Fighting to save lives in Scotland’s drug death crisis

“I’ve been losing people since I was 16,” says James, who started using drugs as a teenager. “I’ve lost people this year and I lost people last year. People are dying in their droves.”

In the drug-related death figures for 2019, published on 15 Dec, those people appear as numbers categorised by age, gender, health board area, and the chemical substance behind their untimely death. 

A total of 1264 people died last year – the highest number since records began in 1996. Two thirds of those who died were aged 35-54 and seven out of ten were men.

More than half of the deaths were in the Greater Glasgow and Clyde, Lanarkshire, and Lothian health board areas. Heroin and morphine were implicated in over 50 per cent of all deaths.

But for James – and so many others who have lost loved ones and friends due to drug overdoses – it’s insulting to talk about people as statistics. 

“I don’t think about numbers,” he says when we speak just over a week before the new figures were published. “I think about the people that I’ve cared about, the people that I’ve spent years with. 

“I see the people who were kind and caring and who would go out of their way to do anything for you.” 

These people were part of his community. He’s overdosed numerous times and knows he could have been one of those numbers. 

But call it luck, fate or just good timing, over two years ago his mother was given a leaflet for a new service called River Garden, a recovery community in south Ayrshire. 

Now he’s living on the Auchincruive site, where residents help manage the land, grow veg or work in the café, and he’s been able to stop using drugs. But he still thinks about those that didn’t make it. 

The number of people dying from drug-related deaths in Scotland has increased dramatically since the mid-nineties, more than doubling within the last decade. 

In 2018 1,187 died, an increase of 27 per cent on the previous year and more then any other country in the EU.

And now the 2019 figures – published following a six-month delay due to a dispute over funding between the Crown Office and Glasgow University – show a further six per cent rise . 

Last July the Scottish Government appointed a drug deaths taskforce, which some campaigners claim has failed to deliver the change needed in the face of a public health emergency. 

Others argue the focus should be on the government and local alcohol and drug partnerships, which could be implemented immediately if additional resources were put in place. And then there’s Westminster’s drug laws, over which Scotland has no control

Yet as the spotlight falls again on drug deaths and where blame lies, what are the solutions? How can Scotland not only keep more people alive, but give those struggling with addiction, and their families, a better life?

James cut his drug use at River Garden
James is working on his recovery at River Garden

For James, now 32, saving lives starts with understanding why people use drugs in the first place.

“When I was growing up I didn’t feel a part of anything,” he says. “I moved about a lot, I never had a solid sense of identity and I was really insecure about myself. When I went to school I felt like I was handed knowledge, but there was no teaching of knowledge of self. 

“I radiated towards rebellious people and that’s when I started using drugs. That’s also when I found my identity, where I felt like I was part of something.”

For a while that felt good. But for him, the addiction spiralled and he started injecting heroin along with using other substances. Eventually he stopped caring whether he lived or died. 

He was just 19 years old when, following the birth of his son, he first asked for help. But the substitute legal drugs did not address the root issues. 

“I was prescribed diazepam and all the discussions that I had were about chemical solutions to the problem,” he says. “It was just about replacing the drugs that were causing the chaos.”

Now, after two years in recovery at River Garden – where he’s gone from struggling to manage his own life, to managing the community’s café – he has more insight into his addiction. 

“That [treatment] didn’t address the behaviours and underlying trauma that needed to be looked at,” he says. “I thought it was the drugs were causing me the problem, not that I was a broken person in need of help. 

“Now I can see that for me it [taking drugs] was a way of dealing with my emotions, a way of controlling my anxiety and suppressing pain.”

Criminalisation doesn’t work, he says, quoting Richard Cowan’s 1986 theory that as law enforcement becomes more intense, the potency of prohibited substances increases. 

So what does work? First there’s the immediate – he claims he’s only here today thanks to the help of ambulance crews, and fellow drug users, who saved his life using naloxone, a medication that blocks the effects of opioids.

But the thing that gave him a real reason to keep on living was finding human connection. “And that’s where families can come in,” he says. 

Now I can see that for me it [taking drugs] was a way of dealing with my emotions, a way of controlling my anxiety and suppressing pain.

James

“Before addiction came into my life, like a lot of people I was judgemental,” says his mother, Denise. “But until it’s on your doorstep you have no idea.” 

It is early December and along with Denise on this video call are five others from the Scottish Families Affected by Alcohol and Drugs (SFAD) family reference group. 

Colin Hutcheon’s experience supporting his son and setting up a West Lothian support group has led him to become a member of the drug death task force, representing the views of family members. 

Kaye – also on the call – cares for a 19-year-old with drug use issues and has professional experience of supporting teenagers in the Borders. She knows of five young people who died in 2018 alone. 

Linda’s husband has a dual diagnosis of mental health and addiction issues which makes it almost impossible for him to get the help he needs, and Caroline Butler lost her son Kevin to a heroin overdose 21 years ago. 

Karen’s son, Lee, has been using drugs since he was 14. She says he had such bad experiences with local drug services, that at one point he discharged himself for a six-month period. 

Now 35, he is back in treatment and is just about to start a buprenorphine alternative to methadone, which can be given as a monthly injection. It means no more queuing up outside the chemist on a daily basis, a humiliating ritual that these family members think has no place in modern services. 

“It’s inhumane,” says Caroline, who set up a support group in Aberdeenshire after realising that the stigma surrounding drug use was such, that no-one said they were sorry about the way her son died.

Earlier in the week she stopped to speak to a group of men, and one woman, huddled outside a chemist shop near her Aberdeenshire home. They were all in their forties and fifties and she listened to them speak about how they were treated as less worthy, and the shame that they felt. “There has to be a more dignified way to treat people,” she says.  

