Chamber and committees

Like you, Mr Ewing, I am not a clinician. You have, however, heard the evidence from Dr Carole Hunter, who is a senior pharmacist of many years’ standing.

This is one of the issues that I have written to NHS Grampian about. On the specific point about dihydrocodeine, while prescribers can make judgments on a case-by-case basis, based on clinical judgment and health and safety, the bottom line—as I understand it as a non-clinical person—in accordance with the United Kingdom guidance that Dr Hunter referred to and the guidelines for Police Scotland and healthcare professionals, is that the routine use of alternatives such as dihydrocodeine does not meet the required level of support for MAT standards, and they should only be used in exceptional circumstance, not routinely. That is what I have stated in my correspondence with NHS Grampian. Essentially, it is a reiteration of the guidance.

For information on the broader context of my correspondence with NHS Grampian, convener, I have written in fairly direct terms to say that it has come to my attention and I am aware that, despite the longstanding nature of the issue, it still does not routinely provide OST in all circumstances. The issue is around the routine nature of the provision. Yes, Dr Hunter spoke about exceptional circumstances but the health board should be in a position to provide OST routinely and it should not be disrupting people’s medication. I have therefore asked NHS Grampian if that is the case, and if it is, what is it going to do to remedy it, and when? I would be happy to share that letter and any response I receive in due course with the committee, if it would be helpful.

Good progress has been made in increasing the distribution of take-home naloxone kits. Quarterly figures were published on either Monday or Tuesday that approximately 6,500 take-home naloxone kits have been distributed. Members can refer to those published figures at their leisure but they give a breakdown of the settings from which they come, including prisons, community pharmacies and the Scottish Ambulance Service.

There are 13 alcohol and drug partnerships that have a prison within their catchment area, and 85 per cent of those have made specific arrangements with their community justice partners around identifying risks, part of which is the issuing of naloxone. In some cases, good use is also being made of peers, peer networks and people with lived experience who are now in recovery going into prison settings and supporting people with training on the take-home naloxone kit.

There is another statistic that we monitor. I hate talking about statistics in this fashion, convener, because, at the end of the day, we are talking about lives, but the reach of Scotland’s national naloxone programme continues to increase, and it is estimated that 66 people out of every 100 who are at risk of opioid overdose have been provided with a take-home naloxone kit.

Naloxone is very important but it is just one part of the solution, which is a whole system of care, treatment and support. I believe that we are making progress but we need to continue on our trajectory.

On the broad point, health boards and IJBs should monitor that. Through their routine reporting structures, they can and do raise workforce issues with the Government and NHS Scotland.

On the work that I and my drug policy officials are pursuing on the implementation of MAT standards, a financial resource is attached to that implementation. When I spoke to the committee before the summer recess, I said that approximately 100 posts were going to be funded. That figure has increased. To be specific and more helpful, I know that Moray, where Elgin custody centre is, has been successful in recruiting staff to work in and around MAT standards. Similarly, NHS Aberdeenshire has sought a number of staff and has largely been successful with that.

I am not disputing that there are issues with the workforce but there are examples of where those have been overcome, either through additional resource to help with recruitment or through the redesign of services.

There are two points there, Mr Torrance. One is a more global point about the implementation of MAT standards. They are vital and they are a big part of the Government’s reform programme. They are about ensuring that people have quick access to and informed choice about their evidence-based treatment, and that services are planned and operate in a way that they anticipate people’s needs. All of that is connected to mental health and primary care, and the MAT standards are therefore crucial and not optional. Members will be aware of the statement that I made to Parliament earlier this year, and I will make a further statement next week.

On the specific issue of the prescription of medicine or opiate substitution therapy in police custody settings, MAT standard 3 requires people’s treatment to be provided to them irrespective of their setting. OST needs to be routinely available to those for whom it is prescribed in custodial settings if MAT standard 3 is to be met. All health boards, alcohol and drug partnerships and integration joint boards have accepted the importance of that and our shared agenda for implementation of MAT standards.

We have been engaging on the issues raised by the petitioner in committee with various police and healthcare networks, such as the Police Care Network and, to the best of my knowledge, the only place where there appeared to be an issue was in Elgin. However, I want to be clear—and the guidance and MAT standards are clear—about what should happen.

In my view, as Minister for Drugs Policy, any interruption of a person’s medical treatment is utterly unacceptable because of the consequences that the committee is well aware of. The interruption of someone’s medical treatment is discriminatory and not acceptable. Ultimately, the implementation of MAT standards will resolve the issue where it exists, and as I said, the issue appears to be specific to Elgin.

I hope to convey to the committee in the strongest terms that the practice, where it exists, is discriminatory and that we treat drug and alcohol problems as a health condition, so drug and alcohol treatment has to be on a par with any other treatment for any other condition.

