Drug-related Deaths

– in the Scottish Parliament on 17th June 2021.

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Photo of Alison Johnstone Alison Johnstone Green

I remind members that social distancing measures are in place in the chamber and across the Holyrood campus. I ask members to take care to observe the measures, including when entering and exiting the chamber. They should use the aisles and walkways only to access their seat and when moving around the chamber.

The next item of business is a debate on motion S6M-00400, in the name of Angela Constance, on tackling drug-related deaths. I will give members a couple of minutes to rearrange their seating positions.

I invite members who wish to speak in the debate to press their request-to-speak button.

Photo of Angela Constance Angela Constance Scottish National Party

Thank you, Presiding Officer. I welcome you, as well as new and returning MSPs—including health spokespeople—to your new roles. I look forward to working with you all as we continue on our national mission to prevent drug-related deaths.

At the start of the year, the First Minister announced an additional £250 million over the next five years to promote recovery and reduce the harm that is caused by drugs. In my role, I will continue to work across boundaries to both save and improve lives, through drugs services and services in mental health, homelessness, the justice system, and drugs education and prevention, as well as through tackling inequality. The core aim of this work is to support more people into the treatment and recovery that is right for them.

In March, I gave a commitment to Parliament to provide an update on this work and on funding allocations. In that month, we announced that £18 million would be allocated to four new funds: for recovery, local support, families and children, and service improvement. I am pleased to say that those funds opened at the end of May. They are multiyear funds, which will provide a shift to longer-term funding that provides security for third sector and grass-roots organisations, which are often at the forefront of saving lives.

I have listened to and acted on feedback about previous schemes. There is now a lighter-touch application process for smaller funds, and we are providing funding to third sector partners to help people through the application process. The first round of grants is reaching communities this month, so that funding is already making a difference.

Another important step forward has been the publication of the new medication-assisted treatment—MAT—standards at the end of May. The implementation of the new standards for treatment and care will be one of the key foundation stones for changing and improving services, meaning that, no matter where someone lives, the right treatment will be available to them quickly. The standards make a vital connection between informed and wider choice of treatment and other services and support, such as mental health, housing and welfare, and they include a presumption of family involvement. The standards make crystal clear what everyone has the right to expect and can demand from services.

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

Does the cabinet secretary agree with me that it is vitally important that, where we are trying to help mothers with substance-use issues to manage those issues, they are able to do so with their children, so that we are not compounding the adverse childhood experiences of those children?

Photo of Angela Constance Angela Constance Scottish National Party

Absolutely. In short—yes, I agree that we must keep the promise.

The implementation of the standards is key. That is why, following the first meeting of the national mission implementation group yesterday, I announced £4 million of investment to ensure that we translate words into action. The first two standards—on same-day treatment and a wider range of options—should be implemented as a priority. We expect them to be in place in many areas by autumn, and to be fully in place by April 2022.

The MAT standards also pave the way for new and improved treatment offers. One of those will be long-lasting buprenorphine, or Buvidal, which is an alternative to methadone. Buvidal treatment has three main benefits. It requires only a weekly or monthly injection, which helps reduce the stigma that many feel when they have to go to the pharmacy every day. It gives people more clarity of thought, allowing them to get on with their lives. In addition, Buvidal is not usually associated with overdoses. It will not suit everyone, but feedback from people who have switched to Buvidal in pilot areas and in prison settings is very positive. We are allocating £4 million this year to encourage services to make that option more available.

The number of deaths in which illicit benzodiazepines are implicated continues to rise. It is therefore imperative that we build consensus among clinicians and others, working in collaboration with the sector and with people with lived experience, to help develop a treatment offer that reduces risks for people who are using street substances and addresses their needs. Related prescribing guidance is being produced this year by both the Scottish Drug Deaths Taskforce and the Scottish Government. I will continue my efforts to persuade the United Kingdom Government of the necessity for drug-checking facilities in Scotland, which would help identify any substances that put lives at risk. I am also continuing to call on the UK Government to allow for restrictions to be set on the possession of pill presses.

Along with many other members, I also support heroin-assisted treatment as another option that should be made more available. It requires significant resources and a comparatively long lead-in time to set up, but I believe that it is worth the effort, and we are working with health boards to identify areas in which such services could be introduced. We will allocate £400,000 to explore the opportunities.

The Government is also fully committed to the establishment of safer drug consumption facilities. The evidence quite simply shows that they help to reduce drug deaths.

Photo of Stephen Kerr Stephen Kerr Conservative

Karen Briggs, the chief executive officer of Phoenix Future in Falkirk has said:

“We know many people across Scotland would benefit from residential treatment but aren’t able to access it.”

Will the Government take steps to provide more beds in residential situations? There are currently no beds at all in Falkirk.

Photo of Angela Constance Angela Constance Scottish National Party

Absolutely. We are committed to investing in and increasing the capacity in residential care, particularly where there is acute need.

I go back to the point about safer drug consumption facilities, on which I thought Mr Kerr was going to opine. I will continue to pursue two approaches at the same time. I am engaging the UK Government on the evidence, and seeking to persuade it to allow those life-saving facilities or to devolve the powers to the Scottish Parliament. In the meantime, we are also working with services to leave no stone unturned to overcome the existing legal barriers in our duty to seek solutions here in Scotland. [

Interruption

.] I want to move on. I did not realise that I had only 11 minutes; I thought that I had 13. Perhaps I can take the member’s point later; I do hope so.

The majority of people who die as the result of an overdose will previously have been treated in our national health service for a near-fatal overdose. Therefore, a major focus in our work will be to improve our response to near-fatal overdose. The Scottish Ambulance Service set up our first, formal near-fatal overdose pathways and we will expand those pathways so that they exist nationwide.

In the first few months of 2021, our front-line emergency services also increased the use of naloxone, which can help to avoid death from overdose. Every opportunity must be taken to get people the immediate treatment and support that will help to prevent a fatal overdose. We are therefore investing £3 million to build capacity in services and to increase the number of people who are brought to services following an overdose.

There are still far too many people who services have not reached, so we will invest another £3 million to support outreach services. That will help to ensure that there is effective outreach in every local authority area.

Alcohol and drug partnerships play a vital role in supporting and shaping front-line services. To ensure that those services provide support to families, through a whole-family approach, I am allocating £3.5 million to ADPs. On top of that, we will also ensure that ADPs receive an additional £10 million, and I am specifying that £5 million of that must be used to increase the use of residential rehabilitation and associated aftercare. I will be following the money with health boards to ensure that it is being used effectively for people who need support.

During the next five years, we are committing to invest £100 million for residential rehabilitation, which will be provided through an increasing profile of investment over five years. It will start with around £13 million of investment this year through the ADP funding and through the recovery and improvement funds, which were launched a few months ago. During the summer, working with the residential rehabilitation working group and other partners, we will agree milestones for that five-year investment. After recess, I will bring more details on those to Parliament.

Earlier this year, we published a detailed breakdown of current capacity. We are now working with partners to assess the demand for placements, where they will be provided, and what sort of specialist facilities will be needed. I am particularly concerned about the lack of provision for women with children.

The working group is developing new guidance to increase accessibility and improve referral pathways and support for people when they are leaving rehabilitation. That is so that we can realise our ambition that, where residential rehabilitation can be of benefit, everyone can access it in a way that is right for them.

In March, I gave a commitment to Parliament to ensure that the voice of real-life experience informs our journey every step of the way. I said that people, families, networks and communities will be more involved in local and national decision making. I am allocating £500,000 to ADPs to be used to improve the existing local forums and panels that they lead. Many of those work well, but there is more to be done to build consistency for everyone. We will be working with ADPs during the summer to support necessary improvements.

During the summer, I will also set out our timetable for establishing a national experience collaborative. I see that national collaborative as one part of our preparations for a citizens assembly on drug law reform. I have allocated another £500,000 to support the setting up and running of the new collaborative.

People with problem drug use can be the most isolated, marginalised and vulnerable of citizens, and they are likely to be among the worst affected by Covid. It has been challenging to maintain a full range of face-to-face support during the pandemic, but many of those who are already in treatment have experienced more contact, albeit mainly by phone or online. We expect to see National Records of Scotland’s annual report on drug deaths for 2020 in July. That will give us a better picture of the impact of Covid last year.

During the pandemic, we have significantly improved drugs surveillance. Public Health Scotland, working with Police Scotland, has captured regular reports of potential drug deaths, and those reports have already helped services to react faster to emerging trends. That is why we are now building a better public health surveillance system.

We are also working with National Records of Scotland on how more regular reporting of drug deaths will be put in place this year, in addition to its annual report. We are currently consulting on a new annual target for treatment and a framework to measure progress, implementation and the allocation of resources, and we will also run media campaigns on the use of naloxone and, crucially, tackling stigma. We are working with partners and the lived and living experience communities to develop campaigns.

Finally, families and the lived and living experience communities tell me that accountability at all levels is important to them. That is the challenge for each and every one of us. I have a duty to work with and collaborate with everyone, whether they are local partners or the UK Government, but I also have a responsibility to fully utilise our existing powers and resources and to seek solutions in Scotland.

I look forward to this afternoon’s debate.

I move,

That the Parliament supports the national mission to tackle drug-related deaths and harms; welcomes proposals for the introduction of guidance to increase the accessibility of residential rehabilitation programmes; notes that increased funding is supporting enhancements to ensure that resources reach frontline treatment, rehabilitation and recovery services in areas of acute demand; believes that the new Medication-Assisted Treatment Standards are fundamental to ensuring that everyone who requires support can get access to the drug treatment or support option that they seek; further believes that actions on the standards, such as the implementation of same-day prescribing and increasing the range of treatment options available across the country, will help save lives, and supports calls for an urgent four-nations summit to consider reform of the 50-year-old Misuse of Drugs Act 1971 to fully align the law with a public health response, so that all options for tackling the harm caused by drugs can be deployed, if supported by the Scottish Parliament.

Photo of Sue Webber Sue Webber Conservative

I will speak to the amendment that has been lodged in my name on behalf of the Scottish Conservatives.

Drug deaths have become Scotland’s national tragedy under the SNP. They have now reached a record high, and too many families and communities have been blighted by the crisis. The drug death rate in Scotland is three and a half times worse than that in the rest of the UK, and it is the worst in Europe. After nearly 14 years in power, the SNP has finally admitted that it should have done more to tackle Scotland’s scandalous rate of drug deaths. I listened with keen interest to what the cabinet secretary said.

By Nicola Sturgeon’s own admission, she took her eye off the ball. In 2007, 455 people died in Scotland following drug use; in 2019, the figure had risen to 1,264. The drug death rate has almost tripled on the SNP’s watch, and the SNP should be ashamed of its record. The First Minister completely failed to act before the crisis spiralled out of control.

Drug-related hospitalisations have tripled in the past two decades. According to figures that were released by Public Health Scotland earlier this week, in 2019-20 there were 14,976 drug-related hospital stays. The drugs hospitalisation rate in Scotland now stands at 282 per 100,000 people. That is up from 87 per 100,000 people in 1997. The NHS Tayside figure of 334 per 100,000 people is far higher than the national average, and the Dundee City Council area boasts the worst drug death rate in Scotland. More locally, in the Lothian health board region, the number of people who died following drug use rose from 54 in 2007 to 155 in 2019—an upward trend that matches the Scotland-wide picture.

One cannot disagree that that increase has a significant knock-on effect on the national health service, reducing its capacity to deal with other cases. We hear time and time again that Scotland’s NHS is at its limit—that cannot be argued with. By doing all that we can to reduce those admissions, we can relieve pressure on the NHS. That is something that we can control now, and it should be a priority.

In a meeting with me, a constituent who has a lot of experience working in that sector highlighted several areas of concern. One cause for concern is not just the increase in drug deaths in the past ten years, but the fact that poly-drug use has increased so significantly. One of the biggest changes in the past seven years has been the massive increase in the use of non-prescribed benzodiazepines or “street BDZs”.

