Scotland could pioneer a scheme to cut drug deaths by allowing users to consume narcotics under supervision and with medical assistance on hand. The establishment of overdose prevention centres (OPCs) is proposed in a consultation launched yesterday by Labour MSP Paul Sweeney, who believes his Bill will 'implement changes that will save lives'. Sweeney, a former Royal Regiment of Scotland reservist, previously volunteered in an unofficial safe injection van in Glasgow and has told the Scottish parliament that he saw people saved from overdose.
These centres would take what volunteers have already done and give it a legal framework. Although these centres are already used in parts of the US and Europe, Scotland would become the first UK jurisdiction to introduce them. OPCs would not provide drugs but would allow users to consume their own under the ‘continuous and permanent presence of at least one formally qualified medical practitioner’ along with staff trained to administer the drug naloxone to reverse heroin overdoses or a defibrillator to those overdosing on cocaine. Research from Canada found a 35 per cent reduction in fatal overdoses when Vancouver trialled a supervised injection facility.
Scotland’s notoriously high rate of drug deaths continues to baffle health authorities and policy-makers. Last year saw 1,295 drug-related fatalities, making Scotland the deadliest part of the UK for drug users and one of the deadliest in Europe. National Records of Scotland figures document 13,406 deaths between the year devolution began – 1999 – and 2020, more than 10,000 of them under the current SNP government. That is higher than Scotland’s confirmed Covid-19 death toll, more than three times the death toll of the Troubles, and more than four times the Israeli death toll from terrorism since 1948. One Scot dies from drugs every eight hours. This is a health emergency and a moral crisis.
Sweeney's Bill is no silver bullet – something he readily admits – but it reads like a promising start. As well as the legal changes mentioned above, it would replace the Scottish Drug Death Taskforce with a Scottish Drug Death Council that is operationally independent of the Scottish government. That’s a good thing. The SNP has tried to manage drug deaths like every other problem it encounters: top-down, politically-minded and with ministerial interference in supposedly arms-length bodies.
Last December, the chair and vice-chair of the Taskforce, Professor Catriona Matheson and Neil Richardson, resigned, claiming ministers were rushing them to reach conclusions in pursuit of ‘meeting targets’ and before they were ‘confident it is safe and effective to do so’. As an indication of the priority the Scottish government gives to drug deaths, six months on from her resignation the ‘About the Taskforce’ webpage still describes the forum as ‘chaired by Professor Catriona Matheson’.
In addition to the potential for saving lives, the Bill saves money. A 2017 paper published by the Glasgow City Integration Joint Board’s health and social care partnership found that the city’s 350 routine injection drug users accounted for £200,000 in A&E visits and £1.5m in inpatient stays. While the merits of OPCs cannot be reduced to a balance sheet calculation, these figures highlight the cost to the taxpayer of abandoning people to overdoses in bedsits and back alleys.
There is one potential hurdle to Sweeney’s Bill: the Misuse of Drugs Act. That legislation is reserved to the UK parliament and the Johnson government is not favourable to OPCs. Sweeney does not believe his public health approach falls foul of the Act. It would not involve ‘producing or attempting to produce’, ‘supplying or attempting to supply’ or ‘offering to supply’ a controlled drug, as the terms of the Act require. He is also relying on the fact that the decision to prosecute in Scotland lies with the Crown Office and Procurator Fiscal Service. Last September, Dorothy Bain QC, the Lord Advocate, extended the recorded police warning guidelines to include possession of Class A drugs such as cocaine and heroin. This permits police officers discretion to give warnings for possession of any illegal drug instead of reporting the offence for potential prosecution.
That sounds like a practical fix, though it doesn’t preclude the possibility that the Home Office, not wishing to give impetus to campaigns for OPCs in England, might challenge the Bill as outside the powers of the Scottish Parliament. When I asked the Home Office about Sweeney’s proposals, they said:
“We have no plans to introduce drug consumption rooms in the UK. A range of crimes would be committed in the course of running such facilities, by both service users and staff, such as possession of a controlled drug or knowingly permitting the supply of a controlled drug on a premises.
I declare an interest as someone who believes in the legalisation of drugs. But whether under a future, liberalised regime or the present legal framework, drug addiction is something that has to be managed, be that through the regulated sale of narcotics, the supply of opioid substitutes, or abstinence-based recovery. That makes reducing fatal overdose rates and other drug-related deaths a priority. You can’t get someone in recovery if they’re already dead. Paul Sweeney’s proposals are modestly drafted and cautious in their aims but they could yield significant rewards, not least a measurable reduction in Scotland’s drug death rate.
His Bill does not answer all the questions. It does not go to the root causes of addiction, the most effective way to treat it, or the broader question of legality. But, then, it’s not meant to. Sweeney’s Bill is directed at overdose prevention and all sides of the drug debate should be able to support that. In the face of a moral crisis, it is easy to demand that ‘something must be done’ then rationalise the doing of the wrong thing on the grounds of urgency. That is why it is important that Sweeney’s proposals are focused on saving lives in a well-regulated setting. There are no grand schemes here, no sweeping changes in the law. Just a determination that the lives of all Scots should have value and dignity.