Scottish drug deaths

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David LiddellStark statistics

Scotland has recorded its highest ever number of drug-related deaths. DDN looks at what’s behind this bleak trend, and what could be done to reverse it

Last year there was cautious optimism when figures showed that the number of drug-related deaths in Scotland fell by just under 10 per cent in 2013. Admittedly, this followed 2011’s record high of 584, a figure almost unchanged in 2012, but many still hoped that the tide had finally turned.

Those hopes were dashed last month when the 2014 statistics from National Records of Scotland were released, recording the highest death toll ever, at 613. Once again, the vast majority were older drug users, with 67 per cent of deaths in the over-35s. ‘I think within the whole sector there was a feeling of depression that the figures were going up again, and a realisation that it’s likely the trend is still upwards,’ Scottish Drugs Forum director David Liddell tells DDN.

As well as being older, the majority of those dying appear not to have been engaged with services at the time, raising questions not only around access, but also about what should be done ‘for those falling out’, he says. ‘Should we be doing more in terms of assertive outreach and looking at other models to chase people up?’

With services already under intense press­ure, changing approach to become even more proactive is going to be a challenge, he acknow­ledges. ‘But I think it’s definitely some­thing we need to do. The other thing that links into that, knowing what we know about the protective factors of treatment, is that in Scotland we’ve probably got half the popula­tion of 60,000 [problem drug users] in treat­ment. In countries like Switzerland and Holland it’s much higher, and that’s what we should be aiming at.’

On the subject of pressures, some have commented that government cuts and austerity measures will have played a role in the increased number of deaths. Is that something he’d go along with?

‘I’m only cautious in the sense that it’s very difficult to prove that,’ he says. ‘But certainly what we have with the older group is a group that came out of the 1980s and mass unemployment and austerity, so what we’re seeing is that same group being hit by a second wave of austerity now. Clearly that’s having an impact. Whether it’s adding to people’s ambivalence as to whether they live or die, and those whole feelings of despair – I’m sure that’s the case, but it’s very hard to quantify.

‘More generally, in terms of service cuts, we’ve been very fortunate in Scotland in that core funding for specialist health services has been ring-fenced for many years,’ he continues. ‘It hasn’t kept pace with inflation, but it’s largely been untouched. But some of the wider services, particularly within local authorities, have obviously been hit. I’m sure it’s had some impact.’

It’s been pointed out that older drug users perhaps haven’t been as much of a priority, because they don’t tend to be as involved in acquisitive crime. Is that focus starting to change? ‘It has to, just because of the profile of the population in services,’ he states. ‘There has been that sense that you’ve had a group who maybe weren’t creating significant demands, but I think services do need to pay more attention.’

However, it’s important not to lose sight of the fact that deaths in under-35s have actually remained fairly constant over the last couple of decades. ‘It was interesting in that the narrative was that the deaths had continued to fall in the younger age group as a percentage, but certainly when we looked at the actual figures they were up,’ he says. ‘In the 15-24 group they were up by 14 on the previous year, and for 25-34 they were up by 19.’

Here lies the challenge around the aging cohort narrative, he stresses. ‘It’s true in overall terms, but there are still younger people developing drug problems and of course you still have a large group of vulnerable young people. So sadly it shouldn’t really come as any surprise.’

It also highlights the importance of continuing to pay attention to the emerging population, he says. ‘It’s not an easy balance, but certainly it’s a wake-up call. We can’t just adapt our services to an aging cohort then realise that there’s a younger group that have opted out of services because we’re not meeting their needs.’

As he’s pointed out, little has changed for that older cohort over the last three decades. Is it becoming more accepted that problem drug use is largely the result of poverty, or is the dominant message still the opposite?

‘I don’t think it’s largely recognised, beyond people who work in the area or are more widely involved in health policy,’ he says. ‘I just did an article in the Edinburgh Evening News and got a particularly vicious email response, basically saying these people should be left to die. I was talking about underlying problems such as trauma, on the basis that a lot of the public narrative is around lifestyle choices and so on. It’s about trying to get people to understand that the folk who are dying are actually victims of society, by and large – they’ve had a raw deal, their drug use is largely a way of coping with the hand they’ve been dealt, and they deserve a bit more public sympathy. But clearly that’s an uphill struggle.

‘Our government has been hugely supportive in trying to reduce drug-related deaths, but you do have to think that if there were 600 deaths in any other area, there’d be a public outcry. It’s a sad state of affairs, but it’s the reality.’