1. Drugs and Alcohol Needs Assessment 2011/12: Dissemination of findings

2. Introduction and background: Annual Needs Assessment Funding Needs Assessment - historically looked only at drug misuse National Drug Strategy was published in 2010 Flexibilities in funding

3. Introduction and background continued: 2012/13 System Tender; Identification of trends Changing patterns of use Gaps in service provision Innovation

4. Drugs and Alcohol: Achievements over last 5 years Year on year increase on numbers in treatment and retained Increased funding into treatment system More offenders being attracted to and entering treatment (via DIP) Forest Bank – continued to build on and strengthen relationships Reduction in drug related crime Increase in community based provision (i.e. pharmacies, GPs) Accessible delivery of community based services – i.e. support groups from UCAN centres

5. Drugs and Alcohol: Achievements over last 5 years continued Reduction in deaths as a result of Overdoses Attracted a younger cohort Re-design of system Waiting lists down More throughput Innovation e.g. SHINE Reduction in hospital related admissions Priority for Bolton Community Strategy

6. Needs Assessment 2011/12 Aims and Objectives: What works well, and for whom in the current system and unmet needs across the system Where there are gaps for drug users in the wider reintegration and treatment system Where the system is failing to engage and/or retain people Hidden populations and their risk profiles Enablers and blocks to treatment and to reintegration

7. Needs Assessment 2011/12 The Needs Assessment reports on: Prevalence of Opiate / Crack User (OCUs) in Bolton. Prevalence of alcohol users in Bolton Numbers in treatment, retention in treatment and treatment outcomes. The profile of the population in treatment. Areas of interest and gap analysis – exploring the potential for treatment provision to be improved.

8. Needs Assessment 2011/12 Some examples of data sources used: Annual National Treatment Agency (NTA) data for Needs Assessment Monthly & quarterly NTA reports Agency data – Monthly performance reports; population data PCT Health Survey data Local Alcohol Profiles for England Test On Arrest Previous Needs Assessments North West Public Health Observatory reports National guidance and strategy documents

9. Drugs – headline findings: OCU estimate down - 2,272 Opiate or Crack users Of these 1,180 (52%) are in effective treatment. Not known 417 Treatment penetration continues on an upward trend and is again at an all-time high For the period June 2010 to May 2011 we see 83% of OCUs and 76% of all presentations are retained into effective treatment.

10. Harm Reduction: The proportion of the ‘in treatment’ population who inject has increased dramatically (32% - 50%) Whilst HBV and HCV interventions are prominent, actual take up of these remain low. The recommendation for enhanced provision from pharmacy needle exchanges has been taken forward Specific interventions for amphetamine injectors was recommended – this is an on-going priority Overdose prevention and basic life support training to staff, drug users and significant others should be continued, including in prisons

11. Drugs – headline findings: Amphetamines The number of new amphetamine users who presented to treatment services in 2009/10 was 67 the number presenting in 2010/11 increased very slightly to 75 The proportion of the139 amphetamine users in treatment who were injectors in 2009/10 was 55% (n=77); the proportion of the 256 in treatment who were injectors in 2010/11 increased significantly to 70% (n=180). The worrying conclusion is that there is a significant increase in primary amphetamine use, allied to a trend of injecting.

12. Types of Drug Use Continuing trend toward combined opiate and crack use. Bolton’s OCU population is ageing – implications include increasing risk of poor health or death, and rising demands on medical and social services. Increasing trend of poly drug use, both among recreational users (non-OCUs) and OCUs, including alcohol – which may exacerbate risk factors such as long-term health damage and risk of overdose. OCU use being replaced by range of drugs. No under 18yrs OCU presentations. CrackHeroin 1,158 (1,248) 852 (885) 262 (339) Fig. 1: Home Office estimates of the patterns of PDU drug use (2010 data in brackets)

13. Treatment Outcomes: Retention and Exits Retention of new clients in effective remains high – during Q1-Q4 there was between 85 – 87% OCUs Care planned exits – improved in year but still an on-going priority - 37% of all treatment exits were care planned in Q4

14. Alcohol, findings: Estimated; 47,336 increasing risk drinkers 14,118 Higher risk drinkers 54,187 Binge drinkers The potential for alcohol problems therefore is focused on less than a third of the Bolton population. Bolton reports lower than the North West average across a range of indicators included alcohol attributable and alcohol specific hospital admissions.

