Drug Use Among Adults

This topic area covers statistics and information relating to drugs use among adults in Hull including local strategic need and service provision. Further information relating to Drug Use Among Young People is given under Lifestyle Factors within Children and Young People. Use of drugs has been collected within Hull’s Health and Wellbeing Surveys and full reports are available under Surveys within Tools and Resources. A needs assessment was completed in Hull during 2023 for people with multiple unmet needs which included people who used drugs. The report – which was finalised in 2024 – is available within Multiple Unmet Needs under Vulnerable Groups.

This page contains information from the Office for Health Improvement & Disparities’ Fingertips. Information is taken ‘live’ from the site so uses the latest available data from Fingertips and displays it on this page. As a result, some comments on this page may relate to an earlier period of time until this page is next updated (see review dates at the end of this page).

Headlines

• Different illicit drugs and prescribed medication have different effects on physical and mental health, and some are highly addictive. Drugs can have a serious impact not just on the individual, but also their family and friends, and there is a detrimental effect on the entire community.
• From the local Health and Wellbeing Survey 2019, around one in ten men aged 16-24 years, people who were unemployed and people who were not working due to long-term illness or disability stated they used drugs other than those required for medical reasons either everyday or weekly. Fewer than 2% of men aged 65+ years and women aged 35+ years did. Around 6% of men aged 25-34 years, around 4% of men aged 45-64 years and around 3% of women aged 16-24 years also used drugs other than those required for medical reasons either everyday or weekly.
• For 2016/17, it was estimated that there were around twice as many opiate and/or crack users in Hull compared to England (18.1 versus 8.9 persons per 1,000 population with a total of 3,146 people aged 15-64 years who used opiates and/or crack cocaine.
• A more recent update (2020/21) gave the number not in treatment as 1,625 with 48.4% not in treatment this equates to an estimate of 3,357 opiate and/or crack users in Hull for 2020/21. The percentage in treatment at 51.6% for Hull was higher than it was for England (47.9%).
• Just over one-third (34%) of adults aged 18+ years with substance use treatment need engage with community-based drug services following their release from prison which is lower than England (43%) for 2022/23.
• Two in a hundred (2%) of people in Hull waited for more than three weeks for drug treatment in 2022/23 compared to 1.5% for England. In 2022/23, only 20 people had waited for three weeks or more for drug treatment in Hull.
• During 2022/23, there were 2,288 adults aged 18+ years in Hull in treatment at specialist substance services which is 10.6 per 1,000 population (more than twice as high as England at 4.5 per 1,000 population).
• Successful completion of drug treatment (left free of drug dependence and did not re-represent within six months) was 20.1% for non-opiates and 3.5% for opiates in Hull for 2022 which was lower than England (31.4% and 5.0% respectively).
• Over 80% of people admitted to treatment for substance use smoked in Hull, and whilst the data is 2019/20, it is still likely to be very high in Hull.
• The directly standardised mortality rate from drug misuse was statistically significantly higher in Hull compared to England for 2020-22 (8.7 versus 5.2 deaths per 100,000 population) with 67 deaths in total over the three year period. The mortality rate was higher among men with 48 deaths (12.3 deaths per 100,000 population) than it was with women with 19 deaths (4.9 deaths per 100,000 population).
• The number of drug misuse deaths in Hull increased between 2001-03 and 2005-07 to reach a peak of 7.9 deaths per 100,000 population. The rate then gradually decreased in Hull to a low of 3.8 deaths per 100,000 population for 2013-15. The number of drug misuse deaths did increase, and there were a number of deaths in 2017 which increased the rate to 7.0 deaths per 100,000 population for 2015-17. Whilst the rate did decrease to 4.8 deaths per 100,000 population for 2018-20, the rate has increased sharply to a new high of 8.7 deaths per 100,000 population in 2020-22.
• However, whilst the sharp increase in the drug misuse deaths in Hull is of concern, perhaps of even more concern is the increase in deaths from drug poisoning in Hull. Traditionally, the number of drug misuse deaths is seen as a measure of the impact of drugs on mortality, but drug misuse deaths in Hull are a decreasing percentage of the drug poisoning deaths in Hull. Drug misuse deaths form a subset of drug poisoning deaths, and a death can only be classified as a drug misuse death if a drug controlled under the Misuse of Drugs Act 1971 is specifically mentioned on the death certificate. In Hull, the number of drug misuse deaths as a percentage of drug poisoning deaths was just over 50% for 1993-95 but increased to 80% in 2010-12 before falling to only 37% in 2020-22. In contrast, the percentage for England has increased from 40% in 1993-95 to over 60% for 2020-22.
• The total number of drug misuse deaths has increased in Hull in the last decade or so. There were just over 40 deaths in each three year period between 2008-10 and 2011-13 with number decreasing to just over 30 for 2012-14 and 2013-15. The numbers did increase to 57 for 2015-17 when there were a high number of deaths in Hull due to the introduction of a very toxic ingredient (carfentanil/fentanyl) into the local drug supply (predominantly heroin) which was swiftly dealt with by the National Crime Agency. Whilst the numbers fell to 37 deaths for 2018-20, the numbers have increased to reach a new high of 67 deaths for 2020-22. However, by reporting the mortality rate from drug misuse alone, this masks an even larger increase in Hull from deaths from drug poisoning. Between 2008-10 and 2013-15, there were between 53 and 63 deaths each three year period in Hull from drug poisoning, but this has increased sharply to 181 deaths for 2020-22.
• The mortality rate from drug poisoning in Hull was 8.8 deaths per 100,000 population in 2001-03 and increased to 10.6 deaths per 100,000 population for 2004-06, but decreased to 8.2 deaths per 100,000 population for 2008-10 and remained around 8 deaths per 100,000 population until 2013-15. The rate increased to 13.8 deaths per 100,000 population for 2015-17 and remained around 14 deaths per 100,000 population until 2018-20, but increased to 20.0 deaths per 100,000 population for 2019-21 with a further increase in the last year to 23.6 deaths per 100,000 population for 2020-22.
• There was a slightly higher percentage of drug poisoning deaths among women which were registered during 2020-21 compared to 2015-19 (27% versus 24%) and the age at death was higher for deaths registered during 2020-21. Nationally, an increase in the number of deaths was also noted together with a reduction in the number of new drug users which suggests a higher death rate among existing long-term drug users. The Office for National Statistics state possible explanations are an ageing cohort of drug users likely to be suffering from the effects of long-term drug use and becoming increasing susceptible to a fatal overdose, new trends in taking specific drugs which may increase the risk of an overdose, and a potential increase in disengagement or non-compliance with opiate substitute therapy.
• The mortality rate among those in drug treatment was 51% higher than England for the three year period 2019/20 to 2021/22 with 116 deaths in total over those three years. This covers deaths from all causes including those not related to substance use.

