Scotland's addiction services missing key targets

Scotland's addiction services have failed to achieve key targets that were set to reduce drug deaths, according to a new report.

Nearly 60% of services did not give addicts the option to start treatment the same day they turned up.

This was a key standard set by the Scottish government's Drug Death Taskforce, after it emerged 1,339 Scots died from drugs misuse in 2020.

Drugs Minister Angela Constance said progress had not been good enough.

The drug deaths in Scotland in 2020 were a record number for the seventh year in a row - the figures for 2021 are due to be released next month.

A Public Health Scotland report published on Thursday examined whether five out of 10 of medication assisted treatment (MAT) standards have been achieved by addiction services.

MAT refers to the use of medication, including opioids like methadone, alongside psychological and social support to treat and care for people with drug problems.

The targets were set by the Scottish Drugs Death Taskforce last November and are seen as a major part of the Scottish government's drive to reduce drug deaths.

The report showed that out of the 29 alcohol and drugs partnerships (ADPs) in Scotland, only Borders had fully implemented five standards.

Both Argyll & Bute and Moray had performed the worst, failing to implement three out of the five and partially implementing the other two.

The report also showed 59% of services across Scotland had failed the first standard - to give same-day treatment - which is considered a crucial measure in reducing deaths.

The other standards deal with choice, length of treatment and harm reduction.

Yvonne MacPherson first used heroin at age 14 - an addiction that spiralled due to her experience of abuse in the care system.

She had just left prison when she attempted to get a prescription for Suboxone - a combination medication used to treat opiod use disorder.

"I had tried not to use all weekend so that I could get on my prescription," she said. "I was really serious about getting clean but I was told that I had no drugs in my system, so it would be hard for them to prescribe when I didn't have a habit."

The 41-year-old from Glasgow has now been completely free from drugs and alcohol for a year, having attended a Cocaine Anonymous programme.

But for others, she says, the problems with accessing same-day treatments are directly linked to the deaths of addicts in Scotland.

She said: "Some people are accessing same day [treatment], some people are having to wait weeks, months, and some people get tired of waiting. The outcome is they die.

"I've taken part in ADP meetings and it's like banging your head against a brick wall. For an ex-service user, I feel it's like you're getting told stuff but nobody is following through the way they're saying they are. That's been my experience through the last couple of years."

The places people can access this treatment varies depending on which ADP covers their area - but services are often delivered by voluntary organisations as well as the NHS and local authorities.

The problems services are experiencing have been caused by delays in recruitment, conflicting priorities due to Covid-19, and challenges with leadership and financial planning.

For example staffing levels in smaller areas have directly impacted the use of buprenorphine - used to treat opiod use disorder - as it requires a Home Office license to be stored in the community, out with hospitals and pharmacies.

It cannot be administered by the person who prescribed the drug or taken at home - meaning a person in a small rural community might struggle to access this treatment.

The report recommended that the five standards be implemented in full by April 2023 - a year later than the original target.

Two years ago, only an estimated 40% of problem drug users in Scotland were in treatment.

According to those tasked with turning around the spiralling drug deaths of the last decade, this was down to disjointed and underfunded addiction services.

So this report will not make comfortable reading for staff trying to improve those services, nor for the Scottish government.

It made much of its new MAT standards when it announced £250m additional funding over the next five years.

Today's stats show that, despite that investment and "partial" implementation, the challenges remain.

If you speak to frontline workers or those desperately trying to overcome addiction, they will tell you same-day prescribing for things like methadone would make a huge difference.

For some, this is happening. For others, they face the same barriers to treatment as before.

Minister for Drugs Policy Angela Constance said the progress being made to implement the standards was "neither good enough nor quick enough".

The minister has written to all health boards, integration authorities and councils, saying leaders are now responsible for meeting these targets in full.

She said "The new oversight arrangements I'm putting in place will also strengthen accountability to communities, through the involvement of lived and living experience in the quarterly or monthly reporting now required.

"If necessary, we will consider further powers to intervene through the implementation of the National Care Service, which will introduce a more formal, single framework of accountability."

The Scottish Conservatives' drugs spokesperson Sue Webber MSP said it was completely unacceptable that targets had been pushed back.

She added: "Drug-related deaths are Scotland's national shame, yet once again the SNP government's actions have fallen short.

"This statement lays bare their damning failure to meet a critical target that is the cornerstone of their strategy for dealing with this crisis.