National Mission on Drugs: annual report 2022-2023

Introduction

1.1 Overview

On 20th January 2021, the First Minister made a statement to parliament which set out a National Mission to reduce drug deaths and improve lives through a range of improvements to treatment, recovery and other support services.

In the first year of the National Mission, important foundations for change were built and the first annual report set out our year one commitments and progress from January 2021 to 31 March 2022.

This annual report sets out the progress made from April 2022 to March 2023 against the National Mission Plan. A separate analytical report monitoring the progress of the National Mission in 2022-23 will be published in the autumn.

The National Mission annual report is organised into chapters that relate to the six outcomes in the National Mission Plan; six cross-cutting priorities; finance; reporting and monitoring.

Outcomes and cross-cutting priorities chapters have the following format:

An overview provides context, including data, to understand the scope and purpose of the outcome.

Progress in 2022-23 sets out our activities related to the outcome throughout the reporting period: the projects being delivered across sectors, locally and nationally have been highlighted, including dedicated funding and case studies. High level plans for the period 2023-24 are also set out.

The finance chapter provides summary statements, by theme and area for the reporting period, and Government’s commitment against forecasts.

Reporting and monitoring describes governance and reporting arrangements: how groups and boards work together, and how we are ensuring accountability of the National Mission.

In 2022, there were 1,051 drug misuse deaths registered in Scotland.^[1] This was a decrease of 21% (279 deaths) compared with 2021. This is the lowest number of drug misuse deaths since 2017. The change between 2021 and 2022 is the largest year on year decrease on record.

Despite this recent fall, drug misuse deaths are still much more common than they were in 2000. After adjusting for age, there were 3.7 times as many drug misuse deaths in 2022 as in 2000 (Figure 1) and drug death rates are still higher in Scotland than in the rest of the UK.

While the reduction in drug deaths in 2022 is welcome, the Scottish Government does not underestimate the scale of the challenge we continue to face, including responding to new threats such as synthetic opioids and stimulant use. We remain committed to continue the National Mission to reduce deaths and improve the lives of those impacted by drugs.

The suspected drug death management information for the first half of 2023, published on 12 September 2023, indicate the scale of the challenge still ahead. There were 600 suspected drug deaths during the first six months of 2023. This was 7% (38) higher than during the same period of 2022.

Source: National Records of Scotland

1.2 Taskforce Response/Cross Government Approach

In July 2022, the Scottish Drug Deaths Taskforce published its final report, Changing Lives, containing 20 recommendations and 139 actions. It called for the Scottish Government to respond to their report within six months. The Taskforce was clear that change is needed, and that change is possible. This change will require a whole system, cross-government approach.

We, therefore, published our cross government response, Drug Deaths Taskforce Response: A Cross Government Approach, in January 2023. Alongside this a detailed response to each of the 139 actions was provided.

Our response contained 3 sections: section one covered the recommendations that require a cross-government approach; section two covered the recommendations that are specific to drugs policy and services and section three sets out the stigma action plan (see section 2.2.3 for more details).

Two transformational principles underpin our response. Across government, we are committed to:

• treating problem drug use as any other health condition is treated, insofar as is possible within devolved competence and
• ensuring people affected by substance use are involved in government policy and strategy development that affects them.

Taking this approach will help ensure that people are able to access the services they need and are entitled to without fear of discrimination. Developing policy and strategy with the people that are affected by it helps to ensure that services are accessible and meet the needs of their users.

The cross-government action plan outlined over 80 actions identified across government portfolios. It highlights the wide range of areas which have mobilised to support the National Mission, from employment programmes, to justice, transport to education, and across the health and social care sector. The plan highlights existing work, outlines new initiatives, and details ways that policy is being refocussed to better support the needs of people who use drugs. It is supported by significant new spending commitments totalling over £68 million over the remainder of the parliament.

Progress against these actions will be incorporated into future annual reports.

1.3 National Mission Partners

The National Mission is a collective endeavour. We work with key partners across public policy and beyond. Our key stakeholders and partners are detailed below.

Integration Authorities (IAs) are responsible for integrating certain health and social care services provided by or for Area Health Boards and Local Authorities such as alcohol and drug services. IAs have oversight of planning, designing, and commissioning services and ensure the design and delivery of efficient, integrated services. IAs were established in 2014 in each local council area and, except in Highland, IAs have been established as Integration Joint Boards (IJBs) and in many local areas the integrated services are identified as being provided by a Health and Social Care Partnership (HSCP) rather than separately though Health Boards and Local Authorities.

