Chamber and committees

That is where our support of the work that is led by Public Health Scotland is really important. I know that Mr O’Kane is familiar with the RADAR—rapid action drug alerts and response—work, which is about putting out alerts when there are reports of new or novel substances.

We know that there was a spike from October to November. The overall figure for suspected drug deaths in 2022 was down 16 per cent, but there was an increase in the final quarter of last year. The figure in that quarter is the highest since 2021, although the number of suspected drug deaths for the year as a whole is the lowest that it has been in five years, and the figure in the quarter in which there was a spike was the ninth lowest out of the past 24 quarters. Nonetheless, I reiterate the point that I always make, which is that the figure remains too high.

We will have to wait for the passage of time. We will get more evidence when we receive the annual report, which deals with confirmed deaths. Until then, we will not know whether there is a relationship between the spike in deaths that we saw in the last quarter of last year and the public health alert in relation to nitazenes.

Synthetic opioids worry me greatly. Although we have a problem with synthetic benzodiazepines, that is not so much the case with synthetic opioids. However, it is necessary only to look at the experience in America and Canada to realise why I am deeply concerned. As far as engagement is concerned, I attended last week’s United Nations conference on narcotic drugs, which was in Vienna, although I can assure the committee that I saw very little of Vienna. That was an opportunity to engage with countries where synthetic opioids are an issue. I wanted to get a better understanding of treatment opportunities and what we would have to do differently.

If we were to have an issue with synthetic opioids, that would add to the case for safer drug consumption facilities, but the American experience thus far points to the fact that some of the treatments for opioids would continue to be effective. There are some issues that need to be managed with regard to the introduction to treatment—from a clinical point of view, that can be a bit harder—but the international evidence-based treatments for opioid addiction can work for synthetic opioids. We are highly alert to that.

I can well understand why the committee has grappled with that, because unplanned discharges from court with little or no support elevate risk. The baseline approach is that we need to reform and change the whole system. That begs the question of whether remand should be used less so that we can get better bail arrangements in place. That would help to prevent those unplanned discharges from court.

Some interesting work is being done around the country in this area. In Edinburgh, there is a really interesting nursing team that does crucial court work. I met it some time ago. Again, that is all about continuity of treatment for people with substance use difficulties.

I absolutely agree that we could reduce the number of unplanned discharges from court by reforming the use of bail—where that is appropriate, obviously, because public protection is always paramount—and reducing the number of people who are on remand. It really has to be about every part of the system—whether it is justice, health or social work—being in a position to respond to needs much more quickly and swiftly. That goes back to the importance of the throughcare standards.

Where we need a cultural shift or a shift in mindset is that, first and foremost, we need to see families as partners because, at the end of the day, they often know their loved one better than any service provider does. As well as working to support the loved one who is affected by substance use, we must ensure that individuals within families receive support for all their needs. Families have expertise that we really need to tap into, respond to and listen to. That is the raison d’être of the family-inclusive practice that is at the heart of the whole-family approach. We have attached funding amounting to £6.5 million a year to that via ADPs and the Corra Foundation. There is continuity of that funding.

That is why the audit is really important. Although it might not make me universally popular, I am asking for more information than ever before about what people are doing with Scottish Government funding, because it is important in improving consistency and accountability. I am accountable to Parliament and local services and local politicians are accountable to their communities. We are currently working through that audit.

As well as bearing down and scrutinising what is or is not happening, we are, through the multidisciplinary expert group, trying to provide practical, hands-on support.

There is on-going engagement with my officials, as you would expect. I would have to check when I last spoke to Police Scotland. In the past, I have had lots of engagement with Assistant Chief Constable Gary Ritchie, who was very involved in the task force.

Yes, I believe that it has. As it often does, Audit Scotland made an important and serious point about our needing transparency. The criticism of that is that we will have to ask for lots of information that we then have to publish and people will complain about the resource that is attached to that. We have heard Ms McNeill raise a fair point about the bureaucracy around that.

For clarity, I accepted Audit Scotland’s point, and I believe that we have demonstrated transparency through our reporting on the national mission; our annual report, which is available for people to read; and the publication of quarterly reporting around things such as publicly funded residential rehabilitation.

That is an important point. Obviously, local partners are accountable for the implementation of both reports from the Dundee drugs commission. The commission has done an impressive amount of detailed work. From my engagement with the local ADP and, crucially, senior leaders in the integration joint board and the health board, I know that there is a commitment to taking that forward.

What is most notable to me is that there have been attempts at a real reset of the relationship with the third sector. We have not spoken much about the third sector this morning but, not just in Dundee but elsewhere, we need leadership in that regard. We need meaningful partnership and a bit more parity of esteem between statutory services and the third sector. I see some movement on that in Dundee. I am happy to provide further information on that to Ms Chapman directly.

