About Public Health England

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Adult substance misuse statistics from the National Drug Treatment Monitoring System (NDTMS)

1 April 2014 to 31 March 2015

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About Public Health England

Public Health England exists to protect and improve the nation’s health and wellbeing, and reduce health inequalities. It does this through world-class science, knowledge and intelligence, advocacy, partnerships and the delivery of specialist public health services. PHE is an

operationally autonomous executive agency of the Department of Health.

Public Health England Wellington House 133-155 Waterloo Road London SE1 8UG Tel: 020 7654 8000 www.gov.uk/phe Twitter: @PHE_uk

Facebook: www.facebook.com/PublicHealthEngland Prepared by: Jonathan Knight

For queries relating to this document, contact: EvidenceApplicationTeam@phe.gov.uk

You may re-use this information (excluding logos) free of charge in any format or medium, under the terms of the Open Government Licence v3.0. To view this licence, visit OGL or email psi@nationalarchives.gsi.gov.uk. Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned.

You can download this publication from www.gov.uk/phe Published December 2015

PHE publications gateway number: 2015511

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For the first time, this report brings together information on people receiving specialist interventions for drugs and alcohol. Because many people experience problems with both substances and receive interventions for both, drugs and alcohol services are increasingly commissioned together. However, while the people who seek treatment for drugs and alcohol share many similarities they also have clear differences, so this report divides people in treatment into the four substance groups described below.

In all, 295,224 individuals were in contact with drug and alcohol services in 2014-15. Of these, 141,646 started treatment during the year – 97% started within three weeks.

The age profile of people in treatment is rising. For example, 44% of the 152,964 people in treatment for opiates are now 40 and over. Since 2009-10, the number of opiate users aged 40 and over starting treatment has risen by 21% (12,761 to 15,487). This ageing cohort is often in poor health, with a range of vulnerabilities associated with long-term drug use. These people require a wide range of support, including social care. When considering all ages, presentations to treatment for opiates have been falling over the last six years (55,494 to 44,356), reflecting the downward trend in prevalence of heroin use.

The number of people presenting for alcohol problems in 2014-15 was 150,640. Of these, 89,107 were treated for problematic drinking alone, and 61,533 for alcohol alongside other substances. Alcohol only clients had an older age profile than opiate users (68% aged 40 and over).

While the overall numbers accessing treatment for alcohol have increased by 3% since 2009- 10 (86,385 to 88,904), the number aged 40 and over accessing services has risen by 21% and the number aged 50 and over by 44% (42,128 to 50,786, 21%, 16,627 to 24,017, 44%). Many

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The majority of younger people (18-24) presenting to treatment in 2014-15 cited problems with either cannabis or cocaine (7,369, 52%, and 3,272, 23%). Most presentations for new

psychoactive substances (NPS) are also in the younger age groups, though the total number accessing treatment for NPS remains relatively low (1,370, 0.5%). Overall, the number of under-25s accessing treatment has fallen by 33% since 2009-10, with the largest decrease in opiates (mainly heroin) where the numbers presenting to treatment have fallen by 60%. This reflects a shift in the type of drug use among young adults.

Men made up 70% of the entire treatment population in 2014-15. The gender split varied depending on the presenting substances – 73% of people using drugs were male compared to 62% presenting with alcohol only. Individuals recorded as white British made up the largest ethnic group in treatment, (85%, 245,380) with a further 4% from other white groups.

Since 2013 the overall rate of people exiting treatment successfully has slowed. This is mainly because the rate of opiate clients successfully completing treatment has fallen, which is likely to be a result of those now in treatment having more entrenched drug use and long-standing and complex problems.

In all, 130,609 people exited the drug and alcohol treatment system in 2014-15, with 52%

(67,788) having successfully completed their treatment free of dependence. Non-opiate-only clients had the highest rates of successful exits with almost two thirds (64%) completing

treatment, followed by 61% of alcohol clients. Opiate clients had a completion rate of 30%. The recovery rates for non-opiates and alcohol have remained higher and stable largely because users of these substances are more likely to have access to the personal and social resources that can aid recovery, such as employment and stable housing.

The number of people who died while in contact with services in 2014-15 was 2,360. Most of these (61%, 1,428) were opiate clients who tended to be over 40 (median age 43) and were likely to have been using heroin for a long time.

While not all deaths in treatment will be attributable to an individual’s substance use, the use of drugs is a significant cause of premature mortality in the UK.¹ Drug misuse deaths registered in England and Wales between 2012 and 2014 increased by 42%, with the number now 2,120 per year, the highest since records began in 1993.² The number of deaths involving heroin in 2014 increased by 64% from 2012.

