In Europe’s drug death capital, politicians plead for new powers to stem the tide – POLITICO

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EDINBURGH — At least once a month, on average, in the small Scottish county of Fife, a user addicted to heroin or other drugs will have to have their leg amputated — the result of injecting an illegal substance directly into the groin.

“[The groin] is a very difficult place to inject cleanly and safely,” says Gareth Balmer, who runs harm reduction services in Fife for the charity With You.

“If left to their own devices, they can get serious bacterial soft tissue infections, which can end in amputation. They inject their groin every day and cause a lot of damage.”

The example is one of many sinister – and, campaigners say, unnecessary – by-products of Scotland’s burgeoning drugs crisis.

Fife is not the worst affected area, being in the lower rankings of a grim chart tracing drug deaths across Scotland and far behind the crisis epicentres of Glasgow and Dundee. In Glasgow, campaigners and other charity workers tell similar stories of drug users risking their lives by sharing needles in wasteland or injecting in rat-infested alleyways.

According to new annual figures published Thursday1,330 people lost their lives to drug abuse in Scotland in 2021. This means Scotland retains the unwanted title of Europe’s capital of drug-related death, with a death rate almost four times higher than that of its nearest competitor, Norway.

The new figure is almost identical to the previous year, when an all-time high of 1,339 deaths was recorded across Scotland. This is the seventh consecutive annual record.

Scotland’s death rate is also around 3.7 times that of the UK as a whole, which experts attribute to a combination of deprivation, minor differences in healthcare and the increased prevalence of the benzodiazepine drug class.

“Every drug death is the loss of an individual who was loved and valued. So while it is welcome that deaths in 2021 were down slightly from the previous year – and that this increase of year on year since 2013 has come to a standstill – we know there is much more to be done to address this unacceptable crisis,” said Scottish First Minister Nicola Sturgeon tweeted in response to Thursday’s figures.

Scottish Conservative leader Douglas Ross has repeatedly criticized Sturgeon for his handling of the crisis and on Thursday describe his use of the word “welcome” as “a disgraceful political twist”, given that only nine fewer people had died than the previous year.

Other opposition MPs question his decision to devote so much government time and energy to preparing for a second independence referendum – something Westminster has already ruled out – instead of focusing on Scotland’s social and economic problems. Indeed, Sturgeon, who leads the pro-independence Scottish National Party, herself admitted in 2020 that her government had “taken eyes off the ball”.

Nonetheless, activists are cautiously welcoming increased attention lately. In January 2021, additional funding of £250m was allocated to address the issue over the next five years. Sturgeon’s appointment of Angela Constance as sole minister responsible for drug policy has drawn praise.

Yet the deaths continued.

Powerless to turn the tide

As with every political debate in Scotland, the seemingly endless wrangle over delegated powers and the independence of Westminster looms large.

One proposed intervention is the introduction of drug consumption rooms, also known as supervised consumption facilities or overdose prevention centres. In these facilities, users are allowed to inject their own drugs – or drugs provided legally by healthcare workers – in a clean, supervised environment.

The Scottish Government believes that such facilities would significantly reduce exorbitant death and amputation rates. They and other proponents argue that consumption rooms eliminate many of the immediate health risks of injecting drug use and would prevent fatal overdoses. Opponents say they can encourage drug taking that wouldn’t otherwise take place.

“People don’t die in these facilities. If someone were to overdose on this ward, there would be qualified or suitably trained staff to handle that,” said Kirsten Horsburgh, chief operating officer of the Scottish Drugs Forum.

Constance, Scotland’s minister for drugs policy, told POLITICO: “They’re an opportunity to save lives, but they’re also an opportunity to engage with people where they are and connect them to other services and supports.”

The risk of amputation can also be significantly reduced, according to Balmer of the charity With You, as medical professionals show users safer parts of their bodies to inject the drugs.

“We have to be brave and bold and follow the evidence,” Constance said.

