 I welcome to the second joint meeting in 2023 of members of the criminal justice, the health, social care and sport and the social justice and social security committees to consider the progress made in implementing the recommendations of the Scottish drugs death task force. We have apologies this morning from Paul O'Kane, who is attending a meeting of the Equalities, Human Rights and Civil Justice Committee. Before we begin, I wish to place on record our thanks to Claire Hohie and Sue Weber for visiting Aberlour mother and child unit on our behalf and for the helpful note that they provided of their meeting. I'd also like to thank Aberlour for facilitating that visit and express our particular thanks to the two women who took the time to speak about their personal experiences. We are very grateful. Our first item of business is to decide whether to take item three in private, which is a review of today's evidence. Are we all agreed? Thank you. Our next item of business is an evidence session on tackling drug deaths and drug harm. I am pleased to welcome our first panel of witnesses today. They are Kirsten Horseborough, chief executive officer and Wes Steele, senior training and development officer with the Scottish Drugs Forum, Simon Raynor, service lead at Aberdeen alcohol and drug partnership, and Tracey McFall, chairperson of the Scottish Recovery Commission. Warm welcome to you all. I refer members to papers one and two and I thank witnesses who provided written submissions. We'll move straight to questions and, as ever, I will open up just perhaps to help set the scene and get some discussion under way. I'd like to perhaps ask individual members of the panel just their broad response in relation to the statistics on drug-related deaths. There's been a lot of commentary and coverage of drug-related death statistics. The most recent publication of the annual drug-related death statistic shows a decline. However, the figures published by the National Records of Scotland found that 1,051 people died due to drug misuse in 2022, which was a decrease compared to 2021 and the lowest annual total since 2017. However, we know that drug death numbers remain stubbornly high, so I wonder if I can perhaps just ask individual members what their responses and what commentary they might have around the recent statistics for drug-related deaths. Do you feel that we've perhaps started to turn a bit of a corner? We'll come to Kirsten first and then we'll work across the panel. We were obviously welcoming the news that there had been a slight reduction in the numbers of drug-related deaths—much better, of course, than the numbers going up. However, still over 1,000 people who have died from a preventable death are still over 1,000 families, communities affected. If we count those numbers up over the years, the numbers of lives that have been lost are just totally unacceptable. We would like to think that some of the things that have been put in place are making an impact, but it's impossible to say that after only one year of a small reduction in the numbers. I'm looking at the police-aspected drug deaths for the start of this year. We would need to see three to five years of the deaths coming down to know that what we were doing was really making an impact. The issue itself gets described as a public health emergency, and the frustration that we have is around the urgency of that. We talk about an emergency, but we don't really see a true emergency response. There are things that are good that have been introduced, such as the medication-assisted treatment standards, but those need to be rolled out much more rapidly and need to be meeting the needs of everybody. Still, there are still lots more for us to do. Obviously, we are welcome news to see a slight reduction, but I'm nowhere near enough that's needed. Thank you very much, and thank you for the invite for coming today. I would echo pretty much everything that Kirsten's just said. Obviously, we welcome the reduction. I think that it's way too early to say that it's a downward trend. I would like to see a much more substantial reduction over many more years to classify it as a downward trend. I'm very apprehensive of what might be around the corner for us regarding substance use in Scotland. We have seen small amounts of more toxic drugs in our drug supply, and I am personally quite worried that if we see more of these substances being present and we haven't got things like a safe drug consumption room available to more people, then we'll be available to just with the Glasgow pilot. Drug check-in, I think, could help reduce the harms of these substances too. We still see a real strong prevalence of street benzodiazepines implicated in the drug-related deaths, and again, until I think we address this issue and give people much more adequate support as a wraparound alongside medication, I think we're still fighting an uphill battle, to be honest, and I think 2.7 times the death rate of the rest of the UK is still massively unacceptable for Scotland, and we can do much better. I would echo much of what's been said. Aberdeen was an area in 2022 that had a reduction in drug deaths, but still 42 people died. In 2023, in terms of suspected deaths, there is still a lot of concern about the numbers that are being presented in Aberdeen currently, so I don't expect that decrease to be continued this year. So there's that huge variable about the substances that people are taking. It doesn't take very much in a place the size of Aberdeen for a significant number of people to be affected very quickly. I have concerns that, despite all the things that we have done and all the things that we haven't managed to do yet, we managed to see a bit of reduction, but that variable in terms of the supply side of substances is really dangerous. We'll maybe come back to some of the underlying factors that are helping to see that slight decrease. Tracy, good morning, committee, and thanks for the invite. I will echo everything that my colleagues have said in relation to drug-related deaths. I don't think that we are out of the woods yet in relation to the trends. I think that one year is very early days in relation to the downward trend, and obviously the police stats show potentially an upward trend. A couple of anomalies for me, though. In terms of some of the statistics, there were 474 people who had methadone implicated in their deaths. We need to understand that those people were in treatment, because those 474 deaths were those people who bought methadone from the street or were those people in treatment. I think that there's a wee bit of more work that we have to do underneath the statistics. I spoke to Public Health before coming to the committee and we've not recorded some of those statistics nationally for some time. Locally you will find those in the drug-related death review groups, but if we are talking about potential consumption rooms, heronassisted treatment and different treatments that should be protective, we need to understand if those people are dying in treatment why that is. There are a couple of anomalies in the stats. A big one for the Scottish Recovery Consortium is cocaine use. There's an increase in cocaine use. Potentially we don't have an antagonistic approach where you have methadone and opiates. That's about wraparound support and psychological support, so this is just bigger than treatment. We need to think about the broader wraparound support that people need in relation to psychological support. That was the two standouts for me at early days, but those were standouts for me in terms of different trends emerging from the drug-related death statistics. We talk about the drug deaths and drug usage in Scotland and how high it is in comparison to the rest of even Europe. Do you feel that we should be looking at that more closely and carry out more research as to why Scotland is higher? I'll put that to Tracy first of all. Scotland is very different from other countries in many respects. We know some of the underlying factors in relation to drug-related deaths. That's about poverty. It's about depending where you live in the country, whether you've got opportunities, whether you've been through other childhood experiences, whether you've had trauma. There is quite a body of evidence out there already to give us a sense of what causes people to use alcohol and drugs. I think that, more broadly, I think that, as a country, we need to look at some of those cross-cutting pieces. If you look at the justice system and all the justice committee and all the convener of the justice committee, but if you look at mental health justice, and in your submission we talked about the hard edges report, we have loads of thousands of people in Scotland bouncing around mental health addictions, justice services, domestic violence and homelessness. There's something we can do in that to join those dots. One, potentially, there's not a big pot of money at the end of the rainbow, so we might save some money if we look at this as a whole system, but we need to start joining the dots. We need to take every single opportunity, every single intervention point where people are coming in touch with services. That no-wrong door approach is absolutely critical. We could do more research, and that would be absolutely fantastic, but we do know the underlying causes of why people use drugs. That's about poverty, trauma, where you come from, lack of opportunities, lack of hope. It's very difficult to get off that merry-go-round once you're in that, but we need to join the dots, we really do. Just quickly, can I come in on that? You touched upon methadone as well as the cause of drug-related overdoses as well. Is that a combined thing? I just wanted to draw that out. Methadone has been implicated in 474 deaths. We don't know whether those people were in treatment and that's my question around. We really need to dig a wee bit deeper around because, if people are dying, what implicated methadone in their deaths is that because they're buying it from the street or is that because they were actually in treatment? That's one of the reasons why I think we really need to get underneath some of these stats. I think that's why we need to dig a wee bit deeper in relation to the local drug-related death reviews and what that looks like nationally. In terms of the research, I think that research is always helpful and always good. I think that we probably fall into a little bit of a trap in terms of thinking that Scotland is a homogeneous unit. We've got extreme poverty and extreme rural rurality. I think that there is obviously by the nature of the Parliament and politicians and major organisations being in the central belt that there is often a focus, or excuse me, on a lot of the harm that goes on there, but I think that we need to think about different ways of tackling it. Not all drug-related deaths are a single substance these days. It's multiple different substances and we need different approaches to tackle that. I think that I prefer to see additional resources put towards helping us in this public health emergency that we're in, rather than researching the drivers and the underlying causes, if I'm honest. I think that there needs to be a more immediate response to helping the people that are struggling and are at the most risk of drug-related harms right now. That's just my personal opinion. Just super quickly, if I may, on the methadone being implicated, I would hazard a guess that it's really going to be low numbers where it is only methadone. It's always going to be poly drug use. It's going to be use in combination. I do think we know some of the drivers. We might not have gold standard evidence to suggest exactly what it is, but I think access to treatment, difficulty in people access in treatment, I think we know is one of the drivers of the drug-related deaths in Scotland and I'd prefer to see resources going to helping people get support that they need. I would agree that we know what the drivers of problem drug use are, so it wouldn't make sense to continue to research that. I think that we should be expanding our efforts on introducing action and all the recommendations that have been made from numerous bodies on this topic. One thing that I just wanted to add