Home affairsWritten evidence submitted by Public Health England [DFU 01]

LETTER FROM THE COMMITTEE SPECIALIST TO DUNCAN SELBIE, CHIEF EXECUTIVE, PUBLIC HEALTH ENGLAND, 13 NOVEMBER 2013

I am writing to you regarding an evidence session that the Home Affairs Committee is holding on New Psychoactive Substances and Khat. Please could you inform us as to:

1.The number of people who have approached treatment services regarding an addiction to either a NPS or Khat in a)2010 b)2011 and c)2012?

2.The estimated cost of treating those with an addiction to either an NPS or Khat?

3.The different aspects of work which Public Health England does regarding NPS’?

4.The different aspects of work which Public Health England does regarding Khat?

It would be helpful to have a response to this letter by Wednesday 20 November.

Committee Specialist

13 November 2013

LETTER FROM ROSANNA O’CONNOR, DIRECTOR OF ALCOHOL & DRUGS, PUBLIC HEALTH ENGLAND, TO THE COMMITTEE SPECIALIST, 20 NOVEMBER 2013

Re: New Psychoactive Substances (NPS)1 and Khat

Thank you for your letter of 13 November 2013 asking for information from Public Health England (PHE) on the new psychoactive substances (NPS) and khat. Please see below our answers to the questions that you have raised.

1. The number of people who have approached treatment services regarding an addiction to either an NPS or khat in a) 2010 b) 2011 and c) 2012?

Number of new treatment presentations to adult treatment services for problems with either mephedrone and khat (2010–11–2012–13)

2010–11

2011–12

2012–13

Mephedrone

839

900

1630

Khat

112

135

75

Notes

- All figures are for adults (18 and over)

- The figures show the numbers citing any use of mephedrone and khat among new adult presentations to treatment per year

- A code for mephedrone was added to the National Drug Treatment Monitoring System (NDTMS) Core Data Set in 2010–11.

- NPS are emerging at an unprecedented rate, and surveillance data takes time to catch up. The NDTMS data set was updated in April 2013 to capture treatment presentations for NPS not previously recorded. This data is not yet reportable.

Number of new treatment presentations to young people’s services for problems with either mephedrone and khat (2010–11–2012–13)

2010–11

2011–12

2012–13

Mephedrone

893

818

N/A

Khat

10

6

N/A

Notes

- All figures are for young people (18 and under)

- The figures show the numbers citing any use of mephedrone and khat among new presentations to young people’s treatment per year

- A code for mephedrone was added to the NDTMS Core Data Set in 2010–11

- The 2012–13 young people’s treatment data is due out 4 December 2013, so we are not able to release 2012–13 figures until after this date

2. The estimated cost of treating those with an addiction to either an NPS or khat?

Treating NPS or khat requires a therapeutic process tailored to each individual’s needs. Treatment typically involves psychosocial interventions (talking therapies designed to encourage positive behaviour change). PHE is unable to provide a breakdown for the cost of treating NPS or khat alone. This is because treatment typically involves a range of interventions, and it is not possible to isolate each individual component costs, how they are combined and for how long they last for each individual treated. Decisions about what to spend on drug treatment and what services to provide are the responsibility of each local area.

3. The different aspects of work which Public Health England does regarding NPS?

PHE’s current action on NPS falls into three broad categories: prevention, surveillance and supporting better treatment.

Prevention

PHE is responsible for the FRANK service which provides credible information and advice about all drugs including NPS and is highly trusted by its young audience. The service is accessible 24 hours a day, seven days a week in the following channels: talktofrank.com, a helpline, web chat, email and SMS. The website highlights the dangers of NPS in a number of ways from dedicated A-Z pages which explain the risks of specific substances, to news articles which provide the facts behind the NPSs that make the media headlines. In addition there is information for young people to help them resist pressure and say no to drugs.

PHE worked with the Home Office on a NPS campaign, between July—Oct 2013, which signposted people to further information on FRANK. This national work compliments targeted prevention campaigns being run by a number of local areas.

Surveillance

PHE’s Centre for Infectious Disease Surveillance and Control (CIDSC) has revised a number of systems covering drug use and sexual activity to capture the potential impact of NPS use, including efforts to assess levels of use and associated infections risk among men who have sex with men.

The NDTMS changed its data set in April 2013 to capture treatment presentations for NPS not previously recorded.

PHE has developed a National Intelligence Network on Health Harms2 associated with drug use, including NPS and provides intelligence for the Home Office led Drugs

Early Warning System (DEWs). The UK Focal Point3 hosted within the PHE Alcohol and Drugs team feeds intelligence into the European-wide early warning system for NPS. PHE is also looking at amending existing mortality datasets in order to better capture NPS information. Finally, there has also been local action, supported by PHE regional centres, to map local profiles of NPS use.

