It’s hard to overstate the severity of Scotland’s drug problem.
Figures published in July revealed that 1,187 people north of the border died drug-related deaths in 2018, triple the rate of England and Wales, more than the rest of Europe and – shockingly – even greater than the United States, where there is a well-publicised opioid crisis. In the last 20 years, while the population has increased by just over 6%, the rate of drug related deaths has increased by a factor of five to overtake traffic accidents as a cause of death.
But under the SNP, spending on drug and alcohol rehabilitation has fallen by 14% in cash terms since 2015. Healthcare, housing and criminal justice – key planks of public order and rehabilitation – are all devolved to Holyrood.
So far politicians in both Edinburgh and Westminster have tended to prioritise eye-catching initiatives over long-term policy changes. The response should begin with an acknowledgement that black-and-white decriminalisation of drug use, as argued for by the new head of the new ‘Drug Deaths Task Force’ is not a sufficient solution.
Instead, what needs addressing is not just that half of patients believe they are being under-prescribed legal treatments, but also the length of time initial contact with NHS Scotland is taking and the changing demography of drug use. Work must also begin to robustly implement shorter term measures like the universal distribution of naloxone throughout addict communities. That’s especially urgent given that In 2017 the BMJ reported that take-home programmes for the overdose drug reached only 14% of users.
It’s important, though, that we don’t get swept up in absolute terms and take on board some important context. A report by the working group of the Scottish Drugs Forum found that the ageing and drug addicted are at risk from a host of secondary diseases such as Deep Vein Thrombosis. Again, not enough is being done in this area, with only 40% of known addicts in treatment for a drug-related illness.
The latest figures show that the greatest year-on-year increase in mortality has been among the “Trainspotting” generation – those over 35 – not from overdose but from the late presentation and treatment of these diseases. That suggests the most effective answer to rising drug-related deaths is not simply ‘more cleaner drugs’ or safe platforms for consumption.
What these figures have shown is that the fundamental approach to addiction treatment in Scotland has failed to deliver the joined-up treatment and institutional memory called for by the Drug Strategy Delivery Commission, and which will make the greatest change to these figures through the better treatment of its fastest-growing group.
Doing so effectively will begin to bring down the proportion of all addicts who believe they need to supplement their dose, but also of the ageing addicted who need greater long term care for secondary conditions. Research published on alcohol dependence amongst addicts has mentioned as a prime example the co-morbidity of Hep C infection and problem drinking in accelerating hepatic cirrhosis in addicted patients.
There is no doubt that replacement therapy and safe consumption rooms are effective in at least one way. That is in changing consumption behaviour, especially amongst the young. In countering the spread of blood-borne diseases like HIV and Hep C this measure – at least – has proven to be effective in preventing peer to peer contamination. So, the introduction of the euphemistically named ‘shooting galleries’ may ultimately have some basis – to prevent needle litter, for example, or prevent harm to the wider public from secondary infection. But we need to able to draw the line between those measures which are providing actual harm reduction and those which enable destructive behaviours to continue.
No-one is talking about the decriminalisation of drug dealing. But the oft-touted decriminalisation of consumption also presents some questions. Policymakers would be wise to consider whether decriminalisation would create simply make it even easier for users to get hold of drugs, reducing the deterrent of prosecution and fattening criminal profits.
Ultimately, change begins with the frank understanding that the SNP’s approach is not working. Instead, the Scottish government must focus on areas such as improving the housing for recovering users and fundamentally reforming NHS provision and diagnosis for the middle-aged (who are less likely to seek treatment). These are the best ways to address the problem from both ends of the spectrum – the struggling new user but also the aged addict succumbing to DVT.
Otherwise we commit ourselves to a doom loop of lapsed recoveries and greater numbers of young people falling into sustained use of increasingly potent synthetic opiates. Unless we start treating these issues more effectively a new generation will find that they have lit the long fuse on a great deal of secondary disease and distress.
There is no need to give in to despair. Scotland has a bright, dynamic and hopefully drug-free future – ensuring it is realised means dispensing with the farcical policies of the SNP and putting some real compassion into treating some of the county’s most vulnerable people.