Drug Use Among Adults

This topic area covers statistics and information relating to drugs use among adults in Hull including local strategic need and service provision. Further information relating to Drug Use Among Young People is given under Lifestyle Factors within Children and Young People. Use of drugs has been collected within Hull’s Health and Wellbeing Surveys and full reports are available under Surveys within Tools and Resources. A needs assessment was completed in Hull during 2023 for people with multiple unmet needs which included people who used drugs. The report – which was finalised in 2024 – is available within Multiple Unmet Needs under Vulnerable Groups.

This page contains information from the Office for Health Improvement & Disparities’ Fingertips. Information is taken ‘live’ from the site so uses the latest available data from Fingertips and displays it on this page. As a result, some comments on this page may relate to an earlier period of time until this page is next updated (see review dates at the end of this page).

Headlines

• Different illicit drugs and prescribed medication have different effects on physical and mental health, and some are highly addictive. Drugs can have a serious impact not just on the individual, but also their family and friends, and there is a detrimental effect on the entire community.
• From the local Health and Wellbeing Survey 2019, around one in ten men aged 16-24 years, people who were unemployed and people who were not working due to long-term illness or disability stated they used drugs other than those required for medical reasons either everyday or weekly. Fewer than 2% of men aged 65+ years and women aged 35+ years did. Around 6% of men aged 25-34 years, around 4% of men aged 45-64 years and around 3% of women aged 16-24 years also used drugs other than those required for medical reasons either everyday or weekly.
• For 2016/17, it was estimated that there were around twice as many opiate and/or crack users in Hull compared to England (18.1 versus 8.9 persons per 1,000 population with a total of 3,146 people aged 15-64 years who used opiates and/or crack cocaine.
• A more recent update (2020/21) gave the number not in treatment as 1,625 with 48.4% not in treatment this equates to an estimate of 3,357 opiate and/or crack users in Hull for 2020/21. The percentage in treatment at 51.6% for Hull was higher than it was for England (47.9%).
• Just over one-third (34%) of adults aged 18+ years with substance use treatment need engage with community-based drug services following their release from prison which is lower than England (43%) for 2022/23.
• Two in a hundred (2%) of people in Hull waited for more than three weeks for drug treatment in 2022/23 compared to 1.5% for England. In 2022/23, only 20 people had waited for three weeks or more for drug treatment in Hull.
• During 2022/23, there were 2,288 adults aged 18+ years in Hull in treatment at specialist substance services which is 10.6 per 1,000 population (more than twice as high as England at 4.5 per 1,000 population).
• Successful completion of drug treatment (left free of drug dependence and did not re-represent within six months) was 20.1% for non-opiates and 3.5% for opiates in Hull for 2022 which was lower than England (31.4% and 5.0% respectively).
• Over 80% of people admitted to treatment for substance use smoked in Hull, and whilst the data is 2019/20, it is still likely to be very high in Hull.
• The directly standardised mortality rate from drug misuse was statistically significantly higher in Hull compared to England for 2020-22 (8.7 versus 5.2 deaths per 100,000 population) with 67 deaths in total over the three year period. The mortality rate was higher among men with 48 deaths (12.3 deaths per 100,000 population) than it was with women with 19 deaths (4.9 deaths per 100,000 population).
• The number of drug misuse deaths in Hull increased between 2001-03 and 2005-07 to reach a peak of 7.9 deaths per 100,000 population. The rate then gradually decreased in Hull to a low of 3.8 deaths per 100,000 population for 2013-15. The number of drug misuse deaths did increase, and there were a number of deaths in 2017 which increased the rate to 7.0 deaths per 100,000 population for 2015-17. Whilst the rate did decrease to 4.8 deaths per 100,000 population for 2018-20, the rate has increased sharply to a new high of 8.7 deaths per 100,000 population in 2020-22.
• However, whilst the sharp increase in the drug misuse deaths in Hull is of concern, perhaps of even more concern is the increase in deaths from drug poisoning in Hull. Traditionally, the number of drug misuse deaths is seen as a measure of the impact of drugs on mortality, but drug misuse deaths in Hull are a decreasing percentage of the drug poisoning deaths in Hull. Drug misuse deaths form a subset of drug poisoning deaths, and a death can only be classified as a drug misuse death if a drug controlled under the Misuse of Drugs Act 1971 is specifically mentioned on the death certificate. In Hull, the number of drug misuse deaths as a percentage of drug poisoning deaths was just over 50% for 1993-95 but increased to 80% in 2010-12 before falling to only 37% in 2020-22. In contrast, the percentage for England has increased from 40% in 1993-95 to over 60% for 2020-22.
• The total number of drug misuse deaths has increased in Hull in the last decade or so. There were just over 40 deaths in each three year period between 2008-10 and 2011-13 with number decreasing to just over 30 for 2012-14 and 2013-15. The numbers did increase to 57 for 2015-17 when there were a high number of deaths in Hull due to the introduction of a very toxic ingredient (carfentanil/fentanyl) into the local drug supply (predominantly heroin) which was swiftly dealt with by the National Crime Agency. Whilst the numbers fell to 37 deaths for 2018-20, the numbers have increased to reach a new high of 67 deaths for 2020-22. However, by reporting the mortality rate from drug misuse alone, this masks an even larger increase in Hull from deaths from drug poisoning. Between 2008-10 and 2013-15, there were between 53 and 63 deaths each three year period in Hull from drug poisoning, but this has increased sharply to 181 deaths for 2020-22.
• The mortality rate from drug poisoning in Hull was 8.8 deaths per 100,000 population in 2001-03 and increased to 10.6 deaths per 100,000 population for 2004-06, but decreased to 8.2 deaths per 100,000 population for 2008-10 and remained around 8 deaths per 100,000 population until 2013-15. The rate increased to 13.8 deaths per 100,000 population for 2015-17 and remained around 14 deaths per 100,000 population until 2018-20, but increased to 20.0 deaths per 100,000 population for 2019-21 with a further increase in the last year to 23.6 deaths per 100,000 population for 2020-22.
• There was a slightly higher percentage of drug poisoning deaths among women which were registered during 2020-21 compared to 2015-19 (27% versus 24%) and the age at death was higher for deaths registered during 2020-21. Nationally, an increase in the number of deaths was also noted together with a reduction in the number of new drug users which suggests a higher death rate among existing long-term drug users. The Office for National Statistics state possible explanations are an ageing cohort of drug users likely to be suffering from the effects of long-term drug use and becoming increasing susceptible to a fatal overdose, new trends in taking specific drugs which may increase the risk of an overdose, and a potential increase in disengagement or non-compliance with opiate substitute therapy.
• The mortality rate among those in drug treatment was 51% higher than England for the three year period 2019/20 to 2021/22 with 116 deaths in total over those three years. This covers deaths from all causes including those not related to substance use.

