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Summary

In 2012-13, Merton Substance Misuse Services were reported to be the highest performing nationally for successfully completed episodes, and were subsequently inspected and commended by the National Treatment Agency for Substance Misuse as an exemplar of good practice in this activity.

In terms of local treatment population statistics for drug misuse, in Merton in 2011-12 it was estimated that 5,024 people aged 18-64 were dependent on drugs and of these approximately two thirds were male. By 2020 it is predicted that the number of people dependent on drugs will increase by 11%. This includes all drug users and is based on a national prevalence rate of 3.4%.  Most dependence is estimated to be on cannabis only (2.5%), rather than other drugs (0.9%).   In [2011-12] 505 clients were actually in treatment, of which 370 were men and 133 were women 39% (n=196) of clients in treatment presented with crack and/or opiates as their main drug used. The total number of clients presenting has decreased by 25% from 2010-11 (675 clients in treatment); this may reflect a national trend with a modest decline in demand for servies across the country.

In Merton, [in 2011-12] there were an estimated 1,029 opiate or crack cocaine users (OCUs),  a rate of 7.1 per 1,000 population, lower than both London (9.4 per 1,000) and England (8.9 per 1,000). Of OCUs in Merton, just over 20% (n=209) were injecting drug users. Taking those already in treatment and/or those known to the treatment system, it is estimated that there were some 678 people in the community not presenting or having not ever presented to services – 65% of the total estimated users. This has grown from 2010-11 when the figure was estimated at 45%.

In 2011-12 of those starting treatment the proportion in effective treatment was 83% for OCUs and 86% for all drug users and there was a high-planned exit rate from treatment, which shows they were successful completions. The planned exit rate in 2011-12 was 58% of all treatment exits, compared with 42% in London and 43% in England. The percentage of opiate-based successful completions was 44%, higher than both London (37%) and England (33%).  

 

Key facts on reducing harm from drugs

When engaged in treatment, fewer people use illegal drugs, and will commit less crime, improve their health and manage their lives better.

Accordingly, drug treatment planning and service provision for Merton has been specifically set up to ensure the achievement of the following core objectives, namely an increase in:

  • those reducing their drug and alcohol misuse and those achieving abstinence
  • those reducing their offending including repeat offenders
  • those improving health and wellbeing
  • those reintegrating with education, training and employment, housing and other services.

‘In effective treatment’ has been the standard performance measure and outcome in drug misuse for a number of years now and includes all individuals in contact with Tier 3 or 4 services for 12 weeks or more, or who had a planned exit from treatment within 12 weeks. Since 2012 and in line with the recovery agenda, a new national measure for substance misuse has been introduced to work alongside this. ‘Successfully Completed Treatment Episodes’ highlight the importance of  people being able to leave treatment in a planned and positive way.

The National Drug Treatment Monitoring System (NDTMS) records drug users presenting to specialist drug agencies and GPs offering structured care. The database includes people treated in London agencies and excludes local residents treated elsewhere, though this number is probably small.

From the NDTMS records, annual statistics on substance misuse are calculated and published and in 2012-13 in England 185,429 adults were reported as in effective treatment and a further 29,855 people were successfully leaving treatment and free from dependency; 20,688 young people under the age of 18 years were reported as being in treatment also. Data from the National Drug Evidence Centre (NDEC) in 2013 suggests that the number of heroin and crack cocaine users in England has fallen below 300,000 for the first time.  The latest estimates support the continuing shift away from the most harmful drugs, particularly among young people.  However behind this positive picture, an older and vulnerable population of users poses major challenges for local treatment systems.

In 2012-13 Merton Substance Misuse Services were reported to be the highest performing nationally for successfully completed episodes, and were subsequently inspected and commended by the National Treatment Agency for Substance Misuse as an exemplar of good practice in this activity.

In terms of local treatment population statistics for drug misuse, in Merton in 2011-12 it was estimated that 5,024 people aged 18-64 were dependent on drugs and of these approximately two thirds were male. By 2020 it is predicted that the number of people dependent on drugs will increase by 11%. This includes all drug users and is based on a national prevalence rate of 3.4%. Most dependence is estimated to be on cannabis only (2.5%), rather than other drugs (0.9%).1In [2011-12] 505 clients were actually in treatment, of which 370 were men and 133 were women; 39% (n=196) of clients in treatment presented with crack and/or opiates as their main drug used. The total number of clients presenting has decreased by 25% from 2010-11 (675 clients in treatment); this may reflect a national trend with a modest decline in demand for services across the country.

In Merton, there are an estimated 1,029 opiate or crack cocaine users (OCUs), a rate of 7.1 per 1,000 populations, lower than both London (9.4 per 1,000) and England (8.9 per 1,000). Of OCUs in Merton, just over 20% (n=209) are injecting drug users. Taking those already in treatment and/or those known to the treatment system, it is estimated that there are some 678 people in the community not presenting or having not ever presented to services – 65% of the total estimated users. This has grown from 2010-11 when the figure was estimated at 45%.   

Trends in problematic drug users in treatment.

In 2011-12, of those starting treatment the proportion in effective treatment was 83% for OCUs and 86% for all drug users and there was a high-planned exit rate from treatment which shows successful completions. The planned exit rate in 2011-12 was 58% of all treatment exits, compared wit 42% in London and 43% in England.  The percentage of opiate- based successful completions was 44%, higher than both London (37%) and England (33%).  

Vulnerable groups at greater risk of developing problematic drug use include homeless people, sex workers, offenders, young people excluded or truanting from school, looked-after children, and children whose parents misuse drugs. Alcohol, tobacco and cannabis use is strongly related with youth offending.

Heroin use is linked with less affluent groups in the population, while unemployed 16 to 29 year olds have higher rates of drug use for any drug, for heroin and for Class A drugs. Socio-economic status and geographical area of residence, as well as age and sex, are among the factors linked to levels and patterns of drugs misuse.

The Diagnostic Outcomes Monitoring Executive Summary (DOMES) for the last quarter of 2013-14 shows that there were 239 adult opiate users and 212 non-opiate users in effective treatment in Merton (slightly below the national average).  The average length of time spent in treatment for all clients was 2.4 years. 10% of clients were long-term (predominantly opiate) users, having been in treatment for more than six years.  Successful completion rates for opiate users are in the top quartile of national performance, which is in line with a national decline in new opiate users presenting for treatment. 53% of non-opiate clients successfully exited treatment (a 6% increase on the previous year), with 35% of this group not representing within six months of having left. No client had to wait more that three weeks to start drug treatment.

See also Merton: Alcohol, drugs and substance misuse

Key commissioning recommendations

For the treatment system as a whole:

  • Continue to monitor local treatment services against an agreed Performance Assessment Framework and local indicators and outcomes for substance misuse as indicated in the Public Health Performance Dashboard.
  • Safer Merton, Public Health and the Merton CCG to review current usage of commissioned substance misuse inpatient (Tier 4) bed nights and further develop community treatment capacity to manage down future demand for inpatient services.
  • Safer Merton and Public Health to develop new substance misuse prevention frameworks and reinvestment proposals to complement these.
  • Continue to develop assertive outreach capacity to support hard-to-engage populations.
  • Further develop local capacity to respond to parents who misuse alcohol and other drugs, and to safeguard children.
  • Maintain integrity, commitment and future resourcing for integrated substance misuse treatment services.

For drugs:

  • Use the Targeted Drug Testing on Arrest programme effectively to identify and treat drug misusing (particularly Class A) offenders.
  • Ensure that local treatment services are linked and contribute to effective Integrated Offender Management work locally.

References

1. ^ PANSI (2011).