Scottish Drug Policy Reform: Keeping vulnerable people safer by putting health first
The UK Government has made it clear it will not change its drugs policy – regardless of the evidence. Regardless of the record numbers of people dying as a result.
Pressed by a growing, and principled, cross-party group of MPs to change direction, Theresa May just says she wants more War on Drugs, while the Home Secretary says her strategy aims to deliver a 'drug free-society'. Basing policy on a Nixon-like goal that is so clearly unachievable just shows the UK government approach is about ideological posturing. Not helping the vulnerable, or the communities we all live in.
This was underlined in the Parliamentary Debate on Safer Drug Consumption Rooms (DCRs) led by the SNP MP Ronnie Cowan last week. Speaker after speaker laid out the in-depth evidence of their effectiveness from decades of experience world-wide, backed by the most sober and respected organisation and health bodies.
The Drugs Minister Victoria Atkins response? To spout untruths, which could have been considered accidental were it not for that fact that when asked to correct them in a Parliamentary Point of Order by Ronnie Cowan MP she refused.
For example, she said there was only one Drug Consumption Room in Spain, open for one hour a day - but even the House of Commons Library briefing for the debate says there are 13 in 7 cities. Similarly, to the anger of groups in Canada, she claimed that the Supreme Court of Canada only ordered that the Vancouver DCR Insite be kept open because of the constitutional rights of its users, not any evidence it worked. But the Supreme Court judgement (which she claimed to have read) says the opposite. Were Insite to be shut:
"This deprives the clients of Insite of potentially lifesaving medical care, thus engaging their rights to life and security of the person." Furthermore, the Supreme Court laid out quite clearly that it was ordering the Canadian Government to allow the operation of Insite because: “Insite saves lives. Its benefits have been proven. There has been no discernible negative impact on the public safety and health objectives of Canada during its eight years of operation."
And beyond this, it also found against what is one of the UK Government's key arguments against DCRs:
“The effect of denying the services of Insite to the population it serves is grossly disproportionate to any benefit that Canada might derive from presenting a uniform stance on the possession of narcotics.”
Pictured: Ron Hogg, PCC for Durham, and Arfon Jones, PCC for North Wales, visiting a Heroin Assisted Therapy Clinic in Geneva, Switzerland
But the story does not end there. Theresa May is not the only one with power to deliver life-saving changes to our approach to drugs. We are working with Police and Crime Commissioners, police forces, treatment providers and local authorities increasingly taking matters into their own hands. For example, I have visited both drug consumption rooms and heroin prescribing clinics in Europe with PCCs like Ron Hogg and Arfon Jones to see them in action - and they have come away determined to do what is right for the people they are charged with representing and protecting.
But it is Scotland that is now at the forefront of moves in the UK to end the drug war, and take a health based approach. Led by the NHS, Glasgow has almost everything in place to open a big Drug Consumption Room, with an attached Swiss-style Heroin Assisted Treatment clinic for 50 people as well.
And it needs it. With 500 people street injecting, and an HIV epidemic, it is little wonder the DCR proposal has been backed by successive Labour and SNP City Councils - but is being blocked by the UK Government. (We have just heard Glasgow NHS will go ahead with the heroin prescribing element, and needle exchange which is a step in the right direction.)
But Scottish politicians are not taking this lying down. For the DCR parliamentary debate, a cross-party group of dozens of Scottish MPs led by Alison Thewliss, called for the UK Government to back off and allow drug consumption rooms, with Labour, Lib Dem and SNP MPs speaking out.
As Paul Sweeney, Labour MP for Glasgow North East said; "Shocking to listen to the Prime Minister cling to outdated ideas about a 'War on Drugs' at #PMQs, instead of treating drugs as a public health issue. Safe consumption rooms save lives. Theresa May is effectively condemning my constituents to death when they could be helped."
With the Scottish Government getting behind these calls as well, the Scottish Parliament has a unique opportunity to deliver innovative drug policy that would transform Scotland from the drug-death capital of Europe, to a beacon of compassionate, effective approaches.
We all want a fairer, healthier Scotland that protects the young and the vulnerable. But a better Scotland cannot exist while it has the highest drug death rates in Europe, combined with entirely preventable outbreaks of HIV infection within our most vulnerable communities.
The criminalisation and stigmatisation of people who use drugs prevents them from leading healthy lives. And this briefing, produced by Transform and Recovering Justice, explains what Scotland can do to change that.
Transform Head of Campaigns
We all want a fairer, healthier Scotland that protects the young and the vulnerable. But a better Scotland cannot exist while we have the highest drug death rates in Europe combined with entirely preventable outbreaks of HIV infection within our most vulnerable communities. The criminalisation and stigmatisation of people who use drugs prevents them from leading healthy lives. But the UK government has said it will not change its drugs policy – regardless of the evidence.
The Scottish Government has a unique opportunity to deliver innovative drug policy that would transform Scotland from the drug-death capital of Europe, to a beacon of compassionate, effective approaches.
A deadly snapshot - change is needed
- At a record 867 drug deaths in 2016, and 247 deaths per million people, Scotland has the highest drug death rate in Europe: 12 times the EU average, 42 times Portugal’s rate, and 4 times the rate in England and Wales.
