Senior doctors on the Scottish Government advisory body, the National Forum on Drug Related Deaths, have recommended that supervised "consumption rooms", where intravenous drug users can take heroin in a safe environment, should be considered to try to stall the drugs death toll, especially among older users.
Shooting galleries and prescribed heroin could help keep some of the country's most chaotic addicts alive, say leading medics Roy Robertson and Saket Priyadarshi in the National Forum on Drug Related Deaths report.
However, ministers are against such facilities being introduced in Scotland, despite them being well established across northern Europe.
A spokesman said: "The Scottish Government has no plans to introduce drug consumption rooms due to the ethical and legal issues raised by such proposals."
Robertson and Priyadarshi say there was "considerable potential to reduce the number of drug-related deaths by undertaking targeted harm reduction measures".
Arguing that older intravenous drug users were particularly vulnerable, they add: "More should be done to engage such populations with recovery opportunities. Potential means of achieving this are the availability of assertive outreach by harm-reduction services, low-threshold treatment services, heroin-assisted treatment and drug consumption rooms."
The doctors urge Alcohol & Drug Partnerships, or ADPs - the multi-agency teams handling addicts - to "assess the need for interventions identified above".
Despite official disapproval, at least one ADP has discussed establishing drug consumption rooms, although it seems managers baulked at the idea.
The report also reveals that in nearly three-quarters of fatal cases the user had been in contact with drugs services, and three-fifths of them had been in contact in the last six months of their life.
Dave Liddell of the Scottish Drugs Forum said: "There is an urgent need to explore the specific service needs of this most vulnerable group and let them know their lives matter. We should be open to new thinking on what more accessible services might look like, [and] exploring new options, including assertive outreach, heroin prescribing and drug consumption rooms. These approaches can draw people in, build trust and enable small steps towards recovery."
Liddell was backed by independent MSP John Finnie, who said: "Where there is a will there is a way. All I want is for fewer people to come to harm."