Meeting of the Parliament

Meeting date: Tuesday, September 12, 2023

Official Report 1002KB pdf

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Drug Deaths

The next item of business is a statement by Elena Whitham on drug deaths. The minister will take questions at the end of her statement, so there should be no interventions or interruptions.

14:23  

Last month saw the publication of the drug-related death statistics from National Records of Scotland, which confirmed that we lost 1,051 fellow citizens to drugs in 2022. Every person lost is a tragedy that is felt keenly by families and communities right across Scotland. I send my condolences to each and every person who has been affected by a loss from drug use. Those deaths are as preventable as they are unnecessary, and the collective loss of all that talent and potential from across the country is heart-breaking.

The NRS figures show a decline in the number of drug-related deaths in 2022. There was a reduction of 279 on the previous year, which is the largest year-on-year decline on record. Although that is, of course, welcome, the numbers are still far too high. We remain committed to delivering on our national mission to ensure that we continue to see further reductions in these tragic deaths.

Most of the decrease was seen in males, with a reduction of 26 per cent from 2021, down to 692 deaths. The number of female deaths was down by 10 per cent on the previous year. That further reinforces the need for us to deliver on initiatives that will be of benefit to women, while recognising that men remain at the highest risk of a drug death.

It is also encouraging to see drops in nearly all age groups. The number of deaths in the under-25s fell slightly, but the greatest reductions were in the age groups from 25 to 39, all of which reduced by more than a third. The only group in which there was a rise in the number of deaths was the over-55 group, which saw an increase of eight from 2021.

As in previous years, the majority of deaths involved more than one drug, with an average of three substances implicated or present in a death, which highlights that poly drug use continues to be a significant challenge for us to tackle.

Opioids were the most commonly implicated drug although, again, there was a slight reduction to 867 deaths. The number of deaths from benzodiazepines also remains high; they were implicated in 57 per cent of deaths. The prevalence of street benzodiazepines remains a real concern. They are implicated in nearly half of all drug deaths.

The number of drug deaths involving cocaine reduced from 403 in 2021 to 371 in 2022 but they make up an increasing proportion of drug-related deaths. The implications of that make clear the need for more support to be available for people with problem cocaine use, and I will follow up with local areas to understand what provision is currently available and planned on that.

There was a fall in the number of deaths in two thirds of Scottish council areas. However, there is so much more to do, and I am clear that buy-in and accountability for implementing the national mission locally is a fundamental requirement for progress across the country.

Since taking up my portfolio, I have visited many parts of the country, seen the recovery and treatment services that are in operation and spoken to people who are benefiting from some of the transformational changes that have already taken place as a result of the national mission, whether through work to implement medication-assisted treatment standards, improvement in access to residential treatment services, or increased investment in grass-roots organisations.

I believe that the tireless effort that those on the front line continue to put in has contributed to the reduction in the number of drug-related deaths in 2022. I thank them all for their on-going commitment to that work. I include in that all the families on the front line and I say to them: “I see you.”

However, I am in no way complacent about the work that is still to be done. That is borne out by the suspected drug death figures for the first half of 2023, which were published this morning. Those figures indicate that there were 600 suspected drug deaths between January and June 2023, which is an increase of 38 on the same period in 2022.

We need to do all that we can to continue the decrease in the number of drug deaths that we saw in 2022. Complex problems require multiple solutions, all of which are valid. That means continuing our work to deliver MAT standards, to increase treatment options, including residential rehab, and to push harm reduction initiatives.

Yesterday, the Lord Advocate set out her position on the proposal for a safer drug consumption facility in Glasgow. She stated that, if Glasgow authorities were to open a pilot facility, she would be prepared to issue a statement of prosecution policy to the effect that it would not be in the public interest to prosecute people for the possession of illegal drugs within the confines of that facility. I strongly welcome that position. Although the position of the Lord Advocate does not sanction or approve the establishment of a safer consumption facility, it provides a necessary assurance to the Glasgow authorities, which will now take their proposal to the integration joint board for its approval. Although there are still limitations around what a facility that operates within existing legislation can do, that is fantastic news and represents a real step forward in establishing the first official safer drug consumption facility in the United Kingdom.

