A Unique Challenge?

There are a number of characteristics in the behaviours, profile and patterns of drug use and people who use them that both differentiate and add complexity to the nature of our challenge.

High risk patterns of drug use

The average number of drug identified in toxicology reports has increased from 4 drugs in 2008 to 6 in 2018. This includes opioids e.g. heroin and/or methadone, benzodiazepines e.g. etizolam, cocaine, a stimulant that increases heart rate, gabapentinoids, possibly also prescribed antidepressants and alcohol. It is considered that the combined toxicity of opioids, cocaine and benzodiazepines can be particularly fatal.

A high-risk cohort of people

Evidence of a high-risk cohort of people who use drugs whose first exposure began in the 1980s, in a post-industrial era when unemployment was high and the heroin market expanded and took hold in deprived communities. This cohort, now in their 40s, suffer multiple, complex disadvantage in terms of poor physical and mental health, unemployment, unstable housing, involvement with criminal justice and family breakdown. Issues around the funding and consistency of access to treatment and support services in the last 12 years may have led to insufficient emphasis on addressing these underlying issues with psychosocial support.

Those most at risk can have a pattern of near-fatal overdose incidents leading to a fatal outcome. The Taskforce therefore had a focus on developing successful response to Near-Fatal Overdose in Scotland.

Concentrated social deprivation

Areas with concentrated social deprivation. Scotland has a number of communities which have suffered acute deprivation. Deprivation is associated with more people who use drugs in a problematic way, high levels of trauma and adverse childhood experiences which are recognised risk factor for drug use.

Stigma creating a barrier

Stigma creating a barrier to anyone seeking support. People who use drugs are highly stigmatised -when trying to seek general healthcare or work – the healthcare system only sees a drug problem, not a person with multiple health and social problems whose quality of life could be improved.

We know that factors such as poverty and inequality, trauma, mental ill health, alcohol and drug dependency are all closely linked. Addiction is not a crime and you cannot punish people out of addiction. That has been the approach for years and it hasn’t worked.

David Strang, Taskforce Chair