Chamber and committees

That is an excellent question. We, as the Scottish Government, think that we need a range of services that suit individuals’ needs, whether the need is for abstinence, medicated managed services, stabilisation services, detox in the community, detox in a unit or other recovery interventions. We need all those services in order to offer a truly person-centred approach to a recovery pathway that works for each person.

Yes, and MAT standard 1 is about same-day intervention, which is a huge change.

I see that Dr Priyadarshi is nodding, but I do not know whether that is because he agrees with me or because he has some experience to share.

It is worth hearing about some of the international evidence around synthetics, the challenge that they pose, the fact that they are now being mixed with other substances that people do not know about, which means that people do not know that they have contaminated substances, and the fact that they are 50 to 500 times more powerful. My gentle argument back is that we have to be prepared for that coming down the line. We need to be very aware of what has been seen in the rest of the world.

In my first week in this role, I took part in a round table on synthetics with colleagues from Canada, New York and Ireland, and I heard about the actions that they have been able to take to tackle synthetics in the supply chain, and about how dangerous such situations can be. That is one of the reasons why the drug-checking facilities and the national hub will become very important. We will be able to see that coming in, which will enable us to pivot towards an alert system—indeed, I think that Public Health Scotland has already used such a system to alert people that something is not safe, and that they should therefore check it out or be safe when they administer it.

I also hear that there is synthetic opioid contamination of benzodiazepines and that people who are shifting to those substances do not realise its presence or its impact. There is also a shift whereby people are moving to injecting cocaine, which brings with it a range of health issues. In addition, we do not have a naloxone for stimulants: there is currently no treatment for stimulants, so there is a huge amount of work to do there, too.

I am taking quite a broad approach, but it might be that we are seeing that because synthetics are in the news and at the top of everyone’s agenda right now, and because they pose such a threat. I am alert to that, but it is not my experience here. Work is on-going in all the other areas. We are hearing from stakeholders about how behaviour is changing, how issues are being dealt with and how we can intervene, either through those stakeholders or with other services.

Synthetic opioids are a big threat, which we must not downplay, but I give a commitment that we are looking not only at that threat but at all the other information. The toxicology results and all the rich data that we get from NRS in the summer will give us some indication of what has been happening in the past year. The RADAR results are telling us that benzodiazepines and cocaine are playing a bigger part than they used to.

I will ask Alison Crocket to come in, because she takes part in lots of international work and has long experience. She may be able to give you an overview of the global picture and how we are using that to inform the work that we are doing here.

Police Scotland, too, has learned from other parts of the world in developing its guidance on how it will protect local communities while ensuring that we do not put more barriers in the way of people coming and seeking support.

I am really hopeful about the drug-checking facilities, which I think will give us real-time data on what is happening in local areas. We will also have the national hub, which will be sited between the University of Dundee and Ninewells hospital. It will allow further analysis to be done so that we have a real and deep understanding of the issue. It is one aspect of how we understand what is in the system.

I was in Aberdeen on the day when the people up there submitted their licence application to the Home Office. At the moment, there are two drug-checking facilities—a postal one called WEDINOS, which is based in Wales, and another in Bristol—and they have experience of the process and how tricky and complex it can be. We are certainly leaning a lot on our friends in other parts of the UK, and our officials have excellent working relationships with Home Office officials. I should also say that the criteria were designed not just to tackle that complexity but to ensure that whatever we do is within the law and allows us to maintain the restrictions of the Misuse of Drugs Act 1971. That challenge aside, the determination to do this has resulted in many organisations working together.

Siting the facility with an existing service that already provides other support will mean that people will not just get checked but will also be exposed to all the other support that is available to them. That is the Aberdeen model, which I think the convener will be very interested in. It is certainly worth taking some time to visit and speak to the people in that facility. As I said, they were the first to get their application in. It took a long time for them to meet all the criteria, but their application is now in. The Dundee application has gone in, too, and Glasgow’s application is imminent—it is being worked on right now with Home Office officials and the people who deliver for Glasgow. The facility will give us results within minutes on whether a substance is more dangerous.

As I said, though, the facility is only one pathway by which a person can be exposed to all the services that are available. There are other intervention points that we can use to offer people support. It is important that people can make an informed choice and get the right advice. In that way, consumption rooms become part of the whole system, because someone who comes in might be told, “That doesnae look that safe—that’s the advice we’re giving you.” The point is that they will be somewhere safe where, if they take the substance and have a reaction, they will be looked after. That is incredibly important because, again, this is all about harm reduction and reducing drug deaths.

