The next item of business is a debate on tackling drug deaths and drug harm.
14:53
As the convener of the Health, Social Care and Sport Committee, I welcome the opportunity to open the debate. I apologise that I might not be in the chamber for the closing speeches, but I have let the Presiding Officer know.
When my committee took evidence from the Minister for Drugs Policy last year, it became apparent that a number of key policy levers in this area lie with the United Kingdom Government. As part of our joint scrutiny work, we heard evidence that the Misuse of Drugs Act 1971 is outdated and fails to reflect the public health-led approach that we want to pursue in Scotland. Indeed, a root-and-branch review of the 1971 act was a key recommendation of the Scottish Drug Deaths Taskforce. It is therefore extremely disappointing, in the face of evidence and recommendations from experts in the field, that the UK Government has no plans to review the 1971 act.
Given that mix of devolved and reserved powers, I was pleased that we were able to take evidence from the UK Minister for Crime and Policing, Kit Malthouse. I hoped that he could give us confidence that UK Government levers could be used to work with us, in Scotland, with the aim of reducing drug harm—an aim that everyone across this Parliament shares. However, the session with the minister highlighted quite a fundamental difference in approach between the UK and Scottish Governments. For example, the UK Government is clearly anxious that creating safe consumption facilities, even on a trial basis, might be seen as condoning drug use. However, that is a misunderstanding of the underlying reasons that drive people to take drugs in the first place. Overwhelming evidence underlines a strong link between poverty, deprivation and trauma and a heightened risk of drug addiction. The statistics bear that out. In 2020, people in the most deprived areas of Scotland were 18 times more likely to suffer a drug-related death than those in the least deprived areas. People will not stop taking drugs simply because they are illegal. For people in a desperate situation, a criminal justice-led approach will not help and can, in fact, make things much worse.
Indeed, a recent report from the House of Commons Health and Social Care Committee called for a shift from the current criminal justice approach to a health approach such as the one that we have in Scotland, and for responsibility for drugs policy to move from the Home Office to the Department of Health and Social Care. That would be very progressive. The provision of safe consumption facilities needs to be considered in that context—first and foremost, as a health intervention. There is strong evidence that, by providing facilities where people can take drugs in a safe and supervised environment, safe consumption rooms can reduce overdoses, drug deaths, blood-borne virus infection rates and public injecting.
During our joint committee, I was encouraged by the UK minister’s apparent willingness to consider new evidence of the successful trialling of safe consumption facilities in New York, which has already saved many lives. Unfortunately, Mr Malthouse’s more recent comments to the media have been less than encouraging. However, I am hopeful that proposals from Glasgow city health and social care partnership will enable a safe drug consumption facility to be piloted in Glasgow within the current legal constraints.
Giving evidence to the Criminal Justice Committee in November last year, the Lord Advocate acknowledged the scale of the crisis that we face and offered a potentially pragmatic way forward. She indicated that, in the instance of a proposed safe consumption room that was
“precise, detailed, specific and underpinned by evidence”
and supported by Police Scotland, prosecutions might be deemed not to be in the public interest. During the pandemic, the Lord Advocate demonstrated a similarly pragmatic approach by issuing guidance that it would not be in the public interest to prosecute anyone registered with the Scottish Government population health directorate who was supplying naloxone to be administered in an emergency to counteract a drug overdose.
I am hopeful that such pragmatism will help us to navigate the legal constraints that we face and continue to pursue a public health-led approach to tackling drug deaths and drug harm. Clearly, the trialling of safe consumption facilities is only one element of an effective public health-led approach. I agreed with Mr Malthouse, when we took evidence from him, that there is no silver bullet when it comes to tackling drug deaths. However, the committee sees this as a public health issue as opposed to one that is justice focused.
I wonder whether, in any of the evidence that was gathered by the committee or in the representations that the committee received from the UK Government minister, there was any analysis or evidence of why the number of drug deaths is almost four times higher in Scotland than it is in the rest of the UK.
I am not sure that that would come from the UK Government. In the Health, Social Care and Sport Committee, we have heard that a lot of historical, multigenerational deprivation has led to the situation. The member lives in Dundee and will know that to be the case there. Things that happened decades ago, which took the life-blood out of communities, have led to deprivation and are possibly one of the reasons why we have this situation.
I will talk briefly about our recent inquiry into the health and wellbeing of children and young people. It is important that we address the particular impact of problem drug and alcohol use in families on children and young people. Connected to that is the impact of stigma around drug use by women. We cannot say that someone is not a good mother because they have an issue with drug use. Again, when it comes to women, a criminal justice approach puts more pressure on the family and the children.
I have run out of time, because I took that intervention. I look forward to working collaboratively with other parliamentary committees on our shared goal of identifying a sustainable, long-term path to tackling drug deaths and drug harm in Scotland.
I call Elena Whitham to speak on behalf of the Social Justice and Social Security Committee.
15:00
I thank the convener of the Health, Social Care and Sport Committee for opening this important debate. That committee rightly highlights the point that drug deaths and problem drug use are a public health issue. While there continues to be debate over whether this is a public health or criminal justice issue, we need to keep in mind that it is primarily a social justice issue. Drug deaths do not often occur in more wealthy populations; they are a distressing and wholly avoidable indicator of inequality, deprivation, poverty and trauma.
The Scottish Association of Social Workers told us:
“Poverty is still one of the leading contributing factors for substance use and so a wider focus on tackling poverty and inequality is essential. The impact of poverty, food insecurity, fuel poverty and digital exclusion on Scotland’s families and communities is devastating and increases the risk of pushing individuals toward drug use. Harmful drug use is also most damaging to communities already struggling with disadvantage, poverty and marginalisation.”
Those are complex, structural problems that are far from unique to Scotland. We need to redouble our efforts to tackle the underlying causes of poverty and inequality—all of us in the Scottish Parliament, across all committees, must commit to that task.
Our joint work across three committees is a great example of widening the focus, but it is not an easy task.
The member will have heard my intervention on Ms Martin’s speech, when she highlighted deprivation in parts of Scotland. There are areas of England that have experienced the same deprivation as areas of Scotland—in some areas, the deprivation is deeper—yet they do not have the levels of drug addiction and drug deaths that we have in Scotland. Has your committee taken any evidence to explore those issues?
I thank the member for the intervention. Aside from repeating what Ms Martin has already said, I point to the fact that we have a multifaceted issue with polydrug use that is unique to Scotland, which might explain some of the issues that we face.
If the Social Justice and Social Security Committee does anything, it highlights the complexity of such issues, recognising that the life of every individual in Scotland does not fit into a single remit. As a committee, we have heard that individuals can get trapped in a funnelled web of complex issues that can become ever worse. For someone with little income, just one event—losing a job, taking on caring responsibilities, an increase in fuel costs—can start a downward, often lonely, spiral. For someone who is experiencing multiple, severe and complex disadvantage, the risk of problem substance abuse multiplies.
In our current inquiry on problem debt and low incomes, we are hearing that many families and individuals are in no position to build any financial resilience. They cannot absorb the shock of changes in circumstances, which can also impact hugely on their emotional resilience.
Poverty is a feature not only of unemployment, as those in low-paid, precarious jobs also face significant financial challenges. Many people struggle with their mental health because of debt, and some people with existing mental health problems find it hard to engage with services and support to help them get out of debt. As we have heard, stigma also magnifies these issues. We know that, with not enough to live on now and in the face of the cost of living crisis, some people are at real risk.
We know that the reasons why someone turns to drugs are complex and dependent on many factors. For some, it is youthful experimentation; for others, what might have started as recreational use will progress into escapism and self-medication—the means to a way out of a hopeless situation when other means seem not to exist.
However, there is a light on the horizon. We are hopeful that the trend that we have seen over the past year, of a decrease in drug-related deaths, will continue—remaining mindful, however, that any such death is one too many. In a personal and work-related capacity, I know just how devastating a loss is and how far the ripples go. That tentative but positive decrease in deaths is the result of specific actions that have been taken to provide holistic support. The housing first approach recognises the social barriers that people face; the impact of the lack of that most fundamental of needs, a safe place to call home; and the need for services to gather around vulnerable people.
Organisations such as Simon Community Scotland, Faces and Voices of Recovery UK, We Are With You and Turning Point Scotland tell us that it is not just about prevention of death and further harm, but about working with people over a long time and at their own pace, providing the support that they need and recognising a sometimes traumatic past.
Turning Point Scotland says that, although the complexity of need was identified as a priority for the task force, no specific recommendations were made. It calls for greater integration and strategic thinking so that work across the system is co-ordinated. It also highlights the positive step that homelessness prevention looks set to become a duty across the public service system, though it emphasises that co-ordination is required across public services to realise the good intentions of policy.
What can prevent that holy grail of co-ordination of services around the needs of individuals, or the no-wrong-door approach for all those who need support? We are made aware daily of the brilliant, innovative and compassionate projects that respond to need. We saw how quickly we could respond to need, particularly homelessness, during the pandemic, and we know that systems can change. The system that creates poverty needs to change.
To conclude, there are different layers to the problem: the immediate joined-up compassionate support that a person needs to prevent them falling further; the actions of public services to ensure that all that they do is co-ordinated, agile and aligned with the third sector, which is crucial in this; and, finally, the need to end the structural unfairness that makes people vulnerable in the first place, which we all have the power to end but which is perhaps the hardest, though the most crucial, thing to achieve.
I gently remind members who wish to participate in the debate that they should press their request-to-speak button. That includes those who have made an intervention.
15:06
It is my pleasure to open the debate on behalf of the Criminal Justice Committee.
Last year, the Criminal Justice Committee heard from people with lived and living experience of problem drug use, who told us that they wanted to see tangible outcomes from the work of the Scottish Drug Deaths Taskforce. I am very grateful to members of the Health, Social Care and Sport Committee, the Social Justice and Social Security Committee and the Criminal Justice Committee for agreeing to collectively consider the implementation of the task force’s recommendations.
The written evidence that we received highlighted the wide range of innovative work that has been undertaken in response to the recommendations, but it also identified gaps and barriers to implementation that need to be addressed. Today’s debate will be wider in scope, and I will focus on the police service’s role in reducing drug deaths and tackling drug harm.
We know that, in the course of their operational duties, police officers frequently engage with people who are impacted by problem drug use. We know that adverse childhood experiences and trauma are risk factors for problematic drug use, so it is vital that initial police contact is trauma informed and trauma responsive. The committee welcomes the fact that training is being delivered to officers that will support them in signposting people to appropriate recovery and treatment services earlier and more effectively, often at a time of increased vulnerability.
Police Scotland, in partnership with Medics Against Violence, has piloted a pathfinder service in Inverness for people with problematic drug use, which refers individuals to support that connects them with organisations that can aid their recovery. Following evaluation, the service is to be expanded, which is a very welcome development. However, that approach will be effective only if treatment and recovery services can meet the demand. The task force recommended that the Scottish Government pursue increased weekend access to treatment and support, but the evidence that we received suggests that out-of-hours treatment and support, especially at weekends, remains a gap in the delivery of a whole-system model of care.
Staying on the theme of collaborative working, and among the many examples that were provided in the written evidence, the committee welcomed Police Scotland’s partnership work with the Scottish Drugs Forum, the Scottish Recovery Consortium, Scottish Families Affected by Alcohol and Drugs and the Crown Office and Procurator Fiscal Service to provide training to probationary officers on substance use and the barriers to support and treatment that are caused by associated stigma. The committee also welcomed Police Scotland’s work with Scottish universities such as Robert Gordon University to allow a quick turnaround time in drug analysis.
The task force recommended that the distribution of naloxone be maximised. Police Scotland’s proactive approach to training officers to administer the naloxone nasal spray to those suspected of a drug overdose has undoubtedly saved lives. However, police officers are rightly concerned about facing investigation and/or prosecution when naloxone has been administered in response to an overdose and the person has subsequently died. That is an important issue that we consider needs to be addressed.
Another area of current focus is the legality of the provision of safe drug consumption rooms. The UK Government is not considering a legislative framework to support their introduction, and it has not devolved powers to the Scottish Government for that purpose. Police Scotland’s discussions with the Crown Office and Procurator Fiscal Service have indicated that
“there is the belief that a legal framework may exist to allow those who would operate a Safe Drugs Consumption Facility to do so within current legislative provisions.”
