Chamber and committees

I appreciate the committee digging into the issue. Because drugs policy can rarely be considered in isolation, the debates in the chamber or during other committee appearances that I have been obliged to make have often been very wide-ranging. It has therefore been useful for me to take a specific issue in a specific locality and bore down into the detail. Thank you for that.

Thank you.

You will indeed.

That is a fair point. I will not sugar-coat instances in which progress has not been good enough or fast enough. You are right to allude to the fact that, although the majority of the red-amber-green statuses in the benchmarking report by Public Health Scotland were amber, there were not enough greens and there were too many reds, particularly in and around MAT standard 1, which is that crucial, life-saving, same-day treatment. That is why, for the very first time, we have a ministerial direction that places certain requirements on chief officers and chief executives of health boards, integration joint boards and local authorities.

I am due to update the Parliament imminently—maybe in the next fortnight or so; certainly in the next month—on progress since my last update. That is based on the improvement plans that we have received from every area. Some areas are in a cycle of quarterly reporting. Others, where the challenge is greater, are subject to monthly reporting.

We are beginning to see some good and innovative practice in and around rural areas, and perhaps we should share some case studies with the joint committee. I point to the Borders, which is a rural area and is the only area that was able to secure green status across MAT standards 1 to 5. If we can do it in the Borders, we can do it elsewhere. Let us not underestimate the challenge, but that can and should be done.

I distil that into three important factors. It is complex, and we have deep-rooted challenges in Scotland. The task force and various other academics have written extensively about the acute poverty in particular areas of the country. We all know the research on the relationship between substance use, past trauma and poverty.

You asked specifically why there is an issue in Scotland. First, according to the information that we are able to gather, there is a higher prevalence of problematic drug use in Scotland. There is an existential question as to why that is.

The second point is the prevalence of heroin and benzodiazepines in drug-related deaths. It is not always possible to make direct comparisons, because England is a bit different when it comes to the underlying work on drug misuse deaths and the proportion of cases that go through toxicology and forensic screening. However, benzodiazepines are much more greatly implicated in our deaths than is the case in England and Wales—although I have noticed that some reporting and recording have begun to indicate a rise in benzodiazepine problems south of the border. The higher implication of opioids and heroin in our drug deaths speaks to higher-risk behaviours, more injecting and the lethal combinations of polydrug misuse and people with multiple and complex needs.

Thirdly, it is about treatment. Time and again, I have been utterly frank that not enough of our people are under the protection of treatment. We need to get more people into treatment—and, if they fall out of treatment, we need to follow up on that. That speaks to the importance of the MAT standards, and not just investing in services but reforming them. I have opinions on other aspects—for example, the Misuse of Drugs Act 1971. However, a core part of the national mission is about the need to invest in and reform our treatment services, which we are doing. Crucially, however, that must not be done in isolation from the other cross-Government work that is so important.

Thank you very much, convener, and good morning to all your colleagues. I very much appreciate the opportunity to come back to this tripartite committee as we embark on the national mission, particularly in our work to respond to the vital final recommendations of the Drug Deaths Taskforce, which are essentially about ensuring that all aspects of the public sector and all parts of Government are aligned. Although it is not for me to tell the committees how to proceed with their scrutiny of Government, it appears to be a fitting approach for scrutiny to be joined up, too.

You raise two crucially important aspects of our drug death challenge. When we look at the annual report that was published in the summer, we see that, although more men die, and significantly so, there has been a disproportionate increase in the number of women who are dying, and that has been a trend for some years. The annual report shows a small decrease in the number of men who are dying, but a continued increase in the number of women we are losing.

We know that the issue is complex. It relates to trauma, including past life trauma, but it also relates to women who are mothers. If we think that people who use drugs are stigmatised, that is even greater for women, in my view, and particularly women who are mothers. We know that the removal of children has a huge, traumatic impact and is a contributory factor to deaths.

We are working through the recommendations of the Drug Deaths Taskforce, and we will be supporting alcohol and drug partnerships to do likewise and, indeed, to develop pathways. You may have noticed that, earlier this week, we published the first annual report on the national mission and the alcohol and drug partnerships. We need to make more progress with some specific care pathways for women. Some of our investment in residential rehabilitation and residential services has been prioritised to meet that need.

