Substance use in West Wales isn’t just something that happens “in the cities”.
It’s in quiet streets, lay-bys, guest houses, farms, town centres after closing time, and living rooms where no one talks about it.
It cuts across housing, mental health, poverty, trauma and grief. And when the system is slow or hard to reach, people fall through the gaps.
This post isn’t about blaming individuals or professionals. It’s about:
- What’s actually happening in Wales
- How overdose is being tackled (and where it isn’t)
- What support exists in Pembrokeshire
- How community-based advocacy and support fit alongside the clinical system
1. The reality in Wales: not “a few problem users”
The latest figures from the Office for National Statistics are blunt:
- In 2024, 417 deaths related to drug poisoning were registered in Wales – up from 377 in 2023.
- That’s 140.4 deaths per million people, significantly higher than the previous year.
These aren’t just “overdose” in the dramatic sense. They include deaths linked to heroin, methadone, prescription meds, synthetic opioids, and combinations of drugs and alcohol.
Public Health Wales has been clear:
- Opioids remain the leading factor in drug-related deaths in Wales.
- Naloxone is preventing many more deaths than it used to – but not all of them.
Behind each of those 417 are:
- Families who often didn’t know where to turn
- People who tried to get help and hit waiting lists, closed doors, or confusing phone systems
- Whole communities who quietly absorb the shock
This isn’t a “big city problem”. It’s a Wales problem, and very much a Pembrokeshire problem too.
2. Why substance use in Pembrokeshire doesn’t fit the stereotypes
In a rural county, “drug use” looks different to the stereotypes:
- People may use them in isolated homes or caravans, far from neighbours.
- Farm workers, hospitality staff, seasonal workers and older adults can be affected just as much as younger people in town centres.
- Drugs are often used to blunt pain, trauma, poor mental health, ADHD, poverty, or loneliness, not just for “partying”.
Because villages are small and everyone knows everyone, many people are scared to ask for help:
- “What if the worker knows my family?”
- “What if social services get involved?”
- “What if I lose my housing or kids?”
That fear means people hide problems until they’re at crisis point – or until there’s a blue-light response and flashing lights outside.
3. Overdose in real life: it rarely looks neat
Overdose isn’t always a dramatic collapse in an alleyway.
It can look like:
- Someone “just sleeping it off” on a sofa and quietly stopping breathing.
- A mix of alcohol, benzos and opioids building up over hours.
- Someone with chronic pain taking “just one extra” on top of their prescribed meds.
- A person in withdrawal is using again at their old dose and their body is not coping.
In rural areas, there’s often:
- Longer ambulance response times
- Fewer people nearby who recognise overdose signs
- No nearby services open at 2am to ask, “Is this serious?”
That’s why Wales invested in Take-Home Naloxone and harm-reduction work in the first place.
4. Naloxone and Take-Home Naloxone (THN) in Wales
Naloxone is a medicine that can temporarily reverse the effects of an opioid overdose (for example heroin, methadone, morphine, buprenorphine, some painkillers). It buys time so emergency services can get there.
In Wales:
- Take-Home Naloxone (THN) has been supplied since 2009 through substance-misuse services, prisons, Integrated Offender Services and approved homelessness services.
- Public Health Wales confirms Naloxone can still be ordered for free in Wales via the DAN 24/7 helpline and online.
- Services like Barod run a Naloxone “click and deliver” service, posting kits out after a brief remote assessment.
- UK-wide changes in 2024 also made it easier for police forces to purchase naloxone directly, widening who can carry it.
Kits may be:
- Nyxoid® – nasal spray
- Prenoxad® – pre-filled injectable syringe
- Other Naloxone preparations, depending on the service
Every kit comes with basic instructions. Training in Wales is usually short, practical, and focused on:
- Spotting overdose
- Calling 999
- Giving rescue breaths if safe to do so
- Administering Naloxone and staying until help arrives
It doesn’t turn anyone into a paramedic – it just makes the difference between “too late” and “still breathing when the ambulance gets there”.
5. How people actually reach help in Dyfed Pembrokeshire
On paper, the route in West Wales is clear:
- The Dyfed Drug and Alcohol Service (DDAS) is the first point of contact for adults (18+) with drug or alcohol concerns in Carmarthenshire, Pembrokeshire and Ceredigion.
- DDAS is a Barod-led consortium, working with Kaleidoscope and others, and sits alongside Hywel Dda University Health Board’s teams.
In practice, that means:
- You don’t need a GP referral – you can self-refer.
- You can contact DDAS:
- By phone on 0330 363 9997 (this is the central adult substance-misuse access line for Dyfed).
- Via the online chat / enquiry link on the DDAS pages (often via Barod’s website).
- By phone on 0330 363 9997 (this is the central adult substance-misuse access line for Dyfed).
They can then link you into:
- Community drug and alcohol teams
- Detox / rehab options where appropriate
- Harm-reduction services, including Naloxone
- Support for people affected by someone else’s use
Hywel Dda UHB also runs a Community Drug and Alcohol Team, providing specialist support and care plans as part of the wider NHS system.
6. Local harm-reduction and support in Pembrokeshire
Depending on the situation, people might link into:
- DDAS (Dyfed Drug and Alcohol Service) – first contact for structured treatment, harm-reduction and support.
- Hywel Dda Community Drug and Alcohol Team – specialist NHS input, care planning, and medical support.
- PATH – Pembrokeshire Action for the Homeless – for people whose substance use is tangled with homelessness, eviction risk, mental-health crisis or complex trauma.
- Citizens Advice Pembrokeshire – for benefits, debt, employment, and rights when substance use has knocked everything sideways.
