Independent Expert Review of Opioid Replacement Therapies
The next item of business is a debate on motion S4M-08422, in the name of Roseanna Cunningham, on the independent expert review of opioid replacement therapies in Scotland. I invite members who wish to speak in the debate to press their request-to-speak buttons now, or as soon as possible, and to locate their microphones effectively, remembering that they are directional microphones. I call the minister—when she is ready—to speak to and move the motion in her name. You have 14 minutes, minister—as soon as you are ready to proceed.
14:43
It would be useful to remind the chamber of the background to this afternoon’s debate. In August last year, it was reported in national statistics that, in 2011, drug-related deaths reached the highest level recorded. Some 584 people in Scotland lost their lives to drugs and, for the first time ever, methadone was implicated in more deaths than heroin. Those deaths affected, and continue to affect, friends, families and communities.
That background is why I asked the chief medical officer, Sir Harry Burns, to commission an independent expert group on opioid replacement therapies. The expert group published its report “Delivering Recovery—Opioid Replacement Therapies in Scotland” in August. My thanks go to Sir Harry Burns, Dr Brian Kidd, who was the chair of the group, and Doctors Charles Lind and Kennedy Roberts, who undertook the research, for their drive and determination in producing the report. I also extend my thanks to everyone who contributed to the process, including members of this Parliament.
The report provides recommendations on the delivery of opioid replacement therapies in Scotland and on the wider delivery landscape, and looks at themes such as social exclusion and health inequalities; recovery; governance and accountability; information, research and evaluation; and the improvement approach that is needed to drive change. Today, the Minister for Public Health and I will provide a cross-Government response to the report.
Since the report was published, the Government has held two events to provide those who work in alcohol and drug partnerships and primary and secondary care with an opportunity to reflect on it. As members are aware, some of the report’s recommendations refer to the national health service. I will touch on some of those recommendations, but Mr Matheson will provide more detail later about how we are responding to them.
First, I want to ensure that everyone is aware of the headline finding in the report. Last year’s drug-related death figures resulted in media coverage that questioned the use of methadone. However, the expert group concluded that opioid replacement therapies have
“a strong evidence base ... and should be retained in Scottish services”
and
“should be delivered as part of a coherent person centred recovery plan”.
The report is clear that methadone, like other treatments such as residential rehabilitation, community detoxification or psychiatric support, has a place only in the context of recovery. In practice, recovery is best realised through the development of
“recovery oriented systems of care”,
which is a term that is used frequently in the report. It means systems that enable people to progress at their own pace with a planned and integrated care pathway from their first entry into services to their return to non-specialist services.
With that in mind, the Government has been developing an alcohol and drug quality improvement framework, which will ensure quality in the provision of care, treatment and recovery services as well as in the data that will evidence the outcomes that people are achieving. The framework is aligned with the themes that are outlined in the report. Following collaboration with service users, people in recovery and delivery partners, we are about to consult Scotland’s 30 ADPs on the development of quality principles, embedded in a human rights approach, for drug and alcohol services.
We have achieved huge success in reducing waiting times—the latest statistics show that 96 per cent of people started treatment for their drug problem within three weeks or less; in 2007, people could wait for over a year for an appointment—but securing quick access to treatment is the least that we can do. The quality principles to which I referred will set out what someone who accesses a service can expect to achieve, and will be measurable at service, local and national levels. They include high-quality, evidence-based interventions; workers who are appropriately trained and supervised; full strengths-based assessments and person-centred recovery plans that are agreed and regularly reviewed; and, if it is helpful to the individual, the opportunity for their family to be involved. We know that some areas are taking that approach already, and examples of good practice are highlighted in the report.
Delivering quality also depends on the availability of robust information that is capable of demonstrating recovery outcomes. Access to meaningful and reliable information is essential if ADPs and local services are to monitor their progress in delivering recovery. We are currently working with the Information Services Division of the NHS in Scotland and ADPs to scope out the development of an integrated drug and alcohol information system. The proposed system will integrate the existing waiting times database and the drug misuse database, and gather information on alcohol treatment and recovery indicators. We are also working with members of the expert group via the independent Drugs Strategy Delivery Commission to explore the feasibility of agreeing key priorities for research on substance use in Scotland.
The Scottish Government created ADPs with NHS Scotland and the Convention of Scottish Local Authorities four years ago. The report tells us that there are real concerns around the lack of progress on delivering recovery that has been found in many ADPs. We must not be complacent, and we must ensure that governance and accountability are robust within those structures. The Government is committed to working with current expert advisory structures on drugs to review their impact, performance and lines of accountability.
We have already taken steps to improve the accountability of ADPs. Planning and reporting mechanisms have been developed and agreed, and in order to drive performance locally, I have set ministerial priorities for all ADPs to report on in their annual reports.
Those include the delivery of the health improvement, efficiency and governance, access and treatment standard to maintain fast access to treatment; increasing levels of compliance with the Scottish drug misuse database; sustaining the quality of data in the national drug and alcohol treatment waiting times database; and increasing the number of take-home naloxone kits supplied to those at risk of opiate overdose. Those pieces of information must be supplied on an annual basis. ADPs have taken those priorities seriously and have committed to taking forward the areas identified for improvement. For example, over the past six months the number of take-home naloxone supplies that have been distributed has increased.
Our focus on improvement is crucial. I met ADP chairs last month and urged them to set an improvement goal that sets out specifically how they will respond to the independent report. For example, West Lothian ADP has stated that, by December 2016, 100 per cent of people who receive substitute prescribing will have had a review and will have a recovery plan in place, and Edinburgh ADP will, in 2014-15, increase by 30 per cent the proportion of people who are linked, rather than just referred, to recovery communities and/or mutual aid groups following a planned discharge from specialist treatment. Those examples demonstrate that a real change is taking place as a result of the Government’s alcohol and drug quality improvement programme and the expert group report, on which we have already begun to act.
However, it is important to remember that people affected by drugs are extremely vulnerable and often experience other significant health conditions, including the effects of ageing. The evidence also tells us that stigma is a significant barrier to delivering recovery. The CMO recognised that in his foreword to the expert group’s report, in which he highlighted that
“Overcoming the stigma and further increasing the numbers of people in recovery will be challenging—but achievable.”
In line with Government priorities, the report emphasises the importance of workforce development, not only in upskilling but in addressing stigma and attitudes towards drug use and recovery, which are present even within the wider workforces that deal with people who use drugs. The attitudes of many professionals themselves must therefore be challenged.
Scottish training on drugs and alcohol—STRADA—our nationally commissioned workforce development agency, is working with ADPs to support them to identify training needs around the development of recovery-oriented systems of care. In addition, the Scottish recovery consortium delivers recovery workshops for treatment providers, giving workers opportunities to connect with people’s own experiences of recovery as well as to learn about recovery tools and practices that are used elsewhere in Scotland. I am delighted that, by taking that work across the country, the recovery consortium will work with all addictions staff in NHS Ayrshire and Arran in the coming months.
The report makes recommendations on the quality, consistency and availability of drug treatment services within Scotland’s health service. Inconsistency was reported to be driven by the opt-in nature of the general practitioner contracting process for substance use treatment. To increase consistency, the report calls for discussions within primary care and pharmacy about the delivery of drug treatment services and suggests the development of national standards for primary care and community pharmacy.
The Government has increased the number of GPs in Scotland and we now have more GPs per head of population than the rest of the UK. We are leading the way with the world’s first patient safety programme for primary care and we invested more than £757 million to deliver primary care services last year, which is an increase of more than 17 per cent since 2004.
Does the minister acknowledge that there needs to be uniformity of services and that there cannot be any areas in which there is an opt-out due to public perceptions of treatment for people in drug programmes?
It is always going to be a challenge to deliver uniformity of services, particularly across a wide range of services, many of which are designed to be responsive to local needs and conditions and involve a variety of professional groups and professional interests. We need to work very hard to overcome that challenge.
However, we must remember that patient care is provided by the whole clinical team and not just by GPs. They use their professional judgment to work with patients to agree the best and most appropriate care to support individuals’ general health, including their recovery from drug use. In delivering care, GPs should take account of all aspects that affect a patient’s care and, where necessary, actively link with specialist services to deliver the care that is required.
The report does not make light of the role of pharmacists in delivering recovery. Since the publication of the expert group’s report, the Government published “Prescription for Excellence” in September. That document is our 10-year vision and action plan for pharmaceutical care in Scotland. It gives a firm commitment to work with pharmacists and other healthcare professionals to develop and implement new NHS standard specifications for drug and alcohol services. The expert group’s report will build on work that is already taking place in NHS boards and inform the development of that work.
At the event with healthcare professionals that was held just this month, both the Minister for Public Health and I made individual commitments on how we can better engage with the NHS. I committed to bringing together relevant healthcare professionals each year to ensure that people with drug problems are supported in their recovery, and the Minister for Public Health committed to identifying an accountable officer from every NHS board to be responsible for the delivery of opioid replacement therapies in local areas. Mr Matheson will provide more information on that later.
I also take this opportunity to reassure the Parliament that recovery is alive across Scotland. Last year, I announced the development of a recovery initiative fund, and since then almost £100,000 has been distributed to individuals and recovery communities. Examples of successful applicants include the unity recovery football club, which is a Glaswegian football group consisting of people in recovery and their families, and hectic life in Edinburgh, which is a social enterprise that aims to provide training and permanent work for individuals in recovery from addiction through furniture building, restoration and recycling. Meaningful work and activity are extremely important when we are talking about recovery.
I have also had the privilege of attending five-year anniversary events for “The Road to Recovery: A New Approach to Tackling Scotland’s Drug Problem”, at which we discussed not only what still needs to be done but the achievements that have been made since the introduction of that strategy in 2008. I think that all members have been sent a copy of “The Story So Far: A collective summary of reflections on Scotland’s road to recovery since 2008”, which reflects on how things have changed in Scotland in the past five years.
While we must not be complacent about the improvements that still need to be made, I would like to finish with a quote from “The Story So Far” that I think summarises where we are today:
“Momentum is building and I hope that in 5 years time we will have reached a tipping point that washes all the unhelpful stigma and moral rhetoric away. I appreciate that sometimes we can be seen as naive optimists and know that living can be tough whoever you are, whatever demographic, social, economic situation you’re in ... But it is right to pursue recovery in this way, at this time, in an inclusive and hopeful way ... and it is working.”
I move,
That the Parliament notes the August 2013 publication of the report and findings of the independent expert group on opioid replacement therapies commissioned by the Chief Medical Officer and led by the independent Drugs Strategy Delivery Commission; endorses the expert group’s conclusion that opiate replacement therapies have a strong evidence base, should be retained in Scottish services and should be delivered as part of a coherent person-centred recovery plan; agrees with the six priority themes identified in the report and calls on members to endorse an improvement approach, as enshrined in the “three-step improvement framework for Scotland’s public services”, at national and local level to address health and social inequalities for people affected by drug problems in Scotland, address variability in service provision to ensure that high quality recovery-oriented systems of care are in place across Scotland that recognise the contribution of primary and secondary care, continue to improve the governance and accountability of the delivery system and further develop information, research and evaluation systems on substance misuse at a national level; recognises the role and contribution of the workforce in delivering a recovery-oriented system of care in Scotland, and supports the continued development of all those working to make recovery from problem drug use a reality.
