National Mission on Drugs

– in the Scottish Parliament on 13th January 2022.

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Photo of Alison Johnstone Alison Johnstone Green

I remind members that Covid-related measures are in place and that face coverings should be worn when moving around the chamber and across the Holyrood campus.

The next item of business is a debate on motion S6M-02761, in the name of Angela Constance, on tackling drug-related deaths through the first year of the national mission on drugs. I invite those members who wish to speak in the debate to press their request to-speak buttons or to enter an R in the chat function on BlueJeans now.

Photo of Angela Constance Angela Constance Scottish National Party

Every drug death is a tragedy, leaving families, friends and loved ones looking for answers and support. I offer condolences to everyone who has been impacted by a drug death and reaffirm my commitment to them that I will continue doing everything possible to turn the tide on drug deaths in Scotland.

This month marks the end of the first year of the national mission to save and improve lives, and it is important that the Parliament has an opportunity to reflect on the actions that have been taken thus far, before looking ahead to the next steps on our journey. The commitment of members in all parts of the chamber to reducing drug deaths as quickly as possible is giving a sharper focus and more of a shared understanding of what needs to be done.

In the past 12 months, we have laid the foundations for the work ahead, getting in and about the issues that we face so that we can focus on delivering change on the ground that will make a real and tangible difference to people’s lives. We have set out the platforms for change on standards of care, such as the medication-assisted treatment standards, and on residential rehabilitation through the milestones that I set out at the end of last year. I put on the record my thanks to the Drug Deaths Taskforce and the residential rehabilitation working group for giving us the tools for scaling up and making the necessary changes and improvements.

The year ahead begins with the appointment of a new chair to the Drug Deaths Taskforce. I have asked David Strang to take on that role with immediate effect and I am delighted that he has accepted. David brings a wealth of relevant experience. He is a former chief constable who has also served as chief inspector of prisons. More recently, he chaired the independent inquiry into mental health services in Tayside. His appointment marks a new chapter for the task force, which has been a valued contributor to the work that is being done across Scotland. I have asked him and his colleagues on the task force to accelerate their final recommendations that are planned for this year, and aim to get them for the summer. As we now focus on delivery and change on the ground, we need quicker practical advice from the task force to build on what it has already provided and achieved.

The First Minister set us a challenge through the national mission, recognising that real change needed an all-Scotland, cross-Government, cross-chamber approach. She set out clear priorities to wrap support around those people who are most at risk, through fast and appropriate access to treatment, increased access to residential rehabilitation, better support after non-fatal overdose and recognition of the vital role of front-line, often third sector organisations.

The national mission was underpinned by additional funding of £255 million, with £5 million for the end of the previous financial year and £50 million per year for the next five years. That included £100 million over five years specifically for residential rehabilitation and aftercare. Dedicated national funding for grass-roots organisations, families and residential rehabilitation has proved hugely popular as it provides direct support where it is needed. Additional funding has been used to maintain services during the pandemic, particularly during the lockdown periods, when people were more at risk.

We have improved emergency responses, increasing the availability of naloxone, which is now carried by ambulance technicians and by police officers in pilot areas. Police Scotland is considering rolling that out nationally, and additional opportunities for naloxone carriage are being explored with our emergency services.

Funding has been provided to alcohol and drug partnerships for non-fatal overdose pathways. The Glasgow overdose response team is a good example of what is needed across the country. It provides a focused period of support for people after an overdose. The Scottish Ambulance Service has also led the way in the distribution of take-home naloxone and in connecting people to services, thereby helping to prevent, as well as respond to, overdoses. Colleagues will have noted the media strategy that ran during the last months of 2021 to raise public awareness of the signs of overdose, the important role of naloxone and, crucially, how to help.

During the first year of the mission, I have taken a balanced approach to treatment and recovery, announcing support for harm reduction through the MAT standards and for recovery through increasing access to residential rehabilitation. Both are vital and both are part of a whole system of care.

Photo of Brian Whittle Brian Whittle Conservative

I am pleased to hear about all the steps that have been taken and the potential success. However, what work is the Scottish Government doing to ensure that, as people are rehabilitated and they recover, their place is not taken by somebody else who has fallen into the trap of addiction?

Photo of Angela Constance Angela Constance Scottish National Party

Prevention is crucial in relation to our education system and early years provision, as well as the work to prevent poverty and mental health problems. The member makes an important point about prevention.

On residential rehabilitation, last year we published for the first time details on the placements that were available, and we set up funding streams to ensure that people could access them. In November, I set out plans to increase the numbers of residential rehab beds by 50 per cent and publicly funded placements by 300 per cent over the next five years.

Photo of Angela Constance Angela Constance Scottish National Party

I will make a wee bit more progress first.

I signalled the need to move to national commissioning for placements, to ensure better consistency across the country.

To build a system of fast and appropriate access to treatment, we published the medication-assisted treatment standards in May last year and set services a stretch target to have those embedded by April 2022. In December, I provided the Parliament with the first six-monthly update on how the standards will be embedded, then sustained and improved. For the first time, we have a commitment of a £40 million plan over five years to implement fast and appropriate access to treatment, making the key links between mental health, primary care and advocacy for housing and benefits.

Photo of Angela Constance Angela Constance Scottish National Party

Not just now.

The standards will ensure that people have access to trauma-informed and psychologically informed services, and they will help to make rights a reality in practice.

The standards include criteria to combat stigma, which remains a significant barrier for people coming to treatment. In the first half of the year, we supported a group of people with lived and living experience to develop and publish a stigma charter for services to adopt. The additional funding in the first year of the mission allowed us to run a successful media campaign to raise awareness of stigma, which challenged us all to think about how we can all play our part in tackling it, and recognised that people need help, not judgment.

We need to be aware of the wider impact that drugs have on families, which is an important part of our preventative approach. I announced in December the launch of our new whole-family framework, with additional funding, through ADPs, of £3.5 million per year. That will help local services to provide support to families who have been impacted by problematic drug use and adopt a whole-family preventative approach in the support that they provide.

We have introduced for the first time quarterly reporting of suspected drug deaths. That allows services to respond more quickly and keeps the Parliament informed. It is a very important step forward, but it does not replace the official reports produced annually by National Records of Scotland.

Photo of Stephen Kerr Stephen Kerr Conservative

I want to roll back a bit. The minister mentioned percentage increases in the number of beds. Can she tell us the exact number of beds that we are talking about?

Photo of Angela Constance Angela Constance Scottish National Party

The ambition for residential rehabilitation that I laid out just before Christmas was to ensure, over the five-year period, that we increase publicly funded placements in residential rehabilitation to at least 1,000 per annum.

We are moving forward with our commitment to establish a safer drug consumption room to operate within the current legal framework. A new service proposal in Glasgow has been provided and we are continuing to work closely with the Glasgow City health and social care partnership, the police and the Crown Office to ensure that we have a sustainable approach that is clinically and legally safe for staff and those using it. We are serious about that commitment, as we know that such facilities have a strong evidence base in saving lives and helping some of our most vulnerable citizens. A fresh proposal will be made to the Lord Advocate once further detail on operation and policing is developed.

Our focus on lived and living experience will be carried forward through the creation of a national collaborative, the independent chair of which will be announced this month. The national collaborative will be well placed to recognise and understand the impact of trauma and to bring together and support the voices of people with lived and living experience, and families, ensuring that they are at the very heart of the national mission to shape and implement a human rights approach that will stand the test of time.

In March, I will announce our first treatment target, which reflects the MAT standards. In December, I announced funding for new research into prevalence, and the outputs of that research will help to inform future targets.

By March, we will have published evidence on the impact of methadone in poly drug use deaths, as well as an evidence summary on benzodiazepines, which will inform discussion for an expert group that will meet at the end of January to consider the role of benzos in treatment and recovery, and inform our work on stabilisation services, as recommended by the task force.

This year, I will ensure that plans for the establishment of the national care service are an opportunity both to improve person-centred care and to put drug and alcohol services on a firmer footing through clearer expectations, standards and accountability.

In all our projects and initiatives, one of the most significant challenges that we face is the workforce. We are currently mapping the workforce, including existing training capacity. Over the next year, we will focus on increasing capacity and training to ensure delivery of the national mission.

I will also continue to work closely with ministerial colleagues to focus on action to support people with multiple, complex needs—joining up with mental health, justice, homelessness and others. I am particularly keen to see more progress around justice issues, which will include better throughcare, especially for people on release from prison. I will return to the Parliament with justice colleagues in the spring.

I will continue to press for the introduction of drug checking facilities, which could save lives if we were allowed to introduce them in Scotland. The task force has funded a project to research and scope the key components required to implement drug checking facilities in three areas in Scotland: Dundee, Glasgow and Aberdeen. We expect licence applications for the first of those to be submitted to the Home Office by the end of February.

In this first year of the national mission, solid foundations have been laid, but much remains to be done. My focus and that of the Government will be on delivery on the ground, where it matters most. I look forward to members’ contributions.

I move,

That the Parliament believes that drug deaths are tragic, preventable and an unacceptable loss of life; supports the national mission that seeks to galvanise an all-Scotland response to this public health emergency, and recognises that no single intervention will be enough on its own; notes the need to continue to build on the work of the Drug Deaths Taskforce and other expert groups to implement evidence-led interventions that reduce deaths and improve lives; further notes that this includes increasing capacity of rehabilitation beds by 50% and providing more than a 300% increase in publicly-funded placements; welcomes the new Medication-Assisted Treatment Standards, including the implementation of same-day treatment and increasing the range of treatment options available across the country, to help save lives; commends further consideration of measures to make rights real and to implement in practice a human-rights approach through person-centred care; considers that safer consumption facilities are an important public health measure that could save lives, and supports all options within the existing legal framework being explored to enable the delivery of these facilities.

Photo of Sue Webber Sue Webber Conservative

I draw members’ attention to my entry in the register of interests—I am a councillor on the City of Edinburgh Council and a member of the Edinburgh alcohol and drug partnership.

I welcome the chance to speak in such an important debate. I want to do all that I can to look for the positives and to reflect on the cross-party ambition and willingness to work together to tackle and reduce our country’s shocking and shameful drug-related deaths. Today, we are asked to consider the first year and next steps. I know that we all want to see evidence of real improvements in services and support for those who desperately need help, and we want to save people from dying needlessly.

However, in Scotland today, people are still being denied access to the addiction treatment that they need, while the drug death rate has almost tripled on the Scottish National Party’s watch. The SNP’s devastating handling of the crisis has been thrown into further chaos by the recent resignation of members of its Scottish Drug Deaths Taskforce. I acknowledge and welcome the appointment of Mr David Strang.

