Chamber and committees

Absolutely. International evidence is crucial, because many other countries around the world have a far higher drug deaths rate than that in Scotland, and we should be looking at the very best practice not only in Scotland and across the UK but internationally. We have a lot to learn, and I make no bones about that.

I am sure that Mr Findlay will have discussed in detail with the justice secretary things such as Rapiscan scanners. The safety and wellbeing of prison staff and prisoners is of the utmost importance.

It is reflective of what we know about the wider community that we cannot arrest our way out of a drug deaths crisis. It has to be about addressing the root causes of people’s substance use and the bigger and broader agenda of homelessness and poverty. It is also about ensuring that people have access to the treatment that is right for them. Access to treatment and support in prison is crucial when it comes to healthcare. An important survey of prisoners’ health and social care needs will be completed by the spring, if I recall correctly.

Really important work is being led by the recovery community in our prisons. I have visited a number of recovery cafes. We must be focused on addressing the needs of individuals.

There are also broader issues about overcrowding in prison. I think that most commentators would be of the view that our prison population is too large.

Yes, I am. Sorry, Ms Mackay, but I do not think that I caught all of your question, but I am sure that it is about safer drug consumption rooms and the evidence that Mr Malthouse gave to the committee yesterday.

It is a matter of public record that work is being done on a pilot for a safer drug consumption facility in Glasgow. A proposition for that pilot has been made by the health and social care partnership in Glasgow. Very extensive work is being done between the Crown Office, the police, us—the drugs policy division—and our local partners in Glasgow.

Mr Malthouse and I come from different positions on this. I am strongly of the view that there is no disputing the evidence that safer drug consumption facilities can save lives. I refer members to the evidence paper that the Government produced not long ago and that I am sure that we shared with the Criminal Justice Committee at the time. I have also shared an exchange of correspondence between Mr Malthouse and me. He sees more problems than I see. There are undoubtedly issues that need to be resolved, and that is what we are actively engaged in doing.

There are three avenues to pursue with regard to drug consumption facilities. The UK Government could introduce primary legislation, perhaps in the way that Ireland did a number of years ago. It could devolve powers to Scotland and enable us to introduce legislation. The third option is for us to pursue what we can within our powers to bring forward a proposition that is clinically and legally safe for those who use and work in the service.

It is delicate and detailed work, and it has its difficulties, but it is progressing. We are absolutely committed to doing everything that we can, where possible within our powers, to implement evidence-based interventions that save lives.

There are three aspects to that. I will deal with the devolved aspect first; there is also a reserved aspect.

The point about the recommendation on single records needing to be addressed is well made. I have met Community Pharmacy Scotland and the Royal Pharmaceutical Society, and they rightly point out that, with better linkage of records, they could do more. My officials have raised that issue with the chief pharmacist and the health division. I absolutely accept the point. The pharmacists are absolutely correct to raise it, and I want a resolution to be found, because I think that pharmacy services can bring much more to the table.

That links to the issue of naloxone being registered as a controlled drug, on which our engagement with the UK Government is important. If naloxone was classified differently, different options would be available. It could be provided as part of a pharmacy service. People can have an individual consultation with a pharmacist about a range of medications; they could do that in relation to naloxone and kit that involves a needle, in particular.

The pharmacists also make the argument that if nasal naloxone was reclassified, it could be sold in chemists in the same way as decongestion products are sold. That would require changes at UK level, but it would help in widening distribution and acceptance of naloxone.

Over and above that, the task force has done really good work. The reach of naloxone is up to about 59 per cent. If you would like a technical explanation of how that is worked out, I will hand over to Morris Fraser. As a result of our naloxone campaign, 4,000 kits have been distributed. The work of Scottish Families Affected by Alcohol and Drugs on the click and deliver service is first class, as is the work of the police. The Scottish Ambulance Service has given out 1,000 kits. As well as distributing take-home naloxone kits, its work in connecting people to services is also relevant.

The task force has done good work in and around naloxone—naloxone is also becoming available to people in prisons, prior to their release—but there is more to do on pharmacy. There is also much more that we could do on mental health services. There are areas in which there can be improvement; the point about pharmacy was well made.

On the latter point, we are on track in developing our public health surveillance system, which builds on existing warning systems and is broader than a traffic-light system or distribution of naloxone. We are also waiting to hear the results of the UK-wide consultation on naloxone. We will certainly endeavour to keep Mr Briggs and the committees informed about what is happening.

With regard to treatments, I say that it is crucial that they be based on evidence. That has to be a priority. On NET, we have corresponded with Mr Briggs about it and we have pointed people in the direction of the chief scientific officer with regard to pursuing trials.

Mr Briggs made a fundamental point about informed choice, which is a core part of the medication assisted treatment standards. All patients who receive a healthcare service make informed choices and are supported in that by clinicians and practitioners. People should be able to make informed choices around medication assisted treatments and other types of treatment. The whole purpose of MAT is to make the connection between the options and possibilities in pharmaceutical interventions and those in psychosocial interventions. Mr Briggs’s point about the need for a balanced approach and for implementation of what works, based not only on the evidence but on what meets individuals’ needs, is important.

