National Drug Treatment Monitoring System Research Articles

The development and internal validation of a multivariable model predicting 6-month mortality for people with opioid use disorder presenting to community drug services in England: a protocol

BackgroundPeople with opioid use disorder have substantially higher standardised mortality rates compared to the general population; however, lack of clear individual prognostic information presents challenges to prioritise or target interventions within drug treatment services. Previous prognostic models have been developed to estimate the risk of developing opioid use disorder and opioid-related overdose in people routinely prescribed opioids but, to our knowledge, none have been developed to estimate mortality risk in people accessing drug services with opioid use disorder. Initial presentation to drug services is a pragmatic time to evaluate mortality risk given the contemporaneous routine collection of prognostic indicators and as a decision point for appropriate service prioritisation and targeted intervention delivery. This study aims to develop and internally validate a model to estimate 6-month mortality risk for people with opioid use disorder from prognostic indicators recorded at initial assessment in drug services in England.MethodsAn English national dataset containing records from individuals presenting to drug services between 1 April 2013 and 1 April 2023 (n > 800,000) (the National Drug Treatment Monitoring System (NDTMS)) linked to their lifetime hospitalisation and death records (Hospital Episode Statistics-Office of National Statistics (HES-ONS)). Twelve candidate prognostic indicator variables were identified based on literature review of demographic and clinical features associated with increased mortality for people in treatment for opioid use disorder. Variables will be extracted at initial presentation to drug services with mortality measured at 6 months. Two multivariable Cox regression models will be developed one for 6-month all-cause mortality and one for 6-month drug-related mortality using backward elimination with a fractional polynomial approach for continuous variables. Internal validation will be undertaken using bootstrapping methods. Discrimination of both models will be reported using Harrel’s c and d-statistics. Calibration curves and slopes will be presented comparing expected and observed event rates.DiscussionThe models developed and internally validated in this study aim to improve clinical assessment of mortality risk for people with opioid use disorder presenting to drug services in England. External validation in different populations will be required to develop the model into a tool to assist future clinical decision-making.

The hospital admission profile of people presenting to specialist addiction services with problematic use of alcohol or opioids: A national retrospective cohort study in England.

BackgroundOver the past decade in England the rate of alcohol and opioid-related hospitalisation has increased alongside a simultaneous reduction in people accessing specialist addiction treatment. We aimed to determine the hospitalisation patterns of people presenting to addiction treatment with problematic use of alcohol or opioids, and estimate how individual sociodemographic characteristics and hospital admission diagnoses are associated with the rate of hospitalisation, death and successful completion of addiction treatment.MethodsA national record linkage between Hospital Episode Statistics (HES) and the National Drug Treatment Monitoring System (NDTMS) captured lifetime hospital admission profiles of people presenting to addiction services in England in 2018/19. Latent class analysis assigned individuals to clusters based on the ICD-10 diagnosis coded as primary reason for admission. Negative binomial, and multilevel logistic regression models determined if outcomes differed due to sociodemographic characteristics or assigned diagnostic clusters.FindingsInpatient data were available for 64,840 alcohol patients, and 107,296 opioid patients. The most common reasons for admission were alcohol withdrawal (n = 20,024 (5.3% of alcohol-cohort admissions)), and unspecified illness (n = 11,387 (2.1% of opioid-cohort admissions)). Seven diagnostic clusters were identified for each substance cohort. People with admissions predominantly relating to mental and behavioural disorders, and injuries or poisonings had significantly higher hospitalisation rates (adjusted IRR 7.06 (95%CI 6.72–7.42);p < 0.001), higher odds of death during addiction treatment (adjusted OR 2.71 (95%CI 2.29–3.20);p < 0.001) and lower odds of successful treatment completion (adjusted OR 0.72 (95%CI 0.68–0.76);p < 0.001).InterpretationThis is the first study to interrogate national hospitalisation patterns within people presenting to addiction services with problematic use of alcohol or opioids. Having identified high-risk, high-cost individuals with increased hospital usage, and increased odds of death, future work should focus on targeting appropriate interventions, to improve their health outcomes and prevent unnecessary hospital readmission.FundingThe work was funded by the Medical Research Council (MRC).

