Drugs and Alcohol Needs Assessment (Jon Taylor)
The Health and Wellbeing Board received a presentation from the Data Insight and Intelligence Lead regarding the Oldham Drug and Alcohol Needs Assessment 2022.
Oldham had a total population of 237,628 (according to the Mid-Year Estimate, 2020) of which 49.4% are male and 50.6% female. Those who were 18 years or older represent 75.0% of the population. It is currently estimated that White/White British ethnicities comprise the largest concentration (71.3%) followed by Asian/Asian British communities with 22.4%.
In terms of Indices of Multiple Deprivation (IMD) Oldham is 19th worst in England and had five LSOAs (Lower Super Output Areas) which now sit in the most deprived 1% nationally.
As of March 2022 the number of adult drug users in treatment in Oldham was 1,197 compared to 1,046 in the previous year – an increase of 14.4%. The number of adult alcohol-only clients also increased significantly by 17.9% from 385 in March 2021 to 454 in March 2022. These increases are significantly greater than averages for Greater Manchester, the North West region and England. The number of new presentations to adult drug treatment services in Oldham increased sharply by 28.9% from 450 to 580 which was accompanied by a rise of 18.3% amongst alcohol-only clients from 268 to 317. Again, increases in this context were far higher than sub-regional, regional and national averages.
Estimates of unmet need, based on the proportion of people who are dependent on opiates and/or crack cocaine or alcohol not in the treatment system, show that rates amongst Oldham’s population, except for ‘crack (only)’, are inferior to national averages. Successful completions since ‘historic lows’ in 2018/19 are currently showing signs of recovery, approaching 6% amongst opiate users and a four-year high of 37.2% amongst non-opiate clients. The rates of successful completions are now beginning to compare well with national and ‘local outcome comparator’ group averages.
In the past 12 months the rates for re-presentations within six months of a successful completion are also, to a large extent, improving. Amongst non-opiate users, rates have dropped to zero and typically 0% to 4% amongst the combined user category of ‘Alcohol & Non-opiates’. Rates amongst opiate users fell from 42% in March 2021 to 17% in March 2022. However, amongst alcohol only clients the rate increased to 17% during the same period following a consistent period of sub-five percent rates.
Within Oldham’s adult in-treatment drug user population 72% are male. White/White British ethnicities represent 85% of this cohort, with Asian/Asian British communities being the next largest grouping at 8%. This means that while White ethnicities are overrepresented in the treatment population, South Asian communities are significantly underrepresented when compared to the general population. In terms of age, 30- to 49-year-olds account for 63% of adult in treatment. 9. Almost 7% of drug users in treatment indicated ‘urgent housing problems’ and 13% cited other ‘housing problems. Approximately two-thirds (65.7%) had a ‘mental health treatment need identified’ when they presented to drug treatment services in Oldham. In March 2022 the largest referrers to drug treatment services in Oldham were ‘Self, Family & Friends’ (53.1%) with the next largest proportion of referrals coming from ‘criminal justice’ agencies (22.6%).
From 2018/19 to 2021/22 the key trends in substance involvement amongst adult drug user engaging with treatment are as follows:
i. Upward trend in combined opiate/crack cocaine use from 31.3% to 33.5%
ii. ii. Cocaine (powder) almost doubling from 11.1% to 21.4%
iii. iii. Cannabis up more than 1½ times from 19.0% to 30.3%
iv. iv. Alcohol citations up by almost one-third from 22.9% to 29.7%.
Deaths in drug treatment increased from 13 in 2019/20 to 19 in 2020/21. The proportion of adults Oldham with opiate problems in treatment for 6 years or more was now 33% compared to 27% nationally. The proportion of missing data with regards to adult drug user clients declaring their parental status when presenting to treatment services in Oldham has decreased from 13.8% in 2020/21 to 5.7% in 2021/22. This compares to a national average of 1%. It is important all information in relation to parental status and clients declaring whether or not they live with children is accurately recorded for safeguarding purposes.
Amongst adult alcohol only clients in treatment in Oldham 62% are male and 38% were female. More than nine in ten (94%) are from White/White British backgrounds. Almost one in five (19.2%) are aged 30-39 years, 28.9% aged 40-49 years and almost 36% aged 50-64 years. Approximately 1.3% of alcohol only clients in treatment indicated ‘urgent housing problems’ and 8.2% cited other ‘housing problems’, whilst approximately two-thirds (65.9%) had a ‘mental health treatment need identified’ when they presented to alcohol treatment services in Oldham.
In March 2022 the largest referrers to alcohol treatment services in Oldham were ‘Self, Family & Friends’ (51.7%) with the next largest proportion referral coming from ‘hospital’ (12.0% up from 6.7% in the previous year). The third highest proportion was via GPs with 7.3%. The monthly consumption of alcohol units amongst alcohol only clients presenting to treatment indicated increases in higher values. For instance, the proportion of those stating that they consumed 1,000 or more units per month almost doubled from 10.6% in 2018/19 to 19.2% in 2021/22.
The rate per 100,000 of hospital admissions decreased from 835 in 2019/20 to 681 in 2020/21, however, although lower than the North West average (795), it remains higher than that of England (587). Alcohol specific mortality per 100,000 population in Oldham in 2020 (latest figures) was 15.9 which was similar to GM (15.8) and the North West (14.6) averages but almost 1½ times the rate for England (10.9). Mortality due to chronic liver disease (per 100,000 population) in Oldham was 19.3 which was similar to GM (18.1) but higher than North West (16.8) and England (12.2) averages.
In considering the report and presentation the Board expressed its concerns at the degree of addiction issues that were prevalent across the Borough, noting various other, underlying issues that were making the problems much worse, such as poverty and deprivation.
1. That the report be noted.
2. That the Director of Public Health be requested to commission a piece of work, consulting all relevant agencies, regarding the underlying issues that were adversely affecting addiction levels, in the Borough of Oldham and scoping an improvement plan that could be put in place.