Brent JSNA

2019/2020

Substance Misuse

Summary

• Drug and alcohol misuse is associated with a wide range of health and social issues and creates significant costs to the public purse.

• Dependency in particular is commonly linked to poor outcomes in relation to physical health, mental health, parenting, education, training, employment and

housing with anti-social and criminal activity that adversely affects individuals, families and communities.

• Estimates of the level of substance misuse in Brent (from the National Drug Treatment Service Monitoring System, NDTMS) indicate that the borough has

rates of opiate and crack misuse which are higher than the London or national average; of opiate use which is also higher than the London or National

average; and of crack use which is similar to the London average and above the national average.

• There are no waiting times for specialist substance misuse services in Brent. However, the proportion of estimated users who are accessing treatment is

lower than the national average for all categories of drug misuse. This is particularly the case for women.

• Reflecting past harm minimisation approaches to treatment, Brent has a larger proportion of clients who have been maintained in treatment for long periods

of time than is the case nationally. These clients are aging and developing co-morbidities

• Once people access treatment for drug or alcohol problems, in Brent the numbers who “drop out” of treatment are less than national averages.

• As is the case nationally, most referrals into treatment are from the criminal justice system or self referrals with relatively few from GPs (5%) or hospital / A&E

(3%)

• Treatment services in Brent have higher rates of “successful completion” of treatment than nationally and lower re-presentation rates

• Rates of hospital admission due to alcohol for adults are higher in Brent than London or nationally.

• The rate of alcohol-specific hospital admissions for under 18s is significantly below the London average and the national average. Most young people do not

misuse drugs. Specialist young people’s substance misuse services are accessed by around 140 young people in Brent. The commonest route of referral is

from youth justice system and cannabis is by far the commonest substance used.

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Substance Misuse in Brent

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NDTMS (National Drug Treatment Monitoring System) helps provide an understanding into local patterns of drug and alcohol

misuse and compares this to London and national averages. This system in turn allows us to highlight the number of substance

misusers who are referred to treatment as well as those that are yet to refer and enter treatment (known as treatment naive).

In Brent NDTMS have estimated there are:

Source: NDTMS data, 2019

Substance Misuse Prevalence Estimates

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In Brent the latest prevalence

estimates of opiate and crack

users show that at a national level

and in the London region, the

combined numbers of people who

take crack cocaine on its own,

illicit opiates on their own and

those who take both drugs is

lower than Brent’s prevalence

estimates.

Source: Adults drug commissioning support pack, 2019/20

Percentage of unmet needs in Brent and National Figures

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National figures for 2017/18 would suggest that the percentage of unmet need is as follows:

Substance Local

(n)

Rate per 1000 Unmet need Unmet need by Sex

Male Female

OCU 2,310 10.33 75%

54% 63%Opiate 1,732 7.84 69%

Crack 1,331 5.95 73%

Substance National

(n)

Rate per 1000 Unmet need Unmet need by Sex

Male Female

OCU 313,971 8.85 54%

48% 39%Opiate 261,294 7.37 47%

Crack 180,748 5.10 60%

Source: PHE, Fingertips, 2019

Drug Use and Treatments in Brent

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Number of Individuals receiving Drug Treatment in Brent

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Drug misuse is when individuals regularly take one or more substances to change their mood, emotion or state of consciousness, this includes addictive drugs

such as heroin and cocaine. In Brent there are currently 818 people receiving treatment for drug misuse with 312 individuals starting new treatment. This data is

split by males and females in order to assess the needs for each sex, for example women may present poorer mental health or they may be carers of children

which could impact their recovery.

Numbers in Treatment in Brent

818 Adults in Drug Treatment

Proportion of Males Proportion of Females

77% 23%

Numbers in Treatment National figures

192,696 Adults in Drug Treatment

Proportion of Males Proportion of Females

73% 27%

Ages of adults in drug treatment in 2017-18

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People in treatment in 2017/18 for opiate and drug use tended to be 30 years or above. The median age of individuals in drug treatment is was 40 years old.

