Introduction

This section contains data, information and a summary profile in relation to the nature and impact of illegal/illicit drug use amongst the residents of Oldham.  This summary will include separate analysis and profiling of three mutually exclusive substance use categories:

• Opiate users (mainly heroin)
• Non-opiate users (including Cannabis, Cocaine (powder), Crack cocaine only)
• The combined user category of Non-opiate(s) & Alcohol (as non-opiate plus alcohol)

Data Overview

Opiate users in treatment in Oldham

Firstly, focus is given to the number of adults (18+) in treatment for dependency on and misuse of opiates (predominantly heroin).  Figure 1.1 below shows the numbers in treatment and new presentations amongst Oldham’s adult opiate users from April 2014/March 2015 to April 2022/March 2023.  Following a gradual downward trend from April 2015/Mar2016 to March 2021 numbers in treatment have been on a modest upward trend. 


Figure 1.1 above also shows that new presentations peaked at 225 in April 2018/March 2019 which was then followed by gradual decreases until the most recent period. In April 2022/March 2023 new presentations amongst Oldham’s opiate users increased to 203 – the second highest recorded over the nine years on view.

Across GM Oldham has the fifth highest rate of opiate users in treatment services with 4.32 per 1,000 of the adult (18+) population. Bolton has the highest with 6.21 and Trafford the lowest with 2.20. Oldham’s rate is slightly less than the GMCA average (4.58 per 1,000) and the North West rate (4.64) but significantly greater than the England average of 3.42.

Table 1.1 below shows the rate of unmet treatment need for individuals affected by opiate and/or crack cocaine misuse and/or dependency for Oldham, North West and England for the year April 2022 to March 2023. Oldham’s rate for unmet treatment need is 62.5% which higher than both the North West (54.1%) and England (57.9%) averages. The prevalence estimate for Oldham of the number of its residents involved in problematic opiate (heroin) and crack cocaine use and not in treatment is 2,051 (or 11.37 per 1,000 of 18+ population). This is 49.2% greater than the national rate of 7.62 (per 1,000) and 20.2% more than the North West rate of 9.46 (per 1,000).

Table 1.1 Unmet treatment need and prevalence for opiate and crack users (OCU) in Oldham, North West and England (April 2022 to March 2023)
	Unmet treatment need	Numbers in treatment	Prevalence estimate
Oldham	62.5%	769	2,051
North West	54.1%	25,444	55,424
England	57.9%	143,580	341,032
Source: NDTMS / OHID

Summary profile of opiate users in treatment in Oldham

Figure 1.2 below shows data in relation to the demographic make-up of Oldham’s opiate using clients in-treatment population from 2020/21 to 2022/23.


Historically, approximately 75% of adult opiate users in treatment were male. Typically, around 85% are from White/White British ethnicities with approximately 10% from Asian/Asian British backgrounds. The largest age cohorts are amongst the 40-49s and 50-64s, with the latter age group increasing in proportionality as younger age-bands are shrinking. More than one-fifth of opiate using clients live with children aged 0-17 years. Currently more than one-quarter have ‘contact with the criminal justice system’ – approximately 10 percentage points greater than the rate recorded for the previous two years.

Referrals in to drug treatment services amongst opiate users in Oldham

Figure 1.3 below shows referral sources amongst adult opiate users newly presenting to treatment services over the past three years in Oldham.  By far the most common referral amongst this user cohort is ‘Self, Family & Friends’ which typically accounts for 55% to 60% of all referrals.  In 2021/22 and 2022/23 ‘Criminal Justice’ accounted for more than one in four (27.1%) of referrals – more than 1½ times that recorded in 2020/21.

Accommodation need and co-occurring mental health treatment need in opiate clients

‘Accommodation need’ status and ‘co-occurring mental health treatment need identified’ amongst Oldham’s opiate users are shown in Figure 1.4 below.  Excluding the data shown for 2022/23, due to data quality issues, urgent housing problems amongst this user cohort almost doubled from 7.5% in 2020/21 to 14.6% in 2021/22, while less severe problems have fallen from 20.8% to 15.1% over the same period.


Figure 1.4 above also shows that co-occurring mental health treatment needs were identified has increased from 58.4% in 2020/21 to two-thirds (66.5%) in 2022/23 – similar to national trends.

