northern ireland substitute prescribing database report ... from... · substitute prescribing...

Northern Ireland Substitute Prescribing Database Report

31st March 2014

2

Contents Summary ............................................................................................................................................. 3

Summary of Activity 2010-2014.......................................................................................................... 5

All activity during 2013/14 .................................................................................................................. 6

Census as of 31 March 2014 ............................................................................................................... 6

Time in Treatment ............................................................................................................................ 10

Main Problem Drug ........................................................................................................................... 11

Substitute Medication....................................................................................................................... 12

Prescribing Responsibility ................................................................................................................. 13

Patient Improvement ........................................................................................................................ 14

Stabilisation ....................................................................................................................................... 14

Heroin usage at Initiation of Treatment and at Review closest to 31st March 2014 ........................ 14

Continuing Drug Usage ..................................................................................................................... 15

Injecting Behaviour at Initiation of Latest Treatment and at Review closest to 31st March 2014 ... 16

Missed Appointments ....................................................................................................................... 17

Salivary/Urinalysis Testing by Health & Social Care Trust ................................................................ 17

Viral Testing during Treatment ......................................................................................................... 18

Personal Living Arrangements .......................................................................................................... 19

Discontinuation from Substitute Prescribing Services ...................................................................... 20

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Statistics from the Northern Ireland Substitute Prescribing Database:

31 March 2014

This bulletin summarises information on individuals referred to the Northern Ireland Substitute Prescribing Scheme (SPS). It relates to those referred up to and including the 31 March 2014 and focuses on those patients in contact with Substitute Prescribing treatment services during 2013/14. The figures produced in this report are extracted from the Substitute Prescribing Database held by the Health & Social Care Board (HSCB), Performance Management & Service Improvement Directorate in County Hall, Ballymena. It collects detailed data, including information on drugs misused and injecting behaviour on these individuals at various stages throughout their course of Substitute Prescribing treatment. This is the seventh such report produced since 2004, and the second produced since responsibility for managing the database was delegated to the HSCB from the Department of Health, Social Services and Public Safety in 2010.

Summary 687 individuals were in treatment across Northern Ireland as of 31st March 2014.

822 patients in total received substitute prescribing treatment in 2013/14. This was a 9%

increase on the previous year.

The NHSCT continues to have the highest number of patients at 252 (37%), followed by

BHSCT at 154 (22%)

There were 167 initiations onto the scheme in 2013/14. This compares with 175 initiations in

2012/13

112 patients discontinued from treatment in 2013/14, compared with 119 the previous year.

Of these 112 42% underwent “managed discontinuation”.

39% of patients have been in treatment for 5 or more years, up slightly from 37% in 2012/13

48% of patients were prescribed Buprenorphine while 46% were prescribed Methadone.

The Database relies on the timely and accurate submission of forms from the Community Addiction Agencies. Each Health & Social Care Trust provides a Substitute Prescribing Treatment Service and the location of each Agency can be seen in Figure 1 below:

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In addition to the Trust based services 32 GP practices have a Northern Ireland Locally

Enhanced Service (LES) contract. This means at least one GP in the practice is trained to

prescribe substitute medications on a shared-care basis with community based trust

services. There are 14 GP practices in Belfast LCG area providing this LES, 15 practices in

Northern LCG are and 3 in South-Eastern LCG area.

Prescriptions from both secondary care and primary care are dispensed and supervised in

community pharmacies. In 2013/14 the service was provided by 117 pharmacies across

Northern Ireland, which represents 22% of all pharmacies.

To maintain confidentiality the figures in this report are based on the Health & Social Care

Trust area where people presented for treatment, not their place of residence.