However, Police Scotland has stated that, although that may provide a basis on which to operate a facility, it would not address the potential criminality of those with addiction issues attending to use safe consumption rooms while in possession of illegal drugs. I very much hope that that issue can be resolved timeously.
There are many more issues that I would like to cover. However, it is really encouraging—this is endorsed by the committee—to hear about the innovative and collaborative work that is taking place to tackle the complex and multiple issues that contribute to drug deaths and drug harms. The latest data, on suspected drug deaths in 2021, shows a fall of 8 per cent from the previous year. As we know, however, every death is a tragedy; therefore, although that is good news, there is still much more to do. I believe that, by working together in the Parliament, across Government and across the public and third sectors, we can and we will make an important contribution to tackling drug deaths and drug harms.
15:13
Every drug death is a tragedy, and drug deaths leave families, friends and loved ones looking for answers and support. As I always do, I offer to everyone affected by the drug deaths crisis my condolences and my continuing commitment to work across Government, Parliament and beyond to save and improve lives.
I thank the three parliamentary committees for coming together across their portfolios to help to provide insight into what has been done and what should be done to tackle drug deaths and harm. That mirrors the approach of the national mission, which is a whole-systems, holistic approach to providing care and treatment, not judgment, and opportunities for recovery and hope for people who use drugs.
I also extend my thanks to the task force for the quality and breadth of its work, and its commitment to publishing recommendations this summer. Its focus on evidence-based recommendations has helped to shape the priorities for the national mission alongside the advice from other groups, such as the residential rehabilitation working group.
Our national mission represents a significant step forward in tackling drug harms, because it seeks to link crucial evidenced-based drug treatment and recovery and essential health and social care services with the wider personal, social and economic needs of people impacted by drugs, who often find themselves in need of support across a range of services.
We are making better links in health services, especially with alcohol issues and mental health, but the mission also links closely to improvements in community and criminal justice, homelessness and housing, education and many other factors. Making change and improvement across all those areas, together, is what marks out the mission as a rights-based, public health approach.
We are in the second year of the national mission to save and improve lives and we are making the best use of the additional £250 million over the lifetime of the parliamentary session. Our focus is on delivery and implementation on the ground.
The medication-assisted treatment standards demonstrate the public health approach clearly by linking clinical service standards, such as same-day treatment, with standards on psychologically informed and trauma-informed care, as well as standards on advocacy support for housing and benefits. The MAT standards reinforce a rights-based approach to treatment and emphasise the importance of empowering people to make informed decisions about the types of help that are available to them.
We are working in partnership with local areas to implement, improve and sustain standards across the country, which will ensure that everyone has access to high-quality treatment and recovery services. I will return to Parliament next month, in a few weeks’ time, to provide an update on progress with that.
To reinforce the rights-based approach, we will increase the number of publicly funded placements in residential rehabilitation by 300 per cent over the parliamentary session. That work is backed by £100 million in funding.
We have made significant announcements on the establishment of a national family rehabilitation service and two child and mother houses, and on increasing capacity in other residential services. Yesterday, we published evidence on the benefits of rehab in terms of improving health and wellbeing.
We are helping local areas to develop a standardised approach to commissioning residential rehab services and improving the pathways into and from rehab services. That includes better links from prisons.
The mission makes crucial links to the justice system. Now that emergency services are carrying naloxone, lives are being saved from overdoses. The task force helped to shape what is now the world’s most extensive distribution network of naloxone. Seeing colleagues in the justice system provide that life-saving intervention is really positive. I add my thanks to Police Scotland for becoming the first force in the world to roll out the carriage of naloxone.
Our justice system as a whole needs to be more treatment orientated and trauma informed, and we are taking forward the task force recommendations on drug law reform that apply to the Scottish Government. As part of our public health approach, I again state my strong support for safer consumption rooms, as the evidence is clear that they save lives. We are leaving no stone unturned to find a way for such facilities to operate in our existing legal framework.
As part of our mission, we are linking with other parts of the Government to tackle problems that are associated with drug harms, such as poverty and homelessness. We are taking a cross-Government approach to tackling poverty, which includes funding through social security to reduce child poverty. People in our most deprived communities are 18 times more likely to die from drug use than are those in more affluent areas, which is unacceptable.
The Government has published the ending homelessness together action plan and, with the Convention of Scottish Local Authorities, we are consulting on a new duty to prevent homelessness.
Too often, stigma stops people accessing the help that they need, which is why we are taking forward the task force’s stigma strategy. At the turn of the year, we ran a media campaign to challenge stigma. We are working on a charter that will encourage organisations to consider best practices to create a stigma-free Scotland.
I have heard repeatedly how stigma and problem drug use can cause untold hardship and trauma to families and loved ones. In December last year, I published a framework on how we will improve holistic support for families. That has been supported by an additional £3.5 million for alcohol and drug partnerships and a fund of £3 million to support vital front-line and third sector services. We will continue to work with local areas to implement that framework across the country.
The national collaborative for people with lived and living experience, which is chaired independently by Professor Alan Miller, will bring forward the vision for integrating human rights into national policy and local service design and delivery. That will be based on internationally recognised human rights, to be included in our forthcoming human rights bill. I have no doubt that the national collaborative will hold us all to account and ensure that people affected by drug use can participate in the decisions that affect them. It will also ask tough questions and demand clear answers.
I thank the committees again for working together. That is a welcome approach and in the spirit of the national mission, which is an all-Scotland, all-Government public health approach to reducing drug deaths and improving lives.
15:20
Under the Scottish National Party, drug-related deaths have spiralled out of control. It is clear that the SNP’s current strategies to help people who are struggling with addiction have failed. There was a record number of deaths in 2020 and the death rate is 3.5 times that of the rest of the UK. It is also higher than in any European country.
That scandal is Scotland’s national shame. It goes without saying that every death brought about by the misuse of drugs is a tragedy, not only for the victim but for their family and friends. We cannot go on like this. Lives are being lost and families are being torn apart.
My intervention is about language. I hear Conservatives saying “shame” all the time. Does Sue Webber not think that that is stigmatising language and that we need to get away from such language when we are talking about drugs?
Personally, I think that it is an absolute shame that people continue to die from drug-related causes in Scotland. I repeat that it is an absolute shame.
The Scottish Conservatives believe that a different approach is needed to help people who suffer from addictions. The SNP Government must listen to front-line experts and back our proposed right to recovery bill, which would guarantee treatment for those most in need. The key principle that underlies our proposed bill is to ensure that everybody who seeks treatment for addiction to drugs and/or alcohol can access the treatment that they require. Individuals must not be refused treatment from drug and alcohol addiction services.
Angela Constance said that she would give our proposed right to recovery bill proper consideration to see whether it will do what is claimed. She has confirmed that she backs the principle that people who suffer from addiction should have a right to treatment and that our proposed bill will be given a fair and sympathetic hearing. That shift in language from the minister is welcome.
The consultation on our proposed bill showed that more than 77 per cent of respondents backed plans to guarantee treatment for those suffering with addiction. The bill was drafted alongside front-line experts, who are overwhelmingly positive about the plans. We all know that no single measure can help to tackle the scandal of Scotland’s drug deaths, but a guarantee of being able to access treatment can signal a new approach in that fight.
Annemarie Ward from the charity Faces & Voices of Recovery UK—FAVOR UK—who helped to draft the bill alongside the party, has also welcomed Angela Constance’s change of direction towards the proposed legislation. FAVOR Scotland said it had been told privately by some SNP MSPs that they will support the bill.
We have services that are currently inflexible. Addiction and mental health are constantly changing, and services need to adapt to that. Our services need to adapt to the individuals; the individuals should not be adapting to the services.
Stigma has rightly been mentioned. Many people are ashamed to admit to their issues and to seek the help that they require. We believe that our proposed right to recovery bill will help with that issue, as it will provide everyone with a statutory right to addiction and recovery treatment services.
In September 2021, the Lord Advocate announced that class A drug users could be let off with a recorded police warning. The SNP’s effective decriminalisation of class A drugs will mean that thousands get away with drug use. It is estimated that, of the 30,469 crimes of drug possession recorded in 2019-20, 7,000 were for possession of class A drugs.
With regard to Ms Webber’s comments on recorded police warnings, it is appropriate that she recognises that that decision was taken by the independent Lord Advocate, although, of course, the Government is supportive of it. Does she recognise the international evidence, which overwhelmingly states that we need to move towards a public health approach, as opposed to a criminalising approach, which causes more harm than good?
I can give you your time back, Ms Webber.
I have recognised that—I mentioned that the Lord Advocate made that announcement.
We are dismayed that a single public health approach is being taken. An element of justice must be involved. We believe that the possession of class A drugs is a serious offence and should not be dealt with through warnings. Rather than making the police’s job to combat the supply of drugs more difficult, our focus should be on improving access to rehabilitation and treatment.
Will the member take an intervention?
No, I am carrying on for the moment, thank you.
Disappointingly, the SNP Government has refused to sign up to a UK Government scheme to tackle drug dealing and organised crime. Project ADDER—addiction, diversion, disruption, enforcement and recovery—is a UK-wide initiative with £150 million of investment in England and Wales that is designed to tackle addiction and the supply of illegal substances. Project ADDER helps people with their addictions and assists them access recovery, but it also takes a hard-line stance in targeting the criminality associated with drug gangs.
The UK policing minister called the SNP’s decision not to sign up to the scheme “deeply ... alarming and distressing”. Scotland’s drug deaths are a national crisis, yet the SNP refuses to engage with such schemes. Surely, it should try anything, especially schemes such as Project ADDER, where there is evidence of their being effective.
We know that the Drug Deaths Taskforce recommended safe drug consumption rooms and that the SNP Government says that it is moving forward with plans to establish such rooms. However, Chief Constable Iain Livingstone said that “stronger evidence” is needed before he could support drug consumption rooms.
The Scottish Conservatives will not oppose the use of drug consumption rooms, but we have serious reservations about their operation. As Chief Constable Iain Livingstone said, we need to proceed with caution. Therefore, although we will not oppose a pilot, if that is the route the Scottish Government is to take, we need to see more evidence on their use.
Drug consumption rooms are not a silver bullet; they will not solve all our problems. However, unlike the SNP Government, we will consider all options to tackle the crisis.
I am looking for leadership and pragmatism from the SNP Government. I would hope that our approach is reciprocated and that the Scottish Government also takes that approach by accepting Project ADDER and our game-changing proposed right to recovery bill. The final bill proposal, which was developed with the help of those with lived experience, was lodged by Douglas Ross yesterday.
Our bill will save lives. It will provide a statutory right to addiction and recovery treatment services, including, but not exclusively, residential rehabilitation. Now that it has successfully passed through the consultation stage, it is time for the SNP Government to throw its weight behind it, so that we can tackle this national scandal once and for all.
15:27
I welcome this afternoon’s debate and the work of the three committees. We can all agree that Scotland’s drug death figures are unacceptable and shocking. We know that more people die in Scotland from drug overdoses than in other countries across the rest of Europe. Our high rate of drug deaths destroys families and communities, and too often continues a cycle of drug dependency and addiction.
Although our fatality rate is high, we are not alone in facing the challenge. There is evidence of other countries and cities that have changed their approach and turned round the despair and misery that comes from addiction and drug dependency by focusing on harm-reduction measures, investing in services—not only in addiction services but in mental health and family support services—changing their criminal justice response and tackling isolation and stigma.
With leadership, focus and determination across Government and our public services, we can change our direction in Scotland. Scotland’s drug deaths are not our fate; we have the resources and capacity to save lives.
I welcome the approach of the Health, Social Care and Sport Committee, Criminal Justice Committee and Social Justice and Social Security Committee and the opening speeches of the conveners today. Scrutiny of policies and progress is crucial. With two members’ bills in the area of drugs policy coming to Parliament, the committees will be responsible for considering proposals on overdose prevention centres and on patient’s rights, if those proposals get members’ support. There is also the Government’s work to scrutinise. Labour will give all proposals a fair hearing.
