Deaths due to drug abuse in Scotland have hit an all-time high. In 2018 1,187 people died in Scotland as a consequence of drug abuse a rise of 27% on the already frightening figures of 2017. This places Scotland in a class of its own in Europe with a level of drug-related deaths twice that of the next nearest country (Estonia). It would be difficult to underplay the size of the problem. The drug-related death rate in Scotland is now three times the size of that in the U.K. as a whole and last year more people died in Scotland from drug misuse than from the direct effects of alcohol!
The figures did unnerve me but unfortunately they did not come as a surprise. In the decade before I moved to Wales, I worked as a consultant psychiatrist in a deprived area of Scotland and had witnessed first hand the growing problem. More importantly, I had also seen the developing drug strategy which was being pursued. This policy seemed doomed to failure and almost guaranteed to increase the amount of death and injury due to recreational drug use.
The main reason for this was that the strategy in Scotland had only one string to its bow and that string was Harm Reduction. This took a number of forms including needle exchanges, methadone prescribing, safe spaces and the like. While harm reduction can be valuable it is not enough on its own unless you can reduce the harm to negligible levels (which is not going to be the case with something like drug use). The simple logic is that if you reduce the rate of harm to half of what is was before then this will look impressive, but if at the same time you triple the number of people taking the risk then you will have increased, not reduced, the total amount of harm done. The evidence is that Scotland has many, many more people abusing drugs than previously and thus as a consequence many more deaths. It is important to note that about half of these deaths involve methadone which is the prescribed opiate which was intended to reduce the harm.
More people taking these drugs leads to more deaths and a false sense of security by harm reduction strategies may compound the problem. The need is to reduce the harm, but more importantly, to reduce the usage of drugs. It is unlikely that laws against usage will make any great headway, there is little evidence that laws deter people from drug use. Indeed, there is a little evidence that illegality enhances the cachet of drugs in some groups and promotes their use. This cachet is further enhanced by our culture’s tendency to glamourize drug use; watch any late evening chat show or read any interview with a modern media star and see the use of drugs being used as a badge to garner respect. In the recent race to become the Tory party leader, and hence Prime Minister of the UK, had the unedifying spectacle of all the candidates competitively ‘confessing‘ their drug misuse in an attempt to win the youth vote.
In addition to this cultural acceptance of drug use there is the further problem that, now, drug misuse is an access route into welfare benefits. In a country, such as Scotland, with high levels of unemployment and poverty there will be some pressures to look at the problem of addictions differently – when being on the sick role as an addict could mean being prescribed opiates (methadone) by the state and receiving money in the form of Personal Independence Payments. (Addictions UK for example have a service to help secure payments when you have an addiction). The biggest problem facing those with addiction problems is securing autonomy and independence again, compounding a drug dependency with a welfare dependency will simply amplify the problem.
In an ideal society people would be free to decide on their use of drugs but also responsible for the consequences of taking them. There is little to suggest that the state will be able to make this aspect of our behaviour disappear but there is good reason to think that it has the capacity to make problems worse. Prescribed opiates are now killing as many people as illicit ones, and we have developed a large industry which lives on the backs of those trapped in cycles of dependency. The last decades have seen Scotland move to a much more authoritarian and controlling nation state. This change has important social and cultural effects and these figures showing a dreadful loss of life, and hinting at even worse disability and hurt, should act as a wake up call to the risks involved.