Drug-Related Deaths in Scotland – Our Response
Drug-Related Deaths in 2018 Figures Yesterday Scotland’s drug-related deaths figures were released by National Records of Scotland. The figures showed a steep rise in drug-related deaths, from 934 in 2017 to 1,187 in 2018 – amounting to a 27% increase in one year.
Grant Sugden, Waverley Care’s CEO responded to these figures stating:
“We are saddened to see the continued rise in drug-related deaths in Scotland and we expect these figures will not reduce during 2019. However, from our experience delivering frontline services, we are not surprised to learn of these figures, with the human impact of drug-related deaths felt by our staff and service users across Scotland. This in itself is a poor reflection of how our most vulnerable and disadvantaged people are cared for in society. Without a significant change in Scotland’s response to rising drug-related deaths, frontline services can only do so much to prevent further lives being lost within the current legislative and economic climate. As a third sector organisation supporting individuals and families directly affected by drug-related deaths, we are joining our colleagues across the sector in calling for a public health approach to prevent further harm in our communities.”
Drug-Related Deaths and Our Work
At Waverley Care, our work centres on supporting people affected by HIV, hepatitis C and poor sexual health across Scotland. We also focus on preventing new STI, HIV and hepatitis C infections. Through our community support services, as well as our Street Support Team in Glasgow, we work with people who inject drugs to minimise the risk of new blood-borne viruses transmission, as well as supporting people who are living with HIV or hepatitis C. Many of the people we work with are made vulnerable through poverty, living with poor mental health and using drugs as a means to cope. They experience multiple forms of stigma, because of drug use, homelessness, as well as their blood-borne virus status.
As a blood-borne virus organisation, we deliver one of a range of services that people affected by drug use may engage with. We work alongside addiction services, mental health services, housing, and many others across Scotland. Each service is working together to prevent drug-related harm, however, there is a limit on what a system of support can achieve with reduced resources across the health and social care sector, as well as legislative barriers to introducing evidenced harm reduction, such as drug consumption rooms.
Impact of Drug-Related Deaths
In Glasgow and Edinburgh, where the highest rates of drug-related deaths are located, we asked our staff for their reflections on what these figures mean for our work as frontline services, while recognising the limitations of any single service or organisation in addressing a nationwide crisis. Three areas were highlighted including the influence of limited resources, the human impact and the need for a practical approach tackling drug-related harm.
Each of our staff highlighted the limitations of frontline services in preventing drug-related deaths when both statutory and non-statutory services are often underfunded and under-resourced.
“These figures really highlight the rising pressure of providing community-based and residential services to people who use drugs. With fewer resources, our team’s capacity to support the most vulnerable people is significantly reduced. Many of the people we support experience multiple barriers to engaging with services so when thinking about preventing drug-related deaths our staff need to consider at what point should they be concerned when there has been no contact with someone they believe to be at risk. This raises questions, whose answers are often impacted by resources and capacity. Questions such as, at what point should staff be concerned when there has been no contact with someone? And when should they take extra steps to make contact by following up? What does following up entail? It might be by calling; texting; going to the person’s own home; calling the GP and chemist to check if they have been seen; calling blood-borne virus clinics to check attendance; calling social work or other support services to check database systems, or requesting police welfare checks.
This is always a judgement call and it is not easy for staff to know if they are making the right decision. This is particularly the case with people who are deemed as having ‘capacity’ but continue to use drugs for a variety of reasons – from coping with their mental health to coping with poverty.
– Liz Marr, Milestone House Residential Services
“There are many people in Edinburgh who have addiction issues, who are lost to statutory addiction services as they are overrun and have to prioritise. Early intervention with people who use drugs is important to halt escalation of harm. Within our services in Edinburgh, we look to refer people to additional support such as SMART recovery groups but, capacity is an issue within such groups too.”
– Allison Murphy, Community Projects
When we see the latest drug-related deaths figures, this means more than a statistic or a number to the people we work with, our staff and our communities. These numbers represent real people and communities around them, who grieve their loss.
“The emotional impact on staff in these situations is significant. For example, we had a drug-related death within Milestone several years ago and it’s not something that you can walk away from without feeling a sense of guilt or responsibility – even when you know you’ve done everything you could to prevent it. In this particular case, the person had been selling their Methadone in the community but hadn’t told anyone about this. When they came into Milestone they were taking the full prescribed daily dose and died as a result.
We do try to get as comprehensive an assessment as possible but this does not always reflect the true picture of someone’s drug use. Community projects and residential staff all carry out risk assessments but often they are not as in-depth as they could be when they are limited by capacity, resources and continued reduction in funding of services.
– Liz Marr, Milestone House Residential Service
“The drug-related deaths were sadly expected but still devastating. For every statistic, there is a human being who had their own dreams and aspirations. At the HIV Street Support Project, we have lost three service users in the space of 6 months to drug-related harm. We work with people every day who battle with their own addiction whilst living in poverty and dealing with a wide range of issues including PTSD, depression/anxiety, fear, stigma. Many feel that they and their lives don’t matter. However, what we see are resilient, intelligent, insightful people who have been let down at almost every point in their lives. The people we support are also those who have experienced overdose themselves, often having witnessed friends and family die as a result of drugs.
Each and every one of those statistics is someone that mattered even if, sadly, they did not feel they mattered. Organisations are doing all that they can to address the wider complex health and social issues but it is the root causes that need to be tackled – and for resourced, holistic, consistent, non-punitive, self-directed support to be made available and accessible to the most vulnerable people in our society. Scotland has to take notice and needs to do better than this.”
– Mhairi McKean, HIV Street Support Project
Moving to a Public Health Approach
Earlier this year, Waverley Care joined with a number of other health and social care charities calling for the Scottish Government to take a practical harm reduction approach to service provision, including establishing drug consumption rooms. This call was driven by Glasgow’s continuing HIV outbreak and informed by moving from criminal justice to public health approach tackling drug use, as internationally evidenced to effectively reduce related societal harm.
“In Glasgow, we have a forward-thinking, recovery-oriented system of care in place for people who use drugs, with Waverley Care’s services working within this system to address bloodborne virus and sexual health needs of people who use drugs across the city. Although the continued HIV outbreak and drug-related deaths are the cities ongoing crisis, Glasgow’s comprehensive harm reduction services focus on working together to reach out to its most vulnerable citizens. However, despite the number of services and community groups working in partnership, drug-related deaths figures continue to rise, with Glasgow having the highest rate of drug-related deaths in Scotland (33% of all drug-related deaths). Starkly, this also means Glasgow has the highest number of drug-related deaths per capita in Europe – clearly illustrating that the current UK legislative framework, primarily the Misuse of Drugs Act, is preventing the Scottish Government from taking practical action tackling what is Scotland’s ongoing human tragedy.
While the UK takes a nationwide prohibitionist approach to drug use, Scotland is prevented from initiating internationally evidenced approaches, such as drug consumption rooms, or moving to decriminalise drugs for personal use. This turns away from the reality that people use drugs for a variety of biological, social, psychological, economic and environmental reasons – none of which can be addressed through criminalisation.”
– Jennifer Goff, Research and Engagement Project