Meeting of the Parliament

Meeting date: Thursday, September 5, 2019

Official Report 1070KB pdf

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Drug-related Deaths

The next item is a statement by Joe FitzPatrick on tackling drug-related deaths. The minister will, of course, take questions at the end of his statement.

14:23  

My statement provides an update on the action that we are taking to tackle the continued rise in the number of drug deaths in Scotland. The situation that we face is a public health emergency. The latest figures from National Records of Scotland show that 1,187 people lost their lives in 2018 as a result of drug use. Each and every one of those deaths is a tragedy for the individual and for their family, friends and community. I am sure that I speak for the whole chamber when I send my sincerest condolences to all those people who have lost a loved one.

Last month, National Records of Scotland published its “Annual Review of Demographic Trends”, which showed that life expectancy improvements in Scotland have stalled. The number of drug-related deaths has been highlighted as one of the reasons for that change. The NRS’s two reports put into stark reality the effect that drug use has on the population of Scotland.

Sunday 1 September marked international overdose awareness day—a day that has come to be an all-too-painful reminder to many people across our country in recent years. To mark the day, I attended an event hosted by Addaction Dundee at which I heard directly from a range of people who have been affected by the loss of a family member, friend or loved one from substance use. I know that members across the chamber also attended events around the country, and we are all indebted to those who had the courage to speak.

Deaths caused by substance use are avoidable. This Government, this Parliament and the nation need to work together to address this emergency. I am determined that we will continue to do all that we can with the powers that we have and to press the United Kingdom Government to work with us on this vital issue to deliver change.

I am asking for the continued support of Parliament for the actions that we are taking—in particular, support for the new drug deaths task force. There is no easy solution; we need to look to the evidence to see what has worked both internationally and closer to home. For example, we know that individuals engaging with treatment services can have a protective effect, so it is vital that we do all that we can to increase the number of people who do so, particularly among those who are most at risk.

We also know, from the evidence, that opioid substitution therapy can save lives, reduce the risk of lethal relapse, improve quality of life and reduce crime. We need to do more to ensure that its use is not further stigmatised and to make it easier for those who need such therapy to access it. That may happen through the provision of low-threshold services or through our doing more to address the high levels of discharge from some services as well as ensuring that people are on an optimal dose. The new task force’s central aim will be to identify measures to improve health by preventing and reducing drug use, harm and related deaths. It will also examine other factors that are key drivers of drug deaths, and it will advise on further changes in practice or in the law that could help to save lives and reduce harm.

I have asked Professor Catriona Matheson, who is an internationally respected expert in addiction studies at the University of Stirling, to chair the group. There will be representation from Police Scotland and the Crown Office, the Royal College of General Practitioners and Community Justice Scotland, as well as the chief medical officer and the chief social work officer, among others. The task force will also include voices of lived and living experience, giving both the perspective of an individual in recovery and the perspective of family members. That is an integral part of the work, and that input into the meetings will be invaluable.

I met Professor Matheson this week to discuss the upcoming work ahead of the first full meeting of the task force, which will take place on 17 September. We are both clear that the group needs to identify areas for change or improvement quickly rather than meet for months and then issue a final report. We need action soon.

Beyond the setting up of the group, a significant amount of activity has been going on. For example, Professor Matheson has begun to take on additional engagements in her new role, which includes engaging with the chief pharmacist to discuss the stocking of naloxone in pharmacies and the introduction of a community recovery event in Kilmarnock, which is aimed at developing evidence at a community level.

Much other on-going work will also make a difference for those who are living with problem substance use. For example, our new alcohol and drug strategy, which we published at the end of last year and which sees substance use as a public health issue and, importantly, recognises the rights of those people who are impacted by it, has been broadly welcomed. The rights-based approach that is set out in the strategy has been taken up by the Scottish Recovery Consortium, which has been exploring just what taking a rights-based approach to recovery means.

In July, we published a partnership delivery framework that sets out a shared ambition across local government and Scottish Government that local areas should have in place specific arrangements around substance use. Furthermore, in the coming weeks, an action plan that sets out how the Government, in collaboration with a range of partners, will deliver on the remaining commitments in the strategy will go out for further consultation with our alcohol and drug partnerships, followed by publication in October.

