Scottish Drugs Forum’s CEO, David Liddell, has written an article that was recently published in the Sunday Herald in which he emphasises the key points that the upcoming refreshed drug strategy for Scotland should seek to address.
“A drug problem is not a lifestyle choice or a sign of moral failure or weak character. Problem drug use is rooted in disadvantage, inequality and trauma – the very things which should be a concern and focus of community and political action.”
– David Liddell, CEO, Scottish Drugs Forum
Scotland has the vast majority of the powers required to significantly improve our response to problem drug use and in particular impact on the tragic loss of life through drug use we are seeing. At the moment we are spending too much of our resources on what might be described as reactive spend. For example, government figures show we are spending increasing amounts on unplanned hospital stays for people with drug problems and this is projected to increase further over the coming years. We also spend large sums on criminal justice interventions including prison. Proactive spend is to invest in better treatment, support and primary care services that intervene earlier.
So, we have the power and the money. What we need is the will and the vision to make a step change in how we work with people to help them overcome their drug and other problems. This is my hope for the new strategy to be announced in the summer – that Scotland will have a world-leading evidence-based humane drugs policy.
A drug problem is not a lifestyle choice or a sign of moral failure or weak character. Problem drug use is rooted in disadvantage, inequality and trauma – the very things which should be a concern and focus of community and political action. Scotland is deluding itself if it has a self-image of being inclusive and valuing equalities – unless we can include this group of vulnerable people. I hope the new strategy will challenge Scotland to address this stigma and drop easy and lazy stereotypes and start to view people with a drug problem primarily as people and as the sons and daughters, brothers and sisters and mothers and fathers of hundreds of thousands of Scots.
The number of people with a drug problem has not changed in recent years. So, the same number of people are moving on from a drug problem or sadly dying as are developing a problem. Clearly, we need to prevent future problem drug use. We should follow the evidence – drug problems are often based in adverse events in childhood and how these were handled. We need to protect children and young people and better support them when bad things happen. We need to engage young people with mental health services before they start self—medicating with street drugs. This means investing in services and promoting understanding of the crucial role this work has.
For people who already have a drug problem, we need to minimise the harms that they have to recover from and maximise what they can recovery to. In terms of harms, we don’t have to look to far too to see where the challenges lie – large numbers of people with the Hepatitis C virus and 867 overdose deaths in a year and an HIV outbreak involving 120 people. Expanding and improving drug treatment is key. Easily accessible and evidence-based high-quality services are required but also we must contextualise drug treatment. This is not a medical matter only. What people need is positive experiences with other services – housing, money advice, health, education, training and employment services.
To do this they may need support and advocacy. For too long drug services have had to work in isolation without support from other mainstream services, including mental health services. For too long drug workers have been stretched monitoring people’s compliance with a treatment regime and working with people’s crises to be able to offer wider supports that help address their other issues and challenges.
In terms of medication we need a spectrum of substitution programmes including methadone. Methadone is not suited to some people and people should be able to switch between medications including diamorphine, buprenorphine and potentially other opioids. People should be on doses that eliminate the need to use street drugs and be empowered to vary these doses in response to progress and setbacks as they occur.
However, the transformative change will occur when mainstream services are encouraged to engage with people with a drug problem around all their other issues. This is the last group of people about whom it is still socially acceptable to voice the most outrageous prejudice. A start would be to talk about and treat those with drug problems as people.