Drug Deaths

– in the Scottish Parliament on 14th January 2021.

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Photo of Lewis Macdonald Lewis Macdonald Labour

The next item of business is a members’ business debate on motion S5M-23613, in the name of Monica Lennon, on Scotland’s drug deaths crisis. The debate will be concluded without any question being put.

Motion debated,

That the Parliament considers problem drug use across the country, including in the Central Scotland region, to be a national public health crisis; believes that every life lost to drug and alcohol misuse is a preventable tragedy; notes the views that more action could be taken at a national and local level to prevent this, that funded access to residential rehabilitation must be widened so that people who feel ready have better options into treatment and that recovery and overdose prevention work, including safe consumption facilities, is vital to harm reduction, and further notes calls urging the Lord Advocate, the Crown Office and Procurator Fiscal Service, Police Scotland and all levels of government and health authorities, to take immediate action to prevent further deaths, reduce stigma and ensure that people who are dependent on substances have access to healthcare and support services, in a way that respects their right to life and health.

Photo of Monica Lennon Monica Lennon Labour

I am grateful to colleagues on all sides of the chamber who signed the motion and made it possible for the debate to happen. I am also grateful to those members who are going to speak in the debate, and I look forward to listening to their contributions.

This is the third motion on substance misuse that I have lodged for a members’ business debate since I joined the Parliament in 2016. The first debate was in 2017 and the second was in 2019—and now here we are again, debating Scotland’s drug deaths crisis. Our drug death rate is now the highest in Europe.

Words do not feel adequate in response to this humanitarian crisis. For years, recovery activists in Scotland have been telling us politicians, “You keep talking, we keep dying. You keep talking, we keep dying.” Tragically, to our collective shame, they are right. Just before Christmas, following a six-month publication delay, it was finally confirmed that 1,264 people had died in drug-related deaths in 2019. That was in one year alone—it is the highest yearly rate on record. The loss of life from drugs has doubled in a decade.

I put on record my condolences to everyone who has lost a loved one. Behind those grim statistics are real people. They were our mothers and fathers; our husbands, wives and partners; our sons and daughters; and our grandchildren, nephews, nieces and cousins. They were our friends, neighbours and colleagues. In their memory, and to show respect to all who have died, I would be grateful if colleagues would join me in observing a minute’s silence of remembrance.

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Silence.

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Thank you, colleagues.

We have agreed many times in this Parliament that such deaths are preventable. I welcomed Angela Constance to her post as Minister for Drugs Policy last month, and I do so again today. She has been tasked with a critical job, and I know that she is determined to use the time that remains in the current parliamentary session to maximum effect.

I also acknowledge the work that was undertaken by Joe FitzPatrick in his role covering the broader portfolio of public health, wellbeing and sport. I believe that it is right that Joe left his post to allow for fresh leadership, but I want to put on record that his sincerity was never in doubt. I hope that the positive changes that he made, including the work to reduce stigma, are built on.

However, the First Minister has admitted that the Scottish Government’s record on and response to Scotland’s drug deaths crisis is unacceptable and inexcusable. That a minister has been given a very specific and narrow responsibility for drugs policy is very welcome, but it must be backed up with hard cash and a step change across Government. That means no more silo working, no more passing the buck and no more wrong doors. The response to this humanitarian crisis needs a comprehensive public health approach through which person-centred support is available 24/7. That has to be for people who live with substance misuse and, crucially, their families.

On that note, I was pleased this week to see Scottish Families Affected by Alcohol and Drugs receive funding to run the families as lifesavers project. Lack of money and resource for statutory and third sector services has not been the only driver behind the increase in Scotland’s drug deaths, but it is a major factor. Services are running on shoestring budgets. Rehab beds have closed, including on the First Minister’s own doorstep. It has been left to friends and families to pick up the pieces too many times. Some £20 million is required right now for residential rehab, as an absolute minimum.

This morning I spoke to Annemarie Ward, the chief executive officer of Faces & Voices of Recovery UK, or Favor UK. That organisation gave a report with 23 recommendations to the Scottish Government over a year ago. I am pleased to hear that the minister will meet Favor in a few weeks’ time. I asked Annemarie Ward what the new minister needs to do, and she said, “Help people get well.” We need to give people the opportunities to get well and the opportunities to get off drugs. The reality is that too many people are met with a boarded-up door or a waiting list as long as your arm.

Last year, before the lockdown in March, I went to the Castle Craig residential rehab clinic in the Borders and to Abbeycare Scotland in North Lanarkshire. I met staff who had previously been service users and who, when they had felt at rock bottom 15 or 20 years ago, had been able to go to their general practitioner, ask for help and, in a matter of days, enter residential treatment and rehab. In Scotland, over the years, that opportunity has become available to fewer and fewer people.

