joint strategic needs assessment (jsna) refresh on drugs
TRANSCRIPT
Joint Strategic Needs Assessment (JSNA) Refresh on Drugs and Alcohol
CABINET OFFICE
November 2020
2
Contents
1. Introduction .................................................................................................... 4
1.1 The impact of substance misuse ................................................................ 4
1.2 Methodology ........................................................................................... 4
1.3 Evidence review ....................................................................................... 5
1.4 Chief Constable’s annual reports 2018 to 2019 and 2019 to 2020 ................. 5
1.5 Director of Public Health Annual Report 2019: The Isle of Man - An Equal Society? .................................................................................................. 5
2. Review of Data ................................................................................................ 6
2.1 Premature Mortality ................................................................................. 6
2.2 Alcohol-related mortality ........................................................................... 8
2.3 Deaths from drug misuse.......................................................................... 8
2.4 Deaths from drug misuse.......................................................................... 9
2.5 Drug Arrest Referral Scheme (DARS) ......................................................... 9
2.6 Possession of controlled drugs by sex ....................................................... 11
2.7 Possession of controlled drugs by age ....................................................... 11
2.8 Driving in charge of vehicle whilst over the prescribed alcohol limit ............. 12
2.9 Driving in charge of a vehicle whilst over prescribed alcohol limit by age ..... 12
2.10 Driving whilst unfit through drink or drugs ................................................ 13
2.11 Drunk and disorderly by age .................................................................... 14
2.12 Drunk and incapable by age (3 year totals) ............................................... 14
2.13 Amount of drugs seized - Isle of Man Constabulary .................................... 15
2.14 Street value of drugs seized – Isle of Man Constabulary ............................. 16
2.15 Drug Seizures – Customs and Excise......................................................... 17
2.16 Total drug seizures per financial year ........................................................ 17
2.17 Isle of Man Prison Data Urine drug screen result ....................................... 18
2.18 Percentage - illicit drug use of total receptions .......................................... 18
2.19 DHSC Pharmacy - Needle exchange – quarterly contacts ............................ 19
2.20 Domestic abuse, violent crime, sexual offences ......................................... 19
2.21 Drug and Alcohol Team (DAT) ................................................................. 20
2.22 Motiv8 Addiction Services – caseload overall figure .................................... 21
2.23 Current caseload ..................................................................................... 22
2.24 Successful completion of treatment .......................................................... 22
2.25 Referrals to Motiv8 .................................................................................. 23
2.26 Isle of Man Youth Survey 2015 and 20188 ................................................. 23
3
2.27 Health and Lifestyle Survey 20169 ............................................................ 26
2.28 Household and Income Expenditure Survey 2018/1910 ............................... 30
3. Review of Qualitative Information ................................................................ 31
3.1 Theme: Changes seen in the last three years ............................................ 31
3.2 Substance misuse and risk-taking behaviour.............................................. 33
3.3 Seeking help for drug and alcohol issues – Prison ...................................... 33
3.4 Theme: Current and emerging trends and issues ....................................... 34
3.5 Theme: Significant threat to safety of the Isle of Man in relation to substance misuse ................................................................................................... 34
3.6 Connection between substance misuse, risk-taking, violence and criminal activity ................................................................................................... 36
3.7 Theme: Domestic abuse and sexual assault .............................................. 37
3.8 Theme: Multi-agency working .................................................................. 37
3.9 Theme: Improvement to services to tackle substance misuse issues............ 38
4. Discussion ...................................................................................................... 38
4.1 Quantitative Feedback Summary .............................................................. 38
4.2 Qualitative Summary ............................................................................... 40
5. Unmet needs and service gaps ...................................................................... 41
6. Conclusions .................................................................................................... 42
7. Options .......................................................................................................... 42
Appendices
Appendix 1: Improvement to services to tackle substance misuse issues ........... 44
Appendix 2: Classification of Drugs ..................................................................... 47
Qualitative Study – participants .......................................................................... 48
Government Department and Divisions ................................................................ 48
Third Sector Organisations ................................................................................. 48
References ........................................................................................................... 49
Acknowledgements .............................................................................................. 50
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1. Introduction This document aims to provide an update to some sections of the previous iteration of the Joint Strategic Needs Assessment (JSNA)1, where there has been meaningful change or evidence of emerging trends and issues that were not apparent or an issue when the previous JSNA was published. Many of the findings from the original JSNA are still relevant and the key priorities identified in the original report are documented in the Substance Misuse Strategy 2018 to 20232.
1.1 The impact of substance misuse Drug misuse can damage an individual’s physical and mental health and have a negative impact on their family and the wider community. Injecting drug users are at increased risk of contracting and spreading blood-borne viruses such as hepatitis B and C, and experience complications of drug misuse such as deep vein thrombosis and septicaemia, which can be fatal. Alcohol misuse can have adverse health and social consequences for the drinker, as well as for other individuals. Its consumption has been identified as a component cause for more than 200 health conditions covered by the International Classification of Disease (ICD-10) and injury codes and is associated with social consequences such as loss of earnings or unemployment, family or relationship problems and crime. Overall, the harmful use of alcohol results in a significant health, social and economic cost to society and ranks among the five top risk factors for disease, disability and injury throughout the world3.
1.2 Methodology
Isle of Man data was analysed for new trends and emerging issues. Stakeholder engagement was carried out through 1-to-1 interviews with service providers and key stakeholders from across government and third sector organisations. A review of the implementation of the Substance Misuse Strategy was undertaken and the results are available in a separate document.
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1.3 Evidence review The following documents were reviewed: Department of Health and Social Care (DHSC), Isle of Man Joint Strategic Needs
Assessment on Drugs and Alcohol, April 2017
Department of Home Affairs (DHA), Chief Constable’s Annual Report 2019-20
Director of Public Health Annual Report 2019: An Equal Society?
1.4 Chief Constable’s annual reports 2018 to 2019 and 2019 to 2020
The Chief Constable’s Annual Report5 highlights that the trade in drugs remains the most significant threat to safety on the Isle of Man. Organised criminal groups supply large amounts of Class A and Class B drugs to the Isle of Man. Small, organised groups exist on the Island and they seek to make profits from their work. The harm caused by the drugs and by the people who trade in them cannot easily be overstated. Aside from the deaths caused by Class A drugs, the addiction, health issues and violence follow as a direct result of drug trafficking. People fall into debt, either when the police seize a consignment of drugs, or when part of the drug network stops functioning as planned. Debts are often collected through violent retribution, or through “taxing” when property, such as electronic goods, are stolen from an individual. The rise in violent crime, now in its third year, is directly linked to the supply of drugs. Most of those subject to violence of this kind do not wish the police to investigate. Furthermore, the impact of adverse childhood experiences, mental health and the harm caused by matters such as domestic abuse continue to occupy much of the Constabulary’s attention.
