This week it was announced that 1,187 drug-related deaths were registered in Scotland in 2018, the largest number ever recorded.
This caused a shockwave to run through Scottish politics, though it wasn’t such a shock to those on the front line who knew the figures would be terrible. But seeing anecdotal evidence of a spiralling public health emergency translated into official figures has brought the issue very much to the foreground of political debate.
Who is dying?
The majority (72 pc) of drug-related deaths last year were men, though the increase in fatalities among women was steeper than for men.
The Health Board areas with the highest rates of drug deaths were Greater Glasgow and Clyde, Tayside and Ayrshire and Arran. The Board areas seeing the largest increases in mortality were Greater Glasgow and Clyde, Lothian and Lanarkshire.
74pc of those who died were aged between 35-64, with the largest increases in mortality affecting people aged between 35-44 and 45-54. This is consistent with the pattern of previous years where the bulk of drug-related deaths were found in an older cohort of drug users who had been using drugs for a long time.
This is important to understand, as people often associate drug use with young people and assume that younger people are most at risk of dying. This isn’t true. The longer you use drugs the more likely you are to die and this is, in large part, what we are now seeing.
We can extrapolate from an analysis of drug-related deaths in Glasgow in 2017 to tell us a bit more about the likely characteristics of the people who died in 2018, as those characteristics tend to be consistent.
Those figures show that over three quarters lived in the most deprived 20pc of communities in the city. Co-morbidities such as physical health problems e.g. respiratory disease (32pc) and mental health problems e.g. depression (58pc) or anxiety (32pc) were common.
59pc of them had spent some time in prison and 20pc of individuals had been arrested in the 6 months prior to their death. 12pc of them had made a recent homelessness application.
So, typically, those most at risk from a drug-related death are long-term drug users living in areas of deprivation often with poor physical health and usually with underlying mental health problems who are likely to spend some time in the criminal justice system. Other research suggests that many of them are also likely to have experienced trauma, whether as children or in later life, and to have a heightened level of vulnerability.
What is killing them?
The vast majority of drug related deaths are due to people taking more than one drug. It is not always possible to determine exactly what killed an individual but toxicology can show what combination of substances were implicated in their death.
Opiates or opiods including heroin, morphine and methadone were implicated in 86pc of deaths.
Benzodiazepines (roughly speaking tranquilisers) – predominantly non-prescribed street versions of these drugs – were implicated in 67pc of deaths.
Gabapentin and/or pregabalin (roughly speaking anti-seizure/painkillers) were implicated in 31pc of deaths.
Cocaine was implicated in 23pc of deaths.
Alcohol was implicated in 13pc of deaths.
Amphetamines were implicated in 4pc of deaths and Ecstasy-type drugs were implicated in 3pc of deaths.
This paints a picture of widespread polydrug use where people have been habitually combining prescribed or more likely street drugs with heroin or methadone.
The huge increase in the use of street benzodiazepines – implicated in 56pc of deaths – is enormously worrying. These drugs are being churned out by gangsters based here in Scotland, selling at extremely low prices and being consumed in large quantities.
Who is to blame?
In a political sense, we all are. In the rush to point the finger of blame, some things have been said over the past days which would have been best left unsaid. Using this crisis to score political points doesn’t help anyone.
All of us with political responsibilities need to reflect on what more we can do and what needs to change. It really doesn’t matter who is the most to blame at this stage. What matters is that we do better.
But this is also a societal issue and people at every level of society should reflect on the fact that the stigmatisation of problem drug use and treatment and, frankly, the contempt expressed by too many people towards those struggling with addiction has contributed to this crisis. As a society we also have to do better.
What should we do?
There will be a range of specific responses at both local and national level. In Glasgow a lot of work is already underway and I am sure the same will be true in other areas experiencing high levels of mortality. At national level the Scottish Government has established a dedicated task force led by Professor Catriona Matheson.
Responding to the epidemic of street drugs must be a high priority both nationally and for locally based services. Tackling a form of problem drug use which is very new, very localised to Scotland, and for which there is no real existing evidence base in terms of what approaches are most effective will be challenging and will require a high level of commitment from multiple partners.
There should be a national agreement around and commitment to the basic principles which can guide us forwards.
The recently refreshed Scottish Government drug strategy focuses on switching from a criminal justice to a public health approach towards problem drug use. This is supported by most experts and politicians.
What does this mean in practice? It means everyone working together to destigmatise drug use and treatment and to support radical harm reduction policies leading to recovery.
The most hotly debated example of a targeted harm reduction approach is Glasgow’s plan to introduce a safer drug consumption facility. This model is clearly the best option to engage with high risk chaotic drug users who are most distant from services. It’s a model which has been proven to not only save lives but to increase engagement with treatment.
But it’s a model which needs legislative change.
I genuinely appreciate that this is difficult for Conservatives. It’s easy for me to support a radical harm reduction model because there is nothing about that which conflicts with my values or principles. I do understand that, for many Conservatives, this approach does conflict with values and principles which are important to them.
But I ask them to recognise that Scotland faces a very distinct, worsening and urgent crisis. Doing more of the same is not the answer.
Sometimes politicians don’t need to lead, they need to listen. I ask them to listen to the clinical, academic, social work and third sector experts urging us to change tack and to support that change, not only with respect to a safer consumption facility but to a whole system change to the health-based model which has been shown to be effective in other countries. This isn’t the only change we require to make but it is probably the most crucial one.