When I started as Labour’s drugs spokesperson a year ago, I recognised the failings of the Scottish Government and its culpability for the spiralling level of fatalities, but I also gave a commitment to be constructive and supportive where we see progress. I recognise the roll-out of naloxone, the investment that is now going into the third sector and the expansion of the recorded police warning scheme. Plans to increase capacity in residential rehabilitation facilities are positive steps but more investment is required to make a more significant impact.
I welcomed the introduction of the MAT standards, which, if effectively implemented, would be transformational. However, I said in response to the statement last week that it gives me no satisfaction to say that the commitment to embed and implement the MAT standards in a year is heading for abject failure.
The Government is now moving the goalposts. It is saying that embedding is different from delivering and that delivery is not a tick-box exercise. None of those caveats was given a year ago, when the First Minister said that the standards would be rapidly implemented. When the minister announced that the standards would be in place by the end of April 2022, I spoke about the challenges in achieving that and the importance of accountability. I called for robust monitoring of implementation and interim reporting on progress, so I await the report in June that will set out progress. I am critical of the failure to react with the speed that is required in an emergency, so I will scrutinise progress and press the Government to make haste.
There are challenges in delivering the MAT standards, but if the Government falls short, lives will continue to be lost, people will continue to suffer, individuals will disengage with treatment services, jeopardising their health and wellbeing, the high level of non-fatal overdoses will continue, the risk of people catching serious infectious diseases will remain, and the opportunity to rebuild lives will be more limited.
The Scottish Drugs Forum survey from October last year included views of users. One man said:
“I am hearing of guys going to the clinic and being told to come back in 2/3 weeks’ time. By that time, you are dead. Two weeks is a long time to an addict, it’s more like two years.”
Other members will talk about the importance of treatment programmes and rehabilitation beds. Of course, a range of treatments must be on offer, and everyone should have access to treatment that meets their needs. However, full implementation of the MAT standards is crucial for reducing the number of preventable deaths. We are beyond admiring the problem; we need to see action.
Fundamental issues need to be addressed. From speaking to people working in the third sector and in the national health service, I know that more needs to be done to ensure that there is investment in addiction psychology services and that those services are valued. There needs to be greater consistency across the country in the availability of treatment, and the role of primary care needs to be enhanced.
Progress is too slow. Two and a half years ago, the Scottish Government declared that the drug deaths crisis was a public health emergency, but we have not seen the emergency response that is required. Alarm bells are ringing, with the rise in the level of fatalities among women and young people, so urgent action needs to be taken.
According to Audit Scotland, Government ministers have still to develop a drug and alcohol plan that is “clear, transparent and measurable” to tackle the crisis. Very few people are receiving heroin-assisted treatment, and drug-checking facilities are not up and running, although they are now in place in Somerset.
The Mental Welfare Commission recently found that there is a serious lack of drug addiction and mental health support for prisoners. That comes a decade after it raised similar concerns.
Overdose prevention centres have yet to be established. We do not even have a finalised proposal, although, as others have said, the Lord Advocate has indicated an openness to finding a solution.
Drug use among young people is different, but there are still few bespoke services for young people, and a full response to the rise of street benzos has still not been realised.
We need to recognise that the call for culture change comes at a time when a recent workforce survey of front-line staff in the drugs and alcohol sector showed that many are underresourced, undervalued and under pressure. Demand on services is exceeding availability, with unsustainable workloads leading to mental and physical health issues for front-line workers. The workforce is under pressure and underresourced, which will, in turn, impact on the implementation of the MAT standards and the delivery of treatment.
It is welcome that the committees have taken an interest in the matter, and we have heard today about the evidence that they have taken. I encourage the committees to play their full part in ensuring that we deliver on the national mission to tackle the appalling level of preventable drug deaths in Scotland. The Parliament must not take its eye off the ball.
I call Beatrice Wishart, who joins us remotely.
15:33
I, too, thank all three committees and their clerks for the work that they are putting in jointly to examine this vitally important and complex issue.
Before I go any further, it is important that we all pause to reflect on the impact that the drug deaths crisis has had on people in Scotland. As has already been highlighted, there were just over 1,300 drug deaths in 2020 and, for the seventh year in a row, Scotland had the highest rate in Europe. I express my condolences to all those who have been affected by a drug death. Although I know that a debate such as this will not ease the pain of loss, I hope that it provides some reassurance that we are taking the issue seriously.
Scottish Liberal Democrats have long called for all issues and problems surrounding drugs to be viewed through the lens of public health rather than criminal justice. We believe that people who are caught in possession of drugs for personal use should be directed down a path of treatment or education, rather than face a fine or prison time.
By taking a public health approach, we can ensure that people get fast access to support and wraparound services, which can help those at risk of drug-related death as well as their families. That can be done through, for example, safe drug consumption rooms. My party has consistently called for such facilities and I note that Paul Sweeney’s recently proposed member’s bill seeks to allow them to be created.
My party and I look forward to working constructively with Mr Sweeney on the issue, but it is disappointing that it has taken an Opposition MSP to finally raise such proposals for discussion. However, that seems to be the norm when it comes to the approach of both of Scotland’s Governments to tackling the drug deaths crisis.
In 2015 and 2016, the Scottish National Party cut funding for drug and alcohol partnerships by 22 per cent, which hit vital services and caused relationships between service providers and users to collapse. Given how crucial those services are in helping people to get the treatment that they need, there is no doubt that the impact of the decision was devastating.
It is not just the Scottish Government that needs to do more, however—the UK Government’s actions on the issue are equally lacking. As the House of Commons Health and Social Care Committee stated in an inquiry report in 2019, there needs to be a shift at UK Government level to a health rather than a justice approach. That view was shared by the Scottish Drugs Death Taskforce in its recommendation that there should be a “root and branch review” of the Misuse of Drugs Act 1971.
Mr Malthouse might, as he did when he gave evidence to the committees, point to the ADDER projects in England and Wales as a sign that the UK Government understands the need for a public health approach. However, there very much seems to continue to be a belief that the issue is a criminal justice one.
I fear that, if the UK Government continues to take that approach, we might never tackle this crisis. Although Douglas Ross’s proposed bill on the right to recovery could highlight a shift in Conservative thinking, Scottish Liberal Democrats are still concerned that it might not do enough. However, as I mentioned, we will always work constructively on a cross-party basis to take long-overdue measures to tackle the drug deaths crisis. Given the track records of both of Scotland’s Governments on the issue, my party and I believe that it is time for an independent body, such as the World Health Organization, to be brought in.
The issue will not be resolved overnight. Positive steps such as the roll-out of naloxone to Police Scotland are welcome, but there is still much to be done. If we are to tackle the issue, we must change our approach. Providing people with the support that they need through safe drug consumption rooms and stabilisation services, rather than handing them fines or looking to imprison them, will, as I have said repeatedly, save lives. We do not have time to waste.
We move to the open debate.
15:37
I first recognise everyone who has suffered unduly, mentally or physically, and those who have tragically died because of substance misuse or unsafe drug consumption. Every death that is attributed to unsafe drug consumption is an absolute tragedy for the families who lose their loved ones.
The current level of harm that is being experienced by people who consume drugs calls for radical change in how we tackle the issue. I say that as someone who has experienced friends and loved ones appearing in the drug deaths figures. For decades, successive UK Governments have made a concerted effort to continue their so-called war on drugs, with grave human cost and at huge expense to the legal system, the everyday taxpayer and our society.
Will the member take an intervention?
I will see how I get on. I will maybe take one at the end.
In dealing with substantive policy, we must of course take a cautious yet research-based approach. We also owe it to all the people living in Scotland to explore all options at our disposal to reduce harm in our society. That is why we must not shy away from creating a national conversation on how to do exactly that.
Change is needed as a matter of urgency. The UK Government needs to give serious consideration to radical reform of drug laws. After its decades-long failed war on drugs, to roll that out without due consideration would be a serious disservice, driven only by ideology rather than proper research and evidence. There are plenty of international examples that evidence that decriminalisation, or legalisation and regulation, can be successful in reducing drug deaths and harm.
There is more than one incentive to explore that potential. For example, organised crime groups would no longer thrive off the proceeds from the illicit drug industry, which are often used to fund other criminal operations such as human trafficking.
Will the member take an intervention?
Maybe at the end—I will see how I get on.
Drug reform must be about taking a realistic and commonsense approach. We in Scotland are trying to forge a different path from the one being forged by the Government south of the border.
Like other countries with commonsense drug policies, Scotland has taken a public health approach to tackling the issue. Under the guidance of Angela Constance and within the limitations of devolution, this SNP Scottish Government has taken its responsibility on reform seriously by setting out a national mission to improve lives and save lives, committing an additional £250 million over the next five years to increase access to services for people affected by drug addiction and exploring the need for safe consumption rooms for people who use drugs.
It is not just a pity that we do not have the same level of commitment to Scotland from the Government in Westminster; it is an absolute disgrace. It has long been observed by clinicians that social determinants of health tip the scales against people who are addicted to substances in the already daunting quest to recover from any type of addiction. To be clear, the World Health Organization defines the social determinants of health as
“the conditions in which people are born, grow, live, work and age ... These circumstances are shaped by the distribution of money, power and resources at global, national and local levels”.
We already know that the cost of living crisis will do untold harm to just about all of us who have less than those in the UK Government, but, make no mistake, it will also have a wide and long-lasting impact when it comes to health outcomes and substance misuse issues.
To tackle the issue, Scotland needs full and comprehensive powers over drug reform in our Parliament. Perhaps a quicker fix is Scotland gaining its independence—I hear a few groans. Mitigating the worst of bad UK Government policy should be a thing of the past, and its current policy on drugs is inadequate. Stigma and criminalisation suppress the potential for future rehabilitation, harming an individual’s employment prospects and often leading to the continuation of generational cycles of poverty and adverse childhood experiences.
Penalties related to drug consumption should not be more damaging to an individual than the consumption of the drug itself. The picture of drug harm in Scotland is different from that south of the border. That is why it is so important that we in Scotland have full powers over our destiny, to ensure that our Government, laws, customs and values are reflective of the people who choose to live here. The UK Government continuing to cling to powers that should be in the remit of the Scottish Parliament is not just ineffective but actually damaging.
Will the member take an intervention?
I am speaking fast so that I have time to take youse in.
However, Scotland is a progressive nation brimming with innovation and confidence in our role in the world. On matters devolved, we are at the forefront of tackling some of the biggest issues in the 21st century. As we look to the future, fantastic work is already under way to make positive change. Perhaps someday soon, with the full powers over our own destiny, Scotland can join other progressive nations that have been able to radically decrease the rate of harm caused by unsafe consumption of illicit substances. Change is needed.
I have 30 seconds to take an intervention.
I am quite depressed at the tone of that contribution. I hope that the member will reflect on the language used on a very sensitive subject.
Scotland has a drug death rate that is three-and-a-half times that of the rest of the UK, including areas that suffer from far more deprivation than many parts of Scotland. No member on the Government benches has been willing to admit that, to accept and acknowledge it or even to explain it, which is surely what they should be doing.
Karen Adam, I can give you the time back.
I do not know why the member is asking me to reflect on my tone; I think that that was uncalled for. In terms of reflecting on the issues that are bespoke to Scotland, that is exactly why we need powers here. A UK-wide approach is obviously not working for Scotland.
I can advise members that there is a little time in hand, so any member taking an intervention should get most of the time back.
15:44
Last year, Nicola Sturgeon announced the launch of what she called
“a national mission to end what is currently a national disgrace”.—[Official Report, 20 January 2021; c 26.]
She was talking about Scotland’s drug death toll, which has risen every single year under this SNP Government and has doubled during her time as First Minister.
Douglas Ross later challenged the First Minister on why she allowed a drug rehab facility in her Glasgow constituency to close. In a line that caused incredulity at the time, she admitted taking her “eye off the ball”. She did not take her eye off the ball, of course; she knowingly cut addiction services as the number of drug deaths continued to climb.
Scotland is the drug death capital of Europe. Drugs cause abject misery and despair. It is encouraging that this national disgrace is being treated primarily as a public health issue; I agree that we cannot arrest our way out of the problem, and I cannot think of anyone who puts that forward as a credible solution. However, it would be equally misguided—naive, even—to think that public health measures in isolation are the cure.
