Investigation: Life on the front line of Scotland's drugs death crisis

In Glasgow, where 280 people lost their lives last year to drugs, the case for pioneering treatment services has never been more urgent according to experts. Plans are already in place to bring a heroin assisted treatment facility, where drug users will be supplied with medical-grade heroin on site, to an existing homeless unit by Autumn.

The previous plans to bring a safer drug consumption room to the city centre have created tension between the UK and Scottish Governments after the Home Office blocked the move saying there was no legal framework to allow it. Despite the complex web of problems affecting drug users at the very edges of society, the city is fighting hard against the odds.

Dedicated staff provide thousands of clean needles and injecting equipment every year, try and convince people to move away from needles altogether, and the city’s recovery community is “thriving”, according to one former drug user. A huge factor in the soaring death toll, however, is Street Valium, a 12p pill which has flooded the Scottish market in the past four years.

The pills, along with the rising trend in polydrug use, the plummeting prices of drugs and the increasing sense of hopelessness among those in the most deprived situations, has created a “perfect storm” for fatal overdoses.

Claire Muirhead, social care worker, Glasgow health and social care partnership

Every week Claire Muirhead discovers someone she knew has died from a drug-related death. The social care worker is more aware than most people of the realities facing the thousands of Scots in the grip of addiction.

Now she is trying her best to help them escape the cycle of drug use, crime, prison and homelessness which she says is all too common among the injecting drug-user population, who are the most at risk of overdose and death.

Muirhead, now 43, is a recovering drug user herself and it is this experience which, she said, enables her to relate and reach out to others in the same situation. For 16 years she used heroin and kept it a secret from her family, friends, employers and even her GP. Although not injecting straight away, towards the end of her drug use she had moved to injecting. 

While studying psychology at Edinburgh University, she started experimenting with drugs such as cocaine, LSD and cannabis, before trying heroin at the age of 19. it was an admission to a mental health unit due to psychosis at the age of 35 which started her on her journey to recovery.

She said: “I was university educated, I came from a good family. Nobody would have ever thought for a minute I was in the depths of heroin addiction. At the time I wouldn’t have told anybody as I was so fearful of the stigma surrounding it, fear of how I was going to be treated, what my family and associates would think.

READ MORE: One 12p pill has outdone years of work in the war on drugs, say Glasgow addiction experts 

“I really did use in secret and in isolation. For some people their drug use starts as recreationally, it then becomes problematic and then dependent. It follows that pattern.”

Trauma, according to Muirhead, is one common factor among the majority of drug users she knows and works with.

She explained: “For some there may not have been trauma early on, but for many there will be. The very nature of the lifestyle people lead within addiction amasses trauma.

“From the start, it’s about the ways and means to actually pay for their drugs. Initially it may be to take away the physical pain but very quickly it becomes about their emotional pain - the incarceration, criminal records, prostitution, violence, disintegration, of families.

“People are losing friends too, as it tends to be close-knit groups who are using drugs. You’ve lost someone and you think ‘I might be next’. How do you cope? You use more drugs.

“Personally it was pretty much the loss of everything - self-respect, confidence, deterioration of my mental health and any hope for the future. That is very much the case for the majority of people who have gone through the lifestyle of addiction.”

Recovery communities across Glasgow have gone a long way in helping Muirhead break the cycle of drug use and are a growing and thriving part of the city’s attempts to tackle the issue. One vital part of the recovery process, however, is still missing.

She said: “I believe is very important today for their to be services like the enhanced drug treatment facility and safer consumption room, because that in itself sends out a message to people using drugs that you do care, you are important and we are here to help. The challenge is about people engaging with the services that are there. These services would go a long way in making that change.

READ MORE: Drug death rate in Scotland at record high 

“ Within recovery networks, you are hearing about people you lose all the time. At the weekend there I found out five people had died, all from drugs.

“There are lots of people affected who were in recovery, in full-time positions, working. Often people think that somebody with addiction problems are within this small group of people who are publicly injecting, or who are living on the streets. In fact, addiction doesn’t discriminate at all.

Dr Saket Priyadarshi, Associate Medical Director for Addiction Services, NHS Greater Glasgow and Clyde, has worked with drug users for the past 17 years and witnessed a huge change in the types of drugs, and the ways in which they are being taken, over his career.

He said Glasgow has a problem with drug users injecting cocaine as well as an even larger issue with “poly drug use” - where people are taking more than one substance at any given time.

The change in behaviour combined with an increasingly ageing drug-using population is pushing people even closer towards death.

Priyadarshi explained: “It’s a ticking timebomb. People have reached an age where the street supply is such that they are really really pushing things. Reversing that trend is a huge challenge, and for me its about how can we control it, minimise it and improve outcomes for that population as best as possible.

“A 45-year-old injecting drug user who has been injecting for 20 years is somebody whose cardiovascular and respiratory function is probably that of a 75 to 80-year-old.

“Their ability to absorb the shock of using additional drugs, as they may have done when they were 25 or 30, is a lot lower than it was. That pushes them closer to the edge of fatal overdoses. That is one of the key drivers around drug-related deaths.

