Substance Use Prevention in Scotland: The National Mission to Reduce Drug Deaths

Substance Use Prevention in Scotland: The National Mission to Reduce Drug Deaths

The Scottish Government launched the National Mission on Drug Deaths in January 2021, representing a comprehensive approach to substance use prevention in Scotland. With a detailed plan spanning from 2022 to 2026, this initiative aims to reduce the alarming rates of drug-related mortality while improving the lives of those affected by substances. The government is investing £50 million annually throughout the current Parliament to support the Mission.

The Critical Need for Drug Death Reduction in Scotland

Current statistics highlight the urgent need for focused substance use prevention in Scotland. In 2023, 1,172 people died of drug-related deaths—a concerning 12% increase from 2022 figures. While this represents the second lowest number in six years, drug deaths in Scotland remain disproportionately high when compared internationally.

Scotland’s drug poisoning mortality rate stands at 25.3 per 100,000 population, substantially exceeding rates in Wales (12.9) and England (9.1). This stark contrast underscores why drug death reduction in Scotland has become a national priority requiring comprehensive intervention strategies.

The impact of substance use falls unequally across Scottish society. Individuals in the most deprived areas are 15.3 times more likely to die from drug-related causes compared to those in the least deprived areas. This inequality ratio has remained largely unchanged since the National Mission began, highlighting how substance use prevention in Scotland must address profound socioeconomic factors.

Framework for Substance Use Prevention in Scotland

The National Mission employs a structured approach built around six key outcomes:

  1. Fewer people develop problem substance use
  2. Risk is reduced for people who use harmful substances
  3. People at most risk have access to treatment and recovery
  4. People receive high quality treatment and recovery services
  5. Quality of life is improved by addressing multiple disadvantages
  6. Children, families and communities affected by substance use are supported

These outcomes work alongside six cross-cutting priorities: centring lived experience, promoting equalities and human rights, tackling stigma, using data to inform approaches, developing a skilled workforce, and ensuring psychologically informed services.

Primary Prevention: Stopping Problem Use Before It Begins

Primary prevention represents a cornerstone of substance use prevention in Scotland. Current data indicates that 1% of people in Scotland reported having a current problem with substance use in 2023, though survey limitations make tracking significant changes difficult.

Encouraging findings show that opioid dependence among younger people (15-34 years) decreased from 1.24% in 2014/15 to 0.87% in 2019/20. New data expected in Spring 2025 will provide more current insights into the effectiveness of prevention strategies.

School-based interventions remain vital to substance use prevention in Scotland. Data shows 375 cases of exclusion from local authority schools involving substance misuse in the 2022/23 academic year (3.2% of all exclusions). While this represents an increase from 2020/21 (150 exclusions, 1.8%), it is comparable to pre-pandemic levels.

The focus on prevention extends to addressing supply. In 2023/24, 4,223 crimes related to drug supply were recorded in Scotland, a 3% increase from the previous year but lower than before the National Mission began. These statistics must be interpreted cautiously as they may be influenced by police activity and reporting patterns.

Expanding Access to Treatment for Drug Death Reduction in Scotland

Ensuring those in need can access appropriate treatment forms a critical element of drug death reduction in Scotland. In 2023/24, 14,869 referrals resulted in community-based specialist treatment, a 6% increase from the previous year and 5% higher than before the National Mission began.

Treatment timeliness is crucial for effective intervention. In 2023/24, 93% of referrals resulted in treatment starting within three weeks, slightly better than the previous year (92%) though lower than pre-National Mission levels (95%). The median wait time improved to four days, down from five days in 2022/23.While NHS boards have consistently met the national target of 90% of people waiting no more than three weeks at the national level, only four have achieved this standard in every quarter since the Mission began.

Notably, all Alcohol and Drug Partnership (ADP) areas reported having referral pathways in place for people who experience near-fatal overdoses, ensuring those at highest risk receive prompt support. This consistent coverage across Scotland demonstrates the comprehensive approach to intervention for those most vulnerable.

Enhancing Residential Rehabilitation

A significant advancement in substance use prevention in Scotland has been the expansion of residential rehabilitation services. In 2023/24, statutory funding approved 940 residential rehabilitation placements, a 13% inc

By September 2024, Scotland had increased its residential rehabilitation capacity to 513 beds across 25 facilities, up from 425 beds in 2021, progressing toward the target of 650 beds by 2026. Data indicates that the number of individuals publicly funded for residential rehabilitation nearly doubled between 2019/20 and the 2022/23 financial year, reaching the government’s target of 1,000 individuals.

