Drug use in Scotland: a shared agenda for the Scottish Parliament

- report of the Scottish Drugs Forum All-Party Working Group

Executive summary and key recommendations

Background

Drug policy in Scotland has taken many directions since the rapid increase in heroin use in Scotland in the early 1980s. Prior to 1994, the main concern around drug use focused on the threat of HIV and this tended to dominate drug policy. It was not until 1994, with the publication of the Scottish Affairs Committee report and the Ministerial Drugs Task Force report, Drugs in Scotland: Meeting the Challenge that policy began to focus directly and specifically on drug use per se. The Drugs Task Force report was very well received and highly regarded across the UK as a thorough, pragmatic and realistic report. It drew cross-party support and was welcomed as a sound framework for action. There was initially a strong drive from the Scottish Office to implement the report's 62 recommendations. Although some progress has been made, it has been slower than originally envisaged and the consensus, which initially surrounded the response, has shown signs of fragmentation.

At the end of 1997, following the change of Government, the post of UK Anti-Drugs Co-ordinator was created. It was stated that the Co-ordinator would have a "light touch" in Scotland. The Anti-Drugs Co-ordinator's first task was to produce a UK White Paper Tackling Drugs To Build a Better Britain. Although the White Paper primarily focused on England, the Scottish Office was invited to respond with comments by February 1999.

The aim of the Scottish Drugs Forum Policy Working Group was to feed into this process and to assist the Scottish Parliament with the development of a coherent and consensus-based response to drug issues in Scotland. The Working Group set itself two key objectives:

suggesting a framework for a revised Scottish Policy on drug use in Scotland.
suggesting a framework in which the Scottish Parliament can most effectively respond to issues relating to drug use and associated problems.

Foreword

Scottish Drugs Forum (SdF) convened a short-life Working Group to examine all aspects of drug policy and practice in Scotland in recognition of the opportunity presented by the advent of the Scottish Parliament. The response to drug use in Scotland will be one of the major tasks faced by our new Parliamentarians and a strong test of the expressed spirit of the Scottish Parliament to be less confrontational, more thoughtful and consensual in terms of addressing the pressing social issues of the day. Provided that spirit prevails, there will be a real opportunity to examine in a constructive, cohesive and less emotive manner all the complex issues surrounding drug use in Scotland. The Policy Working Group aimed to aid that process and to assist in the development of a coherent and consensus-based response to drug use in Scotland.

Progress has been made but many challenges remain, particularly in relation to the continued high number of drug-related deaths and the severe impact that drug use has had on many of our poorest communities. It is hoped that this report will enhance and inform an effective response to drug problems in Scotland.

The Working Group consisted of representatives of the four major political parties in Scotland and experts in the field (police, criminal justice, health service, social work, education, voluntary sector, family support and drug user representatives). We would like to express our thanks to all the group members for their valuable contribution.

Anne Thomson
Chairperson, Scottish Drugs Forum, March 1999

Executive summary and key recommendations

The recently published UK White Paper Tackling Drugs To Build a Better Britain(1) has a vision to create a healthy and confident society, increasingly free from the harm caused by the misuse of drugs. The Scottish Drugs Forum Policy Working Group fully concurs with this vision, and believes that the overall aim of drug policy in Scotland should be to reduce the availability and use of drugs and to reduce the harm caused by the misuse of drugs. The Scottish Parliament will provide a unique opportunity to establish a distinctive Scottish response to problem drug use. The key task will be to ensure a high degree of consensus regarding any new strategy, and, in particular, to remove of the unhelpful heat from the debate which has polarised recently into one of abstinence versus harm reduction. The Working Group considers that this is unhelpful and ultimately wasteful as it often results in diversion of resources away from the most appropriate interventions. It is crucial that a holistic approach be taken to addressing issues relating to drug use. All too often, one aspect of drug policy is dealt with in isolation from others, resulting in a fragmented and, therefore less effective, response.

The following is a summary of the main conclusions of the Working Group and its key reccommendations:

Education

A need for consistency

Considerable resources continue to be directed at drug education, although little co-ordination has been apparent in this area of work. Input into schools often gives different and conflicting messages. There has been general acknowledgement that approaches that aim to shock young people do not work and yet such programmes are still followed in some schools. Drug education programmes must be based on evidence of "what works" and, where there is no such evidence, pilot programmes should be evaluated.

Recommendations

National guidelines are required on the use of appropriate drug education packages for schools.
Schools need to have not only a policy on drug education but also an overall policy that includes clear guidelines on how to manage drug-related incidents.
There is a need to develop further both peer education and outreach interactive drug education programmes and, in particular, to examine how we might target those young people who could be described as most at risk.
The feasibility of undertaking drug education sessions for parents in parallel with that provided for children should be explored.

Treatment and care

High quality accessible drug services

A range of services is now in place, designed to meet the needs of both problem drug users and those who do not see themselves as having a problem. The availability and accessibility of drug services varies widely across the country and this disparity in provision has to be addressed. There is evidence that spending on drug treatment and care services will reduce costs in other areas (for example, reduce crime and criminal justice service costs). It is therefore recommended that services be expanded and developed to meet the wide-ranging needs of people with drug problems. An area of service provision that requires particular attention is the development of initiatives that seek to intervene early in a person's drug use. This is particularly important in relation to under-16s with drug problems.
Drug deaths continue at an unacceptably high level and it is considered that regular investigation into the circumstances surrounding the current deaths would help policy makers and practitioners to respond more effectively and would assist in reducing this tragic loss of life.