about individual drug deaths and substances is that particularly in relation to methadone, we know generally from the drug death database report that comes out every other year is that it's around 50 per cent of people who are dying with methadone in their system that was in treatment at that time. It used to be quite higher proportions who were not in treatment and now it's leveled out, so it would be interesting to see more up-to-date figures on that, but the reality is that with individual substances that are being found in the bodies, it's very difficult to dig into that in too much detail because it's very open to interpretation by the individual forensic pathologists that are involved in that. I put more on them and doing that analysis, so we tend to try not to focus too much on the individual substances and those trends, but realise that the majority of people who die have died because they have taken multiple substances. I was going to move on to the cross-government action plan, but I think there's a lot to cover, so if I've got time, I'll come back to that. I will move on now to some questions around safe consumption rooms, no surprise. I'm going to bring in Sue Webber and then I'll bring in Katie Clark. Sue. Thank you, convener. I thought we were maybe doing math standards first, but that's fine. I was falling through, but that's okay. Don't worry, I'll maybe get a chance to come on that. We know that Lord Advocate's provided some evidence on the legalities of the drug consumption room that's been specified for Glasgow, but I suppose I'm in terms of that bigger picture. I'm wondering how logistically it will work on the ground in terms of that aspect. I'm looking, Christian, unfortunately. You're nodding the most reverently, so perhaps I would come to you first. Obviously, I've been interested in the subject of safer drug consumption rooms for some time, and initially I was on the short-life working group in Glasgow when they were introducing the proposal for this facility way back in 2016. We've said and advocated for some time that we feel like the Lord Advocate would be in a position to provide a prosecution waiver to allow these facilities to exist, so it's great that that is now finally happening, although we do have concerns about some of the restrictions that will be in place because there's not a change to the misuse of drugs acts, so there will be some restrictions in terms of how they can operate, but I'm understanding from the Glasgow services that it's already been identified where the site will be, and it will be in the same building as the heroin-assisted treatment is, or the enhanced drug treatment service at the moment. It's likely that the service will operate from 9 till 9. It will be open 365 days a year. It will be available to anyone in that locality who is injecting drugs. I'm understanding that it won't be an inhalation facility because of some of the restrictions. We really welcome this news. The anxiety about it is that we don't want to see a situation where we have one facility introduced in Glasgow that prevents anywhere else in Scotland from opening until the service is evaluated, so we would want to make sure that there wasn't a long lengthy evaluation period that was then going to prevent other areas who were absolutely in need of introducing similar services and that the model that's introduced in Glasgow wouldn't be set in the precedent for every model that had to be introduced across Scotland, so it's important when we are introducing these facilities that we have lots of different types, so we could have mobile units, we could have fixed site units, we could have just a room within an area that's already providing needle exchange facilities, so I would hope that we could not delay other areas by introducing this one. There was a couple of things on the back of that. In terms of evaluation, it would be interesting to know if you know how and what methods are going to be used to evaluate the service, but a lot has been said that this will be the opportunity to engage with people and get people into it, so I'm curious about the level of support and what other services will be available in that environment. I'm not sure Tracey and yourself might be best up to answer those. They will be introducing an extensive community engagement and consultation period in terms of the service for local businesses, local partners, et cetera, and of course with people who would benefit from using the service. I'm just sorry, I'm just trying to remember. My question was about how are you going to evaluate it, but also if the consultation comes back saying that none of the local businesses want it there, what are we going to do with another one? It was more about the evaluation to determine the success and what's worked well, et cetera, and also what other services would be in the signposting aspect of this. I don't know the exact detail of the evaluation, but I know that partners and colleagues are working on that. I've got a long way down the line with what will be evaluated from other countries. They have evaluated things like engagement in other services, such as reductions in bloodborne virus transmission, such as reductions in drug-related deaths, so it won't differ too much from the international evidence base around how they evaluate it. There will be all those things that are looked at. The biggest bonus for having those types of facilities and the biggest evidence bases around the more somebody attends a facility like this, the more likely they are to then engage with other wraparound services. That will be key for the service as well, to make sure that people can be linked into treatment services, that there will be services there for bloodborne virus treatment, there will be wound care, there will be all sorts of wraparound services attached to the service. That's a lot of harm reduction, but I'm looking for recovery services. I mentioned treatment there as well, so I did say that people would be able to access treatment services as part of that. There shouldn't be an expectation if somebody attends a drug consumption room that the end goal is abstinence. I think that's key for this. We can't turn the drug deaths crisis into a conversation about how we get everyone drug free. I'm not doing that. It's just about how we make sure that people are not judged, that they're given an option to connect with people in a way that they haven't been able to through any other service provision, and that they make their own choices about what's best for them and their quality of life. Goals like abstinence absolutely should be on the table, but that should never be promoted to people as that should be where your head is, and it shouldn't be entirely up to the individual. Thank you, convener. The witnesses will have had the opportunity to look at the Lord Advocate statement and I wonder whether they believe that the scope of the Lord Advocate's recent statement in relation to drug consumption rooms and in particular any potential criminal offences is sufficient, or have they got any concerns that staff or others may not have the reassurance that they need to be involved in this kind of initiative? Maybe I don't know if Tracy would be interested in coming in. Yeah, key to this is going to be Police Scotland in relation to how this is managed and how this is policed, so I think we have to go through this process and see what that's going to look like, but if the direction has been given by the Lord Advocate, then I would hope that all of us as a society, all of us locally, then actually we want to try and see if this option works. So I don't necessarily, SRC don't necessarily have any concerns. I think we need to see how this is going to work in practice. What I do know in terms of our experience in SRC, my experience in working in the sector is, and I think it touches on what Kirstyn said, is if someone is in real chaos and they are buying their street drugs in an area, it's very unlikely that they're going to get onto two buses to get to an injecting facility in a safe consumption room. So we need to be really careful in relation to, as Kirstyn said, what that looks like, get the pilot up and running, but what does that look like in local areas? Where are the hotspots? I would hope that our colleagues in Police Scotland underlining by the Lord Advocate's letter will actually do what it says in the tin, and that's about not criminalising people when they are in or near that facility. Just to touch on another point in terms of wraparound services in relation to the heroin-assisted, in relation to the consumption rooms, there is some learning we can look at. The heroin-assisted treatment facility in Glasgow has been evaluated and there was some real learning in that in relation to some limitations in relation to the learning, but other things that we can maybe learn from in relation to the safer consumption facility, so a lack of non-dedicated medical staff. We need third sector in here. We need third sector to look at that broader recovery, housing, mental health support. The location of the service was critical to the people who use the heroin-assisted treatment because it was hard to get to Covid and an impact on that as well. People had to walk through areas where there's high drug use to get to, so those are all things that we should be looking at and learning from in relation to the drug consumption facility. It was overclinical. People who talked to the research team said it was overclinical. It's very difficult to get a drug consumption room to be trauma-informed and I don't mean nice couches and fluffy carpets, but we really need to take on board some of the learning that people who've used this facility have told us, and the high turnover staff had their real implication on the relationships that people built. So, yes, the more people come into the facility, the more chance they will engage with services over time, but there needs to be consistency in staff to create those relationships and those recovery conversations need to be every single part of that journey. It was just to contextualise that. Does that make sense? On the issue of the Lord Advocate statement and the way it's been drafted, do any of the other witnesses have any concerns, or do they think it provides sufficient comfort to enable this to go ahead? I'll bring in Kirsten. Yes, I think it was interesting to see that word, and it was specifically about people who were accessing the service who would not be charged for possession of drugs. There was no mention around the staffing, and my understanding is that Glasgow is covering that aspect of it to ensure that the staff providing the service are protected. So, I don't see any concerns. Glasgow certainly wouldn't be proceeding with it if we felt that there was any concerns for people who were staffing the service or people who were involved in the running of it at all. So, I think it's okay. Obviously, ideally, if there was a change to the Misuse of Drugs Act, that would make things better for the rest of the UK as well, to be able to open up the doors a bit further. However, I think it's sufficient for what's being proposed. Before I bring in Paul Sweeney, I wonder if I can just pick up, Tracy, you mentioned challenges around the high turnover of staff. I wonder if it might be helpful just at this point to look at that a wee bit and maybe expand on that. I'll maybe come back to you, Tracy, and then I'll maybe bring in Simon Rainer on that. I don't know if I sent the committee the link to the heroin assisted treatment evaluation, but working in a heroin assisted treatment facility and the pressures within that did create NHS high turnover of staff. There's not a lot of detail in the evaluation about why that was, but I think that that's certainly a question that we need to ask ourselves when we go in to start to develop a safe consumption facility because burnout trauma, the staff are saying, there's an opportunity here to actually take some learning from that, convener. So I don't know the detail, but I can certainly send a link to the evaluation, but that's a question for our NHS colleagues. Thank you, that would be welcome, and if I can maybe just, I'll see you wanting to come in two seconds, I'll maybe come to Simon, maybe just to get