Like Sue Webber, I want to talk about project ADDER. ADDER stands for addiction, diversion, disruption, enforcement and, crucially, recovery. Described as a whole-system approach, the project puts a ring of steel around drug-ravaged communities and aggressively targets violent and parasitical gangs, while giving addicts the help and support that they so desperately need.
I am interested in the language that has been used. Will Russell Findlay explain what he means by a ring of steel?
It is a robust policing approach that prevents a flow of drugs going into such communities, for the benefit of the people who live there.
Given that the number of drug deaths in Scotland is, inexplicably, 3.5 times higher than that of the rest of the UK, it was obvious that the UK Minister for Crime and Policing, Kit Malthouse, wanted to deploy project ADDER here. He identified Dundee as an ideal place for it, but, to his bafflement, the SNP decided to keep the ADDER approach behind Hadrian’s wall. The minister is on the record expressing his disappointment. Many people suspect that the SNP blocked ADDER due to its strategy of taking a different approach to England, just for the sake of being different.
Mr Findlay might not be aware that the Scottish Government participates in a learning network to monitor project ADDER and that there are diversion and support for recovery aspects of project ADDER that mimic or mirror the national mission. I wonder if he is aware that the UK minister really just wanted to rebadge work that we were already doing in Scotland as project ADDER. There was no serious offer behind it.
I can give you the time back for the intervention, Russell Findlay.
Thank you.
Yes, I was aware of that. That is the first suggestion that I have heard from Angela Constance that this was merely a branding exercise, which I think will come as news to the UK policing minister, too.
This episode raises concerns that, despite Scottish Government rhetoric, it sometimes does not treat the issue as a national mission. Let us take another example—that of drugs in prisons. It is scandalous that so many prisoners go in clean and come out addicted. Far too few get the meaningful help that they need to beat drugs and break the cycle of reoffending.
When prison officers told me that drugs had never been so widespread and that most arrived in drug-soaked mail, I raised it repeatedly with the Government, but for months nothing happened. In that time, prisoners died and overdosed, yet officers’ pleas for help were ignored. The Minister for Drugs Policy responded to my calls to ban drug-soaked mail with a bizarre and patronising dismissal. It was only following a mass overdose at a maximum-security prison that the mail was finally stopped. That resulted in a dramatic and immediate reduction in the number of drug incidents and ambulance call-outs. Given Nicola Sturgeon’s supposed national mission, why did her Government not listen to prison officers far sooner?
Then there is the issue of firefighters carrying naloxone, which is used to treat opioid overdoses. Three months ago, the First Minister and the drugs minister turned up at Bathgate fire station for a public relations event to make an announcement about that. The only problem is that her Government has not even reached an agreement with firefighters, who have many concerns. I spoke to a Fire Brigades Union official today who does not know of a single firefighter who has volunteered to carry naloxone. If it really is a national mission, the Government needs to put persuasion and partnership before PR.
One respected campaigner, who has already been mentioned, is Annemarie Ward from FAVOR UK, which stands for Faces and Voices of Recovery. Ms Ward agrees that ADDER would certainly benefit Scotland. The charity is led by people who are either living with or have lived through the damage of addiction. They know what they are talking about.
Ms Ward also helped to draft my party’s right to recovery bill, which was lodged this week by Douglas Ross. It is simple and compelling legislation that would enshrine in law the right of people with addictions to get the treatment that they need. Glasgow has an estimated 18,000 problem drug users—maybe more—yet it has fewer than 20 rehab beds. No one suggests that the right to recovery alone is the answer to everything, but its merits are clear and I look forward to hearing more from my colleague Dr Sandesh Gulhane. The bill has secured strong public support and I was very pleased with the response from the Minister for Drugs Policy, who said that it would be given a “fair and sympathetic” hearing.
For the sake of thousands of families suffering from the devastation caused by drugs, let us hope that the Government will work with the Scottish Conservatives and other parties on this. It is time for a real “national mission” to put an end to this “national disgrace”.
15:51
I have a long-standing interest in drug policy and the work to reduce the number of drug-related deaths across Scotland—not only as a registered nurse, but as a member of the Health, Social Care and Sport Committee during this session and as a member of the Health and Sport Committee in the previous session of Parliament. I also participated in the joint inquiry into drugs deaths in Scotland, which was carried out by the Scottish Affairs Committee at Westminster and led by Pete Wishart.
I will, in my short contribution, make three points. They will address the evidence-based action that the Scottish Government is taking, using the powers that are available to us to reduce drug-related harm; the importance of continued action to reduce drug-related stigma, which others have mentioned; and the response of the UK Government to the tri-committee inquiry.
First, since the national mission to reduce drugs deaths was announced in 2020, the Scottish Government has taken action to transform our approach to drug policy, within the constraints of the outdated Misuse of Drugs Act 1971. We have changed our approach, and are moving away from one that focuses on criminalisation to one that puts first the health and medical needs of those who are impacted by drugs. In health, that has included roll-out of carrying naloxone to save the lives of people who experience a heroin overdose; development of better outreach services; increased provision of rehabilitation beds; and development of non-fatal-overdose pathways and MAT standards.
Another form of unintended overdose that occurs in Scotland is one in which benzodiazepines—whether illicit or prescribed—are taken and mixed with other substances, including alcohol. It is worth highlighting that those overdoses are a cause of death, especially in rural areas.
Naloxone works only for reversal of opioid overdoses. From my experience as a nurse, I know that there is a reversal agent for benzodiazepines called flumazenil. There can be side effects to use of flumazenil. Can the minister tell us whether any work is being done to pursue a naloxone-type reversal drug that would apply to use of benzos, especially in rural areas?
In education, the Government is bolstering teaching on drug and alcohol harms, thereby ensuring that children are educated at an early age about drug safety and the harms that addiction causes. By taking forward those and other measures, the Scottish Government is creating a new whole-system approach, and is implementing an integrated person-centred and medical, rather than punitive, approach to tackling drug harm.
I also welcome the work of project MATCH—matching alcoholism treatments to client heterogeneity—which takes a person-centred and client-centred approach to recovery. Harm reduction is also part of recovery, because we must remember that recovery includes relapse as well as support.
I turn specifically to stigma. By addressing stigma and the silence and alienation that it causes, we make it easier for people to seek help. Stigma is not only damaging to an individual’s mental health and sense of worth; it also discourages them from coming forward to seek the help that they need.
The media have an important role in addressing stigma. For example, in my South Scotland region, when I put out a press release welcoming drug funding and the progressive approach that is being taken in Scotland and the focus on stigma, a local newspaper used a stereotypical picture of a metal spoon with powder on it, next to a used syringe. The paper has agreed to consider changing the images that it uses in the future. I would welcome other print media also addressing addiction sensitively in order to help to tackle, and possibly eradicate, stigma.
It is welcome that the drug deaths task force has developed a strategy that identifies actions to help to reduce stigma. However, I often hear from constituents and others that an issue with stigma still exists among a minority of health, social care and allied health professional staff.
In a debate in January, the minister agreed to my request that the possibility of an e-learning module on drug stigma be explored—for example on the NHS learning system Turas—for our healthcare professionals, including pharmacists. I ask the minister, when she closes the debate, to give an update on whether that e-learning model to tackle stigma is progressing.
There is strong evidence from other countries that safer drug consumption facilities help to prevent fatal overdoses, and that they encourage people who use drugs to access longer-term help. The European Monitoring Centre for Drugs and Drug Addiction and the Advisory Council on Misuse of Drugs both support use of drug consumption rooms and have said:
“The effectiveness of drug consumption facilities to reach and stay in contact with highly marginalised target populations has been widely documented.”
Can Emma Harper cast some light on when her Government will bring forward detailed plans on what DCRs will look like and where they will be?
I thank Russell Findlay for that intervention. I am not in the Government, so I cannot speak for it at this time, but I look forward to any plans that it will announce, because I believe that drug consumption rooms that help to support people and prevent overdoses should be introduced in Scotland.
Will Emma Harper take an intervention?
I will if I have time, Presiding Officer.
I can give you some of the time back.
I apologise for using some of Emma Harper’s time, but I thank her for taking the intervention.
Is Emma Harper aware that since as recently as 2016 NHS Greater Glasgow and Clyde has had some very detailed plans for what drug consumption rooms would look like? We are not starting from scratch—there is a health-based approach with plans already in place.
I thank Bob Doris for that update on what is happening in greater Glasgow. My focus is on South Scotland, so I often do not know what is happening in other health boards directly, and we have not got to that yet in the Health, Social Care and Sport Committee.
In recent years, both the UK Parliament’s Scottish Affairs Committee and the Health, Social Care and Sport Committee have recommended introduction of such facilities, but they are continually blocked by the UK Government, which refuses to accept the evidence and refuses to devolve control over drug policy to this Parliament.
My final point is that the UK Government’s whole approach to drug addiction is summed up well by minister Kit Malthouse, who said at the tri-committee that people who take drugs are “sad” and not bad. Drug users are so much more complicated than that. I believe that what he said was condescending and belittles people who are struggling through harmful use of drugs and alcohol. I am sure that he didnae mean to dehumanise them and to focus on criminality, but we need proper powers to take forward our own Scottish approach to tackling drug harm—one that is focused on evidence-based practice.
I repeat my call for the UK Government to devolve drugs policy to this Parliament.
15:58
I welcome the opportunity to contribute to the debate, having followed the committees’ discussions on the issue. I will reflect quickly on the debate. I note—I think that the minister will be aware of this—that its tone is in marked contrast to the tone of debates that we have had previously on the subject. Labour members would be very concerned if there was a breakdown in consensus on the scale of the challenge that we face, and on the need for a humble approach by the Government and concerted and reasonable support from the Opposition.
A vacuum has been created in the debate due to the lack of a strategic plan from the Government. We now have proposals from both sides of the chamber on action in the area. If we do not have a strategic approach from the Government, more rancour will result, which will not serve the people of this country well.
The committee discussions were certainly helpful on a very narrow range of issues, but they gave no real strategic insight into why Scotland is the drug deaths capital of the world, with a level of drug deaths that remains almost four times that of the rest of the UK, even though it comes under the same drug laws.
Will the member take an intervention?
I will not at the moment. I want to make some progress. I might take an intervention later.
I remain deeply concerned that the Government does not have an evidence-based understanding of why the situation is so horrific. In essence, that is the point that I made to SNP colleagues, to whom I am grateful for allowing my interventions. Gillian Martin cited issues to do with poverty. However, we know that areas of England have higher levels of poverty but nowhere near the level of drug deaths that we have in Scotland.
Polydrug use was cited by Elena Whitham—
Angela Constance rose—
I will take an intervention in a moment. Polydrug use exists across the UK. It is certainly not on the same level as benzodiazepine use, but it is clearly an issue.
In less than one minute on 13 January, the minister provided Parliament with her personal analysis of why the situation in Scotland is so much worse. She cited a higher level of drug use, benzodiazepine use, and not enough people being in recovery. However, without an authoritative accompanying evidence base, that is well-qualified speculation. I do not necessarily disagree with the minister that those are serious issues. However, set out alone, in one minute, they are pretty much useless.
On benzodiazepines, my contention is that the withdrawal of Valium scripts and the creation of a wild-west street market for tablets of varying content and potency is the most lethal policy error of the devolution era.
In the debate that I mentioned, the minister stated:
“my opinion as to why we have seen that increase differs from Mr Marra’s,”—[Official Report, 13 January 2022; c 112.]
yet no alternative analysis has been provided. If the minister wants to make an intervention now, I would appreciate an answer to that.
In the past, I have made the point to Mr Marra that I am a politician, not a clinician, and I do not prescribe medications. However, it is a fact that, in Scotland, the prevalence of drugs use is double the level south of the border. I think that we agree on the significance of the implications of benzodiazepines and heroin, and I hope that we agree that it is a fact—rather than my opinion—that not enough people are in treatment. That is why all of our national mission, at its core, is about getting more people into treatment that is right for them.
I appreciate the minister’s reiteration of exactly what she said in the previous debate. However, clearly, that is not a coherent analysis that covers the scale of the issue. No evidence—[Interruption.]
If the minister will let me go on, I note that no evidence has been presented in any marshalled way against the numbers that she has brought to the chamber, in order to give an analysis of the where, the why, the how and the when. That would be appreciated by all members.
Will the member take an intervention?
No, thank you.
