The UK Government must help end Scotland's drug-related death crisis

Jo Kimber and colleagues1Kimber J Hickman M Strang J Thomas K Hutchinson S Rising opioid-related deaths in England and Scotland must be recognised as a public health crisis.Lancet Psychiatry. 2019; 6: 639-640Summary Full Text Full Text PDF PubMed Scopus (28) Google Scholar are right to call for the government to announce a public health crisis in response to a record number of drug-related poisonings in the UK. Recognising and responding to public health emergencies is a core responsibility of government. The UK's drug-related death crisis is most acute in Scotland, which has already had the highest drug-related death rate in Europe (at 17 per 100 000 population, equating to 934 deaths) in 2017, before the released figures that showed a further 27% rise (to 1187 deaths) in 2018.2National Records of ScotlandDrug-related deaths in Scotland.https://www.nrscotland.gov.uk/statistics-and-data/statistics/statistics-by-theme/vital-events/deaths/drug-related-deaths-in-scotland/2018Date: 2018Date accessed: July 26, 2019Google Scholar This figure will put yet more pressure on the UK and Scottish Governments to act. When the Canadian province of British Columbia (which has a population similar to Scotland) saw its drug-related death rate reach 11·1 per 100 000 people in 2015, it declared a public health emergency, encouraging the mobilisation of provincial and federal resources and a more public health-led strategy.3British ColumbiaProvincial health officer declares public health emergency.https://news.gov.bc.ca/releases/2016HLTH0026-000568Date: April 14, 2016Date accessed: July 26, 2019Google Scholar Rates continued to rise, driven by the synthetic opioid fentanyl (another threat which could yet effect the UK), but the British Columbia Centre for Disease Control stated that without the resulting introduction of emergency harm reduction and treatment responses, overdose-related deaths would have been at least twice as high. Measures that they credit with averting increased mortality included improved access to opioid substitution therapy, availability of naloxone, and supervised drug consumption rooms. Such rooms alone averted 230 (range 160–350) fatal overdoses over a 20-month period in the province.4British Columbia Centre for Disease ControlOverdose deaths would be at least twice as high without emergency harm reduction and treatment response.http://www.bccdc.ca/overdose-deaths-would-be-at-least-twice-as-highDate: June 5, 2019Date accessed: July 26, 2019Google Scholar The use of drug consumption rooms has expanded rapidly across Canada, from two in 2016 to over 50 in 2019. Every person at risk of a drug-related death should be valued as highly as someone at risk from cancer, someone who has had a road traffic accident, or from any other threat. An effective response will require the UK Government and devolved authorities to work together, including implementing all of the existing recommendations by the Advisory Council on the Misuse of Drugs to reduce opioid deaths.5Advisory Council on the Misuse of DrugsReducing Opioid-Related Deaths in the UK.https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/576560/ACMD-Drug-Related-Deaths-Report-161212.pdfDate: 2016Date accessed: July 26, 2019Google Scholar Furthermore, if the Scottish Government wishes to apply a genuinely health-based, effective approach to drug policy (for example, with supervised drug consumption rooms and Portuguese style de jure decriminalisation) it must be allowed to do so. However, although health policy is devolved to Scotland and Wales, drug laws are reserved to Westminster. So, while the UK Government is opposed to such innovations, the power to act needs to shift. This transition of power could be done either through amendments to the 1971 Misuse of Drugs Act, or by declaring a health emergency in Scotland and granting Holyrood emergency powers to pilot these measures first. If lives are saved, as proved to be true for bans on smoking in enclosed public places, other parts of the UK would no doubt want to follow suit. We declare no competing interests. Rising opioid-related deaths in England and Scotland must be recognised as a public health crisisIn England and Scotland, the number of drug-related poisonings in 2017 was the highest ever recorded.1,2 Opioid-related deaths are the biggest contributor to drug-related deaths, and have driven the recent increase in such deaths. In 2017, 815 opioid-related deaths were recorded in Scotland (double the number recorded in 2007)1 and 1829 were recorded in England (a 40% increase since 2007; figure).2 This marked increase in avoidable mortality must be recognised as a public health crisis. Full-Text PDF