Drug Misuse

• Drug use and abuse can have wide ranging impacts on the individual, their families, and communities.

• This JSNA describes key data on drugs, drug treatment and drug related harm in Wirral, placing these in regional and national contexts.

• Wirral was one of the first areas in the country to experience the dramatic growth in heroin use in the early-mid 1980’s. This has led to higher rates of opiate and crack cocaine use compared to national figures. Long-term consequences are being seen in Wirral ahead of other areas and include an older drug using population with more complex needs and higher rates of drug related deaths.

• Most drug related deaths are in people aged over 45.

• Historically Wirral experienced more than double the rate of hospital admissions due to drug misuse in 15-24 year olds compared to England, however the most recent trend shows Wirral is now below the England average.

• Around 22% of people in treatment for opiate use in Wirral are parents living with children, in line with regional and national figures.

• 65% of those in drug treatment are from most deprived neighbourhoods.

• Wirral engages around 82% of those people released from prison with a drug use problem in community treatment, which is significantly higher than regional or national figures.

• Across the region there are higher rates of prescribing for opioid pain medications, benzodiazepines (hypnotics and anxiolytics), gabapentinoids (pain medication) and zdrugs (hypnotics) than England, with Wirral around average across the region.

• In 2021-22 and 2022-23, Wirral received an additional £1.4m p.a. of government funding to prevent drug related harm, with this investment due to significantly increase over the 2 year period 2023-25.

• The Wirral Combatting Drugs Partnership is a nationally mandated, multi-agency partnership responsible for delivering the goals of the national and local drugs strategy.

• Wirral has a comprehensive drug treatment service delivered primarily by Change Grow Live (CGL), a large national charity that specialises in this field. The service has been rated as ‘outstanding’ in two consecutive Care Quality Commission inspections.

• Wirral performs well against other areas when comparing length of time in drug treatment. Whilst this is associated with lower harms it may indicate dependence on services, or be a reflection of the complexity of clients.

• Drug completion rates appear low in the Wirral but compare favourably when complexity is considered in the analysis.

• Response Drug and Alcohol service supports young people aged 13 to 19 years where drug/alcohol use or mental wellbeing is causing concern for them, their parents/carers, or friends.

• An audit of Response service users found that cannabis was the most commonly used drug, followed by cocaine, illicit  prescription medication, ketamine and ecstasy.

• This drug misuse needs assessment has informed the Wirral Drug Strategy 2023-2027, due to be published shortly, which will be implemented through the multi-agency Wirral Combatting Drugs Partnership.

• Please also review Gaps and Next Steps section for future work and/or action.

• This drug misuse needs assessment has informed the Wirral Drug Strategy 2023-2027, due to be published shortly. The strategy has identified five priorities:

1. Building a positive culture to reduce drug-related harm.

2. Protecting children and young people.

3. Strengthening our excellent treatment and recovery system.

4. Reducing health-inequalities and reducing drug-related deaths.

5. Working together to reduce drug-related crime and harm in Wirral.

• The strategy will be implemented through the multi-agency Wirral Combatting Drugs Partnership, facilitated by the government funding grant: Supplementary Substance Misuse Treatment and Recovery grant (SSMTR).

• Due the size and breadth of this topic area it is has been necessary to present this content as Adult Drugs Misuse JSNA. This means there are further pieces of work to create a suite of content that provides the necessary overview. A work programme will be developed to provide topic, type of report and approximate timeframe for completing this supplementary work. This will likely include content related to substance misuse of children and young people, opioid usage, over the counter medicines and ketamine (See Substance Misuse JSNA prospective topics).

• This document has also not included a section on blood borne viruses such as Hepatitis C. The plan is to consider this area of prevention and management in a separate supplement which will be published on the Health Protection page of the website. https://www.wirralintelligenceservice.org/strategies-and-plans/health-protection/

• It is apparent that data sharing between healthcare services, such as the hospital, and the drug treatment service is not optimal. Drug treatment services receive limited information in referrals to their service which can lead to sub-optimal care.

• With high rates of hospital admissions in young people related to drug misuse, it is unclear as to how effective our current approaches in preventing drug use are in this population. This is compounded by several factors:

  • a lack of detail on hospital admissions related to drug use due to ill-defined clinical codes.

