Scottish drug users must be given better access to treatment to prevent drug related deaths according to a new study, which also claims consumption rooms and safer supply initiatives are needed to save lives.
Published in the Lancet, the research, led by Glasgow Caledonian University, found death rates for those not in drug treatment – including opioid replacements like methadone and buprenorphine –were three and a half times higher than for those who were.
But the study, which involved about 50,000 people, also found that death rates in those in treatment have increased over the last decade. The researchers claim this suggests offering medication is not enough on its own.
They said additional harm reduction measures were “necessary” including supervised drug consumption spaces. Safer supply initiatives, such as prescribing benzodiazepines to those taking street valium, should also be offered according to study authors, who said issues such as poverty and inequality must also be addressed.
Drug consumption room given backing
Last year, then drug policy minister Angela Constance MSP, confirmed the Scottish government was working with police, health authorities and the Crown Office “to examine how a safer drug consumption facility could operate within the existing legal framework”. But the Home Office, which controls drug laws, remained opposed to proposals.
Some campaigners – while backing harm reduction measures – said more focus should be on ensuring people had access to better drug treatment and workers with experience of recovery, who could “offer people hope”.
Concerns have been raised that guidelines which should ensure people struggling with addiction get access to the treatment of their choice – from prescriptions to counselling and rehab – known as Medication Assisted Treatment (MAT) standards, are not being enforced.
Charity Favor UK, along with other campaigners, have worked with the Scottish Conservatives on the Right to Addiction Recovery Bill, which would give people a legal right to treatment.
In 2021 – when 1,330 people died from drug related deaths in Scotland – the Scottish Government declared the situation “a public health emergency”. Though additional funding of £250m was released in response, some claim not enough has been done to improve people’s life chances.
Between January and December 2022, 1,092 suspected drug deaths were recorded but official data will not be released until next month.
The Caledonian University study notes drug-related death rates among people who were dependent on opioids in Scotland more than trebled between 2011 and 2020. Death rates increased across all age groups, disproving claims that deaths were due to drug users getting older.
Drug related death rates were almost three and a half times higher among those who were not in treatment.
Dr Andrew McAuley, Glasgow Caledonian University
Dr Andrew McAuley, of Glasgow Caledonian University’s school of health and life sciences’ research centre for health (ReaCH) and principal researcher, said the study “confirmed” the protective effect of opioid replacement treatments.
“Drug related death rates were almost three and a half times higher among those who were not in treatment,” he said.
“However, unlike in many other countries, we found that drug related death risk for people on opioid agonist therapy (OAT) also increased over time, highlighting that on its own it is not enough to address Scotland’s epidemic.
“Other interventions, such as take-home naloxone, drug consumption rooms and drug checking services, are necessary,” he added. “Addressing the socioeconomic inequalities which are driving drug dependence should also be prioritised.”
Kirsten Horsburgh, chief executive of the Scottish Drugs Forum, said Scotland’s Medication Assisted Treatment (MAT) standards should be “fully implemented at pace to ensure that people can access good quality treatment immediately” with treatment offered for those using cocaine and benzodiazepines, not just opioids like heroin.
“That would save lives,” she added. “That requires leadership and adequate resources.”
She claimed “a full range of services, interventions and approaches are needed to meet the challenge of Scotland’s drug deaths crisis” adding: “Scotland is some distance from meeting that challenge and is falling further behind other countries in its response.”
The deaths to me are indicative of wider societal ills, where people on the margins do not see a role for themselves and feel hopeless in the face of daily trauma.
Anna Ross, Edinburgh University
Anna Ross, senior teaching fellow in health and social sciences at the University of Edinburgh, also backed calls for drug consumption spaces, and drug checking, as well as widening out of heroin assisted treatment, which has been trialled as part of a small Glasgow pilot project and is currently being evaluated.
But she claimed that societal changes were also needed. “The deaths to me are indicative of wider societal ills, where people on the margins do not see a role for themselves and feel hopeless in the face of daily trauma,” she added. “That trauma stems from the policies of policing drugs, the institutions that ‘treat’ as well as the communities in which many find themselves in.”
Annemarie Ward, chief executive of charity Favor UK, said hope was the missing ingredient, claiming that Scotland needed to scale up the number of drug workers with experience of recovery in services. “The treatment offered in Scotland is still lacking,” she added. “We need a culture change.”
Drug and alcohol policy minister Elena Whitham said: “Drug deaths in Scotland are still too high and every life lost is a tragedy. I’m focused on supporting those affected by problem substance use, delivering real change on the ground and implementing evidence-based approaches to improve and save lives.”
As well as offering opioid substitution therapy, expanding residential rehab and supporting grass-roots projects, she said the government was working towards introducing safer drug consumption facilities and a pilot scheme to deliver drug-checking facilities.