If members had a full understanding—a shared understanding—of why the situation is happening, we could say whether the measures that have been suggested by other members would be appropriate reactions to that situation. Frankly, it is not good enough.
On the associated issue of clinical care, we still await the benzodiazepine harm reduction guidance. The minister talked about not being a clinician. Draft guidance was published in August 2021, but no follow-up guidance has been published. I have lodged parliamentary questions about that today; it would be good to know when that guidance will arrive.
All this remains a mission without a plan that is visible to Parliament or, crucially, to the public. We should be deeply worried for everyone concerned. We can hope that the Drug Deaths Taskforce report provides an analysis—whenever that is forthcoming—but we will wait and see.
In closing, I mention the Dundee drugs commission, which published its two-year review report on 2 March. Three months on, there has been no response from the partner agencies that are involved, of which the report is particularly critical. There has been no meeting with the commissioners, no report to Dundee City Council and no discussion at the local health board. The report is clear that the critical bodies in the city have failed to grasp the scale of the challenge. Key recommendations from the first report, which was two years ago, have simply not been addressed.
Unsurprisingly, the rebranding of the integrated substance misuse service—which was, itself, a rebranding of a rebranding—as Dundee drug and alcohol recovery service, has done nothing to change the culture or perception that it is a service that is failing clients, families and my city. The closure of Constitution house should have happened years ago, but, at long last, it has been accepted that it should happen by the end of this year.
The next steps cannot be cosmetic change. There must be a wholesale change from the centralised medical model, which must be deconstructed. Relocating is not enough. The Dundee partnership must respond fully to the work that has been done and must accept in full the recommendations that were made for it, including the recommendations from the original report.
Clients deserve services for which hard-pressed staff are proud to work—and in which they can have confidence, be respected and invest in hope.
I say to the minister that, in the absence of a real, published strategy and a plan that we can scrutinise to see whether our proposals meet, the tone of the debate might just get worse.
16:04
Drug-related deaths and drug harms are a public health emergency. The number of people dying from drugs in Scotland is heartbreaking, and the ripple effect of one person having an addiction can be far reaching.
One of my first speeches after my election was on this topic. I started it by paying tribute to my brother, Brian, who we lost to an overdose in 2002. Brian was at the forefront of my mind again when I was thinking about today’s debate and the effect that drugs have on people. He often talked about the monkey that he could not get off his back, no matter what.
Brian lived with me for a while. One of the biggest regrets of my life was asking him to leave because of his chaotic lifestyle. I never saw him alive again. I just wish that there had been the right support mechanisms in place for addicts and their families to cope. If there had, I could be telling a different story today.
My dad chose the song “For a Dancer” by Jackson Browne for Brian’s funeral, and I think that the words sum up his lifestyle perfectly. Do not worry; I am not going to sing it.
“I don’t remember losing track of you
You were always dancin’ in and out of view
I must’ve thought you’d always be around
Always keeping things real by playing the clown
Now you’re nowhere to be found”.
Before he died, Brian was living in Hope house in Glasgow and had been off drugs for six weeks. He was doing well, and all the guys there thought that he was brilliant. He was offered a job as a security guard at a festival, which he accepted. Brian and his friend ended up overdosing. Paramedics managed to revive his friend, but, sadly, Brian got that monkey off his back in the worst possible way. He was pronounced dead on arrival at the hospital.
Since then, some things have changed. In 2011, Scotland was the first country in the world to introduce a national naloxone programme, which has empowered individuals, families, friends and communities to reverse an opiate overdose. Since then, roll-out has increased dramatically, from police officers and paramedics, to the take-home kits that are given to individuals who are at risk of overdose and to their relatives.
Had naloxone been so widely available back in 2002, Brian could be alive today. My speech could have been focused on my lived experience as the sister of someone who had survived an overdose, had managed to get that monkey off his back, and was living a happy life, there to see his daughter grow up and to be the amazing uncle that he could have been.
Like many others whom I have spoken to, I hope that sharing my experience shines a light on how we might tackle the drug crisis, and on the importance of putting in place the right support for people who take drugs and their loved ones.
I encourage anyone who is watching to visit stopthedeaths.com and to order naloxone. It could save a life.
Of course, although naloxone is a vital tool, we must accept that there are many opportunities to help a person before it comes to administering it. At the heart of the national mission to save and improve lives is getting people into the treatment and recovery that is right for them.
One aspect is residential rehabilitation, which the Scottish Government recently reviewed. More can be done on that, but I welcome the action that has been taken to date to improve access to, and to boost the use of, publicly funded residential rehabilitation.
Another very welcome development is the MAT standards, which will ensure that people can get help on the day that they ask for it. That is so vital for addictions.
Any approach to tackling drug harms must accept that a range of possible interventions is required. We need treatments to be available through the NHS, whether that is heroin-assisted treatment, opioid substitutes, detox or residential options. We need interventions in the community, such as peer support workers. We need access to advice for housing, social security, employment and training.
I recently visited the Wise Group and learned a lot about its work. That work—from signposting, to mentoring schemes, to support for getting back in touch with relatives—benefits people who have experience of substance misuse. Relationships and family are a crucial part of the recovery process for many people, so that kind of wraparound support is extremely important.
More generally, we should be cautious about thinking that there is a one-size-fits-all solution. Residential treatment might be great for one person but, for another, taking one drug instead of many would be a success. Given that polydrug use is now the leading cause of drug-related deaths in Scotland, if we are serious about tackling the drug deaths emergency and drug-related harms, we must accept that complexity.
We must also realise that tackling deprivation is key to reducing the adverse impacts on individuals and communities. Tory policies in the 80s and today have driven inequality, which is associated with drug use and addictions.
I fully appreciate that the number of people dying from drugs in Scotland is not just a number. Each and every person is a mum, dad, brother, sister, son, daughter or friend who had their own hopes and dreams. It is essential that we facilitate recovery and improve treatment options and access to healthcare. Same-day treatment will make a big difference, and we need to continue the work to remove stigma and support families.
16:11
As I begin this speech, my thoughts are with everyone who has lost a loved one to a drug overdose. I pay tribute to Collette Stevenson for her powerful speech.
When we have these debates, we often focus on policy and reform, but it is important that we also take time to reflect on the lives lost and the terrible pain felt by those who have been bereaved. For too long, our criminal justice system and drug treatment services have robbed people of the dignity that they deserve. Our focus must be on restoring that dignity while preventing further deaths. The Misuse of Drugs Act 1971 is outdated and obsolete, and it further erodes the dignity and safety of people who use drugs. In its 2021 report on drug law reform, the Scottish Drug Deaths Taskforce stated that it was
“unequivocal that the Act in its current form creates barriers to the implementation of a public health approach.”
When the case for reform was put to the Minister of State for Crime and Policing at the joint committee meeting, however, it was clear that he did not have a good grasp of either the situation in Scotland or the root causes of drug use. When asked whether he recognised that poverty was an underlying cause of drug use that needed to be tackled, he answered no and said that he believed that drugs and violence drive poverty.
I have spoken before in the chamber about the fact that Scotland’s drug deaths crisis can be traced back to 1980s deindustrialisation and the subsequent economic and social impact. According to the Royal College of Physicians of Edinburgh, some of those experiencing the highest levels of drug deaths and drug-related harms grew up in the post-industrial 1980s, when unemployment levels were high and the heroin market expanded into deprived communities. That group suffers multiple, complex disadvantages, including poor physical and mental health, unemployment, unstable housing arrangements, involvement with the criminal justice system and family breakdown.
The UK Government is so far behind in this conversation, it should worry us all. How can we hope to tackle the crisis effectively when UK ministers are espousing such ill-informed views, which further stigmatise people who use drugs? Kit Malthouse refused to entertain the prospect of drug-checking facilities here in Scotland. As we heard in the chamber last week, there are now plans, and a licence issued by the Home Office, to operate a facility in Bristol. Such services can save lives. I wish the Loop, which will operate the facility, the very best. I hope that it will have incredible success and, hopefully, once and for all, provide evidence that the UK Government will listen to. It is nonsensical and hypocritical to rule out drug-checking services in Scotland and allow them in England. We need those powers to save lives.
The varying purity and strength of illicit drugs makes it impossible—
It is my understanding that no application for a licence has been made so far in Scotland, but I would greatly welcome drug-checking services. Would the member, and the Government of which her party is a member, agree that a pilot, if it is forthcoming, must be funded appropriately, with staff costs and the right equipment required to make such facilities work?
I was reflecting on the questions that we had asked Kit Malthouse. One of the questions that we put to him was whether the UK Government would back drug-checking facilities in Scotland; the answer was no. If it is something that we were able to introduce, I would be more than happy to chat to the member about all the measures that he has just mentioned.
Safe consumption rooms are another life-saving intervention, and they must be allowed to operate in Scotland. Mr Malthouse said that he needed more evidence on safe consumption rooms. Considering that they have been operating in Europe for around three decades and have proved effective in a range of countries from around the world, including Australia, Canada, Spain, Switzerland and the Netherlands, I am not sure what further evidence he requires. Those facilities could be saving lives now.
I found the minister’s focus on enforcement particularly disturbing. In Scotland, there is a general consensus that a public health approach is needed to solve the crisis. It is clear that the UK Government does not share that view but instead sees it as a criminal justice matter, despite all the harm and stigmatisation that the war on drugs has caused.
I was also disappointed by the minister’s use of stigmatising language, which I will not repeat. We do people a disservice when we label them. It robs them of their dignity and humanity and it others them. If we want treatment services built around human rights, we must dispense with such language and speak about people as if they are human beings deserving of our respect and compassion.
We need a person-centred system that views people as whole beings, rather than various conditions that need to be categorised and dealt with separately. Above all, we must seek to reduce and prevent harm wherever possible. We must maximise every opportunity to connect people with services. The more we embed stigma-free treatment and life-saving interventions in the community, the greater the chances of connecting with those who need the help the most. For example, I was pleased to see the roll-out of naloxone to some taxi drivers in Edinburgh, which will surely result in more lives being saved. I applaud all those in the scheme, which has also been implemented in Glasgow. I hope to see it being implemented in more of our cities and towns.
The Scottish Greens also support the roll-out of heroin-assisted treatment across Scotland. According to NHS Greater Glasgow and Clyde, there is high-quality evidence to suggest that HAT can improve individual and societal outcomes when provided as a second-line treatment for people with chronic opioid dependency. It is yet another area where meaningful progress is being blocked. Stakeholders have reported to the Drug Deaths Taskforce that the process for submitting an application for a licence for HAT is overly complicated and resource intensive. The ability to offer HAT alongside other medication-assisted treatment should be more widespread, and any remaining barriers to the provision should be removed.
Despite the fact that HAT is a well-evidenced intervention, with clear health and social benefits, roll-out has been hindered by an overly bureaucratic process. I have heard the Minister for Drug Policy say on more than one occasion that we need to turn expressions of interest from health boards into commitments. At the moment, health boards must apply to the Home Office and the Scottish Government and could be approved by one and rejected by the other. That may discourage some boards from applying.
It is vital that HAT licensing is devolved to Scotland in order to reduce the administrative burden and to facilitate its roll-out across Scotland.
16:18
I thank the committee conveners and other members for their speeches in today’s debate. The fact that it is a joint debate demonstrates the impact that drugs misuse has on many aspects of everyday life in Scotland. I am very glad that we are spending sufficient time to discuss the issue today.
Although I am now a member of the Social Justice and Social Security Committee, I was not a member at the time of the joint session with the Criminal Justice Committee and the Health, Social Care and Sport Committee, which was held on 1 February. However, when I read the Official Report, a few things stood out.
In her question to Kit Malthouse, the UK Minister of State for Crime and Policing, Elena Whitham asked about the link with poverty. A few members have raised that issue today. She stated there are very strong links between poverty, deprivation, adverse childhood experiences and trauma, and drug deaths, especially here in Scotland. She said:
“We all know that it is a very complex and multifaceted issue to address. Would you agree with the opinion that Scotland’s higher rate of drug deaths reflects historical patterns resulting from economic policies of the 1980s, which we can also see in the north-east of England?”
She also asked about whether anti-poverty measures taken by Scottish Government would have an impact. On the link with poverty, Kit Malthouse stated:
“I would be careful about the difference between correlation and causation”.