Everything that needs to be said about what a public response to this emergency should encompass—an emergency that is rooted in poverty, trauma and inequality—has already been said. It has been debated here and elsewhere many times. I am not going to repeat it all now—the answers are already on the minister’s desk. I would be grateful if the minister would outline what immediate action she has taken already and will take in the weeks ahead to ensure that there is a full spectrum of harm reduction, recovery and prevention interventions. We owe it to those who have died and those who are fighting for their lives today to finally treat this emergency with the seriousness and the budget that it deserves.

Photo of Ruth Maguire Ruth Maguire Scottish National Party

I thank Monica Lennon for securing the debate, and welcome the Minister for Drugs Policy, Angela Constance, to her new role.

Three quarters of all drug-related deaths have been in five health board areas: Greater Glasgow and Clyde, Lanarkshire, Lothian, Tayside, and Ayrshire and Arran. Ayrshire and Arran is one of the health board areas with the largest increase in drug deaths over the past decade.

Far too many lives of friends, family members and neighbours have been lost. They were important lives—lives that mattered. It is important to recognise that a lot of good work is being done by good people who are doing their very best, although there is more for all of us to do—in particular, politicians and policy makers.

For complex issues, a person-centred approach has the best chance of being successful. Provision that is truly person centred will meet people where they are, recognise barriers in their way and remove them, and understand and act on the fact that substance addiction is a symptom of wider difficulties, for which it will also identify and provide support. A person-centred approach cannot only be words on a policy document or action plan—it must be the reality for our citizens who need help. Our actions and the experience of our people and their families who require assistance must match the fine words.

I have raised before the matter of punitive sanctions regimes that exist in treatment services. I acknowledge that sanctions in treatment and recovery are not advocated by the Scottish Government, but that has been, and might well remain, the experience for people who try to access help.

I recognise the need for local flexibility and responses, but the sharing across Scotland of knowledge, skills, procedures and processes that work must increase and improve at pace. There is good life-saving work happening. If housing officers in North Ayrshire can, as they have, save lives by administering naloxone, that should be possible across Scotland. If drop-in access and same-day prescribing can be offered and can work in one part of the country, what on earth can be the logic, reason or justification for them not being available to everyone who needs them?

I know that outcomes and measures are important to policy makers and suggest that if it remains easier to buy a dangerous street drug than it is to get help and support, we should consider that to be a measure of failure.

Lives are being saved and services are being delivered now by kind and compassionate workers and volunteers, who will be in pain and distress at the tragic loss of life. Importantly, we also have in our communities people who are in recovery who are supporting their peers to have hope and purpose in their lives. Let us listen to all of them, and not only to the people and organisations who are already plugged in to the system and are frequently consulted and engaged with and who speak our language. Let us listen to the challenging and uncomfortable voices that push us all and show us the reality for our citizens, and not only to the policy intentions in our strategies and action plans.

Most important, let us act with urgency and immediacy—the same urgency and immediacy to save lives that we acted with at the start of the pandemic. We have shown what can be done. We know what needs to happen to save lives, so I say, frankly, shame on all of us if we do not get on with it.

Photo of Neil Findlay Neil Findlay Labour

I congratulate Monica Lennon on bringing forward the debate, and I welcome the minister to her post.

This debate should have been held in Government time, because the drug death crisis is our national shame. It is a collective failure of Government, public bodies and political leaders over the entire duration of the Parliament’s existence and beyond, and it has accelerated in the past decade to the point at which we have the worst drug death record in the developed world.

I have made speech after speech in debates such as this for years, and the only thing that changes is that the situation gets worse. In the short time that I have, I will make only positive suggestions in the hope that the minister—indeed, any minister—might take on board some of what I suggest, all of which is based on having spoken to friends, family, neighbours and constituents who have gone through addiction, whose family member has gone through addiction or who work in the field.

First, can we agree that the war on drugs has been an abject failure? There are more drugs and more deaths than ever in our history, so it is time for a new approach. The impact of drugs is a class issue, because the greatest impact is on the poorest communities; without a serious concerted change of Government policy that sees those communities receive a disproportionately high level of public investment, change will not come.

Although pharmacological intervention for substance misuse can be required, the socioeconomic factors that drive substance misuse and drug-related deaths have to be addressed. Can we agree that we should stop jailing people because of their illness and instead address their conditions through treatment, with a range of options being made available, based on their wants and needs? Can we agree to stop discharging people from prison or hospital on to the streets with no support, treatment, care plan, home or hope? Those people fall out of the system and end up dead.

Can we also agree that the current services that are available to people who want to end their drugs use are completely inadequate, and that we need comprehensive services to meet different needs? Of course, methadone might be part of the solution, but many more people want to be free of illicit and prescription drugs. That is their objective, so we need services that allow that to happen. However, we need a human rights approach that is fully embedded within all services, and we need acknowledgement that rights holders can hold duty bearers to account and that services for the cocaine and benzos crisis are nowhere near adequate and must be addressed as a national priority.

