Scotland’s drug shame Addiction is out of control – and nothing is being done

The withdrawal associated with heroin and, indeed, all opiates, is brutal and unforgiving. Indeed, the phrase “kicking-the-habit” refers to the physical agony of going cold-turkey, where addicts become emotionally and physically excruciated as the substance makes its long, painful retreat from their tortured minds and bodies, forcing them to kick-out involuntarily, as if convulsing.

Serious heroin addicts with a high tolerance for the drug become trapped in the hellish cycle of scoring drugs to escape withdrawal symptoms, which isn’t cheap. This is why criminality becomes a necessity for many.

This bone-chilling fear of withdrawal trumps the shame of social exclusion, the indignity of prison and the permanence of death. The need to pursue the next fix, at the cost of all else, leaves many drug-abusers physically and morally disfigured.

Only when contending with that reality, does my 50-year-old drug-dealing friend’s rationalisation for peddling smack sound a little more believable. Having gone through a ‘rattle’ — slang for withdrawal — he, in his own words, “knew how much these people needed it”.

It’s broad-daylight in the heart of this bustling post-industrial community. Another two men loiter behind a pair of battered phone-boxes which partly shield them from the glare of a busy high street. They’re here to score. It’s not even tea-time and nobody anywhere is battling an eye-lid. The police-station round the corner will close shortly, not that it will make a difference. Here, even the cops have all but accepted that drugs and their attendant miseries are inevitable.

Scotland has a proud pioneering history. We brought the world antibiotics, telecommunications and a paradigm-shifting enlightenment. But we also lead the way in delusional hubris, and finger-pointing. In Scotland our successes are our own, but our failures — and they are many — are usually someone else’s fault. And by far the greatest blemish on our storied history in recent times is the collective abandonment of the most vulnerable, persecuted and excluded group in our society: drug-addicts.

Data recently published has revealed that in Scotland, drug-related deaths rose by a shameful 27% last year to 1,187. That means the death-toll in Scotland was equivalent to five Lockerbie bombings or fifty 7/7s. It is nearly three times that of the UK as a whole, and, per capita, the drug death rate in Scotland is higher than that of the U.S. Yet no national emergency has been declared.

In 1996, an e-coli outbreak, which affected 200 people and caused 21 deaths, led to a public inquiry which produced a damning report placing blame on a Wishaw butcher and council health officials. But in 2019, with tens-of-thousands hooked on drugs and 1,187 dead last year, there is quite simply no accountability. The buck stops nowhere.

In Scotland, the drug-problem is now out of control. Much like a fire that leaps from one structure to another, it has taken on a life of its own. It is now self-sustaining, independent of the conditions that caused it.

And the cause has baffled many. Myself included. It may be attributable to a number of factors, including the sharp managed-decline of the industries around which many working-class communities formerly cohered. The mechanisms by which they once lifted themselves out of poverty were sacrificed on the altar of the free-market and replaced with Frankie and Benny’s, American-style shopping malls, casinos and, in Dundee (the drug-death capital) a world-leading design museum — partly funded by the billionaires implicated in the U.S. opioid crisis.

Drug-related deaths, like untreated disease and violence, beget drug-related deaths. Much like flowers that drop seeds before wilting, those who perish in such sordid, undignified and often terrifying ways, don’t serve as warnings to others; instead, they become martyrs of sorts. They are mourned, not just by their families, but by those they with whom they sought and used the drugs that killed them.

Opiates such as heroin, diazepam, methadone and morphine are implicated, but by far the most consequential development in recent years has been the rise of counterfeit versions of prescription benzodiazepines, such as etizolam (street Valium) as well as cheap, deadly imitations of the popular American anti-anxiety drug, Xanax.

My theory is that the drug problem is worse in Scotland for the same reason the drink, cigarette and life-expectancy problems are worse: the severity of deindustrialisation was that much more acute north of the border because we lacked the political autonomy to mitigate its impact in context-specific ways. Then again, I’m not an academic. Maybe it’s just the weather that’s killing everyone.