1 Murray, CJ, Richards, MA, Newton, JN, Fenton, KA, Anderson, HR, Atkinson, C, ... & Davis, A (2013). UK health performance: findings of the Global Burden of Disease Study 2010. The Lancet, 381(9871), 997-1020.

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Among those accessing treatment for alcohol only problems, there were 792 deaths. Again the majority were aged 40 and over, (median age 49). Users of other substances made up the remaining deaths, with the lowest number of deaths seen among users of non-opiates (39 deaths), the lowest median age (35 years) was also seen in this population.

The drug-related death rate among people in treatment is significantly lower than among those who are not in treatment.³

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1. Background and policy context

The statistics in this report on treatment for alcohol and drug dependence are collected through the National Drug Treatment Monitoring System (NDTMS). This publication is the first time information on individuals receiving specialist interventions for drugs and alcohol are brought together in one report. In doing so it recognises that people may experience problems with the use of many substances, including alcohol and may well require treatment to address issues of dependence together. It also reflects a growing trend for local authorities to commission drugs and alcohol services together.

Specialist treatment services are vital component parts of local authority treatment and recovery systems. Treatment services have a key part to play in helping local authorities address the harms associated with alcohol and drug use, including to health, families and communities, along with the associated crime. The government’s drug and alcohol strategies stress the importance of treatment services in reducing both the harm and public expense caused by problematic use (www.gov.uk/government/publications/drug-strategy-2010--2, www.gov.uk/government/publications/alcohol-strategy).

Specialist treatment is one of a range of interventions that need to be in place to address alcohol and drug problems effectively – to reduce harm and to help people recover. Others include alcohol identification and brief advice (IBA); information and advice on reducing harm;

needle and syringe exchange programmes; outreach work and support along with broader but related support such as access to housing and employment opportunities. Such interventions are provided in a range of settings including specialist services, general practice, pharmacies, hospitals and prisons, and by a range of providers – the NHS and the voluntary sector. Local authorities, who are responsible for commissioning treatment services, are well placed to bring the component parts of an effective system together, along with the NHS, to ensure all

elements work together for the good of their populations.

Alcohol and drug treatment services are now well established in communities across the country and over the past decade the number of people accessing help has increased considerably, as has the proportion recovering from their dependence. Evidence-based and effective interventions can improve the lives of individuals and the life chances of their children and the stability of their communities. They also have a significant impact in reducing the spread of blood-borne viruses, in reducing crime and in saving lives. The harmful effects of alcohol and drugs are greater in poorer communities and effective treatment services can play an important role in addressing these inequalities.

These statistics are used by national and local government to monitor the availability and effectiveness of alcohol and drug treatment in England. The information is collected from approximately 1,500 treatment services on a monthly basis. This data is regularly fed back to local service commissioners and service providers in the form of benchmarked reports, toolkits

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These resources are integral in assisting local areas to respond to need and improve outcomes. They can help local authorities ensure that the services they commission are effective and good value for money within the context of competing local priorities.

Information on the total number of people in alcohol and drug treatment in each local authority in England, the numbers accessing it each year, and the numbers leaving treatment can be found at www.ndtms.net/default.aspx.

While these statistics provide information on the numbers of people accessing treatment for alcohol dependence, they do not give an indication of prevalence of alcohol dependence in England. PHE will be releasing prevalence estimates of dependent drinkers in each local authority in early 2016.

For information on the wider harms associated with alcohol use, the Local Alcohol Profiles for England (LAPE) fingertips.phe.org.uk/profile/local-alcohol-profiles present a comprehensive picture of different health harms for alcohol related conditions, as well as information on mortality where alcohol is considered to have been a contributory factor.

Similarly for drugs, estimates of the number of individuals using opiates, crack and injecting drugs in England, reported nationally and by local authority, can be found at

www.nta.nhs.uk/facts-prevalence.aspx. The Crime Survey for England and Wales reports the prevalence of the use of all drugs nationally and can be found at

www.crimesurvey.co.uk/index.html.

Information on the history of the data collection of specialist drug treatment can be found in chapter nine of this report and chapter ten provides an explanation of the abbreviations that have been used throughout the report.

More detail on the methodologies used to compile these statistics and the processes that are in place to ensure data quality can be found at /www.ndtms.net/resources/secure/Quality-and- Methodology-NDTMS-2014-15.pdf.

If an error is identified in any of the information that has been included in this report then the processes described in the PHE revisions and correction policy will be adhered to. The policy can be found at www.gov.uk/government/organisations/public-health-england/about/statistics.