Other substance use cited by opiate clients in treatment

Figure 1.5 below illustrates the use of other substances as cited by opiate users in treatment in Oldham from 2020/21 to 2022/23.  During this period opiate clients reporting additional use of ‘crack cocaine’ has increased from 54.4% to 59.5% thus indicating greater prevalence and dependency.  Approximately two in thirteen (15.5%) opiate clients indicated that they also consumed alcohol while 12.8% (one in eight) cited use of cannabis.


Figure 1.5 above also shows that indications of the use of ‘benzodiazepines’ is on a downward trend, falling by almost one-third from 9.6% in 2020/21 to 6.5% in 2022/23.

Deaths in treatment amongst opiate clients in Oldham

Table 1.2 below shows the proportion of opiate using clients accessing treatment who died in 2022/23.  The proportion of deaths amongst opiate clients in Oldham (2.36%) is lower than the averages for all other geographies. 

Table 1.2: Proportion of opiate clients accessing treatment who died in Oldham, GMCA, North West and England (2022/23)
	Number of client deaths	Number of clients in treatment	Deaths as a % of those in treatment	Oldham ranking in GMCA & North West
Oldham	17	711	2.39%	3rd lowest in GM (out of 10 LAs) 6th lowest in NW (out of 23 LAs)
GMCA	240	9,300	2.58%
North West	689	24,490	2.81%
England	2,619	137,780	1.90%
Source: NDTMS / OHID

Oldham’s rate is the 3rd lowest of the 10 local authorities in GMCA and 6th lowest out of the 23 authorities that make up to the North West region.  The area with the highest proportion of such deaths in GMCA was Salford with 3.13% [24 from 767] – approximately one-third greater than the rate for Oldham – and the lowest was in Trafford with 2.23% [8 from 358].  Across the North West region Cumbria had the highest proportion with 3.96% [54 from 1,362] while Halton recorded the lowest rate with 2.09% [8 from 383].

Treatment exits, successful completions and re-presentations in opiate clients

Figure 1.6 below illustrates treatment exit status amongst opiate clients in Oldham from 2020/21 to 2022/23.  It can be observed that ‘planned exits’ amongst this user cohort fell by approximately seven percentage points, from 26.8% in 2021/22 to 19.6% in 2022/23.  Over the same period ‘unplanned exits’ increased – to between 51% and 55%.  Those who were ‘transferred – in custody’ trebled from 5.8% in 2020/21 to 17.2% in 2022/23.


Figure 1.7 below shows trends for successful completions of treatment and re-presentations to treatment amongst Oldham’s opiate clients from 2015/16 to 2022/23. It can be observed that successful completions ranged from 3.6% (2020/21) to 7.4% (2017/18). Oldham’s most recent rate (4.5%) is similar to the North West average of 4.8% but lower than the England average of 5.2%. Oldham’s rate is also similar to the GMCA average of 4.7%. The highest (i.e. best) rate across the North West was recorded by Warrington with 9.0% while the lowest was in Blackpool with 2.1%. Across the GMCA, Trafford had the best rate (6.7%) while Tameside had the worst rate with 3.8%.


Figure 1.7 above also shows re-presentation rates. Re-presentations are defined as where an individual presents to treatment within 6 months of a successful completion of treatment and is, therefore, not considered to be a ‘new presentation’. Oldham’s performance has been characterised by fluctuating rates from a low of 11.1% in 2016/17 – its best rate – to a high of 41.7% in 2020/21.

In the most recent period, 2022/23, Oldham’s re-presentation rate was 27.8% which is higher (i.e. worse) than GMCA (20.4%) and North West (21.5%) averages. The lowest (i.e. best) rate across the North West was recorded by Warrington with 6.5% while the highest was in Halton with 40.0%. Amongst the ten boroughs that comprise GMCA Bury had the best rate (7.1%) while Tameside had the worst rate with 31.3%.

Sub-intervention reviews (SIRs)

Table 1.3 below consists of the top ten rates for the most frequently used sub-interventions amongst Oldham opiate clients in comparison to England averages. Oldham rates are worse than England’s in over half of the interventions listed which include ‘Buprenorphine (tablet/wafer) – Opioid maintenance’ (11.8% in Oldham compared to 17.2% for England); ‘Mutual aid’ (9.1% for Oldham which is less than half the England average of 21.7%); ‘evidence-based psycho-social interventions to support relapse prevention’ (4.5% for Oldham – one-third the England average of 14.2%); and ‘Contingency management (Oldham with 5.8% compared to 17.3% for England). Oldham’s rates for ‘Housing support’ and ‘Methadone (oral solution) – Opioid withdrawal’ are also inferior to those for England.