The Population Affected – Why Is It Important?

Different illicit drugs and prescribed medication have different effects on physical and mental health, and some are highly addictive. From the NHS, the health risks from illicit drugs and substances include death from an overdose, lung disease from smoking drugs, HIV or viral hepatitis, serious infections in the body and bloodstream, fertility problems, damage to veins and body tissue through injecting drugs, overheating and dehydration, kidney problems, schizophrenia, hallucinatory states, insomnia, fits, agitation, aggression, confusion, paranoia, psychosis, memory problems, depression, anxiety and lack of concentration. It can also be dangerous to drive after taking drugs, increasing the risk of an accident.

Illicit drugs and prescribed medication misuse can have a serious impact not just on the individual, but also their family and friends who may require considerable support. There also can be a detrimental effect on the entire community.  It is estimated that individuals dependent on opioids and/or crack cocaine are responsible for 45% of acquisitive crime (shoplifting, burglary, vehicle crime and robbery).

When a person has been ill or where a death occurs following an event such as a heart attack or stroke, it is possible to register the death very quickly. These deaths are generally registered within five days of occurrence of the death. However, suspicious and unexplained deaths need to be investigated to determine the cause of death. For these types of deaths including all drug-related deaths, a Coroner’s Inquest is required. After a Coroner’s Inquest is held, the death certificate is issued and the death can be registered. As deaths from drug poisoning can take some time before they are registered, the national statistics relating to drug misuse and drug poisoning mortality relate to the period of time in which the death was registered rather than when the death occurred (also see Delays to Death Registration below for further information).

The underlying cause of death is determined by the Office for National Statistics based on information recorded on the death certificate and is coded using the International Classification of Disease version 10. Deaths related to drug use are a subset of the drug poisoning deaths.

Drug poisoning deaths involve the following underlying cause of death (ICD 10 codes):

• mental and behavioural disorders due to drug use (F11-F16, F18-F19);
• accidental poisoning by drugs, medicaments and biological substances (X40-X44);
• intentional self-poisoning by drugs, medicaments and biological substances (X60-X64);
• assault by drugs, medicaments and biological substances (X85); and
• poisoning by drugs, medicaments and biological substances, undetermined intent (Y10-Y14).

