Key Health Data for the West Midlands 2000
Chapter 8: Drug Misuse
List
of Tables
List
of Figures
Main Body
1:
West Midlands Geography
2:
Inequalities and Health
3:
The Burden of Disease
4:
Communicable Disease
5:
Environment and Health
6:
Progress on Targets set by "Our Healthier Nation"
7:
Crime and Health
8: Drug Misuse
8.1 Introduction
In 1989 the Department of Health (DoH) funded the Regional Health Authorities to set up databases to collect anonymised data on drug misusers attending specialist services such as community drugs agencies.
The drugs agencies collect data on people presenting to their service for the first time or for the first time after a break of six months or more. Selected personal details and information on main drugs of use are forwarded to the Regional Drug Misuse Database (RDMD).
The RDMD identifies all records received, which contain attributable (see below) data from face to face contacts. People who attend at more than one agency in the RDMD area are only counted once.
The RDMD is now the only routinely collected information source on the use of drug services. RDMDs collect data from a wide range of drugs agencies. The information that is generated is used for planning and development of services and for identifying and responding to changing trends in drug misuse. Data on injecting behaviour are also collected and this is important because of the potential for the transmission of blood borne viruses.
The West Midlands RDMD was set up in April 1991. The first episode of problem drug misuse held on the RDMD was completed on the 3 December 1990 and new episodes have since averaged 2920 per annum. By November 2000 the RDMD held details of 31916 episodes from 22282 individuals.
The West Midlands Drug Misuse Database records numbers of individuals who present to services with a drug problem for the first time or after a break of six months. By matching on attributable data, an adjustment is made so those individuals who may have attended more than one agency during the reporting period are only counted once.
Obviously the RDMD does not collect data on individuals who do not attend for services and it does not count users who stay in contact with those services.
The data are recorded at or around the time of the initial face to face contact between the client and the agency or health professional. An individual can generate more than one episode of contact either by attending a second agency or by re-presenting to an agency after a break of six months or more.
This report uses data obtained from the first presentation in the financial year 1999/2000 even if previous or subsequent episodes have more complete data. This may or may not be the first ever presentation by the individual.
Not all drugs services currently report to the RDMD, efforts are being made to improve this. Drug misuse contacts in general practice, hospitals and in social services departments are generally under-reported.
This report covers the first full year where alcohol has been collected as main drug of use. Alcohol accounts for 5% of reports.
Ad hoc reports can be produced for any combination of agencies that report to the RDMD. If required the data can be filtered by sex, age range, ethnicity, place of residence and postcode.
8.2 Summary of Database
A total of 5049 individuals were reported to the RDMD in 1999/2000, 966 more than the previous year, a 24% increase.
Thirty-six agencies, mostly statutory community based drug services, are currently reporting to RDMD. The number of reports from General Practitioners (GPs) remains disappointingly low.
The quality of the data has improved, particularly relating to health district of residence which is now recorded for 4635 (92%) individuals. This is sufficiently complete to allow data to be presented by district of residence rather than by the district in which the reporting drug agency is located (district of presentation).
There are wide variations in drug agency attendance rates between health authorities. These may reflect true differences in the pattern and nature of problem drug use but may also be due to variations in patterns of service provision and practice within individual agencies.
The gender distribution of users shows a male to female ratio of 4:1. This is similar to that seen in previous reporting periods and contrasts with the national picture where a greater proportion of women present for treatment and the sex ratio is 3:1. Health districts vary in the proportion of female attendees. These gender differences may be due to a real difference in the nature of problem drug use in the West Midlands but are more likely to be due to the success of agencies in attracting women into treatment.
Overall 22% of attendees are aged under 20 and 26% are aged 30 or over. This contrast with the national picture where the proportions are 15% and 33% respectively. This means that services in the West Midlands are catering for younger drug users. This is encouraging.
There is some suggestion that even when allowing for missing data persons of black ethnic origin are under represented in some health districts.