Ballymena

Omagh

Antrim

Newtownabbey

Craigavon

Moyle

Community Addiction Team, Ballymena

Woodlea House, L'Derry

Addiction Treatment Unit, OmaghND & A Community Addiction Services, N'Ards

Belfast HHSST SP Team, Belfast

Ards

Armagh

Ballymoney

Banbridge

Belfast

Carrickfergus

Castlereagh

Coleraine

Cookstown

Derry

Down

Dungannon

Fermanagh

Larne

Limavady

Lisburn

Magherafelt

Newry and Mourne

North Down

Strabane

Ward 15, Downshire Hospital, DownpatrickAddiction Services, St. Luke's, Armagh

Figure 1: Location of Substitute Prescribing Treatment Agencies

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Summary of Activity 2010-2014 Figure 2 shows the total number of patients receiving Substitute Prescribing treatment during each

year and at the Census date each year, 31st March 2014. Data shows the continual increase in

numbers of patients being treated.

Figure 3 shows that over the past four years each Health & Social Care Trust has reported an increasing number of patients receiving Substitute Prescribing Treatment.

639

720

755

822

552

627

648

687

300

400

500

600

700

800

900

2010/11 2011/12 2012/13 2013/14

Figure 2: Total Number of Patients receiving Substitute Treatment during the years between 1st April 2010 and 31st March 2014 also showing the Census of Patients at 31st March each year

Total Patients seen during year Census of Patients at 31st March each year

150 149160

181192

246253

271 272

290

66

78 82 85

97

42

74

118113

131

72

85 89

104112

0

50

100

150

200

250

300

350

2009/10 2010/11 2011/12 2012/13 2013/14

Figure 3: Total Patients receiving Substitute Prescribing Treatment Services during years 2009/10; 2010/11; 2011/12; 2012/13 & 2013/14 by Initiating Health & Social Care Trust

Belfast Northern South-Eastern Southern Western

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All activity during 2013/14:

A total of 822 individuals were in contact with Substitute Prescribing treatment services. There were 167 Initiations during the time period.

112 patients discontinued from the scheme. “Managed discontinuation” accounted for 47 patients leaving the scheme, with “unmanaged discontinuation of SP” and “failing to present for SP” accounting for a further 25 and 16 patients respectively.

45 patients transferred between NI trusts in 2013/14 and 13 continued their treatment outside NI.

5 patients were recorded as deceased during the reporting period.

Census as of 31 March 2014:

On the 31st March 2014 in total 687 individuals were receiving substitute medication. 563 (82%) of those patients were reported as stabilised. 266 (39%) of patients were in treatment for 5 or more years.

46% of patients were in receipt of methadone and 48% buprenorphine, the remainder classed as “other” or “unknown”. There is considerable variation between Trusts with 66% of patients receiving methadone in BHSCT area compared to 13% in WHSCT area.

Table 1 shows that during the year between 1st April 2013 and 31st March 2014 the five

Health & Social Care Trusts treated 822 patients in Substitute Prescribing Treatment

Services.

Table 1: Total patients who received Substitute Prescribing Treatment by Trust between 1st April 2013 and 31st March 2014

Health & Social Care Trust Area

Patients in SP Treatment

Percentage Trust

Population

Patients per 100,000

population

Belfast 192 23% 349618 55

Northern 290 35% 466724 62

South Eastern 97 12% 350788 28

Southern 131 16% 365712 36

Western 112 14% 296883 38

Total 822 100% 1829725 45 Population Source: (NISRA, Mid-2013 Population).

The figures are based on where people presented for treatment not their place of residence and are calculated as the incidence of treatment per 100,000 HSCT population. The figures range from 62 patients per 100,000 population in the Northern Trust to 28 patients per 100,000 population in the South Eastern Trust.

Table 2 shows the number of patients who commenced Substitute Prescribing treatment between 1st April 2013 and 31st March 2014 and also the number who discontinued during

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the year. It also shows the number of patients receiving Substitute Prescribing Treatment as at 31st March 2014.

Table 2: Number of Initiations and Discontinuations between 1st April 2013 and 31st March 2014. Also Number in Substitute Prescribing Treatment Services at 31st March 2014

Patients Belfast Northern South-Eastern

Southern Western Prison Total

Initiations 49 49 16 21 29 3 167

Discontinued Treatment During Year

31 24 10 11 35 1 112

In treatment as at 31/3/2014

154 252 79 112 70 20 687

The initiations can be categorised as follows:

New patient (new to the Service, never previously treated in NI);

Recommenced (patients had stopped receiving treatment, then restarted within 3 months);

Returned (patients had received treatment in the past and had returned to the Service, this is considered a break in treatment rather than recommencing current treatment episode )

Table 3 shows the initiation type of the 167 patients who started Substitute Prescribing Treatment between 1st April 2013 and 31st March 2014.

