Spotlight on drug-related deaths – and potential solutions 

Michelle Major, Improvement Lead with Homeless Network Scotland summarises new data on early mortality among people experiencing multiple disadvantage, the latest data on drug related deaths in Scotland and the solutions put forward by the Scottish Drug Deaths Taskforce.

Every day in Scotland, three people suffer a drug-related death. Each death is a personal tragedy for them, their friends and families, their communities – and every one of them is preventable. The National Records of Scotland’s latest report shows that in 2021, 1330 deaths were drug-related in Scotland, and while this is 9 fewer deaths than in 2020, it is still the second highest annual total on record. Of all drug deaths recorded in Scotland, 84% involved opiates, and 69% involved benzodiazepines. In 93% of all drug deaths, more than one drug was found to be present. In Scotland, men are 2.4 times as likely to have a drug related death than women, however over time this gap has decreased; in the early 2000s males were more than 4 times more likely to die from drug misuse than females.

Scotland’s drug related death rate is nearly 4 times higher than the UK as a whole and higher than that of any European country – making it a national crisis and now, according to Scottish Governement, a national mission. It is notable that within Scotland, people in the most deprived areas are over 15 times more likely to die from drug misuse than those in the least deprived areas. This deeply embeds the roots of the crisis in poverty, inequality and trauma – exacerbated by cumulative policy and clinical decisions over recent decades.

A new study from Dr Emily Tweed at Glasgow University also highlights the high number of avoidable deaths amongst people experiencing multiple disadvantage in Scotland. Experiences of homelessness, justice involvement, opioid dependence and psychosis often co-occur and the population of people experiencing these issues is growing and aging. This new research suggests that those who experience more than one of these disadvantages are most at risk of premature and avoidable death.

All this means that the recent efforts to understand and create solutions to alleviate the crisis are very welcome and much needed, with key reports published in recent weeks. Over the last three years, the Scottish Drug Deaths Taskforce have listened to the voices of people from across Scotland and beyond – people with experience of using drugs, families, service providers, community representatives, those in our justice and emergency services, academics and many more. Their stories have been heard and learned from. Combined with findings from an examination of the evidence base, these stories and experiences are at the heart of the recommendations and actions from the Taskforce. The final report, Changing Lives, was published on 21 July and includes recommendations for a No Wrong Door approach to accesssing services. Taking a No Wrong Door approach means breaking down traditional silos between services and sectors so that there is easier access to the treatment and support that people want. This is critically important.

Reporting on the Changing Lives report, Scottish Housing News highlighted the recommendation that Scottish Government should continue to support Housing First and scale up the approach across all Scottish local authorities, and that learning from the Housing First model could be used to support the design of other services. With a strong evidence base, Housing First has a high success rate for people whose homelessness is made harder by experiences including addiction and trauma. The nature of the support is open-ended and flexible, is not dependent on abstinence to access secure, permanent housing, and the model is based on a set of principles, one of which is harm reduction.

The extent to which the law can be leveraged to reverse the drug deaths crisis has been explored in different ways too. The Taskforce produced a Drug Law Reform report in September 2021 which focused on how existing drug legislation, a matter reserved to UK government, affects the public health approach that needs to be taken in Scotland. In July 2022, Turning Point Scotland launched a campaign advocating action on drug law reform and the limitations of the Misuse of Drugs Act 1971. Meanwhile, the Scottish Conservatives focused on the powers that the Scottish Parliament has to legislate in this area, publishing and consulting on a proposed Member’s Bill in 2021 called the Right to Addiction Recovery (Scotland) Bill. The proposed bill was developed with activist organisation Favor UK and associates with direct experience of addiction, recovery and of different treatment options. This lived experience lens and expertise, alongside our belief in the importance of rights to redress disadvantage, led Homeless Network Scotland to be among the 78% of respondents who supported the bill when the final proposal was lodged with the Scottish Parliament in May 2022. It has subsequently gained enough support in parliament for the Scottish Conservatives to introduce a Member’s Bill which will go through the relevant stages for new Bills in the Scottish Parliament.

Involving people affected by problem substance use is important for a human rights-based approach to policy making. The Scottish Government has made an important commitment to put people with lived and living experience at the heart of the National Mission to reduce drug related deaths. This approach aims to empower people so that their voices and their rights are acted on in decision-making. Professor Allan Miller, an internationally recognised human rights leader, will be leading on this work and will bring together people affected by drugs and alcohol alongside people who provide services to form the National Collaborative. The National Collaborative will make recommendations to government and will make decisions independently. There is an open invitation for people to nominate themselves or others to be part of the Change Team of the National Collaborative, and for groups who are well placed to advise the National Collaborative to put themselves forward as reference groups. More information and an expression of interest form can be found here.

While there is much to be done to tackle the high rate of drug related deaths in Scotland, when we understand the causes and contributing factors, we are better placed to create solutions and conditions that help.