Table 1.3: Sub Intervention and Treatment Modality Reviews for adult opiate clients in treatment services in Oldham and England (2022/23)
Top 10 interventions (Oldham)	Oldham		England
Motivational interventions	87.3%		84.4%
Recovery check-ups	76.5%		37.7%
Methadone (oral solution) - Opioid maintenance	63.6%		50.2%
Cognitive/behavioural relapse prevention	18.3%		18.2%
Buprenorphine (tablet/wafer) - Opioid maintenance	11.8%		17.2%
Mutual aid	9.1%		21.7%
Housing support	6.2%		7.4%
Contingency management	5.8%		17.3%
Evidence-based psycho-social interventions to support relapse prevention	<5.0%		14.2%
Methadone (oral solution) - Opioid withdrawal	<5.0%		9.6%
Source: NDTMS/OHID	Worse than England	Similar to England	Better than England

Table 3.1 above also show where Oldham is better than the national average is ‘recovery check-ups’ (76.5% - double the rate for England of 37.7%) and ‘Methadone (oral solution) – Opioid maintenance’ (63.6% compared to 50.2%).

Non-opiate(s) only users in treatment in Oldham

Figure 2.1 below shows the numbers in treatment and new presentations amongst Oldham’s adult non-opiate users from April 2014/March 2015 to April 2022/March 2023.  Overall numbers in treatment amongst this user cohort have been an upward trend culminating in an 11.1% decrease from 234 in 2021/22 to 208 in 2022/23.


Figure 2.1 above also shows that new presentations following a similar trajectory to numbers in treatment peaking at 192 (the highest number recorded over the period in view) in April 2021/March 2022 dropping by 17.2% in 2022/23 (the second highest on view).

Summary profile of non-opiate users in treatment in Oldham

Figure 2.2 below shows data in relation to the demographic make-up of Oldham’s non-opiate using clients in-treatment population from 2020/21 to 2022/23.  In the most recent period the proportion of males involved in non-opiate use increased from a typical 70% to approaching 80%.  Approximately 80% are from White/White British ethnicities with 10% from Asian/Asian British backgrounds.  The largest age cohort was recorded for 30-39 year olds – since 2020/21 this has increased by almost one-third from 31% to 39% in 2022/23.  Whilst most other age-bands have broadly maintained their distributions, it can be observed that over the same period those aged 50-64 have halved.


Figure 2.2 above also shows that around one-fifth of non-opiate using clients live with children aged 0-17 years. Currently, approximately one-third have ‘contact with the criminal justice system’ – almost double the rates of the previous two years.

Referrals in to drug treatment services amongst non-opiate users in Oldham

Figure 2.3 below shows referral sources amongst adult non-opiate users newly presenting to treatment services over the past three years in Oldham.  Until the most recent period, by far the most common referral amongst this user cohort was ‘Self, Family & Friends’ which typically accounted for 58%-59% of all referrals.  In 2022/23 referrals from this source decreased by almost one-third to approximately 42%.  Over the same time, however, referrals from ‘criminal justice’ almost doubled from 17% to 33%.


Figure 2.3 above also shows, albeit at a lower level, that referrals from ‘Other health/Mental Health’ sources have increased four-fold since 2020/21.

Accommodation need and co-occurring mental health treatment need in non-opiate clients

‘Accommodation need’ status and ‘co-occurring mental health treatment need identified’ amongst Oldham’s non-opiate users are shown in Figure 2.4 below. Excluding the data shown for 2022/23, due to data quality issues, urgent housing problems amongst this user cohort have remained consistently below 5%, while less severe problems have dropped by one-third over the same period.


Figure 2.4 above also shows that co-occurring mental health treatment needs were identified have remained broadly similar over the three census periods ranging from 65.6% to 69.2% – similar to national trends.

