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Comment: Drug deaths are not inevitable – but stopping them will take bold action

Laura Kelly - Image credit: David Anderson/Holyrood

Comment: Drug deaths are not inevitable – but stopping them will take bold action

In 2005, Scotland – and Glasgow in particular – was notoriously violent. Knife crime hit horrifying levels.

There were 137 homicides in 2004-05, prompting a United Nations report to conclude that Scotland was the most violent country in the developed world.

More than 1,000 people a year required treatment for facial trauma alone, many of them as a result of violence.

The World Health Organisation dubbed Glasgow the “murder capital of Europe”.

Traditional policing responses were not working, so Karyn McCluskey, principal analyst for Strathclyde Police, included a blunt recommendation in her report on the violence: Do something different. That’s exactly what they did.

Scotland’s Violence Reduction Unit (VRU) was inspired by a similar project in Chicago.

Recognising the parallels between the spread of violence and disease contagion, their pioneering public health approach addresses the causes rather than the symptoms.

The drivers for violence, they recognised, were often outside the scope of policing – poverty, inequality, toxic masculinity, alcohol use.

Working in schools, communities, hospitals, prisons, and workplaces, VRU projects run from educating young people to social enterprises that offer work to people with convictions.

They have a firm emphasis on prevention.

By 2018-19, the number of homicides in Scotland was down to 61, down 55 per cent from those shocking 15-year-old statistics.

No longer notorious for its knife crime, Glasgow’s violence reduction model is now renowned for taking great strides to tackle a seemingly intractable problem.

As knife crime in England and Wales reaches record levels, Metropolitan Police commissioner Cressida Dick, London mayor Sadiq Khan and Labour leader Jeremy Corbyn have all turned to the VRU for advice.

Yet in 2020, Scotland – and Glasgow in particular – has again found itself notorious. Drug-related deaths are at horrifying levels.

Last year, the number of people who died reached 1,187, marking a massive 27 per cent increase on the year before, and the highest number since records began in 1996.

Scotland’s rate of drug-related deaths is now worse than any EU country, according to official statistics.

Later this month, experts from England, Scotland, Wales and Northern Ireland will converge on Glasgow to “discuss how to work together to best prevent deaths related to drug misuse”.

Despite some controversy between the UK and Scottish governments at the outset – with Scottish public health minister Joe FitzPatrick issuing a statement saying he was “very surprised that the UK Government announced a summit in Glasgow without any consultation with the Scottish Government and Glasgow” and the Scottish Government scheduling its own drugs conference for the day before – this gathering is a chance to get to grips with a very real public health emergency.

It will host ministers, drug recovery experts, health professionals, senior police officers – the people with the levers of power to enact solutions.

Again, traditional policing responses are not working so, as Karyn McCluskey did in response to the knife crime epidemic in 2005, I urge them to do something different.

They must think radically and globally to tackle an issue that blights our communities and takes the lives of far too many of our citizens.

It is easy to feel hopeless at the scale of the problem. As with violence, we know drug use is linked to a slew of complicated societal problems.

From physical and mental health issues, to poverty and inequality, homelessness, family breakdowns – these are some of the most difficult issues we face as a nation.

But it would be an unforgivable mistake to hold back from doing something, just because we can’t immediately fix everything.

Following the work of the VRU, murders in Scotland are at their lowest level since the 70s.

For anyone who might doubt it, it’s an emphatic reminder that evidence-based policy can, and does, change real-world outcomes.

We must again learn from the best solutions to be found in the international community.

The Scottish Government has already shown support for the introduction of supervised drug consumption rooms (SDCRs), in which addicts can inject under medical supervision.

In several countries, including Denmark and Canada, these initiatives have dramatically reduced drug-related deaths.

Addicts who overdose in Danish drug consumption rooms rarely die, because a nurse will swiftly administer an antidote and call an ambulance.

By providing clean needles, they also decrease the spread of disease and, importantly, they are a gateway to rehabilitation services.

For the wider community, they are also a win – removing needles and other drug paraphernalia from their streets and parks.

The international evidence is there, and yet the Home Office continues to block the NHS application to open a facility in Glasgow.

The UK Government’s arguments against it have included contending that it didn’t have health benefits, would be too hard to police, and it would support the illegal drug market. All are crumbling in the face of robust global studies.

If we truly care about reducing harm, there is no reason for continued opposition to SDCRs.

But, let’s be honest here, drug addicts are not a group for whom our society is overflowing with sympathy.

If you can view people as ‘just junkies’, it makes them a lot easier to overlook in favour of ‘upstanding citizens’ who don’t want that kind of facility in their area or city.

SDCRs would be a start, but given the scale of the challenge, it is surely time to think bigger.

In the 80s, one in every 100 people in Portugal was battling heroin addiction. The country was plagued with overdose deaths, high rates of HIV infection and drug-related crime.

In 2001, the country took the bold decision to decriminalise the possession and consumption of all illegal drugs.

The policy freed a broad range of services to get to grips with the health, housing, employment and other issues fuelling addiction.

It was followed by dramatic drops in problematic drug use, HIV and hepatitis infection rates, overdose deaths, drug-related crime and incarceration rates.

Portugal has, understandably, become a lodestar for advocates of the harm reduction school of thought.

The country’s success goes beyond a change in the law, to a cultural shift in which the broader society accepts that it is both ethical and effective to treat people’s problems, rather than treating them as a problem.

The success of the VRU came from their belief that violence is preventable, not inevitable.

We must learn to believe the same is true of our current crisis of drug-related deaths.

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