Scotland saw more drug-related deaths than any other European Union country in 2018, after a 27 per cent increase in a single year brought the total to its highest level since records began 23 years ago.
The National Records of Scotland statistics show 1,187 people died taking drugs last year, bringing the death rate to triple that of England and Wales, and making it higher even than the US, which is in the grip of an opioid crisis.
The majority of deaths involved more than one substance, with heroin and other opiates a factor in 86 per cent of fatalities and “street” benzodiazepines like etizolam, which have flooded the market in recent years, seen in 57 per cent of recorded deaths.
Scotland’s public health minister Joe FitzPatrick decried the figures as “shocking”, and called for “innovative and bold new approaches” to save lives. He and Ronnie Cowan, vice chair of the all-party parliamentary group on drug reform, renewed calls for the UK government to enable the creation of safer drug consumption rooms, which advocates say could help to stem Glasgow’s HIV outbreak and help healthcare professionals engage more effectively with long-term addicts.
“Scotland’s record drug deaths are an avoidable tragedy, and the failure of politicians in Westminster and Holyrood to act is simply shameful,” said James Nicholls, CEO of drug reform charity Transform. “This crisis is a consequence of policies they support, and continue to impose, despite deaths increasing year after year. Bereaved families may wonder why the UK drugs minister won’t visit Scotland to better understand why their loved ones died, or appear before Scottish MPs to justify her government’s failed approach.”
While the steadily rising number of drug deaths in Scotland and the UK is often attributed to the difficulties in treating an ageing population of addicts – 887 of those who died in 2018 were over the age of 35 – this is also exacerbated by failings within treatment services.
Only 40 per cent of people with a drug problem are currently in treatment in Scotland, due in part to waiting times of up to six months and a focus on abstinence rather than harm reduction.
“Scotland prides itself in having an equalities and rights-based approach to policy and service provision,” said Scottish Drug Forum CEO David Liddell. ”But the latest drug deaths statistics again suggest that Scotland’s sense of itself as inclusive may be dangerous self-delusion.”
Mr Liddell said the figures raised “serious concerns” about Scotland’s response to opioid addiction, suggesting that 50 per cent of people in treatment were being prescribed methadone doses lower than the World Health Organisation’s minimum recommendation. “If people are not getting the substitute medication dose they require then it is no wonder they ‘top up’ with street drugs and get involved in polydrug use,” he said.
Of the deaths recorded, 47 per cent involved methadone. Reports of the role played by the heroin substitute in overdoses have in the past led some politicians to call for it to be replaced with alternative treatments. However, experts say this is missing the larger problem.
“Some people misrepresent the evidence by claiming that methadone is causing these deaths,” said Zoe Carre, policy researcher at Release, a national drugs charity offering legal advice and support. “This is wrong, not least because prescribing methadone as an opioid substitute is one of the most evidence-based ways of preventing premature death.
“This also ignores the fact that most of these deaths involved one or more opioids, such as heroin/morphine or methadone, which suggests that some people are being let down by drug treatment, for example if they are not being prescribed optimal doses of methadone.”
Mr Liddell said the “stigma” surrounding drug treatment was leading some patients to adopt a misjudged attitude that “the less medication they are on, the ‘better’ they are doing”.
“We need a concerted effort to address this stigma and achieve a consensus that allows us to join the rest of Europe and the world in recognising that opioid substitution therapy is part of an evidence-based response to opiate drug use and that the quality of the services that deliver this is crucial,” he said. “Otherwise, we will continue to see people die needless and preventable deaths. The government and politicians, the NHS, drug services, the media and wider society have a part to play in this.”
In 2008, the Scottish government introduced a strategy called Road to Recovery, which placed increased emphasis on abstinence. Roy Robertson, professor of addiction medicine at Edinburgh University, said while this helped widen attitudes towards drug problems, it “had the unintended consequence of diverting attention and resources away from harm-reduction measures” and “had no strategy for dealing with” the new range of drugs on the market.
“It should have been revised some years ago and we now have an uphill struggle with a culture change in treatment services to address the ongoing opiate and stimulant drug problem,” he said.
What could be the UK’s first heroin-assisted treatment centre is due to open later this year in Glasgow, which accounted for one-third of 2018’s drug deaths. The programme will see heroin given to those for whom two other forms of treatment (methadone and buprenorphine) have been unsuccessful, with advocates hoping it will entice a small percentage of ageing, problematic drug users who publicly inject in the city centre back into contact with health professionals.
“Similar clinics should be established in all health board areas with minimum delay,” said Professor Robertson, who was previously a GP in Edinburgh’s Muirhouse, where Trainspotting was filmed.
Mr FitzPatrick said: “The number of people who have lost their lives because of drug use is shocking. It is vital this tragedy is treated as a public health issue, and we are prepared to take innovative and bold measures in order to save the lives of those most at risk.
“Last week I gave evidence to the Scottish Affairs Committee and I asked for help in persuading the UK government to either act now to enable us to implement a range of public health-focused responses – including the introduction of supervised drug consumption facilities – or devolve the power to the Scottish parliament so that we can act.
“I want to ensure that the work of the new taskforce which I have established is driven by strong evidence, and the voices of those with experience of using drugs, and their families, are heard. I am determined to shape our services in every walk of life to prevent harm and reduce the appalling number of deaths. So I will give consideration to any proposals they bring forward which may help to tackle this issue and, ultimately, save lives.”
Andy Cowan, a campaigner at pressure group Anyone’s Child who lost his son to a drug overdose, called for the rapid decriminalisation of all drugs. “These new statistics show once again that many of our people across all ages and social classes are buying unsafe, and in many cases deadly, drugs from criminals, and then consuming them without any advice or supervision,” he said. “This is resulting in record numbers of deaths and misery for families. And all because our deep prejudice against the use of some drugs for recreational purposes blinds us to the answer.
“Were we to be bolder, we would prioritise the safety of our citizens above our prejudice. We would seize control of the entire manufacture and distribution of drugs from criminal cartels, by legalising their production, supply and use, while putting in place strict regulation to minimise harm. In other words, to end the failed ‘war on drugs’ and for the first time embark on a compassionate new approach aimed at saving lives.”
Additional reporting by PA