Scotland drug services still failing users, families claim

Annual statistics on drug deaths in 2023, due to be published on August 20 by the National Records of Scotland, are expected to show an increase. There were a suspected 1197 overdoses last year, according to already-published provisional data. Figures for early 2024 are also higher than the previous year.

There was a small dip in 2022 when 1051 confirmed drug-related deaths were registered, the lowest number since 2017.

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Scotland still has a higher level of drug deaths than any other European country and there have been concerns that numbers could rise further due to the increase of super-strength synthetic opioid-based drugs being found across the UK.

Meanwhile Scottish Government data has revealed that despite launching its flagship “medication assisted treatment” standards for drug services more than three years ago, these have still not been fully implemented.

Drug laws are reserved to Westminster but in Scotland an annual budget of £50m was allocated to improving treatment, including access to residential drug rehab, in 2021 as part of a “national mission” to prevent deaths and improve people’s lives.

Ten treatment standards were also introduced in April of that year, which aimed to ensure better help was available more quickly. Research shows that deaths are prevented by having more people in treatment.

But a report published last month revealed that despite progress they had still not been fully implemented across Scotland.

Insiders said endemic workforce shortages were partly to blame, particularly in terms of mental health support, leading to huge, unmanageable caseloads.

Charity Scottish Drug Forum claimed that some people using drugs had given up on services and told charity workers there was “no point” in attending treatment services because they were unable to offer the help they needed.

Some said the problems were particularly acute for those using drugs such as cocaine or benzodiazepines – or street valium – for whom opioid replacements like methadone were not appropriate.

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One family told The Ferret that their son – now in his early thirties and risking his life on a daily basis by taking street valium – had been fighting for five years for a safer prescription or proper mental health support without success.

Other heartbroken families said not enough had changed, leaving them shut out of care plans and unable to discuss the needs of their loved ones with drug workers.

In an introduction to the Scottish Government’s report on the implementation of the treatment standards drugs minister Christina McKelvie claimed the progress achieved was “a demonstration of what can be achieved when we identify a key issue and bring people together to design and deliver change”.

However she also admitted: “Everyone involved in the delivery of services knows that there is still a way to go – not everyone we speak to has noticed change and there are still individuals and families who do not have access to care and support on the day they ask for help.”

The report found the first five treatment standards – which include same-day access to methadone and harm reduction measures like clean needles – had been implemented in 90% of the alcohol and drug partnerships.

But the report also found that this was not borne out on the ground with examples of people waiting two weeks for an appointment, even longer to get a prescription of methadone or other opioid replacement drugs and insufficient staff to ensure that those in crisis were proactively offered treatment. Examples of people queuing for methadone or being given consultations in public view, causing embarrassment, were also reported.

The other five standards – which include mental health support, group and individual counselling and advocacy – had not been fully implemented according to the report. Provisional data suggested 91% of alcohol and drug partnerships had started implementation but others had not yet begun three years in.

The report found “mental health care can be difficult to access” and said care should be more trauma informed. Research has linked drug dependency to adverse childhood experiences such as physical, emotional or sexual abuse, and compounded by adult trauma such as domestic violence, homelessness and time in prison.

They are also associated with living in poverty. People in the most deprived areas of Scotland are almost 16 times as likely to die from drug misuse compared to people in the least deprived areas according to the 2022 statistics.

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The report findings are borne out by families who spoke to The Ferret.

Iona and her son Ross – who requested we do not use their real names – have been fighting for urgent treatment from their drug and alcohol partnership service in a rural west coast town for five years.

Ross, now in his early thirties, has been able to stop using heroin with the help of a methadone prescription but continues to use street valium. He also struggles with attention deficit hyperactivity disorder (ADHD) as well as anxiety and depression.

He previously took valium on prescription. “Then the GP changed and that prescription was stopped quite abruptly,” Iona explains.

“At that point he started to source them [street valium] on his own. We were absolutely terrified about the level of risk he was taking as a result. We were asking about drug checking, but it’s not available and it feels as if no-one is prepared to help.”

A few years ago the family discovered Wedinos, a Welsh postal drug checking service and have been working with their son to send away samples to test the drugs he is taking in an attempt to keep him safe.