I just want to say—very briefly and without trying to interfere with the management of the committee—that my officials met with police on 17 January in relation to safe drug consumption facilities. They also met with the Crown Office on 18 January, and they met with the Glasgow Health and Social Care Partnership on 23 January. I want to put that on the record.

The charter was published in November, and the stigma action plan was published in January as part of our response to the Drug Deaths Taskforce report. The principles of the plan are that stigma kills and we need to tackle it, that people who are impacted by drugs and alcohol need to be at the heart of shaping and informing service and, crucially, that we need to consider drug and alcohol problems as health conditions first and foremost. However, the purpose of the plan is to take the charter and turn it into concrete action, and the vehicle for doing that will be the accreditation scheme that will be developed.

It is important to say that the Scottish Government will start by looking at where in our policies we are inadvertently excluding people as opposed to proactively including them. It is also an important point that the Government will lead by example.

We have had considerable local interest—people are beginning to approach us and ask more about the action plan and how they could be involved in any accreditation scheme—and there is also a bit of international interest in the work that we are pursuing in the area. Although some of the work of the national collaborative is focused specifically on the human rights bill, it will also amplify voices, and part of its work will be on the sharing and dissemination of best practice in tackling stigma and responding in a human rights-based way.

It is fair to say that we are on a journey and we still have some distance to travel, but the Scottish social attitudes survey provided some quite interesting reading about people’s responses to a public health approach.

The majority of people who took part in the survey said that they are not concerned about working next to someone who has a drug or alcohol problem but, when asked whether they would be concerned about living next door to someone with a drug or alcohol problem, they gave different answers. We are beginning to see a shift—although I appreciate that that may appear to be anecdotal—where people are moving toward a public health approach, and they want to focus on what actually works to get people the help that they need and get them into treatment and recovery.

Of course, I think that the zeitgeist in all this is the lived experience community, because that community is visible proof that recovery is possible, and we know from the Scottish social attitudes survey and other evidence that contact with someone who has lived or living experience is what changes people’s attitudes the most.

With regard to the whole-family approach, there very much is a presumption in the MAT standards that family involvement is, by and large, a good thing. Of course, individuals will have different circumstances in which that might not be appropriate, or it might not be what the individual who is in treatment or recovery desires.

However, even in cases such as, for argument’s sake, that of a son who does not want his mother fully informed, there are actually reasons for some involvement, and some residential establishments do that very well. The Lothians and Edinburgh abstinence programme, which is led by Dr David McCartney in Edinburgh, has a families group. On a week-by-week basis, the staff do not necessarily go into the care of individual loved-ones but they will say, “This is the shape of the programme—this is what we are doing this week and this is what you might expect.” There are always ways to engage and be helpful and support a family member, even if consent has been withdrawn to share private medical information. Scottish Families Affected by Alcohol and Drugs is also doing some work just now, which is much more focused on models of care and service delivery and standards in and around that. I think that that will be very important moving forward.

As I indicated in my last update to Parliament on MAT standards, we are on a journey to really bear down on people to get the standards, as they stand, implemented. However, at some point, we need to come to the question of how MAT standards evolve. MAT standards will need to be more explicit about treatment in and around different substances, and they could be more explicit around things such as leadership, how we better support women and how we work better with families, because working with families is core. It should be core not only to what we do in drug policy but to what we do in the early years, education and housing support. That is not a nice extra—it has to be our core business, and we have to get the core and the foundations right.

All of us are at one on that, I think. I do not need to repeat to this audience the worldwide evidence about safe drug consumption facilities, which is irrefutable. They are not a silver bullet but they save lives, and the scale of the challenge in Scotland is such that we need all solutions at our disposal.

There would have been an easier way to do it. I will happily answer questions on that, if required. However, I and my party made a commitment that we would leave no stone unturned.

It is not all in my gift. We have an operationally independent police force, and the Lord Advocate and the Crown Office are independent; nobody here needs me to give a lecture on why that is. However, it is encouraging that the proposal that was submitted to the Crown Office was supported by Police Scotland and Glasgow City Health and Social Care Partnership.

It will be for the Crown Office and the Procurator Fiscal service to take matters forward. They are continuing to work well with Police Scotland and it is important that they continue that work, which, as the committee will know, is around the policing of any facility, should it be required. It is imperative that clarity exists on that point for both the public and police officers.

I have done everything that I can up to this point. As everybody else here is doing, I am waiting on the conclusion of those vital discussions between the Crown Office and the police and on any forthcoming decision from the Lord Advocate. I will have to respond to that decision—whatever it is—in due course, and I give you my absolute commitment that I will do anything that I can within my gift, because safe drug consumption facilities work.