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CLIENT CLASSIFICATION

Has client presented to treatment citing opiates as a problem substance?

Has client presented to treatment citing non-

opiates as a problem substance?

NO

Has client presented to treatment citing alcohol as a problem substance?

YES

OPIATE CLIENT YES

NON-OPIATE ONLY CLIENT

NON-OPIATE AND ALCOHOL

CLIENT

ALCOHOL ONLY CLIENT NO

YES

NO CLIENT ENTERS

TREATMENT

2. Change in method of reporting alcohol and drug statistics

In 2012-13 the National Treatment Agency (NTA) consulted on changes to reporting practices and there was strong consensus among respondents that drug and alcohol treatment journeys should be combined. Previously, an individual recorded with a primary alcohol treatment episode concurrent with, or followed by, a primary drug one was reported twice, once as an alcohol client and once as a drug client. Some 6,000 individuals nationally had been double counted in this way.

Following this feedback, the newly formed PHE consulted further to align the way treatment journeys were reported across alcohol and drug treatment, and the way individuals were

categorised by their problem substances. The agreed methodological changes are illustrated in the diagram below.

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A client presenting to treatment citing problematic substance misuse is now categorised by the following hierarchal criteria:

 any mention of opiate use in any episode would result in the client being categorised as an OPIATE client (irrespective of what other substances are cited)

 clients who present with non-opiate substances (and not opiates or alcohol) will be classified as NON-OPIATE ONLY

 clients who present with a non-opiate substance and alcohol (but not opiates) recorded in any drug in any episode in their treatment journeys will be classified as NON-OPIATE AND ALCOHOL

 clients who present with alcohol and no other substances will be categorised as ALCOHOL ONLY

Due to these changes it is not possible to compare the statistics in this report to previous adult drug and alcohol NDTMS statistical publications for more detail see section 9.2.

Additional changes were also consulted on at the same time and subsequently agreed and implemented. The age limit for clients has been extended to 100 to reflect the increasing age of the general treatment population, in particular those citing alcohol only as a problematic

substance.

Individuals not citing any problematic substance (known as misuse free) are excluded from these statistics as the codes "drug-free" and "alcohol-free" were initially introduced to report on abstinent clients who were in structured treatment to prevent relapse. These were since

removed from the valid drug codes a number of years ago with guidance being that the drug the individual was in relapse prevention for should be recorded.

Prescribed opiates are also now included in the opiate category where previously they would have been classified as non-opiate only or non-opiate and alcohol. These changes have also been applied to all trend data in this report.

The consultation summary can be found here:

www.nta.nhs.uk/uploads/feedback-from-the-online-consultation-regarding-methodology-for- drug-and-alcohol-treatment-reporting-from-ndtms.pdf.

More information on the consultation can be found here:

www.nta.nhs.uk/new-reporting-methodology.aspx.

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3. Assessment of quality and robustness of 2014-15 NDTMS community data

Data collection through NDTMS was suspended between November 2014 and February 2015 (a period of four months), to introduce security enhancements into the system.

The system was fully restored in March 2015. Providers were given up until the end of July to submit and validate data entered locally during the downtime, as well as to catch up with any backlog of data that they may have not been able to record while the systems were suspended.

PHE worked closely with all providers of drug and alcohol treatment through eight regional based teams to support this process.

While the NDTMS closure was unscheduled, it was possible to ensure that the downtime was well managed and coordinated. Through the commitment and goodwill of the treatment

providers, PHE were able to ensure that any risks to the provision of a complete 2014-15 dataset were minimised.

The intelligence gathered by PHE NDTMS teams as part of their support of treatment providers suggests that data collected for 2014-15 is reflective of activity and that all appropriate

measures were put in place locally to ensure full data recovery. There is no current evidence that the downtime had any adverse long term effects on quality or compliance. More detailed information can be found at

www.nta.nhs.uk/UKSA-data-quality-asssessment-2014-15.aspx

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152,964

25,025 28,128

89,107

Opiate Non-opiate Non-opiate and alcohol

Alcohol only

Opiate Non- 52%

opiate 8%

Non- opiate

and alcohol

10%

Alcohol only 30%

4. Characteristics of clients

During 2014-15 NDTMS reported a total of 295,224 individuals aged 18 to 100 in contact with structured treatment. This total includes all individuals in treatment for either problematic drug use, alcohol use or both. Figure 4 below presents how the 295,224 individuals are segmented by the four substance groups used throughout this report. Just over half the clients in contact with treatment during the year (52%) had presented with problematic use of opiates, a further 18% had presented with problems with other drugs and just under a third (30%) had presented with alcohol as the only problematic substance.

