Drug Misuse 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 Misuse 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.

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. Drug abuse has 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.
• Based on estimates of 3,357 opiate and/or crack users in Hull for 2020/21, it was estimated that 1,625 (48%) were not in treatment.
• Over one-third (36%) of adults aged 18+ years with substance misuse treatment need engage with community-based drug services following their release from prison which is similar to England (37%) for 2021/22.
• One in twenty (5.3%) people in Hull wait more than three weeks for drug treatment compared to one in a hundred (1.2%) for England.
• During 2020/21, there were 2,137 adults aged 18+ years in Hull in treatment at specialist drug misuse 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 21.4% for non-0piates and 2.8% for opiates in Hull for 2021 which was lower than England (34.3 and 5.0% respectively).
• Over 80% of people admitted to treatment for substance misuse smoked in Hull.
• The mortality rate among those in drug treatment was 35% higher than England for the three year period 2018/19 to 2020/21 with 93 deaths in total over those three years.
• The directly standardised mortality rate from drug misuse was only slightly higher in Hull compared to England for 2018-20 (5.1 versus 5.0 deaths per 100,000 population) with 37 deaths in total over the three year period. However, the numbers in Hull increased for 2019-21 to 57 deaths and are now higher than England (7.3 versus 5.1 deaths per 100,000 population).
• During 2018-20, there were 110 drug poisoning deaths in Hull giving a rate of 15.0 deaths per 100,000 population which was higher than England (7.6). The numbers increased for 2019-21 to 153 drug poisoning deaths in Hull. The mortality rate in Hull at 21.2 deaths per 100,000 population is now highest in the region and fifth highest nationally, and more than 2.5 times higher than England (7.9).
• For a higher percentage of drug poisoning deaths in Hull that were registered between 2020 and 2022 have long delays in death registration (time between death occurrence and death registration) compared to deaths registered during 2015-19. This is likely associated with the COVID-19 pandemic and a potential backlog of Coroner Inquests.
• 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 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 NHS, the health risks from illicit drugs and substance misuse 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 abuse has 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).

Suspicious and unexplained deaths need to be investigated to determine the cause of death. After a Coroner’s Inquest is held, the death certificate is issued and the death can be registered. As deaths from drug misuse and 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.

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. Drug misuse deaths 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).

Drug misuse deaths 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 drug misuse deaths is that drug misuse deaths 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 needed to be named on the death certificate. Different coroners across the country may record their evidence and information on the death record differently so it is possible that it is not all drug misuse deaths are classified as such. The local coroner provides information to Hull City Council’s public health team with any deaths which are considered to be drug misuse deaths. However, the coding of deaths and assigning International Classification of Disease codes is undertaken by the Office for National Statistics based on information supplied on the death record by the coroner. Locally there have been differences in number of cases of death provided by the local coroner to public health which were thought to be drug misuse deaths and the numbers of deaths produced by the Office for National Statistics in their official statistics for Hull relating to drug misuse deaths. It is possible that there is an underestimate of drug misuse deaths due to the way in which information is recorded on the the death certificates, so caution is advised when examine the mortality rates from drug misuse.

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.

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

During 2021/22, 36% of adults aged 18+ years with substance misuse treatment need engaged with community-based drug services following their release from prison.

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 also 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 is currently only slightly lower than England.

Wait for Substance Misuse Treatment

During 2020/21, 5.3% of individuals with waiting more than three weeks for drug treatment, which was the highest in the region.

There has been considerable variability in the percentage of individuals waiting more than three weeks for drug treatment in Hull. It is possible that the changes over time are due to changes in commissioning and the re-commissioning cycle. However, since 2016/17, the percentage waiting more than three weeks has been statistically significantly higher in Hull compared to England.

Numbers in Treatment at Specialist Drug Misuse Services

During 2020/21, there were 2,137 people aged 18+ years in Hull in treatment at specialist drug misuse services.

Since 2013/14, there have been around 2,000 people aged 18+ years per year in treatment at specialist drug services, although it was slightly lower in 2017/18. The number in 2020/21 is among the highest over the period 2013/14 to 2020/21.

The rates are also given as the numbers in specialist drug misuse 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 misuse 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 misuse 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 Misuse Services

During 2016/17, 5.6% of people entering drug misuse treatment 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 2021, 21.4% of non-opiate users and 2.8% of opiate users successfully completed treatment compared to 34.3% 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. Between 33% and 39% of non-opiate users in England were free of drug dependence and did not re-present within six months of completing treatment, but in Hull this percentage generally ranged from 27% to 30% with the exception of 2010 (35%) and 2016 (42%). 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 2021, 102 non-opiate users successful completed treatment (out of 477) 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. It is likely that this was due to a change in commissioning and/or the way the local substance misuse services were run. Furthermore, 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 between 2020 and 2021. Services were initially disrupted due to the COVID-19 pandemic and this could be a possible explanation. The confidence intervals are also relatively wide due to small numbers (see Confidence Intervals and Small Numbers in the Glossary for more information).