A compounding factor is the panic that grips those communities of drug-users who can’t go a day-or-two without hearing another story about someone who’s died. Thanks to a largely useless mainstream media (with a few notable exceptions), drug-abusers are invariably portrayed as vulgar, selfish and feckless individuals, whose problems are entirely self-generated. The notion that they may actually care about each other and, indeed, take care of one another, has thus far, eluded the public conscience. But drug-takers survive by moving in tight-knit communities, bonded by the acute and constant social-exclusion they endure.

Every time one addict is found dead, the others grieve. They sense too that they might be next. They feel that society has all but abandoned them. Socially excluded, bastardised by the public and misunderstood by many who wish to help them, what is there to live for? And so they do what we all do when terrible things happen: they reach for whatever numbs the pain. And so the fire spreads, tearing through entire families and communities, leaving death and despair in its wake.

Back on the street corner, as the men candidly regale me with their tales of drug addiction, the self-abuser in me begins to feel nostalgic about my past drug-use — a sign of the insanity that defines the condition of addiction. I drift into a day-dream about that half Temazepam from years ago, that I should have just swallowed before the police got their hands on me. “What a waste”, I think to myself, able to recall its sweet taste and chalky texture in my mouth.

Also known as benzos, eggs, norries, rugby balls, vallies, moggies, mazzies, roofies or downers, tranquilisers came in different forms. One was a small egg-shaped pill, soft to touch, not dissimilar to the texture of a Kiwi fruit. The other, a thick, white, chalky tablet.

They start to take effect between about 20 and 40 minutes after swallowing, at which point a euphoric lethargy washes through mind and body. You are not tired, but should you close your eyes, you would appear to be asleep. Falling asleep after the drug has taken hold, though, would be a terrible waste of its pleasant effects.

Staying awake is also important because it can be terribly hard to wake up out of a tranquilised sleep. And physically getting up is quite the chore. Limbs are heavy against whichever surface you are rested upon. A hard floor becomes a soft bed.

The constant physical tensions you often mistake as natural mannerisms (a furrowing brow, a tapping toe, or an incessant nail-picking finger) begin to leave the body, joining an exodus of unintentional scowls, facial twitches and stomach butterflies. You feel heavy, but the extra weight is offset by your lack of desire to move.

Should you wish to speak, you may notice your voice is noticeably quieter — not because it is being suppressed, but because it returns to its natural level; it is no longer inhibited by the physical stress placed on the voice-box, which so often modulates the tone and volume of your speech. Words come a little easier, especially for those who struggle to make conversation because they second guess themselves.

You listen more actively and are usually more considered and sensitive in your response. It’s hard to know if it improves how you communicate, or whether you are just less concerned about communicating badly. You may also suddenly feel capable of articulating precisely that which you so often struggle to express. Words that have failed, eluded and embarrassed you, become your keen and humble affiliates – or perhaps this is a lack of concern for how much nonsense you are really talking.

These are called tranquilisers for a good reason. They induce a peace, serenity and sense of well-being that is difficult for even the most prolific and articulate drug-abusers to describe.

To the uninitiated, such a drug may hold an alluring curiosity. “How do the dealers come up with this stuff?” you may ask. But this drug is not the vulgar concoction of illicit dealers, it is a pharmaceutical-grade, state-approved chemical-compound. And one which was so widely prescribed by GPs in the Nineties, that addicts have been chasing its effects ever since.

That’s why, even though drug-abuse is so often framed as an issue for the feckless individual, we must also consider why and how these substances are created — and how thoughtlessly (and sometimes malignantly) they are introduced into society.

What risk-assessments were undertaken before drugs such as methadone, diazepam and tranquillisers were introduced through the NHS? Beyond the risk-benefit analysis on the individuals being legally prescribed them, what other factors were taken into consideration? When drugs are road-tested for approval, their broader social-implications are rarely contemplated.

There is a long-established pattern of drugs being developed and introduced into society through pharmacies and healthcare-systems before later being withdrawn because of their negative social impact. An impact which cannot be predicted when the chemicals are tested on rabbits and rats.

