There is a particular kind of document produced by modern bureaucracies which manages, with great skill, to describe catastrophe while avoiding any responsibility for it. The latest quarterly bulletin from Public Health Scotland, comfortably situated within the expanding landscape of state-funded bodies often grouped under the ‘quango’ label, is a near perfect example. It tells us, plainly enough, that suspected drug deaths have risen by 31 percent in a single quarter, that the drug supply is increasingly toxic, that polysubstance use is now the norm rather than the exception. It gives us numbers, trends, indicators, alerts. It gives us everything except the one thing that matters, which is a change of direction.
You can read the full report yourself here:
But to read it merely as information is to miss what it really is. This is not just a report. It is a ritual. A quarterly act of institutional self-absolution. The harms are acknowledged, the tone is suitably grave, the numbers are laid out with clinical precision. And then, with almost liturgical inevitability, the same conclusions are drawn, the same policies affirmed, the same path continued.
Activity without movement. Motion without progress. At this point, it would be surprising if even a doubling of the numbers produced anything more than slightly more sombre language and perhaps an additional dashboard.
Pause for a moment and sit with the central contradiction. Harms remain high. Deaths are rising. Treatment starts are falling by 14 percent. That is not a minor fluctuation. That is a system quietly losing its grip on the very people it claims to serve. And yet, having assembled this evidence, the institutional response is to double down on the same set of ideas that have accompanied this decline.
Drug checking. Consumption rooms. “Low threshold access”.
It all sounds humane. It all sounds reasonable. And it all carefully avoids the central fact that addiction is not being resolved, only managed.
The argument for drug checking is dressed up as a matter of rights. People deserve to know what they are taking. Very well. But notice what has happened here. The crisis has been reframed. The problem is no longer addiction, that relentless compulsion which dismantles lives piece by piece. The problem is impurity.
Nearly half of samples tested did not contain what the buyer believed they had purchased. This is presented as justification for scaling up drug checking. Which leaves us with the rather curious spectacle of a public service whose function is to confirm that the chaos is, in fact, chaotic.
We are, in effect, constructing a system to help people more safely consume a chemically unpredictable mixture of cocaine, benzodiazepines, opioids, and synthetic sedatives, often in combinations of four, five, even six substances at once, as the report itself makes clear. The obvious response to such a situation is to help people stop doing this. That, it seems, is now regarded as rather unfashionable, and in Scottish policy circles, even dismissed as stigmatising, which tells you almost everything you need to know about how far the argument has drifted.
This is not a solution to addiction. It is an accommodation to it. A quiet lowering of expectations. The ambition is no longer to help people escape the storm, but to provide them with a slightly better umbrella while they remain in it.
There is also a quieter question, rarely asked with any seriousness, about who these services are actually reaching. In practice, drug checking tends to be used by those whose drug use retains a degree of organisation, people who can plan, wait, and engage with a service before consumption. That is not typically the profile of those most at risk of fatal overdose. The highly chaotic, polysubstance users described elsewhere in the report, often dealing with withdrawal, instability, and immediate compulsion, are unlikely to delay use in order to submit samples for analysis. This is not a moral failing, but the defining feature of addiction.
The result is an uncomfortable mismatch. Services presented as a response to rising deaths are most accessible to those least likely to die, while those most at risk remain largely beyond their reach. Evidence shows drug checking is widely used and effective among organised, recreational users, particularly in nightlife settings, but the evidence base is far thinner when it comes to engaging the most chaotic, high-risk populations driving overdose deaths.
It raises an awkward question. To what extent are these interventions aimed at those most at risk, and to what extent do they exist to reassure those managing the system that they are, at the very least, doing something?
The same sleight of hand appears in the renewed enthusiasm for drug consumption rooms, now being advanced again with the support of Scottish Drugs Forum and local consultations run through City of Edinburgh Council:
https://consultationhub.edinburgh.gov.uk/hsc/sdcf
These facilities are always defended on the narrowest possible grounds. They may reduce the risk of overdose in the moment of use. That is true, as far as it goes.