Figure 4 Numbers in treatment by main substance group 2014-15

4.1 Substance use profile

Table 4.1.1 and figure 4.1.1 show the distribution of substances for all individuals in treatment in 2014-15, by the four substance groups used within this report.

Forty per cent of opiate clients also presented with crack cocaine, the next highest adjunctive substances were alcohol (22%), cannabis (19%) and benzodiazepines (12%). Cannabis was the substance that the majority of non-opiate only clients presented to treatment (62%) with, this was followed by 31% of clients presenting with cocaine and 17% with amphetamines.

Cannabis was also the drug that the majority of non-opiate and alcohol clients presented with to treatment (60%), with 39% of clients presenting with cocaine and 11% with amphetamines.

Overall, 51% of clients in treatment in 2014-15 presented with problematic alcohol use, 89,107 of these individuals presented with alcohol alone, with the other 61,533 individuals also

reporting problematic use of other substances.

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0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Opiate (not crack cocaine) Both opiate and crack cocaine Cannabis Cocaine Benzodiazepine Amphetamine (other than ecstasy) Alcohol

Opiate

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Crack cocaine (not opiate) Cannabis Cocaine Benzodiazepine Amphetamine (other than ecstasy) Other drug Ecstasy Novel psychoactive substances Hallucinogen

Non-opiate

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Crack cocaine (not opiate) Cannabis Cocaine Benzodiazepine Amphetamine (other than ecstasy) Other drug Ecstasy Alcohol

Non-opiate and alcohol

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Opiate (not crack cocaine) Both opiate and crack cocaine Cannabis Cocaine Benzodiazepine Amphetamine (other than ecstasy) Alcohol

Total

Figure 4.1.1 Substance breakdown of all clients in treatment 2014-15

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Table 4.1.1 Substance breakdown of all clients in treatment 2014-15

Substance Opiate Non-opiate Non-opiate

and alcohol Alcohol only Total

n % n % n % n % n %

Opiate and/or crack cocaine use Opiate (not crack

cocaine) 91,530 60% - - - - - - 91,530 31%

Both opiate and crack

cocaine 61,434 40% - - - - - - 61,434 21%

Crack cocaine (not

opiate) - - 2,178 9% 2,449 9% - - 4,627 2%

Other drug use

Cannabis 29,568 19% 15,425 62% 16,809 60% - - 61,802 21%

Cocaine 8,896 6% 7,822 31% 11,039 39% - - 27,757 9%

Benzodiazepine 19,017 12% 1,515 6% 1,314 5% - - 21,846 7%

Amphetamine (other

than ecstasy) 7,666 5% 4,160 17% 3,110 11% - - 14,936 5%

Other drug 1,917 1% 1,370 5% 764 3% - - 4,051 1%

Hallucinogen 403 0% 618 2% 347 1% - - 1,368 0%

Other prescription drug 488 0% 121 0% 148 1% - - 757 0%

Anti-depressant 437 0% 37 0% 143 1% - - 617 0%

Solvent 137 0% 104 0% 133 0% - - 374 0%

Major tranquiliser 112 0% 25 0% 25 0% - - 162 0%

Barbiturate 78 0% 10 0% 19 0% - - 107 0%

Alcohol

Alcohol 33,405 22% - - 28,128 100% 89,107 100% 150,640 51%

Total number of

individuals * 152,964 100% 25,025 100% 28,128 100% 89,107 100% 295,224 100%

*The total number of individuals will be less than the sum of the reported substances as an individual may present with more than one problematic substance

**Percentages may equal 0% or not sum to 100% due to rounding

Table 4.1.2 presents a breakdown of substances that are categorised under a heading of ‘club drugs and new psychoactive substances (NPS)’, a collective term for a number of different substances typically used by people in bars and nightclubs, at concerts and parties, before and after a night out. Mephedrone citations make up the largest proportion of club drug/NPS

presentations for all individuals in treatment in 2014-15 (1.0%), with 6% of non-opiate clients citing the substance and 0.4% of opiate clients.

The second most common club drug cited was ecstasy (0.7%) followed by new psychoactive substances (0.5%). When NPS are broken down, the majority of presentations were for NPS that had cannabinoid or stimulant effects.

