Drug deaths in Scotland: hope on the horizon?

This week in Scotland we’ve been reeling from the impact of the publication of the 2019 drug-related death statistics. The awful graphs are everywhere, their bright colours standing in sharp contrast to the horror they relate. Our feelings clamour for attention, a powerful mixture of anger, grief, bewilderment and shame. 

The newspapers are full of reaction to the statistics; front page bold headlines shout in outrage, editorials call for action. The stories lead on TV news broadcasts. Every morning and evening this week on my commute I’ve listened to radio broadcasters on BBC Scotland debate the issues and heard people, some of whom I know – experts and those with lived experience – interviewed for their reactions. Conversations with colleagues are dominated by the subject.

It’s been an affecting experience, but it’s reminiscent of something – something that disturbs me. It’s reminiscent of the reaction to last year’s drug death statistics publication. The worry I have is that after a fortnight of clamour, the dust settles, the feelings are emolliated, and other issues take the lead in the newspapers and on the TV. Then, if nothing changes, we go through the Groundhog Day again in the autumn of 2021. That would be heart-breaking.

Something changing?

Despite these fears, there are grounds to be a bit more optimistic. I do think the response this year is different. There is an urgency, a collective outrage, a widespread determination to make things different. There is an edge to this that is making us put our shoulders back, grit our teeth and hold our heads determinedly high in spite of the shame. 

Journalists, broadcasters and national bodies have given a voice to those not normally heard – the families of victims, those suffering from addiction and those in recovery. This has happened to some extent before, but this year the voices are louder, clearer, more stirring. Out of this I can see a resolve developing that is different to what’s gone before. It’s encouraging.

There’s more though: a potential gamechanger – something I don’t think we’ve seen or heard before. Our First Minister (FM), Nicola Sturgeon, has said with frankness that what’s happening is ‘indefensible’ and that she would take criticism ‘squarely on the chin’.

Every person who dies an avoidable death because of drug abuse has been let down.

Nicola Sturgeon

She also said

We have much to do to sort this out – and sorting it out is our responsibility.

Alan Massie, commenting in the Times, describes this response as ‘unprecedented’ and ‘unusually candid’. 

Action

Ms Sturgeon is going to attend the next meeting of the Drugs Deaths Task Force and will report back to parliament by the end of January. When pressed in parliament about poor rehab access, she said she was ‘not satisfied” that the number of rehab beds available was “necessarily sufficient or that they are being used sufficiently”. I hope she’s saying that because she’s been briefed on the Residential Rehabilitation Working Group’s report, published a couple of weeks ago.

Scotland’s had a historical blind spot with regard to residential rehabilitation, but here’s further evidence that things are changing. The Residential Rehabilitation Working Group was set up by Public Health Minister, Joe Fitzpatrick at the end of the summer this year. We were told to start from the underlying principle that everyone who needs rehab should have access to it – a clear commitment to improving things.

The rehab group was allowed to be independent and experienced no interference or even influence by government. Our recommendations were entirely our own and the report was published in full. These recommendations have been welcomed and some resource already allocated to take them forward. Rehab is not the solution to drug-related deaths, but it will have a part to play.

Shared responsibility

While Nicola Sturgeon has taken responsibility for our drug deaths crisis, I don’t think the responsibility is hers alone to shoulder. We all have a part to play. The causes of drug (and alcohol) related deaths are complex and manifold. The solutions need to be diverse. 

Harm reduction interventions need to be widely available, accessible, delivered efficiently and proactively and evaluated and improved. Harm reduction services also need to have porous borders with treatment and recovery services and have hope embedded in the form of peers in recovery working within teams. A recovery-oriented system of care sees interventions not in silos, but in a continuum with the individual’s needs at the centre and the person on a journey. The person’s goals, not the professional’s goals (which can be at odds) should be paramount.

Treatment needs to be a full menu of evidence-based, joined-up interventions, accessible when needed, which is funded according to the need of the nation. If we have more than three times the drug death rate of England, the first step needs to be to increase the resource to meet our need. When the last round of cuts came, in my service we were asked to work harder with less resource, which we did for the sake of our patients, but we need so much more than the expectation of workers knuckling down with goodwill.

Research

The part that communities of recovery and those with lived experience can play in alleviating the crisis needs to be better recognised. So much of our research is focussed on the problem and interventions to try to ameliorate the problem. I have no beef about the importance of that. But are we missing a trick?

We have thousands of people in Scotland in long term recovery from substance use disorders. What worked for them? What barriers did they face? Why did they not die from addiction? Why don’t we know the answers to these questions? Those answers will help us. Perhaps some resource needs to be focussed on solutions already experienced. Perhaps then the solutions will grow for others.

Hope instead of despair

Finally, I think that we as citizens and communities need to take responsibility too. It’s our nation’s problem. The risk factors for addiction – trauma, stigma, poverty, lack of opportunity, intergenerational substance dependence, lack of hope etc. – these are not just the responsibility of government. Each of us who feels sorrow and shame over the current emergency can play a part in addressing these. Many already are. 

The best way to not feel hopeless is to get up and do something. Don’t wait for good things to happen to you. If you go out and make some good things happen, you will fill the world with hope, you will fill yourself with hope

Barack Obama

Photo credit: istockphoto.com/ZargonDesign (under license)