National administrative record linkage between specialist community drug and alcohol treatment data (the National Drug Treatment Monitoring System (NDTMS)) and inpatient hospitalisation data (Hospital Episode Statistics (HES)) in England: design, method and evaluation

ObjectivesThe creation and evaluation of a national record linkage between substance misuse treatment, and inpatient hospitalisation data in England.DesignA deterministic record linkage using personal identifiers to link the National Drug...

Factors associated with concurrent illicit use of opiates and crack/cocaine among opiate-users in treatment: implications for treatment services in England

Background: The aim of this study was to identify factors associated with concurrent illicit drug use of opiates and crack/cocaine use among individuals receiving of opioid medication-assisted treatment (MAT) in one English rural/urban County Council area.Methods: 776 opiate users in treatment were assessed using the Addiction Dimensions for Assessment and Personalised Treatment (ADAPT) assessment tool. The tool encompasses three domains and 14 subdomains covering addiction severity, recovery strengths and coexisting health and social needs. Data were opportunistically matched to the National Drug Treatment Monitoring System (NDTMS) and the Treatment Outcome Profile (TOP). Two backward stepwise logistic regression models were run to discern the nature of concurrent illicit drug use.Results: Addiction severity (Odds Ratio [OR] 12.55, Confidence interval [CI] 6.49–24.27), low recovery strengths (OR 2.30, CI 1.30–4.07) and no ‘urge/control’ (OR 27.45, 13.18–57.16) were strongly associated with concurrent use. Individuals with moderate psychological needs were more likely to be abstinent (OR 2.97, CI 1.67–5.29) compared to those with no need. Abstaining from injecting (OR 2.38, CI 1.15–4.93), alcohol consumption (OR 1.55, CI 1.05–2.30), increasing age (OR 1.03, CI 1.01-1.06) and increased quality-of-life (OR 1.05, CI 1.00–1.10) were associated with abstinence from concurrent use.Conclusion: Practitioner assessments with self-report data offer unique perspectives on service users’ holistic needs. Interventions addressing concurrent use during MAT should consider managing urges and control of illicit Class A use, injecting and alcohol consumption within a stepped-care approach. Packages for developing recovery strengths supporting psychological need and enhancing quality-of-life is recommended.

Ageing opioid users’ increased risk of methadone-specific death in the UK

BackgroundThe first evidence that the hazard ratio (HR) for methadone-specific death rises more steeply with age-group than for all drug-related deaths (DRDs) came from Scotland’s cohort of 33,000 methadone-prescription clients. We aim to examine, for England, whether illicit opioid users’ risk of methadone-specific death increases with age; and to pool age-related HRs for methadone-specific deaths with those for Scotland’s methadone-prescription clients. MethodsThe setting is all services in England that provide publicly-funded, structured treatment for illicit opioid users, the methodology linkage of the English National Drug Treatment Monitoring System and mortality database, and key measurements are DRDs, methadone-specific DRDs, or heroin-specific DRDs, by age-group and gender, with proportional hazards adjustment for substances used, injecting status and periods in/out of treatment. ResultsLinkage was achieved for 129,979 adults receiving prescribing treatment modalities for opioid dependence during April 2005 to March 2009 and followed-up for 378,009 person-years (pys).There were 1,266 DRDs: 271 methadone-specific (7 per 10,000 pys: irrespective of gender) and 473 heroin-specific (15 per 10,000 pys for males, 7 for females). Methadone-specific DRD-rate per 10,000 person-years was 3.5 (95% CI: 2.7–4.4) at 18–34 years, 8.9 (CI: 7.3–10.5) at 35–44 years and 18 (CI: 13.8–21.2) at 45+ years; heroin-specific DRD-rate was unchanged with age.Relative to 25–34 years, pooled HRs for UK clients’ methadone-specific deaths were: 0.87 at <25 years (95% CI: 0.56–1.35); 2.14 at 35–44 years (95% CI: 1.76–2.60); 3.75 at 45+ years (95% CI: 2.99–4.70). ConclusionInternational testing and explanation are needed of UK’s sharp age-related increase in the risk of methadone-specific death. Clients should be alerted that their risk of methadone-specific death increases as they age.

