Drugs and Alcohol in Primary Care Steve Brinksman Clinical Lead - - PowerPoint PPT Presentation
Drugs and Alcohol in Primary Care Steve Brinksman Clinical Lead SMMGP Medical Director Cranstoun Group GP Trends and Issues Traditional drugs Prevalence Alcohol Age Addiction to Medicines Co-morbidities Novel
Steve Brinksman Clinical Lead SMMGP Medical Director Cranstoun Group GP
Reduction
Drugs ordered by their overall harm scores, showing the separate contributions to the overall scores of harms to users and harm to others. The weights after normalisation (0–100) are shown in the key (cumulative in the sense of the sum of all the normalised weights for all the criteria to users, 46; and for all the criteria to others, 54). CW=cumulative weight. GHB=γ hydroxybutyric acid. LSD=lysergic acid diethylamide.
Drug harms in the UK: a multicriteria decision analysis
The Lancet, Volume 376, Issue 9752, Pages 1558 - 1565, 6 November 2010
doi:10.1016/S0140-6736(10)61462-6
Estimates suggest over 300,000 problematic heroin & crack users in the UK Over 6 billion £s a year spent on illicit drugs in the UK 70% of acquisitive crime drug related Over a 20 year injecting career, 75% will become infected with hepatitis C Mortality rates between 6-16x higher than general population
both legal and illegal drugs registered in England and Wales in 2016, the highest since comparable records began in 1993.
involving illegal drugs only.
highest ever recorded, at 65.8 deaths per million population.
Graph showing deaths, comparing untreated patients with those in Methadone maintenance treatment in the Swedish study (2).
(Reproduced from Gronbladh et al)
patient stays registered whether still using,
including continuity and the treatment of associated health problems
needing behavioural change
“Habit is habit, and not to be flung out of the window by any man, but coaxed down-stairs one step at a time.”
Samuel Langhorne Clemens
Engaging users with treatment programmes has been shown to vastly reduce the cost of drug addiction to society in a number of ways: for every £1 spent on drug treatment, there is a saving of £9.50 to society as a whole
(Department of Health, 2008).
Reduce barriers to entry High quality medical and psychosocial services Treatment retention Orientation towards social rehabilitation Sufficient duration of treatment Detoxification only of willing, well stabilised patients with established abstinence
engagement Reintegration Reducing Harm Supported Stability Abstinence Recovery
Public Health advises just one glass of wine a day
FACTS FIGURES LAs 152 Inc + High % 22 Dep % 3.8 Practices 8,261 GPs 33,364 ENGLAND LAs PRACTICE GP Total Population 53,588,218 352,554 6,487 1,606 Adult Population 43,580,873 286,716 5,275 1,306 Dependent drinkers 1,568,911 10,322 190 47 Increasing and Higher Risk 9,849,277 64,798 1,192 295
18 Alcohol interventions in Primary Care 13 Alcohol interventions in Primary Care
Key drivers for growth in burden and mortality, First 3 all preventable:
non-alcoholic steatohepatitis (NASH)
Overall, it is estimated that around 214,000 people (0.4%) in the UK are chronically infected with hepatitis C. Despite being a curable infection only 3% of those infected receive treatment each year.
Hepatitis C in the UK 2013. PHE publications gateway number: 2014058 July 2014
Van de Meer et al JAMA 2012
Primary Care has a key role to play
to 95% of patients with chronic HCV can be cured
Addiction to medicines policy November 2014 * Not including illicit opioids
“may signal an emerging problem in the UK similar to the issue that is now well established in the USA.” 50 100 150 200 250 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013 Other opiate Tramadol Dihydrocodeine not from compound Codeine not from compound
Novel Psychoactive Substances, Club Drugs, Legal Highs
[Synthetic Cannabinoid Receptor Agonists]
Oh, East is East, and West is West, and never the twain shall meet
Rudyard Kipling
Commissioners, Social Services, Housing etc.
service for GPs
and mental health problems and premature ageing
worryingly high
Care and the Third Sector can provide effective care and aftercare