14:57
I welcome the opportunity to debate the findings of the independent report on opioid replacement therapies, although it feels as if it has been a long time coming. It was announced in October last year, and at that time the recommendations were supposed to be produced by the spring. Nevertheless, I am pleased that we are, at last, discussing the important and often contentious issues around the treatment of people who suffer from heroin addiction.
Labour members welcome the acknowledgement in the Government’s motion of the concerns that are contained in the report, which raises many important issues about how services are delivered across Scotland. I do not argue that all those issues fall at the feet of Government, but in using 11 of the recommendations to form the basis of what it terms an “immediate improvement process”, the report places the responsibility on Government to provide leadership. We feel that more urgency is required than is displayed in the Government’s motion.
Importantly, the report identifies that opioid replacement therapy is an “essential” service with a “strong evidence base”. I repeat that, as the minister said, that has been verified through research in a number of countries around the world. Among the actions recommended by the report are that there should be a more co-ordinated approach from all service providers to tackle the effects of health inequality and stigma; that ORT should be offered in the context of a flexible and mixed treatment system; and that therapy should be part of a person-centred recovery programme with both the care pathway and the progress of individuals able to be objectively determined.
There was clear and significant concern about the performance of alcohol and drug partnerships across the country. There is an argument that their functions need to be reviewed, as some have displayed little evidence of a real impetus towards recovery and a lack of progress towards recovery-oriented systems of care, or ROSCs, and quality assurance.
The report notes that there is an urgent need to address
“the lack of institutional memory”
in planning, delivery and governance, which I imagine is some form of management speak for a failure to learn from past mistakes or instances of good practice. There is also a lack of accountability, including lines of accountability to the Scottish Government, and there is a need for an approach that has a track record of delivering change. Indeed, there is a lack of outcome measurement at the moment, and even the very modest SMR-25b follow-up forms are not completed for the majority of clients. Research and academic inquiry is also noted to have been poorly developed in Scotland.
Our amendment focuses on the need to make real progress on the issues identified in the report, and to demonstrate commitment to that by determining a timetable for action on the required improvements that have been identified.
The report notes that the average age of heroin users is increasing. Heroin does not seem to be the drug of choice of younger people—it is not seen as cool. That is good, but it may be due to the easy availability of so-called legal highs, which of course bring many dangers such as extreme psychosis and which need to be the subject of scrutiny. Perhaps we need a separate debate on that.
However, the increasing age of heroin users brings with it problems, as prolonged use leads to more complex and severe physical and mental health problems, and we should not assume that current unpopularity of heroin among younger people indicates that it will eventually fall out of use. I am advised that drug popularity is cyclical and that future generations may not eschew heroin to the extent that young people do today.
Heroin users do not engender much in the way of sympathy from the general public. The report noted that the UK Drug Policy Commission found
“high levels of blame and intolerance”
among the Scottish population and that
“the fear of and the need to exclude people with drug problems were higher in Scotland than the rest of the UK”—
a finding that the report describes as “sobering”.
Attitudes towards medication-assisted recovery are also more negative in Scotland, and Scotland has higher rates of harm and premature death than other European Union countries have. Those rates have not fallen in the way that they have in other countries, so we have a challenge here in Scotland.
In addition to stigma, the debate around drug treatments is often ill informed, with a lack of information regarding available treatments and what is meant by recovery. The lack of a shared definition of recovery is noted in the report. Although there is a definition in the “Road to Recovery” that recognises that recovery is about voluntarily moving on from problem drug use, and there is the UKDPC consensus statement on recovery, those definitions do not seem to be universally understood or accepted, and there is a perception that recovery equates to having achieved abstinence.
Of course, that is the goal for many heroin users and their families, as indeed it should be: where it is possible for a user to become drug free that should be the aim, and efforts and support should be directed towards that aim, but for some it will not be possible to totally cease opioid replacement treatment, because some people are too ill ever to be able to come off medication. Before people criticise that and ask why the NHS is paying for it, I point out that we pay for the consequences of obesity, smoking and other choices that people make. This is the same issue.
Dr Murray was right to highlight stigma. Does she agree that the attitude that people make a lifestyle choice when they choose to misuse drugs neglects the fact that such people are often in the poorest and most deprived parts of the country, and that therefore that lifestyle choice is not the choice that people say it is?
I acknowledge that; indeed, I will come to that issue in my speech.
The standard opioid replacement is methadone, although buprenorphine, which is also known as Suboxone or Subutox, is becoming a more common alternative. In most ADP areas only one patient in 20 is prescribed buprenorphine, although in two of our ADP areas it is one in three. Clearly, that is a clinical decision—I hope that it is not based on the fact that buprenorphine is three times as expensive. It takes longer to supervise and is easier to conceal, as it is a tablet, which can be concealed under the tongue. It is harsher on the user as he or she remains totally sober and therefore has to be psychologically and physically robust enough to tolerate its use.
However, there must be something to be learned about its use from the two ADP areas that prescribe it so much more frequently. It is important that users who want to progress into recovery—and, I hope, abstinence—are offered the road most suitable for them, whether that be methadone, buprenorphine or abstinence.
I want to touch on a couple of other issues in the report. The first is the HEAT target that anyone with a drug problem should wait no more than three weeks for treatment. We believe that that target needs to be refined, as it does not monitor recovery. The Scottish morbidity database reviews all clients at three months and then annually or upon discharge but, in 12 ADP areas, reviews were not followed up in more than 50 per cent of cases because data collection is not mandatory. The HEAT target should be person centred and based on recovery rather than just access to treatment.
The report also pointed out that fewer than half of Scotland’s health boards can offer any access to specialist addiction psychology services. Given the problems that we have in Scotland with addiction, whether it be alcohol, smoking, gambling, eating disorders or drug abuse, I find that situation very worrying and hope that it does not indicate that a too low priority is being accorded to mental health services.
An estimated £36 million is spent annually on substance misuse services in Scotland. However, the independent expert group estimates that when all the services and agencies such as justice, child protection, social services and so on are taken into account the total cost of drug addiction to the public sector in Scotland could be almost 100 times that amount, or £3.5 billion. When we are talking about a sum of public money of such magnitude, we need to get our act together to develop a more effective response to drug abuse.
We must also use early intervention to support vulnerable individuals and prevent them from getting on the road to substance abuse in the first place. As Jim Eadie mentioned in his intervention, drug users have often experienced trauma, sometimes in childhood through parental drug or alcohol abuse, family breakdown, a parent in prison, the death of a key family member or sexual and domestic abuse, or poor engagement with education and social services. Many have had problematic relationships with alcohol in their early teens before moving on to misusing other substances. Indeed, some, including many of those who have left the armed forces, have experienced trauma later in life. As a result, identification of and support for people at risk of self-medicating with alcohol and drugs would save them and their families a lot of misery as well as saving the public sector significant costs across a range of services. Indeed, that is why our amendment states that the strategy should include preventing drug use from starting by identifying and supporting those who are vulnerable to its attractions. That is very important.
Finally, our amendment changes the final phrase of the Government's motion. It might be the way I read it but it appears to recognise the contribution and role of the health service workforce alone and does not include everyone outside with NHS, many in the voluntary sector, who also make a vital contribution to support for and the recovery of drug users. I am thinking, for example, of the Scottish Drugs Forum, First Base in my constituency and a whole load of people in the third sector who make an extremely important contribution in a variety of ways.
I hope, therefore, that members will be persuaded to support our amendment, which, as I have said, adds to the Government’s motion.
I move amendment S4M-08422.1, to leave out from “the workforce” to end and insert:
“everyone in delivering a recovery-oriented system of care in Scotland; supports the continued development of all those working to make recovery from problem drug use a reality; considers that the ultimate aims of the Scottish Government’s strategy should be both prevention and providing people with routes to overcome their addiction, and calls on the Scottish Government to determine a timetable to enact the improvements contained in the report.”
15:07
I am delighted to speak in this debate but will start by suggesting to the minister in the most constructive way that I would have found it very helpful to have received the Government’s response prior to the debate. Perhaps she was not sure that I was speaking this afternoon; indeed, I have not been in recent times.
Having been a member of parliamentary health committees for many years, as well as a member of cross-party groups on drugs and alcohol as far back as 1999, I must say that I, like my colleague Annabel Goldie, fully supported “The Road to Recovery”. On that basis, I very much welcome the minister’s remarks about the emphasis on outcomes, the quality principles for ADPs, what a person can expect to achieve, family involvement and naloxone. In fact, there was very little that the minister said that I do not welcome, and I find that very positive.
I acknowledge that there is not an exact overlap between “The Road to Recovery” and the report from the independent expert group that we are debating this afternoon. After all, the former looked at recovery, delivery and prevention, while our focus today is on opioid replacement therapy. However, I have to say that, five and a half years after “The Road to Recovery”, the progress that we all expected and which everyone on all sides of the chamber supported has been, to say the least, disappointing. Even more disappointing is that many of the themes and recommendations that we are debating this afternoon were put forward in 2008.
As a result, although I welcome what has been said, I would like more regular updates on the progress of the actions that have been taken. More information on the response to treatment would allow treatment services to be benchmarked and make the effectiveness of interventions that are supplied to patients more transparent.
For example, does everyone who is on the methadone script get a monthly test to determine the presence of illegal drugs? I am not sure. Government statistics for the quarter to June this year state that 96 per cent of people attended an appointment for drug treatment within three weeks. I welcome that, but it is what happens after those three weeks that is important. I welcome what the minister said today, but that is the target that we have just now. I commend the focus on the outcomes, which we heard about today, rather than on the three-week period before the first appointment.
There is much good practice in the country. One example is the North, East and South Ayrshire alcohol and drug partnership, which piloted a methadone cessation programme that was aimed at supporting long-term methadone users over a period of six months. Given the information that we have, that is an example of a programme that has, undoubtedly, seen some notable success.
I have submitted various parliamentary questions on the issue. One such question, from 2001, was answered by Iain Gray, who was then the Deputy Minister for Health and Community Care. He said that drug users often claim that methadone is harder to come off than heroin. I am not sure that that is always understood. We need to listen to those who are addicted to drugs, those who are in recovery and those who are having difficulties addressing their drug usage. I would also welcome the inclusion of families.
The review says that
“there are still huge inconsistencies across the country in terms of ... availability of treatment ... or the range or quality of care”
and that little evidence was presented by some ADPs regarding a real impetus towards recovery.
