Scotland has the highest rate of drug-related deaths in Europe and the numbers are continuing to rise at an alarming speed. What can be done about Scotland’s drug death crisis?
Changing the law to decriminalise the use of drugs has risen to the top of the agenda in recent months.
That does not mean drugs would be legal but people would not be prosecuted for possession for personal use.
Almost all the witnesses who gave evidence to Westminster’s Scottish Affairs Committee inquiry said that putting drug users in prison was not a solution to the problem.
Police Scotland’s Assistant Chief Constable Steve Johnson called for radical reform, saying politicians should have the “confidence and courage” to decriminalise.
He said the criminal justice process was actually pushing people into a place where there was more harm.
It said Germany, Spain, Switzerland, Canada and, most notably, Portugal were among 25 nations to loosen the punitive attitude to drug possession to enable treatment programmes to succeed.
The woman leading the Scottish government’s new drugs taskforce, Prof Catriona Matheson, told BBC Scotland the evidence for decriminalisation was strong.
She said: “It is about not putting these marginalised drug users into prison because that further marginalises them and that makes the recovery all the more difficult.”
Dr John Budd, a GP who works with homeless people in Edinburgh, said he saw patients who had been in and out of prison.
He said each time they go to prison on drug-related charges they are “destabilised”, lose their housing and are put at risk of further harms.
He added that the criminal justice system was often used as a “mopping-up service” for people who had significant mental health difficulties but could not access mental health support.
Dr Budd said savings made through people not going to prison should be used to treat drugs, alcohol and mental health issues.
2. Safe consumption rooms
It is almost three years since Glasgow City Council first proposed allowing users to take their own drugs under the supervision of medical staff at a special facility in the city.
The idea is to encourage users who inject heroin or cocaine on Glasgow’s streets to enter a safe and clean environment.
It is hoped the special room would encourage addicts into treatment, cut down on heroin needles on city streets and counter the spread of diseases such as HIV.
The so-called “fix rooms”, which would be the first of their kind in the UK, have the support of the Scottish government but drug laws are reserved to Westminster.
The UK government’s Home Office has refused to allow the Glasgow plans, saying a range of offences would be committed, including possession and supply of controlled drugs and knowingly permitting the supply of a controlled drug on a premises.
However, Scotland’s drugs tsar Prof Matheson said supervised consumption facilities were operating in countries around the world and were definitely a route worth considering.
Prof Alex Stevens, of the Advisory Council on Misuse of Drugs, told MPs simple changes to the Misuse of Drugs regulations could ensure people running drug consumption rooms would not be prosecuted for possession of illegal drugs.
Elinor Dickie, of Public Health Scotland, said there was 30 years of evidence that the services attracted the most vulnerable people.
She said they also provide education around how to reduce the risks and an opportunity to get users into “engagement with other services.”
David Liddell, of the Scottish Drugs Forum, said he had first pushed for drug consumption rooms in 1996 but they would be needed across the country if they were to make an impact.
3. Tackle child poverty and homelessness
When asked by MPs how to tackle the drug misuse problem, Dr Budd said “eradicate childhood poverty”.
The GP said poverty was the source of so many issues with alcohol, drugs and mental health.
Dr Budd said the vast majority of his patients had experienced very significant adversity in childhood.
Drug use is 17 times higher in Scotland’s poorest areas compared to the wealthiest.
“If you look at drug or alcohol-related deaths, those are very focused on people coming from deprived backgrounds,” Dr Budd said.
“The harms related are not just a random selection. It is very much a health inequality issue.”
Dr Budd, said 70% of his patients have tri-morbidity – long-term substance use issues, chronic mental health problems and chronic physical health problems.
“When we consider that the average age of our patients is 39, we are really looking at a morbidity picture that you would expect to see more in people in their mid to late-80s. It is a very unhealthy population,” he said.
Dr Budd said homelessness was an expression of underlying difficulties.
Patricia Tracey, from Turning Point, said if people have a home then it makes it easier to work with other issues.
She added: “When you are using substances and become homeless, you add in another level of trauma on multiple traumas, which again can keep people in the cycle.”
4. Harm reduction
The most significant harm reduction services are methadone and buprenorphine which are offered to heroin addicts to reduce the risk of fatal overdose.
Methadone is controversial because it was implicated in more drug-related deaths than heroin, the drug it is a substitute for.
Experts said methadone was recognised by the World Health Organisation as an essential medicine but the way it was being delivered was not effective.
Elinor Dickie, of Public Health Scotland, said methadone could be significant for keeping people in treatment but there needed to be an “integrated model of care” to provide broader support.
“Methadone is one of the most evidence-based medical treatments that exist, but it is probably the most stigmatised treatment,” said Dr Saket Priyadarshi, from NHS Greater Glasgow and Clyde.
“We are talking about a group of patients and service users who often want to dissociate themselves from using a very stigmatised treatment. Some of the ways that we deliver that – for example, supervision in pharmacies and so on – add to the barriers.”
David Liddell, of the Scottish Drugs Forum, there were problems around access to methadone services and retention of drug users within treatment.
He said some countries such as Norway had a policy of “no unplanned discharges” and they would actively seek to bring people back into treatment.
Mr Liddell also said there was a “massive issue” around people on too low doses.
“We estimated around half of those on methadone are on too low a dose, so what is happening for individuals is they are then forced to top up on street drugs.
“That’s fuelling the poly-drug use problem that we have and leading to deaths as a result.”
Dr Budd told MPs he can use opiate substitute treatment to draw people into services.
“Then we can actually start working with them on other issues,” he said.
“The vast majority of our patients have long-term chronic physical health conditions at a very young age. The average age of death for our patients is 47, so we are talking about Victorian levels of life expectancy.
“In some ways, opiate substitute treatment just enables people to have a degree of stability in their life. If we can then get them into some accommodation, that further enables them to start looking at some of the other underlying issues.”
5. Reduce stigma
All the experts who gave evidence to Westminster’s Scottish Affairs Committee said the stigma around drug addiction was stopping people seeking treatment.
Prof Matheson, Scotland’s new drug tsar, said the people who needed help were the “most marginalised in Scottish society”.
She said they were not willing or interested or engaged with services because they are stigmatised and do not want to come forward.
Prof Matheson called for a “non-judgemental” public health approach.
Patricia Tracey told the Commons committee: “Services are available, but people often find it difficult to come forward, and the services are on the periphery rather than the mainstream.
“We need to address the stigma. People experience difficult times and sometimes they abuse substances. We can work with them.”