Chamber and committees

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

I thank Carol Mochan for lodging her really important motion, and I also thank members for their considered contributions this afternoon. From the outset, I want the chamber to know that I support the motion.

We all agree that urgent action is needed to address the number of deaths from alcohol and to reduce alcohol-related harm. I offer my condolences to all the families who have been impacted by alcohol deaths and restate my commitment to do everything in my power to tackle this public health emergency. As a member of a family that has been affected by the matter, I have to say that it is personally important to me.

As we have already heard, National Records of Scotland has reported a 2 per cent increase in the number of alcohol-specific deaths in 2022. The mortality rates in the most deprived areas are more than four times as high as those in the least deprived areas, and according to Public Health Scotland statistics, admission to hospital was six times higher from the most deprived areas. Those gaps are reducing over time, but they are clearly still far too large, and tackling poverty must remain a clear focus for us all.

I am also particularly concerned by the reported rise in the mortality rate for women and the over-65s. We must ensure our prevention policies and treatment services address the specific needs of those groups and are tied into the work being carried out across Government that Brian Whittle and others have talked about. We need to respond the health inequalities that are experienced acutely by women but by other groups, too; indeed, we should also note the increase this year in the deaths of women by suicide. We need to look at how all of these things are tied together and whether, as Alex Cole-Hamilton has suggested, some of this has come out of the pandemic. It remains to be seen whether the situation will continue, but we really need to keep a close eye on it.

The motion asks Parliament to note its belief that

“a plan is needed to address”

this “public health emergency”. In response, I will set out the Government’s plan for doing so. However, I agree with everybody: the issue is so large that we need to find time to bring it back and Government time to start considering it fully.

On pricing, we will soon be laying our report on the operation and effectiveness of minimum unit pricing in line with our commitments under the Alcohol (Minimum Pricing) (Scotland) Act 2012. I look forward to discussing with Parliament the next steps for that flagship policy, as well as launching a public consultation on its future. It is, as some members have said, not a single magic bullet, but is part of a suite of things that we are trying to do.

Minimum unit pricing was a whole-population attempt to drive down consumption. From the reports that we have seen, we know that there has been a 3 per cent reduction in overall consumption, but I am acutely aware of how that impacts dependent drinkers, so I will keep that under close consideration. We will have a full debate on that when we get to it.

Linked to that work is the outcome of our alcohol marketing consultation, which closed in April. In the coming months, we will publish the findings and our next steps, including how we further engage on this critical issue. We will also continue to keep any proposals for a levy under consideration.

On harm reduction, alcohol brief interventions can help clinicians and patients to identify harm-reduction behaviours or the need for outside support in reducing alcohol intake. We have just completed a comprehensive review of ABIs, which will be published shortly. It will include recommendations, and we will provide Parliament with details of the actions that will be taken in response to those to make improvements that help reduce harm and can improve outcomes for people impacted by alcohol.

The earlier that we can do the work to identify people who are drinking at harmful or hazardous levels, the better. I welcome the work that Drinkaware is undertaking on helping people to self-identify issues and I look forward to seeing how that can work in tandem with the review of alcohol brief interventions.

On increasing access to treatment, we have asked Public Health Scotland to investigate the reduction in numbers for referrals to services. We need to ensure that referrals are made wherever appropriate and that there is capacity within services to meet peoples’ needs. Therefore, it is vital that we understand what is behind the data.

I also want to understand where the gaps in data are, as Pauline McNeill mentioned. How do we understand how many people are engaged in fellowship organisations throughout the country? Those organisations are vital and help many people.

We saw the findings of the Scottish Drugs Deaths Taskforce. Some of those findings on drugs can be extrapolated to alcohol harms. However, as Carol Mochan pointed out, the picture is complex. We need to continue to examine the matter to understand what is driving consumption in our communities. Some of it is to do with poverty and inequality but a lot of it is to do with other matters. The increase in over-65s is particularly perturbing to me. Is there something to do with retirement age that means that people’s habits start to change? I assure Brian Whittle that examining that matter over time is a key part of what I want to do.

I cannot, sorry. I do not have enough time. There is just too much to talk about. That speaks to why we need a further debate in the chamber.

We have just commissioned Healthcare Improvement Scotland to take forward work to enable us to deliver our mental health and substance use plan. The first part of that work is currently under way as HIS works with stakeholders to develop an exemplar operational protocol to set out how mental health and substance use services should work together. That is vital, given the number of alcohol-specific deaths that were caused by mental or behavioural disorders. We cannot allow people to be bounced between services.

