Readers in Scotland – and perhaps further afield, given the breadth of news coverage it achieved last week – won’t fail to have noticed that drug-related deaths in Scotland have doubled in the last five years and are now higher than any other country in the EU. Sadly, figures for the early part of this year suggest this dire trend is set to continue.
Statistics and percentages often serve to distance us from the individual stories behind the data. Every fatality leaves a family, friends, and a community behind them. We must never forget the life-long impact each death has on those who are left behind. It is imperative that we not only support people in crisis more effectively but address the root causes of Scotland’s problematic drug use.
The National Records for Scotland report exposed the fact that 1,119 of the1,187 deaths (more than 94%) involved people using more than one drug at a time and two-thirds involved benzodiazepines, such as diazepam or Valium.
While heroin and methadone remain the drugs most frequently implicated in deaths, there has been a 55% increase in cocaine-related deaths since 2017. Looking slightly further back gives a greater sense of the scale of this grim growth, with the data showing a staggering 658% increase in cocaine-related deaths in Scotland since 2008.
Cocaine, ecstasy-type drugs and amphetamines were implicated in – or potentially contributed to – 273 deaths (23%), 35 deaths (3%) and 46 deaths (4%), respectively. Stimulant drugs were implicated in or potentially contributed to 354 (of 1,187) people dying.
Since 1992, Crew has been providing up-to-date information, advice and professional support on stimulant drugs, helping people make informed decisions about their own health.
Over the last few decades, Crew has documented dramatic shifts in drug consumption and behaviours, including the rise of stimulant drug use. However, our current national definition of ‘problem drug use’ does not take account of stimulant drugs, and has therefore been masking the true extent of the issue.
We recommend that stimulant drug use urgently needs to be included in the Information Services Division/NHS National Services Scotland definition of problem substance use, to reflect the changing patterns of drug harm in Scotland and to ensure that research, budgets and services can be developed according to the changing national needs.
As with so many difficult policy issues, as citizens we often struggle to know what can be done to effect change, to correct worrying trends. The team here at Crew works at the sharp end of this debate day-in, day-out. Our collective experience over decades of working in this area has led us conclude that the following measures are necessary if we are to halt and reverse the rise in drug-related deaths:
1. We need to treat drug-related deaths and the situation in Scotland as a wider public health issue. We must address the impacts of adverse childhood environments and experiences, trauma and the wider social and economic causes of health inequalities, all of which contribute to and exacerbate drug harms and drug-related deaths.
2. We should not wait until a person’s drug use is problematic before we offer education, harm reduction and ongoing support. Drug education falls within the Health and Wellbeing components of the Curriculum for Excellence. However, the stigma attached to drug use and to the people who take drugs, combined with the taboo effect that results from the criminalisation of drug use, makes it difficult to implement effective drug prevention as part of school education. It also creates barriers for teachers and students to have open conversations that include a harm reduction component. Young people in England are already indicating this to MentorUK/Mentor Scotland in focus groups. Given that Scotland's issues with drugs are particularly acute, this raises specific issues for young people in education here, where there is a heightened need for effective drug education that explicitly addresses:
the local contextcritical thinking around social normsharm reductiondeveloping resilience skills through effective dialogue
This should be properly funded and supported to develop as an evidence-based and, even more crucially, evidence-producing part of the health and wellbeing curriculum.
3. We need to increase funding for effective treatment services and sustain this consistently over time. We must also adopt a non-judgemental, person-centred approach to support participants and do everything possible to keep them engaged even if they relapse, rather than punishing people who do relapse by making them wait before they are accepted back into treatment services.
We need to listen and understand why people with lived and living experience are using drugs and consider what kind of help and support they need, including more widely available treatment for people who take stimulant drugs.
People seeking help at the right time should be able to access reliable community-based drug testing and medically supervised consumption facilities, which could help prevent immediate harms, improve access to services, and prevent drug related deaths.
Opiate replacement therapies need to be available and responsive to people’s individual needs. These programmes should work with people to optimise prescribing dose and duration and provide heroin-assisted treatment for people for whom these methods have not been effective.
Take-home naloxone can reverse opioid overdoses and should be made widely available to people who take drugs like heroin.
Supervised consumption facilities, optimised Opioid Replacement Therapy and take-home naloxone are all recommendations from the Advisory Council on the Misuse of Drugs 2016 and the UK Government’s own 2017 guidelineson the clinical management of drug harms.
4. Criminalisation of people who use drugs is often one of the biggest social and economic barriers to providing effective education and to people getting help. Even the most expensive treatments as alternatives to imprisonment are more cost effective.
Decriminalising drugs will not prevent harm or reduce drug deaths on its own, but decriminalising people will give individuals a much better chance to access support, reduce harm and recover.
Simply importing and imposing a model from a different country and socio-economic context is unlikely to be successful, but there is much we can learn from progressive, evidence-based approaches which have transformed drug death statistics elsewhere. For example, the Portuguese approach of investing heavily and consistently over time in education, treatment and support is admirable.
Harnessing the criminal justice system to direct and support – but, most importantly, not force – people into treatment and recovery rather than prison could reduce significant harm and save lives.
There are no overnight fixes, which makes it all the more pressing that we act now to start making the kind of policy changes that will improve not only the statistics, but the everyday lived experiences of so many families throughout Scotland.
Emma Crawshaw is the chief executive of Crew, a charity whose goal is to reduce harm, challenge perceptions and help people make positive choices about their use of cannabis, stimulant and other drugs and sexual health by providing non-judgmental, credible and up to date information and support.