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Drug misuse prevention

About

What is covered

This interactive flowchart covers targeted interventions to prevent misuse of drugs, including illegal drugs, 'legal highs' and prescription-only medicines. It aims to prevent or delay harmful use of drugs in children, young people and adults who are most likely to start using drugs or who are already experimenting or using drugs occasionally.
This interactive flowchart does not cover broader activities, both population-level (universal) and targeted, that aim to build people's skills, resilience and ability to make positive decisions about their health and which address the wider determinants of health. For more information, see the NICE guidance on lifestyle and wellbeing.
For information on the treatment of drug misuse, see what NICE says on drug misuse management in over 16s.

Updates

Updates to this interactive flowchart

28 March 2018 Drug misuse prevention (NICE quality standard 165) added.

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Your responsibility

Guidelines

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Technology appraisals

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Short Text

Everything NICE has said on drug misuse prevention for children, young people and adults in an interactive flowchart

What is covered

This interactive flowchart covers targeted interventions to prevent misuse of drugs, including illegal drugs, 'legal highs' and prescription-only medicines. It aims to prevent or delay harmful use of drugs in children, young people and adults who are most likely to start using drugs or who are already experimenting or using drugs occasionally.
This interactive flowchart does not cover broader activities, both population-level (universal) and targeted, that aim to build people's skills, resilience and ability to make positive decisions about their health and which address the wider determinants of health. For more information, see the NICE guidance on lifestyle and wellbeing.
For information on the treatment of drug misuse, see what NICE says on drug misuse management in over 16s.

Updates

Updates to this interactive flowchart

28 March 2018 Drug misuse prevention (NICE quality standard 165) added.

Sources

NICE guidance and other sources used to create this interactive flowchart.
Drug misuse prevention (2018) NICE quality statement 165

Quality standards

Drug misuse prevention

These quality statements are taken from the drug misuse prevention quality standard. The quality standard defines clinical best practice for drug misuse prevention and should be read in full.

Quality statements

Assessment of looked-after children and young people

This quality statement is taken from the drug misuse prevention quality standard. The quality standard defines clinical best practice for drug misuse prevention and should be read in full.

Quality statement

Looked-after children and young people having their annual health plan review are assessed for vulnerability to drug misuse.

Rationale

Looked-after children and young people are at increased risk of drug misuse. Assessing vulnerability as part of their annual health plan review provides an opportunity to give early targeted support, which can reduce the likelihood of drug misuse.

Quality measures

Structure
a) Evidence of local arrangements for the use of an agreed brief and valid questionnaire to assess looked-after children and young people’s vulnerability to drug misuse at their annual health plan review.
Data source: Local data collection, for example, from service specifications.
b) Evidence of local arrangements for staff to be trained by specialist services in how to assess looked-after children and young people’s vulnerability to drug misuse.
Data source: Local data collection, for example, from service specifications.
Process
Proportion of looked-after children and young people having their annual health plan review who have an assessment of vulnerability to drug misuse.
Numerator – the number in the denominator who have an assessment of vulnerability to drug misuse.
Denominator – the number of looked-after children and young people who have had a health plan review in the previous 12 months.
Data source: Local data collection, for example, local audit of local authority records.
Outcome
a) Number of looked-after children and young people who misuse drugs.
Data source: Local data collection.
b) Proportion of looked-after children and young people misusing drugs, who access support for drug misuse.
Data source: Local data collection. Data collection is required for the children looked after data return SSDA903 on whether children looked after by local authorities in England are identified as having a substance misuse problem for each year up to 31 March.

What the quality statement means for different audiences

Service providers (such as primary care services and looked-after children health teams) ensure that staff who assess the health of looked-after children are provided with guidance and training from specialist services so that they know the indicators of drug misuse, how to approach the assessment with sensitivity, how to use brief questionnaires (such as CRAFFT) accurately and how to respond to identified needs. They ensure that arrangements are in place for assessments to be included in the annual health plan review.
Healthcare professionals (such as GPs and school nurses) use a consistent, locally agreed brief and valid questionnaire, such as CRAFFT, to assess looked-after children and young people for vulnerability to drug misuse at their annual health plan review. They use an approach that is respectful, non-judgemental and proportionate to the young person’s presenting vulnerabilities, and consider whether any further action is needed.
Commissioners (NHS England and local authorities) work with providers to produce a strategy to identify looked-after children and young people who are at risk of drug misuse. They ensure that they commission services in which looked-after children and young people have an assessment of vulnerability to drug misuse at their annual health plan review.
Children and young people who are looked after are asked brief questions at their annual health plan review to assess whether they are at risk of drug misuse. This is so that their needs can be identified and responded to.