That was raised by Audit Scotland in its report on drug and alcohol services in 2009. It was also the conclusion of a 2009 report by the Health and Sport Committee, of which Michael Matheson and I were members. Further, “The Road to Recovery”, which was published five and a half years ago, states that
“there were serious shortcomings in a number of ADATs”.
That was in 2008, so what we have today is not new.
I welcome the commitment and the focus, but I do not want to see the same problems coming up again in another five and a half years.
One of the themes in the report is health inequalities. “The Road to Recovery” talked about
“An appropriate range of drug treatment and rehabilitation services to promote recovery”
and
“Better integration of medical treatment with ... mental health”.
That is what we have heard today. We knew that that was a problem five and a half years ago.
Another theme in the report is
“a lack of institutional memory (at all levels) regarding an agreed understanding of the key issues and the plans”.
It says that, without that understanding,
“systems are destined to continue repeating mistakes”.
“The Road to Recovery” states:
“agreed understanding and collaboration is a central theme”.
Theme 5 in the report talks about
“an urgent need to develop meaningful information systems”.
That was also in “The Road to Recovery”.
“The Road to Recovery” also contained 10 actions to support the setting up of
“a new national drug strategy website to bring together all policy and research in one place for academics, practitioners, key experts, service users and the public.”
We have heard the same thing today.
I welcome what the minister has come forward with today. I welcome the focus on outcomes. However, I ask whether she will work with us, because she has support from across the chamber, and I ask for regular updates on progress.
15:14
The issue of substance misuse is a complex one, but we must always have at the forefront of our discussions the fact that this is about people’s lives—the lives of those who are recovering from substance misuse, of their families and of the people in the communities in which they live.
The causes of substance misuse are multifaceted. Therefore, tackling the issue requires a strategic approach, with all the relevant Government departments, agencies and organisations working together to achieve what I believe are the shared objectives of recovery, harm reduction and prevention.
We must ensure that all that necessary activity and service provision is underpinned by high-quality, evidence-based practice. Opioid replacement therapies have a strong evidence base, as was recognised by the independent expert review. Dr Brian Kidd, the chair of the Drugs Strategy Delivery Commission, stated:
“We have concluded that ORT with methadone is an effective treatment and must remain a significant element of the treatment options available for those struggling with opiate dependency in Scotland. However, ORT must be one of a comprehensive range of treatment options in every area.”
The expert review highlights the fact that
“Systematic reviews have ... concluded that ORT is associated with improved retention in treatment, reduced illicit opioid/heroin use and reduced HIV and blood borne virus risk behaviours - related to injecting.”
The review’s conclusion is clear: ORT should be retained in Scottish services and
“should be delivered as part of a coherent person centred recovery plan”.
Another requirement in tackling these issues is national leadership. I pay tribute to the work of the Minister for Community Safety and Legal Affairs and the Minister for Public Health for the constructive and inclusive way in which they have taken matters forward.
The context for the debate, as Mary Scanlon reminded us, is the national drug strategy “The Road to Recovery”. The strategy was published in 2008 by the Scottish Government, but it has been endorsed by the Parliament and commands widespread support across all the relevant agencies and organisations that deliver services as the right approach for addressing Scotland’s legacy of drug misuse. It states:
“Central to the strategy is a new approach to tackling problem drug use based firmly on the concept of recovery. Recovery is a process through which an individual is enabled to move-on from their problem drug use towards a drug-free life and become an active and contributing member of society.”
The key phrase is “towards a drug-free life”. There must be an acceptance and understanding of the fact that someone who has a history of drug misuse will, in many if not the majority of cases, simply not be able to become drug free overnight even if becoming drug free is the ultimate objective.
The dichotomy with which we are sometimes presented, with abstinence on the one hand and harm reduction on the other, is a false one. That point was made effectively by the United Nations Office on Drugs and Crime in its report in 2009.
Does the member acknowledge that the problem is often that there is an underlying mental health problem and that a dual diagnosis and psychological support are required, not just detox and rehab?
I agree absolutely with the point that the member makes. I will discuss mental health in a moment.
One of the barriers to accessing services and achieving recovery is the stigma that exists for current and former drug users and their families. That point has been highlighted by the expert review and, this afternoon, by the minister and Elaine Murray. The review goes on to make the sobering observation that such stigma is endemic at all levels in society. Let us pause for a moment to consider what that means. It means that some of the most vulnerable people are not accessing services although they may be more at risk of premature death, which is a sobering thought indeed.
There has been a transformation in attitudes towards people with mental health problems in our society. Would it not be equally satisfying if we were to see similar changes in public attitudes towards people who are recovering from drug misuse? If stigma is endemic in our society, it would be naive to believe that negative attitudes do not exist on the part of some professionals who are involved in providing addiction services. I was told by someone who has significant experience in the field that one service user told him, “I go to services as an addict and I get punished as an addict.” There is a clear challenge for the NHS and other agencies to ensure that there is appropriate training and continuing professional development for all staff who work in services that are designed to assist people on their recovery journey.
The evidence tells us that recovery is achieved most effectively when service users’ needs and aspirations are placed at the centre of their care and treatment. The role of community pharmacy featured prominently in the review and was endorsed as making a vital contribution to the provision of high-quality care for substance misuse patients. A number of recommendations in the review will improve the provision of services in that area. I pay tribute to the Scottish Drugs Forum for the work that it undertakes to harness the talents, experience and skills of service users to improve the quality of services, promote employability and support individual recovery.
There are a number of challenges in the report that we must tackle if we are to bring about improvements in the provision of services covering a range of areas. The aim must be to minimise what people need to recover from and to maximise what they can recover to.
In conclusion, the review provides yet further supporting evidence to underpin the important role of ORT in tackling drug misuse, identifies areas where further improvement must be made and provides a valuable platform that will allow many more people with substance misuse problems to achieve good outcomes. That is something around which all of us in the Parliament should unite to support.
15:20
I am keen to contribute to this important debate on the review of opioid replacement therapies in Scotland.
In my region of Glasgow, the issue is of particular importance, as it affects thousands of families who are struggling with addiction and substance dependency issues. I am confident that members across the chamber will agree that opioid replacements such as methadone can, in particular circumstances, help to stabilise drug users and direct them away from the most harmful of illegal drugs.
However, I am also confident that we could do much more to help addicts to dispose of their drug habit altogether through greater use of community recovery resources. I believe that, as a short-term solution, methadone can act as an effective intervention that removes the individual from dependency on other substances and the lifestyle associated with acquiring that. However, a longer-term strategy will need to address the social, economic and medical reasons behind the process of addiction to drugs such as ecstasy, cocaine and heroin.
The most effective strategy will not just be medical but will reflect on the reasons why people become addicted and provide individuals with a route out of their addiction altogether. Fundamentally, that will mean tackling effectively problems such as poverty, unemployment, homelessness and crime. The harsh reality is that there is no one solution that will comprehensively eradicate the harm caused by drug addiction. Serious investment is required in a number of areas if we are to have a greater impact on the lives of those most affected.
I welcome the findings of the review into opioid replacement therapies, which recommends that we attempt to prioritise recovery from addiction and aim to work more consistently with grass-roots agencies across the country. However, I would still like to see from the Scottish Government a timetable outlining the action being taken to provide clear and effective routes from addiction to recovery. Those who depend on the support of key agencies and services are not only the drug users themselves but their families and the wider community, all of whom are affected by the criminal behaviour that facilitates the traffic of drugs into Scotland.
Having worked within the field of addiction for the past 20 years in various roles and projects, including latterly as a social work professional for Glasgow City Council, I know that drug treatment and testing orders can play an important role in helping to deal with drug-related crime—a point that is also highlighted in the report. However, my experience has taught me that we need to use DTTOs better as part of a joined-up system that supports addicts to overcome their addiction. Very often, drug treatment and testing orders are too little, too late and are handed down to individuals who are already well acquainted with a life of hard drugs and the criminal behaviour required to pay for them.
We need to be smarter about when we intervene with drug users. In my view, intervention should be as early as possible. Our agencies should be working within local communities where drug dependency is known to be high, and they should be carrying out preventive work with young people in schools and youth centres. For established users, our systems need to be effective at helping those who combine a number of drugs as well as those who misuse alcohol on top of drugs. It is a mistake to oversimplify the problem by isolating substances and neglecting the pattern of abuse that, for too long, has ruined lives and families.
We know that the number of drug deaths in Scotland is too high. I will work with the Scottish Government to tackle that tragic reality, and I commend the basic principles of the report on ORT. I urge the Government to look more widely at the issues that we face and to place an emphasis on the kind of preventive work that will result in Scotland becoming a cleaner and safer place to live for future generations.
15:24
We are all aware of the effects of substance abuse on the individual, those close to them and the wider community. Indeed, many members have visited such individuals and the families and the groups that look after them and perhaps even those peoples’ families, as Anne McTaggart mentioned. We should all pay tribute to their hard work in looking after and supporting families and those who suffer from substance misuse, particularly as they often do so voluntarily. I hope that members also agree that people who suffer from substance misuse need understanding and support, and that they endorse the expert group’s conclusions and recommendations while we continue to improve that support.
Scotland’s 30 alcohol and drug partnerships are vital in delivering those aims, and I welcome the minister’s announced consultation with the ADPs on the development of quality principles and, importantly, a strong commitment to human rights.
It is true that concerns have been expressed that, as Mary Scanlon mentioned, ADPs have not been as transparent as they could be. It is therefore encouraging to see new planning and reporting mechanisms agreed. However, it is also important that they are given the flexibility to develop local strategies as the level of substance misuse and underlying reasons differ widely across Scotland. Indeed, I am sure that members have many different stories to tell about what happens in their constituencies and regions.
David Liddell, director of the Scottish Drugs Forum, when commenting on the report highlighted the fact that
“significant income and health inequalities ... underpin much of Scotland’s drug problem.”
Anne McTaggart also mentioned that matter in her speech.
In Glasgow, the prevalence of drug misuse is still considerably higher than the national average, which is in part due to the inequalities that exist in that great city and the constituency that I represent. Although tackling the issue may fall outwith the remit of the report, it is important to remember those underlying reasons. I therefore welcome the minister’s comments on health inequalities and the public health minister’s involvement in the work. I encourage joint working, if at all possible, with other Scottish Government departments to tackle inequality at all levels.
The minister mentioned the recovery initiative fund and the unity recovery football club. That is a great example of a local initiative that not only supports recovery, but offers other healthy avenues that give people a new interest and focus. The fact that it also fosters a sense of community among those participating is, to my mind, an important aspect of such projects.
There are many other projects in Glasgow that take a holistic approach to treatment rather than adopting more mainstream methods. Just like us, which is based in Milton in Glasgow, is another great example. It offers a structured 10-week spiritual-based skills programme that focuses on empowering individuals to take control of their lives in a meaningful way and reduce their reliance on prescribed medication. There are plenty more examples of such an approach not just in Glasgow, but throughout the country. They are important to our overall perception and treatment of substance misuse. Perhaps the minister would look at including that approach in the Government’s future drugs strategy.