The National Records of Scotland reported that 94 per cent of all drug-related deaths in Scotland involve people who took more than one substance—poly-drug use. Opiates such as heroin and methadone are implicated in the majority of deaths, but users are often taking a lethal cocktail of substances, which increasingly includes benzodiazepines. I was shocked to learn that only one street benzodiazepine death was recorded in 2009, but that there were 814 in 2019.

My constituent also noted how addiction services have been subjected to disinvestment for at least the past 15 years and how services have struggled to retain staff, which continues to be a huge problem. We need to continue to designate additional funding in that direction, and I was glad to hear about some of that work today.

When patients tragically die, the workforce that helps them is shaken. I heard of one member of staff who had to struggle with two deaths in one day. Those staff are determined to deliver the highest quality service possible and, despite everything that they face, create bonds and form relationships with the service users. We need to find a way to protect and support them too.

The Scottish Conservatives secured an extra £20 million a year for residential drug rehab facilities. The measures were announced as part of a £250 million package over five years, which is specifically aimed at tackling the shocking drug death figures. Those measures are welcome news after the SNP’s hugely damaging cuts to rehab beds. However, it should not have taken the SNP 14 years to finally realise that its drug policies had failed.

Scotland has a large network of injection equipment provision and our national take-home naloxone programme was introduced in 2011. One could perhaps assume that those initiatives would help prevent opiate deaths rates—I am certain that they have—but rates continue to rise. We are not measuring in detail the success of the take-home naloxone programme, so we do not know for sure how many lives have been saved by it, although Public Health Scotland’s enhanced surveillance of problem drug use, which started in the past 12 months, is welcome. We do not know how many drug-related deaths there might have been without the take-home naloxone programme. If we are not measuring the achievements of those programmes in detail, how do we know which programmes to invest in and which ones to put on hold?

A strong level of support exists for the introduction in Scotland of drug consumption rooms, which are used frequently in other countries across Europe. There are 31 facilities across 25 cities in the Netherlands, and 24 facilities in 15 cities in Germany. Other countries—Australia, Canada, Denmark and France—are increasingly adopting drug consumption rooms as part of drug harm reduction strategies and are seeing positive effects.

It is not as simple, however, as a straight comparison between us and other countries. What works there does not necessarily translate into a solution for Scotland. We have heard about all the solutions that are available to us right now in the minister’s proposal today.

Photo of Sue Webber Sue Webber Conservative

No, thank you.

The Scottish Government must now find a solution to the hugely complex situation in Scotland that includes access to the new treatments that we have heard about; safe and secure housing, which is key; support through the justice system; and a preventative approach with children and young people—[

Interruption

.] No, I will not take an intervention.

As we said in our manifesto, we want to prioritise abstinence-based programmes. Everyone should have the right to rehab, and we are committed to working on a cross-party basis to deliver that for vulnerable people. We will continue to appeal for cross-party support to tackle drug deaths by opening up access to treatment and rehabilitation programmes. That is why we have lodged an amendment that calls on the Scottish Government to introduce a right to recovery as the starting point for the introduction of a bill that would ensure that everyone has access to the necessary treatment when they need or want it, not when professionals or organisations determine that they can be accommodated.

It is clear that the SNP’s Drug Deaths Taskforce has failed. In 2019, the SNP assembled the task force to tackle the rising number of drug deaths in Scotland. However, a year after the creation of the task force, leading campaign group FAVOR warned that Scotland was going backwards with its efforts on tackling drug deaths. Chief executive officer Annemarie Ward said:

“Even before the pandemic struck, we were seeing very little concrete action ... we need the Scottish Government to start properly funding rehabilitation and recovery programmes.”

The sector is rapidly losing confidence in the poor performance of the Drug Deaths Taskforce. It must publish a comprehensive review into the provision of drug and treatment services before the end of the year.

We cannot stop here. Appointing a drugs minister who reports directly to the First Minister is a positive move, and I look forward to working with Angela Constance in my role as shadow minister for drugs policy. However, the SNP must take action and work closely with key stakeholders in order to deliver support to those who need it most.

More should have been done earlier. Families have been failed, and entire communities have been left broken. This Parliament must ensure that drug deaths are reduced once and for all, and it must introduce a right to recovery to enshrine in law that everyone has access the necessary addiction treatment.

I move amendment S6M-00400.1, to leave out from “reform of the” to end and insert:

“how to work constructively across the UK to tackle drug-related deaths, and calls on the Scottish Government to introduce a Right to Recovery to enshrine in law that everyone has access to the necessary addiction treatment.”

Photo of Claire Baker Claire Baker Labour

I welcome this afternoon’s debate, and I am pleased to be leading for Scottish Labour on the issue in my role as shadow minister for drugs policy.

We must tackle Scotland’s high number of drug deaths, and I want to work with MSPs across the chamber to put saving lives and bringing an end to the misery of drug fatalities first, before our political differences.

In the previous parliamentary session, it was rightly made clear that the Government had failed to address a rising rate of drug deaths, and that Scotland having the highest rate in Europe was shameful, a poor reflection on policy makers and past decisions, and demonstrated an unacceptable lack of leadership and complacency from the Scottish Government.

We are at the start of a new session, and recent announcements from the Government, including the MAT standards and the investment to support their delivery, are welcome. Although my colleagues and I will push the minister and the Government to urgently deliver significant and meaningful change—and will hold them to account for the significant challenges in our communities that drive drug use and dependency—I will work constructively and co-operatively with the minister to find solutions that address the health crisis, support the on-going work of the Drug Deaths Taskforce, and examine Scotland’s relationship with drug use, which would lead to a healthier society that values everyone and supports positive choices.

We will support the Government’s motion this afternoon, although I make clear that, although we accept the call for a four-nations summit, it must not be about nursing a constitutional divide that will lead to an impasse.

I wish the minister well in exercising her persuasive skills to present an evidence-based argument, but it is fair to say that it will be a difficult discussion. Making changes to the Misuse of Drugs Act 1971 would take time, but we do not have time to spare in Scotland. The Scottish Government must demonstrate that it will pursue all options in the existing legal framework to advance safe consumption rooms, testing facilities and other measures that can contribute to reducing fatalities and harmful drug use.

Clearly and correctly, the Lord Advocate is independent of Government, but we want to see the justice and prosecution service prioritise public health and harm reduction.

In her statement in March, the minister said that she was determined to “overcome the legal barriers” to establishing overdose prevention facilities, and that a team of officials was

“working to pull together expertise and options.”—[

Official Report

, 18 March 2021; c 53.]

In closing, I ask the minister to say more about how that work is progressing. Our amendment supports finding solutions in the existing legal framework, and I want that to be demonstrated.

Although the proposal for a UK summit focuses on where there are barriers, I want to recognise what we can do urgently that will make a significant difference. When the MAT standards are introduced, they will be transformational. Their introduction will have the effect of a creating a right to treatment without having to rely on introducing legislation.

The Dundee drugs commission established the need for many of the policies that are reflected in the MAT standards. Given the scale of Scotland’s drug deaths crisis, there should not have been such a delay in their being introduced. We now need to see huge cultural change in services and an increase in rehabilitation capacity—including for mothers and babies—that is supported by investment. We need to address stigma and discrimination through medical intervention and work on mental health and trauma recovery, as well as social and community support.

Commitment to April 2022 as an implementation date means that some people will still fall through the cracks and not receive the treatment that they deserve and need in the coming months. Progress must therefore be accelerated. This year will be challenging. The standards are going to be incredibly hard to achieve but there must be accountability. Our amendment calls for an interim report at the six-month point in order to monitor progress. I recognise that the MAT standards include reporting mechanisms; however, we need robust monitoring of implementation, and clarity over where accountability lies.

There are changes that we can introduce in order to demonstrate accountability. We need the establishment of baselines so that improvement can be measured. The service is patchy across Scotland. We need to know where the gaps are and what ADPs and health boards are doing to address those. The MAT standards recognise the reality of staff burnout and fatigue. We need flexibility in relation to, for example, staff meeting the same-day prescribing target.

What is being done to address the issue of data on drug fatalities? The 2019 figure was the highest annual figure on record, making it the sixth year in a row that that has happened. The next set of drug figures that we receive will be from 2020. That makes it very difficult to model, test and evaluate policy innovation, although I note that the minister has talked about the public health surveillance programme, which might address some of the issues. Covid-19 has shown that we can extract data quickly and in an anonymised format. We need to look at how we can improve data and ensure that forensic toxicology is fully resourced and supported, with issues resolved.

However, there is really good stuff in the MAT standards, and work must be done to raise awareness and expectation. Commitments to assertive outreach and anticipatory care are all positive. In Fife, we now have an alert system for non-fatal overdoses, and we need to look for more options for intervention at key points. Will the minister also look at the expansion of the use of the nasal spray for naloxone, as opposed to an injection? That method is quicker and easier to administer. Taken together, the standards will make a significant difference to treatment and to recovery.

This week, I visited FIRST—the Fife Intensive Rehabilitation and Substance Use Team. Although this is my first drugs policy debate in my new role, I have a long relationship with drug treatment services across Fife, and I thank them for the work that they do in rebuilding people’s lives. They have been at the sharp end of service delivery for many years, and they understand intergenerational addiction, the impact of poverty and trauma, and the need for a culture change in all our addiction services. However, they can also talk about how people’s lives and families can be transformed when they are given the right support and are treated with humanity.

I move amendment S6M-00400.4, to insert at end:

“; considers that the resources of the police and justice system should be focused on supporting lifesaving, public health interventions and believes that all options within the existing legal framework should be explored to support the delivery of safe consumption facilities; notes that delivering the new Medication-Assisted Treatment Standards will require significant service reform; believes that, given the scale of the drugs deaths crisis in Scotland, there must be public accountability and scrutiny over implementation of the standards, and calls on the Scottish Government to report on a six-monthly basis to the Parliament on the progress of implementation and service improvement.”

Photo of Gillian Mackay Gillian Mackay Green

Dignity, which we all hope to maintain, is something that drug addiction has robbed from many, that the criminal justice system has eroded and that the continued lack of reform of the Misuse of Drugs Act 1971 will suppress for many.

Drug deaths have been rising year on year in Scotland. Since 2014, Glasgow has faced the largest incidence since the 80s of HIV, which has affected people who inject drugs. Scotland has the highest number of drug deaths in Europe, and the war on drugs has categorically failed.

David Liddell, the chief executive officer of the Scottish Drugs Forum, said:

“Scotland’s drug problem has its roots in the harsh climate of 1980s deindustrialisation and the economic and social impact in the subsequent decades. Other countries chose a more interventionist approach by which the state created alternative employment and opportunity during these changes. This was not the policy in the UK. The consequence of this ongoing approach is a large and more entrenched drug problem nationally.”

[

Interruption

.]

The member’s colleague did not give way, so neither will I.

Communities were robbed of their dignity through not being supported after their industries collapsed. As a result of a lack of intervention, second and third generations are suffering from addiction and complex trauma.

We know that, often, those with addiction have low incomes or no income and have issues in accessing a wide range of services, such as income support, NHS treatment and housing, as a result of a vast range of issues, including those that are not related to their addiction. Those who manage to access treatment experience stigma, particularly in relation to medication.

We must ensure that support for those who experience addiction is person centred and holistic. Ensuring that the trauma that may have been the catalyst for their addiction, or any other acquired trauma, is addressed properly is essential to addressing the issues that dominate their lives.

We have to ensure that being drug free is not a condition of treatment. We would not require someone with lung cancer to stop smoking before we started treating them, so why are we insisting that, after a lengthy wait on a waiting list, someone must be drug free before being treated? Often, drugs are a coping mechanism and trauma is the real issue. Behaviour policing should never be part of our approach to rehab; it should be about maintaining dignity.

There are wider impacts that also need to be addressed, including housing and how we engage with people who may have had negative experiences when accessing services in the past. Stigma is an enormous issue in relation to accessing services. I hope that we can work with the Government and local government agencies to ensure that we remove that judgment of those who require help.