Other substance use amongst non-opiate clients in treatment

Figure 2.5 below illustrates the use of other substances as cited by non-opiate users in treatment in Oldham from 2020/21 to 2022/23.  Throughout this period Cannabis has remained the most common substance with approximately six in ten adult non-opiate users citing its use.  The second most cited substance is Cocaine (powder) with indications amongst this user cohort increasing by one-third from 30.4% in 2020/21 to 40.9% in 2022/23.


The use of Crack cocaine, although fluctuating, was cited by one in six (16.3%) of this user cohort in 2022/23. While the remaining substances are indicated by small proportions of non-opiate users, Figure 2.5 also shows that indications for the use of Amphetamines have fallen by two-thirds since 2020/21.

Table 2.1: Proportion of non-opiate(s) clients accessing treatment who died in Oldham, GMCA, North West and England (2022/23)
	Number of client deaths	Number of clients in treatment	Deaths as a proportion (%) of those in treatment	Oldham ranking in GMCA & North West
Oldham	0	208	0.00%	Equal lowest in GM (out of 10 LAs) Equal lowest in NW (out of 23 LAs)
GMCA	3	2,306	0.13%	~
North West	14	5,355	0.26%	~
England	82	29,523	0.28%	~
Source: NDTMS/OHID

Treatment exits, successful completions and re-presentations in non-opiate clients

Figure 2.6 below illustrates treatment exit status amongst opiate clients in Oldham from 2020/21 to 2022/23.  It can be observed that ‘planned exits’ amongst this user cohort fell by approximately one-quarter, from 51.5% in 2021/22 to 39.0% in 2022/23.  ‘Unplanned exits’ have been on a downward trend since 2020/21 – falling by seven percentage points.  The most significant increase was seen amongst those who were ‘transferred – in custody’ which more than doubled from 6.7% in 2020/21 to 15.1% in 2022/23.


Figure 2.7 below shows trends for successful completions of treatment and re-presentations to treatment amongst Oldham’s non-opiate(s) clients from 2015/16 to 2022/23. It can be observed that successful completions have ranged from a high of 56.8% (2015/16) to a low of 21.9% (2018/19). Oldham’s most recent rate (27.4%) is lower (i.e. worse) than both North West (31.1%) and England (33.7%) averages. Oldham’s rate is similar to the GMCA average of 29.9%. The highest (i.e. best) rate across the North West was recorded by Wirral with 46.3% while the lowest was in Sefton with 13.8%. Across the GMCA, Trafford had the best rate (41.7%) while Wigan had the worst rate with 24.6%.


Figure 2.7 above also shows re-presentation rates. Re-presentations are defined as where an individual presents to treatment within 6 months of a successful completion of treatment and is, therefore, not considered to be a ‘new presentation’. Oldham’s performance has been characterised by an upward fluctuating rates from a low of 0.0% in 2021/22 – its best rate – to a high of 20.0% in 2019/20.

In the most recent period, 2022/23, Oldham’s re-presentation rate was 9.4% which is more than double (i.e. worse) the GMCA (4.5%) and North West (4.1%) averages. The lowest (i.e. best) rate across the North West was recorded by six areas (Blackburn with Darwen, Bury, Cheshire West & Chester, Halton, Sefton and Trafford) with 0.0% while the highest was in Blackpool with 13.0%. Amongst the ten boroughs that comprise GMCA, Bury and Trafford had the best rate (0.0%) while Oldham had the worst rate with 9.4%.

Sub-intervention reviews (SIRs)

Table 2.2 below consists of the top ten rates for the most frequently used sub-interventions amongst Oldham non-opiate(s) clients in comparison to England averages.  Oldham rates are worse than England’s in all but two of the interventions listed which include ‘Motivational interventions’ (51.3% in Oldham compared to 75.8% for England) and ‘Cognitive/behavioural relapse prevention’ (7.7% for Oldham which is less than half the England average of 17.1%).

Table 2.2: Sub Intervention and Treatment Modality Reviews for adult non-opiate(s) clients in treatment services in Oldham and England (2022/23)
Top 10 interventions (Oldham)	Oldham		England
Recovery check-ups	70.5%		34.9%
Motivational interventions	53.1%		75.8%
Cognitive/behavioural relapse prevention	7.7%		17.1%
Mutual aid	<5.0%		21.7%
Mental health interventions	<5.0%		5.3%
Contingency management	<5.0%		11.6%
Peer Support	<5.0%		14.3%
Evidence-based psycho-social interventions to support relapse prevention	<5.0%		13.3%
Psycho-social for mental health	<5.0%		3.9%
Employment support	<5.0%		2.4%
Source: NDTMS/OHID	Worse than England	Similar to England	Better than England

Table 2.2 above also shows that where Oldham is better than the national average is ‘recovery check-ups’ (70.5% - double the rate for England of 34.9%).

