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The number of people in the North East using hard drugs such as crack cocaine, heroin and super-strength painkillers has jumped by 2,000 in the last five years.
About 19,000 people in the area are addicted to the drugs, according to new figures from Public Health England - the highest in the country.
Of those, 1,500 are teenagers and young adults under the age of 25.
Simon Stephens, director of casework at Addictions UK, said the figures only represented those receiving some sort of treatment.
He said there were "many more" using drugs who were not showing up in the figures.