It is all multilayered. There is the practical stuff—that is, what people need to know to make the decisions that they need to make, and to give them the confidence to make such decisions—and there is the data and analysis aspect, which will allow us to understand whether the profile of what we are seeing in the system is changing. If we suddenly see an increase of something very dangerous in the system, Public Health Scotland and other organisations can, as they have done once before, put out an alert to everybody on the front line so that people can be supported, know that there is something in the system that is potentially 500 times more powerful than their usual thing and be told how dangerous it is. There are different reasons why these facilities are good things.

We have looked into that; my predecessor in the role looked into it. Some festivals have managed to do it. The Home Office is pretty rigid, but we are working with it. Mobile units at big events could be a life-saver for some people, so my mind is not at all closed on that, but there are challenges in the Misuse of Drugs Act 1971, which makes it really difficult for that to happen. We have some experience of organisations asking to do it, but the situation is pretty rigid.

Given that we set the MAT standards, we want everybody who accesses the service to get that service at the highest quality, and we want people to be informed about the choices that they have. The MAT standards are included in that. I mentioned mental health and dependency, and there is a specific MAT standard to tackle that issue. We are working closely. The advice that I was given by both previous ministers in the role was to keep driving up the MAT standards and make sure that the budget is protected. Those were two very good pieces of advice to me as I came into the role.

We published in 2021, and work is going on across the board to drive up the standards, not just in health but in all services. It is really a way of pushing forward the idea that the issue is one of health and it should be treated as such, and that people should have a high quality of service. It is a bit of a change for people who deliver the services—particularly in health boards—as regards how we increase all the standards in the way that we want to and give people the choices that they need in order to make the right decisions for their health.

We are also applying the MAT standards to justice settings. In relation to the points that Russell Findlay made earlier about what is happening in prisons, I add that we have prison to rehab, which is covered by the MAT standards as well. We hope to make sure that everyone is covered.

Great progress has been made. There is a great diagram that allows me to see immediately where we are. It shows red, amber and green statuses. Much of the work is coloured green or amber, so real progress is being made, particularly on MAT standards 1 to 5. Progress is also being made on standards 6 to 10. There are some challenges, particularly in rural areas and areas where there is a high incidence of issues that we need to face. However, I see things moving on quite markedly now, and I see, hear and understand that when I meet people. They understand it, too.

When I was in Blackburn on Monday, I was asked whether the health improvement, efficiency, access and treatment—or HEAT—targets do not work well with MAT standards under a trauma-informed approach. I will take that point away and look at it. It might be that we have frameworks or standards that do not quite work well together. I will consider that to see how we can use the MAT standards to push things forward in a more modern way.

We are keeping track of what is happening in each area across Scotland. Where we are seeing challenges, organisations are coming forward with monthly reporting so that we can give advice, support and guidance on a monthly basis to push forward progress in tackling all those challenges. There are a number of areas where reporting has shifted from monthly to quarterly or from quarterly back to monthly, depending on where they are on the progress chart. In many areas, organisations have taken advantage of the opportunity to work with us on a monthly basis when reporting their progress on the standards, and I will continue with that work.

I am aware that Justina is sitting right behind me. [Interruption.] Sorry—apparently she has gone. I will catch up with her soon.

Justina Murray has been an absolutely superb advocate in this area. I will have to look at what she was saying, because I did not catch that bit of the committee’s meeting this morning.

I go back to a point that I made to Mr Findlay. We have to ensure that we have a number of pathways available for people so that they have a choice about the pathway that works for them. As I said, we get pulled in different directions. Some people think that a certain pathway is the best one, and other people think that another pathway is the best. Our responsibility is to create that choice for people so that they can understand the pathway that works for them. Two people who I met yesterday at Abbeycare, who are currently on an abstinence programme in a rehab facility, said, “We tried this and we tried that.” They had both tried the same two things, which had not worked for them, but the programme has worked. That is important in understanding where the challenges are coming from.

Our stakeholders are doing amazing work, and we need to take on board their ideas about what works best. From my point of view, the responsibility is to create the choice that allows people to have the pathway and the person-centred approach that will work for them.

I have been clear that the money from the Scottish Government for ADPs that goes into the system via local authorities is going to ADPs. I do not think that I could be clearer about that. We have challenges in the budget—everyone has challenges in the budget—and some of those are not of our making. However, I know that we have had a 67 per cent increase in the budget for ADPs.