The Misuse of Drugs Act 1971, which is about to have its 50th anniversary, is out of touch and should rightly be out of time. The briefing provided by the Transform Drug Policy Foundation notes that the Home Office’s independent review of drugs, led by Dame Carol Black, has been explicitly prevented from addressing the overarching legislation.

It is very clear that this is a health crisis. Health is devolved to the Scottish Parliament and powers over drugs legislation should also be devolved to ensure that a more compassionate approach is taken than that taken by the UK Government.

I turn to the substance of my amendment. Portugal decriminalised possession of all drugs in 2001 and in 2019 it established its first mobile safe consumption room. Drug-related deaths in Portugal have been below the European Union average since 2001 and the proportion of prisoners sentenced for drug-related offences has fallen from 40 per cent to 15 per cent. Rates of drug use have remained consistently below the EU average. The facilities primarily aim to reduce acute and direct harm by preventing overdoses from happening and, when they do happen, by providing intervention, and by ensuring that needles are not reused and that no one puts themselves in a dangerous or vulnerable position.

During the election campaign I had the pleasure of meeting and occasionally debating alongside Peter Krykant. Peter is a fellow Falkirk bairn and runs the mobile safe consumption room in Glasgow. He documents on Twitter his experience of running the service and the great work that he does. One of his most distressing posts is about a young woman—given our debate this week on women’s health, the post is particularly relevant. The young woman did not want to come inside the van to inject herself for fear of being arrested. Instead, she went down the nearest close, pulled her trousers round her ankles and sat on the ground, which was full of broken glass, animal faeces and dirty water. What have we done for her dignity? Without Peter to keep an eye on her, anything could have happened.

We have the ability to start today to make a change. I encourage all parties to support my amendment. Let us take a stand today to restore people’s dignity and support the fantastic work of people such as Peter.

I move amendment S6M-00400.3, to insert at end:

“; considers that safe consumption rooms are an important public health measure that could reduce drug deaths and deliver wider benefits to communities, as they have done elsewhere; condemns the UK Government’s refusal to support trials in Scotland and urges it to reconsider, and calls on the Scottish Government to investigate, as a matter of urgency, what options it has to establish legal and safe consumption rooms within the existing legal framework.”

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

I begin by thanking Angela Constance. In my intervention on her, I made the mistake of referring to her as a cabinet secretary, which has been picked up by other members. She should see that as a reflection of how important members regard her role to be. We all want and need her to succeed. I am grateful for the cross-party consensus that she is trying to build on this important topic.

Evidence matters. Professor Harry Burns said:

“Unless you have evidence all you have is opinion.”

The Liberal Democrats have had an evidence-based approach to drugs policy for years. We called for the decriminalisation of drug use long ago, and Portugal is just one example of that policy’s effectiveness, as we have just heard in another excellent speech by Gillian Mackay. We have all the evidence that we need; it is now time to act.

Laurell K Hamilton once wrote:

“There are wounds that never show on the body, that are deeper and more hurtful than anything that bleeds.”

She was talking about unresolved trauma. The Liberal Democrat amendment puts trauma-informed care at the heart of every aspect of recovery from drug addiction because there is an undeniable correlation between adverse childhood experiences and drug misuse.

Adults who experienced four or more adversities in their childhood are 11 times more likely to have used crack cocaine or heroin. In 2017, 74 per cent of drug death casualties in Tayside were known to have had a co-existing mental health condition—most commonly, depression or anxiety—at the time of their passing. In 2019, written evidence to the Westminster Scottish Affairs Committee recommended that the views and lived experiences of people who are affected by drug harms should be included when developing legislation. We, in this Parliament, must listen to those voices, too.

We must reduce the misery of drug abuse with compassion and treatment rather than prosecution. In the final days of the previous session, the Parliament unanimously agreed with that idea. We agreed to the principle of diversion by endorsing an amendment that was lodged by my party. That was an important moment, not least because it showed that the debate was maturing.

My amendment today seeks to continue that conversation because, although the conversation in the chamber might well have moved on, the situation on the ground has not. We are still sending the same number of people to prison for personal possession as we were a decade ago. That has devastating consequences. Police officers are well aware of the cruel cycle that follows an arrest. Assistant Chief Constable Steve Johnson gave devastating evidence to the Scottish Affairs Committee in July 2019. He told MPs:

“It is just a matter of time ... Of those people who come out of prison, 11% of them will die within the first month of having been released ... the police officers get used to this carousel, this sense of hopelessness and helplessness.”

That carousel must stop, and we, as a nation, are already empowered to stop it.

The Lord Advocate issues guidance to the police that sets the parameters of all police operations. It is the frame to the doorway into the criminal justice system. The guidance could direct more people who misuse drugs to the treatment and support that they need, as opposed to the destructive experience that many have in the criminal justice system. We know from correspondence with the outgoing Lord Advocate that the guidance has already been used to facilitate recorded police warnings for minor offences.

I reassure the Government that our amendment does not seek to direct the Lord Advocate. That is not its intention or its implication. It is important to be clear about that, because the Lord Advocate’s role is rightly independent, and that independence must be absolute. Dorothy Bain, as the new post holder, will no doubt have the drug death crisis near the top of her in-tray. Should she consider that a review of the guidance is necessary, it is important that she understands that she can do that in the knowledge that the Parliament will back her up and support her.

Rehabilitation is equally as important as trauma in the debate. I am gratified that access to residential rehab seems to enjoy support from across the chamber—and so it should. Residential care is not just about stabilising a person physically; it is about all the wraparound support services that come with it.

Before I came to the Parliament, I worked for Aberlour, Scotland’s national children’s charity. We operated a residential rehabilitation facility in a block of new-build flats, just off Glasgow Green, where mothers with addiction issues could come, with the children living with them, to get clear of those issues. It was the only facility of its kind in the country, and it even cared for neonatal mums and their babies, too. It still moves me, almost to the point of tears, that our service at Aberlour was equipped with what were referred to as “tummy tubs”, which were, in effect, oversized buckets that would be filled with warm water and used to comfort babies who were going through withdrawal by simulating the feeling of being in utero.

Problematic substance use among mothers accounts for as much as a third of drug dependency in some parts of the country. We know that having a drug-using parent in a child’s early years is an adverse childhood experience in itself, but so too is time in care. Removing children from mothers for the duration of their rehab can lead to trauma, attachment disorder and loss. That might impact those small children for the rest of their lives.

That Aberdour facility was closed a little over five years ago, as it was no longer deemed a strategic priority by Glasgow City Council. That reprioritisation was due, in large part, to the fact that the Scottish Government reduced funding to alcohol and drugs partnerships by 23 per cent that year. Sometimes, our service would see occupancy at 100 per cent, but it would also drop below 50 per cent, and the city did not regard that as optimal. However, that is the nature of residential rehab; it is not a hotel. People are never wholly sure when they will need it, but when they do, they are glad that it is there.

I hope that we, in this chamber, can find consensus on this matter above almost every other aspect of social policy. I hope that we can come together and address the challenge of this monstrous public health issue.

I move amendment S6M-00400.2, to insert at end:

“; notes the recommendation made by Sir Harry Burns to routinely record adverse childhood experiences, and believes that all aspects of recovery and treatment should be trauma-informed; understands that guidance has previously been issued by the Lord Advocate to police officers relating to the use of recorded police warnings in certain cases of minor offending; would support a new Lord Advocate reviewing this guidance and examining how it can be strengthened, in light of the resolution of the Parliament on motion S5M-24396 on 18 March 2021 and the support expressed for working towards diverting people caught in possession of drugs for personal use into treatment, and believes that a parliamentary statement after the summer recess from the new Lord Advocate on the principles and practicalities of diversion would be beneficial in informing public debate and the response of authorities to Scotland's drugs deaths crisis.”

Photo of Liam McArthur Liam McArthur Liberal Democrat

We move to the open debate, the first speaker in which will be Stephanie Callaghan, who is making her first speech to Parliament.

Photo of Stephanie Callaghan Stephanie Callaghan Scottish National Party

I thank the minister for her update on yesterday’s meeting, and I look forward to hearing more. I welcome the additional financial commitments and the work around women with children. It was also good to hear from Gillian Mackay and Alex Cole-Hamilton.

I am honoured to make my first speech as the first woman MSP for Uddingston and Bellshill constituency. My predecessor, Richard Lyle, has the proud record of being the longest-serving SNP politician, having first been elected to public office way back in 1976, when I was just a five-year-old wee lassie. Richard’s retirement was well earned after a lifetime of serving our communities.

I am sorry—I have a bit of a cold, so I am stuffed up.

I thank the members of my wonderful team, who put heart and soul into my campaign; my good friend and election agent, Peter Craig; and my family, for their patience, love and hugs. I thank the people of Uddingston and Bellshill for entrusting me with the great honour of being their representative; I will represent every corner of our constituency. I promise always to respect and value their views and opinions and to seek to apply good judgment and balance in all my work. I will also pursue the clear mandate that they voted for—that Scotland’s future will be in Scotland’s hands in a future independence referendum.

Our local communities are rooted in the densely populated heart of Lanarkshire, with a 100-year history of coal mining, and our working-class people are our biggest asset. People have stepped up to help during Covid-19, just as they did when my grandfather broke his back down in the pits.

However, we are not without our problems, and drug deaths devastate too many families. After Glasgow’s health board, Lanarkshire’s health board has the highest rate of drug deaths in Scotland, which, at the last count, was 163—an increase of 66 on 10 years ago. Imagine for a moment wiping out nearly 15 football teams—the full Scottish Premier League—or more than six classrooms full of children. That is the scale of the problem, and that is just Lanarkshire. We know what the root causes of addiction are, because the evidence is clear: poverty, deprivation, trauma, childhood adversity and poor mental health or mental illness. Those things destroy human connections and destroy hope.

Today’s motion is about a shared commitment to reverse the heartbreaking and appalling loss of life that affects all of us to some degree. We all know someone who is cursed with drug addiction. We must offer them hope and listen to their lived experience, and a citizens assembly is very welcome indeed. I welcome the motion’s support for

“the national mission to tackle drug-related deaths and harms”, which has been a long time coming. The minister noted the Scottish Government’s commitment to provide £250 million of funding over the parliamentary session to give vital support to local outreach services, to expand residential rehab services, to implement the medication-assisted treatment standards that were published last year and, crucially, to move to a five-year funding cycle for third sector and grass-roots organisations on the front line. The evidence tells us that tailoring effective individual support and providing same-day treatment empowers people to seek support and recover. It works elsewhere, and it will work here, too.

We have not previously done enough in Scotland to directly stem the deepening crisis and prevent harrowing deaths that traumatise the next generation. We must do better. Today, we hear lots of statistics, and it is absolutely right that we do, but I will leave that to others. It is also right that the steps to directly tackle addiction must continue to be part of the Scottish Government’s holistic plan for improved access to housing, health and social care, education and training, and welfare and family support. We simply must continue to take steps towards eradicating poverty and to hold the UK Government to account for inflicting austerity policies.

My ask today is that all those who are listening at home, in school or in the chamber have compassion for those who suffer addiction, recognise that it is not a lifestyle choice, or poor decision making or hedonism gone wrong, and take account of the underlying issues and inequalities.

We must also recognise that the actions of someone who is addicted are not a true reflection of the person they are inside—who they are, were or could be. Addiction is a soul-sucking riptide that casts people adrift from their true selves. It separates them from family and friends and pushes them to the margins of society. It is a public health issue, not a criminal one.

I have worked in some of the poorest areas, where drugs are rife. Sadly, I have seen the light go out in a young person’s eyes as life spirals out of their control, but I have also seen the spark of hope ignite, and watched it grow and flourish into a better future that is happy and fulfilling. Our compassion is key. In addition to the practical steps on funding, accountability, delivery of the MAT standards nationwide and safe consumption, we must look after these people—and one another.

By empowering people who face addictions, we help to break the vicious cycle for tomorrow’s kids. The motion promotes progress and hope.

