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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