Source guidance

Definitions of terms used in this quality statement

Assessment of vulnerability to drug misuse
An assessment that is respectful, non-judgemental and proportionate to the child or young person’s presenting vulnerabilities that uses a consistent, locally agreed, brief and valid questionnaire, such as CRAFFT. The child or young person’s circumstances should be discussed, taking account of their age and developmental stage. The initial discussion could include:
  • their physical and mental health and their personal, social, educational or employment circumstances (which may trigger a more in-depth assessment)
  • any drug use (including the type used and how often).
[Adapted from NICE’s guideline on drug misuse prevention, recommendations 1.2.2 and 1.2.3, and College Centre for Quality Improvement’s Practice standards for young people with substance misuse problems]
Health plan review
A looked-after child has a health plan review at least once every 12 months from the age of 5.
A looked-after child or young person’s health plan forms part of their wider care plan. It is based on the written report of the health assessment, which takes place before the child or young person is placed with the local authority, or if that is not reasonably practicable, before their first case review.

Assessment of care leavers

This quality statement is taken from the drug misuse prevention quality standard. The quality standard defines clinical best practice for drug misuse prevention and should be read in full.

Quality statement

Care leavers having a health assessment as part of planning to leave care are assessed for vulnerability to drug misuse.

Rationale

The transition from care is an important time for young people to receive a comprehensive assessment of their physical, emotional and mental health needs, as part of planning to leave care. Assessing a care leaver’s vulnerability to drug misuse provides an opportunity to identify risks and give them targeted support.

Quality measures

Structure
a) Evidence of local arrangements for the use of an agreed brief and valid questionnaire to assess care leavers’ vulnerability to drug misuse at their health assessment.
Data source: Local data collection, for example, from service specifications.
b) Evidence of local arrangements for staff to be trained by specialist services in how to assess care leavers’ vulnerability to drug misuse.
Data source: Local data collection, for example, from service specifications.
Process
Proportion of care leavers having a health assessment as part of planning to leave care who have an assessment of vulnerability to drug misuse.
Numerator – the number in the denominator where there is an assessment of vulnerability to drug misuse.
Denominator – the number of care leavers having a health assessment as part of planning to leave care.
Data source: Local data collection, for example, audit of local authority records.
Outcome
a) Number of care leavers who misuse drugs.
Data source: Local data collection.
b) Proportion of care leavers misusing drugs who access support for drug misuse.
Data source: Local data collection. Data collection is required for the children looked after data return SSDA903 on whether children looked after by local authorities in England are identified as having a substance misuse problem for each year up to 31 March.

What the quality statement means for different audiences

Service providers (such as primary care services and social care services) ensure that assessments of care leavers’ vulnerability to drug misuse are carried out as part of their health assessments. They also ensure that staff are provided with guidance and training from specialist services so that they know the indicators of drug use, how to approach the assessment with sensitivity, how to use brief questionnaires such as CRAFFT accurately, and how to respond to identified needs.
Health and social care practitioners (such as GPs and social workers) use a consistent, locally agreed brief and valid questionnaire, such as CRAFFT, to assess care leavers for vulnerability to drug misuse at their health assessment. They use an approach that is respectful, non-judgemental and proportionate to the young person’s presenting vulnerabilities, and consider whether any further action is needed.
Commissioners (NHS England and local authorities) work with providers to produce a strategy to identify young people who are at risk of drug misuse. They ensure that they commission services in which care leavers have an assessment of vulnerability to drug misuse at their health assessment.
Care leavers are asked brief questions at their health assessment to assess whether they are at risk of drug misuse. This is so that their needs can be identified and responded to.

Source guidance

Definitions of terms used in this quality statement

Assessment of vulnerability to drug misuse
An assessment that is respectful, non-judgemental and proportionate to the young person’s presenting vulnerabilities that uses a consistent, locally agreed, brief and valid questionnaire, such as CRAFFT. The young person’s circumstances should be discussed, taking account of their age and developmental stage. The initial discussion could include:
  • their physical and mental health and their personal, social, educational or employment circumstances (which may trigger a more in-depth assessment)
  • any drug use (including the type used and how often).
[Adapted from NICE’s guideline on drug misuse prevention, recommendations 1.2.2 and 1.2.3, and College Centre for Quality Improvement’s Practice standards for young people with substance misuse problems]
Health assessment
When developing a pathway plan for young people preparing to leave care, an assessment of the needs of the young person should be carried out that includes their health and development.

Assessment of children and young people in contact with youth offending services

This quality statement is taken from the drug misuse prevention quality standard. The quality standard defines clinical best practice for drug misuse prevention and should be read in full.

Quality statement

Children and young people having a young offender assessment are assessed for vulnerability to drug misuse.

Rationale

Children and young people who are in contact with youth offending services are at increased risk of drug misuse. Youth offending teams can use young offender assessments to assess vulnerability. This provides an opportunity to give early targeted support, which can reduce the likelihood of drug misuse.

