It was a success almost not worth mentioning: 2021 was the first year since 2013 that drug-related deaths in Scotland didn’t rise. 1,330 people died in 2021, only nine less (or a 1% drop) than in 2020. While Scotland’s first minister Nicola Sturgeon welcomed this as a sign of change, continually high drug deaths is a public health crisis that has silently spiralled out of control in the northern nation.
Make no mistake: Scotland’s drug crisis is dire. It has the highest drug death rate in Europe, almost four times higher than Norway, the next country on the list. And Westminster’s latest round of drug policy looks set to continue the suffering.
How did we get here?
Decades of harsh austerity measures and deindustrialisation have created high levels of deprivation As a result, people in the most disadvantaged areas of Scotland are 15 times more likely to die from drug misuse than those in the least deprived areas.
For some, drug use is a way to block out the constant mental challenges that economic precarity and unstable housing bring. It’s also a way to cope with traumatic experiences, the majority of which are not adequately addressed by the health system.
“Poor physical and mental health, unemployment, unstable housing, involvement with the criminal justice system and family breakdown can predispose people to high-risk drug use”, says David Strang, chair of the Scottish Drug Deaths Taskforce (SDDTF), an independent body set up to recommend solutions to the drug death crisis.
Significant cuts in alcohol and drug treatment services have also hamstrung the ability of frontline organisations to support some of the most vulnerable people in society. In 2015, the Scottish government reduced the direct funding of Alcohol and Drug Partnerships, the Scottish multi-agency groups responsible for the improvement of drug treatment services, by 22%. This cut was thanks to the UK’s Conservative government, which slashed spending on treatment services by almost 20% from 2013 to 2018.
With serious policy change not being considered by Westminster, drug deaths are widely expected to continue to rise. The latest white paper, published in July 2022, outlines government thinking on how to address drug-related harms, emphasises the importance of rebuilding drug treatment services (after they were defunded during David Cameron’s and Theresa May’s premierships), yet stops short of acknowledging other globally-tested and evidence-based solutions to this exact same issue.
The paper instead creates new fines for drug use, mandatory drug awareness courses for those caught possessing drugs, as well as additional punishments like a ‘drug tag’ (ankle bracelets that measure drug content in sweat) and the confiscation of passports or driving licences.
All these issues are compounded by a stigmatising public narrative around problematic drug use, where people that die from drug use are perceived as deserving their fate. A big cultural shift is needed to address the long-term harms, but an even bigger policy change is desperately required to stop people from dying now.
We know what the solutions are.
After three years of research, the SDDTF produced its final report in July of this year, with 20 recommendations to tackle the drug death crisis.
Some recommendations are straightforward, such as the inclusion of people with lived experience in treatment services and policy-making. Others, however, demand a paradigm shift.
“Evidence shows that unacceptable and avoidable stigma and discrimination towards drug use is increased by criminalising people. We have heard that the Misuse of Drugs Act (MDA) 1971 is outdated and needs to be reformed to support harm-reduction measures and the implementation of a public health approach,” says Strang.
Two key measures known to reduce drug-related deaths and tackle stigmatisation are the decriminalisation of drugs and the creation of overdose prevention centres (OPCs).
Drug decriminalisation removes criminal penalties for the possession of any substance, and has been implemented in over 30 countries. By re-allocating resources from the criminal justice system to the public health system, it legally perceives people who use drugs as patients rather than criminals.
OPCs are sites where people can use drugs under the supervision of a trained specialist, who can provide medical assistance in case of an overdose, or connect people to health or social services. OPCs have been implemented in 15 countries, most recently in the US, where 59 overdoses were reversed in the first three weeks of an OPC in New York.
In October 2021, the highest legal authority in Scottish lands, Lord Advocate Dorothy Bain advised that police should divert those found in possession of drugs to treatment services rather than arresting them. While this was hailed by drug policy experts as a step in the right direction, it maintains criminalisation and doesn’t redirect any sorely-needed resources to treatment services. A more concrete policy change would enable this shift – yet this is prevented by Westminster.
Devolve drug legislation now.
The UK government currently holds total authority over the way drugs are regulated within the union through the MDA of 1971, which dictates the prohibition of drugs, and outlines the punishments for their possession, production, and distribution.
Although many powers were devolved to the Scottish Parliament in 1998, drug policy-making was not, meaning drug decriminalisation and other harm reduction measures are effectively blocked by British legislation.
Meanwhile, the new UK government white paper has ramped up its prohibitionist discourse, equating all drug users to criminals and proposing passport confiscation from those who use them. Conservatives have questioned the evidence of OPCs’ efficacy, while Labour leader Keir Starmer has denied his support for any progressive changes, choosing instead to perpetuate the racist and classist ‘war on drugs’ that is killing more people than ever before.
As Strang explains to TalkingDrugs, an online news platform on drug policy developments, there is consensus in Holyrood on what must be done because they [in Scotland] “are much closer to the problem of addiction and the harm it causes” than those in Westminster. Scotland’s drugs minister, Angela Constance, has openly supported OPCs, and when contacted for comment, a Scottish Government spokesperson said: “Scotland is in the midst of a public health emergency and that needs a public health response and we call again on the UK government to either reform the MDA or devolve it.”
Medical experts in Scotland have also supported serious policy change. Over 70 medical associations and professionals have called for OPCs to prevent overdoses, and the Royal College of Physicians of Edinburgh has explicitly endorsed decriminalisation. Yet these calls have fallen on deaf ears.
Peter Krykant, a drug policy maverick, became tired with political inaction and set up an unsanctioned OPC in Glasgow in September 2020. He acquired a minibus, equipped it with needles, sterile equipment and naloxone, an overdose-reversal medication.
Over nine months, 894 injections occurred under his supervision, with nine overdoses successfully reversed. Not a single person died. Meanwhile, 722 people died from drugs in Scotland across roughly the same period.
While Krykant agrees that OPCs and decriminalisation are needed, he believes people will continue to die in large numbers if treatment remains inaccessible. “[People] want to access treatment, they can’t access it because there’s multiple appointments and wait times to get through,” he says.
At times, Krykant feels devolution has been used as a political excuse for inaction. He believes that significant strides forward can be made without Westminster, and that certain harm reduction policies are already within Holyrood’s reach
The SNP has committed to tackling drug-related deaths, stating it will increase treatment spending and will “explore every legal avenue” to implement OPCs. However, as Krykant notes, certain improvements could already be made by Holyrood to improve the lives of people with problematic drug use.
Medication-Assisted Treatment (MAT), a specific form of treatment already used in England and Wales, involves prescribing certain drugs, like opioids, alongside psychological and social support, to people struggling with drug-related problems. As MAT is a health policy, it could easily already be implemented by the devolved government: in fact, the SNP did commit to develop the regulatory standards for MAT’s nation-wide implementation in early 2021. However, in a June 2022 update, the drugs minister admitted that very little progress had been made.
While evidence of the UK’s failing drug control system mounts, and pressure builds to address this spiralling public health crisis, people who use drugs are being held hostage by a stagnant and hostile political system. While it’s true that Westminster holds the majority of power over drug policy-making, Holyrood has also been failing to implement the policies they had originally set out to establish.
Unfortunately, this political deadlock is common within the drug policy world. As is frequently chanted by drug policy activists across the world: “they talk, we die”.