David Liddell: Treatment focus on heroin misses wider issues. Deaths involving cocaine and other drugs rise again.

2nd  August 2021

Almost all Scotland’s drug deaths involve the use of more than one substance and 89% involve the use of heroin or another opiate. But the mix of drugs is changing and the rise in deaths in which cocaine is implicated should be a focus for concern and action. We need to address this issue if we are to achieve the Government’s stated national mission to reduce drug deaths.

The latest drug death figures show a continued upward trend in cocaine being implicated as a cause of death. In 2020 the figure was 459, 34% of the total. In 2019 the figure was 372 (29% of deaths); in 2015 the figure was 33 (7% of deaths). Of the 459 deaths in which cocaine was implicated 397 also involved opioids.

Reports from frontline staff and surveys of people with a drug problem show people who may be or have been primarily using heroin also now using cocaine. Some of this use involves injecting cocaine and in others cocaine is prepared for smoking, in the form of crack.

There is huge support within the sector and from policymakers for getting more people into treatment quickly and ensuring that they stay in treatment for as long as they need it but this approach will be undermined if the needs of people using cocaine alongside depressant drugs like heroin and benzodiazepines are not adequately addressed.

Focussing solely on the heroin element of someone’s drug use is a narrow focus for treatment and services should be encouraged to take a more holistic and person-centred approach. Even in terms of prescribing medication – which is often key in achieving stability for many people with a drug problem, we need to consider how we can expand treatment options.

Services have developed over the last 35 years for people with opiate problems and by and large they are not well equipped to deal with opiate users who are also stimulant users.

The annual drug death figures are a reminder to us all of the tragic human cost of a collective failure to understand and address the fundamental issues here and develop an adequate policy and holistic service response that addresses these issues.

This year’s figures will hopefully help inform an evidence-based use of new Government spending in developing service for people most vulnerable to overdose deaths.

David Liddell, CEO, Scottish Drugs Forum


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