Table 3: Initiations by Type of Initiation between 1st April 2013 and 31st March 2014

Type of Initiation Belfast Northern South-Eastern


New patient 33 21 11 17 18 3 103

Recommenced (<3 months)

2 10 2 2 1 0 17

Returned (>3 months)

14 16 3 4 10 0 47

Total 49 47 16 23 29 3 167

Table 4 shows in time bands the 47 patients who returned to the Substitute Prescribing Service after earlier treatment. 19 returned within 1 year; 8 returned within 1-2 years; 11 within 2-3 years and 9 within 3-6 years of discontinuing from the Service.

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Table 4: Returning Patients - Length of Time between discontinuing & returning to the Substitute Prescribing Service

Length of Time between discontinuing &

returning Belfast Northern

South-Eastern

Southern Western Prison Grand Total

3 mths - 1 year 8 6 1 2 2 0 19

1 - 2 years 2 2 1 1 2 0 8

2 - 3 years 3 5 1 0 2 0 11

3 - 6 years 1 3 0 1 4 0 9

Grand Total 14 16 3 4 10 0 47

Figure 4 shows the breakdown by gender and age-band, the 167 new patients who started

to receive Substitute Prescribing Treatment Services between 1st April 2013 and 31st March

2014. The highest percentage (29%) was in the 30-34 age-band and the lowest percentage

was in the 45+ age-band (7%).

Since May 2013 data has been collected from the Prison Addiction Team. Previously, data in reports would have appeared to show that treatment discontinued on entering prison and was initiated again on release; this will now correctly show continuing treatment and any initiations in prison.

At 31st March 2014, 687 people were receiving Substitute Prescribing treatment services.

Table 4 shows the split by gender and location of treatment. The proportion of females and

males is shown with the highest percentage being males (73%). The highest percentage of

3% 5%

8% 9%

1% 2%

7%

15%

21%

16%

9%

5%

0%

5%

10%

15%

20%

25%

18-25 26-29 30-34 35-39 40-44 45+

Pe

rce

nta

ge

Age-Band

Figure 4: Substitute Prescribing Treatment Services Patient Initiations (167) between 1st April 2013 and 31st March 2014

by Gender and by Age-Band

Females as a % of Initiations Males as a % of Initiations

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males is within Southern Trust (78%) and the highest percentage of females accessing the

service is in the Western Trust (36%).

Table 4: All Patients receiving Substitute Prescribing Treatment Services at 31st March

2014 by Gender

Gender Belfast Northern South-Eastern


Female 45 (29%) 66 (26%) 23 (29%) 25 (22%) 25 (36%) 0 (0%) 184 (27%)

Male 109 (71%) 186 (74%) 56 (71%) 87 (78%) 45 (64%) 20 (100%) 503 (73%)

Total 154

(100%) 252

(100%) 79 (100%) 112

(100%) 70 (100%) 20 (100%) 687

(100%)

Figure 5 below shows the 687 patients by age-band. The majority of patients both male and

female receiving the service (23%) are in the 35-39 age-band. The lowest percentage of

patients (5%) was in the youngest age-band, 18-25. The youngest person accessing the

service at 31st March 2014 was 19 and the oldest was 66.

2% 3%

6% 7%

4% 4% 3%

9%

16% 16% 18%

12%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

18-25 26-29 30-34 35-39 40-44 45+

Pe

rce

nta

ge

Age-Band

Figure 5: All Patients (687) receiving Substitute Prescribing Treatment Services at 31st March 2014

by Gender and by Age-Band

Females as a % of Total Males as a % of Total

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Time in Treatment

Table 5 and Figure 6 illustrate the length of time patients were in treatment patients at 31st March

2014.

