Devon Drug and Alcohol Strategic Partnership update report
1. Introduction
This report covers the period from April 2023 to Summer 2024.
Devon’s Drug and Alcohol Strategic Partnership (DDASP) was formed in November
2022. The partnership covers the Devon County Council footprint and aims to support
the ambitions in the National Drug Strategy ‘From Harm to Hope’ 2023-2033.
- Increase numbers of people in treatment
- Reduce alcohol and drug related deaths
- Improve continuity of care for people engaged in the criminal justice system
- Reduce the supply and demand for illicit substances
The partnership is chaired by Steve Brown, the Director of Public Health (Devon
County Council) and has representation from a number of key partners including drug
and alcohol treatment services, Devon and Cornwall police, Devon health partners,
Probation Service South West and Voluntary and Community Sector partners.
A Health Needs Assessment was compiled in 2022 and has been used to inform our
delivery plan. Key points identified included the need to:
- Involve people with lived experience in our work (local action)
- Improve our understanding of those who are accessing the services and how
we reach those who would benefit from support for alcohol or other drug use
(local action) - Improve integration of the health and social care system (local and national
action) - Professionalise the workforce and improve skills and understanding of
addiction (local and national action) - Address stigma and discrimination and promote trauma responsiveness (local
and national action
The Needs Assessment is currently being refreshed and the next iteration, anticipated to be completed by year end, will include a Devon Drugs and Alcohol Strategic
Partnership Data Dashboard which will align with the National Combating Drugs
Outcomes Framework and priorities identified by the DDASP.
During 2023/24 The DDASP has been working to achieve the national objectives
by:
- Increasing capacity in the young persons and adult services
- Reducing waiting times for adults wanting to access alcohol or other drug treatment
- Preventing opiate users disengaging with treatment by establishing opiate safe clinics across Devon
- Helping prevent drug related deaths by training people in the use of Naloxone, trialling the use of Nitazine testing strips and improving our Local Drug Intelligence System (LDIS)
- Increasing the volume of educational sessions provided to young people about the harms of alcohol and other drugs
- Reducing the number of people in Devon living with an alcohol or drug dependency not in treatment.
Ongoing challenges in Devon:
- There are significant housing challenges in Devon, both in terms of affordability, vailability and quality of housing stock. This is well articulated in the recent Housing Commission Report. The relationship between housing and recovery is well understood.
- The Pharmacy First contract; we have experienced large pharmacy chains closing stores within Devon (e.g. Boots, Lloyds). This, coupled with a chronic lack of lack of trained Pharmacists in Devon and the South Westi means there are challenges in capacity for supervised consumption and needle and syringe provision from community pharmacy.
- The majority of our released prison population exits HMP Exeter, a Category B local and resettlement prison. With an average stay of just 23 days, there is limited time for the prison and community workforces to develop robust release plans. This short duration impacts our ability to ensure continuity of care and this is reflected in our continuity of care rates.
- Devon is geographically a large and rural county and we lack the ability financially to ensure we have assertive outreach provision to address unmet need and to effectively rural proof our services.
- Both our Young Persons and Adult Community Substance Misuse treatment service workforces are predominantly recovery worker based; we are hoping to improve the diversity of the roles and career progression opportunities within services. However, we face an ongoing significant resourcing and recruitment challenge to realising this ambition.
- There is evidence of Synthetic Opioids within the local and national drugs market representing a significant increase of risk, predominantly but not limited to opiate users.
If you are interested in the work of the DDASP please contact publichealth-mailbox@devon.gov.uk or call 01392 383000. Key documents for the DDASP are held
at Welcome to Devon Health and Wellbeing – Devon Health and Wellbeing.
2. Delivery Update
Reducing Drug Related Crime and Reducing Drug Supply (Police)
1 Review of drugs part two: prevention, treatment, and recovery – GOV.UK (www.gov.uk)
Devon and Cornwall Police are in the process of validating their data sources. In future
they will supply the Devon Drug and Alcohol Strategic Partnership with the following
data:
a) Quarterly drug trend report
b) Quarterly County Lines data report
c) Possession data
d) A report about synthetic opioids
Reducing drug-related deaths and harm
For the period June 2023-May 2024 there were 32 deaths of individuals in treatment
in Devon (this equates to 1.39% of the treatment population and is above the national
percentage of 1.28%), this is a slight increase from 29 in the same period the year
before. The majority in Devon (21 cases) were people known to use opiates.
