#Stopthedeaths

The Scottish Drugs Forum (SDF) “works to improve Scotland’s response to problem drug use.” I was lucky enough to attend the SDF conference in Glasgow; Connection During Crisis – Preventing Drug Deaths in Scotland.

This came at a timely moment as the national drug deaths in Scotland were recently published showing 1,187 drug-deaths in 2018, 27% up in a year. Further, this conference comes at a time when the Scottish government is renewing calls for more powers to be devolved to Holyrood allowing it to take measures to halt the increasing number of fatalities. As well as this, the Scottish Affairs Committee is currently undertaking an inquiry into problem drug use in Scotland showing support for drug consumption rooms and maybe even, decriminalisation. Why not? The Misuse of Drugs Act has clearly failed in Scotland and other Western countries alike. Why shouldn’t Scotland be the first in the UK to radically admit to the failure of the War on Drugs? Scotland is incredibly progressive in other sectors of social issues such as LGBTQ matters and policy such as being the first to ban smoking in public spaces. Wouldn’t we, as a country look great if we took a stand and showed care and compassion for our people and helped them rather than wound them further. 

As I entered the Radisson Blu hotel, I noticed a stark contrast between the attendees. There were the expected men and women dressed business like, but there were also those in more casual tracksuit bottoms and trainers. I would later learn that the Forum invited those who are currently problem drug users, those who are recovering and those who have recovered, as well as CEOs of charities and organizations. This proved to be a running thread throughout the conference; let’s include those in which we speak about. 

We found a seat and watched as Joe Tay, a Chair of the SDF introduced the conference with a stark reminder of why we were all there; a story of an overdose victim who passed away two weeks prior. He then, movingly, declared the issue of the day a public health emergency and pleaded for common humanity. 

Next, Dave Liddell, CEO of SDF, took to the stage. With four decades in the field under his belt, he reminded the attendees of the disturbing figures with the use of graphs. Although, this was effective to a crowd of interested individuals, I couldn’t help but feel this would not resonate with the general public and politicians who we are trying to persuade to come around to our way of thinking. He then took to asking some important questions which should be answered before action is taken such as why are these issues so catastrophic? With answers such as poverty, inequality, welfare reform, trauma, polydrug use and multiple morbidity to follow. Liddell then concluded with the fact that we, as a nation, cannot hide from the numbers, lack of leadership and challenges to implement better services for users have failed the most vulnerable in our society. He called on less disconnect between the NHS and the voluntary sector.  He then turned his attention to the youth by calling for better family support. He also listed ways in which we can improve the quality of life for problem drug users, another theme that ran throughout the conference. Reducing stigma, increasing Naloxone supplies (drug that prevents overdose in emergencies), introducing drug consumption rooms, better access to services for prisons, same day prescriptions, better outreach and peer supply networks which currently only presides in Glasgow. In terms of constitutional issues, Liddell stated that a focus should be on what we can do now rather than issues we have little control over, which I can only assume meant radical change to drug policy. However, I couldn’t help but wonder why the CEO of SDF can’t chew gum and walk at the same time. Can’t we focus on helping those in need now with the restrictions in place as well as campaign, raise awareness and push for those restriction to be broken?

The key note speaker was next. A blatant contrast to the CEO in a suit was Garth Mullins in a long leather jacket and baggy jeans. Mullins is a recovering heroin addict from Canada who started his own podcast, Crackdown which covers the Drug war by drug users as war correspondents. Mullins has been using methadone for sixteen years now. The theme of Mullins speech seemed to be, bring the problem drug users to the table. They know more about prescribing than policy makers. He tells various anecdotes about his time as an activist in Vancouver which has seen its own rise in drug deaths. One of note was how Mullins was part of the team that created drug consumption rooms illegally, stating users can’t wait for policymakers who won’t do anything without a push. That push, illegal safe consumption rooms. Mullins states that if they had not have started these illegal drug consumption rooms, the death toll for problem drug users might have doubled. He also warns of the imminent danger of fentanyl, a synthetic opioid used as a pain medication as well as mixed with heroin to reduce costs to dealers but raise deaths for the user. The graph below shows the three waves of rises in opioid deaths. First, the big pharma companies pushed doctors to prescribe pain medication like Oxycodone, the second wave came when the patients who ended up addicted to these pain medications turned to heroin. And the third wave came when drug makers in countries like China started mixing their heroin with fentanyl and shipping this to the US, causing heroin users to use what they believed to be just heroin and dying at colossal rates as shown in Figure 1.

Mullins warned that fentanyl could come to Scotland which could increase drug deaths even further and faster. Another point of note was Mullins comparison between pubs and drug consumption rooms stating

Dr Betty Metcalfe, a consultant in Sexual Health and HIV in NHS Greater Glasgow, was next to speak. She is part of a clinical team managing the HIV outbreak amongst people who inject drugs in Glasgow. She spoke about the resurgence of HIV outbreaks in 2015 and various other figures relating to HIV outbreaks such as 1/3 of HIV outbreaks being female and over 50% of HIV outbreaks experiencing homelessness beforehand. I wondered why Metcalfe made the point that 1/3 of HIV outbreaks were female, surely the more thought-provoking statistic is that 2/3 of HIV outbreaks were male. 