some commentary about perhaps other issues that are impacting on staff turnover. Sure, so I'm also a service manager in our local area, so day in day out working with front line staff in particular, third sector and nursing and clinical staff working in this area. I would say that our staff are all working in this area because they want to help and they want to make a difference. I think there are systemic problems in terms of the workforce. There is no sort of professional structure, no professional qualification to work in the addictions field. There's lots of additional add-on bits of training that people can do, post qualifying. In terms of recruitment, there are particular challenges in the northeast in terms of nursing staff and medical staff and psychologists. I appreciate my colleagues' sort of view on the third sector and absolutely third sector and lived experience needs to be core to our workforce, but the fundamental bit around drug consumption stabilisation and max standards is that there is a clinical element to be provided. So in terms of drug consumption rooms, when facilities in whatever shape or form they manifest themselves in Scotland, they can't afford to fail and they need to be safe for the public and they need to be safe for staff and people using them. So I think there needs to be, in my view, a more considered view on the structure of addiction services or addiction support for people in Scotland. We have an estimated 60,000 people with problematic substance use and 20,000 people in treatment. We need to vastly scale up and make this an attractive place for people to work in. The pressure that staff fail day and day out in terms of delivering the mat standards, reducing drug deaths, people feeling it's their fault that they're not working hard enough to challenge these things, causes the burnout and the stress and the trauma for people, but we need to turn that round and have a workforce. I know there's a working group looking at workforce, but it needs something more about increasing the number of staff working in this area and wanting to work in this area. Thank you very much. Very quickly. It's just that, in Edinburgh, we're very close to the access place where we are here and I know from correspondence from people that work in there, again, recognising how much they're committed to it, but having prescribers available is one of the biggest issues. Is that something that you recognise, Simon? Absolutely. There's sort of innovation around non-medical prescribing, which is great, but certainly the north-east. I mean, there is just a deficit of nursing and medical staff wanting to work in this area. It might be different in the central belt, people can move around, et cetera, but a band five nurse is not going to relocate to the north-east of Scotland and nurses can learn more in wards doing shifts and things like that, so there needs to be a fundamental, you know, if we're going to be innovative and aspirational around drug consumption rooms and all the other stabilisation facilities and all the other things that we should be doing in terms of an emergency response, we need to have an infrastructure. We can't just keep firefighting and stitching things together. There needs to be that well-considered plan and structure and aspiration for the future that we've got a workforce that's properly trained, properly supported, properly invested in and properly rewarded for the work that they do and not sort of blamed for the drug death figures when they're all trying their best to do the right thing. Thank you very much, thank you. Briggan Paul Stronina. Thank you, thanks to the panel for your contribution so far. The Minister for Drugs and Alcoholists said that the overdose prevention pilot in Glasgow will be limited to some extent, clearly by the law of advocates guidance. The constraints imposed by the 1971 act, but also potentially the issue being the design of the facility. So do the panel have a view on whether the pilot being a higher threshold access could hamper its efficacy, bearing in mind that the enhanced drug treatment service in Glasgow is only available to people who are already engaged with the homeless addiction team and was only designed to scale up to around the maximum of 40 persons using the facility at any regular basis. Do you believe that there's potential constraints? Perhaps we as steel would like to come in first just to kick that off. I'd like to think that the drug consumption room is going to be piloted and evaluated and I'm hoping that that will open the door to lower threshold services and I think people would find it more accessible to go to maybe a third tech to provide. I'd love to see it rolled out in homeless accommodation, I've got a background in homelessness and I think that some of the work we're seeing with the high tolerance in these services, you know people are already living there, they're already using there or around there potentially. I think you would increase the uptake and the acceptability of people. I think it will be a barrier if I'm honest. I think a high clinical presence and the high threshold potentially will put people off but I think you know it needs to be piloted, it needs to be evaluated and evidenced that it is safe to do and then I would love to see us really drop that threshold. We see some really good practice in places like Canada where it's people who lived and live and experience that are actually facilitating and running these overdose prevention sites. Thanks for that. Is there any other thoughts on that in just the initial stages? Yeah, I mean this is what I was I guess trying to hint earlier in terms of the different models that are required. I don't think it would be fair to describe this as a high threshold model, I think it's quite different from the enhanced drug treatment service where it is very high threshold given the nature of the prescribing there. So I think that it'll be a much more open door policy for the drug consumption facility element of it. I do think that there are going to be some restrictions just in terms of what the Lord Advocate has put in place, in terms of what's been felt to be within the Lord Advocate's gift to be able to do. Perhaps things like it being attached to another service and that sort of clinical element of it and I think ideally we do want to see much more fluid air around how these services are operated so we have numerous outlets for providing injecting equipment to people fully in the knowledge that when we provide that equipment they may well nip round the corner and inject in the close or in an abandoned building or in a car park or under a bridge in really unhygienic undignified unsafe conditions. So we would really like to see in the future a you know a strategy where any place who was providing injecting equipment also had a space where people could use if their alternative was going to be in one of those types of environments. So I think we can't be setting a precedent that's too high for the rest of Scotland and putting off other areas from introducing these facilities thinking that they're going to cost millions of pounds and we absolutely need to have that flexibility in how they're delivered going forward. I think that's helpful and I did note that the initial Herons Institute in Pilot in Glasgow was a capital spend of £1.2 million which suggests that it wasn't scalable to a great extent beyond a fairly limited network. Though in contrast there's 45 needle exchanges in Glasgow currently so that maybe shows the scale in which we could potentially move towards. Is there any other thoughts on where this could evolve to? I think having as many different methods of trying to roll this out I mean I suppose the key principle is that people have somewhere safe clean hygienic and monitored to use substances which has not been available to them because of the stigma and the criminality associated with substance use. So for me the drug consumption room is one way of doing that. I think we need to think about other ways of providing that environment for people but I do think that it will cost millions of pounds to do it properly and safely. There will be a co-location with the Heron Assisted Treatment Service. What would the interface for that be like? Obviously one of the big challenges with street injection is purchasing on controlled substances of unknown toxicity and dosage et cetera. Will there be an effort to try and encourage people to substitute street bot drugs for prescribed alternatives that would be safer and more controlled? I can't answer that. That's a glass bowl question. Fair enough. Is there anyone who might have an insight on that potential interface? Kirsten can maybe come in after me but you would hope that there's a pathway that we could provide in relation to that treatment facility and as Kirsten said that people who are injecting unsafely have maybe not engaged in services for a very long time. They will take a lot to build up that relationship for them to come on to that treatment pathway but you would hope there's a treatment pathway that would help people come through to more safer inject and more safer use but actually on to treatment and then potentially recovery. Just a couple very quick points in terms of what you said earlier. We need to make sure that we're not assuming it's professionals here that we know what people need in this facility so we need to make sure that lived experience is driving this and that was very clear in the drug desk task force. This should not be service centric. It needs to be service user centric so we need to remember those people in this and we need to ask them what they need. In terms of how we're going to know it's working we need the evaluation to be very agile. We need the evaluation to be evaluating quickly and making changes quickly in relation to those thresholds. Thresholds generally create exclusion so that's why we need the evidence base to be very agile so we can adapt and shift and if we're looking at it and that's really really important because it's a bit early in invention and prevention. This is a bit saving people's lives so there's loads in this but the big thing for me is when we start the evaluation in this it needs to be agile. We need to make sure it's real time if possible and we need to shift and change depending on what the different needs are. Paul, so I hope that answers. That's very helpful. There was just one more thing I wanted to ask. Obviously Mr Steele had mentioned Canada as an interesting model to look at as a benchmark. I understand there's around 147 over those prevention sites globally in 91 communities in 16 countries. Did the rest of the panel have any thoughts on other potential benchmarks that the committee might want to look at in terms of where it's performing relatively well based on your experience if anyone has any immediate thoughts on that? Yeah, I mean I've visited a few in different countries and they all operate similarly but also differently and probably Barcelona is probably where I've had some of my thoughts in terms of the different types of models. There were some of those that were based within hospital settings, there were mobile units, there were fixed site units, there were some that were led by peers, there were some that really involved a sort of community approach. There was one that was opposite a police station so there were lots of different types of models and I think once they start to be introduced you would hope that then they would be accepted as for what they are and certainly all the evidence from all the countries that introduced them. Part of what I did previously when I went to explore and bring back some evidence for Scotland about these facilities was to try and give a balanced picture and say like here's some of the positives that we have for introducing them and here's some of the potential negatives and you literally can't argue against them because they're just overwhelmingly positive in terms of the outcomes that they can produce. So I think there's a lot to learning from all countries and obviously Switzerland was the first to do them and now have multiple facilities as well. Thanks very much. Okay, that's very much. Okay, I know some members are interested in asking some questions around stigma