We must follow the example of progressive police and crime commissioners across the UK who have, under the same legal restrictions as Scotland, been using a wide range of measures to reduce deaths and addiction, to improve public health and to divert people from prosecution.

Can we agree to reinstate the money—and more—for every cut that has been made to the drugs and alcohol budget, and stop insulting the memory of those who have died by claiming that there have not been any cuts? Given the crisis, we need to ring fence that money so that it cannot be diverted to the people who are the worried well.

Can we agree that the Government can and will act to end police involvement with the Glasgow overdose prevention van, and that such facilities should be rolled out in communities where people are dying?

Can we agree to hold to account the bodies and agencies that have been funded year on year to address the situation? If they have failed, we should take the funding from them and fund new effective provision, and ensure accountability and appropriate governance arrangements.

Can we understand what we are spending money on, what the cost of treatment is and the real number of people who access treatments? Can we agree to undertake a full assessment of local needs based on accurate data?

Finally, will the minister agree to initiate an immediate independent review to look at the experience of decriminalisation of all drugs in other countries, which have had similar problems to Scotland’s?

I could say more, but I have no time to do so. However, I say to the minister that my door is open and that I will work with her on any of that, because the matter is far too important for it to be a party-political bun fight. I know that colleagues who want to speak in the debate would also work with her.

Photo of Stuart McMillan Stuart McMillan Scottish National Party

I thank Monica Lennon for bringing the debate to the chamber. Although the motion talks about central Scotland, I will focus my comments on Inverclyde or Scotland rather than central Scotland, which is not my area.

I refer members to my entry in the register of members’ interests: I am a member of the management board of Moving On Inverclyde, which is a local addiction service.

I welcome Angela Constance to her new ministerial position and I wish her well in that challenging role. I thank Joe FitzPatrick for his efforts and for the creation of a drug deaths task force, which I am sure will prove to be a vital addition to dealing with the crisis as we move forward.

The latest figures for 2019 must be a wake-up call for every politician but also for society. Tough decisions need to be taken; the souls of 1,264 people need to force every one of us and every politician to look at every policy and delivery model to see whether it is doing enough. It is essential that those 1,264 deaths tell us to look at the gaps in policy areas. I must emphasise to colleagues that that is not a constitutional point. Some of the policy gaps may be in devolved areas, although some may be in reserved areas. Fundamentally, every policy area must be on the table for discussion.

Sadly, Inverclyde is behind only Dundee and Glasgow, respectively, with regard to drug deaths: 33 of my constituents died as a result of drugs in 2019, which was almost a 50 per cent increase on 2018. It cannot continue. If we consider the three areas with the most deaths, it is clear that social justice is a key issue in the extent of drugs deaths in Scotland. Poverty, deprivation, unemployment and industrial decline are reasons behind many—although not all—drug deaths. It is also a fact that many more deaths are of older drug users.

On 15 December, the BBC wrote:

“During the 1980s and 90s there was a significant increase in problem drug users in Scotland, which peaked about 20 years ago.

There is now an ageing population of drug addicts, mainly men, who have been using heroin for decades.”

We already know this. Clearly, it needs to be highlighted time and again. If we can sort out some of the social justice and equalities issues, we can give drug users and communities a better chance for the future.

I would like to see a few things considered as we try to deal with the national crisis. First, Inverclyde is not included the naloxone pilot that is under way in Dundee, Glasgow and Falkirk. All three areas cover different health board areas, and Inverclyde should be included because of our current situation. Secondly, third sector organisations that are more successful in helping people with drug addictions should be considered for direct funding. Thirdly, an increase in the number of people going to residential detox facilities is important. I have spoken to many people about that in the past.

Fourthly, the introduction of drug consumption facilities is essential. Emma Harper and I met Peter Krykant outside the Parliament only a few weeks ago, and I have become even more convinced that such provision will help many more people and communities. Fifthly, further analysis of local alcohol and drug partnerships is essential. Inverclyde has had a major change of direction over the past 18 months, and I hope that that change will save more lives in the future.

There are many more things that I would like to discuss, but time is short. I am keen to discuss issues with the minister directly if her diary allows that.

Photo of Brian Whittle Brian Whittle Conservative

I thank Monica Lennon for giving us another opportunity to discuss this continuing crisis—death from drug and alcohol misuse is a crisis in Scotland. The current rate is the worst in the world per capita and is three times that of the UK. The drug deaths rate more than doubled between 2008 and 2018, and it shows no sign of slowing down.

