Charities working with drug users have warned MSPs that it is “too early” to say if Scotland’s national emergency is making a difference.
Last month, Elena Whitham, the Scottish Government's drugs minister said the country was "turning the tide on the drugs death crisis".
She was speaking after figures released by the National Records of Scotland (NRS) showed there were 1,051 deaths due to drug misuse in 2022 – down 279 on the previous year, a drop of 21%.
It is the second year in a row that the total number of drug fatalities has fallen.
However, Scotland’s death rate is still staggeringly grim, and around 2.7 times higher than the UK average.
Speaking to a special joint session of three Holyrood committees on Tuesday morning, Kirsten Horsburgh, the Chief Executive Officer of the Scottish Drugs Forum, told MSPs there needed to be three to five years of falling death rates "to know that what we were doing was really making an impact."
Her colleague, Wez Steele, told the committees he was “very apprehensive of what might be around the corner” regarding substance use in Scotland.
A crackdown on opium in Afghanistan by the Taliban has had a significant impact on the global supply.
Heroin made from Afghan opium makes up 95% of the market in Europe.
While the supply has withered, the demand remains strong with people turning to synthetic opioids, including laboratory-created substances such as fentanyl.
They can be up to 50 times stronger than heroin and 100 times more potent than morphine.
Mr Steele said that drug checking could help users in Scotland.
“Until I think we address this issue, and give people much more adequate support as a wraparound alongside medication, I think we're we're still fighting an uphill battle. To be honest, I think 2.7 times the death rate of the rest of the UK is still massively unacceptable for Scotland and we can do much better.”
The MSPs were also warned that Scotland’s first drug consumption room (DCR) could be limited in what it can do.
The facility – set to be based in Glasgow’s Hunter Street – was effectively given the go-ahead earlier this month when the Lord Advocate said it would not be in the “public interest to prosecute drug users for simple possession offences committed within a pilot safer drugs consumption facility.”
While the law officer is responsible for prosecution, the Misuse of Drugs Act remains reserved to Westminster.
Ms Horsburgh said that could cause difficulties.
“We do have concerns about some of the restrictions that will be in place because there's not a change to the Misuse of Drugs Act, so there's some restrictions in terms of how they can operate.”
“My understanding is that it won't be an inhalation facility because of some of the restrictions,” she added.
Ms Horsburgh said she was also anxious about how long it would take for the Glasgow DCR to be assessed. She warned that a lengthy evaluation could prevent anywhere else in Scotland from opening.
She also said that the model introduced in Glasgow should not set the precedent for every DCR to be introduced across Scotland.
“It's important when we are introducing these facilities that we have lots of different types so we could have mobile units, we could have fixed site units, we could have just a room within an area that's already providing needle exchange facilities.”
While Ms Horsburgh agreed that there needed to be wraparound help on offer to the people using the facility, she pushed back against calls to put demands on users.
“There shouldn't be an expectation if somebody attends a drug consumption room that the absolute end goal is abstinence,” she said. “I think that's key for this, we can't turn the drug deaths crisis into a conversation about how we get everyone drug free.
“And it's just about how we make sure that people are not judged, that they're given an option to connect with people in a way that they haven't been able to through any other service provision and that they make their own choices about what's best for them and their quality of life.
“Goals like abstinence absolutely should be on the table but that should never be promoted to people as 'that should be where you're heading.' It should be entirely up to the individual."
Tracey McFall, chairperson, of the Scottish Recovery Consortium, said the key to how the DCR operated would be Police Scotland’s willingness not to charge people in and around and on their way to the facility.
“If someone is in real chaos and they're buying their street drugs in an area, it's very unlikely that they're going to get on two buses to get to an injection facility in a safe consumption room.”
She said the facility needed to work with local communities.
“We can’t do to communities, we have to take communities with us,” she said.
“There has been a number of examples over the years where there’s been residential rehabilitation service set up and there was local opposition but actually in some of those rehabilitation services the community actually engage.
“It’s about demystifying some of the stigma that’s attached with this work.
“We need proper consultation… we need to talk to the community, we need to acknowledge their fears and say ‘we get it, however there’s an evidence base across the world to say there’s not going to be that crime in that area, there’s not going to be an increase in drug use in that area’.”
She added: “My experience in developing services over the years is if you take the community with you, they get it.
“But don’t just drop it in to say ‘this is happening in your area’ and I don’t think Glasgow are planning that.”
She said there was some learning for the operation of the DCR from some of the evaluations of the heroin-assisted treatment facility, particularly when it came to staff and a high-turnover.
Simon Rayner from the Aberdeen Alcohol and Drug Partnership agreed. He said there was “just a deficit of nursing staff” in the North East, and clinicians were able to earn more working in wards.
If we're going to be innovative and aspirational around drug consumption rooms and all the other stabilisation facilities and all the other things we should be doing in terms of an emergency response, we need to have an infrastructure.
“We can’t just keep firefighting and stitching things together.
“There needs to be that well-considered plan and structure and aspiration for the future that we have a workforce that is properly trained, properly supported, properly invested in, and properly rewarded for the work that they do, and not blamed for the drug death figures when they're all trying their best to do the right thing.”