In 1895, for example, the German drug manufacturer Bayer marketed diacetylmorphine (an opiate) as an over-the-counter cough-suppressant under the brand-name Heroin. Yes, you read that correctly. Heroin was developed as a morphine substitute but despite being marketed as “non-addictive” it wasn’t long before it scored some the highest rates of addiction among those who used it.

Fast-forward to the opioid crisis in the United States where over-prescription more than 30 years ago claimed the lives of over 200,000 Americans between 1999 and 2016. The United States is home to 5% of the world’s population but currently accounts for 80% of all opioid use. Again, those communities devastated by 21^st-century deindustrialisation are the ones more adversely affected – with the opioid-crisis rising sharply in the period of economic-decline between 2001 and 2009.

Where the U.S. led, Scotland followed. Research published by Scottish Universities in 2018 found that 18% of the Scottish population was prescribed at least one opioid painkiller in 2012 and that “there were four times more prescriptions for strong opioids dispensed to people in the most deprived areas, than to those in the most affluent areas”. Every bit of data available points to a large increase in the prescription of addictive painkillers like co-codamol and tramadol over the last 10-years in the very communities where people are dying.

The drug-crisis may be framed as an issue about dangerous cocktails of counterfeit drugs, but many of the illegal substances on the market today, the ones linked most often to the drug-deaths, are simply amateur attempts to mimic the effects of state-approved substances which were either withdrawn or restricted — once the damage was done. Also, people who become dependent on pain pills may switch to heroin because it is less expensive. In 2016, the National Institute on Drug Abuse in America estimated that nearly half of young people who inject heroin turned to the street drug after abusing prescription painkillers.

The fake drugs are dangerous because nobody can ever be sure what’s in them. State-approved drugs are dangerous because when over-prescribed, they increase the likelihood of addiction and tolerance and therefore the demand for drugs rises — including the fake ones. While America is now doing something about the scourge, what are we doing in Scotland? The Scottish government has cut funding for Alcohol and Drug Partnerships by 6.3% since 2014/15.

Which brings me to my final point. The risk of addiction rises in areas of deprivation for a multitude of reasons. There is interplay between the prescription of drugs for health problems and the subsequent uptake of addictions. This is as true of treatment for physical pain as it is for anxiety and depression. It is also commonplace for people to take drugs that were not actually for them.

Analysis by the BBC suggests around 2.3 million people in England took a prescription painkiller that was not prescribed to them in 2016-17 alone, which means we can be sure it’s going on in Scotland. My drug problems actually started when my gran gave me a painkiller to help me sleep when I was a teenager. Within a week, I was dipping into the medicine cabinet.

In poorer communities, ill-health is more commonplace, increasing both the likelihood of treatment and the risk that a patient (or someone in the household taking the drugs) may become dependent. Society is awash with psychoactive substances in an age of chronic emotional and psychological stress. Increasing numbers are turning to drugs designed to treat chronic physical pain and mental health problems to self-medicate the emotional pain, stress and anxiety of poverty and social alienation.

Put simply, without serious action on social-inequality, drug-related death and despair are inevitable. If we want to make a serious impact on this matter, we must be prepared to analyse the environments in which addictive behaviours are likelier to emerge.

For some, the social conditions are so miserable, the addiction so severe, and the range of options available so few, that injecting a dirty needle into the groin, despite already having had a leg amputated, seems like a reasonable solution. When that’s your threshold for pain, popping a few tablets is merely a formality.

Back on the street corner, one man is bloated and jaundiced, his black, sunken eyes disappearing into a weathered yet expressionless face. “You have a choice before you take it”, he says, “but after you’ve tried it the choice is gone.” The others nod knowingly as do I, before they break into a discussion about addiction, each recounting their experiences of drug misuse in a manner suggesting they are all, in their own way, resigned to its permanence.

I tell them I have never tried heroin, and they all warn me to keep it that way. Even though they have only just met me, because I have showed them a modicum of respect, they have a genuine concern for my well-being. For in their world of addiction, crime and social-exclusion, telling someone never to try heroin is an act of purest love.

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