The Population Affected – Why Is It Important?

Different illicit drugs and prescribed medication have different effects on physical and mental health, and some are highly addictive. From the NHS, the health risks from illicit drugs and substances include death from an overdose, lung disease from smoking drugs, HIV or viral hepatitis, serious infections in the body and bloodstream, fertility problems, damage to veins and body tissue through injecting drugs, overheating and dehydration, kidney problems, schizophrenia, hallucinatory states, insomnia, fits, agitation, aggression, confusion, paranoia, psychosis, memory problems, depression, anxiety and lack of concentration. It can also be dangerous to drive after taking drugs, increasing the risk of an accident.

Illicit drugs and prescribed medication misuse can have a serious impact not just on the individual, but also their family and friends who may require considerable support. There also can be a detrimental effect on the entire community.  It is estimated that individuals dependent on opioids and/or crack cocaine are responsible for 45% of acquisitive crime (shoplifting, burglary, vehicle crime and robbery).

When a person has been ill or where a death occurs following an event such as a heart attack or stroke, it is possible to register the death very quickly. These deaths are generally registered within five days of occurrence of the death. However, suspicious and unexplained deaths need to be investigated to determine the cause of death. For these types of deaths including all drug-related deaths, a Coroner’s Inquest is required. After a Coroner’s Inquest is held, the death certificate is issued and the death can be registered. As deaths from drug poisoning can take some time before they are registered, the national statistics relating to drug misuse and drug poisoning mortality relate to the period of time in which the death was registered rather than when the death occurred (also see Delays to Death Registration below for further information).

The underlying cause of death is determined by the Office for National Statistics based on information recorded on the death certificate and is coded using the International Classification of Disease version 10. Deaths related to drug use are a subset of the drug poisoning deaths.

Drug poisoning deaths involve the following underlying cause of death (ICD 10 codes):

• mental and behavioural disorders due to drug use (F11-F16, F18-F19);
• accidental poisoning by drugs, medicaments and biological substances (X40-X44);
• intentional self-poisoning by drugs, medicaments and biological substances (X60-X64);
• assault by drugs, medicaments and biological substances (X85); and
• poisoning by drugs, medicaments and biological substances, undetermined intent (Y10-Y14).

Deaths related to drug misuse involve the same underlying causes of death, and deaths from mental and behavioural disorders due to drugs (F11-F16 and F19), but accidental poisoning (X40-X44), intentional self-poisoning (X60-X64), poisoning of undetermined intent (Y10-Y14), assault of drugs (X85), and mental and behavioural disorders due to the use of volatile solvents (F18) require that a drug controlled under the Misuse of Drugs Act 1971 was mentioned on the death certificate.

Thus the difference between drug poisoning deaths and deaths due to drug misuse is that deaths due to drug use need to have a specific mention of a drug controlled under the Misuse of Drugs Act 1971 mentioned on the death certificate for deaths relating to accident poisoning, accidental poisoning, poisoning with undetermined intent, those related to assault, and mental and behavioural disorders due to volatile solvents. Whereas the drug poisoning deaths just need any of these causes to be mentioned and the specific drug(s) do not need to be named on the death certificate. Different coroners across the country may record their evidence and information on the death record differently. The coding of deaths and assigning International Classification of Disease codes is undertaken by the Office for National Statistics (ONS) based on information supplied on the death record by the coroner. Due to the way in which information is recorded on the death certificate and coded by ONS, it is possible that a person who has used drugs for a long time who dies of drug poisoning is not necessarily recorded as dying from drug misuse (but are classified as dying from the broader category of drug poisoning).

The Hull Picture

Frequency of Using Drugs Other Than Those Required for Medical Reasons

In Hull’s Health and Wellbeing Survey 2019, 85% stated they had never used drugs other than those required for medical reasons, 4.6% had not used them in the last five years, 2.1% not in the last year, 1.9% rarely in the last year, 1.9% had used them a few times a year, 0.8% monthly, 1.5% weekly and 2.2% everyday.

