Drugs policy - update: statement by the First Minister - 20 January 2021

In 2019, the number of people in Scotland who died a drug-related death was equivalent to three people losing their lives each and every day.

Every single one – 1264 in total - was a human being with dreams and aspirations, talent and potential.

There were all someone’s mother, father, daughter, son, brother, sister. 

Each of them left a hole in the lives of those who loved them.

They mattered.

And while we can’t help them now, we must do much more to make sure others don’t suffer the same fate.

The fact is all of these people - and those who died in years gone by - were in some way failed by us.

Responsibility for that rests - first and foremost - with government.

And the failure is not just a moment in time.

Anyone who ends up losing their life as a result of drug addiction, is not just failed at the time of their death – in most cases, they will have been failed repeatedly throughout their whole lives.

I believe that if we have the will, we can and we will find the ways to stop this happening.

Doing so requires a national mission to end what is currently a national disgrace.

It is a reasonable criticism to say that this government should have done more earlier, and I accept that.

But I am determined that we will provide this national mission with the leadership, focus, and resources that it needs.

To help with this, I have appointed Angela Constance as a Minister dedicated to leading this work and reporting directly to me.

She will work with the Drugs Deaths Taskforce which is already doing very good work and I want to take this opportunity to thank everyone contributing their time and expertise to it.

Part of Angela’s task will be ensuring that this work is embedded across all areas of government, but particularly in our efforts to improve mental health, tackle homelessness and ensure a humane and responsive justice system.

She will also lead work with partners across the country, and in particular with grassroots and third sector organisations.

And she will ensure that we listen more to those with real-life experience of drug addiction - those who live or have lived with addiction, and also with their families who so valiantly try to support them.

We will also tackle all aspects of this problem. The focus of my statement today is on treatment and support services. But there are many other areas that will require improvement too.

For example, like many MSPs, I know that the widespread availability of benzodiazepines - street benzos - is scarring too many of our communities.  

That’s why Angela Constance and Police Scotland are urgently considering - with people from those communities - what more we can do to address that issue.

And we do recognise that this requires, not just action to disrupt supply, important thought that is, but also improvements to treatment that are necessary to stem demand.

We will also do more to tackle head on the stigma that is still, too often, associated with drug use.

Stigma doesn’t just affect people’s sense of their own value – although that is in itself damaging.

It also discourages people from coming forward to get the help and services they need.

So we must remember at all times that people addicted to drugs are family members, neighbours, and colleagues.

Addiction is of course very often linked to poverty and deprivation, but it could affect any family - including our own.

Stigma is therefore one of the issues Angela Constance and I discussed with the drug deaths task force last week.

By addressing it, and the silence and alienation it causes, we make it more possible for people to seek help. And I think that will benefit all of us.

Last week’s discussion with the task force, together with other discussions we have had in recent weeks, was hugely helpful.

They have provided us with a clear sense of the issues we need to work on most urgently.

We know that there is a lot of work ahead.

Today’s statement can only be a start to this process. It cannot possibly address all of the issues that need work, and it cannot at this stage offer all of the answers. But I intend today to outline five key areas that will be of particular and immediate focus.

But firstly, let me confirm that our actions will be backed by significant additional resources.

In what remains of this financial year – until the end of March – we will provide an extra £5 million so that work can get underway urgently.

Beyond that, from the start of the new financial year until the end of the next Parliament in 2026, we intend to allocate an additional £50 million of funding each year.

This funding –  a total of £250 million over the next parliament - will support further investment in a range of community-based interventions, including primary prevention, and an expansion of residential rehabilitation. We will also commit additional funding, if required, to improve toxicology services and enhance public health surveillance of drugs issues, which is essential to effective and timely interventions.

A significant proportion of extra funding will go directly to alcohol and drug partnerships and we expect much of it then to flow to the grassroots organisations that do so much vital work in our communities.

