South West Public Health Observatory
	The impact of drug misuse on health in the South West, 1996-2001

Summary

Incidence and prevalence

According to the Regional Drug Misuse Database (RDMD), the incidence and prevalence of chronic drug misuse problems presenting for treatment has doubled in the region during the past five years. There were 7,718 persons newly notified to the RDMD in 2000/0*, an annual incidence rate of 3.1 per 1,000 of 15–44 year-olds. The estimated prevalence of those with chronic drug misuse problems in the South West was 39,600 (± 3,000), or 20.3 per 1000 of 15–44 year-olds. These figures are consistent with other parts of England, though there were wide variations between Drug Action Team areas within the region. As elsewhere the gender ratio is approximately 3:1 males to females, with the suggestion of more recent increases in the proportion of females. The proportion of newly notified under 16-year-olds doubled over the period 1996–2001. 

Severity

Over half of the people newly notified to the RDMD, between 1996/97 and 2000/01 reported heroin as their main drug of choice, and 56% had injected drugs at some time. By the time of first notification 38% injected regularly, and 28% had shared injecting equipment. Whilst the use of heroin and other Class A drugs was similar in the South West to other parts of the country, the region had a high proportion of people who shared injecting drug equipment.

Spread of infection

The prevalence of AIDS/HIV and hepatitis A and B in the region has stabilised as elsewhere outside London. The rate of hepatitis C infection has reached epidemic proportions, with 929 cases notified from the South West in the year 2000, compared to 23 in 1992. The proportion of England's hepatitis C cases in the region was 17.5%, for the years 1995 to 2000, more than expected in proportion to the numbers of problem drug users. An estimated 24% of injecting drug users in the South West are already infected and the longer a person is injecting, the more the risk of infection increases. The consequences, apart from the risk of infection to others, are life limiting liver disorders in later life.

Deaths and overdoses

There has been a marked increase, in England and other parts of the UK during the past ten years, in the number of drug related deaths and hospital admissions for overdoses. Psychiatric admissions for drug related disorders remained stable. The South West has seen similar increases in deaths but not in overdoses, and a stable pattern of psychiatric admissions. Within the region, from 1993 to 1999, Bournemouth, Plymouth, Bristol, and Bath and North East Somerset had above average deaths from heroin/morphine or methadone, compared to figures for England. Regarding admissions to hospital for overdoses, South and West Devon had higher than expected numbers. Dorset had higher than expected psychiatric admissions. Other areas had numbers of admissions to hospital, for overdoses or psychiatric conditions, proportional to population. The region has a high proportion of road accident fatalities (8.1%) with traces of multiple drug use compared to other regions in the UK.

Area variations

There were marked variations in notifications made to the regional database; Bournemouth and Poole agencies were exceptions in the South West for consistently not notifying people with drug misuse problems to the RDMD. Of the numbers who were notified, half lived in and around the Bristol area, in the counties that used to be Avon. In addition, over 10% of new cases came into the South West from other parts of the country, mainly to the clusters of private residential rehabilitation facilities in the region, or prisons.

Age of first use and age of first problems

On average the reported age of first use of drugs was 15 years, the reported age of first problems was 19.5 years, and the age of first notification was 28 years. By the time individuals approach drug agencies for help, or are notified by the criminal justice system, many have already run the risks of infection and overdose. This report reinforces the need to find ways to discourage the injecting of drugs and sharing of injecting equipment, alerting people to the dangers of infection, as well as primary prevention aimed at reducing any drug use. Ways to engage younger people with drug problems sooner should be a priority for services.

Children and families

Although the numbers are likely to be an underestimate, nearly 5,000 children in the South West have one or more parents with drug misuse problems.