Annemarie Ward, who is the chief executive officer of Favor UK—Faces & Voices of Recovery UK—has said:

“We have stood by helplessly while friends become more traumatised by the day. We have witnessed friends and family die, watching the slow car crash as each reached out for help that more often than not wasn’t there.”

The absence of hope in our treatment systems is damaging not only to service users but to those working in services. As I asked yesterday in the debate on mental health—and it is just as valid today—

“how can a workforce that has reached burn-out deliver compassionate care when they face periods of stress and anxiety?”—[Official Report, 12 January 2022; c 41.]

How can they do so when they watch people’s lives destroyed by substance misuse daily?

As my amendment states, the next phase of action must also include preventative measures and policies that ensure that, as Mr Whittle said, those who are helped with their recovery are not replaced by more people who fall into the cycle of addiction. To do that, we must understand why Scotland has the crisis that it has. What is unique to Scotland that causes so many drug-related deaths? Only when we understand that can we create a preventative agenda that will work to save lives in Scotland.

That is one of the reasons why the Scottish Conservatives have launched our right to recovery bill, which will ensure that those with addiction issues are able to access the necessary treatment that they require. I have had the invaluable opportunity to speak to stakeholders and those with lived experience, who will have submitted responses to the call for consultation. I thank them all for taking the time to engage with the bill and for sharing the issues that they still face, 12 months on.

Right now, the treatment system in Scotland lacks the quality, the diversity and the capacity to fulfil its potential in protecting people from harms related to substance use, including drug-related deaths.

Stephen Wishart said:

“the proposed Bill does address this. It ensures equal funding must be provided to allow local authorities/NHS health boards to perform its duties. It also”— importantly—

“shifts the balance of power from the opinion of individual decision makers and to the right of the person to choose what their plan is.”

Yes, we welcome the £250 million to tackle drug deaths. It should not have taken 14 years to finally realise that the drug policies had failed, that families had been failed and that entire communities had been let down and broken. That is why the Scottish Conservatives are pushing forward with our proposals for a right to recovery bill. With the consultation now closed, it was astounding to see the level of interaction and submissions from across the country. We have received overwhelming support and, again, I acknowledge and thank everyone who took the time to submit their views on the right to recovery bill.

As I said, the £250 million of funding is welcome but, sadly, the SNP Government has refused to sign up to the United Kingdom-wide scheme to help tackle drug dealing. Project ADDER—addiction, diversion, disruption, enforcement and recovery—would have provided investment designed to tackle addiction and the supply of illegal substances.

Photo of Angela Constance Angela Constance Scottish National Party

My understanding, via my officials and via UK Government officials, is that no extra resource is attached to project ADDER, should Scotland participate, and that, to be blunt, the proposal from the UK Government was to rebadge, as project ADDER, work that we were already doing.

Photo of Sue Webber Sue Webber Conservative

I thank the minister for her intervention, but surely the SNP should be doing everything possible, and taking any approach possible, to tackle our national crisis, rather than playing party politics, yet again, and refusing to engage with Westminster. That is tiresome and unnecessary, when we all know that we must work together to save lives.

Across the country, alcohol and drug partnership meetings have taken on a more upbeat and positive feel for the first time in years. More funding has helped, as they strive to have the new MAT standards embedded within their areas by April 2022. However, that is where things start to go wrong. April 2022 is only four months away, yet ADPs across the country are starting from very different places. Some have already admitted that they will not be able to establish and embed all the standards by that timeline, including Edinburgh Alcohol and Drugs Partnership, which has an established pre-existing service that includes many of the standards.

Half of the ADPs that did not respond to the Public Health Scotland survey said that they had yet to set up a pathway to residential rehabilitation. When it comes to other reasons for ADPs not responding to the survey on residential rehabilitation, 42 per cent said that it was because no referrals were received, and 8 per cent said that no staff were available to complete the template. That is astounding. Such a variation in services across the country underpins the inequalities that we face. We need to wake up.

It is for that very reason that people need the right to recovery, as it is clear that the SNP has failed to support residential rehabilitation. The SNP Government funded only 13 per cent of residential rehab places in Scotland in 2019-20. Furthermore, the number of Government-funded places in residential rehabilitation declined throughout 2021, from 47 placements in March to 36 in September. That is a long way from reaching that figure of 1,000.

I will take time to acknowledge the invaluable work that is going on across my city of Edinburgh. The violent offender watch—VOW—project is led by Police Scotland and consists of four police officers and three peer mentors.?It aims to empower young people who are involved in the criminal justice system to break the cycle of offending, by providing support to people who are deemed to be at significant risk of drug-related harm in the community. That assertive outreach relies on the unique experiences of the peer mentors, who have lived experience, and on the police officers, who offer access to a wide professional network of contacts who can provide opportunities for training and employment.? There is no doubt that the project has saved lives, but funding is an issue.

Tackling drug-related deaths should always be a priority, which is why the Scottish Conservatives launched our right to recovery bill. There has been criticism. Some say that there are flaws in the bill, but those working with us have hit back. Annemarie Ward, the chief executive officer of Favor, said today:

“enshrining people’s rights in the law will ensure access and choice to a plethora of services over and over again ... it is nothing short of incredible.”

She continued:

“This legislation is a starting point to people being able to access services that at the moment are not even available.”

I hope that the Parliament continues to demonstrate consensus and collaboration in tackling the complex issues involved in drug-related deaths. It is our national shame. We should all support the proposed right to recovery bill, making a recovery a legislative certainty—that is the very least these people deserve.

I move amendment S6M-02761.2, to insert at end:

“; acknowledges the valiant efforts of the third sector in ensuring that targeted funds successfully reach frontline service users; believes that it is vital that a right to recovery is legislated for, in order to safeguard the future of funding and focus beyond the current parliamentary session, and calls for the next phase to also include preventative policies that ensure those who are helped with their recovery are not replaced by more people who fall into the cycle of addiction.”

Photo of Claire Baker Claire Baker Labour

One year on from the First Minister’s statement, this debate is an opportunity to examine progress and to focus on the next steps. A year ago, a declaration was made, a national mission was announced and an acknowledgement of failure was given. A year on, the early indications are that progress on reversing the high rate of fatalities in Scotland—by far the highest in Europe and more than three times that of England and Wales—is slow.

The recent Police Scotland data showed a slight decrease, which suggests a plateau rather than progress. Perhaps at this stage, the Government would argue that more progress is not to be expected, but when will it be? The funding commitment is for five years. Is that the aim of the national mission and what does success look like? If we are to have confidence that progress will be made, when we reflect on policy announcements and responses to the crisis, it should be with a critical eye and focusing on the further action that is required.

I recognise that there has been activity over the past year. That includes the medication-assisted treatment standards, plans to increase capacity in residential rehabilitation facilities and expansion of the recorded police warning scheme—although more investment is needed if they are to make a difference.

Our amendment talks about the need to fully resource the MAT standards implementation. In June, the minister committed £4 million to the first two standards being implemented as a priority. The six-month update did not share any data to demonstrate progress—we only have the minister’s word on that. The commitment is for full implementation by April. Will that be achieved?

A briefing from the Royal College of Psychiatrists highlights the need for more support for health boards and integration joint boards that are struggling to meet the standards, with a focus on leadership and increased staffing levels. Our amendment also talks about barriers to residential rehab. How will the minister ensure that the expansion in capacity addresses equal access?

I am looking for support for our amendment today, but we will support a united voice in Parliament. However, the minister’s motion lacks acknowledgment of the failure of the Scottish Government to act much earlier when fatalities began to spiral upwards, or to set out a clear course of action. Although I fully recognise that the addictions of the modern era in Scotland are fuelled by industrial change, unemployment and deprivation, trauma and mental health, the responsibility of the Government is to respond—the drug deaths crisis represents a failure of the Government in recent years. It shows the devastating impact of what can happen when focus is not on critical issues that are allowed to escalate as policies continue on a mistaken path. Lives could have been saved if action had been taken far earlier.

Although we welcome several announcements that have been made in the past year, there is still much work to be done. A year ago, the First Minister stated support for adopting safe consumption rooms in Scotland and exploring how to overcome barriers to doing that. Over the past year there have been a number of statements from the Government on the work that is under way. I was seeking assurances that we were moving forward and I appreciate the minister’s comments today on a Glasgow proposal—it sounds like it is coming closer. I support her in pushing forward that plan with other agencies.

Wales has had a drug checking service since 2013, but we are still to get the pilots started. Although a commitment was given, there has been a lack of progress on expanding heroin-assisted treatment, which is important in reducing fatalities, and blood-borne viruses, as the Hepatitis C Trust has highlighted.

Accountability, transparency and scrutiny will be essential going forward, which is why the Labour amendment calls for an independent review—an audit of activity. I await more information on the national collaborative that the minister referred to today and whether it could play a role in that.

A year ago, the First Minister stated the importance of a clear focus on what works and the need to evaluate interventions so we know what works and what does not. A review should cover not only the recommendations of the Drug Deaths Taskforce but also other measures announced by the Government, so that we can assess how effective these interventions are and identify quickly where further change is needed. There is a balance between urgency and evidence-led policy making. That challenge is for the minister. I share her frustration at the pace of change, but we must not lose sight of the importance of informed policy making.

The resignations of the chair and the vice-chair of the Drug Deaths Taskforce reflected a breakdown in the relationship between the Scottish Government and the task force that it appointed. It is unfortunate that, by pushing for urgency—the Government itself had not demonstrated that for a long time—the Government created a situation of uncertainty and conflict. Steps must be taken to avoid that negatively impacting on the on-going work of the task force.

I welcome the clarity today over the appointment of David Strang as the chair of the task force, and I wish him well in leading its work. Its contribution is important, and I urge the minister to work constructively with it and to support completion of the work.

The task force has, of course, already made recommendations. We need to hear what progress has been made with those, including evaluations and updates. The recent report by the Parliament’s Criminal Justice Committee raised concerns at the lack of progress on implementation of the recommendations and called for much faster progress to be made.

We also need increased transparency on the national mission and related work, which demonstrates an inclusive approach. The national drugs mission implementation group, which is chaired by the minister, was set up to drive action across Government and services and to oversee delivery of the task force recommendations. It was due to meet every three months, but information on the Scottish Government website shows that a meeting took place in June 2021, and it gives no indication whether it has met since then. No minutes are available. That does little to instil confidence in the process or transparency. Will the minister, in concluding, advise on additional meetings of the implementation group and outline its current work?

The national mission must be more than a statement: it has to save lives and it has to build futures.

