Statistics on Drug Misuse, England 2020

NHS Digital

Hospital Episode Statistics (HES) processes over 125 million admitted patient, outpatient and accident and emergency records each year.

HES is a data warehouse containing details of all admissions, outpatient appointments and A&E attendances at NHS hospitals in England. This data is collected during a patient's time at hospital and is submitted to allow hospitals to be paid for the care they deliver. HES data is designed to enable secondary use of this administrative data, i.e. use for non-clinical purposes.

It is a records-based system that covers all NHS trusts in England, including acute hospitals, primary care trusts and mental health trusts. HES information is stored as a large collection of separate records, one for each period of care, in a secure data warehouse.

A detailed record is collected for each 'episode' of admitted patient care delivered in England, either by NHS hospitals or delivered in the independent sector but commissioned by the NHS.

Admitted patient care data is available for every financial year from 1989-90 onwards. HES data is now collected monthly.

The drug misuse related hospital admissions have been calculated using HES data. Information on the methodology used is provided in Appendix B.

Hospital Episode Statistics, Admitted Patient Care Activity publications are National Statistics
https://digital.nhs.uk/data-and-information/data-tools-and-services/data-services/hospital-episode-statistics

Office for National Statistics

The Office for National Statistics (ONS) provides data on deaths related to poisoning by drug misuse in England and Wales from 1993, by cause of death, sex, age and substances involved in the death.

Death classified as drug misuse must be a drug poisoning and meet either one (or both) of the following conditions; the underlying cause is drug abuse or drug dependence, or any of the substances controlled under the Misuse of Drugs Act 1971 are involved.

ONS mortality data are National Statistics.

Deaths related to drug poisoning in England and Wales – Statistical bulletins

Office for National Statistics

This is an annual statistical release that examines the extent of, and trends in, illicit drug use among a nationally representative sample of 16 to 59 year olds resident in households in England and Wales.

The release covers the following topics:

• Extent and trends in illicit drug use among adults, including separate analysis of young adults (16 to 24 year olds)
• Frequency of illicit drug use in the last year
• Illicit drug use by personal, household and area characteristics and lifestyle factors
• Use of new psychoactive substances (NPS)
• Perceived acceptability of use of and ease of obtaining illicit substances
• Drug use within generations over time (a pseudo-cohort analysis)

Crime Survey for England and Wales data are National Statistics.

Drug misuse statistics 

NHS Digital

The Adult Psychiatric Morbidity Survey (APMS) provides data on the prevalence of both treated and untreated psychiatric disorders in the adult population of England. Topics covered include the prevalence and trends in drug misuse and in signs of dependence

The most recent survey was in 2014.

Adult Psychiatric Morbidity Survey data are National Statistics.

Adult Psychiatric Morbidity Survey

Public Health England

PHE’s national drug treatment monitoring system (NDTMS) records information about people receiving tier 3 or 4 treatment for drug misuse in England (i.e. structured community-based services, or residential inpatient services), in order to monitor and assist the management of progress towards the Government targets for participation in drug treatment programmes.

Data are provided separately for adults, young people and prisons and secure settings.

NDTMS data are National Statistics.

Alcohol and drug treatment statistics 

NHS Digital

Smoking, Drinking and Drug Use among Young People in England (SDD) is a biennial survey of secondary school pupils in England in years 7 to 11 (mostly aged 11 to 15). Topics covered include drug use prevalence and consumption.

SDD data are National Statistics.

Smoking, Drinking and Drug Use among Young People in England 

The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) provides an annual statistical bulletin containing the most recent available data on the drug situation in Europe provided by the Member States.

European Monitoring Centre for Drugs and Drug Addiction

Home Office

This annual statistical release provide figures for seizures of drugs made by local police forces and the UK Border Force. The data relate to all drugs controlled under the Misuse of Drugs Act 1971.

Drug seizure data are National Statistics.

Seizures of drugs in England and Wales statistics

Annual report and data tables from the UK Focal Point on Drugs on the national prevalence, impact, prevention and treatment of drug use.