However, there was a substantial difference by age and gender with 11.4% of men aged 16-24 years stating they used such drugs weekly compared to fewer than 2% among men aged 65+ years and women aged 35+ years. Just under one in ten people who were unemployed or were not working due to long-term illness and disability also stated they used such drugs weekly.

Estimated Prevalence of Opiate and/or Crack Cocaine Use

The Office for Health Improvement & Disparities’ Fingertips provides information on drug related behaviours and deaths.

In 2016/17, it was estimated that the prevalence of opiate and/or crack cocaine use among people aged 15-64 years was 18.1 per 1,000 population in Hull which was more than double the rate in England.

The estimated prevalence uses a capture-recapture method to estimate the number of people who used opiate and/or crack cocaine. The capture-recapture method is often used to estimate the population size of an animal species with animals trapped, marked in a harmless way and released, and then new traps are set a few days later, and the number of marked and unmarked animals caught being recorded. The population size is then estimated to be the number in the first sample multiplied by the number in the second sample divided by the number in the second sample previously marked. In the case of opiate and/or crack use, the number of people who use opiate and/or crack cocaine were identified from drug treatment, probation, police and prison data was used, and then the overlap between the data sources was used together with modelling techniques to examine this overlap and to produce prevalence estimates for those aged 15-64 years based on this capture-recapture methodology.

The rate in Hull was also highest across the Yorkshire and Humber region for 2016/17.

The estimates have been similar in Hull for 2011/12, 2014/15 and 2016/17 at around 18 to 19 per 1,000 population aged 15-64 years, substantially higher than the rate in England which increased from 8.4 in 2011/12 to 8.9 in 2016/17 per 1,000 population.

Estimated Numbers Not in Treatment

The estimated number (calculated as the average of the last 3 years prevalence numbers) of opiates and/or crack cocaine users aged 15-64 years have been produced by Liverpool John Moores University for each local authority. These figures have been compared with the numbers in treatment to estimate the number of opiate and/or crack cocaine users who are not in treatment.

During 2020/21, it was estimated that there were 48% of opiate and/or crack cocaine users in Hull who were not in treatment. Whilst the percentage was among the highest in the region, it was slightly better than England.

The percentage has decreased slightly in Hull. If it is assumed that the estimates of the number of opiate and/or crack cocaine users has been reasonably accurately estimated in Hull, then this means that a slightly higher percentage are currently in treatment in Hull.

For 2020/21, an estimate of 1,625 people who are opiate and/or crack cocaine users who are not in treatment representing 48.4% of the population suggests that there is an overall estimate of 3,357 people who are opiate and/or crack cocaine users. This is higher than the estimate above at 3,146 for 2016/17 and more comparable to the estimates for 2014/15 (3,309) and 2011/12 (3,229).

Adults With Substance Use Treatment Need Who Engage With Services Following Release From Prison

During 2022/23, just over one-third of adults aged 18+ years with substance use treatment need engaged with community-based drug services following their release from prison. This was lower than England and the region where the percentages were 43%.

The number of individuals who successfully engage in community-based structured treatment following release from prison is defined as starting a treatment intervention within 21 days of release from prison. The indicator is presented as a percentage out of the number of individuals who at the point of departure from prison were transferred to a community treatment provider in the local authority for structured treatment interventions post release.

In 2015/16, the percentage was 35%, but halved to around 16% between 2016/17 and 2018/19. In contrast, the percentage in England and across the region increased slightly. However, since 2018/19, the percentage in Hull has increased and was only slightly lower than England 2020/21 and 2021/22, although with a recent slight decrease in the percentage in Hull from 35.8% in 2021/22 to 34.2% in 2022/23, the percentage is now statistically significantly lower in Hull compared to England.

Wait for Substance Treatment Services

During 2022/23, 2.0% of individuals with waiting more than three weeks for drug treatment services, which was the third highest in the region, although still relatively low with only two in every 100 waiting more than three weeks.

The percentage waiting three weeks or more for treatment at 2.0% is among the lowest it has been since 2013/14 in Hull.

Overall during 2022/23, 20 people in Hull waited three or more weeks for drug treatment services.

Numbers in Specialist Drug Treatment Services

During 2022/23, there were 2,288 people aged 18+ years in Hull in specialist drug treatment services. The size of the adult population differs across the local authorities in the region, so it is not possible to compare local authorities here.

With the exception of 2017/18, there have been over 2,000 people in treatment at specialist drug misuse services in Hull. The numbers in Hull have steadily increased since 2017/18 to a high of 2,288 people in treatment for 2022/23.

The rates are also given as the numbers in specialist drug treatment services per 1,000 population aged 18+ years.

In 2020/21, there were 10.6 people aged 18+ years per 1,000 population in Hull who were in specialist drug treatment services, which is 2.4 times higher the rate in England.

The rate in Hull is the highest across Yorkshire and Humber. For 2020/21, only Middlesbrough (15.4), Hartlepool (11.6) and Blackpool (11.4) have higher rates among the 147 upper-tier local authorities across England with data for this indicator. However, with any such comparison, the numbers accessing treatment will be influenced by the way services are provided within each geographical area, and it is possible that certain geographical areas will have a higher percentage accessing services in whom there is a need, and there also might be differences between the ‘entry’ criteria for those accessing treatment or waiting lists, so any comparison needs to take these factors into consideration. Nevertheless, it is clear there are very high numbers of people in Hull accessing specialist drug treatment services.

The rate in Hull has been around 10 per 1,000 population (or 1% of the population) in Hull since 2013/14, but as previously mentioned slightly lower in 2017/18.

