Chamber and committees

I was probably being a bit too broad in my statement about lifting the law of the land, but it helps people to understand that it is not a straightforward case of Edinburgh just being able to do what Glasgow did. The Thistle project involved a careful process of working with the Lord Advocate and the community to assure ourselves about the limited circumstances in which we can change how prosecution policy applies in a specific geographical area.

The top of my list of ways to fully take a harm reduction approach would be to devolve drug laws, because the Misuse of Drugs Act 1971 prevents us from taking such an approach. Examples of the challenges that exist are the creation of safe consumption rooms and the provision of tourniquets, because the law prevents us from providing sterile tourniquets and paraphernalia, which is the category that tourniquets come under. The Thistle has an exceptionally sterile environment, but people need to, for example, tie shoelaces around their arms to pop their veins up so that they can inject. Even a layperson can see the risks that are associated with that; if a person were to go into a hospital environment to get an injection, they would expect a sterile tourniquet to be used.

The law also prevents us from providing inhalation pipes. One of the greatest harms that we face in Scotland at the moment is the injection of cocaine. One reason that that is so harmful is that people take cocaine in bursts and, as the day progresses, they become intoxicated and their injection technique becomes poorer, so they face more harm in relation to the injection site. Cocaine is also a local anaesthetic, so people do not feel pain if they get it wrong. Therefore, encouraging people to smoke cocaine rather than inject it, and providing them with the tools to do so safely, would be a reasonable harm reduction strategy, but we are prevented from doing that.

There are strong reasons why we want to take a different approach, overarching all of which is the devastating level of drug deaths in Scotland. I sometimes wonder whether my colleagues in England quite appreciate the level of harm that we are facing—we are having different conversations in Scotland than those that are happening in England. If my colleagues in England do not want to take the approaches that we do, the most straightforward way to solve that problem would be to devolve the power to us so that we can take those harm reduction approaches.

11:30

Well, it is nearby. A unit within the mainstream school supports children with additional support needs, and the work that it is doing is phenomenal. When I asked the teachers specifically about how supported they felt in their training and in their ability to support those young learners, they told me that one of the most important things for them was their access to the full multidisciplinary team, which visits the school. When those specialists come in, they sometimes support individual children, but they also often help staff to support learners in their learning. Staff are clearly supporting parents to do that, too.

I want that to happen everywhere. One of the reasons that I visited that school was that we had announced £7.6 million of funding to support community interventions for neurodivergence, and I would like to see the quality of care and learning that happens there to take place everywhere.

That is a fair summary, but you did not mention the increase in the number of people who are seeking support. Ten years ago, when we first considered an LDAN bill, there was a low level of awareness, particularly in relation to neurodivergence—people did not know about it or understand what it was. Since then awareness has greatly increased, and many more people—the number has sometimes increased by several hundred percent—are seeking diagnosis, assessment and support in many parts of our country. We cannot fix the problem overnight, as much as we would all wish to. There will need to be a process to ensure that people get support. People will, to an extent, need to be triaged, and we will need to build a system that can respond to the level of need.

That will not happen overnight, but I am committed to it happening, because I agree with you. I know that you were focused on the LDAN bill and that you did a lot of work to ensure that it became a commitment of the Scottish Government. Yesterday, I met a lived experience advisory panel, and I share its disappointment at the change of direction. However, at this time, I need to focus on improving service delivery, not on creating legislation that gives people expectations and rights that cannot be upheld unless there is a system that has been built to respond to those needs. We are not for a second deprioritising that work; we are just shifting our focus to practical improvements, policy reform and targeted investment to get a more rapid impact, which is what we all want to see.

How do I unpick all that? We need to be very careful in how we talk about drugs and harm reduction. It is not an either/or when it comes to rehab and harm reduction strategies, which might cover opioid substitution therapy, right up to facilities like the Thistle, which are safe injection rooms.

This week, published statistics showed that we not only met our target of increasing the number of publicly funded placements in residential rehab to 1,000, but actually exceeded the number this year. That means that, during the national mission period—from 2020 to 2026—there has been a 60 per cent increase in access to residential rehab.

It is a really vexing, difficult problem. More than 1,000 people die of drug harm every year, with all of the tragedy and cost that that causes in our communities. We need to take many measures and many steps in order to tackle drug harm.

11:15

With regard to opioid substitution therapy, it is important that we look at the evidence. You are a vet, so you will be used to evidence-based medicine. The evidence would suggest that opioid substitution reduces the risk of death by around 70 per cent for individuals. In a country that is facing a huge level of drug-related deaths, we must not rule out evidence-based approaches to tackling that harm. Opioid substitution therapy is not the be-all and end-all, and it is not the end of treatment for people; very often, it is the start.

I would say that the Thistle has been a life-saving intervention. We get regular data around it. There is zero evidence to support your claim that it encourages drug use.