There are important issues here for health authorities and agencies. The UK Anti-Drugs Co-ordinating Unit (UKADCU) has identified equal access to services for women, young people and people from minority ethnic groups as an important issue.
Heroin was the most frequently reported main drug accounting for 63% of users, the proportion reporting cannabis has fallen slightly from 11.5% to 10% and is the second most frequently reported drug. Alcohol was reported by 5% of users, amphetamines by 5% and cocaine (including crack) by 6%. The proportion reporting methadone was 4%. There are health district differences with respect to the main drug of use. These differences may reflect drug availability and user preferences but type of agency and reporting practice will also influence the observed patterns of drug use.
Where injecting status is known, on average 34% of users report recent injecting. This is lower that the national average of 44%. Some districts report significantly higher injecting rates while others have below average rates. Where sharing status is known, on average 21% of users report recent sharing. This is not significantly different from the national average of 19% but is well above the Health of the Nation (HoN) target of 5% by 2000. Some districts had significantly lower rates.
8.3 Individuals and episodes
A total of 5476 episodes were reported by agencies in the West Midlands to the Regional Drug Misuse Database in 1999/2000. There were 5049 individuals of whom 3629 were attending for the first time (Table 7.1). Only 399 individuals had more than one episode during the year (Table 7.2). Males outnumbered females by about 4:1.
In comparison with 1998/1999 the number of episodes has increased by 28% (4271 to 5476). The number of individuals has increased by 24% (4083 to 5049) and the number of new individuals has increased by 18% (3066 to 3629) (Figure 7.1).
Figure
8.1: Individuals reported to West Midlands RDMD 1990/1991 - 1999/2000.
Table 8.2: Episodes per individual. 1999/2000.
8.4 Health authority of presentation and health authority of residence
Health authority of residence was recorded for 4635 (92%) individuals. Data on residence is now sufficiently complete to allow data in this report to be presented by health authority of residence rather than by the district in which the reporting drugs agency is located (district of presentation). At national level data on residence is only available for 81% of records.
This is very important for health authorities and other organisations that want to understand the scale and nature of problem drug use within their boundaries and develop services to meet the needs of drug users and their families.
It is important to bear in mind that differences at health authority level may reflect true differences in the pattern and natutre of problem drug use but may also be due to variations in patterns of service provision and practice within individual agencies.
Health Authority of presentation is summarised in Table 3 and health authority of residence is summarised in Table 4 (attendance rates have been calculated using health authority mid-1999 population estimates).
Table 8.3: Reports of individuals by health authority of presentation. 1999/2000.
Health authority of residence was recorded for 4635 (92%) of individuals reported by agencies (Table 8.4). Drug agency attendance rates have been calculated using health authority mid-1999 population estimates.
Table 8.4: Report rates by sex, by health authority of residence. 1999/2000.
Table 8.5: Gender of individuals by health authority of residence. 1999/2000.
In the region as a whole the gender distribution of users shows a male to female ratio of 4:1. This is similar to that seen in previous reporting periods and contrasts with the national picture where a greater proportion of women present for treatment and the sex ratio is 3:1.
Some health districts, for example Walsall, appear to have a greater proportion of female attenders but because of the small numbers involved these differences are not statistically signifiant. Conversely some districts (Dudley, Solihull) appear to have a below average proportion of women attendees. However again these differences are not statistically significant.
These gender differences may be due to a real difference in the nature of problem drug use in the West Midlands but are more likely to be due to the success of agencies in attracting women into treatment. There are important issues here for health authorities and agencies. The UKADCU has identified equal access to services for women, young people and people from minority ethnic groups as an important issue.
Overall 22% of attendees are aged under 20 and 26% are aged 30 or over. This contrast with the national picture where the proportions are 15% and 33% respectively. This means that services in the West Midlands are catering for younger drug users. This is encouraging.