Hepatitis Tests and Vaccinations Among Eligible People in Drug Treatment Services

During 2016/17, 5.6% of people entering drug treatment services who were eligible had had a course of hepatitis B vaccination (compared to 8.1% in England), and for 2017/18, 84.3% had had a hepatitis C vaccination (compared to 84.2% for England).

Users Successfully Completing Treatment

For 2022, one-fifth of non-opiate users and 3.5% of opiate users successfully completed treatment compared to 31.4% and 5.0% respectively for England.

Successful treatment was defined as users who had left drug treatment (free of drug(s) of dependence) who did not then re-present to treatment again within six months (and it is given as a percentage of the total number of users in treatment).

Between 2010 and 2020, except for 2016, the percentage of non-opiate users aged 18+ years successfully completing treatment has been consistently lower than England. The percentage in Hull is among the lowest it has been since 2010 with only 2019 marginally lower at 19.0% than the current rate of 20.1% in 2022.

The percentage in England has shown a gradual decrease since 2014 falling from 39.2% in 2014 to 31.4% in 2022.

There is considerably year-on-year variability in Hull as illustrated by the relatively wide confidence intervals as the total numbers are relatively small (see Confidence Intervals and Small Numbers in the Glossary for more information).

In 2022, 109 non-opiate users successful completed treatment (out of 542) in Hull.

In general, the same pattern occurred for opiate users and successful completion of treatment although there was less of a discrepancy between Hull and England. In 2016, the percentage was also high as it was for non-opiate users.

The success rate also decreased between 2016 and 2019 for opiate users, but in contrast to non-opiate users, the success rate decreased for opiate users between 2019 and 2020 to the lowest percentage it has been since 2010, although the rate increased slightly for 2021 and 2022. Services were disrupted in this period due to the COVID-19 pandemic. The confidence intervals are also relatively wide due to small numbers (see Confidence Intervals and Small Numbers in the Glossary for more information).

In 2022, 59 opiate users successful completed treatment (out of 1,686) in Hull.

Smoking Prevalence Among Adults Admitted to Substance Treatment Services

Over 80% of people admitted to substance treatment services in 2019/20 smoked.

The number of adults admitted to services who smoked has increased over time in Hull, but it is possible that this increase is due to better recording of smoking status.

Deaths from Drug Poisoning and Drug Misuse

Difference Between Drug Poisoning and Drug Misuse Causes

As mentioned above deaths from drug misuse are a subset of drug poisoning deaths. Deaths are only classified as a drug misuse death if the specific name of a drug controlled under the Misuse of Drugs Act 1971 is mentioned on the death certificate record (see The Population Affected – Why is it Important? above for more details).

Deaths from Drug Misuse

The directly standardised mortality rate per 100,000 population (standardised to the European Standard Population) for deaths related to drug use is statistically significantly higher in Hull for 2020-22 compared to England for both men and women.

The mortality rate in Hull is 62% higher than England for men and 69% higher for women.

Between 2001-03 and 2020-22, in general, the mortality rate per 100,000 population from drug use has been statistically significantly higher in Hull than England with only five time periods where the rate was not statistically significantly higher (although for four of these five periods the rate in Hull was still higher than England just not statistically significantly with only one year where Hull had the same mortality rate as England).

The number of drug related deaths in Hull saw a spike in 2017 due to the introduction of a very toxic ingredient (carfentanil/fentanyl) into the local drug supply (predominantly heroin). The National Crime Agency and law enforcement took swift action to identify and cut off supply lines with the situation closely monitored by all agencies subsequently.

However, whilst the mortality rate decreased between 2015-17 and 2018-20 from 7.0 to 4.8 deaths per 100,000 population with the exclusion of the year 2017, the rate in Hull has increased between 2018-20 to a new high of 8.7 deaths per 100,000 population for 2020-22.

Since 2009-11, there has been around 40 deaths registered in each three year period, with a temporary spike in 2017. In 2018-20, the rate is among the lowest it has been in Hull since 2001-03 (only 2012-14 and 2013-15 had lower rates) with a total of 37 deaths from drug misuse over the three year period 2018-20. However, the numbers have increased and there were 67 deaths from drug misuse during the three year period 2020-22 so an average of 22 deaths per year.

The majority of the 67 deaths during 2020-22 were among men with 48 (72%) of deaths registered in total over the three year period. There has been some year-on-year variability in the mortality rate. The mortality rate was high at 14.1 deaths per 100,000 population in 2004-06, but had steadily decreased to a low of 5.3 deaths per 100,000 population for 2012-14. The rate had subsequently increased to 11.6 deaths per 100,000 population for 2015-17 before decreasing to 7.2 deaths per 100,000 population for 2018-20.

In the last two years, the rate has increased sharply – almost doubling – to a high not yet seen since 2005-07.

The confidence intervals are relatively wide due to small numbers (see Confidence Intervals and Small Numbers in the Glossary for more information).

For women, there has been around 10-12 deaths registered for most of the three year periods 2002-04 to 2018-20 although in some cases fewer than 10 (and the data is not presented for those years due to small numbers). The mortality rates from drug misuse has increased for women in Hull in the last two years to reach a new high of 4.9 deaths per 100,000 population. The highest rate prior to 2020-22 was 3.6 deaths per 100,000 population for 2019-21 and 3.4 deaths per 100,000 population for 2007-09.

The confidence intervals are relatively wide due to small numbers (see Confidence Intervals and Small Numbers in the Glossary for more information). Where data is presented for Hull, the mortality rate has been higher than England for all periods except for 2016-18 where the rate is the same as England.