In 2021, 47 opiate users successful completed treatment (out of 1,679) in Hull.

Smoking Prevalence Among Adults Admitted to Substance Misuse Treatment Services

Over 80% of people admitted to substance misuse 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

For the three year period 2018/19-2020/21, the indirectly standardised mortality ratio of drug users within treatment was higher than England at 1.35 and statistically significantly higher than England. The mortality rate among drug users within treatment is 35% higher in Hull compared to England.

This is the number of deaths among adults in drug treatment in the local authority as a ratio of the expected number of deaths in drug treatment if the local authority experienced the same age-specific mortality rates as in the whole drug treatment population in England. The Office for Health Improvement & Disparities states that this indicates where local authorities have a higher or lower than expected mortality rate, and is indicative of the safety, effectiveness and protection afforded by drug treatment services. However, the indicator will also be affected by the types of people in treatment. Local authorities which have a high percentage of people in treatment out of all the people with drug misuse issues might have a lower mortality rate if the severity of their service users is lower, whereas local authorities which have a higher percentage of services users who have a longer history of drug misuse and/or have poorer health may have a higher mortality rate.

The standardised mortality ratio for those in treatment has been statistically significantly higher than England, and for four of the six periods from 2013/14-20215/16 to 2018/19-2020/21. The mortality rate in Hull has generally been at least 25% higher than England with the exception of 2017/18-2019/20 which was 14% higher.

The directly standardised mortality rate per 100,000 population (standardised to the European Standard Population) for deaths from drug misuse is only just slightly above that of England for persons and males for 2018-20, and for females, the numbers are too low in Hull for the data to be presented.

The Office for National Statistics has more recent data for 2019-21 which show an increase in the rate for Hull to 7.8 deaths per 100,000 population (with 57 deaths in total over the three year period) which is now considerably higher than England (5.1 deaths per 100,000 population).

In general, the mortality rate per 100,000 population from drug misuse 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 (carfentanyl/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.

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).

The majority of the deaths are among men with 29 of the 37 deaths registered over the latest period 2018-20 being among men which is more than three-quarters. For this latest period, this equates to around 10 deaths registered per year among men.

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 2016-18, although for some years and the most recent two years (2017-19 and 2018-20) the numbers have been less than 10. Data is presented for Hull where the number of deaths is 10 or more, and data is not presented for Hull for nine periods of time between 2002-04 and 2018-20 due to small numbers. 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.

The Office for Health Improvement & Disparities’ Fingertips presents the number and mortality rates for deaths from drug misuse, but information is also available on deaths from drug poisoning, although not on Fingertips.

Based on official statistics from the Office for National Statistics, there were 51 deaths among Hull residents that were recorded as a result of drug poisoning which were registered during 2020 and 67 registered during 2021. These are the highest absolute numbers since at least 1993.

It is possible that the way in which the underlying cause of death is determined by the Office for National Statistics based on information provided within the death certificate could have changed slightly over time. There could be other changes over time which could have influenced the recording of drug poisoning deaths.

Year of registration	Number of drug poisoning deaths in Hull	Number of drug misuse deaths in Hull
1993	7	3
1994	10	5
1995	24	14
1996	29	17
1997	22	13
1998	31	18
1999	20	14
2000	37	25
2001	24	16
2002	27	18
2003	22	15
2004	26	15
2005	33	28
2006	27	21
2007	25	16
2008	29	20
2009	20	14
2010	14	11
2011	19	17
2012	22	12
2013	22	12
2014	17	7
2015	21	11
2016	39	25
2017	49	21
2018	24	8
2019	35	14
2020	51	15
2021	67	28

Over the three year period 1993-95, there were 41 drug poisoning deaths registered among Hull residents but this increased over time to around 80 deaths over three years between 1996-98 and 2007-09. The number of drug poisoning deaths fell slightly to around 60 over each three year period between 2008-10 and 2013-15. However, since 2013-15, the number of deaths has increased to just over 100 over three years between 2015-17 and 2018-20 before increasing to 153 for the latest three year period 2019-21.