From the outset, I want to highlight that there are two sides to the issue: treatment for those caught in addiction and the creation of an environment in which addiction is avoided. I will speak about the link between deprivation and addiction, which is an issue that I have been working on for some time. Children who are born in the most deprived areas are three times more likely to die before they are 25. That undoubtedly correlates with increased alcohol and drug abuse, coupled with suicides.

In 2019, I joined the Scottish Affairs Committee at Westminster for its investigation into Scotland’s drug issue. The committee concluded that deprivation does not directly cause addiction and that the links between poverty and drug misuse are complex. The main mechanisms that are described as credible links between deprivation and problem drug use are weak family bonds, psychological discomfort and personal distress, low employment opportunities and few community resources. Once someone has a drug problem, they also have more limited means of escaping poverty—the chance of obtaining paid employment is much reduced, and having a criminal record, lacking an employment history and the stigma of having or having had a substance problem all play a part.

To me, it stands to reason that resources should be allocated prior to people becoming addicted. Surely, that has to be the most cost-effective investment. Put simply, we know where the areas are, so we can ensure that the solutions and investment are targeted. If there are fewer community resources in those areas, resources should be developed to fit the communities.

The Scottish Drugs Forum found that there is a significant connection between poverty and personal factors that increase the likelihood of problem drug use. Such factors include adverse childhood experiences; poor engagement with, or outcomes from, educational services; poor engagement with health services; early engagement with the criminal justice system; imprisonment; and homelessness.

According to the conclusions from the conference “A Matter of Life and Death”, which was attended by some 110 organisations that are associated with the prevention and treatment of drug and alcohol misuse, the main causes of drug and alcohol misuse include marginalisation and exclusion; a lack of social structure; poor relationships; a lack of protective factors; self-medication associated with masking the pain of previous trauma; stigma; self-deprecation; barriers to achievement; and homelessness. Deprivation and inequality make those factors more acute and can lead to a situation in which it is less likely that a person can access quality treatment and help. They also mean that a person might lack access to general community services, have an unmet complex health need and lack an effective support structure.

Between 2008 and 2018, the number of rehabilitation beds was cut drastically from 352 in 22 facilities to fewer than 70 in three facilities. Those cuts must be reversed, and quickly. That is a key ask of the Scottish Conservatives.

We have to invest in rehabilitation hubs, which pull together the resources of the NHS drug and alcohol partnerships and the third sector. As others have mentioned, the third sector is fragmented and underfunded. Organisations spend far too much time scrapping with one another for limited funding pots.

Many of the hardest-to-reach people in our society who are caught by the scourge of addiction are from the most deprived areas. They are also the least likely to engage with services in a medical facility. They are, however, more likely to work with third sector agencies in the community with which they can identify and take the time to build a trusting relationship.

From my interaction with services such as recovery enterprises in my area, I know that their work provides the best route for the most vulnerable, but that work is done on a shoestring budget. Once that relationship is created, there is the potential to offer medical interventions on the premises from healthcare professionals, welfare officers, housing officers and so on. In other words, we should bring services to those people.

In the hubs, there should be the option of rehabilitation beds, cafes and professional advice. Mental health services should be offered as an integral part of rehabilitation services. Given that drug misuse is so prevalent in prison communities, pathways from prisons into communities have to be created. There should also be an increase in the number of needle exchange programmes, with a view to reducing the number of cases of HIV and eradicating hepatitis C.

Those actions are all within the competence of the Scottish Government, and we know from those on the front line that they can have a significant impact on addiction. We cannot hide behind constitutional disagreements. The Government’s calls for changes in the legal framework would be more viable if it was prepared to make use of the substantial powers that it currently has at hand.

Those actions will require significant resources and attention, and that focus is long overdue. As Neil Findlay said, many of us who have been consistently involved in such debates would put party politics aside and work with the minister to develop a strategy. I ask the minister to please take us up on that offer.

Photo of Emma Harper Emma Harper Scottish National Party

I welcome the opportunity to speak in the debate and thank Monica Lennon for securing it.

I congratulate Angela Constance on her appointment as the Minister for Drugs Policy, and I look forward to meeting her to explore options to address drug misuse in rural areas such as Dumfries and Galloway in my South Scotland region. I have no doubt that her Government experience and prior work will be hugely beneficial in her new role. I also thank Joe FitzPatrick for his previous work.

I agree with the motion and the Government that the drug-related death figures that were published in December are unacceptable. We need to move at pace, with new and innovative person-centred approaches, to better deal with problem drug use in Scotland.

As the deputy convener of the Health and Sport Committee, I had the opportunity, in 2019, to participate in the Scottish Affairs Committee’s inquiry into drug-related deaths. All the witnesses to the inquiry said that urgent reform is needed to solve the issue of drug deaths in Scotland. The inquiry heard from experts from Portugal, Germany and Canada in order to examine evidence from international examples of countries that are taking a progressive public health response, and not a punitive approach, such as jailing people, as Neil Findlay described. A progressive public health approach is what we need to tackle harmful drug use. The inquiry found that levels of drug deaths and addiction in those countries have reduced significantly, including, in Canada, by as much as 40 per cent.

