Letter from the Scottish Police Federation to the Criminal Justice Committee, 4 November 2021
I refer to the above and thank you for inviting the Scottish Police Federation (SPF) to contribute to the work of the Committee. This is a broad topic and so we will limit our comments to select elements of the committee's remit.
The SPF considers that Scotland’s drugs death crisis is a tragedy that deserves much more focus, effort and attention than “sticking plaster” approaches such as issuing police with Naloxone Spray. The solution to tackling the drugs deaths crisis is not this.
The SPF has been in many discussions with the Police Service of Scotland (PSoS) since the first suggestion that officers be encouraged to inject drug users with naloxone when it was first mooted in 2018.
As Police officers, we have to deal with the effects of drug deaths. The misery, the pain and the waste that this brings to families and friends. We have an important role in the response to drugs misuse but that role is not a medical one.
The issue of drugs deaths is an emotive one, and in such discussions, there is a risk for exaggerated claims to demonstrate the effectiveness of any particular action. In the recent Police Scotland trial it has been claimed that dozens of lives have been saved.
Given that nobody has died in the UK (ever) because Police didn’t have access to naloxone, that simply cannot be accurate. It has been administered multiple times but there is no evidence that these have resulted in improved outcomes - especially given that ambulances have attended so soon afterwards to provide proper clinical interventions.
We have also been concerned that the reaction to officers who do administer naloxone is driving bad behaviours. We are aware of at least one occasion where an officer trained in Naloxone was “racing the ambulance” (so they could administer naloxone). In some other accounts, there appears to have been some corporate embellishment that officers have subsequently admitted to feeling compelled to go along with.
The matters of service efficiency, mission creep, lack of evidence base etc have all been presented to the Chief Constable. He has considered our “legitimate concerns” but has decided to proceed with his Test of Change and we respect that decision.
However, SPF’s statutory responsibility is not just efficiency but welfare too. Our primary (and now sole) objection to Police Officers carrying Naloxone has been as a consequence of the unique status of Police Officers hold in society. In the event that a member of the public dies following contact with the police there must be independent investigation and examination (usually by means of a Fatal Accident Inquiry). These processes are stressful, exhausting, impact on careers and put officers in legal jeopardy- even if they have done nothing wrong. They also drag on for years.
The SPF acknowledges the Police Service of Scotland currently has no appetite to pursue officers should a person die or suffer an adverse reaction following the administration of Naloxone. However, Crown Office, the Police Investigations and Review Commissioner (PIRC) and the Police Service of Scotland continue to use the terms “unlikely” and “do not expect” in response to concerns raised, none have categorically ruled out the possibility. When we ask for a statutory protection to be sought ensuring that officers who intervene medically cannot be subject to these procedures, we are denied this.
Whilst advocates of Naloxone correctly state that Naloxone is a safe drug, the risk is bringing people out of an overdose situation rapidly and without support.
Police Scotland clinical advice remains that,
“Drug overdoses are a medical matter and the SAS [Scottish Ambulance Service] is the primary agency of response in incidences such as these.
and
“The Scottish Ambulance Service is the appropriate responding group for persons with a suspected drug overdose.
In addition, an NHS (England) Patient Safety Alert titled Stage One: Warning Risk of distress and death from inappropriate doses of naloxone in patients on long-term opioid/opiate treatment states;
“Naloxone must be given with great caution to patients who have received longer term opioid/opiate treatment for pain control or who are physically dependent on opioids/opiates. Use of naloxone in patients where it is not indicated, or in larger than recommended doses, can cause a rapid reversal of the physiological effects for pain control, leading to intense pain and distress, and an increase in sympathetic nervous stimulation and cytokine release precipitating an acute withdrawal syndrome. Hypertension, cardiac arrhythmias, pulmonary oedema and cardiac arrest may result from inappropriate doses of naloxone being used for these types of patients.”
A further NHS (England) Patient Safety Alert titled Stage Two: Resources - Support to minimise the risk of distress and death from inappropriate doses of naloxone states;
“The safety of all patients depends on staff who understand that doses that can be life-saving for one patient group and set of circumstances, can be life threatening for another patient group.”
Whilst these risks may be acceptable for ordinary members of the public, police officers sit in a different and unique category.
Police officers are not trained diagnosticians and the potential for allegations of assault is very real. In Birmingham in 2019, Police were criticised for administering Naloxone to a male who was simply sleeping. Police officers have been reported for criminal allegations of assault in other instances where drugs were administered for what were considered life-saving reasons.
In situations where a person to whom Naloxone is administered and refuses to remain with the officers until the arrival of an ambulance, officers will have to assess if that person has the capacity to make the decision to refuse further treatment. A decision that is made more perilous given that Naloxone’s effects may wear off shortly after the subject has left. In such circumstance’s officers can expect to face some form of scrutiny and have their judgement questioned on whether the subject should have been allowed to leave prior to the attendance of the ambulance. It puts officers in an impossible position as while emergency ambulance crews can accept such a disclaimer without personal risk, Police Officers cannot.
The SPF is supportive of the principal of Safe Consumption Rooms if managed and operated by appropriate medical professionals, and within a clear legal framework. Absent the latter, thought needs to be given to the expectations on police officers who will undoubtedly find themselves on duty in, or close to such facilities.
It is often forgotten that the powers of a police officer are vested directly in the individual and are not passed to them by dint of a policy or command decision by a senior officer. Individual officers will need to decide whether to turn a blind eye when they see drug abusers visiting such facilities (presumably with drugs). That decision cannot be made for them. Regardless of wider perceived health imperatives, it is unclear what this might mean for wider public confidence in police officers to simply uphold (and enforce) the law.
Whilst the expectation exists for officers to use Misuse of Drugs legislation when they reasonably expect offences to have occurred, Police Officers need to be given protection if they choose not to enforce the legislation. We note that the Lord Advocates recent guidance relates to diversion when offences are being reported, but not in actions prior to that such as search and seizure.
The SPF is concerned that the focus on reactive measures such as naloxone divert people from the real issue - poverty. The route to drug addiction, and sadly drugs death is rarely a chosen one. Drugs are a symptom of wider society ills and we observe that people turn to drugs as an escape. The routes in are depressingly familiar and sadly officers can often predict who the next generation of abusers are going to be. While the focus is on drugs deaths just now, we believe that more attention is needed on the cause and less on the symptom.
The SPF receive complaints from many of its members that the focus is either on pursuing high end dealers or dealing with individuals, with little in between. Our members feel there is a marked decrease in focus towards local dealing, at least partly driven by a reduction in our local policing capacity and consequential intelligence products. This relative lack of activity in the ‘middle’ is seeing local dealers thrive while policing efforts are focused on their suppliers and customers.
SPF believe that the role of policing in the Drugs problem needs reviewed and redefined. We cannot be an educator, a medic and an enforcer.
In conclusion, SPF disagreed with the Chief Constable over the case for Naloxone to be piloted but respects his decision to do so. However, in the absence of legal protections, we will continue to warn our members of the unique risks that they as police officer take in carrying and administering it.
On other matters we appreciate that the Scottish Government is frustrated by the Home Office’s reluctance to amend existing legislation but tinkering in areas of devolved responsibility can have unintended consequences, mixed messages and contradictory policy/legislation.
Finally, Policing needs its role clearly defined, because just now, we are all over the place.
Yours sincerely,
Letter from Anthony McGeehan, Crown Office and Procurator Fiscal Service to the Convener, Criminal Justice Committee, 9 November 2021
Letter from Police Scotland to the Convener, Criminal Justice Committee, 12 November 2021