We will also shortly consult on a workforce development framework that has been developed with the Scottish Drugs Forum, which will support the workforce to better identify and support people who experience alcohol and drug problems. In August, the Dundee commission, which was looking specifically at drug deaths, published its findings. Prior to that, I had met the chair of the commission and the authors of the report to discuss how we can enact some of its recommendations.

Over the summer, I gave evidence to the Scottish Affairs Committee at Westminster as part of its helpful and wide-ranging inquiry into problem drug use in Scotland. Thus far, the Home Office has failed to give evidence to the inquiry, which is frustrating, because drugs law that affects Scotland’s ability to take a public health approach is reserved.

In August, the Office for National Statistics published the latest figures for deaths relating to drug poisoning in England and Wales, which showed that they are at the highest level on record. With figures like that, surely we should be able to work together across Parliaments on the issue. Following the publication of the Scottish figures, I contacted the previous Home Secretary, and I have since written to the new Home Secretary twice, asking the United Kingdom Government to engage with us. That included an invitation to come to Scotland to take part in a summit on this vital issue. So far, I have not had a response. I am adamant that the issue should not be a political or constitutional one, and I would welcome a commitment from the UK Government to work with us.

One area that was the focus of my session at the inquiry and that has come up numerous times since the publication of the drug-related death figures is the introduction of an overdose prevention facility in Glasgow. In June, I visited such a facility in Paris, and I am convinced by the evidence that it could make a massive difference to many people in the most desperate circumstances. We have repeatedly asked the UK Government to allow us to move forward with the introduction of that type of service, and the First Minister raised the issue at her first meeting with the Prime Minister.

Although that is an important proposal, it is not the answer to all our problems. As I have said before, we need to be open to exploring new ideas that are supported by evidence and that might make a difference. One such proposal is the introduction of a heroin-assisted treatment service, which the health and social care partnership in Glasgow is progressing and which is expected to open later this year. That service can treat only a small number of people compared to an overdose prevention facility, but it provides the option of prescribing heroin to people who have been in and out of treatment services for a number of years, which could be the difference between life and death for them. The task force will also consider drug testing, as has been offered at a number of festivals and other sites in England.

Recognising the problem is only the first part of finding the solution. Since 2008, we have invested nearly £800 million in tackling problem alcohol and drug use. In our programme for government, we have allocated a further £10 million for the next two years specifically to support local services and provide targeted support. That is in addition to the £20 million per year that was delivered through the programme for government in 2017 and that is continuing to make a difference to treatment services.

That new money will go towards initiatives that will change and improve the lives of those who are affected by problem substance use. The money will allow our new task force to support pathfinder projects, test new approaches and drive forward specific work, which is based on evidence, to improve the quality of services. It will also allow us to establish joint-working protocols between alcohol and drug services and mental health services, with the aim of improving access, assessment and outcomes for individuals, and to develop and test integrated services for mental health and alcohol and drug use. Further, the money will aid us in developing a new national pathway for opiate replacement therapy, which will increase its effectiveness across the country. Crucially, that work will help us to reduce the stigma that is associated with the use of such therapy.

I know that health spokespeople across the Parliament want to make progress in the area. I welcome the fact that, in advance of the first meeting of the drug deaths task force, the spokespeople have accepted an offer from Professor Matheson to meet and discuss the subject. Cross-party support will be vital as we try to address this tragic loss of life and improve the health of those who are most impacted by problematic substance use. I am committed to working across the chamber, and I hope that the spokespeople will make a similar commitment to work with me as we seek to make a real difference to this vulnerable section of society.

I will finish by reminding members of an upcoming event. September is international recovery month. As part of that, the Scottish Recovery Consortium and its friends and partners organise a recovery walk. This year, the walk will take place on 21 September in Inverness, and I will be there, as I was in Glasgow last year and in Dundee the year before. I am sure that it will be a fantastic celebration of all things recovery. The day includes a roses ceremony to commemorate each of the lives lost to substance use in the previous year. That is a particularly poignant moment, and that visual representation of the scale of loss sits heavily with me.

