The alarming scale of drug-related deaths in Scotland has again been laid bare. 1,330 people lost their lives last year — nine fewer people than in 2020. The Scottish Government believes this is something of a victory. Its press release “welcomed an end to seven annual increases in drug deaths”. I doubt the loved ones of the missing will derive much comfort from this.
Campaigners have reacted with righteous indignation to yet another year of unspeakable loss. “You keep talking, we keep dying” is an oft-seen and powerful mantra. These words are more apposite than the government would ever admit. Its years of panels and focus groups, position papers and postulation are eyed with extreme suspicion on the front line, and even with contempt.
Ministers have promised £250 million over the course of this parliament to tackle drug deaths and are implementing recommendations of a Drugs Deaths Taskforce. They have also promised to “report back on further actions” in the coming weeks. With years of unspeakable failure, and anger across communities, failing to deliver on these latest promises is not an option.
Abstinence is the outcome drug users themselves want
Some have suggested radical action to drive down deaths in Scotland. Labour MSP Paul Sweeney wishes to see safe consumption facilities, to get drug users off the streets. These facilities would provide clean materials and medical oversight for users as they inject Class A drugs. A service was run unofficially from a van in Glasgow for several years. I must admit I’m not fully convinced of the ethics of such facilities, but I well understand the arguments for them. Their introduction would likely reduce drug deaths in Scotland, as they have elsewhere. That is the main moral and political goal in this crisis. But like other harm reduction approaches, they would not solve the underlying problems fuelling addiction and death.
Scotland’s long-standing methadone programme is an example of a dangerous obsession with harm reduction. It sees drug users weaned off one harmful substance and parked on another one. Big pharma gets a paycheck, and health providers wash their hands. A cycle of state-prescribed methadone with no end in sight is not an answer to addiction, yet this is life for thousands of struggling Scots.
The quality of data on the methadone programme is severely lacking. The most recent estimates suggest that around 24,000 people are on methadone. However, the Scottish Public Health Observatory stresses that figures should be “treated with caution” given serious gaps. It’s also unclear how long people spend on methadone. In 2016, one Scot claimed he’d been on it for 21 years.
Prof Neil McKeganey, of Glasgow’s Centre for Substance Use Research, says: “We still don’t know how many addicts are on the methadone programme, what progress they’re making, and with what frequency they are managing to come off methadone. Successive inquiries have shown the programme is in a sense out of control; it just sits there, delivering more methadone to more addicts, year in year out”.
My own view, based on contact with front line professionals over the years, is that abstinence-based treatment is the best path and the one that should be prioritised. A relative of mine headed up a residential rehab charity in a rural community. Services like hers — which are willing to provide holistic support over a long period — are the only approach that truly provides freedom from addiction.
Addictions UK, a charity established by recovering addicts, alcoholics and carers, also stresses the efficacy of the abstinence approach: “If an individual is abusing illicit drugs or prescription drugs, abstinence-only treatment is likely to be most effective. Likewise, if a person has caused significant damage to his or her life or the lives of others, abstinence-only treatment is the most advisable course of action.”
Abstinence is the outcome drug users themselves want. Research by a team of UK academics identified “widespread support for abstinence as a goal of treatment” among drug users in Scotland. It found that: “More than half (56.6 per cent) of drug users questioned identified ‘abstinence’ as the only change they hoped to achieve on the basis of attending a drug treatment agency.”
By contrast, relatively small proportions of surveyed drug users identified harm reduction changes in terms of their aspiration from treatment. 7.1 per cent cited “reduced drug use”, and 7.4 per cent cited “stabilization”. Less than one per cent of respondents identified “safer drug use” or “another goal”, and just over four per cent reported having “no goals”. The prioritisation of abstinence over harm reduction was crystal clear.
Policy makers must exit their ivory towers
The problem with abstinence programmes, politically, is that they’re difficult and expensive. It can take years of relapses and visits to rehab before a person is free from drugs. By contrast, harm reduction provides the appearance of doing something immediate, with some benefits, at a fraction of the cost. It’s often left to the private sector — charities and religious groups — to fund abstinence in Scotland. Sadly, these organisations are dogged by unfair criticism. My relative’s charity was maligned due to its Christian ethos and repeatedly threatened with funding cuts by the state — despite helping more people exit addiction than similar groups. This prejudice is odious. It doesn’t matter if a charity is religious in its designation. If it is saving lives and assisting people to live free from drugs, surely it should be lauded?
It’s important to note that tackling drug deaths, and a wider culture of addiction in Scotland, doesn’t end with drugs policy. A friend of mine who has worked alongside people caught in addiction argues that seeing real change in Scotland will require wider societal attempts to reduce poverty — a key driver behind it. In the challenging fiscal climate we are entering, this will become all the more challenging.
My friend also stresses that people with real life understanding of addiction, and how it is exited, should have a seat at the table in government. Lamenting that they are often passed over, he states: “People who have entered, experienced and exited addiction are crucial to policy around treatment for substance misuse” but “even now, these voices are situated on the margins”.
Tackling poverty through a range of interventions in a number of policy areas is vital. Listening to people who are at the coal face of serving the last, the least and the lost can provide enduring change. The people with the best ideas often move in circles outside the Holyrood political bubble and academia. Policy makers must exit their ivory towers.
A personal frustration of mine when it comes to challenges facing Scotland is the tiresome virtue signalling of our governing elites. In the last decade, Scotland’s government has presided over a litany of failed policies aimed at “sending a message” and giving the nod to fashionable ingroups. These have cost the taxpayer countless millions, while wasting precious parliamentary time that could go towards true crises.
The Offensive Behaviour at Football Act, the Named Person Scheme, the smacking ban and the Hate Crime Act — all these policies are united in being unnecessary, unpopular and unworkable. They’ve also proved counterproductive. Rather than helping Scots in the poorest communities, they are designed to problematise, stigmatise and criminalise them. They are deeply patronising.
I can’t help wondering if we’d be where we are on drug deaths today if our government had invested more time on the drugs crisis, and less time on pseudo-moralistic meddling. I fear their pettiness has been a harmful distraction.
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