so I'm going to bring in Claire Hoche and then Gillian Mackay. Thank you very much, convener, and good morning to the panel. Thank you for coming along this morning. There was a very helpful piece of evidence from the Scottish Recovery Consortium submitted to committee and it highlighted how the biggest challenge to accessing treatment or accessing recovery communities was stigma. I note from the final report of the Scottish Drugs death task force that they also highlighted stigma and said there had to be a broad cultural change from stigma discrimination and punishment with regards to offering treatment and care for people with addiction issues. So I'll be keen to hear from the panel how effective do you think action has been in terms of tackling stigma to date? I think some of the groundwork has been started in terms of reducing stigma. I still feel that probably alcohol and drug related harm is still very much rooted in specialist services, ADPs, specialist groups in the country. I think that there needs to be a wider debate and engagement with the public, particularly if we're getting into the territory of drug consumption, overdose prevention, decriminalisation. I think that we need to have a better understanding around the drivers for people to understand some of the root causes for the problems that people experience and what they can do to help. I think that for the scene in the press, some of the comments or social media, some of the comments are on the idea of drug consumption rooms or overdose prevention centres, et cetera, and people sort of misinterpreting or misunderstanding some of that. So in a sense that I go back to that point, these things can't fail, we can't allow them to fail and we need to engage with the public in relation to that. I think that the second bit is then the wider system. So I suppose, to some extent, it's much more in our direct control, but certainly I welcome the leadership from having a cross-government committee looking at these things. So I think that it does need that sort of leadership across health and social care services, all public services, really in terms of taking a lens to the whole issue of drug and alcohol harm and making sure that every opportunity counts and that our systems that are there to help people aren't barriers to people accessing help. Ideally, we wouldn't need a lot of these investments in terms of overdose prevention centres or other facilities like that if people were able to get mainstream help for some of the issues. So that will take a long time to sort of get to that point where the health and social issues related to substance use are adequately supported in mainstream services and that people couldn't access all that without feeling stigmatised or judged, but I think that that will take a while. Waze, did you want to come in here? Yes, please, thank you. I think we've really got a long, long way to go in reducing stigma even in specialist services. I think we still see a lot of paternal and punitive practice even around people, around appointment systems, people being discharged, people being reduced on their prescriptions for other substance use. I think, you know, if we're not getting it right in specialist services, I think we've definitely then got a long way to go in the wider support services that we've potentially got out there. I'll just speak very quickly if I may just to my own personal experience that irony for me as a problematic substance user was that I was, I had an inability to even try and address my substance use until I was accepted along with it and what I see often I believe in services is we're trying to lead people towards outcomes that they haven't necessarily voiced they want to pursue and again the irony for me is when I was kind of accepted waltz and all for want of a better phrase was when I could start looking at some of the support needs I had and I do feel we've got a long, long way to go in services in Scotland. Thanks. I think you touched on a few issues, said that I'd like to explore a wee bit further if that's okay, you spoke about leadership and about leading people to outcomes that they don't necessarily want and you also touched on some of the commentary that has been the press. Can I just quote to you a couple of things that I've seen recently from MSPs in this Parliament? So one wrote, some campaigners have long demanded drug consumption rooms where addicts will be free to take heroin, crack cocaine and other dangerous narcotics. Another tweeted, I have serious concerns for locals this is in relation to the the siting of the Glasgow consumption and it's very close to a large amount of student housing as well as a fire station and family shopping areas. How does that help to tackle stigma and get people to access the help and care and treatment that they need? I don't think it does. I think it just reinforces a lot of the stereotypes. I suppose some of the behaviour and some of the public's perception of people who use substances has been driven by the fact that we criminalise the use of substances. You know we say drugs are bad and therefore people who use the drugs are bad and it's a devastating situation for any individual or family to be in and we need obviously mixed ways of dealing with it but in Scotland we have got a significant issue and a significant problem and we need to recognise that there are 60,000 people in Scotland who are not coping with life very well and need lots of non-judgmental help and support to reduce some of the harm but we need to be able to engage with the public on that and not just be seen as working against the public's concerns or fears that might be there. We all have a responsibility to really look at ourselves in relation to our communications, our words, our actions and our language so all of us as leaders in Scotland and when we talk about tackling stigma the first place for me is me. I need to think about my language, my attitude, my values in creating an environment in my workplace with my staff teams that we can challenge that stigma so I think the first place to start is ourselves and I think that's really important. Individually, institutionally and in society there's problems with stigma across a range of different things, mental health, justice, addictions, homelessness. Again, if this is a joint committee there's an opportunity here to really take a national look at this and I mean going back to education and training, I mean in primary school and this is about vulnerability so take away the drug and alcohol stigma per se. This is about people being different and this is about people being judged around their differences in vulnerabilities. That cuts across a range of policy areas so I think there's a massive opportunity, there's a huge way to go as my colleagues have said but I do think this is bigger than just addictions. This is about training, education, primary school, secondary school, workplace, academia goes right through the whole system and we have to accept that this will take a long time. It shouldn't stop us but we need to keep drip feeding this approach right across a range of different policy areas so another opportunity to join the dots. From the final report, the Scottish Drugs Death Task Force, one of the things that they said is that this is everyone's responsibility and it sounds like from what you're saying Tracy, you will heartedly agree with that statement. 10%. Thank you. Okay, thanks very much. Bring in Gillian Mackay. Thanks, convener. Just to pick up on what you were just saying there Tracy about the multiple ways people can be stigmatised. How do we address that compound stigma for people who use drugs? The stigma also relates to mental health conditions, bloodborne viruses, housing status, various other things that may also be impacting those individuals. That stigma we know kills and we know it is compounded across these other things as well but how do we give a voice to the impact of that stigma because that's one thing I don't think we hear enough of. We all know it has an impact on individuals but I don't think we hear that in people's own words enough in this space and do you think enough is being done to to address that compound stigma? That was one of the reasons why Scottish Recovery Consortium really wanted to get the voices of lived experience across because you go into most treatment services in most recovery communities across Scotland and they'll tell you examples of how they've been stigmatised. Again, this is another opportunity to really raise the voice and amplify the voice of lived experience. Stigma absolutely devastates communities, whole communities potentially, also devastates families, also devastates children within those families. Is there one solution? No. If you were asking me for a solution in relation to drugs and alcohol just in isolation then there's a huge challenge ahead in relation to workforce development. How are we training people in relation to working with drug and alcohol? What's our learning experience? This goes back to a bigger question for me actually because we need to think about how we're commissioning services differently because we think about we say words like trauma informed person centres human rights based approach. What does that mean? That means we need to do things differently. In order to do things differently we need to commission services differently so that staff don't, I mean you can put a thousand staff in Scotland in a training course about reducing stigma, it needs to be embedded in the workplace so that means supervision, support, coaching and mentoring. There's very little room now to do that because the way services are commissioned because we're so stretched. So again this is really big discussions that we have to have but I think we should be having them. So I don't have an answer but I'm happy to continue those chats but it's multi-pronged but there's a massive workforce development issue in that for me too. I think Simon wants to come in. I just would echo what Tracy has said in terms of workforce and that investment in that infrastructure. I think there are voices there and there are people giving consistent messages. I just wonder who's listening and if it's the right people that are listening and if the right people are not listening then we're not going to see the changes that are required. It would be my view. I think increasing the skill mix in the teams and increasing the mix of people who lived and live in experience of substance use in specialist service, in third sector service providers. We could services could do some mystery shopper type research into their own services to actually find out what it is like coming and presenting at a service rather than it being from a kind of top-down approach. What does it feel like for someone walking through that door asking for help and support and to really see what the environment is like for people? That's a really interesting suggestion and something that I definitely think we should take back. Just moving on to a slightly different topic that we've often spoken in Parliament about the need for a no wrong door approach. Is there evidence this is being implemented in practice or are people who use drugs still facing barriers when accessing, for example, mental health treatment and other services that would particularly come back to what we're seeing earlier on about thresholds and things as well to services? I don't know. Tracy? Yeah. We have a strange thing in Scotland whereby mental health services comes in through a funding stream. Addictions comes in through a funding stream. Justice comes in through a funding stream. Housing and homelessness comes in through a range of different funding streams. That creates silos so it is sometimes really difficult to have that no wrong door approach throughout that whole system. Are we there yet? No, because it's indicated in the drug death task force in the cross-government action plan. Does it happen in some areas? Yes, is there a focus of good practice? Yes, but I think what doesn't help that is the way the funding stream comes in from government to local authority because it creates silos. I think that's potentially some learning and actually we could probably save money in relation to if we actually fund things slightly