I am determined that I will do everything that I can to reduce the harms associated with substance use. I call on everyone across the chamber to join us and help to save lives.

There is a lot of interest in the debate, so I encourage all members to keep their questions and answers concise.

I thank the minister for the advance copy of his statement.

We all agree that we need to develop a radical new approach to addressing the drug deaths emergency and the increasing drug misuse that is faced by individuals, families and communities across our country. I wish the task force members well and hope that they can achieve a consensus and drive real and positive change. Families and people with lived experience want to be directly involved in the work of the task force, but I have concerns that, to date, we have seen limited scope for their involvement.

During the recess, I visited the Lochee hub in the public health minister’s constituency and was told by drug service workers and users about cuts to drug education projects in primary and secondary schools in Dundee. The public health emergency needs cross-ministerial and cross-governmental department working to develop the radical new approach that we all want to see. If that does not happen, ministers will not turn the national emergency around.

In the minister’s statement, why was there no mention of education and prevention? Can he assure me that those matters will be priorities? Will the minister agree to monthly meetings with health spokesmen, to make sure that the work is taken forward?

I thank Miles Briggs for his comments and his good wishes for the task force, which is crucial. I also thank him for the tone of his questions. There were three substantial points, which I will address as briefly as I can.

The first point, which relates to lived experience, is hugely important. I am absolutely clear that the lived experience of both the individuals and the families who have been affected must be at the heart of the task force. The details of the task force are published on the Scottish Government’s website, and spokespeople can see that it specifically includes people from both of those groups. Their role is not to be a token person; I hope that their role will be to make sure that we are managing to reach out and hear those wider voices.

It would be impossible to get everyone who could add value to the task force’s work into a room, but I am sure that, as the task force goes on, Catriona Matheson will be happy to discuss matters with parties’ spokespeople. The task force members will be expected to look outwith their number for expert advice—we could have involved a huge number of people, and it is important that we hear all those voices—but lived and living experience is absolutely crucial.

On education, it is obviously impossible to get everything into a statement, but, if members speak to Catriona Matheson, I am sure that she will be open to discussing particular points. Education is very important, and I am told that we are doing quite well on it and that levels of drug use among younger people across Scotland remain relatively low. However, there is anecdotal evidence that there are areas in which that is perhaps not the case. Therefore, we need to be mindful of ensuring that our education is as up to date as possible. That is partly why I am supportive of the principle of having a drug testing system to make sure that the information that we are giving people is as good as possible.

I am sorry, but I have forgotten the third point.

Monthly meetings.

Monthly meetings are a great idea. If spokespeople are up for having those, we can discuss how to take them forward.

I thank the minister for advance sight of his statement and for his time over the summer recess when we met to discuss the seriousness of the drug death crisis that is gripping Scotland.

It is a public health emergency. Those who have died are not statistics to be debated; they are human beings—mums, dads, sons and daughters, brothers and sisters and our friends. They are people who are gone forever and whom we should have been able to save. I am glad that the minister acknowledges that those deaths are avoidable.

There is a lot to welcome in today’s statement. However, since the 2018 figures were published in July, we have to accept the reality that things have been getting worse instead of better. Therefore, although we welcome the establishment of the drug deaths task force, I will repeat the question that I asked the First Minister on Tuesday. Will the Scottish Government legally designate a public health emergency under the existing powers that it has, in the way that it would for any other major event that was causing such a huge loss of life, so that it can compel every public body—health boards, councils, the police and everyone on the front line—to now take the urgent and bold action that is needed to save lives?

I thank Monica Lennon for the constructive way in which she has approached the subject. From what all the party spokespeople have said, it is clear that the issue goes beyond normal party politics. Ms Lennon is absolutely right about how important it is for us to remember the lives lost and that although a high number of them was mentioned, that number represents individual losses, each of which is a tragedy.

I agree that this is a public health emergency—that is a fact. The suggestion that all our public services should work together is central to the strategy that I launched last November, and it is exactly why we are doing that. Our action plans are about ensuring that rather than putting people into boxes—for example, saying that someone has a housing, substance misuse or mental health problem—we bring all those factors together in a more integrated way and look at all their needs, which is crucial.