Effectiveness of community psychosocial and pharmacological treatments for alcohol use disorder: A national observational cohort study in England

BackgroundThis was a national English observational cohort study using administrative data to estimate the effectiveness of community pharmacological and psychosocial treatment for alcohol use disorder (AUD). MethodsAll adults commencing AUD treatment in the community reported to the National Drug Treatment Monitoring System (April 1 2014–March 31 2015; N = 52,499). Past 28-day admission drinking pattern included drinks per drinking day (DDD): 0 (‘Abstinent’), 1–15 (‘Low-High’), 16–30 (‘High-Extreme’) and over 30 DDD (‘Extreme’). The primary outcome was successful completion of treatment within 12 months of commencement with no re-presentation (SCNR) in the subsequent six months, analysed by multi-level, mixed effects, multivariable logistic regression. ResultsThe majority reported DDD in the ‘Low-High’ (n = 17,698, 34%) and ‘High-Extreme’ (n = 21,383, 41%) range. Smaller proportions were categorised ‘Extreme’ (n = 7759, 15%) and ‘Abstinent’ (n = 5661, 11%). Three-fifths (58%) achieved SCNR. Predictors of SCNR were older age, black/minority ethnic group, employment, criminal justice system referral, and longer treatment exposure. Predictors of negative outcome were AUD treatment history, lower socio-economic status, housing problems, and ‘Extreme’ drinking at admission. In addition to psychosocial interventions, pharmacological interventions and recovery support increased the likelihood of SCNR. Pharmacological treatment was only beneficial for the ‘Low-High’ groups with recovery support. ConclusionsOver half of all patients admitted for community AUD treatment in England are reported to successfully complete treatment within 12 months and are not re-admitted for further treatment in the following 6 months. Study findings underscore efforts to tailor AUD treatment to the severity of alcohol consumption and using recovery support.

Effectiveness of inpatient withdrawal and residential rehabilitation interventions for alcohol use disorder: A national observational, cohort study in England

BackgroundThis was a national English observational cohort study to estimate the effectiveness of inpatient withdrawal (IW) and residential rehabilitation (RR) interventions for alcohol use disorder (AUD) using administrative data. MethodsAll adults commencing IW and/or RR intervention for AUD between April 1, 2014 and March 31, 2015 reported to the National Drug Treatment Monitoring System (n=3812). The primary outcome was successful completion of treatment within 12months of commencement, with no re-presentation (SCNR) in the subsequent six months, analysed by multi-level, mixed effects, multivariable logistic regression. ResultsThe majority (70%, n=2682) received IW in their index treatment journey; one-quarter (24%, n=915) received RR; 6% (n=215) received both. Of treatment leavers, 59% achieved the SCNR outcome (IW: 57%; RR: 64%; IW/RR: 57%). Positive outcome for IW was associated with older age, being employed, and receiving community-based treatment prior to and subsequent to IW. Patients with housing problems were less likely to achieving the outcome. Positive outcome for RR was associated with paid employment, self/family/peer referral, longer duration of RR treatment, and community-based treatment following discharge. Community-based treatment prior to entering RR, and receiving IW during the same treatment journey as RR, were associated with lower likelihood of SCNR. ConclusionsIn this first national effectiveness study of AUD in the English public treatment system for alcohol-use disorders, 59% of patients successfully completed treatment within 12months and did not represent for more treatment within six months. Longer duration of treatment and provision of structured continuing care is associated with better treatment outcomes.

Does paying service providers by results improve recovery outcomes for drug misusers in treatment in England?

To compare drug recovery outcomes in commissioning areas included in a 'payment by results' scheme with all other areas. Observational and data linkage study of the National Drug Treatment Monitoring System, Office for National Statistics mortality database and Police National Computer criminal records, for 2 years before and after introduction of the scheme. Pre-post controlled comparison compared outcomes in participating versus non-participating areas following adjustment for drug use, functioning and drug treatment status. Drug services in England providing publicly funded, structured treatment. Adults in treatment (between 2010 and 2014): 154 175 (10 716 in participating areas, 143 459 non-participating) treatment journeys in the 2 years before and 148 941 (10 012 participating, 138 929 non-participating) after the introduction of the scheme. Scheme participation, with payment to treatment providers based on patient outcomes versus all other areas. Rate of treatment initiation; waiting time (> or <3weeks); treatment completion; and re-presentation; substance use; injecting; housing status; fatal overdose; and acquisitive crime. In participating areas, there were relative decreases in rates of: treatment initiation [difference-in-differences odds ratio (DID OR)=0.17, 95% confidence interval (CI)=0.14, 0.21]; treatment completion (DID OR=0.60, 95% CI=0.53, 0.67); and treatment completion without re-presentation (DID OR=0.63, 95% CI=0.52, 0.77) compared with non-participating areas. Within treatment, relative abstinence (DID OR=1.50, 95% CI=1.30, 1.72) and non-injecting (DID OR=1.32, 95% CI=1.10, 1.59) rates were improved in participating areas. No significant changes in mortality, recorded crime or housing status were associated with the scheme. Drug addiction recovery services in England that are commissioned on a payment-by-results basis tend to have lower rates of treatment initiation and completion but higher rates of in-treatment abstinence and non-injecting than other services.

