Fixing our drugs crisis
1264 people died of a drug overdose in Scotland in 2019. The figures, published just before Christmas, mark a record high. They are the worst they have ever been, and the worst in Europe.
The real tragedy is that the majority of these deaths could have been avoided. Most of these people did not intend to die. Maybe they took too much. Maybe they took the wrong stuff. Maybe, on top of other things, they took something that had an unintended effect.
We don’t know because most of them died alone. Behind closed doors. Unable to call for help by the time they realised they needed it.
Some of our fellow citizens still hold to the view that these people brought this upon themselves. No-one’s fault but their own. These are not priority deaths. This callousness breeds an out of sight, out of mind mentality which has held back public policy for decades.
But there are a lot of deaths now. Over the last decade more than Covid. And each one is somebody’s son or daughter, somebody’s mum or dad. Most families in Scotland now have a member whose life has been destroyed, or ended, by problem drug use.
The public are ready for action. Ready to learn from abroad. To do better. To stop the killing. Scotland’s political class needs to step up to the mark and lead. So the First Minister’s determination to prioritise action on drug deaths is extremely welcome. So too is the creation of a dedicated ministerial post and the appointment of Angela Constance to it.
As the law stands right now, there is a lot more that can be done. Advice and treatment can be stepped up. Public agencies – including Police Scotland – can focus on diversion rather than punishment of problematic users.
Drug deaths ought to be regarded as a public health emergency, not just in Scotland, but throughout the UK. But the problem is unique. Unlike any other health problem, this whole area is set against the backdrop of the criminal law. It is one thing to regulate or prohibit the manufacture, supply and distribution of substances. It is quite another to outlaw their use altogether.
It can be a crime to sell or consume alcohol in certain places at certain times, but it is not a criminal offence, per se, to drink it – say, within the confines of your own home. We treat drugs, other than nicotine and alcohol, quite differently. The 1971 Misuse of Drugs Act (MDA) classifies a range of substances, themselves, as illegal; not just to sell, but to possess or to consume.
And this is now our biggest problem. A piece of legislation which was designed to protect society from problem drug use is now the greatest impediment to doing just that.
Because all drugs, and everything to do with them, are illegal, every individual member of staff and the agencies they work for risk falling foul of the law when they make any intervention at all.
There is no other major piece of legislation which has sat unamended on the statute book for half a century. All the more remarkable when you consider that the problem it was intended to address is manifestly bigger and quite different than it was when Rod Stewart topped the charts with Maggie May.
Later this year, a range of organisations will launch a campaign to review and repeal the MDA on the occasion of it fiftieth anniversary. They will have the backing of most in the medical profession and probably a majority of senior police officers. This is a campaign the SNP should support.
Prohibition doesn’t work - it never has. Simply making everything to do with drugs illegal means our society pretends the problem has gone away. But it hasn’t gone away. Far from it. Instead, it operates outside the law and is entirely regulated by criminals. Supply is not a problem. You can go to any town or city in this country and within 60 minutes have whatever drugs you want delivered to you. Prohibition means there is no control of what is sold, or where, or to whom. Pushing heroin to thirteen year olds at the school gate is no more or no less illegal than friends sharing a spliff at a party.
Increasingly, countries around the world are realising that the absence of state regulation simply licenses organised crime to step in. And increasingly, they are doing something about it.
This debate, like most, could do with some honesty. Since history began, human beings have been drinking potions and chewing leaves in an attempt to chemically stimulate their minds. Often this is driven by a desire to alleviate hurt or suffering, but often too it is driven by boredom. The hedonistic pursuit of pleasure is intrinsic to the human condition.
That said, of course some stuff can be harmful, especially if you take too much. Also, since we are talking about substances which change behaviour, people other than the consumer need to be protected too. All of which underlines the need for proper regulation and control of substances which alter how humans interact with each other. But the premise on which any system must be based is that of reducing, if not eliminating, harm to the user and to the wider society. And that really ought to be based on hard evidence. So, for instance, whilst it should be illegal to drive if under the influence of cannabis, it is hard to see what social protection is offered by making it an offence to smoke a joint in a private place.