The inquiry recommended that the carrying of personal amounts of drugs should be decriminalised. It also recommended that the UK Government urgently legislate to devolve power to the Scottish Parliament to allow it to deliver its own approaches, including the establishment of safe consumption facilities in Scotland. Such reforms would, for example, help people such as Peter Krykant, whom I met outside Parliament before Christmas, as Stuart McMillan mentioned. All Peter wants to do is support people who have problem drug use that is causing them harm.

The Scottish Affairs Committee’s findings remain important, and I am keen to hear the minister’s thoughts on the inquiry recommendations, especially since the UK Government has completely ignored them all. It would be good if all Governments worked together to save lives.

Today, I spoke with Grahame Clarke from the Dumfries and Galloway alcohol and drug partnership. Grahame described a number of actions that are already in place locally and nationally. He and his team should be thanked for all their work. The actions include the national naloxone programme, the distribution of take-home naloxone kits, which are used to prevent fatal overdoses of heroin-based drugs, and making nasal naloxone available to Police Scotland and drug support groups.

Grahame also described assertive outreach following non-fatal overdoses, which involves engaging, treating and offering support in relation to housing, food, social security, child and adolescent mental health services, recovery cafes, recovery communities and even apprenticeships and independent living. All of that sounds to me like joined-up, not siloed, working. It is all good work.

The Scottish Government has also implemented the drug and alcohol information system, which commenced on 1 December 2020 and provides key information on the impact of drug and alcohol treatment services.

All the actions that are being taken to address the issues, especially stigma, are important. Tackling stigma is one of the actions that Grahame and his team have taken forward in Dumfries and Galloway, and it is hugely important.

I ask for a commitment from the minister that any policy approach will ensure that rural parts of Scotland are considered, listened to and included. I welcome the swift action that the First Minister and the minister have taken on the issue since her recent appointment.

Grahame Clarke told me today that getting help to those who are most at risk, not only at the time of crisis but through recovery and support, will reduce the number of deaths of our fellow citizens in Scotland. I look forward to supporting progress and to the achievement of better outcomes in future.

Photo of Alex Cole-Hamilton Alex Cole-Hamilton Liberal Democrat

I am grateful to Monica Lennon for securing time for the debate, and I, too, welcome the new Minister for Drugs Policy to her place. It is a desperately important role—she knows that, because she knows the figures.

We have had record numbers of deaths for years. Since the start of this parliamentary session, 4,253 people have died from a drug-related death. Scotland’s drug-related death rate is more than 3.5 times that of England and Wales or, indeed, anywhere else in Europe. Scotland is quite literally off the charts.

There has long been fatalism in the discussions around Scotland’s drugs death crisis. We say that these people are not well, that there is little that anyone could have done and that it is the unavoidable and inevitable legacy of ageing drug users and a so-called “Trainspotting” generation, as Stuart McMillan mentioned. However, those excuses are cold comfort to the families of the 1,264 people who died in 2018, of whom 76 were under 24—a figure that has doubled in two years—and 677 were between 25 and 45. People are dying three, four and five decades earlier than they should. Every death is preventable.

At the outset of this session of Parliament, ministers described the situation as a legacy of misuse that stretched back for decades, but at that same moment they chose to make a devastating 23 per cent cut to drug and alcohol partnership budgets. That cut amounted to £1.3 million per year in our nation’s capital alone, and services and expertise that people relied upon were surrendered. The impact of that is still being felt, and we see the selfless acts of private citizens such as Peter Krykant, who are unwilling to see that gap go unfilled.

The cut was preventable. On the day that that Scottish budget was passed, Willie Rennie was the only person to appeal for a rethink. The tragic truth is that Scottish ministers did not see drug reform as a vote winner. Kenny MacAskill, who was Cabinet Secretary for Justice for seven years, including at the time of the independence referendum, acknowledged that. Writing in 2017, he said:

“Silence may have been understandable when the referendum was on-going. Now it is simply cowardly as tragedy unfolds.”

I repeat:

“Silence may have been understandable when the referendum was on-going.”

Tell that to the families.

It is time to put recovery first. I ask the new drugs minister not to shy away from the mistakes of the past, but to own them. I know and like Angela Constance, and I am confident that she will do that. We must be able to talk openly about what is missing if we are to talk about what must now be done. I ask her to look again at our long-held proposals, including those that the Government voted down last January. We should look again at the Portuguese model: we are leagues behind our European partners’ best practice and what is now mainstream evidence of what works.

