Time to change direction – and move to treatment that is proved to work

Comment By David Liddell

Fatal drug overdoses are personal tragedies for the individuals concerned and for their families and friends.

These are clearly of a scale which is a national tragedy that requires a fundamental rethink of our approach.

Other countries have achieved a reduction in overdose deaths by ensuring that people are appropriately retained in high-quality treatment and we must aspire to do the same.

Again and again we are asked what can be done and what works. There has been a rumbling debate in Scotland for years on these matters. And yet the evidence is clear – there is no doubt about what “works” if we review the international evidence of decades of experience. In terms of reducing drugrelated deaths, we need to ensure that people are in treatment.

For many people dependent on opiates that will mean treatment involving opiate replacement therapy, most effective when it is prescribed at high enough doses to reduce the urge to use other drugs. That treatment will be most effective when it is supplemented by psychosocial therapies and good support around basic physical and mental health.

People need the basics – a home and something to do. People speak about the Trainspotting generation to refer to older drug users but we are at a stage where the 35-year-old users who we regard as older were barely born in the times in which the book was set. Time is passing and the challenge is growing.

We need a shift and change in approach. We face a situation where the majority of those seeking help for a drug problem will be over 35 and more vulnerable due to multiple health issues. Our research shows this group are not held well in services. l David Liddell is chief executive of Scottish Drugs Forum