The fight against Scotland’s drugs death crisis

A little over 20 years ago, 51-year-old Colin George moved to Dundee for love. If the small, spiky city halfway up Scotland’s north east coast felt a long way from his native Tottenham, that’s because it was. ​“I’d met a young lady and, yeah, it was a culture shock at first, but that [didn’t] last for too long.” At first, the city felt like a fresh start. He liked the quiet, proximity to the coast and the easy friendliness in his new community. The months he still remembers as the good times.

Change was gradual, a slow drift into a difficult crowd and the bad habits that came with them. ​“The circles I was in, heroin was everywhere,” George explained when we met in late October at the city centre base of Eagles Wings Trust, a Dundee addiction and homelessness charity. After years of injecting, methadone had recently brought some stability and control to his life. ​“It’s been a great help for me. As has this place. The people are brand new. If you’ve got a problem, they’ll do their best to solve it.” But for George, as for many others in the city, there has long been the feeling that things are on the decline all over, a hardness that is impossible to ignore. ​“We’ve lost a lot of people. I’ve lost over 30 friends these last few years, male and female. The drugs have been destroying people”.

Talk of Scotland’s drug deaths crisis is nothing new. Over the last decade and more, much concern and innumerable column inches have been devoted to a public health emergency that has been labelled the worst of its kind in Europe. Last year, 1,051 deaths were attributed to drug misuse across the country, a rate three times higher than the rest of the UK (England and Wales saw 4,907 deaths by drug poisoning in 2022). If the headline figure actually represented the first slight overall decrease in fatalities since 2017, few were in celebratory mood. Adjusted for age, the numbers were still 3.7 times higher than they had been at the turn of the millennium. Opioids and their plentiful, dirt-cheap synthetic alternatives are involved in the vast majority of cases, with cocaine – crack, powder or, increasingly, injected – also seeing a jagged spike in prevalence.

Naturally, the poorest have it the worst, particularly in the country’s biggest urban centres, from Glasgow and Edinburgh to Aberdeen and back down to Dundee and Stirling. In their most deprived corners, there were 52 deaths per 100,000 people last year. For the most affluent, that figure drops to three.

Who, or what, is to blame? According to the Scottish government’s own 2022 taskforce, ​“leaders on all levels have been allowed to obfuscate while deaths have [continued] to rise”. Ex-First Minister Nicola Sturgeon admitted her SNP government ​“took our eye off the ball” as the numbers spiralled. Certainly, their swingeing cuts to drug and alcohol services didn’t do much to help. Others have blamed a succession of increasingly cartoonish hard-right law and order-obsessed Tory governments down in Westminster, with some justification. Though only some.

Health and justice are devolved matters and, as many including Sturgeon have belatedly noted, much more could, and should, have been done to reverse the gradually unfurling catastrophe. Graham Callander is the policy lead for Scotland at With You, one of the UK’s leading addiction charities. ​“You’ve got an overall reduction [in deaths] which is great, but it’s a mixed picture. These synthetic opioids and benzodiazepines remain a real problem, right across Scotland. There’s some positivity, but also a lot to do”.

In January, the Scottish press reported on a spate of fatalities linked to SWG3, a lively arts venue and club on the fringes of Glasgow’s West End. Between August and the start of this year, three 18-year-olds died after attending club nights at the venue due to taking highly potent ecstasy. These tragic incidents could have been prevented, campaigners and charities noted, if drug testing had been legal and readily available at the venue. The UK, noted one drug policy analyst, has between 50 and 60 MDMA deaths a year. In the Netherlands, where testing is plentiful and normalised, that figure sank to one or two.

Still, there has been some tentative progress on the harm reduction front. Last September, it was announced that Glasgow had finally been given the green light to open the UK’s first safe drug consumption room after tireless campaigning by public health professionals across the city and beyond. Predictably, and tediously, enough, ex-Home Secretary Suella Braverman voiced her full-throated opposition to the ​“wrong policy” which wouldn’t ​“deal with the root cause of addiction and dependency”, though such impotent rhetoric wasn’t enough to derail a scheme which has the potential to spread across the rest of Scotland.

​“The need is there,” Callander told me. ​“We really welcome the safe injection rooms. It’ll give the opportunity for people to link in to treatment. If we can get access to people coming through then we can potentially get people moving through the system and on to better and brighter things.” State-funded rehab places are also on the rise, as part of the slightly Messianic-sounding ​“National Mission” to reduce drug deaths. In 2021, there were 140 places under way. By March last year that number was up 33, spread across Scotland.

The late autumn visit to Eagles Wings Trust wasn’t my first. At the end of 2018, I’d spent an afternoon at their old premises, a 15-minute walk to the fringes of Dudhope Park, having been sent up from London to report on the spike in drug deaths in the city, a topic which was starting to provoke a wave of appalled national media coverage. The timing was propitious, from a writer’s perspective at least. Dundee’s gleaming waterfront V&A Museum had just opened after a half a decade’s worth of gilded promises and ballooning construction costs: a sturdy marker of a city on the up. The Wall Street Journal had recently declared Dundee ​“Scotland’s coolest city”, a statement which inspired some local bemusement. This contrast between a freshly opened blue chip arts institution and several public health crises was rawly apparent. Back then, I’d met with health workers, volunteers and substance users. Their immediate day-to-day reality felt a long way from the excitement around the V&A opening. Instead, they spoke of decaying services, treatment funding cuts, poor housing, and increasingly toxic and readily available street drugs.