Ages of adults in drug treatment in Brent

Age ranges Brent National

18-29 195 33,349

30-39 356 70,438

40-49 286 61,320

50-59 209 23,270

60-69 37 3,841

70-79 3 340

80+ 0 45

Proportion of time adults in Brent spent in substance misuse treatment

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Substance misuse treatment were categorised

into 3 categories: Opiate, non-opiate and

non-opiate and alcohol.

Treatment time was assessed for opiate users

through clients who were in treatment for

under 2 years or 6 years or more. Treatments

were also given to non-opiate clients who were

in treatments for 2 years or more, as well as

non-opiate and alcohol clients in treatment for

2 years or more.

This was compared nationally which showed,

the highest number of clients were in treatment

for under 2 years in Brent, this was lower than

the national average.

Brent had a number of clients in treatment than

national average for all other treatment.

Source: Drug commissioning support pack, 2019/20

Routes into treatment for drug misuse

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In 2019/20 In Brent many of the referrals came through self-referral and the criminal justice system.

Source: Adults drug commissioning support pack, 2019/20

Treatment engagement for drug misuse

In Brent individuals who have been receiving treatment in 2018/19 are significantly more engaged in their treatment than national figures. This table highlights that

Brent has a low rate of early unplanned exits and successful treatment engagement in comparison to England averages.

The information below shows the proportion of adults in Brent who entered treatment in 2018-19 and left in an unplanned way before 12 weeks, commonly referred to

as early drop outs.

Early unplanned exits in 2018-19

Brent National

Opiate 21 7,129

Non-opiate 1 3,396

Non-opiate and alcohol 4 3,756

All 26 14,281

Source: PHE JSNA Drug data support pack

Waiting times in treatment

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Waiting time for first intervention Brent Proportion of initial waits National Proportion of all initial waits

Initial waits under three weeks to start treatment

432 100% 100,786 99%

Initial waits over six weeks to start treatment 0 0 474 0%

In Brent there good waiting times to start treatment and

individuals are able to access treatment to little waiting time.

Although primary opiate users remain the largest group

engaged in services, there are still unmet needs, the figure

shows 75% of opiate and crack users, 69% of opiate users

only and 73% of crack users only in Brent, all still display a

need to access drug misuse treatment services. Therefore, in

Brent we aim to minimise any barriers that may make it

challenging for individuals to engage in services .

Source: Adults drug commissioning support pack, 2019/20

Client Profile for drug treatment in Brent

13PHE: Drug commissioning support pack, 2019/20

Problem Alcohol and Treatments in Brent

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Client Profile for Alcohol New Presentations

This data shows information on demographic groups that presented to problem alcohol treatment in 2017-18.

Religion Proportion of individuals

Christian 43%

Hindu 11%

Muslim 7%

No Religion 24%

Missing / incomplete 8%

PHE: Alcohol commissioning support pack, 2019/20

Hospital Admissions for Alcohol conditions

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Health conditions in which alcohol plays a causative role can be classified as either ‘alcohol specific’ or ‘alcohol related’. *the next

two slides will explain this further*

Types of Alcohol Hospital Admissions

Alcohol Related Alcohol Specific

Alcohol related hospital admissions can occur in hazardous or

high risk drinkers, dependent drinkers or binge drinkers.

Alcohol-related conditions are broken into two categories;

narrow and broad. The narrow measure is where an alcohol-

related disease, injury or condition is the primary reason for a

hospital admission or there was an alcohol-related external

cause. Alcohol related broader measures look at a range of other

conditions that could be caused by alcohol

Alcohol Specific admissions relate to hospital admission caused

specifically by the use of alcohol, for example, alcohol induced

behavioural disorders, alcoholic liver disease and epilepsy.

Hospital Admissions for Alcohol-related conditions

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Alcohol related hospital admissions can be due to regular alcohol use that is above low risk levels and is most likely to involve high risk drinkers, dependent drinkers and binge

drinkers. In Brent the hospital admission rates have increased from 2013/14 to 2017/18 in Brent, in particular the rates for alcohol related conditions are higher for men in Brent

in comparison to London and England averages.

The data highlights that the number of hospital admission

episodes in Brent are significantly worse than London and

England averages and the numbers are increasing each year.

Similarly, the number of hospital admissions for women in Brent is significantly in worse than London and England average.

