Substance misuse has been seen as two separate issues, namely illegal drug misuse, particularly heroin and crack cocaine, and alcohol misuse and Plymouth has higher than national average levels of both categories of misuse. In addition we have seen levels of addiction to prescribed drugs and to drugs sourced on the internet rise to unprecedented levels over the last decade. Whilst drug and alcohol use is seen across the population, drug and alcohol problem use is concentrated in our deprived neighbourhoods and our most vulnerable population groups and as such is a drive of health inequalities. It is important to view substance misuse as part of a complex needs system, because it is closely related to adverse childhood experiences (ACE) and should be seen more as a means of coping with psychological distress, rather than as an illness in and of itself. Substance misuse is also strongly associated with homelessness, mental illness, domestic violence, child protection, acquisitive crime (drugs), violent crime (alcohol), unemployment, anti-social behaviour and early disease and premature death.
Of note relating to our local context;
- Plymouth has higher rates of opiate and crack use than national average.
- Plymouth has higher rates of drug poisoning admissions to hospital than national average
- Plymouth has higher rate of drug related deaths than national average.
- Plymouth treats a higher percentage of opiate and crack users than the national average [61% compared to 50%] and has 98% compliance with waiting time
- Our services are efficient, effective and amongst the lowest unit cost in the region.
- Plymouth’s treatment cohort tends to be older, sicker, more likely to be injecting and have more complex needs than the average and rates of discharge are therefore lower than the national average [proportion in treatment for more than 6 years 35% compared to 27%].
- Patterns of addiction are changing in recent years drug markets have changed with increased internet access driving a rise in ‘grey’ markets for prescription drugs such as valium and strong pain killers. We have a larger proportion of prescription (POM) only and over the counter (OTC) addicts in treatment than the national average.
- Plymouth has seen levels of chronic pain and mental illness rise over the last 10 years and we are now an outlier for pain prescribing and anti-depressant prescribing. We are seeing increasing numbers of people addicted to prescribed drugs in Primary Care and specialist pain services.
- Substance misuse is also a significant driver of demand for Children’s Social Care with estimates of between 35% and 40% of all cases being related to substance misuse.
Our Public Health investment for substance misuse treatment and support is all provided within the Plymouth Alliance for Complex Needs contract. The services provided include community based drug and alcohol treatment services, detox provision, day services, support and recovery services along with additional prescribing from GPs and supervised consumption from Pharmacies. The current level of investment for this is approximately £4.5 million (covering adults and young people). The Substance Misuse Treatment and Recovery Grant is providing an additional £770,000 of investment in 2022/23 to increase community treatment capacity and to work to reduce the record numbers of drug related deaths. This funding will be used to provide additional capacity within the existing Plymouth Alliance partners.
It is estimated that every £1.00 spent on drug treatment saves £2.50 in costs - principally in criminal justice cost savings through reduced offending (without methadone treatment the average heroin user spends £1400 per month on drugs, mainly funded through acquisitive crime, sex working and drug dealing); through reduced demand on childrens services; reduced costs to hospitals through reductions in ED attendance, infectious diseases due to blood borne viruses, liver and lung disease, overdoses and early deaths.
In addition around 44% of people in mental health services also have substance misuse problems [dual diagnosis] which delays recovery and leads to frequent relapse and around 70% to 80% of people in substance misuse issues also have mental health problems (European Monitoring Centre for Drugs and Drug Addiction (EMCDDA)). A Joseph Rowntree Foundation report found 70% of the homeless population suffer from substance misuse.
Apart from the primary purpose of treating some of our most marginal and deprived people, substance misuse services also underpin delivery of children's social care, homelessness services, offender services and a range of health services.