They have been requesting an NHS prescription of benzodiazepines since 2019 and have found a pharmacist willing to oversee a taper programme – where the amount taken would be gradually reduced. But they have been unable to find a prescriber.

“We have a good GP and he cares,” said Iona. “But he says he can’t prescribe without the permission of an addiction consultant and there hasn’t been one in post since 2019. Our GP feels caught between a rock and a hard place. He’s asked for a referral to an out-of-area service and had no response.”

In correspondence shared with The Ferret the GP admits he is “stuck for options”.

The Home Office is currently considering licence applications for three drug-checking pilots in Glasgow, Aberdeen and Dundee.

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Mental health support has been equally hard to access. Ross has a “five minute phone consultation with a psychiatrist once a year who admits he knows little about addiction or his ADHD,” his mother said.

Meanwhile her son is becoming “increasingly frustrated, anxious, angry and disillusioned”.

“It’s no wonder why people are dying,” she added. “It feels as if no one is prepared to help. I understand there are risks attached to prescriptions but no-one seems to be acknowledging the risks that we are facing as a family every day.

“It’s had a huge impact, not just on my son, but on all of us. It’s affecting every single aspect of our lives. We need services that offer proper support for our loved ones.”

Kirsten Horsburgh, chief executive of Scottish Drugs Forum, said the evidence was clear that being in treatment was “a protective factor against overdose death”.

“Yet we still struggle to attract and retain people in treatment so they can benefit from its protection,” she added.

“Resources are still an issue and we also have to change the demands we make on treatment services to ensure a greater emphasis on building therapeutic relationships.

“At the moment we have people stating they might ‘take the risk’ of accessing treatment but they have little confidence that they will be provided with a service that truly meets their needs.

“Some people who are using opiates as well as cocaine, benzodiazepines and other drugs tell us they see ‘no point’ in attending treatment services that they know will only focus on their opiate use. This is despite significant efforts to improve the system so we clearly have a long way to go.”

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She claimed the third sector should be more involved in treatment provision, as is the case in England, to provide “broader options”.

Most people who die from drug overdoses are using multiple drugs, according to figures, with 82% of people testing positive for opioids like heroin, 57% for benzodiazepines and 35% for cocaine, which includes crack cocaine. In recent years the number of people injecting cocaine has increased dramatically, due to its availability in cities like Glasgow.

Louise Stewart, director of service delivery at alcohol and drug support charity WithYou, agreed that those using substances like benzodiazepines [known as “benzos”] and cocaine in a harmful way tended to avoid services because there was no treatment equivalent to methadone for those not using opioids. “We find that these clients often come directly to third sector organisations,” she said.

“Across our services, our staff are very experienced in supporting people who are using cocaine and benzodiazepines, through structured one-to-one and group interventions. However, we need to be able to offer an alternative to [drug] use in addition to that.

“More generally, drug services should not be delivered in isolation. We need a cross-cutting approach that includes preventative community measures, availability of appropriate housing, and access to health and mental health services.”

Catriona Matheson, a substance use professor at the University of Stirling and former chair of the Scottish Government’s drug death task force, which wound-up in 2023, said that while some “real progress” the aim to provide more trauma informed care was ongoing, with additional resources for staffing and recruitment needed.

“Access to mental health has and will continue to be challenging,” she admitted. “When mental health nurses work as key workers they have huge caseloads and can’t spend the time required to do the psychological work with people.”

She also claimed additional clinical research was needed so new treatments could be provided, particularly in terms of poly drug use [using different drugs at once].

“The Scottish Government has never invested in clinical research in this area – we need to compare it to other clinical areas like cancer, cardiovascular and dementia in terms of spend versus mortality and harm.”

A Scottish Government spokesperson said it was “working hard to ensure the best care” was available for cocaine and benzodiazepine users” as well as to respond to the growing threat from “highly dangerous, super-strong synthetic opioids like nitazenes”.

“Through our £250 million National Mission on drugs, we are taking a wide range of measures to reduce harm and save lives,” they added, claiming the “roll-out” of the MAT standards continues.