Source: PHE Fingertips, 2019

Hospital Admissions for Alcohol-specific conditions

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Alcohol Specific admissions relate to hospital admission caused specifically by the use of alcohol, for example, alcohol induced behavioural disorders, alcoholic liver

disease and epilepsy.

.

Women in Brent since 2013/14 have the lowest rates for alcohol specific

hospital admissions compared to London and England regions.

In Brent, the data shows a slight increase in admission rates for men in

Brent which are much lower in comparison to London and England

averages

Source: PHE Fingertips, 2019

Number of Individuals receiving Alcohol Treatment

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The harm caused by misuse of alcohol and drugs can come in multiple different forms including health, social and criminal justice terms. It is therefore

important and an aim for Brent Public health, for individuals who have alcohol problems to enter treatment.

274 people in Alcohol Treatment

Proportion of Males Proportion of Females

69% 31%

75,555 people in Alcohol Treatment

Proportion of Males Proportion of Females

60% 40%

Age of adults in alcohol treatment

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In Brent and England, the median range of adults in alcohol treatment were in the age range of 40-49 and 50-59.

Length of time in Alcohol treatment

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Successful completions of treatment

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The data below shows the proportion of drug-users who completed their treatment free of dependence, it also however shows the progress Brent has made in comparison to

national figures.

Source: Adults drug commissioning support pack, 2019/20

Substance Misuse and Mental Health: Dual Diagnosis

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Dual diagnosis relates to the co-existence of mental ill health and the problematic use of drugs and/or alcohol.

In Brent, 23.1% people who were in contact with mental health services were in concurrent contact with substance misuse services for drug misuse in 2016/17. This was

lower than the England average of 24.3% (NDTMS).

Source: PHE, Public Health Outcomes Framework : Fingertips

Criminal Justice System

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Drugs and alcohol are identified as two of the key drivers of crime and disorder in the Home Office Modern Crime Prevention Strategy (2016).

Individuals dependent on opioids and/or crack cocaine (OCUs) are responsible for an estimated 45% of acquisitive crime (shoplifting, burglary, vehicle crime and robbery),

equating to the commission of more than 2,000,000 offences. Around 40% of all violent crimes are alcohol-related, which translates into almost 500,000 violent incidences per

year. Drug and alcohol misuse are related to other issues such as child protection, impaired driving, anti-social behaviour and domestic abuse. Alcohol and drug-related

offending are estimated to cost £11 billion and £13.9 billion, respectively.

Source: PHE Fingertips, Substance Misuse 2019.

Criminal Justice System (Continued)

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The graph shoes the routes into drug and alcohol treatment in 2017-18. This gives us an indication of the levels of referrals from criminal justice and other sources into specialist

treatment. ‘Referred through CJS’ means referred through an arrest referral scheme or via a drug rehabilitation requirement (DRR), an Alcohol Treatment Requirement (ATR),

prison or the probation service.

In Brent the highest number of

individuals referred into

treatment from criminal justice

are from prisons.

Housing and homelessness

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This data highlights the

amount of individuals self-

reported housing status when

they started their treatment

services.

Also the number of individuals

who reported homeless as well

as individuals who no longer

reported a housing need.

Engaging with local housing

will ensure individuals going

through treatment are living in

a stable home environment.

Source: PHE JSNA Drug data support pack

Substance Misuse in Young People

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Substance Misuse on Young People in Brent

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Young People’s Services – Substance Misuse 2019-20

• The role of specialist substance misuse service is to support young people to address their alcohol and drug use, to reduce the harm it causes them and prevent it from

becoming a greater problem as they get older.

• While the majority of young people do not use drugs, drug and alcohol misuse can have a major impact on young people’s health, their education, their families and their

long term changes in life. Effective commissioning and delivery of services can ensure young people understand the risks that they may face from misusing substances.

• Most recent figures show that in 2017/18, there were 139 young people in specialist services in the community- down compared to 2015/16 figures.

• 100% of all waiting times were under 3 weeks and planned exits went up 2 percentage points to 78% (England average remains static at 79%).