1.5 Director of Public Health Annual Report 2019: The Isle of Man - An Equal Society?
The Director of Public Health’s Annual Report6 documents that the ability of individuals to choose healthy lifestyle behaviours and participate in social and community networks, is strongly determined by their socio-economic status and the environment they live in. Reducing inequalities in health benefits society as well as individuals and families. If we want to improve our population’s health and wellbeing we have to address socio-economic and environmental factors (the so-called wider determinants of health) as well as health care and healthy behaviours. We can only do this if we understand the distribution of these factors across our population and how this correlates with health behaviours and outcomes. Those who have issues with substance misuse/dependency may have some negative experiences with regard to the wider determinants of health which may impact on their choice of lifestyle and their mental health and wellbeing.
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The diagram below shows in more detail the wider determinants of health that can have both positive and negative impacts on health and wellbeing.
Diagram 1: Dahlgren and Whitehead - Model of the wider determinants of health
2. Review of Data A review of existing data was undertaken to identify where we are now three years on from the publication of the JSNA on drugs and alcohol. The purpose was also to identify any current new and emerging trends.
2.1 Premature Mortality Table 1: Shows how the Isle of Man compares to the England average on measures of premature mortality and possibly preventable mortality for conditions that are potentially substance and alcohol related. For cancer deaths, and cancer deaths considered preventable in males, the Isle of Man is statistically worse than the England average. However, for liver disease and respiratory disease the Isle of Man is overall better than the English average.
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Table 1: Public Health Outcomes Framework
Better
Not significantly different
Worse
Indicator description - under 75 mortality rate Male / Female IOM / England Rate 2012-2014 2015-2017 2016-2018
IOM Rate 78.8 79.0 79.8
England Rate 75.7 72.5 71.7
IOM Rate 116.6 111.0
England Rate 101.3 100.4
IOM Rate 42.1 49.2
England Rate 45.2 44.4
IOM Rate 50.1 54.3 54.6
England Rate 49.2 45.9 45.3
IOM Rate 80.3 79.3
England Rate 69.2 68.4
IOM Rate 28.6 30.4
England Rate 23.9 23.3
IOM Rate 150.8 136.7 143.1
England Rate 141.5 134.6 132.3
IOM Rate 151.6 170.3 170.9
England Rate 157.7 149.6 146.5
IOM Rate 150.3 103.1 115.7
England Rate 126.6 120.7 119.0
IOM Rate 94.1 86.1 92.0
England Rate 83.0 78.0 76.3
IOM Rate 90.5 102.8 100.9
England Rate 90.5 84.1 82.0
IOM Rate 98.0 69.5 83.3
England Rate 76.1 72.3 71.1
IOM Rate 17.0 13.1 13.2
England Rate 17.8 18.5 18.5
IOM Rate 20.1 17.9
England Rate 24.3 24.3
IOM Rate 6.1 8.5
England Rate 13.0 12.9
IOM Rate 14.7 11.5 12.0
England Rate 15.7 16.3 16.3
IOM Rate 17.7 17.1
England Rate 21.8 21.8
IOM Rate * *
England Rate
IOM Rate 31.3 27.9 30.6
England Rate 32.6 34.3 34.7
IOM Rate 30.2 28.9 35.0
England Rate 38.3 39.9 40.3
IOM Rate 32.4 26.9 26.3
England Rate 27.4 29.0 29.3
IOM Rate 12.4 13.7 16.6
England Rate 17.8 18.9 19.2
IOM Rate 12.3 15.7
England Rate 21.2 21.5
IOM Rate 15.0 17.5
England Rate 16.7 16.9
*Suppressed due to numbers <10.
All
Male
Female
All
Male
Female
From respiratory disease considered
preventable
All
Male
Female
All
Male
Female
All
Male
All
Male
Female
From respiratory disease
Female
All
Male
Female
From cancer considered preventable
All
Male
Female
From all cardiovascular diseases
From all cardiovascular diseases considered
preventable
From liver disease
From liver disease considered preventable
From cancer
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2.2 Alcohol-related mortality The overall number of alcohol-related deaths per 100,000 population is not statistically significantly different from 2017 to 2019. However, alcohol-related deaths in males is significantly higher compared to females during this period.
Figure 1: Alcohol-related mortality rate per 100,000 population 2017-2019
2.3 Deaths from drug misuse The overall number of deaths from drug misuse per 100,000 population has continued to reduce from 2015 to 2019. However, the number of deaths in males is significantly higher compared to females during this period and there is a slight downward trend in female deaths.
Figure 2: Deaths from drug misuse, rate per 100,000, rolling 3 year trends (2015 – 2019)
46.841.2 41.2
69.8
61.5
69.8
26.722.7 22.6
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2.4 Deaths from drug misuse The chart below shows the overall reduction in drug deaths from 2015 to 2019.
Figure 3: Deaths from drug misuse, rate per 100,000, rolling 3 year trends (2015-2019)
2.5 Drug Arrest Referral Scheme (DARS)
The DARS programme allows those arrested for possession of a small quantity of a substance for personal use, and who have no previous drug-related convictions to be cautioned with no further action taken if they complete the drug education programme. The number of people entered onto the DARS programme from 2015 to 2019 has increased year on year. However, during 2019-2020 there was a 15% drop in entrants, nevertheless there was a consistant level of passes. From 2017-2018 to 2018-2019 the number of under 18 years joining the programme increased compared to a decrease in 2019-2020 as shown in figure.
8.7 8.4
6.5
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2015-2017 2016-2018 2017-2019
Rate
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10
Figure 4: Drug arrest referral scheme (DARS)
The table below shows the number of entrants to DARS and the primary drug they were arrested for. Table 2: Number of entrants to DARS
Primary Drug Arrested For:
2017-2018 2018-2019 2019-2020
Cocaine 14 16 16
Ecstasy 6 6 4
Amphetamine 1 1 0
Cannabis 109 148 127
Heroin 1 2 0
Prescription Medication 5 10 8
Total 136 183 155
Source: Drug arrest referral scheme (DARS)
106122 111
30
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2017-2018 2018-2019 2019-2020
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2.6 Possession of controlled drugs by sex The graph below shows the number of people who were caught in possession of a controlled drug. The data indicates that more males have been caught in possession of a controlled drug compared to females and during 2018-2019 there was significant increase in the numbers of males caught in possession of a controlled drug. However, 2019-2020 is showing a downward trend.
Figure 5: Possession of a controlled drug by sex
2.7 Possession of controlled drugs by age The data shows that the majority of people caught in possession of controlled drugs were in the younger age groups 10-20 years and 20-30 years as shown in the graph below.
Figure 6: Possession of a controlled drug by age
298361
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2017-2018 2018-2019 2019-2020
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2.8 Driving in charge of vehicle whilst over the prescribed alcohol limit The graph below shows that in 2019-2020 there has been a slight increase in the number of people driving over the prescribed limit in comparison to 2017-2018 and 2018-2019.