We need political support for the principle of diversion for people who are caught with drugs for personal use. We need support for those routes to be created—the use of imprisonment in such cases should cease. Let us look at what can be done by using the powers of the Lord Advocate. We should follow the Thames Valley Police, North Wales Police and Durham Police pilot schemes. We ought to plan for a Scotland-wide network of heroin-assisted treatment and look at why families are having to self-fund residential rehab. We must commit to protecting drug partnership budgets.

I also want to see change at the UK level. It is a matter of public record that I support extending the Scottish Government’s involvement in the development of a UK-wide policy framework on drugs. The Scottish Government cannot use the constitution to avoid the conclusion arrived at by the Scottish Affairs Committee. There is undoubtedly more that it can do.

I look forward to working with the new minister.

Photo of Bob Doris Bob Doris Scottish National Party

I thank Monica Lennon for securing a crucial and timely debate and I welcome Angela Constance to her post. I look forward to working with her and I thank Joe FitzPatrick for his years of service.

As other members have said about their communities, my constituency has been blighted for too many years by drug-related deaths. The numbers continue to increase. That has had a scarring effect. This is about not only a tragic loss of loved ones, but the consequences for and impact on the families left behind that can last a lifetime.

The debate is an opportunity to again record my belief that we need far more rehab facilities in Scotland. I have called for that in the Parliament on several occasions. Before I say more about that, I acknowledge that there are many pathways to recovery. I welcome the community supports that exist and want to give a special mention to Sustainable Interventions Supporting Change Outside, which is very active in my constituency. I look forward to a hoped-for meeting with the minister, SISCO and Anne McLaughlin MP in the coming weeks.

I also welcome the heroin-assisted treatment that exists in Glasgow. I know that that is relatively small in scale, but I hope that it can be expanded and rolled out across the country. I also acknowledge the substantial efforts of Peter Krykant, whose work on overdose prevention and safe consumption facilities in Glasgow has already been mentioned.

Safe consumption facilities save lives. It is clear that if drugs legislation were altered, or were devolved to this Parliament, NHS Greater Glasgow and Clyde would be ready to deliver a purpose-built service. That is not a constitutional point. I am merely stating that the health board is ready to roll out that service. That said, I look forward to hearing from the minister about how we can resolve the current legal deadlock, which puts a man with a van who simply wishes to save lives at risk of conviction. That does not seem right to me.

I said that I wanted to look at residential rehab. It is simply not possible to offer the range of treatment options and supports for people who are living with addiction within the extent of the rehab beds and facilities that we have in Scotland just now. The Scottish Government’s short-life working group via the task force has shown that there are only 365 beds in Scotland, of which 100 are for people not normally resident in Scotland. Of the people who are in those beds, 36 per cent are self-funded, 27 per cent are funded through social security and charities, 22 per cent are funded through private insurance and only 13 per cent are funded through alcohol and drug partnerships. That does not seem right.

Of the 1,340 estimated starts for people in rehab beds in the last year that we have figures for, 830 were people who were normally resident in Scotland, which contrasts with 40,000 alcohol and drug treatment starts over that same period. Of those 40,000 treatment starts, only 830 looked at rehab as part of their treatment options, which is 5 per cent of all referrals. In Europe, the figure is around 11 per cent, so we need a doubling of the rehab opportunities in Scotland, at the very least.

The short-life working group also said:

“A review of the evidence in 2017 ... found that although seen as expensive, residential rehabilitation’s initial costs are to a large extent offset by reductions in subsequent healthcare and criminal justice costs.”

I do not mention that in relation to the economic argument for rehab beds. It is more about the fact that people who have healthcare and addiction issues should not have to go through the criminal justice system time and again. Too many of them are unfortunately ending up dead.

There are positive signs of change, although not fast enough, clearly. The new prison to rehab pathway for people leaving custody is in its early days. There has been £150,000 of investment, but only eight people have been through that service so far. It has to be upscaled and rolled out more widely. I read about the Scottish Recovery Consortium, which is developing a mixed community and rehab model aimed at people who have survived overdoses or who are at high risk of overdosing. I do not have any numbers for that minister, so I would like to hear much more about it and how it can be upscaled.

When we look at the success of rehab, the Government work was only able to get five facilities to provide figures. The number of people who completed rehab periods for their stays ranged from 24 to 88 per cent at the different facilities. That is a dramatic range. However, it was unclear for what length of time individuals were staying within facilities or what additional community support pathways existed, depending on where individuals were. What was clear from Phoenix Futures was that 92 per cent of people in residential rehab had significant emotional and mental health issues, so the wraparound help and support of residential rehab is just part of that solution.