Another important aspect of support and prevention must be to help people coming out of prison to ensure that they do not simply fall back into substance misuse. Unfortunately, the transition from prison life back into society has seen a number of people go back to past habits, reoffend and be sent back to prison. As a member of the Justice Committee, I know only too well from prisoners’ experiences and the evidence that we have heard that substance misuse is part of the revolving door back to prison. It is very much a vicious cycle that must be ended if we are to avoid further drug misuse.
The Scottish Government’s public social partnerships have been used in Low Moss prison to tackle that issue and offer the necessary support to individuals after they leave prison. I have an example to share. One user of the partnership said:
“There are so many wee things that you need to sort out. Housing, benefits, meds, and add all these wee things together and it feels like an uphill struggle from the start.”
After leaving prison, he went to his doctor’s but he had been deregistered and was told that he would not get what he called his “subbie” or, in other words, his prescription, as they had not received a fax from the prison about it. Faced with that, it would have been easy for him to slip back into substance misuse. However, in his case, the PSP spoke to the prison doctor and got the matter sorted out. That is not an isolated incident but, with the support of the PSP, it was much easier for him not to offend again. PSPs have been shown to work. Would the minister consider rolling the model out across Scotland?
I welcome the independent expert review of opioid replacement therapies in Scotland and the fact that, at its heart, it promotes person-centred recovery. The review also highlights the desire further to develop information, research and evaluation systems at a national level. I encourage the minister to include in that research the use of holistic approaches to drugs misuse and the use of public social partnerships in achieving the aims of the Government’s drugs strategy.
15:30
The change in the debate on this subject compared with last year is remarkable and I welcome the fact that we have got back to more of a consensus on drugs misuse. The issue was probably all sparked off, to David Clegg’s great delight, by the Daily Record, which targeted what it called the methadone millionaires.
I met Mr Houlihan who was a so-called methadone millionaire. He is a pharmacist who has built up his business and works in some of the hardest communities in the west of Scotland. I have never seen a pharmacist more engaged in the interests of the people whom he serves. He wants to change their lives, and I was inspired by his commitment to his community, so I did not recognise him as a methadone millionaire. I think that the profit and the turnover were mixed up on that. He was not, as he was characterised in the Daily Record, somebody who did not care about the people whom he served.
The report was also inspired by the concern that methadone was triggering a number of deaths from drugs. It should be recognised that many commentators said that it was really about a heroin drought that, in that period, was forcing drug users to experiment with different types of drugs. When people experiment, sometimes things go wrong. Methadone itself was not the problem; there were wider issues at play as well.
We were also dealing with a group of people who dropped in and out of services and had chaotic lives. I will not say that it is natural for such events to happen to such people, but we could understand the reasons why they happened, which is why a superficial look at the figures was not helpful.
I am glad that we have got to the bottom of why the number of deaths was increasing, because I am clear that methadone is part of the solution, not part of the problem. If we compare Russia, which does not have a similar needle-exchange and methadone programme, with the United Kingdom and Scotland, we see that the blood-borne virus problems there are far greater than they are here. We should recognise the differences that we have made over time, and I am glad that the Kidd report endorsed the point of view that methadone is part of the solution, not part of the problem.
I was recently at the Phoenix Futures graduation ceremony in Glasgow. I was a wee bit daunted by going into the Woodside halls in Glasgow, I have to say. There were a lot of people who—how can I put it?—have seen the hard end of life. Many of them had tattoos on their knuckles and had various other marks. However, when I went in, it struck me that they were all hugging one another. They were hard people and had seen difficult bits of their communities, but they were hugging one another.
That was a mark of the success of Phoenix Futures. The organisation has created recovery communities—people who look after the emotional side of one another’s needs. It was a tremendous recommendation. Those people were delighted to have graduated out of drugs misuse, and that is the kind of project that we should celebrate.
I also attended a project in Kirkcaldy not long ago and met a young man who said that he was more frightened of recovery than he was of drugs misuse. He was recovering but he said that, having come off drugs, he now saw the world and had to face up to all his demons, from which he had managed to hide in the past. He said that it was getting more difficult being in recovery. Members can understand why people dip in and out of recovery over time and that it is not easy to progress naturally from methadone to abstinence.
Yesterday’s Scottish Drugs Forum conference was an excellent event that focused on trauma. Jim Eadie is right that poverty and deprivation are major contributory factors to drug misuse, but traumatic events in people’s lives—regardless of the background that they come from; people from wealthy backgrounds as well as people from poor backgrounds are affected—are significant, too. The SDF’s event focused on the effect of trauma—not just the trauma of one-off events, but longer-term trauma.
Elaine Murray is right that there is still a bit of debate about what recovery is. I think that there is a general understanding that recovery means improvement and that it is different for everyone. Some people in the sector view recovery as complete abstinence, although I would not say that they are the majority. I think that that is a healthy debate. When I was at the Phoenix Futures event, someone said that they condemned methadone—they did not like touching it one bit—but the majority of people I meet in the drug misuse community recognise that it has a role to play.
The issue is not just about medicine; it is also about the mind and the wider factors in life. Another consideration is the degree of compulsion that should be involved. To what extent should we encourage drug users to undergo treatment? People would never be compelled to undergo treatment, but how far along the track from encouragement to compulsion should we go? That is critical. There is also a lively debate about residential treatment versus community treatment.
I think that the biggest shake-up that is needed is in the NHS. We need to try to get the NHS in the wider sense to engage properly. Drug abuse affects a range of services from housing to health to justice. Justice takes the lead, but the NHS needs to take a lead, too. That is why it is important that the medical director should be the lead person when it comes to opioid replacement. We need a person in the NHS to take a much more comprehensive lead on such matters.
Does the member agree that the integration of social care and health might be a pathway to relieving some of his anxieties?
You should be drawing to a close, please, Mr Rennie.
Perhaps, but we should not look only to structural changes to change minds. We need to get leading people in the NHS to fully embrace drug misuse instead of just leaving it to someone else. The issue goes beyond the simple one of recovery. We need to sort out issues of housing, work and family. Another issue that I have noticed to an increasing extent is that of boredom: people who are drug misusers are just bored.
And finally—
A bit of good news is the fact that the number of younger drug users is dropping. We should welcome that, because it means that we are moving in the right direction. We still have a lot of work to do, but we are moving in the right direction.
15:38
I congratulate Willie Rennie on saying that we are moving in the right direction.
Like many of my generation, I have lost too many friends and family members to drug use. I am not surprised by the finding that there are more individuals with a drug use problem in the 35 to 64 age group than there are in the 15 to 34 group. My generation failed to recognise the danger of drug use and, today, the same generation is failing to recover from it. More to the point, many of my generation still consider drug use to be a recreational habit and still claim that they should have the freedom to choose to use drugs. They ignore the cost to society and the human cost—more than 500 lives a year are lost to drug use in Scotland.
I am delighted to have the opportunity to speak on the independent expert review of opioid replacement therapies that was commissioned by the chief medical officer and led by the independent Drugs Strategy Delivery Commission. Some members have already told stories about what is happening today. Because the biggest problem is among the older generation, I would like to share with the chamber a story about one of my friends back in France before I came to Scotland.
This person was normal—he could have been somebody’s neighbour. He was a young plumber of 18 years old. He looked after his flat and his little car very well, and he was careful about what he ate. However, he loved recreational drugs, which he took all the time. He told me all the time, “Christian, you should share this with me. You should try it.” I always said that it was not for me and I argued that it would lead to the use of harder drugs. He always dismissed me. He had a regular life and a regular girlfriend, who was his sweetheart. When I left France, he was one of the friends whom I really missed.
Two or three years later, I heard that my friend had died. I did not understand why, so I inquired and I discovered that he had died of a drug overdose. What happened was a silly thing—his sweetheart left him and one thing led to another. He did not die with tattoos or doing anything illegal; he just died of an overdose.
That story shows that, although everyone could be led to believe that using drugs is a personal choice, addiction is extremely difficult to recover from. In those days, people did not have the same opportunities as are available today. I wish that my friend Pascal had had the opportunities that opioid replacement therapies offer people in Scotland today.
In my area—in Aberdeen city and Aberdeenshire—the statistics show that the number of drug-related deaths fell between 2011 and 2012. In my region—North East Scotland—recovery communities have been set up. Aberdeen in recovery was formed by a small group of people in recovery in 2012, with support from Aberdeen city alcohol and drugs partnership, to help to reduce stigma and raise the profile of recovery from addiction to drugs and alcohol. Fraserburgh in recovery has received £1,000 of grant funding. It offers peer mentoring and alternative therapies and it showcases recovery journeys.
“The Road to Recovery” is the only way to tackle the problem of drug use, but I am delighted that the expert group recognised that it can be delivered only as part of a coherent person-centred recovery plan.
The rate of drug taking in the population is falling, and drug-death statistics show an ageing cohort of drug users. The number of drug deaths among under-25s is falling and is at its lowest level since records began. Many of those who are lost to us are older drug users who have become increasingly unwell over the years. Drug-death statistics reflect wider sources of data that show a decrease in drug use among the population and show that far fewer young people are using drugs than before.
My generation has a huge responsibility for the number of people who are affected by the problem of drug use. Too many people of my age still choose to ignore the danger of drug use, despite the number of friends and family members whom we have lost to it over the years.
I can see that, through the education programme that is in place for Scottish schoolchildren, younger generations have a different attitude to drug use. I know that my daughters have that and I hope that my grandchildren will have the same kind of attitude. That is borne out in the statistics, which show that the rate of drug taking among young people is the lowest in a decade.
The position is encouraging. I thank everyone who is involved in delivering the Scottish Government’s strategy, which is keeping people alive. I know how important it is for families of different backgrounds across Scotland. Opioid replacement therapy—methadone—is keeping a member of my family alive and I am thankful for that.
15:44
I thank Christian Allard for his thoughtful and heartfelt speech. The debate very much benefits from such contributions.
I welcome the debate, which follows a debate we had last year. The issue is important.
Mr Hepburn, I am having difficulty in hearing you. Will you move your microphone slightly?
Okay.
Thank you.
I will try to talk louder, Presiding Officer, and see whether it helps. People do not usually have difficulty hearing me.
Few of our constituents have a dependency issue, so I will use some of the statistics that are available for the NHS Lanarkshire area that covers my constituency. Those statistics set out the situation in some detail, but there is a serious impact on an individual who has such a dependency. Such people often suffer from complex multiple problems and they can be very vulnerable, as Elaine Murray said.
There is, of course, an impact on the person’s family. Who among us would hope for their child to have a drug addiction?
Then, of course, there is the impact of dependency on our wider society and our communities. We know that many people get involved with criminal activity to feed their habit. It is therefore absolutely right that we are having this debate and I welcome the expert group’s report.
