Five ways to tackle Scotland's drugs crisis

By Steven Brocklehurst
BBC Scotland News

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image captionStreet Valium is also known as Street Blues

Scotland has the highest rate of drug-related deaths in Europe and the numbers are continuing to rise at an alarming speed.

New figures show that 1,264 people died in 2019, which was even worse than the year before.

Almost 18 months after the deaths were declared a public health emergency, what is being done to tackle the problem?

1. Decriminalisation

image captionThe Daily Record is campaigning for decriminalisation of drug use

In July last year, two weeks before the latest official figures showed 2018 had been the worst year on record for drug deaths in Scotland, the Daily Record newspaper launched a campaign calling for the decriminalisation of drug use.

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.

Changing the law to "decriminalise" does not mean class A drugs would be legal but people would not be prosecuted for possession for personal use.

All UK drugs misuse legislation is currently reserved to Westminster.

The 1971 Misuse of Drugs Act bans the possession, supply, manufacture, import and export of controlled drugs except by licence.

A cross-party Westminster committee - chaired by SNP MP Pete Wishart but including four Conservative MPs, three Labour members, two Lib Dems and two other SNP MPs - found that decriminalisation was a "public health" approach that could cut the stigma around problem drug use and encourage people to seek treatment.

Schemes elsewhere channel drug addicts committing low level crimes into treatment instead of jail.

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.

The woman leading the Scottish government's 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."

In September this year, 10 months after the committee produced its report, the UK government responded by rejecting its recommendation to reform the 1971 Misuse of Drugs Act and decriminalise drugs for personal use.

The UK government said decriminalisation would not "eliminate the crime committed by the illicit trade, nor would it address the harms associated with drug dependence".

It added: "There is a strong link between drugs and crime, which is why we reject the assertion that the Department for Health and Social Care should lead on drug misuse. We know that people who regularly use heroin, cocaine or crack cocaine are estimated to commit around 45% of all acquisitive crime."

2. Emergency overdose treatment

image captionNaloxone can reverse the effects of an opiate overdose if used in time

The Scottish government set up a drugs deaths taskforce in response to the crisis.

Its first year has been spent gathering evidence and proposing changes that could quickly save lives.

The main focus of this has been the distribution of Naloxone, a medication that can reverse the effects of an opiate-related overdose.

Users often die because they are unable to breathe and, if used in time, Naloxone can restore breathing and save their lives.

Drug campaigners have been trying to get the kits into the hands of anyone who might witness a drug overdose. This is mainly drug users but could also be anyone involved in services such as hostels or outreach workers.

Last month, Police Scotland began a pilot project for its officers to carry Naloxone while on patrol.

The aim is to put tens of thousands of Naloxone kits in the hands of those who might be able to use them to save lives.

3. Harm reduction

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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.

David Liddell, of the Scottish Drugs Forum, 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," he said.

"That's fuelling the poly-drug use problem that we have and leading to deaths as a result."

He also said 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.

Prof Matheson, chairwoman of the Drug Deaths Taskforce, said Scotland had not been good at pushing options such as buprenorphine, which is now available as an injection that gives a long-lasting effect.

It means users no longer need to visit chemists to pick up methadone prescriptions every day.

It is hoped this will allow patients to focus on improving their lives and overall health rather than managing their dependence.

She also said the drugs taskforce was implementing a new set of standards for treatment to try to ensure people could access services quickly and stay in them as long as they needed to.

In addition, the Scottish Conservatives backed calls for more investment in residential drug rehab facilities.

"We need to start helping people to get off drugs and get well, we can't simply try to manage addictions and leave it there," said Donald Cameron, the Scottish Tory health spokesman.

4. Reduce stigma

image captionScotland's new drug tsar has called for a public health approach

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 said the people who needed help were the "most marginalised in Scottish society".

She said they were not willing, interested or engaged with services because they were stigmatised and did not want to come forward.

Prof Matheson said only about 40% of people who needed treatment were getting it.

She said: "They don't want to go to their GP if they have health problems, they feel stigmatised if they have a criminal record and they are stigmatised about getting work.

"This is keeping people excluded from the help and the care they need."

Prof Matheson said that, as a result, older drug users - who have a range of respiratory, cardiac, liver and kidney issues - were not seeking treatment and were physically more vulnerable to an overdose.

5. Safe consumption rooms

image captionDenmark is among the countries to have introduced fix rooms

It is now more than four 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" are in place around the world but this would be the first of its kind in the UK.

They have the support of the Scottish government but drug laws are reserved to Westminster.

The House of Commons committee that investigated Scotland's drug crisis recommended new legislation to provide for safe drug consumption facilities but it was rejected in the UK government's response to its report.

The UK government said: "We want to do all we can to stop people having access to drugs that could ultimately kill them. No illegal drug-taking can be assumed to be safe and there is no safe way to take them."

In November last year, Glasgow announced Scotland's first scheme giving drug addicts diamorphine, a pharmaceutical-grade form of heroin.

The Enhanced Drug Treatment Service (EDTS) aims to use the medically-licensed drug to treat patients with the most severe, long-standing and complex addictions.

They will have to attend the clinic, which has been licensed by the Home Office, twice a day, every day.

It is hoped the facility will help reduce street drug use, overdose deaths and the spread of HIV in the city.

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