Drug services must adapt says Louise Stewart

Earlier this month, I had the opportunity to visit The Thistle, the UK’s first safer drug consumption facility. I was so impressed by the care that has gone into creating this welcoming space.

Small details like the calming colour of the walls and the provision of laundry facilities will play a vital role in making people feel valued, and giving them the opportunity to engage with a wider range of support.

During my visit, Dan Daly, a registered mental health nurse with NHS Greater Glasgow and Clyde and the operational manager at The Thistle, explained that the vast majority of people visiting the facility are injecting cocaine. This might come as a surprise, as harmful drug use in Scotland is typically associated with heroin.

A report published last week by Public Health Scotland shows evidence of a small reduction in the estimated number of people with opioid dependence. Interestingly, it also shows that the prevalence of opioid dependence is much lower amongst those under the age of 34. As we look ahead to the next generation of people who will need drug support services, we must recognise that the majority of this cohort won’t be using heroin.

At our WithYou services across Scotland, we are already seeing an increase in clients who use cocaine either as their primary substance or alongside other substances, such as opiates or benzodiazepines. There will be many reasons for this growth, including that cocaine is now cheaper and more accessible than it has ever been, and that its strength has increased in recent years. The Scottish Government, Health and Social Care Partnerships, Alcohol and Drug Partnerships, and third sector partners, like WithYou, need to work together to adapt our treatment and support options to the changing landscape.

Scotland can be proud of the innovative and forward-thinking approach we have taken to developing interventions for people who use heroin. In 2011, we became the first country in the world to introduce a national naloxone programme. The Scottish Drugs Forum should be applauded for its instrumental role in making training on and provision of this life-saving medication freely available. But naloxone only works on opioid overdoses; there is no equivalent for stimulants like cocaine.

Similarly, services like ours are able to distribute fresh needles to help reduce the risk of blood-borne viruses amongst people who inject drugs. But it is not legal for us to make safer inhalation devices available for people who smoke drugs. This is particularly frustrating, given that a key piece of harm reduction advice is that it is safer to smoke cocaine than it is to inject. I hope that the conversations about introducing an inhalation room at The Thistle will lead to a wider range of harm reduction support being available across the country.

In my opinion, the biggest challenge we face in our response to the growth of cocaine is the current over-reliance on opioid replacement therapy (ORT) as a means of treating dependency. Firstly, this works only to reduce opioid withdrawal symptoms and cravings; it cannot treat cocaine use. Secondly, and most importantly, it does not address the complicated reasons for people using drugs harmfully. This is why it is not uncommon for a person who is receiving ORT to also use cocaine.

I believe that everyone can benefit from understanding and tackling the challenges that lead people to use drugs harmfully. That is why our WithYou services across Scotland offer a range of psychosocial interventions that can be delivered alongside ORT to strengthen its impact, or in isolation, for people who use substances other than opioids.

In the final year of the National Mission, we must show much more agility in the way we respond to changing landscapes in order to create a permanent reduction in drug-related deaths in Scotland. And as we consider what the National Mission will look like post-2026, we must develop a cross-cutting strategy that interrogates why so many of our citizens use drugs in a way that is harmful and seeks to improve quality of life here in Scotland.

Louise Stewart is director of operations at WithYou, a drug and alcohol support charity that has been working in communities across Scotland for more than 20 years wearewithyou.org.uk