Written evidence submitted by Addaction (UMD0020)
Scottish Affairs Committee - Use and Misuse of Drugs in Scotland inquiry
Addaction Scotland
Addaction is the largest third sector provider of drug and alcohol services in Scotland. Every month we help more than 2,500 people turn their lives around through our network of 16 services nationwide. The majority of our services are direct access and recovery orientated, but we also have specialist projects for young people, people affected by HIV and hepatitis, individuals who have alcohol related brain damage and people who have a history of trauma. Our engagement team helps people who use our services to become more actively involved in their communities, and provides a bridge to the growing recovery network in cities and towns throughout Scotland.
● What are the unique drivers of drugs abuse in Scotland? How is drugs misuse in Scotland different from the rest of the UK? To what extent does UK-wide drugs legislation affect the Scottish Government’s ability to address the specific drivers of drugs abuse in Scotland?
Historically Scotland has had substantially higher level of drug related deaths than the rest of the UK. In 2017, the most recent year we have available statistics, the rate of drug related deaths was more than double in Scotland (170 per million people) compared to England and Wales (66 per million people). One of the reasons for this is the considerably higher levels of opiate and benzodiazepine users within Scotland, reflected in the proportion of drug related deaths in which individuals were found to have opiate/opioids and benzodiazepines present. In Scotland it’s estimated that 1.62% of the population, or almost one in 60 people, are problematic drug users whereas the rate in England is approximately half that at 0.89% or one in 120 people (although the two countries include different substances the majority in both is made up of opiate users).
Most drug related policies are devolved to Scotland, such as responsibility for a national strategy and determining treatment commissioning structures. UK-wide drug legislation is unlikely to have a significant impact on the drivers of drug abuse, which are usually related to social policy issues and structural problems. However, it is likely to have a significant impact on the ability to support people with drug issues and providing effective harm reduction services and advice for individuals taking/considering taking drugs.
● What is the relationship between poverty and deprivation and problem drug use?
Overall drug consumption doesn’t increase with deprivation. For example, according to statistics the highest level of cocaine use is by those earning £50,000 or more.
However, research has repeatedly shown that deprivation is heavily correlated with problematic drug use. It is found to be associated with the sustained use of more harmful drugs, particularly crack cocaine and heroin, and drug related health and societal harms. Deprivation is more likely to relate to a lower age of first use, progression to dependence, injecting drug use, other risky use, health and social complications from use.
In deprived areas there are more likely to be drug misuse risk factors, such as an unstable home, unemployment, school exclusions and adverse childhood experiences. It can be more difficult for individuals from deprived areas to overcome drug problems as they have less access to factors that support recovery such as meaningful employment and suitable housing.
Problematic drug use is often to do with structural disadvantages, limited opportunities, alternatives and resources, all of which are more common in deprived areas. For those who experience social exclusion and disadvantage prior to drug use, the onset of excessive drug taking in early adulthood may be a form of escape, a way to deal with the lack of resources available to the rest of society.
Drug related deaths increase in areas with the highest levels of deprivation. For example, the rate of deaths related to drug poisoning in England and Wales is about ten times higher in the most deprived decile than the least deprived decile. Unfortunately the same statistics are not available for Scotland.
One of the many reasons people we work with use drugs is to cope with underlying traumatic issues or forget certain circumstances and events in their lives. This is particularly the case for women. We have found from our services that people misuse substances to address the traumatic stress they experience – including self-medicating to escape invasive memories, or make traumatic relationships more tolerable. This usage can be heightened amongst certain groups, particularly children who face additional complexity in their lives, including; looked after children, those seeking asylum, those witnessing or involved in violence. This is also true of adults who experienced one or more of these issues as a child. People living in deprived conditions and communities are more likely to have experienced trauma in their lives.
People with multiple adverse childhood experiences (ACE) are more likely to develop substance issues, in part to manage the overwhelming emotional and somatic sensations associated with trauma. Children who experience four or more adversities are eleven times more likely to go on to use crack cocaine or heroin. The chances of developing a dependence on substances double if a child has also experienced sexual abuse or other forms of violence.
● How is the drugs market in Scotland changing? How well do current regulations meet the challenges of new trends in drug disruption, such as the “dark web”. Are any changes needed to the current regulatory landscape?
Trends in drug use are forever changing. Scotland is no exception to this. We carried out a survey of drug users in Scotland last year in order to get a better understanding of these changes, in particular the extent of poly drug use (people who take multiple drugs) and the level of possible drug issues people have with drugs generally, whether or not people showing signs of dependence and are accessing support.
