One in a regular series of slide sets on interesting data about alcohol and other drugs (and the wider issues to do with multiple needs) from a UK perspective.

1. Interesting things about
alcohol and other drugs
October 2017
Andrew Brown
@andrewbrown365

2. Estimated number of opiate and/or crack cocaine users by
age in England in 2011/12 and 2014/15
32,628
109,124
152,127
30,190
91,808
178,785
0
20,000
40,000
60,000
80,000
100,000
120,000
140,000
160,000
180,000
200,000
15 to 24 years 25 to 34 years 35 to 64 years
2011/12 2014/15
Source: Estimates of the Prevalence of Opiate Use and/or Crack Cocaine Use, 2014/15: Sweep 11 report (LJMU 2017)

3. Estimated number of opiate and crack users in England in
2011/12 and 2014/15
16,935
46,337
36,270
24,085
34,329
21,952
54,985
32,935
26,051
17,675
48,814
36,662
25,057
34,822
25,910
52,487
32,734
26,622
-
10,000
20,000
30,000
40,000
50,000
60,000
North East North
West
Yorkshire
and the
Humber
East
Midlands
West
Midlands
East of
England
London South East South
West
2011/12 2014/15
Source: Estimates of the Prevalence of Opiate Use and/or Crack Cocaine Use, 2014/15: Sweep 11 report (LJMU 2017)
Nationally, there was a 2% increase in
the estimated number of OCUs, but
this change was not statistically
significant.The number of OCUs in
the East of England increased by 18%,
from 21,952 in 2011/12 to 25,910 in
2014/15, and this increase of 3,958
was statistically significant (95% CI:
270 to 7,606). There was an increase in
the point estimate in the North West
of 2,477 – an increase of 5% - but this
was not statistically significant.All
other regions saw increases in the
point estimate apart from a small fall
in the South East and a larger (but still
not statistically significant) fall in
London.

4. Estimates of the number of households experiencing core
homelessness in Great Britain, by type, in 2011 and 2016
(rounded)
6,100
5,900
7,900
47,100
10,000
42,900
9,100
8,900
12,100
42,200
19,300
68,300
-
10,000
20,000
30,000
40,000
50,000
60,000
70,000
80,000
Rough Sleepers Car, tent, pub
transport
Squatting Hostels, refuges
etc.
Unsuitable
Temporary
Accommodation
Sofa Surfers
2011 2016
Source: Homelessness projections: Core homelessness in Great Britain (Crisis/Herriot Watt University 2017)
“The scale of core homelessness
has increased significantly across
Great Britain (33% between 2011
and 2016).”
“At any one point in time, core
homelessness in 2016 stood at
around 160,0002 households in
Great Britain (143,000 in
England, 5,100 inWales, 11,800
in Scotland).”
“We estimate that core
homelessness contains 57,000
‘family’ households (couples or
lone parents) containing 82,000
adults and 50,000 children, so
that the core homeless
‘population’ is 236,000.”

5. Projections for the number of people sleeping rough in
England, Wales and Scotland
-
5,000
10,000
15,000
20,000
25,000
30,000
35,000
40,000
45,000
2011 2016 2021 2026 2031 2036 2041
England Wales Scotland
Source: Homelessness projections: Core homelessness in Great Britain (Crisis/Herriot Watt University 2017)
“A sub-regional housing market model has been
adapted to forecast future levels of homelessness
which has modelled 15 additional variables.*The
model depends on many assumptions but for the
purpose of this analysis it has been fixed on a
relatively neutral/ benign scenario for the economy
and labour market, and current policy settings
including planned welfare reforms.”
*The 15 variables used are rough sleeping, hostel
residents, unsuitable temporary accommodation,
sofa surfers, total core homelessness, homeless
acceptances, total homeless applications, total in
temporary accommodation, people asked to leave
household, evictions, wider homelessness, relative
low income poverty after housing costs, crime
rates, welfare reform cuts impact (from Beatty &
Fothergill), households in financial difficulty.

6. LGA survey of local authorities about providing naloxone
in the community
99%
25% 25%
21%
18%
12%
6% 5%
25%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Drug
treatment
service
Hostels Outreach
workers
Pharmacy
needle and
syringe
programme
Peers (other
people who
use drugs)
Primary
care
Community
pharmacies
A&E Other
Which services or organisations provide take-home naloxone? Nine in ten respondent local authorities (90
per cent) currently made available take-
home naloxone. Six of the fourteen
respondents which did not currently make
naloxone available subsequently
commented that they were either
considering, planning or about to make it
available.
“All service users accessing our local drug
treatment services are offered take home
Naloxone -We have piloted the distribution
of take home naloxone in 3 community
pharmacies providing high level of needle
exchange and are looking to expand this
provision across all needle exchange
pharmacies over the coming year subject
to ratification” (West Midlands).
“Naloxone saves lives and is a very
important tool in tackling DRDs in our
area” (South East).
n = 121
Source Naloxone survey 2017 (LGA 2017)

