The Scottish government has announced that they will be introducing Drug Consumption Rooms in an attempt to get to grips with the ongoing drug crisis in Scotland. This announcement comes shortly after the latest statistics reveal a record number of drug related deaths, the highest since records began, with a 5% increase in DRDs since 2019. We commend the Scottish Government for taking such vital action that will undoubtedly save lives and begin to pragmatically respond to this ongoing crisis. 

The Scottish Gov have announced that they will introduce DCRs in a move to reduce their deaths. In doing this Angela Constance and Nicola Sturgeon show that the lives of people who use drugs in Scotland matter and that a Government can be responsive and take action no matter what the consequence ….They say they will do this regardless of what the UK Gov has to say and i personally and professionally commend them for their actions.” – George Charlton 

Key finding from the 2020 report

The report shows that there were 1,339 drug-related deaths in Scotland in 2020. Despite calls from advocates the level of drug related harm and death has continued to skyrocket over the past 20 years. The number of DRDs in 2020 were over four times higher than in 2000, over 3 times higher than that for the rest of the UK, and the highest in Europe.

There are clear gendered differences associated with the risk and likelihood of drug related  death in Scotland. In 2020 men were 2.7 times more likely to die from a drug related death than women. While the rate of DRDs has decreased for men over the past 20 years, there is a stark difference, and this is an area that needs further attention. Research from the US shows that these differences may be linked to higher rates of drug use and dependency amongst men, however, it’s important that further research is conducted to explore this issue in a Scottish context.

Over the past 20 years there has been a shift in the average age of drug related death, from 32 to 43. In 2020, over half of all drug-related deaths were aged between 35 and 54, this finding likely correlates with the cohort of Gen X, long-term opiate users, who are more at risk of dying from drug use as they get older. There are various health complications that stem from long term opiate use, and the prevalence of drug related harm and death amongst this cohort shows the consequences of persistently ignoring the needs of those who use drugs.

The lowest death rate was amongst those aged 15 to 24, although it’s important to note that this has risen in recent years, and should be closely monitored to understand how this cohort can best be supported. If policy fails to effectively engage with this cohort there may be a detrimental loss of life in the future, like we see across the 35-54 age bracket now.

 

One major driver that puts users at a higher risk of drug-related death is poverty and deprivation. The latest statistics reveal that those who were living in the most deprived areas of Scotland were 18 times more likely to have a drug-related death than those living in the least deprived areas. This figure has almost doubled since 2000, and it’s worrying how it may continue to rise, especially during times of post-Covid economic recovery. It is likely by nature of living in more deprived parts of the county users will experience marginalised access to vital services, such as drug treatment programmes. Investment into these areas with considerable measures of deprivation will be an integral part of any strategy aiming to reduce the impact of social and economic inequalities on DRDs. 

The area with the highest (age standardised) rate of DRD between 2016 and 2020 was Greater Glasgow and Clyde, where there were 30.8 deaths per 100,000 of the population. This area has seen the largest increase in drug related death during this period, followed by Tayside and Ayrshire, and Arran. Of the local authority areas, Dundee City had the highest rate of drug related death between 2016-2020, with 43.1 deaths per 100,000 of the population, and this rate has significantly increased over the past 20 years. Glasgow city and Inverclyde had the next highest rates of drug related deaths.

The data for 2020 reveals the complexity and reality of polysubstance use, and how this contributes to drug related death and harm. Of all drug related deaths in 2020 93% involved more than one drug. 

  • Opiates were present in 1,192 deaths (89% of all drug related deaths) 
  • Benzodiazepines were present in 974 deaths (73% of all drug related deaths)
  • Gabapentin and/or Pregabalin were present in 502 deaths (37% of all drug related deaths)
  • Cocaine was present in 459 deaths (34% of all drug related deaths) 

Between 2015 and 2020 the number of drug related deaths involving these drugs have dramatically increased: street Benzodiazepines, methadone, heroin, gabapentin, and cocaine.