Compared with the region as a whole, in some districts, notably Warwickshire, attendees are significantly younger. On the other hand other districts have a below average proportion of young attendees although these differences are not statistically significant. Over half attendees are aged under 25. Compared with England as a whole, individuals attending drugs agencies in the West Midlands are of younger average age.
Table 8.6: Age group of individuals by health authority of residence. 1999/2000.
8.5 Drugs of Misuse
Users must have at least on drug of misuse recorded and a maximum of five drugs. Just over half (53%) were recorded as misusing only one drug.
Heroin was the most frequently reported main drug accounting for 63% of users (Table 8). This proportion is similar to that seen in previous reporting periods. The proportion reporting methadone was 4%, slightly lower than in previous reports and below the national rate of 9%. The proportion reporting cannabis has fallen slightly from 11.5% to 10% and is the second most frequently reported drug. Alcohol was reported as the main drug of use by 5% of users, amphetamines by 5% and cocaine (including crack) by 6%.
As expected, solvent, hallucinogen and cannabis users were younger than heroin and cocaine users who in turn were younger than alcohol, barbiturate and benzodiazepine users (Table 8.8).
Six hundred and seventy individuals (544 males, 126 females) said they had stopped using their chosen drug at the time of attendance.
There are health district differences with respect to the main drug of use reported by attendees. Heroin is the main drug reported by the majority of users in most districts but in Warwickshire cannabis is reported by a third of users. Alcohol is reported by 30% of users in Shropshire and Walsall. These differences may reflect drug availability and user preferences but type of agency and reporting practice will also influence the observed patterns of drug use.
Table 8.7: Individuals Main drug of use category by health authority of residence. 1999/2000.
Table 8.8: Age and age of first use of individuals by main drug of use. 1999/2000.
8.6 Injecting and Sharing
One of the key Health of the Nation targets was to reduce the proportion of injecting drug users who report sharing equipment. Tracking this target is hampered by missing data, which means that the injecting and sharing status of a substantial proportion of users is not known.
In the Region as a whole injecting status in the previous four weeks is not known for 12% of users (Table 8.9). The range between the best and the worst performing districts is 1%-20%.
Where injecting status is known, on average 34% of users report recent injecting. This is lower that the national average of 44%. Some districts (North Staffordshire, Dudley, Worcestershire, Herefordshire) report significantly higher injecting rates while others have below average rates.
In those known to have recently injected, sharing status is not known for 18% of users (Table 8.10). The range between the best and the worst performing districts is 0%-48%.
Where sharing status is known, on average 21% of users report recent sharing. This is not significantly different from the national average of 19% but is well above the HoN target of 5% by 2000. No districts reported above average sharing rates but some (Walsall, Sandwell) had significantly lower rates.
Table 8.9: Injecting behaviour in the last four weeks by health authority of residence. 1999/2000.
The Health of the Nation target was to reduce the percentage of injecting drug users who reported sharing equipment in the previous four weeks by at least 50% by 1997, and by at least a further 50% by the year 2000 (from 20% in 1990 to no more than 10% in 1997 and no more than 5% by the year 2000).
8.7 Employment, Ethnic Origin
Although the RDMD has made efforts to improve data quality, the value of these data is still severely limited by the amount of missing data.
Data on ethnic group is particularly important so that agencies and health authorities can reassure themselves that services are being accessed by person of black and minority ethnic origin. There is some suggestion that even when allowing for missing data persons of black ethnic origin are under represented in some health districts (Table 8.12).
Table 8.11: Employment status of individuals by health authority of residence. 1999/2000.
Table 8.12: Ethnic origin of individuals by health authority of residence. 1999/2000.
References
- Department of Health (1999) Statistical Bulletin: Statistics from the Regional Drug Misuse Databases for Six Months ending September 1999.
- Drug Misuse Database, West Midlands Regional Report Number Three April 1999 to March 2000.
- Tackling Drugs to Build a Better Britain (1998).
For more information please contact Carol Richards
© Department of Public Health and Epidemiology, University of Birmingham