• Of all clients, the majority (83%) were referred through youth justice system (incl. the Secure Estate) and nearly all were accessed with psychosocial interventions (99%)

Source: National Drug Treatment Monitoring System (NDTMS) DOMES YP report 2014/15

Substance Misuse and young people

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Drug-taking can cause significant social problems and carries significant risks. Therefore specialist services treatment for substance misuse must deliver age-

appropriate interventions, asses the risks and promote the safeguarding and welfare of children and young people. Services should be based on developmental

need rather than age. The needs of 18-24s are different to those under 18s as it the legislative framework.

The data shows that young people aged 16-17 in Brent have higher rates than National figures of misusing substances such as Cannabis and Heroin and/or

crack.

Age by Substance < 13 yrs.

old

14-15 yrs.

Old

16-17 yrs.

old

18-24 yrs.

old

Heroin and/or crack 0% 11% 33% 56%

Stimulants (cocaine,

ecstasy, amph, not

crack)

0% 6% 16% 78%

Cannabis 2% 14% 61% 23%

Alcohol 0% 9% 24% 67%

Tobacco 0% 8% 25% 67%

Other drug 0% 0% 25% 75%

Source: PHE Young people, substance misuse commissioning support pack 2019/20

Young people’s services.

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This data represents information on the number of hospital admissions related to drug misuse in young people. Brent has significantly lower numbers of under 18 alcohol-

specific hospital admissions in comparison to London and England figures:

From 2013-14 to 2017-18 we can see that

Brent has the lowest number of young

people admitted into hospital for alcohol-

specific conditions in comparison to

London and England regions. There has

also been a gradual decrease in the

number of admissions of alcohol specific

conditions for young people in Brent.

Source: PHE Fingertips, Substance Misuse 2019.

Young people and Substance Misuse treatment services

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The evidence shows that being in treatment itself reduces levels of offending, so the Modern Crime Prevention Strategy focuses on the need for treatment,

prevention and enforcement to mitigate the impact of drug-related crime. Evidence-based drug and alcohol treatment also help in terms of health improvements,

reduced drug and/or alcohol related deaths and wider social harm.

The data below reflects the number of young people in specialist substance misuse services in Brent from 2015 to 2018. This figure also highlights there are more

young people entering specialist services nationally than in Brent. In Brent the numbers of young people entering services has decreased in 2017 since 2015.

Specialist Services Brent England

Number of young adults (aged under 18) in specialist services in the community) 139 15,952

Number of young adults (18-24) in young people specialist services in the community 52 3,308

Number of young people (aged under 18) in specialist services within the secure

estate

10 1,289

Priorities for future work

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The high rates of hospital admissions which are related to alcohol and the lack of referrals from hospitals to community specialist treatment

services suggest a need to develop the detection and response to problematic alcohol use in the acute sector and to improve pathways

between hospital and community services.

Services, both substance misuse treatment services and general physical and mental health services, need to respond to an aging and

older cohort of people misusing alcohol and / or drugs. These residents require a more co-ordinated response from substance misuse

treatment services, from physical and mental health services, and from social care due to the increasing complexity of their needs.

Preventative and early intervention work to reduce opiate usage, crack and crack cocaine in Brent remains a priority. However there is also

a need to recognise the new challenges posed by Novel Psychoactive Substance (NPS) and how services can be adapt to meet new

treatment needs. This is likely to require closer working between substance misuse and sexual health services.

Preventative and early intervention work to reduce the level of cannabis and problematic alcohol use amongst Brent’s young people is

recognised as a priority. This will include the development of improved pathways and interventions between young people’s substance

misuse services, sexual health, youth justice and mental health.

Technical notes

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DefinitionsOCU – Opiate and Crack Users

Substance Misuse – Misusing substances such as crack, drugs, opiate and alcohol

NDTMS – National Drug Treatment Monitoring System

Data sources

Public Health England, Local Alcohol Profiles for England:

Local alcohol profiles

National Drug Treatment Monitoring System:

National Drug Treatment Monitoring System

PHE: Drugs Commissioning Support Pack, 2019/20

PHE: Alcohol Commissioning Support Pack; 2019/20

PHE: Young people Substance Misuse Commissioning Support Pack, 2019/20

1. Conception statistics. England and Wales. 2017. ONS 2019

2. Wellings K et al. 2016. Changes in conceptions in women younger than 18 years and the circumstances of young mothers in England in 2000-12: an observational study.

Lancet 388 (10033), 586-595. 6 August 2016