All of this is a world away from the MDA. Nothing is going to change overnight, and there’s a reasonable possibility that Scotland could become an independent country, with the capacity to devise a new framework for drug regulation, before the UK gets round to changing theirs. That, in itself, is a good reason to be part of the process of advocating and developing new policy right now.
If Scotland gets the chance to implement change first, that’ll be a bonus. And, as in so many other areas, the new Scotland could be a beacon for social reforms across the island of Britain, pioneering progressive change. Certainly, in this area, you get the feeling that one of the drags on reform is the faux morality of middle England. Unburdening that baggage could allow us to have more purposeful grown-up debate about how to change.
Meanwhile, people are dying. So we cannot put off doing something until the entire legal framework changes. Whilst waiting for that, some small changes can be made now which would have a major effect on keeping people alive.
Which brings me to the Problem Drug Use Bill 2021 which I will publish next month with cross party support in the House of Commons. This spells out how specific changes can be made now to drug laws with the aim of allowing much more effective intervention. The bill shifts the whole area out of the criminal justice arena and locates it firmly in health policy. It also mandates the Secretary of State to consult devolved ministers on a review of the MDA and to bring forward proposals for change – the need for which we discussed above.
But then the bill proposes specific immediate changes to the law. Central to these are measures to facilitate the creation of supervised drug consumption rooms within health centres where users can consume their own drugs. Probably better called overdose prevention centres, these facilities are central to the fight against drug deaths in many parts of the world. I’ve seen them in action in Canada, Germany and Portugal. They work.
People are not supplied with drugs and not assisted to take them. But, if something goes wrong, staff are on hand to deliver naloxone (a drug which counteracts opioids) or CPR in the case of cardiac arrest. It can even be as simple as placing someone in the recovery position so they don’t choke.
The international experience shows that when people use such facilities, and develop trust in those running them, then they are receptive to interventions to help them manage their addiction. This can often mean referral to other health professionals, advice with money and benefits, or being put in touch with agencies who can help with housing or work.
Let’s be clear. This is not about getting people off drugs. It is about keeping them alive long enough so that that might become an option for them.
Now, the law on such facilities is unclear, and some argue that they could be set up now with a commitment from prosecuting authorities not to take action against them. In this regard to interpretation of the law which the Lord Advocate in Scotland has decided is unhelpful to say the least. Some police and crime commissioners in England seem likely to take a more liberal interpretation of the current law and direct law enforcement not to intervene.
But there can be no doubt that clarifying the law to exempt treatment centres and the staff who work in them from the provisions of the MDA would help. This is exactly what my bill proposes. Other measures include decriminalising the possession of small amounts of any substance for personal use so that users cannot be arrested on approach to a treatment centre, practical action to reduce and remove stigma, and ensuring that the benefits system does not discriminate against people who are addicted to drugs.
I should make it clear that I am under no illusion that my bill will become law, nor get anywhere near it. Westminster doesn’t really allow for that sort of thing. So, unless the government of the day get behind it, change simply will not happen. The bill is essentially a campaigning tool, designed to help raise awareness of the issue and of practical steps that can be taken now. It will put pressure on the UK government to explain why it will not support such measures and why it is becoming increasingly out on a limb in comparison to other countries.
Let me finish by acknowledging that problem drug use cannot be divorced from other social problems. Of course, this is a problem that afflicts working class communities most. It is wound up with poverty, inequality and alienation. The more brutal and painful your life is, the more likely you’ll be to use drugs to escape its misery. But no-one, in my experience, advocates tackling the social problems more than those who call for changes in drug laws.
It is not an either/or situation. We need action to create a better society and a more mature attitude to drugs too. If we do not allow effective medical intervention, remove stigma, and begin the process of wrestling the control of drug supply away from organised crime, then we will condemn another generation to death at the hands of their exploiters.
Written for the Yellow Papers Project - 27th February 2021