I move amendment S6M-02761.1, to insert after “loss of life”:

“calls on the Scottish Government to provide clarity on the future of the Drug Deaths Taskforce, its leadership and viability of the timescale for completing its final report, as well as provide an update on progress in implementing the recommendations made so far; believes that safer drug consumption facilities, heroin-assisted treatment and drug checking facilities should be urgently progressed as part of harm reduction measures to address Scotland’s drug deaths crisis; further believes that there needs to be swifter action to progress these measures, which can save lives, improve health outcomes and act as a gateway for vulnerable drug addicts to access drug treatment services and other forms of support; acknowledges that the Medication Assisted Treatment (MAT) standards, developed with direction from those with lived experience, have the potential to make a positive difference to people affected by drug use, but agrees that there must be enough investment in services to turn these into reality and ensure that they are sustained in future years; agrees that the expansion of the Police Recording Warning scheme should act as an enabler for vulnerable drug users to access treatment and support services, and that resources should be put in place to ensure that this happens; believes that expansion of residential rehabilitation must address the needs of those areas in Scotland where there is limited service access, that barriers to provision must be identified and removed, and that action must be taken to ensure that all age groups, including young people, can access these services; agrees that there must be a fully independent review to examine the extent to which measures announced by the Scottish Government, including those that were recommended by the Drug Deaths Taskforce, are making the most effective interventions and are tackling the drug deaths crisis;”.

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

I welcome this debate and reaffirm my good wishes to Angela Constance in her work. I think that all parties want her to succeed. I also welcome the appointment of David Strang, whom I know from working with on prison reform and matters relating to constituents. I have always found him to be a man of deep compassion and intellect, and I welcome him to his place.

I acknowledge the political progress that has been made on the subject. A year ago, we debated a motion on the issue in the name of Monica Lennon. At that point, it was customary for Opposition time to be afforded to the drug deaths emergency, so I am gratified that the Government is now leading such debates in its time.

Progress is still painfully slow, however. Last summer, Scotland hit a particularly grim milestone, with more than 1,300 people dying of drug overdoses—I am sure that everyone in the chamber is familiar with that. For the seventh year running, we had the highest number of drug deaths ever seen in Scotland. The mortality rate in Scotland is three and a half times higher than those of our English and Welsh counterparts, and it is higher than that of any other European country.

Although deaths are the main focus of the debate, it is worth noting that addiction has devastating consequences from the cradle to the grave. In fact, just last week, my party revealed through a freedom of information request the devastating reality that, since 2017, more than 850 babies have been born with neonatal abstinence syndrome. That not only has immediate and painful side effects for newborns, such as seizures, tremors and breathing difficulties, but can cause serious developmental issues. It is hard to imagine a more difficult start to life. I have talked about that several times, and particularly the work that I did outside the Parliament in that regard.

To solve the crisis and identify solutions, we have to shift away from the perception that addiction is a criminal issue. We are starting to do that. Addiction is a debilitating and consuming sickness that masks unresolved pain and is sometimes born out of mental health conditions or economic circumstances. In some communities, it is also even a rite of passage. To be properly treated, that illness must be met with empathy and a holistic understanding of the factors that contribute to it. The Lib Dems, alongside others, particularly in the Labour Party, have been campaigning for that approach for a very long time.

The Royal College of Physicians advises that, although we are in desperate need of direct policies to tackle drug deaths, we have to address the impact that employment, social security and housing, for example, have as contributing factors to addiction. The royal college says that there must be a joined-up approach and joined-up care across all those stables for people who struggle with addiction, to tackle the epidemic from all angles. Despite the expertise of the royal colleges, why does the Government not always heed that advice?

Only two weeks ago, the head of the Drug Deaths Taskforce, Catriona Matheson, and her deputy, resigned. Why? They said that it was because they could not cope with the Government’s drive to meet the targets quickly, rather than achieving them on a sustainable basis. I hope that David Strang is afforded more latitude to complete his work at a rate that works.

We know that sustainable change can be achieved by precise action and expertise. We can see that from international examples, such as that of our near neighbours in Portugal, who have grappled with such issues and have succeeded. That is why I and my party have previously called for the help of the World Health Organization to provide a specialist task force for Scotland, which could blend international expertise and solutions that work to tackle our drugs death epidemic head on.

My party has called for safe consumption spaces for a long time, following the heroic efforts of people such as Peter Krykant and Paul Sweeney, before he came to this place, to provide spaces for safe consumption and clean equipment. The risk of drug mortality reduces considerably if we reduce the rate of deadly infections such as hepatitis, and there are other vital impacts.

Moreover, we have campaigned for an increase in rehabilitation services. It is of course encouraging to hear about the measures that the Government is working on to reward such efforts and increase rehabilitation capacity by 50 per cent. More can and should be done, however. We need to match that with recognition of the problems in our stabilisation services, which I have discussed with Angela Constance. I hope that she will address the Government’s commitment to that in her closing remarks. We cannot get people into meaningful rehabilitation until we have stabilised the various chaotic aspects of their lifestyle.

As I have mentioned before, more must be done to provide a united approach across different services. We have recently heard extremely troubling reports that those in drug and alcohol rehabilitation must leave rehabilitation immediately because, otherwise, they could lose their council homes and tenancies. Is snatching away people’s homes really an appropriate way to treat people who are in such desperate need of help, considering that it would be perfectly plausible for the Government to use emergency housing funding to help people to keep their homes and tenancies while they undergo that vital treatment? The Liberal Democrats have repeatedly called for that, and I ask the minister to reflect on that in her closing remarks.

The motion that we are debating also considers safe consumption facilities, which are an important measure, and it

“supports all options within the existing legal framework”.

However, the law is not as black and white as the SNP would lead us to believe. The Government could be pushing and challenging the boundaries of the law to break the legal impasse and properly introduce safe consumption rooms. After all, that was confirmed by the Lord Advocate a few months ago, when my party pushed for a review into the laws.

Above all, it must be remembered that every drug-related death that occurs is a tragedy, but the rate and scale here make the issue a particularly Scottish tragedy. It is a preventable loss of life among people who are in need of compassion and support rather than judgment, and help instead of punishment. A mark of a modern and liberal society is how readily and effectively we offer assistance to those who need it most.

Photo of Gillian Martin Gillian Martin Scottish National Party

As politicians, we can all come to the chamber with our views on how to help people who are at risk of death from drug use, but it is incumbent on us all to reach out and speak to those with experience. I do not have experience, professionally or personally, and I am acutely aware of that every time that I engage on the issue. I have not felt the pain, as a mum, of seeing my children struggle with addiction, wondering whether they will ever become healthy again and whether, one day, I might get that phone call. However, I have spoken to families for whom that is a constant fear.

Drug addiction does not have a type, but it has some very stubborn root causes that some people are more at risk from than others. In thinking about all the interventions that Ms Constance has outlined over the past year, we must remember that poverty is the most egregious of those causes. No one standing up here today should ever ignore that root cause, which has been many decades in the making. With the mitigations that the Government, drug and alcohol agencies and clinicians can make, it sits stubbornly in the room like the proverbial elephant.

Ms Constance has said many times that she wants to throw the kitchen sink at this issue and that she will consider anything if it works. I was pleased to see the pledge of £1.1 million over three years for projects to monitor progress on the interventions that are being made. Those interventions include surveillance projects on new problem drug use prevalence estimates, hospital-based toxicology studies and improvements to the national drug-related deaths database. Those projects are vital, because we need to know what is working and what is not.

We have no time to waste. We need to leave entrenched political ideology at the door. Some politicians in the chamber have, over the time that I have been here, been far too wary of following other countries’ radical but ultimately successful approaches such as the one in Portugal that Alex Cole-Hamilton has just mentioned. Those politicians are too stuck on purely abstinence-based recoveries and too quick to dismiss safe consumption facilities. They have not recognised that people who suffer from addiction can also have caring responsibilities, which means that they need wraparound care and treatment that consider those responsibilities. I believe that some of those entrenched views are not only stigmatising but unrealistic, given the complex nature of addiction.

Our goal is to help people to recover from addiction and stay recovered. The way to get there will require myriad approaches, not all of which are traditional political vote winners. One of the most significant Government interventions is the implementation of the medication-assisted treatment—MAT—standards across Scotland.

On the matter of stigma, we must all be resolute in our assertion that we are talking about a health issue and that we need to stop constantly referring to it as a justice issue for those who are addicted. The tone and rhetoric of some of the Conservative MSPs who questioned the Lord Advocate on her announcement on diversion from prosecution was slightly disappointing in that regard. That move, which seeks to aid in the recovery for victims rather than compound their trauma by putting them into the justice system, is significant. I also implore politicians to stop using the word “shame” in the media when discussing the issue, no matter how it is meant.

Yesterday’s mental health debate had some moving and quite personal speeches from MSPs across the chamber. For some of our citizens, poor mental health leads to a reliance on drugs or alcohol, which can turn into life-threatening addiction. That manifestation is not a lifestyle choice; it is often a symptom of trauma and poor mental health.

If the law is a barrier to recovery, it simply must be changed. I look forward to asking the UK Government minister Kit Malthouse in early February about the UK laws that prohibit the use of safe consumption rooms in a joint session with the Health, Social Care and Sport Committee, which I convene, and the Criminal Justice Committee.

I come back to where I started, which is my determination always to consult those with experience whenever I speak on drugs policy. With that in mind, I asked my colleagues at Alcohol & Drugs Action in Aberdeenshire what they think of the policy interventions of the Scottish Government in the past 12 months. The director, Fraser Hoggan, said:

“In Aberdeenshire, there are issues not only around opiate users, where MAT standards are very much welcomed. But we also recognise increases in polydrug use within a younger age group. We need to ensure that within the investment plan ... we create an adaptive and flexible treatment system—specialist services that will emphasise and include the vital preparatory work that is trauma informed, care and stabilisation opportunities, and post care such as re-integration planning for any rehabilitation placement.

There is the need to consider broader aspects that ensure relevant assessment processes and a wider ‘wraparound’ and more joining up of wider health and social providers. So increasing the range of treatment options is indeed essential, but also those involved in delivering them. It is important to stress that rehabilitation beds in themselves won’t succeed even with the best of intention if we don’t have a ‘systems-based’ approach. MAT standards will very much be a key lever for opiate users at high risk. But we must broaden out the ‘standards’ approach further, given that many of those suffering non-fatal and fatal overdoses are polydrug users with a wide variety of other underlying health and social issues.”

Photo of Brian Whittle Brian Whittle Conservative

I am pleased to be given the opportunity to speak in the chamber on tackling Scotland’s drug deaths shame.

Those furthest from society during the pandemic have suffered disproportionately. We have endured nearly two years in which isolation and lack of public contact have been mandated, but for those who are caught by addiction, isolation and lack of contact are the worst of all worlds.

