Harm Reduction Is Growing in Scotland––But So Are Overdose Deaths

In November 2018, Scotland launched a revised national drug policy that prioritizes recovery resources, including enhancing harm reduction resources. But according to a new report produced by the country’s public watchdog agency, harms associated with drug use continue to skyrocket, far surpassing the likes seen in the rest of the United Kingdom and elsewhere in Europe.

In its investigation into the success of public health approaches to drug and alcohol use that were outlined in the government’s November document, Rights, Respect and Recovery: Alcohol and Drug Treatment Strategy, Audit Scotland found that harm reduction strategies, like opioid substitution treatment (OST), naloxone, and safer injection equipment, have increased in accessibility.

“There are many people with a drug problem alive today thanks to the early introduction of needle exchange and opiate substitution therapies in Scotland in the late 1980s and these becoming available across Scotland in the 1990s as well as through the delivery of the national take-home Naloxone programme in the 2010s,” testified Scottish Drug Forum last week before a government committee. “Otherwise many more people would have died through overdose or through health complications resulting from their drug use”

But problems in their implementation continue, which has in turn exacerbated overdose mortality rates. Mostly involving opioids, drug-related deaths in Scotland have soared from less than 80 deaths per million in 2004 to almost 120 deaths per million in 2011. Five years later, the country saw an all-time record of 934 deaths, with Scottish aged 35 and older leading in the rates. For Public Health Minister Joe Fitzpatrick, “What Scotland faces in drug deaths is an emergency,” according to a press release.

Source: Audit Scotland

The Audit Scotland report suggests that “inconsistencies in terms of availability, quality and range of treatment and care” related to OST could be contributing to the rising mortality rates for people using drugs.

“For those treated with opiate substitution therapy (OST), we need to ensure they receive [an] optimal dose and are supported to remain in treatment for as long as it is needed,” described Rights, Respect and Recovery authors. Yet, Audit Scotland found that service providers were not meeting this goal, instead offering irregular reassessments, inadequate dosages that failed to meet UK guidelines, and a dearth of integrated services.

The investigators are puzzled why opioid-involved overdoses are increasing when the number of Take Home Naloxone (THN) kits distributed are moving upward, as well. According to the report, over 46,000 kits have been supplied between its creation until 2018, which breaks down to a rate of 376 kits per 1,000 people at risk. Although noting further research is required, they suggest that people may now be more frequently using opioids alone, nullifying the life-saving potential of the distributed naloxone.

More can be done to mitigate the drug-related deaths in Scotland. In the Ministerial Foreward to Rights, Respect and Recovery, Fitzpatrick endorsed “supporting responses which may initially seem controversial or unpopular, such as the introduction of supervised drug consumption facilities,” which he notes “are driven by a clear evidence base.” Though the political commitment in Scotland seems to be there, a proposal for a Glasgow supervised consumption space, initially approved, was rejected because the authority to “grant an exemption to the Misuse of Drugs Act 1971… is reserved to the UK Government,” wrote the audit.

Fitzpatrick “welcomed” the audit and intends to convene “an expert group to advise on what further changes, in practice or in law, could help save lives and reduce harm.”


Graphic: Sessi Kuwabara Blanchard

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