Earlier today, we heard about the study by researchers from the University of Glasgow that found that austerity was the most likely reason why life expectancy stagnated after 2012 and death rates in the poorest areas increased. It is clear that there is a link.
Kit Malthouse also stated:
“over the years, there have been lots of attempts to deal with the underlying problems of poverty and deprivation, in the hope that doing so would deal with the violence and drugs that were perceived at the time to be the product of those problems.”
It is clear that the UK Government needs to do more to tackle poverty. I still think that the UK Government sees this as a criminal rather than predominantly a health issue.
During the joint committee meeting, Elena Whitham stated that the cohort of people among whom we are seeing the most drug deaths, as well as multiple deprivation and problematic drug use, are people who were born in the 1970s. In his reply, Kit Malthouse stated:
“The police could play an enormous role in assisting health professionals and those who can give counselling, emotional support and everything else that is required to turn someone around from drugs by ensuring that there are fewer drug dealers and less drugs in Scotland.”—[Official Report, Criminal Justice Committee, Health, Social Care and Sport Committee, and Social Justice and Social Security Committee (Joint Meeting), 1 February 2022; c 15, 17.]
A focus on poverty as a contributing factor in drug deaths is part of the national drugs mission, and understanding that it is predominantly a health issue is fundamentally important.
The second aspect that I want to touch on is drug consumption rooms. Gillian Martin, Gillian Mackay, and Pauline McNeill all pressed Kit Malthouse on the issue. As we know, many experts, people with lived experience and committees such as the Scottish Affairs Committee at Westminster have recommended the introduction of such rooms, because of the contribution that they could make to reducing drug deaths in the UK.
In relation to drug consumption rooms, Gillian Mackay said:
“There are at least 39 sites in Canada, there are peer-reviewed articles from Portugal and there is an evidence base in San Francisco, Seattle, Boston, Vermont, Delaware and Portland, Oregon.”
Pauline McNeill pointed out that there are 66 cities throughout the world with consumption rooms and that
“300 health professionals in England and Wales signed a letter after the Health and Social Care Committee at Westminster called for the introduction of drug consumption rooms.”—[Official Report, Criminal Justice Committee, Health, Social Care and Sport Committee, and Social Justice and Social Security Committee (Joint Meeting), 1 February 2022; c 7, 8.]
The case for the UK Government to change its position is strong and compelling.
In its report on drug consumption rooms, the Royal College of Physicians of Edinburgh stated:
“Safe drug consumption facilities have been operating in Europe for around three decades and offer opportunities to reduce ‘...the acute risks of disease transmission through unhygienic injecting, prevent drug-related overdose deaths and connect high-risk drug users with addiction treatment and other health and social services.’”
The report further stated that evidence from the European Monitoring Centre for Drugs and Drug Addiction highlights that
“such facilities also help to reduce both drug use in public places, and the prevalence of discarded needles.”
The report also stated:
“Drug consumption rooms have proved effective in a range of countries including Australia, Canada, Spain, Switzerland, The Netherlands and others—and the evidence indicates that such facilities do not increase drug use, nor do they increase the frequency of injecting. The College would, therefore, recommend that drug consumption rooms can, if implemented well, provide PWUD in Scotland with an environment to take drugs using safe equipment, with expertly trained staff to support their emotional and physical health needs.”
Will the member take an intervention?
Do I have time, Presiding Officer?
For a brief intervention. There is a bit of time, but not much will be added on.
What is the member’s view on the chief constable of Police Scotland asking for greater evidence before we support drug consumption rooms?
The evidence that I have presented is clear and compelling, as I just said.
I want to touch on a few other issues that the RCPE raised in its report. It stated that optimising the use of medication-assisted treatment can mitigate opioid use disorder, and we have heard that in the debate already. The new standards of MAT will ensure that the necessary range of support is available wherever people live in Scotland to reduce harm and promote recovery.
The task force has identified as a priority getting more people on to MAT in a timely manner and supporting them in treatment for as long as they need. The RCPE supports the MAT standards, and continued focus on the area is key.
The other issue that I want to touch on is rehabilitation beds. People in services have better protection from drug deaths—that is a fact. One hundred million pounds of the £250 million of additional investment will support further investment in, and expansion of, residential rehabilitation and associated aftercare.??
We need to develop sustainable capacity in regional centres across the country, and that work will be inclusive of different models of care. Different funding models can play a significant role in determining the availability of rehabilitation services locally and across the country.?Getting people into the treatment and recovery that is right for them at the right time is at the core of our national mission.
In conclusion, the debate has been a good debate on what we all know is a complex issue. There is much agreement, but there are still areas where we disagree. At times, the tone has not been helpful. Progress is being made; let us make sure that we work together to continue progress and support individuals, families, communities in Scotland, who we were elected to serve.
16:24
Patricia knows only too well how Scotland’s SNP Government is failing families who have loved ones struggling with addiction. Patricia’s son is 47. He has a drug addiction, and he has been on methadone for years. He wants to be free. He describes methadone as being like “liquid handcuffs”. It is as if he is shackled to the chemist, and he fears that he will remain so for the rest of his days. That is because support for recovery and rehabilitation is thin on the ground.
For recovery to work, of course, those with addictions must want to change. However, to do so and to take responsibility for their own recovery, they need long-term support and supervision from professionals who believe in them. Recovery is a long, bumpy and winding road. People with addictions who try hard to get their lives back on track often suffer daily with headaches, nervous symptom disorders and disorientation. It is important that we have their backs and are there for them in the long run.
Patricia explains that that is simply not happening. Furthermore, from her experience, there is far too much red tape to get through to access services in the first place. When mistakes occur, such as a service having failed to communicate an appointment, guess who gets the blame for not attending.
Dentistry is an important part of the recovery process, not only for repairing extensive tooth decay and treating gum disease. Poor dental health is a stigma associated with drug addiction. It influences how people see addicts and how addicts see themselves. Dental interventions can change self-image for the better, and that is important for wellbeing and recovery.
Patricia wrote to me again on Friday. She is pleading for access to a safe and well-supported rehabilitation unit—a caring service that will help her son off his dependency on methadone so that he can have, as she says, a live worth living. Her son is a 6 foot man who weighs just 9 stone. He is crying out for just one right in life: a right to recovery.
We are not seeing anywhere near enough progress to advance the rehabilitation and treatment of addiction in Scotland. Addiction is ruining countless lives. Families are being torn apart and, over the past decade, thousands have died directly from drug-related causes. More than 1,300 people died in 2020 alone. There were five times as many drug-related deaths in 2020 as there were in 2000. Scotland’s drug rate is three and a half times that of the UK as a whole. That is a scandal. It is Scotland’s national shame—no, it is our Parliament’s shame. It is a failure of Government.
I believe that, across the chamber, we agree that the current strategies do not work. The Scottish Conservatives support a public health approach to substance use. We need to have a right to treatment and on-going support to turn lives around. We need to care and encourage people right through their recovery journey. That is why we feel so strongly about our right to addiction recovery bill. The key underlying principle is to ensure that everyone who seeks treatment for drugs or alcohol addiction is able to access the necessary addiction treatment that they require. That would be a clear, binding commitment to families and communities throughout the country. It would be an unambiguous promise enshrined in law.
The consultation on our proposals showed an overwhelmingly positive response, with 77 per cent of people supportive of them. That included organisations with hard experience of working with sufferers of addiction, including Faces & Voices of Recovery, Sisco, the Scottish Tenants Organisation, Recovery Enterprises Scotland and the Church of Scotland. I am pleased that the Minister for Drugs Policy has signalled a move towards Scottish Government support for our proposals, and I hope that we can speedily work together across Parliament to ensure that a right to recovery is put into law as soon as possible.
Of course details are important, but so is delivery. In order to deliver the right to recovery bill, there is an obligation on NHS health boards, the Scottish ministers and others to provide treatment and set up reporting arrangements so that the quality of, and the access to, the treatment provided can be monitored and reported to the Scottish Parliament, because the Scottish Parliament needs to see the data. If we do not measure it, we cannot improve it.
The addiction and recovery treatment services would include community-based short-term and long-term residential rehabilitation, community-based and residential detox, stabilisation services and substitute prescribing services. Individuals could access a preferred treatment option, unless it is deemed to be harmful by a medical professional.
Our right to addiction recovery bill would also prevent individuals from being refused access to treatment because they had a criminal history that involves substance abuse or a mental health assessment or because they were in receipt of substitute prescribing services or were still using alcohol and drugs. If someone wants support, they should get it.
I believe that all of us in the chamber are horrified by the rising toll of addiction-related deaths and by how addiction has spiralled out of control—it is tearing families apart and blighting communities. The problem is huge for Scotland, and it is complex. Tackling it head on requires co-ordinated action to include support for recovery, reducing demand and restricting supply.
It is worth noting that co-ordination among the four nations on tackling drug dealing and organised crime is important. We heard in February that police in Kent raided a manufacturing facility and seized 27 million street benzodiazepine tablets that were bound for Glasgow. Just as we do not want Scotland to be seen as a safe place for criminals to do business in, we need to work with partners across the UK to damage the source of their supplies.
The thrust of my speech is about supporting people who want to kick their addiction. We should strive to ensure that no one falls through the gaps and that no stigma is attached to addiction.
Dr Gulhane, could you please bring your remarks to a close? Thank you.
We need to commit to long-term support, and local areas that have the highest level of need must receive the most support. Our right to addiction recovery bill is the way forward. I refer members to my registered interest as a practising NHS general practitioner.
16:31
I welcome the opportunity to speak in the debate. As a member of the Criminal Justice Committee, I welcome the commitment to a public health approach, as it is clear that the criminal justice-led approach has not worked. It has not prevented the rise of problematic drug use or turned round the lives of those with drug abuse problems.
I think that we all know that drug abuse is a major problem in many of our communities. It is a major problem for our criminal justice system, and it has become a massive problem in our prisons, where drugs are readily available and where many prisoners take drugs for the first time. Many offences are committed while individuals are under the influence of drugs, and many offences are associated with serious drug abuse.
There were 1,339 drug-related deaths in 2020. As a number of members have said, there is no doubt that there is a direct link to poverty, trauma and deprivation.
Scotland has a problem with high-risk patterns of drug use, and we need to look at how that compares with elsewhere. The number of drug-related deaths has been increasing since 1996 and has increased substantially in the past 20 years, when the average age for a drug-related death has increased from 32 to 43. People who live in the most deprived areas are 18 times more likely to have a drug-related death than those who live in the least deprived areas, although the likelihood has been only 10 times greater in the 2020s. We also know that more than one drug is present in a person’s body in 93 per cent of deaths.
We need to be aware of all those factors when we look at how we tackle the problem. More than 10,000 people have lost their lives to drugs since 2007. The crisis is complex, and we need bold action to reduce drug-related harms. We need a holistic approach that is grounded in public health. We also need to recognise the problem of those who are living with addiction being exploited by criminal gangs. The drugs trade has links with organised crime.
The cuts to council services and to alcohol and drug services, which Claire Baker spoke about, and the underfunding of public services more generally are an important factor. Levels of inequality are rising, and the gap between rich and poor in our society is growing.
Last year, the Scottish Ambulance Service attended 2,500 incidents in which street benzos were involved. More than 1,000 of those were overdose incidents. As has been said, we know that the problems are becoming greater for women, in particular, which is an aspect that we need to consider very seriously.
We know that there are no silver bullets, but there is strong evidence that drug consumption rooms and safer drug consumption facilities are effective. They are not a new idea—the idea has been around for many decades—but there has been disagreement over many years as to whether the practice is compliant with the misuse of drugs legislation.
Earlier in the parliamentary session, the Criminal Justice Committee heard evidence from the Lord Advocate that she believed that there might be a possible legal route, or a public interest ground, for providing drug consumption rooms in the public sector. She indicated that she would consider a new proposal on public interest grounds provided that it was
“precise, detailed and specific, underpinned by evidence and supported by those who would be responsible for policing such a facility”—[Official Report, Criminal Justice Committee, 3 November 2021; c 20.]