Workforce—recruitment in particular—is a challenge across all services at the moment. In the autumn, we will publish a workforce action plan on alcohol and drug services to help shape recruitment, retention and service design. That should help to create service capacity to make improvements, such as establishing alcohol care teams in hospitals to identify people with underlying alcohol problems earlier. I am meeting the chair of the group on that this afternoon.

I am meeting local leaders across the country to ensure that they are committing effort and resource to ensure services are in place, accessible and effective. I also recently wrote to ADPs to reassure them that it is welcome if they use national mission resources to support services that offer treatment and support to people who are impacted by alcohol use alongside those who are impacted by drug use. Any concerns that they have should be flagged to my officials.

To help to ensure that changes are delivered, the Government has committed to developing treatment standards to offer people better access to support and a wider range of choices in treatment, in line with what is available through the medication-assisted treatment standards. The standards will be informed by the United Kingdom-wide clinical guidelines for alcohol treatment that will be launched in the coming months. The implementation of those guidelines and our proposed standards will provide the impetus for improving the identification and testing of patients who are at risk of liver disease in primary care. As we have heard from Stuart McMillan, that is welcome.

On recovery services, we are encouraging specialist services to link more closely with recovery communities and we continue to provide funding to third sector recovery groups. We are on track to increase our beds from 425 to just shy of 600 in this session of the Parliament, which is a 40 per cent increase. That represents about 1,000 publicly funded placements, which is important.

There are innovations such as the Simon Community’s managed alcohol programme, which seeks to drive harm reduction for people who are drinking at the most harmful levels.

There is so much in the issue that I cannot get through all of it. However, as the minister with responsibility for both drugs and alcohol, my role is to drive improvements in outcomes for people who are impacted by alcohol, drugs or both and do so in all the ways that help to tackle the twin public health emergencies. The Government will continue to work with statutory and third sector partners to deliver the plan to reduce alcohol harm and alcohol deaths. I will work at pace to bring all of that together to ensure that our ambition is communicated effectively, and I will seek to bring the matter back to the Parliament.

14:00 On resuming—  

Every life lost to drugs is a tragedy, and we collectively feel the loss of the talent and potential of far too many of our people. I offer my condolences to everyone who has felt that loss and my unwavering commitment to continue the work to turn the tide on this public health emergency.

Families and people with real-life experience of drug and alcohol problems tell me that there must be a commitment to change at all levels from the front line to local leaders and from public services to national leaders. That is reflected in the report, “National benchmarking report on implementation of the medication assisted treatment (MAT) standards: Scotland 2022/23”, which Public Health Scotland published this morning.

The report covers the year up to April 2023 and charts the significant progress that has been made across the country since the first benchmarking report was published in June 2022. I am heartened by the progress that the report shows. However, there is still much work to do to fully implement the standards by April 2025 and for them to be sustainable by April 2026.

From my previous work in homelessness, supporting many people dealing with substance use issues, as a Scottish Women’s Aid worker and, indeed, as a councillor campaigning for change, I am fully aware that the targets that we have set for local areas to implement the MAT standards have always been ambitious, but the standards will save lives and make a long-term difference for people in treatment.

Today’s report includes maps comparing progress with the position in April 2022. The national picture is clearly improving, and the maps allow us to chart progress area by area. Naturally, much attention will focus on the red-amber-green implementation tables, which show good progress on MAT standards 1 and 2. There has been a transformation in rapid access to opioid substitution therapy, with 18 of the 29 local areas having fully implemented MAT standard 1, compared to just one area in 2022. Likewise, MAT standard 2, on choice, is now fully implemented in 27 of the 29 alcohol and drug partnership areas.

Overall, by April 2023, 66 per cent of MAT standards 1 to 5 had been fully implemented, compared to 17 per cent in 2022, and 88 per cent of MAT standards 6 to 10 had been partially implemented. I realise that we were aiming for 100 per cent implementation of MAT standards 1 to 5 and partial implementation of standards 6 to 10 for this report. That has not been achieved, and many will see that as not good enough. Although I absolutely agree on the need for urgency and pace around reducing harm and saving lives, I also know that, from the outset, many people did not believe that services could achieve what they now have achieved. It is better to aim high than not to attempt to make any significant change at all.