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Table 4.1.2 Club drug and new psychoactive substances breakdown of all clients in treatment 2014-15

Club drug and new psychoactive

substances Opiate Non-opiate Non-opiate

and alcohol Total

n % n % n % n %

Mephedrone 662 0.4% 1,492 6.0% 894 3.2% 3,048 1.0%

Ecstasy 468 0.3% 967 3.9% 774 2.8% 2,209 0.7%

New psychoactive substances 328 0.2% 668 2.7% 374 1.3% 1,370 0.5%

Ketamine 270 0.2% 499 2.0% 261 0.9% 1,030 0.3%

Methamphetamine 81 0.1% 289 1.2% 89 0.3% 459 0.2%

GHB/GBL 33 0.0% 320 1.3% 83 0.3% 436 0.1%

Further breakdown of new psychoactive substances:

Predominantly cannabinoid 121 0.1% 266 1.1% 126 0.4% 513 0.2%

Predominantly stimulant 88 0.1% 214 0.9% 126 0.4% 428 0.1%

Other 88 0.1% 138 0.6% 86 0.3% 312 0.1%

Predominantly sedative/opioid 30 0.0% 25 0.1% 16 0.1% 71 0.0%

Predominantly hallucinogenic 8 0.0% 41 0.2% 19 0.1% 68 0.0%

Predominantly dissociative 2 0.0% 16 0.1% 10 0.0% 28 0.0%

Total 152,964 100% 25,025 100% 28,128 100% 295,224 100%

*Percentages may equal 0% or not sum to 100% due to rounding

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4.2 Age of clients

The age of individuals at their first point of contact with the treatment system in the 2014-15 financial year is reported in table 4.2.1 and figure 4.2.1. The median age (the middle number in an ascending list of all ages) of non-opiate clients in treatment in 2014-15 was 29 years, slightly younger than the median age for non-opiate and alcohol clients, 34 years. Opiate clients were older, with a median age of 38 years, but still younger than the projected median age for the population of England, which is 39 years (ONS mid-year population 2013). Only the alcohol only clients have a median age (45 years) older than the general population

(www.ons.gov.uk/ons/publications/re-reference-tables.html?edition=tcm%3A77-322718).

Similarly, individuals in treatment only presenting with problematic alcohol use (alcohol only) have the oldest age distribution, with 68% of clients in treatment being 40 years and over and 11% 60 years and over.

Individuals are most likely to start using drugs in their late teens and early twenties and, on average, seek treatment within eight years of initiation of their use. Non-opiates clients, both those who have presented with alcohol and those just using non-opiates, tend to be younger than individuals that have presented with opiates.

The distribution of ages of individuals in treatment reflects patterns seen in estimates of prevalence. A large proportion of heroin/opiate users in treatment in 2014-15 will have started using heroin in the epidemics of the 1980s and 1990s and are now over 40 years of age, having been using heroin for a significantly long period of time.

Those who use other substances tend to be younger, as can be seen in figures 1.2, 1.3 and 1.4 in the 2014-15 Crime Survey for England and Wales. This survey shows that cannabis, ecstasy and powder cocaine are the most commonly used substances for 16-24 year olds with, for example, 16.3% having used cannabis in the last year (compared to 6.7% for the general population aged 16-59).

(www.gov.uk/government/uploads/system/uploads/attachment_data/file/462885/drug-misuse- 1415.pdf).

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Table 4.2.1 Age of all clients in treatment 2014-15

Age Opiate Non-opiate Non-opiate

n % n % n % n % n %

18 158 0% 1,234 5% 975 3% 262 0% 2,629 1%

19 281 0% 1,014 4% 577 2% 278 0% 2,150 1%

20-24 4,910 3% 5,537 22% 3,707 13% 2,773 3% 16,927 6%

25-29 15,597 10% 5,310 21% 4,843 17% 5,775 6% 31,525 11%

30-34 31,198 20% 4,204 17% 4,779 17% 8,739 10% 48,920 17%

35-39 34,176 22% 2,879 12% 3,990 14% 10,722 12% 51,767 18%

40-44 29,598 19% 2,007 8% 3,624 13% 14,140 16% 49,369 17%

45-49 20,233 13% 1,398 6% 2,912 10% 15,023 17% 39,566 13%

50-54 10,142 7% 740 3% 1,682 6% 12,971 15% 25,535 9%

55-59 4,174 3% 334 1% 725 3% 8,708 10% 13,941 5%

60-64 1,869 1% 159 1% 231 1% 5,178 6% 7,437 3%

65-69 493 0% 86 0% 54 0% 2,865 3% 3,498 1%

70+ 135 0% 123 0% 29 0% 1,673 2% 1,960 1%

Total 152,964 100% 25,025 100% 28,128 100% 89,107 100% 295,224 100%

Figure 4.2.1 Age distribution of all clients in treatment 2014-15

0%

5%

10%

15%

20%

25%

18 19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70+

Opiate Non-opiate Non-opiate and alcohol Alcohol only

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4.3 Gender of clients

Table 4.3.1 presents the gender distribution for all clients in treatment, segmented by the four substance groups. Overall 30% of individuals in treatment are women, compared to 51% of the population in England (www.ons.gov.uk/ons/publications/re-reference-

tables.html?edition=tcm%3A77-286262).

