August 5, 2021

It is hard to explain just how bad Scotland’s drug deaths epidemic is. In 2020 there were 1,339 in a country of just five and a half million people. Comparison helps: in Holland, the death rate is 18 per million; in Ireland it is 43 per million; in the whole of the UK it is 76 per million; in Scotland, it is 295 per million. Scotland’s drug deaths have more than doubled since Nicola Sturgeon became First Minister seven years ago and nearly tripled since her party took office — when the health minister in charge of the issue was, it’s worth noting, a certain Ms Sturgeon.

This week, the roll call of substance abuse fatalities during the SNP’s period of government is set to hit 10,000. That’s more than the number of people killed in Hurricane Katrina, or who perished as the Titanic went down. More than those killed at Pearl Harbor, in 9/11 or during the 7/7 London or Manchester arena attacks — more than British troops killed at the charge of the Light Brigade. It is more than the number of people killed in the Blantyre mining disaster or the Dunblane Massacre or the Lockerbie bombing. In fact, it is more than all ten of these events combined. And yet, while each of these losses of life have been faithfully recorded in our history books, there has been no equivalent recognition or examination of the current unfolding tragedy.

Why? Because of the people who are dying. According to the national figures, people in the most deprived parts of the country were 18 times more likely to have a drug-related death than those in the least deprived. The poor. The marginalised. The people who don’t vote.

But these people aren’t just statistics. Every death is a person with a story and loved ones mourning their loss. Bryan Hogg died in 2019 from street valium abuse. He was 29 years old and not long out of prison. His mum, Sandra Mackin, says the system failed him. “The politicians don’t care — it’s just another number to them. I think my boy was failed. After he died nothing was done — there was supposed to be an investigation. He had a wee boy and now he has to live without his dad.”

During May’s Scottish elections, Nicola Sturgeon was tackled on the issue and admitted her government had “taken its eye off the ball”. Public Health Scotland says that “every drugs-related death is preventable” and “quality treatment options” are “essential”. But as deaths have spiralled, funding has been cut and treatment options have narrowed. Over the first 12 years of the SNP’s time in office, funding to Scotland’s drug and alcohol services was cut by more than half. For those trying to pull themselves out of their addiction and get better, it’s had a devastating effect.

Scotland has some of the best residential rehabilitation facilities in Europe. So good, in fact, that Dutch authorities and insurers pay to place patients in facilities such as the Castle Craig hospital in the Scottish Borders. In 2002, Castle Craig admitted 257 patients funded by the NHS; in 2019, the number dropped to just five. There’s no shortage of demand for services, but they aren’t accessible to the Scots most in need. Currently a quarter of Castle Craig’s places are being filled by Dutch patients, with most of the remainder being funded privately or via health insurance.

Meanwhile Glasgow’s largest residential rehab centre, Phoenix Futures, was forced to abruptly cut its number of beds from 54 to just 14 in 2019, after a Government tender was revoked. The Mungo Foundation’s Cothrom Eile service — in Nicola Sturgeon’s own Glasgow constituency — was forced to close its doors completely in 2019 due to funding cuts.

Those who have benefitted from such services are concerned at their closure. When Bruce Munro started at Phoenix Futures he was “eight stone and taking food from bins and begging to fund a drug habit — I didn’t feel part of society”. He had been abusing substances for more than 20 years, becoming homeless and suffering mental health problems. After five months of rehab, he was ready to move into supported accommodation. “To have only 14 beds for a city the size of Glasgow is disgraceful. I think this model works for me because it’s not just about putting down the drugs. You are getting therapy, bereavement and trauma counselling rather than just putting the drugs down, because that’s the easy part.”

The outcry over these cuts — and the spiralling death toll which has accompanied them — forced the Scottish government into action in January. As well as reversing some of the funding cuts, Nicola Sturgeon established a Drugs Death Task Force and appointed a minister to directly oversee the issue. But huge question marks remain: there has been little change of direction in policy that has spectacularly failed over the last 14 years.

Dr Neil McKeganey, Director of the Centre for Substance Use Research in Glasgow, worries ministers are intent on just doing more of the same. “We have the same people advising the same government year after year, with no evident impact on the number of drugs deaths and no real accountability.” Dr McKeganey has repeatedly advised ministers and officials to better support residential rehabilitation —

“only to be told that their preference is for methadone and now benzodiazepine prescribing. That methadone is implicated in 53% of Scottish drugs deaths and benzodiazepines in 74%, should tell even the most ardent refusenik of the importance of abstinence-based treatments that prescribing addictive drugs is part of the problem — not part of the solution.”

CEO of the charity Faces and Voices of Recovery, Anne Marie Ward is more blunt: “The Drugs Death Task Force insists on pursuing the same failed options that got us into this mess.” She insists “we need the Scottish Government to start properly funding rehabilitation and recovery programmes”. The Scottish Government currently funds just 13% of the residential rehab places in Scotland (even Universal Credit funds twice as many) and their own figures show waiting times of up to year.

Of course, the barrage of criticism which has accompanied its sustained failure has prompted the SNP to hit out, trying to switch blame. The SNP has long campaigned to introduce consumption rooms — also known as shooting galleries — where addicts can access clean needles and inject in a safe environment. But the Scottish Parliament does not have the legislative power to introduce them — that is reserved for Westminster, and the UK Government does not support the policy.

When the record drug death figures were announced last week, SNP members were quick to point the finger south. Nicola Sturgeon tweeted that “we will continue to argue for reform of drugs law, which is not currently within our power” while Edinburgh East MP Tommy Sheppard stated that “major changes in UK law [are] required to really tackle the problem.”

Pretty shameless stuff, as well as being self-incriminating. On Tuesday, England and Wales released their drugs death figures, both now five times less than the Scottish rate. Pointing out that the laws are exactly the same on both sides of the border indicates that some other factor or combination of factors is to blame for the enormous discrepancy. As Anne Marie Ward has previously stated: “Bluntly, the obsession with drug consumption rooms (DCRs) is making it inevitable that more people in Scotland will die from addiction. DCRs are the same silver bullet trope I’ve heard for 30 years.”

A public health emergency that has built up over many years is not about to be fixed by a stroke of a legislator’s pen, and it is dishonest for those in charge to pretend otherwise. Still, even ideas with limited impact are something the UK government should be prepared to discuss with their SNP counterparts. The people being killed are UK citizens, too.

The truth is both complicated and mundane. We need better data and analysis of those who have died and the factors contributing to those deaths; we need earlier interventions, a number of different pathways, and joined-up support — so those dropping out of treatment or switching between areas or options are not lost in the system. We need to review the extent to which “stabilising” drugs such as methadone and benzodiazepines are prescribed and what the patient journey looks like once a more stable living situation is achieved.

Yes, replacing the funding that the Scottish Government has cut over the years is important — but only if it is directed well. Residential rehab will not be the best option for everyone, but it needs to be available and attainable for those who would benefit from it.

The hard work of policy development and service delivery is the only thing that will start to unpick the thousands of individual human tragedies that led us here. Unfortunately, this work is unglamorous. Until now, there hasn’t been much incentive for the SNP to do it. It has taken 14 years and nearly ten thousand deaths for the Scottish Government to be shamed into acting on drugs deaths. And now the party is wasting time and energy on glib finger-pointing. The country is watching, and waiting.