My apologies—I can see that we are pushed for time. I finish by saying that there are still many gaps in information from the mapping exercise that the Scottish Government conducted on residential rehab, but we cannot take the time to do a second mapping exercise. We have to upscale now and put significant additional residential rehab facilities in place, perhaps nationally and funded nationally, and we should allow alcohol and drug partnerships to bid for beds in those national facilities, if required. If that national network was put in place and ADPs were not referring people who would benefit from that treatment, we would have to ask why and make it happen.

The Deputy Presiding Officer:

The last speaker in the open debate is John Finnie.

Photo of John Finnie John Finnie Green

I join others in thanking Monica Lennon for bringing this important debate to the chamber. I also thank Joe FitzPatrick, the former minister, and welcome Angela Constance to what is clearly a challenging post. I am sure that she is up to it.

I will quote variously from the motion, which mentions a “national public health crisis”. It is unquestionably that; and as others have said, it is not only the preserve of the urban central belt. It also affects rural communities in a devastating way and

“every life lost ... is a ... tragedy”.

The motion also says that

“more action could be taken at a national and local level”.

Undoubtedly it could, although, as other members have said, some great work has been done.

The problem, to my mind, is that drug deaths are not a priority for many of our constituents. Sadly, many of them view such deaths as an inevitable consequence of the actions of some unclean criminal underclass. We all know that that view is not only deeply offensive, but wholly inaccurate. However, it plays into the wider public discourse on the debate, so I welcome the element of the motion that discusses addressing stigma, as a number of members have done.

The motion says that

“funded access to residential rehabilitation must be widened”.

Of course, although I am concerned about some of the discussion on that from some quarters—certainly not from the author of the motion—including quaint notions of curing people in residential establishments and of “out of sight, out of mind.” Residential treatment is important, but it is one of a range of treatments that should all be available and all be properly funded. The debate is all about treatment, recovery and on-going support; it is about understanding addiction and understanding the support for the lapses that will inevitably occur.

Patrick Harvie co-signed with me a letter to the Lord Advocate about the case that many members have alluded to, concerning a gentleman in Glasgow. Although I did not expect a detailed response in respect of that particular situation, I commended to the Lord Advocate the practice that his predecessors had adopted in relation to the public interest approach when instructing prosecutors regarding instances that were contrary to the clear legal position of the day. I cited the situation of consensual homosexual sex.

The Lord Advocate’s predecessors were rightly lauded for adopting a bolder emphasis on prosecuting in the public interest, and I commended that same approach. I got a reply from the Lord Advocate yesterday. He obviously could not comment on the specific case, but he had published prosecuting guidelines in relation to the use of naloxone, which some members spoke about earlier. He said:

“It will be clear to you that what I have described is quite different from providing a statement of prosecution policy of general application”.

I am sorry, but it is not quite clear; I think that it does create a precedent that should be built on.

That is a very frustrating point, given the limited time that we have, but I wish to say that our obligation as legislators is to understand whether there is a legislative problem that needs to be addressed. There is a legislative problem: UK drugs legislation, which is focused on the long-discredited phoney war on drugs. A headline in a satirical magazine said, “Drugs Win Drug War”. The legislation is part of the problem; it is certainly not the solution. The legislation is reserved and, if people want to think of the issue as a constitutional one, that is fair enough—they can do that—but that is not what it is about for me. We should be doing our very best to address a situation and, if the legislation is a problem, as I believe that it is, then we must legislate, pushing the boundaries and, indeed, the competence of the Parliament. Or we can just sit and await the next series of grim figures.

We rightly marked the deaths with silence, but I suspect that I am not alone in wanting to scream out in anguish at the situation that we find ourselves in.

My time is up. I wish the minister well and, like others, I am happy to work with her.

Photo of Angela Constance Angela Constance Scottish National Party

Every day in Scotland, three of our fellow citizens—someone’s brother, sister, son or daughter—die from a drug-related death. I put on record my condolences to all families who have lost a loved one. Those deaths are both tragic and preventable. I thank Monica Lennon for securing this critical debate, and I thank all members who have participated for their contributions, commitment and suggestions. I will indeed be taking members up on some of their offers.

I am happy to meet Stuart McMillan, Emma Harper and Bob Doris, and I have many meetings already arranged with MSPs, councillors and MPs from across the party-political divide.

I am crystal clear that, to save lives, we need to do more, we need to do better and we need to do it faster. As a pragmatist, I will always focus on what I can do as opposed to what I cannot. The first thing that I did as Minister for Drugs Policy was to meet people with lived experience, and that will not be a one-off event. Ensuring that the voice of real-life experience informs every step of our journey was crucial in the work that I was involved in when I was last in the Government: social security, homelessness and child poverty. Those with lived—and living—experience and their families will be at the heart of our national mission.