Figure 7: Driving/in charge of a vehicle whilst over the prescribed limit
2.9 Driving in charge of a vehicle whilst over prescribed alcohol limit by age The table 3 shows there has been an increase in driving whilst over the prescribed limit in 2019-2020. The table indicates that those under 40 years account for 61.25% of those driving over the prescribed limit.
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2017-2018 2018-2019 2019-2020
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Table 3: Driving in charge of a vehicle whilst over prescribed limit by age
Age Range 2017-2018 2018-2019 2019-2020
10 < 20 5 6 7
20 < 30 17 13 21
30 < 40 19 23 21
40 < 50 12 12 12
50 < 60 12 10 12
60 < 70 6 9 4
70 < 80 3 0 3
Total 74 73 80
Source: DARS Referral and attendance data 2017-2020
2.10 Driving whilst unfit through drink or drugs The graph below shows that in 2019-2020 there has been a statistically significant difference in the number of arrests for driving whilst unfit through drink or drugs compared to 2017-2018 and 2018-2019. The majority of those arrested for drug driving were again in the younger age groups. However, to protect confidentiality the numbers are too low to present in a graph or table
Figure 8: Driving whilst unfit through drink or drugs
10
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2017-2018 2018-2019 2019-2020
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2.11 Drunk and disorderly by age The data indicates that the majority of people who have been arrested for drunk and disorderly behaviour are in the 20-30 years age group.
Figure 9: Drunk and disorderly by age
2.12 Drunk and incapable by age (3 year totals) The data in the graph below indicates that those under 40 years account for 67.6% of the total arrests for being drunk and incapable in the last three years.
Figure 10: Drunk and incapable by age (3 year totals)
2017-2018, 2018-2019, and 2019-2020
<10 <10 <100
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10 < 20 20 < 30 30 < 40 40 < 50 >50
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10 < 20 20 < 30 30 < 40 40 < 50 50 < 60 60 < 70
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2.13 Amount of drugs seized - Isle of Man Constabulary
The table below shows the amount of drugs seized. In 2019-2020 there was a significant increase in the amount of cocaine seized compared to 2017-2018 and 2018-2019. However, 2019-2020 recorded a decrease in the amount of ecstasy seized compared to 2017-2018 and 2018-2019. Table 4: Amount of drugs seized
Drug Unit 2017/2018 2018/2019 2019/2020
Heroin g 574 962 438
Cocaine g 1862 1295 3837
Crack Cocaine g 0 0 10
LSD tabs 0 34 5
Amphetamine g 219 5 2
Ecstasy units 688 11054 142
MDMA crystal g 165 34 40
Cannabis Resin g 66600 27311 1089
Herbal Cannabis g 14406 25775 23823
Cannabis Plant plants 79 29 6
Source: Chief Constable’s Annual Report 2019-2020
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2.14 Street value of drugs seized – Isle of Man Constabulary The table below gives the street value of the drugs seized by the constabulary over the past three years. Values are based on average price where a range exists. Table 5: Street value of drugs seized
Drug 2017/2018 2018/2019 2019/2020
£ £ £
Heroin 357,370 - 143,426 396,226 - 240,565 43,792 - 109,481
Cocaine 186,244 129,547 383,726
Crack Cocaine - - 1,299 - £3,118
LSD - 170 25
Amphetamine 3,285 - 4,380 77 - 103 27 - 36
Ecstasy 6,876 - 10,313 110,542 - 165,813 1,415 - 2,123
MDMA crystal 6,615 1,355 1,597
Cannabis Resin
380,285 155,948 6,217
Herbal Cannabis
288,121 515,505 476,469
Cannabis Plant
44,240 - 132,720 16,240 - 48,720 3,360 - 10,080
Total 973,036 - 1,152,104 1,025,610 - 1,257,726 917,927 - 992,871
Source: Chief Constable’s Annual Report 2019-2020
17
2.15 Drug Seizures – Customs and Excise The graph below specifies the drug seizures by classification. In 2019-2020 there was an upward trend in seizures of class ‘C’ drugs and psychoactive substances and a downward trend in the seizures of class ‘A’ and class ‘B’ drugs.
Figure 11: Drug seizures by classification per financial year
2.16 Total drug seizures per financial year
There was an overall steady increase in drug seizures from 2017-2018 which peaked 2018-
2019 then showed a downward trend in 2019-2020.
Figure 12: Total seizures per financial year
0
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10
12
14
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18
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2015-2016 2016-2017 2017-2018 2018-2019 2019-2020
Num
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Seiz
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Class A seizures Class B seizures
Class C seizures Psychoactive substance seizures
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2015-2016 2016-2017 2017-2018 2018-2019 2019-2020
Num
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2.17 Isle of Man Prison Data Urine drug screen result The graph below shows the results of the urine drug screen tests for February to December 2019. The results show that more benzodiazepine was detected than any other drug during this period.
Figure 13: Prison – urine drug screen result 2019 (Feb to Dec)
2.18 Percentage - illicit drug use of total receptions The graph below indicates that the percentage of prisoners at reception of whom 31% were current regular drug users, 16.9% had a current drug addiction and 14.5% were taking prescription drugs that were not prescribed by a GP.
Figure 14: Percentage of illicit drug use of total receptions 2019 (Feb–Dec)
0 20 40 60 80 100 120 140
Cocaine
THC
MTD
Morphine
Benzodiazepine
Buprenorphine
Pregabalin
Positive Test Result
31.0%
16.9%14.5%
Current regular drug use Current drug addiction Current prescription drug use(not prescribed by GP)
% o
f R
ecep
tio
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Drug Use
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2.19 DHSC Pharmacy - Needle exchange – quarterly contacts The numbers attending the needle exchange programme has remained stable. There was a noticeable dip in 2020. At this time the COVID-19 virus was declared as a pandemic and by the end of quarter four the Island was in full lockdown.
Figure 15: Needle exchange – quarterly contacts 2015 – 2020
2.20 Domestic abuse, violent crime, sexual offences On the Isle of Man, 32% of domestic incidents reported to the constabulary involved alcohol, 16% involved drugs and 8% involved drugs and alcohol.7 2.20.1 Domestic abuse
The data is from all incidents recorded on the Domestic Abuse forms, some of which have also resulted in recorded crimes. The rate per 100,000 is not comparable to England.
Table 6: Domestic abuse – rate per 100,000 population
Year Rate per 100,000 population
2017/18 6.7
2018/19 8.7
2019/20 7.4
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2015 2016 2017 2018 2019 2020
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2.20.2 Violent crime and sexual offences against a person Table 7: Violent crime – sexual offences per 100,000 population
Year Rate per 100,000 population
2016/17 0.7
2017/18 0.9
2018/19 0.8
2019/20 0.9
2018/2019 England Rate 2.5 - The Isle of Man is statistically significantly
better. No comparison available for 2019 – 2020
2.20.3 Violent crime and violence population Table 8: Violent crime – violence per 100,000 population
Year Rate per 100,000 population
2016/17 3.9
2017/18 4.3
2018/19 4.9
2019/20 6.3
2018/2019 England Rate 27.8
Isle of Man is statistically significantly better. No comparison available for 2019 – 2020.