The Scottish Affairs Select Committee highlighted in its evidence work by the Advisory Council on the Misuse of Drugs that said that no overdose deaths had occurred in such facilities as at 2016. I hope that the Scottish Government is considering what can be done to address the specific issues that the Lord Advocate raised in relation to drug consumption rooms, which Paul Sweeney seeks to introduce in his proposed drug death prevention bill, to ensure that we can consider how to provide a legal framework in the public sector for drug consumption rooms. That is only one small part of a complex and challenging issue for the Government and all of us, but I hope that it is one aspect on which we can quickly see movement from the Scottish Government.
16:37
I remind members that I am a board member of the addiction recovery service Moving On (Inverclyde).
This joint debate by three committees of the Parliament provides an example of the type of joined-up working that is required. I agree with Elena Whitham that every committee in the Parliament has a role to play.
The debate is of particular importance to me due to the sobering figures that I read when the drug death figures are published each year. Inverclyde is normally one of the areas with the highest numbers of drug-related deaths per head of population. In 2020, 33 constituents—28 men and five women—died. Of those people, 63 per cent were in the 35 to 54 age category. That is my age group.
Last night, I was reminded of how my age group can be caught up in drugs misuse. After a meeting that I attended, I was informed of a school friend who, sadly, has been involved with heroin for some time. Growing up in Port Glasgow with declining traditional employment opportunities will certainly be part of the reason why some people become involved in drugs. I have spoken about that in the chamber previously. That is where deprivation, which was touched on by earlier speakers and in Michael Marra’s intervention on Elena Whitham, is relevant.
The report that has been published today by the University of Glasgow and the Glasgow Centre for Population Health suggests that people are dying younger as a result of UK Government austerity. That certainly will not help the situation that we face as a society. The report states:
“there is evidence of the effects of UK Government ‘austerity’ measures ... Their impact is seen as two-fold: reducing levels of important services such as addictions, housing, mental health, welfare rights etc.; and cutting individual incomes by reductions in social security payments, leading to further drug use as a ‘coping mechanism’.”
There are many areas of society that we all can and must do more to improve, but we cannot do anything once someone has passed. They leave behind parents, children and friends who have to live with that loss forever.
We must and can do more. That is why I welcomed the First Minister’s announcement in January 2021 of a new national mission to reduce drug-related deaths and harms. I also welcome the fact that that will be supported by an additional £250 million of funding over this parliamentary session, which will go towards improving and increasing services for people who are affected by drug addiction. The aim of the national mission is
“to save and improve lives through”,
for example,
“fast and appropriate access to treatment and support through all services”
and
“improved frontline drugs services (including third sector)”,
which is an issue that I and others have touched on in the chamber before.
Last week, I met the head of the Inverclyde alcohol and drug recovery service. In recent years, the local ADRS has changed its strategy by bringing together the alcohol team and the drug team—previously, they had operated independently. In March 2020, a paper to the Inverclyde integration joint board highlighted:
“The review of alcohol and drug service provision within Inverclyde is nearing completion with an aim to develop a cohesive and fully integrated whole system approach for services users affected by alcohol and drug issues ... Inverclyde historically has not had a well-developed recovery community, therefore developing more robust recovery opportunities has been identified as an area of required focus and attention. Work has commenced with a Recovery Strategy being developed”.
I welcome those local changes. I am aware that a more cohesive partnership approach is being taken that just has not happened before.
All parties across the chamber will agree that we need to listen more to the needs and experiences of those who have lived with an addiction and to their families and friends. Too often, those with an addiction also suffer from mental health issues, which can cause issues with housing and finances and put pressure on family dynamics. That can then lead to the person’s life being difficult to manage, and they fall away from treatment services.
The Scottish Government has highlighted the need to address high “did not attend” rates, as we know that a high proportion of people who have died from drug-related causes never had contact with a drug treatment service. To help to achieve that aim, the Scottish Government is providing £3 million a year to local services through alcohol and drug partnerships to increase outreach to people who need support.
The Scottish Government is also increasing the capacity of statutory funded residential rehabilitation placements by 300 per cent by the end of 2026, when at least 1,000 people’s placements will be publicly funded.
Safe drug consumption rooms and naloxone have been spoken about. I welcome the naloxone roll-out programme—I bought into that at the very outset—but it has taken me longer to accept the need to establish safe drug consumption rooms. The marketing campaign to raise awareness of naloxone and the signs of overdose will, I am sure, prove to be very beneficial in the long term. As I said, the need for safe consumption rooms took me a lot longer to accept. However, it is a fact that they work and that they save lives. If all parties want to save lives, every single thing must be on the table for consideration.
I thank the minister and the Scottish Government for investing £400,000 in the Jericho Society in my constituency. The society runs two residential units in Greenock, one of which is for men while the other is for women. It also received £78,000 from the Government last year, which allowed the society to increase staff hours in the women’s house by 50 hours.
One size does not fit all. I genuinely believe that debating the issue and getting all parties in the Parliament to agree on the actions to be taken across society is the only way in which we can make the needed changes and save lives.
We now move to closing speeches. I call Pauline McNeill, who has up to six minutes.
16:43
It is important that the Scottish Government as a whole acknowledges that it has failed to tackle Scotland’s outrageous and tragic level of drug deaths, so that we can assess our approach to this scandalous state of affairs, which has dire human consequences, as Stuart McMillan just outlined in his useful and important contribution.
However, as Michael Marra and others said, we still have no answer as to why Scotland in particular has such high figures—as Claire Baker said, they are the worst in Europe. She also said that we are not alone in facing this challenge, but it is important that we keep on trying to get an answer to that question; otherwise we will not be sure that we are heading in the right direction.
As Claire Baker said, the Government is already being slow in meeting its commitments on MAT standards. It is therefore all the more important that Opposition parties work with it, as we have all committed to do, but also push it to deliver on what it has promised, especially in relation to treatment programmes and MAT standards.
I do not envy Angela Constance in her ministerial job, and she has my full support in her endeavours. I welcome the commitment that she has made to increase the number of drug treatment facilities by 300 per cent by the end of the parliamentary session, but I must interrogate that commitment. It will be meaningless unless reports can tell us what that looks like in a year, in two years and in the year after that. We need to see what progress we will make in the preceding years.
There have been some excellent contributions. Gillian Martin was the first of many members to point out the link between drug deaths and deprivation. That is even more worrying, given that, unfortunately, the worst cost of living crisis in living memory is likely to create more deprivation and will make the Government’s job even harder.
Although drug misuse is now, I hope, recognised primarily as a public health issue rather than a criminal justice issue, as Katy Clark said, we need to go a lot further in reducing the stigma of addiction, as Emma Harper outlined. Fundamentally, drug addicts are people in mental and physical pain. Usually, some sort of past tragedy develops into trauma, and drugs are used to numb some of the difficulties that manifest in daily life. I pay tribute to the courage of Collette Stevenson, who talked about her family’s experience and her brother. That must have been hard to talk about, so I commend her for doing so. Darren McGarvey, whose series on Scotland’s problems with addiction recently aired on the BBC, said that alcoholics and drug addicts “need our love”. I believe that to be true.
However, if the Government wants our constructive support, it needs to focus on what we can do now. We have two separate proposals—one from Douglas Ross and one from Paul Sweeney—which exist because of the vacuum in Government policy on preventing drug deaths. Both proposals are worthy of consideration, and I will say more on that later.
As we have heard, there were nearly five times as many drug deaths in Scotland in 2020 as there were in 2000. We should probably reflect on how outrageous that statistic is. That is why we ask those with power and influence, such as the Lord Advocate, to consider what can be done within the law to change that situation.
Portugal is often highlighted as a success story. Drug rates there were similar to the European Union average, but, in 2001, it changed its policy to a health-led approach. Since then, the drug-related death rate has remained below the EU average. There is no reason why Scotland cannot turn things around in a similar way, but we need to ask whether we are on track to do that. As Claire Baker said in her opening speech, we cannot allow the Government to backtrack on the swift implementation of medically assisted treatment standards, because, until they are implemented, lives will unnecessarily be lost.
I will talk a little bit about drug consumption rooms and naloxone, as other members have done. As we have said on many occasions, the well-known Peter Krykant ran a drug consumption facility in a minibus for more than a year. Over 10 months, the facility supervised more than 800 injections. David Liddell from the Scottish Drugs Forum said:
“there was no public interest in prosecuting him for the drug consumption room that he ran, and no prosecution followed. It is a ridiculous state of affairs that he can run such a service and not be prosecuted, but NHS Greater Glasgow and Clyde cannot run one, although it wants to.”—[Official Report, Criminal Justice Committee, 27 October 2021; c 31.]
I do not think that there is a lot of disagreement on the issue, but we need to sort out public policy on it very soon, because it seems to be a bit of a mess.
As I have argued many times in the chamber, drug consumption rooms are one small part of what needs to be done, but it is important to make the point that they are a gateway to treatment for those who are seeking it, and the minister has committed to expanding treatment services. Drug consumption rooms exist in countries such as Australia, Canada, Switzerland and the Netherlands. The introduction of such facilities would clearly be a radical step to take, but it is important to acknowledge that there have been no deaths when consumption rooms have been used.
That is also acknowledged by the Royal College of Physicians of Edinburgh, which recommends safe drug consumption facilities as well as rolling out heroin-assisted treatment programmes in all major centres in Scotland. The college says that safe drug consumption facilities can prevent drug-related overdoses. That is only one way, but it is important to sort it out.
I await with real interest the report that the minister said will be published in June. I hope that, in that report, there will be signs that we are on the right track but, if we are not, it is important that ministers come to the chamber humbly and tell us that. If we are all serious about tackling the issue, we will acknowledge the situation and then put our heads together and work together to change the situation. We must do that, because far too many lives are at stake.
16:50
I echo the sombre comments that others have made and pass on our condolences to anyone watching the debate who has been affected by not just drug-related deaths but the presence of drugs in their lives or the lives of their families. I commend Collette Stevenson for sharing her deeply personal and moving experience and what that meant to her. We often forget that we are in a position of great privilege and can use our platforms in public life to share our personal experiences. As someone who has tried to do that, I know that it is not easy.
I would prefer it if future debates on the subject leaned more, in tone and content, towards talking about some of the progress that we are making and not the year-on-year rise in drug deaths that has often been the topic of such debates. Having listened carefully to the debate, I share Mr Marra’s concern that the collegiate tone and constructive consensus that existed in the early days of our consideration of the topic have been replaced by a merry-go-round of blame, political or otherwise. That is deeply unfortunate.
The statistics are grim, and the truth is that we are the drug deaths capital of Europe. The point that many have made repeatedly today, and that I tried to make earlier, is that the rate of drug deaths in Scotland is much higher than that in the rest of the UK, where there is a very similar legislative environment dealing with drugs—arguably, it is more relaxed in Scotland than in other parts of the UK. Equally, there are huge pockets of deprivation across England, especially in the midlands and the north, where there have been major drug problems, and that is widely accepted by the Government south of the border. However, the drug death rate there is markedly lower, and that has never been properly and academically identified and discussed without a conversation where people say, “It’s your fault”, “It’s her fault”, “It’s their fault” and, “It’s that minister’s fault, not my minister’s fault.” We could and should have a conversation about that issue.
Back in the mid-2000s, when I did a lot of work with people experiencing drug use, I would traipse round lots of GP practices trying to get prescriptions for benzodiazepines for those people, but general practice had wholesale stopped prescribing those, due to the fact that they were being sold on the open market. Does the member agree that that is one key area where we perhaps saw a shift in the way that Scotland dealt with drugs and drug deaths?
That is one of many factors. I do not disagree that the supply of cheap street drugs is a major problem. Members would not need to go far from this building to speak to people about how cheap and easy it is to source illicit factory-made pills that replace those that hitherto were prescribed. We are not clinicians—well, some of us are—and those are complex issues that need to be discussed.
I realise that there are a wide range of factors, many of which have been mentioned. Members have talked about social deprivation in the 1980s in areas such as the one where I grew up. I accept that those are fundamental root causes going back a generation, but that was 40 or 45 years ago. I am saying that we now have a powerful devolved Parliament and Government that could have made different choices in the past decade.
We cannot talk about the use of drugs without also addressing the important issue of supply, which has been missing from the debate so far. Drugs do not magic themselves on to the streets of Scotland; they are put there through a complex network of production, supply and distribution that starts with the dealers who are right at the top. Right now in Scotland, factories are making little blue pills that are sold for 50p a pop. People are overdosing on those and mixing them with other drugs, which is a fundamental reason for so many of them suffering fatal outcomes.
