The war on drugs: interview with Angela Constance

On 17 December, First Minister Nicola Sturgeon stood in front of parliament and admitted that her government’s record on reducing drugs-related deaths was “indefensible”.

She told her fellow MSPs that every person who had died as a result of drug use had been “let down”, and conceded that much of the criticism directed at her government over Scotland’s shameful statistics was “valid and legitimate”.

In truth, there was very little else the First Minister could do other than hold her hands up and admit that the drugs crisis in Scotland was out of control and that her government had failed – consistently – to do anything to alleviate it.

The number of deaths rose to a record 1,264 in 2019 – more than double the number of deaths in 2014 – and represented the worst rate in Europe. Perhaps even more shocking, the figures were three and a half times worse than those in England and Wales.

Even Sturgeon dubbed it a “national disgrace”.

It was no surprise, then, that public health minister Joe Fitzpatrick quit shortly after the grim figures were published, saying his presence as a minister would be a distraction to the focus of saving lives.

Instead, the First Minister created a new dedicated role and announced that Angela Constance would become Scotland’s first Minister for Drug Policy.

A former social worker who has worked with people with a history of drug abuse and families living with the consequences of addiction, Constance also led the government’s early work on the impact of Adverse Childhood Experiences, and as Communities Secretary worked on poverty and homelessness, making her a safe pair of hands for this challenging role.

“This will be my seventh portfolio and I’ve absolutely no doubt that in many ways this will be the toughest portfolio yet,” she tells Holyrood. “But my experience within and outwith government I’m sure will stand me in good stead. I’m raring to go, I’ve got my sleeves rolled up.”

While Constance may be full of enthusiasm, experience and good intentions, there’s no denying that she has her work cut out.

To say Scotland’s drug problem is a “national disgrace” is an understatement. It is deep-rooted, multi-faceted and, above all, embarrassingly under-funded.

In light of all that, is Constance feeling overwhelmed by the scale of the problem she is faced with?

“In terms of outlook, I’m so not a defeatist,” she says. “I don’t do complacency, I don’t do denial, there’s no need for anything to be sugar-coated and this is why I have spoken about the need for a national mission. 

“But what comes with being 50 and having lots of experience within and outwith government I suppose is a sense of resilience. I’m the type of person who will continue to run up a hill even when the wind is howling in my ears and the rain is pelting on my face. I’m stubborn.”

Stubborn she may be, but Scotland’s drug deaths have been rising steadily for the past six years amid government cuts to drug and alcohol partnerships. Stubbornness alone is not going to reverse years of underfunding and an inherent drugs culture rooted in poverty, homelessness and mental health issues.

“Government absolutely needs to lead, needs to be visible, needs to be doing much more, better and faster,” agrees Constance.

“I hope that with the [funding] announcement from the First Minister, you can see that statement of intent. I will take forward a whole range of actions on the back of the new resources that have been announced.”

The funding Constance is referring to was announced by Sturgeon last month, where she backed up her commitment to tackling Scotland’s drugs crisis with a pledge of an extra £250m over the next five years.

The £50m annual investment will include £20m a year for vastly under-funded residential rehabilitation services and “significant” funding for local alcohol and drugs partnerships and grassroots organisations.

It will also include £5m before the end of March for “urgent” initial work, including to open extra placements in residential rehab, which the First Minister admitted was “not as immediately accessible as it should be”.

Constance already has big plans for the initial £5m.

“My priority with officials is to use that resource wisely between now and the end of the financial year to get some additional investment into residential rehabilitation so that more people can access that,” she says.

“Residential rehabilitation is a big priority, but it’s not the only priority. To bolster frontline services, there will be additional resource going to alcohol and drug partnerships but there will also be additional resource – and this is particularly important to me – to go to the third sector and grassroots and lived experience organisations as well. So the immediate priority is to get additional resource out there into the real world and out there into the front line. 

