Latest statistics on drug-related deaths paint a stark picture of the harm that people experience through disadvantage. Homeless Network Scotland Impact Lead James Stampfer says better joined-up working – especially for those at the hard edges – and scaling up proven interventions like Housing First can reduce the tragic effects of systemic failure to properly support people.
The most recent official figures on drug-related deaths in Scotland showed that 1,133 people lost their lives to substance use in 2025 – an 11% increase on the previous year. Data suggests that for 25 to 49-year-olds, the primary driver for excess mortality is drug-related death followed by suicide and certain types of cancers.
Looking beyond the statistics, that 11% increase translates to 116 more families and loved ones who attended a funeral when compared with the previous year. Public Health Scotland suggested 34of those funerals were for people aged under 25. In total, across all age groups, 830 men and 303 women.
For me these statistics have always held the faces of people I know, their laughter, their larger-than-life presence and the heartfelt loss that comes from never being able to see them again.
This is compounded by the effects of intergenerational trauma and its impact on the ability to regulate the nervous system. People reach for ever more dangerous substances to cope, with drug trends changing quicker than services can respond. Cocaine use is skyrocketing while we lack effective treatment modalities for stimulant use. This is only scratching the surface of the complexity of the issue.
It is estimated that those from the most deprived areas are more than 15 times more likely to die from drug use than those in the least deprived areas. This can be seen nowhere more starkly than the figures on homelessness deaths in Scotland. The most recent figures, from 2024, estimated 231 homeless deaths, 34% of those which are estimated to be 79 people, were a direct result of substance use.
Prison leavers have long been known to be an at-risk group, as a reduction in substance use in prison lowers tolerance and puts people at higher risk of overdose upon release. A study published in January 2026 by Stirling University found those recently released from prison have 8 times more substance use related contact with A&E, compared with a similar population who had not attended prison for five years.
With overlapping disadvantages requiring cross sectoral interventions, the need for joined up responses is essential, as those overrepresented in statistics often need holistic support rather than services that meet one need at a time.
Meeting one need, such as stabilising drug use with a prescription, is often difficult when mental health, housing or criminal justice issues remain unaddressed, creating stresses that undermine stability.
Homeless Network Scotland has collaborated with stakeholders across sectors to co-produce an evidence-based protocol that supports joined-up service delivery that can better help people experiencing multiple disadvantage. The protocol, called The Level, is backed by more than 50 organisations and was launched at the National Summit on Severe and Multiple Disadvantage in Perth earlier this month.
Housing First – providing a home first with wraparound support – is a proven way to provide the stability of a home as a foundation to better understand and meet the needs of those who are overrepresented in the statistics. Despite tenancy sustainment rates of 80-90%, current provision falls drastically short of estimated need. Housing First Scotland needs to be expanded at pace to provide more spaces for people to build a healthy future.
The Sustainable Housing on Release for Everyone (SHORE) standards are also key to protecting jail leavers from being released into situations that support drug use and reoffending. For many prison leavers, Housing First provides the ideal safety net, and examples of this in practice are included in the SHORE standards.
The new Ask and Act homelessness prevention duty – which will from 2028 require a wide range of public bodies to enquire about someone’s housing situation in the course of their regular work, and act if someone is threatened with homelessness – is explicitly referenced in the Scottish Government’s Alcohol and Drugs Strategic Plan 2026-35, Prevent Harm, Promoting Recovery.
Improved prevention pathways can act as a buffer, so less people fall through the cracks into the homeless system. In my experience, the homelessness system can be a dangerous place, where trauma and stress meet with the opportunity to consume substances. The decision to use substances is influenced by the difficulty of the situation. This can ruin futures and potentially result in people becoming statistics.
Mutual aid groups, recovery workers, harm reduction workers, housing support workers and the frontline workforce who work compassionately with people entrenched in substance use do amazing work. When they meet people where they’re at without judgement it can make a difference in people’s lives. I know this from personal experience of having had some amazing workers support me and working alongside some amazing workers in frontline services.
We all want to see better outcomes. For good frontline workers that is what gives the job meaning. How decision makers move forward and empower those workers with the resources that create space for people to achieve better outcomes is pivotal.
There are structural barriers despite policy already pushing for positive change; the implementation gap still leaves a lot to be done to meet needs, support people and improve the material conditions that perpetuate continued substance use harms.
Adequately funded implementation will continue to be a matter of life or death until it becomes a priority.