I am tired of fighting to keep my son alive. I’ve had enough misery to last me a lifetime.

Karen, Mother

Most of this group are outraged by the way they see power wielded over drug users by addiction services. Denise claims she wouldn’t have believed that her son would be turned away and told to use street drugs, if she hadn’t heard it herself. 

“And yes, I disliked my son at times when he was using drugs,” she says. “But that wasn’t him. Addicts do not set out to become addicts. But people think it is self inflicted, especially the so-called professionals. Who in their right mind would want to lead the life of an addict?”

Later, Karen emails testimony of her journey – an account she also sent to the drug death taskforce – that covers what she considers to be a litany of failures her son has faced. 

The list documents the struggles Lee had to have his wish to reduce his methadone prescription supported, and the lack of autonomy he was given over his own treatment. There was also the discriminatory treatment he encountered from workers and pharmacists, the lack of choice, of agency, the need for Karen to intervene and advocate for her son at every turn. 

“I am tired of fighting to keep my son alive,” she says.  “I’ve had enough misery to last me a lifetime.”

But at least her son – a lovely, talented man, she says, who can turn his hand to anything – is still here. His friend will appear in the 2019 statistics. 

She claims Lee’s friend had his methadone prescription stopped as a “punishment”, after workers interpreted his behaviour as disrespectful, and then threatening, at a meeting to discuss his request to be given a two week supply to allow him to go on holiday with his parents and his two children. 

“He wouldn’t go back to services after that because of the way he’d been treated,” she says. “He ended up back on street drugs and was dead six months later. 

“So there’s two wee bits of weans left without a dad, a mum and dad left without their son, and brothers and sisters left without their brother.”

In the midst of all this tragedy, the sense of powerlessness is palpable. “It’s a living hell trying to help your child, or any family member or friend with addiction,” says Denise.

“As a parent you think you should be able to fix it, and feel where did we go wrong. You often unwittingly enable them thinking it will help. In the beginning when we sought help I found we often didn’t fit the criteria required.” 

She remembers turning to the local drug recovery centre when James was only 15, only to find he was a year too young to access its services.

Like others, it was family support groups that got her through, and helped her make those near impossible judgements about when to keep fighting and when to step away. They listened when she needed to talk, and encouraged her to stand-up for the right to support her son. 

It’s the central role family members can play that inspired a new pilot initiative soon to be launched by SFAD. Provisionally called Families as Lifesavers, the two-year project funded by the drug death taskforce, aims to “wrap intensive support around families” who have a loved one struggling to cope with addiction. 

“Our starting point is recognising how much families are doing behind the scenes to keep their loved ones alive, or to keep them alive for longer,” says Justina Murray, chief executive of SFAD. 

 “We want to test out as well what happens if you properly support the family member. What happens if you get them included in their loved ones’ care and treatment, and if you really recognise their role, [if you] really empower the family member with skills and knowledge and understanding of addiction, recovery and relapse and all the different treatment options?”

Murray is clear that this can only ever be a small part of the solution. But she hopes it can be part of a wave of actions that will start to make a difference. 

In the past year we’ve learned that we can do things differently, even at a time of crisis. The challenge for us now is to ensure the legacy of these changes is a positive one

Dr Andrew McAuley, Glasgow Caledonian University

There are other burgeoning signs of change. In November, Scotland introduced a consultation on Medication Assisted Treatment (MAT) standards, which aims to end the postcode lottery of drug services, giving people immediate access, choice in their treatment, and a therapeutic approach by trained staff. 

And while there are already concerns about if and how that culture shift can be implemented, Dr Andrew McAuley, reader in public health at Glasgow Caledonian University, says the Covid-19 pandemic has forced some positive steps to be taken.  

“In the past year we’ve learned that we can do things differently, even at a time of crisis,” he says. 

Street homeless people have been accommodated, he notes, and many methadone users given take home prescriptions so that they no longer need to queue outside the pharmacy every day. 

He adds: “Remarkably, naloxone supply has actually increased in 2020 thanks to a series of service innovations involving the ambulance service, family support groups and an interjection from the Lord Advocate [he provided guidelines assuring drug services it was legal for them to provide take home kits]. More and more services are adapting to allow same day prescribing.”

The “ongoing political and legal stalemate” over the UK Government’s refusal to grant permission to Scottish authorities to set–up drug consumption spaces remains “a huge source of frustration”, he says. 

But he also claims the drug consumption van, set-up this year by Peter Krykant has helped prove the value of the harm reduction approach. Since it started operating in the city centre in September, it has supervised 100 injections safely, discarded more than 120 needles and attracted support in the local community. 

“The challenge for us now is to ensure the legacy of these changes is a positive one, to evaluate them and understand what works but also to honestly and objectively assess what does not,” adds McCauley. 

Here you are treated with respect. You have rights. Your opinions are valued.

James

At River Garden, James is trying to deepen his understanding of what’s at the heart of all this. 

Could drug addition be seen as a symptom of a sick society, that values profit over people and nature? he wonders. “And could falling by the wayside under the neurotic pressure of social expectations in our dog-eat-dog world be understood not as an immoral decision, but a rational response to a future plagued with uncertainty and a challenging past?”

The acceptance he found at River Garden is the fundamental change he needed. “I didn’t know how to stay sober,” he says. “But I’ve learned that here. It has been an amazing experience, the investment they put into your growth, the time and the energy. 

“Here you are treated with respect. You have rights. Your opinions are valued.” 

For his mum, Denise, the result of that is simple.  “We have our son back,” she says. Tragically, that not something every parent supporting their child through addiction in Scotland can say. 

This story was first published on 14 Dec and updated on 15 Dec to include the 2019 statistics.

Cover image thanks to iStock/ysbrandcosijnexclusive

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