Table 5: All Patients receiving Substitute Prescribing Treatment services at 31st March 2014 by Length of Time in Treatment by Service

Time in treatment Belfast Northern South-Eastern


< 1 yr 36 38 10 20 18 20 142

1 year 25 27 11 18 11 0 92

2 years 12 26 9 25 5 0 77

3 years 6 16 9 24 6 0 61

4 years 12 25 3 8 3 0 51

5 years or more 63 120 37 17 27 0 264

All Patients 154 252 79 112 70 20 687

Of the number of patients receiving treatment South-Eastern Trust had the highest percentage

(46%) in treatment for more than 5 years while Northern Trust had (47%), Belfast Trust had (41%),

Western Trust had (39%) and Southern Trust had the lowest percentage (15%).

0

50

100

150

200

250

300

All Patients Over 1 year Over 2 years Over 3 years Over 4 years Over 5 years

Figure 6: All Patients by Length of Time in Treatment by Health & Social Care Trust

Belfast Northern South-Eastern Southern Western Prison

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Main Problem Drug

The database records information on the main problem drug for the patient and up to four other drugs that the patient may be using; these drugs do not have to be opiates. Figure 7 shows the main problem drug used by new patients to the service between 1st April 2013 and 31st March 2014. The chart shows that the main problem drug continues to be Heroin.

“Other Drugs” include (in decreasing order of popularity): Diazepam, Cannabis, Mephedrone, Methamphetamine, Crack and Benzodiazepine). There was 1 blank form and it is included in the “Other Drugs” category.

76%

55%

63%

70%

35% 33%

18%

30%

37%

22%

48%

67%

6%

15%

0%

8%

17%

0% 0%

10%

20%

30%

40%

50%

60%

70%

80%


Figure 7: Percentage of Initiations (167) to Substitute Prescribing by Main Problem Drug on Initiation by Health & Social Care Trust between 1st April 2013 & 31st March 2014

Heroin Other Drugs Other Opiates including prescription and OTC

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Substitute Medication

Figure 8 shows the Substitute Medication prescribed to the 687 patients who were in receipt of treatment (whether they had stabilised or not) as at 31st March 2014. The chart includes Substitute Medication prescribed to patients in Prison at 31st March 2014. Overall, data shows that 48% of patients received buprenorphine, 46% received methadone and 6% received treatment classified as “Other” or “not known”. This information relies on the submission of SP2 forms and in this instance 6% of SP2 forms were not submitted although some data was obtainable from the SP3 forms.

66%

47% 52%

32%

13%

50%

25%

52%

46%

62%

70%

45%

9%

1% 2% 6%

17%

5%

0%

10%

20%

30%

40%

50%

60%

70%

80%


Figure 8: All Clients receiving Substitute Prescribing Medication treatment at 31st March 2014 by their Prescribed Medication and by

Health & Social Care Trust & Prison

Methadone Buprenorphine Other + Not Known

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Prescribing Responsibility

Figure 9 illustrates that the majority, of prescribing responsibility remains with Specialist Services with 85% in the Southern Trust and 76% in the South-Eastern Trust. Northern Trust has the highest percentage of patients whose prescribing responsibility is with/shared with Primary Care (GP) (28%). For those patients in prison, prescribing responsibility remains with the Prison Addiction Team.

Although prescribing responsibility may be with the GP, the vast majority of such patients remain in a Shared Care arrangement with specialist services and roles continuing to be provided by the Trust, for example Key Worker.

69%67%

76%

85%

62%

0%

18%

28%

19%

3%

8%

0%3% 2% 1% 0%

9%

100%

10%

3% 4%

12%

21%

0%0%

20%

40%

60%

80%

100%

120%


% o

f C

lien

ts (

Tru

st)

Health & Social Care Trust & Prison

Figure 9: All Clients receiving Substitute Prescribing Treatment Services at 31st March 2014 by Prescribing Responsibility by Health & Social Care Trust & Prison

Specialist Services Primary Care (GP) Prison Addiction Team Not Known (awaiting SP2)

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Patient Improvement

Stabilisation

Table 6 shows that of the 687 patients receiving substitute medication 82% were reported as being stabilised. This data is only available on the SP2 form; there may be a degree of subjectivity with this data.