Supporting better treatment

PHE’s Alcohol and Drugs Team is supporting, and contributing clinical expertise to, the development of the first set of clinical guidance on the acute management and treatment of NPS called project NEPTUNE, developed by the Central and North West London NHS Foundation TRUST (CNWL). We have also included information on best practice, innovative responses and relevant data on NPS in relevant commissioning support resources, including Joint Strategic Needs Assessment materials for this year’s local authority planning round.

Local PHE staff are supporting local areas to develop responses relevant to their areas, including scoping need for specialist commissioning which will inform 2014–15 plans for treatment. This work follows on from the National Treatment Agency for Substance Misuse (NTA) report “Club drugs: emerging trends and risks” (published November 2012), which called on services to adapt current treatment approaches and to make appropriate links to specialist medical treatment in order to better respond to NPS-related harms.

PHE’s local intelligence demonstrates that local substance misuse treatment systems are beginning to respond to NPS. There is evidence of an increased commissioning focus in several parts of the country, with some areas doing specific needs assessments. Several specialist services have been developed, including in London, Leeds, and Manchester. Service providers and local PHE staff are actively collaborating to share best practice on what works and some local PHE teams have hosted national and local experts to present to networks of service providers and commissioners.

Finally, PHE Alcohol and Drugs are promoting better awareness and closer working links between sexual health and drug treatment services. This work was initiated by a roundtable meeting of relevant stakeholders which agreed to:

Support improvements in service provision by sharing good practice examples.

Providing advice and guidance for commissioners.

Collating and disseminating evidence of effective interventions with particular groups.

4. The different aspects of work which Public Health England does regarding khat?

PHE’s current action on khat falls into four broad categories: prevention, raising awareness, collecting khat treatment data and helping local commissioners meet khat-related need.

Prevention

The FRANK website and helpline (see information above) provides credible information and advice about khat. The website highlights the dangers of khat in a number of ways from dedicated A-Z pages which explain the risks of specific substances, to a news article which explained the recent change in the law. PHE’s support for local areas will further highlight the need to tailor drug prevention initiatives to include khat as appropriate.

Raising awareness

PHE will lead on identifying opportunities to raise awareness of the potential harms of khat and associated community needs at a local level. We will also provide additional advice to local areas where khat is used, which will cover a range of issues highlighted by the Advisory Committee on the Misuse of Drugs (ACMD), including the need to:

Ensure that treatment providers are competent to support people whose khat use is problematic;

Alert clinicians in mental health services to the scope for khat to complicate treatment of existing mental health problems; and

Alert midwives and health visitors to the risk of potential harm to children from khat use in pregnant women or breast-feeding mothers.

Collecting data on treatment for khat problems

Figures of people seeking treatment for khat problems are collected by the National Drug Treatment Monitoring System as part of the regular monitoring provided by treatment agencies for national statistics, and published for providers and commissioners.

PHE produces quarterly reports for individual areas with detailed data about their in-treatment populations, which will include information about khat use in relevant local authorities.

Helping local commissioners plan to meet khat-related need

The Joint Strategic Needs Assessment (JSNA) is a key document drawn up by local authorities to inform coordinated action across health and social care. PHE has developed JSNA guidance and data for local public health commissioners, which includes information about khat.

Commissioners are expected to understand their local populations, and plan substance misuse treatment services to meet identified need. The very small numbers of khat users currently in treatment can provide a good indication of the local areas where khat is most used and where there may be emerging demand.

PHE will support local areas in England where there are centres of khat use and related concerns, so that local commissioners and providers can act appropriately. If possible, we will facilitate communication between areas which have khat-using populations, to share information and good practice.

We will ensure that local public health officials in those areas are aware of policy developments on khat so that they can make advance preparations in case previous khat users need help once they find it is no longer available.

PHE will shortly send out a brief guide providing advice for local health and care commissioners on the forthcoming control of khat under the Misuse of Drugs Act 1971 and implications for strategic and service responses to local populations that use the drug.

Yours sincerely

Rosanna O’Connor
Director of Alcohol & Drugs

20 November 2013

1 “New psychoactive substances” (NPS, often colloquially termed “legal highs”) are psychoactive drugs that are either “new” or ones that until recently were little used in the UK.

2 The network includes representatives from the largest drug treatment providers in the country and national professional and membership bodies.

3 Based at Public Health England, the UK Focal Point collates data and information on drug misuse in the UK and reports it to the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA).

Prepared 19th December 2013