We have been clear in our commitment to establishing a safer drug consumption facility. Supporting evidence from around the world is extensive. Sixteen countries had legal and operational drug consumption rooms in 2022. Following the Lord Advocate’s statement of her position, we will work closely with colleagues in Glasgow to agree the next steps and review options around implementation, including funding.

That is a significant step forward for us in Scotland. However, even given the Lord Advocate’s helpful position, a safer drug consumption facility that operates in Scotland will still be restricted by the Misuse of Drugs Act 1971. The best approach, therefore, would be for the UK Government to give approval for a safer drug consumption facility, so I repeat my call to the UK Government to work with us on the issue and either give approval for a pilot, or devolve the necessary powers to us.

The recess period also saw the publication of NRS’s alcohol-specific death statistics, which recorded a rise of 2 per cent since 2021 to a total of 1,276 deaths in 2022. Again, I convey my sympathies to all those who have lost a loved one. No one should die as a result of alcohol consumption, and we are working with partners to continue to deliver a range of activity to ensure that people are able to access the correct form of treatment when they require it. We will continue to take a whole-population approach to tackling alcohol-related harm in line with the World Health Organization’s focus on the affordability, availability and attractiveness of alcohol. The programme for government reaffirmed that commitment.

We will soon publish our report on minimum unit pricing alongside a consultation on its future—that is, on whether the scheme should continue and, if so, at what price. We are also reviewing the responses to the alcohol marketing consultation. No one should be in any doubt that we will take further action to reduce alcohol harm, particularly to protect children from its ill effects.

At the end of August, we recognised international overdose awareness day. Coming so close to the publication of our annual drug-related death figures, that is always a poignant day in Scotland. As part of that day, I was pleased to spend time with Police Scotland colleagues, one year on from the roll-out of their national naloxone carriage initiative.

Police Scotland is the only national police force in the world in which every front-line officer is trained in the use of naloxone and carries a kit for use in the event of encountering an overdose. To date, police officers have administered naloxone on more than 300 separate occasions. One of the officers with whom I spoke told me that they had been trained in the use of naloxone in the morning and then had to administer it later that day.

Police Scotland hopes that having officers carrying naloxone in a highly visible manner will encourage others to learn about naloxone and consider carrying it themselves. That is a message that I would reiterate, and I encourage everyone here to get themselves trained and to carry a kit.

September is also international recovery month, and I am pleased to have been invited to take part in a number of events this month, with further events to come. As Minister for Drugs and Alcohol Policy, I welcome opportunities to join with communities, not only to stand with them in support of the work that they do but to demonstrate our commitment to recovery and providing people with the support that they need, when they need it.

As we continue to deliver on that commitment through our national mission, I am delighted to see the publication today of a report from the Corra Foundation that provides an overview of the various projects that are funded through the national mission funds from April 2021 until March 2023. Following the recent funding round that was announced in May 2023, the Corra funding, which totals £65 million over the lifetime of this Parliament, now supports more than 200 grass-roots and third sector projects across Scotland. Vitally, those funds are multiyear, which provides much-needed assurance to those funded organisations and is highly welcomed across the sector.

I recently visited one of the funded projects, Back on the Road, which is a unique employability project in Glasgow’s east end that supports those who are in recovery from drug and alcohol addiction. Through the restoration of vintage vehicles and training in workshop practices, alongside the development of the softer skills that are required in a work environment, they develop an individual’s self worth, sense of belonging and feeling of self responsibility. In addition, they build trust with others, their workshop colleagues and tutors, thus further reducing the stigma around addiction.

That is just one example of what the funding can do. The Corra Foundation report provides information on the outcomes and progress, along with the challenges and successes of all the funded projects that have supported more than 37,000 people across Scotland.

Despite the progress that we have seen to date through the funding that has been allocated and, more important, the number of lives that have been saved, I am in no doubt about the work that is still in front of us. We know that the most important thing is being able to offer people the type of treatment that works best for them, at the time that works for them. We know that there remain a number of challenges for us to address in order to get to that point. However, we also know that change is possible and that the reduction in our drug death figures shows that the work we are doing is making a difference.

The minister will now take questions on the issues that were raised in her statement. I intend to allow around 20 minutes for questions, after which we will move on to the next item of business.

