There were no surprises in the Scottish drug death figures announced this morning. As anticipated, the numbers are bleak: another 1,339 lives were lost in 2020 to drug-related deaths, which was an increase of 5 per cent on the previous year.
This is the largest number of drug-related deaths since records began in 1996, and brings the total in the 14 years the SNP has been in power to more than 10,000. It is the seventh year in a row the figures have risen, consolidating Scotland’s grim position as the drug death capital of Europe. The figures also show that people in the most deprived areas of Scotland were 18 times more likely to die than those in the least deprived.
These statistics are a source of shame for Nicola Sturgeon. Previously, the First Minister has admitted that her government has “taken its eye off the ball” in relation to tackling the number of drug-related deaths. Alex Cole-Hamilton, the Scottish Liberal Democrat health spokesperson, said the Scottish government had previously cut millions of pounds from drugs prevention services and, therefore, had to take responsibility for the rise of deaths from drugs.
The announcement of the 2019 figures of drug-related deaths, which were delayed by six months because of Covid, led the Scottish government to make some immediate changes. In December 2020, Joe FitzPatrick, the SNP MSP for Dundee City West, was replaced as public health minister by Angela Constance, who became a drugs policy minister. In January, Sturgeon announced an extra £250m over five years in an attempt to reduce the number of drug-related deaths. The figure included £20m a year investment in the number of residential rehabilitation beds across the country. The First Minister also attended the Scottish Drug Deaths Taskforce, which was established in July 2019, to witness its work.
The Scottish government’s action to tackle the drugs epidemic does not diminish the shock of the figures that have been announced today, but it is the context in which they have to be read. Although the figures reinforce the government’s failings pre-December, they say little about the progress that has been made since.
[See also: Why are the UK’s drug laws so backward?]
In the last seven months, there have been some promising developments. Investment, which is intended to be split between harm reduction and recovery, is now at a level more proportionate to the scale of the crisis. There has been an expansion of the country’s Naloxone programme – Naloxone is a medicine that can temporarily reverse the effect of opioids – and police officers and paramedics in Scotland are now trained to carry and administer the antidote if they encounter someone who has overdosed.
The Scottish Drug Deaths Taskforce has worked to optimise the engagement with Medication-Assisted Treatment (MAT). MAT is a treatment programme for drug users that combines the use of medication, such as opioids, and psychological and social support. Only 40 per cent, however, of drug user’s in Scotland are engaged in treatment.
“We also have a poor record of retention,” says Andrew McAuley, epidemiologist at Glasgow Caledonian University. “There is lots of evidence that people are cycling in and out of treatment. When they do that, their tolerance levels go up and down, and when their tolerance level is low, they are much more likely to overdose if they relapse.”
Now, the Scottish Drug Deaths Task Force has come up with ten standards – including same-day prescription, choice of medication and dose, and psychological support – which the Scottish government has promised to implement by March 2022.
To transform the system, however, the Scottish government and Scotland’s new Lord Advocate, Dorothy Bain, will need to be braver, bolder and more willing to act independently of the UK government.
The SNP has previously suggested that it would prefer to treat drugs as a public health issue, rather than in the criminal justice system. It wants to emulate countries such as Portugal, which successfully cut its drug death rate. But the party has argued that the UK’s Misuse of Drugs Act 1971 – which the UK government does not appear to be open to reviewing – is outdated.
In 2017, James Wolffe, the former Lord Advocate, said he could not authorise a safer drug consumption room in Glasgow because it was illegal under the legislation (something which is contested).
Police Scotland have said that its officers do not have discretion over which offences they pursue. And yet, even as the Scottish government was bemoaning its limitations, police and crime commissioners in England and Wales were forging their own paths, in defiance of the UK government’s emphasis on drug enforcement.
Thames Valley and Durham forces, for example, have introduced diversion schemes which offer those caught in possession of small quantities of drugs the opportunity to take part in community education programmes or to access services rather than face prosecution.
Similarly, Avon and Somerset has a Drug Education Programme, which allows a user to avoid a criminal record if the individual engages with the programme. They also have a pilot scheme, which aims to steer young people who are dealing drugs into jobs or further education in an attempt to end the “revolving door” of reoffending.
Having demonstrated the effectiveness of these approaches, the forces now appear to be winning even the Conservative Party over.
Of course, Boris Johnson knows his audience, hence his populist “tough on crime” rhetoric. In recent days, the Prime Minister has been trumpeting the increased use of “chain gangs” to combat crime and anti-social behaviour. But if you look at the UK government’s response to Carol Black’s independent review of drugs it appears that we may be witnessing a subtle shift in attitude.
The Black review, published by Public Health England, advocates for a shift to a health-led approach, including diversion from the criminal justice system. On 27 July, the UK government agreed it would “learn from, strengthen and develop” the approaches being taken by Thames Valley and Durham. It also pledged to invest a further £31m in Project ADDER (Addiction, Disruption, Diversion, Enforcement and Recovery), expanding it to eight more local authorities.
In Scotland, there have been moves in a similar direction. The Positive Outcomes Project (POP), a joint initiative between Police Scotland and Glasgow Health and Social Care Partnership, focuses on stabilising addiction with a view to reducing offending.
In April 2020, Community Justice Scotland issued new proposals on diversion from prosecution applying to a range of offences, including drug dependence, where support might be the better option. Unlike in England and Wales, however, the discretion over whether or not to charge and prosecute still lies with the Crown, not with police officers.
What is required, campaigners say, is for the Lord Advocate to give explicit support to diversion schemes, allowing them to be rolled out across the country. Having such diversion schemes in place would also facilitate the introduction of drug consumption rooms, because they would allow possession to be dealt with through referrals to support services rather than through the courts.
They would reduce stigma and become the first step in building a holistic, integrated treatment and recovery system similar to those in some European countries that have had great success at bringing down drug-related deaths.
The 2019 drug death figures represented a turning point for Scottish government. The backlash marked the moment the SNP realised it could not go on playing politics with the lives of vulnerable people. That it took so long is an indelible stain on its legacy.
The 10,000 people who have died since 2007 cannot be brought back. But other lives can be saved. What matters now is that the Scottish government delivers on the commitments it has made – namely by making sure the £250m is invested wisely and the new MAT standards are implemented as quickly as possible. Most importantly, it must stand up for what it believes in: a society in which drug use is treated as a public health matter, not a criminal justice one.
Only by keeping its eye firmly on the ball can it begin to atone. Only by delivering on its promises can it hope to break the vicious cycle of drug deaths.