By Neil Gray, Cabinet Secretary for Health and Social Care
I would like to update Parliament, following the most recent drug and alcohol death statistics for Scotland, which were published recently by National Records of Scotland. Importantly, I will outline the action that we are taking as part of the national mission to reduce harm and fatalities.
In 2023, tragically, we lost 1,172 lives to drugs and 1,277 lives to alcohol. Every single one of those lives lost is a profound tragedy; behind those stark statistics are children, parents and friends who have left behind families and loved ones grieving unimaginable losses. The NRS statistics show that 2023 was the second-lowest figure in six years for drug deaths. However, the rise of 12 per cent from 2022 is, of course, a heartbreaking disappointment and worry. I offer my sympathies to every person who is affected by the death of a loved one to drugs or alcohol. Those losses are shared by all of us and they serve as a reminder of the work that we still have ahead of us.
Deprivation has a clear influence on the numbers of drug and alcohol deaths, with people in our most deprived areas being 15 times more likely to die from drug misuse than people in the least deprived areas and four and a half times more likely to die from alcohol misuse. That highlights that drug and alcohol dependency is not purely medical. It is deeply rooted in social determinants and structural inequalities.
As in previous years, we continue to see a high level of polydrug use. Opiates continue to be the drug that is most commonly implicated in deaths. However, deaths where cocaine was implicated have increased. The increasing prevalence of cocaine, especially injected cocaine, presents new challenges for our services.
We are also confronting a dangerously and continuously evolving drug landscape, with synthetic drugs increasingly infiltrating the market. Those highly toxic and potent substances elevate the risks of overdose and death, and their rapidly evolving composition makes regulation and enforcement exceedingly challenging. Public Health Scotland has recently issued public health alerts for nitazenes and xylazine through its rapid action drug alerts and response—RADAR—surveillance system. I urge colleagues to share those alerts and sign up to the RADAR reporting system.
It remains essential that we continue the work of our national mission to prevent deaths, reduce harm and improve lives. That unwavering commitment is driven by the belief that change is possible and necessary. It is important to acknowledge the significant progress that has been made through the national mission. Our approach has been ambitious, and we have pushed beyond existing levels of service provision, focusing on harm reduction, improving treatment, supporting our workforce and taking a holistic, person-centred approach.
Widening access to residential rehabilitation for people who use drugs and alcohol is a key part of our national mission. We have made £100 million available from 2021 to 2026 to ensure that 1,000 people receive public funding for their placement each year by 2026. We are on track to meet that target, with 938 publicly funded placements approved in 2023-24.
We have also seen significant advances in harm reduction. Police Scotland is the first force in the United Kingdom to issue naloxone kits to all front-line officers, and it has now administered the life-saving drug more than 450 times. Public Health Scotland estimates that, by the end of 2023, take-home naloxone had been supplied to nearly three quarters of all people in Scotland who are at risk of an opioid overdose. Those are remarkable strides, and we will continue to push for more widespread access.
The opening of Scotland’s first safer drug consumption facility, scheduled for next month, is another significant milestone. The evidence-based initiative will provide a safe space for those who are most at risk of overdose and will serve as a model for other areas.
On our 10 medication assisted treatment standards, the progress has been equally encouraging. By July 2024, 90 per cent of MAT standards 1 to 5 were fully implemented, and MAT standards 6 to 10 showed strong early progress, with 91 per cent provisionally green.
Experiential feedback highlights improvements, fewer and shorter delays in accessing treatment, more choice being offered for opioid substitution therapy and an increased sense of care and support from workers. That reflects the heart of our mission, which is to ensure that people receive the help that they need when they need it.
As we enter the delivery intensification phase of the national mission, we are putting in place a strategic framework to consider how we can carefully and collectively drive delivery and monitor progress. As the MAT standards benchmarking report of July 2024 showed, although we see tremendous progress in standards 1 to 5, we need to accelerate our efforts in areas such as psychosocial care and mental health support, which are critical components of treatment, especially for non-opiate substances.
We are developing a national specification for drug and alcohol care services, which will go further than our previously planned treatment target. That will provide clarity on what treatment and recovery services should look like and will ensure that people have access to high-quality, stigma-free, trauma-informed services.
Additionally, we are stepping up our response to the growing threat of synthetic drugs. Public Health Scotland is expanding its surveillance data to help us to respond more swiftly and to identify any sudden increases in the number of overdoses. We plan to establish public-use drug-checking facilities in Dundee, Glasgow and Aberdeen, and applications for the necessary Home Office licences are currently being processed. Those will be complemented by a national testing laboratory, located in and supported by the University of Dundee, to provide further confirmatory testing of samples.
Further, when it comes to the wider health and social care landscape—the national care service, regulation, inspection and funding—we are looking beyond 2026.
Recovery communities provide essential support, hope and a sense of purpose and belonging. During a recent visit to the Scottish Maritime Museum in West Dunbartonshire, I spoke to individuals who are benefiting from the Skylark IX Recovery Trust project, which is funded through the national mission Corra Foundation funds.