15. Alcohol, findings: The Single Point of Contact has created fast access to triage, BI and intermediary interventions 630 alcohol misusers were in treatment 48% of all alcohol exits are planned and alcohol free or occasional users

16. Trends in alcohol use: Heaviest drinking areas are the more affluent ones Volumes and complexity very high Health impacts lower than expected Health impacts linked to deprivation Increase of drinking in the home Greater amounts being consumed in the home

17. Recovery: Recovery is a process through which an individual achieves sustained control over their substance use which maximises health and well-being and participation in the rights, roles and responsibilities of society. Unemployment - ETE provision is becoming increasingly important, the Government’s focus on welfare reform, with the aim of getting people off long-term benefits and back into work, will have a substantial impact Housing needs - 20% of new drug clients and 11% of new alcohol clients in 2010/11 had housing problems or were of no fixed abode Reintegration – lifestyle / health & wellbeing

18. Hidden Harm: The ACMD report ‘Hidden Harm’ (2003) focussed attention on the impact of parental problem drug use on children, estimating that the parents of 2-3% of under 16 year olds are opiate/crack users. In addition, an Alcohol Concern publication estimated the numbers of children affected by parental alcohol use Bolton estimate For children under 16 years old in Bolton this approximates to; 14,350 living with hazardous drinkers and 3,890 living with dependent drinkers. Between 1074 and 1611 children living with opiate/crack users A substantial proportion of new treatment starts in Bolton are parents or have children residing with them (51% for drugs and 60% for alcohol).

19. Dual Diagnosis: Dual Diagnosis is the term used to describe concurrent mental health and drug/alcohol problems. Only 16% of new drug presentations and 11% of new alcohol presentations are reported as having a mental health issue. All evidence indicates that a high proportion of drug and alcohol treatment clients in Bolton are likely to have concurrent mental health needs. There has been a concerted programme for raising of awareness about dual diagnosis, and appropriate training for frontline staff in partner organisations (such as Police, Probation, Jobcentre Plus) to enable full understanding of pathways and protocols.

20. Over to you……. What does all this mean for you? What have we missed? Are there other priorities we should be considering? What are your priorities?

21. Challenges: Drugs During the year 2010/11 in the North West 48% of all clients ‘completed treatment’ where as in Bolton 38% did so; Low but increasing numbers of inter agency transfers (201 this year, last year 179); Rising cost of substitute prescribing. Alcohol The profile of drinkers presenting to treatment remain weighted towards the heavier end; Both the volume of alcohol consumed and the complexity of additional problems of those presenting to treatment is much greater than the national average; The impact of drinking upon health; particularly those in the more deprived communities.

22. Frequent Flyers Frequent attenders to hospital with alcohol related illness which may or may not result in an admission. This group of patients The Alcohol Learning Centre places Alcohol Frequent Flyers as one of the ‘High Impact Changes’ when looking at a cost and benefit to additional interventions. In Bolton the top 43 frequent flyers received a total of 290 episodes of care costing nearly £650k in the last year.

23. Frequent flyers in Bolton

24. Substance Misuse: The future Changing profile of drug misuse Necessity to produce more for less – decreasing budgets Identification of opportunities to bring together drugs and alcohol treatment systems Implementation of digital strategy Engagement and ‘buy-in’ from partners Information and advice for different drug groups Development and promotion of specific provision for identified substance misuse groups Overdose Prevention Training Recovery Strategy