2.21 Drug and Alcohol Team (DAT) Figure 16 refers to the number of clients referred to DAT during the three year reporting period. The data clearly shows there has been a downward trend in the number of female referrals for alcohol, drugs or both during the three year period from 2017 to 2020. In comparison, overall more males have been referred to the service for alcohol, drugs or both, during this period. However, there was a spike in male drug referrals during 2018-2019. There is significantly less male and female referrals for both drug and alcohol issues during this three year period.
21
Figure 16: DAT referrals (financial years)
2.22 Motiv8 Addiction Services – caseload overall figure The graph below specifies the caseload as an overall figure for all Motiv8 services including The Alcohol Advisory Service, Drug Aware, The Family Alcohol Service and YP@Motiv8 (young people under the age of 18).
Figure 17: Substance misuse caseload
<10<10<100
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Male Female Male Female Male Female
Alcohol Drugs Both
No
. of
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2.23 Current caseload The graph below outlines what number episode clients are currently on (more than one means that they have returned to the service for support after previously being discharged). The caseload includes all services at Motiv8. 29.6% of Motiv8 clients have had more than 1 episode.
Figure 18: Current caseload and number of episodes 30 September 2020
2.24 Successful completion of treatment The data below includes successful completion of treatment, whereby a client has been discharged as ‘treatment complete’ or ‘situation improved/resolved’ and includes both substance users and significant others/family members.
Figure 19: Successful completion of treatment
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ALCOHOL ADVISORY SERVICE (ALCOHOL)
DRUG AWARE (DRUGS)
FAMILY ALCOHOL SERVICE (ALCOHOL ANDDRUGS)
YOUNG PEOPLE @ MOTIV8 (UNDER 18SALCOHOL AND DRUGS)
2019 2018 2017
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2.25 Referrals to Motiv8 The graph below indicates the number of referrals to services over a three year period. The data shows that the majority of clients across all services attend due to their own alcohol or drug use.
Figure 20: Motiv8 referrals 2017-2018, 2018-2019, 2019-2020
2.26 Isle of Man Youth Survey 2015 and 20188
The survey provided a platform for young people to express their views and opinions about what life is like growing up on the Isle of Man in 2015 and 2018. The target audience was young people living on the Island aged 11 to 18 years. For the JSNA refresh only the questions pertaining to drugs and alcohol have been used.
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Own AlcoholUse
Sig. Other/Family
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Own Drug Use Sig. Other/Family
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Own Alcohol orDrug Use
Sig. Other
ALCOHOL ADVISORY SERVICE(ALCOHOL)
DRUG AWARE (DRUGS) FAMILY ALCOHOL SERVICE(ALCOHOL AND DRUGS)
YOUNG PEOPLE @ MOTIV8(UNDER 18S ALCOHOL AND
DRUGS)
2017/2018 2018/2019 2019/2020
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2.26.1 Alcohol
How often do you have a drink containing alcohol?
In 2015 the majority of respondents - just over 70% - indicated that they had never had a drink, with approximately 16% drinking monthly or less. In 2018 there was a slight decrease in the number who had not had a drink and a slight increase in those who were drinking monthly or less; this is not statistically significantly different.
Figure 21: How often do you have a drink containing alcohol?
In the last 3 months, how many times have you had 6 or more alcoholic drinks in a row?
Approximately 1% of respondents indicated that they had drunk more than five drinks in a row. The majority of respondents - over 80% - for 2015 and 2018 had never drunk five or more drinks in a row as shown in Figure 22.
0%
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20%
30%
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80%
Never Monthly or less 2-4 times permonth
2-3 times perweek
4+ times per week
% R
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Alcoholic Drinks2015 2018
25
Figure 22: In the last 3 months, how many times have you had 6 or
more alcoholic drinks in a row?
2.26.2 Drugs The data indicates that over 95% of respondents have never used a drug or substance to get high without knowing what it is.
Figure 23: Have you ever used a drug or substance to get high
without knowing what it was? (2018)
0%
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None 1 to 2 3 to 4 5+
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Alcoholic Drinks 2015 2018
No, I have never done this
Yes, I have done this in the last 12 months
Yes, I have done this but not in the last 12months
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
% Respondents
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2.27 Health and Lifestyle Survey 20169
The Isle of Man Health and Lifestyle Survey explored a range of issues relating to the general health of the whole population. The following graphs are taken from the alcohol and drug consumption section of the report. The graph below indicates that 41.3% of people taking part in the survey drink on two or more occasions during the week
Figure 24 : How often do you have a drink containing alcohol?
2.27.1 Binge Drinking Binge drinking is defined as women who drink more than six units in one day and men who drink more than eight units in one day. 8.2% of people on the Isle of Man fall into the category of a binge drinker.
Figure 25: Percentage of alcohol binge drinkers
0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0%
Never
Monthly or less
2-4 times a month
2-3 times a week
4 or more times a week
% Respondents
91.8%
8.2%
No Yes
27
2.27.2 Binge drinking by age Binge drinking was closely linked to age. 17% of those aged 18 to 24 years fell into this group and 13.3% of those aged 25 to 34 years. Levels of binge drinking thereafter drop steadily by age cohort.
Figure 26: Binge drinking by age
2.27.3 Response Alcohol AUDIT categories A standard way to categorise people’s drinking and the affect this might be having on them is the Alcohol Use Disorders Identification Test (AUDIT). This asks a number of set questions which are scored. Depending on the score given people are put into one of four categories which are: lower risk, increasing risk, higher risk and possible dependence. Four out of five (80.3%) of people in the Isle of Man fall into the lower risk category of drinking.
Figure 27: Response alcohol AUDIT categories
0% 10% 20% 30% 40% 50% 60% 70% 80% 90%
0-7 Low Risk
8-15 Increasing Risk
16-19 Higher Risk
>20 Dependent
% Respondents
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2.27.4 Family alcohol use
Figure 28: Percentage affected by family’s use of alcohol
Over one in five (21.5%) people said that they had been affected by the use of alcohol of someone in their family.
29.7% of those aged 18 to 24 years said that they had been affected by the use of alcohol of someone in their family. This was the highest proportion of any age cohort.
2.27.5 Drug use The graph in figure 20 indicates that of those who had used drugs (758 people): 54% had acquired the drugs from someone known to them
5% acquired their drugs from a dealer
36% had bought or been given them at someone else’s home
35% had used drugs at someone else’s home
18% had used drugs at home.