United Kingdom drug situation: Focal Point annual report

The National Programme on Substance Abuse Deaths (NPSAD) publish reports which analyse drug-related deaths that have occurred in a calendar year and cover trends and data on drug-related deaths including accidental or intentional deaths from prescription medications, recreational drugs such as cocaine and MDMA, deaths resulting from long-term drug use including complications as a result of intravenous heroin use, and novel psychoactive substances or ’legal highs’. 

National Programme on Substance Abuse Deaths (NPSAD)

The European School Survey Project on Alcohol and Other Drugs (ESPAD) provides an overview of trends in substance use among 15–16- year-old European students and covers most of the European continent. 

The most recent survey was in 2015.

The 2015 ESPAD Report | www.espad.org

The National Institute for Health and Care Excellence (NICE) provides guidance, advice, NICE Pathways and quality standards on drug misuse.

Drug misuse | Topic | NICE

Department of Health and Social Care

This essential guide for drug and treatment professionals provides the most up to date scientific evidence on the health harms arising from drug misuse.

A summary of the health harms of drugs

FRANK is a national drug education service jointly established by the Department of Health and Home Office in 2003. It is intended to reduce the use of both legal and illegal drugs by educating teenagers and adolescents about the potential effects of drugs and alcohol. It also includes a glossary of names given to different drugs including slang terms.

Honest information about drugs | FRANK (talktofrank.com)

Drug Drive has been set up as part of THINK! road safety, from the Department of Transport, to provide information on how different drugs can impair driving.

Drug driving – THINK!

These notes help to explain some of the measurements used and presented in this report or provide links where appropriate.

The report presents three measures for the number of drug misuse related hospital admissions:

1. Admissions for drug-related mental and behavioural disorders: This represents NHS hospital finished admission episodes with a primary diagnosis of drug related mental and behavioural disorders (ICD10 codes F11-F16, F18, F19).
2. Admissions for poisoning by drug misuse: This represents NHS hospital finished admission episodes with a primary diagnosis of poisoning by drugs that are listed as controlled under the Misuse of Drugs Act 1971 (ICD10 codes T40.0 to T40.9, T43.6). This includes both intentional and unintentional poisoning.
3. Admissions where drug-related mental and behavioural disorders were a factor: This represents NHS hospital finished admission episodes with a primary or secondary diagnosis of drug related mental and behavioural disorders (ICD10 codes F11-F16, F18, F19).

The number of admissions is a count of the records meeting the required criteria for the measure.

A finished admission episode is the first period of in-patient care under one consultant within one healthcare provider. Please note that admissions do not represent the number of in-patients, as a person may have more than one admission within the year.

The primary diagnosis is the first of up to 20 diagnosis fields in the Hospital Episode Statistics (HES) dataset and provides the main reason why the patient was in hospital. The secondary diagnosis is one of up to 19 secondary diagnosis fields that show other diagnoses relevant to the episode of care.

HES data are classified using the International Classification of Diseases (ICD). The tenth revision of this classification is currently in use (ICD-10).

These measures do not include outpatient data. Outpatient data is not used as the quality of diagnosis codes are not sufficient to be sure the activity carried out was related to drug misuse.

Data has been suppressed in line with the latest HES suppression methodology in order that individuals can’t be identified in the data. This means that in LA tables, the number of admissions have been rounded to the nearest 5, with small numbers between 1 and 7 suppressed. Age standardised rates have been rounded to the nearest whole number.

Age-standardised rates

Rates per population for hospital admissions have been directly age-standardised using the European standard population. This involves adjusting the number of admissions to account for variations in age profiles between areas. Changes in the values of an age-standardised rate should not be affected by any changes in the distribution of an area’s population by age.

The European Age Standardised Rate
= Sum of (a_i * e_i ) for all age groups (i) / 100,000
Where:
a_i = age specific rate per 100,000
e_i = age specific European standard population

For more information on the European Standard Population see below:
Eurostat European Standard Population 2013

The Index of Multiple Deprivation (IMD) is the official measure of relative deprivation for Lower Super Output Areas (LSOAs) in England.