  • a lack of knowledge on current drug use in our Wirral Children and Young people (CYP) population.

  • a lack of knowledge on whether the current CYP drug  treatment offer is meeting demand and changing outcomes.

  • See Drugs Misuse JSNA webpage for updates that point to further pieces of work, including children and young people, to create a suite of content that provides the necessary overview.

• It is difficult to estimate the mental health needs of the Wirral drug using populations for reasons detailed in this report. Anecdotally, drug treatment service users report being excluded from mental health treatment due to their drug use, whilst problem drug use is recognised to be driven in some individuals by poor mental health, thus creating a catch - 22 situation. Further investigation is required around this to ensure that the mental health needs of this population are being met.

• Estimating the prevalence of illicit drug use is difficult due to the hidden nature of the problem, and reliable estimates are scarce

• National estimates suggest higher rates of people using opiates and/or crack cocaine in Wirral compared to the North West and England. Local intelligence suggests Wirral prevalence is lower

• Wirral has an ageing opiate and/or crack cocaine users (OCU) population in contact with treatment services (the 35-64 age-group). This differs to the national picture, where the highest rates of treatment for OCU are 25-34 year-olds

• Rates of opiate and/or crack cocaine use have historically been higher in males than females (also the case for the North-West and England and is a long-term trend)

• Wirral was a lower prescriber of strong opiates and Gaba-ergic drugs and a higher than average prescriber of benzodiazepines and Z-drugs, compared to similar Clinical Commissioning Groups (CCGs). Prescribing rates were higher in Wirral than England in 2017/18 for these four classes of prescribed drugs

• The number of people accessing drug treatment in Wirral in 2017/18 was 2,412. The most common drug group clients sought assistance with was opiates (51% of all clients in Wirral)

• Of the four localities in Wirral, Birkenhead had the largest number (1,572) and rate (23.8 per 1,000) of clients in treatment (Wallasey was next highest)

• Wirral substance misuse service clients appear to have a much greater need for mental health treatment services at presentation than in England overall (61% locally versus 41% nationally)

• There are more referrals to treatment for alcohol issues, but the largest group in treatment are opiate users (due to opiate users remaining in treatment for longer)

• In 2017/18, GPs in Wirral were most likely to refer patients for alcohol issues and least likely to refer clients for opiate issues. A higher proportion of treatment referrals come from GPs in Wirral than is seen nationally (18% compared to 10% nationally)

• The proportion of re-presentations for treatment (within 6 months) was higher in Wirral compared to England in three of the four drug groups; only non-opiate drug clients had re-presentation rates lower than England. Wirral had a much higher rate of planned exits from treatment than England overall in 2017/18

• The most common reason for young people to be referred to Response by A&E was not drugs (it was alcohol), but MDMA/Ecstasy was the most common drug reason for referral

• Groups most likely to be admitted to hospital with a drug-related condition in Wirral were men, those aged 45-54, and people living in the most deprived areas of Wirral

• Groups most likely to die from a drug-misuse death in Wirral were men, those aged 35-49 and those living in the most deprived areas of Wirral

• A high proportion (84%) of people who died while in contact with drug treatment services (2015-17) were aged under 60, while in Wirral overall, only 10% of the population die before the age of 60. While only around one quarter of these were directly linked to drug misuse by the coroner, these figures reflect the range of health harms caused by drug misuse

• The largest proportion of Wirral Drug-Related deaths examined by the Coroner in 2017/18 were eventually ruled as suicide or misadventure (25%)

• Drug misuse deaths have been increasing in Wirral, North West and England (with some fluctuation) since 2001. Wirral has seen higher rates of drug misuse deaths than England for the past 4-time periods (2012-14 to 2015-17) and the rate was significantly higher than the England average for the past 2 time periods (2014-16 and 2015-17)

Drugs Misuse (May 2019)

Drugs Misuse (May 2019)

Previous Drugs Misuse Chapter – warning large document (Last updated - October 2012)

PHE JSNA Support Packs for Alcohol, Drugs and Young people’s substance misuse (July 2020)