Covid’s impact on drug and alcohol consumption, and on death rates, has been significant. Much has been said in the chamber on the subject over the past five years. Although it took far too long for the Scottish Government to acknowledge the severity of the issues, with the First Minister admitting that the Scottish Government had taken its eye off the ball, it is fair to say that action has been taken at long last. Much of that action was repeatedly called for by the Scottish Conservatives, especially on reinvestment in rehabilitation beds, which had been so drastically cut.

In our last debate on the issue in the previous session of Parliament, the Scottish Conservatives recognised that the debate had to move on and, despite serious reservations, we supported a Government motion that included exploring the viability of safe consumption rooms. Those reservations about safe consumption rooms being the most effective way of deploying public funds and tackling addiction issues remain, but the debate on solving the crisis cannot be allowed to hang on that particular issue.

As the Government motion today says, the debate is about the first year of the new measures, their effectiveness and what steps have to be taken next. We have had a year of putting measures in place to tackle the immediate crisis, helping those with the most urgent and chronic addiction problems and ensuring that they get the treatment that they desperately need—something that the Scottish Conservatives would like to enshrine in law with the right to recovery. Those are understandable first steps, but I want to discuss how we ensure that, as we help each person with their rehabilitation and recovery, their place is not just taken by somebody else who has fallen into the addiction trap. In other words, how can we develop policies that help to prevent people from stepping into that life in the first place, or at the very least catch the problem as early as possible before it reaches crisis point? That is more complicated and long term, but it is, nonetheless, critical that we address it.

Understanding the reasons for addiction and specifically why Scotland has such a poor record is a critical first step in developing a strategy to tackle addiction, which is something that the minister and I have debated and discussed before, and I think that that debate will probably continue. According to the conclusions from a conference called “A Matter of Life and Death”, which was attended by around 110 organisations that are associated with prevention and treatment of drug and alcohol abuse, some of the main causes of drug and alcohol misuse include: marginalisation and exclusion—loneliness; a lack of social structure; poor relationships; lack of protective factors; self-medication associated with masking the pain of adverse childhood experiences and previous trauma; stigma; self-deprecation; barriers to achievement; and homelessness.

Photo of Jim Fairlie Jim Fairlie Scottish National Party

On that list of reasons why people take drugs, the one that was blatantly missing was poverty. Would Brian Whittle accept that poverty is a major contributor to drug use?

Photo of Brian Whittle Brian Whittle Conservative

I thank Mr Fairlie for that intervention, because that was my very next sentence.

I joined the Scottish Affairs Committee at Westminster in the previous session of Parliament for its investigation into deprivation and addiction. It concluded that, although deprivation does not necessarily cause addiction, deprivation and inequality make the causes I listed more acute, leading to a greater likelihood that people have an inability to access quality treatment and help, lack access to general community services, have an unmet complex health need and lack an effective support structure. Therefore, although Mr Fairlie rightly cited poverty in his intervention, that committee, which is chaired by one of his fellow Scottish National Party members, concluded that it was not necessarily the cause of addiction.

There are successful interventions around the country and we do not need to reinvent the wheel. Many people in organisations on the front line who have lived experience are doing great work. Much of the solution is about supporting work that is already being done. The most effective tools that the Scottish Government has at its disposal to tackle the scourge of addiction, and deaths from it, lie in education, health and the third sector, responsibility for which has been totally devolved to the Scottish Parliament for 20 years.

Successive Governments’ inability to create legislation to tackle, invest in and focus on the issue is an abject failure of the Parliament. Make no mistake: the Scottish Government has a significant toolbox with which to radically alter the approach to addiction and, therefore, the outcomes. I highlight that, within those actions, we must recognise non-clinical interventions, which are not an attempt to replace clinical services but, rather, to augment them. I fear that we are medicalising human distress.

Clinical and third sector partnership solutions must include financial partnerships. I know that the minister recognises that, but we have had these conversations before and there have been too many instances of the third sector organisations that interact with the most isolated patients not getting access to Scottish Government funding.

If I may, I have some suggestions to make. A range of support should be made available in one location—a one-door approach—and services should work together to reflect the needs of individuals and families in the treatment plan. Services should be available within communities, which would provide a sense of feeling connected. There should be sharing of information, continuity of care and more joined-up working between addiction services and community mental health services.

Long-term solutions rely on understanding why Scotland has such a disproportionately bad record on drug deaths and addiction, and I would like to hear an appropriate response. I hope that the minister will answer that in summing up, because to tackle the crisis in the long term, the solution must include prevention.

Photo of Paul McLennan Paul McLennan Scottish National Party

We mark one year of the national mission to save lives and improve lives. In preparing my speech, I reminded myself of the main aim of the national mission, which is to save and improve lives through

“fast and appropriate access to treatment and support through all services ... improved frontline drugs services (including third sector) ... services in place and working together to react immediately and maintain support for as long as needed ... increased capacity in and use of residential rehabilitation” and a

“more joined-up approach across policies to address underlying issues”.

I recently met with MELDAP—Midlothian and East Lothian Drugs and Alcohol Partnership—to discuss how I could help and add value to the mission in East Lothian. East Lothian has actually had a slight drop in drug deaths, from 18 to 14, in the past year. Most of the deaths, like many in Scotland, were of long-term users who had existing issues, many of whom were multiple drug users. Again, like in the rest of Scotland, many—but not all—were from poorer backgrounds. Fourteen lives have still been lost in East Lothian and 14 families are suffering.

Over the next five years, £250 million will be spent on addressing the crisis, and the Scottish Government is determined that every penny of that additional funding will make a difference. The first year of the mission has seen a lot of consultation and honest and frank discussions, but we need to move on to implementation.

The Scottish Drug Deaths Taskforce was set up in 2019 and has considered strategies in some key areas. I will focus on a few of those. The first is stigma, which we should not underestimate. For years, phrases such as “He’s just a junky”, “He’s just a pothead”, or “They’re just a waster” have been bandied about. People threw around such comments without thinking about their impact. Stigma affects individuals, families and communities. People with drug and alcohol problems often see themselves in a way that reflects the prejudice and judgment of others. That will not go away, and it can override any sense of self-worth or self-esteem. There are strong links between stigma and problems with wellbeing and mental health, as we have heard.

I want to reflect on a constituent whom I have known for a long period of time. Our families grew up 200 or 300 yards away from each other. I have seen him struggle with addictions over a 30-year period. I have seen him being verbally abused on the local high street on a number of occasions—I have seen him in tears because of that. On one occasion, he came up to me and said, “Paul, I just need help. I hate being like this.” That stuck with me. His mental health has suffered. He is a good lad who realises that he needs the joined-up approach that we are talking about.

I know that some members attended the drug and alcohol misuse cross-party group a few weeks ago, when we heard about family members being affected by stigma. It can limit their ability to get help for their loved ones, it is tiring for them—we kept hearing them say that—and it can stop them seeking help for themselves.

Photo of Brian Whittle Brian Whittle Conservative

On stigma, I have heard the horrible phrase, “the hierarchy of death”, which means that what appears on the death certificate determines how the family is treated. If “drug death” appears on the certificate, the family tends to be stigmatised. Does the member agree?

Photo of Paul McLennan Paul McLennan Scottish National Party

I certainly do. One of the key things is that we have now moved on from criminalising people to looking at their health problems. I am glad that the member brought up that important point.

Communities with problem substance use are also stigmatised. That can be the case when substance use is higher or is just seen to be higher, and the whole community can be defined by substance use. I have been a councillor for 15 years, and I have heard people say, “If you go in that housing area, there are certain types of people that live there.” That brings communities down and makes the people who live in them feel bad, which can cause communities and residents to feel cut off and isolated. We need to work with communities to make sure that that does not go on.

Why does tackling stigma matter? Stigma can make people uncomfortable asking for help, so they reach a crisis point. For the chap I mentioned who came and spoke to me, I think that part of the problem was that he was stigmatised. Stigma also stops issues with mental and physical health, housing and debt being addressed—the problems are much broader.

I also want to talk about medication-assisted treatment, which is very important. It is all about access, choice and support, and that is key. What do the MAT standards mean for the people who use services and support? One thing that I would ask the minister to touch on when she winds up is how we can monitor MAT on a local authority basis. Treatment needs to be consistent across the country, which means that people can get a prescription or other treatment support requested on the day that they present to any part of the service.

People also have a right to involve others, and we have talked about family support. A key thing that came across on the few times that I have been at meetings of the drugs and alcohol misuse cross-party group was the fact that people relish family support.

Staff also need to help people to choose MAT. We need to ensure that information about independent advocacy services is available and that people feel able to use those services to discuss the issues that matter to them. Such services need to be as local as possible and to be consistent across Scotland, and I again ask minister to say how we can monitor that.

We need to make everyone aware that the treatment is not conditional on abstinence from substances or uptake of other interventions, and we need to ensure that information and advice on recovery opportunities in the community is well known.

What do the standards mean for staff across all the services? That is very important—we have to think about who is providing services. Staff can feel confident and supported to discuss and offer all treatment and care options for MAT on the first day that a person presents. Where a staff member is not trained to do that, they should be able to use a clear pathway to refer a person, on the same day, to colleagues who can.

We have made an encouraging start. We have raised awareness of the national mission, but as MSPs, we have a role: to lead in our communities, to make it a mission for our constituencies and to be advocates for people and their families.

The Presiding Officer:

Before I call Michael Marra, I ask that members who wish to speak in the debate make sure that they press their request-to-speak buttons.

Photo of Michael Marra Michael Marra Labour

Much has already been said about the recent developments around the Drug Deaths Taskforce, and I do not intend to take up too much of my time reviewing that unfortunate set of circumstances. Governments do not get everything right, and some Governments get very little right. However, we should welcome it when, if they believe that their approach is not working, they change course.

We are all concerned about the pace of progress. It cannot be allowed to replicate the glacial pace of recognition and acceptance of responsibility from the Government of this astonishing national shame. The cost of that neglect and delay is measured in lives more than it is by time. The impact on my home city of Dundee, the North East Scotland region that I represent and the whole country are huge. Our community remains deeply frustrated that the situation is still of such desperate failure, with continuing trends of death, destruction and devastation to families and communities across Scotland.

As our amendment and our actions have shown so far, Labour strongly supports the MAT standards and wishes to see them put into practice consistently across the country with the urgency that the minister consistently speaks of. Those reforms, which are to be implemented universally in a matter of weeks, are being demanded at an unprecedented pace, but they are of course responding to an unprecedented situation. I know that the minister will hear even more regularly than I do the well-founded concerns of agencies and experts about how they can be achieved, but we cannot allow inertia to prevail, and neither can we ignore the huge distances that some services have to travel.