This morning, it was revealed that there have already been 600 suspected drug deaths in the first half of 2023, which is up 7 per cent on the same period last year. It is vital that the Scottish Government takes every practical step that it can to tackle the epidemic of drug misuse that is sweeping our country.

I have reservations about the effectiveness of consumption rooms. However, the Lord Advocate’s decision yesterday tells us that there was always a way to take that measure, and the Scottish National Party now has one less excuse for its failures.

Annemarie Ward of drugs charity Faces & Voices of Recovery UK—Favour UK—has said that safe consumption rooms need to be underpinned by vital access to prescription programmes, detoxification and rehabilitation services, as laid out in the right to addiction recovery (Scotland) bill. It is now up to the SNP Government to demonstrate that safe consumption rooms can work, to back our crucial right to addiction recovery (Scotland) bill and to finally start tackling the drug deaths crisis that Nicola Sturgeon and now Humza Yousaf have presided over.

Following the minister’s statement in June, I asked her about the recovery programmes for those suffering from addiction in our prisons. The answer referred only to those services provided to people after they leave prison. I will therefore ask the question again: can the minister tell us what is being done to break the cycle of addiction in prisons?

I recognise Sue Webber’s intense focus on this area. Indeed, I welcome that focus from members across the chamber, as we all have to work together on this issue.

On justice settings and the medication-assisted treatment that we are pushing and for which we are providing support in local areas, including to healthcare teams in prisons, we need full implementation to be achieved by 2025, as previously announced. We know that there are specific challenges in justice settings, as was highlighted in the benchmarking report. However, we have already announced our intention to improve healthcare in prisons through new models of care. HMP Perth is now an improvement site for medication-assisted treatment standards, and the learning from that will be cascaded through the entirety of the prison estate.

Peer naloxone workers are working within the prison estate to cascade life-saving naloxone treatment to people in prison. This year, the MAT standards implementation support team will be supporting health teams in prison settings in embedding MAT standard 3, in particular. That involves assertive outreach, which can also happen in prison settings. There are a lot of recovery communities and recovery cafes in prison settings, which is important, too.

A lot of work is on-going in prisons, and I will be happy to have a meeting with Ms Webber to keep her updated on that.

Since the SNP declared the drugs crisis a public health emergency in 2019, more than 4,000 lives have been lost. In the past six months, the number of drug deaths has gone up to more than 600. I welcome the intervention by the Lord Advocate. Not prosecuting people for using safe consumption rooms is a pragmatic approach that allows progress to be made in the pilot scheme in Glasgow.

However, as others, including anti-poverty campaigner Darren McGarvey, have commented, the law has not changed. The constitutional fighting between the two Governments has, thankfully, not stood in the way of progress, but the shame is that the measure could have been taken ages ago, and perhaps more lives would have been saved.

Consumption rooms are only one part of the fight against drug deaths and drug use, however. We need to ensure that treatment and rehabilitation services are available when people need them. Why have there been cuts to the alcohol and drug treatment budgets? Why are facilities such as the Turning Point Scotland centre for women with addictions being closed down? Can the minister confirm when the medication-assisted treatment standards that were promised 18 months ago will be fully implemented?

I thank Jackie Baillie for her question, but I will point out, before I answer the substance of the second part of her question, that the position that the Lord Advocate took yesterday concerned a very specific proposal that was placed in front of her by us and the Glasgow health and social care partnership. That varies hugely from the original proposal that went to the Lord Advocate previously. Although the law has not changed, we needed a very specific proposal for the Lord Advocate to look at.

Regarding the budget that we have in front of us, I must ensure that people understand that there are no cuts to the budget. Those claims are based on a misrepresentation of a recent answer to a portfolio question, not the total budget available to alcohol and drug partnerships or the third sector, and do not represent the full drugs and alcohol budget. In 2021, the total drugs and alcohol budget was £140.7 million; in 2022-23 the total budget was £141.9 million; and there has again been an increase in the budget, to £155.5 million, for 2023-24.

It is important to point out that no one has proposed any reduction in funding for our community justice response within settings, including in Glasgow and Turning Point Scotland’s 218 service.

