Drugs, health & social services

All illegal drugs have side effects that might not only lead to addictions but short and long-term mental and physical health impacts too. That’s before mentioning legal drugs like alcohol and tobacco – but that’s for another time.

• Cannabis has been linked to psychosis.
• Cocaine and amphetamines cause long-term damage to the circulatory system, increasing the risk of heart attacks.
• Benzodiazepines can cause coordination problems and depression.
• Ecstacy can cause dehydration and overheating similar to heatstroke.
• Heroin needs no introduction while injecting any drug puts the user at risk of contracting HIV or other blood-borne diseases if they can’t access clean needles.

According to Public Health Wales¹, there were just under 4,400 hospital admissions relating to illicit drug use during 2022-23 – which was an 11%decrease from the previous year.These figures are still around a third of the number of hospital admissions relating to alcohol.

Opioids (such as heroin) were the main driver of hospital admissions, with cannabinoids (which include much stronger synthetic cannabis such as “spice”) in second place. This is alongside a marked increase in admissions relating to cocaine.

Up to 5,000 children were receiving social services help because of substance abuse by parents during 2022-23– though that figure includes alcohol. This accounts, on average, for between 30-40% of all children receiving social services support.

The number of children receiving support for theirown substance abuse over the same period was 390.869 children were excluded from school due to substance abuse in 2020-21 – a 190% increase since 2011-12.

Substance abuse services in Wales

In the year to March 2022, there were just under 28,000 referrals to substance misuse services in Wales (below), with 14,500 people starting treatment over the same period². As of February 2024, the Welsh Government spends around £67million annually on substance misuse services.

Substance misuse services are tiered based on the level and intensity of intervention required.

• Tier 1– Early intervention, including advice, screening and/or referral to more specialist substance abuse services. This will happen at the GP level.
• Tier 2 – Open-access drop-in services, with possible referral to formal treatment and harm reduction (i.e. needle exchange).
• Tier 3– Structured drug treatment in the community.
• Tier 4 – Residential/inpatient drug rehabilitation and detox.

A 2018 review of substance abuse services by Healthcare Inspectorate Wales³ found that care was generally well-managed and was “good and effective”.But – as is typical with health services in Wales – there were often long waiting lists and inconsistent access to Tier 4 services (particularly in rural areas).

There are at least seven Tier 4 centres in Wales. However, some patients have to travel long distances, often to England, to access them.

Drug-related deaths

Undertakers have long been unintentional beneficiaries of the drug trade.

As you can tell from the above,the number of deaths linked to drug poisoning in Wales has gradually increased since 1993.

“Drug poisoning” means any death that involves an accidental or deliberate overdose – including prescription drugs and alcohol.

It’s often impossible to tell which drug is responsible for a death.Although across EnglandandWales as a whole, opiates (including opioid medicines, heroin and methadone), benzodiazepines, new psychoactive substances and cocaine were most commonly listed on death certificates.Paracetamol was listed up to five times more often than cannabis and ecstasy too.

Men account for the majority of drug-related deaths in Wales (consistently between 65-75% since 1993), and the death rate is generally highest amongst those aged 30-50.

The death rate per million people in Wales (92.9 in 2021) has been consistently higher than the all-England figure (79.1) and would rank towards the top in Europe.

On a nations and regions basis, Wales would rank in or around the top 5 (out of 10) and the drug death rate in Wales remains more than half that of Scotland (around 250-270 deaths per million).

1. Public Health Wales (11th April 2024). “Data mining Wales: The annual profile for substance misuse 2022-23”. Available at: https://phw.nhs.wales/publications/publications1/data-mining-wales-the-annual-profile-for-substance-misuse-2022-23/
2. Stats Wales. “Substance misuse, summary of quarterly activity”. Available at:https://statswales.gov.wales/Catalogue/Health-and-Social-Care/Substance-Misuse/summary-of-quarterly-activity
3. Healthcare Inspectorate Wales (July 2018). “Review of Substance Abuse Services in Wales”. Available at: https://www.hiw.org.uk/sites/default/files/2019-06/180725smen.pdf