With the introduction of synthetic opioids (Nitazines) entering the UK drugs market,
preventing drug related deaths and harms continues to be a challenging area. In April
2024 we witnessed two confirmed deaths of individuals and eight non-fatal overdoses
amongst individuals who consumed a contaminated batch of heroin containing
nitazines. In August/Sept 2024 we witnessed three suspected drug related deaths and
seven non-fatal overdoses in Exeter (though forensic results have not been
established at the time of publishing this report). All incidents involve people who are
known to use and seek illicit drugs (but not necessarily engaged with drug treatment
services) and therefore the current risk assessment is that the threat and risk to the
general public remains low. However, we keep this under continuous review to ensure
our approach is responsive to emerging evidence regarding synthetic opioids across
substance groups;
Our efforts to monitor the situation include, working closely with the police regarding
the testing of vapes to understand the potential for adulteration and continuous review
of Wedinos data to understand potential patterns of adulteration. Given the threat of
synthetic opioids, it is also important that anyone who consumes drugs recreationally
is aware that synthetic opioids can be present in any substances purchased online or
from dealers regardless of how they are labelled or appear. We continue to urge people
to access drug treatment and avoid using illicit substances. Where people continue to
use illicit drugs, we promote the following harm reduction messages:
- Go slow and dose low.
- Ensure you use your drugs in the presence of a sober buddy who is trained in
the administration of Naloxone and has Naloxone available
As of 10th September 2024, Devon County Council has appointed a Deaths of Despair
Prevention Co-ordinator role to ensure we are reviewing, learning and disseminating
learning effectively to help prevent future deaths and overdoses.
The DDASP has also facilitated a system–wide Inclusion Health Partnership which, by
working in partnership, aims to improve access to, experience of and health outcomes
for marginalised and vulnerable populations and groups including people with drug and
alcohol dependence and those living in rural, coastal and remote rural communities.
The partnership is currently focussed on implementing the NHSE Inclusion Health
Framework across the ICB (Integrated Care Board).
By working in a larger Inclusion Health Partnership, we are recognising the complexity
of the people accessing substance misuse services and endeavouring to develop
system-wide responses with a wider set of partners including housing, health and adult
social care. It also creates an opportunity to share best practice in care across health,
social care and local government, thus breaking down stigma and garnishing a better
understanding of the needs of people with a range of often co-existing needs, including
substance use disorder.
Further actions taken to prevent drug related harms and deaths include:
- Introduction of Opiate safe clinics for those who traditionally fall off their Opiate Substitution Treatment prescriptions
- Investment in long-acting injectable Buprenorphine (although note expansion
of this is limited by the level and confirmed sustainability of financial
resources) - Improvements in Continuity of Care from prison to community treatment
- Piloting and evaluating the effectiveness of providing Nitazine testing strips for
people who use drugs as a harm reduction measure - Training and widening provision of Naloxone (again limited by financial
resource) - Increased capacity in the treatment services as this is a protective factor
- Promotion of smoking cessation within the treatment service, including swap to
stop - Seeking lived experience views of access to treatment from rural/coastal
communities to inform our approach and service provision - Devon & Cornwall Police establishing relationship with University of Bath to
enable more rapid lab testing of illicit drugs - STaR team providing a multi-agency approach to supporting Rough Sleepers
in Exeter into treatment alongside access to holistic health care needs - Continuous review and development of our Local Drug Information System to
monitor local drugs patterns/use and reach a wider range of partners. - Local suicide bereavement charity ‘Petes Dragon’s’ offering bereavement
support in Exeter for six months (April-Oct 2024). - Education package for GPs, Pharmacies and Emergency Departments
- Supporting the use of Naltrexone for relapse prevention
- Establishing a process of referral from ambulance care to treatment services
for non-fatal overdose and welfare checks - Having a dedicated post to focus on prevention of avoidable death work.
Involving People with Lived Experience
The CLERO (College of Lived Experience Recovery Organisations) have a recovery
strategy with the idea of active citizenship at its core. In February 2024 they published
national standards to guide groups looking to: develop and sustain their model, review
current practice, and to identify ways to develop and to evidence and quality assure
their practice. In the standards guidance is provided on four types of group
organisational structure and on how to move towards a constituted group or
organisation or a LERO.
In Devon work has been ongoing since 2022 to scope out the landscape of groups and
providers who help people to get involved with shaping, developing and evaluating
services and a system wide repository is in place for the DDASP members. And since
2023, we have begun to strengthen involvement from people with lived experience of
adverse substance use. There have been three main areas of work: firstly, a group has
started with people with lived experience of adverse substance use, secondly, peer
researcher roles have been operationalised, and, finally, we have been looking as a
system at people’s involvement in research and evaluation in projects, both
traditionally through logic modelling and through human learning system methods.
