Chapter 4.3

Drug-related deaths have been ignored for too long. Excuses have been made and leaders at all levels have been allowed to obfuscate while deaths have continued to rise.

People who use drugs have been demonised, stigmatised and discriminated against for decades by a system that criminalises and marginalises them. Leaders need to take ownership of this problem and work urgently to change the pervasive culture which sees a person who uses drugs as less worthy of support than someone who does not.

Numerous reports have called for national and local leadership to foster whole-systems change. We are clear that strong decisive leadership is critical to success.

In 2020, there were 1,339 drug-related deaths. This represents more than three deaths a day.

The evidence is clear. Now is the time to act.

National leadership

Rightly, overall responsibility for drug-related deaths sits with the First Minister and Scottish Government. We have already described the ministerial appointment and other initiatives launched by the Government in response to the crisis.

Despite these positive developments, Audit Scotland published an updated report on drug and alcohol services in March 2022 (46) that highlighted

a lack of drive and leadership by the Scottish Government.

The previous Minister for Public Health and Sport declared Scotland’s drug deaths crisis a public health emergency, a step that was welcomed by many, including the Dundee Drugs Commission. The Commission’s report, however, stated that “it is unclear whether such a declaration will unlock any new powers or resources”.

it is unclear whether such a declaration will unlock any new powers or resources.

For many in the sector, this question remains unanswered.

What needs to change

Many have drawn parallels between the current drug deaths crisis and the Covid-19 pandemic, which drew an unprecedented Government response. The First Minister
and Minister for Drugs Policy have repeated that drug deaths represent Scotland’s other public health emergency.

We support this level of response to what is a tragic and unacceptable loss of life. It is important, however, that these are not simply empty words. The rhetoric needs to
be backed up by action.

The Scottish Government should learn from international examples of public health emergencies to outline what a meaningful response to the drug-deaths crisis means
in practice.

Action 105.

The First Minister should commit to sustaining and accelerating the current focus on drug-related deaths, with a dedicated Minister for Drugs Policy, until there is a meaningful and sustained downward trend in drug related deaths.

Action 106.

The First Minister/Minister for Drugs Policy should clearly define what a public health emergency response to drug-related deaths means in practice, what new powers or resources it unlocks and how it influences activity under the National Mission.

Dame Carol Black called for “strong and coordinated action across multiple departments” in the UK Government (47). This has not been our experience of observing activity in the Scottish Government.

Fragmentation across policy areas has been all too apparent, with little join-up between work on drugs policy and key policy partners such as mental health, justice,
housing, poverty and inequality.

The expansion of the Drug Policy Division, introduction of a new minister and creation of internal boards that bring together ministers and senior civil servants from
across portfolios are welcome. Questions remain, however, about progress in aligning objectives across Government and driving change to tackle the root causes
of drug-related deaths.

Consideration should be given to whether the scale of this problem warrants a cabinet subcommittee or joint ministerial group to drive change across the Scottish
Government and support the implementation of our recommendations and actions.

Action 107.

The Scottish Government should work to break down silos in policy-making and ensure that appropriate groups are in place internally to drive action on drug-related deaths and facilitate the implementation of the Taskforce’s recommendations and actions.

The Audit Scotland update report on alcohol and drug services of March 2022 (46) called on the Scottish Government to “set out a clear integrated plan on how
additional investment can be used most effectively and demonstrate how it is improving outcomes.”

Transparency and monitoring are key themes of the update. We have faced challenges when reviewing activity in this space to enable us to advise on the most effective strategy.

We found it challenging to understand the National Mission programme as a whole and to develop a clear picture of what practical steps are being taken on the ground.

A national outcomes framework would provide much needed accountability and scrutiny of the Scottish Government and local activity. It would also drive improvement activity and involve more people in developing the National Mission.

The outcomes framework should feed into local outcomes frameworks and ADP strategy documents. We noted the commitment to publish such a framework made
by the Minister for Drugs Policy in the Scottish Parliament on 26 May 2022 (48) and look forward to its publication.

Action 108.

The Scottish Government should publish a national outcomes framework and strategy underpinning the National Mission. This should outline the outcomes, drivers and indicators through which the Mission will be measured. It should also clearly outline what funding is allocated to each overarching objective.

Local leadership

While national leadership is important, it is not enough in isolation. Local leadership is vital to tackling drug-related deaths and harms.

Leadership sets the ethos for an organisation. Good leadership can:

• embed a culture of continuous improvement;

• give people the confidence to challenge poor behaviour and stigma; and

• drive services to deliver the treatment and support needed by people who use drugs.

The Dundee Drugs Commission stated that the test of local leadership will be when the

“agreed changes are owned and supported by the statutory and third sectors, recovery communities, service users and families”.

The Commission makes a key point about the importance of involving the people who will be delivering the services and those with lived, living and family experience in the process of developing local services. It places the responsibility for ensuring these groups are engaged on local leaders.

We support this principle and agree that local leadership should take a lead in ensuring that lived and living experience is at the heart of developing local services.

What needs to change

The National Mission will rely on senior leadership across the whole community to have an impact on drug-related harms and deaths.

Leaders in every local area, including chief officers, service managers and leaders of recovery communities, must work together to deliver the whole system of care outlined in this report. They must work jointly to strive to embed the principles of a person-centred, human rights-based approach that is trauma-informed and puts lived, living and family experience at the heart of services.

Action 109.

Local leaders at all levels must take ownership of the drug-deaths crisis in their area. They must take responsibility for delivering the whole system of care outlined in this report and embedding the principles of a person-centred, human rights-based and trauma-informed approach in services, with people with lived, living and family experience at its heart.