First paragraph: The newly published figures of annual drug-related deaths (DRD) in Scotland are appalling. The National Records of Scotland figure of 867 represents the highest annual total recorded &ndash; a 23% increase on the previous year, and a 100% increase since 421 Scottish DRDs were reported in 2006

McAuley, Andrew

Parkes, Tessa

Robertson, James Roy

English

Stirling Online Research Repository

9/6/2017 Scotland's drug death crisis needs a radical harm reduction response – nowhttps://theconversation.com/scotlands-drug-death-crisis-needs-a-radical-harm-reduction-response-now-82650 1/5AuthorsAndrew McAuleySenior Research Fellow, School of Health& Life Sciences, Glasgow CaledonianUniversityJames Roy RobertsonProfessor of Addiction Medicine, Universityof EdinburghAcademic rigour, journalistic flairThe newly published figures of annual drug-related deaths (DRD) in Scotland areappalling. The National Records of Scotland figure of 867 represents the highestannual total recorded – a 23% increase on the previous year, and a 100% increasesince 421 Scottish DRDs were reported in 2006.The recent annual figures for England and Wales covering the same period alsoreported a record high figure of 3,744 deaths, representing a 2% increase on theprevious year.ShutterstockAugust 17, 2017 2.39pm BSTScotland’s drug death crisis needs a radical harm reductionresponse – now9/6/2017 Scotland's drug death crisis needs a radical harm reduction response – nowhttps://theconversation.com/scotlands-drug-death-crisis-needs-a-radical-harm-reduction-response-now-82650 2/5Tessa ParkesResearch Director, University of StirlingThis makes the Scottish figures even more concerning: it is estimated that the Scottish DRD rate isnow 2.5 times that of elsewhere in the UK, and among the highest in Europe. Drug use has been recently confirmed  as a leading cause of early death in Scotland, ahead of chronic liver diseases andcolorectal cancer.Root causesAn ageing cohort of polydrug users (those who use a combination of drugs), the availability ofincreasingly strong and diverse street drugs, cuts in drug treatment budgets, and wider economicausterity, all create a perfect storm for such a crisis.The roots of the situation seem to be historic and intertwined with pervasive social inequalities. New research on DRD has described a “cohort effect” for those born between 1960 and 1980, especiallyamong men living in the most deprived areas in Scotland. The researchers conclude that “exposure tothe changing social, economic and political contexts of the 1980s created a delayed negative healthimpact”.Recent research on the needs of older drug users in Scotland found a group experiencing some of themost extreme health inequalities seen in Scottish society today. In addition to poor physical health,persistent and enduring mental health problems were common, exacerbated by loneliness, isolation,National Records of Scotland9/6/2017 Scotland's drug death crisis needs a radical harm reduction response – nowhttps://theconversation.com/scotlands-drug-death-crisis-needs-a-radical-harm-reduction-response-now-82650 3/5homelessness and stigma. It is not only older drug users who are affected, however: over a quarter(28%) of all deaths in 2016 involved those aged under 35.Although dramatic changes in the age profile of DRDs have been observed, the make up of DRD inScotland has not changed much in 20 years in terms of the drugs used. The substantial rise in thenumber of DRDs is not driven by Fentanyl use, as seen in North America’s opioid crisis, nor is it dueto the adverse effect of the UK Psychoactive Substance Act which, in the banning of “legal highs”, isbelieved to push some users towards more dangerous substances.New drugs and behaviours come and go and influence the mortality data to varying extents but themain problem and cause of death in Scotland remains opioids, consistently involved in around 90% ofcases and increasingly in combination with benzodiazepines (sleeping pills and anxiety medication).Encouraging people out of opioid substitution treatment (OST) prematurely can increase the risk ofrelapse and overdose.How to respondScotland’s Minister for Public Health and Sport, Aileen Campbell, recently announced a “refresh” ofthe national drugs strategy. Given the scale of the increase in DRDs since it was launched in 2008, theneed for the refreshed strategy to be firmly evidence-based, with a measurable framework of actions,is of utmost importance.In 2016, the Advisory Council on the Misuse of Drugs (ACMD) published a report on reducing opioid-related deaths in the UK. The report was largely ignored in the drugs strategy published in July by theUK government whose focus has switched from harm reduction to abstinence and recovery.9/6/2017 Scotland's drug death crisis needs a radical harm reduction response – nowhttps://theconversation.com/scotlands-drug-death-crisis-needs-a-radical-harm-reduction-response-now-82650 4/5However, the ACMD report did make a number of recommendations that are within the gift of theScottish government, including: continued investment in high-quality OST of optimal dosage andduration; provision of heroin-assisted treatment for patients for whom other forms of OST have notbeen effective; availability of the opioid antagonist Naloxone to people who use opioids, their familiesand friends; and provision of medically supervised drug consumption clinics in localities with a highconcentration of injecting drug use. All these interventions are also recommended in the recentlypublished UK treatment guidelines for drug misuse and dependence.Making progressIt is essential to also recognise the progress that has been achieved in Scotland. The national naloxone programme was the first of its kind internationally and has been endorsed by the World Health Organisation. Evaluation of its impact concluded that it has had a significant effect in reducingopioid-related deaths following release from prison, a period of elevated DRD risk. Without this, thelatest DRD figures may well have been even higher.Glasgow’s council and health officials have now approved the establishment of the UK’s first safer drug consumption facility and a heroin-assisted treatment service. This development was largely inresponse to an ongoing outbreak of HIV in the city, but also aims to respond to increasing drug-related mortality within this vulnerable population.Widespread availability of street drugs, cuts in treatment programmes and general economic austerity have created aperfect storm for a drug crisis. ShutterstockProf Sir John Strang - Supervised heroin treatment for entrenched har…9/6/2017 Scotland's drug death crisis needs a radical harm reduction response – nowhttps://theconversation.com/scotlands-drug-death-crisis-needs-a-radical-harm-reduction-response-now-82650 5/5Poverty Opioids substance abuse Scotland Drug addiction harm reduction drug deathsLess impressive is Scotland’s treatment record. Treatment is a known protective factor against DRDyet too few of the country’s 61,500 problem drug users are engaged in treatment and, critically,retention rates are poor, particularly in comparison to countries like Norway, which have achieved aturnaround in DRD rates over the past five years.What next?Reiterating the conclusions of both the ACMD report and Scotland’s Independent Expert Review on OST, integrated services are needed across health and social care that are well tailored to each person.These should help them to achieve wider recovery outcomes, including those focused on generalhealth and well-being. The new UK treatment guidelines should also be at the heart of achieving thisambition and improving the quality and effectiveness of Scotland’s treatment landscape.The prevention of DRDs in Scotland requires an immediate and radical harm reduction led response,developed in collaboration with people who use drugs. Evidence-based solutions are available, but itis absolutely crucial that they receive support from all sections of Scottish society in order todestigmatise drug use and encourage people to seek help.The tragedy of Scotland’s spiralling deaths from drug use is everyone’s problem. The time for braveleadership and concerted action is now.We produce knowledge-based, ethical journalism. Please donate and help us thrive.Tax deductible.Make a donationYouTube/Scottish Drugs Forum. 

Scotland’s drug death crisis needs a radical harm reduction response – now

Stirling Online Research Repository (RIOXX)

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Scotland’s drug death crisis needs a radical harm reduction response – now

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