Call for urgent investment in Scottish drug services to stop deaths

The Scottish Affairs Committee will tomorrow launch its report on problem drug use in Scotland in which is it expected to recommend substantial reform, including a call for drugs to be decriminalised. It heard consistent evidence in support of the approach during its inquiry, announced in March and chaired by SNP MP Pete Wishart.

But leading academics and those working to support drug users told the Sunday National that without adequate investment in drug treatment, the policy would not deliver the dramatic impact needed to save lives.

Last year drug-related deaths – which record overdoses but not related suicides or health conditions – reached an all-time high of 1187. It is understood that early data from the Alcohol and Drug Partnerships (ADPs) suggest numbers will be higher again this year.

Yet last week, drug rehab services in Glasgow saw beds reduced from 55 to 14. While the council claimed beds lay empty, charities hit back, insisting people on Opiate Replacement Therapy (ORT) such as methadone were not being supported to take up places.

Going to a rehab unit usually involves reducing methadone or suboxone to minimal doses with the help of community addiction workers.

Founders and staff at the privately run Castle Craig rehab, which previously treated about 250 Scots said it now only has two or three NHS Scotland-funded patients a year. More than 200 from the Netherlands are funded by the Dutch Government.

Staff at Jericho House rehab in Greenock said despite recovery rates that exceed national averages, it receives no statutory funding, forcing it to the brink of closure last year.

Others claimed that wrap around psycho-social services such as counselling, mental health support and cognitive therapies had been stripped back, leaving people without treatment plans and just 10 minutes a week with a drug worker.

Though both the current and previous Scottish Government strategies aim for a “person centred approach” to drug treatment, it is argued that is impossible without giving people options.

In an action plan published late last week the Scottish Government committed to “develop and implement a programme of work to improve access to treatment and recovery services” but not until 2021.

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Emma Crawshaw, director of Crew 2000, said: “We absolutely need more investment – services should be equipped and ready to meet the changing needs of the ageing and the younger people who are using drugs, rather than struggling to stay open in the face of cuts.”

She claimed that there was a particular lack of treatment services for those not taking opioids. While they are still implicated in the highest number of deaths, cocaine-related deaths have risen 658% since 2008. Crew 2000 is one of the only services offering counselling for cocaine use outside of Cocaine or Narcotics Anonymous.

“We also need more low-threshold, accessible, responsive services, whose development is informed by people with lived and living experience,” she added.

Dr Andrew McAuley, an academic and NHS practitioner, said additional investment in treatment was necessary if the benefits of decriminalisation were to be seen. Demands on services would increase if people were diverted from criminal justice to treatment, he explained.

“Current treatment services would not be able to cope with that at the moment,” he added. “Treatment services have been stripped back so much in the last decade that an influx would mean they need to be resourced. We need to make sure it [decriminalisation] doesn’t just have the unintended consequence of increasing waiting times.”

Funding to ADPs was cut from £69 million to £53.8m in 2016/17. Though the Scottish Government announced an additional £20m per year in 2018, it has been argued this merely took services just past original funding levels.

Drug worker and campaigner Natalie Logan MacLean said better investment was essential. She has been in recovery since 2011 when she was one of just four Scots given NHS funding to do a three-month rehab programme at Castle Craig.

She said: “In 2011 I’d got to the stage where I was so broken, so crippled by trauma, that I had both of my kids removed from my care. I needed rehab and I knew it had to be residential – I know some people can get into recovery in the community but I needed to extract myself.

“It took months for me to get the funding. My care manager was amazing – she was like a dog with a bone and she kept saying that I would end up dead unless I got that place. She knew all about the trauma I’d been through – she was the first person I disclosed to. She knew I was looking for an escape.”

In the end MacLean spent six months at Castle Craig dealing with the untreated trauma, followed by aftercare sessions and Smart recovery meetings in the community, and has remained in recovery.

“What I see is generally though is, the rich get rehab and the poor get methadone,” she said. “I ask people who are on methadone if they have a care plan and no-one has seen one. If we really want to have a person centred approach we need to give people choices. At the moment those choices are not there.”

Jardine Simpson, chief executive of the Scottish Recovery Consortium, said he “remained convinced” that the Scottish Government was committed to change but needed strong leadership and transparency was needed if the “failing system” was actually to improve.

“As drug death numbers have risen over the last few years there has been a parallel erosion of the resourcing available for treatment and support,” he said. “The financial resourcing question seems to have come to dominate clinical decisions made about health outcomes for people.

“Residential rehabilitation places have been reduced almost universally across all localities in the last 10 years. Yet this intervention is evidence based – the science tells the longer the stay the better the outcomes are likely to be. So why reduce the number of places offered? If the answer is finance then why, when locality commissioners have had some financial easement from Scottish Government over this last year, do they continue to reduce residential places for people?”

Additional problems were caused, he claimed, when ADPs set blanket “optimal-dosages” of methadone rather than work with individual circumstances.

A Scottish Government spokeswoman said that it had been “absolutely clear” that Scotland was facing a public health emergency due to drug deaths. “We continue to take actions to address this crisis, including setting up a dedicated drug deaths taskforce to shape steps to reduce the harms caused by drugs, and advise on further changes in practice, or in the law, which could help save lives,” she added. “We’ve recently committed a further £20m over two years to support the taskforce’s work and to ensure the provision and quality of drug and alcohol treatment services are further improved to meet the range of complex health and social care needs of those most at risk.”