Welcome to Europe’s drug death capital. Christopher Furlong/Getty Images
Tourists emerging from Glasgow’s Central Station onto Gordon Street are immediately confronted with a scene familiar to every Glaswegian: cold air, tornadoes of litter, and the visible overlap of the city’s drug and homelessness crises. To the right, a group huddles around a beggar, exchanging stories about the latest blue-light drama, giving the encounter an oddly social feel. Across the street, two rough sleepers sit outside a Sainsbury’s, cups in hand. One has a fresh facial injury and scolds the other for encroaching on his begging spot. The recipient of the rant seems unbothered, however, as he informs his rival that he can’t hear him because he’s deaf.
This scene takes place just after midday on a Monday — nothing unusual. Commuters and taxis pass by, indifferent to the events surrounding them. This is life in Europe’s drug death capital. Yet, for the city’s marginalised substance users, a new hope has been promised in the form of Scotland’s first sanctioned drug consumption room (SDCR). Scheduled to open last week, safety checks on the building have led to delays. The stunted opening seems in keeping with Scotland’s troubled approach to its drug crisis — the worst in Europe and second only to America, globally.
The road to the UK’s first official SDCR has been long and winding. The first facility of its kind was run illegally by activist Peter Krykant out of a van in the city centre. In perhaps the most significant example of direct action in the history of drug campaigning in the UK, Krykant’s activism was instrumental in mainstreaming debate around Scottish drug reform, influencing the eventual approval of the UK’s first sanctioned drug consumption room in Glasgow.
Running parallel to Kyrkant’s campaign was Glasgow’s Heroin Assisted Treatment (HAT) programme, launched in 2019, which aimed to provide chronic heroin users with a pharmaceutical-grade substitute (diamorphine) under medical supervision. This harm reduction approach sought to reduce overdose deaths, minimise the harms associated with street heroin, and improve the quality of life for participants who had not responded to other treatments.
Despite the initial hope, various reports on its effectiveness present a mixed picture. Participants saw improved health, reduced criminal activity, and access to additional services. However, enrolment was low with only 20 participants while also being expensive at an estimated annual cost of £12,000–£15,000 per person. This led to criticism of its scalability and limited impact on Scotland’s broader drug crisis, especially given the underfunding of other drug treatment services, namely residential rehab. While certainly a significant development in the long arc of a crisis now spanning decades, the HAT programme’s overall impact was nothing to write home about. This is, of course, a running theme where government-backed harm reduction strategies are concerned.
Legal heaven and earth have been moved to establish a safe drug consumption room in Glasgow. This was initially hindered by UK legislation that criminalises drug possession and use. However, after years of advocacy and pressure from public health experts and local officials, the Scottish government worked with then Lord Advocate Dorothy Bain, Scotland’s chief legal officer, to find a pathway. In 2023, Bain agreed not to prosecute users of the proposed facility, effectively decriminalising drug use within the site and allowing the pilot programme to proceed without changes to UK-wide drug laws. This move marked a significant step forward in harm reduction efforts amid Scotland’s ongoing drug crisis. But in truth, like many policies adopted in Scotland, it came about 10 years too late and is not part of any wider strategy to steady the ship.
While the SDCR is expected to reduce overdoses, infections, and connect users to services, the deeper issues driving demand for drugs persist. People in deprived communities are 18 times more likely to die from drug-related causes, pointing to poverty as a root cause. The healthcare offer made to the poorest is always inferior, but this inequality is compounded for addicts who face additional stigma in healthcare settings, where addiction is too often seen as a moral failing rather than a health condition. Treatment options remain limited, and SDCRs, such as methadone programmes, will at best merely keep users stable until better solutions emerge. Be under no illusions that this action alone will make any significant impact on the overall crisis.
That’s why it’s odd that the Scottish government chose to expend so much political capital creating the legal headroom for this initiative, because even if it succeeds as hoped, its impact will be minimal. In truth, politically speaking, a legal standoff with London was the path of least resistance when you consider the true scale of the crisis and the action on social inequality required to turn it around. Creating a constitutional spectacle produces a sense that something radical is being done when in truth, the status-quo has simply been repackaged.
Rather than take more politically risky action that may involve ruffling the feathers of middle-class voters, leaders with no coherent vision for a more comprehensive treatment landscape look instead to well-placed harm-reduction advocates who propose more of the same initiatives. The challenge facing the SDRC is immense. Even if it all goes well, its remit is limited and questions remain as to how exactly these short-term, pop-up initiatives will have any real impact on a nationwide epidemic.