During the three year period 2020-22, there were 19 deaths from drug misuse among Hull women so an average of around six per year.

Deaths from Drug Poisoning And Comparison With Deaths from Drug Misuse

The Office for Health Improvement & Disparities’ Fingertips presents the number and mortality rates for deaths from drug misuse, but information is also available on deaths from drug poisoning (although not on Fingertips).

Based on official statistics from the Office for National Statistics, there were 51 deaths among Hull residents that were recorded as a result of drug poisoning which were registered during 2020, 67 registered during 2021 and 63 registered during 2022. These are the highest absolute numbers since at least 1993.

Year of registration	Number of drug poisoning deaths in Hull	Number of deaths due to drug misuse in Hull
1993	7	3
1994	10	5
1995	24	14
1996	29	17
1997	22	13
1998	31	18
1999	20	14
2000	37	25
2001	24	16
2002	27	18
2003	22	15
2004	26	15
2005	33	28
2006	27	21
2007	25	16
2008	29	20
2009	20	14
2010	14	11
2011	19	17
2012	22	12
2013	22	12
2014	17	7
2015	21	11
2016	39	25
2017	49	21
2018	24	8
2019	35	14
2020	51	15
2021	67	28
2022	63	24

Of particular note is the percentage of deaths that are recorded as drug misuse deaths out of the total number of drug poisoning deaths. Between the three year periods 1993-95 and 2015-17, the majority of drug poisoning deaths were also classified as drug misuse deaths. Between 1993-95 and 1996-98 and between 2012-14 and 2015-17, the percentage was under 60%, but for the period 1997-99 and 2011-13 the percentages ranged from 61.6% to 79.2%. For the last four year periods of 2017-19 to 2020-22, the percentages have been 39.8%, 33.6%, 37.3% and 37.0% respectively.

The main difference between deaths recorded as drug misuse and recorded as drug poisoning is that drug misuse deaths require a mention of a specific drug controlled under the Misuse of Drugs Act 1971 on the death certificate. It is possible that the changes have occurred over time in either the use and/or recording of specific drugs on the death certificate. This could result if there were changes over time in the specific drugs people were dying from, if these were not specifically listed by name under the Misuse of Drugs Act 1971. If this was the case, this would result in a lower percentage of drug poisoning deaths recorded as drug misuse deaths. As the number of deaths from drug misuse is generally the measure used for drug-related mortality, this does become a problem for Hull as it will not give the true picture on the impact of deaths which are related to drug misuse in Hull. It is also possible that the way in which the underlying cause of death is determined by the Office for National Statistics based on information provided within the death certificate could have changed slightly over time. There could be other changes over time which could have influenced the recording of drug poisoning deaths.

However, the pattern is different for different for England with a tendency for the number of drug misuse deaths as a percentage of the total drug poisonings death to have increased over time from around 40% for 1993-95 to 64% in 2020-22.

Over the three year period 1993-95, there were 41 drug poisoning deaths registered among Hull residents but this increased over time to around 80 deaths over three years between 1996-98 and 2007-09. The number of drug poisoning deaths fell slightly to around 60 over each three year period between 2008-10 and 2013-15. However, since 2013-15, the number of deaths has increased to around 110 over three years between 2015-17 and 2018-20 before increasing to 153 for 2019-21, and in the latest three year period 2020-22, there were a record high of 181 deaths from drug poisoning that were registered among Hull residents.

Whilst the number of drug misuse deaths has varied considerably over time from 22 in 1993-95 to a high of 67 in 2020-22, the increase over time has not been as obvious partly because the total number of deaths from drug misuse was particularly high between 1998-00 and 2006-08. The total number of drug misuse deaths in Hull increased from 22 for 1993-95 to over 40 between 1995-97 and 1997-99 before increasing to 57 deaths during 1998-00. Whilst the number did decrease to 48 deaths for 2002-04, the numbers gradually increased to 65 deaths in 2005-07. The numbers decreased to 30 deaths for the three year period 2013-15, but increased to 57 in 2015-17. There was a particularly high number of deaths in 2017 as mentioned above, and the total number of deaths from drug misuse did decrease to 37 for 2018-20. However, the numbers have increased for the last two years to a new high of 67 drug misuse deaths which were registered in the latest three year period 2020-22.

The increase in the number of drug poisoning deaths registered during the three year period 2020 to 2022, has increased the directly standardised mortality rate for drug poisoning in Hull. There were 23.6 deaths per 100,000 population in 2020-22 in Hull compared to 8.1 deaths per 100,000 population in England.

The rate in Hull was the highest across the region and sixth highest out of the 290 lower-tier local authorities with data. The rates range from 2.6 to 30.0 deaths per 100,000 population, but is likely that the 19 lower-tier local authorities without data have rates which are lower than this and they have not been given due to small numbers.

There is a strong association with deprivation. Based on the Index of Multiple Deprivation 2019, among the 317 local authorities at the time, Hull was ranked the fourth most deprived local authority in England, and Blackpool, Middlesbrough and Hartlepool were also ranked in the bottom 4% of local authorities, although Carlisle was less deprived (ranked as 117 out of 317 which was within the most deprived 37% of local authorities) but Barrow-in-Furness was relatively high in terms of its deprivation being the 31st most deprived lower-tier local authority.

The mortality rate for deaths from drug poisoning is ranked fourth highest for men (out of the 258 lower-tier local authorities with data) and eighth highest for women (out of 164 lower-tier local authorities with data).