The three drug groups, opiate, non-opiate and non-opiate and alcohol have a very similar distribution with about three quarters of each group being male. This is broadly comparable with figures reported in 2014-15 Crime Survey for England and Wales where 11.9% of males aged 16 to 59 had taken an illicit drug in the last year, compared to 5.4% of females

(www.gov.uk/government/uploads/system/uploads/attachment_data/file/462885/drug-misuse- 1415.pdf).

Among those in treatment for alcohol problems only, males made up a lower proportion (62%).

Table 4.3.1 Gender of all clients in treatment 2014-15

Male Female Persons

n % n % n %

Opiate 111,779 73% 41,185 27% 152,964 100%

Non-opiate 18,867 75% 6,158 25% 25,025 100%

Non-opiate and alcohol 20,679 74% 7,449 26% 28,128 100%

Alcohol only 54,973 62% 34,134 38% 89,107 100%

Total 206,298 70% 88,926 30% 295,224 100%

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4.4 Ethnicity of clients

Table 4.4.1 reports the ethnicity of clients in treatment in 2014-15. Where reported, most individuals (85%) were white British compared to 80% of the English population,⁴ ranging from 87% of alcohol only presentations to 79% of non-opiate clients. Other white was the next most common ethnicity, (4%) compared to 5% of the English population. No other ethnic group accounted for more than 2% of the total cohort. Within the non-opiate substance group, 3% of individuals had an ethnicity of Caribbean, compared to the other substance groups and the English population where the proportion is 1%.

Table 4.4.1 Ethnicity of all clients in treatment 2014-15

Ethnicity Opiate Non-opiate Non-opiate

n % n % n % n % n %

White British 126,646 86% 19,516 79% 23,220 85% 75,998 87% 245,380 85%

Other white 5,920 4% 832 3% 737 3% 2,979 3% 10,468 4%

Not stated 1,487 1% 600 2% 349 1% 2,188 2% 4,624 2%

White Irish 1,512 1% 213 1% 361 1% 1,317 2% 3,403 1%

Indian 1,686 1% 192 1% 213 1% 1,135 1% 3,226 1%

Caribbean 1,221 1% 696 3% 528 2% 530 1% 2,975 1%

White and black Caribbean 1,330 1% 458 2% 408 1% 425 0% 2,621 1%

Pakistani 1,691 1% 325 1% 176 1% 268 0% 2,460 1%

Other Asian 1,404 1% 235 1% 137 0% 550 1% 2,326 1%

Other 1,305 1% 224 1% 186 1% 511 1% 2,226 1%

Other black 854 1% 437 2% 372 1% 412 0% 2,075 1%

African 391 0% 434 2% 290 1% 570 1% 1,685 1%

Other mixed 706 0% 256 1% 200 1% 271 0% 1,433 0%

Bangladeshi 1,078 1% 147 1% 58 0% 82 0% 1,365 0%

White and Asian 418 0% 92 0% 80 0% 163 0% 753 0%

White and black African 252 0% 88 0% 98 0% 154 0% 592 0%

Chinese 49 0% 14 0% 15 0% 31 0% 109 0%

Unknown 5 0% 1 0% 1 0% 1 0% 8 0%

Total 147,955 100% 24,760 100% 27,429 100% 87,585 100% 287,729 100%

Inconsistent/missing 5,009 265 699 1,522 7,495

Total 152,964 25,025 28,128 89,107 295,224

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4.5 Source of referral into treatment (new presentations)

Table 4.5.1 shows a breakdown of new presentations to treatment by source of referral (ie, the routes by which people accessed treatment). Information about source of referral was provided for 140,306 (99%) of all new presentations to treatment in 2014-15. Of all recorded referral sources, self-referrals were the most common for all individuals and within the four substance groups (ranging from 48% for non-opiate clients to 45% for alcohol only clients).

For alcohol only clients, the next most common referral source was through health services (33%). This was made up of GP referrals (20%), hospital (6%), social services (2%) and other health services (5%).