differently. Are we there yet? No. Is some areas working? Yes, but I think there's a long way to go in terms of that no wrong approach. Very briefly, if there was one area of anti-stigma work that the panel would like to see prioritised, what would it be? I think that if we were to truly address stigma we would also decriminalise people who use drugs. I think that that would go a long way to moving the discussion away from punishment to support, so I think that that would play a big role. If I may just come back on your comments around the no wrong door thing in terms of the mental health, my background is mental health nursing and I am from over 10 years seen that the difficulties with people access and mental health specialist support. However, I do firmly believe that we do have a high proportion of mental health nurses working within our drug treatment services and the majority of people who attend drug treatment services have got some level of mental health issues going on for them. I think that it's a capacity issue as well in services to be able to provide adequate mental health support rather than always trying to push off to other different services. With the no wrong door approach, I would also like to see different ways of us providing treatment, also providing prescribing through the third sector. I can't remember who was talking about prescribers earlier, but having prescribers based within third sector services as well and providing people with that choice around which service they access to get their prescribing I think would be important. Thank you. I think that short of decriminalisation I think staff training I think it would be really useful for services to have a really robust reflective practice session. Type policy in place for people to explore their own kind of belief systems I guess. I think for me personally I've been on quite a lengthy journey around you know even fighting my own right in reflex it's really difficult sometimes to try and support people when you see they're doing massive harm to themselves and others around them but have that real impartial non-judgmental professional approach to them still. So I think it is a really big ask to kind of ask people. So I think a you know workforce development training type package I would say. That's great. Thank you. Simon, were you looking to come in? I think an immediate thing that we could all do I think one of the most harmful things just now is blame that you know we blame services for not doing the right thing or not being perfect or we blame people for using substances. I think taking the blame out of it would help a lot in terms of just even reinforcing the positive message to the workforce at the front line that you know by and large I know individual people will have their own experiences but we are all working flat out to try and improve things and make things better and you know 90% or 100% of the workforce I think are there to try and do the right thing there will be obviously be people you know different people there for different reasons but the vast majority of people are trying to do the right thing it just makes it much more difficult and complicated if there is stigma and blame compounding the situation for people trying to do the right thing. Two things sorry. Very quickly for all of us as leaders just to reflect on ourselves and I think because I can change me and I can do that today so there's something around all of us doing that but I would be really good to see more lived experience within the treatment system because that helps. All of us see that it's possible and change is possible and people have something to contribute so that's two things sorry but yeah. No, two good things thank you. I'm going to bring in Russell Finlay I apologize I should have brought you everywhere I know you were interested in asking some questions around safe consumption. Yeah I was just going to come back thank you just look back to duck consumption rooms and I know Kirstyn you've spoken passionately about previous committee me things you've worked on it for seven years and your knowledge is I think probably unmatched. It's more about the practicalities and I should perhaps know this and maybe it's been said but is the facility in glass going to be going to be run by the NHS entirely yeah okay. I don't know the exact detail of this but I when the original discussions had been happening the the aftercare area was going to be a partnership approach so I can't confirm whether that's happening and that they were going to have lived experience roles and remits within there so I don't know for sure if that's the case. I'm understanding primarily this is about safe injecting but it's not necessarily limited to that do we know that yet would it be other substances as well? I don't think they're proceeding with the inhalation element of it just because of the restrictions in terms of what they're able to provide at the moment so it would just be for substances to be injected. So that's been decided as far as we know? I think so yeah. All right okay right again those Simon talked about flexibility and perhaps other facilities opening elsewhere in the country where there's different needs so for example in an area where I'm in Glasgow's got a big problem with crack cocaine if that's required is that the next step or should this facility offer that as well? I would really hope that that would come out in evaluation you know as soon as that starts being looked at what what are people presenting with what sort of substances are people appearing with and I think that would be Tracy mentioned earlier about sort of timely action based on evaluation as well and I think that would be one of the key things as well so I think this evaluation will highlight a lot of things that could be done differently and that should be introduced. But from the starting point it's injection only as far as we know? Yes. You believe it should from the beginning include inhalation of certain substances? I think if we were providing a full range of support yeah we should be providing inhalation but I don't think that's Glasgow's fault for not for not doing that I think they're restricted in terms of what they're allowed right okay now there's been talk about stigma as well um this particular facilities near a couple of businesses who've been identified in the media and they may have difficulties with having this in the doorstep with given the associations with the crime that might take place and the behaviours that might occur the Scottish social attitude survey shows significant numbers of people in this country might support rehabilitation and treatment but they don't want it in their doorstep so how do we persuade people that this is something that should be in their community or in their doorstep and anyone can come in on that I don't know of those. I just go back to the point it needs to be properly staffed and we need to win the hearts of minds of the public in terms of if they're not being incidents and spell out behaviours and things like that so that's all I could really suggest is that you know having the right number of staff making sure that it's safe environment for the public and and people using it so show them it works is that Tracey do you have anything to add to that we can't do to communities we need to take communities with us and there's been a number of examples over the years where there's been a residential rehabilitation service that's been set up and there was local opposition but actually some of those rehabilitation services now the community actually engage so it's about demystifying some of the some of the stigma that's attached to this work so we need proper consultation I think Kirsten said that was going to be happening we need to talk to the community we need to acknowledge their fears and say we get it however there's an evidence base to say that there's no one an evidence base across the world to say there's nobody be that crime across in that area there won't be an increase in drug use in that area so I think we really need to start demystifying this to think again all of us have a responsibility as leaders is to say right okay this is what it means to take people with us and actually my experience in developing services over the years if you take the community with you they get it but don't just drop it in to say this is happening in your area and I don't think Glasgow are planning that I think Glasgow are planning a huge range of consultations that will include local businesses as well it needs to because there's fear in this and that needs to be acknowledged okay thank you can I quickly move on to legislation yeah thank you very much um now there's a lot of talk about decriminalisation being necessary or desirable um but in reality if you take the most recent statistics there was just over 30 000 people found the possession of drugs in scotland in 2019 2020 and of that just over 30 158 were convicted of possession um is it not the case that effectively already the police in the crown are operating a de facto decriminalisation and I don't know who would want to come in on that kirsten thank you um yeah I think it's that it's more about how a person is perceived in terms of decriminalisation I am and taken away that sort of punitive undertone for all of that is key I would really like to know um we introduced a policy of I guess it was described at the time as de facto decriminalisation when we made possession of all classes of substances eligible for recorded police warnings we don't seem to have any data on that at all about how that's been rolled out in practice um I'd be really interested to find out how that's actually operating whether that's actually been beneficial for people who would want it to be beneficial for in terms of our target group people experiencing drug problems so that I think that's one one area of it but I do think um that sending less people to prison putting people less less people through the court system but just having a general sense that what people's people were doing wasn't illicit is quite a lot for a person as well but people aren't getting sent to prison for possession of drugs but they're going through the court system and through you know they might be getting fines and all of that sort of undertone in terms the criminality is still there possession the numbers are minuscule and it also makes people a hidden population though as well the reason why people are injecting in unsafe environments is because they're hiding away their their drug use from the population you know it's just the whole the whole culture that it affects for people is would be massively switched on its head without that criminalisation we've struggled to get data on use of record police warnings there was the lord advocates announcement in 2020 one is that the one you're referring to yeah yeah and what she said at that time is there would be a presumption against prosecution which based on the figures I've just referenced effectively already exists but she did say that she are the crown doctor reserve the right to prosecute where it's deemed appropriate to do so do you agree with that or is that completely wrong should there just be a blanket non-prosecution yeah is that the universal view for personal use of substances so yeah I think when it's left to anyone's discretion I think stigma then can still play a part I think you know you get an inconsistency across different localities and different geographical areas and I think that full decriminalisation would have a massive shift in the public's perception I think the public might not you know some people that might not have any experience of of substance use themselves or loved one with with substance use will presume that it must be bad if it is therefore illegal and I think that's not necessarily accurate so I think it could do more than just influence and have a more positive outcome on the person using the substances themselves I think it could have a societal impact I think with Simon wanting to come in it just very quickly just on that very point I think the Lord Advocate wanted to maintain that right for the purpose of prosecuting those who are dealing but they've got possession amounts on them and that might be the reflection on