Public health approach at heart of new drug and alcohol strategy

Addict in injecting room
Image caption The new strategy supports evidence-led initiatives such as fix rooms

Scotland's first drugs strategy for a decade focuses on treating the issue as a public health concern rather than a criminal justice issue.

Public Health Minister Joe FitzPatrick said he had combined the strategy for drug and alcohol misuse because they had many solutions in common.

He said those with drug and drink problems often carried the burden of poverty, trauma and inequality.

The minister said support not stigmatisation was needed.

Figures published earlier this year showed there were a record 934 drugs-related deaths in Scotland in 2017.

Older addicts

This was more than double the total from 2007.

There was also a corresponding rise in drug-related hospital admissions.

The average age of those dying from drugs has risen from 34 in 2007 to 41 last year.

Research has shown that these older addicts are more vulnerable due to multiple health issues and are moving in and out of treatment.

The most recent prevalence study estimated 61,500 people were "engaged in problematic use of opiates and benzodiazepines in Scotland".

Image caption Joe FitzPatrick: "The ill-health and deaths caused by substance misuse are avoidable"

Mr FitzPatrick said: "Improving how we support people harmed by drugs and alcohol is one of the hardest and most complex problems we face.

"But I am clear that the ill-health and deaths caused by substance misuse are avoidable and we must do everything we can to prevent them. This means treating people and all their complex needs, not just the addiction."

Image caption Recovering addict Davie recently completed a qualification to help support peers

Recovering addict Davie, who is now a Dundee peer mentor and volunteer, said he decided to take advantage of the recovery options offered during his time in prison.

He said: "When you do decide that you want recovery, you've got to really want it. You've got to be willing to meet the services halfway.

"I just finished an SQA in peer mentoring and support.

"I'm using that to let people see there is light at the end of the tunnel and it's worth getting up in the morning and persevering with your day."

Reduce harm

The Scottish government's strategy, which will be backed by an additional £20m a year, says it supports well-evidenced approaches to reduce harm, even among people who feel unready for treatment.

It is supportive of proposals such as drug consumption rooms or "fix rooms", which allow users to take heroin safely under medical supervision.

A "fix room" was planned for Glasgow because of an increase in street injecting in the city and a rise in HIV infections among users.

But the Home Office, which controls drug legislation, said it was illegal, and it expected police to enforce the law.

No such rooms exist in the UK and they would require the UK government to amend the Misuse of Drugs Act.

Another harm prevention measure is providing Naloxone kits to all people at risk of opiate overdose.

The strategy also supports providing injecting equipment to users, such as clean needles, to ensure they are not spreading viruses and infections.

The Scottish government's report - Rights, Respect and Recovery - says the burden of drug and alcohol abuse is much higher in the most deprived areas.

The strategy says the police regularly come into contact with people with alcohol and drug problems and they can "divert" people into treatment or other interventions that would reduce harm.

Research suggests that a third of people in police custody have hazardous alcohol intake or are alcohol dependent, with between 11% and 35% dependent on a range of substances including cannabis and heroin.

The strategy suggests more integrated approaches such as Custody Hubs, which recognise that people who have alcohol and drug problems are likely to have other problems such as poor mental health and homelessness.

It also says there are a range of sentencing options, including Community Payback Orders (CPOs) and Drug Treatment and Testing Orders (DTTOs) which provide alternatives to prison.

Jardine Simpson, from the Scottish Recovery Consortium, who contributed to the new strategy, agreed that some people might not like the "soft touch" approach to criminal justice.

He told BBC Radio Scotland's Good Morning Scotland programme: "Maybe our society in the 21st Century needs a softer touch generally.

"Maybe everyone has to ask themselves the question 'how can I be more compassionate to the people I walk past in the street every day and I pretend are not there?'.

"These people are human beings who are very often marginalised before they reach primary school.

"It is my contention that the public health approach is needed to rectify this issue."

What else does the strategy say?

The updated strategy sets out a number of approaches, including:

  • Support people to find "their own" type of recovery
  • Public health ought to be evidence-led - that means supporting responses that might be controversial or initially unpopular (such as drug consumption rooms)
  • A focus on prevention and early intervention in education, housing and justice
  • Diverting people with problematic alcohol and drug use away from the justice system and into treatment support
  • Challenge the stigma of addiction and build services based on respect and dignity as well as clinical need.

Alcohol-related deaths and hospital admissions have reduced in recent years but are higher than they were in the early 1980s.

While harmful use of alcohol is declining across the whole population it is increasing among older adults.

About 4% of the adult population have possible alcohol dependency.

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