Deaths related to drug misuse involve the same underlying causes of death, and deaths from mental and behavioural disorders due to drugs (F11-F16 and F19), but accidental poisoning (X40-X44), intentional self-poisoning (X60-X64), poisoning of undetermined intent (Y10-Y14), assault of drugs (X85), and mental and behavioural disorders due to the use of volatile solvents (F18) require that a drug controlled under the Misuse of Drugs Act 1971 was mentioned on the death certificate.

Thus the difference between drug poisoning deaths and deaths due to drug misuse is that deaths due to drug use need to have a specific mention of a drug controlled under the Misuse of Drugs Act 1971 mentioned on the death certificate for deaths relating to accident poisoning, accidental poisoning, poisoning with undetermined intent, those related to assault, and mental and behavioural disorders due to volatile solvents. Whereas the drug poisoning deaths just need any of these causes to be mentioned and the specific drug(s) do not need to be named on the death certificate. Different coroners across the country may record their evidence and information on the death record differently. The coding of deaths and assigning International Classification of Disease codes is undertaken by the Office for National Statistics (ONS) based on information supplied on the death record by the coroner. Due to the way in which information is recorded on the death certificate and coded by ONS, it is possible that a person who has used drugs for a long time who dies of drug poisoning is not necessarily recorded as dying from drug misuse (but are classified as dying from the broader category of drug poisoning).

The Hull Picture

Frequency of Using Drugs Other Than Those Required for Medical Reasons

In Hull’s Health and Wellbeing Survey 2019, 85% stated they had never used drugs other than those required for medical reasons, 4.6% had not used them in the last five years, 2.1% not in the last year, 1.9% rarely in the last year, 1.9% had used them a few times a year, 0.8% monthly, 1.5% weekly and 2.2% everyday.

However, there was a substantial difference by age and gender with 11.4% of men aged 16-24 years stating they used such drugs weekly compared to fewer than 2% among men aged 65+ years and women aged 35+ years. Just under one in ten people who were unemployed or were not working due to long-term illness and disability also stated they used such drugs weekly.

Estimated Prevalence of Opiate and/or Crack Cocaine Use

The Office for Health Improvement & Disparities’ Fingertips provides information on drug related behaviours and deaths.

In 2016/17, it was estimated that the prevalence of opiate and/or crack cocaine use among people aged 15-64 years was 18.1 per 1,000 population in Hull which was more than double the rate in England.

The estimated prevalence uses a capture-recapture method to estimate the number of people who used opiate and/or crack cocaine. The capture-recapture method is often used to estimate the population size of an animal species with animals trapped, marked in a harmless way and released, and then new traps are set a few days later, and the number of marked and unmarked animals caught being recorded. The population size is then estimated to be the number in the first sample multiplied by the number in the second sample divided by the number in the second sample previously marked. In the case of opiate and/or crack use, the number of people who use opiate and/or crack cocaine were identified from drug treatment, probation, police and prison data was used, and then the overlap between the data sources was used together with modelling techniques to examine this overlap and to produce prevalence estimates for those aged 15-64 years based on this capture-recapture methodology.

The rate in Hull was also highest across the Yorkshire and Humber region for 2016/17.

The estimates have been similar in Hull for 2011/12, 2014/15 and 2016/17 at around 18 to 19 per 1,000 population aged 15-64 years, substantially higher than the rate in England which increased from 8.4 in 2011/12 to 8.9 in 2016/17 per 1,000 population.

Estimated Numbers Not in Treatment

The estimated number (calculated as the average of the last 3 years prevalence numbers) of opiates and/or crack cocaine users aged 15-64 years have been produced by Liverpool John Moores University for each local authority. These figures have been compared with the numbers in treatment to estimate the number of opiate and/or crack cocaine users who are not in treatment.

During 2020/21, it was estimated that there were 48% of opiate and/or crack cocaine users in Hull who were not in treatment. Whilst the percentage was among the highest in the region, it was slightly better than England.

The percentage has decreased slightly in Hull. If it is assumed that the estimates of the number of opiate and/or crack cocaine users has been reasonably accurately estimated in Hull, then this means that a slightly higher percentage are currently in treatment in Hull.