We know that there is a wealth of international evidence supporting safer drug consumption facilities, so it is hugely welcome to have confirmation that, if a facility of the type set out in the Glasgow proposal were to open as a pilot, the Lord Advocate would be prepared to publish a statement of prosecution policy that it would not be in the public interest to prosecute users of that facility for simple possession offences committed within the confines of the facility.

Given that latest development, can the minister set out the Scottish Government’s next steps in supporting Glasgow to establish this vital facility?

It is now for Glasgow’s health and social care partnership to take the proposal to the next meeting of its integration joint board, which I understand is scheduled for 27 September. To proceed, the partnership will need to provide an update to its integration joint board and be instructed to undertake public consultation work, as requested by the Lord Advocate, to establish the evaluation framework for the pilot. That public consultation work is so important.

We have been clear in our commitment to establishing a safer drug consumption facility in Scotland. Following the position from the Lord Advocate, we will continue to work closely with colleagues in Glasgow to agree the next steps and review options around implementation, including funding.

It is clear from the statement that the Scottish Government always had the ability to act on a pilot of drug consumption rooms, if only the SNP had asked the right question, but it did not.

Implementation is key to any pilot, so my questions are on that. Where will the rooms be? Will local residents be consulted? Will addicts be expected to travel from local communities into town centres? What support and interventions will be available in the consumption rooms?

The proposals that the Glasgow partnership will put before its integration joint board will include some of the details that Dr Gulhane asks about. The consultation with the community will be vital, because we need to ensure that there is no stigma associated with it and that communities definitely feel as though they have been part of the decision making. We know that between 400 and 500 people are injecting in alleyways in Glasgow city centre, so I anticipate that the proposals will include a city centre location. That is for the Glasgow partnership to set out, and we wait to see what it takes to the integration joint board.

I, too, welcome the announcement yesterday from the Lord Advocate. Does the minister agree that Police Scotland’s support and its commitment to work with partners to reduce the harms associated with problematic substance use are crucial in ensuring that policing is not a barrier to treatment?

Yes, absolutely. We are hugely grateful for the support that Police Scotland has provided. It would not have been possible to reach this point without its collaboration and partnership in the development of the proposal that was submitted to the Lord Advocate. That follows the appearance of the Lord Advocate at the Criminal Justice Committee, where she laid out the parameters as to the type of proposal that she would be willing to look at should something be put in front of her.

Police Scotland remains a key partner in our work to reduce drug deaths. It remains committed to working in partnership to reduce the harm associated with problematic substance use and addiction. In addition, it runs its own drug strategy board, which brings together key partners and stakeholders from a number of areas, including Government and third sector organisations. Part of the work of that board is to develop a public health approach to policing.

As I said earlier, I am grateful that all our police officers now carry life-saving overdose reversal first aid in the form of naloxone.

Yesterday’s announcement from the Lord Advocate is a vindication for all those who have long said that such an approach was possible, particularly Peter Krykant, who I worked with on an unofficial overdose prevention pilot in Glasgow in 2020, saving eight lives, and who is in the public gallery today. In 2017, the previous Lord Advocate said that it was not possible, despite operating under the same laws and guidance as the current Lord Advocate. Over those six years, what exactly has changed in the latest proposal to make it possible? What does the minister have to say to the 7,127 families who have lost loved ones since the previous Lord Advocate rejected the original proposal, many of whom would still be alive today if there had not been such devastating intransigence from people in positions of power in this country?

We need to recognise that the proposal that was put in front of the previous Lord Advocate was much wider in its scope. That proposal asked the former Lord Advocate to change the law, which he was not able to do. In his response to that request, he set out the reasons why he could not do that.

That was why it was important for time to be taken to work through a proposal that would meet the parameters that the new Lord Advocate set out to the Criminal Justice Committee in November 2021. The proposal was worked on solidly by officials in the Scottish Government and partners in the Glasgow health and social care partnership and Police Scotland, to ensure that the information that was set in front of the Lord Advocate allowed her to come to the position that she came to yesterday.