It is made up of seven LSOA level domain indices. These relate to income deprivation, employment deprivation, health deprivation and disability, education skills and training deprivation, barriers to housing and services, living environment deprivation, and crime which reflect the broad range of deprivation that people can experience. IMD is a measure of the overall deprivation experienced by people living in a neighbourhood, although not everyone who lives in a deprived neighbourhood will be deprived themselves.

Further details can be found here:

English indices of deprivation

Using this information, LSOA level admissions (based on patient residence) and population data have been be allocated to an IMD decile, and admission rates calculated. These have been age standardised using the European standard populations.

Offences under the Act include:

• Possession of a controlled drug unlawfully.
• Possession of a controlled drug with intent to supply it.
• Supplying or offering to supply a controlled drug (even where no charge is made for the drug).
• Allowing premises you occupy or manage to be used unlawfully for the purpose of producing or supplying controlled drugs.

Misuse of Drugs Act 1971

This Act came into force on 1st January 2006 and includes the following clauses:

• A reversal of the burden of proof in cases where suspects are found in possession of a quantity of drugs greater than that which would be required for personal use.
• Compulsory drug-testing of arrestees where police have “reasonable grounds” for believing that Class A drugs were involved in the commission of an offence.
• The inclusion of fresh Liberty Cap or “magic” mushrooms in Class A of the Misuse of Drugs Act.

Before this Bill, only dried or prepared mushrooms were considered illegal. The Act has also linked drug legislation with measures to deal with Anti-Social Behaviour so that anyone given an Anti-Social Behaviour Order must undergo compulsory testing and drug treatment.

Drugs Act 2005

This Act came into force on 26 May 2016 and is intended to restrict the production, sale and supply of new psychoactive substances, previously referred to as "legal highs", and nitrous oxide (laughing gas).

Psychoactive Substances Act 2016

The drug strategy 2017 sets out how the government and its partners, at local, national and international levels, will take new action to tackle drug misuse and the harms it causes.

Drug strategy 2017

From our engagement with customers we know there are many users of this report. There are also many users of these statistics who we do not know about. We are continually aiming to improve our understanding of who our users are in order to enhance our knowledge on what the uses of these data are via recent consultations and feedback forms available online.

In 2016 a consultation was implemented to gain feedback on how to make the report more user-friendly and accessible while also producing it in the most cost-effective way. The results of this consultation can be found at the below link.

Consultation on Lifestyles Compendia Reports

Below is listed our current understanding of the known users and uses of these statistics. Also included are the methods we use to attempt to engage with the current unknown users.

Department of Health and Social Care (DHSC) use these statistics to inform policy and planning as shown in Appendix C.

NHS use the reports and tables for analyses, benchmarking and to inform decision making.

Public Health England use these data for secondary analyses.

Media - these data are used to underpin articles in newspapers, journals and other articles.

Public Health Campaign Groups - data are used to inform policy and decision making and to examine trends and behaviours.

Public - all information is accessible for general public use for any particular purpose.

Ad-hoc requests – the statistics are used by NHS Digital to answer Parliamentary Questions (PQs), Freedom of Information (FOI) request and ad-hoc queries. Ad-hoc requests are received from health professionals; research companies; public sector organisations, and members of the public, showing the statistics are widely used and not solely within the profession.

This publication is free to access via the NHS Digital website:

Lifestyles - NHS Digital

Consequently, the majority of users will access the report without being known to us. Therefore, it is important to put mechanisms in place to try to understand how these additional users are using the statistics and to gain feedback on how we can make these data more useful to them. On the webpage where the publication appears there is a Contact us link at the bottom of the page. Any feedback is passed to the team responsible for the report to consider.

We also capture information on the web activity the reports generate, although we are unable to capture who the users are from this.

The Statistics on Drugs Misuse 2019 report generated over 255 unique downloads in the 4 weeks after publication on 28 November 2019.

Comments on this report would be welcomed. Any questions concerning any data in this publication, or requests for further information, should be addressed to:

The Contact Centre
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This report is available at:
Statistics on Drug Misuse, England 2020 - NHS Digital

Previous reports on Statistics on drug misuse: England can be found on our website:
Lifestyles - NHS Digital