1. …Implications for Wales Josie Smith Programme Lead for Substance Misuse, Public Health Wales TOWARDS A HEALTH BASED APPROACH

2. AIMS: - Economic implications (£) - Impact on existing and future threats to health - Simple hopes

3. "the science and art of preventing disease, prolonging life and promoting health through organized efforts and informed choices of society, organizations, public and private, communities and individuals.“ Winslow ‘The untilled Fields of Public Health’ 1920

4. Estimated number of problematic drug users in Wales 2009-10: 30,443 (95% CI 23,172 – 38,809) Number of individuals in direct contact with NSP services: 17,838 (01/04/2014-30/09/2014)

5. Current expenditure… £50 million per annum Welsh government current expenditure on substance misuse (health) - inc health board ring fenced, capital and revenue funding for APB, education and awareness raising, information/statistics, service user engagement and policy development, reducing availability - not inc disease treatment costs etc. The health service cost in Wales of problem drug use has been estimated at £17.6 million per year COLES, E. and PATES, R. for WELSH ASSEMBLY GOVERNMENT. The Economic and Social Costs of Class A drug and alcohol abuse in Wales. Cardiff: Welsh Assembly Government (Unpublished) Criminal justice non-devolved… £13.3 billion per annum Home Office / PCC current expenditure on substance misuse in UK (https://www.gov.uk/government/policies/reducing-drugs-misuse-and-dependence, 2013 ) 1 billion = 1,000 millionhttps://www.gov.uk/government/policies/reducing-drugs-misuse-and-dependence The total economic and social cost of Class A drug use in Wales has been estimated to be around £780 million, and drug related crime accounts for 90 per cent of this. http://www2.nphs.wales.nhs.uk:8080/SubstanceMisuseDocs.nsf/%28$All%29/6361D5806F16EEDD80257C5B005AC8AF/$File/Working%20Together%20to%20Reduce%20Harm%20-%20SM%20Strategy%202008-2018.pdf?OpenElement

6. In England and Wales 2014: 14% of men and women in prison were serving sentences for drug offences The average annual overall cost of a prison place in England and Wales for 2012-13 was £36,808.* *Ministry of Justice (2013) Costs per place and costs per prisoner by individual prison, National Offender Management Service Annual Report and Accounts 2012-13: Management Information Addendum, London: Ministry of Justice In Wales, there are 5 prisons with around 3000 beds (official operational capacity 2,795) In Wales – cost of prison for drugs offences per annum (14% x 2,795) = 391 x £36,808 = £14,402,970

7. PHW research 2006-2009 (n=500 of which 347 had been imprisoned at least once) Nearly three quarters of those that had been imprisoned reported continued use of drugs whilst in prison Less than one quarter were offered any follow up or aftercare following release from prison Only 20% remained drug free for one month or more following release from prison http://www2.nphs.wales.nhs.uk:8080/BloodBorneVirusesDocs.nsf/7c21215d6d0c613e80256f490030c05a/c662fce951549dd880257355004cc bbf/$FILE/Needs%20assessment%20of%20harm%20reduction%20and%20health%20care%20services%20for%20substance%20misusers%20ac ross%20Wales.pdf

9. Profile of drugs seized by police forces in Wales, 2012-13 Overall, police forces in Wales recorded 11,766 drug offences in 2013-14

10. Hospital admissions for alcohol specific conditions and poisoning by illicit drugs diagnoses in the primary position, all ages, 2008/09 to 2013/14 Mismatch between drugs offences and health harms

11. http://gov.wales/docs/dhss/report/141029submisuseprofilewalesen.pdf http://www2.nphs.wales.nhs.uk:8080/SubstanceMisuseDocs.nsf/%28$All%29/30384D701A04C69980257C5 B0057A8E4/$File/SMTF%20Health%20and%20Wellbeing%20Compendium.pdf?OpenElement

12. Health harms Premature death / drug poisoning/ multiple drugs Injecting related – DVTs, wound infections Chronic blood borne virus infection (inc hepatitis C (liver disease) and HIV Mental health issues inc depression, psychoses, General poor contact with health services → poorer overall health Poor dental health Poor diet / eating disorders Physical / psychological dependency and withdrawal Social isolation, exclusion, suicide

13. Impact on future threats to health Screening, diagnosis and treatment for hepatitis C – reduce pool of +ve patients Improved access to wound care and development of services to address injecting risk, public injecting, social isolation …DCR’s Early identification/evidencing of high risk substances and behaviours – ketamine bladder Preventing drug deaths – Naloxone Profiling drugs on market and those being manufactured within UK: knowledge is power – WEDINOS… Open discussions and policy formulation based on harms– learning from experts Primary and secondary prevention: Early engagement – prior to escalation to problematic

14. But even more…

16. “… I do not think that the tax payers of Wales would be happy to think that their hard earned money was being spent encouraging drug use…” Tax payers (and their families and friends) take drugs too….

17. Regulation of drugs to: Protect and improve public health Reduce drug related crime, corruption and violence Improve security and development Protect the young and vulnerable Protect human rights Base policy on evidence of what works and provides good value for money Transform

18. Questions? Josie.smith@wales.nhs.uk Useful sites: www.wedinos.org www.siedsinfo.co.uk www.wales.nhs.uk/sitesplus/888/page/72997