Consider the practicalities of actually getting people through the door of the facility when it opens. One challenge is geographical: expecting vulnerable addicts to travel into the city centre frequently is unrealistic. Advocates argue there are plenty of drug users within the city centre already who are eligible, but many dispute not only those figures but also the merits of a service set up to target a narrow cohort of serious addicts within a small urban area. Arguably, it’s the intravenous drug users in the city’s surrounding housing estates who are not only most vulnerable but who are also creating the greatest negative impacts in their communities. Wouldn’t they stand to benefit most, with their participation reaping greater social benefits? In any event, how will they be incentivised to make the trip? How likely is it that they will hold onto a bag of heroin and jump a bus into town before safely injecting?
Even once enrolled, participants face numerous barriers. Many will fear being drawn onto the social work or criminal justice radars merely by identifying themselves or filling out paperwork. Distrust of authority is pathological among this marginalised community for obvious reasons. If they do present at the SCDR, who will greet them? Who will reassure them and gain their trust? Will drug workers with lived experience lead this important work, or will well-meaning but less streetwise staff who arouse suspicion in users pull the strings behind the scenes? Ultimately, will the same class dynamics that subtly underscore lopsided drug policy and debate in Scotland be needlessly replicated, or has serious work been undertaken to identify and correct for that problem? Then there’s the very basic harm-reduction paradox produced by the pilot’s central focus on intravenous drug use — will smoking heroin or cocaine be discouraged even though it’s often safer than injecting?
The notion the SDCR will act as a portal to other services only sounds plausible if you know nothing of what’s actually out there in this baron treatment hellscape. What other services do we mean, exactly? Even people with no history of drug problems may wait months for the most basic mental health counselling. The complexities of lives ravaged by addiction, police involvement and homelessness often require specialist multi-faceted care, that is, quite simply, unavailable for most people. Addicts also face lengthy waits — up to a year — for rehab placements should they desire one, by which time the addiction may have deepened, or the desire to enter a residential setting may have waned. We don’t have an integrated system that pulls in the same direction as in Norway, where, for example, rehab facilities are integrated with some prisons. In Scotland, different organisational factions operate independently of one another, pushing their own agendas, pursuing their own interests, often based on selective assessments of a narrow evidence-base and a keen awareness of what’s “trending” with the hapless Government holding the purse-strings.
Staff turnover in the drug sector is also high due to burnout, demoralisation and short-term funding settlements while wider health services are overwhelmed. Unlike Germany or Switzerland — cited often by advocates as best practice that could be easily replicated — Scotland’s fragmented and underfunded services, operating well overcapacity in a more structurally unjust society, will hamper similar success, irrespective of noble intentions.
I want it to succeed. If not simply for the minor morale boost it may generate at a time where even seasoned campaigners like me have grown apathetic or walked away from the fight to regroup. Despite critics being labelled regularly as cynical (admittedly with some justification), it’s decades of dire harm reduction outcomes in Scotland that fuel this scepticism. The problem is not harm reduction as a philosophy, it’s the fragmented and untimely manner in which Scotland implements these policies. We’re always playing catch up while dealing with the consequences of unforced errors like cutting safe benzodiazepine prescribing (which drove demand for deadly street Valium) or slashing funding to services that demonstrably save lives. This has been the way of things since the first methadone programme was introduced as a treatment in the Nineties and it remains the predominant treatment for heroin addiction despite showing up on around half of all drug death certificates since records began.
Nearly 40 years later, with drug deaths now many times higher than in those early days, harm reduction remains the only real tool in Scotland’s drug policy box — a political choice and not one imposed by Westminster. The safe consumption room pilot must be viewed in this broader context. Rather than a clean break offering something new, it’s the latest iteration of the same idea we’ve seen before, yet for some reason, we are encouraged to expect different results. Rumours of staff walking out after inductions, a defensive management team unwilling to address tough questions, and the fact the SDCR was still advertising job vacancies as recently as mid-September (one month before it was due to open), suggest to this hardened cynic deeper issues behind the delay than the building safety checks cited.
If the countless headline-grabbing initiatives we’ve seen throughout the past decade — as deaths have risen to intolerable levels — are anything to go by, this may mark yet another harm reduction gimmick struggling before it even begins. I hope I’m wrong, but it all reads like a familiar tale and one that tells the real story of Scotland’s drug crisis.
Darren McGarvey is a Scottish hip hop artist and social commentator. In 2018, his book Poverty Safari won the Orwell Prize and his new book The Social Distance Between Us (Ebury Press) is out on 16th June.
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SubscribeI can’t understand what Bitcoin is or does or what benefit it offers society. It is not fiat money regulated by law. It is not a physical entity like gold, silver and platinum. What the hell is it? My guess is that it is best avoided (especially by those of us who are not fortunate enough to be very talented) but it is typical of Trump to take a punt on it. He is going to need a strong Treasury Secretary, Fed Chairman, SEC Chairman, Commerce Secretary, FTC boss and OMB boss (i.e., his economic ministers) and he is going to have to listen to them.