This has been a historic week and this is an important debate. It might not be as historic as some of the other debates that we have had this week, but it gives the lie to the suggestion that some in the Parliament have made that Scotland is on pause. Today’s debate is a vivid demonstration of the Scottish Government taking action and getting on with the business of Government by working to improve support for and treatment of those who have an addiction.
The Government has a good record in that regard. It established and published the national drug strategy, “The Road to Recovery”, in 2008. Last November we had a debate to follow the commissioning of the independent group whose report we debate today. That is a significant effort towards improving support for those who have an addiction.
As I said earlier, I will talk about the situation in my area. Mary Scanlon said that she is concerned about the rate of progress. We should all be concerned about that and do everything that we can. However, there is broadly a good record in the NHS Lanarkshire area, which covers my Cumbernauld and Kilsyth constituency.
In this year, the Scottish Government has allocated almost £6 million, up from £4.3 million in 2008-09, for drug and alcohol treatment, and that has made a real contribution to starting to tackle the problem of drug taking in the NHS Lanarkshire area. Drug taking across the general population has fallen from 12.6 per cent in 2006 to 9.1 per cent of 16 to 59-year-old self-reporting drug users in 2010-11. Again, among young people, the figure in 2010 was the lowest it had been for a decade. It dropped from 23 per cent to 11 per cent of 15-year-olds reporting drugs use in the past month.
In the NHS Lanarkshire area, 98.8 per cent of people are treated for drugs and alcohol addiction within three weeks, as opposed to the Scotland-wide figure of 96 per cent. No one is waiting more than six weeks for treatment in NHS Lanarkshire.
Lest I be accused of painting an entirely rosy picture, I recognise that, in the past four years, there has been an increase in the number of drug-related deaths in the Lanarkshire area. I am not saying that everything is perfect. There is obviously still more to be done, but the overall picture is one of progress and that is to be welcomed.
I very much welcome the report of the independent expert group. It has to be seen as a contribution to and building on progress. Dr Brian Kidd, who chaired the group, set that out when he said that the review has identified a range of areas in which progress is required. Looking at how people have responded to the report, we see that David Liddell, the director of the Scottish Drugs Forum, has welcomed the expert group’s report, which is very important given the fact that the forum works with people on the ground who are affected by addiction and campaigns for greater awareness and change in the area. It obviously supports the report.
Willie Rennie made a good speech, and his point about the work of pharmacists was well made. They buy into the report, too. Community Pharmacy Scotland made a number of important points in its briefing to members. It points out that community pharmacists are the health professionals who have the most interaction with patients who receive opioid replacement therapies and that pharmacists are probably the healthcare professionals that people who live in the areas of greatest deprivation will see most often. We are aware of the correlation—it is not a hard and fast rule—between poverty and addiction, and community pharmacists have an important role in rising to the challenge.
It is clear that the report has been welcomed. I very much welcome it and I look forward to seeing further work from the Government on the issue.
I apologise for interrupting your speech, Mr Hepburn. We seem to be having slight problems with the sound levels and I have asked for them to be checked. Other members have told me that they are having difficulty hearing, so it is not just me. As you pointed out, we usually can hear you quite well.
15:51
We should remember that we have faced 35 years of challenge in relation to drugs misuse as it affects Scotland. As many members have said, in that time, much has been achieved by those who are employed by the Government and those in the third sector through the various elements of work that they do to combat the threats, dangers and health risks that are presented by drugs misuse.
In that light, I welcome the presentation of Dr Brian Kidd’s report and the work done by the team who assisted him. Jim Eadie rightly identified that the strategic approach that underlies some of the lessons that Dr Kidd outlines is one of the most important messages. Willie Rennie mentioned that he has visited some groups. Like him, I have visited many groups. However, I do not fully agree with his assessment of how we arrived at the current situation. It is fair to say that, when the review was initiated, there was a growing clamour and criticism in the Parliament—I was one of those who offered criticisms—and a campaign by the Daily Record. The review took place on the back of those developments. No matter what brought the review to pass, it is most welcome.
In my view, there was never a presentation that suggested that there should be an end to opioid replacement therapies. To argue that there was is either a misunderstanding of the case or a misrepresentation of what people were trying to achieve. The problem that we were trying to address, which we now understand more clearly, is the number of people in Scotland who are accessing treatment therapies, particularly methadone. That is in excess of 20,000 people, with the cost of the service that is being provided estimated to be about £36 million, or £100,000 a day. The number of drugs deaths has risen to a record high and, last year, 41 per cent of those deaths involved methadone. Unfortunately, the United Nations Office on Drugs and Crime places Scotland in the unenviable position of leading the league tables on opioid abuse, which is not something that any of us would wish to be the case.
There has rightly been cross-party support for successive Government and Administration policies. However, that support should not be given without a commitment and without the ability for us to offer observations and criticisms. It is important that the new review has focused firmly on recovery-oriented systems of care. I welcome that impetus and focus on delivery of outcomes that involve recovery, which can mean many things to many people.
I hope that the minister will say at the end of the debate that steps will be taken to deal with the lack of evidence presented by some ADPs regarding a real impetus towards recovery, that the real concerns around the lack of progress found in many ADP areas on the delivery of recovery-orientated systems of care will be dealt with and that he will monitor the outcomes.
The third point made in the report is that a lack of institutional memory has led to repeated mistakes, false trails and a failure to capitalise on success. As was said earlier, the report refers to improving local information systems to better identify people on ORT so that we know what works.
There will not be a member—I include those in this chamber and those who have not attended the debate—who does not want the Government to succeed; we all want success in this area. However, we need to measure what we are doing. We need to know that what is being done in our name through the policy of “The Road to Recovery: A New Approach to Tackling Scotland’s Drug Problem” is effective and is giving everyone who is involved in treatment the opportunity to succeed on their terms.
It has been said that some people will not recover and that they will require to be maintained through methadone or some other means. We need to accept that, but we need also to have an ambition for every patient who enters our care, to give them a chance to be all they can be in their lives and to allow them to play a full part in their family, their community and Scotland’s future. In that context, we urge the ministers to apply the lessons from the review with some energy and to come back to the chamber regularly to tell us what has been achieved and what benefits we have gained from applying the pressures as suggested.
I support the amendment in the name of Elaine Murray. Thank you for the opportunity to speak in the debate.
15:57
I am very glad that Graeme Pearson has had the opportunity to contribute to the debate. When I was a member of the former Justice 1 Committee, which Pauline McNeill convened, I first met Graeme Pearson over dinner in Glasgow to discuss drug problems. The dinner was excellent, but the message was compellingly disturbing.
I recall that on that occasion Graeme Pearson told us of a drug dealer in Glasgow who had gone into a showroom with cash and bought a brand new Bentley. He told us that that same individual had bought a fleet of cars for his private hire taxi company. He told us that this is a social problem as well as an economic problem, costing perhaps 1.5 to 5 per cent of our gross domestic product. If we were to look at it just in economic terms, that is a loss of tax take of between £0.5 billion and £1.5 billion for Scotland alone.
The reality is that the finance is not really the issue. I first spoke in the Parliament in a drugs debate on 27 October 2004. At that point I said:
“Addiction is a feature of human behaviour and, realistically, it cannot be eliminated.”—[Official Report, 27 October 2004; c 11150.]
In “A Counter-blaste to Tobacco”, which was written 400 years ago, James VI said that the smoker
“by custome is piece and piece allured.”
The whole issue of addiction is very far from new.
It is perhaps worth saying that in the 1890s, Sears and Roebuck, a well-known American retailer, had in the catalogue that it distributed to millions of homes across the United States a syringe and cocaine that could be bought for $1.50.
Attitudes have changed and the impact of addiction has changed. However, it was recognised 100 years ago that it was a major issue. The first international drug control treaty was the international opium convention of 1912, which came out of a conference that was held in Shanghai.
From the 1950s, of course, we started to see a relatively small group of morphine addicts being looked after by general practitioners. My father, who was a GP, looked after a tiny handful. Even then, the impact of criminality could be seen. In 1951, a single drug addict broke into a dispensary on the outskirts of London; a decade later, it was discovered that, from that single criminal act, 60 addicts had been created, who suffered problems. It is all too easy for little acts to have huge consequences in the area.
In the 1960s, it was, of course, thought that there were relatively few addicts. In fact, in 1964, the Home Office reported that there were 753 addicts in the UK as a whole. I think that that was questioned at the time; it was also questionable. It certainly led, with greater understanding, to the dangerous drugs legislation. However, it was thought at that time that the problem was so limited in Scotland that no provision whatsoever was made for Scotland. By the late 1970s, boy we knew that we had a problem.
We now have an excellent report that shows what we are doing to deal with that problem. We certainly cannot undo our position simply by reversing the actions that got us here. We must be proactive.
Originally, we sought simply to support the addicts and deal with their addiction medically. Now, of course, addiction has a huge reach into criminality. It is also a public health and infection issue that has to be dealt with.
Let us not forget, either, that opioid addiction, which is the subject of the debate, is part of a whole series of addictions. We have in our society alcohol, gambling and nicotine addictions. A member of staff who worked for me—among the hundreds who did so—was even addicted to a proprietary nasal spray. He consumed 20 bottles of it a day, although it did not seem to affect his life.
The illegal drugs that we are talking about and the issues with which we have to deal in that context are in part related to the free cigarettes that were dispensed to servicemen during the second world war. That desensitised us to the idea that addiction should be avoided.
In closing, it is worth welcoming very much the consensual nature of this debate. It has brought together different points of view, experiences and inputs, but they all point in the same direction. I think that Willie Rennie referred to that.
Two examples of how things can be mishandled are perhaps worth going back to.
Derek Hatton, who was the Labour deputy leader of Liverpool City Council, wanted to attack Margaret Thatcher. I might be up for that, but he did so by designating Liverpool as “smack city”. We are still living on the back of that.
In my constituency, a now-deceased GP, Sandy Wisely, quite unnecessarily and unjustifiably talked up a drug problem in Fraserburgh. We are still dealing with that today in reputational terms.
We have had a good, balanced debate. Let us hope that that continues.
I very much support the essence of what Labour’s amendment says, but very much support the Government’s motion.
16:03
Methadone maintenance treatment is not a solution to drug addiction; it replaces one form of addiction with another. However, it can enable an addict to stabilise their addiction and begin to rebuild their life. As well as making their addiction more manageable, methadone treatment is safer than taking drugs of unknown origin and strength, which may also involve sharing syringes and needles, with the risk of contracting hepatitis and HIV.
Methadone treatment is sometimes criticised by the media or by members of the public who think that more should be done to cure addiction through abstinence. I understand that that alternative is used in some countries, including Russia—Willie Rennie mentioned that—but for many users, withdrawal is easier said than done. There may be adverse physiological and psychological consequences; that is the nature of addiction. For that reason, opiate replacement therapies have long been essential harm-reduction measures; that role was endorsed five years ago by the road to recovery strategy.