More detail of the allocation of the funding will be set out by Angela Constance in due course, but we will adopt – and expect our partners to adopt – a clear focus on what works.

It is important to be clear that all interventions need to be well evaluated so we know what works and what doesn’t.

As part of our approach, we will seek to overcome the divide that sometimes exists in public debate, between harm reduction and recovery. Because we think both of those things are vital.

But most urgent of all is saving lives.

Beyond funding - though the new funding will support all of this - there are five key areas that we need to address urgently.

These include fast and appropriate access to treatment; residential rehabilitation; the creation of a more joined up approach - one that supports people living with drug addiction to address all of the underlying challenges they face, of which drug addiction is often just the symptom, and which ensures better support after non-fatal overdoses; and also the vital role of frontline, often third sector, organisations.

However I want to address at the outset the issue of safe consumption rooms.

And let me take the opportunity to thank Peter Krykant for meeting with Angela and I a couple of weeks ago to share his views on this and other matters.

There is strong evidence from other countries that these facilities help prevent fatal overdoses, and encourage people who use drugs to access longer-term help.

That is why we are so keen to see that model formally used here.

I can confirm that are continuing to explore how we overcome the legal barriers that currently restrict us in this respect and while I cannot report on our conclusions of that today, it is an issue that I know Parliament will return to.

However, as we do so, we will maximise what can be done now within the current law to reduce harm and stop people dying.

An example of this is heroin-assisted treatment.

There is evidence again from other places that heroin-assisted treatment reduces deaths.

In addition - by taking away some of the chaos that drugs create in people’s lives - heroin-assisted treatments can create the space to address other issues, such as homelessness or mental health problems.

Currently these treatments are available only to a relatively small group of people in Glasgow - where a pilot has been operating for the past year.

But I can confirm today that we will make additional funding available - starting in this financial year - to make heroin-assisted treatment services more widely accessible across the country. 

The next important issue I want to address is access to treatment.

Currently, only around half – and indeed according to some estimates even less than that - of the people most at risk of drug-related death are accessing drug treatment.  This needs to change and fast.

Part of the issue of course is the availability, speed and consistency of help. 

We must ensure that anyone who needs it has access to the type of support that works best for them – whether that is a Medication-Assisted Treatment, a psychosocial treatment, rehabilitation in the community, or rehabilitation in residential placements.  For most people it will be a combination of all of these.

We will therefore rapidly implement –across Scotland - the new standards for treatment developed by the drug deaths task force.

Funding will be provided for that in this financial year.

The new standards – acknowledged as a “huge step forward” by the Scottish Drugs Forum - set out the help people who use drugs should be able to expect, regardless of where in Scotland they live.

Crucially, the standards make clear that people must be able to start receiving support on the same day that they ask for it. The standards also stress the importance of people making informed choices about the type of medication and support available to them.

Making help available, and giving people an informed choice, is an essential part of respecting a person’s agency, rights and dignity.

It is also an approach which is much more likely to be effective and provide people with the help and treatment they need.

We are also taking steps to widen distribution of naloxone – the drug that we know saves lives in the event of an overdose.

And we will also further increase the availability of a long acting form of opiate replacement - in both prisons and in the community. 

We will work as a matter of urgency with experts and those with lived experience to develop firm targets in relation to treatment.

I mentioned at the start that, at most, only around half of those who need help currently get it. Undoubtedly even fewer will get it as quickly as they should.

Improving that figure significantly, so that a clear majority of people who use drugs get the treatment they need, when they need it, has to be central to any strategy for reducing drug deaths.

The final point I want to make about treatment is that people should receive support for as long as they need it.  Services must have the resources to stick with people even when, because of their addiction, that becomes really challenging.   

At the moment the number of people who drop out of support and treatment services is far too high. So we will work with alcohol and drug teams to very significantly improve that over the next year.

Achieving these objectives on treatment will of course be challenging – but it is essential and the basic aim is clear.