Quality measures

Structure
a) Evidence of local arrangements for the use of an agreed brief and valid questionnaire to assess children and young people’s vulnerability to drug misuse at young offender assessments.
Data source: Local data collection, for example, from service specifications.
b) Evidence of local arrangements for staff to be trained in how to assess children and young people’s vulnerability to drug misuse.
Data source: Local data collection, for example, from service specifications.
Process
Proportion of young offender assessments which include an assessment of vulnerability to drug misuse.
Numerator – the number in the denominator which include an assessment of vulnerability to drug misuse.
Denominator – the number of young offender assessments.
Data source: Local data collection, for example, audit of records.
Outcome
a) Number of children and young people in contact with youth offending services who misuse drugs.
Data source: Local data collection.
b) Proportion of children and young people who are in contact with youth offending services, misusing drugs, who access support for drug misuse.
Data source: Local data collection.

What the quality statement means for different audiences

Service providers (youth offending teams) ensure that staff use a consistent, locally agreed brief and valid questionnaire, such as CRAFFT, to assess children and young people for vulnerability to drug misuse at young offender assessments. Staff are also provided with guidance and training from specialist services so that they know the indicators of drug use, how to approach the assessment with sensitivity, how to use brief questionnaires accurately and how to respond to identified needs.
Youth offending team workers and managers use a consistent, locally agreed brief and valid questionnaire, such as CRAFFT, to assess children and young people who are having a young offender assessment for vulnerability to drug misuse. They use an approach that is respectful, non-judgemental and proportionate to the young person’s presenting vulnerabilities, and consider whether any further action is needed.
Commissioners (local authorities, Youth Justice Board) ensure that they commission services in which children and young people who are having a young offender assessment or review have an assessment of vulnerability to drug misuse.
Children and young people children who are having a young offender assessment with a youth offending team are asked brief questions to assess whether they are vulnerable to drug misuse. This is so that their needs can identified and responded to.

Source guidance

Drug misuse prevention: targeted interventions (2017) NICE guideline NG64, recommendation 1.2.1

Definitions of terms used in this quality statement

Assessment of vulnerability to drug misuse
An assessment that is respectful, non-judgemental and proportionate to the young person’s presenting vulnerabilities that uses a consistent, locally agreed, brief and valid questionnaire, such as CRAFFT. The child or young person's circumstances should be discussed, taking account of their age and developmental stage. The initial discussion could include:
  • their physical and mental health and their personal, social, educational or employment circumstances (which may trigger a more in-depth assessment)
  • any drug use (including the type used and how often and relationship between their offending and drug use).
[Adapted from NICE’s guideline on drug misuse prevention, recommendations 1.2.2 and 1.2.3, and College Centre for Quality Improvement’s Practice standards for young people with substance misuse problems]
Young offender assessment
The young offender assessment process is designed to find out the risk and protective factors playing a part in a young person’s offending. ‘AssetPlus’ is the Youth Justice Board for England and Wales’s comprehensive end-to-end assessment and planning framework approved by the Youth Justice Board for England and Wales.

Information and advice for adults

This quality statement is taken from the drug misuse prevention quality standard. The quality standard defines clinical best practice for drug misuse prevention and should be read in full.

Quality statement

Adults assessed as vulnerable to drug misuse are given information about local services and where to find further advice and support.

Rationale

It is important that adults who have been assessed as vulnerable to drug misuse are provided with clear information and advice on the harms of drugs use and where to get help. This can help to reduce the likelihood of the misuse of drugs, such as preventing drug dependency.

Quality measures

Structure
Evidence of local arrangements to provide written information about local services and where to find further advice and support.
Data source: Local data collection, for example, list of local services.
Process
Proportion of adults assessed as vulnerable to drug misuse who are given information about local services and where to find further advice and support.
Numerator – the number in the denominator who are given information about local services and where to find further advice and support.
Denominator – the number of adults assessed as vulnerable to drug misuse.
Data source: Local data collection, for example, audit of patient, specialist services monitoring reports and service user records.
Outcome
a) Proportion of people aged 16 to 59 years who use drugs frequently.
Data source: Local data collection. The Home Office produces annual Drug misuse statistics which examines the extent and trends in illicit drug use among a sample of residents in households in England and Wales.
b) Proportion of people aged 16 to 24 years who use drugs frequently.
Data source: Local data collection. The Home Office produces annual Drug misuse statistics which examines the extent and trends in illicit drug use among a sample of residents in households in England and Wales.