7. Prevalence of blood borne viruses amongst people who
inject drugs in England, Wales and Northern Ireland
44% 43% 43%
47% 47%
43% 43%
47%
49% 50%
53%
28%
20%
18% 17% 16% 16% 17% 16%
14% 13% 14%
1.3% 1.1% 1.6% 1.5% 1.1% 1.2% 1.3% 1.1% 1.0% 1.0% 0.9%
0%
10%
20%
30%
40%
50%
60%
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Hepatitis C Hepatitis B HIV “…data from the main UnlinkedAnonymous
Monitoring Survey of PWID, which is targeted at
people who inject psychoactive drugs, indicate that
the proportion ever infected with hepatitis B has
declined and that the prevalence of HIV remains
stable and low. Hepatitis C remains the commonest
infection among this group and overall prevalence is
currently stable…Whilst the vast majority of those
with HIV were aware of their status, half of PWID with
antibodies to hepatitis C remain unaware of their
infection, even though four-fifths reported having
been tested for hepatitis C infection. After increasing
during the previous decade, the uptake of testing for
hepatitis C infection has changed little over the last
few years. Services should aim to have testing for
blood-borne viruses available for patients at first
assessment. Repeat testing of people who inject drugs
is recommended, and when risk is assessed as high,
testing may be carried out up to once or twice a year.”
Source: People who inject drugs: HIV and viral hepatitis monitoring (PHE 2017)

8. Characteristics of participants in the Unlinked Anonymous
Monitoring Survey of people who inject drugs in 2016
70%
91%
68%
75%
13%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Currently in treatment Ever used a needle exchange Ever been in prison Ever been homeless Ever traded sex for money,
goods or drugs
Source: People who inject drugs: HIV and viral hepatitis monitoring (PHE 2017)

9. Proportion of participants in the Unlinked Anonymous
Monitoring Survey (who had injected in preceding four weeks)
who reported injecting crack, powder cocaine and amphetamine
35% 35% 35%
29% 29%
32%
36% 37%
40%
46%
53%
16%
19% 18% 17% 18%
23% 22% 23% 24%
17% 17%
12%
12% 11%
8% 7%
9% 9%
7% 8%
10% 10%
0%
10%
20%
30%
40%
50%
60%
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Crack Amphetamine Cocaine
“Injection of crack increased in recent years,
with 53% (95% CI, 50%-55%) of those who
had injected in the preceding four weeks
reporting crack injection as compared to 35%
(95%CI, 33%-37%) in 2006.”
“Crack injection also increased among the
recent initiates, with 50% (95%CI, 40%-59%)
of those who had injected in the preceding
four weeks reporting crack injection in 2016,
vs. 28% (95%CI, 22%-33%) in 2006.”
“There was no significant change in the
injection of cocaine (10%, 95%CI 9%-12% in
2016 vs 12%, 95%CI, 10%-13% in 2006) or
amphetamine (17%,95%CI 15%-19% in 2016
vs 16%, 95%CI, 14%-18% in 2006) among
those who had injected in the preceding four
weeks.”
Source: People who inject drugs: HIV and viral hepatitis monitoring (PHE 2017)

10. Symptoms of an injection site infection (swelling containing pus
(abscess), sore, or open wound at an injection site) among those
who injected during the preceding year
15%
20%
25%
30%
35%
40%
45%
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Under 25 25 to 34 35 and over Symptoms of a possible injection site
infection are common among PWID
across England,Wales and Northern
Ireland. In 2016, 36% (95% CI, 34%-
38%) of PWID who had injected during
the preceding year reported that they
had experienced an abscess, sore or
open wound at an injection site – all
possible symptoms of an injection site
infection - during the preceding year.
This is a similar level to 35% (95% CI,
33%-37%) in 2006, but an increase from
28%-29% reported in 2011-2013.The
levels of possible injection site infection
were particularly high among the
under-25 year age group at 43%
(95%CI, 30%-58%), which is higher
than the 27% reported in 2006 (95%CI,
22%-32%).
Source: People who inject drugs: HIV and viral hepatitis monitoring (PHE 2017)

11. Proportion of participants in the Unlinked Anonymous
Monitoring Survey (who had injected in preceding four weeks)
who reported injecting in their groin.
35%
32% 32%
35%
34%
35% 35%
38% 38% 38%
40%
25%
27%
29%
31%
33%
35%
37%
39%
41%
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
“Injecting into the groin has been
associated with a number of health
problems, including damage to the
femoral vein and artery, infections and
circulatory problems.The proportion of
current PWID who reported injecting into
their groin during the preceding four
weeks varied across England,Wales and
Northern Ireland. By country, the
proportion injecting into the groin in 2016
was as follows: England 40% (95% CI,
38%-43%);Wales, 39% (95% CI, 31%-
48%); and Northern Ireland 60% (95% CI,
39%- 79%). Across England, there are
differences in the proportion reporting
injecting into their groin, ranging from
47% (95% CI, 40%-54%) in the SouthWest
to 33% in the East of England (95% CI,
25%-42%).”
Source: People who inject drugs: HIV and viral hepatitis monitoring (PHE 2017)