Table 6: Patients stabilised receiving Substitute Prescribing Medication at 31st March 2014 by Health & Social Care Trust & Prison

Stabilisation Belfast Northern South-Eastern Southern Western Prison Total

Yes 124 (81%) 219 (87%) 66 (81%) 81 (73%) 56 (81%) 15 (75%) 561 (82%)

No 11 (7%) 24 (9%) 8 (10%) 16 (14%) 4 (6%) 2 (10%) 65 (9%)

Not Known 18 (12%) 10 (4%) 7 (9%) 14 (13%) 9 (13%) 3 (15%) 61 (9%)

Total 153

(100%) 253

(100%) 81

(100%) 111

(100%) 69

(100%) 20

(100%) 687

(100%)

Heroin usage at Initiation of Treatment and at Review closest to 31st March

2014

Figure 10 shows the comparison of the use of Heroin as a main problem drug at the start of treatment and at latest review closest to 31st March 2014. Overall 72% of patients used heroin at the start of treatment and at last review closest to 31st March 2014, 15% were using heroin.

81%

73%

54%

83%

49%

70%

17% 17%

1%

23%

3% 0%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%


Figure 10: Percentage of Clients using Heroin at Initiation compared with those using Heroin at last review closest to

31st March 2014

Using Heroin at Initiation Using Heroin at Last Review

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Continuing Drug Usage

Figure 11 gives a more detailed breakdown of the continued drug use by patients. 33% had no problem drug recorded, 21% had recorded Cannabis as their main problem drug, 21% had a variety of “Other Drugs*” recorded while 14% recorded heroin as their main problem drug.

*Other Drugs have been categorised as other opiates/Class A drugs, Class B and C drug, “New Psychoactive Substances (NPS) prescription drugs, OTC drugs and (in decreasing order of popularity): *Diazepam, Mephedrone, Dihydrocodeine, Codeine, Benzodiazepines, Amphetamines, Cocaine, Codeine & paracetamol, Other Drugs, Morphine, Opiates – Others, Temazepam, Methedrone, Nubain, Speed (amphetamine sulpha) and Tramadol.

10%

4% 8%

10%

20%

85%

17%

46%

29% 29%

36%

15%

21% 21%

33%

19% 14%

0%

17% 17%

1%

23%

3% 0%

35%

12%

29%

19%

27%

0% 0%

10%

20%

30%

40%

50%

60%

70%

80%

90%


Figure 11: All Patients in Substitute Prescribing Treatment Service at 31st March 2014 by Main Problem Drug on Review by Health & Social

Care Trust & Prison

No SP3 received

No Problem Drugs

Cannabis

Heroin

Other Drugs

16

Injecting Behaviour at Initiation of Latest Treatment and at Review closest to

31st March 2014

A measure of patient improvement is comparing the injecting behaviour of patients at

initiation of treatment and at their latest review closest to 31st March 2014. Overall, 52% of

patients injected at initiation of treatment compared to 10% at last review. Figure 12

compares this with their injecting behaviour at last review closest to 31st March 2014.

Overall there was an 81% reduction in the number who were injecting at start of treatment

with Substitute Prescribing Services.

66%

47%

41%

54%

41%

60%

15% 10%

0%

13%

4% 0%

0%

10%

20%

30%

40%

50%

60%

70%


Pe

rce

nta

ge o

f P

atie

nts

Health & Socical Care Trust & Prison

Figure 12: Patients in Substitute Prescribing Treatment at 31st March 2014 - Comparison of Patients who injected at initiation compared to

those who injected their main problem drug at last review

Injecting at Initiation Injecting at last review

17

Missed Appointments

Of the 687 patients receiving Substitute Prescribing Treatment at 31st March 2014 it was recorded on their last review that 10% of them missed appointments. Table 7 illustrates this by Health & Social Care Trust & Prison.

