The Scottish Government’s National Mission on Drug Deaths, established in 2021, was created to tackle the rising tide of drug-related deaths and improve the lives of those impacted. Backed by a comprehensive plan for 2022-2026, this initiative aimed to drive systemic change in Scotland’s approach to combating drug harm. However, insights gathered from a recent evaluation present a mixed picture, revealing both successes and significant gaps that need to be addressed.
Funding Injection – A Double-Edged Sword
One of the National Mission’s most notable achievements has been the allocation of £250 million to enhance services aimed at tackling substance-related harms. While this funding injection was largely welcomed as a much-needed investment, it is important to note the underlying context. Much of this funding is perceived as merely reversing previous budget cuts, limiting its potential to enact transformational change. Furthermore, concerns of bureaucratic delays and misallocation of funds have also emerged. For example, significant portions of funding directed towards residential rehabilitation facilities have raised debates over opportunity costs. Critics question whether these resources could have been more strategically allocated.
True and lasting change requires not only financial commitment but a targeted application of resources to ensure the best possible outcomes for individuals, families, and communities affected by substance-related harm. A clear roadmap for resource allocation is essential to avoid diluting the impact of funding.
Progress in Accountability
The introduction of a dedicated Minister for drugs and alcohol has been one of the National Mission’s key achievements, driving improved accountability. Increased scrutiny ensures that services are more consistent and evidence-based, moving away from reliance on anecdotal outcomes. This has gone a long way towards restoring public confidence in Scotland’s drug policy.
However, accountability gaps remain entrenched. For example, stakeholders such as local Health Boards and Integrated Joint Boards have not yet fully embraced their roles and responsibilities in the national drug response. Interviewees stress that accountability must extend beyond token gestures of oversight and must reflect real, transparent integration of all relevant stakeholders.
The Need for Prevention
Prevention is the backbone of any effective strategy to reduce substance-related harms. Unfortunately, this has been identified as a major blind spot within the National Mission. While current plans focus heavily on treatment and recovery services, they largely overlook the systemic factors that perpetuate substance use, such as housing insecurity, unemployment, poor mental health, and social inequities.
Interviewees called for a comprehensive framework that addresses these root causes, supported by a national prevention strategy. Tackling substance-related harm requires more than keeping individuals alive—it demands serious investment in creating environments and opportunities that deter the initial path towards substance misuse.
A Holistic Approach
The current over-reliance on medicalised models of care has drawn criticism for its limited scope. True progress in reducing drug-related harm lies in adopting a holistic, person-centred approach. This means engaging recovery communities, fostering collaboration with the third sector, and introducing clear pathways that integrate service provision across housing, mental health, and social care.
Critics note that no single sector can tackle this issue in isolation. A collaborative, whole-system approach, akin to successful models seen in other areas such as cancer care, will be essential to ensuring no one falls through the cracks. A lack of unified pathways encourages fragmented care, where responsibilities are passed between services, with the individual left to suffer the consequences.
Supporting the Workforce
Frontline workers often form the backbone of substance use services, yet their struggles remain overlooked. Interviewees highlighted widespread burnout, stress, and feelings of being undervalued among Scotland’s alcohol and drug workforce. Without addressing these glaring issues, Scotland will continue to face barriers to delivering top-tier care.
Calls were made for investment in workforce planning to ensure manageable caseloads while enhancing training opportunities to prepare professionals for the complexity of polydrug use and other evolving challenges. Building a sustainable workforce is an essential component of any plan striving for long-term success.
Challenges of Polydrug Use
A significant gap identified in the evaluation is the insufficient attention given to non-opioid drugs and polydrug use. Scotland is seeing a shift in drug-use patterns, with a rise in stimulant use, benzodiazepines, and other synthetic compounds. Yet, services remain overly focused on opioid dependency, leaving professionals ill-equipped to address this growing challenge.
Polydrug use combines various substances like stimulants and tranquilisers, complicating its treatment. Interviewees stressed the urgent need for evidence-based clinical guidelines and tailored approaches to keep pace with this changing landscape. Ignoring these trends risks further harm to individuals and communities as services fail to meet evolving needs.
A Call for Systemic Change
The findings from the evaluation highlight the need for systemic reform within Scotland’s National Mission. The current fragmented approach and lack of a fully integrated strategy constrain its impact. To achieve meaningful progress, Scotland must adopt a long-term vision that prioritises prevention, supports its workforce, and develops collaboration across all sectors.
This path forward should focus on reducing reliance on short-term, isolated solutions. By addressing the societal drivers of substance use, ensuring that marginalised communities have access to the right support, and fostering collaborative systems, Scotland can work towards its goal of reducing drug-related harms and strengthening the quality of life for its citizens.
The National Mission has made some gains, but the road to success lies in tackling these challenges head-on with a unified, prevention-focused ethos. Systemic reform, cross-sector cooperation, and sustainable resource allocation are the keys to forging a healthier, more resilient Scotland.
Source: Public Health Scotland
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