Evidence tells us that overdoses occur when people take a combination of substances, including benzodiazepines or blue or street benzos, which account for 73 per cent of overdoses. Such incidents are particularly prevalent in rural areas such as Dumfries and Galloway. There is a reversal agent for benzodiazepines called flumazenil, which I used when I worked in a perioperative department as a registered nurse. Will the minister provide an update on the research that is under way on the reversal agent, bearing in mind that it would only be part of a multipronged approach to preventing deaths?

The use of flumazenil can be an effective part of an overall strategy to tackle the harms that are caused by benzodiazepines. Flumazenil is an antagonist and antidote to benzodiazepine overdose that has been studied fairly extensively. Given the risks from side effects that have been identified in studies, current UK clinical guidelines restrict the drug’s use to trained clinicians, which means that there is little prospect of it being used outside of hospitals currently. However, the drug can be used in stabilisation services, so the Scottish Government has committed to supplying an extra £2 million every year of the rest of the current parliamentary session to ensure that we scale up stabilisation services to address the use of illicit benzodiazepines, which we know are so harmful.

Like the minister, I was pleased to read yesterday’s update from the Lord Advocate on a safe consumption facility in Glasgow. I pay tribute to Peter Krykant, who is in the gallery, and our colleague Paul Sweeney for the groundbreaking and pioneering work that they did in this area.

There is still a drug deaths emergency—about 100 people a month are still dying—so there is not a moment to lose, but we are slipping backwards, as we saw from statistics today.

People hundreds of miles outside Glasgow could also benefit from such spaces, so how will the Government share learning from the pilot? Is the Government acting right now to build towards the establishment of a network of safe consumption facilities as soon as possible, so that everyone who needs help can access life-saving services?

I share and echo Alex Cole-Hamilton’s desire to see a network of such facilities across the country, because that is how we will interrupt the most amount of harm and save lives. The Lord Advocate has set out the position that she is willing to take on the specific proposal that was in front of her, and we will have to evaluate the pilot in order to understand how such facilities operate. The Lord Advocate’s statement does not give us the right to roll out other such facilities across the country. That is the limitation that we are operating under with the position that the Lord Advocate has taken, as opposed to our having the full powers to provide such services ourselves or the UK Government working with us to ensure that we have safe drug consumption facilities right across the UK.

I welcome the minister’s update and the support that she is offering for the pilot of a safe consumption facility in Glasgow.

The UK Home Affairs Committee recently found that drug laws are outdated and in need of reform in order to support greater use of public health-based drug interventions. Does the minister agree that the UK Government needs to give proper consideration to the Scottish Government’s progressive proposals for reform and to start treating problematic drug use as a public health issue, rather than one of criminalisation?

I absolutely welcome the cross-party Westminster Home Affairs Committee report that was released last month, which recommends a review of current drug laws. Multiple committees, experts and independent organisations—including the independent drug deaths task force—have already called for an urgent review.

We have been clear that Scotland faces a public health emergency in relation to drug deaths, and we cannot rely on only one route to change. We are working hard with the powers that we have but, although there is more that we need to do, the fact remains that the legal framework in which we operate undermines our public health approach.

We are open to a full range of options and have set out policies that could be implemented through the devolution of further powers to Holyrood, including powers to change the criminal law on the use of drugs, or wider constitutional changes, such as Scottish independence. Clearly, the fastest and simplest way forward is for the UK Government to review and change the Misuse of Drugs Act 1971 to support a public health approach across the entire UK. The number of drug deaths is increasing across the whole of the UK, despite the welcome decrease that we saw in 2022, and we will experience the increasing prevalence of really strong synthetics and even stronger street benzodiazepines, so we need to have all the weapons in our armoury to be able to respond to that.

I echo the minister’s condolences to all those who have lost a loved one. I thank the minister for advance sight of her statement, and I welcome the Lord Advocate’s statement. I want to follow other colleagues by paying tribute to campaigners, particularly Peter Krykant, who have worked tirelessly on the issue.

What engagement has the minister had with the UK Government, and is she satisfied that it will work with the consensus here, in Scotland, to allow a pilot safe consumption room to proceed?