“I also have to recognise that residential rehabilitation isn’t for everyone so we need that range of services also in the community and services that can respond immediately when someone has an overdose and survives. We know that 54 per cent of people who die from a drug-related death have a history of overdose. An overdose is a cry for help, is it not? 

“So, getting more people into treatment and enabling services to be able to respond quicker to crisis will be a particular priority in the year forward, as will be partnership working with the lived experience community.”

Increasing the availability of anti-overdose drug Naloxone is one way of improving the chance of survival among those who overdose, and the government has already committed to funding a new scheme to give take-home kits to high-risk drug users.

In 2019, the year that Scotland saw its worst drug deaths figures, the Scottish Ambulance Service was called to around 5,000 incidents where Naloxone was administered. Now, kits will be given to the victim, friend or family member after a 999 call, so that it can be administered in the case of a future overdose.

Practical initiatives like these can save lives, but Constance is acutely aware that there is no one-size-fits-all approach when it comes to helping drug users access treatment.

“It’s really important that we don’t see people as one big homogenous group,” she continues.

“People who have used drugs or who are continuing to use drugs are first and foremost citizens, citizens who we need to claim as ours, they’re in our communities. We’re talking about somebody’s mother, father, brother, sister, aunt, uncle. In the same way that government as a corporate identity led the way when it came to care-experienced young people, saying ‘these are our bairns, these are our weans’, while we, in terms of folk who use drugs, we’re talking about adults primarily, there is that thing about claiming people as our citizens, they are our citizens too and with that they have rights like the rest of us.”

She adds: “Having the right range of treatment is crucially important in terms of driving down drug related deaths and we have to ensure that our emergency response, what it is that you do right there right now when you’re faced with someone who’s at risk of dying with an overdose, that emergency response needs to be embedded in other services, it needs to be embedded in our work in mental health, work in education, our work with community services and residential services and when someone is in crisis – and I know this from my social work days as well – as well as needing to act quickly to protect or care for people in crisis, it is also a golden moment to get people into longer-term treatment and that means you have to act fast.

“I’ll be very focused on frontline services particularly where they can take a human rights approach and recognise that people should have options around their care and treatment and if you’re going to deliver services that are better and can respond to people’s needs faster, ultimately these services need to provide what works for individuals to reduce harm and promote recovery.”

One of the first things Constance did after taking up her new role was to meet people with lived experience of drug use; the people who are best placed to comment on what needs to be done to stop themselves or their loved ones becoming a statistic when the next set of drug death figures are published. 

“While it’s 15 years since I’ve worked on the frontline now, social work never leaves you, so real life and frontline experience remains important to me,” she says. “That focus on lived and living experience was always very important to me in any job I’ve done within government, whether it’s been around social security, homelessness, child poverty, youth employment so I’ve got a good track record of working with those on the frontline and also with people with real life and lived experience.

“As a social worker you always recognise the importance of working with people’s families as well, where possible.”

Among the people she met was Peter Krykant, a drugs activist who operates a mobile overdose prevention facility Glasgow.

While the Scottish Government would like to see such supervised overdose prevention facilities – also known as safe injecting rooms – piloted in Scotland, this would require a change to the law, which is reserved to the UK Government.

Constance jokes she is adding the issue to her growing ‘to do’ list.

“Of course it’s frustrating that legal barriers exist, but that’s the reality that we are in right now, that there are legal barriers,” she says.

“As you know, the Scottish Government is very much in favour of overdose prevention facilities. There are about 100 of them across the world. There are ten European cities that have these facilities and there’s evidence going back 30 years and I’m particularly focused on what works. I’m not interested in ideological approaches, I’m interested in what works.

“We do want to implement and support overdose prevention facilities, but we need to do so in a way that gives a safe legal framework both to people who would use the service but also to people who would work in the service.” 

“I hope that for every problem we have, we have an action on something that we can do,” adds Constance.

“We don’t have time to waste. 2021 needs to be the year that we demonstrate not just by our words but by our investment and by our actions, that this is the year that we begin to turn the tide against drug deaths in Scotland.”