I would like to place on record my thanks to the Minister for Drugs Policy and the Minister for Mental Wellbeing and Social Care for meeting me and the Brechin Healthcare Group before Christmas break to hear about the fantastic work that it is doing and the challenges that it faces. The good will and receptiveness of the ministers at the meeting was evident and appreciated, but I still left it with very real concerns about how the MAT standards will be implemented in rural and semi-rural areas, which have lost so many health services over the past 14 years. Of course, how the reality of service access meets the rhetoric of ambition, even in Scotland’s urban areas, has been set out in this chamber.

In Dundee, the absence of a functioning same-day prescription service has been central to the tragedy that continues to plague the city. It is now three years since the publication of the Dundee drugs commission report, which had at its core the need for those services to be operational and working in tandem with other support for people. Since the report was published, far more than 195 people have died. That number reflects the published statistics and not the number of people who we have lost since last summer. It is a trend that has continued upwards for a decade and shows no signs of reversing.

The two-year assessment by the independent commission of what has happened with the implementation of the report is now concluding.

I have not had sight of that report but, given the many discussions that I have had, I would be greatly surprised if it were to say anything other than that very little change has taken place. Services have been rebadged and tests of change, as they are now called, have been started, but I can see nothing that has radically altered the situation that Dundonians face. There has been none of the urgent action that is needed to meaningfully improve the life chances of people who are in need of support. I might sound pessimistic, but more than 200 lost Dundonians and the grief of their families is the fatal proof.

David Strang is no stranger to the challenge of systems that resist rather than embrace change, given how slow the implementation of recommendations from his report into mental health services in Tayside has been.

A Scottish Drugs Forum report assessing progress towards the implementation of MAT standards across the country has found that just 8 per cent of the research participants had access to same-day prescribing. The interminable delays in Dundee’s service change must not be tolerated across Scotland.

The debate marks the first anniversary of what the minister calls the national mission. It is a mission with, unfortunately, little real success to show. In all honesty, I find it difficult to describe what the realistic evidence-based intent of the mission is.

Photo of Brian Whittle Brian Whittle Conservative

Does Michael Marra agree that we need to get to grips with why Scotland is caught in such an addiction trap before we can get to a proper solution?

Photo of Michael Marra Michael Marra Labour

I absolutely agree. If it is a mission, we should all share it and everyone must know its story and intent. Why is Scotland’s drug deaths record the worst in the world by such a huge distance? That is a key question. Why, when we have the same drug laws as the rest of the UK, is the number of drug deaths in Scotland three and a half times as high? A year on, Scotland is yet to hear answers to those vital questions from the minister or the Government.

What has come through the Dundee drugs commission is a picture of what the local problem has been—its character, the type of drugs and the situation. The why and the where are absolutely critical for a form of analysis that the public can buy into. I want to hear more from the minister in that regard. In order for there to be leadership out of the crisis—walking alongside families, individuals and communities—we need to hear the story of why.

In the early part of the past decade, under this Government, prescribing policy changed to stop the dispensing of Valium. That led directly to an illicit street market for cheap and toxic replica drugs. That is the most lethal policy error of devolution, and it has opened a Pandora’s box of unintended consequences. Why did it happen? What warnings were made and ignored? How can we avoid that happening again if the tragedy is not recognised and explained? I hope that the conclusion of the task force will be a moment for the minister to answer those questions—the questions of why—and to tell a painful story for which we must all write a better ending.

Photo of Emma Harper Emma Harper Scottish National Party

I welcome the opportunity to speak in this important debate. Like colleagues across the chamber, I offer my condolences to the families, friends and loved ones of those who have lost their lives. I appreciate the huge amount of work that the minister and task force have already put in place, and I thank them all.

I will focus on two areas: tackling stigma and the action to address drug-related stigma, and naloxone treatment for people who are struggling with addiction in rural areas of Scotland.

Drug-related stigma is damaging, not only because it affects an individual’s mental health and sense of self-worth but because it discourages people from coming forward to obtain the help that they need. The minister, Paul McLennan and Gillian Martin have already spoken about stigma. By addressing stigma and the silence and alienation that it causes, we can make it easier for people to seek help, which will benefit everyone.

I welcome and endorse the vital work of We Are With You, which includes stigma reduction. That work is supported by the Scottish Government and includes the stigma charter that the minister described. It is good that active measures are being taken to address stigma. That will be one of the issues to be discussed in my upcoming meeting with the chair of Dumfries and Galloway Alcohol and Drugs Partnership.

In my previous role as clinical nurse educator, which I did prior to coming to the Parliament, I placed a great value on the role of education for all health specialities. I support education being delivered in different ways, especially during the pandemic, because face-to-face seminars have not been possible.

We need to reduce prejudice, discrimination and associated stigma. I have had feedback from nurses and support workers who work in alcohol and drug services who feel discriminated against because they are actively assisting people who need medical help, support and intervention so that their recovery can start. There persists the view among the public that people who make harmful use of drugs and alcohol are just low-lives and criminals who do not deserve anyone’s help. They do need our help. They are our sons and daughters, our friends and family members, and we need to support them. Attracting health workers into jobs in drug and alcohol services is difficult enough, so we must do whatever we can to reduce stigma around them.

In my professional career, I have witnessed the negative consequences of using stigmatising language such as “addict”, “alcoholic”, “druggie” and “junky”, and that needs to change. In November last year, I picked up that issue with NHS Education for Scotland in asking whether an online education module or modules could be created, aimed at teaching health and care staff who do not work directly in alcohol and drugs services what stigma is and ways to address it. Health and care staff who do not work directly in drug and alcohol services often come into contact with persons who engage in harmful use of illicit opiates and prescribed substances as well as alcohol. Online education could include allied health professionals, such as pharmacists, physiotherapists and occupational therapists.

NES responded by saying that it intended to create such education modules, but I have not seen those on the ground yet. I therefore ask the minister if that work is being taken forward and whether there are any timescales for the completion and publication of such online modules, so that education for health professionals who are not working directly in those services can be taken forward. Even third sector organisations would benefit from anti-stigma advice and learning so that they can help to engage and ensure that persons can access the treatment that they need without discrimination, prejudice and judgment. Accessible online learning could be a key way of helping to deliver anti-stigma education for professionals in healthcare across Scotland. I would welcome the minister’s comments on that.

I will now address naloxone and its provision in rural areas. I welcome the fact that, during the pandemic, families of those who use opiates, as well as professionals who work in drug services, have been allowed to supply take-home naloxone kits to anyone who might be likely to witness an overdose. It is welcome that it is intended that naloxone be given to police officers across Scotland to help when they attend cases of suspected overdose.

Across areas of rural Scotland, however, concerns have been raised about the availability of places for naloxone and the number of people who are being given naloxone who are trained to use it. We know that naloxone, given via nasal delivery by the police who are trained, and by injection by others who are trained, is the first line of defence against overdose. In Dumfries and Galloway, 30 per cent of non-fatal overdoses were people who do not access services, so other places need to be considered to support delivery of naloxone kits. That has occurred really successfully in some places such as Aberlour and Dumfries. Can the minister help local ADPs to identify and assist with making naloxone pick-up at the less formal, non-medicalised sites that people access?

I ask the minister to assure us that rural Scotland is absolutely part of Scotland’s national drugs mission, that people who live rurally are considered equally for all treatment pathways for their alcohol and drug harm, and that the Government continues to pursue this as a public health issue, not a criminal issue. I thank the minister for this past year’s work.

Photo of Liam McArthur Liam McArthur Liberal Democrat

I call Gillian Mackay, who joins us remotely. She will be followed by Stephen Kerr.

Photo of Gillian Mackay Gillian Mackay Green

I too extend my condolences to anyone who has tragically lost a loved one to a drug overdose. As the motion points out, drug-related deaths are tragic, preventable and an unacceptable loss of life. They are a symptom of people who use drugs being denied the rights and dignity to which they are entitled.

I will focus on these words in the motion:

“notes the need to continue to build on the work of the Drug Deaths Taskforce and other expert groups to implement evidence-led interventions that reduce deaths and improve lives”.

I think that we can all agree that we need to improve the lives of people who use drugs, but I must put to those who are opposed to harm reduction measures and decriminalisation the question, how can you improve someone’s life by criminalising them? How can we take a human rights approach by prosecuting people for their addictions? Prosecution and punishment have no place in this conversation, and I am reassured by the Government’s clear focus on intervention that will reduce harm and improve access to treatment and support.

I am pleased to see the recognition that safer consumption facilities are an important public health measure that could save lives. As members will know, in June last year, my amendment that called on the Scottish Government to investigate, as a matter of urgency, what options it had to establish safe consumption rooms within the existing legal framework was supported by the majority in the Parliament. I am very grateful for the minister’s update on that, and I sincerely hope that all stakeholders will engage with the proposal in a constructive manner to ensure that we can save lives.

The motion also

“recognises that no single intervention will be enough on its own”, which is crucial. We need a package of measures and a range of treatment options. It would be a failure of the Parliament to focus on one solution and ignore others. I accept that safe consumption rooms are not a magic bullet, but neither is any other intervention or treatment.

I am concerned about the intense focus on residential rehabilitation. Of course, we need to expand the provision of residential rehab, and everyone who needs and wants to access it must be able to do so, but as I have said previously in the chamber, it will not be the right option for everyone and it should not be prioritised over other treatment options. A truly person-centred approach to the drug deaths crisis will recognise that people need to be able to access the treatment and support that work for them, and that drug use comes in many different forms.

Constituents have expressed concerns to me about the fact that opiates are often the focus in conversations about drug overdose, and that not enough attention is paid to poly drug use and benzodiazepines. I know that work on that issue is already being carried out by the Drug Deaths Taskforce, but it is vital that we continue to highlight the issue in the Parliament.

Like other members, I was concerned to hear of the resignation of the chair and vice-chair of the Drug Deaths Taskforce. I am grateful to the minister for providing an update on a new chair, and I sincerely hope that the change will not stall the progress that is being made.

The publication of the medication-assisted treatment standards was a huge step that established same-day access to treatment, which will reduce the risk of people dropping out of treatment and improve accessibility for vulnerable groups, such as people who are experiencing homelessness. There is also evidence that it reduces heroin use and HIV and hepatitis C risk, as well as overdose and criminal charges.

The living experience of people in medication-assisted treatment was recently surveyed by a team of 13 researchers at the Scottish Drugs Forum. They found that access had improved as waiting times had reduced, although waiting periods were still too long, and that while some participants had reported that there was a greater choice of medication, decisions around choice and dose were not always shared between the person and the prescriber. That suggests that we still have some way to go before treatment is fully person centred, but the picture is encouraging. I eagerly await further progress in that area as a step towards creating flexible treatment services that take account of an individual’s circumstances, needs and—crucially—wishes.

