Is the fall in drug deaths in Scotland the beginning of a downward trend?

The truth is it is too early to say, but there is cause for optimism.

The latest figures reveal the largest year-on-year decrease - by far - since records began in 1996.

For the past two decades, drug misuse deaths crept up nearly every year, before accelerating rapidly from 2013 onwards, so a decline of 21% appears significant.

The Herald: Drug misuse deaths fell sharply in 2022Drug misuse deaths fell sharply in 2022 (Image: NRS)

The question is whether it can be sustained, and what may have caused it?

One of the bleakest forecasts I ever heard was from an long-time addictions worker who remarked that the death toll would have to come down - inevitably and eventually - "once we run out of people to die".

READ MORE: Drug deaths fall for second year in a row - but rich-poor gap widens

Their point was that the vast majority "drug deaths" are not the headline-making tragedies of otherwise healthy young people taking pills on a night out.

Most are years in the making, often rooted in trauma and despair, and resulting from progressively worsening chronic health problems which culminate in an accidental overdose - usually involving opioids - from which their body cannot recover.

The average age of someone who died from drug poisoning last year was 45, compared to 32 in 2000.

This is a generation whose battle with addiction goes back 20 to 30 years.

The Herald: Drug misuse death rates by deprivationDrug misuse death rates by deprivation (Image: NRS)

Like most public health crises, it goes hand-in-hand with poverty and inequality.

The poorest Scots are now 16 times more likely to die from drug misuse than the most affluent, a gap that continues to widen; in 2001, the difference was ten-fold.

Exactly why Scotland ended up with a drug problem so much worse than our neighbours in the rest of the UK and Europe - and much closer to the US - is harder to decipher, however.

READ MORE: What can Scotland learn from Ireland's surge in life expectancy? 

David Liddell, CEO of the Scottish Drugs Forum has said it "has its roots in the harsh climate of 1980s deindustrialisation", which disproportionately impacted Scotland at the time, with an economic and social ripple effect continuing over subsequent decades.

Austerity appears to have turbo-charged the situation, with a misguided decision by the Scottish Government to withdraw £15 million in funding from Alcohol and Drug Partnerships in 2015 weakening our ability to respond as the crisis spiralled.

So what's changed?

One factor may be the increased availability of naloxone, which can reverse the effects of potentially fatal opioid overdoses.

Between March 2020 and March 2023, more than 72,000 kits have been issued to drug users - roughly as many as were distributed in total during the previous nine years.

The Herald: Naloxone distribution has increased substantiallyNaloxone distribution has increased substantially (Image: PHS)

In addition, £100 million has been invested towards the Scottish Government's goal of growing the number of publicly-funded residential rehab beds from 425 in 2021 to 650 by 2026. It currently stands at just under 600.

As for what's next, the Scottish Government favours Portuguese-style decriminalisation in relation to possession of drugs for personal use.

READ MORE: What can Scotland learn from Lisbon's approach to drug addiction? 

It argues that this would pave the way to a "compassionate" drugs policy focused on preventing harm rather than punishment.

This could include safe consumption rooms and drug checking facilities, where samples can be analysed for toxins.

The UK Home Office - which holds most of the cards when it comes to drug laws - remains opposed.

The Herald: A mobile safe consumption roomA mobile safe consumption room (Image: PA)

Meanwhile, the Scottish Conservatives are pushing forward with their Right to Recovery Bill, which would give people ready to break their addiction a legal right to the treatment of their choice - from methadone to rehab.

In the meantime, the spectre of synthetic opioids hangs over Europe.

The 2022 statistics may predate the effects of a growing trade in ultra-strong heroin-like drugs, such as fentanyl and nitazenes, spurred by the Taliban's recent ban on poppy growing in Afghanistan. 

These are already beginning to appear in Scotland and there are fears they could set overdose deaths spiralling once again.