Last week saw the publication of the annual report by the National Forum on Drug Related Deaths, Scotland’s independent expert body which makes recommendation on drug policy to the Scottish Government.  There were few surprises within the report, the data was published previously, so the headline figure of 581 deaths had already been widely reported.  There was little change either in the number of annual deaths or in the demographic patterns, with older intravenous drug users and those living in areas of high deprivation remaining at disproportionate risk.

This is the second time in a year there has been  a large report on drug policy in Scotland; the last annual report from the National Forum was greeted with a moral and media panic over methadone treatment.  In response, the Scottish Government commissioned an expert review into opiate replacement therapies, led by the Chief Medical Officer.  That review which runs to 173 pages, makes clear the context in which it is written,

“some Scottish newspapers focused on the place of the drug methadone, with articles reporting in an extremely negative manner and challenging the prominence of opioid replacement therapies in general and methadone in particular”

before clearly outlining the evidence base for the use of methadone and alternatives like buprenorphine in saving lives and assisting users in their recovery.  So despite what the papers say, the facts haven’t changed.  The report goes further however, arguing that in some cases “Heroin Assisted Treatment” (i.e. providing clean, pharmaceutical heroin to those users most at risk) is a policy option which deserves to be taken seriously.  This week’s report formalises those findings, by recommending that heroin be made available to those judged to be in high risk groups.  It’s not a blanket suggestion that this should instantly be the preferred choice in all circumstances but an acknowledgment that if the intention is preventing deaths, then every option should be on the table.

An extract of the first recommendation from the Forum, advocating Heroin prescription.

The Scottish Government have had time to prepare, as it was clear that following the Chief Medical Officer’s report in August last year, this annual report would suggest Heroin Assisted Treatment.  Their response?  Just say no. Predictable, familiar, not likely to annoy the press.

We’ve been here many times before with drugs policy at a UK level.  Being a scientist is a dangerous game when advising governments, as the many former members of the Advisory Council on the Misuse of Drugs (ACMD), who were either sacked, forced out or walked away because no-one was listening, can attest.  We had the debacle where cannabis was reclassified to a Class C drug and then changed back to Class B (against advice) and the rush to criminalise methadone (ditto).  Any hope of reform from Westminster or even just allowing scientists to do science and advisors to give advice has long departed.

David Nutt was sacked from the ACMD, for telling the truth about ectsasy.

Holyrood has made some positive progress, the SNP’s heroin policies have focused on recovery as opposed to abstinence and we’ve even been creative with the law to allow Naxolone, a drug which helps save lives in the event of overdoses, to be distributed by people who come into contact with heroin users who wouldn’t otherwise be allowed to prescribe drugs.  While drug deaths are not falling, it’s vital to point out that our current approach saves, prolongs and improves the lives of thousands of drug users and their families.  Yet, we reach a brick wall when it comes to just prescribing heroin, even when our own advisors say that may be the best way to tackle addiction.

In rejecting the recommendations of those whose job it is to make them, a spokesperson for the Government cites “the ethical and legal issues raised by such a proposal.”  By “ethical”, they mean the papers and by “legal issues”, they mean the constant suggestion that we have to wait for independence to even talk about what we’d like to do.  Neither of those defences really stack up.

“Some Scottish newspapers” would doubtless have a field day with the proposal on the table, even the Herald reported the story with reference to the plan for “shooting galleries.” By making a sterile backroom of a chemists sound simultaneously glamorous and dangerous, the recommendation is already being unhelpfully sensationalised. Prescribed heroin would have to be taken somewhere, there is a large body of evidence which suggests that supervision is one of the key factors in determining the success of recovery programs, so making space available for that to occur within the health service is the only plausible option.

Are the SNP worried about what “some Labour MSP” might say in “some Scottish newspapers?”

Then there are the legalities.  Whilst it is certainly the case that Holyrood doesn’t have the power to change the legal status of heroin, that didn’t stop the government promising (and then not delivering)  foils to users to help with the move from injecting to smoking.  Needles are already made freely available via exchange programs, meaning those handling old needles may have class A drugs in their possession and are knowingly assisting others in taking class A drugs in future.  Is it really a massive jump to just provide a safe space for heroin consumption or even clean heroin?  With policing and health powers devolved and the Lord Advocate issuing “letters of comfort” allowing non clinicians to dish out Naloxone, are we really to believe that a Government sponsored program involving Heroin Assisted Treatment would result in users and health professionals ending up in the pokey?

With voters being asked to choose between Westminster and Holyrood in a referendum, we should surely be hearing about what our Government would like to do, should they overcome the “legal issues raised“, by gaining independence.  The White Paper points out that drug policy and drug classification are being run from different places; an acknowledgment that in practical terms, Holyrood are responsible for making most decisions about drugs. Yet there isn’t a word about what changes would occur to classification or even how that would be decided in an independent Scotland.  There has been general babble about  “experts”, “science” and “truly independent body” (i.e. not like the ACMD) but if the Scottish Government’s response to the latest report tells us anything, it’s that experts and science only matter when they are saying politically expedient things.

The SNP can’t take credit for the harm reduction strategy and declare themselves powerless simultaneously – nor hide behind the referendum without saying what they‘d do if we vote Yes.  If they don’t eat their brocolli, by being as creative as they can with health and policing powers, they may not get any pudding.

If we just made the Chief Medical Officer write a 173 page report to shut the Daily Record up for a few months, then serious questions must be asked about where we’re heading. There is no leadership from Holyrood and little to suggest that an  independent Scotland would do much besides commission a big report about classification and then ignore it, if we even got that far.

A mature response would be to start outlining the case for prescribing heroin, irrespective of the result of the referendum.  Aside from the growing body of evidence which suggests this approach can effective in assisting recovery and reducing harm, it’s a policy which would have an array of other benefits; clear cost benefits, crime reduction, breaking the link with dealers and drugs like crack, allowing the impact on our health, police and justice services to be more predictable and stable.

No-one is engaged in the debate because they want to take heroin or because they want others to take it, so we‘ll just have to deal with the fact that “some Scottish newspapers” won‘t be keen on the idea of heroin being prescribed on the NHS.  It’s not as though the tabloids would otherwise be jam-packed full of pro-Holyrood propaganda, so it’s unclear why these fading tale merchants are still wagging the drugs policy dog.  We cannot allow our politicians to stand on the sidelines, playing with their ethical issues; heroin is the drug above all others which demands an urgent response.

We face a stark choice between saving lives and saving face.  Only independent MSP, John Finnie responded to the recommendation of Heroin Assisted Treatment by pointing out what everyone in Holyrood knows, “where there’s a will, there’s a way.”  We must make the choice to find a way.

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Further reading:

Methadone isn’t the problem or the only solution
Yes We Cannabis: Reigniting Scotland’s drugs debate
Testing times for Scotland’s pill takers

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