In comparison health services only accounted for 10% of opiate client referrals. The criminal justice system was the second most common referral source for opiate clients (28%), made up of prison/CARAT referrals (14%), arrest referrals/DIP (8%), probation (3%) and other criminal justice system referral routes (2%). By contrast, only 8% of referrals for alcohol only clients were from the criminal justice system.

Overall, substance misuse services accounted for 9% of referrals into treatment (ranging from 5% for non-opiate clients to 12% for opiate clients).

A further breakdown of referral routes into treatment can be found in the supporting tables.

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Table 4.5.1 Source of referral into treatment, new presentations to treatment 2014-15

Referral Source Opiate Non-opiate Non-opiate

n % n % n % n % n %

Self, family and friends

Self 20,572 47% 8,191 48% 8,522 46% 27,335 45% 64,620 46%

Other family and friends 176 0% 236 1% 240 1% 623 1% 1,275 1%

Self, family and friends

subtotal 20,748 47% 8,427 49% 8,762 48% 27,958 46% 65,895 47%

Health

GP 2,884 7% 1,333 8% 2,112 11% 11,950 20% 18,279 13%

Health – other 698 2% 807 5% 870 5% 3,175 5% 5,550 4%

Hospital 449 1% 147 1% 407 2% 3,722 6% 4,725 3%

Social services 213 0% 524 3% 384 2% 1,104 2% 2,225 2%

Health subtotal 4,244 10% 2,811 16% 3,773 20% 19,951 33% 30,779 22%

Criminal justice

Arrest referral/DIP 3,640 8% 1,612 9% 1,042 6% 883 1% 7,177 5%

CARAT/Prison 6,291 14% 304 2% 239 1% 268 0% 7,102 5%

Probation 1,326 3% 1,119 7% 1,129 6% 2,063 3% 5,637 4%

Criminal justice – other 1,012 2% 697 4% 659 4% 1,405 2% 3,773 3%

Criminal justice subtotal 12,269 28% 3,732 22% 3,069 17% 4,619 8% 23,689 17%

Substance misuse service

Drug service non-statutory 3,058 7% 522 3% 665 4% 1,929 3% 6,174 4%

Drug service statutory 2,222 5% 300 2% 470 3% 1,322 2% 4,314 3%

Community alcohol team 97 0% 8 0% 256 1% 1,981 3% 2,342 2%

Substance misuse service

subtotal 5,377 12% 830 5% 1,391 8% 5,232 9% 12,830 9%

Other 1,142 3% 1,370 8% 1,440 8% 3,163 5% 7,115 5%

Total 43,780 100% 17,170 100% 18,435 100% 60,923 100% 140,308 100%

Missing or unknown 576 168 113 481 1,338

Total 44,356 17,338 18,548 61,404 141,646

(23)

4.6 Age and presenting substance (new presentations)

Table 4.6.1 shows the substance distribution for individuals presenting to treatment in 2014-15, reported by the four substance groups. Forty-two per cent of opiate new presentations also presented with crack cocaine, the next highest adjunctive substance alongside opiate use, was alcohol (20%). For non-opiate only clients, the majority of individuals cited cannabis as a

problematic substance (61%), this was followed by just under a third (32%) of non-opiate clients presenting with cocaine.

Cannabis was also the main drug non-opiate and alcohol clients presented with, 58% having done so, with cocaine the next most cited substance (41%).

Overall, 63% (88,904) of individuals starting treatment in 2014-15 presented with problematic alcohol use, of these 61,404 cited alcohol as the only problematic substance. The next most commonly cited substance was opiates (31%), followed by cannabis which was cited by 20% of individuals.

Table 4.6.1 Substance breakdown of new presentations to treatment 2014-15

Substance Opiate Non-opiate Non-opiate

n % n % n % n % n %

Opiate and/or crack cocaine use

Opiate (not crack cocaine) 25,799 58% - - - - - - 25,799 18%

Both opiate and crack

cocaine 18,557 42% - - - - - - 18,557 13%

Crack cocaine (not opiate) - - 1,414 8% 1,471 8% - - 2,885 2%

Other drug use

Cannabis 7,205 16% 10,630 61% 10,837 58% - - 28,672 20%

Cocaine 2,154 5% 5,627 32% 7,678 41% - - 15,459 11%

Amphetamine (other than

ecstasy) 1,985 4% 2,852 16% 1,916 10% - - 6,753 5%

Benzodiazepine 3,938 9% 917 5% 749 4% - - 5,604 4%

Other 1,168 3% 2,711 16% 1,681 9% - - 5,560 4%

Alcohol

Alcohol 8,952 20% - - 18,548 100% 61,404 100% 88,904 63%

Total number of

individuals* 44,356 100% 17,338 100% 18,548 100% 61,404 100% 141,646 100%

*The number of individuals will be less than the total of the reported substances as an individual may present with more than one problematic substance

(24)

Table 4.6.2 and figure 4.6.1 report the distribution of the substances by age for new presentations to treatment in 2014-15.