12. Top 10 telephone enquiries to the National Poison
Information Service and TOXBASE accesses relating to
drugs of misuse
163
140
116
100
76
74
68
67
54
51
0 50 100 150 200
Cocaine (including crack)
MDMA (including ecstasy)
Cannabis
Drug of misuse (not known)
Diazepam
Branded products
Heroin
Methadone
Amphetamine
SCRA
Telephone enquiries
11,499
10,281
5,201
3,980
3,904
3,887
3,166
2,593
2,148
2,062
- 4,000 8,000 12,000
Cocaine (including crack)
MDMA (including ecstasy)
Heroin
Amphetamine
Methylphenidate hydrochloride
Cannabis
SCRA
GHB and sodium oxybate
Ketamine
Branded products
TOXBASE Accesses
Branded produces - These are sold in packages with distinctive branding. Examples (sometimes previously termed ‘legal highs’) include ‘Black Mamba’, ‘Vertex’ and ‘Sweet Leaf’.
The constituents of these products are often unknown and may be inconsistent. Although many contain SCRAs, they are listed separately because some may contain other drug
types.
Source: National Poisons Information Service Report 2016/2017 (PHE, 2017)

13. Provision of support specifically for women across local
authority areas in England, by domain
68.9%
64.2%
53.6%
49.0%
37.7%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
Mental health Offending Complex needs Substance misuse Homelessness
N = 151
In England, the majority of
local authority areas
(n=122; 80.8% of all local
authorities) offer support
in two or more domains,
with the average being 2.8
(mean). Only in nineteen
local authority areas in
England (12.6% of all local
authorities) can women
access localised support
across all five domains.
Source: Holly, J. (2017). Mapping the Maze: Services for women experiencing multiple disadvantage in England and Wales. London: Agenda & AVA.

14. Types of identified substance misuse support for women in
England and Wales
33.7%
33.7%
12.0%
10.8%
9.6%
0.0% 10.0% 20.0% 30.0% 40.0%
Women’s group in generic
service
Substance misuse midwife
Women-only residential
rehabilitation facility
Other type of substance use
support
Women-only non-residential
substance misuse service
N = 83
Data from the National DrugTreatment
Monitoring System (NDTMS) indicates
that currently around a third of people
accessing drug treatment services are
women, with the figure rising to almost
40% in alcohol only support services.
As such, finding that only around half of
all local authority areas in England (n=74,
49.0%) and five unitary authorities in
Wales (22.7% of all authorities in Wales)
are home to localised support specifically
for women experiencing substance use
problems is disappointing
Source: Holly, J. (2017). Mapping the Maze: Services for women experiencing multiple disadvantage in England and Wales. London: Agenda & AVA.

15. Number of convicted BAME men placed in a high security
prison, for every 100 White men convicted of the same types of
offence
82
125
142
127
143
126
120 121
0
20
40
60
80
100
120
140
160
Black Asian Mixed ethnic All BAME
Drug offences All offence groups
Source: Lammy Review (2017)
“Many prisoners arrive in custody as
damaged individuals. In the youth estate,
33% arrive with mental health problems,
whilst a similar proportion presents with
learning difficulties. A third of children in
prison have spent time in the care system,
45% arrive with substance misuse
problems and 61% have a track record of
disengagement with education. In the
adult estate, an estimated 62% of men
and 57% of women prisoners have a
personality disorder, while 32% of new
prisoners were recorded or self-identified
as having a learning difficulty or disability.
Many have been both victims and
perpetrators of violence, with resulting
trauma and psychological damage.”

16. Deaths by drug poisoning where any opiates were mentioned on
the death certificate, English regions, 1993 - 2016.
0
50
100
150
200
250
300
350
400
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Yorkshire and the Humber West Midlands South West South East Outter London
North West North East Inner London East of England East Midlands
Source: User requested data (ONS, 2017)

17. Use of Asset Recovery Incentivisation Scheme funds
£.0m
£10.0m
£20.0m
£30.0m
£40.0m
£50.0m
£60.0m
£70.0m
£80.0m
£90.0m
2011-12 2012-13 2013-14 2014-15 2015-16
Asset Recovery work Crime Reduction projects Community projects Miscellaneous
“Law enforcement agencies allocated
the largest amount of monies received
from ARIS to fund future asset recovery
work8 .This was £73m in 2015/16,
representing 88% of available funds.
The remaining funds supported crime
reduction projects (£3m), community
projects (£1.5m) and miscellaneous
payments (£6m).”
“These figures only account for monies
and projects where the Home Office
have received a return from the law
enforcement partner and does not
reflect all theARIS monies that have
been distributed in a given year.”
Source: Asset recovery statistical bulletin: financial years ending 2012 to 2017 (Home Office, 2017)

18. Number and proportion of patients who have an emergency
alcohol-specific readmission to any hospital within 30 days of
discharge following an alcohol-specific admission
21,161
22,016
23,341
24,036
11%
12%
12%
13%
0%
2%
4%
6%
8%
10%
12%
14%
0
5,000
10,000
15,000
20,000
25,000
30,000
April 2011 - March 2014 April 2012 - March 2015 April 2013 - March 2016 April 2014 - March 2017 (Provisional)
Source Clinical Commissioning Group Outcomes Indicator Set (NHS Digital 2017)