However, despite the apparent consensus, the evidence is not clear-cut. The expert review recognises that there are issues with the evidence that is available and quotes the 2012 UK drug policy commission:
“Drug policy is currently a mix of cautious politics and limited evidence and analysis. This is coupled with strident and contested interpretations, both of the causes of problems and the effects of policies. In fact, for as long as there has been a drug policy, there have been gaps in the evidence as well as uncertainty about how to understand and act on the evidence that we do have.”
In that context, I am pleased that the review not only dealt with the many people who are involved in delivering and receiving a variety of treatments, but accorded their views and experiences equal status with those of local and national bodies. If we are to develop an effective person-centred approach to opioid addiction, it is essential that such evidence is a significant part of our consideration of what will be the best way forward.
One aspect that has been made clear by such stakeholder input is that some alcohol and drug partnerships perform poorly when it comes to recovery. The report notes:
“There was little evidence presented by some ADPs regarding a real impetus towards recovery. Stakeholder reports supported this view.”
The review highlights that basic information was not often accessible, and that
“Clear strategic plans and objective reports of improvement were rare ... Elements of recovery orientated services were often absent.”
It also stated that
“There was not a strong sense of accountability ... systems are destined to continue repeating mistakes or failing to capitalise on successes.”
Those views add up to quite a damning indictment.
Addicts who are motivated to stop are unlikely to succeed without the right help and support—not only for the initial period of withdrawal, but for the longer term. However, that help must address the circumstances that contribute to drug addiction and the relationship between drug taking and criminal behaviour. I welcome the review’s consideration of those issues and its findings, which seek a more consistent approach that focuses on recovery as a primary aim.
The review recommends that a full range of care services be available in every area, including community rehabilitation services such as detoxification, residential rehabilitation, and services that deal with employability and housing. It also recommends development of better ways to link action on health inequalities with action to address problem substance misuse. One key measure would be to ensure that local inequalities strategies refer to plans to address the risks that are associated with substance misuse.
Drug treatment and testing orders have an important role to play in respect of drug-related crime. We need to use them better, as part of a joined-up system that supports addicts to overcome their addiction. The debate has focused on opioids, but we should bear it in mind that many addicts have multiple addictions. Systems need to take account of patterns of drug use that encompass combinations of alcohol, opiates and other substances.
I note the recommendations on pharmacy services; the role of pharmacies has evolved and has become important, so given how that role has changed, we need to examine its operation in order to ensure that it is working to best effect, as part of the overall strategy. I support the recommendation that there should be a national specification to ensure consistent high-quality care across the country, and that the system that is used to reimburse pharmacists for dispensing methadone should be reviewed.
You must conclude.
We have heard how many deaths result from substance misuse, but any such death is one death too many. We need to ensure that we have a system that provides appropriate treatment options for everyone who wants to escape the dangers of addiction.
16:10
I am pleased to be speaking in the debate. Although it is primarily a justice debate, I will take a little of my time to raise issues to do with health inequalities by touching on what I have learned during my time on the Health and Sport Committee. I will come to that in a moment or two.
When we debate the impact of drug use, we must acknowledge the devastating impact that it has on communities, families and individuals. That is just as important when we debate how best to treat people who have a history of drug abuse and are trying to get clean. Due to their past problems, some lose friends, become lepers in their community and find that they are shunned by family members, yet those groups of people are the resource that is needed to ensure that those who seek treatment are given encouragement to continue with it, and support when challenges emerge—as they surely will. It is at those times that local agencies must come to the fore to offer their support. Without them, there is a danger that people will not complete their treatment and will fall back into drug misuse.
In my constituency, an organisation called Alternatives West Dunbartonshire Community Drug Services offers support to people who suffer from drug abuse. Since February 2000, it has been working in the Clydebank area to offer alternatives to drug use through a range of services to individuals and families who are, or who have been, affected by drugs. The organisation carries out a great deal of work and is proactive in its attempts to bring people out of drug abuse. Its outreach programme is an umbrella term for a style of work that means it literally reaches to where people are at. Alternatives WD does not wait for people to seek help once they see themselves as having a drug or health problem, but seeks them out with the aim of providing education and services directly in the community.
Although the motion acknowledges that opioid replacement therapies have a strong evidence base, it is important to look at other avenues for treating people who suffer from drug misuse. The Alternatives WD group is one such avenue, and I commend it for the hard work that its members and volunteers carry out in the community. More important is that it should—given the impact of its work on individuals and families—be encouraged by all.
I have contributed to a number of health debates in Parliament in which the main theme has been the need to move to person-centred treatment and recovery, and this afternoon’s debate is no different. I am pleased that the Scottish Government has accepted the expert group’s conclusions and that it is committed to delivering on the recommendations as part of a coherent person-centred recovery plan. All services, be they local or national, must be focused on the individual’s needs. I support the calls for better information systems to identify people who are on opioid replacement treatments and ensure that they are making progress with their recovery.
There is little point in offering the treatment if it is not part of a plan with SMART—specific, measurable, achievable, realistic and timeous—goals. In order to ensure that there is progress in treatment and recovery, there must be constant monitoring to ensure that recovery is taking place to a satisfactory level.
It is difficult to look at the different systems that are in place, or that should be strengthened or established, with the level of inequality that exists. Some people argue that inequality in access to health contributes to, and is the main cause of, drug abuse, but that misses the bigger picture. Health inequality, social inequality and inequality across the board can be summed up in one word: poverty. It will come as no surprise to anyone that people who live in poorer areas are more likely to suffer from the effects of drug abuse—either personally or in their family. Regardless of how much money is thrown at health inequality, it can be a waste if we do not bring people out of poverty. If someone grows up in a family or an area where they are written off or have been told time and again that they are useless or worthless, it will make no difference to them if resources are ploughed into their area. There are people in bad circumstances who, because of the stigma of poverty and perpetual messages of hopelessness, adopt a fatalistic attitude that for them amounts to, “This is as good as it gets for people like me. This is my lot.” Therefore, in order to tackle the cause we need to break the cycle of poverty.
If we make people’s lives meaningful with well-paid employment, which would give them the confidence to believe in a better life, I promise that health inequalities will narrow as people are lifted out of poverty.
You must conclude.
The Scottish Government has well and truly got that message. This Parliament needs full powers if it is to change the lives of people and make a difference in terms of both inequality and drug misuse. I commend the motion to Parliament.
Thank you. We are now running rather short of time, so I ask the next three members to keep to their six minutes, please.
16:17
I, too, welcome the broad consensus that we have heard, and which I hope will continue. I was delighted to hear the minister talk about the human-rights based approach that will be taken.
I want to comment on some research by the Scottish Drugs Forum, which looked at the life stories of 55 people: people, not statistics. The main aim of that research was to record and understand the life stories of problem drug users; we have heard many examples of what came out of that. It is compelling that the interviewers were SDF volunteers who were addicts in recovery. I commend that approach, which was also used in SDF’s naloxone peer-educator initiative.
I was delighted that the research covered urban and rural Scotland, because the problem is not limited to the central belt—it covers the entire nation, unfortunately. It will come as no surprise to anyone that most problem drug users are from disadvantaged neighbourhoods and are personally disadvantaged. There is no doubt in my mind that antipoverty policies and the promotion of equality, in terms of income disparity, have the potential to make a significant impact.
We heard from members that an association between problem drug use and deprivation is worsened by stigmatisation. I find such stigmatisation to be particularly galling when it comes from people who systematically abuse alcohol, as it often does. There is almost a strange snobbery associated with that.
Many of the 55 people talked about significant childhood problems, including anxiety and attention deficit, hyperactivity and conduct disorders. I hope that the getting it right for every child approach will catch that. Anne McTaggart’s comments about education were very important, and I certainly commend the patient-journey approach, which looks at where interventions could have made a difference.
We heard in the research that using alcohol and drugs relatively heavily from a relatively young age happens usually in the context of socialising and having fun. In a previous debate I mentioned to the health minister the cynical targeting by social media that is taking place, which is a significant problem; alcohol promotion—whether peer promotion or global promotion—is something that we need to address.
We hear of the multiagency approach to everything, which is fine; however, local authorities and housing associations face challenges in having to deal with competing issues including provision of housing to people who have drug addiction issues and the disruption that can sometimes result. We need to address that and we need to address GPs refusing access to people because of their addictions.
Of course, many addicts are not bothered or concerned about the implications of what they do and will experiment with so-called legal highs because they feel that they have nothing to live for. We also have to remember that many of them are victims of the violence that is associated with the street drugs trade.
I am particularly concerned about the problem of estrangement from families and about difficulties with care and custody of, and access to, children. We should work very hard to keep family units together and social work departments—rightly—take a child-centred approach to such matters.
I, too, support methadone as an important part of the process. It is regarded as an essential aid on the road to recovery, offering the possibility of improvement, increased stability and—significantly for me—a reduced need for street drugs. Interestingly, the SDF research also highlighted difficulties in getting and keeping a methadone prescription. In my earlier intervention on the minister, I asked about the patchwork of services and I certainly think that there should not be any no-go areas—including Argyll in my region, where thus far ignorance has prevailed. However, I think that NHS Highland is going to ensure that the full range of services that should be available to all citizens will be available.
I want to raise with the minister an issue that has previously been raised by my colleague Patrick Harvie about diamorphine, which as we know is a controlled drug but can be prescribed for treatment of drug misuse and addiction. In the response to Mr Harvie’s written parliamentary question, the cabinet secretary Alex Neil said:
“Such decisions should be based on individual patient need and are a matter for the clinical judgement of the patient’s doctor”.—[Official Report, Written Answers, 18 November 2013; S4W-17911.]
The fact that no licensing requests have been made might be connected with an understanding that such a move would be a departure from Government policy, but I want nothing to be ruled out in terms of assisting people who have drug issues, including the prescribing of heroin on a harm-reduction basis. Of course, that would need to be assessed, but I would welcome either minister’s comments on the matter. Of course, the same goes for the very challenging approach of supervised injection, which also has a role in harm reduction, and street-drug analysis. There is no doubt that our harm reduction people often deal with very challenging individuals and disruptive lifestyles, so anything that can be done to help is worth trying. I therefore ask ministers to consider such initiatives.
A very compelling phrase in the SDF research was about
“maximising what people can recover to.”
People must have something to aspire to; with compassion, understanding and care, we can make things better for them.
16:23
In what has been a very positive and consensual debate, most members have, I think, referred to the person-centred approach. I have to say that this sort of thing is not new. I am sure that, with her social work background, Anne McTaggart will testify to the fact that it has been used for many years and, given his previous life as an occupational therapist in the health service, the minister, Michael Matheson, will be well aware of the approach.