There are other regular Scottish drug surveys routinely carried out. However, they have relatively small samples sizes or focus solely on people in drug treatment. The results of this survey include responses of 8,518 individuals. To put this in context the most recent national drug survey in Scotland had 618 people take part who had taken substances within the last year and the 2018 Global Drug Survey had 1,300 respondents in Scotland.
Below are some of the headline figures from the survey. However, if helpful we would be willing to share more details and further statistics to the Committee.
● Substances
More than 80% of respondents said they had taken cannabis in the last year and almost three quarters (72%) said they used cocaine/crack. Almost half (47%) reported using MDMA/ecstasy, more than one quarter (25%) of people said they had taken valium and a similar proportion (23%) said they had taken ketamine.
By comparison the latest Global Drug Survey found that 61.9% of respondents reported ever using cocaine, 51.7% having used in the last year. The most recent Scottish crime and justice survey in 2015/16 found that of the people who had taken substances in the past 12 months, 81% had taken cannabis, and only 30% cocaine and 22% ecstasy.
According to our survey over two thirds of people who took drugs in Scotland last year (71%) said they took more than one substance over that period. Generally we can see that very few people only took one substance. There is a multitude of interesting trends when breaking down polydrug use among different substances. For example, almost 40% of people taking hallucinogens also took ketamine and a very similar number took hallucinogens and mdma.
On average people who used cocaine last year took three other substances. When we broke the results from our survey we found that just over one third of people who took cocaine also took MDMA and just less than one quarter also took ketamine. Three quarters of people taking valium last year took at least three other substances over the course of the year.
● Drug misuse and dependency
People responding to the survey were asked questions to determine whether or not they were showing signs of any issues with the substances they were taking. We found that more than two in five people (40.4%) had results suggesting they may have a significant problem and possible dependence with drugs, although this varied depending on the substance. Most worryingly two thirds (67%) of those said they had never received any sort of support or help.
Over 73% of Heroin and Methadone users displayed significant problems suggesting dependency. Almost half of people who had taken valium (46.6%), more than half of Xanax users, one third (32.2%) of cocaine users and 38% of ketamine users showed signs of significant problems.
● Image and Performance Enhancing Drugs
The number of people taking image and performance enhancing drugs (IPEDs) appears to be on the rise. They took 5 substances on average with a very high proportion of them taking cocaine (91%), cannabis (76%), mdma (65%) and valium (53%). When individuals taking IPEDs these were asked if they were able to stop taking the drugs when they want the majority said no. Unfortunately the majority also said they had never sought help or support.
● Conclusions
Our findings suggest that people who take substances in Scotland often take multiple different drugs over the course of a year. A substantial number of people taking substances are demonstrating signs that they might have issues with those drugs, that they might be negatively impacting their health and wellbeing. Unfortunately only a few of those people have looked for support.
It’s important that people are aware of their drug use and understand the damage it might be causing them and the best methods of minimising that damage. We need to encourage more people to come forward and look for that help and support though. People need to feel comfortable looking for advice, so there needs to be multiple options and tools available for them. That can range from traditional services to online support.
The more informed and up to date with drug consumption trends within Scotland the better advice we can prepare and harm reduction and treatment services we can put in place.
● Would further devolution of powers enable the Scottish Government more effectively address drugs misuse in Scotland and tailor their approach to Scotland’s needs?
Scotland is prevented from introducing a completely unique approach to drug misuse due to UK wide drug legislation, such as the Misuse of Drugs Act 1971 and the Psychoactive Substances Act 2016. This legislation precludes Scotland from controlling the schedule or classification of specific drugs as well as introducing certain policies or services that could be interpreted as breaching that legislation, most notably drug consumption rooms.
In 2015, an outbreak of HIV occurred among people who inject drugs (PWID) in Glasgow, with 50 new HIV cases reported in Scotland, which was more than double the average number of new HIV cases detected annually in the period 2006-2014. The proportion of people who inject drugs in Glasgow who testes positive for HIV increased by 1,000%. There is a general consensus among health professionals and local policymakers that a drug consumption room would reduce health related harms among people injecting drugs in Glasgow, including the transmission of blood borne viruses such as HIV and Hepatitis C. However, this has been blocked as the Lord Advocate believes a drug consumption room would breach the 1971 Act, which in effect is preventing an innovative and evidenced response to a public health crisis.
Although Scotland can introduce programmes such as heroin assisted treatment and drug testing facilities it can only do so through exceptions and licences granted through UK wide legislation. Therefore it does not have true control over them and their long term sustainability.
Addaction believes Scotland should have control to respond to unique and localised drug misuse issues in a progressive and innovative manner that is most likely to address the problem. There should be a comprehensive public health approach adopted to drug misuse, a move away from a position that often simply criminalises vulnerable individuals. Scotland should have the ability to formally introduce an approach such as this and not through informal, means