1. Sex, drugs and alcohol – impact on health services Dr Marion Lyons Josie Smith NPHS

2. Consequences of alcohol misuse key factors associated with young people committing offences more specifically, drinking by young people is associated with violence young people who drink are significantly more likely to take drugs of all kinds than young people who do not drink. Among 15-year-olds who first drank alcohol at 10 years or younger,17% had taken Class A drugs at the age of 14, compared with 2 % of those who first drank when they were 14 years or older teenagers are significantly less likely to use contraception when drunk and, therefore, risk pregnancy or sexually transmitted infections. Also much more likely to regret having sex in the first place

3. Consequences of sex Not all negative! What can be painful: –Acute infection –Long term sequelae –Inability to conceive –Inability to maintain relationships –Unwanted pregnancy –Ectopic pregnancy –Chronic disease –Sexual assault / rape

4. Consequences of drug use Not all negative! Depends on type of drugs (stimulants, depressants, legal and illegal) and how they are taken Use of alcohol in combination with drugs (e.g. benzodiazepine) Range of consequences dependent on level of drug use –Disorientation / Disinhibition – sexual contact –Drug/drink driving –Dependence – harms inc physical, psychological –Chronic – including non-fatal overdose, infection with blood borne viruses

5. Healthcare implications of clubbing – sex, drugs and alcohol Physical assault – lacerations most common injury Alcohol intoxication Drug overdoses Sexual assault

6. Alcohol – impact on health services Over 15,000 referrals to alcohol treatment services in 2007/08, representing 0.5% of total population of Wales. 31% were under 30 years old, 1.8% were under 15 years Strong association between alcohol consumption and accidents Hospital admission for alcohol related liver disease rose by over 25% from 2000-2006 Hospital discharges with an alcohol related diagnosis in Males and Females aged under 15 and 15-19 years 2000 – 2007

7. Alcohol – impact on health services

8. Sex – impact on health services Pregnancy: Maternal alcohol consumption during pregnancy appears to be associated with conduct problems in children, independent of other risk factors Methadone does not damage the unborn child, but the baby may experience withdrawals – impact on health services

9. Sex – impact on health services Sexually Transmitted Infections Incidence and rates of chlamydia in Wales: 1991-2007

10. Sex – impact on health services Incidence and rates of gonorrhoea in Wales: 1991-2007

11. Sex – impact on health services Cases and rates of infectious syphilis (primary and secondary stages only) in Wales: 1995-2007

12. Drugs – impact on health services During 2007/08 there were 12,443 referrals to services in Wales for problematic drug use 48.7% (n=6064) of these referrals were for heroin use Increased numbers accessing mental health services for stimulant related psychosis, reported increases in diagnoses of schizophrenia related to drug use Widespread use of steroids and performance and image enhancing drugs (PIEDS) – impact on health of heavy end users (e.g. heart, liver function) Poly-drug use – NPHS research indicates that the vast majority of problematic substance misusers use more than one substance over a given period, with related health implications, and this pattern may change over time.

13. Drugs - Impact on health services Injecting drug users estimated to be just under 20,000 problematic drug users in Wales, of which at least 8,000 are IDUs IDUs are at increased risk of infection with both blood borne viral and bacterial infections 42% of IDUs in Wales report having experienced at least one non- fatal overdose One third of IDUs in Wales report experiencing recent injecting- associated health problems such as abscesses, deep vein thromboses and septicaemia There are both direct and indirect non-fatal overdose-related morbidities, including those associated with falling, assaults while unconscious, peripheral neuropathy and chest infections. Ambulance call-out and hospital treatment is regularly required in these cases

14. Ambulance statistics Figures from Central and West regional ambulance service: Figure 1 – incidents of ambulance attendance for 2006/07 by drug. Complaint at the time of call was Cardiac Arrest, Overdose, Poisoning or Psychiatric/Suicide Figure 2 - Age range for cases with keyword “Heroin”. During 2006/07 30.33% of patients were aged between 19 and 25 years of age, and a further 20.49% of these cases were aged between 15 and 18 years of age and 74.6% were Male.

15. Drug and alcohol related death Alcohol related deaths 1996 - 2006Drug related deaths 2000 - 2006