Seòmar agus comataidhean

The business case will go through its process. The Thistle will need to work with the Lord Advocate on how that interacts with the 1971 act and the statement of prosecution policy that was developed for the safer drug consumption facility. The Lord Advocate will need to give a view on how possible such a space is and what legal exemptions from prosecution would be required to develop the facility in that way.

We have heard clearly from the clinicians who operate the Thistle about the issue of not allowing inhalation. It is about being agile—my frustration is that we need to be able to be agile to the changing pattern of drug use. We have heard loud and clear that one of the barriers to coming in and using drugs in the Thistle is that people like to smoke at the same time as they inject. We need to think carefully about how, in this challenging area of harm reduction, we best meet the needs of the people who would benefit most from coming across the Thistle’s threshold. My officials and I will support, in any way that we can, any changes that need to be made.

There is a broader challenge with the 1971 act and harm reduction when it comes to paraphernalia. We have spoken about inhalation pipes, which cannot be supplied. What is happening at the moment, as you have heard in evidence today, is that people are injecting cocaine, and there are real risks because of the frequency of injection. There are real risks of increased levels of blood-borne viruses from sharing needles, and there are significant risks—to the extent of amputation—from injection site reactions; people can run into real difficulty from injecting 10-plus times a day, particularly if they become more intoxicated during the day. Being able to supply alternative, safer and less harmful means of using a drug—such as inhalation pipes—would be a significant step towards harm reduction that we could take but, currently, the 1971 act prevents us from doing that.

I also heard from the people at the Thistle about tourniquets. Even to laypeople, it is obvious that having injection procedures that are as sterile as possible would be a good harm-reduction intervention but, at the moment, the Thistle cannot supply sterile tourniquets for injections, because the 1971 act bars that.

Absolutely. I advocate for that, but I am not sure that it is listening to me.

Tara Shivaji might want to come in on this, but I will give a first response. All of us will, like me, welcome that substantial decrease—we are very pleased to see it. However, in the earlier evidence session, you heard from other witnesses about the changing market and the differences in the way in which people are taking drugs. That is bringing new threats, which indicates to me that we need to be agile in how we respond to those harms.

When we started the national mission back in 2020, we were largely dealing with the injecting of opioids and heroin. Now, in 2025, we have a significantly increased threat from injecting cocaine, which, as your medical witness described, requires more frequent injecting episodes. There is also a real risk from injection harm. The market is undoubtedly contaminated, so the bulk of what people are buying in Scotland is not what they think that they are buying. There has been a recent spike in harm in Glasgow caused by cocaine contaminated with synthetic cannabinoids, and we have also found heroin contaminated with nitazenes. That is causing real challenges for how we respond to the situation. We have seen a difference in the way in which people are taking drugs. As well as the increase in the number of injecting episodes from cocaine, we are seeing more smoking than we had before, and there are more inhalation routes.

We need to remain agile. It is quite a dynamic situation—things are not static. We have brilliant systems in place to understand what is happening out there, and to learn quickly where the harms are coming from and get good, high-quality information out across the country. However, it is a challenging situation to stay ahead of. Tara Shivaji might want to say more about RADAR.

Are you talking specifically about post-mortem toxicology?

It made a suggestion about mobile units being more cost effective, and I can think of certain areas where that might meet the pattern of need better than a fixed unit. However, the challenges with the 1971 act as it is and the conditions that have been set by the Lord Advocate mean that the model of a safer drug consumption unit is not scalable and not sustainable.

We need the legislation to change, and I think that it is reasonable to ask for it to be reviewed. The legislation is more than 50 years old. It is older than I am, and I am a granny. I do not think that it is fit for modern purposes and for the threats and harms that we face as a population today, so it is reasonable for us to look at modifying it to see whether it can be made more effective and, in particular, enable us to better take a public health harm reduction approach.

There are a number of barriers—that is the challenge with this whole issue. You will be well aware, having been involved for a number of years, just how complex and difficult the subject is. Stigma is a big issue. There are lots of reasons why services are set up in such a way that people struggle to get through the door even just to access them. There is no simple answer to fixing the problem. If there were, we would have done it—all of us would have pushed to have done that. I do not think that there is a simple, straightforward way around it; we just have to work hard to understand what is happening out there and what the barriers and challenges are in each local area. We have heard about some of the challenges that women face in accessing services. We need to understand why certain cohorts find it difficult to access the services that we provide, and we need to make it easier for them to access those services.

The charter of rights will help us to make progress in this area, because stigma is a big part of the problem—every day, it prevents people from accessing help. We have a lot to do, but I do not think that there is a simple answer. If there were, we would have implemented it.

My equivalent in the UK Government is a Home Office justice minister, and although the public health minister also attended the UK four-nations meeting, she was brand new that week. I do not think that those ministers will have had a chance to visit the Thistle yet, but I would certainly recommend that to them.

I worked in a hospital for 20 years, so I am used to a clinical environment. I worked in a mental health hospital, so I am used to working with people who are often stigmatised and on the edge of society, and I was hugely impressed by the facility. I was impressed by the professionalism of the staff, the warm welcome that they gave and the thoroughness of the work that goes on there. I have absolutely no doubt that the Thistle is life saving.

As I have said before, I agree with much of what the Scottish Affairs Committee said; it is right to encourage us to look at more cost-efficient models—I agree with all that. The legal environment in which we are operating is very challenging and, without a wholesale review of the Misuse of Drugs Act 1971, we have challenges with scaling and sustainability for facilities such as the safer drug consumption facility. That is my main takeaway from the inquiry. It is frustrating that, although people agree with us, we still do not have the power to change the situation that we are in.

Will you remind me what the second part of your question was?

Again, Richard Foggo can come in on this, but yes, they do tie in. Addictions were identified as one of the key themes in the target operating model. The implementation and embedding of MAT standards is a key part of ensuring that that approach works effectively within the system.

Buvidal is, or should be, available all over Scotland. The Scottish Medicines Consortium has assessed it and has made recommendations about where and how it should be used.

Please indulge me, because I am a pharmacist as well as a Government minister. In some ways, it can be seen as a wonder drug. It is a little bit different to other opioid substitution therapies because it is a mixed agonist-antagonist, which means that it has some inherent, built-in protection against overdose. That is really important for the prison population, given the recognised risk of overdose immediately after liberation from prison.

The generic name is buprenorphine, and Buvidal is the brand name. It is a long-acting injection, which means that it is given by injection at intervals and reduces the need for individuals to present daily at a chemist’s, which can be quite degrading. Some people find that a supportive intervention, whereas others find it degrading and feel that it interferes with their getting on with rehabilitation and resuming caring duties, employment, volunteering or whatever else they need to do on liberation from custody.

The fact that it is a long-acting injection means that it is impossible to divert, which is another advantage. I would not call it a wonder drug, but the inability to divert it is a real advantage when decisions are being made on the best choice of opioid substitution therapy—given that, globally, the evidence is very strongly in favour of opioid substitution therapy and shows that it reduces deaths, harm and criminality and helps people to recover and stabilise. In the most recent detailed interrogation of drug deaths data, we found that 53 per cent of people who died had methadone in their system, but 40 per cent of the individuals who died after taking methadone were not prescribed it. There is a level of diversion in the system that is dangerous and contributes to drug deaths. That is another reason why long-acting buprenorphine, which cannot be diverted because it is injected into the patient, has an advantage over other forms of opioid substitution. The MAT standards make it very clear that individuals who are receiving the medication and accessing healthcare should be a part of the decision-making process around which drug is right for them.