And here we arrive at the phrase that is used, almost as a moral trump card, to close down the argument. “Dead people can’t recover.”
It is, on its face, undeniably true. No serious person is arguing that people should be allowed to die. It is also, on closer inspection, dangerously incomplete. The real question is what kind of system we build in the name of keeping them alive. Either one oriented towards restoration and recovery, or one that quietly reconciles itself to the indefinite management of addiction. A curious ambition, given that addiction is defined by the loss of control. A condition that cannot be controlled is now to be managed indefinitely by a steadily expanding network of state-funded organisations and professionals, whose continued relevance depends upon that management. What, precisely, is being managed is difficult to discern, though the machinery of management shows no sign of contracting.
To invoke the phrase “Dead people can’t recover.” as a justification for the current direction of travel is to commit a subtle sleight of hand. It shifts the debate from means to ends, as though any intervention that reduces the immediate risk of death must therefore be justified, regardless of what it does to a person’s long-term prospects.
But survival, in this context, is not a neutral outcome. Survival within an unchanged system is not the same as survival into a different life. Keeping someone alive while leaving them trapped in the very conditions that will require their life to be saved again and again is not, in any meaningful sense, a solution.
It is, at best, a postponement.
And if the system becomes very good at postponement while neglecting the harder work of recovery, then the slogan begins to turn in on itself. Because a life indefinitely managed in addiction is not the same thing as a life restored. One is sustained. The other is transformed.
The uncomfortable truth is that this argument, repeated often enough, can become a form of moral cover. It allows a system to claim compassion while lowering its expectations of what people are capable of. It asks less of services, less of policy, and ultimately, less of the human beings it is meant to serve.
Dead people cannot recover. That is true.
But neither can people who are never offered a real way out.
And so the question that is never properly asked returns with greater force. Do these interventions reduce addiction itself? Do they lead to recovery? Do they decrease the total number of people living and dying in dependency?
The international evidence is, at best, modest and highly contingent. The European Union Drugs Agency is careful to note that drug consumption rooms are targeted interventions for small, high-risk populations and are not designed to reduce overall drug use or prevalence:
https://www.euda.europa.eu/publications/topic-overviews/drug-consumption-rooms_en
A systematic review in the International Journal of Drug Policy reached a similarly constrained conclusion. Supervised consumption sites may reduce local overdose mortality, but there is limited evidence that they increase entry into treatment or reduce long-term drug use:
https://www.sciencedirect.com/science/article/pii/S095539591400297X
In other words, they may keep some people alive in the short term. They do not solve the problem. They do not even attempt to.
And here is where the RADAR report becomes quietly devastating, if you are willing to read it honestly. While all this energy is being directed towards managing risk at the point of use, the number of people actually starting treatment is falling. The exits are narrowing while the waiting room expands.
This is not a coincidence. It is displacement. When you build a system around managing addiction, you inevitably starve the pathways out of it. Resources follow priorities. Attention follows incentives. And in this case, the incentive structure is clear. It is easier to count needles than recoveries, easier to log contacts than transformations, easier to maintain the problem than to solve it.
Success, in such a system, is quietly redefined. No longer recovery, reintegration, restoration. Instead, engagement, stabilisation, survival.
The economist Keith Humphreys has warned about precisely this dynamic in his analysis of North American drug policy experiments. Writing in The Atlantic, he observed that when systems focus on reducing harm without building strong treatment pathways, help-seeking does not increase and deaths can rise:
https://www.theatlantic.com/ideas/archive/2024/03/oregon-drug-decriminalization-failure/677713
The lesson is not subtle. Harm reduction without recovery is not balance. It is abandonment with better branding.
And then there is the politics, which runs through this entire exercise like a concealed wire. These reports do not simply describe reality. They shape it. They frame the crisis in ways that make certain responses appear inevitable and others unnecessary.