Criminal Justice Project: Drug Interventions Programme - DIP Activity in Wirral
The Drug Interventions Programme (DIP) in England has an overarching aim to identify and engage with offenders in the criminal justice system who use drugs and/or alcohol, and encourage them towards appropriate treatment services in order to reduce acquisitive crime. The Criminal Justice Intervention Team (CJIT) data set captures client information, episode details (including drug and alcohol use, and offending behaviour), referrals to structured treatment and recovery support sub-interventions. DIP assessments allow CJIT workers to determine whether further intervention is required to address drug and/or alcohol use and offending. These DIP Activity reports for Wirral presents data for clients accessing DIP between April and March in given years, contextualising CJIT data. It complements the monthly DIP Performance Reports by providing an annual snapshot of the CJIT data set.
2018/19 report and data and Wirral Infographics
2017/18 report and data

Healthier Lives: Alcohol & Drugs Profile for Wirral (March 2015)  
Alcohol and drug misuse are widespread throughout our society, and while the number of people with serious problems is relatively small, there is evidence that the impact on people’s lives is increasing. This online tool provides key data and information to understand the issues at a local authority level.

Integrated Monitoring System: Annual Report Cheshire and Merseyside (2013/14)
(Produced by Centre for Public Health at Liverpool John Moores University)
This publication is the first report for the IMS (Integrated Monitoring System), which includes information previously reported in the “Alcohol Treatment in Cheshire and Merseyside” and IAD (Inter-­-Agency Database) NSP (Needle and Syringe Programme) reports, alongside information on drug and alcohol use in the region.

Drug and Alcohol related Deaths in Wirral: A report for Wirral Public Health Team by Centre for Public Health at Liverpool John Moores University (2013).
This report by Centre for Public Health at Liverpool John Moores University (2013) Drug and Alcohol - Related Deaths in Wirral: Action Plan Development has highlighted a number of issues that local partners will be considering in their future work to minimise the impacts of drug and alcohol misuse.

Childhood adversity, substance misuse and young people’s mental health (2017)
Addaction (with other members of the Young People’s Health Partnership, a consortium of organisations working with the Department of Health, Public Health England and NHS England) has produced a briefing (PDF) about young people’s substance misuse and how local services and commissioners can respond to this issue. 

Summary of findings:

• Statistics show reductions in young people’s substance misuse overall

• There remain concerning statistics relating to vulnerable groups of young people and substance misuse that need to be addressed by targeting services in the right way

• Substance misuse service provision for young people should include a range of early interventions and programmes

• Substance misuse cannot be addressed in isolation from the wider issues affecting young people including sexual health, mental health and wellbeing, education and family issues

• Peer to peer activities should be recognised as an effective way of delivering early intervention drug and alcohol messages to young people

• Young people must be involved in all stages of intervention design, delivery and improvement

• Commissioners must consider how to monitor the impact of early intervention substance misuse work to understand short, medium and long term impact

Delivery of the three National Drug Strategy programmes (ADDER programme,
inpatient detox, and Individual Placement Support programme) has strengthened local capacity to reduce drug-related harms for people who use drugs and our wider communities.

The Supplementary Substance Misuse Treatment and Recovery (SSMTR) programme will build on the work of the ADDER programme. The remit of the programme is expanded beyond that of ADDER, to include children and young people and acknowledge the interactions between alcohol and drug  m0isuse.

Proposals for the SSMTR programme have been developed with support from partners on the Wirral Combatting Drugs Partnership and are subject to approval by the Office for Health Improvement and Disparities. Proposals include investment in the wider system, beyond direct drug treatment services, to deliver the aims and objectives of the 10 Year National Drug Strategy.

National Substance Misuse Grant Funding Update (March 2023)

This briefing provides an overview of the local data and insight collated to inform the bid submission for the ADDER (Addiction, Diversion, Disruption, Enforcement, Recovery): Place-based Accelerator funding.

There is also background information explaining why Wirral has been awarded the funding, the partners involved and the proposals to utilise the funding to ensure the three main objectives are achieved:

1. Reduction in drug-related deaths

2. Reduction in drug-related offending

3. Reduction in prevalence of drug use

ADDER Briefing 2021