UK Government should follow the evidence when it comes to The Thistle

Scotland has the highest rate of drug-related deaths in Europe, with 1,017 drug misuse deaths recorded in 2024 alone. Problem drug use also brings high levels of drug-related harms like blood-borne viruses and injection wounds, much of which is concentrated in Glasgow.

It's from this public health emergency that ‘The Thistle’ was born – the UK’s first sanctioned Safer Drug Consumption Facility. The site opened one year ago in Glasgow’s east end, on the basis of a three-year pilot. In The Thistle, people can use drugs in a clean, supervised environment, where staff can help prevent overdoses and provide sterile injecting equipment.

The Thistle’s work goes beyond immediate harm reduction, offering clinicians a chance to build trust with hard-to-reach people who use drugs. These relationships can become gateways to wider services, including drug treatment, counselling, and housing assistance, which can address the underlying causes of substance use. Although its opening represents a major shift in approach to UK drug policy, similar facilities already operate successfully in over 60 cities worldwide. 

The House of Commons Scottish Affairs Committee, which I chair, began an inquiry into The Thistle the week it opened. We considered the challenges in setting up and running the pilot and explored the unique legal arrangement it operates under.

To be effective, The Thistle must meet the needs of the population it's trying to help

In its first 10 months, The Thistle supervised over 6,000 injecting episodes, managing 78 “medical emergencies” on site. Alarming though this might sound, it means there were 78 cases where people received medical help they might not have had otherwise, potentially with far more severe outcomes. Indeed, none of these emergencies resulted in a fatality.

During our inquiry, we heard The Thistle's impact will be highly localised and is unlikely to shift the dial on national drug death figures – but it wasn't necessarily designed to, given its local focus. However, it is expected to reduce public injecting, hospital admissions, ambulance callouts and treat blood-borne illnesses. Although The Thistle is expensive, we heard this could lead to savings elsewhere in the health service. For example, preventing six to eight cases of HIV annually would potentially generate savings equivalent to The Thistle’s annual cost of up to £2.3m.

Experts were also clear that The Thistle is just one tool among many to address Scotland’s drug crisis and complements, rather than replaces, existing recovery services.

When we published our report on The Thistle in autumn last year, we commented on its unique legal situation. Under UK law, there's no statutory basis for The Thistle to operate. Instead, the facility has special dispensation from the Lord Advocate, who decided it would not be in the public interest to prosecute people who use The Thistle. Our report concluded that this reliance on prosecutorial discretion risks instability, as it depends on the Lord Advocate's opinion.

The committee’s report is careful not to pre-judge The Thistle’s effectiveness. The pilot facility is subject to an expert independent evaluation that will look at many different factors. The report’s key recommendation is about following the evidence. The committee suggested that, if The Thistle is found to be effective at helping Glasgow’s drug crisis, the UK Government should listen to that evidence and provide a comprehensive legal framework to put the facility on a stable footing.

Experts and evidence, not preconceived ideas, should determine the facility’s future

However, our report also highlights that local community concerns must be taken seriously. We recommended additional responsive engagement work be done to support this. We’re also reassured that the ongoing independent evaluation is monitoring the levels of discarded drug paraphernalia and the pilot’s wider community impact.

The UK Government replied to our report in November, saying it would “welcome any evidence” emerging from The Thistle's evaluation but had no plans to amend the UK law to provide a statutory footing for such facilities in the UK, even if it achieves the outcomes hoped for.

With statistics showing that drug deaths in 2025 are likely to be higher than in 2024, any intervention which can save lives and reduce harm shouldn't be dismissed. Experts and evidence, not preconceived ideas, should determine the facility’s future.

Our report has only become more prescient in recent months.

Firstly, other parts of Scotland have expressed interest in developing similar facilities. As the Lord Advocate’s prosecutorial discretion only applies to The Thistle, any new facility would need its own statement of prosecution policy. Rather than individual arrangements, it's more appropriate to have a common legal basis.

Secondly, Glasgow’s drugs trends are shifting towards drug inhalation. The Thistle isn't equipped with inhalation facilities, which are prohibited under reserved and devolved legislation. Plans have been announced to potentially install inhalation facilities, and our report called for any application to be considered by the UK and Scottish Governments on its merits. To be effective, The Thistle must meet the needs of the population it's trying to help, and inhalation is key to this. A fair evaluation of The Thistle’s effectiveness may also be inhibited without one.

In its response to our report, the UK Government said it doesn’t support enabling inhalation, suggesting it would be for the Lord Advocate to grant an exemption to reserved legislation.

It's clear The Thistle is operating and potentially expanding regardless of whether the UK Government approves or not, and more facilities may follow. Whilst this reflects devolution and Scotland’s separate legal system, it’s not ideal. Rather than having multiple facilities with individual prosecution policy arrangements, it would be more appropriate for them to operate on a clear, legal basis, common to all.

The government shouldn’t dismiss The Thistle before its evaluation is completed. If it is effective at combatting drug related harms, the UK Government must not ignore that. Only by following the evidence can both governments tackle this public health emergency.