I am glad that Monica Lennon recognised the support that we have given to the families as lifesavers project. I will hear from families who have received too little, too late. I will also hear from parents who are worried sick about receiving that phone call or knock on the door. I will hear, too, from survivors who are in recovery or treatment. I am determined to find the best way to reach out to those who currently live with drug addiction but who are not in treatment or engaged with services. Being in treatment is a protective factor. My focus will be on getting more people into treatment that is right for them, particularly those who are hard to reach and most at risk. We must remove barriers to people accessing treatment and obstacles to their remaining there.

I want to build consensus both within and outwith the Parliament. That will not necessarily be comfortable or cosy, and it most certainly will not be complacent; it will be about challenging ourselves and each other on the basis of what works. I will learn from experience, evidence and research, regardless of whether it has been done at UK, European or international level.

We need a spectrum of services and approaches that will respond to this public health emergency, reduce harms and promote the right route to recovery for each individual—nothing less than the right treatment at the right time. We need to have a culture of change and compassion to ensure that services are responsive, flexible and people centred.

We do not need to wait around for evidence; we can gather it in action. As well as doing things differently, like Ruth Maguire I want to scale up work that already has promise. The drug deaths task force, which the First Minister and I met this week, has tested and led the way on life-saving emergency treatments such as naloxone. I have met a father who told me that naloxone saved his son time and again. The Scottish Ambulance Service is doing great work to increase distribution of that tool on the front line.

However, I am also acutely aware that 60 per cent of those who died from drug deaths in Dundee died alone—they were using drugs alone and they died alone. We need to scale up pilots to ensure that, if someone to presents to services with an overdose, we not only save their life but offer them treatment immediately. We know that more than half of those who die drug-related deaths have a history of overdose. We need to roll out, at pace, the task force’s previous work on new standards of care and treatment so that there is equity of access across the country. I hear what Stuart McMillan said in that regard. We need a presumption of family involvement, and all individuals must have good treatment options. We need better treatments for poly-drug misuse and benzodiazepine dependence, and we must ensure that prescribing practice is effective in keeping people alive. Ruth Maguire was quite correct to say that people should never feel punished for seeking help.

All the individuals on the task force, including those with lived experience, have given their time and talents to identify what we must do now. I am grateful to them. However, I say to members of the Scottish Parliament that the Scottish Government’s strategy is bigger and broader than the specialist, focused work of the task force. We need to ensure that our own house is in order. We need to join the dots across Government, making all the correct connections through our good work on mental health, homelessness, adverse childhood experiences and the justice system, and of course through tackling poverty and inequality in our communities.

I agree with Neil Findlay that this is indeed a class issue, but I also agree that addiction can affect any family at any time, anywhere in the country. It is our job in the Government to lead, to have a razor-sharp focus on implementation and to work with others—whether it is health and social care bodies, alcohol and drug partnerships or the third sector—to ensure that funding reaches the front line. Also, we need to prevent unplanned discharges from treatment and to support people and follow up when that happens.

Our folk should never run out of chances for change. Sometimes, people need second chances, third chances or fourth chances. We need to stick with people over the long term. I am cognisant of the particular role that the third sector has to play, in genuine partnership with the statutory sector. It can be fleet of foot and responsive and help us with outreach services and reach those who are furthest away.

There is an urgent necessity to act to reduce harms now; I believe in the housing first approach model, but I also believe in the power of residential rehabilitation. The First Minister will make a statement next week laying out how we will achieve a step change in the short, medium and longer term. That will include a commitment to increase the provision of residential rehabilitation and bring our bed numbers up to the European average.

This is a new portfolio and I would never demur on the importance of resources. I have been clear, in discussions with the First Minister and the finance secretary, that the scale of work should not be underestimated. It will require significant investment over time to effect the change that we want.

I will very much follow the money, whether that is in relation to current or new resources, and I will be constantly assessing the impact of that money. If we have to change how we provide funding, we will consider that, because Monica Lennon is right—there must be no wrong door when it comes to receiving support.

Our response to the global pandemic has demonstrated that rapid change is possible and there should be no returning to normal where new approaches to care and treatment within prison and within the community have worked.

Last week, I had the pleasure of meeting Peter Krykant and hearing directly about the work that he does in Glasgow. We discussed our shared desire for overdose prevention facilities to be made available in Scotland and I assured him that we would investigate any possible avenue that would allow for the operation of such facilities here. It is vital that we do not close the door to any evidence-based solution, but it is also important that any service that we offer is provided within a safe, legal framework for the sake of those who will use the service and those who work in that service.

However, there is not one solution—there are many. That is why having the courage to debate what works is crucial, because everything that we say and do must lead to better-informed debate that knocks down stigma and obstacles to change and leads to better outcomes for the people we seek to serve. We seek to serve those who have been underserved and to do so for their sake but also in memory of those who are gone but not forgotten.

The Deputy Presiding Officer:

That concludes the members’ business debate on Scotland’s drug deaths crisis.