Recommendations

A minimum level of service provision is required across Scotland and we recommend that the present disparity in drug service provision be addressed as a priority.
Outreach work should be developed as a priority as it will be crucial in intervening at an early stage with young heroin users who may not perceive themselves as having a problem.
Services for under-16s are piecemeal and difficult to access and services have to be developed for this group.
Work should be undertaken with service providers and service commissioners to develop appropriate quality standards for drug services both in the statutory and voluntary sectors.
The current and future service needs of drug injectors with hepatitis C be addressed as a matter of urgency.
Structures should be put in place that enable dialogue to take place with drug users and that allow meaningful drug user involvement in the planning and provision of services.
A regular investigation into the circumstances surrounding the current drug-related deaths would help policy makers and practitioners to respond more effectively.

Social exclusion

Social factors that exacerbate drug problems need to be addressed

Drug problems are more widespread in areas of low economic activity, high unemployment, poor social housing and where there is a lack of expectation and opportunities for young people. We therefore require to recognise that there is a social context to drug use and that drug use is likely to impact differently on different communities. We must tailor responses to the needs of different communities. Any comprehensive strategy aimed at impacting on the drug problem must address social factors.

Recommendations

There should be substantial investment in legitimate economic activity in order to counter and undermine the illicit drugs economy currently gripping the multi-deprived communities in Scotland.
The need for dedicated services for people with both mental health and drug use problems should be assessed.
The time is right to seek support from the business sector to assist in the employment of some of those who are trying to enter or re-enter the job market after experiencing drug problems.

Criminal justice

Police, courts and procurators fiscal can divert people away from drug use

A considerable number of people with drug problems will be arrested for drug or drug-related offences and this contact can provide opportunities to divert people away from drug use. This can be achieved either by arrest referral schemes, diversion from prosecution or through alternatives to custody. Such schemes can help problem drug users to confront their drug use and can lead to positive changes in behaviour. The imprisonment of drug users is three-four times more costly than the most intensive drug treatment alternative. Drug-related criminal behaviour is rarely addressed in prison and the cycle of drugs and crime is sadly, rarely broken following a period of imprisonment. Re-offending and the treadmill of drugs, crime and imprisonment have to be addressed. It would be more effective to make the most of the possibilities for directing drug users away from the expensive and ineffective (in terms of breaking the cycle of drugs and crime) use of imprisonment into community services that combine treatment, care and rehabilitation.

Recommendations

Effective joint working between criminal justice social work teams and prescribing services must be developed to improve the outcome of non-custodial court disposals.
Diversion schemes for people with drug problems should be developed across Scotland.
Arrest referral schemes should be developed in each of the eight Scottish police force areas.
As alternative to prisons, community sentences which combine treatment, care and rehabilitation should be further developed.
There has to be an improvement in the level, quality and consistency of treatment and care in prison, which match more closely that in the community in terms of prescribing, support and counselling.
Prison throughcare requires to be further developed as a matter of priority.

Planning, co-ordination and funding

Effective local and national planning structures are required with clear lines of accountability

The creation of the Scottish Advisory Committee on Drug Misuse (SACDM), Drug Action Teams (DATs) and Drug Forums has stimulated action across the country. These key groups require to be supported and developed in order to ensure vigorous and co-ordinated action. In addition, there has to be clear linkage between national and local planning structures to ensure that all those operating in the field are aware of, and are clear about, policy and practice and can work together effectively. Drug use requires a multi-agency and multi-disciplinary response. The task of the Drug Action Teams and other planning groups is to ensure that all agencies are working towards common goals. Policy and action need to link together - all too often we have witnessed good work in one area being undermined by well intentioned but counter-acting responses in another. Funding is crucial to the development of effective responses and existing funding for responses to drug use in Scotland has to be examined more closely and critically. It is estimated that current expenditure on responses to drug use is at least ¿50 million. We have to ensure that the present allocation of resources is being used to best effect. There should be no "sacred cows" in the examination of current spending and the guiding principle should be that funding is provided to areas of action proven to be effective in reducing drug use, crime and other associated harm. The main funding for prevention/education and treatment is currently protected and made available through health boards and this funding should continue to be protected. In addition, the role of local authorities in responding to drug use should be enhanced.
Steps should be taken to investigate how mainline resources within local authority, health, police and criminal justice budgets might be targeted more effectively at tackling drug use within our communities.

Recommendations

The Scottish Advisory Committee on Drug Misuse should be re-established as the focal point for policy development in Scotland.
Mechanisms should be put in place to ensure that Drug Action Teams have clear lines of accountability.
Funding structures need to be created which encourage joint working and co-operative approaches. Funders should be prepared to commit resources transparently and consistently for joint development by Drug Action Teams in line with a local strategy.

Measuring progress

Measuring progress must be a fundamental part of any drug strategy

Recommendations

Outcomes need to be realistic, achievable and sensible. When setting outcomes, the complexities of working with drug users - and the nature of such interventions - must be fully understood and should reflect the "real world".
While the emphasis has generally been placed on measuring outcome in the field of treatment and care, as it is easier to measure, it is equally important to measure the outcome of interventions in the education and criminal justice sectors. Interventions in these areas are often taken on faith rather than proven worth and this is clearly not sensible when determining where best to place resources.

Scottish Parliament

An opportunity for an effective, co-ordinated and pragmatic response to drug use

The Scottish Parliament provides the opportunity to develop a more coherent and focused response to Scotland's drug problem. It is to be hoped that this will be consensus-based, pragmatic and founded on evidence of effective responses.

Recommendations

The Scottish Parliament should establish a Standing Committee on Drug Use, with a membership drawn from Members of the Scottish Parliament (MSPs) throughout Scotland, and work in close partnership with SACDM.
An all-party Working Group, convened by Scottish Drugs Forum, should continue to meet in some form in order to assist the Scottish Parliament develop its response.

Copies of the full report are available from SdF Information Officer Irene Hendry.