More than 200 hospital beds were occupied every day as a result of issues related to alcohol and drug misuse. This finding is contained in a new report published by the Comptroller and Auditor General, Kieran Donnelly CB, today (Tuesday 30 June).
Mr Donnelly’s report on Addiction services in Northern Ireland highlights the cost of substance misuse to the public purse. It concludes that substance misuse causes significant harm in Northern Ireland, to individuals, families and wider society, with impacts on physical and mental health, unemployment, homelessness and criminal activity.
Alcohol misuse alone costs Northern Ireland as much as £900 million a year, with up to £250 million of this falling on the already stretched Health and Social Care sector. Despite these significant costs, the Department of Health allocates a relatively small budget to tackling the problem - £8 million for implementation of its Drugs and Alcohol strategy, and a further £8 million for statutory addiction services from the mental health budget (around 5 per cent of the budget).
Whilst alcohol misuse remains the most prevalent substance issue in Northern Ireland, the number seeking treatment for drug misuse has grown significantly, doubling from 2,107 people in 2007 to 4,183 people in 2019. The number of deaths relating to substance misuse is also rising, with drug misuse deaths more than trebling in the last decade. The level of harm is most acute in areas of high deprivation, where deaths related to drug and alcohol misuse are around four and a half times that seen in the least deprived areas.
Commenting on the report’s findings, Mr Donnelly said: “This is an increasingly unsustainable burden. Alcohol and drug addiction are complex problems and don’t occur in isolation. People need support with a wide range of issues, not just their addiction. While this report focuses on the services delivered by healthcare providers, it is clear that only a joined up approach across the whole of government will begin to tackle this issue effectively.
"While the information that is available paints a worrying picture of a growing problem, it is disappointing that the Department has little reliable information on outcomes for people seeking treatment for addictions. As a result it has not been possible to determine whether spending on addiction services provides value for money or whether service users are getting the best possible outcomes. The future focus must be on the impact services are having on people’s lives, not just the number of people looking for help. That’s why my report recommends that clearly defined objectives and outcomes are built into the Department of Health’s new alcohol and drugs strategy.”
Other key findings
The reports also reveals that prescription drug misuse is a growing problem in Northern Ireland, with the majority of drug related deaths now involving prescription drugs such as pregabalin and diazepam. Northern Ireland prescribes more pregabalin and diazepam per capita than anywhere else in the United Kingdom. While the potential for the misuse of pregabalin is widely known and guidance was provided to all GPs and community pharmacists in Northern Ireland in 2012 and 2016, prescriptions of the drug have continued to rise.
While harm reduction and early intervention services are a cost effective way of tackling harms related to drug and alcohol misuse, addiction services are facing a number of pressures. These include an increase in the number of referrals. For example, the Belfast Trust saw a 300 per cent increase in referrals to its Substitute Prescribing Service between 2018 and 2019. Waiting time targets in Northern Ireland are considerably longer than elsewhere in the United Kingdom. A number of Trusts have struggled to meet the target that people should not wait more than nine weeks from referral for an initial appointment.
The report highlights shortcomings in the information collected on addiction services, including significant issues with data quality and completeness. The Substance Misuse Database, an annual summary of those presenting to services, has not been published in over two years due to poor quality data. There is also no regional information on the outcomes for those with the most complex and severe addiction issues.
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