ICD Description Number of admissions
Appleton (69)
T40.2 T42.4 F12 F11
Poisoning by other opioids (codeine, morphine) Poisoning by benzodiazepines Mental and behavioural disorders due to cannabinoids Mental and behavioural disorders due to use of opioids
19 13 11 10
Beechwood (8)
T40.2 Poisoning by other opioids (codeine, morphine) -
Birchfield (24)
T40.2 Poisoning by other opioids (codeine, morphine) 7
Broadheath (46)
T40.2 F11
Poisoning by other opioids (codeine, morphine) Mental and behavioural disorders due to use of opioids
12 11
Halton Castle (51)
F11 T40.2 T40.4 T42.4
Mental and behavioural disorders due to use of opioids Poisoning by other opioids (codeine, morphine) Poisoning by pethidine Poisoning by benzodiazepines
15 10
8 7
Daresbury (8)
T42.4 Poisoning by benzodiazepines -
Ditton (80)
T40.2 F11 T42.4 F14 T40.4
Poisoning by other opioids (codeine, morphine) Mental and behavioural disorders due to use of opioids Poisoning by benzodiazepines Mental and behavioural disorders due to cocaine Poisoning by pethidine
19 15 10
7 7
Farnworth (18)
T40.2 T42.4
Poisoning by other opioids (codeine, morphine) Poisoning by benzodiazepines
6 -
Grange (73)
T40.2 F11 T42.4 T40.4
Poisoning by other opioids (codeine, morphine) Mental and behavioural disorders due to use of opioids Poisoning by benzodiazepines Poisoning by pethidine
20 11 10
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Hale (5)
F12 Mental and behavioural disorders due to cannabinoids -
Halton Brook (48)
T40.2 T42.4 F11
Poisoning by other opioids (codeine, morphine) Poisoning by benzodiazepines Mental and behavioural disorders due to use of opioids
18 8 6
Halton Lea (73)
T40.2 F11 T42.4 T40.4
Poisoning by other opioids (codeine, morphine) Mental and behavioural disorders due to use of opioids Poisoning by benzodiazepines Poisoning by pethidine
26 13 10
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Halton View (27)
T42.4 T40.2
Poisoning by benzodiazepines Poisoning by other opioids (codeine, morphine)
6 5
Heath (19)
T40.2 T42.4
Poisoning by other opioids (codeine, morphine) Poisoning by benzodiazepines
6 5
Hough Green (68)
T40.2 F11 F12 F14
Poisoning by other opioids (codeine, morphine) Mental and behavioural disorders due to use of opioids Mental and behavioural disorders due to cannabinoids Mental and behavioural disorders due to cocaine
21 11
9 7
Kingsway (67)
T40.2 F11 T40.4
Poisoning by other opioids (codeine, morphine) Mental and behavioural disorders due to use of opioids Poisoning by pethidine
16 15
7
Mersey (70)
T40.2 F11 T42.4
Poisoning by other opioids (codeine, morphine) Mental and behavioural disorders due to use of opioids Poisoning by benzodiazepines
26 15
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Ward Name (total admissions)
Sub-chapter
ICD Description Number of admissions
Norton North (20)
T40.2 Poisoning by other opioids (codeine, morphine) 10
Norton South (57)
T40.2 T40.4 T42.4
Poisoning by other opioids (codeine, morphine) Poisoning by pethidine Poisoning by benzodiazepines
19 11 10
Riverside (75)
F11 T40.2 F14 F12
Mental and behavioural disorders due to use of opioids Poisoning by other opioids (codeine, morphine) Mental and behavioural disorders due to cocaine Mental and behavioural disorders due to cannabinoids
23 12 11 10
Windmill Hill (38)
T40.2 F12 T42.4
Poisoning by other opioids (codeine, morphine) Mental and behavioural disorders due to cannabinoids Poisoning by benzodiazepines
15 8 8
‘-‘ denotes value of less than 5, so data supressed
Hospital admissions with a primary diagnosis of poisoning by illicit drugs (crude rate per 100,000 population, all ages. 2013/14) (figure 6)
Figure 6 above shows that the Halton rates for males is lower than the North West average but higher than England. However, the female admission rate for poisoning by an illicit drug is higher than England and the North West.
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Hospital admissions with a primary or secondary diagnosis of drug related mental health and behavioural disorders (crude rate per 100,000 population, all ages. 2013/14) (figure 7)
Figure 7 above shows that the Halton admission rate for drug related mental health and behavioural disorders was similar to the North West for both males and females. However, the Halton was higher than the England average, especially for males.
Treatment data Under 18s in specialist treatment services in Halton (includes alcohol) (figure 8)
Between 2011/12 and 2013/14, the number of under 18s in specialist treatment services in Halton, fluctuated between 35 and 66. However, in 2014/15 the number
increased from 70 at the start of the financial year, to 122 at the end of the year. The number has remained around 115 during 2015/16.