5.6%
21.5%
72.9%
Not recorded Yes No
29
Figure 29: Who or where did you get the drugs from?
2.27.6 Family drug use 7.5% had been affected by the drug use of someone in their family.
Those aged 35 to 44 years were the most likely to report that they had been affected by the drug use of someone in their family, closely followed by those aged 45 to 54 years (9.3% and 9.2% respectively).
8.1% of those aged 18 to 24 years said that they had been affected by family drug usage.
Figure 30: Have you been affected by someone in your family’s use of drugs?
0.0% 20.0% 40.0% 60.0%
A known dealer
A dealer not known to you personally
A family member
A shop
A stranger
Someone else known to you only by sight or to speak to casually
Someone else known to you (e.g. a friend, neighbour, work, colleague)
The internet
Other
Don't want to answer
Don't know
% Respondents
5.2%
7.5%
87.3%
Not recorded Yes No
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2.28 Household and Income Expenditure Survey 2018/1910
The Household Income and Expenditure Survey is the second largest survey, after
the Census, that Economic Affairs undertakes on behalf of Government. The
purpose of the survey is to better understand the income sources and expenditure
patterns of different types of households on the Isle of Man.
The detailed average weekly household expenditure for alcohol in the home is £12.75 and the breakdown of this expenditure can be seen in the graph below.
Figure 31: Average weekly household expenditure - alcohol in the home
£2.85
£6.41
£0.20
£0.84
£1.86
£0.38
£0.09£0.12
Spirits and liqueurs (brought home)
Wine from grape or other fruit (brought home)
Fortified wine, Port and Sherry, Martini(brought home)
Champagne and sparkling wines (brought home)
Beer, lager, Bitter, Ale and Guinness (brought home)
Ciders and Perry (brought home)
Alcopops (brought home)
Meal deal alcohol
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3. Review of Qualitative Information This section of the report documents the views of professionals who took part in the 1-to-1 interviews from across government and third sector agencies who have significant experience of issues relating to substance misuse. This section of the report identifies themes that are common to all agencies.
3.1 Theme: Changes seen in the last three years
Following on from the publication of the previous JSNA, professionals working across a number of agencies have seen changes in attitudes and behaviour relating to drug and alcohol misuse. 3.1.1 Drugs and alcohol A number of agencies indicated that cannabis has increasingly been normalised and has become as acceptable as drinking alcohol. It is not seen as addictive or something that you may need help for. There is a belief among some young people that there is no risk or danger in taking this drug.
“Alcohol is already a cultural norm and cannabis is becoming one”
DHSC, Social Care, Children and Families
Cannabis is classified as a class B drug, which means it is illegal to have for personal use to sell or give away. However, it appears that taking cannabis has become more acceptable across society in general.
“There has been an increase in class B seizures”.
Treasury, Customs and Excise
The Child and Adolescent Mental Health Service (CAMHS) have seen more use of ketamine amongst young people aged 16-18 years who are using this service. The service has indicated that they have seen an increase in the use of ecstasy and MDMA crystal. However, it appears that some young people may be moving to class ‘A’ drugs.
“The move to class ‘A’ drugs in this age bracket is worrying”
DHSC, CAMHS
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It has been previously perceived that drug misuse may be seen in particular sections of society, however, agencies report that there is no stereotype or demographic for substance misuse. Some agencies have indicated that they are seeing an increase in the use of Cocaine, Xanax and LSD. However, heroin use appears to be relatively stable and the numbers attending pharmacies for needle exchange and supervised methadone consumption has remained steady. Furthermore, the use of the needle exchange for those injecting anabolic steroids suggests that this is a largely unaddressed problem. It appears that some people are purchasing drugs online; although this may be a cheaper and easier option, there is no quality control, and no way of knowing what the drugs have been cut with. 3.1.2 Misuse of prescription drugs
The majority of agencies taking part in this study have indicated that there is an issue with the misuse of prescription drugs such as benzodiazepines and pregabalin sourced both online and as a result of the diversion of prescribed medication.
“Starting sedatives such as benzodiazepines in young people can affect normal
neurodevelopment, leading to lifelong difficulties managing anxieties”.
DHSC, Drug and Alcohol Team (DAT) 3.1.3 Alcohol misuse
With regard to alcohol, it appears that pre-loading and drinking alcohol before going out has become the ‘norm’ across all age groups, and as a result people are going out later and drinking more. It looks likely that some people are pre-loading with alcohol and when out, use drugs instead of buying alcohol as this is a much ‘cheaper’ option. Binge drinking is still a problem the police see regularly, particularly amongst young people.
“Binge drinking is still a problem with young people, and vodka is the drink of choice”
Isle of Man Constabulary
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It appears that some people use a ‘cocktail of substances’ such as prescription medication, illegal drugs and alcohol with some agencies reporting that polydrug use in young people is common. Information received suggests that alcohol is not as popular with some young people whose preference is to use drugs. Nevertheless, some agencies have indicated an increase in referrals for alcohol- related issues (adults) as shown by the comments below.
“May as well spend money on Class ‘A’ drugs rather than alcohol”
DHSC, CAMHS
“Alcohol referrals have steadily increased”
Motiv8
The Emergency Department (ED) see approximately two attendances a day due to alcohol-related issues and two attendances a day for injuries related to alcohol consumption.
“There continues to be a seasonal pattern in attendances to ED relating to substance misuse, for example, a ‘spike’ over the festive period
and the August 2020 four day bank holiday”
DHSC, ED
“The majority of attendances to ED related to substance misuse are linked to alcohol”
DHSC, ED
3.2 Substance misuse and risk-taking behaviour Risks are often taken when: Under the influence (although not always), monetary gains, being under
pressure and in debt to their dealers
Sometimes the only way to pay their debt is to carry drugs to the Isle of Man
Substance use can be linked to long-term mental health issues.
“There is a huge connection with risk-taking and repeat offending”
DHA, Prison
3.3 Seeking help for drug and alcohol issues – Prison
Sometimes male prisoners are stigmatised amongst their own peer group when working with drug and alcohol teams Those with children who require help are often reluctant to reach out due to stigma.
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3.4 Theme: Current and emerging trends and issues
Agency representatives identified a number of current and emerging trends and issues: It appears that the role of the internet including the use of popular social media
sites may be a way of sourcing drugs for Island residents
There appears to be an increase in violent crime associated with intoxication
An indication that prescribed drugs are being misused
There appears to be an increase in older people (60 years +) with alcohol issues
Indications of increased violence often caused by drug debt
Some young people may be moving to class ‘A’ drugs
Drugs are easily available and recreational use can be high
It appears that cannabis is widely used
Possible increase in self-harm among young people
Lifestyle impact, such as a breakdown in the family
People falling through the gaps with dual diagnosis or comorbidities.