What the quality statement means for different audiences

Service providers (such as primary and secondary care services, social services, sexual and reproductive health services, specialist drug and alcohol services, mental health services, housing and benefits, and criminal justice services) have systems in place for adults assessed as vulnerable to drug misuse to be given information about local services and where to find further advice and support.
Health and social care practitioners, and criminal justice system professionals (such as GPs, community nurses, health visitors, hospital workers, social workers, mental health professionals, specialist drug services professionals, police and probation officers) give information about local services and where to find further advice and support to adults who are assessed as vulnerable to drug misuse.
Commissioners (NHS England, local authorities, clinical commissioning groups) ensure that they commission services where adults assessed as vulnerable to drug misuse are given information about local services and where to find further advice and support.
Adults who are assessed as vulnerable to drug misuse are given information about local services and where to find further advice and support. This should be both verbal and written. It should be provided in a non-judgemental way and tailored to the person's preferences, needs and level of understanding about their health.

Source guidance

Drug misuse prevention: targeted interventions (2017) NICE guideline NG64, recommendation 1.4.1

Definitions of terms used in this quality statement

Information on local services and where to find further advice and support
Information and advice given should be both verbal and in writing.
For general information about drugs, a reputable source should be given for where people can access further information, such as NHS Choices. Information about local services should also be provided so that support can be accessed as needed.
[Adapted from NICE’s guideline on drug misuse prevention, recommendations 1.4.1 and 1.4.2 and expert opinion]

Equality and diversity considerations

Information about drug misuse should be accessible to people with additional needs such as physical, sensory or learning disabilities, and to people (including families and carers) who do not speak or read English or who have reduced literacy skills. People should have access to an interpreter or advocate if needed.

Effective interventions library

Effective interventions library

Successful effective interventions library details

Implementation

NICE has produced resources to help implement its guidance on:

Pathway information

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Your responsibility

Guidelines

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Technology appraisals

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Supporting information

Groups at risk of drug misuse, including:
  • people who have mental health problems
  • people who are being sexually exploited or sexually assaulted
  • people involved in commercial sex work
  • people who are lesbian, gay, bisexual or transgender
  • people not in employment, education or training (including children and young people who are excluded from school or who truant regularly)
  • children and young people whose carers or families use drugs
  • children and young people who are looked after or care leavers
  • children and young people who are in contact with young offender teams but not in secure environments (prisons and young offender institutions)
  • people who are considered homeless
  • people who attend nightclubs and festivals
  • people who are known to use drugs occasionally or recreationally.

Glossary

people aged 25 or under who have been looked after by a local authority for at least 13 weeks since age 14, and who were looked after by the local authority at school leaving age or after that date
any drug that is described in the Misuse of Drugs Act 1971 and the Psychoactive Substances Act 2016, as well as new psychoactive substances (often described as 'legal highs'), solvents, volatile substances, image- and performance-enhancing drugs, prescription-only medicines and over-the-counter medicines
any drugs that are described in the Misuse of Drugs Act 1971 and the Psychoactive Substances Act 2016, as well as new psychoactive substances (often described as 'legal highs'), solvents, volatile substances, image- and performance-enhancing drugs, prescription-only medicines and over-the-counter medicines
dependence on, or regular excessive consumption of, psychoactive substances, leading to physical, mental or social problems; it does not refer to occasional or experimental drug use
dependence on, or regular excessive consumption of, psychoactive substances, leading to physical, mental or social problems; it does not refer to occasional or experimental drug use
being dependent on, or regularly making an excessive consumption of, psychoactive substances, leading to physical, mental or social problems; it does not include occasional or experimental drug use in adults
being dependent on, or regularly making an excessive consumption of, psychoactive substances, leading to physical, mental or social problems; it does not include occasional or experimental drug use in adults
people who care for children and young people who are looked-after; this includes long-term care, emergency overnight care, and short-term care
children and young people looked after by the state where the Children Act 1989 applies, including those who are subject to a care order or temporarily classed as looked after on a planned basis for short breaks or respite care; it includes residential care, foster care, or boarding school, or with birth parents other family or carers – children and young people who are in young offender or other secure institutions are not included in this definition, because this group is outside the scope of these recommendations
prevent or delay drug use, prevent people who are already using some drugs from using other drugs, and prevent people who already experiment or use drugs occasionally from using drugs regularly and excessively
preventing or delaying drug use, preventing people who are already using some drugs from using other drugs, and preventing people who already experiment or use drugs occasionally from using drugs regularly and excessively
the teaching of specific verbal and nonverbal behaviours (including personal and social skills) and the practising of these behaviours by the person receiving the training
people who are vulnerable to drug use are those in multiple groups at risk, whose personal circumstances put them at increased risk, who may already be using drugs on an occasional basis or may already be regularly excessively consuming another substance, such as alcohol
people aged 10 to 18, as well as people aged up to 25 who have special educational needs or a disability (consistent with the Children and Families Act 2014)

Paths in this pathway

Pathway created: February 2017 Last updated: March 2018

© NICE 2018. All rights reserved. Subject to Notice of rights.

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