I will finish on a personal note. On the one hand, just over a year ago, sadly, I lost a close family member to drugs. On the other hand, a close friend has beaten addiction. For them, access to medication and training led to a job, new friends, a loving partner and raising a family of their own. They were lucky. We must ensure that investment is available to everyone and that it does not come down to luck. We must live up to the motion—and more.

The Deputy Presiding Officer:

Many congratulations, Ms Callaghan, and well done for dealing with a sore throat—there is no evidence that Richard Lyle ever suffered from a sore throat.

I call Brian Whittle. Do not take this the wrong way, Mr Whittle, but we have a bit of time in hand, so members should feel free to intervene, and I will give you the time back.

Photo of Brian Whittle Brian Whittle Conservative

I hope that you are sitting comfortably, Presiding Officer.

Once again, I am delighted to have the opportunity to speak on what is a hugely important subject. As has already been said, Scotland has the unfortunate reputation of being the drug death capital of Europe. Our drug death rate is more than three and a half times that of the rest of the United Kingdom.

My final speech in the previous session was on this topic, and I am delighted to have the opportunity to carry on where I left off. A few short weeks ago, I asked Angela Constance a crucial question in a bid to develop effective solutions to the crisis: why is Scotland so bad when it comes to drug deaths? I would have asked Gillian Mackay the same question if she had allowed me to intervene on her. Incidentally, I suspect that the situation is linked to the fact that Scotland also has the highest death rate among the homeless community. The answer that I got from the minister was that Scotland had seen a 400 per cent increase in street benzodiazepines, compared with a 50 per cent increase south of the border. I say to her that that is the what, not the why. That has contributed to the skyrocketing numbers, but it does not explain the reason for them.

Photo of Angela Constance Angela Constance Scottish National Party

I am firmly on record as saying that there are three reasons why we have a distinct problem in Scotland: proportionally, more of our people are engaged in problematic drug use—there are deep reasons for that; frankly, we do not have enough of our folk in treatment; and yes, there has been a 450 per cent increase in the implication of benzodiazepines in drug-related deaths, which is greater than the increase south of the border.

Photo of Brian Whittle Brian Whittle Conservative

I am only quoting the minister’s speech and the exchanges that we had the last time round.

I must ask the question again: why has there been such a huge increase in street benzos compared with elsewhere in the United Kingdom? She must be able to answer that question if she is to develop a successful strategy.

This week, I asked questions of some of those on the front line, from volunteers to survivors and those battling addiction. I will share some of the responses. One volunteer told me of the 40 home visits that she undertakes on a Thursday as part of the centre’s outreach programme to visit those people who used to come to the centre pre-Covid. She said:

“When we knock the doors, the number of people who say, ‘I thought you’d forgotten about me’ is quite incredible.”

She went on to say:

“The deprivation and the poverty we witness is heartbreaking. People walking the streets because they have no carpets or white goods or heating. The kids without clothes or shoes. I wish the people making decisions would walk with us when we do these visits and then we might end up with a different understanding of the problem.”

Mark then picks up the story. I know that the minister took the time to speak to him, and I am grateful to her for doing so. He said:

“I have tried to speak to the council about unmet needs but nobody wants to discuss this because it actually raises a failure in the system and they find that very difficult to face. People are being demonised and don’t access statutory services because of the way they are treated. They are made to feel worthless. People’s human rights are not being met.”

Finally, he said:

“No wonder people are gubbing street benzos.”

Those are his words.

As a wee addendum, those on the front line are reporting that people are swapping alcohol for street benzos because they are a cheaper way to self-medicate. I have to ask the Scottish Government whether any work is being done on that issue, because, again, we need to know whether the by-product of a minimum price on alcohol is people switching to a cheaper option, and whether that is a component of the increase in street benzo use. In the end, it might go in another column in the ledger, but it is still someone dying.

Photo of Angela Constance Angela Constance Scottish National Party

I am grateful to the Presiding Officer and to Mr Whittle for allowing me to intervene.

We are, of course, engaged in work to really understand the reasons behind people’s use of street benzodiazepines. However, I wonder whether Mr Whittle would also join the Scottish Government in calling on the UK Government to introduce pill press regulation, which would make it harder for people to produce vast quantities of these street drugs, which they can then go on to sell for pennies in our communities.

Photo of Brian Whittle Brian Whittle Conservative

Angela Constance will be surprised to hear that I concur with her on that, and I would support such a call.

A service user, who is now a volunteer, spoke to me about his journey in and out of prison and how recovery enterprises were the intervention that put him on a better path. He got out of prison at the end of the week. That is a practice that has to stop. As I have said over and over again in the chamber, why are we releasing prisoners into the community at a time when they cannot access any services for several days? It was precisely that situation that recovery enterprises rescued him from. They helped him to access accommodation and services, and generally made him feel welcomed back into the community. He said that, without them, he would have ended up back in prison, in what he called his “safe place”. Prison was his safe place—the powers that be simply assumed that once his sentence was over, they would open their doors and that person, with an addiction problem, would know just how to fit back into society.

It costs £40,000 a year to keep someone in prison, not counting police and court costs. We could spend a fraction of that if we stopped releasing prisoners on a Friday and had a step-down service available to transition prisoners back into society. The gentleman I am quoting lost a sister and brother to addiction, so perhaps the intervention that he received will break the chain.

Recovery enterprises might be unorthodox and difficult to fit into a support model. As the minister will know, Mark can shoot from the hip and make people feel uncomfortable, but he is passionate and knowledgeable. Unorthodox or not, such services save lives—is that not the main criterion that should instigate support? Sometimes success is just keeping somebody alive until tomorrow, and that is what those services, and others like them, do. However, the support that was promised by the Scottish Government is not getting to all the places that it needs to, and it is certainly not getting to the third sector, where I am aware that it is needed, and where the minister wants it to go.

Third sector organisations are most likely to be able to work with those who do not engage with statutory services. They are the ones that are reaching out and building relationships and trust with the most vulnerable and isolated and those who are most in danger, whom society seems to have forgotten. They are the organisations that can respond to immediate needs. Those organisations are run by the disruptors and troublemakers—the ones who make us feel uncomfortable, and so we should. They are the ones who are likely to have been in recovery themselves.

I am glad that, at long last, the Scottish Government seems to have its eye back on the ball and is using the extensive powers that it has always had at its disposal to tackle this crisis. However, the minister needs to ensure that those on the front line are getting resource and support as intended. I am telling her that, at present, that is not universally true, and I urge her to look at how those significant gaps can be plugged and how the voices of the most vulnerable in our society can be heard. They need a fully resourced third sector, and the minister will need a fully resourced third sector if she is to be as successful as we all hope that she will be.

The Deputy Presiding Officer:

I thank Mr Whittle and the minister for embracing so whole-heartedly my invitation to make and take interventions.

Photo of Emma Harper Emma Harper Scottish National Party

I welcome the opportunity to speak in this important debate on Scotland’s drug policy. I agree with the Government that the drug-related death figures that were published in December are unacceptable, and I welcome the fact that we are moving forward with updated, innovative and person-centred approaches to better address problem drug use in Scotland.

I welcome the publication of the medication-assisted treatment standards and all the work that the minister outlined in her opening remarks. There is so much going on, and I look forward to any progress. I agree that it is crucial to address inequality, listen to lived experience and work in partnership with housing, the police and families.

I am keen to continue supporting efforts to enhance ways of working. I plan to continue to be part of the cross-party group on drug and alcohol misuse, along with my colleague Monica Lennon, and I would welcome others who might wish to join that cross-party group.

In the previous session, as the deputy convener of the Health and Sport Committee, I had the opportunity to participate in the Scottish Affairs Committee’s inquiry into Scottish drug-related deaths in 2019. The inquiry heard directly from drug and alcohol support agencies, health services, academics, those with lived experience and families who had been affected by problem drug use. All the witnesses agreed that urgent reform is needed to solve the issue of drug deaths in Scotland.

The inquiry also heard from experts from Portugal, Germany and Canada, who examined the international evidence from countries that are taking a more progressive public health approach, not a punitive criminal justice approach, to tackling problem drug use. We found that the levels of deaths associated with drug misuse and eviction in those countries had reduced significantly, including by as much as 40 per cent in Canada. One recommendation from the Scottish Affairs Committee was that the UK Government must urgently introduce legislation to allow the Scottish Parliament to take its own approach to this hugely significant issue.

I support the motion, which calls for a four-nations summit, and I agree that the 50-year-old law needs to be reformed. A collective, four-nations approach could recommend and achieve law reform. The Conservativesamendment does not go far enough in addressing that. Working constructively is welcome, but continuing with a criminal justice approach, not a public health approach, is wrong according to the current evidence-based approaches that we are reading about. I am not surprised by the Conservatives’ amendment, however, as the UK Government’s Home Secretary, Priti Patel, has consistently stated that she will not give the powers over drug policy to this Parliament or change the Misuse of Drugs Act 1971. Indeed, she has stated that the drugs law is fit for purpose. However, maintaining the status quo isnae gonnae work.

In the past few months, much welcome work has been undertaken by the SNP Government, which has committed £250 million of additional funding for urgent action to deal with addiction issues and the harm caused by addiction. We are preventing and reducing both alcohol and drug harm among many individuals by establishing the new national mission to reduce drug-related deaths and harms. The mission was announced by the First Minister and is supported by an additional £50 million per year.

Drug and alcohol services have been supported during the Covid-19 pandemic, including in Dumfries and Galloway, in my South Scotland region, where assertive outreach is under way. The investment, through the programme for government in 2021-22, of a further £20 million over two years to tackle illicit drugs is also really important.

Brian Whittle talked about street benzos, and that subject has been covered extensively in my South Scotland area by the BBC. More people are accessing illicit street benzos through the internet, through Facebook advertisements and so on. My understanding is that street benzos are being used when people cannot access their heroin or cocaine dealers. Street benzos can be much more potent in their strength, especially when consumed with alcohol, and that leads to the devastating consequences of death that we are seeing.

In addition to other areas that the Government is investing in, I am interested in what the minister said about the £1.4 million and the 10 third sector projects that are being funded through the national development project fund. That is also welcome, as we know how important our third sector partners are.

I will highlight some further issues for the minister. Anything that we undertake needs to tackle stigma and discrimination, which are a huge issue, especially in rural areas. I also ask for a commitment from the minister that any new policy approach will ensure that rural parts of Scotland are included. I look forward to seeing progress across the whole of Scotland, including in my South Scotland region. I welcome the acknowledgement that we need to achieve better outcomes and support services and that we must talk about compassionate communities.

I look forward to hearing the minister’s response at the conclusion of the debate.

Photo of Michael Marra Michael Marra Labour

I refer members to my entry in the register of members’ interests and to my recent employment, before I was elected to the Parliament, as the deputy director of the Leverhulme Research Centre for Forensic Science.

Drug laws are the same across the entirety of the UK, yet there are four times as many drug deaths in Scotland as there are in the rest of the country. Labour wishes to see the UK working together to progress reform wherever possible, but we must also exhaust every avenue and challenge the limits of our powers and imagination to make urgent change in Scotland.

The medically assisted treatment standards are welcome; implementing them is the hard work of service reform, and I am afraid that we have seen far too little of that in the long 5,158 days of the SNP Government. In that time, the number of drug deaths has spiralled and budgets for drug services have been cut. What is needed now is appropriate resource to make those standards possible. We must write in accountability and scrutiny. Earlier exchanges at First Minister’s question time were useful in exploring the tensions of legislation and urgent action, and I believe that Labour’s amendment is a useful solution in that regard.

The Dundee drugs commission recommended a number of the same policies as the MAT standards, including same-day prescribing and, crucially, the recognition that mental illness and addiction must be treated at the same time. We are now years on from the publication of the commission’s report and progress has been painfully slow.

When a drug user reaches a moment when they believe that change is possible, treatment must be available to them. If they overdose on a Tuesday, survive and resolve to seek help on the Wednesday but then have to wait till the next week for the two-hour slot when prescribing is available, that is not same-day treatment by any real definition.