3.5 Theme: Significant threat to safety of the Isle of Man in relation to substance misuse Agency representatives highlighted a number of issues that may be a threat to safety on the Isle of Man in relation to substance misuse. These concerns have been grouped under appropriate headings: 3.5.1 Drug Misuse
The quality of drugs, and what they are cut with before they are sent to the Island.
The changing levels of purity that may increase the risk of an overdose
It appears that drug accessibility and affordability are within reach of some
adolescents
The use of stimulants such as cocaine and methamphetamine
The perceived normalisation of drug use, particularly cannabis
Drug use in adolescents may lead to chronic addictions where crime may follow
Appears acceptable by some to take medication that was prescribed to someone
else
Long-term use of addictive prescription drugs such as benzodiazepines and pain medication
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The purchasing of prescription medicines online has shown a steady increase in the last few years.
“People are buying prescription medicine online from India where hygiene and content are not known”
Treasury, Customs and Excise
3.5.2 Drug dealing, drug debt and associated issues
It appears that drug debt enforcement is becoming increasingly violent and this
may include threats to the home, family, use of weapons such as knives, baseball bats and more recently firearms
An increase in the seizure of offensive weapons
The possibility of criminal gangs travelling to the Island
Indications that children, adults, drug users or people generally who need money are being used as ‘mules’ both to bring drugs in and take the proceeds out.
Children often used as dealers to other children
Some dealers are paid in drugs, fostering dependence
Concerns around the lack of capacity regarding exploitation issues and lack of legislation
“If the Isle of Man was not a separate nation then this
would be a ‘county lines’ situation”.
Isle of Man Constabulary
3.5.3 Mental health and wellbeing
There appears to be a lack of provision and capacity in some support services which means presentations are medicalised, which may result in inappropriate prescriptions that may be difficult to stop or reduce
Mental ill health problems that may be driven by substance misuse, or mental health issues causing the use of substances
Substance misuse can be heavily linked to long-term mental health implications that may resonate for years down the line
Perceived increase in the number of drug-induced psychosis
Lack of appropriate shared care agreements in place
The perceived high risk of domestic abuse linked to substance misuse.
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3.5.4 Border control The lack of identification required for people travelling via the sea ports, may be an easy gateway for drug dealing. It is perceived that the borders could be ‘tighter’ to reduce the number of drugs coming to the Island via this route.
3.6 Connection between substance misuse, risk-taking, violence and criminal activity There appears to be direct and indirect links between substance misuse and criminal activity, whether this is around behaviour to fund habits or risk-taking.
“There is a huge connection with risk-taking and repeat offending”
DHA, Prison
Feedback suggests there are a number of reasons why people take risks in relation to drug misuse. For example, due to the pressure of being in debt to their dealers or for monetary gain. It appears that sometimes the only way to pay their debt is to carry drugs to the Isle of Man. There are indications that some dealers may prey on the vulnerable.
“Service users are all vulnerable.”
St Christopher’s Aftercare
There appears to be a younger cohort dealing drugs and there are indications of exploitation, for example, vulnerable children such as those leaving care may be targeted and some young people may have incurred significant drug debts.
“Young people think they are part of a gang and don’t realise they are being exploited.”
DHSC, Adult Social Care Substance misuse can be linked to assaults and injuries.
“Stimulants such as benzodiazepine and cocaine taken with alcohol can increase incidents of violence”
DHSC, ED
The majority of people attending ED relating to violence and/or substance misuse are brought to ED by the police and are not a self-referral. ED see the end result to violence linked to substance misuse.
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3.7 Theme: Domestic abuse and sexual assault There is a strong relationship between alcohol and domestic abuse, violence and sexual assault. Whilst alcohol should not be used as an excuse for those who perpetrate violence and abuse, neither should its influence be ignored.4
“There is a high risk of domestic abuse when there is drug and alcohol misuse”.
Victim Support
It appears that rape and sexual assault is often carried out by someone known to the victim and if they have been drinking or under the influence of drugs, this may become more prevalent. In relation to controlling behaviour, it appears that alcohol may be used by some people to control an individual who has alcohol dependency issues. Furthermore, the generational use of alcohol could be considered a ‘big’ issue and sexual abuse can be linked to this. The misuse of alcohol by parents/guardians may link to domestic abuse and safeguarding issues.
3.8 Theme: Multi-agency working
The majority of agencies reported that they did work collaboratively, however, this was dependent on the type of work and need, for example, for the ‘good’ of service users or to share information and data. Whilst there were some good examples of collaborative working there were also some barriers to overcome.
“We work really well with most agencies and have good links in place”
Motiv8
“Information sharing and referrals could be improved both ways”
Crossroads
“Good joint working happens when service users request support and Graih link with the services”
Graih
“Work with a number of agencies who deliver educational sessions to pupils and deliver staff training”
DESC, Advisor
“Working with other agencies can come down to professionals,
individuals and not always service led”
DHSC, Social Care, Childrens and Families
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“Multi-agency working has been very successful with DAT and mental health provision is much improved compared to three years ago”
DHA, Prison
There needs to be a greater emphasis on the duty to share information in order to treat people holistically. It appears that data protection is sometimes used as a means not to engage. It has been suggested that all strategies should be interconnected to reflect the overlapping issues across all agencies.
“Different agencies should be able to sit around a table and share what information they have in order to build a complete picture, whilst maintaining confidentiality.”
Isle of Man Constabulary
3.9 Theme: Improvement to services to tackle substance misuse issues Professionals suggested a range of improvements to services across government and third sector agencies. For example, improving capacity in areas that are understaffed, improved legislation and statutory frameworks to support a range of wider issues associated with drug and alcohol misuse. For more information refer to Appendix 1.
4. Discussion
4.1 Quantitative Feedback Summary 4.1.2 Data (update) In 2017, the JSNA highlighted that there was a lack of formal quantifiable data sources. This was considered a major evidence/intelligence gap. In 2020 there is much improvement with an increase in data analysts across government. There is still some way to go in getting all agencies to provide robust data for analysis. 4.1.3 Alcohol and drug-related mortality The data indicates that there are more male deaths related to alcohol misuse compared to females during the three year period (2017-2019). However, the overall trend in drug-related deaths continues to decrease. 4.1.4 Criminal justice and offending The data confirms that substance misuse is strongly associated with many crimes including possession of controlled drugs, driving whilst unfit through drink and drugs, drunk and disorderly, domestic abuse, violent crime and sexual assault. The majority of people caught in possession of a controlled drug were male, and the 30 years and under age groups account for the majority of people caught in possession of a controlled drug from 2017 to 2020.
