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‘Nobody ever punished anyone out of addiction’

Scotland’s drug deaths reinforce the need for a significant rethink of substance misuse policy, writes Alison Bavidge

Picture of a safer drugs consumption facility
UK ministers rejected calls to trial Safer Drug Consumption Facilities

Published by Professional Social Work magazine 21st September 2020

The need to reduce drug-related harms in Scotland is clear. Just look at the statistics. We have 213 drug-induced deaths per one million people – almost three times the rate in England and Wales (76 per one million people). In 2018, the most recent year for which statistics are available, drug-related deaths hit a record high of 1,187. That was an increase of 27 per cent on the previous year and more than double the 485 deaths seen in 2010.

What needs to change? Last year Westminster’s Scottish Affairs Committee set out its vision and called for a radical rethink of drugs policy. The MPs urged the UK government to declare the “drug death crisis” a public health emergency and tackle it in this way, rather than as a criminal justice matter.

They recommended decriminalising the possession of small amounts of drugs for personal use. They also urged the UK government to either legislate to allow for a pilot of a safer drug-consumption facility in Scotland or devolve the powers to allow for this to the Scottish Parliament.

Recently, the UK government responded. It rejected these recommendations saying: "There is a strong link between drugs and crime, which is why we reject the assertion that the Department for Health and Social Care should lead on drug misuse. We know that people who regularly use heroin, cocaine or crack cocaine are estimated to commit around 45 per cent of all acquisitive crime."

As social workers we know that substance use and addiction is a response to environment, deprivation, poverty, adverse experiences, trauma and mental health needs. The UK government’s linking of drugs and crime is “correct” but its analysis of the causes is completely and illogically off the mark.

They have asked only one “why” – we know it takes a lot of “whys” to get to an understanding of any complex issue. They are making a political stand rather than risk grasping this inconvenient nettle.

In doing so they are failing to develop policy based on evidence and the advice of professionals and people who have lived with the experiences of substance use. The criminal justice approach to drugs has not worked. It has failed to reduce harm, and, in the justice system, it costs the public purse more than £35,000 to keep a person in prison each year let alone the costs of police, courts and lawyers. 

I have recently been working on a project looking at health and social care in prisons. Here drugs and drug treatment is a significant issue. In 2017-18, some 71 per cent of people entering Scottish prisons tested positive for illicit drugs.  Many get great support from the NHS health centres in our prisons. Opiate substitute therapies like methadone are a major daily health routine in prisons. Yet as things stand there is currently little holistic support on offer that links into wider social factors.

Providing that kind of holistic approach in prisons, embedded in a social model that considers individual circumstances, relationships and aspirations, might help people to engage in work, education and other daily activities while they are in prison. This might enable people to move away from harmful drug use and help them engage in planning for a more positive future.

Gaps in post-release support need to be addressed too. Currently throughcare is well-intentioned but it is also voluntary for the vast majority leaving prison. Many return to drug use and in the worst cases die from overdose. If people do hit crisis soon after leaving, we berate, shame and stigmatise them.

In another example of simplistic narratives being used for a complex issue, people are dismissed as having “chosen” to return to chaotic lives. This ignores the fact many leave prison without the key element of a home, benefits, access to primary healthcare and pharmacy needs being set up (30 per cent are immediately homeless). But if things go wrong, the narrative goes, “it was their choice”.  

There is some positive action being taken here. The Drugs Deaths Taskforce was established in 2019 and one of its strategic areas is services for people in the justice system. This includes providing take-home Naloxone to people on release from prison. It is a lifesaving medication that reverses the effects of opiate overdose.

Somebody said (and I can’t remember who – please come and claim it) “nobody ever punished anyone out of addiction”.  A gem of absolute truth and insight that I quote regularly.   

David Liddell CEO of the Scottish Drugs Forum writes that the UK Government’s response is entirely predictable. He suggests some ways that Scotland might choose to use the powers that it already has around decisions to charge and prosecute certain drug-related offences.

This could significantly reduce the number of people entering the justice system due to drugs and would help to perhaps release resource to support people in the community, in prison and on release.

Scotland has these procedural options and others such as including bringing fully integrated health, social work and social care (as part of the Scottish Government’s Health and Justice Collaboration Board programme) into Scottish prisons. Professional assessment and multi-disciplinary support plans could go a long way to a more positive prison experience that sets people up to succeed. There is hope.

Alison is due to take up post as National Director of the Scottish Association of Social Work from 1 October .