Area	IMD rank	DSR persons	DSR males	DSR females
England		8.1	11.2	5.2
Yorkshire & Humber		11.2	15.3	7.1
Hull	4	23.6	34.2	12.7
Blackpool	1	30.0	40.7	19.5
Middlesbrough	5	26.6	37.7	15.9
Hartlepool	10	24.9	36.3	14.5
Carlisle	117	24.2	33.2	15.5
Barrow-in-Furness	31	24.1	31.8	16.6

In contrast, as a high percentage of the drug poisoning deaths are not recorded as drug misuse, Hull does not rank as highly for drug misuse deaths. The mortality rate for drug misuse for deaths registered during 2020-22 is 12.3 per 100,000 population for Hull which is ranked 35th highest out of the 240 lower-tier local authorities with data, and it is ranked 44th highest for men (out of 186) and 27th highest for women (out of 146). Across all lower-tier local authorities in England for deaths registered during the three year period 2020-22, mortality rates for drug misuse range from 1.6 to 19.5 per 100,000 population for persons, from 2.4 to 28.4 per 100,000 population for men, and from 2.0 to 15.7 per 100,000 population for women.

From the low of 3.8 deaths per 100,000 population from drug misuse in 2013-15, there has been an increase of 129% to 8.7 deaths per 100,000 population for 2020-22 (with the rate more than doubling). However, for drug poisoning, from the low of 6.9 deaths per 100,000 population in 2009-11, there has been an increase of 242% to 23.6 deaths per 100,000 population for 2020-22 (more than triple the rate). Whilst the time periods differ, when comparing to the lowest mortality rate, it is clear that the increase in the mortality rate from drug poisoning in the last decade has been much greater than the increase in the mortality rate from drug misuse.

There has also been an increase in both the drug poisoning and drug misuse mortality rates for England but the increase in the rate for drug poisoning in Hull has been much greater than for England.

Local Analysis of Drug Poisoning Deaths

A local analysis of drug poisoning mortality has been undertaken in Hull to compare the mortality rate over time and examine the recent increase in the number of deaths which included examining data for 2015-19 and 2020-21 to assess any potential impact on the number of deaths due to the COVID-19 pandemic. The local analysis has been undertaken using the local mortality dataset which contains limited information on personal characteristics (gender, age at death, postcode from which deprivation can be measured and ward of residence, and underlying cause of death based on the International Classification of Disease version 10). It is not possible to undertake a local analysis on drug misuse deaths as information relating to the name(s) of specific drugs mentioned on the death certificate is not included in the dataset, although the ICD codes for cause of death are included which are much broader. Nevertheless it may provide some insight into the recent increase as follows by comparing drug poisonings deaths registered during 2015-19 with those registered during 2020-21:

• Of the 167 drug poisoning death registered during 2015-19, there was more than one year but less than two years between the date of death and the date of registration of the death for 11 (6.6%) deaths. For deaths registered during 2020-21, 17 (14.4%) of the 118 drug poisoning deaths had a delay of more than one year in death registration.
• Just under one-quarter (24.0%) of deaths registered during 2015-19 were among women compared to 27.1% for deaths registered during 2020-21.
• Whilst a similar percentage of drug poisoning deaths among men occurred in men aged under 35 years that were registered during 2015-19 (25%) and 2020-21 (23%), a higher percentage of men were aged 45+ years for deaths registered during 2020-21 (49%) compared to 2015-19 (35%). Among men, the median age at death was 41 years for deaths registered during 2015-19 but 44 years for deaths registered during 2020-21.
• Among women, around two-thirds (65%) of drug poisoning deaths registered during 2015-19 were among those aged under 45 years, this was 41% for deaths registered during 2020-21. Among women, the median age at death was 41 years for deaths registered during 2015-19 but 45 years for deaths registered during 2020-21.
• Based on the Index of Multiple Deprivation 2019, a higher percentage of deaths were registered during 2020-21 among men living in the most deprived areas of Hull compared to deaths registered during 2015-19. Overall, 37% of drug poisoning deaths among men that registered during 2020-21 occurred among men living in the most deprived fifth of areas of Hull and 26% occurred among men living in the second most deprived fifth of areas of Hull compared to 26% and 32% respectively for deaths registered during 2015-19. This was not the case for women, who had a higher percentage of drug poisoning deaths among women living in the most deprived areas of Hull for deaths registered during 2015-19 compared to 2020-21.
• Almost one-quarter (23.7%) of drug poisoning deaths which were registered during 2020-21 occurred among residents of St Andrew’s & Docklands ward, and this was considerably lower for deaths registered during 2015-19 (13.8%). The local authority was involved in relocating many homeless people from hostels into other temporary accommodation during the COVID-19 pandemic. If the people who died of drug poisoning whose deaths were registered during 2020-21 had recently moved then this could have affected the associations between deprivation and ward.
• For drug poisoning deaths registered during 2020-21, the percentage that were classified as suicide and undermined intent was lower compared than those registered during 2015-19 (8% versus 11%).
• The majority of drug poisoning deaths had an underlying cause of accidental poisoning, and this was the case for men for deaths registered during 2015-19 (87%) and 2020-21 (92%) and for women for deaths registered during 2015-19 (78%) and 2020-21 (84%).
• The number of deaths from ‘nonopioid analgesics, antipyretics and antirheumatics’, from ‘antiepileptic, sedative-hypnotic, antiparkinsonism and psychotropic drugs, not elsewhere classified’ and from ‘other drugs acting on the autonomic nervous system’ were too small to present separately, but overall from all three categories combined, there were five deaths among men and women that were registered during 2015-19, and 10 deaths among men and women that were registered during 2020-21. This was almost three times as many deaths registered during 2020-21 (8.5%) compared to 2015-19 (3.0%).
• It is not possible to examine drug poisonings from specific drugs as the coding is too wide with ‘narcotics’ as an entire group (38% of deaths registered during 2015-19 and 21% of deaths registered during 2020-21), and the majority of drug poisoning deaths are classified as ‘other and unspecified drugs, medicaments and biological substances’. The percentage of deaths from this latter category was higher among deaths registered during 2020-21 than 2015-19 (69% versus 50%). It is possible that this difference could reflect changes in the information presented on the death certificate or it could reflect differences in the substances or possibly combinations of substances.