For 2020/21, an estimate of 1,625 people who are opiate and/or crack cocaine users who are not in treatment representing 48.4% of the population suggests that there is an overall estimate of 3,357 people who are opiate and/or crack cocaine users. This is higher than the estimate above at 3,146 for 2016/17 and more comparable to the estimates for 2014/15 (3,309) and 2011/12 (3,229).

Adults With Substance Use Treatment Need Who Engage With Services Following Release From Prison

During 2022/23, just over one-third of adults aged 18+ years with substance use treatment need engaged with community-based drug services following their release from prison. This was lower than England and the region where the percentages were 43%.

The number of individuals who successfully engage in community-based structured treatment following release from prison is defined as starting a treatment intervention within 21 days of release from prison. The indicator is presented as a percentage out of the number of individuals who at the point of departure from prison were transferred to a community treatment provider in the local authority for structured treatment interventions post release.

In 2015/16, the percentage was 35%, but halved to around 16% between 2016/17 and 2018/19. In contrast, the percentage in England and across the region increased slightly. However, since 2018/19, the percentage in Hull has increased and was only slightly lower than England 2020/21 and 2021/22, although with a recent slight decrease in the percentage in Hull from 35.8% in 2021/22 to 34.2% in 2022/23, the percentage is now statistically significantly lower in Hull compared to England.

Wait for Substance Treatment Services

During 2022/23, 2.0% of individuals with waiting more than three weeks for drug treatment services, which was the third highest in the region, although still relatively low with only two in every 100 waiting more than three weeks.

The percentage waiting three weeks or more for treatment at 2.0% is among the lowest it has been since 2013/14 in Hull.

Overall during 2022/23, 20 people in Hull waited three or more weeks for drug treatment services.

Numbers in Specialist Drug Treatment Services

During 2022/23, there were 2,288 people aged 18+ years in Hull in specialist drug treatment services. The size of the adult population differs across the local authorities in the region, so it is not possible to compare local authorities here.

With the exception of 2017/18, there have been over 2,000 people in treatment at specialist drug misuse services in Hull. The numbers in Hull have steadily increased since 2017/18 to a high of 2,288 people in treatment for 2022/23.

The rates are also given as the numbers in specialist drug treatment services per 1,000 population aged 18+ years.

In 2020/21, there were 10.6 people aged 18+ years per 1,000 population in Hull who were in specialist drug treatment services, which is 2.4 times higher the rate in England.

The rate in Hull is the highest across Yorkshire and Humber. For 2020/21, only Middlesbrough (15.4), Hartlepool (11.6) and Blackpool (11.4) have higher rates among the 147 upper-tier local authorities across England with data for this indicator. However, with any such comparison, the numbers accessing treatment will be influenced by the way services are provided within each geographical area, and it is possible that certain geographical areas will have a higher percentage accessing services in whom there is a need, and there also might be differences between the ‘entry’ criteria for those accessing treatment or waiting lists, so any comparison needs to take these factors into consideration. Nevertheless, it is clear there are very high numbers of people in Hull accessing specialist drug treatment services.

The rate in Hull has been around 10 per 1,000 population (or 1% of the population) in Hull since 2013/14, but as previously mentioned slightly lower in 2017/18.

Hepatitis Tests and Vaccinations Among Eligible People in Drug Treatment Services

During 2016/17, 5.6% of people entering drug treatment services who were eligible had had a course of hepatitis B vaccination (compared to 8.1% in England), and for 2017/18, 84.3% had had a hepatitis C vaccination (compared to 84.2% for England).

Users Successfully Completing Treatment

For 2022, one-fifth of non-opiate users and 3.5% of opiate users successfully completed treatment compared to 31.4% and 5.0% respectively for England.

Successful treatment was defined as users who had left drug treatment (free of drug(s) of dependence) who did not then re-present to treatment again within six months (and it is given as a percentage of the total number of users in treatment).

Between 2010 and 2020, except for 2016, the percentage of non-opiate users aged 18+ years successfully completing treatment has been consistently lower than England. The percentage in Hull is among the lowest it has been since 2010 with only 2019 marginally lower at 19.0% than the current rate of 20.1% in 2022.

The percentage in England has shown a gradual decrease since 2014 falling from 39.2% in 2014 to 31.4% in 2022.

There is considerably year-on-year variability in Hull as illustrated by the relatively wide confidence intervals as the total numbers are relatively small (see Confidence Intervals and Small Numbers in the Glossary for more information).

