Transcript War on Drugs - Implications for Wales

TOWARDS
A HEALTH
BASED
APPROACH
…Implications for Wales
Josie Smith
Programme Lead for Substance Misuse, Public Health Wales
AIMS:
- Economic implications (£)
- Impact on existing and
future threats to health
- Simple hopes
"the science and art of preventing disease, prolonging
life and promoting health through organized efforts
and informed choices of society, organizations, public
and private, communities and individuals.“
Winslow ‘The untilled Fields of Public Health’ 1920
Estimated number of
problematic drug users
in Wales 2009-10:
30,443
(95% CI 23,172 – 38,809)
Number of individuals
in direct contact with
NSP services:
17,838
(01/04/2014-30/09/2014)
Current expenditure…
£50 million per annum
Welsh government current expenditure on substance misuse (health)
- inc health board ring fenced, capital and revenue funding for APB, education and awareness raising, information/statistics, service
user engagement and policy development, reducing availability
- not inc disease treatment costs etc. The health service cost in Wales of problem drug use has been estimated at £17.6 million per
year
COLES, E. and PATES, R. for WELSH ASSEMBLY GOVERNMENT. The Economic and Social Costs of Class A drug and alcohol abuse in Wales. Cardiff: Welsh Assembly Government (Unpublished)
Criminal justice non-devolved…
£13.3 billion per annum
Home Office / PCC current expenditure on substance misuse in UK
(https://www.gov.uk/government/policies/reducing-drugs-misuse-and-dependence, 2013) 1 billion = 1,000 million
The total economic and social cost of Class A drug use in Wales has been estimated to
be around £780 million, and drug related crime accounts for 90 per cent of this.
http://www2.nphs.wales.nhs.uk:8080/SubstanceMisuseDocs.nsf/%28$All%29/6361D5806F16EEDD80257C5B005AC8AF/$File/Working%20Together%20to%20Reduce%20Harm%20-%20SM%20Strategy%202008-2018.pdf?OpenElement
• In England and Wales 2014: 14% of men and
women in prison were serving sentences for drug
offences
• The average annual overall cost of a prison place
in England and Wales for 2012-13 was £36,808.*
*Ministry of Justice (2013) Costs per place and costs per prisoner by individual prison, National Offender Management
Service Annual Report and Accounts 2012-13: Management Information Addendum, London: Ministry of Justice
• In Wales, there are 5 prisons with around
3000 beds (official operational capacity 2,795)
In Wales – cost of prison for drugs offences
per annum
(14% x 2,795) = 391 x £36,808 =
£14,402,970
PHW research 2006-2009
(n=500 of which 347 had been imprisoned at least once)
• Nearly three quarters of those that had been imprisoned reported
continued use of drugs whilst in prison
• Less than one quarter were offered any follow up or aftercare
following release from prison
• Only 20% remained drug free for one month or more following
release from prison
http://www2.nphs.wales.nhs.uk:8080/BloodBorneVirusesDocs.nsf/7c21215d6d0c613e80256f490030c05a/c662fce951549dd880257355004cc
bbf/$FILE/Needs%20assessment%20of%20harm%20reduction%20and%20health%20care%20services%20for%20substance%20misusers%20ac
ross%20Wales.pdf
Profile of drugs seized by police forces in Wales, 2012-13
Overall, police
forces in Wales
recorded 11,766
drug offences in
2013-14
Mismatch between drugs offences and health harms
Hospital admissions for alcohol specific conditions and poisoning by illicit drugs diagnoses in the primary
position, all ages, 2008/09 to 2013/14
http://www2.nphs.wales.nhs.uk:8080/SubstanceMisuseDocs.nsf/%28$All%29/30384D701A04C69980257C5
B0057A8E4/$File/SMTF%20Health%20and%20Wellbeing%20Compendium.pdf?OpenElement
http://gov.wales/docs/dhss/report/141029submisuseprofilewalesen.pdf
Health harms
• Premature death / drug poisoning/ multiple drugs
• Injecting related – DVTs, wound infections
• Chronic blood borne virus infection (inc hepatitis C (liver disease) and
HIV
• Mental health issues inc depression, psychoses,
• General poor contact with health services → poorer overall health
• Poor dental health
• Poor diet / eating disorders
• Physical / psychological dependency and withdrawal
• Social isolation, exclusion, suicide
Impact on future threats to health
• Screening, diagnosis and treatment for hepatitis C – reduce pool of +ve patients
• Improved access to wound care and development of services to address
injecting risk, public injecting, social isolation …DCR’s
• Early identification/evidencing of high risk substances and behaviours –
ketamine bladder
• Preventing drug deaths – Naloxone
• Profiling drugs on market and those being manufactured within UK: knowledge
is power – WEDINOS…
• Open discussions and policy formulation based on harms– learning from experts
• Primary and secondary prevention: Early engagement – prior to escalation to
problematic
But even more…
“… I do not think that the tax payers of Wales
would be happy to think that their hard earned
money was being spent encouraging drug use…”
Tax payers (and their families and friends) take drugs too….
Regulation of drugs to:
• Protect and improve public health
• Reduce drug related crime, corruption and violence
• Improve security and development
• Protect the young and vulnerable
• Protect human rights
• Base policy on evidence of what works and provides good value for
money
Transform
Questions?
[email protected]
Useful sites:
www.wedinos.org
www.siedsinfo.co.uk
www.wales.nhs.uk/sitesplus/888/page/72997