As we seek to improve the lives of people who use drugs, we must tackle infections such as hepatitis C, which are drivers of health inequalities. According to the Hepatitis C Trust, despite a dramatic increase in people completing treatment for hepatitis C in recent years, infection rates have not fallen. Around half of people who inject drugs have had the virus at some point and one in four is currently infected, which makes hepatitis C the most common blood-borne infection for people who inject drugs. As 90 per cent of new infections occur through the sharing of contaminated injecting equipment, safe consumption rooms would be an important tool in the fight to reduce the spread of hepatitis C. The trust is clear that efforts to eliminate hepatitis C will be wasted without the implementation of evidence-based harm reduction services, such as needle and syringe programmes, opioid substitution therapy and heroin-assisted treatment.

We also need to increase knowledge and awareness of blood-borne viruses, which disproportionately affect people who inject drugs, including among those who work in addiction services.

The Scottish Drugs Forum has said that the understanding and perception that front-line staff have about conditions such as HIV are often still informed by events that happened in, or practice from, the 1980s. There is often a lack of understanding of new treatments that mean that people can now live long and healthy lives with no risk of infecting their sexual partners. We need a dual approach that seeks to reduce the risk of people becoming infected and, through education, reduces the stigma.

As we progress through the national mission and look to next steps, I would be grateful if we could look in depth at how we can support families who have members with drug or alcohol issues. Reducing adverse childhood experiences will ensure that we do not continue to perpetuate the trauma associated with drug and alcohol misuse.

Above all, we must respect the humanity of people who use drugs and must restore the dignity, rights and choice that too many have been denied for too long.

Photo of Stephen Kerr Stephen Kerr Conservative

I congratulate all members who have contributed to the debate. There is a broad consensus across the chamber on the issue. I agree with my colleagues on the far side of the chamber—particularly Michael Marra and Claire Baker—that although it is important to look forward and work together, it is also important to understand what has happened in the past.

The chamber is a forum for democratic accountability. I therefore make no apology for reminding the chamber that the First Minister herself admitted in April 2021 that the Government had taken its eye off the ball in relation to drug deaths. That was while we were experiencing 1,000 drug deaths a year. Jim Fairlie can sigh out loud if he likes, but it is the nature of parliamentary process to look at what has happened and try to learn from mistakes that have been made, so that we can go forward with the consensus that we all seek on this difficult issue.

I was disappointed to learn in response to a freedom of information request, that, despite all the rhetoric and promises, the First Minister has not met any of the 31 alcohol and drug partnerships since last year’s election. Given the emphasis that she has rightly put on the issue, I would have thought that she would have found time to do so.

Just before Hogmanay, we saw the resignations of Neil Richardson and Professor Catriona Matheson from the Scottish Drug Deaths Taskforce. I welcome David Strang to his new role and wish him well. However, there are some important questions to be asked about comments made by Professor Matheson on the BBC’s “Reporting Scotland” programme last night. She seemed to cast doubt on the Government’s intention to create policy on the basis of evidence. For example, she said:

“If there’s a rush to get things tied up, where does that leave the evidence? Is it about being seen to do something, rather than doing the right thing? That is my concern.”

Many people will be concerned to have heard those words from Professor Matheson on television last night.

Further on in the interview, in relation to the circumstances that led to her resignation, Professor Matheson said:

“That came straight out of the blue, and it came just three weeks after we’d received our letters of engagement for the second phase of engagement with the taskforce work, which stated in those letters of engagement that the work would go on until December 2022.”

I think we have heard that David Strang’s work will go on until July 2022. Professor Matheson went on:

“So what was behind that? And it crossed our minds, is this an attempt to kind of force our resignation and sideline the taskforce altogether? That was one consideration.”

The minister should take the opportunity to address those comments in this Parliament.

Professor Matheson went on to make a far more serious comment about the breakdown in the relationship between the minister and the task force:

“We didn’t have the full support of the minister any longer, and that ultimately made us concerned about what was driving this and the politics behind it, I suppose. The concern is that when politics comes into this, and that is across the political spectrum, unfortunately the evidence, and an evidence-based approach, can get squeezed.”

I accept Professor Matheson’s point about the political spectrum. Perhaps the Minister could respond to those comments for the sake of the record and for the information of the Parliament.

Photo of Angela Constance Angela Constance Scottish National Party

I take the opportunity to reassure Mr Kerr that the task force and the work that it has undertaken receive my full support. Indeed, that is why I am seeking to implement, for example, the new medication-assisted treatment standards. I say for the record that I wish Professor Matheson well and thank her for her contribution. There is, of course, always a tension between acting on evidence that is never complete and acting now. The reality is that we have to find a balance and do both.

Photo of Stephen Kerr Stephen Kerr Conservative

I thank the minister for her comments. I will come back to the idea of action, which is what we all need to focus on.

I recognise a comment that Alex Cole-Hamilton made. I do not think that he is in the chamber at the moment, but he mentioned the figures that were released last week that show that, since 2017, 852 babies have been born addicted to drugs. That important issue was brought home to many millions of people on, of all days, Christmas day in an episode of “Call the Midwife”. Many people, including me and speakers who came before me, will not have seen the effects on children of being born in those circumstances and the programme vividly brought the realities home. I know that it is only a drama, but that medium often has a powerful impact on the public. It certainly showed me the reality of the suffering that is borne, and included in that is the suffering of newly born babies.

The bottom line is that it is surely past time for the Government to get a grip on the issue. This is very much a time for us to keep our eyes firmly on the ball. Other political issues should be set aside in favour of the national mission that my colleague Paul McLennan described in great detail. I appreciated the tone of his remarks.

Something that concerns me whenever we debate this issue in the chamber is that there is quickly a resort to the old constitutional battle lines. It becomes a matter of lining up to blame someone else for things that we can and should be taking care of in Scotland, given the devolved powers that this Parliament and the Scottish Government enjoy. I appeal to colleagues not to fall into that habit, not to create those battle lines, and to stop blaming. We should realise that more could and should have been done in the past 15 years. It is now promised that it will be done, and the job of this Parliament and its various committees will be to gauge not just the tone of the rhetoric, the expressions of intent or the energy that is applied to the delivery, all of which are good, but what happens, what changes and what improves. That is what really matters.

Photo of Paul Sweeney Paul Sweeney Labour

I thank the minister for bringing the debate to the chamber. I struggle to think of a more serious issue that we could discuss in Parliament. As colleagues have outlined, there were 1,339 avoidable drug-related deaths last year, and I fear that, without action, the number will increase again in the next set of figures.

I read the Government’s motion with interest, and I would struggle to disagree with much of it. It is probably fair to say that there is broad consensus on the measures that are needed to tackle the crisis. My concern is about the pace of the change that is required.

I intend to keep my remarks to the subject of what I believe is not the only but the single most important change that we could make, which is the introduction of overdose prevention sites. That will not come as a surprise to the minister, given our previous interactions and my personal experience of volunteering at the unofficial pilot project in Glasgow. I welcome the minister’s intention to take a revised proposal for an official pilot in the city to the Lord Advocate in due course.

Lots of questions are asked about whether overdose prevention sites can be established within the existing devolution settlement, whether they are effective and whether they will save lives. To put it simply, the answer to all those questions is yes. They can be established within the current devolution settlement, they are effective and they will save lives. How do I know? Because I have seen it at first hand. I volunteered with Peter Krykant, week in and week out, and I was never arrested or charged with any offence, meaning that such sites can clearly be established within the current legal framework. If they were illegal, I would have been lifted and charged, meaning that I likely would not have been standing here. The fact is that I was not.

I saw overdoses being reversed and more than a dozen lives being saved in front of my eyes, so I defy anyone in the chamber to tell me that overdose prevention sites do not work. The evidence is incontrovertible. I saw vulnerable young men and women who had been failed by many other aspects of the state being shown dignity, compassion and respect for the very first time, regardless of what traumas they had endured that led them to substance misuse.

It cannot be left to volunteers to fill the gap. As part of the unofficial pilot, Peter took into his care a 21-year-old girl who overdosed in front of him three times. She was sleeping in a tent in an alleyway in Glasgow because she had been sexually abused, and she was fearful of reaching out to any sort of care or official service because she had suffered so badly as a result of having done so previously. Peter frequently broke down because he was terrified that he would turn up the next day and she would be dead. That culminated in his being triggered—because he is a recovering addict—to the point where he relapsed and his own life was then at risk. I had to feel the fear that my friend potentially would not pick up the phone to me. That is a lived experience for hundreds, if not thousands, of Scots and it is something that we cannot tolerate any more. That was another learning experience from the unofficial pilot in Glasgow.

My heart breaks whenever I hear politicians from whatever side dismiss overdose prevention sites or, worse, hide behind constitutional grandstanding, because, every time that they do so, critical time is wasted.

Photo of Brian Whittle Brian Whittle Conservative

I want to make it absolutely clear that, when we are talking about the effectiveness of the services that the member discusses, my reservation is around deployment of that resource. I would like to see the evidence that that resource is better deployed in that way than it would be if it was moved upstream and deployed in other ways, because we have a finite resource.

My constituency is very rural, so another issue is how a safe injection room would impact—or not impact—on the rural community.

Photo of Paul Sweeney Paul Sweeney Labour

I am not standing here to make the point that overdose prevention sites are a panacea or that they will be suitable in every set of circumstances. What I am saying is that the approach works. Evidence from more than 90 cities in the world demonstrates that it works. The international body of evidence is incontrovertible, as is the evidence from the unofficial pilot in Glasgow. Lives are saved and, for a relatively modest investment, the impact is significant. The approach also leads people into a sense of engagement, which potentially leads them on to a path to recovery. So, let us not make the perfect the enemy of the good, raising expectations and setting standards that we are doomed to fail to meet. We have to meet people where they are at with their lived experience. The drugs are either taken in filthy alleyways or they are taken in sterile conditions—that is the choice before us today.

Every six hours in Scotland, someone dies a drug-related death. That means that, by the time we go to bed tonight, at least one more person will have died such a death, leaving behind heartbreak and agony for their loved ones.

The frustrating thing is that we know that overdose protection sites are now possible. In evidence to the Scottish Affairs Committee in the House of Commons, the Law Society of Scotland stated that, in order to establish overdose prevention sites, there would need to be either a change to the Misuse of Drugs Act 1971, which is within UK Government competence, or there would need to be

“prosecutorial discretion from” the Crown Office and Procurator Fiscal Service

“not to prosecute in certain circumstances.”