“If you went back about 20 years ago, drug-related deaths would have been the overwhelming cause of death among drug users. In the last 10 years, mainly because of treatment responses, drug-related deaths as a percentage of all-cause mortality in drug users has been falling. Things like cancers, cardiovascular disease, respiratory disease, infections and sepsis have become the most common causes.

“Because of what has happened in the last 4 years, things are rebalancing again and drug-related deaths are rising.”

Staff working with drug users who die are increasingly exposed to trauma from their deaths, according to the medic.

He said: “It is a shock and a real sense of loss. In the last year, I have lost one patient who I had worked with for three or four years. We knew their family, their social situation. The fact is that individual was in quite advanced recovery. They were working, trying to reintegrate with their family, had multiple clear urine samples, but over a short period of time something went wrong in their life and unhelpful coping strategies kicked in.”

While some of the 1187 people who died from fatal overdoses last year were in recovery, many, according to Priyadarshi were not.

He explained: “We have a really thriving recovery community which has been probably the biggest positive development in Glasgow in terms of alcohol and drugs.

“On the other end we have a homeless, street-living, public injecting population. In the middle are a large number, the bulk of drug users, who are either totally disengaged and keeping things under the radar, or engaged in a suboptimal way, and people who are actually doing okay in treatment and care.

“Yes, if you are street living and public injecting, using multiple substances, you are at the highest risks of the worst outcomes but the other folk remain at risk as well. We do see, unfortunately, drug deaths across that whole spectrum.

“Glasgow’s alcohol and drugs partnership has implemented a huge range of things to help people engage in treatment in a better way.

“We try to find the most at risk populations, we have injecting equipment provision, a mobile van we use trying to plug the gap around Central Station and divert people away from injecting to foil use. We have a range of homelessness and third-sector partners who are working with people who are homeless, begging and street living.

“However, when people are in the absolute grip of addiction, their ability to engage with any of that wider stuff is difficult. Their view is ‘I’m injecting, I need money to source the drugs, I’ve got the drugs, I’m injecting, I need money to get the drugs.’.

Priyadarshi said that facilities such as the heroin assisted treatment facility planned to open in Glasgow in autumn, and the currently stalled plans for a safer drug consumption room, would help to break the cycle.

He said: “It would chip away at that cycle. The Heroin Assisted Treatment says ‘Okay, you don’t need the street. Come to us, we will provide the drug but you have to engage and get the benefits of that’.”

John Campbell manages the needle exchange programmes in Glasgow and is the injecting provision lead for NHS Greater Glasgow and Clyde.

He has monitored the costs of drugs and consumption habits and said drugs in 2019 are roughly 80% cheaper than they were three decades ago.

He said: “It’s a recipe for disaster.

“It is driven by market forces. Go back to 1986, the majority of people injected heroin alone, and took maybe Temazepam.

“Fast forward to now, you get twice as much heroin for your money – real time inflation hasn’t happened.

“You used to get 100mg and you’re now getting 200mg for the same £10. Temazepam was £1.50 a tablet.

“Today we have Etizolam, which is 12p or less a tablet. Along with that you also have cocaine being injected, alcohol being consumed and prescription drugs that people are accessing now that they didn’t before. There is a much wider range, much more easily available, much cheaper and they are more potent.

“Its 93% cheaper for heroin and Temazepam, and if you add in cocaine and alcohol, its 80% cheaper in real terms for a typical drug user.

“There are definite links between deprivation and drug use, no doubt, but in this country at this time, people problematically using drugs are able to, by whatever means, acquire enough money to get hold of a really wide range of drugs.

“With all of these driving forces, it can be frustrating sometimes when the drug death figures are released and people look to us and say ‘What are you doing about it?’ There are so many motivated people out there in the field, we have a fantastic naloxone programme and access to services is good, but we are having to deal with these really strong competing market forces and a huge organised crime network.”

Campbell works with some 400 publicly-injecting drug users in Glasgow city centre, trying to ensure they have access to clean needles and advice on where to get help, if they accept it.

He said: “We have public injecting drug-users who are trying to take their drugs in alleyways, in crawlspaces which are unsanitary, poorly lit, the injections are often very hurried as they are looking over their shoulders to see if someone is coming. All those things just increase the risk and likelihood of harm.

“That is one of the most frustrating things - we are providing people injecting with a very good range of paraphernalia, needle and syringe coverage across the city is genuinely superb, nobody lives far from a needle exchange. Last year we also gave out 500,000 sheets of foil to try and encourage people away form injecting, but we are still seeing these problems increasing.

“The reality is, we are not there when people are actually injecting their drugs. The benefit of a safer consumption facility is that we are there. We can suggest alternatives to them, as well as all the other benefits they can get from a facility – they are not injecting in the street, there is not that public nuisance aspect leaving discarded needles which affect communities and businesses.”

“We struggled throughout the years to reduce heart disease and diabetes because people had easy access to high fat and sugar foods. It is very much like that now; except we don’t have the means to regulate the supply of the substances causing the problems.”