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In 2019-2020 the number of people driving whilst over the prescribed alcohol limit increased. Those aged 40 and under account for 61.25% of people who committed this offence. There was a significant increase in drug driving during this period. Those aged between 20 and 30 years account for the majority of drunk and disorderly offences and those under 40 years account for 67.6% of the total arrests for being drunk and incapable. Data from the information recorded on the domestic abuse forms indicates that 2018-2019 had a rate of 8.7 per 100,000 and in 2019-2020 that rate had reduced to 7.4. Violent crime and sexual offences per 100,000 population has slightly increased to 0.9, however, the Isle of Man is statistically significantly better than the 2018-2019 England rate of 2.5. Violent crime and violent offences has seen a significant increase in 2019-2020, however, this was statistically significantly better than the 2018-2019 England rate of 27.8. 4.1.5 Drug seizures Isle of Man Constabulary and Customs and Excise undertake drug seizures across the Island based on intelligence. During the three year accounting period from 2017 to 2020 a large amount of drugs have been seized on Island, and the value of the drugs seized is around one million pounds per year. The type of drug seized and the amount varies year on year. However, during 2019 -2020, there was an increase in seizures of cocaine, a decrease in ecstasy and the first seizure of crack cocaine for a number of years. 4.1.6 Prescription drugs The urine drug screen results at the prison indicated the benzodiazepine was detected more than any other drug and it appears that some professionals are seeing an increase in the use of pregabalin in the community.
“There is an increase in the use of pregabalin in the community that has caused real concern amongst GPs and community pharmacies.”
Pharmacy Advisor
4.1.7 Services The majority of clients presenting to DAT are male. The majority of referrals (male and female) to the service are for either drug or alcohol dependency compared to clients referred for both drug and alcohol dependency. From 2018 to 2020 Motiv8 has had a caseload of around 600 across all their services. The majority of clients attend due to their own drug and alcohol use. 29.6% of clients have had more than one episode.
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4.1.8 Isle of Man Youth Survey 2015 and 2018 Reponses from the two youth surveys indicated that the majority of young people (around 70%) had never had an alcoholic drink and over 80% of young people had never drunk five or more drinks in a row. In relation to drugs, approximately 1% of respondents had used a drug or substance without knowing what it was, however, the majority of respondents had never done this.
4.1.9 Health and Lifestyle Survey 2016 The results of the health and lifestyle survey indicated that over 40% of respondents drank on two or more occasions a week. Just over 8% fall into the category of a binge drinker. The majority of those in the category of binge drinker were 34 years and younger. Around 80% of respondents fell into the lower risk category of drinking. Overall 21% indicated that they had been affected by family members drinking, and this was around 30% in the 18-24 years age group. Around 54% of respondents acquired their drugs from someone they knew. The most popular place to purchase, be given or take drugs was in someone else’s home. Some respondents were affected by a family member’s drug taking and this spanned across the age groups from 18-54 years. 4.10 Household and income expenditure survey This survey indicated that the average weekly household spend on alcohol was £12.73.
4.2 Qualitative Summary Since the publication of the JSNA in 2017 professionals have reported a number of changes in perceptions, attitudes and behaviour towards drug and alcohol use and is as follows: The perceived normalisation of cannabis and how this appears to have become
as acceptable as drinking alcohol.
Increase in the use of cocaine, Xanax, LSD, Ecstasy and MDMA crystal. However, heroin appears to be stable at this time. This information is substantiated by the Police drug seizure data.
Concerns across agencies about the misuse of prescription drugs and in particular benzodiazepines. This is substantiated by the upward trend in Class C seizures as shown in the data supplied by Customs and Excise and the Prison.
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In relation to the current and emerging trends, and threats to the safety regarding substance misuse, many issues raised by those taking part in the interviews are substantiated by the data, and the Chief Constable’s annual report, for example, the increase in violence caused by drug debt, increase in the use of weapons, exploitation and the direct and indirect links between substance misuse and criminal activity. Some agencies voiced concerns around border control and the lack of identification required at the sea ports and would support tighter restrictions. In the 2017 JSNA it was documented that there were strong links between drug and alcohol misuse, domestic abuse and sexual assault this is still relevant in 2020. There are concerns about the lack of provision and capacity in some agencies and the mental ill health problems that may be driven by substance misuse and the wider determinants of health. The majority of agencies do work collaboratively across government agencies and third sector organisations and this works well. However, there are some barriers to overcome such as sharing information in order to treat people holistically.
5. Unmet needs and service gaps The 2017 JSNA highlighted a number of unmet needs and service gaps and they are still relevant in 2020. For example:
Need for improvement in systems for data collection A lack of formal pathways for substance misuse Commission alcohol intervention and brief advice (IBA) within health settings.
Unmet needs and service gaps that have been identified during the 1-to-1 interviews are as follows: Drug and alcohol education does not just sit with schools; it should be
community-wide education
Earlier more preventative work required, needs to be greater emphasis on the
duty to share information to treat people holistically
Lack of nurse/s who specialise in alcohol issues working in ED on a daily basis to see and follow patients on the wards through to discharge
Lack of capacity in DAT and CAMHS leading to longer waiting times
There is not enough availability of rural housing on-Island to rehouse someone away from their issues
Need to find out what are the socio-economic roots of the problems that blight these lives of the homeless.
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6. Conclusions The findings from this JSNA refresh has highlighted a number of emerging trends, threats and issues. These have been substantiated by the data, the Chief Constable’s annual report 2019-2020, Director of Public Health annual report 2019 and the qualitative information from the professionals who took part in the 1-to-1 interviews. Taking into consideration the evidence and the wider social determinants of health that may impact on those with substance misuse issues, a holistic approach should be considered to address the emerging issues of concern.
7. Options The following options are for discussion with the Substance Misuse Steering Group.
Continue to work with agencies to improve the quality of robust data for analysis
Improve appropriate information sharing across agencies
Develop improved governance mechanisms to hold to account and prioritise key issues across the wider substance misuse agenda
Develop a collaborative approach to tackle drug dealing, violence and other issues associated with ‘county lines’, including the threat arising from the Island’s borders.
Work in partnership with agencies (government and third sector) to tackle substance misuse issues associated with the wider social determinants of health
Continue to investigate the ‘causes of the causes’ in relation to substance misuse issues (e.g. ACE’s, domestic abuse, violence, and sexual assault) and develop a multi-agency action plan.
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Appendices
44
Appendix 1: Improvement to services to tackle substance misuse issues
The majority of representatives highlighted areas for improvement and gaps in services and are as follows:
DHA Police
All strategies to be interconnected to reflect overlapping issues (domestic abuse
etc.)
DHA Prison
Low level offending, could this be dealt with in the community (tagging etc.).
This is a wider discussion to be had with the courts and police
The Isle of Man, Jersey and Guernsey are unique in what we have to offer with
the justice system, ‘front end and back end’.
Treasury Customs and Excise
Look at the different methods used to import drugs to the Island, their countries
of origin.
DHSC Emergency Department (ED)
ED meets the acute healthcare needs (drugs and alcohol) but does not provide
holistic comprehensive care.
