Scotland is a textbook case of how the toxic combination of growing social exclusion and poverty, the diversification of drug markets, and repressive, abstinence-only drug policies can lead to a deadly drug overdose epidemic. A new paper published by the Scottish government gives us hope that the country can now set an example to other states on how to give a compassionate and pragmatic response to the crisis.
When we visited Edinburgh in February 2023, I had the privilege to meet and interview many outstanding professionals and activists who work on reforming drug policies in Scotland (we will publish our video on Wednesday!). I was deeply moved by some of the personal stories I heard about how people with diverse backgrounds suffered the consequences of stigma and discrimination fueled by repressive drug policies.
A system, originally designed to “control” drugs and “protect” public health, had failed people in more than one way.
It failed people who are labelled as “drug abusers”. Those who have to buy drugs of unknown quality, from unsafe sources, risking their health and their lives. Some of them were condemned to the decades-long struggle for survival on the street. Left alone, isolated and immersed in self-hatred, with their manifold mental health and drug problems.
Like Pat, who identifies as a recovering drug addict and told me his real addiction was the belief that he was a shitty person, not worthy of love. A belief reinforced day by day by a society that criminalised and stigmatised him for using drugs.
The system also failed those people who could benefit from the medicinal value of some illicit substances. Who are suffering from the long-lasting effects of physical injuries, unprocessed traumatic experiences, or other mental health conditions. With no access to substances that could save their lives – because research and treatment options are severely restricted.
Like John, a psychologist who told his powerful story at a hearing of the Scottish Parliament in February. He was abused as a child and, as a consequence, was suffering from a severe, treatment-resistant form of bipolar depression. In his desperation he was considering suicide when he tried psilocybin, the active ingredient of magic mushrooms, as a last hope. And, together with psychotherapy, it worked, and saved his life.
Both Pat and John are lucky to be alive. But how many more lives could have been saved if the system had not failed them?
Scotland retains the unwanted title of Europe’s drug overdose death capital, with a death rate three and a half times higher than in England and Wales. This number even puts the country ahead of America, which has been suffering a very severe drug toxicity crisis in recent years. The rise in drug deaths has been significant enough to contribute to a fall in life expectancy in Scotland, surpassing heart disease and Alzheimer’s in healthy lives lost.
For too many years policy makers and most of the general public were trapped in the false belief that drugs are the enemy. That the solution is to deter people from using drugs and force users to become abstinent. The Misuse of Drugs Act was created in this spirit in 1971. It took thousands of lives lost to overdoses to realise that people who use drugs are not the enemy, but the key to the solution.
At least in Scotland, where the government has listened to the advice of the Scottish Drug Deaths Taskforce, an independent and multidisciplinary group of experts. After assessing the links between criminalisation and drug harms, the Taskforce recommended decision makers to urgently review the Misuse of Drugs Act 1971 to align with a public health approach.
In a new paper, published on the 6th of June, 2023, the government declares its intention to change the focus of its drug policies in three fundamental ways.
First, to provide access to a wide range of evidence-based harm reduction programs, including innovative interventions, such as supervised drug consumption facilities, drug checking services and take-home naloxone (currently none of these are possible because of repressive laws). Second, and this is the prerequisite of the first point, to decriminalise the personal use of illicit substances. Third, to explore the potential for a strictly regulated supply of drugs.
It is important to understand that these steps build one upon the other. It is not enough to decriminalise drug use without providing effective support for people who use drugs and their families. It is not possible to provide effective support without ending criminalisation and discrimination. And it is not enough to provide access to health services and decriminalise drug use without creating a safer supply of drugs to reduce the risks of the illegal market.
The end goal is to create a system that does not fail people like Pat or John or the thousands of families who have lost a loved one to drug overdoses. A system that invests in people, meets them where they are at, and provides the support they need, rather than investing more and more money in the clearly ineffective enforcement of bad laws.
But what are the chances that the government can deliver what it declares in this paper?
Of course Scotland is not an independent country. The UK government in Westminster has the last word in changing the drug laws. Elena Whitham, the Scottish Minister for Drugs and Alcohol Policy, outlines three different routes to deliver the change they call for.
The easiest solution is if the UK government itself changes the Misuse of Drugs Act. But the Tory government, with its tough-on-drugs rhetoric, has shown no intention of doing so. The second option is that Westminster gives special powers to the Scottish government, through a Section 30 order, to create new law. Again, this is not very likely to happen. The third version is a wider constitutional change – Scottish independence. After the failed independence referendum in 2014, the government has not given up on the possibility of a second referendum, but it is not on the agenda right now.
Even if reform is unlikely in the near future, the Scottish government has taken a very important step in speaking up for long overdue changes in drug policies, and setting an example of how to deal with the crisis and save lives.