The idea of our being able to use legal powers in this context comes from Canada, where British Columbia was able to press a legal button that meant that the Canadian federal Government had to take particular actions based on that. Unfortunately, such a button is not available here. I assure Ms Lennon that if there were a legal mechanism whereby I could press a button to make the UK Government respond in the way that the British Columbian Government was able to make the Canadian Government respond, I would press it. We should be able to do so.

I reiterate that I would be happy to engage with Monica Lennon on the issue again, in the constructive way in which she has engaged with me.

Drugs deaths are avoidable, yet Scotland now has the highest rate of such deaths in the European Union, so the Government’s recognition that this is a public health crisis—as is the consensus that we need to act together across the parties and across the Parliament—is welcome.

I ask the minister what steps he can take to ensure that community practices that really know what they are doing—for example, the Edinburgh access practice—have the capacity and the resources that they need to ensure that they can continue to deliver the fabulous help that they provide. Sometimes it is too difficult for people to get on to the programmes that they want to, or they can be on them for only a very short time. What action will the minister take to ensure that such practices do the best that they can? They do a great job.

I thank Alison Johnstone for raising the work of the Edinburgh access practice, which I visited in the Christmas and new year period. It does fantastic work and is staffed by amazing people.

In the past, we have perhaps talked too much about finding innovation, which is why my statement has been clear that, as well as looking at the best international evidence, we should look closer to home. The Government is clear that where there is good practice here that needs a bit of extra support, additional funding would be made available.

This morning I visited the north-east Edinburgh recovery hub. There we discussed the fact that there are lots of pockets of very good practice across the country and we agreed that perhaps we need to think about how we can facilitate getting together and sharing the best practice. That does not necessarily require money; it is simply about sharing ideas and helping people to realise that they are part of a much bigger campaign to fight against drugs deaths. We should do what we can to facilitate that.

The minister has just mentioned international evidence. I encourage him to ask the task force to look at the Portuguese model. It is trying to treat the problem as a health issue rather than a criminal one and has had some success in that regard.

We are clearly failing when 50 per cent of prisoners who leave Addiewell are testing positive for illegal drugs. Our system is clearly not working, and the reports of a large number of deaths are harrowing. I urge the minister to look at the Portuguese model. If that requires UK-wide action, that is exactly what we should be asking for, because our current policy on drugs is not working.

I thank Willie Rennie for his contribution. I certainly think this is an area in which we should be able to work across the two Parliaments. If we look at Portugal, we can see a country that, 20 years ago, was on a trajectory to have similar levels of drug deaths as that which Scotland now has.

It took a bold decision, which no other country in Europe was in a position to take at that time. We have taken a bit longer to come to the idea that we need to deal with the situation as a public health issue, which is, in effect, what Portugal did 20 years ago. I would not for a second suggest that we could just take what has been done in Portugal and import it to Scotland. However, we need to start looking at the issue, across these islands, as a public health issue.

I thank Willie Rennie for not making it into some sort of constitutional issue. We need to make the changes—however they happen. If the UK Government will not help us, I would be delighted to work with Willie Rennie to find other ways for us to achieve them. The most obvious way would be to give this Parliament the powers. That is not any kind of constitutional point. We just need to get on with it, because we have an emergency here in Scotland.

Will the minister provide further detail on the commitment on page 102 of the programme for government to

“developing a national pathway for Opiate Substitute Therapy”?

Specifically, will he outline whether that plan includes the prescribing of Buvidal, which has been shown to reduce associated stigma due to its method of administration?

Emma Harper is right that the Scottish Medicines Consortium published advice that recommended Buvidal as a therapy for adults and adolescents who are aged 16 or over and who have a dependency on opioids such as heroine and morphine. It is important that there are a range of options for people. Clearly, the decision about what is best for someone is for a discussion between the individual and their clinician; that is how it should be taken forward. However, it is good that there is now another option that they can discuss.

I start by saying to the minister that, contrary to his assertion that there is no collaboration between Westminster and the Scottish Parliament, members of the Health and Sport Committee—all of whom are here—have been taking part in the Scottish Affairs Committee’s investigation at Westminster. The Scottish Parliament and Westminster are starting to work together on the issue.