DHSC Pharmacy
Using pharmacist in DAT, good evidence-based examples in the UK, currently
testing the model, and if it works, require a business case and resources
Consider, senior doctors delegating monitoring of and reviewing patients to other professionals, then they only need to see the complex/new patients
Pharmacists on the ‘difficult to recruit list’.
DHSC Social Care Children and Families
Consider commissioning specialist psychological assessments from off-Island to
undertake assessments of parents with substance misuse issues to see if they have the capacity to change and the support required
Consider special psychological assessments on-Island and routine drug testing
A pathway or preventative strategy for adverse childhood experiences (ACE) and
a shared children’s strategy.
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DHSC Adult Social Care
Professionals trained in motivational interviewing who are discussing substance misuse support referrals with individuals
Need to collect data on substance misuse as a primary indicator to understand current and future demands
Older population increasing, a review of resources required
Need to be adaptable to changing addictions using multi-faceted approach (prevention and reaction).
DHSC Drug and Alcohol Team
Roll out the ‘take home’ naloxone programme following on from the successful pilot scheme
Bill to amend the Prescription Only Medicines (Human Use) is going before Tynwald in 2020
DAT operating with a deficit of four staff, new referrals on a waiting list (high risk situation).
DHSC CAMHS
CAMHS is understaffed as a resource
Long waiting lists (not specific to substance misuse)
Treatment waiting lists not moving (not specific to substance misuse)
Try to refer to Motiv8 and DAT to get things moving (substance misuse).
Motiv8
Contract for Motiv8 has not been formalised yet; the old contract expired in
2018, and currently exists on a financial directive (FD8) waiver
Planning difficult without budget, currently uncertainty around funding
More psychological packages or care, and more group work
Introducing a Cognitive Behavioural Therapy (CBT) programme, a motivational interview programme, a harm reduction pathway, and a new mentoring project.
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Crossroads
Crossroads aware they have a big waiting list. The organisation is growing to meet the demand but this is impacted by funding available
Some members of the public will wait until crisis point until they ask for help. Crossroads monitor referrals closely.
Housing Matters
Drug and alcohol services responding to need – more accessibility and more workers needed
Consideration should be given to free bus journeys for anyone with a mi-card
Have an outreach support worker for mental health. It would be great to have an outreach worker for drug and alcohol.
Victim Support
Applied for funding from the lottery for a specific person to deal with domestic
abuse
Statistics indicate that victims of domestic abuse would have talked to their GPs but the GPs aren’t able to pass this information forward.
St Christopher’s Aftercare
Service users signposted to substance misuse services
Policy change needed as not working for drugs and alcohol
Prison is at the tax payers’ expense and prison is not always the answer.
Graih
Is like an emergency treatment, provide basic shelter and food and send them
back out
Financial situation fluctuates, currently have funding until Summer 2021
Unstable funding - difficult to plan ahead
Statutory framework and legislation needed to support – all feels chaotic and fragile
No supported living on-Island – where support workers help people with wider issues.
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Appendix 2: Classification of Drugs
Class A Crack cocaine, cocaine, ecstasy (MDMA), heroin, LSD, magic mushrooms, methadone, methamphetamine (crystal meth)
Class B Amphetamines, barbiturates, cannabis, codeine, ketamine, methylphenidate (Ritalin), synthetic cannabinoids, synthetic cathinones (for example mephedrone, methoxetamine)
Class C Anabolic steroids, benzodiazepines (diazepam), gamma hydroxybutyrate (GHB), gamma-butyrolactone (GBL), piperazines (BZP), khat
Source: https://www.gov.uk/penalties-drug-possession-dealing
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Qualitative Study – participants
Government Department and Divisions
DESC Education Advisor
DHA Isle of Man Constabulary
DHA Isle of Man Prison
Treasury Customs and Excise
DHSC Emergency Department, Noble’s Hospital
DHSC Pharmacy
DHSC Social Care, Children and Families
DHSC Adult Social Care
DHSC Drug and Alcohol Team (DAT)
DHSC Child and Adolescent Mental Health Service (CAMHS)
Third Sector Organisations Motiv8 Addiction Services
Crossroads
Housing Matters
Victim Support
St Christopher’s Aftercare
Graih
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References
1. The Centre for Public Innovation (2017) Joint Strategic Needs Assessment on Drugs and Alcohol https://www.gov.im/media/1360642/20180226-isle-of-man-drug-and-alcohol-jsna.pdf accessed 28.10.2020
2. Isle of Man Government (2018-2023) Substance Misuse Strategy
https://www.gov.im/media/1360859/substance-misuse-strategy.pdf accessed 28.10.2020 3. Public Health England (2016) The Public Health Burden of Alcohol and the Effectiveness
and Cost-Effectiveness of Alcohol Control Policies – An evidence review https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/fil
e/733108/alcohol_public_health_burden_evidence_review_update_2018.pdf accessed 28.10.2020
4. Institute of Alcohol Studies (2014) Alcohol, Domestic Abuse and Sexual Assault
http://www.ias.org.uk/uploads/IAS%20report%20Alcohol%20domestic%20abuse%20and%20sex
ual%20assault.pdf accessed 26.10.20 5. The Department of Home Affairs (2019-2020) Chief Constable’s Annual Report
https://www.tynwald.org.im/business/opqp/sittings/20182021/2020-GD-0020.pdf accessed 28.10.2020
6. Public Health Directorate (2019) Director of Public Health Annual Report, The Isle of
Man: An Equal Society? https://www.gov.im/media/1367077/director-of-public-health-annual-report-2019.pdf accessed 28.10.2020
7. Department of Home Affairs, IOM Constabulary (2018) Analytical report, The role of the
Misuse of Substances in Domestic and Sexual Abuse 8. Youth Trust (2015 & 2018) Isle of Man Youth Survey https://youthtrust.im/docs/2018-ys-
summary-web.pdf https://www.gov.im/media/1350837/youth-survey-results.pdf accessed 28.10.2020
9. The Centre for Public Innovation (2016) Isle of Man Health and Lifestyle Survey
https://www.gov.im/media/1360860/20180208-iom-lifestyle-survey-2016-report-vfinal.pdf accessed 28.10.2020
10. Isle of Man Government (2018-2019) Household Income and Expenditure Survey
https://www.gov.im/media/1367701/isle-of-man-household-income-and-expenditure-survey-
2018-19-161219.pdf accessed 28.10.2020
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Acknowledgements
Thank you to all those within the Public Health Directorate, Government Departments and Third Sector Organisations who have facilitated and taken part in qualitative interviews.
Cabinet Office, Public Health Directorate
Cronk Coar, Nobles Hospital Strang, Douglas,
Isle of Man IM4 4RJ.
Tel: +44 1624 642639
www.gov.im/publ ichea lth @publ ichea lthiom
Ref: D&A 20 05/21
This document can be provided in large print or in audio format on request