Metcalfe spoke about the unspoken theme of the day as well. Perhaps if the quality of life was improved amongst the most vulnerable in our society, i.e. housing for the homeless, more job opportunities and safer drug consumption, then HIV amongst those who inject drugs would decline. Metcalfe also spoke of other reasons contributing to HIV outbreaks such as incarceration and older age. She cites other statistics such as 43% of those diagnosed with HIV die within a year. She hits home when she states, “No one should be dying of HIV infection in 2019,” perhaps referring to the preventative measures that should be in place, measures we know how to implement. Lastly, she refers back to quality of life, mentioning other factors that could be addressed to prevent drug deaths such as addressing adverse childhoods, mental health, social care, the criminal justice system and addiction and recovery facilities. She ends her speech with “every life matters.” 

Last to take to the stage is Fiona Gilbertson. She is part of Recovering Justice; people in recovery from problematic substance use whose mission is to end the stigma and criminalisation of people who use drugs through policy change and they also advocate for solutions based in human rights and health. She speaks of telling the story of problem drug users from a policy perspective by taking their lived experience and using it for fundamental change. Backed by international evidence and informed by personal experience, Recovering Justice advocates for policy positions which treat people with compassion and understanding rather than punishment. She believes people need rights not concessions. This somewhat contrasts the talking points of Dave Liddell as Gilbertson, rather than focusing on, solely, what can be done now with the restrictions put in place legally and politically, she focuses on helping people now as well asadvocating for radical policy change to enforce a lasting tranformation. She advocates for whoever is not in the room to be in the room, if that be sex workers, drug users or past offenders.

“Gilbertson refers to drug policy as about “human rights, freedom from oppression, criminalisation, poverty and stigma.””

Overall Gilbertson impressed me the most, with her idiomatic, relatable tone. With the focus on radical change, she was able to make an effective case for policy change, showing how the war on drugs and the Misuse of Drugs Act 1978is out of date and woefully ineffective. Rather than cold facts and statistics, Gilbertson spoke as if she was advocating for her human rights to the Scottish Affairs Committee during its upcoming inquiry. Therefore, Ms Gilbertson, I would thoroughly recommend you speak “at the table” of that inquiry to make fundamental change through lived experience. 

After a lunch break, I attended Garth Mullins’ workshop entitled ‘How to start up an organization led by people who use drugs.’ To teach this, Mullins demonstrated how he would begin his first meeting for an organization by first advising to put up posters advertising towards people with problematic drug use to attend the first meeting. He spoke of the first meeting of the Vancouver Network of Drug Users which took place in a park with pizza and a flipchart. He advised that in order to entice people to join in, he offered a small amount of money for each person who attended a whole meeting. He admitted that some people would say, “they will just use that to buy more drugs” and Mullins’ answer; so what? Being a problematic drug user is a full-time job, so taking time out of their day to attend a meeting when they could be making money towards their next dose would be tough, so giving small amounts of money at least gets people with lived experience in the circle. These people are needed to portray how to help them. Overall, the point of these meetings is to figure out what the people experiencing problematic drug use need to help them and halt future fatalities. If this group come up with ideas to go to the local government and demand safe consumption rooms or more naloxone, then that’s what they’ll do. As Mullins said, the people in power won’t do anything without a forced hand from strong willed individuals (paraphrased). Watching Mullins subtly transform this workshop into the first meeting of a new-born organization was inspiring as towards the end of the workshop, Mullins was standing aside watching after he gave the baton (marker) to a recovering drug user in the audience to run the rest of the meeting. Yes, there was friction between those who wanted to speak and those who were speaking but that is to be expected. Mullins still effectively showed how bringing ten or so people together in a park with nothing more than some food and a flipchart could bring fundamental change. 

On the whole, this conference instilled hope in my mind that we are moving in the right direction. Bringing like-minded people together from all walks of life is definatly the correct format to ensure everyone’s voice is heard and respected. Some people focused on what can be done now within the current policies and laws, other focused on radical policy change in order to break free of the restrictions in place. In my opinion, both should be key factors in bringing lasting change. Yes, Scotland’s drug deaths have risen profusely, however, I have faith in Scotland. We are a progressive nation. Just looking back on the last three or so years, I have witnessed a significant change in how the general public view drug issues. Three years ago, I was posed a question from a philosophy student regarding drug decriminalisation. I was taken aback and made my case that if we make drug use legal, everyone would become addicted and more people would die. Then, I sat back and was engulfed in the wide array of arguments for drug decriminalising and then I realised, I had found something I could focus on. After that night, I filmed a documentary about drug policy, I joined Crew2000 as a volunteer, read multiple books regarding the topic and attended this conference. Over that time, I have seen people change their minds in front of me as I put forward those same arguments the philosophy student bore down on me.

If we can continue to speak about issues relating to problematic drug use, we can reduce stigmas, change minds, transform policies and, ultimately, save lives.