The combined user category of Non-opiate(s) & alcohol users in treatment in Oldham

Figure 3.1 below shows the numbers in treatment and new presentations amongst the combined user category of adult non-opiate & alcohol users in Oldham from April 2014/March 2015 to April 2022/March 2023.  Overall numbers in treatment amongst this user cohort have been an upward trend following a slump during April 2017/March 2018 culminating in an 9.8% decrease from 254 (the highest recorded) in 2021/22 to 229 in 2022/23.


Figure 3.1 above also shows new presentations following a similar trajectory to numbers in treatment peaking at 196 (the highest number recorded over the period in view) in April 2021/March 2022 dropping by 15.3% in 2022/23 (equal-second highest on view).

Summary profile of (combined) non-opiate & alcohol users in treatment in Oldham

Figure 3.2 below shows data in relation to the demographic make-up of Oldham’s the combined user category ‘non-opiate(s) & alcohol’ using clients in-treatment population from 2020/21 to 2022/23.  In the most recent period the proportion of males involved in combined use of non-opiates and alcohol has increased slightly from 72% in 2021/22 to 75%.  Approximately 85% are from White/White British ethnicities with between 6% and 8% being from Mixed/Dual Heritage backgrounds.  Clients from Asian/Asian British backgrounds typically account for 5% to 6% of this user cohort in treatment in Oldham.  The largest age cohort was recorded for 30-39 year olds – since 2020/21 this has decreased from 43% to 38% in 2022/23.


Figure 3.2 above also shows that since 2020/21 the proportion of combined non-opiate and alcohol users in treatment who live with children aged 0-17 years more than halved from 27% to 13% in 2022/23. Currently, almost one in four have ‘contact with the criminal justice system’ – five percentage points more than in 2020/21.

Referrals in to drug treatment services amongst combined non-opiate and alcohol users in Oldham

Figure 3.3 below shows referral sources amongst combine non-opiate and alcohol users newly presenting to treatment services over the past three years in Oldham.  In the most recent period, by far the most common referral amongst this user cohort is ‘Self, Family & Friends’ with 52% compared to 45% in the previous year.  Referrals from ‘criminal justice’ in the two most recent census periods account for approximately one in four of all referrals.


Figure 3.3 above also shows, albeit at a lower level, that referrals from ‘Other health/Mental Health’, ‘GP’ and ‘Hospital’ have increased year-on-year.

Accommodation need and co-occurring mental health treatment need in non-opiate clients

‘Accommodation need’ status and ‘co-occurring mental health treatment need identified’ amongst Oldham’s combined user category of non-opiate and alcohol users are shown in Figure 3.4 below.  Excluding the data shown for 2022/23, due to data quality issues, urgent housing problems amongst this user cohort have remained consistently below 5%, while less severe problems increased from 13.6% in 2020/21 to 16.8% in the most recent period.


Figure 3.4 above also shows that co-occurring mental health treatment needs identified have increased gradually from 69.4% in 2020/21 to 74.1% in 2022/23 – broadly mirroring national trends.

Other substance use amongst combined non-opiate and alcohol using clients in treatment

Figure 3.5 below illustrates the use of other substances as cited by combined non-opiate and alcohol users in treatment in Oldham from 2020/21 to 2022/23.  Throughout this period, with the exception of alcohol, Cannabis and Cocaine (powder) have remained the most common substances with 52% to 56% citing their use.


The use of Crack cocaine, although fluctuating, was cited by one in eight (12.7%) of this user cohort in 2022/23.

Deaths in treatment amongst opiate clients in Oldham

Table 3.1 below shows the proportion of non-opiate and alcohol (combined use) clients accessing treatment who died in 2022/23. Deaths in treatment amongst this user cohort are relatively uncommon when compared to opiate users and even alcohol only clients. During 2022/23 there were less than five deaths recorded amongst non-opiate users in treatment Oldham. All other geography levels recorded rates of less than 0.60%.