Last week, I met the UK Minister for Crime, Policing and Fire, Chris Philp, and we discussed the possibility of the position statement coming from the Lord Advocate. Although it is within the UK Government’s powers to prevent us from moving ahead with the pilot, I do not think that its colleagues in this chamber will stand in our way; they have said that they would welcome the evaluation that a pilot would provide. I urge the UK Government to listen to its colleagues here and to the rest of the chamber and allow us to move forward with what I know will be a life-saving facility in Glasgow.

I remind the chamber that I am the vice-chair of Moving On Inverclyde, which is a local recovery service.

Although the number of drug-related deaths in Scotland as a whole fell, there was an increase in Inverclyde compared with 2021. Inverclyde has consistently been in the top three areas per head of population when it comes to drug-related deaths. I welcome the minister’s commitment to me in writing that she will meet Inverclyde’s alcohol and drug partnership, but can she confirm that, if additional resources are requested, she stands ready to seriously consider any and all proposals?

Following the publication of Scotland’s drug deaths figures for 2022, my officials are developing a programme of targeted engagement in the areas where there has been an increase in drug-related deaths and, in particular, difficulties in delivery, which includes Inverclyde.

We should take a moment to reflect on the fact that people who live in poverty are 16 times more likely to experience a drug-related death. It is incumbent on me and all ministers in our cross-Government response to consider how we can intervene as early as we can. The whole-family approach that we have embedded is about getting alongside families at the earliest opportunity to try to disrupt any propensity for somebody to use substances.

In 2023-24, more than £112 million has been allocated to local areas for delivery partners and local alcohol and drug services to support them to tackle the challenges in their area. I look forward to engaging with the delivery partners in Inverclyde to better understand their challenges and requirements and to tackle any barriers that they have to improving services and the outcomes for people who use drugs.

A few weeks ago, the Minister for Drugs and Alcohol Policy, Elena Whitham, was asked four times how many rehab beds there are in Scotland, and four times she could not answer. Campaigners and charities say that many people still cannot access residential beds. Can the minister tell us how many rehab beds are available right now and how many people have had to travel outwith Scotland for rehabilitation?

I confirm that we identified 425 beds from the “Pathways into, through and out of Residential Rehabilitation in Scotland” report that we commissioned in 2021. Since then, we have had two rounds of funding for the rapid capacity programme, increasing the number of beds across the country by 172. That represents a 40 per cent increase on the figures that we started with. By the end of this parliamentary session, I anticipate that, through other means, including further money going to ADPs and third sector organisations, there will be an increase to the 650 beds that we have asked for. That will result in a 50 per cent increase in the number of beds available.

It is important to recognise that we need to think about the placements as well as the beds. We anticipate that the 650 beds that we will get to will allow us to have 1,000 publicly funded spaces available every year for people in Scotland to access residential rehab treatment. In the past year, 812 people accessed that service, and the past quarter saw the highest number of referrals to date.

It is important that local areas publicise their residential rehabilitation pathways, and they are on the majority of ADPs’ websites. We are working with Scotland Excel to see whether we can create a directory that would give people choice and scope as to where they could go in Scotland to access the treatment that they need.

The drop in annual drug deaths is very welcome, but I am afraid that, in all the exchanges today, I do not get the sense that the Government knows why that annual figure has fallen. Drug workers and people living with addiction in Dundee tell me that there has been a significant rise in the number of people using crack cocaine, with all the associated impacts on violence and antisocial behaviour. What is the minister’s view on whether the associated fall in deaths may be the result of substituting one drug for another, and can the minister and officials show where and how policy action is directly preventing deaths?

We have engaged Public Health Scotland to do an evaluation and to look at the national mission, where the moneys have reached, and the impact of that, because we need to have a clear picture of where resources are best having effect. I believe the policies that we have put in place, which are evidence based, are helping to turn the situation around, but I recognise the concern that Michael Marra shares with me about the increasing use of cocaine and crack cocaine.

It is interesting to see the rapid switch that has happened in Dundee. I have a close eye on that, because I think that that will mean that the services in Dundee will have to pivot to reflect that cocaine use.

In my travels across Scotland, I have met a number of young people who have presented to services for support and to reduce their cocaine habit. Perhaps that will have started off as recreational and quickly spun out of control.

There are a lot of issues around cocaine. I will work with local areas for them to communicate to me what they are putting in place to ensure that we can respond to that.