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EDINBURGH — At least once a month, on average, in the small Scottish county of Fife, an addicted user of heroin or other drugs will need to have their leg amputated — the result of injecting an illegal substance directly into their groin.
“[The groin] is a very difficult place to inject safely and cleanly,” explains Gareth Balmer, who manages harm reduction services in Fife for drug addiction charity With You.
“If left to their own devices, they can get severe soft tissue bacterial infections, which can end up with amputation. They’re injecting their groin every day, and causing lots and lots of damage.”
The example is one of many grim — and, campaigners argue, unnecessary — by-products of Scotland’s burgeoning drugs crisis.
Fife is hardly the worst-affected area, sitting in the lower rankings of a bleak graph charting drug deaths across Scotland, and lagging far behind the crisis epicenters of Glasgow and Dundee. In Glasgow, campaigners and other charity workers tell similar stories of addicts risking their lives by sharing needles in wastelands, or injecting in rat-infested alleyways.
According to new annual figures released Thursday, 1,330 people lost their lives to drug misuse in Scotland in 2021. It means Scotland retains the unwanted title of Europe’s drug death capital, with a death rate almost four times higher than its nearest competitor, Norway.
The new figure is almost identical to the previous year’s, when an all-time record 1,339 deaths were recorded across Scotland. That was the seventh record annual figure in a row.
Scotland’s death rate is also around 3.7 times that of the U.K. as a whole, something experts attribute to a combination of deprivation, minor healthcare differences and the increased prevalence of the benzodiazepines class of drugs.
“Every death to drugs is the loss of an individual who was loved and valued. So while it is welcome that deaths in 2021 were slightly down on year before — and that year on year increase since 2013 has halted — we know there is much more to do to address this unacceptable crisis,” Scottish First Minister Nicola Sturgeon tweeted in response to Thursday’s figures.
Scottish Tory leader Douglas Ross has repeatedly blasted Sturgeon for her handling of the crisis and on Thursday described her use of the word “welcome” as “shameful political spin,” given only nine fewer people had died than the previous year.
Other opposition lawmakers question her decision to dedicate so much government time and energy to preparing for a second referendum on independence — 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 its eye off the ball.”
Nevertheless, campaigners cautiously welcome an increased focus of late. In January 2021, an extra £250 million in funding was allocated to tackle the issue over the next five years. Sturgeon’s appointment of Angela Constance as a minister with sole responsibility for drugs policy has drawn praise.
Yet the deaths have continued.
Powerless to turn the tide
As with every political debate in Scotland, the seemingly never-ending row over devolved powers and independence from Westminster looms large.
One proposed intervention is the introduction of drug consumption rooms, otherwise known as supervised consumption facilities or overdose prevention centers. In such facilities, users are permitted to inject their own drugs — or drugs legally provided by healthcare workers — in a clean environment, under supervision.
The Scottish government believes such facilities would dramatically reduce sky-high death and amputation rates. They and other proponents argue consumption rooms remove many of the immediate healthcare risks involved with injecting drugs, and would prevent lethal overdoses. Opponents say they may encourage drug taking that would not otherwise take place.
“People don’t die in these facilities. If somebody was to experience an overdose in this service, there would be qualified or suitably trained staff to manage that situation,” said Kirsten Horsburgh, operations director of the Scottish Drugs Forum.
Constance, the Scottish government’s minister for drugs policy, told POLITICO: “They are an opportunity to save lives, but they are an opportunity to also engage with people where they are at and to link them with other services and support.”
The risk of amputation, too, can be massively reduced, according to Balmer of the With You charity, as healthcare professionals show users safer parts of their bodies to inject the drugs.
“We’ve got to be brave and bold and follow the evidence,” Constance said.
But the devolved Scottish government is up against the limits of its powers, with Westminster refusing to relax the law that prevents Scotland immediately setting up consumption rooms.
Sturgeon’s government does in fact hold 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 break existing law, and specifically the Misuse of Drugs Act — a piece of legislation that is reserved to the U.K.
The implication is that any Scot working in or using a consumption room could be arrested and prosecuted.
“We have no plans to introduce drug consumption rooms, and anyone running them would be committing a range of offences including possession of a controlled drug and being concerned in the supply of a controlled drug,” a U.K. Home Office spokesperson said.
“The Misuse of Drugs Act is almost as old as me, and in need of reform and review,” retorted Constance, who is 52 years old.
With such reform unlikely to be forthcoming no matter who succeeds Boris Johnson as U.K. prime minister, Constance and the Scottish government now hope to force the issue on their own terms.
Following detailed work on a proposed consumption room pilot in Glasgow, the Scottish government has asked its chief legal officer to consider whether it has the power to push ahead without Westminster’s agreement.
A bill submitted by the Scottish Labour lawmaker Paul Sweeney calling for the creation of such facilities is already at the consultation stage. Indeed, all Scotland’s main political parties effectively support the introduction of consumption rooms, with even the Scottish Tories placing themselves at odds with their Westminster colleagues by indicating they would not stand in the way of a legal proposal.
Inevitably, the row draws clear parallels with the SNP’s long-running battle for a second independence referendum, which is set to go to the U.K.’s Supreme Court for a ruling later this year on whether Sturgeon has the power to press ahead without Westminster permission.
The evidence from overseas in favor of consumption rooms is increasingly strong, with a number of studies indicating that the facilities reduce the risk of overdosing and can have other social benefits.
Such services exist in a legal form in least 13 countries around the world, including in Germany and parts of the U.S. There are no known cases of fatal overdose inside a consumption room.
“There are services in different parts of the world which are very carefully delivered, funded by the state and are having really positive outcomes as a result,” said campaigner David Badcock, who runs the drug reform charity Drug Science.
“What we know that it doesn’t do is increase the amount of drug use,” he added. “There is no evidence to suggest that’s the case.”
Unexpectedly, Scottish proponents even have a practical example they can point to as evidence of a scheme’s likely success.
Frustrated by inaction from governments in both Edinburgh and Westminster, one campaigner and former heroin addict took matters into his own hands during the coronavirus lockdown of 2020, 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 Glaswegian drug users to inject their own drugs in a clean environment under supervision. The makeshift facility averaged around 30 injections a day.
“It was a political statement for real reform,” says Krykant, who believed beforehand that a consumption room could be legally set up without a change in the law from Westminster.
He was proved partially right. Aside from some supervision from police officers, and one obstruction charge which was later dropped, the law largely left Krykant alone.
“Anything that the Scottish government can [they] sort of bat off to being Westminster’s problem, or [claim] ‘Westminster won’t allow us to do this’,” he said. “I mean, what are England gonna do — send in the tanks?”
A Glasgow Caledonian University study concluded that Krykant’s unsanctioned facility demonstrates that it is possible to run such a service without being closed down by the police.
The Scottish government are hopeful their top law officer will now approve the proposal for a Glasgow pilot, particularly after the officer announced last year 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, activists like Krykant feel driven toward desperate measures.
Every expert interviewed for this article mentioned the gruesome risks involved for those who inject drugs on the open streets, from infection leading to amputation, to spread of blood-borne diseases like HIV through discarded needles, and through the much higher likelihood of a fatal overdose.
“There was one young person, a 20-year-old female, who overdosed twice but was kept alive. She’s now engaged with treatment, she’s doing really well and she’s healthy,” Krykant said.
“She potentially may not be here if she wasn’t in the center we were running.”
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