Substance misuse is widely acknowledged as a significant public health problem1 and may be defined as ‘recurrent use that is causing actual harms (negative consequences) to the person (including dependence, but also other health, psychological or social problems), or is placing the person at a high probability/risk of suffering such harms2. Substance misuse is a leading cause of premature mortality and morbidity, associated with a range of physical and mental health conditions, including anxiety and depression. These comorbidities can complicate substance misuse treatment. The identification of early opportunities for intervention is key to reducing the burden of substance misuse at both the individual and societal level and to prevent escalation to more problematic and harmful use. Earlier engagement, improving assessment of substance use-related needs, and understanding how individuals first interact with any health service, whether primary, secondary care or treatment services, are important ways that linked data can aid policymakers and planners in evidence-based policy and service design and prioritisation. This study aims to provide insight and evidence into potential opportunities for early engagement to prevent escalation to substance misuse.

This Data Insight presents the findings of a study conducted as part of the BOLD Substance Misuse Demonstrator Pilot (Phase 1) in Wales, which focuses on early intervention and prevention of escalation of substance misuse. Further information on the BOLD programme can be found here: Better Outcomes Through Linked Data (BOLD) This research examines the type and timing of healthcare service contact prior to and after the start of problematic or enduring substance misuse in order to identify missed opportunities for prevention of escalation and promote earlier engagement to reduce substance misuse-related harm including death.

P.4 Potential opportunities for intervention were defined as any GP consultation, inpatient admission, emergency department or outpatient attendance in the 2-years pre-index SM event or 2-years post-index SM event contact, where substance use was a presenting or related issue.