We now have that prosecutorial discretion. A matter of months ago, the Lord Advocate stood where the minister is sitting now and said that possession of substances classified under the Misuse of Drugs Act 1971 would no longer be prosecuted.

So what are we waiting for? Although I welcome the minister’s intention to bring forward revised pilot proposals, we already have that body of evidence and we need to expand the pilot rapidly into a national network. I do not doubt the sincerity of the Government or the minister when it comes to this issue; I just think that they are down a deep hole, having taken their eye off the ball for so long. The reality is that they are not moving fast enough, and some of the most vulnerable people in Scotland need them to move much faster.

My message to the Government on overdose prevention sites is pretty simple: it must set them up or I will introduce to this chamber legislation to make it do so.

The Deputy Presiding Officer:

I call the final speaker in the open debate, Kaukab Stewart. After her speech, we will move to closing speeches, when everybody who has participated in the debate should be present.

Photo of Kaukab Stewart Kaukab Stewart Scottish National Party

I welcome the debate and the opportunity to reflect on one of the most complex and significant public health challenges that we currently face.

Throughout the chamber and beyond, we have tried, with great difficulty, to process the heartbreaking statistics of drug-related deaths that continue to devastate the Scottish population. Each death represents a son, a daughter or a parent who found themselves trapped in a vicious cycle and, tragically, paid the ultimate cost. I offer my condolences to all their families.

According to research that was carried out by Scottish Families Affected by Alcohol and Drugs, across close family and wider social networks, for each individual using alcohol or drugs, an average of 11 people are harmfully impacted. If someone is a child of a drug user at five years old, on average, their life will be affected until they become an adult. It can take approximately eight years for that child to reach family support for the first time—a combination of services being unable to reach those in need and the endemic stigmatisation of drug users in our society, which further deters individuals from seeking the help that they deserve. I therefore welcome the recognition that progress will be achieved not by a single intervention but by an holistic, person-centred and multimodel approach that places dignity and respect at the forefront of accessible treatment and support services.

We have seen, as part of the Scottish Government’s national mission to reduce drug-related deaths and harms, promising steps that will facilitate the culture shift that is needed to tackle the crisis—a shift to a culture that appreciates the dangers of prejudice and focuses on funding evidence-led interventions that recognise addiction for what it is: not a moral failing, but a chronic disease.

Thanks to work that was carried out by the Scottish Drug Deaths Taskforce, the identification of key focus areas will serve as a crucial guide moving forward. That has already led to the provision of life-saving assistance through the expansion of naloxone provision. It is not just clinical staff who are now trained in the supply of naloxone but 800 police officers, with 53 life-saving uses having been administered throughout the 2021 pilot programme. Support has also been offered to charities such as Scottish Families Affected by Alcohol and Drugs, allowing them to roll out an award-winning click-and-deliver naloxone service for family members and friends who could provide that valuable life-saving intervention. More than 4,700 kits have now been issued.

In addition, and to continue the valuable work of the task force, we must seriously consider any and all legislative reform that would reflect the mounting evidence of the advantages of reduced criminalisation. The price of inertia is simply too high. Professor Dame Carol Black’s comprehensive independent review of drugs has confirmed that the current public provision for prevention, treatment and recovery in the United Kingdom is no longer fit for purpose. At present, because the Misuse of Drugs Act 1971 is reserved to the UK Government, we remain reliant on Westminster determining that the legislation is incompatible with a public health response to problematic drug use. That is hardly reassuring, because, time and again, we have seen the Conservative Government persist with draconian measures centred around harsh punishment for drug users—a tired hangover from the woefully outdated war on drugs campaign of the 1990s.

Nevertheless, I am hopeful that logic and compassion will prevail and that the recommendations made by the Drug Deaths Taskforce, including the introduction of safe consumption facilities and more people being diverted from the criminal justice system into treatment and recovery services, will be translated into meaningful action. It is an issue that must transcend party politics. The role of any Government is to protect the health and wellbeing of its citizens, and, when such a disproportionate number of lives are lost each year, it is our duty to reflect on our approach, accept responsibility and implement change.

We need only look at countries such as Canada, where the on-going opioid epidemic sparked the progressive drug policy reform in 2017 that led to the 39 supervised consumption sites that now operate across the country. From 2017 to 2019, despite 15,000 overdoses and medical emergencies in those facilities, not a single fatality was reported on site. Why will the UK Government not allow us to pilot such a scheme in Glasgow when it has clearly worked elsewhere?

According to the National Harm Reduction Coalition, more than 100 safe consumption sites are located in more than 11 countries worldwide, including in Germany, the Netherlands, Switzerland, Spain and Australia. We cannot allow ourselves to be shackled by antiquated beliefs. We must go where the evidence leads us, to ensure that avoidable harms and fatalities are, indeed, avoided.

I had the opportunity to walk around my constituency with my colleague Angela Constance, the minister, and we discussed the scale of the challenge that we face. Nothing will improve overnight. However, by redirecting our energy and adopting a more humane approach to drug use and drug users, we can save lives and ensure that Scotland continues to build on its reputation as a progressive and forward-thinking nation.

The Deputy Presiding Officer:

We move to closing speeches.

Photo of Paul O'Kane Paul O'Kane Labour

In the summer of 2021, in one of my first speeches in the chamber, I spoke in a debate on this matter. I spoke of the human cost of the drug deaths crisis in this country—of the families and friends who are left behind, and the communities that feel broken. During today’s debate, we have again heard of that cost and, rightly, our sympathies are with all those who have lost a loved one to drugs.

We have also again seen consensus in trying to find solutions. As Claire Baker, my colleague, outlined in her opening speech, there has been an acknowledgement of failure and a declaration of intent by the Government. However, it is now for us to scrutinise the progress towards that.

Scottish Labour agrees that we need to take a public health approach. We have therefore welcomed the announcements that have been made since January 2021 that could help to reduce the number of drug deaths and amount of problematic drug use, if they are implemented with a degree of speed.

It is clear that more needs to be done, not least in light of the upheaval in the Scottish Drug Deaths Taskforce, which has been spoken about. In common with colleagues, I welcome the appointment of David Strang and am hopeful that his appointment will involve a greater focus on the connection between mental health and substance misuse services, and on using that to achieve the MAT standards—as we have heard, those standards are so important. The questions that Claire Baker raised in her opening speech are key, particularly those on progress to full implementation and on the need for more support for health boards and integration joint boards, as highlighted by the Royal College of Psychiatrists.

Michael Marra, too, spoke powerfully about Scottish Labour’s support for the MAT standards and about the need for greater progress and speed, particularly in his community of Dundee, which I know is so important to him, and particularly on issues such as same-day prescribing. I hope that the minister will pick up on that in her concluding remarks.

Scottish Labour wants to constructively consider all proposals that will reduce harm and support rights of access to treatment. We will, of course, carefully look at the detail of what is brought forward, including the right to recovery bill that was outlined by Sue Webber on behalf of the Scottish Conservatives.

To be a constructive partner is to want to show the way towards a solution to the crisis through honest assessment and honest conversations. Scottish Labour members will always take that approach. We have been clear throughout about what we think we need to see.

We need to see drug consumption facilities being urgently progressed. I take a moment to highlight the contribution of my colleague Paul Sweeney, which I thought was characteristically powerful, as he spoke of his experience in supporting the work of Peter Krykant in Glasgow. It is clear that we must listen carefully to those experiences of what can be done, what can be achieved for people and the reality of what taking that action means. I hope that the minister will further address what progress could be made in moving that agenda forward.

It is clear that we need further progress on heroin-assisted treatment—we need that to be expanded throughout the country—and we need to see drug checking facilities urgently progressed as part of harm reduction measures to address the drug deaths crisis. All those measures are been outlined by colleagues in their speeches. It is clear that they can save lives. Although it is welcome that the Government is planning to look at the introduction of such facilities, we must ask ourselves why it has taken quite so long.

The consensus in the debate is built on the need to move further and faster in recognising the crisis as a public health crisis. In his speech, Alex Cole-Hamilton spoke powerfully about the need to reduce stigma—Paul McLennan made similar remarks. Stigma persists in so many communities across Scotland. We have to replace the outdated criminal justice approach of years gone by. The Lord Advocate’s statement on the expansion of the use of recorded police warnings is welcome. However, that must be an enabler to get people into better treatment and more services.

It is clear that, to make the most of such a step, sufficient resources must be made available to fund local services. As I have said previously in the chamber, we need to ensure that local services are well funded and that local government continues to be funded to ensure that there is a holistic approach to services across the piece.

In the region that I represent, West Scotland, drug deaths remain high—particularly in Inverclyde, where they are among the highest in the country. We have seen efforts by different organisations in the area to reverse that trend. That is truly inspiring and shows what can be done to tackle the crisis when communities and health and care partnerships work together. However, it is abundantly clear that those services are struggling when it comes to the funding that is available to them.

We have also heard about other interventions today, such as the use of naloxone and increasing the availability of naloxone, particularly in rural areas.

There is consensus in Parliament about the actions that need to be taken, but it is clear that there must be robust scrutiny. We need to be a critical friend of the Government in order to move things forward. We know the human cost of drug deaths in Scotland, the pain that is caused to communities and what must be done in order to move the national mission forward.

Photo of Craig Hoy Craig Hoy Conservative

I would like to start my contribution to today’s debate by thanking those who have participated in it. I was going to say that, relative to her ministerial colleagues, the Minister for Drugs Policy, Angela Constance, is a breath of fresh air. That will be particularly true if she can match her words with actions. In that case, we will all wish her well in her role, because Scotland will benefit.

I thank Sue Webber, Emma Harper and Claire Baker, who all made good speeches. Alex Cole-Hamilton talked about the neonatal effects of drugs, which are an important issue to which we should return. Paul McLennan talked of the 14 lives wasted in East Lothian last year—I deliberately say “wasted” rather than “lost”. I also thank Gillian Mackay and Kaukab Stewart, as well as Paul Sweeney, who talked about the fact that drug deaths are the most important issue that we will discuss in the Scottish Parliament. He also talked about drug consumption rooms, which are something that I was—and still am—sceptical about. However, after hearing a speech of the quality of Paul Sweeney’s, we all have a duty to go away and think again.

Drugs are, rightly, an emotive issue and, although there will always be differences of opinion, I do not doubt the sincerity of anyone who seeks to limit the damage that they do. The debate has been an opportunity to reflect on the terrible toll that addiction takes and the damage that is caused by stigma. I was going to say that the toll is on people and their families, but I mean something wider: close and extended family members, friends, friends’ families, colleagues, neighbours and anyone whose life intersects with those unlucky enough to set down the path of drug addiction. Peaceful, loving homes are destroyed by the strain that is caused by drug abuse. Michael Marra referred to that happening in his home town of Dundee. As Paul O’Kane said, lives are shattered and communities are broken.