But Scotland’s devolved government is coming up against the limits of its powers, with Westminster refusing to relax the law that prevents Scotland from setting up consumption rooms immediately.

Sturgeon’s government actually holds specific powers to introduce drug intervention measures, as all health policy is devolved to Scotland. However, the Westminster government argues that setting up consumption facilities would breach existing law, and in particular the Misuse of Drugs Act – UK-only legislation.

The implication is that any Scot working in or using a consumption room could be arrested and prosecuted.

“We do not intend to introduce drug consumption rooms, and anyone who runs them would be committing a range of offenses including possession of a controlled drug and supplying a controlled drug,” said a spokesman for the UK Home Office.

“The Misuse of Drugs Act is almost as old as me, and needs to be reformed and reviewed,” countered Constance, who is 52.

With such reform unlikely, no matter who succeeds Boris Johnson as British Prime Minister, Constance and the Scottish government are now hoping to force the issue on their own terms.

Following detailed work on a pilot consumption room in Glasgow, the Scottish government has asked its legal director to consider whether it has the power to go ahead without Westminster’s consent.

A bill tabled by Scottish Labor lawmaker Paul Sweeney calling for the creation of such facilities is already at the consultation stage. Indeed, all major Scottish political parties effectively support the introduction of consumption rooms, with even the Scottish Conservatives standing at odds with their Westminster colleagues indicating that they would not oppose a legal proposal.

Inevitably, the row draws clear parallels to the SNP’s long-running battle for a second independence referendum, which is set to come to the UK Supreme Court for a ruling later this year on whether Sturgeon has the power to go ahead without permission from Westminster.

More and more evidence

Overseas evidence in favor of consumption rooms is growing, with a number of studies indicating that facilities reduce the risk of overdose and may have other benefits.

Such services exist in legal form in at least 13 countries around the world, including Germany and parts of the United States. There are no known cases of a fatal overdose in a consumption room.

“There are services in different parts of the world that are very carefully delivered, publicly funded and have really positive results as a result,” said campaigner David Badcock, who runs the Drug Science charity.

“What we know it doesn’t do is increase drug use,” he added. “There is no evidence to suggest that is the case.”

Unexpectedly, Scottish supporters even have a practical example they can cite as proof of a project’s likely success.

Frustrated by the Edinburgh and Westminster governments’ inaction, an activist and former heroin addict took matters into his own hands during the 2020 coronavirus lockdown and set up his own overdose prevention center in Glasgow.

For 10 months, Peter Krykant ran an operation from a second-hand van that allowed drug addicts in Glasgow to inject their own drugs in a clean environment under supervision. The makeshift facility averaged about 30 injections a day.

“It was a political statement for real reform,” says Krykant, who previously believed a consumption room could be legally set up without changes to Westminster law.

He was partially right. Aside from some oversight by the police and an obstruction charge that was later dropped, the law largely left Krykant alone.

“Anything the Scottish Government can [they] sort of beats off to be Westminster’s problem, or [claim] “Westminster won’t allow us to do that,” he said. “I mean, what are England going to do – send the tanks?

A Glasgow Caledonian University study concluded that the unauthorized installation of Krykant demonstrates that it is possible to run such a service without being shut down by the police.

The Scottish Government is hoping its senior law officer will now approve a Glasgow pilot’s proposal, particularly after the officer announcement last year, the police should no longer prosecute people caught in possession of Class A drugs.

In the meantime, with other interventions failing to reduce Scotland’s persistently high death rates, campaigners like Krykant feel pressured into desperate measures.

All of the experts interviewed for this article mentioned the horrific risks faced by those who inject drugs on the street, from infection leading to amputation, to the spread of blood-borne diseases like HIV through of discarded needles, and through the much higher likelihood of a fatal overdose.

“There was a young person, a 20-year-old woman, who had two overdoses but was kept alive. She is now on treatment and is doing great and healthy,” Krykant said.

“She might not be here if she wasn’t in the center we run.”

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