I feel that we are looking on the person-centred approach as the magic pathway or whatever when it is, in fact, not. When we talk about a person-centred approach, we must ensure that we are being inclusive. People generally live their lives not in isolation but in a community, if not in a family, and if we do not involve the family or the community, these people might, as Gil Paterson suggested, question their sense of worth. Before they move on to the road to recovery, a person has to identify where they are at and where, perhaps, they would like to be. Sometimes that will require someone else—say, a professional—giving them appropriate guidance and the sense that they are being listened to and that they are very important.
I accept Gil Paterson’s comments about poverty and health inequality—those issues create problems. However, I say to the chamber that I have seen drug addiction in the affluent areas of the north-east. I have seen it happen in situations in which money is no object. I have seen it affecting families who, to some extent, are unaware that it is happening, because it has not impacted on their family life, in so far as the mortgage and bills are still getting paid. However, the misuse is still going on.
We have moved on a great deal in the area of stigma around drug addiction. One of the areas in which we have moved on to a greater extent than people give us credit for is in the community pharmacy service. That service has been embraced by communities, and I commend the work that community pharmacists are doing across Scotland. In Grampian, there are 131 community pharmacy practices. I believe that 127 are engaged in the area that we are discussing. That is to be commended.
People in the community pharmacy can see the bigger picture. They see the individual coming in to get their prescription for methadone, but they can also see the wife, the father, the mother or the brother coming in to get a prescription for something that might perhaps help them to cope with the addiction of one of their loved ones.
We have a long way to go, but we have made significant progress.
I congratulate my friend and colleague Christian Allard for sharing a very personal story with the chamber. Many of us can look at our personal circumstances and reflect on where we and our families are. When I worked in social work, I came across many examples of despair and absolute tragedy—the parent asking, “Why? Why did my daughter die? Why did it happen? What did I do wrong?” They carry guilt for the rest of their lives, believing that they should have done something. However, in reality, they probably did all that they could. It is when we turn our back on people requiring our help—when we turn our back on people in our community and our society because we do not approve of them—that we should feel guilty.
I believe that, in this chamber, we have a consensus to move things forward. I appreciate what Mary Scanlon said. Perhaps the process is not moving quickly enough. However, I think that it is moving at a pace at which we can evaluate it and that will ensure that the evidence is there, because we need that evidence base if we are to move forward in a way that might prevent deaths in t future.
We will never get to the bottom of this. As ever, Stewart Stevenson brought history back to the chamber. Addiction has been with us for centuries and will probably remain with us for centuries.
On a positive note, however, we have consensus and I believe that we have a pathway to success.
16:28
This is an important debate. Like Willie Rennie, I have noted the change of tone since last year’s debate. It is a welcome change. It is always better when we work consensually on sensitive issues such as this one, rather than seeing individuals or parties making a cheap bid for headlines, which can often derail progress that is being made. It is welcome that that has not been prevalent today.
I take on board the points that have been made about the fact that those who are at the sharp end of poverty and disadvantage often find themselves at the sharp end of drug misuse—that is absolutely correlated by figures—but, as Dennis Robertson said, the north-east has a particular problem around affluent drug use. Those people would not classify themselves as problem drug users but would probably consider themselves to be recreational drug users.
We must also remember that there are circumstances that affect an individual beyond their income, such as abuse of a sexual or domestic nature, which does not confine itself to those in the lowest income brackets. We should not define how drug misuse can affect an individual solely by their income. Christian Allard gave an extremely powerful personal testimony and, in last year’s debate, I made the point that I could point to individuals in my school yearbook who had fallen into addiction—individuals who, to all intents and purposes, could be said to have had the same life chances that I had. We do not know what may have gone on in their private lives to affect the trajectory that their lives took.
There is much to be welcomed. Other members have commented on the treatment statistics. In Aberdeen city, 99.5 per cent of people with drug and alcohol problems are being treated within three weeks, and nobody in Aberdeen is waiting more than six weeks for treatment. Those are extremely welcome statistics. Obviously, we want 100 per cent of those people to be treated within three weeks; nonetheless, having 100 per cent treated within six weeks is extremely positive.
Although the number of drug deaths is a lot higher than we would want it to be, the number of drug deaths in the under-25 bracket is at its lowest level since records began. In Aberdeen, the number of drug deaths has reduced from 31 in 2010 to 16 in 2012, which is welcome progress.
In addition, drug taking in the general population has fallen from 12.9 per cent in 2008 to 9.1 per cent in 2011 among 16 to 59-year-olds who self-report their drug use. Among young people, drug taking is at its lowest level in a decade, down from 23 per cent in 2002 to 11 per cent in 2010 according to the statistics that were published by ISD Scotland in December 2011.
There are around 3,200 drug users in Aberdeen, and Drugs Action tells me that around 2,000 of them are currently accessing drug treatment. That means, however, that there are 1,200 drug users out there whom we need to reach and encourage to seek treatment. I imagine that some of them will fall into the category that I mentioned earlier. Drugs Action offers a range of services across the city, including a counselling service that is available to drug users, ex-users and family members. The point has been made that involving the family in an individual’s treatment is vital because they have a role to play in assisting that individual’s recovery. Specialist counselling is also available for people who are affected by HIV, people who have hepatitis B or C, female drug users, young people, the parents or other relatives of drug users and people who are drug free but who are affected by drug misuse through their extended family or friends.
Drugs Action also offers city outreach services, with weekly drop-in advice, information and needle exchange sessions in my constituency at Mastrick, Northfield, Woodside and Middlefield. The Woodside outreach service has a dedicated worker for the Woodside area who operates two days a week at the Printfield Community Project and the Woodside Fountain centre. The outreach drugs worker offers individual counselling, support, advice and training to drug users, families, community groups and professionals in the Woodside area. There is a whole-community approach to recovery, which is important.
There is also the Aberdeen recovery community, which is a partnership between Drugs Action and Aberdeen Foyer. It not only seeks to ensure that individuals recover but identifies skills and interests and tries to ensure that, when the individual has been treated, they have the opportunity to reintegrate into society through employment and the opportunities that arise from that.
If the system receives an individual on the basis of their drug use but does not deal with the other factors affecting that individual, it can be said that the addiction has been treated but the person has not. We need to get to the stage at which the person is treated along with the factors that affect them. That is the concept of wraparound treatment that the Government is emphasising.
I welcome the report and the progress that is being made. I also very much welcome the consensus that has arisen during the debate. If that consensus holds, we can continue to make extremely positive progress in the area.
That brings us to the closing speeches.
16:35
I will start with Christian Allard’s speech, which I thought an arresting contribution to the debate. As well as to his experiences in France—which I, of course, regard as a model for nothing at all—he referred several times to the experiences of his generation. I do not know what age Christian Allard is, but the concept of generation struck me because, I have to say, when I was growing up in the 1960s, drug taking was presented as a highly glamorous thing. Drugs were the food of film stars, of Hollywood, of fashion, of racy society in London, of smart parties. If people died of drug addiction, it was due not to “an overdose” but to “an attack of the vapours” or to their having “a fragile constitution”. Nothing bleak really was portrayed in that language. As we went through later into the 1960s, drug taking was the way that people escaped the realities of Vietnam and LSD was the creative food underpinning the pop movement of the time.
Yet, in her opening speech, Roseanna Cunningham, in a completely unadorned and factual way, got us right back to the fact that in the second decade of the 21st century the reality is that we had the highest number of deaths in Scotland through drugs. Those were not people at smart society parties or film stars or people who were part of the creative process; in all too many cases—though some, perhaps, might have had too much money—they were, as has been said through the course of today’s debate, people who through circumstances of poverty and inequality had been led to that situation.
An important point underpinning the reason why we are considering the report is that, for the first time, a majority of those drug deaths were as a result of methadone. The fact that a majority of those on methadone who died were not on a methadone prescription led to the need for the recommendations that we have been considering. Another depressing fact is that, even within that, the death rate in Lothian was twice as high as the rate in Greater Glasgow and Clyde, although they are similar demographic areas. There are all sorts of underpinning trends in there that require to be addressed.
That is why it is important that there must be a real equality and a standard in the way that community pharmacies dispense methadone and in the services that they deliver. Those who have been dying of methadone not on a prescription have sourced that from somewhere. Unfortunately, it has probably come from those who were being prescribed methadone, so that standard is very important. In saying that, I do not take anything away from the tribute that Dennis Robertson paid to the commitment of community pharmacies. I have visited community pharmacies as well and I have seen that, and I understand that their commitment is very real.
Underpinning many of the recommendations is not just a legislative will. The reason why Roseanna Cunningham could be so unadorned and frank in her speech is that there is appreciation in the Parliament that the subject should be approached on a cross-party consensual basis and that there is no mileage to be gained in exploiting bad news where bad news exists and requires to be dealt with. Underpinning many of the recommendations is not some legislation but a tremendous effort and commitment by human capital going forward in what is not a glamorous task. That represents a huge task, which we should appreciate.
Sandra White introduced the issue of prisons. Information that came to me that I found depressing suggests that, in Saughton prison, some 400 of the 800 inmates are on methadone. They rarely detoxify. There are only two full-time addiction nurses, who have a case load of 200 people each compared with, say, a case load of 30 to 50 in the wider community. That depressing fact is another example of the huge challenge that we need to tackle.
On a lighter note, Presiding Officer, when you said that you were unable to hear Jamie Hepburn, I was going to offer to swap seats with you. Of course, Mr Hepburn makes a profession of gently admonishing me in debates, so let me return the compliment by saying that today his contribution was a model, if not a triumph, of improvisation.
Willie Rennie told us about Phoenix Futures and how everyone was hugging each other as they came through the door. As a father with children, I would do much the same at the sight of a Liberal Democrat—particularly on “Scotland Tonight”, I should say.
We heard from Stewart Stevenson about his personal experience in the reign of King James VI, while Jim Eadie and other members mentioned the need to tackle the stigma that substance misusers face.
I pay tribute to the work of the Scottish Drugs Forum and the addiction worker training project. I know that the minister has visited that project because on the wall there was a photo of her along with many of those there.
Without exciting the temper of the debate, I note that one thing that would most help women to recover would be greater childcare. I hope that we can resist making the obvious point in that regard in the context of this week. Anne McTaggart focused on the trauma that affects families and the circumstances that led to that trauma. Those families want to see a greater understanding, appreciation and projection of that into recovery and, as Willie Rennie said, recovery is an improving situation if we define it as such.
Elaine Murray and Graeme Pearson argued the Labour Party’s amendment in constructive terms, and we are happy to support it. Fundamentally, the minister should know that she has the support of this party in the work that she and her colleague are doing.
16:41
We welcome the review and its findings, which we hope will give a more consistent and rounded approach that has recovery as the main aim. We, too, want to see a clear commitment from the Scottish Government to improve the routes to recovery from drug addiction. That is why we are asking it to produce a timetable for action.