The MAT standards must ensure that the services are genuinely available all day and all week—I hope that the minister can reassure us on that in her remarks later—which will take resource, including consultants, who will simply not appear in a matter of months. The failure of workforce planning is costing lives, and new models of nurse prescribers must become the norm by later this year. There is a huge challenge of culture change in centring service delivery on people rather than dogmatic systems.

Treating addiction and mental health at the same time has proved to be one of the most difficult challenges in Dundee and Tayside. It is hugely resisted by some and dismissed as not being an issue by others, yet Tony of Dundee Fighting for Fairness interviewed hundreds of service users who identified it as the single greatest problem in their lives when receiving treatment.

Individuals who suffer from addiction are typically involved in polydrug use—which has been mentioned by members already—as are the vast majority of problematic drug users. In 2008, benzodiazepines were implicated in 26 per cent of drug deaths; in 2018, with the number of drug deaths increasing dramatically year on year, that figure was 67 per cent. The massive increase was driven by the withdrawal of Valium prescriptions by Scottish NHS providers. I think that that answers Mr Whittle’s question about why such drug deaths have happened in Scotland. Drug users replaced illicit NHS standard pills with street pill replacements. Those drugs cost pennies, as we know, and they are thrown back in batches of 20 or 30 pills at a time. In the words of one expert, that decision by our NHS moved Scotland from safe supply to complete chaos. The answer to Mr Whittle’s question is in the policies that were pursued.

Drug users have no idea what is in those pills, and their strength varies wildly from batch to batch and from day to day. In the words of one user,

Sometimes I feel almost nothing. Sometimes I lose a day.”

The inevitability of that variability is overdose. Those policy decisions, which I am sure were made with good intentions, have been absolutely lethal. As the death toll continues to mount, week by week and day by day, that amounts to one of the most lethal policy errors of the devolution era.

We must own and respond to the challenge. We need close to real-time data on overdoses and deaths. We should not be waiting for two years to find out whether the decisions that we have made are killing people. We have seen on our television screens a fantastic example of such data being provided when the First Minister talks daily about Covid and the number of vaccinations, cases and deaths. We need such data to evaluate what we have done. If we had had the data on the decision to withdraw Valium scripts, we would not be in the situation that we are now in. We have to be able to evaluate what we do and respond to it.

We must recognise not only that the response will require policy remedies that are particular to Scotland but that the causes of major elements of the harm are the decisions that are taken here, in Scotland. Let us have summits and deal with the outdated Misuse of Drugs Act 1971 if we can, but the reasons that Scotland’s drug deaths rate is four times as high as that of the rest of the UK are Scottish reasons, and we must act now to put it right.

Photo of Elena Whitham Elena Whitham Scottish National Party

I rise to speak in support of the motion. After working on the front line supporting people experiencing multiple disadvantage for almost two decades, I finally have cause to believe that we will work collectively to drive forward the whole-system and cultural changes that are necessary to tackle the drug deaths emergency.

Recently, I sat at yet another funeral for a young person, with unbridled tears streaming down my face, mourning the loss of a talented and outspoken individual—a disruptor. I had grief for their loved ones and an almost visceral sense of impotence and a seeming inability to find a way forward that would stop so many needless and preventable deaths in Ayrshire and across Scotland. How much potential and talent have we collectively lost?

I have seen the harms that are caused by addiction up close and personal. I have spent countless hours helping people to try to navigate the disjointed, confusing, unyielding and often bureaucratic and linear world of homelessness services, addiction services, mental health services, prison services and social work services. Those services are full of people who are trying their very best but who are not always able to join up the dots for the individual in the middle.

Some 20 years ago, before trauma-informed care was even spoken about, I and my colleagues on the front lines knew that those we supported were often self-medicating to blunt the sharp and painful edges of their lived experience. I knew that the young woman I was supporting fresh from care who had been abused and abandoned as a child now felt abandoned by the care service and her corporate parents. She was all too easily trafficked from Ayrshire to Glasgow by those intent on profiting from her body and her misery. I tried to pick up the pieces as she sank into a spiral of heroin addiction and prostitution, with little control over any aspect of her young life. At the time, I was only 26. I had a case load of more than 40 at-risk young people to support. We were both drowning in a system that was neither life preserver nor lifeboat.

I do not know what happened to that woman. I think about her often, as I think of the many people I supported who have died through drugs, self-harm or violence. Again, think of all that lost potential. What could they have been, and what could they have done? What has their loss done to those left behind? The trauma ripples right through the very fabric of our country.

I have every confidence that my colleague Angela Constance will deliver the change that is needed on this crucial agenda. She has the experience of being a social worker in a prison environment, ensuring that she understands what sticky support is and why it is critical to the success of someone’s recovery. Like Brian Whittle, I have spent a lot of time with Mark and the team at Recovery Enterprises Scotland. I have also spent time with other grass-roots organisations such as the Patchwork Recovery Community. Those organisations epitomise sticky support.

The minister has written to the UK Government to urgently request a summit so that we can look at what drug law reforms are required and so that drug misuse can at last be understood and treated as a public health crisis. Current legislation hinders our ability to fully align the law with a public health response. Doing so would enable us to deploy all the measures that the Parliament could collectively agree to. I urge members from all parties to see how crucial the reforms are to the overall picture.

Legislation needs to be reformed to treat drug misuse as a health matter and not as a criminal justice matter. Too often, I would see my service users lifted on a warrant—sometimes on a Friday—taken into custody, and then being on remand for months, which in effect wiped out the countless hours of solid support work and progress that we had made. They would then be released into homelessness, thus starting the cycle again.

I whole-heartedly welcome the new MAT standards, as I have always understood that same-day access to services and treatment is vital for recovery. When someone is asking for help for addiction, they need it there and then and not in three months’ time. People need to be at the heart of decision making, and they must have choice over what is appropriate for them. If that includes residential rehab, we must ensure that it is available in every part of the country.

Photo of Michael Marra Michael Marra Labour

The experience that we have had in Dundee in pursuing the issue of same-day prescribing has been exactly as I described. On a Tuesday afternoon, same-day prescribing was available for two hours. Does Elena Whitham agree that, as we implement the standards, we have to ensure that things are genuinely available the same day when they are required, and that that has to be reported on by Government?

Photo of Elena Whitham Elena Whitham Scottish National Party

I agree. From what our minister has set out, I think that that is definitely the way that we are going. However, there is the wider issue of who can prescribe. Members have mentioned the need to have advanced nurse practitioners and so on. We need to have a huge skills audit to see where we need to divert the moneys. I absolutely agree with Michael Marra.

That was my first intervention, and now I have lost my place—hold on.

We need to make sure that there is a collective effort across the sectors to break down the silos. We need to remember that those with lived experience and tireless grass-roots organisations, operating on shoestrings, will play an absolutely vital role in this work. We must provide them with funding opportunities; I was happy to hear the minister reiterate that, and talk about making sure that the funding that is out there is getting to where it needs to go.

We need to dismantle a system that was created decades ago by building single-issue services, and we need to see that as part of a bigger whole. We are finally in a place where housing first and rapid rehousing are being rolled out, with wraparound support for those with complex needs. We are exploring how a duty to prevent homelessness could significantly reduce incidences of homelessness by making sure that the duty goes beyond the door of the housing department.

We have gold-standard domestic abuse laws. We have collective understanding of trauma-informed practice and of how adverse childhood experiences impact on life chances. We are moving towards a community justice model—a smart justice model—that seeks to understand offending behaviour and offer up the tools required for real and meaningful behaviour change without sending somebody down the road of incarceration. By knitting all those golden threads together, we will ensure that people in Scotland can access the sticky, consistent, effective and flexible support that is required to prevent those harms—which, collectively, harm all of us.

The Deputy Presiding Officer:

Now that you have taken your first intervention, there will be no stopping you, Ms Whitham.

Photo of Miles Briggs Miles Briggs Conservative

I note from the outset that I hope that today’s debate is the start of regular updates, debates and cross-party working on this most critical issue, which faces all our communities in Scotland.

More should have been done much earlier. Families have been failed. Entire communities have been let down and left broken, as Sue Webber said at the start of the debate. It is for members in this session of Parliament to make sure that SNP ministers deliver change and are held to account. I welcome the approach that Angela Constance has taken, and Scottish Conservatives have tried to work constructively with her since her appointment.

From speaking to people who are in services or trying to access services today, it is clear that we are at only the very start of the necessary reforms that can make a real difference. We need to start looking at how we can turn around the unacceptable levels of drug-related deaths and harms in our society.

Members have mentioned those working on the front line. Many such people have told me that they expect to see a higher number of drug-related deaths for the 2020 period when the figures are published next month. The pain and heartbreak for many families across Scotland is therefore set to continue. The negative impact that the pandemic has clearly and understandably had should not be underestimated, but it cannot be used as an excuse either.

I will spend some of my time focusing on the experiences of a family that I know personally. My childhood friend Jamie Murray died from a drug-related death. Jamie was found dead in a flat in Perth on 1 September. In his system was a cocktail of drugs including methadone, heroin, street Valium and cocaine.

Jamie’s mum, Jane, bravely spoke out about the chaotic approach that Jamie faced when he tried to access support services and rehab. Much of what I want to say are the words of Jane Murray, because I think that it is vital that we understand the experience of those who, in Scotland today, are desperately trying to support their loved ones with addiction issues and to navigate access to services, which is so often so complicated. For too long, many families have felt excluded and have had to fight for everything for their loved ones while facing stigma and often feeling that they are being blamed by services.

Jane said:

“I used to go with Jamie to meetings, where he would be handed leaflets about methadone programmes, but when he’d beg to be sent to residential rehab, he was told there wasn’t any funding.

He’d ask to get taken off methadone as the side effects are so awful, but when he asked to have his dose reduced or to try a different treatment, he was simply told ‘no’.

It was soul destroying and easy to see why he felt like he was on an endless roundabout with no way off.

And despite the fact that it was supposed to be family meetings we were attending, all the professionals ignored me and just spoke to Jamie, who clearly was very ill and unable to think clearly.”

As others have done, I thank all those who are working in drug and addiction services across Scotland. From the many visits that I undertook across Scotland while I was serving as shadow health secretary, I know that it is one of the most challenging healthcare jobs in Scotland today. However, a key area of improvement—I welcome the minister’s focus on it—is the need to urgently address the issue of continuity of care.

Jane, again, was critical of the system that is supposed to help addicts. She said:

“As soon as Jamie would build up trust in one worker, they would move on, leaving him to start at the beginning again.

What we did see was catastrophic policies which did not involve methadone reduction, but they did insist that if anyone had a dirty test they were out of the program after one strike.”

Photo of Michael Marra Michael Marra Labour

Perhaps in speaking to advocacy groups, the member has heard what I have been hearing: there is significant burnout among professionals who have been working in this situation, particularly during the pandemic, and significant resource will be required to ensure the continuity of care that he is suggesting, and which I entirely agree is appropriate.

Photo of Miles Briggs Miles Briggs Conservative

I absolutely agree with the member on that point. For five years, I have argued with ministers about a workforce plan. Although we have not heard it mentioned today, I know that that is also part of the minister’s work, and we need it to be prioritised.

There is sometimes too much moving around of NHS staff, who rightly get burned out in this service and, as has been mentioned, often feel demoralised in the work that they have to do to pick up the pieces.

A key part of the issue is looking towards how we support patients having rights. For too long, people with substance abuse issues have felt that they have no rights. That is why I fully support the Scottish Conservative calls for a right to rehab. If we are genuinely going to deliver person-centred drug addiction services, which we all want, accessing rehab must be a right and not an afterthought or added extra. I do not doubt that that will present many challenges. In many cases, it will be resource intensive, and I welcome the resources that have now been outlined. However, addiction maintenance services have only got us to the drugs deaths crisis that we have today, so we need reform and a new approach.