The increase in the number of drug poisoning deaths registered during 2020 and 2021 has increased the directly standardised mortality rate for drug poisoning in Hull. There were 21.2 deaths per 100,000 population in 2019-21 in Hull compared to 7.9 and 10.7 deaths per 100,000 population in England and across the Yorkshire and Humber region respectively. The rate in Hull was the highest across the region and considerably higher than the three next highest local authorities of Wakefield (15.2), Doncaster (13.6) and Barnsley (13.3). Among the 291 lower tier local authorities in England with directly standardised mortality rates for drug poisoning (for some local authorities the numbers were too small and not presented), the mortality rate in Hull was fifth highest after Blackpool (29.8), Middlesbrough (28.8), Hartlepool (26.4) and Carlisle (23.2).

There is a strong association with deprivation. Based on the Index of Multiple Deprivation 2019, among the 317 local authorities at the time, Hull was ranked the fourth most deprived local authority in England, and Blackpool, Middlesbrough and Hartlepool were also ranked in the bottom 4% of local authorities, although Carlisle was less deprived (ranked as 117 out of 317 which was within the most deprived 37% of local authorities).

Area	IMD rank	DSR persons	DSR males	DSR females
England		7.9	10.8	5.1
Yorkshire & Humber		10.7	14.6	6.9
Hull	4	21.2	30.7	11.2
Blackpo0l	1	29.8	39.1	20.6
Middlesbrough	5	28.8	40.7	17.4
Hartlepool	10	26.4	40.3	13.0
Carlisle	117	23.2	33.1	13.6

The directly standardised mortality rate for drug poisoning in Hull has been around 10 per 100,000 population between 2001-03 and 2014-16 albeit with some year-on-year variability. However, this increased to around 15 deaths per 100,000 population in 2015-17 which was likely associated with with the introduction of a very toxic ingredient (carfentanyl/fentanyl) into the local drug supply (predominantly heroin) in 2017. However, whilst 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, the high mortality rate remained until 2017-19 whilst the 2017 year was included in the three year period. However, the mortality rate for 2018-20 remained at the same level of around 15 deaths per 100,000 population when 2017 was removed from the three year period. Furthermore, the rate increased considerably in Hull between 2018-20 and 2019-21 to the highest rate seen in Hull for around two decades.

A local analysis of drug poisoning mortality has been undertaken in Hull to compare the mortality rate over time and examine the recent increase in the number of deaths which included examining data for 2015-19 and 2020-21 to assess any potential impact on the number of deaths due to the COVID-19 pandemic. The local analysis has been undertaken using the local mortality dataset which contains limited information on personal characteristics (gender, age at death, postcode from which deprivation can be measured and ward of residence, and underlying cause of death based on the International Classification of Disease version 10). Nevertheless it may provide some insight into the recent increase as follows by comparing drug poisonings deaths registered during 2015-19 with those registered during 2020-21:

