By Ryan Morrice
Scotland is known for many things: its beautiful Highlands and lochs; its world-renowned whisky; its inventors who gave the world a multitude of innovations such as the telephone and penicillin; and lesser known is the great number of preventable deaths that happen every year: in 2018 there were 1,187 drug-related deaths. Per capita, this is the highest rate in the EU and three times as high as the UK. The US, struggling with its opioid epidemic, still has a lower rate than Scotland. Drugs aren’t the end of it: there were 1,136 alcohol-specific deaths in 2018. The 2017 data shows that the per capita rate in Scotland is almost twice that of England. As Alex Salmond (the previous First Minister of Scotland) put it, ‘Scotland is a nation of drunks’.
Much of the cost from the misuse of alcohol and drugs is immeasurable. The moral cost of the lives lost is unquantifiable. So is the damage done to families and friendships as a result of addictions. Where the cost is measurable, it is far too high. The estimated societal cost of alcohol for 2007 was around £3.6 billion. For drugs in 2006 the estimated societal cost was around £3.5 billion. While these figures are from over a decade ago, the high numbers of deaths today suggest that the total cost of drugs and alcohol is still easily in the billions of pounds.
Heavy alcohol and drug use have long been commonplace in deprived communities. Scotland has many of them: research has shown that ‘more than half of the most long term deprived areas in the UK are in Scotland’; and all of the top 10 most deprived areas in the UK in the period 1971-2011 are in Glasgow. It is easy to understand then why the Greater Glasgow & Clyde area had the highest drug-related death rate in Scotland for the period 2014-2018. The difficulty in reducing drug and alcohol deaths is directly related to the difficulty in eliminating this persistent deprivation; the problem does not lie in a single generation which has been dealt a bad hand, but rather generation after generation of communities which have been left to suffer. Much of the surge in drug deaths hasn’t been from people with new addictions, but from the ‘Trainspotting’ generation of 45 to 54 year olds. They are the generation described in Irvine Welsh’s 1993 novel Trainspotting, about a group of heroin users in Edinburgh in the mid 80s.
There is no single person or cause which can be blamed for the origin of this tragedy. Many blame Margaret Thatcher. She presided over the deindustrialisation of the UK, devastating Scottish communities as traditional industries such as steel and shipbuilding were wiped out. This was somewhat inevitable, as deindustrialisation has been a pattern that most advanced economies have followed in their development. However, her failure, and that of successive governments too, lies in the lack of support to develop new industries in the areas that suffered most from deindustrialisation. Britain still suffers from high levels of interregional inequality to this day.
This has all been made worse by government policy which treats drug addiction as a criminal problem rather than a health one. For decades drug users have been fined and locked up. which does nothing to help them break their addictions when they are released from prison. Nor does it work as a deterrent, given the number of people still using illegal drugs. This government policy is not due to a lack of evidence. David Nutt was a government advisor who produced research showing the mismatch between the harmfulness of drugs and the severity of their classification in legislation. For example, he found that cannabis is less harmful than alcohol. Yet alcohol is legal while cannabis is a class B drug, meaning you can be given a maximum five year prison sentence and/or fined for possession. This research eventually got him the sack in 2009.
The devolution of powers to the Scottish Parliament has helped in some areas. They introduced a ban on multi-buy discounts for alcohol in 2010. More impactful was the introduction of minimum unit pricing, which came into effect in 2018. By setting a minimum price per unit of alcohol it eliminated cheap high-strength alcohol. Although much loathed by students and other lovers of cheap booze, early evidence suggests it has been effective in reducing alcohol consumption and alcohol-related deaths.
More can be done. Decriminalising drugs would make it easier to help those suffering from addictions rather than punishing them for their problems. Portugal has shown this to be an effective policy; they introduced it in 2001 in the midst of a heroin epidemic, and since then drug misuse and deaths have plummeted. Today they have one of the lowest drug death rates in the EU. The Scottish National Party (SNP) backed this policy earlier this year. However, this is not a policy the SNP can enact—drugs legislation is a power reserved by Westminster.
Other sensible plans have fallen through because of the UK Government. The Home Office rejected plans by Glasgow City Council to allow for the creation of safe drug consumption rooms. These rooms have two main benefits: firstly, they provide a safe and clean place to inject drugs, preventing the spread of disease; secondly, they steer people with addictions into support programmes to get them help. Countries such as Norway and Germany have shown them to be beneficial. Meanwhile, without them in Scotland, a HIV epidemic continues to spread because of shared needles used to inject drugs.
Ultimately, the performance of other countries shows that drug and alcohol misuse is a solvable problem. With alcohol, the new minimum unit pricing should hopefully help push Scotland towards levels found in the rest of the UK. With drugs, there can be change. When Portugal was at its worst, one in ten were using heroin. Their success can be copied. If it is not, then there will be more deaths and the tragedy will only continue.
The opinions expressed in this article are the author’s own, and may not represent the views of The St Andrews Economist.