these figures but that aside you still think it's a wrong thing that should be the right to prosecute and I don't know maybe repeat yourself but I guess it's probably quite difficult for me to comment properly because I would want to know what the exact thresholds are and the amounts so someone who's got really problematic substance use is probably going to be carrying what police might term dealing amounts for their daily consumption someone who's using less frequently is going to be carrying much less so again I think it's all open to interpretation and open to the discresions of the officers whereas if there's just really strong guidance kind of one way or the other I think you get a more consistent approach and if we had better data and a better understanding of how recorded police warnings worked we could assess this a lot better yeah we um we facilitate groups of people will live in experience of substance use across the country we're probably meeting with about 200 individuals every week I am across Scotland and the subject of this comes up and it's different from you know how you might I receive a police warning or be subject to that in the borders to Glasgow for instance so we're finding real discrepancies in what people are reporting about their own experiences I just can't understand the resistance to providing full details as to what criteria are used for recorded police warnings but there we go sorry I can't answer that specific point you just ended on but I do think there is a sort of a discussion that needs to happen around decriminalisation and legalisation and just unpacking exactly what we mean by these terms I think one of the most powerful speakers I've heard around that whole subject is Crispin Blunt who is very much in favour of regulation of the supply side so we've got the situation where we're decriminalising the demand side of the you know let's think of it as a business in a sense decriminalising that demand side but we're not tackling necessarily or changing the supply side so that's where the majority of the harm comes so I think that decriminalisation has to come with some rethinking about how we're tackling the supply side and I think that probably you know according to Crispin Blunt and that the really interesting thing that things that he's talked about it's about regulation so it's not just decriminalisation it's decriminalisation in the context of regulation as well so rethinking about how we classify drugs the harm that they cause it's not just decriminalising that anybody can go and use a substance whenever they want and drive a car or teach a school or or anything like that there needs to be some parameters around all of it and that that is really the the important bit of think about trying to engage people in that discussion the whole population in that discussion okay thank you have i tend to come back in about time bring you back in time okay i'm going to bring in Katie Clark just on the on the issue of law reform and then i'm going to move to some questions around match standards i'm just watching the time our panel happy to stay on just a little bit beyond 10 30 because i've i'm loath to cut things off when there's some very helpful discussion going on so Katie over to you and then i'll bring in Sue Weber thank you and i'm here from the criminal justice committee and i think you've you've made the case and been very clear about some of the public health arguments for decriminalisation and indeed other harm reduction measures but i'm quite interested in the points that Simon is making in relation to supply side so could you maybe respond as to what you think the impact of some of these kind of proposals such as decriminalisation would be on reducing problem drug use but also on the organised drug trade i don't know if Simon would want to come in on that sorry well i i guess the concern is that the decriminalisation doesn't necessarily impact on the supply side the supply side is hugely harmful to the population and the most vulnerable people impacted on that and in effect it's a pyramid scheme in terms of how people are exploited and our most vulnerable communities are exploited in relation to the supply side i think what decriminalisation does is allow us to uh and you know i go around in circles about whether decriminalisation is the right thing or a harmful thing i think it's absolutely right not to criminalise people for the trauma that they've experienced the difficult lives the poverty etc and the criminalising those parts of the population doesn't help and in fact i think all the evidence would suggest it makes things worse but i guess what decriminalisation does do is is it shifts our thinking about what what how do we educate people around substances how do we invest we know what the drivers are but as they're the long-term investment in terms of parenting and attachment and reducing trauma etc that would help the longer term aspects of harmful substance use i guess the other sort of jargon that gets around is is sort of people using it on a recreational basis and that's again a sort of different population potentially using different substances for for enjoyment and you know people do enjoy elements of substance use we all do in terms of alcohol and tea and coffee you know these are all substances but so i think we need to reform our our relationship with substances a little bit and i think about what actually are we trying to achieve and how do we reduce the most amount of harm to to our vulnerable populations and i'll go back to points that Tracy's made in terms of you know for the sides of scotland you know absolutely we can have joined up health and social care in terms of mental health justice etc you know so much in our time and energy is created by the harm that it makes it difficult to join up and get the integrated holistic care that people need so i do think there are opportunities within that whole discussion about decriminalisation challenging stigma to really have a more structural change to how we respond to the harm the evident harm that is across scotland at the moment. Would any of the other witnesses like to come in on those specific points about the impact of policies such as decriminalisation on perhaps the numbers of problem drug users that would be in scotland whether it would likely increase or decrease or maybe have no impact and indeed its implications with with organised crime effectively through the drugs trade i think by reducing the stigma encourages people to access treatment and i think that would that would definitely assist more people into into treatment for sure i just wanted to comment at last week i was at the university of strathglide for an event that they were holding around and there were presentations from international speakers about drug trafficking and it's just relentless so when we're talking about you know regulation what not i mean decriminalisation yes would absolutely be a a positive step forward but globally if we don't address the global drug trade in terms of trafficking and you know look towards regulation in the future one of the international speakers described it as a rat race i mean it was just relentless in terms of trying to chase drugs constantly the amount of resource that goes into that i do sincerely hope that in decades to come people will look back on this period and be like what were they thinking like continuing with this illicit prohibition approach i'm not sure that for scotland i'm going off on a bit of a tangent because i'm not sure that for scotland we could just regulate and everything would be fine i think it needs a global approach but there's only so much yes decriminalisation positive but there's only so so far you can go against a prohibition context folks want to come in on that at all really important to look at the evidence space around this and if we are moving towards decriminalisation then there is something around if we choose to decriminalise and take a public health approach then we need people need access to services to support their addiction in the first place so areas across the world have done it but they have had massive investment around that public health social context treatment and support if we're taking people out of the justice system not decriminalising them and giving them the options of treatment the options of treatment need to be there so there's a huge investment in relation to that too sort of point of clarification to kirsten i mean you know a lot of the drugs come from places like afghanistan and columbia so what do you mean by regulation i mean like a legalisation in terms of our drug market in the future i'm i do think you know that sensibly that would that would be an appropriate way forward in the future i mean we at the moment you know substances change all the time you know we get fixated on which benzos are the most current in scotland but the market just changes constantly i'm but we you know there are changes in afghanistan in terms of what's happening over there that may well interrupt the heroin market for scotland and then we would start to see more toxic substances introduced like netazines that have been talked about synthetic opioids unfortunately we will know as soon as we get an influx of those here because people will be overdosing even more than they are currently because of the the nature of those types of drugs so i just think as a nation as a global economy the legalisation would i think be a good move forward in the future i'm not saying that something we should be introducing through this parliament but i'm thinking that it's something the future that we should be looking at and keeping an eye on okay i think simon you'd like to come in and then i think julien you'd also like to come in so simon first yeah i do think the bigger threat is is the synthetic substances that are coming i mean the traditional sort of afghanistan south american roots are there and will continue presumably but i do think the synthetic manufacture of substances is is extremely harmful in lots of different ways and i think you know well i mean again we use lots of different words decriminalisation legalisation etc i think for me the important bit is regulation and not necessarily you know there's a spectrum i think and i think it's i think it's for scotland to work out what is the best way to try and regulate and ensure that if people are going to use substances that that's in a controlled safe supply sort of environment that involves services and the wraparound care i guess there's still that fundamental point you know well if we go down these routes will people will the numbers of people using substances increase i think if there's uh you know i suppose it's about why why are people vulnerable to using substances to to manage and cope with their their lives in a way and how how do we get into that space rather than just focusing on the substances themselves how do we actually help people and what do people need to be resilient or you know cope with the the challenges that that we all face just to come back on curson's comments just there if we know what's in these drugs if we do that level of regulation and and things what do you believe the public health outcomes for that is we know one of the issues is that people aren't aware of what is the strength of the drugs that they're taking often what is in them they're told it's one thing it's not it's got something else in it as well what do you believe the public health outcomes of that policy approach would be i think you could address a lot of that through drug checking services right now if we were able to provide services where people could actually check what was in the substances that they were using people would have more autonomy over their substance use and be able to make informed decisions about what they were actually using i mean it's just so difficult for people to even know at the minute so there are other countries that have made real efforts in terms of drug checking and we don't have pilots yet i know there are pilots in progress potentially for scotland but those those would be hugely beneficial for people just to give that autonomy and you know make allow people to make safer choices okay thanks thanks very much so we'll move on to some questions around