Shocking new figures released yesterday expose the extent of Scotland’s growing public health emergency.  A record 706 drug related deaths were recorded in Scotland in 2015,  according to figures from the National Records of Scotland.  This is a 15% increase compared with 2014 and suggests that drug related deaths have continued to rise since 1996.   One tragically familiar observation is that the report reveals older users continue to be at a particularly high risk – and the familiar response from many charities and health professionals has been to call for the extension of  Heroin Assisted Treatment (HAT) and for supervised injecting facilities to be be made available.

HAT and supervised injecting are not new ideas, allowing health professionals, rather than dealers, a degree of supervision over what users are taking and when.  This approach used to be known as “The British Model” and predates even the NHS.  Heroin used to be simply be provided, to the tiny number of users there were, until we effectively privatised and deregulated the supply of the drug via “prohibition” laws and the “war on drugs.”    The effects of these change were disastrous, heroin suddenly became something rare and valuable, something sold on a street corner, something mixed with anything and everything, something more deadly.  Heroin use skyrocketed and deaths associated with drug misuse became endemic.

In response to yesterday’s report, the minister for public health, Aileen Campbell said, “This is a legacy of Scotland’s drug misuse which stretches back decades.”  Campbell also told the BBC, “To address this we have funded research to investigate the issues associated with older drug users through the Scottish Drugs Forum.” Neither of those statements are incorrect in isolation – but the SNP have seemed prepared to continue this legacy of inaction, especially when the Scottish Government has “investigated the issues associated” in the past.   Back in 2013, an expert review commissioned by the Scottish Government had this to say on what needed to be done to address the specific issues affecting older users:

Having commissioned a report almost entirely to please the Daily Record (who’d spent the previous year running a vile campaign to demonise not just methadone and heroin users but also health professionals for doing their jobs), the Scottish Government largely ignored it and drug related deaths have continued to rise. While a spokesperson for the Scottish Government cited “ethical and legal issues” for their refusal to implement this recommendation, I believe that’s shorthand for “we’re shit scared of The Daily Record and want to pretend this is somehow Westminster’s fault.”

The Daily Record (in association with Scottish Labour politicians)  condemned the NHS for “dealing drugs.”  No really.

3 years later, we’re being told we need more research.  We do – and the Scottish Drugs Forum, who described today’s figures as a, “wakeup call to redouble efforts to reduce this tragic and largely preventable loss of life,” are undertaking essential work to help understand how to make services more accessible for older and more economically and socially isolated users.  But we also need to take the steps we should have taken decades ago, based on all the information we already have; we need to stop condemning people to death because some people have “ethical issues” with healthcare being provided to people, that’s what the NHS exists to do.  Long ago, we decided that dirty needles were an avoidable risk – yet we tolerate the fact dirty heroin continues to kill people.

The extension of a clear national strategy for Heroin Assisted Treatment and supervised injecting facilities won’t stop people dying from drug use, HAT is not the most effective treatment for a great number of heroin users; these measures are part of a toolkit to take on the challenges we face, tools which are being unfairly denied to people who use drugs and health professionals by politicians.  Many of the problems facing organisations working with drug users are grimly familiar: lacking resources, unable to provide the same levels of life saving services, forced to cut and cut and cut in the face of austerity.  Needle availability has reduced, HIV transmission as a result of intravenous drug use has increased, services have been ground down, deaths have gone up. If we allow politicians to ignore the impact of their decisions, our communities will continue to suffer.

There have been welcome moves from Holyrood: the shift from abstinence to recovery has been vital for engaging users and the Naxolone programme is genuinely groundbreaking.  Where bold action has been taken, it’s been effective – but inaction has been just as effective at creating the situation we’re now in.  And there are finally plans for a trial of HAT in Glasgow City Centre.  With 60 people expected to become HIV+ as a result of drug use in the city this year, NHS Greater Glasgow and Clyde decided action was needed.  This is welcome news and suggests any “legal issues” (which never existed) have and will be overcome.  But we need action on a national level to make sure services are well-funded, targeted, accessible and effective.

The succesful programme to treat overdoses is proof of what Holyrood can do, if it chooses to.

Beyond action on heroin deaths, we need to take steps to minimise fatalities from the use and misuse of other drugs, many of which are the result of either lack of information besides “Just Say No” or lack of any regulation over what people can sell to those who use drugs.  If we can find a way to provide heroin on the NHS to save lives, we can find a way to allow users of  cocaine, amphetamines, MDMA and ecstasy to test their drugs without risking prosecution.

The Scottish Government can’t be allowed to continue to  pretend this is “the mess we inherited from Labour” [(c.) David  Cameron] or that they just need more time to keep ignoring the answers they’ve already been given.   A brave, bold and genuinely national strategy, with the funding to deliver services which save and transform lives, must be implemented urgently if we are to start turning to tide on drug related deaths.

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Further reading:

Drugs & The Scottish Government – Ask the experts, Just say no anyway

Methadone isn’t the problem or the only solution
If taking pills is Russian roulette, we need to make the odds better

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