As I mentioned last week in the Scottish Government debate on building a fairer Scotland and addressing inequalities, the issue of access to healthcare has been raised by many stakeholders over many years. I welcome some of the reforms that the minister has outlined. However, when she sums up, I hope that she outlines whether the Scottish Government will also now commit to reviewing access to healthcare for people who are living with addictions, as well as for people who are homeless. I especially hope for reform around access to and registration with general practitioners. Last week, I raised the case of my constituents having to queue for just 10 available appointments. That is one of the critical areas that we need to see reformed.

My final point, which the minister and my colleague Sue Webber have touched on, is that it is extremely important that we focus on the changing nature of addictions, drug use and drug deaths. For example, an explosion of self-prescribing has taken place during the pandemic. Here in Edinburgh, the area that I represent, NHS Lothian published figures for 2019-20 that showed that the number of hospital admissions for opioids increased by 24 per cent. There has been a significant trend in the number of hospital admissions for cocaine abuse, which has risen by more than 300 per cent. The number of hospital admissions for cannabinoid abuse has also increased by 64 per cent, and the number of hospital admissions for the use of sedatives and hypnotics has doubled during the past five years. Those are worrying trends, and we need to see more than a one-size-fits-all—

The Deputy Presiding Officer:

The member is in his final minute.

Photo of Miles Briggs Miles Briggs Conservative

The Scottish Government has an awful lot of work to do, and we all want the minister to drive forward the agenda. As Michael Marra said, outcomes and not processes must be at the heart of all the reforms. I want to see more detail about what the treatment targets that have been outlined will mean, because such targets are often not met in this country. Patient pathways are patchy and must be formalised. Standards of care must be delivered and reformed.

I hope that the minister can act in the spirit of urgency and emergency response that we have seen in the cross-Government working during the pandemic, and that we will get constant updates to make sure that we genuinely start to turn around the drug deaths crisis in Scotland.

Photo of Collette Stevenson Collette Stevenson Scottish National Party

Before I begin my speech, I pay tribute to my brother Brian, who we lost to a heroin overdose in 2002. I also want to thank my dad, my sisters and my niece for their unwavering support and their resilience. I am so proud of how they dealt with that.

As well as Covid-19, the Scottish Government is working to tackle another major public health emergency—drug-related deaths. The reappointment of Angela Constance as the dedicated Minister for Drugs Policy shows the Government’s determination. The minister has made many welcome announcements since being appointed, and I support everything that she has said today.

Through the Drug Death Taskforce, much funding has been allocated to effective evidence-based interventions. For example, take-home naloxone kits will now be given to people who are at high risk of accidental overdose. The introduction of same-day support will also be invaluable.

The minister has been proactive in talking with people with lived and living experience, some of whom are developing a stigma charter so that we can work towards a stigma-free Scotland. She has also been engaging with stakeholders and the third sector to address the many issues that are faced by people who have addictions.

Locally in my constituency, the Beacons operates across South Lanarkshire and will have centres in four localities of the council area, including East Kilbride. It aims to ensure that visible treatment and recovery, alongside support services, are embedded in communities, with the essential values of compassion, dignity and respect for all who use the service.

Another organisation called Ypeople operates the pathways service, which is based in East Kilbride. It is a service for homeless people, some of whom have a history of drug use. As well as supported accommodation, it offers a community-based service to help people to maintain their tenancies. Such support is vital. People who have a history of drug use might need supported accommodation to help them in their early days of recovery, or to provide a solid foundation for them to be able to think about recovery.

People maintaining their recovery is made easier by wraparound support being in place. Of course, housing support is just one aspect of that. We need to ensure that people who are in recovery also have the right support to stay clean, whether that support comes from health and social care services or from the third sector. I hope that the Government will continue to keep that in mind as we go forward.

Photo of Collette Stevenson Collette Stevenson Scottish National Party

If Paul O’Kane does not mind, I would rather not. This speech is quite emotional for me.

The Scottish Government’s commitment to increase investment over the next five years will support a range of community-based interventions, quicker access to treatment and expansion of residential rehabilitation.

It is also important that families have somewhere to turn. The families as lifesavers initiative, which is also funded by the Drug Deaths Taskforce, is a new initiative that will help relatives to increase their understanding of drug addiction and will support them so that they, in turn, can continue to support their relative.

I know from experience that many families have felt hopeless and that no matter where they have turned they have faced barriers to accessing rehab, addiction services and self-help groups.

I grew up in the 1980s, when jobs were hard to come by. Benefits were slashed, and nothing came easy to many families. Poverty and inequality laid the foundations for stigma and marginalisation, which never leave some people. For many of us, there was a lack of hope in the 1980s. Many people have experienced that during and after the recession, which is now being exacerbated by Covid.

We had Thatcher in the 1980s, and we have had Westminster austerity for the past decade. Yes, the Scottish Government can improve treatment pathways—that will happen—but the public health response is just one part of the solution. Socioeconomic factors are also important. For too many people, addiction stems from poverty, marginalisation, stigma and lack of opportunity.

Given the Scottish Tories’ inability to understand how their economic ideas affect wider society, and their inability to accept the evidence-based proposal for medically supervised safe consumption facilities, I take exception to their calling out the Scottish Government on the matter. There is nothing in the Government’s motion to which any other party should object.

I note that the Labour, Green and Liberal Democrat amendments will only add to the Scottish Government motion. However, the Tories clearly have no interest in reforming a 50-year-old law. If the Tories are serious about working across party lines to tackle a public health emergency, I want to see them work with the SNP and others to influence their counterparts at Westminster. Let us have an urgent four-nations summit to discuss reform of the Misuse of Drugs Act 1971, and let us at least pilot safe consumption facilities, where they would be appropriate.

I applaud the work that Peter Krykant has done to help to tackle drug-related deaths. He is a former addict, and I know how hard he has worked. I acknowledge the often very lonely experience that he has had to endure.

I want each and every one of the people’s lives that have been lost through drugs to matter. If for nothing else, let them be known for defining in legislation our future policies. As MSPs, let us work together and let us be bold and imaginative as we try to do right by them and to do right by the thousands of people who are currently struggling because of the impact of drugs.

By reforming the law, empowering people to seek support, and making services stick with the people whom they support, we can and will tackle the emergency.

The Deputy Presiding Officer:

Paul O’Kane will be the final speaker in the open debate, before we move to the closing speeches, for which everybody who has contributed to the debate will need to be in the chamber.

Photo of Paul O'Kane Paul O'Kane Labour

In rising to speak in the debate, I feel a number of different emotions. First, I feel an overwhelming sense of sadness about the lives that have been lost. Behind every number is a person. They were sons, daughters, parents, partners, family members, friends, brothers and sisters. Collette Stevenson powerfully described that, as have other members in the chamber today.

The word “scandal” is often overused in our politics, but there is no other word to use. It is painfully sad and heartbreaking for those who are left behind—for people who have all too often struggled to get the right support at the right time for their loved one.

I also feel anger because quite simply not enough has been done to tackle the root causes of the problem and to be innovative and flexible in approaches to policy around care and treatment. I feel anger because there has not been enough funding to support services properly and because there has been a lack of prioritisation of the issues.

Long before the Covid-19 pandemic, a pandemic was raging in our cities, towns and villages. It was born of poverty, trauma and poor mental health. That pandemic demands a public health response of the size and scale that we have seen in our current day-to-day context.

It will take leadership and a genuine commitment to listening—which we know has not always been the case, in the past. The Scottish Government was warned that cuts to the budgets of alcohol and drug partnerships in 2015-16 would lead to more deaths, but it went ahead with the cuts anyway. Labour has long called for funding to reverse the cuts, so it is welcome that the Government appears to be listening.

I want to focus my comments on the required public health response to the crisis. Reporting is not regular enough; annual reporting on deaths, which is two years retrospective, is not adequate for reacting with the flexibility that we need. The minister touched on that; I hope that she will say more in her concluding remarks.

Michael Marra referred to that fact we have, throughout Covid, had a wealth of data at our fingertips and on our television screens daily, including analysis of trends and data-led decision making. We all are acutely aware of the importance of such intelligence in making the right public health decisions. It can be done, so why should it not be done for drug deaths?

We also need better data on issues such as the high number of people who drop out of treatment. The Scottish Drugs Forum has highlighted the high levels of poor retention of people in treatment, and we know through research by the University of the West of Scotland that there have been significant challenges in respect of alcohol and drug partnerships properly recording the number of unplanned discharges and, crucially, the reasons behind them. That data would allow consistent follow-up and support for people to re-engage with services.

Scottish Labour’s amendment calls for robust scrutiny of the new MAT standards, including six-monthly reporting to Parliament. We must ensure that we know whether the standards are met, and that we know what the impacts are of important interventions such as same-day access to services.

Inflexible services fail too many people, which leads to the unplanned discharges that I mentioned. The Scottish Drugs Forum has said that

“Treatment needs to be attractive and offer what people want, when they want it; and it needs to respond to changes in what people want over time—substitution prescription, support to address immediate health or social issues; support with longer term mental or physical health”.

We must invest in services such as those that the Royal Pharmaceutical Society and others advocate—for example, the availability of naloxone in a variety of community settings, and appropriate training for a variety of individuals in communities and healthcare settings on how to use it.

In common with many other organisations and parties across the chamber, Scottish Labour thinks that we must have meaningful and swift action on exploring all options to deliver safe consumption rooms.

Breaking down silos is also key. We cannot just pay lip service to initiatives such as housing first and then witness sustained cuts being made to local government budgets for support services in housing. We also know some of the concerning challenges that Shelter Scotland has raised, which relate to people being forced to give up their homes after having been told that they cannot claim the housing benefit that is needed to pay for stays at residential rehabilitation centres that the voluntary sector runs.

I spoke at the beginning of my speech about the range of feelings that I had in approaching the debate. I also feel a sense of hope that we can work in partnership across the chamber and with individuals and their families, communities, and those who provide services and support, whether in healthcare settings or local government. However, we can achieve that sense of hope and optimism only if the Government is willing to listen. From the tone of the contributions to today’s debate, I believe that there is a sense that the Government is listening.

Labour members will hold the Government to account. We will relentlessly seek the data that we need and we will interrogate it. We will continue to make the case for well-resourced and flexible services that prioritise individual needs and trauma-informed practice, because lives depend on that action.

We need to ensure that we collectively take responsibility, make the right decisions and move Scotland forward to deal with the scourge of drug deaths.

Photo of Alison Johnstone Alison Johnstone Green

We move to closing speeches.

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

It has been a deeply powerful and moving debate. I will reflect on some of the contributions that have been made by members.

As we have heard, the Misuse of Drugs Act 1971 turns 50 this year, and the need to reform the act is greater than ever. It is outdated, it costs the taxpayer billions of pounds every year and it is simply not fit for purpose.

Earlier, when I quoted the evidence that was given by Assistant Chief Constable Steve Johnson, I spoke about the destructive cycle for drug users that is born out of a prison sentence. It is estimated that almost 2,000 organised crime groups are involved in the supply of illegal drugs, and between them they have trafficked more than 1,000 children, as Elena Whitham rightly referred to. The cannabis cultivation industry alone sees children from Afghanistan and Vietnam held in slave-like conditions in 21st century Scotland. Those are not the statistics of a system that is fit for purpose; they are the statistics of a broken system that is failing our most vulnerable citizens.

It is imperative that we work closely and constructively with all other nations across the United Kingdom, but Scotland has a drug deaths problem that is far more acute than that of any of our counterparts in the British isles.

I am grateful for the tone that the minister struck at the top of the debate, and particularly for reinstating her commitment to put lived experience at the heart of Government policy and the route map out of the issue. I am also grateful to her for taking my intervention on the importance of allowing mothers to deal with substance use issues with their children.