Good analysis. Bitcoin is however useful for undertaking illegal transactions (something I expect was in the minds of the (unknown) people who set it up).
Just so my comment makes sense… When discussing finance and economics, it’s essential to separate two key areas in one’s mind: financial investment policies versus economic policies, including commercial or labor-capital policies. The first involves speculative and free-market elements (like stocks, risky assets, and interest), while the second is grounded in the value of labor, products, or services—contributions that are tied to real individuals.
Ideally, the money you save from working hard (like what’s in your bank account) should remain safe and separate from risky financial markets. However, when financial policies allow that saved money to be used in speculative investments, it creates a risky situation. Your hard-earned money in the bank is then exposed to high-risk investments, and that’s where problems arise. This is why many people are hesitant about Bitcoin! If Bitcoin were added to the mix, one could foresee a system that is inaccessible to regular people, potentially leading to many losing their modest savings.
So the question is: why not just separate the two types of financial-economic strategies?
This isn’t a new issue, but it’s especially relevant now. It may be helpful to learn about the Glass-Steagall Act, which was enacted in 1933 and ironically repealed 66 years later. Many believe its repeal contributed to the 2008 financial crisis. This act was designed to keep these types of financial activities separate—something worth reconsidering in today’s financial climate.
The only thing holding us back is that billionaires want to play with everyone’s money without consent.
There are two sorts of money – promise money and token money. Promise money dominates, an institution, a bank or government, promises to pay you a sum of money. You take a risk on the institution meeting the promise and the value of a unit of money issued by a government. Traditional token money hardly exists – it was mostly a gold or silver coin where the value lies in the demand for the precious metal. Crypto currencies are token money, no one has promised anything. Its value is the demand for the token, a number that was tedious to calculate. Since the US election $2.5 billion of “real” money has flowed into the Tether stable coin that is most likely from the sale of Bitcoins. Ordinary savers gave up that money for a number that is tedious to calculate. The only certainty is that that money will not go back to those savers. They will have to hope they can sell their number to someone else who hopes that they can sell their number to someone else who…….
Many thanks JH.
Always value your comments about this particular flavour of Ponzi scheme.
“They will have to hope they can sell their number to someone else who hopes that they can sell their number to someone else who…….“
And how is this so different than other, alternative forms of custody for cash one hopes will appreciate?
With the other token money you can sell the precious metal. With the promise money an institution has promised to exchange the promise for cash or treasury bills, your risk is the institution making the promise goes bust. With Bitcoin you have to hope some stranger will buy it. One day, as with the Emperor’s new clothes, everyone will realise that there is a serious risk that no one will want to own a tedious to calculate number. It cannot end well and end it inevitably will.
Those other forms of custody for cash are real. They are not just smoke and mirrors created by crooks for nefarious purposes.
Stable coins are a form of custody for cash, they can be perfectly legitimate but are not regulated. Some offer more transparency. Their value will relate to the assets they are invested in, often the manager gets the interest. Crypto currency like Bitcoins are not a form of custody for cash, there are no assets. I assume Bitcoins started as a game and can see nothing illegal in them provided no promises or encouragement are given that you can sell them for anything more than zero, the amount available when they go out of fashion and the computers are turned off. The ledgers recording ownership using blockchains are designed for anonymity. They are decentralised but are cumbersome. Scaling up creates problems with some risks if short cuts are taken. They have been used for criminal activity, though the fiat money transfers in and out are not anonymous. You have to trust the community of computer owners. That community has to be paid to keep them going. You have to trust the person that interfaces you to that community. Your asset is a “bearer” asset, a number that is not in anyway attached to you – if it is copied or stolen, or you lose it or forget, it you are left with nothing.
“You have to trust the community of computer owners“. Not only them, but you mostly end up trusting fine, upstanding members of the business community like CZ and SBF as well.
The arguments for having some bitcoin are well-rehearsed. The most injurious thing that governments could do to overturn it would be to manage their own economies properly and in peaceful communication.
Well rehearsed but not convincing on analysis. Most of the claimed benefits are the blockchain – anonymity and decentralised – some claim a benfit is a limited supply but that is a serious problem, it pushes the price up. The real problem is that it does not create an investment, it just transfers existing wealth. So far investors have transferred over $100 billion of their real investments to the early holders of bitcoins who mined them or bought them very cheaply. They, maybe a thousand idividuals, have put those funds in stable coins that are real investments in treasury bills and bank deposits. If investors transfer further savings of one trillion dollars into bitcoins it too will go to existing owners who then save it in something else. No one would deposit with a bank who paid it straight out to the shareholders leaving the bank with nothing.