All ADP areas with remote and rural settings demonstrated innovation in terms of maximising the use of technology, subsidised travel and flexible models of care so that people could benefit from equitable care and treatment. I really thank those ADPs for thinking outside the box.

The report includes some case studies that reflect that change is already happening in many places. Over the past few months, I have had the privilege of speaking with a lot of groups, service providers and people accessing services, and I have visited drop-in centres providing MAT to see for myself improvements and change on the ground. I have seen and heard of the progress that is being made and the future plans for full and sustained implementation of the standards.

The report shows a dramatic increase in capacity and capability in ADPs for evidence collection, with almost all areas now collecting experiential feedback from people who have recently used services. However, putting in place reliable and sensitive systems for collecting that feedback is a major challenge. That will take some time to fully embed, but it is undoubtedly the most important measure for whether the MAT standards are in place. Strengthening the experiential feedback is one of the four key recommendations made in the report, along with recommendations on building sustainable numerical data systems, establishing systems for more direct support and further development of guidance for implementation and assessment.

The report also reflects on next steps for local and national partners to further improve the landscape to help services make necessary improvements. I expect everyone from every service to work collaboratively to deliver on that part of the on-going national mission. For the avoidance of any doubt, the Government remains committed to the continued funding of the mission over the course of this parliamentary session.

The report highlights the need for changes in healthcare models to support implementation of MAT in prisons. We will therefore be focused on establishing a more consistent approach to access and choice in justice settings; addressing data-sharing challenges; and sharing best practice on service models that will deliver better outcomes for people. A justice network for MAT implementation is already sharing experience across areas and identifying best practice models.

For the remainder of the national mission, we are also committed to focusing more on the care and support for people who have problems with benzodiazepines, stimulants and alcohol, rather than focusing only on opioid use. That is absolutely imperative.

We have already committed to all of that on-going work through the Scottish Government’s cross-Government action plan, which we published in January 2023. It sets out how we are responding to the final recommendations made by the Scottish Drug Deaths Taskforce and how the national mission is being taken forward through a whole-Government and whole-Scotland approach. It also includes detail on what we are doing to address the workforce issues that are raised in today’s benchmarking report, and to tackle stigma.

MAT standards are about delivering faster and more responsive services, but they are also about changing hearts and minds, including tackling stigma and discrimination. Make no mistake, Presiding Officer, I am acutely aware of the damaging nature of stigma, which we must challenge wherever and whenever we see it.

ADPs and local partnerships are taking forward innovations to help address drug deaths. One that I know is of great interest to members is the potential use of safer drug consumption facilities. I confirm that the Government remains committed to the introduction of the Glasgow pilot, and I will inform Parliament immediately a view is reached by the Lord Advocate on the proposals from Glasgow city health and social care partnership and Police Scotland.

Although clear improvements have been made in response to the letter of direction that was issued to local services last year, we need to continue with formal oversight procedures and clear local accountability.

We will maintain the requirement for quarterly progress reports from local areas against their implementation plans, with monthly reports from areas of concern. The new benchmarking report will allow us to identify the areas that we now need to focus on. I will be writing to local areas in the coming weeks to update the oversight arrangements accordingly.

I will also be meeting local leaders to challenge them on progress, particularly where we believe that more commitment is needed from senior colleagues. We all want people to exercise their right to treatment, but that will all be for nothing if the services are not in place. The letter of direction requiring local leaders to implement the standards will remain in place and I will continue to provide Parliament with regular updates on progress.

The benchmarking report concludes:

“There has been a transformational change in improved access ... and choice of treatment ... for people with problematic drug use ..., and significant improvement in the other MAT standards. This is a direct result of hard work and collaboration within and between ADPs (including clinical, third sector, and lived and living experience partners) and of a shift in culture that has overcome many barriers to change.”

Of course, the continuing commitment from this chamber and all members is helping to drive improvement as well.

I thank the MAT standards implementation support team for its continuing hands-on support, working alongside local areas, and Public Health Scotland for its vital report. MAT standards are about driving change and improving outcomes. The standards are empowering people to demand the treatment that they deserve and there is no going back. We can now only go forward.

However, to quote again the report’s conclusion:

“implementation of the MAT standards is a vehicle for change and not a sufficient end in itself.”

For this year and the remainder of the national mission, the priority will be full, equitable and sustained implementation of the MAT standards in all areas.