Analysis by David Liddell

The escalation in overdose deaths in Scotland and their sheer scale, represent a national tragedy that demands a fundamental rethink of our approach. Other countries have reduced overdose deaths by ensuring that people are appropriately retained in high-quality treatment and we must do the same.

Again and again we are asked what can be done and what works. There has been a rumbling debate in Scotland for years on these matters. And yet the evidence is clear – there is no doubt about what ‘works’ if we have the courage to learn from our own success and failure and decades of international evidence.

In terms of reducing drug-related deaths, we need to ensure people are in treatment. For many people dependent on opiates that will mean treatment involving opiate replacement therapy; methadone or another medication. That treatment will be most effective when it is prescribed at doses that reduce the urge to use other drugs. It should also be supplemented by psycho-social therapies and good supports around basic physical and mental health. As a basis for this, people need the basics – a home, a source of income and something to do.

When put in these broader terms, the needs of drug users are no different from the needs of the rest of the population. And yet services struggle to deliver. Why?

The answer lies in the configuration of services, their resourcing and fundamentally in the stigma associated with drug use. This impacts on services, the resources allocated to them and how they work with other mainstream services including housing, employment, education and training.

The Government recently announced The Road To Recovery strategy is to be refreshed after a decade. We welcome this, as the status quo is simply not an option.

We now face a situation where the majority of those seeking help for a drug problem will be aged 35 or over and will be more vulnerable due to multiple health issues. Our research has shown that this group are often not engaged in treatment or even if they are, are receiving the minimum intervention. They drop in and out of treatment for various reasons – many of which relate to the unsuitability of services.

There needs to be concerted effort to change if we are to save lives and create more opportunities for recovery. This will include exploring approaches, well-evidenced internationally but new for Scotland, such as drug consumption rooms and heroin-assisted treatment.

If I could make one change it would be to ensure everyone was aware of the impact that stigma has on individuals, services and the whole debate.

Even when we are discussing the personal tragedies of hundreds of drug deaths people betray their own ignorance and stigmatising attitudes by talking about “lifestyle choices” and dismissively talking about 61,500 Scots with drug problems as if they are some alien group who cannot be understood or helped. The good news is that this is not true and a refreshed strategy should be based in understanding and a clear plan of how we can help.