We must empower more people to seek support; we must make that support more consistent, flexible, effective and much faster; and we must help services to stick with the people they are supporting. All of this will go a long way to reducing the numbers of people who die.

The third area I want to cover is residential rehabilitation.

In total around 650 people from Scotland benefited from residential rehab last year.

At the moment there are an estimated 365 rehab beds, across 18 different facilities.

We know that residential rehabilitation, while in no way the whole solution and not right for everyone, can though be an effective way of helping people with addiction problems. But access to it is not as readily accessible as it should be.

And so part of the immediate £5 million we are making available in the remaining weeks of this financial year will support the opening of additional residential rehabilitation placements.

Over the course of the next parliament, we intend to allocate an additional £20 million a year for residential rehabilitation and also associated aftercare which is often the bit that doesn’t get the same attention. We will continue of course to assess funding levels going forward.

A significant proportion of the extra funding will go towards developing sustainable capacity in regional centres across the country.

Our considerations will be inclusive of different models of care.

The aim is to ensure that residential rehab is available to everyone who wants it - and for whom it is deemed clinically appropriate - at the time they ask for it, in every part of the country.

And we must ensure that rehabilitation can be provided much closer to home for people – so that it is closer to the families and support networks they so often rely on.

As Angela Constance said last week, we believe that these measures will bring provision in Scotland into line with other European countries.

And – more importantly – they will help reduce deaths, and aid recovery, for hundreds of people each year.

The next area I want to cover is how those working in drug services can work together better, and share information more easily.

One area where this is of urgent necessity is in support provided to people following a non-fatal overdose.

It is a fact that many people who die as a result of their drug use, will have experienced non-fatal overdoses in the past.

If we can provide better support after those, earlier, overdoses – which are themselves a clear warning sign that support is needed – then we can save lives.

That requires better co-operation and data sharing between different agencies and organisations.

A good example of this kind of approach is the work being led by the Glasgow Overdose Response Team.

They respond quickly to a person after a non-fatal overdose, and help address immediate risks to their health - while connecting them with community or clinical services in the area where they live.

By making additional funding available this year, we can extend outreach initiatives like this, and ensure that similar support is provided in cities across the country.

In addition, by April, all alcohol and drug partnerships will have agreed a common set of steps that need to be taken to support anyone who suffers a non-fatal overdose.

This will ensure that information is shared at the right time, and that support is made quickly when it is needed.

The final point I want to address in the time I have available today, is support for grassroots community organisations.

As I said earlier, they will receive part of the additional funding that I have announced today.

These organisations - working on the frontline and I know this from my own constituency experience - do vital and invaluable work. But they often exist on shoestring budgets and are stretched to the limit.

With extra funding, the work they do will be more secure and they will be able to do more of it and reach more people.

This funding and support is important in itself, but I hope it also sends an important message - that we value and support the work being done by grassroots organisations.

Presiding Officer, This statement has set out a number of immediate actions. There will be more to come in the weeks ahead.

But I hope it will also be heard as a statement of intent.

And I hope it signals very clearly our determination to make change - to no longer fail those who need and deserve our help, but to support them instead to live their lives to the full.

Right now, I spend most of my waking hours thinking about a virus - discussing and deciding the interventions necessary to protect as many people as possible from Covid.

The pandemic has been all-consuming, for all of us, in a way that I hope no other issue will require to be in our lifetimes.

But - and this is a point made already by others - it is time to bring the same resolve, focus, and common purpose that we have all shown in tackling Covid, to reducing the loss of lives caused by drugs.

None of us should accept drugs deaths - not a single one - as inevitable. And nor should we accept the heartbreak or loss of human potential that they cause and represent.

Today’s statement sets out new measures and confirms additional resources.

But perhaps most importantly of all it reaffirms our resolve, and underlines our belief that every single life matters.

There is a lot of hard work ahead – but we are determined to make a difference, and to do so quickly.

We will do so in memory of all those who have died.

But more importantly we will do so to ensure that more people get the support they need to live.