• Of the 167 drug poisoning death registered during 2015-19, there was more than one year but less than two years between the date of death and the date of registration of the death for 11 (6.6%) deaths. For deaths registered during 2020-21, 17 (14.4%) of the 118 drug poisoning deaths had a delay of more than one year in death registration.
• Just under one-quarter (24.0%) of deaths registered during 2015-19 were among women compared to 27.1% for deaths registered during 2020-21.
• Whilst a similar percentage of drug poisoning deaths among men occurred in men aged under 35 years that were registered during 2015-19 (25%) and 2020-21 (23%), a higher percentage of men were aged 45+ years for deaths registered during 2020-21 (49%) compared to 2015-19 (35%). Among men, the median age at death was 41 years for deaths registered during 2015-19 but 44 years for deaths registered during 2020-21.
• Among women, around two-thirds (65%) of drug poisoning deaths registered during 2015-19 were among those aged under 45 years, this was 41% for deaths registered during 2020-21. Among women, the median age at death was 41 years for deaths registered during 2015-19 but 45 years for deaths registered during 2020-21.
• Based on the Index of Multiple Deprivation 2019, a higher percentage of deaths were registered during 2020-21 among men living in the most deprived areas of Hull compared to deaths registered during 2015-19. Overall, 37% of drug poisoning deaths among men that registered during 2020-21 occurred among men living in the most deprived fifth of areas of Hull and 26% occurred among men living in the second most deprived fifth of areas of Hull compared to 26% and 32% respectively for deaths registered during 2015-19. This was not the case for women, who had a higher percentage of drug poisoning deaths among women living in the most deprived areas of Hull for deaths registered during 2015-19 compared to 2020-21.
• Almost one-quarter (23.7%) of drug poisoning deaths which were registered during 2020-21 occurred among residents of St Andrew’s & Docklands ward, and this was considerably lower for deaths registered during 2015-19 (13.8%). The local authority was involved in relocating many homeless people from hostels into other temporary accommodation during the COVID-19 pandemic. If the people who died of drug poisoning whose deaths were registered during 2020-21 had recently moved then this could have affected the associations between deprivation and ward.
• For drug poisoning deaths registered during 2020-21, the percentage that were classified as suicide and undermined intent was lower compared than those registered during 2015-19 (8% versus 11%).
• The majority of drug poisoning deaths had an underlying cause of accidental poisoning, and this was the case for men for deaths registered during 2015-19 (87%) and 2020-21 (92%) and for women for deaths registered during 2015-19 (78%) and 2020-21 (84%).
• The number of deaths from ‘nonopioid analgesics, antipyretics and antirheumatics’, from ‘antiepileptic, sedative-hypnotic, antiparkinsonism and psychotropic drugs, not elsewhere classified’ and from ‘other drugs acting on the autonomic nervous system’ were too small to present separately, but overall from all three categories combined, there were five deaths among men and women that were registered during 2015-19, and 10 deaths among men and women that were registered during 2020-21. This was almost three times as many deaths registered during 2020-21 (8.5%) compared to 2015-19 (3.0%).
• It is not possible to examine drug poisonings from specific drugs as the coding is too wide with ‘narcotics’ as an entire group (38% of deaths registered during 2015-19 and 21% of deaths registered during 2020-21), and the majority of drug poisoning deaths are classified as ‘other and unspecified drugs, medicaments and biological substances’. The percentage of deaths from this latter category was higher among deaths registered during 2020-21 than 2015-19 (69% versus 50%). It is possible that this difference could reflect changes in the information presented on the death certificate or it could reflect differences in the substances or possibly combinations of substances.

For deaths registered up to July 2022, there have been 39 drug poisoning deaths so far in 2022. However, some of these death registrations have been subject to considerable delay in death registration. None of the deaths registered during 2015-20 had a delay of two years or more (difference between date of death occurrence and death registration), but four deaths (10%) have among the 39 registered in 2022 so far (two deaths having a delay of two years or more but less than three years, and two deaths having a delay of three years or more). In total, 13 (33%) of drug poisoning deaths registered during 2022 so far have had a delay of one year or more in the death registration. This increase in death registration is perhaps not surprising due to the COVID-19 pandemic, and it is likely that a backlog of coroner inquest cases resulted. However, it does have the potential to increase the number of deaths which are registered and recorded in the official statistics in relation to drug poisoning mortality, and reduce numbers for early years. In a ‘normal’ year with no or few delays in the Inquests, a death might have been registered sooner and be included in an earlier year for the official national statistics relating to drug poisoning mortality as the deaths are based on year of death registration.

Estimated and Projected Numbers Living With a Drug Dependency

The Projecting Adult Needs and Service Information (PANSI) provides current estimates and future projections at local authority level of the number of people with different health needs. The prevalence for different age groups and for males and females estimated from different surveys and research has been applied to current population estimates and population projections to provide estimates for each local authority.

The estimates relating to drug dependence was based on the Adult Psychiatric Morbidity Survey conducted in 2014 in England. People who reported usage of particular drugs were asked about signs of dependence on that drug. The signs or markers, they were asked about were: daily use for two weeks or more; having a sense of need or dependence; inability to abstain; increased tolerance; and withdrawal symptoms. A new range of psychoactive substances (NPS) have entered the market but were not assessed in the survey. PANSI acknowledge that uncertainty over their content and rapid changes in what is available makes measuring the use of these substances in surveys challenging and knowledge of the prevalence of their use is limited.

The survey was completed some time ago, and it has been acknowledged that there has been the introduction of NPS substances since then. Furthermore, it is likely that the prevalence is higher in Hull given the relatively high levels of deprivation. Nevertheless, the prevalence estimates have been presented here and can be used as a guide to the potential prevalence.

The number of men and women aged 18-64 years with drug dependence is estimated to be 6,384 for Hull in 2020, and that is due to increase slightly with changes in the population structure of Hull.