Consider the repeated emphasis on a ‘rapidly changing drug supply’. It is true, of course. But it is also remarkably convenient. If the problem is the drugs, then the system cannot be blamed for failing to deal with it. It almost begins to appear as though the substances themselves had filled in the policy forms and signed off on the strategy
What disappears from view is the equally real fact that the system designed to respond to addiction has, over time, deprioritised recovery, diluted treatment, and replaced clear, demanding pathways out with a diffuse landscape of engagement and containment.
Without clear pathways into treatment, recovery, and reintegration, policy stops confronting addiction and begins accommodating it. It attempts to stabilise and manage a condition that, by its very nature, cannot be stabilised or managed. If addiction could be controlled, it would not be addiction at all. What follows is not care but containment, a quiet acceptance that some lives will be indefinitely parked on the margins so long as death is delayed.
That is the unspoken settlement at the heart of this approach.
The defenders of this system will say that anything which reduces harm is worth doing. It sounds compassionate. It feels compassionate. It brings to mind the old observation that some people use the evidence in much the same way a drunk uses a lamppost, more for support than illumination.
A serious system would ask a harder question. Not whether a policy reduces harm in the moment, but whether it reduces the total harm over time. Whether it leads people out of addiction or quietly manages them within it.
Because there is a profound difference between saving a life today and changing the conditions that will determine whether that life needs saving again tomorrow.
Scotland’s current approach excels at the first. It is failing at the second.
And the numbers, stubborn and uncooperative, keep intruding. Three hundred and thirty suspected deaths in a single quarter. A 31 percent rise. Treatment starts falling. Polysubstance use entrenched. Synthetic opioids spreading.
At some point, a serious society, led by serious people, would stop adjusting the furniture.
Because what we are watching now is not a lack of effort. It is something more unsettling than that. It is a system that has become very good at performing concern while carefully avoiding the one thing that might disrupt it, which is change.
A bucket placed under a collapsing roof, and described, in earnest, as structural reform.
And behind the language, behind the reports, behind the consultations and the careful statements, there is a harder truth waiting to be said plainly.
This is not just a policy failure. It is a failure of duty.
A system that becomes highly efficient at keeping people alive in addiction, while becoming steadily less effective at helping them escape it, is not a humane system. It is a holding pattern.
And holding patterns, in this context, have a body count. Scotland is already counting it.
Reference
The latest RADAR report from Public Health Scotland (April 2026) shows a 31 percent rise in suspected drug deaths in a single quarter, while treatment starts are falling.
https://publichealthscotland.scot/publications/rapid-action-drug-alerts-and-response-radar-quarterly-report/
Drug checking services are most widely used in organised settings such as nightlife and festivals, not among the most chaotic, high-risk users driving overdose deaths.
https://www.sst.dk/media/xeodzvzu/engelsk-version-litteraturgennemgang-om-stoftest-i-nattelivet.pdf
A major systematic review (Addiction, 2022) finds drug checking can change behaviour among those who use it, but does not demonstrate population-level impact on overdose mortality.
https://onlinelibrary.wiley.com/doi/full/10.1111/add.15734
The European Union Drugs Agency confirms that drug consumption rooms are targeted interventions and do not reduce overall drug use or prevalence.
https://www.euda.europa.eu/publications/topic-overviews/drug-consumption-rooms_en
Analysis of decriminalisation in Oregon by Keith Humphreys found that harm reduction without strong treatment pathways did not increase help-seeking and coincided with rising deaths.
https://www.theatlantic.com/ideas/archive/2024/03/oregon-drug-decriminalization-failure/677713/
Bottom line: Harm reduction can reduce immediate risk. It does not resolve addiction. Without accessible pathways to recovery, deaths will always continue to rise.
Note: This article is published with permission.
Author
Annemarie Ward
CEO, Faces & Voices of Recovery UK
Leave a Reply