1. Drug Misuse Monitoring Identifying Trends Predicting Future Demands Responding to Public Health Needs J McVeigh, MA Bellis & R Thomson

2. Why do we need a robust drug misuse intelligence system? Who contributes to the system? What are the applications of the system? Drug Misuse Monitoring

3. Reasons for a robust drug misuse intelligence system Monitor progress of the National Drug Strategy Assess the needs of specific geographical areas Identify effectiveness of interventions Inform effective commissioning of services Identify trends in substance misuse Predict changes in drug service demand Identify and respond to public health issues Support original research

4. Contributors to the system Pseudoanonymised data from: Health Specialist drug services Agency based syringe exchange services Pharmacy based syringe exchange services Criminal Justice Arrest referral schemes Probation Police arrest data Youth offending teams Additional providers Social services Housing Young people's services

5. Independent database outputs Multiple database outputs Retrospective analyses Responding to public health needs Applications of the drug misuse intelligence system

6. Independent database outputs Merseyside & Cheshire specialist drug service contacts (2000/1)

7. Independent database outputs specialist drug services outcomes (2000/1)

8. Multiple database outputs Merseyside multiple agency contacts: 1/10/2000 - 31/3/2001 514 10.9% 28 0.6% 29 0.6% 294 6.2% 240 5.1% SDA 4730 Probation 2575 Police 546 AR 938 SES 1743 SS 109

9. Data sources used to estimate total number of problematic drug users Estimated Total = 7121 (aged 15-44) 1981799 12 34 1 13 SDA 1847 Police 245 Probation 38 Multiple database outputs Estimate of hidden/total populations of problematic drug users in Liverpool (1998)

10. Percentage of estimated total of problematic drug users reported in treatment Multiple database outputs A higher percentage of females and those aged 25-44 accessing treatment services AreaPercentage of Estimated Total Reported in Treatment All Users MalesFemales15-2425-44 Liverpool26.6%22.1%40.1%21.0%27.8% Sefton30.6%25.8%48.0%14.1%36.1% St Helens & Knowsley26.2%20.9%49.5%18.8%30.0% Wirral46.5%42.6%57.1%29.5%51.8% * ** * 1998 **1999

11. Retrospective data analyses Problematic drug use reported by Merseyside & Cheshire SDA

12. Main drug of use - new clients presenting to agency based syringe exchange schemes in Merseyside & Cheshire Retrospective data analyses *Provisional data

13. Responding to public health needs Unexplained deaths among injecting drug users in NW England: A case control study using Regional Drug Misuse Database April – June 200014 cases in North West (12 fatalities) Need to: Understand the outbreak Identify characteristics of those most at risk Provide harm reduction information and advice Prevent re-occurrence of the outbreak Develop appropriate advice and information in event of re- occurrence 12/14 cases located on DMD 10 controls per case

14. Responding to public health needs Unexplained deaths among injecting drug users in NW England: A case control study using Regional Drug Misuse Database Results: Cases were significantly more likely to be: Female Older Longer users of heroin Injected benzodiazepines Application: Development of risk profile Targeting of prevention activities

15. Developments of the drug misuse intelligence system Expansion of data providers to the Inter Agency Drug Misuse Database Extended outcome monitoring Establishing links with other sources of intelligence Web based dissemination of drug misuse intelligence

16. Conclusions Monitor and predict changes in size/characteristics of drug misuse problems and drug service demand Facilitate the planning and evaluation of health and criminal justice interventions with drug misusers Enable a rapid response to public health investigations

17. For additional information contact: Jim McVeigh / Mark Bellis Centre for Public Health Liverpool John Moores University 70 Great Crosshall Street Liverpool L3 2AB heajmcve@livjm.ac.uk Rod Thomson Public Health Department South Sefton PCT Burlington House Crosby Road North Waterloo L22 0QB Rod.Thomson@southsefton-pct.nhs.uk Web: www.phslive.com www.nwpho.org.uk