This investment in comprehensive residential treatment demonstrates Scotland’s commitment to providing intensive support options as part of its broader strategy for drug death reduction in Scotland.

Improving Treatment Quality to Support Drug Death Reduction in Scotland

Authorities monitor the quality of treatment services by implementing Medication Assisted Treatment (MAT) standards. In 2023/24, 79% of ADP areas had fully implemented MAT standard 1 (option to start treatment from the same day of presentation), while 97% had fully implemented MAT standard 2 (supporting informed medication choices).

The treatment landscape is evolving in response to changing patterns of substance use. Notably, cocaine has overtaken heroin as the most commonly reported primary substance among people starting specialist treatment in Scotland in 2023/24, representing 30% of cases compared to 28% for heroin. This shift highlights the importance of adapting services for effective substance use prevention in Scotland.

The number of people prescribed Opioid Substitution Therapy has remained relatively stable over the past decade, with an estimated 29,817 people receiving prescriptions in 2023/24. However, there have been changes in medication types, with an increased proportion of people receiving long-acting injectable buprenorphine in recent years.

Addressing Multiple Disadvantages

Substance use often intersects with other challenges, including mental health issues, homelessness, and social deprivation. Adults who had used substances in the last 12 months reported lower mental wellbeing (46.3 on the WEMWBS scale) compared to those who had not (49.4).

There were an estimated 100 drug deaths among people experiencing homelessness in 2023, a 12% increase from 2022, though lower than pre-National Mission levels. In 2023/24, 3,474 households assessed as homeless or threatened with homelessness had identified substance dependency support needs, a 10% increase from the previous year.

Progress has been made in addressing the complex relationship between substance use and mental health, with 87% of ADPs reporting formal joint working protocols in place to support people with co-occurring substance use and mental health diagnoses, a significant increase from 59% the previous year. All ADPs reported implementing trauma-informed approaches in their services, recognising the importance of psychological support in substance use prevention in Scotland.

Supporting Families and Communities for Drug Death Reduction in Scotland

Families and communities play a vital role in supporting people who use substances. In 2023/24, 77% of ADP areas had agreed activities and priorities to implement the Whole Family Approach Framework, a slight increase from 72% the previous year.

All ADP areas reported having support services for children and young people affected by a parent’s or carer’s substance use, with the most common services being carer support, diversionary activities, and family support services. Similarly, all ADPs outlined support services for adults affected by another person’s substance use, including support groups (90% of areas).

Child protection data reflects the impact of substance use on family safeguarding. In 2023, authorities identified parental substance misuse as a concern in 2,179 new cases and registered them onto the Child Protection Register, marking an 8% decrease from 2022 and continuing a downward trend since 2019.

Challenges in Substance Use Prevention in Scotland

Despite the National Mission’s comprehensive approach, several challenges persist:

  1. Understanding prevalence and trends: Current data on substance use prevalence is limited, particularly for non-opioid substances. New data expected in Spring 2025 will provide greater insight into trends during the early years of the National Mission.
  2. Attribution of impact: It is difficult to attribute changes in drug deaths directly to specific interventions, due to the complex interplay of factors affecting substance use outcomes.
  3. Regional variations: There are significant geographical differences in service provision across Scotland, suggesting the need for locally tailored approaches to substance use prevention.
  4. Lived experience perspectives: There is limited routinely collected data capturing the experiences of people using services, their families, and communities, which would provide valuable insight into the effectiveness of interventions.
  5. Changing patterns of use: The increasing role of cocaine and polysubstance use presents challenges for treatment services that have historically focused primarily on opioids.

Challenges and Progress in Substance Use Prevention in Scotland

Scotland’s National Mission on Drug Deaths represents an ambitious and comprehensive approach to addressing substance-related challenges. While there have been areas of progress—particularly in residential rehabilitation capacity, treatment waiting times, and joint working protocols—substantial challenges remain. The increase in drug deaths in 2023 following a decrease in 2022 highlights the complexity of achieving meaningful drug death reduction in Scotland.

The persistence of stark inequalities in substance-related harms, with people in the most deprived areas facing significantly higher risks, emphasises the importance of addressing wider social determinants. Equally, the changing landscape of substance use requires ongoing adaptation of services.

As the National Mission approaches its midpoint, substance use prevention in Scotland must remain focused on translating strategic ambitions into tangible improvements in outcomes. This will require continued investment, innovation, and collaboration across sectors, underpinned by robust data and the lived experience of those most affected by substance use.

The challenge of drug death reduction in Scotland remains substantial, but the comprehensive framework established by the National Mission provides a foundation for continued progress in addressing one of Scotland’s most pressing public health challenges.

Source: dbrecoveryresources

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