Effectiveness of treatment for opioid use disorder: A national, five-year, prospective, observational study in England

BackgroundThis the first 5-year effectiveness study of publicly funded treatment for opioid use disorder (OUD) in England. MethodsAll adults initiating treatment in 2008/09 in all 149 local treatment systems reporting to the National Drug Treatment Monitoring System (n=54,347). Admission polydrug use sub-populations were identified by Latent Class Analysis. The treatment outcome measure was ‘successful completion and no re-presentation within six months’ (SCNR) analysed by multilevel, multivariable logistic regression and funnel plots to contrast outcome by treatment system. ResultsSCNR was achieved by 21.9%. Heroin and crack cocaine users were significantly less likely to achieve this outcome than patients who used heroin only (adjusted odds ratio [AOR] 0.90; 95% confidence interval [CI] 0.85–0.95). Older patients (AOR 1.09; CI 1.07–1.11), those employed (AOR 1.27; CI 1.18–1.37) and those enrolled for longer treatment were more likely to achieve the outcome measure. After risk adjustment, the local treatment systems that achieved substantially better outcome performance (14/149) had a lower rate of opiate prevalence in the local population at time of study initiation (incidence rate difference [IRD] 4.1; CI 4.0–4.2), fewer criminal offences per thousand (IRD 28.5; CI 28.1–28.8) and lower drug-related deaths per million (IRD 5.9; CI 5.9–5.9). ConclusionsIn an English national study, one fifth of patients successful completed treatment for OUD and did not present for further treatment within six months. Longer time in treatment increases the probability of achieving and maintaining clinical benefit from treatment. After risk-adjustment, an important minority of treatment systems achieve substantially better outcome performance.

Prevalence of HIV risk-related drug use and sexual activity among men who have sex with men attending a specialist UK club drug clinic

PurposeThe purpose of this paper is to examine patterns of drug use among a cohort of drug treatment-seeking drug-using gay men and other men who have sex with men (MSM), and whether these activities differ between, or predict, HIV status.Design/methodology/approachCross-sectional study was conducted in a specialist club drug clinic in London covering 407 consecutive attendees who identified as MSM. Substance use, including injecting drug use (IDU), associated sexual activity and self-reported HIV status were measured by clinical interview and National Drug Treatment Monitoring System data tool.FindingsOver a 45-month period, 407 MSM attended the clinic. In total, 62.1 per cent were HIV positive, 48.9 per cent had injected drugs, 14.9 per cent reported needle sharing and 73.3 per cent used drugs to facilitate sex. The most commonly reported problem drugs were GHB/GBL (54.3 per cent) methamphetamine (47.7 per cent) and mephedrone (37.8 per cent). HIV status was associated with methamphetamine, mephedrone, IDU, sharing equipment, using drugs to facilitate sex, older age and older age of drug initiation, as well as Hepatitis C virology (HCV) status. Use of methamphetamine, HCV infection, older age and IDU predicted HIV positive status in a logistic regression model.Practical implicationsThe findings describe a constellation of risk factors including high levels of IDU, sharing of equipment and high-risk sexual activity in a population with high rates of HIV positive serology. They also provide further evidence for a link between HIV infection and use of methamphetamine.Social implicationsThe authors suggest a need for greater awareness of HIV-related risk activities and promotion of HIV prevention strategies for MSM by both sexual health and drug treatment services.Originality/valueThis paper is amongst the very first studies of its nature.