Of course, we know that complex cross-border issues exist, such as county lines, trafficking, slavery, and money laundering. What Scotland really needs is for both its Governments to work together on solutions to such intra-UK and international crime issues. That is not helped by the tone of the debate as I have heard it thus far.
I could talk about diversion from prosecution, or the legality or otherwise of safe consumption rooms, but Scottish Conservatives’ views on those matters are well rehearsed and do not need to be played out again here. However, one fundamental aspect that we heard about in the debate is a game changer: the spending review that the finance secretary announced in the moments before the debate started. I am afraid to say that the justice portfolio came out badly in that. That includes spending on our prisons, rehabilitation services and community justice services that help to get people back on the straight and narrow. Spending on our courts and police core funding have also received a real-terms cut over the next five years. We could argue about why and how that has happened, but we must be honest with ourselves and ask the minister whether such cuts to front-line services will deliver the outcomes that she wants. I ask her whether the £50 million per year over this parliamentary session will be ring fenced and will not suffer the same budget cuts as those that have been announced for other portfolios.
I will finish by pleading with the Government. Rather than reflecting the unfortunate tone that I think was used in the debate, and taking issue with other Governments and powers that do not sit with us, I say this: all the front-line services to which people desperately need access will not exist or function properly if they are not properly funded and resourced. Before ministers lament the lack of powers that they claim they need if they are to fix the drug deaths problem, they must be able to demonstrate to Parliament—and to the wider public—that they are willing and able to use the ones that they already have, and use them to the fullest.
I call Angela Constance. You have up to seven minutes, minister.
16:57
I thank all speakers in the debate, but particularly Collette Stevenson for her very personal contribution. That was a great leveller for all members, across the parties. It reminded us that, at times, we just need to buckle down and focus on what matters most, which is saving lives.
Most contributors also recognised that we can only make the necessary impact by tackling problem substance use wherever it presents, be that in our communities, our institutions or our health and social care system. We must ensure that all our services—from primary care to housing and justice—are pulling in the right direction. That is why the national mission is so important in terms of both tone and our actions. It is about how we, as a country, move forward together, despite our differences, to address problem drug use by taking a public health approach that not only saves lives but, crucially, aims to improve life chances.
I do not shy away from the fact that, on coming into my current post, my first priority was to get investment out of the door and on to the front line. I am proud that the national mission has secured a 67 per cent increase in available resources. I hope that members will welcome and recognise the fact that 97 front-line and third sector organisations are now being directly funded by the Government via the Corra Foundation. Not long ago, we also announced that, over the next five years, 77 projects will benefit from £25 million of funding that came from the children and families fund.
Last week, I laid out in a statement—I appreciate that some members were underwhelmed by it; I know that I can bore for Britain on good governance—that accountability, governance and regular reporting at local and national level are crucial. That is why I laid out in the statement the work that we will do on local outcomes frameworks, the national mission annual report and the formulation of a plan—with which we are already proceeding—on prevention, emergency response, treatment, recovery and improving lives. I can assure members that we are gathering and publishing more information than ever before in the interests of transparency and accountability.
I have consistently said that I will give fair wind to the Conservatives’ right to treatment proposition. I have no reason to do otherwise, and the same goes for Paul Sweeney’s proposition on safe drug consumption rooms.
Katy Clark made some important points. She took us right back to the commentary of the Lord Advocate to the Criminal Justice Committee at the end of last year, when the Lord Advocate spoke about the limits that are placed on us by the law across the UK and raised the question of what is in the public interest when it comes to prosecution. I reassure Katy Clark and Pauline McNeill—it is a matter of public record that I have repeatedly said this—that the guts of the work are delicate and detailed; this is about meeting the need to be precise, detailed and specific in our proposition. The evidence around safe drug consumption facilities is compelling, and they are a gateway to other treatments.
With the greatest respect to any individual who comes forward with a proposition, I have never ruled out the need to legislate further. That is why we are moving forward with the national care service and a human rights bill. I and other members know that statements of high principles and propositions for future legislation do not necessarily equate to immediate action. That is why our focus has been on scaling up practical and financial support to implement, embed, sustain and improve the MAT standards, with the financial support increasing from £6 million to £10 million a year. We will return to the issue in just a few weeks because—again, in the interests of transparency and accountability—we will publish a report with 145 indicators across 29 localities.
Although I will not repeat them all now, we have made substantial announcements about our work on residential rehabilitation, which is part of our commitment to women and families and of keeping the Promise.
Members will recall the work that we have done on a treatment target. At the very core of the national mission is the need to get more of our people into the treatment and recovery services that are right for them. I have always said that the fact that we do not have enough people in treatment and recovery is on us.
It is a point of disgrace that, in Scotland at the moment, someone’s ability to get residential rehabilitation is based on their ability to pay. That is an unfortunate fact. The beds are not going to magic themselves into existence overnight. What can the Government do in the short to medium term to improve access to much-needed rehabilitation for the people who need it most?
I appreciate that Jamie Greene probably follows justice matters more carefully than issues in my portfolio. The decisions that I have made will result in 85 additional beds and will increase capacity by 20 per cent. The reason why we are doing all this monitoring and reporting is to follow the money. We are investing more than ever before in residential rehab, and I am following that money very closely, hence my statement to the Parliament last week.
I want to cover the issue of benzodiazepines. The Government brought together the expert group in February this year—Michael Marra is right. One of that group’s recommendations was that the development of the pilot benzo clinic that has been set up in Fife and is funded by £274,000 per year from the national mission should be monitored. I say to Emma Harper that the expert group also thought that it was too early to move to the use of flumazenil, because it is associated with seizures. If she would like to know more about that, she should not hesitate to come and speak to me.
My final point is about drug law reform. I have never demurred from the importance of investment in and reform of services and the need to utilise every aspect of the powers and resources that we have at our disposal. It is important that we do not seek to take the easy road. We must pursue what works. I have always engaged with the UK Government on the basis of evidence. We need a better conversation and debate, not only between ourselves but with communities of interest and place, about what will improve the safety and wellbeing of individuals and communities. That is about—
Please bring your marks to a close, minister.
We must, as a matter of priority, reduce demand and improve access to treatment.
I call Paul O’Kane to wind up on behalf of the Health, Social Care and Sport Committee.
17:06
I am pleased to have the opportunity to close this important debate on behalf of the three committees, Health, Social Care and Sport, Criminal Justice, and Social Justice and Social Security. The committees have, as we have heard, undertaken joint scrutiny work on the issue of tackling drugs deaths and drug harm.
I begin, as colleagues have, on behalf of the committee by offering our condolences to anyone who has lost a loved one to drugs. I thank everyone from all sides of the chamber who has contributed to the debate, bringing their experience and ideas. I particularly thank our committee conveners who opened the debate, the minister and the party spokespeople, and I echo everyone’s compliments to Collette Stevenson for her powerful and personal speech.
The debate and the joint work that preceded it have been important.
There is a wee bit too much noise in the chamber and we all want to hear Mr O’Kane winding up on behalf of the committee.
The debate and the joint work that preceded it have been important and broadly positive and are a strong example of cross-committee collaboration in Parliament. That work also reflects the cross-sectoral nature of the significant challenges that we face in tackling drugs deaths and drug harm and the variety of actions needed to address them. We have heard some of the ideas and thinking about those issues today. We heard from Russell Findlay and Sue Webber about the challenges in rehab services, the limitations of the Misuse of Drugs Act were outlined by Gillian Mackay, and Stuart McMillan outlined the need for long-term support in everyday life.
The evidence that we took as a joint committee from the UK Minister for Crime and Policing, Kit Malthouse, and from Angela Constance as the Scottish Government minister with responsibility for drugs policy, showed that many complex responses and interventions are required and that those will be found at many different levels of Government.
From the perspective of the Health, Social Care and Support Committee, today’s debate has been particularly useful in shining a light on the public health aspects of drugs policy, a number of which the committee will undoubtedly want to explore further as part of its future work programme. Those include the issues of stigma, as raised by Emma Harper, and of safe drug consumption facilities, as raised by many speakers from across the chamber. There will no doubt be other aspects that colleagues in the Criminal Justice Committee and the Social Justice and Social Security Committee will want to take forward.
I hope that the committees can continue collaborating effectively as we progress with our important scrutiny work. It is clear that scrutiny and ensuring Government delivery will be important, particularly on issues such as the MAT. We must ensure that we scrutinise the members’ bills in the names of Douglas Ross and Paul Sweeney that we have heard mentioned today.
Some contributors mentioned the tone of the debate. Gillian Martin spoke about the need to ensure that our tone is respectful, as did Michael Marra and Jamie Greene.
We must continue to focus on finding common ground on the issue, because there is a common view across the Parliament that this is a national emergency that warrants an urgent and concerted response. What we have seen demonstrated today is that there is perhaps less of a consensus on what the solutions might be and how we should move forward.
In the joint committee, I had an exchange with Kit Malthouse in which I asked whether he acknowledged that poverty is an underlying cause of the drug deaths crisis and he responded by saying:
“I do not. I think that it is the other way around”.—[Official Report, Criminal Justice Committee, Health, Social Care and Sport Committee, and Social Justice and Social Security Committee (Joint Meeting), 1 February 2022; c 14.]
He said that violence drives poverty rather than it being the other way round. However, there are contrary views. Some of the written evidence that we received in committee from alcohol and drug partnerships across Scotland specifically highlighted poverty and deprivation as being important contributing factors to drug harms. That evidence points to a significant overlap between our most deprived communities and an increased prevalence of drug harms and deaths.
However, it is also clear that we must drill down further to understand the particular challenges in our Scottish context and why our drug deaths are higher than those of other parts of the UK. I think that there continues to be broad agreement in this Parliament that Scotland’s drug deaths crisis is first and foremost a public health crisis and that our policy response needs to treat it as such, but we must acknowledge the relationship between health and justice, which has all too often jarred over many years.
Ultimately, if we are going to find impactful solutions, we need to follow the evidence, and it is important that we do that without prejudice or preconception. This afternoon, we have heard multiple examples of collaborative work throughout Scotland, the impacts that it is having in tackling drug harms and the further measurable impacts that it could offer for workable solutions that will reduce drug deaths.
In winding up the debate, I will highlight another example. In its written submission in response to our call for evidence, East Renfrewshire alcohol and drug partnership told us about Turning Point Scotland’s successful bid to deliver the WAND initiative in greater Glasgow and Clyde, including East Renfrewshire. The WAND initiative delivers four key harm reduction interventions on an outreach basis, focusing on wound care, the assessment of injecting risk, the provision of naloxone and dry blood spot testing for blood-borne viruses. We heard a lot about many of those interventions across the country in the debate today.
The WAND initiative is one of many innovative approaches that the committee has heard about in written evidence. It is an example of efforts to deliver consistent harm reduction interventions in communities across the west of Scotland. As legislators, we have a responsibility to evaluate and learn from those approaches and to try to replicate what works. That is why it is so important that, in this afternoon’s debate, we heard strong calls for evidence-based decision making, reporting to this Parliament and continued scrutiny and analysis of what is being done in this national mission.
We also heard in written evidence and all our discussions on the subject that early intervention is an important element of an effective policy response. We need to be mindful that an early intervention approach takes time to be embedded and to start delivering results, but it is no less important for that.
On behalf of the committees, I note the minister’s continued willingness to engage with us and be subject to on-going scrutiny in the committees and in Parliament, not only in relation to the work of the Drug Deaths Taskforce and its implementation but with respect to the new national collaborative. As a committee, we look forward to continued engagement and scrutiny of the decisions that the minister takes.
I believe that, across the Parliament, we all share a common goal, which is to achieve a sustainable long-term reduction in drug deaths and harms in Scotland and, ultimately, to eliminate the blight that drugs currently inflict on so many lives. I hope that, over the coming months, we will continue to do that in a collective dialogue, maintaining a laser focus on scrutinising progress. It is through effective collaboration across committees and parties, and by taking an evidence-based approach, that we will have the best chance of delivering on the national mission to reduce and ultimately eradicate drug deaths and harms in Scotland.
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