- There is an HIV epidemic. Among Glasgow’s 500 street injecting population alone, there have been over 100 infections since 2015. In the 10 years prior to that, there were 10 infections per year in this group.
- This is a financial time-bomb - lifetime treatment costs for someone with HIV are £360k.
Scots are dying unnecessarily. They are being seen as collateral damage while successive UK Governments posture as ‘tough on drugs’. Theresa May even says she wants more ‘War on Drugs’, while the Home Secretary (Amber Rudd) echoes Richard Nixon by saying she aims to deliver a ‘drug-free society’. This unachievable goal shows that she is not interested in evidence based policy. In fact, the Home Office’s own evaluations show record drug-related deaths, use not falling, and that enforcement generates violence, harms the vulnerable and their families, and doesn’t restrict supply.
An opportunity for Scotland to lead the way
Approaches to drugs are best tailored to the local situation, with decision-making transferred down to those who understand what is required. But whoever is in charge, drugs should be treated as a health not a criminal justice issue. Many aspects of Health are already devolved, but to make the changes in Scotland necessary to deliver a genuinely health-based approach, relevant drug policy powers under the Misuse of Drugs Act would need to be devolved to Holyrood. In theory, this might not be needed if UK-wide changes were made instead. But the Home Office in Westminster rejects taking a health based approach, and says it will stop Scotland delivering life-saving measures like safer drug consumption rooms.
However, there would be little point transferring powers unless the Scottish Government offers a progressive alternative, genuinely based on evidence of what works, including:
A comprehensive review
Immediately carry out a comprehensive review to ensure drugs are treated as a public health issue. This should include exploring innovative approaches taken in other countries such as decriminalising people who use drugs, and strict legal regulation. This wider review cannot wait until powers over drug policy are transferred to Holyrood. People are dying now.
In addition to fully funding treatment and harm reduction measures, the UK Government’s official Advisory Council on the Misuse of Drugs (ACMD) has recommended Drug Consumption Rooms, Heroin Assisted Treatment and Diversion as cost effective ways to save lives and improve communities. But the UK Government has rejected, or refused to fund them.
Safer Drug Consumption Rooms (DCRs)
There are over 100 DCRs worldwide where people use their own illegal drugs under medical supervision. And the research - including from NHS Scotland - shows they prevent fatal overdoses, reduce blood borne infections and other health problems. They also reduce drug litter, street injecting and save money. The NHS in Glasgow has said it will not proceed with its proposed DCR without a firm legal foundation, to prevent it being open to challenge. The Lord Advocate said he could not provide a ‘prosecution waiver’. As a result, the relevant powers need to be devolved to Scotland, or the law changed at the UK level (something the UK Prime Minister has said will not happen).
Fund Heroin Assisted Treatment (HAT)
In a range of countries (most famously Switzerland), injectable heroin is legally prescribed for supervised use in clinics. Only people for whom other treatments haven’t worked are eligible. It reduces overdose deaths, HIV infections, use of illicit heroin, acquisitive crime and street dealing to fund use, stabilises users’ lives and improves communities, without increasing the number of people who use. UK trials found crimes per user fell from 40 to 13 per month, and switching heavy users of heroin to legal supplies cuts income for organised crime. It is backed by the UK Government - but they refuse to fund it.
This chart shows what has happened to drug deaths in Switzerland (pop. 10.3 million), compared with Scotland (pop. 5.3 million).
Diversion from the Criminal Justice System
The Home Office’s 2014 ‘International Comparators’ report found there was no link between severity of enforcement and use - i.e. criminalising people doesn’t stop them using drugs. Scotland already has ‘diversion from prosecution’ schemes, but far more could be done. Police Scotland should develop a formalised system that ‘diverts’ people caught with any drug for their own use, into education, treatment or other measures instead of prosecuting them. These schemes, already in place in parts of England, reduce reoffending, save police time, increase engagement with treatment, and don’t damage people’s life chances with a criminal record.
... what Scotland could deliver if Holyrood gets full drug policy powers
Proper Portuguese Style Decriminalisation
Portugal was suffering the kind of drug death rates, HIV infections, and open-street injecting found in Scotland. It changed the law to fully decriminalise people who use drugs (but not production or supply). People caught with drugs for their own use are sent to a ‘dissuasion committee’ that can suggest treatment, though most face no further action. Portugal ring fenced part of the money saved from not arresting or prosecuting people for education, prevention and treatment. Treating drug use as a health issue reduced the stigma preventing people seeking help. Youth drug use dropped, and people who use drugs became productive members of their community.
This chart shows what happened to HIV infections.
No Portuguese political party - right or left - now opposes these reforms.
Legal Regulation of Cannabis
A number of US states and Uruguay have legalised cannabis for recreational use. In the Netherlands no market for more dangerous synthetic cannabis products (‘Spice’) developed because people can buy cannabis. Canada’s Government-run cannabis outlets will open in 2018 with a specific aim of reducing access and harm to children, and depriving organised crime of money and power, while raising tax revenue for treatment and prevention. In future, Scotland could follow suit, and also deliver evidence-based medical cannabis, and look at legal regulation of other drugs.