Gender/age	2020	2025	2030	2035	2040
Males 18-24	1,735	1,746	1,959	1,982	1,841
Males 25-34	1,445	1,373	1,287	1,340	1,439
Males 35-44	656	708	736	708	660
Males 45-54	363	327	317	343	359
Males 55-65	195	199	186	168	164
Males 18-64	4,394	4,353	4,485	4,541	4,462
Females 18-24	621	621	695	704	658
Females 25-34	704	653	609	629	673
Females 35-44	388	425	430	403	375
Females 45-54	155	137	136	149	151
Females 55-64	122	122	113	101	99
Females 18-64	1,990	1,958	1,982	1,985	1,956
All aged 18-64	6,384	6,311	6,467	6,526	6,418

Strategic Need and Service Provision

The Government’s 10-year Drugs Plan has three overarching aims to (1) Break drug supply chains, (2) Deliver world-class treatment and recovery services and (3) Achieve a shift in the demand for recreational drugs. The 10-Year Drugs Plan expects to reverse the rising trend in drug use, prevent drug deaths and expand treatment capacity.  The document also recognises that addiction needs to be treated as a chronic health conditions, and therefore more needs to be done to break down stigma, save lives and support long-term recovery.

The Government’s Drugs Plan requires local authorities in England to rebuild commissioned substance misuse services to improve quality, capacity and outcomes, and commits to offer improvement support to make sure that local areas have the capacity and capability to deliver the transformation needed.

Hull’s Alcohol and Drugs Partnership Strategy 2022-25 provides key priorities and recommendations for preventing alcohol related harm. The Strategy has six priorities:

1. Developing a Prevention and Early Intervention approach across the partnership;
2. Implement a more targeted approach to support at-risk groups;
3. Improving services to effectively support young people and adults with co-existing mental illness and substance misuse, and/or with multiple and complex needs;
4. Tackling alcohol/drug related stigma to ensure people have equitable access to services and resources.;
5. Developing community assets to achieve and sustain recovery; and
6. Reducing the risks associated with alcohol/drug use by utilising a harm reduction approach.

The local Strategy has been co-produced with partners and relevant stakeholders to ensure local integration and shared accountability, and is well integrated with other strategies and plans to ensure a well-integrated approach to addressing drug problems across the city.  Such strategies and plans include the Safer Hull plans and programme through the Community Safety Partnership, the Humberside Police Drugs Strategy, and Safeguarding and Early Help Strategies.

Social return on investment tools for drugs and alcohol make the case of investing in treatment programs to reduce overall crime and anti-social behaviour to reduce costs to society and the economy. It is estimated that over 323,447 crimes are committed before drug treatment entry. The main three crimes recorded for people in drug treatment are shoplifting (50%), drug offences (29%) and begging (7%) with an estimated 16% reduction in criminal activity and approximately 50,848 crimes prevented after starting treatment. The gross benefit of drug treatment in 2017/18 in Hull was estimated to be over £16,712,400.

The Office for National Statistics in relation to an increase in the deaths related to drug poisoning in England and Wales, note that the reasons behind this are complex and differ by drug type. They state that the overall trend is driven primarily by deaths involving opiates but also by an increase in deaths involving other substances like cocaine. They state that across Europe, rates of deaths involving heroin and morphine have been increasing while the number of new heroin and morphine users has fallen. This indicates higher rates of death among existing long-term drug users. Their possible explanations include an ageing cohort of long-term drug users becoming increasing susceptible to a fatal overdose, new trends in taking specific drugs which may increase the risk of an overdose, and and a potential increase in disengagement or non-compliance with opiate substitute therapy.

Resources

Local Health and Wellbeing Survey 2019

The Office for Health Improvement & Disparities’ Fingertips: https://fingertips.phe.org.uk/

Office for National Statistics. Deaths related to drug poisoning in England and Wales: 2021 registrations. https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsrelatedtodrugpoisoninginenglandandwales/latest

Projecting Adult Needs and Service Information (PANSI). www.pansi.org.uk

Government’s 2017 Drug Strategy. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/628148/Drug_strategy_2017.PDF

UK Government. From harm to hope: A 10-year drugs plan to cut crime and save lives. https://www.gov.uk/government/publications/from-harm-to-hope-a-10-year-drugs-plan-to-cut-crime-and-save-lives/from-harm-to-hope-a-10-year-drugs-plan-to-cut-crime-and-save-lives

Hull City Council. Drug and Alcohol Support. https://www.hull.gov.uk/health-and-wellbeing/public-health/drug-and-alcohol-support

Hull City Council. Hull Alcohol and Drugs Strategy 2022-25. https://www.hull.gov.uk/sites/hull/files/media/Editor%20-%20Public%20health/Hull%20Alcohol%20and%20Drugs%20Strategy%202022-2025.pdf

ReNew Hull. Recovery Hub. https://www.changegrowlive.org/hull-renew/recovery-hub

Updates

This page was last updated / checked on 2 June 2023.

This page is due to be updated / checked in November 2023.