Is Scotland closer to a consensus on drug treatment?

Scotland’s latest set of drug death statistics made for grim reading and triggered a war of words in parliament and the press. But could the opposing sides now be reaching an agreement, asks DDN

When National Records for Scotland reported that more drug-related deaths had been registered in 2011 than ever before, and had increased by 20 per cent since the previous year (DDN, September, page 4), it was clearly going to be a big story. What really hit the headlines, however, was that methadone had been ‘implicated in, or potentially contributed to’ 47 per cent of them. 

Although it was not known how many of those who died had been prescribed methadone and how many had obtained it on the black market – as the information is not recorded in the death registration process or on pathologists’ questionnaires – leader of the Scottish Conservatives, Ruth Davidson, promptly issued a statement calling the country’s methadone programme a ‘human disaster’, adding that it seemed ‘the more you spend on methadone, the more people it kills’. 

This was followed by sections of the Scottish press, particularly the Daily Record, calling for a parliamentary enquiry and running negative methadone stories, particularly the Record’s articles on ‘methadone barons’ – those who profit from the ‘massive payouts for prescribing the drug’. Alex MacKinnon, the Royal Pharmaceutical Society’s director for Scotland, felt compelled to state that ‘pharmacists dispensing methadone are doing a difficult job and play an important role’ in helping people beat their addiction. ‘It’s important to recognise that pharmacists are only carrying out their duties to the NHS by dispensing methadone,’ he said.

In October, the Scottish Government announced that it was commissioning an independent expert group, chaired by chief medical officer Harry Burns, to consider the evidence supporting the role of opiate replacement therapy and make recommendations to the government in spring 2013. This was followed by the country’s drug strategy, Road to recovery (DDN, 2 June 2008, page 4), being debated in the Scottish Parliament last month.

Described as ‘thoughtful and measured’ by the Scottish Drugs Forum (SDF) – and as ‘clashes over methadone treatment’ by the Scotsman – the debate culminated in the passing of a motion that included recognition of the value of replacement therapies as part of a wide range of treatment options, with Conservative MSP Annabel Goldie stating that ‘polarising’ the issue was unhelpful, as were ‘sensationalist articles in tabloid newspapers’. 

So does this mean that consensus is looking more likely than in recent months and that there’s something approaching cross-party support for the drug strategy? ‘I think broadly, yes,’ says SDF director David Liddell. ‘Political cross-party support has been restored for the moment, but in the choppy political waters leading up to the referendum [on Scottish independence, expected to be held in autumn 2014] it wouldn’t be safe to assume that this can easily be maintained.’ 

 How much was the decision to commission the independent expert group in the first place media-driven – particularly by the Daily Record? ‘Clearly the wish of the government and the sector as a whole is to try and retain political consensus,’ he says. ‘We’ve seen many countries in Europe lurch from one drug policy direction to another and my view is that this costly, unhelpful and should be avoided. I certainly wouldn’t say it was media driven, but rather by the fact that some of the political parties believed that there were easy political points to be scored by attacking the approach being adopted – in particular, methadone.’

 The SDF has previously called for politicians to think more deeply about the issue of methadone, instead of using it as a political football or as a simplistic argument that the drug strategy isn’t working. Could the debate be seen as evidence that they’ve started to do that? ‘I think what we saw was a degree of posturing, which the debate usefully flushed out, and it exposed simplistic arguments – for example the attack on pharmacists as “methadone millionaires”. There will always be those who see solutions in more simplistic ways. A key part of our briefing to MSPs was to highlight one of the key planks of the Road to recovery strategy, that for too long the debate in Scotland has centred on whether the primary aim of treatment for people who use drugs should be harm reduction or abstinence.’

  So if a truce has been called in parliament for now, are the press likely to lose interest in their anti-methadone campaign? ‘Clearly the high level of drug-related deaths and in the number potentially involving methadone continue to be important issues which need to be addressed, but an expert group is a far better way to do this than trial by the media. Such a campaign is also not likely to sell papers, and therefore would probably be difficult to sustain.’  DDN