As Stephen Kerr and Sue Webber pointed out, tackling drug-related deaths should unite the chamber. The need to tackle drug-related deaths should be a matter of consensus, but that does not mean that we should not level criticism where it is warranted. Stephen Kerr was right about that.

We should remember that 2022 marks Scotland’s 15th year under SNP rule. We know that drug-related deaths have, sadly, almost tripled over those 15 years. To its credit, the SNP has acknowledged that it is a huge issue. I welcome the minister’s commitment to tackling it and to developing a sharper focus and a shared understanding, as she said.

I hope that the new national mission on drugs will start to change things. Brian Whittle talked about how the pandemic has exacerbated the issue. However, there must come a point at which the pandemic is no longer used as a convenient excuse for this issue and many other issues.

Photo of Jim Fairlie Jim Fairlie Scottish National Party

I do not mean this to be political in any way, shape or form, but I go back to the point about the Scottish Affairs Committee that Mr Whittle made. He cited that committee as saying that poverty is not necessarily the key contributing factor. I have looked at all the notes of the committee, and I can say that it kept talking about poverty being one of the main problems in driving addiction today. If we are going to find a solution, we have to find the cause. Poverty is one of the main causes of drug addiction, and we have to tackle it.

Photo of Craig Hoy Craig Hoy Conservative

When a politician tells us that they are not going to be political, we should be sceptical. There is a dispute over the account, but I will leave Jim Fairlie and Mr Whittle to take that issue out of the chamber.

In Scotland today, drug users are still, sadly, unable to access the support that they need. As we have heard, Scotland’s drug death rate is three and a half times worse than that of the rest of the UK and is the worst in Europe. People from the most deprived areas of Scotland are 18 times more likely to have a drug-related death than those in the least deprived areas. Therefore, there is clearly a link, but I am not sure precisely what the link is. I would welcome the Parliament and others looking into that.

We have heard about how the SNP has, historically, failed to support residential rehabilitation. Despite recorded drug deaths reaching a record high, just seven more rehab beds were delivered across Scotland last year. In fact, the number of Government-funded placements for residential rehabilitation declined throughout 2021.

There still seems to be some confusion at the top of the Scottish Government about what to do next. Like Mr Kerr, I watched Professor Catriona Matheson on the television news last night, and I saw the minister, too. I wonder whether, after years of inaction and cuts to front-line services, the Government is somehow trying to make up for that now. We must be cautious to ensure that doing something fast means that it will necessarily be effective.

Scotland’s appallingly high number of drug deaths is a national shame. That is why the Scottish Conservatives are bringing forward a right to recovery bill. We are doing that to ensure that the right to life-saving treatment for addiction is enshrined in law. We are very grateful to everybody who has taken the time to respond to our consultation, and we are delighted that the proposals have received an overwhelmingly positive response.

I still have a sense that, despite the action, the Scottish Government is not taking the issue seriously enough. I therefore urge it to support our bill when it is introduced. I also encourage the Government to work closely with the third sector, alcohol and drugs agencies, the police, the national health service and the Scottish Prison Service, because they have vast experience in the area.

I believe that, working together, we can right the wrongs. We can never reverse the damage that was done in the past, but we can reverse recent trends. We can prevent drug addiction and end a national disgrace once and for all.

Photo of Angela Constance Angela Constance Scottish National Party

I, too, start by thanking members across all political parties for their contributions. I very much welcome and appreciate the support and scrutiny of Parliament, because it will help us to build on the foundations, to push on, to scale up and to drive change and improvement through the second year of the national mission and beyond.

I say to Mr Kerr and Mr Sweeney that, much to the annoyance of many of my colleagues, members rarely hear me mention the constitution in drugs debates. I do not, of course, ignore the impact, for example, of the Misuse of Drugs Act 1971, which I believe limits our public health approach, but I hope that members would agree that my attention has a disproportionate focus on the powers and opportunities that we have here in Scotland.

There are many points that I wish to address, and I will do my best to do so. I can tell Mr Cole-Hamilton that, if the Liberal Democrat amendment had been accepted by the Presiding Officer, I would have accepted it. One of the things that I will do this year is bring forward our approach to and plans around stabilisation services, which fits with some of our work on national procurement.

I am sure that members will have noted the national residential family service that we are supporting financially, which will open later this year, as well as our dual housing support fund, which aims to ensure that people do not have to choose between maintaining their place in residential rehabilitation and their tenancy.

On the Tory amendment, I very much welcome and support the comments around the voluntary sector, to which I have given long-term funding commitments, and I welcome the remarks that have been made on prevention.

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

I am very grateful for the assurances that the minister has just made to me through her remarks. Can she confirm to Parliament that residential rehab is not an exact science—it is not a hotel—and that occupancy will sometimes dip well below a normally sustainable level. Can she confirm that those services will be supported when they sometimes lie fallow?

Photo of Angela Constance Angela Constance Scottish National Party

That is a valid point. There is more that we can do to ensure that we utilise and build on existing capacity.

I say to our Conservative colleagues that the only reason why I cannot support your amendment today is that I fear that it is trying to get me to give a 100 per cent guarantee on signing up to a bill that I have not yet seen. Let me reassure you, however, that your bill, along with Mr Sweeney’s, if he introduces it—

The Deputy Presiding Officer:

Speak through the chair, please, minister.

Photo of Angela Constance Angela Constance Scottish National Party

Indeed, Presiding Officer.

Let me assure Parliament that the propositions in Mr Ross’s bill and in Mr Sweeney’s bill, if he introduces it, will be given a very fair hearing from the Government. As I have said time and again, there is no monopoly of wisdom, and we are trying to march forward together.

I agree on much of the direction of travel in the Labour Party’s amendment; unfortunately, however, it would delete all of my motion. I think that we have some common ground, however.

Photo of Claire Baker Claire Baker Labour

Our amendment would make an insertion; it would not actually delete the Government’s motion. Our amendment would make for a rather long resolution, but the amendment is an insertion.

Photo of Angela Constance Angela Constance Scottish National Party

If I read the amendment correctly, it would delete the motion after line 1—or, the effect of the insertion is that it would remove all of my motion apart from line 1.

One of the issues that I have repeatedly addressed over the past year is the question, “Why Scotland?” Let me do so again here in the chamber, for the record. There are three reasons why we have the unenviable position of having one of the worst drug-related death rates in the world—if not the worst. The first reason is that the prevalence of drug use and problematic drug use in Scotland is almost double what it is south of the border. There is an existential question as to why that is, and I will not seek to address it between now and decision time, but it touches on prevention and the need for diversion. At its core, it touches on why we have a national mission that seeks to join drugs policy at the hip with education, the work to address adverse childhood experiences, the work to address poverty and inequality, the work to make our justice system more humane, the work that we do to empower the voluntary sector and the work to address homelessness and issues around mental health.

The second issue is benzodiazepines, which are a problem across the UK. I do not deny that. If we compare Scotland to England, the implication of benzodiazepines in drug-related deaths in Scotland has increased since 2009 by 450 per cent and by 50 per cent south of the border. Although my opinion as to why we have seen that increase differs from Mr Marra’s, I say that we absolutely need a better treatment offer, which is why we are introducing the work on stabilisation services and why we need more consensus among clinicians.

Photo of Michael Marra Michael Marra Labour

I welcome the minister’s addressing of that question, but we should explore why that increase has happened. My understanding is that the removal of Valium scripts has partly created a public policy issue. We have to ensure that we do not open other Pandora’s boxes in the same way. If we do not learn the lessons from things that we have done wrong as a country, we will repeat those things.

Photo of Angela Constance Angela Constance Scottish National Party

I agree. That is why we need a consensus among clinicians. Clinicians are not the only part of the solution, but they are a key part in relation to our taking an evidence-based approach.

I will be candid and blunt about the third reason, which is that we do not have enough of our people in treatment. I have never sought to deny that that situation is largely on us, which is why getting more people into treatment and recovery that is right for them—rather than right for me—and which suits the needs of individuals rather than any of our ideological positions, is at the core of our national mission.

That point takes me to harm reduction and residential rehabilitation. We have sought to take a balanced approach; the debate is not a stultified discussion about recovery versus harm reduction, but about all of the above and more. I accept that we are starting from a low base in relation to residential rehabilitation—I know that from my time in social work.

In the first part of 2021, 112 residential placements were funded with the additional funding that the Government released—almost the same as the number of funded placements in the entirety of 2019. I accept that that is a small indication of a forward move, and that we have some way to go. We need to see year-on-year improvements if we are to reach the goal of 1,000 publicly funded residential care placements per year.

Dreadful statistics are often reported back to me through news articles and in debates—I have actually published most of those statistics, because I have been determined to shine a light on where there are gaps in, or no, care pathways.

Similarly, I want to address some of the issues around harm reduction, given the important briefings that we all received from the Hepatitis C Trust and the Royal College of Psychiatrists. I reassure Gillian Mackay that the actions that they seek are part of my agenda.

I have never demurred from the fact that implementing MAT standards is crucial. However, it is also a massive task. I say to Paul McLennan and Clare Baker that that is why we will publish granular detail, area by area, about the progress that has been made post-April—as with the work that we have done on residential rehabilitation—at my next parliamentary update specific to MAT standards. I am serious about embedding those standards. All will not be well after April, so we will need to improve and sustain that improvement, which is why we have increased the MAT implementation support team—MIST—so that more hands are on deck to assist with that work, and why we have increased the available funding to support it.

I am conscious that time is short, so I briefly say that I pay close attention to what happens in the great city of Dundee. We need to do more to turn expressions of interest on heroin-assisted treatment into hard commitments, but the evaluation of the Glasgow project, which will be published at the start of this year, will help with that work.

I say to Mr Sweeney that I always really enjoy his contributions and his call to go where angels fear to tread.

The work on overdose prevention facilities is detailed and delicate and I am having to find ways to do it within our powers. The Lord Advocate made it clear to the Criminal Justice Committee what needs to be addressed prior to her considerations. That is exactly what I am working on.

I will correspond with Ms Baker on the issues around drug-checking facilities.

Finally, I thank everybody who has participated. We have made progress with other preventable deaths, so change is possible. However, change is not always comfortable—nor should it be, and I make no apologies for that. No one group, MSP or minister is bigger than the national mission. It is a collective and cross-cutting endeavour. We have laid important foundations, but we still have 1,001 bricks to lay. We will lay those bricks, one by one, turning words into actions and building a better Scotland—one that leads, not one that lingers.