Does exposure to opioid substitution treatment at prison release reduce the risk of death? A prospective, observational study in England

BackgroundOpioid use disorders are common in the prison population. Prisoners face an acute risk of death in the first 4 weeks after release. We tested whether prison-based opioid substitution treatment (OST) reduces post-release mortality. MethodsThis was a national prospective cohort study of adult prisoners with opioid use disorders recruited from 39 prisons (and transferred to and released from 123 prisons) in England during 2010–16 linked to Prison Health, Justice Statistics Analytical Services, Office for National Statistics, and National Drug Treatment Monitoring System. We assessed the association between OST exposure at prison release and all-cause mortality using Cox proportional hazards models adjusted for demographic and behavioural confounders and community treatment. FindingsWe created a risk set of 15 141 incarcerations (12 260 individuals) with opioid use disorders (8645 exposed to OST on release, 6496 unexposed). 401 individuals died during the observation period (160 in the first year, 24 in the first month). The mortality risk in the OST-exposed group was lower than in the unexposed group in the first 4 weeks (0·93 per 100 person-years [95% CI 0·4–2·1] vs 3·67 [2·3–5·8]; unadjusted hazard ratio [HR] 0·25, 95% CI 0·10–0·64). Mortality risk did not differ from 4 weeks to 4 months (HR 1·07, 95% CI 0·57–2·00) or from 4 months to 1 year (0·97, 0·65–1·45). OST-exposed prisoners were more likely than the non-exposed group to enter community treatment (odds ratio 2·47, 95% CI 2·3–2·65). The protective effect of OST exposure was not attenuated after adjustment for demographic or behavioural confounders or for community drug treatment (adjusted HR 0·27, 95% CI 0·11–0·71). There was no evidence of an interaction between OST exposure on prison release and community treatment (ratio of HRs 0·99, 95% CI 0·12–8·11; p for likelihood ratio test=0·99). InterpretationOST at prison release lowered risk of mortality in the first month by 75% (removing the excess risk of death in people with an opioid use disorder leaving prison compared with risk of death in the community after 4 weeks) and increased the likelihood of entering drug treatment in the community. FundingDepartment of Health, NHS England, Public Health England.

Fatal opioid poisoning: a counterfactual model to estimate the preventive effect of treatment for opioid use disorder in England

A counterfactual model was used to estimate the number of fatal opioid-related poisonings prevented by public treatment services for opioid use disorder (OUD) in England between April 2008 and March 2011. Patient OUD treatment episode data recorded by the English National Drug Treatment Monitoring System were linked to data on opioid deaths recorded by the Office for National Statistics. The source population was the official estimate of non-medical opioid users (aged 15-64 years; approximately 260 000 each year). The target population was all individuals (aged 15-64 years) treated for OUD in the study period (n = 220 665). The outcome measure was fatal opioid-related poisoning (opioid death). The opioid death rate [per 100 person-years (PY)] and mortality rate ratios (MRR) were computed for study year, age group (15-24, 25-34, 35-64 years) and for three treatment-related states: time spent 'prior to treatment', 'during treatment' and 'after treatment'. Between April 2008 and March 2011, there were 3731 opioid deaths in the study: 741 during treatment (0.20 per 100 PY; referent category); 2722 prior to treatment [0.77 per 100 PY; MRR = 3.76, 95% confidence interval (CI) = 3.18-4.44]; and 268 after treatment (0.41 per 100 PY; MRR = 1.99, 95% CI = 1.64-2.41). By counterfactual estimation, national OUD treatment services prevented an average of 880 opioid deaths each year (95% CI = 702-1084). Between April 2008 and March 2011, a counterfactual model shows that the English public treatment system for opioid use disorder prevented an average of 880 deaths each year from opioid-related poisoning. Counterfactual models of mortality prevention can be used for outcome and performance monitoring of substance use disorder treatment systems.

Prevalence and factors associated with sex trading in the year prior to entering treatment for drug misuse in England

BackgroundThis study estimates the past year prevalence of and factors associated with sex trading (offering sex for money, drugs or something else) among 1796 men and women presenting to 342 drug misuse treatment agencies in England, and identifies service development and delivery implications. MethodsSecondary analysis of baseline data from a prospective cohort was conducted. Short Form-12 measured mental and physical wellbeing, psychiatric diagnoses were self-reported and the circumstances, motivation and readiness tool assessed readiness for/pressure to enter treatment. Logistic regression models determined associations with sex trading separately by sex. Inverse probability population weights were calculated, utilising demographics from the National Drug Treatment Monitoring System and agency specific data collection windows. ResultsThe estimated prevalence rate of sex trading in the past 12 months was 5.1% (15.0% for women and 2.1% for men). For women, adjusted models identified crack use (aOR 1.83, 95% CI 1.22–2.74, p=0.004), previous treatment (aOR 3.00, 95% CI 1.31–6.86, p=0.010) and greater readiness for treatment (aOR 1.12, 95% CI 1.01–1.24, p=0.027) as independently associated with sex trading. For men, lower mental wellbeing (aOR 0.97, 95% CI 0.94–0.99, p=0.030) was independently associated and marginal effects were identified for syringe sharing (aOR 2.89, 95% CI 0.94–8.86, p=0.064) and unprotected sex (aOR 2.23, 95% CI 0.95–5.26, p=0.065). ConclusionsSex trading among drug misusers is associated with additional health risks and specific treatment needs. Given the scale of the problem it is important that treatment providers have the competencies to adequately address the issue and provide accessible and appropriate services.