Table 7: Number & Percentage of Patients who missed appointments, as recorded on their last Review closest to the 31st March 2014

Missed Appointments

Belfast Northern South-Eastern


Total Patients 154 252 79 112 70 20 687

No. of Missed Appointments 27 (18%) 14 (6%) 11 (14%) 6 (5%) 8 (11%) 1 (5%)

67 (10%)

Salivary/Urinalysis Testing by Health & Social Care Trust

Figure 13 shows the percentage of patients tested at the review most recent to 31st March 2014. South-Eastern Trust had the highest percentage of tested patients (94%).

79% 81%

94% 88%

77%

20%

7%

15%

0% 1% 0% 0%

14%

5% 6% 11%

23%

80%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


Figure 13: Percentage of Clients who received a Salivary/Urinalysis at last review closest to 31st March 2014

by Health & Social Care Trust & Prison

Yes No Blank

18

Viral Testing during Treatment

At initiation the SP1 form records if the patient has been tested for HIV, Hepatitis B and Hepatitis C. Figure 14 shows the percentage of patients who were tested for HIV, Hepatitis B and Hepatitis C at initiation of treatment. Figure 15 shows the percentage of patients who took tests for HIV, Hepatitis B and Hepatitis C. The data was taken from the SP1 Initiation form

.

78% 63% 62% 63%

53%

80% 77% 73%

63% 63%

53%

80%

74% 73% 63% 60%

53%

75%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%


% o

f C

lien

ts

Health & Social Care Trust

Figure 14: Of the patients receiving Substitute Prescribing Treatment at 31st March 2014 the percentage who were offered tests for HIV, Hepatitis B and Hepatitis C by Health & Social Care

Trust & Prison

HIV Hepatitis B Hepatitis C

53%

36%

19%

41%

19%

33%

53%

48%

18%

41% 19%

33%

52%

49%

20%

41%

19%

33%

0%

10%

20%

30%

40%

50%

60%


% o

f C

lien

ts

Health & Social Care Trust

Figure 15: Of the Clients receiving Substitute Prescribing Treatment at 31st March 2014 the percentage who took Tests for HIV,

Hepatitis B and Hepatitis C by Health & Social Care Trust & Prison

HIV Hepatitis B Hepatitis C

19

Personal Living Arrangements

With data taken from their last review Figure 16 shows that 37% of patients reported that they were living alone, 16% lived with their spouse, partner and children and 13% lived with their parents, 11% lived with their spouse/partner only, 9% of forms did not specify the living circumstances of the patients.

The “Living With” status of patients is recorded on initiation of treatment and at each

review. Of the patients receiving treatment at 31st March 2014, at initiation of Substitute

Prescribing Treatment 1% of them were recorded as homeless. Continuing to look at those

patients, at their last review no patients were homeless.

Where the *”Other Specify” option was included it showed that the patients lived with: Adult Family; Mental Health Hospital; Sister; Brother; Grandmother; Mother & Dependent child.

Alone, 37%

With spouse/ partner and

children, 16%

With parents, 13%

With spouse/ partner only, 11%

Not Known, 9%

With dependant children, 6%

In Prison - YOC, 3%

With friends, 2% Other Specify, 1% Hostel, 1%

Figure 16: All Clients in Substitute Prescribing Treatment Services at 31st March 2014 by Living Arrangement

20

Discontinuation from Substitute Prescribing Services

112 patients discontinued from Substitute Prescribing Treatment Services during 2013/14. Figure 17 shows their reason for leaving with the main reasons being “Managed Discontinuation of SP” (42%); “Unmanaged Discontinuation of SP” (22%) and “Failed to present for Substitute Prescribing” (14%).

Managed discontinuation of

SP, 47, 42%

Unmanaged discontinuation of

SP, 25, 22%

Failed to present for SP, 16, 14%

Continuing SP outside NI, 13,

12%

Deceased, 5, 4%

Other e.g. Released, 4, 4%

Not suitable for SP, 2, 2%

Figure 17: Number & Percentage of Clients who left Substitute Prescribing Treatment Services during 2013/14 by

Reason of Leaving

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