matt standards i'll bring us to and then paul thank you convener we've heard a lot today about accessing services and i think one of the first comments was the access to treatment it's one of the key drivers of the drug related deaths i think that might be yourself wez that said that do you and you have got them in front they all start with all people all people all people but clearly not all people are getting access to these matt standards that require them or wish them what more could be done to assist in that Stuart Simon where does that get Stuart from Simon i'd go back to workforce investment i think there needs to be an infrastructure that supports these sorts of quality developments um our services in Aberdeen i'm not sure necessarily whether we'll achieve all the standards um we've made good progress i believe we have good services and very committed staff but the structural challenges that we have are fundamental um i think the standards are a good thing um i do worry that they could perhaps become a bit over complicated what do you mean by by that well just the i mean i think all the things that we're trying to do in terms of gather experience people's experiences and feedback the data and improving the quality and having processes etc these are all the right things to do but i don't feel that we've got the the the infrastructure to necessarily support it okay and i think that um certainly in terms of the finance and the way that the finance is communicated by the drug policy unit is is complicated i think that we will have quite soon large numbers of staff that have started innovative projects in terms of bits of funding that have come through Cora or other funding streams i think at one point we've counted that we've got 17 income streams as an adp that we're trying to manage and make sure that services are joined up we will quite shortly have staff who are on project working on projects looking for security in terms of whether those projects are going to continue etc so i do worry that the momentum is huge and it needs to be continued and potentially scaled up so i think the mat standards are a huge task and i understand that the political pressure from people is to get them delivered as quickly as possible and everybody would want to do that but it is a big piece of work and i think that we don't necessarily have the infrastructure to support that. Suzanne Gallagher from the Scottish families affected by alcohol and drugs has sort of made some comments related to the far too much time and effort being spent on mat standards one to five and we're not really progressing on to the others and i know kirsten you spoke at the very beginning about it it's the emergency we talk about that but we don't get a sense of that on the ground it's okay and perhaps uh simon first on that i mean i think i think having it badged as a public health emergency i think is useful because it galvanises people and it sets it in the context of being an emergency but we can't sustain an emergency response for years and years we need to build the infrastructure that sort of makes some of these things business as usual okay so from my point of view that that's what we need i think yes there's been a lot of front loading for mat standards one to five i think certainly in terms of psychology support the infrastructure i mean the bit about funding coming in different silos is one thing but actually mental health services are as equally stretched and challenged around the tasks that they have that at the moment certainly in the northeast it feels a bit like people haven't got the headspace to be innovative or be creative the funding if we don't spend it doesn't get retained the government pull that back or or you know the i'm not quite sure i don't quite understand always what what the restrictions are in the funding are and it's very directed so you know one of the things we've tried to have a discussion with the policy unit is to have an investment plan for Aberdeen and our aspirations and have something that's a bit more relationship based in terms of investment and aspiration rather than it being you know a letter and you know nothing happening in between so i think there's more that the policy unit could be doing to support the implementation back to the agility that kirsten spoke about earlier on when you're talking about things as well kirsten do you want to come in on that i'm just reflecting on we're doing a piece of peer research at the moment where we're following about 60 people on their journey of trying to access treatment we're doing this in a number of health board areas and just reflecting on some of the real challenges that they're seeing one of those has been that we'd intended with this it was like an observational study that we're doing following people around to their appointments and whatnot and one of the challenges has been that people aren't being offered face-to-face appointments and that it's all been over the phone so that's been like something that we were quite shocked about in terms of that follow-up so i think those will be really interesting to the to the committee and to partners when we look at the findings of that just to see what the reality is for some people and don't get me wrong there are some good examples as well a lot of the good examples come from people talking about just being treated well by staff you know sometimes doesn't take a load of qualifications it's just about being a nice human to people so people aren't asking for a lot i do think in terms of what might improve access is something mentioned earlier about having our third sector more involved and being able to deliver prescribing sorry i'll let Tracy speak on that but that is something that we would really support different places for people to go for their services okay thanks Tracy then again institutional memories are really it can be positive and a negative but i'm old enough to know that we had the same discussions when OST in methadone was getting implemented across scotland whereby it became a very clinical approach to get people into treatment and then we realised you need the wraparound support to go with that or else you won't make any difference and it's the same kind of conversations right now treatment is really important people need to get into treatment that reduces the risk that reduces the harm but there needs to be more than just treatment around days and i'm not really seeing that yet in the match standards in relation to that psychological support and the underpinning approach around the match standards about social networks recovery communities and moving people out of treatment and i think Simon you're absolutely spot on we need to move away from crisis management to embedding that into business as usual and that's really really important underpinning all of this goes back to a no wrong door where people come we should be asking them what do you need support with and that sounds complex it sounds really easy and it can be quite complex but we need to be looking across the different systems justice, homelessness, mental health and addictions and as Kerstin's point in terms of face to face we see that across the country so it is amazing to get people into treatment but that needs to be followed up by regular relationships so having a prescription and going to the chemist every day and not seeing your key worker for weeks on end does not build the foundations of a relationship where somebody can change and i think some of this is really basic stuff that we've moved away from that we need to get back to that's been very helpful thank you convener thanks for that insight and i think it really helps to inform us on this and it was interesting just to think reflect on the interface of the previous theme we discussed around supply chains you know noting the habit of the national health service to prescribe routinely benzodiazepines through the 1990s up until it was a kind of sudden pivot point around the early 2000s when prescribed now since being restricted thus ceding a illicit supply chain which has caused significant problems as you're well aware driven the drug-lated deaths on and that respect looking at the matter standards what we know that the junior figures demonstrated that a third of alcohol and drug partnerships have failed to implement the four five standards and we've kind of covered some of the broad reasons for that but looking at the overdose prevention pilot in Glasgow do you think that that presents a potentially novel interface for looking at how we can improve matte standards and actually provide that kind of integrated interface for people to access care where it's about streetblock drugs but then actually transitioning into a matte a more controlled matte environment rather than relying on dangerous drug supply by organised criminals yeah i don't mind coming in on that i don't think it's its primary goal but absolutely that would be something that would be an addition of the service absolutely and like i said the more times people attend a service like that the more likely they are to then go on and access treatment and go back to your previous point as well like the benefit i guess of that co-location is inevitably people that are working in the facility will be having those discussions with people around treatment options and the hero and assisted treatment service will most likely have more recruits into the programme from that i do think it offers up a unique opportunity to engage with people that don't often engage with services hence why we would like to see them in different areas across scotland particularly where there are already issues with people injecting in outdoor type environments and that reaching out and that offering a connection is one of the biggest goals of a service to be able to get people thinking about what options they might want for their future so i think it will be useful and we could see more of them i think for me stepping back from the drug consumption but i'm supposed to objective is to try and give people a safe clean environment for people to engage in harm reduction activity whether that's injecting or all the other sort of harm reduction work that we can do i think for me it still comes down to the structural challenge absolutely we would want to have a whole range of absolutely low threshold ways that people can access all the support that they need but it still comes down to the structural capacity to be able to do that and you know have we got staff can we make it safe for staff can we make it safe for the public can we make it safe for people who need to use that and how is it best delivered for that local community and involving people to to to be involved in involving people in that consultation and that sort of groundwork that needs to happen so for me that underpinning structural capability to engage and do that properly is fundamental the actual you know the pilot in Glasgow is designed to meet a specific need in Glasgow in terms of people who are injecting in streets and in unclean environments which is not necessarily replicated across scotland that we do need to be able to use the legislation creatively to to find solutions that people need and want in their local area it's not on either or for me really and i think if you look at the Glasgow example that's that's primarily because there is a cohort of really vulnerable people at real risk of drug related death and associated harm but for me there's a bigger wider system in relation to the max standards that people should get access to treatment when they need it for as long as they need it with the wraparound support so it's not on either or for me i do think that the example in Glasgow is for a specific population for a specific need as simon said that that will be different all over the country in relation to what people mean but the fundamental is people should get access to treatment when they need it for as long as they need it and they should be treated with dignity and respect and it should be holistic and that should be wraparound excuse the jargon but yeah okay can you just ask on that is um sorry sorry we want to come in on that point just quick if i may i think there's something quite powerful about just meeting that population's need