Contraceptive use and pregnancy outcomes among opioid drug-using women: a retrospective cohort study.

ObjectiveThe contraceptive needs of illicit opioid users differ from non-drug users but are poorly understood. The aim of this study was to describe contraceptive use and pregnancy outcomes in opioid-using women, and to examine their association with a range of risk factors.MethodThis retrospective cohort study used UK general practice records, Treatment Outcomes Profile and National Drug Treatment Monitoring System data, and a nested data validation exercise. A cohort of 376 women aged 20–61 years were in active treatment for opioid addiction in October 2010 at two specialised primary care practices in North-East England. Outcomes were age-adjusted prevalence estimates for contraceptive use and pregnancy outcomes in users of illicit opioids. The association between lifestyle-related risk factors and contraception was explored.ResultsDrug-using women made lower use of planned (non-condom) contraception (24% vs 50%, p<0.001), had more frequent pregnancy terminations (0.46 vs. 0.025, p = 0.004) and higher annual incidence of chlamydia (1.1% vs. 0.33%, p<0.001), when compared with age-matched population data. Specifically, there was low use of oral contraceptives (4% vs. 25%, p<0.001), IUCD (1% vs. 6%, p<0.001), and sterilisation (7% vs. 6%, p = 0.053), but higher rates of injectable contraceptives (6% vs. 3%, p = 0.003). A total of 64% of children aged <16 years born to this group did not live with their mother. No individual risk factor (such as sex-working) significantly explained the lower use or type of non-condom contraception.ConclusionsThis is the first study to describe planned contraceptive use among drug-users, as well as the association with a range of risk factors and pregnancy outcomes. The low uptake of planned contraception, set against high rates of terminations and sexually transmitted disease demonstrates the urgent clinical need to improve contraceptive services, informed by qualitative work to explore the values and beliefs influencing low contraceptive uptake.

Psychiatric co-morbidity among subjects with heroin and cocaine use disorders and its association with HCV infection

Aim: This study aims to determine whether psychiatric co-morbidity is associated with HCV infection in a substance misuse population.Methods: We identified all subjects in the National Drug Treatment Monitoring System (NDTMS) during the period January 2007–December 2010 for whom information was recorded which identified their psychiatric co-morbidity status and their HCV status. Multivariate analysis was used to identify risk factors that could predict HCV infection.Results and conclusions: The HCV prevalence rate was 32%. HCV infected subjects were younger (21.4% versus 23.1%) when they first started to use drugs, they were more likely to be white (85.1% versus 13.1%) and male (74% versus 72.6%), to have urgent housing problems (13.0% versus 9.7%), to inject (42.8% versus 18.8%), and to share injecting paraphernalia (35.4% versus 9.2%). After adjusting for demographics and drug and alcohol use behaviours, the Odds Ratio of psychiatric co-morbidity for HCV infection was 1.33 (95% CI 1.01–1.75). The results suggest that psychiatric co-morbidity is associated of HCV infection.Clinical implications: It is important to take psychiatric co-morbidity into account when treating these patients and designing intervention strategies.

Opioid prescribing in the UK: can we avert a public health disaster?

Opioid prescribing in the UK: can we avert a public health disaster?

