IT is inevitable that newspapers will occasionally get it wrong. Letters to the editor will also sometimes mistake the facts. But when the Minister for Public Health gets his facts wrong it is a little worrying. In his guest column in The National (Lives are at stake, July 17), Joe Fitzpatrick MSP states that drug policy is reserved to the UK Government, but this is not really the case. Drug policy is a devolved issue. It is drug legislation – principally in the form of the Misuse of Drugs Act (MDA)1971 – which is reserved to Westminster.

This distinction matters because whilst the MDA clearly limits the Scottish Government’s room for manoeuvre, it is not totally restricted. There is no doubt that the MDA is an unwieldy and draconian law which successive UK governments have failed to review for almost 50 years, but there remains much that can be done to improve our response to drug problems even within its scope.

The Dutch for instance have had a more liberal, less criminalised response to drug misuse for decades. They have done this largely without altering their Opium Act – a statute every bit as unhelpful as the MDA – by the simple expedient of their version of our procurators fiscal indicating that they will not progress certain offences (notably drugs possession) because it would not be in the public interest.

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The dramatic increases in the untimely deaths of drug users is both worrying and tragic. We do not yet have the full details but it would be reasonable to assume that they are broadly in line with those reported in previous years. These earlier figures show that a significant proportion identified methadone – a substitute drug extensively used in drug treatment – as a factor, usually in combination with other substances including heroin, tranquilisers and alcohol.

That would suggest that many of these deaths involve men and women either currently or recently in contact with treatment services. A huge body of evidence from Europe and the USA over the decades has shown that treatment interventions have a protective impact; they reduce deaths. But Scotland’s death toll appears to be higher than most other countries. Thus, it is reasonable to explore whether something in what we are doing (or not doing) with these services is a factor.

We are continually told that one size does not fit all and that drug users need to be offered a varied package drawn from a range of treatment (and treatment-supportive) options. But the evidence would suggest that too often re-referral across treatment services fails to happen. For instance, surveys of people attending Alcoholics Anonymous and/or Narcotics Anonymous indicate that they are rarely referred by a mainstream agency. Similarly, people in residential rehabilitation consistently report often prolonged struggles to have their desire for such treatment considered.

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This last issue appears most often to be rooted in the misapprehension that residential rehabilitation is a more expensive option. However, numerous studies have shown this not to be the case. Community or outpatient interventions may appear to be cheaper but this is simply because the cost is spread across a number of often unrelated cost centres and is thus largely hidden.

One way forward might be to provide more encouragement for agencies to both work together and to cross-refer. In the 1980s, the UK Government in England and Wales established a drug advisory service which used multi-disciplinary teams (usually seconded for a week from their own treatment agencies) to visit an area, examine the quality of the services there and, crucially, how they fitted together and provide a report highlighting good practice and recommending potential changes. This would seem to offer a relatively inexpensive way of auditing our network of services and their interaction.

For those drug users who are rarely if ever in contact with drug treatment services, other options may be possible. Drug consumption rooms may be part of the solution for this group but it seems unlikely that they would be effective outwith large urban areas and then for relatively small numbers of users. Very little is spent in Scotland on advertising the services that are available and it may be that some users are not aware of the range of options that are available.

The past decade has seen an increase in the use of generalist pharmacies to distribute clean injecting materials and a corresponding decline in the numbers of specialist needle exchanges. But needle exchanges are a vital gateway into other treatment services and offer the possibility (not readily available in a busy pharmacy) of specialist workers undertaking health checks, advising on injecting technique, inspecting injection sites and so on.

Rowdy Yates
President, European Federation of Therapeutic Communities