We have long stigmatised drug users, especially problem users. And - worse - we also stigmatise the medicine which often saves their lives.

Each year my organisation is called on to comment on the drug related deaths figures. It is part of a ritual that has become something of a “state of the nation” – in terms of the tragic toll on people, their families and communities from preventable overdose deaths.

But also in terms of the quality of the debate in Scotland. It is depressing to see the same arguments rehearsed. We are asked again and again about treatment and whether it ‘works’; but no one ever defines what they mean by ‘works’.

Methadone is the World Health Organisation recommended treatment for opiate dependence. It is on its List of Essential Medicines for that reason. There is an evidence base going back over 50 years as to its efficacy.

The harms that people suffer due to street drug use can be avoided; people can stop being involved in the crime that is often necessary to allow people to buy drugs. This base brings stability to people’s lives and can be a bridge into addressing other issues they may face around their mental and physical health. These positive outcomes are dependent on services being delivered effectively. In Scotland the quality of service provision is a huge issue. The main issue is stigma.

The UK Clinical Guidelines and the World Health Organisation are quite clear in terms of the dosing of methadone – that this should be 60mg per day at the very minimum. An optimal dose will vary for people but usually be between 60 and 90mg. So why, in some areas of Scotland, are half of the people in treatment on doses lower than the clinically effective minimum?

The answer lies in an unhealthy culture that we have somehow fostered in Scotland. On both sides of the counter – the prescriber and the person using the services have too often come to believe that the lower the dose someone is on, the ‘better’ they are doing. Progress is measured solely in terms of cutting down or getting off methadone.

This is dangerous and it is, inadvertently perhaps, killing some of Scotland’s most vulnerable people. Being on sub-optimal doses means that people will almost inevitably ‘top up’ with street drugs.

This is highly dangerous and explains why the vast majority of deaths of those on opioid substitution therapy involve more than one substance.

Almost 50% of deaths last year involved methadone but only 7 were caused by methadone alone.

So the stigma that we generate through an uninformed ‘debate’ about whether methadone works, results in deaths. The simplistic view that everyone should ‘just stop using’ is unhelpful and, not to put to fine a point on it, is killing people.

The most progressive countries in Europe have an approach which is about improving the quality of life their most vulnerable citizens and not a narrow measure of success that they are free from drugs.

Portugal has decriminalised possession of drugs but at the same time has improved the range, quality and accessibility of treatment and supported people with their wider needs, mental and physical health, housing, education and finances.

This is fundamentally about a social inclusion agenda that Scotland should follow.

It is chiefly a change in attitude and approach that is required. That demands leadership and co-ordinated action. All stakeholders have their part to play the agenda needs to be set by the chief influencers and so Government, commissioners, service managers and bodies like ourselves each have a role in changing what remains a hugely challenging situation.

We have got ourselves into a difficult situation in Scotland. We need to make far greater efforts if we are going to resolve it.