and about changing the attitudes and the cultures you know if there is a cohort of vulnerable people that need a service in which to come and use their drugs and i think that that can have wider implications for other kind of support needs that are out there if that makes sense just changing that kind of perception and that services can respond to meet needs where they seem yeah just wanted to ask us a follow-up to that um do you feel there is still a big institutional culture change needed in scotland generally i know for example when the unofficial over those prevention pilot ran in glasgo the dean of the medical school glas university wrote to the students who were volunteering on it saying you jeopardising your gmc registration as doctors desist from doing this for example the people were threatened with losing their jobs in the third sector providers for volunteering and participating in these kind of activities do you still feel there is an instinctive risk aversion from a lot of third sector and public sector bodies about engaging in that provision i wonder if some of that commenting on something i don't actually know anything about but i wonder if some of that is to do with if people were prosecuted or i suppose we all have a liability public liability professional liability in terms of insurance and cover so it's some of those things that need to be addressed i think that that's different to the point you're maybe trying to make which is you know are there institutions fundamentally against what we're trying to do i mean certainly in Aberdeen i think you know we we would welcome the opportunity to discuss and plan for services that meet the needs of people whatever shape or form that is but it does need that structural capability of you know insurance and reassurance from the institutions with the third sector or or other otherwise in terms of making it safe for people any other points that people want to make i think he comes down to stigma i think he comes down to not understanding the problem and as a society in Scotland who are we if we do not try and support the most vulnerable so there's a real fundamental question in that for for me but i think fundamentally comes down to stigma i don't think you'll get many third sector organisations that don't understand the rationale that's behind the match standards and i think they're still i think they're still challenges across the nhs and i think we need to be be clear about that i think there's challenges across statutory services but again i think it's down to stigma paul okay thanks okay thanks i think ross mico you wanted to come in with i did and first and foremost about the new girl in the room so my apologies for sitting quietly um and i also want to say thank you to all of you because i've intently been listening for the the last uh what hour and a half or so um which has been very informative tracy you alluded to a point there um which to me in my lack of knowledge sounded very much about the national specification that had been mentioned before about treatment and recovery system that should be should be there across scotland um and now we've moved on a little bit but i want to come back on that because um i'd be interested in your opinion as witnesses as what how we should prioritise the creation of a national specification um where do you think we are on it and you know what what your thoughts on that and we're taking it on to a slightly different angle but i certainly was alluded to in the last piece of information so i would be interested tracy if you would mind starting yeah and if anybody else wants to come in on that thank you and what we know is is variable across scotland so there has been a lot of work done around the national specification and framework around residential rehab and i believe that's that's moving on a pace so that provides that national framework national outcomes national reporting understanding where that looks like but hopefully bring in that local flexibility and that local need but again i think that is a really important part in this puzzle because ultimately um if we're not using the data to flex and shift and redesign and reevaluate or provision to shift around the population needs then there's a fundamental flaw in that so national specification is good it provides those things there needs to be local local flexibility what it's missing in the potentially going back to the match standards for me and src is the not so much the standardisation but that national approach to recovery communities i am not taking away the agility and the flexibility that recovery communities need because they're mostly grass roots but we don't have a standard for edps to say as part of your national specification your retreat your treatment and recovery pathway you need to have this this this in this and that's what we're going to measure you on so that's why it's really important again we keep talking about treatment really important but we need to talk about moving people out of treatment to live fulfilling lives so we need to think about the whole continuum of care i hope that answers that was it it certainly does and it'd be an interest if anybody else has any comments on on that nothing good in terms of that when i suppose we have national organizations in sdf src scotch family affected by drugs and alcohol alcohol focus scotland these are all based in edinburgh and glasgo so from a national point of view being based in the northeast of of scotland i feel that we do miss out on the representation the engagement of national organizations so i'm always advocating that we have local control over how we engage with people i think as taxpayers the people deserve that the population deserves that i think you know that that that from my perspective national often means central belt so i suppose it's that but ensuring that if there are national resources national frameworks etc that there is that local flexibility and it's not just distributing things equally there has to be equity in it in terms of you know that we've got hugely rural areas in our neighbouring local authority with pockets of deprivation we've got a large city with particular issues that are unique and you know obviously a lot of the discussion today has been around glasgo in the drug consumption room there but there are equally other challenges and harms in other parts of scotland that don't necessarily get the air time that colleagues represent in terms of of the work that they're interested in and involved in understand that thank you very much indeed and thank you no more questions thanks very much just we're just sort of coming into the final part of our our session i don't really collect Stevenson if you wanted to come in on anything around the sorry just quickly and absolutely fascinated by all your input today he's probably aware that i have got my own lived experience of a family member who did take drugs and also lost his life to a heroin overdose as well so i found it fascinating but i've also found it really frustrating because there is a lot of jargon used and at the heart of it for a user and an addict they just want that wraparound support but in terms of the actual national specification i'd like to know more about how like loved experience and their families and any other sort of key partners and i've worked with the beacons before in south Lanarkshire have been adequate included in that national specification because when i was involved with my brother one of the things that used to say was he's not hit rock bottom yet you allow them to stay with you you're actually feeding his habit it was some of the worst advice you ever got and one of the things that my brother used to say was the worst thing that could happen to him that he had no family ever to turn to so i'm just wondering if all of that lived experience and any family work as well what's actually been carried out and i'm going to ask Tracy first i mean that phrase that i've heard time and time again is you're colluding with his behaviour you're colluding with her behaviour so i completely understand in that resonate so thanks for sharing that one of the points of the national commissioned organisations and the people around the table here is actually we press the government to make sure that lived experience voices around the table and i think we need to continue to do that we're having the same discussions across justice and across mental health but how you how you get lived experience voices around the table that's representative and it's not tokenistic so it's the same discussions we're having around a range of different policy areas it can be done it is being done it takes time it takes energy and a real bug bugbear i'm going to share my bugbear hope you don't mind but actually we're asking a lot of people who lived experience to come around the table and we're asking them to do that for free we're asking them to do that and volunteer on their own time to do that so there's some value that we're placing on that lived experience so i would like to see some traction around if we're asking people to share their time share their experiences we should be value in that time that's a big massive message for me to say we value your lived experience not just come to two meetings can we take all the information that you have and then we don't need to talk to you again it needs to be embedded in the system i don't think we're quite there yet because it's difficult to do and in the meantime we're trying to save people's lives to get them into treatment but i think we need to start turning in its head and to really start as the national drugs death passport said it needs to be person-centred and not service-centric we need to challenge ourselves on that and i think we've all got a role to play in that just wondering if ways wants to come in thank you um i think while there is definitely a place and lived experience voice at being at the table is really really important i think also it's really good and useful to be included in the living experience voice so the people that are trying to access support right here right now because the landscape is very different i'm problematically used the substance for about six years so the treatment landscape is different the substances that are out there are quite different um i think we need to make sure that we offer people adequate kind of groundwork before including people especially in strategic meetings or anything like that um i know i can often feel out a place at strategic meetings so you know how must someone who's very very new to the whole environment be feeling so i think making sure that that adequate support is there i think we need to think about what we're asking for what we want to hear from the people um who were invited into these type of meetings and trying to get their input often they'll come out with things we might not want to hear if that makes sense and and and and how how well equipped are services or strategic boards ready for that if they really really want to do it um i think i think we need to be quite bold and brave in our approach to doing that because sometimes the truth is it hits hard and i know you know people have spoken about i know people in forward facing roles are working really really hard to try and help and support people and sometimes um you know people criticising that or critiquing that can be quite difficult and i'll just echo the point tracy made um about paying people for their time expertise and insight you know vouchers doesn't pay my mortgage um and we shouldn't be asking people to turn up and have that kind of input for free no further questions okay thanks very much um i think we've covered a lot i really appreciate your forbearance because we have gone quite a bit over time um so thank you very much to you all think that's been a very very helpful session this morning we were um hoping to have the minister for drugs and policy ellenna whitham join us for a second panel um but unfortunately she's very unwell and not able to attend the meeting this morning so we wish her a speedy recovery so on that note that completes the public part of the meeting and we'll just move into private session and have a very quick pause just to allow our panel to leave thanks very much thank you