In 2022, 109 non-opiate users successful completed treatment (out of 542) in Hull.

In general, the same pattern occurred for opiate users and successful completion of treatment although there was less of a discrepancy between Hull and England. In 2016, the percentage was also high as it was for non-opiate users.

The success rate also decreased between 2016 and 2019 for opiate users, but in contrast to non-opiate users, the success rate decreased for opiate users between 2019 and 2020 to the lowest percentage it has been since 2010, although the rate increased slightly for 2021 and 2022. Services were disrupted in this period due to the COVID-19 pandemic. The confidence intervals are also relatively wide due to small numbers (see Confidence Intervals and Small Numbers in the Glossary for more information).

In 2022, 59 opiate users successful completed treatment (out of 1,686) in Hull.

Smoking Prevalence Among Adults Admitted to Substance Treatment Services

Over 80% of people admitted to substance treatment services in 2019/20 smoked.

The number of adults admitted to services who smoked has increased over time in Hull, but it is possible that this increase is due to better recording of smoking status.

Deaths from Drug Poisoning and Drug Misuse

Difference Between Drug Poisoning and Drug Misuse Causes

As mentioned above deaths from drug misuse are a subset of drug poisoning deaths. Deaths are only classified as a drug misuse death if the specific name of a drug controlled under the Misuse of Drugs Act 1971 is mentioned on the death certificate record (see The Population Affected – Why is it Important? above for more details).

Deaths from Drug Misuse

The directly standardised mortality rate per 100,000 population (standardised to the European Standard Population) for deaths related to drug use is statistically significantly higher in Hull for 2020-22 compared to England for both men and women.

The mortality rate in Hull is 62% higher than England for men and 69% higher for women.

Between 2001-03 and 2020-22, in general, the mortality rate per 100,000 population from drug use has been statistically significantly higher in Hull than England with only five time periods where the rate was not statistically significantly higher (although for four of these five periods the rate in Hull was still higher than England just not statistically significantly with only one year where Hull had the same mortality rate as England).

The number of drug related deaths in Hull saw a spike in 2017 due to the introduction of a very toxic ingredient (carfentanil/fentanyl) into the local drug supply (predominantly heroin). The National Crime Agency and law enforcement took swift action to identify and cut off supply lines with the situation closely monitored by all agencies subsequently.

However, whilst the mortality rate decreased between 2015-17 and 2018-20 from 7.0 to 4.8 deaths per 100,000 population with the exclusion of the year 2017, the rate in Hull has increased between 2018-20 to a new high of 8.7 deaths per 100,000 population for 2020-22.

Since 2009-11, there has been around 40 deaths registered in each three year period, with a temporary spike in 2017. In 2018-20, the rate is among the lowest it has been in Hull since 2001-03 (only 2012-14 and 2013-15 had lower rates) with a total of 37 deaths from drug misuse over the three year period 2018-20. However, the numbers have increased and there were 67 deaths from drug misuse during the three year period 2020-22 so an average of 22 deaths per year.

The majority of the 67 deaths during 2020-22 were among men with 48 (72%) of deaths registered in total over the three year period. There has been some year-on-year variability in the mortality rate. The mortality rate was high at 14.1 deaths per 100,000 population in 2004-06, but had steadily decreased to a low of 5.3 deaths per 100,000 population for 2012-14. The rate had subsequently increased to 11.6 deaths per 100,000 population for 2015-17 before decreasing to 7.2 deaths per 100,000 population for 2018-20.

In the last two years, the rate has increased sharply – almost doubling – to a high not yet seen since 2005-07.

The confidence intervals are relatively wide due to small numbers (see Confidence Intervals and Small Numbers in the Glossary for more information).

For women, there has been around 10-12 deaths registered for most of the three year periods 2002-04 to 2018-20 although in some cases fewer than 10 (and the data is not presented for those years due to small numbers). The mortality rates from drug misuse has increased for women in Hull in the last two years to reach a new high of 4.9 deaths per 100,000 population. The highest rate prior to 2020-22 was 3.6 deaths per 100,000 population for 2019-21 and 3.4 deaths per 100,000 population for 2007-09.

The confidence intervals are relatively wide due to small numbers (see Confidence Intervals and Small Numbers in the Glossary for more information). Where data is presented for Hull, the mortality rate has been higher than England for all periods except for 2016-18 where the rate is the same as England.

During the three year period 2020-22, there were 19 deaths from drug misuse among Hull women so an average of around six per year.