Many members, including Elaine Murray and John Pentland, have stated the obvious: we must have a person-centred approach. People’s recovery is different because the causes and types of addictions are different, so if we do not have person-centred treatment available, the approach will not work.
People cannot be put into boxes; they need to be at the centre of and directing the care. Mary Scanlon made the point that, when we are looking to introduce a strategy, we must listen to drug users and recovered addicts because they are the experts. In summing up that concept, Graeme Pearson was right in saying that we need to be ambitious for people, do the best for them and allow them to enjoy their lives and their lives with their families. Those must be the aims of our approach.
We must realise that we are dealing with human beings who have issues that we must help them with. Families are also very much part of that—Christian Allard’s speech about the impact of drug addiction on family and friends was not only moving but helpful to the debate. I recently met Scottish Families Affected by Alcohol and Drugs, and it pressed home that point. Sometimes it is the families who know what the causes are and are best placed to help with the recovery. They should be given the tools and the information that they need, made part of the process and allowed to fulfil that role, so that they are much better able to intervene when the time is right and to help people towards recovery, which was a point made by Gil Paterson.
A number of members talked about the age profile of people who have been addicted to heroin. It means those people’s families, especially their parents, who are often the people looking after their children, are aging and are perhaps becoming disabled themselves due to old age.
There is an issue related to young carers that we must deal with clearly. They have a fear not just about being taken into care but about accessing the available support because they need it for a parent’s addiction. We need to look at a child-centred approach.
I remember walking into a chemist one day and seeing a young lad who was probably about 10 years old. As he saw me coming, he had on his face not embarrassment but absolute shame as he stood beside his mother who was being handed her methadone by the pharmacist. He was in dread of me being a part of that.
The experience brought home to me the impact of stigma—that young lad was aware of the stigma and what he thought my reaction would be. I felt that, as a society, we were really letting him down. He obviously did not have the support that he needed; he was living with stigma every day.
Jim Eadie and many other members talked about stigma. The United Kingdom Drug Policy Commission did a report that discussed the feelings of shame and worthlessness that are engendered through stigmatisation. Those families have an impact on people’s self-worth. We cannot help people through the experience unless we build their self-worth. Families also describe being too afraid to reach out for help because they are too ashamed to speak to anybody about what is happening. If we do not deal with the stigma of drug abuse, we hamper recovery and prevent people from seeking help and, therefore, stop their journeys towards recovery.
As our amendment makes clear, we need not only to help people towards recovery but to tackle the causes of addiction. Many people talked about that. Gil Paterson talked about inequality, and he was right to do so, but there are also deeper causes, such as trauma and mental health problems, which Mary Scanlon mentioned. None of those is income related, but they are also causes of addiction, so we need to consider them all in the round and tackle them.
We need to tackle those issues for the people who suffer from addiction. As Willie Rennie said, the fear of recovery is great because, once people stop using the drugs that helped them to deal with the problems that caused their addiction, they have to go back and deal with those problems, which were insurmountable before and continue to be so unless they get the help that they need to deal with them.
The debate is really about opioid replacements. They have their place, as everyone has agreed. Of course, we need to make sure that the prescription is right. I represent many rural and remote areas where it is not possible for people to attend a pharmacy or access such treatments, and we need to consider different drug treatments.
That is especially the case for people who take prescriptions home with them and who share a home with children or to whose home children have access. Methadone causes respiratory depression, and if a child gets a hold of it by accident—that can happen, because children get everywhere—it can have a real impact on them.
We need to ensure that not only the people who need the prescriptions but the people who live with them are thought of in prescribing. We need to consider that as a matter of harm reduction to help stabilise people and to put in the necessary help and support. It is a question of dealing with the whole person and the causes of their addiction and considering how we can help them to come to terms with that.
Many speakers mentioned the area drug partnerships. As Graeme Pearson said, the Government needs to monitor the improvement in the area drug partnerships, because it is not fair that people do not have a quality of service. People need their issues to be dealt with. There must be national standards and—yes—local strategies, but they should be the same for everybody. People should not be involved in a postcode lottery that means that their addiction is dealt with differently and, indeed, their recovery is less because of where they live.
Many speakers mentioned pharmacies. We need to have a joined-up approach among social work, health, pharmacies and everyone else who deals with the issue. To go back to my point about the young lad, there must be dignity in the provision. There was no privacy for him or his mother, and that had an impact on their reaction to stigmatisation.
I could talk about many other issues and I could go on for ages, but I will not. We hope to see a timetable for the improvements that are outlined in the review, and I hope that that will give people real hope for their futures.
16:49
As some members have already said, this has been a largely consensual debate. Over my years in the Parliament, debates on drugs policy have been largely consensual, although last year’s was not quite as consensual. It is good that there has been much more of a consensus this time.
Out of the people who I recognise have been engaged in the drugs debate in the Parliament over the past 14 years, a few notable individuals have not been able to participate in today’s debate. One such person is Brian Adam, who is no longer with us; he would often participate in drugs debates. Another is Richard Simpson, who is unwell. Annabel Goldie has participated in drugs debates over the years; I suspect that she is prepping for a visit to my constituency this evening.
The debate has been helpful in setting the drugs policy issue in the wider context of inequality in our society. Jackson Carlaw showed his age a little when he reflected on how, over the past generation almost, there has been a change in the way in which individuals have got into drug use. Some of the personal experiences that we heard about from members such as Christian Allard and Mark McDonald demonstrated that.
Over the years, I have lost a number of good friends as a direct result of drug use or through illness or violence associated with drug use. Some of them were my best friends at school; sadly, they are no longer with us. Many members have been touched by the damage that drug misuse can cause.
The report helpfully underlines that “The Road to Recovery: A New Approach to Tackling Scotland’s Drug Problem”, which we published five years ago, is the right approach. It confirms that we are moving in the right direction, while highlighting some areas in which we face challenges and in which we need to take further action.
I want to pick up on a couple of issues. Mention has been made of the alcohol and drug partnerships and the health aspect. In particular, it has been identified that there can be inconsistencies among the 30 ADPs and in the way in which health boards deal with such matters.
Roseanna Cunningham and I are determined to do as much as we can to achieve a level of consistency, where possible. However, there is only so much that we can do. It is worth bearing in mind that ADPs are partnerships—they are partnerships that have been formed by local authorities, health boards and others in an effort to reflect most effectively what is needed in the local community. A top-down approach to prescribing everything that they must do on the ground is not necessarily the best approach, as it will not allow the necessary level of flexibility.
That said, as my colleague Roseanna Cunningham highlighted, ministers set a range of priorities that they expect ADPs to report on annually. That includes information on the health improvement, efficiency and governance, access and treatment—HEAT—standard, the Scottish drug misuse database, quality data in the national drug and alcohol treatment waiting time database and an increasing number of naloxone kits being made available. Some of those aspects can be measured, but it is worth bearing in mind that ADPs are partnerships and that we must allow a level of flexibility to reflect local need.
From what the minister sees in the NHS, does he think that enough senior people in the health service are committed to the job in hand? It is a huge job that crosses many departments and responsibilities in Government. Does he think that the NHS is pulling its weight?
I was going to come on to that in the next part of my speech, which is on health.
I think that, on the health aspect, we can get greater consistency because of the nature of the way in which we configure health services in Scotland. As Roseanna Cunningham did, I have set out that I am clear that I want to see much greater leadership on this issue in the NHS.
When I met primary and secondary healthcare teams a few weeks ago to discuss an aspect of the report, I made it clear that I expected all the boards to have an accountable officer at a decision-making level who could take responsibility and show leadership in this area of policy. That work is now taking place, and we expect all boards to demonstrate that they are doing that and to select the right individual.
We can do more, and I am determined to ensure that we do more and that someone is accountable for ensuring that the work happens. I do not want to prescribe whether that should be a director of public health or a medical director, but the person must be sufficiently senior to bring about the change that is necessary.
I will pick up on an area where we can get greater improvement. Elaine Murray talked about access to psychological services, which can be challenging at times and has been so for many years. That is why we are bringing in a HEAT target on psychological services. It will come into force from December next year, and it will ensure that we have a clear timeline for those who are referred for access to those services.
The availability of psychological therapies has increased across the country and work is on-going to support more of that. That is an example of where we can get more consistency across the country by setting a clear national standard.
A key part of dealing with the health challenges that the expert group’s report highlights is ensuring that GPs are properly engaged in the process. Primary care is central to how we deliver aspects of the drug recovery model, but there are challenges in doing that, because GPs are independent contractors. We must look at how we can build the approach into their contract, but it is not in the Government’s gift just to say that that will happen. We must negotiate with the profession and look at taking the issue forward.
Given what I have said, and although I am keen to have a consensus in the debate, we cannot accept the Labour amendment. That is not because of its main content but because of its final element, which is on setting a timeframe. I am not in a position to set a timeframe for getting a national agreement with GPs; I wish that I was, but the reality is that I am not. It would be false of me to indicate that I could do that, but I can say that the issue is on our agenda and is part of the discussions that we are having. We wish to strike a consensus, but it is a fact that we cannot set a timeframe.
I recognise what the minister says about GPs. Does he acknowledge that a ministerial lead would be needed? He would have to initiate measures such as prescribing heroin, supervised injection and testing for street drugs.
Taking forward such issues with GPs as part of the general medical services contract involves negotiation. We would have to explore the questions. As I said, the issues are very much on the Government’s agenda, and we have to work with colleagues to take them forward.
I turn to prescribing through our community pharmacy services. Willie Rennie and Jackson Carlaw made the point that community pharmacies play an extremely important part in the jigsaw of the recovery model. Some of the publicity and language last year about the methadone programme through our community pharmacy provision was unfortunate. Thankfully, we have moved beyond that.
In September, we published “Prescription for Excellence”, of which a key part is developing and implementing NHS standard specifications on alcohol and drug services and, in particular, pharmaceutical services, which will help us to drive forward improvements in standards. We all recognise that community pharmacies have a role to play in delivering an effective recovery model under drugs policy in Scotland.
Mary Scanlon asked whether individuals who are on the methadone programme are tested monthly for compliance. I appreciate the logic of that suggestion, but the recovery model is such that people often slip back. The suggested approach of testing every month is recognised as not being valuable and can undermine the recovery model. It is resource intensive and it does not demonstrate much in the way of outcomes. However, I appreciate Mary Scanlon’s point that we must ensure that the system has proper checks.
That brings me to my final point, which is the need to make sure that we measure what we are getting from the system. Graeme Pearson is right that we need to be sure that we are clear about what we get from the drugs policy that we are pursuing. The improvement methodology that we are setting out as part of our response on this particular policy will help us to achieve that.
I believe that the report helps us to build on the good progress with drugs policy that has been made in recent years. The consensus that has been struck today gives me strength in knowing that a joint effort is being made across all parties to make sure that we build on the progress. I hope that we have demonstrated to members that Roseanna Cunningham and I are committed to making sure that we take the joint working across Government to build on the good progress that we have been making.