A hard-hitting report on drug deaths in Dundee, which has been named the drug deaths capital of Europe, is demanding a radical culture change within treatment services. It calls on them to abandon their decades-long inflexibility and become “ambitious” on behalf of the people they work with.
The Dundee Drugs Commission evaluation comes the day after alarming figures for England and Wales showed drug-related deaths had hit record levels, as they have done across Scotland, suggesting Britain is facing a public health emergency amid damaging cuts to treatment services. Experts say the solutions it proposes are applicable across the country.
The independent commission was set up in spring 2018, after the city had the greatest concentration of drug-related deaths in Scotland in 2017. The latest figures, released in July, were no better, with 53 deaths in 2018, the highest number recorded.
Drug treatment services in Dundee have faced tough scrutiny: drug users and support services have criticised the rigid, often punitive approach taken by the integrated substance misuse service at Constitution House, the city’s main source of prescriptions, with staff not readily available, delays to prescriptions and sub-optimal dosing.
The report condemns the current system of treatment and support in Dundee as “not fit for purpose”, recommending a new partnership between primary care and the third sector that would prioritise access, retention and quality of care, with a “no unplanned discharges” policy – meaning that addicts are not thrown off their treatment regime because they miss an appointment – and assertive outreach.
Robert Peat, chair of the commission, called for collective leadership across the city “to show the determination to stick with what will be a difficult task over the coming months and years ahead”.
Calling for a new culture of “openness, honesty, respect and trust”, Peat said: “Every life is precious and every death matters. These are the thoughts that have guided our work.”
Nationally, the report also calls for the Scottish government to consider regulation of treatment services.
Dave Barrie, service manager for Addaction Dundee, welcomed the report as a catalyst for change.
“We need a shift from crisis management to more preventative work. There has to be a sense of urgency from the city’s leadership. Dundee has a real opportunity to use these recommendations positively and implement rapid change.”
Barrie said the effect of weekly deaths across the city had taken a devastating toll. “We need to recognise that these deaths affect the whole community. With every loss the sense of hopelessness builds up. There’s still so much stigma around, and a feeling that some lives are dispensable.”
Jenny Marra, Labour MSP for north-east Scotland, who is based in Dundee, called on the Scottish government to collect data on the numbers of problem drug users who were able to access the treatment they needed.
“The fact that there is no inspection process for drugs services is a scandal. All NHS health services should be subject to inspection, not only for patient safety but to ensure that we are providing good services and public money is well spent. The Scottish government needs to rectify this immediately.”