Table 3.1: Proportion of non-opiate(s) and alcohol (combined use) clients accessing treatment who died in Oldham, GMCA, North West and England (2022/23)
	Number of client deaths	Number of clients in treatment	Deaths as a proportion (%) of those in treatment	Oldham ranking in GMCA & North West
Oldham	< 5	229	~ ~	4th highest in GM (out of 10 LAs) 9th lowest in NW (out of 23 LAs)
GMCA	12	3,120	0.38%	~
North West	36	6,972	0.52%	~
England	202	34,991	0.58%	~
Source: NDTMS/OHID

Treatment exits, successful completions and re-presentations in non-opiate clients

Figure 3.6 below illustrates treatment exit status amongst combined users of non-opiate(s) and alcohol in Oldham from 2020/21 to 2022/23.  It can be observed that ‘planned exits’ amongst this user cohort fell by almost one-fifth, from 50.0% in 2021/22 to 41.6% in 2022/23.  ‘Unplanned exits’ have increased by one-sixth from 43.8% in 2020/21 to 50.6% in 2022/23.  In the two most recent census periods ‘transferred – in custody’ increased to 6% to 7% - approximately doubling since 2020/21.


Figure 3.7 below shows trends for successful completions of treatment and re-presentations to treatment amongst Oldham’s combined non-opiate(s) and alcohol using clients from 2015/16 to 2022/23. It can be observed that successful completions have ranged from a high of 48.8% (2015/16) to a low of 12.6% (2018/19).

Oldham’s most recent rate (27.9%) is lower (i.e. worse) than the North West average (31.5%) but similar to GMCA (30.0%) and England (30.3%) averages. The highest (i.e. best) rate across the North West was recorded by Trafford with 43.8% while the lowest was in Sefton with 16.5%. Across the GMCA, again Trafford had the best rate while Rochdale had the worst rate with 25.1%.


Figure 3.7 above also shows re-presentation rates. Re-presentations are defined as where an individual presents to treatment within 6 months of a successful completion of treatment and is, therefore, not considered to be a ‘new presentation’. Oldham’s performance has been characterised by fluctuating rates from a low of 0.0% in 2018/19 and 2020/21 – its best rate – to a high of 20.6% in 2017/18.

In the most recent period, 2022/23, Oldham’s re-presentation rate was 8.8% similar to both the GMCA (8.6%) and North West (9.4%) averages. The lowest (i.e. best) rate across the North West was recorded in Trafford with 0.0% while the highest was in Liverpool with 17.3%. Amongst the ten boroughs that comprise GMCA, Trafford had the best rate (0.0%) while Rochdale had the worst rate with 14.6%.

Sub-intervention reviews (SIRs)

Table 3.2 below consists of the top ten rates for the most frequently used sub-interventions amongst Oldham’s combined user category of non-opiate(s) and alcohol in comparison to England averages.  Oldham rates are worse than England’s in all but three of the interventions listed which include ‘Motivational interventions’ (66.4% in Oldham compared to 77.2% for England) and ‘Cognitive/behavioural relapse prevention’ (15.0% for Oldham which is less than half the England average of 18.7%).

Table 3.2: Sub Intervention and Treatment Modality Reviews for adult non-opiate(s) and alcohol (combined use) clients in treatment services in Oldham and England (2022/23)
Top 10 interventions (Oldham)	Oldham		England
Recovery check-ups	75.7%		39.4%
Motivational interventions	66.4%		77.2%
Cognitive/behavioural relapse prevention	15.0%		18.7%
Mutual aid	5.8%		24.4%
Mental health interventions	<5.0%		6.1%
Psycho-social for mental health	<5.0%		4.9%
Evidence-based psycho-social interventions to support relapse prevention	<5.0%		14.4%
Housing Support	<5.0%		4.8%
Contingency management	<5.0%		11.3%
Family support	<5.0%		4.8%
Source: NDTMS/OHID	Worse than England	Similar to England	Better than England

Table 3.2 also shows that where Oldham is better than the national average is ‘recovery check-ups’ (75.7% - almost double the rate for England of 39.4%).

Further Information & Resources

OHID Data Profiles
Further information and data relating to substance misuse