A report concluded people were ‘swimming in a disjointed system that struggles to meet their needs’
People who use drugs often do so as a means of self-medication to cope with trauma and numb pain(Image: Getty Images )
Drug users in an area of Wales with reportedly the highest number of drug-related deaths have been “swimming in a disjointed system that struggles to meet their needs”, according to a report.
The authors suggested this was due to “cultural paralysis” in the area – Swansea and Neath Port Talbot but referred to in the report as Western Bay – and a lack of services to reflect changes in drug use and the increasingly complex needs of those who take them.
The report was written by an independent commission which heard from more than 250 people. It was set up by a body called Western Bay Area Planning Board, which co-ordinates substance use services, in response to high reported rates of drug-related deaths. The planning board has also instigated other measures and said significant progress has been made.
The commission’s report said complex drug use, the services available and untimely deaths were linked. Recurring themes were how important secure housing and mental health support were for people who experienced problems with drugs.
“Although there are some mixed messages about the specifics of the drug death data for Western Bay compared to other areas of Wales, what is clear to us is that too many people are dying unnecessarily because of drug use,” said the report. “Many others struggle to access the services they need, where and when they need them.”
People in need of support told the commission they had never been asked for their views about services, and many felt the justice system was one of the quickest routes to getting treatment. There was also a strong perception that the nature of drugs and the way users combined them were changing but the services were not, and in terms of treatment, it was a case of “methadone (opioid substitution treatment) or nothing”.
The commission also reported long waiting lists for assessment and burn-out among a multi-agency workforce who, while often passionate and committed, did not feel “sufficiently invested in, appreciated, or equipped to respond fully to the changing complexity of presentations within services”.
It described buildings where drug support services were provided as low-quality and said people requiring help were confronted by locked doors, buzzer entry systems and/or glass partitions. More services, it said, needed to be closer to people’s homes and not just in urban centres. Never miss a Swansea story by signing up to our newsletter here
The report also said stronger leadership was key rather than just another set of plans or performance measures.
“Our main observation is that people in Western Bay who experience problems with drugs have been swimming in a disjointed system that struggles to meet their needs,” it said. “This is because of cultural paralysis, and a lack of service provision reflecting changes in the nature of drug use and increasing complexity of individual presentations.
“We have used the analogy of swimming because we have heard many accounts of the efforts that individuals have had to put in to just tread water. They have described how their circumstances have led them to use drugs as a means of self-medication to cope with trauma and numb their pain.”
The commission made 26 recommendations and further observations for bodies such as the Welsh Government, Public Health Wales and the coroner’s office.
The recommendations include designing a treatment system supporting harm reduction through to recovery, addressing mental well-being and housing at the same time and in the same place as drug treatment, responding to the root causes of drug use such as poverty, trauma, violence, neglect and incarceration.
Western Bay Area Planning Board said it aimed to transform support for people at risk of or seeking help for substance use and that the commission’s report will help.
It said leadership has been strengthened, more say given to people using or providing support services in how, when and where those services are offered, and that waiting times have reduced.
A move to align drug support with housing and mental health services, it said, was also under way, among other measures. It added that South Wales Police had disrupted 56 drug lines, made 486 arrests for drug trafficking and supply and made significant seizures between January 2024 and June 2025.
Deb Lewis, who was area planning board chairwoman at the time the report was received but is no longer in the role, said: “We appointed an independent drug commission to investigate the key causes and consequences of drug use, and to identify where we can further improve the changes we are making.
“While the commission was carrying out its work we have not stood still, and a lot of work has already taken place in recent years to reduce accidental drug-related deaths.”
She added: “Whilst the latest recorded drug use deaths in the Swansea and Neath Port Talbot area have fallen by 23%, every drug-related death is a tragedy. We are committed to ensuring that vulnerable people receive the support and treatment they need.”
Dr Sam Clutton, one of the commission members, said: “When someone is drug dependent, their families live in constant fear of a phone call or knock at the door to tell them that their loved one is dead.
“There was a period before my son’s recovery when I used to regularly wake up in the night and run to open the front door, convinced the knock had come, thankfully it never did. I was with him in A&E on a number of occasions when he had accidentally overdosed, and seconds of time move in slow motion as you hold your breath desperate for the intervention to work.
“I have been lucky; I still have my son, and I am incredibly proud of him and everything he has achieved despite the experiences related to his drug dependency.
“A number of women who I hold very dear have lost their sons, their other children have lost siblings, and their grandchildren have lost their fathers. The impact of a so-called ‘drug-related death’ on families is sheer devastation. People working in drug services are also left with the trauma of a death of someone they have worked so hard to support.”
Dr Clutton added: “Ultimately the real answer to preventing drug-related deaths is to provide the right support at the right time to people living with drug dependency. This is not a criticism of the staff who work so hard in front line services or of the services themselves, the majority of which are simply overwhelmed with demand.”