Next it was the turn of Pete Burkinshaw and Brian Eastwood from Public Health England( PHE), on making the right connections between data and service users’ experience.‘ We wanted to do something a bit different this year. We wanted to hear from you,’ said Burkinshaw.‘ Fundamentally you know a lot more about what’ s going on than we do as civil servants sitting in Whitehall.’ PHE had been stepping up its surveillance through mechanisms such as Report Illicit Drug Reactions( RIDR), as drug use was currently in a‘ dynamic phase’. While the longterm trend was still one of declining rates of use, the agency was still seeing‘ upticks in certain things’, he said.‘ What we do with a lot of that data is summarise things that clinicians should be aware of.’ The agency ran a quarterly forum on health harms to explore shifts and changes, and used this data to help inform local decision making. It was also working to improve local drug alert systems, he said.
‘ Often there’ s a lot of poor information, recirculated, so we’ re looking to improve that,’ he told delegates. PHE also issued alerts on issues such as fentanyl, synthetic cannabinoids and the monitoring of HIV and hepatitis C, and provided an annual data pack to local authorities around drug treatment statistics.‘ We are increasingly data-rich, and if it’ s good and robust hopefully it becomes an important part of local decision making in this increasingly
‘ We want to hear from you.’
Pete burkinsHaW
devolved environment,’ he said.
Eastwood then took over for an interactive exercise that allowed delegates to answer a series of questions using their smartphones. On the subject of whether they were aware of an increase in crack use in their area, 39 per cent were not while 20 per cent said there was a large increase and 16 per cent said there was no increase. On the question of whether they thought crack had become more easily available, around three quarters said yes, 24 per cent were not sure and just 2 per cent said no.
Most people( 80 per cent) that delegates had contact with bought crack via a dealer, while 11 per cent bought it via a partner or friend, while 47 per cent were aware of increasing numbers of young people using crack and heroin for the first time and 35 per cent were not. Just under half of delegates thought fentanyladulterated heroin was now fairly widespread, and 24 per cent were aware of people actively seeking out fentanyl.
Accurately mapping trends in opiate and crack prevalence relied on a large number of data sets, said Burkinshaw – from the police, prisons, drug treat ment – which meant there could often be a significant time lag.‘ It’ s always a few years
behind, but certainly there’ s a trend of declining heroin use – although that decline seems to be slowing down. We’ re confident that the decrease has stalled, and we are seeing an increase in crack use, particularly in areas like Eastern England and the South West. Data can sometimes do funny things, but we are concerned that this data reflects reality.’
While there had generally been a fall in presentations for most substances, there were increases among two distinct populations, he explained – first-time crack presentations, and people using crack alongside heroin. These also had a different age profile, with those presenting for crack use alone tending to be younger while those using crack alongside heroin were likely to be in their 40s.‘ We’ re particularly concerned about those younger cohorts,’ he said.
Another concern was that numbers in alcohol treatment were declining faster than those in drug treatment.‘ That’ s worrying because the treatment penetration rates are much lower for alcohol,’ he said.‘ It’ s a significant cause of concern for us, and we’ re having conversations with all the directors of public health about why this is happening. It raises lots of questions about the type and nature of provision and perhaps the priority alcohol is being given in local areas.’
While NPS use was declining at a general population level, it was becoming more acutely concentrated in marginalised and vulnerable populations such as the homeless and prisoners, he continued.‘ The alarming increase in drug-related deaths has been with us for about four years now, and we’ re also concerned about fentanyl. The rate at which drugs are being synthesized is changing, and more and more people are buying them on the dark web. We’ re at a heightened state of alert, but so far we’ re not seeing fentanyl use spiral out of control.’
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