The tone set by the minister kicked off a thoughtful debate. Sue Webber was absolutely right to raise the proliferation of poly-drug use, particularly the use of street benzos. The correlation between death and street benzos in Scotland right now undermines the suggestion that we have repeatedly heard for many years that our particularly Scottish problem with drug mortality was somehow caused by the ageing “Trainspotting” generation and the comorbidities that lie in that group. It is young people who are dying on our streets right now.

Gillian Mackay was the first to mention the HIV outbreak in Glasgow. That outbreak was absolutely coterminous with the 23 per cent cut in Government funding to alcohol and drug partnerships not only in Glasgow, but across Scotland. Although members such as Emma Harper are keen to restate the level of Government investment since that time, we still come jarring up against that devastating funding decision. Through that decision, we lost organisational memory, relationships and good, hard-working services that had been saving lives for years. Therefore, going forward, this Government should mainstream and protect funding, particularly for rehabilitation.

The current approach is not working, which is why we need a health-centred approach that will not only save lives, but mitigate risk factors that lead to drug use in the first place. In 2001, Portugal ended the criminalisation of people who use drugs, and it established a health-led approach instead. Since then, drugs-related deaths in Portugal have consistently fallen below the EU average. Levels of problematic use and school-age use have also fallen. Portugal has gone from accounting for nearly 50 per cent of yearly HIV diagnoses that are linked to injecting-drug use in the EU to just 1.7 per cent. That is partly why I welcome Labour’s amendment. Safe consumption is essential to saving lives. Blood-borne viruses such as HIV and hepatitis C occur in one in four people who injects drugs, so the safe and adequate provision of clean needles is vital.

Photo of Paul Sweeney Paul Sweeney Labour

Alex Cole-Hamilton is making a powerful speech about the importance of overdose prevention and the use of facilities to ensure other public health benefits such as minimising HIV transmission. In Scotland, the reality is that overdose prevention centres are not illegal. If they were, I would be arrested and charged, and so would Peter Krykant. We need to get a grip of the situation. Does Alex Cole-Hamilton agree that, in the minister’s final remarks, she should address the issues of finding a legal pathway to safe consumption in Scotland and ensuring that Peter Krykant gets the resources that he deserves to continue his work in Glasgow?

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

I am absolutely happy to endorse that point of view, and I hope that the minister will reflect on it in closing.

I take the opportunity to put on record my thanks to Paul Sweeney and Peter Krykant for the volunteer work that they have done on the front line of the drug deaths emergency. They have put themselves at risk of criminal prosecution, but I hope that history will regard them as heroes and pioneers in the field. They deserve all our thanks.

Preventing deaths does not go far enough. We need to provide people who are suffering with addiction with the physical and emotional support that they need to recover, which is why rehabilitation is vital.

In her excellent first speech, Stephanie Callaghan reminded us that we must see the person beyond the addiction, and she revealed just how close to home the issue can be for some of us. I am grateful for her bravery, and for that of Collette Stevenson. In her powerful and emotional speech, Collette Stevenson captured us all and carried us with her.

With his usual absolute clarity, Michael Marra articulated the importance of getting help fast. The people who are in the grip of a chaotic lifestyle cannot wait for days for the help that they have sought in a moment of lucidity that might be all too rare. He was not overstating things in his use of the word “lethal” when it comes to the bad decisions that have been made.

Miles Briggs spoke of the trepidation that we all feel about the publication of next month’s drug death statistics. Addiction is a disease that is in large part brought out by trauma. Paul O’Kane was absolutely right to call it a pandemic. Nobody chooses to become dependent on drugs, just as nobody chooses to develop any disease or mental illness. Those who suffer from addiction deserve the same level of care and compassion as any other person who suffers from a chronic health condition.

People are most at risk of death from drug use when they are at their most vulnerable—for example, after being released from prison, after a bereavement or relationship breakdown, or when in poor mental or physical health. That fact underpins why I say that drug use is a symptom of and response to trauma, rather than the cause of it.

I close by saying that the responsibility for reversing Scotland’s drug crisis does not lie solely with the Government or its task forces—it is incumbent on all of us as MSPs. As a Parliament and as a country, it is time that we stopped asking victims of drug misuse, “What is wrong with you?” Instead, we need to ask, “What has happened to you?” and, crucially, “How can we help you to heal?”

Photo of Maggie Chapman Maggie Chapman Green

I am pleased to speak in support of the Scottish Green amendment. We also support the Labour and Liberal Democrat amendments, and consider that, when taken together, the motion and those three amendments signal a very welcome shift in political support towards doing something very different in order to tackle our drugs crisis. Something different—something so much better—is what we desperately need. We need a culture of care, not a war on drugs.

Scotland has followed many other jurisdictions in pursuing a war on drugs. Such an approach focuses on the criminalisation of users and petty suppliers, rather than seeking a solution to the deeper problems that underpin drug abuse. The war on drugs has totally failed to restrict the use of drugs or to protect from their harms.

In opening for the Scottish Greens, Gillian Mackay talked eloquently about how the drugs death crisis is a public health crisis and about how we need to understand and tackle the underlying causes of addiction if we are to deal effectively with a crisis that should never be considered inevitable.

When it comes to the impact of poverty, drug deaths are like the canary in the mine. We know that drug deaths are highest in the places that suffer most from poverty. Scotland has been scarred by poverty over the past 50 years, so it has some of the worst drug death figures in Europe—about eight times the average. The lives scarred by drugs are, of course, concentrated in particular places. In the region that I represent, Dundee’s drug death rate of 0.23 per 1,000 people is almost double the national average.

Photo of Michael Marra Michael Marra Labour

That point about the impact of poverty and the correlation between poverty and drug deaths was powerfully made, as it has been by others. However, many areas of the UK, such as the north-east of England, have similar levels of poverty to Scotland but not the same levels of drug deaths. Maybe Maggie Chapman will touch on the reasons for that difference. Some of the contributions to the debate have pointed to that core issue of poverty, but the problem is particularly Scottish.

Photo of Maggie Chapman Maggie Chapman Green

I agree that there is a particularly Scottish problem that we need to get to grips with. It speaks to a range of issues around the ways in which we police and criminalise particular communities, which I do not think are mapped across the rest of the UK. The problem deserves much wider discussion. Alex Cole-Hamilton talked about evidence, and we need to understand better why the position in Scotland is so distinctive.

We know that the right response to drug deaths and drugs misuse is to approach them as a public health and social justice issue—not as a criminal justice issue. We must stop criminalising those who suffer from addiction, and we must stop enforcement action that we know disproportionately affects people who are already marginalised.

An example is the practice of stop and search. Two years ago, Police Scotland stopped a seven-year-old girl on suspicion of being in possession of drugs. She was just one of more than 3,000 children who were stopped and searched in a 15-month period. Although one in 20 searches involves a strip search—almost always for drugs—women are more likely than men to be strip searched, even though detection rates for drugs are significantly lower for women who are strip searched.

Unfortunately, we have a Westminster Government with significant powers over drug policy that sees drugs as an issue to be dealt with through the criminal justice system, but only for the poor—we know plenty of UK Government ministers who have got away with their drug use. We have more than 40 years of evidence demonstrating that the criminal justice approach fails. One curiosity of the devolution settlement is that although laws relating to drugs are Westminster’s responsibility, enforcement of those laws is up to the Scottish Government.

That is why Scottish Greens asked the previous Lord Advocate to use his powers to ensure that safe drug consumption facilities be exempted from legal action, and, as I mentioned earlier, we will ask the new Lord Advocate to do the same. Enforcement is not in the public interest. Professionals in places such as Glasgow, as we have heard from Paul Sweeney and others, are taking the lead on providing those vital facilities, but they are doing so at risk of prosecution. We have also been arguing for a care-based approach to public policy that would ensure that drug users get the social and medical support that they need.

Dundee City Council has responded to the situation with a commission to seek solutions to the problem of drug deaths. The commission has made a set of strong suggestions about how to deal with drugs at a civic level, which include seeing the problem as a whole system and seeking whole-person solutions, increasing the accessibility of mental health services and taking an approach that is based on kindness, compassion and hope.

Although that is a move in the right direction, the key questions about how services would be funded and whether we can make the shift from a criminal justice focus to a social focus remain unanswered. The Scottish Government has begun to recognise the value of community-based solutions, but we need a whole-system approach to the issue that cuts across the artificial divide between Westminster and Scottish Government powers. We need to learn from countries such as Portugal, as has been mentioned, where decriminalisation has led to fewer drug deaths and fewer wider societal problems such as organised crime. Taking such an approach would change how we see drugs and begin a move from the war on drugs to a care-based approach that reduces the enormous harm that drugs cause.

Photo of Pauline McNeill Pauline McNeill Labour

The most mesmerizing speaker I have heard in this place—no offence to members—is Nanna Gotfredsen, who is a radical street lawyer who helped open Denmark’s first drug consumption room. I hope to bring her back to the Scottish Parliament so that members can hear her speak. She helped raise a volunteer force to run a drug consumption bus in Copenhagen in 2011, which enabled addicts to consume drugs safely. That soon paved the way for public sanctioned facilities. I chaired the meeting in 2018 at which she spoke, thanks to the work of Fiona Gilbertson of Recovering Justice. Nanna Gotfredsen said:

“We basically don’t have any drug deaths in DCRs and that is the same all over the world. I honestly think it’s crazy that Scotland has such a terrible drug problem and you are not doing this.”

Exactly—what have we been doing? Why are there no beds in Falkirk? It is outrageous. Sue Webber is right to say that the Scottish National Party should be ashamed of its record, but let us work together from this day forward. I raised the issue of high-strength street Valium with the First Minister two years ago and I got a good enough answer, but when I look back now I see that it was utterly complacent. Claire Baker hit the nail on the head: it is about saving lives, and the Lord Advocate should prioritise public health.

As has been highlighted, Scotland is the drug death capital of the world, and we have held that dismal title for six years. As Paul Sweeney said in an intervention, several lawyers—including Aamer Anwar, Mike Dailly and others—believe that we can operate within the law on the ground of the necessity to save lives. We have done that before—for example, in the early 2000s, to protect women in street prostitution in Glasgow. We can operate within the existing law without interfering with the independence of the Crown Office, which is an important point.

In the NHS Greater Glasgow and Clyde area, there were 404 deaths in 2019, which is about the same number as there were in the whole of Spain in the previous year. Scotland accounts for a third of all UK deaths. It is a dark crown to hold, and Brian Whittle is right to say that we have to be able to answer the question: why are we in that position?

Is it any wonder that the Royal College of Physicians of Edinburgh has called for bold measures, including the decriminalisation of the possession of illicit drugs? Portugal once had a similar drug deaths crisis, until it focused on health, not criminalisation, and funded treatment properly.

Drug consumption facilities supervise people who inject their own drugs. No one has ever died from an overdose in such a facility. That is one strand of a bigger policy. Drug consumption facilities are currently operating in at least 66 cities around the world. Concerns that such facilities might encourage drug use or increase crime have proven to be unfounded. Use is also restricted to existing dependent users. A review by the European Monitoring Centre for Drugs and Drug Addiction concluded:

“There is no evidence to suggest that the availability of safer injecting facilities increases drug use or frequency of injecting. These services facilitate rather than delay treatment entry and do not result in higher rates of local drug-related crime.”

Photo of Brian Whittle Brian Whittle Conservative

In the previous session, we voted for a Government motion that discussed accepting safe injection rooms— although, to be honest, I am still to be convinced. My question is whether we have looked at what else we could do with the resource that would be required to deliver safe injection rooms, and whether it might benefit us to spend that money in other areas. A safe injection room would not necessarily have such a big impact in rural areas such as mine. The issue is how the resource can best be utilised.

Photo of Pauline McNeill Pauline McNeill Labour

I agree that such facilities should be one part of a bigger policy. However, as we have heard, and as Paul Sweeney has seen for himself, Peter Krykant has literally saved lives. I have spoken directly to him. I am trying to point out that the evidence is there for any people who might have concerns that such facilities might extend drug use. We have some hurdles to get over, but by no means do I want Brian Whittle to think that Scottish Labour’s position is that such facilities on their own will be able to deal with the problem. He is correct to say that we need to take a comprehensive approach.