Next steps are twofold: Firstly, to strengthen research governance and ethics
frameworks and procedures to enable greater participation in the DDASP by people
experiencing adverse substance use, and secondly to help groups to use the CLERO
standards and other support to help them move towards establishing a LERO for
people experiencing adverse substance use.
3. Increasing engagement in drug treatment
- Adult service As of May 2024, there are 2,295 adults in structured treatment; an increase of 343 people (15%) since March 2022. Identifying and attracting opiate users into treatment remains a local objective.
- Young persons service As of May 2024, there are 218 young people in structured treatment; an increase of 20 people (10%) since March 2022. It is not possible to determine if this is due to an increase in engagement or due to an increase in need amongst young people, though both are possible explanations.
- Prisons Devon has improved the continuity of care rate for people leaving prison with an alcohol or drug treatment need from 35% in March 2022 to 60% in May 2024 (this
is better than the England average of 52%). - Tier 4 (residential rehabilitation and detoxification services) We have used a proportion of the supplementary grant spend to increase access to Tier 4 services in Devon. 32 people accessed Residential rehabilitation between June 2023-May 2024, this is an increase from March 2022 (24 people). We have also funded 10 inpatient detox placements over the last 12 months.
.
Improving treatment and recovery outcomes
- 56% of the adults in treatment in Devon show substantial progress (up to May 2024 compared to 47% nationally. Devon performs better than England for opiate
only and opiate and crack pathways. The performance compared to England for
alcohol only, crack only, non-opiates only and non-opiate and alcohol pathways is
the same or marginally lower in Devon. - The young persons’ service has achieved improvements in reducing the
percentage of young people still using alcohol (12% from 36%) and cannabis (71%
from 74%) and other drugs (24% from 30%) on treatment exit since March 2022
4. Priorities for 2024/25
- Involve people with lived and living experience of alcohol or other drug related
harms in our work including those living in rural and coastal communities. - Create a performance dashboard of the work related to the Devon Drug and
Alcohol Strategic Partnership. - Review the treatment pathway for those being released from prisons for individuals
registered with the Clock Tower Surgery. - Develop processes to share the learning and ensure the recommendations are put
into action to prevent future deaths of despair.
Priorities identified in the Draft Devon and Cornwall 2025-29 Police and Crime
Plan are:
- No more drug dealing and alcohol or drug related disorder in our towns
- Drug networks are deterred from coming through our countryside and
coasts - Zero tolerance to drink and drug driving
- Supply and demand for illegal substances are disrupted
5. Support available to people living within Devon County Council’s boundary
For anyone who lives within the Devon County Council boundary who has concerns
about their or a loved one’s use of alcohol or other drugs please contact the treatment
services for information.
Together Specialist Substance Misuse services
Together- T: 0800 233 5444 (Adults)
E: info@edp.org.uk
Y-SMART (Children and Young People’s service)
T: 01271 388162
E: y-smart@devon.gov.uk
6. Authors
Richard Merrifield (SENIOR COMMISSIONING MANAGER PUBLIC
HEALTH)
Lex Gainsbury (CONSULTANT IN PUBLIC HEALTH
MEDICINE/CONSULTANT IN PUBLIC HEALTH)
Louise Plummer (ADVANCED PUBLIC HEALTH PRACTITIONER PUBLIC
HEALTH)
7. References
Page 1; The National Drug Strategy ‘From Harm to Hope’ 2023-2033
https://www.gov.uk/government/publications/from-harm-to-hope-a-10-year-drugs-plan-to-cut-crime-and-save-lives
Page 1; Health Needs Assessment 2022 https://www.devonhealthandwellbeing.org.uk/library/needs-assessments/
Page 2; Devon Drugs and Alcohol Strategic Partnership Data Dashboard
https://www.devonhealthandwellbeing.org.uk/public-health-dashboards/
Page 2; National Combating Drugs Outcomes Framework
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1158290/National_Combating_Drugs_Outcomes_Framework_-Supporting_metrics_and_technical_guidance_PDF__1.pdf
Page 2; Housing Commission Report
https://news.exeter.ac.uk/wp-content/uploads/2024/07/2024EI047-Devon-Housing-Commission-Final-Report-v8.pdf
Page 3; Reducing Drug Related Crime and Reducing drug Supply (Police)
1 Review of drugs part two: prevention, treatment, and recovery – GOV.UK (www.gov.uk)
2 Special report: the community pharmacy workforce crisis – The Pharmaceutical Journal (pharmaceutical-journal.com)
Page 6; Lived Experience National Standards
https://www.clero.co.uk/clero-standards