Delays to Death Registration

There have been differences over time in the time period between death occurrence and death registration in Hull. For drug poisoning deaths which occurred between 2006 and 2014, none of them were registered a year or more after the death, and fewer than 10% of those deaths which occurred between 2015 and 2017. However, there was an increase subsequently. Just over one quarter (26.5%) of all drug poisoning deaths which occurred in 2018 were registered a year or more later, and this percentage remained relatively high during 2019 (17.5%) and 2020 (15.9%) before increasing to a high of 29.9% for deaths which occurred during 2021.

The relatively high number of deaths which occurred during 2017 and 2018 which were due to the introduction of a very toxic ingredient (carfentatil/fentanyl) into the local drug supply (predominantly heroin) mentioned above likely had an impact on death registration locally as there were greater delays to death registration. Not long after this, from March 2020, there were also substantial delays to death registration due to the COVID-19 pandemic. The number of all deaths increased which would have created additional delays in relation to death registration, and as noted above, combined with a substantial increase in the number of drug poisoning deaths in Hull had further resulted in delays to death registration. It would not have been possible to hold Coroner’s Inquest during the lockdown periods of the COVID-19 pandemic, and there were likely other restrictions which would have prevented or delayed Coroner’s Inquests. This problem is not unique to Hull, there were delays to inquests and death registration throughout the entire country following the pandemic.

The impact on the delays to death registration may affect the pattern of the mortality rates over time as the mortality rates are based on death registration. If there are consistent delays over time, this is less likely to affect the mortality rates. However, if there are delays in death registration it will mean that there will be fewer deaths registered in one year and potentially more later when the backlog is dealt with.

Deaths Among People in Treatment

The mortality rate is given for all people who are in treatment. It covers all causes of death, so the person will be included if they die from other causes, for example, cardiovascular disease, cancer, respiratory disease or from a traffic accident.

The mortality rate relates to individuals who are in treatment or in contact with specialist substance misuse services in the three-year prior who cited a problem with any drug, but also includes those who also cited a problem with alcohol.

For the three year period 2019/20-2021/22, the indirectly standardised mortality ratio for people who used drugs who were in treatment was 1.5 times higher in Hull than England, and the rate in Hull was statistically significantly higher than England.

This is the number of deaths among adults in drug treatment in the local authority as a ratio of the expected number of deaths in drug treatment if the local authority experienced the same age-specific mortality rates as in the whole drug treatment population in England. The Office for Health Improvement & Disparities states that this indicates where local authorities have a higher or lower than expected mortality rate, and is indicative of the safety, effectiveness and protection afforded by drug treatment services. However, the indicator will also be affected by the types of people in treatment. Local authorities which have a high percentage of people in treatment out of all the people with drug treatment need might have a lower mortality rate if the severity of need of their service users is lower, whereas local authorities which have a higher percentage of services users who have a longer history of drug use and/or have poorer health may have a higher mortality rate. Furthermore, it covers all causes of death including those associated with the use of alcohol, and not just mortality due to drug poisoning.

The standardised mortality ratio for those in treatment has been statistically significantly higher than England, and for five of the seven periods from 2013/14-20215/16 to 2019/20-2021/22. The mortality rate in Hull has generally been at least 25% higher than England with the exception of 2017/18-2019/20 which was 14% higher. The rate for 2019/20-2021/22 is the highest it has been over the last seven years. However, as mentioned above, it is likely that the people in treatment in Hull are in poorer health. Certainly from a local health needs assessment for alcohol and drugs completed during 2023/24, it was found that a higher percentage of service users in Hull had currently or had previously injected drugs, and were older in relation to those in treatment within the region.

During the three year period 2019/20-2021/22, there were 116 deaths among people in Hull who were in drug treatment.

Estimated and Projected Numbers Living With a Drug Dependency

The Projecting Adult Needs and Service Information (PANSI) provides current estimates and future projections at local authority level of the number of people with different health needs. The prevalence for different age groups and for males and females estimated from different surveys and research has been applied to current population estimates and population projections to provide estimates for each local authority.

The estimates relating to drug dependence was based on the Adult Psychiatric Morbidity Survey conducted in 2014 in England. People who reported usage of particular drugs were asked about signs of dependence on that drug. The signs or markers, they were asked about were: daily use for two weeks or more; having a sense of need or dependence; inability to abstain; increased tolerance; and withdrawal symptoms. A new range of psychoactive substances (NPS) have entered the market but were not assessed in the survey. PANSI acknowledge that uncertainty over their content and rapid changes in what is available makes measuring the use of these substances in surveys challenging and knowledge of the prevalence of their use is limited.