For younger clients presenting to treatment (those aged 18-24), the main substances cited were cannabis (52%, 7,369), alcohol (44%, 6,290) and cocaine (23%, 3,272), with only 19%

(2,729) have presented using opiates.

The percentage of individuals presenting with problems with alcohol use increased with age, with 66% (13,376 of those aged 40-44 citing alcohol as problematic and 93% (3,756) of those age 60-64.

A further breakdown of clients aged 18-24 can be found in the supporting tables.

Table 4.6.2 Age and presenting substance of new presentations to treatment 2014-15

Substance 18-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+ Total Opiate and/or crack cocaine use

Opiate (not crack cocaine)

1,718 3,677 5,625 5,427 4,386 2,793 1,357 507 208 101 25,799

12% 21% 25% 25% 21% 16% 11% 7% 5% 3% 18%

Both opiate and crack cocaine

1,011 2,778 4,495 4,138 3,072 1,904 831 225 76 27 18,557

7% 16% 20% 19% 15% 11% 7% 3% 2% 1% 13%

Crack cocaine (not opiate)

292 512 572 520 397 288 177 95 21 11 2,885

2% 3% 3% 2% 2% 2% 1% 1% 1% 0% 2%

Other drug use

Cannabis 7,369 5,364 4,812 3,830 3,075 2,321 1,218 499 143 41 28,672

52% 30% 21% 18% 15% 13% 10% 7% 4% 1% 20%

Cocaine 3,272 3,814 3,295 2,181 1,405 873 430 126 46 17 15,459

23% 21% 15% 10% 7% 5% 3% 2% 1% 0% 11%

Benzodiazepine 535 840 1,211 1,153 865 504 261 84 57 94 5,604

4% 5% 5% 5% 4% 3% 2% 1% 1% 3% 4%

Amphetamine (other than ecstasy)

1,271 1,303 1,335 1,114 825 551 245 77 23 9 6,753

9% 7% 6% 5% 4% 3% 2% 1% 1% 0% 5%

Other 1,702 1,045 874 614 554 393 185 94 41 58 5,560

12% 6% 4% 3% 3% 2% 1% 1% 1% 2% 4%

Alcohol

Alcohol 6,290 8,629 11,248 11,951 13,736 13,033 10,376 6,489 3,756 3,396 88,904

44% 48% 50% 55% 66% 75% 83% 90% 93% 93% 63%

Total number of

individuals* 14,178 17,866 22,417 21,544 20,769 17,452 12,470 7,241 4,060 3,649 141,646

*The number of individuals will be less than the total of the reported substances as an individual may present with more than one problematic substance

**Percentages may equal 0% or not sum to 100% due to rounding

(25)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

18-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+

Opiate or opiate and crack cocaine Cannabis Cocaine Other Alcohol Figure 4.6.1 Age and presenting substance distribution of new presentations to treatment 2014-15

4.7 Injecting behaviour (new presentations)

Injecting status at presentation for treatment was recorded for 134,685 individuals (95%) who entered treatment in 2014-15. The majority of individuals presenting to treatment have never injected (76%), though there was variation by substance with 96% of alcohol only clients having never injected any substance compared to 38% of opiate clients. Just over a quarter (26%) of individuals using opiates were currently injecting, compared to 3% and 1% in the non-opiate and non-opiate and alcohol clients respectively. The majority of non-opiate clients who inject are likely to be individuals using methamphetamine and mephedrone.

Sharing of injecting equipment is the single biggest factor in blood-borne virus transmission among individuals who use and inject drugs. It also elevates mortality risk and those who inject have a more complex profile, and are therefore harder to treat.

About Public Health England

Adult substance misuse statistics from the National Drug Treatment Monitoring System (NDTMS)

1 April 2014 to 31 March 2015

About Public Health England

Contents

Executive summary

1. Background and policy context

2. Change in method of reporting alcohol and drug statistics

3. Assessment of quality and robustness of 2014-15 NDTMS community data

4. Characteristics of clients

4.1 Substance use profile

4.2 Age of clients

4.3 Gender of clients

4.4 Ethnicity of clients

4.5 Source of referral into treatment (new presentations)

4.6 Age and presenting substance (new presentations)

4.7 Injecting behaviour (new presentations)