The UK Government’s official advisers—the Advisory Council on the Misuse of Drugs—supports the setting up of drug consumption rooms. Westminster must change the law to allow such facilities across the UK, in the same way that Portugal did. Angela Constance is right that it is not just about changing the 1971 act for that purpose; there are other reasons why we want to modernise the law. I hope that other nations will support us in that.

As other members have done, I pay tribute to Peter Krykant, who has been running an unofficial drug consumption room. As I said, he has saved lives. By the end of March, he had supervised more than 500 injections and had no doubt saved lots of lives without that being on record. There is no further time to waste.

Collette Stevenson and Stephanie Callaghan reminded us that many of us have a personal stake in the issue. I believe that, such is the public concern, the public will, rightly, not allow the Parliament to waste another session. In his excellent speech, Michael Marra said that we must have the data and safe supply, but that we must have same-day treatment, too. I agree. Public Health Wales runs a website and a service that allows users to have their drugs tested anonymously.

The Presiding Officer:

Could you wind up, please, Ms McNeill?

Photo of Pauline McNeill Pauline McNeill Labour

Surely we have learned the lessons from complacency in the past—never again.

Photo of Annie Wells Annie Wells Conservative

I am thankful to be closing the debate for the Scottish Conservatives on a subject that is very close to my heart. There have been excellent and passionate speeches from across the chamber, and I hope that we can all work together constructively to reverse the crisis.

I thank the Minister for Drugs Policy for coming to the chamber to outline the Scottish Government’s plans and I welcome the fact that she is open to working across the Parliament to tackle the emergency. Some of the announcements, particularly around funding, are also a welcome first step and we look forward to scrutinising them in more detail. However, as I will touch on, I believe that we need to go much further to save lives.

As many in the chamber have alluded to this afternoon, that crisis is our national shame. Scotland’s drug death rates remain not only significantly worse than those in the rest of the UK and Europe, but our relative drug deaths numbers also exceed those in the USA. In 2007, in my home city of Glasgow, there were 147 recorded drug deaths in the NHS Greater Glasgow and Clyde area; in 2019, a staggering 404 deaths were recorded.

The nature of this public health emergency is also made clear in hospitalisations, as many people across the country are routinely victim to serious harm from the side effects of drugs. As we have heard from colleagues across the chamber, the recent figures from Public Health Scotland highlight that, in 2019-20, there were 282 drug-related hospital stays per 100,000 people. In 1997-98, at the dawn of Scottish devolution, that figure was 88 per 100,000, so those figures have more than tripled.

The crisis has also hit the most vulnerable the hardest. It has been revealed that approximately half of the patients with a drug-related hospital stay lived in the most deprived areas in Scotland. That is particularly shameful, given that organisations such as Waverley Care have warned that, due to social inequalities, many people, such as those who are currently homeless, are at increased risk of being harmed by drugs.

I have lived in Springburn most of my life and I have seen at first hand the devastation that drugs can have on families, friends and communities. I spoke to a neighbour about that issue just this morning, and he said to me:

“How many people do we know in this street alone who have lost their lives due to drugs?”

That fact hits home—families up and down Scotland have been impacted by this dreadful crisis in some way. In the election campaign, Nicola Sturgeon admitted that her Government took its eye off the ball on that issue, when the drug deaths rate in Scotland almost tripled on the SNP’s watch after 14 years in power. Played over many years, those are human costs and real-life consequences of a Government losing focus on tackling the issues that really matter.

Two years ago, the SNP set up the Drug Deaths Taskforce. It had an explicit remit to improve the health outcomes for people who use drugs, by reducing the risk of harm and death, but drug deaths continue to climb, as more victims needlessly lose their lives. It is no wonder that the failure of the task force to come up with effective solutions to one of our nation’s biggest challenges has been criticised by many third sector organisations.

Frankly, victims deserve better. Conservative members have consistently called for drug users to have better access to rehabilitation treatment and recovery programmes but, as the First Minister admitted in the chamber this afternoon, the SNP’s record in Government on that has fallen far short. The SNP Government funded only 13 per cent of residential rehab places in Scotland in 2019-20, at a time when we needed it to go much further. According to the Government’s own reports, waiting times for residential rehab can be up to a year, which is nowhere near good enough for people who are often critically ill and who require urgent support.

In the previous parliamentary session, the Scottish Conservatives helped secure an extra £20 million per year for residential rehab facilities. Along with many charities, we remain convinced that more funding in that area will be effective in providing support and, most importantly, saving lives.

I have been clear that my colleagues and I will continue to robustly hold this Government to account on drugs policy but, where possible, I am open to having a constructive relationship with the minister.

As things stand, Scotland’s shameful drug deaths crisis is expected to worsen. Action must be taken now and for the future.

The Conservatives have appealed for cross-party support to tackle the crisis. A key pillar of our approach is to open up access to treatment and residential rehab treatment. The Scottish Conservatives have pledged to introduce 15 ambitious bills over the parliamentary session to secure Scotland’s recovery from Covid. One of those bills will be on a right to recovery. Embedded in such a bill will be the belief that everyone in Scotland should have a right, enshrined in law, to the necessary addiction treatment that they seek. Never again should we be in a situation where fantastic recovery organisations need to seek legal counsel because people are denied access to rehabilitation and drug treatment.

The time has come to completely rethink how we deliver rehabilitation services and addiction treatment, or else we will continue to have more avoidable deaths. How the Government responds to the public health emergency will be one of the defining issues of the session. I hope that the minister will heed views from across the parties on how we can use the powers that the Parliament already has to reverse the drug deaths crisis.

Over the years we have heard many words, but now the time has come for bold action. Scotland is watching and we owe it to the victims to do better.

Photo of Angela Constance Angela Constance Scottish National Party

When I spoke in the Parliament in the previous session, I said that I was determined to build a consensus across the Parliament and the country. I stress the point that consensus is not complacent or cosy—it is about collaboration, but it is also about challenge. Today’s debate has been a good reflection of that. Both Claire Baker and Pauline McNeill noted that, given that we are at the start of a new parliamentary session, it is time to renew our commitment and focus on solutions, based on evidence and on what will work. I make a commitment to members to return to Parliament and the committees at regular intervals, to have one-to-one meetings and to hold round-table events. A debate such as this one can only ever scratch the surface.

Photo of Tess White Tess White Conservative

Would the minister consider reopening the Mulberry unit at Stracathro hospital in Angus?

Photo of Angela Constance Angela Constance Scottish National Party

I would be grateful if Ms White would write to me on that matter so that I can consider whether it is an issue for me or for the Cabinet Secretary for Health and Social Care. I will look out for that correspondence.

I give a commitment to have a deeper dive into the integration of addiction and mental health services; access to healthcare—not excluding primary care; workforce planning and support, including how we overcome issues around culture and burnout; reporting and data, which are important levers to change alongside legislative options; issues in and around our criminal justice system; gender-based issues; and issues in respect of minorities. We need a deeper-dive debate on residential rehab and other harm-reduction, evidence-based interventions.

Photo of Pam Duncan-Glancy Pam Duncan-Glancy Labour

I appreciate the opportunity that the minister has set out to consider how the issue impacts people from various different backgrounds. Will she consider taking the opportunity that we hope will come before us in this parliamentary session to examine the incorporation of various human rights treaties into legislation in Scotland in order to strengthen the rights of various groups, particularly people who have experienced drug use, in their access to housing, mental health support and community care services?

Photo of Angela Constance Angela Constance Scottish National Party

Yes, absolutely. We need to have a rights-based approach both to treatment and to the broader agenda. If we are to address some of those wicked issues around how we treat dependence on benzodiazepines, we need to engage in that debate, guided by clinicians, and develop that consensus, so that we have a safer treatment option for people who are using benzodiazepines.

We are connecting medication-assisted treatment with the broader agenda on housing and welfare, but at the heart of it all there needs to be choice—informed choice—and a public health approach with rights all the way through it. We are not picking and choosing; we need a solid whole-systems approach.

At the start of the debate, Sue Webber, who I welcome to her position, spoke about how she is very much in favour of abstinence-based treatment. I, too, am supportive of residential rehab and abstinence-based models. However—to paraphrase something that I read earlier this week—I do not support harm reduction over recovery, or recovery over harm reduction; I support, and we should be supporting, people, which is about getting the right treatment for the right person at the right time.

Gillian Mackay spoke powerfully about removing barriers and lowering thresholds for treatment. At the core of that is getting more of our folk into treatment that meets their needs, either to get them on the road to recovery or to stabilise them and stop them dying. We must not see harm reduction in isolation from either recovery or residential rehabilitation.

Many colleagues spoke about the importance of a trauma-informed approach. I say to Alex Cole-Hamilton that I will meet Aberlour and other providers very soon. Stephanie Callaghan and Collette Stevenson got to the heart of the matter in saying how we all need to take to our hearts the root causes of drug use. They both spoke about loss but also about hope, and they said that we should not leave it to luck, as we will all be judged on our actions. Elena Whitham spoke about her experience in the homelessness sector. She talked about how we all need to get out of our silos—that of course applies to political parties—and how we need to stick with people.

In the time that I have left, I turn my attention to the amendments. I will accept the Liberal Democrat amendment, and I appreciate Mr Cole-Hamilton’s assurances that he is not seeking to direct the Lord Advocate, but I have to put some words on record. In accepting his amendment, we should all understand that the Lord Advocate exercises her functions regarding prosecutions of crime and investigations of deaths

“independently of any other person”, as enshrined in the Scotland Act 1998. There are well-established principles and reasons—

Photo of Angela Constance Angela Constance Scottish National Party

No, thank you, Mr Briggs. I am not going to get into a debate about the role of the Lord Advocate, but we will come back to many other issues—[

Interruption

.] I will not take an intervention, because I am short of time, and I do not want to get six of the belt off the Presiding Officer.

I emphasise to Parliament that, irrespective of the constitutional opportunities and constraints, I am determined that we find solutions here in Scotland. On that basis, I am more than happy to accept the Green amendment.

I am sad to say that I cannot accept the Conservative amendment, but I want to be clear about where we agree and where we disagree. I assure members on the Conservative side of the chamber that I work collaboratively with everyone, including the UK Government, but I am not going to be ignored. I am not going to stand by and allow the UK Government to ignore our communities, or indeed the will of this Parliament. I am not going to ignore the importance of the Misuse of Drugs Act 1971, because it is time for a grown-up debate, based on the growing evidence that the act is incompatible with a public health approach to tackling our drug deaths crisis.

Photo of Angela Constance Angela Constance Scottish National Party

No, because I really am short of time—I apologise to Mr Briggs. With regard to enshrining a right to treatment, I would argue that our services already have a duty to provide treatment on the basis of other legislation, but I am genuinely open minded on that. I will look closely at the proposition when colleagues bring it forward, and I will not rule it out. In the past, under previous portfolios, I have introduced legislation to the Parliament on the basis that we sometimes need legislation to lock in progress and to get us over the line. I assure Parliament that, on the issues that members seek to address, we are engaged in that right now. That is about access, capacity and following the money, of course.

I am pleased to be able to accept and support the amendment from the Labour Party, because it touches on those core pragmatic issues of implementation, the scale of the change, accountability—absolutely—and the importance of reporting on progress.

It was not another politician and it was not a civil servant who persuaded me of the importance of the new medication-assisted treatment standards; it was Colin Hutcheon, a parent who I met through Scottish Families Affected by Alcohol & Drugs. Our last word should go to those from the lived and living experience community. I am quoting Becky Wood, Allan Houston and Colin Hutcheon when I say:

“The road to reducing drug related deaths is rocky and twisting but is one we must persevere on if we are to go any way towards making Scotland a safe and happy place to live for everybody. All lives are precious, all children should expect to be nurtured and feel safe. All parents should expect their children to live long productive lives ... We believe it is vital we adapt and evolve our current systems using compassion, kindness, respect and dignity.”