I appreciate the committee digging into the issue. Because drugs policy can rarely be considered in isolation, the debates in the chamber or during other committee appearances that I have been obliged to make have often been very wide-ranging. It has therefore been useful for me to take a specific issue in a specific locality and bore down into the detail. Thank you for that.

Thank you.

You will indeed.

That is a fair point. I will not sugar-coat instances in which progress has not been good enough or fast enough. You are right to allude to the fact that, although the majority of the red-amber-green statuses in the benchmarking report by Public Health Scotland were amber, there were not enough greens and there were too many reds, particularly in and around MAT standard 1, which is that crucial, life-saving, same-day treatment. That is why, for the very first time, we have a ministerial direction that places certain requirements on chief officers and chief executives of health boards, integration joint boards and local authorities.

I am due to update the Parliament imminently—maybe in the next fortnight or so; certainly in the next month—on progress since my last update. That is based on the improvement plans that we have received from every area. Some areas are in a cycle of quarterly reporting. Others, where the challenge is greater, are subject to monthly reporting.

We are beginning to see some good and innovative practice in and around rural areas, and perhaps we should share some case studies with the joint committee. I point to the Borders, which is a rural area and is the only area that was able to secure green status across MAT standards 1 to 5. If we can do it in the Borders, we can do it elsewhere. Let us not underestimate the challenge, but that can and should be done.

I distil that into three important factors. It is complex, and we have deep-rooted challenges in Scotland. The task force and various other academics have written extensively about the acute poverty in particular areas of the country. We all know the research on the relationship between substance use, past trauma and poverty.

You asked specifically why there is an issue in Scotland. First, according to the information that we are able to gather, there is a higher prevalence of problematic drug use in Scotland. There is an existential question as to why that is.

The second point is the prevalence of heroin and benzodiazepines in drug-related deaths. It is not always possible to make direct comparisons, because England is a bit different when it comes to the underlying work on drug misuse deaths and the proportion of cases that go through toxicology and forensic screening. However, benzodiazepines are much more greatly implicated in our deaths than is the case in England and Wales—although I have noticed that some reporting and recording have begun to indicate a rise in benzodiazepine problems south of the border. The higher implication of opioids and heroin in our drug deaths speaks to higher-risk behaviours, more injecting and the lethal combinations of polydrug misuse and people with multiple and complex needs.

Thirdly, it is about treatment. Time and again, I have been utterly frank that not enough of our people are under the protection of treatment. We need to get more people into treatment—and, if they fall out of treatment, we need to follow up on that. That speaks to the importance of the MAT standards, and not just investing in services but reforming them. I have opinions on other aspects—for example, the Misuse of Drugs Act 1971. However, a core part of the national mission is about the need to invest in and reform our treatment services, which we are doing. Crucially, however, that must not be done in isolation from the other cross-Government work that is so important.

Thank you very much, convener, and good morning to all your colleagues. I very much appreciate the opportunity to come back to this tripartite committee as we embark on the national mission, particularly in our work to respond to the vital final recommendations of the Drug Deaths Taskforce, which are essentially about ensuring that all aspects of the public sector and all parts of Government are aligned. Although it is not for me to tell the committees how to proceed with their scrutiny of Government, it appears to be a fitting approach for scrutiny to be joined up, too.

You raise two crucially important aspects of our drug death challenge. When we look at the annual report that was published in the summer, we see that, although more men die, and significantly so, there has been a disproportionate increase in the number of women who are dying, and that has been a trend for some years. The annual report shows a small decrease in the number of men who are dying, but a continued increase in the number of women we are losing.

We know that the issue is complex. It relates to trauma, including past life trauma, but it also relates to women who are mothers. If we think that people who use drugs are stigmatised, that is even greater for women, in my view, and particularly women who are mothers. We know that the removal of children has a huge, traumatic impact and is a contributory factor to deaths.

We are working through the recommendations of the Drug Deaths Taskforce, and we will be supporting alcohol and drug partnerships to do likewise and, indeed, to develop pathways. You may have noticed that, earlier this week, we published the first annual report on the national mission and the alcohol and drug partnerships. We need to make more progress with some specific care pathways for women. Some of our investment in residential rehabilitation and residential services has been prioritised to meet that need.

On young people, the annual report that was published in the summer shows that, although the number of young people under 25 who had died reduced in 2021, it remains too high. It is important not to look at one year’s figures in isolation; we know that the three preceding years showed concerning increases. As you will see in the annual report, although alcohol and drug partnerships all have services and supports available for young people, we need to do much more to be clear about the types and range of services that should be available in each area. That, in part, is why we have a stream of work specifically on young people, which relates to the co-design of standards of care and treatment and to the range of services. That work is proceeding, and I will endeavour to keep the committee and Parliament up to date on it.