Witnessing the dedication of the volunteers and staff, I was reminded of the widespread passion that fuels our efforts. The Skylark IX project is just one of 300 local and grass-roots projects that have been supported since the start of the mission. I thank the people who work on the front line, in the vital national health service, local partnership and third sector organisations, alongside the dozens of mutual aid and recovery communities who provide hope in such challenging circumstances. Their dedication is saving lives.
I turn to our focus on the prevention of alcohol harm. The Scottish Government has taken steps in its world-leading minimum unit pricing policy, with the minimum price increasing to 65p per unit from 30 September. That is intended to ensure that the public health benefits of the policy—the hospitalisations averted and the lives saved—continue and, indeed, increase. In The Lancet, international public health experts stated:
“Policy makers can be confident that there are several hundred people with low income in Scotland who would have died as a result of alcohol, who are alive today as a result of minimum unit pricing.”
However, we know that we need to do more to reduce harm. The earlier consultation on potential restrictions on alcohol advertising and marketing, which closed in 2023, made it clear that there is a wide range of views. I know that our doctors and nurses, who see harm to health from alcohol misuse every day, want action to be taken on alcohol marketing. I have also listened to business and industry concerns. I take all those concerns seriously. We remain committed to progressing that work to ensure that it will have the greatest impact, particularly on children and young people who are exposed to alcohol advertising and marketing, while striking the right balance when it comes to potential effects on business and industry. We need a route to achieve that.
It is clear that steps to reduce alcohol harm are vital to supporting good public health and to reducing alcohol-specific deaths. It is therefore vital that we are clear on the evidence that proposals would be effective, that action to reduce alcohol harm supports good public health and would reduce alcohol-specific deaths, and that the decisions that we take are led by evidence, balanced with the potential impact on the wider economy. Therefore, I will commission Public Health Scotland to carry out a review of the evidence on the range of options to reduce exposure to alcohol marketing in order to help us in that aim.
That work is for the future. We are also taking action right now by ensuring that people with problematic alcohol use continue to receive the same quality of care as those with problematic drug use. I can therefore confirm that the forthcoming alcohol treatment guidelines will also provide support for alcohol treatment, similar to the medication assisted treatment standards for drugs. In addition, the publication of Public Health Scotland’s review of how alcohol brief interventions are delivered is imminent, and we will incorporate its recommendations into our national treatment specification for drug and alcohol treatment.
We also continue to support innovative pilots, such as the managed alcohol programme and the primary care alcohol nurse outreach service, which has recently been embedded into mainstream services in the Glasgow city alcohol and drug partnership.
We continue to strive to prevent deaths, reduce harm and improve lives, and we do that at a time of unprecedented and significant financial challenge. This Government has consistently warned of the challenge ahead with regard to our public finances, but we will continue to support people in services where they need it most. That is why, this year, the Government has made more than £150 million available to continue the progress that we have made as a result of the national mission. Three quarters of that funding is delivered through local alcohol and drug partnerships, which play a central role in delivery and responding to local need.
It is essential that we continue to address the stark inequalities that exist in drug deaths, particularly in our most deprived areas. We must focus on prevention through education. We must also target the structural and social determinants of health. That will require increased collaboration across Government departments and statutory and third sector partners.
It is clear that no single service can tackle the issue alone. No single intervention is or will be enough. Only by working together to deliver a range of harm reduction support opportunities can we create a Scotland where everyone has the support that they need. We must pull together, harness the incredible work that has already been done and drive forward with a shared sense of purpose.
Top of page: Prison officers taking classes in Barlinnie Prison in Glasgow in a bid to cut the number of drug deaths.
Drug deaths are a tragedy. That we all know. So are alcohol and alcohol related deaths.
Our level of drug deaths are by comparison to the USA absolutely miniscule. Drugs, and indeed alcohol are a multi faceted problem and there is no simple solution.
The propensity for people to want change their perceptions and mental state through the use of drugs or alcohol has been a desire throughout the history of humanity.
It is only through education, influence, culture and selective societal controls that abuse can be controlled to a relatively acceptable level.
Having an area awash with a drug, like Dumbarton is apparently at present with crack cocaine is generally not a good thing. Folks know that. But human choice comes into the equation just like the decision to have a drink. So do we ban drink. The USA tried that. It didn’t work. Reduced availability, restrictive or demand moderating pricing does that work. Or education does that work.
Cigarette smoking has reduced very substantially these last forty years. How did that happen, what brought that about, is there something to be learned from that.
Or what about drunk driving. Once considered very much acceptable drunk driving is now universally recognised for the societal horror that it was. How did that change happen. Is there something to be learned from that.
Education, reinforcement of what is bad or dangerous does with other measures change outcomes.
We should all bear that in mind when we ya boo politic political party to political party. Drug and drink deaths, together with social damage need big tent solutions if we are going to have any chance of influencing where we want to be.
Or is it a case of there’s money, big money in drink and drugs and people should be free to kill or injure themselves causing as much havoc as they go.
We should bear that in mind when we selectively criticise policies like let us say alcohol minimum prices, or medically supervised drug consumption spaces.