Area Health Boards (HBs) are responsible for the prevention and the treatment of disease. HBs have delegated responsibility for specific healthcare functions and related budgets to IAs and this includes some care and support functions for people impacted by substance use.

National Health Boards are specialised and include Public Health Scotland, Health Improvement Scotland, Scottish Ambulance Service.

Local Authorities (LAs) are responsible for providing social care and social work services, including support services for people impacted by substance use, and have delegated responsibility for specific functions and related budgets to IAs.

Alcohol and Drug Partnerships (ADPs) are multi-disciplinary, non-statutory partnerships established at local authority level to bring together organisations, including statutory and third sector organisations, the Police and the Scottish Prison Service who are all working to tackle alcohol and drug issues locally.

Core funded organisations (CFOs) provide vital expertise and services to support those with substance use problems and their families. This includes peer-led delivery of services and maintaining recovery communities.

• Crew (Scotland) is a nationwide public health charity that aims to reduce the harm and stigma associated with psychostimulant drug use.
• With You is a charity that provides free confidential support to people who are experiencing issues with drugs, alcohol, or mental health.
• Scottish Families Affected by Alcohol and Drugs support families across Scotland who are affected by a loved one’s substance use and raise awareness of the issues affecting them.
• Scottish Drugs Forum is a drugs policy and information agency, working to reduce drugs harm in Scotland and provide a wide range of training and support to people who use substances and to people working in the sector.
• Scottish Recovery Consortium is a recovery-oriented charity that builds and promotes recovery from addictions in Scotland.

Other third sector organisations are also supported via grant funding and make an invaluable contribution to delivery.

Corra Foundation deliver funding programmes for grass roots and third sector organisations for the National Mission on behalf of the Scottish Government.

Justice Partners including Police Scotland, Crown Office, and Procurator Fiscal Service (COPFS), Scottish Prison Service and Community Justice.

1.4 Key publications and milestones

• Jun 22 - MAT standards and improvement plans. Update on Medication Assisted Treatment Standards - gov.scot (www.gov.scot).
• Jun 22 - MAT Standards National benchmarking report on implementation of the Medication Assisted Treatment (MAT) standards - Publications - Public Health Scotland.
• Jun 22 - National Statistics publication. Drug-related Deaths in Scotland in 2021 | National Records of Scotland (nrscotland.gov.uk).
• Jun 22 - Publication of the Drug Deaths Taskforce - Final report - Changing Lives (knowthescore.info).
• Aug 22 - MAT Standards Supplementary information for the national benchmarking report on implementation of the Medication Assisted Treatment (MAT) standards. 2021/22 (publichealthscotland.scot).
• Oct 22 - £65 million support for drugs services - gov.scot (www.gov.scot) Drugs Mission Funds, administered via Corra Foundation opened for round two of applications.
• Nov 22 - Reopening of the Residential Rehabilitation Rapid Capacity Programme - gov.scot (www.gov.scot) for round 2. Harper House - New family drugs treatment service - gov.scot
  (www.gov.scot) A National Specialist Family Service run by Phoenix Futures, opens. The first of its kind in Scotland.
• Nov 22 - Substance use and mental health concerns - The Way Ahead: rapid review recommendations - gov.scot (www.gov.scot).
• Dec 22 - Government commits to supporting the National Collaborative Roadmap (www.alliance-scotland.org.uk).
• Dec 22 - Parliamentary Statement: MAT & Workforce Update.
• Jan 23 - Aberlour opens in Dundee. Opening of Mother and Child Recovery House - gov.scot (www.gov.scot).
• Jan 23 - Response to Drug Deaths Taskforce report Cross-government action plan backed by £68 million.
• Feb 23 - £14 million announced to support three new residential rehabilitation facilities.

1.5 Outcomes Framework

The National Mission outcomes framework articulates our aim to reduce drug deaths and improve the lives of those impacted by drugs and the underpinning outcomes and cross-cutting priorities we believe are necessary to achieve this aim.

The framework is presented in more detail in Annex A.

Reduce Deaths and Improve Lives:

• Fewer people develop problem drug use
• Risk is reduced for people who take harmful drugs
• People at most risk have access to treatment and recovery
• People receive high quality treatment and recovery services
• Quality of life is improved for people who experience multiple disadvantage
• Children, families and communities affected by substance use are supported

Cross-Cutting Priorities:

• Lived Experience at the Heart
• Surveillance and Data Informed
• Equalities and Human Rights
• Resilient and Skilled Workforce
• Tackle Stigma
• Psychologically Informed