Richard Simpson: a 'refreshed strategy' on drug deaths will not do
Dr Richard Simpson - Parliament TV
Drug deaths are now a national disgrace. They have more than doubled since the SNP came to power and the current minister’s pathetic excuse is that they are rising across Europe. As always with this government, it is a truth which denies a reality. In England the numbers have risen to 3,740 but, in Scotland, they should be around 330 in proportion. They are now in fact 867.
When I was the deputy minister for justice in charge of drug misuse, the numbers were rising.
Along with my predecessor, Iain Gray, and successor Hugh Henry, we put in place measures to try to halt the increase.
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These included Drug Courts and Drug Treatment and Testing Orders. I funded Families Against Drugs and opened their first conference. I believed then and still believe that harnessing the energy of families is vital. But also we must recognise that 867 deaths means a similar number of families in pain and grief.
We also recognised that offenders rapidly resumed use after custody. Home Office research showed that prison often converted users into dealers.
A short sentence allowed recruitment into the network. So we funded the 218 Time Out Centre for women, which took 500 nonviolent drug misusing women out of the prison system. This centre was evaluated as a success and yet has never been replicated or piloted for men.
Only now, 13 years after that evaluation and 5 years after the Angiolini Report, is that centre being partially replicated in ‘Criminal Justice Centres’.
We increased resources for ADATs (alcohol and drug action teams). We also realised that there was a schism between adult psychiatry and drug treatment in the ADATs, hence our report ‘Mind the Gap’. That gap remains massive and damaging to those with mental ill health and drug misuse co-morbidity.
Perhaps the most important change was to end the ‘Just Say No’ approach substituting ‘Know the Score’. This was more than just semantics. Alongside education on drugs in school, it was designed to recognise the new reality in a new generation.
It is just possible that the positive changes in reduced drug use and the reported reduction in the age of starting to drink alcohol have resulted from ending the failed ‘war on drugs’.
For the year after my term as a minister and for two years thereafter, the number of drug related deaths in Scotland reduced and then flattened. But as they began to rise again Labour commissioned a report and responded with ‘Taking Action to Reduce Scotland‘s Drug-Related Deaths’ in December 2005. We took action and planned further action. We set up a standing group to review and monitor drug deaths.
The SNP, partly in response to pressure, created a new strategy ‘Road to Recovery’. This strategy, correctly in my view, sought to rebalance harm reduction with abstinence and recovery. But it has failed to address the rising deaths.
Restructuring, which is too often another bankrupt political response to problems, has been a failure, Alcohol and Drug Partnerships (ADPs) being no more successful than their predecessor ADATs.
The increase in deaths last year was 23 per cent. Thirty per cent of all the deaths were in Glasgow, which also had the highest death rate per 1,000 users, with Tayside second. Forth Valley increased from 18 to 32 deaths on three year trends. These figures are the worst on record.
Anecdotally I am hearing that the deaths in 2017 will be even worse and that the deaths from NPS (novel psychoactive substances), 277 implicated in 2016, could be rocketing following the decision to ban the overground sales of so called ‘legal highs’.
With over 150 new substances reported by the EU monitoring centre (EMMDC) in the last two years, the new laws may result in more harm than harm prevention.
I would like to know (can anyone reading this tell me the situation in their locality?) whether there are the cuts to ADPs which I hear have been happening following the supposed transfer of funds from Justice to the NHS. Shona Robison promised there would not be cuts.
The only programme which may be helping to mitigate increases has been the Naloxone programme for overdoses.
Glasgow has also recently banned the use of Suboxone, requiring prescribers to use generic Buprenorhine instead. Is this switch, which is being made entirely on cost grounds, being monitored? Buprenorhine is a useful alternative to Methadone maintenance. However it is relatively easily abused when compared to Suboxone (a Naloxone blocker and Burprenorhine combination).
The only bright spots in an otherwise bleak ten years are the SALSUS findings: the proposed injecting room for Glasgow, which I had proposed as a trial in 2002, surprisingly supported by a Daily Mail Editorial, and which was successfully researched in England by Professor Strang, could help the very group showing the largest increases in deaths; the funding to the Scottish Drugs Forum to train recovered misusers to provide support and advice; the Naloxone programme, including paramedics, prisons and police is applauded across Europe.
Finally, the Scottish Prison Service/NHS throughcare programme which, after some false starts is improving.
Aileen Campbell, as minister, must acknowledge the appalling reality and stop excusing these increases in drug deaths.
To even imply that because the median age of deaths is increasing and there is a drop in deaths in those under 25 somehow makes it all even slightly better is unacceptable. The minister is new and cannot be held personally responsible for the past, but a 'refreshed strategy' alone will simply not do. Urgent action is needed.
I have a few suggestions.
She could start by reopening the Fife Drug Court (closed on cost grounds); revitalise the DTTO programme which is running at less than 40 per cent of the levels of 2007/8; ensure that the NPS use and consequent deaths are being effectively monitored; monitor closely the NHS/IJB expenditure on ADPs and require reversal of any cuts; ensure that prison throughcare is fully funded and not just piloted and abandoned; check if the recommendations from the Drug Deaths Reporting Group set up by Labour and led by Dr Roy Robertson are being fully implemented; and ensure that those with combined morbidity of drug misuse and mental ill health are not shuttled between drug treatment and mental health services ( review the ‘Mind the Gap’ report).
In respect of this last area, she must ensure that veterans who have problems and present to drug misuse services (or prison) are properly and urgently assessed for mental health.
It is time to ensure ‘rapid testing’ at venues where everybody knows that drugs are being taken. This is employed in other countries and has been shown to improve safety, and help meet the challenge of new psychoactive substances.
The minister should also consider restoring the Central Information and Research Unit which was highly respected across Scotland but abolished as a cost cutting measure in 2004.
Finally, when I was a minister, the only official overseas visit I made was to Portugal to study the new policies there. Fifteen years on, Portugal has the lowest level of deaths in Europe and Scotland the highest. It is time for us to look again at their approach.
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