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Problematic substances for young people in treatment (figure 9)
Technical Notes: Figures are of young people in specialist substance misuse community services April to March each year. Substances cited are from any episode for the young person in the year (any citation in drug 1, 2 or 3). Individuals may have cited more than one problematic substance so percentages may sum to more than 100%.
Between 2011/12 and Q3 2015/16, the percentage of under 18s in specialist treatment services citing cannabis and alcohol as problematic has fluctuated. The number of young people citing cocaine as a problematic
substance has decreased since 2011/12, however, the numbers for ecstasy and NPS (novel psychoactive substances – legal highs) have increased slightly since 2013/14.
Adults in drug treatment services (figure 10) During 2014/15, there were 526 adults from Halton who were in drug treatment, and 73% of these were males. Figure 10 below shows the overall (persons) breakdown by different age bands.
For both 2013/14 and 2014/15, the 35 to 39 age group had the highest percentage, followed closely by the 40 to 44 age band. This is different to the emergency admissions data which shows that the highest rate was
in the 20 to 24 followed by the 25 to 29 age group. However, this could be due to people not realising they need or want help until they are older.
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Percent Rank Percent Rank
Halton 10.0% 20th 52.2% 12th
Knowsley 6.2% 106th 54.1% 8th
Liverpool 7.0% 80th 49.4% 21st
Sefton 3.8% 148th 43.5% 45th
St Helens 6.9% 83rd 39.4% 65th
North West 8.3% 44.2%
England 7.4% 39.2%
Opiate Non-opiate
Problematic substances for adults in treatment, 2014/15 (table 8)
Substances cited (all in treatment)
Non-opiate only
Opiate alcohol and non-opiate
Opiate and alcohol
Opiate and non-opiate
Opiate only
Opiates 0 14 10 41 115
Opiates and crack 0 27 0 169 0
Crack - 0 0 0 0
Benzodiazepines - - 0 19 0
Amphetamines 12 0 0 5 0
Cocaine 71 5 0 31 0
Hallucinogens 0 0 0 - 0
Ecstasy - 0 0 0 0
Cannabis 91 10 0 36 0
Anti-depressants 0 - 0 0 0
Other drugs (excluding NPS)
- - 0 - 0
Novel psychoactive substances (NPS)
- 0 0 - 0
Prescription drugs 6 7 0 6 0
‘-‘ denotes value of less than 5, so data supressed
Table 8 shows that the 5 main categories used for drug treatment classification, along with the specific drugs the treatment users cited as problematic. It shows that the drugs which were cited as problematic the most were opiates & crack followed by opiates, then cannabis. This suggests that drug users are more likely to use cannabis when they are young (as that was the most common drug cited for under 18s), but then move on to stronger/illegal drugs as they get older.
Successful completion of drug treatment – adults 2014 (table 9)
% of opiate/non-opiate drug users that left drug treatment successfully, who did not re-present to treatment within 6 months, as a proportion of all adults in treatment. 2014 calendar year, with individuals followed up to June 2015 as necessary.
Rank out of 149 county and unitary authorities, where 1
st is
the best.
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Table 8 shows that Halton had the best successful completion percentage for opiate users in Merseyside during 2014, and was the 20th best in England. The percentage was also better than the North West and England averages. For non-opiate users, the Halton successful completion percentage was the 2nd best in Merseyside, and the 12th best in England. It was also better than the regional and national averages.
Deaths related to drug misuse (figure 10)
The Halton death rate due to drug misuse was very similar in 2006-08 to 2009-11, but during 2012-14 the rate did increase. However, as the England average increased slightly in 2012-14, the Halton rate isn’t significantly different.
The rates for Liverpool, Sefton and Knowsley also increased during 2012-14.
Deaths related to drug misuse by sex (table 10)
Males Females
Halton 77% 23%
England 75% 25%
The table above shows that Halton, like England, has a higher percentage of deaths related to drug misuse for males than females. Also the Halton and England percentages split by sex were very similar between 2006 and 2014.
Drug related deaths by type of drug
In Halton, opiates were the most common drug mentioned for deaths where a drug related code was included in the mortality file. The percentage where an opiate code was present was 52%. Again, this is very similar to England where the percentage was 53%.
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Data Sources used in developing this profile
Public Health England (PHE) fingertips tool: admissions due to substance misuse (15-24 yrs)
Office of National Statistics (ONS): resident population estimates/drug related death data
Secondary Uses Service (SUS) data: hospital admissions/episodes data
Health & Social Care Information Centre (HSCIC): hospital admissions data
National Drug Treatment Monitoring System (NDTMS): drug treatment data
Primary Care Mortality Database (PCMD): detail on the cause of deaths of residents Profile Author: Jennifer Oultram - Public Health Intelligence Officer
Public Health Evidence & Intelligence Team