The survey was completed some time ago, and it has been acknowledged that there has been the introduction of NPS substances since then. Furthermore, it is likely that the prevalence is higher in Hull given the relatively high levels of deprivation. Nevertheless, the prevalence estimates have been presented here and can be used as a guide to the potential prevalence.

The number of men and women aged 18-64 years with drug dependence is estimated to be 6,384 for Hull in 2020, and that is due to increase slightly with changes in the population structure of Hull.

Gender/age	2020	2025	2030	2035	2040
Males 18-24	1,735	1,746	1,959	1,982	1,841
Males 25-34	1,445	1,373	1,287	1,340	1,439
Males 35-44	656	708	736	708	660
Males 45-54	363	327	317	343	359
Males 55-65	195	199	186	168	164
Males 18-64	4,394	4,353	4,485	4,541	4,462
Females 18-24	621	621	695	704	658
Females 25-34	704	653	609	629	673
Females 35-44	388	425	430	403	375
Females 45-54	155	137	136	149	151
Females 55-64	122	122	113	101	99
Females 18-64	1,990	1,958	1,982	1,985	1,956
All aged 18-64	6,384	6,311	6,467	6,526	6,418

Strategic Need and Service Provision

The Government’s 10-year Drugs Plan has three overarching aims to (1) Break drug supply chains, (2) Deliver world-class treatment and recovery services and (3) Achieve a shift in the demand for recreational drugs. The 10-Year Drugs Plan expects to reverse the rising trend in drug use, prevent drug deaths and expand treatment capacity.  The document also recognises that addiction needs to be treated as a chronic health conditions, and therefore more needs to be done to break down stigma, save lives and support long-term recovery.

The Government’s Drugs Plan requires local authorities in England to rebuild commissioned substance treatment services to improve quality, capacity and outcomes, and commits to offer improvement support to make sure that local areas have the capacity and capability to deliver the transformation needed.

Hull’s Alcohol and Drugs Partnership Strategy 2022-25 provides key priorities and recommendations for preventing alcohol related harm. The Strategy has six priorities:

1. Developing a Prevention and Early Intervention approach across the partnership;
2. Implement a more targeted approach to support at-risk groups;
3. Improving services to effectively support young people and adults with co-existing mental illness and substance use, and/or with multiple and complex needs;
4. Tackling alcohol/drug related stigma to ensure people have equitable access to services and resources.;
5. Developing community assets to achieve and sustain recovery; and
6. Reducing the risks associated with alcohol/drug use by utilising a harm reduction approach.

The local Strategy has been co-produced with partners and relevant stakeholders to ensure local integration and shared accountability, and is well integrated with other strategies and plans to ensure a well-integrated approach to addressing drug problems across the city.  Such strategies and plans include the Safer Hull plans and programme through the Community Safety Partnership, the Humberside Police Drugs Strategy, and Safeguarding and Early Help Strategies.

Social return on investment tools for drugs and alcohol make the case of investing in treatment programs to reduce overall crime and anti-social behaviour to reduce costs to society and the economy. It is estimated that over 323,447 crimes are committed before drug treatment entry. The main three crimes recorded for people in drug treatment are shoplifting (50%), drug offences (29%) and begging (7%) with an estimated 16% reduction in criminal activity and approximately 50,848 crimes prevented after starting treatment. The gross benefit of drug treatment in 2017/18 in Hull was estimated to be over £16,712,400.

The Office for National Statistics in relation to an increase in the deaths related to drug poisoning in England and Wales, note that the reasons behind this are complex and differ by drug type. They state that the overall trend is driven primarily by deaths involving opiates but also by an increase in deaths involving other substances like cocaine. They state that across Europe, rates of deaths involving heroin and morphine have been increasing while the number of new heroin and morphine users has fallen. This indicates higher rates of death among existing long-term drug users. Their possible explanations include an ageing cohort of long-term drug users becoming increasing susceptible to a fatal overdose, new trends in taking specific drugs which may increase the risk of an overdose, and a potential increase in disengagement or non-compliance with opiate substitute therapy.

Resources

Local Health and Wellbeing Survey 2019

The Office for Health Improvement & Disparities’ Fingertips: https://fingertips.phe.org.uk/

Office for National Statistics. Deaths related to drug poisoning in England and Wales: 2021 registrations. https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsrelatedtodrugpoisoninginenglandandwales/latest

Projecting Adult Needs and Service Information (PANSI). www.pansi.org.uk

Government’s 2017 Drug Strategy. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/628148/Drug_strategy_2017.PDF

UK Government. From harm to hope: A 10-year drugs plan to cut crime and save lives. https://www.gov.uk/government/publications/from-harm-to-hope-a-10-year-drugs-plan-to-cut-crime-and-save-lives/from-harm-to-hope-a-10-year-drugs-plan-to-cut-crime-and-save-lives

Hull City Council. Drug and Alcohol Support. https://www.hull.gov.uk/health-and-wellbeing/public-health/drug-and-alcohol-support

Hull City Council. Hull Alcohol and Drugs Strategy 2022-25. https://www.hull.gov.uk/sites/hull/files/media/Editor%20-%20Public%20health/Hull%20Alcohol%20and%20Drugs%20Strategy%202022-2025.pdf

ReNew Hull. Recovery Hub. https://www.changegrowlive.org/hull-renew/recovery-hub

Updates

This page was last updated / checked on 3 October 2024.

This page is due to be updated / checked in May 2025.