National survey of alcohol treatment agencies in England: Characteristics of clients

Background: To map and contact all alcohol treatment services in England offering Tier 2, 3 and 4 interventions and describe the characteristics of their service-users.Methods: A national cross-sectional survey of alcohol treatment providers in England, designed to gather information about the characteristics of clients referred, assessed, and treated in the financial 2003/4.Results: A total of 696 alcohol treatment agencies were mapped, of which 388 (55.7 %) responded to the survey. The majority of clients were men, particularly within residential and non-statutory agencies. A higher proportion of residential clients were highly alcohol dependent, homeless and neurologically impaired, whereas, community clients were more likely to be offenders or to have mental health problems. Non-statutory services were more likely to see homeless clients, offenders, and clients with mental health problems and neurological deficits than statutory services who, typically, see a more dependent population.Conclusions: Findings support the need for more specialist service provision for severely dependent offenders and dependent drinkers with serious mental illness. To aid future mapping of alcohol services, which allows areas of need to be identified, it is recommended that services have a monitoring system similar to that for drug misuse with the National Drug Treatment Monitoring System.

Estimating the numbers of children of problematic drug users and their residential circumstances to inform United Kingdom research, policy and practice

Aims: To estimate the number of children of problematic drug users (PDU) in Cheshire and Merseyside (England) in 2007/08 and their residential circumstances using two national monitoring systems, and to assess the suitability of these systems for this purpose.Methods: The proportions of PDU reporting numbers of children were calculated (e.g. zero–40%, 1 child–20%) for three datasets (National Drug Treatment Monitoring System (NDTMS), Drug Interventions Programme (DIP) and DIP/NDTMS amalgamated). Indirect standardization was used to estimate the number of children of PDU in Cheshire and Merseyside. The proportion of the overall population of under 16 years old who are children of PDU was calculated. Residential circumstances of children of PDU were examined using DIP data.Results: The estimated total number of children of PDU residing in Cheshire and Merseyside were 14,517 (NDTMS), 24,552 (DIP) and 19,029 (amalgamated dataset); 3.3% (NDTMS), 5.3% (DIP) and 4.3% (amalgamated dataset) of the total population were of under 16-year olds. Children of male and female PDU had different residential profiles.Conclusions: Findings illustrate the substantial potential burden of care on services and family members. Inconsistencies in data collection mean the use of these monitoring systems to produce estimates need further consideration.

Illegal drug use in the age of ageing

Both historically and currently, UK policies on illegal drug use have been largely focused towards younger people, but there is growing evidence of a shift in the demographic profile of people who use illegal drugs, with an increasing substantial number of drug users aged over 40 years. There is limited evidence for a change in the age profile of drug users from the British Crime Survey which documents drug use in the general population of England and Wales.1 This survey reports that the prevalence of illegal drug use (predominantly cannabis, cocaine powder, ecstasy, amyl nitrate, and amphetamines) in the previous year has fallen significantly between 1996 and 2008/2009 for those aged 16 to 29 years, while the prevalence has increased among those aged 30 to 59 years.1 Unfortunately, the British Crime Survey does not collect information about illegal drug use by those aged 60 years and over, so identifying population level data on drug use for the oldest age groups presents a challenge. Further evidence of this demographic change among people accessing drug treatment services (primarily users of opiates and/or crack cocaine),2 is available from surveillance data. Using data from established monitoring systems (including the National Drug Treatment Monitoring System [NDTMS] which currently records data on people accessing structured treatment interventions in England), Beynon et al 3 demonstrate that the percentage of people in drug treatment in Cheshire and Merseyside aged 40 years and over increased from 9.8% in 1998 to 23.1% in 2004/2005 (with 1.7% of these aged 50 years and over in …

Older and sicker: Changing mortality of drug users in treatment in the North West of England

Background The study examines the age at which drug users die and ascertains whether there is a significant difference in the causes of death (‘drug related’ versus ‘non-drug related’) according to age. Methods Details of people reported to the North West of England's National Drug Treatment Monitoring System as dying (years 2003/2004–2007/2008) were matched by the Office for National Statistics to death notifications to identify the cause and date of death. Spearman's rank correlation was performed on median age at death by year. Mantel–Haenszel statistics tested the association between age and type of death, adjusted for year. Results Causes of death were ascertained for 504 people. Median age at death increased significantly from 36.46 in 2003/2004 to 41.38 in 2007/2008. The odds of a person aged 40 and over dying from a non-drug related death were 3.27 the odds of a person aged less than 40 dying from a non-drug related death. Conclusion Current focus on drug related deaths detracts attention from other causes; in particular, the types of death which disproportionately affect older drug users. Ongoing debates about reintegration into society and employment presuppose that drug users are of working age and are healthy enough to work.