Causes of drug related deaths in the Scottish context 

The drivers of the drug crisis in Scotland are complex, and will require a dynamic response to start saving lives.

In a briefing by the Scottish Drug Forum it is noted that poverty and deprivation; trauma from adverse childhood and adult experiences; and mental health are the key drivers of drug related death and harm in Scotland. It’s clear that a socio-medical approach to this public health issue will be key to saving lives in Scotland; and it’s even more obvious that the criminalisation and stigmatisation of those who use drugs, and are experiencing problematic drug use, only perpetuates harms, and leads to more death.  

Solutions 

Pragmatically addressing 50 years of failed prohibitionist drug policy through progressive reforms is a good place to start when trying to address this urgent crisis. Decriminalisation of personal possession can serve as a vehicle for reducing drug related harms, as witnessed in Portugal. Though it is crucial that decriminalisation is enacted alongside a commitment to major investment in drug treatment services, and harm reduction services; which ultimately will save lives.

The Scottish Drug forum identified some key areas of consideration for addressing the drug crisis in Scotland. There is an urgent need for major investment into drug treatment services, to  ensure that services are able to effectively engage with users; retain those who are in treatment; expand access to services; and offer more choice and autonomy within treatment plans. Moreover, the expansion of residential rehabilitation treatments, and implementation of Medically Assisted Treatment Standards (MAPS) will be vital in supporting 

Furthermore, there are harm reduction approaches that play a vital role in saving lives, such as the introduction of DCRs, and the expansion of access to the opiate overdose treatment, Naloxone. 

Responses 

While it has taken 20 years of persistent calls to action, there finally seems to be some effective change being introduced. There has recently been a major investment of £250 million into Scottish treatment services, as announced last year. There is currently an ongoing public consultation on whether to expand access to Naloxone. Furthermore, as mentioned, DCRs will be introduced in Scotland, despite the UK government’s objection to them. 

“People can feel overwhelmed and powerless in the face of the numbers of overdose deaths in Scotland but these deaths are preventable. Even in the moment that people encounter someone who may be experiencing an overdose it is important that people do not feel helpless. With a little knowledge and training people can make a life-saving difference. In the time people wait for an ambulance the first steps can be made that can save that person’s life. Recognising that someone may be experiencing an overdose, dialling 999 and administering naloxone are all part of the response that gives that person the best chance of recovery. In Scotland there is widespread access to naloxone kits and training and it’s crucial that as many people as possible get involved.” – Kirsten Horsburgh, Strategy Coordinator for Drug Death Prevention at Scottish Drugs Forum

Moreover, in light of International Overdose Awareness Day the Scottish Drug Forum has launched the Stop the Deaths Campaign in collaboration with the Scottish government. The campaign aims to raise public awareness around the signs that someone is having an overdose, and how to respond with Naloxone and emergency service intervention. The campaign also encourages the public to engage in Naloxone training and carry this life saving drug with them. 

“This is a significant development in Scotland’s national naloxone programme and provides a chance for the public – people who are likely to witness an overdose –to fully engage with the programme and the national mission to reduce drug deaths.This is also a step change in the annual #StopThe Deaths initiative we inaugurated three years ago. Crucially, this also sends a clear message to people with a drug problem, their families and those who support them that their lives are valued by the whole of Scottish society.” – David Liddell, Scottish Drugs Forum CEO, said:

The rise in preventable drug related deaths over the past 20 years in Scotland shows the  urgent need for a health focus, harm reduction drug strategy, which the Scottish government seems to now recognise the importance of. It’s important that we continue to stand in solidarity with those who use drugs, and those who have lost friends and family members to preventable drug related deaths. It’s time to end criminalisation and stigmatisation of drug users, and start saving lives. 

This piece was written by Ella Walsh, Content Officer at Volteface. Tweets @snoop_ella

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