I am very much aware of Ms McNeill’s work in the area; I frequently meet stakeholders who talk about her work and events that she has hosted in the past.

With regard to Mr Malthouse’s comments about services such as safe drug consumption facilities sending out the wrong message or encouraging drug use, I point out that there is simply no evidence for that. We hear people verbalising that concern, but there is no evidence for it, whereas there is evidence to show that safe drug consumption facilities reduce overdose deaths and save lives. They reduce transmission of blood-borne viruses, reduce infection in wounds and improve wound care, and they help in reaching people who inject drugs and who might not otherwise engage with, or be visible to, services.

Ms McNeill is a Glasgow MSP. Much of the campaign that is coalescing around safe drug consumption facilities came about because there is also a community benefit from reducing drug-related litter and drug use in public places. There is evidence that such facilities work and about their benefits. They are not a magic bullet—nothing ever is. However, in Scotland, we need all the options. I have views about the Misuse of Drugs Act 1971, but we want all the available options to help us to address this national scandal and crisis.

Some of the work that we are actively engaged in is on updating prevalence information. We need to update our understanding of the extent, or prevalence, of drug use in our society. There is some existing data; just before Christmas, I announced funding to update it. We need to understand more about prevalence in Scotland. That information is important because it is crucial to introducing our treatment targets.

In direct answer to Gillian Martin’s question—I think that this is a fair critique—I will say that we do not have enough of our people in treatment and we do not do enough to retain them in treatment or to follow them up if they fall out of it; hence, our investment in, for example, non-fatal overdose pathways and outreach. The new treatment target and the indicators that underlie it will therefore be crucial in improving and scrutinising the number of people who are in treatment. As I said to Parliament, we will announce that in the spring

With regard to capacity, much of our work on MAT standards and residential rehabilitation is about not just improving our ways of working but increasing capacity. Workforce capacity is important, so right now we are mapping the shape and size of the workforce in order to identify gaps and to look more at training needs.

The issue of stigma is very pertinent to the workforce; workers, too, often feel quite stigmatised. We will consider a recruitment campaign, but that has to be joined up with other big national workforce strategies across the Government.

I am really excited about the national collaborative. I was committed to bringing it forward—in part due to my experience in social security and the work that we did around lived experience with experience panels, and in part because of my days in education, where I saw the benefits of the early years collaborative.

I think that it is absolutely crucial that there is a vehicle that is owned by the voices of the experienced—that it is theirs. I am delighted that Professor Alan Miller, who is Scotland’s leading human rights expert, has agreed to chair the national collaborative. He comes with independence. He is well placed to understand the impact of trauma and has worked with survivors of in-care abuse, through which he brought forward a programme of work that amplified their voices and ensured that change happened. I am thinking in particular of the redress scheme.

I am very confident about the national collaborative. Professor Miller is now involved in a series of engagements—introductory and one-to-one meetings with the sector and with people with lived and living experience. He will work with them to develop a programme of work, including milestones and timescales.

The national collaborative is a very important part of the national mission, because we need to ensure that voices of experience are plugged in to every aspect of that mission. It is also about enabling those voices to inform and drive change, and about what we do being informed by a human rights approach.

That is a really important question, Mr Gulhane; I know that you are a former GP. I often talk about our life-saving work being connected to the work to improve people’s lives. You and I may take the role of primary care for granted in our own lives, but I know that many general practices are the front line of our communities and are already doing great work to support people and their families who are struggling with drug use.

We are finding across Scotland that there are different pictures of the organisation of services. In some areas, GPs can offer more services to people who are affected by drug use, while in others pathways and routes point more towards specialist services. Regional variation is fine as long as it works.

However, in taking a public health approach, GPs can play an absolutely core role. Part of my job is to engage with clinicians from all backgrounds—psychiatrists, GPs and clinicians from specialist addiction services. The connection between the important issue of harm reduction and immediate access to treatment for a drug problem and primary care is made in standard 7 of the new medication-assisted treatment standards. People should have choice with regard to the connections between their MAT and primary care.

There are two important strands to that question, but the committee will appreciate that my work on reducing drug-related deaths focuses primarily, although not exclusively, on illicit drug use. My colleagues in public health focus more on how we reduce dependency on prescribed drugs.

The issue is of interest to me, however, because we know—I am not telling you anything that you do not know—that people can, and do, become addicted to prescribed drugs. A consultation took place on the recommendations of the short-life working group, and health colleagues are implementing an action plan about prescribing guidance and assessing, monitoring and recording prescriptions.

It is a side issue, but the Royal Pharmaceutical Society is interested in how it could work with Government to implement a tool that better records the amount of over-the-counter medications that people buy, because that is an issue for some people as well.

The prescribing guidance around proscribed drugs is complementary to the prescribing guidance around illicit benzodiazepine use. For the drugs policy division, the work to reduce dependency on and the use of illicit benzodiazepines in our communities is connected to the work around prescribed benzodiazepines, for example. We are involved in a range of work—in devolved and reserved areas—to tackle the issue around street Valium as well. I will stop here, convener. Someone might want to pick up the benzodiazepine issue later.