Why Scotland can’t get clean Politicians only pay lip service to addiction

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.

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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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