They’d also talked about a tight-knit community and the relentless kindness of those providing frontline support. Tony Gibson, 45, is such a figure, though the avuncular Dundonian doesn’t really go in for effusiveness. He’s been at Eagles Wings for the best part of a decade, joining not long after having quit a destructive relationship with alcohol. ​“Things are different from when you were up in 2018,” he told me as we chatted over a cup of tea in late October. ​“Different but also a lot of the same old same old.”

The charity offers the thrice weekly drop-in centre, as well as a nightly soup kitchen for anyone in need of a square meal. It would be wrong, Gibson told me, to look at drug harm as a standalone problem, particularly in a city home to some of the poorest wards in the UK. ​“Some of these guys are training themselves to live without food. I’m very often on the phone to help people with their power bills. I’m on first name terms with one of the girls in the call centre now.”

Gibson had refused to sugarcoat the reality of the last few years, a web of interlocking and overlapping crises. ​“The numbers of people coming to us for help are climbing. We’re dealing with people’s basic needs. Some folk have been at the bottom of everyone’s list for a very long time.”

Drug dealers are an ambient fact of daily life, just as they were half a decade ago. Only now, there’s a nagging sense that they’re getting younger, always a sure enough sign of an economic downswing. ​“The [older ones] know we have vulnerable people coming through here,” Gibson told me. Other things have changed for good and ill alike. Over the past couple of years, crack cocaine has flooded a city long dominated by opiates, as both Gibson and George confirmed. Some concerned onlookers, like the local Labour MSP Michael Marra, have questioned whether this shift could partially explain the decline in deaths in 2022 to 38, the lowest for eight years. If less immediately fatal than opiates, it has created its own privations. ​“It’s not like heroin, is it,” says George. ​“It makes people unpredictable. And it [hadn’t] been seen here before”.

There have been victories amid the chaos. In 2019, Dundee was one of the first local authorities in Scotland to introduce a ​“nonfatal overdose pathway”. It’s a simple enough idea: a rapid intervention – NHS workers will be armed with Naloxone, an opioid-overdose-reversing nasal spray – when someone has suffered a non-fatal drug overdose anywhere in the city. What treatment might they require in its aftermath? What services, moving forward? Its impact has been immediate. After being rolled out across Glasgow, a single NHS clinic reported seeing 600 people over just the first six months of 2022. In Dundee, Gibson told me that he’d recently become a member of Fighting For Fairness, a council-backed community initiative. ​“Sorry to toot my own horn, but they’ve had tremendous success. It’s about people having their voice heard in local politics, from the bottom to the top. It’s not the best it can be, but it’s there. There was a complete absence of that before. We’re moving forward. It’s about rolling with the punches really.”

When 35-year-old Kirsty Nelson found herself ​“dragged out” to help out at the Eagles Wings soup kitchen more than a decade ago, the genial nurse had no intention of it becoming a regular thing. ​“But I loved it. It felt like a calling I suppose, or something like that.” Today, Nelson is a full-time ​“parish nurse” at Steeple Church in the heart of Dundee city centre. Every week sees dozens of people, who might be struggling with poverty and addiction, pass through their doors. Some are as young as 16. ​“It’s people-centred, how nursing should be. We try to meet the individual where they’re at that specific time. And that changes all the time.” If anything irritates Nelson, it’s the bickering between different agencies and services. ​“It’s so harmful. If you see a need in your area, just go and do it. You have to work together.” The Dundee Recovery Roadmap, a visual guide to the services available across the city, was a source of particular pride. ​“You can actually see what’s out there, from activity groups to mental health support. There’s a wealth of stuff. We want to gently guide people to it.”

In the days before my trip up the east coast, I’d watched a recent Sky News dispatch zoning in on Dundee as ​“the drug death capital of Europe”. The reporter soberly recited the main statistics off camera, accompanied by a few lingering shots of rundown housing estates on the fringes of the city. One interviewee, a heroin user who had lost his leg due to gangrene after a protracted infection, is encouraged to let the viewers know just how bad things remained. Nelson had smiled when I mentioned the clip. Oh yeah, she knew who I was talking about. He was one of their regulars. Media coverage could be a mixed bag, she told me.

​“It can be unhelpful. There’s an element of folk wanting to watch that so they can say, ​‘look, I knew Dundee was awful’. But there’s a lot of good stuff, too. The media has a massive role to play.” It wasn’t about diminishing or ignoring the problems at hand, ​“but there are these amazing, positive stories about recovery as well”.

Only the wildest, or most deluded, optimist would be able to declare the Scottish drugs death crisis a thing of the past. Neither would it be right to indulge in despair. The facts on the ground are complex and ever-shifting, beholden to political will and treatment funding, as well as the relentless momentum and market fluctuations in the underground drug economy. No one I spoke with believed in anything like a quick fix. Change has been slow, sometimes glacial, and often liable to reversal, as change often is.

Colin George told me he was hopeful for his own future and those of his friends, his community, at Eagles Wings Trust. ​“I believe that things will get better. I really believe that. It’s because of places like this. People meeting up and being together. Somewhere to talk and open up and get [to] where you need to. I’ve managed to get stronger.” If he could do it, then others could follow that lead. ​“I know that because I’ve been there myself.”

If you’re dealing with drug or alcohol addiction, or know someone who is, there is always help out there. Turning Point offers free, individual support for drug or alcohol issues, and mental health concerns. And friendly, confidential helplines such as Frank are just a call away.