With any tragic death, there is a huge impact on the family and the community. The question that I wanted to ask is about what consideration the Scottish Government has given to support for those who are suffering in the aftermath of such a tragic loss due to drug or alcohol addiction.

First, I appreciate that good work is going on between the Scottish Affairs Committee and the Health and Sport Committee; there has been a number of exchanges. My issue is with the UK Government. Drugs policy remains reserved, and if people do not want to have the constitutional argument about it being devolved here, the UK Government should at least answer the request to sit down and have a meeting with us to discuss how we can take some public health approaches, which the evidence shows make a difference.

I add that the task force will consider some of those approaches. It will look beyond our powers to see what might make a difference in Scotland, because if—at the end of all those discussions—the way forward is that Westminster decides to devolve those powers to this Parliament, we should be ready to rise to that challenge and make a difference. That is really important.

I have now forgotten Brian Whittle’s question.

It was about family support.

Yes—that is also a very important point. That is why I was clear that, as well as having someone with direct lived experience on the task force, someone with family experience will also sit at the core of the meetings and be central to them.

It is important that we get the wider voice of families—that is absolutely crucial. Families feel the devastating tragedy of loss, but they can be part of the solution in helping to prevent deaths in the future. Brian Whittle is absolutely right, and that is why families are central to the task force.

I welcome the minister’s statement, and the programme for government’s announcement of additional funding of £20 million to be invested to help tackle the crisis.

Although I appreciate that the minister touched on it in his answer to Monica Lennon, could he expand on how the Scottish Government is engaging with wider public service agencies to address issues such as poverty, poor mental health and homelessness, in order to prevent drug-related deaths?

I will try to be quicker than I might have been, given that I answered some of the question before. Rona Mackay is right; around 80 per cent of people with drug issues have other challenges such as mental health or homelessness issues, so it is really important that we work together. That will be one of the things that the drug deaths task force looks at, as well as supporting pathfinder projects and looking at evidence-based approaches to drive forward specific work to improve the quality of service.

It is really important that joint protocols between alcohol and drug services and other services work, whether those services are for mental health or poverty-related issues, some of which are not under this Parliament’s control. Today, at the recovery hub, I heard that it has had to massively increase the number of food vouchers that it provides to people, because individuals are being sanctioned and we have services that do not understand the challenges for people who are in recovery or treatment. We need to do better.

I will work with anyone on this issue, because it is one of the most important issues in Scotland at the moment. However, that must not stop us from holding ministers to account for their actions—or their inaction.

Why was there no mention in the minister’s statement of the current HIV outbreak in Glasgow? Will the minister confirm whether there is someone on the task force with lived experience—either a current or former drugs user—so that they can give their input? Six months after the task force was announced, why has it still not met? Does the minister support the Portuguese model of decriminalisation?

I think that the minister has answered some of those questions.

Some of the questions have already been answered, but, given that Mr Findlay has specifically asked again about lived experience, I note that that is very important. I cannot say too often that it would not be right for us to develop policy without input from people with lived experience, and I confirm that there is someone with lived experience on the task force. That person is a central part of the task force, but my expectation—I know that Catriona Matheson has already started some of this work—is that the task force will look at how to get a wider view from people with lived experience, because it is hugely important.

I wish that I could have included in my statement everything that is going on in my portfolio, but it would have taken all afternoon, leaving no time for questions.

The HIV outbreak in Glasgow is just one piece of the evidence that makes the compelling case for an overdose prevention facility in the city. The evidence is overwhelming that such a facility would save lives; the HIV outbreak is one of the unfortunate issues that confirms that. Services in Glasgow are working hard together and in innovative ways to provide outreach support. There are lessons to be learned from Glasgow’s approach to the HIV outreach, not just for HIV services but for how to provide any service to people who are harder to reach.

Neil Findlay raised important points, but there were four or five of them—I apologise for not getting to them all.

I apologise to Stuart McMillan, as we will not have a chance to call his question. I apologise also to five other members—Pauline McNeill, Shona Robison, Gail Ross, Annie Wells and Jenny Marra—as we do not have time to take their questions.