On young people, the annual report that was published in the summer shows that, although the number of young people under 25 who had died reduced in 2021, it remains too high. It is important not to look at one year’s figures in isolation; we know that the three preceding years showed concerning increases. As you will see in the annual report, although alcohol and drug partnerships all have services and supports available for young people, we need to do much more to be clear about the types and range of services that should be available in each area. That, in part, is why we have a stream of work specifically on young people, which relates to the co-design of standards of care and treatment and to the range of services. That work is proceeding, and I will endeavour to keep the committee and Parliament up to date on it.

The member is probably aware that separate statistics are produced about deaths that relate to illnesses or health conditions that can be traced to the problematic use of alcohol. I know that we are talking about statistics but, for the record, we are also talking about lost lives and people. I will try to do that as sensitively as I can, rather than get into a too dispassionate discussion of statistics.

The annual figure for drug-related deaths is in relation to the use of illicit substances and controlled drugs. That is the purpose of those statistics—they show how many deaths happen as a result of controlled drugs and illicit substances. You are right to point to the figure that 93 per cent of the people we lose have more than one substance in their system. Of those we lose, 11 to 12 per cent also have alcohol in their system. That figure is down on previous years. In some years, it was up to about 30 per cent. That speaks to the growing problem with other substances, as opposed to a reducing problem with alcohol.

There is another area in which we need to distinguish. The national mission is absolutely focused on those who are at risk of dying, and therefore on developing treatment options for opiates, benzodiazepines and cocaine. However, if we speak to organisations such as Scottish Families Affected by Alcohol and Drugs, they will say that their number 1 concern about the families and people that they support is still alcohol. The work done by David Nutt and published in The Lancet details the harms caused to individuals, society and others by various substances, and it shows that alcohol is at the top of the list.

We have information from some of the surveys that are done in education. We know that young people are different from those in other age groups—I refuse to use the term “older”. We know that young people are less inclined to use heroin, and that cannabis and cocaine are bigger factors in young people’s drug use patterns.

I did not address the part of your earlier question about what we are doing on education and prevention. That is why we have a national mission. Our drugs policy and our work in the here and now to prevent people from dying cannot be in isolation from the longer-term and very necessary work. I do not want to read too much into the reduction in the number of young people dying in one year’s statistics, because it is always important to get underneath the headlines.

The work in schools is crucial. There is work with young people that is about substances overall. We should not overly fragment that. We must engage, and we are engaging, with young people through a curriculum that looks at tobacco, alcohol and illicit substances.

One of the asks in the cross-Government plan is to review what we are doing, and there are strong arguments with regard to the need to up the data. Last year, we published research on interventions, which must be about increasing young people’s resilience, confidence and knowledge. Although we want young people to have particular information so that they are equipped to reduce the harm that is associated with substances, there is a broad approach that is about upskilling young people and increasing their resilience.

There is a larger agenda outwith education about diversion from the criminal justice system. I am interested in the way that some areas are looking to adapt—not just shift and lift—aspects of the Icelandic model. That model is about not just treatment and diversion from the criminal justice system but investment in young people and their resources, pastimes and broader health and wellbeing as well as other purposeful activities.

That is a fair point, and it is important to remember that our focus on the national mission and on drug deaths sits in the context of wider efforts to improve the health of the population as a whole. My understanding is that some data is collected with regard to deaths for specific reasons, including deaths as a result of HIV. Information is published on issues such as wound care and blood-borne viruses. However, I will consider whether enough of that information is routinely published—it is a conversation that I have with Ms Todd—as well as where that sits with regard to management information and experimental information and whether there is an appropriate regular publication cycle. That issue sits very much in the terrain of improving overall population health. I will come back to the member on that.

I agree that it is important that we have a wide and appropriate dashboard of information so that we can understand all the harms as well as the contributing factors to drug-related deaths. It is important that we have that information about all drug-related harms. Through the publication of the national mission plan in September and the national mission annual report and the ADP annual report, I hope that I have demonstrated, at least to some extent, that we have an outcomes framework. In the national mission plan and the national mission plan annual report, you will see the information that we are using and that feeds in so that we can capture those harms. However, if the committee came to the view that we were not capturing all that, we would endeavour to address that.