Third-sector organisations in Pembrokeshire may offer:
- Counselling or mental-health support
- Housing and legal advice
- Social-lettings schemes
- Mediation to keep tenancies or relationships from collapsing
Advocacy projects (including DCAG alongside larger providers) can help with:
- Understanding letters and decisions
- Preparing for assessments or reviews
- Requesting reasonable adjustments
- Making complaints when systems misfire
None of these are magic, but together they form a web. The trick is knowing which strand to pull first.
7. Substance use, mental health and trauma: three strands of the same rope
Very few people wake up and think, “I’ll ruin my life with drugs today.”
What you see instead is:
- People using substances to manage trauma, anxiety, ADHD, psychosis, chronic pain or grief
- People leaving services feeling unheard or dismissed, and going back to what numbs things quickest
- Families burning out trying to keep someone alive while juggling work, kids, and constant crisis
Public Health Wales and organisations like Barod have repeatedly highlighted:
- The impact of Adverse Childhood Experiences (ACEs) on later substance use
- The need for trauma-informed responses, not punishment-led ones
In Pembrokeshire, that plays out in:
- People being excluded from hostel or supported housing for behaviour that’s actually trauma or withdrawal
- Court orders and enforcement being used where early intervention might have worked better
- Families terrified to ask for help in case it triggers child-protection processes without support
Trauma-aware and harm-reduction-minded services (statutory and community-based) try to work with this, not against it.
8. The role of police and emergency services
Police officers in Dyfed-Powys often end up being the first people on scene when:
- Someone collapses in a public place
- There’s a welfare concern in a property
- Neighbours report shouting, strange behaviour or suspected dealing
UK-wide changes now allow police forces to buy naloxone directly and increase how widely it’s carried.
In a good day-to-day system, police, NHS, DDAS, housing and voluntary services:
- Share information appropriately
- Aim for diversion into support, not just enforcement
- Use community-based projects (including advocacy) as part of the safety net
When that works, people get help earlier. When it doesn’t, police become the default crisis service for everything – which isn’t fair on them or the people in crisis.
9. How advocacy actually fits into all this
Advocacy won’t detox anyone.
It won’t prescribe medication, run a rehab unit, or staff an ambulance.
What it can do is:
- Help someone understand what DDAS or the NHS are offering, and what their options are
- Support them to ask questions without freezing, especially if they’ve had bad experiences before
- Help draft complaints when things go badly wrong – delays, poor communication, unsafe discharge, or inaccessible appointments
- Make Subject Access Requests (SARs) so people can see what’s been written about them and correct dangerous inaccuracies
- Stand alongside people at meetings (within non-statutory limits) so they’re not facing systems alone
In Pembrokeshire, that might mean:
- Supporting someone to phone DDAS when they’re scared to
- Helping a family member write to social services about unsafe housing and substance use
- Breaking down benefit letters that talk about “misuse” and “dependency” in cold, clinical language
- Making sure housing, health and substance-misuse teams all understand the same story, not three separate versions
Statutory advocacy providers (like Advocacy West Wales) have defined legal roles in certain situations. Independent community advocacy (including DCAG) sits alongside that – filling some of the day-to-day practical gaps for people who fall between the cracks.
10. Where to start – if you, or someone you care about, is struggling
This isn’t an exhaustive list, but it is a practical one.
If you’re worried about overdose or immediate safety:
- 999 – in any life-threatening emergency
- DAN 24/7 – all-Wales drug and alcohol helpline (information, Naloxone, service signposting)
For treatment, harm reduction and structured support:
DDAS – Dyfed Drug and Alcohol Service
- First point of contact for adults (18+) in Carmarthenshire, Ceredigion and Pembrokeshire
- Phone: 0330 363 9997
- Online: via Barod / DDAS web pages (self-referral and webchat options)
Hywel Dda Community Drug and Alcohol Team
- Accessed via DDAS or NHS routes for specialist clinical input
For housing, homelessness and linked mental-health support:
PATH – Pembrokeshire Action for the Homeless
- Homelessness prevention, housing support, social lettings, mental-health counselling and legal advice
- Website: PATH Pembrokeshire
- Main contact number: 01437 765 335 (Mon–Fri)
For benefits, debt and rights:
Citizens Advice Pembrokeshire
- Phone: 01437 806070 (Mon, Tue, Thu 10am–1pm)
- Website: pembscab.org
For wider community connection and support:
PAVS Community Connectors and local third-sector projects – linking people into local groups, recovery spaces, volunteering, and support networks.
Advocacy – whether through larger providers, peer-led organisations, or small independent projects like DCAG – can plug into all of the above by helping people:
- Read and respond to letters
- Prepare for assessments and reviews
- Ask for adjustments or raise concerns
- Keep a clear paper trail so their story isn’t lost or twisted
11. Closing: harm is real, but so is support
Substance-use and overdose in Pembrokeshire aren’t abstract problems.
They’re the reason some names stop appearing in town, or at the surgery, or on social media – and no one quite says why.
The numbers in Wales are stark: 417 drug-poisoning deaths in a year is not a statistic any community should be comfortable with.
But alongside that, there are:
- People carrying Naloxone who’ve already quietly saved lives
- Workers in DDAS, the NHS, PATH, Citizens Advice and other projects trying to hold things together
- Families who haven’t given up, even when they’re exhausted
- Advocates and community projects trying to make systems understandable instead of terrifying
You don’t have to call what you’re dealing with “addiction” to deserve help. You don’t have to be “clean” before you’re treated with respect. You don’t have to have the right words before you’re allowed to ask questions.
If this post leaves you uneasy, that’s not a bad thing.
Uneasy is the space where people start checking on each other, reading letters properly, picking up the phone, and quietly asking:
“What can we change, here, so that fewer people end up as a number in next year’s report?”
That’s where the real work begins – in Pembrokeshire’s streets, kitchens, waiting rooms and back offices – not just in policy documents.
