Tackling Drugs in Scotland: Action in Partnership

chapter 2

This Government are committed to making Britain a better place to live and to tackling the immense harm caused by the misuse of DRUGS

Part 2: Progress

What's been done?

This chapter describes the action taken by Government and the drug agencies in Scotland in tackling drug misuse.

The context

Scotland's drugs strategy has shaped the current pattern of activity around the country, and it is upon this foundation that further progress must be built. Scotland has a good reputation for innovation in tackling drug misuse, particularly where drug services are concerned. Improvements in the way activities are co-ordinated nationally, and managed locally, will help those fighting drug misuse to make further advances.

This section describes the action taken on drug misuse in Scotland, presented in narrative form in the categories normally associated with this work, but also in information boxes for the four main strategic aims of the strategy: covering young people, communities, treatment and availability. These categories are part of the framework for the delivery of the strategy and form the overall structure for Scotland's Objectives and Action Priorities.

UK White Paper

The Government are committed to making Britain a better place to live and to tackling the immense harm caused by the misuse of drugs. The aim is to create a healthy and confident society increasingly free from the harm caused by the misuse of drugs. The UK Anti-Drugs Coordinator is helping to galvanise the work of all agencies across Britain, to bring better coherence and focus to domestic and international efforts. A priority then was to replace the English strategy Tackling Drugs Together, which was coming to an end, but the opportunity was also taken through a considerable consultation exercise to learn from existing strategies and work already being carried out across Britain, based on sound evidence of effectiveness. The resulting White Paper Tackling Drugs to Build a Better Britain is a comprehensive strategy, underpinned by an integrated approach across Government with a clear focus on achievement.

In Scotland the Government have been asked to consider policy development in the light of this strategy. This document is the outcome. Tackling Drugs in Scotland: Action in Partnership, reflects the four UK strategic aims in tackling drug misuse:

YOUNG PEOPLE - to help young people resist drug misuse in order to achieve their full potential in society; COMMUNITIES - to protect our communities from drug related anti-social and criminal behaviour; TREATMENT - to enable people with drug problems to overcome them and live healthy and crime-free lives; AVAILABILITY - to stifle the availability of illegal drugs on our streets.

It also encompasses the UK's four key corporate objectives on which the overall progress of the strategy will be monitored and measured, supported by specific objectives most appropriate to Scotland.

Drugs Task Force

The Drugs Task Force report of 1994 provides an important part of the framework for tackling drug misuse in Scotland. It is also an important reference point for advice on day to day drug issues. The report advocated a multi-agency and multi-disciplinary approach to the problem, with co-ordinated action at both national and local level. The recommendations in the report have been substantially implemented, including the establishment of Drug Action Teams (DATs) to act as focal points for local action. Action on implementation continues.

Strengthening the framework

On coming into office the Government moved to strengthen the structures of the Task Force report by building in the key elements of a strategic framework. This is improving accountability, based upon the defined local responsibility of the DATs, and information is being made more readily available through implementation of a Drug Misuse Information Strategy.

A policy evaluation of DATs and Alcohol Misuse Co-ordinating Committees, commissioned by The Scottish Office in April 1998, has now been completed. The evaluation examined the achievements of those organisations and made recommendations for future policy and practice, which have been taken into account in framing this document.

Current drugs specific action

Comprehensive drugs specific action continues in all service areas and is outlined below.

Education and Prevention

The Government place a strong emphasis on the need for effective drug education for all young people. Education authorities have been encouraged to provide health education, including drug education, within a comprehensive programme of personal and social development aimed at providing young people with the necessary knowledge and skills to enable them to choose a healthy life-style.

Health education, including drug education, has a secure place in national advice on the 5-14 curriculum. The Health Education for Living Project (HELP), introduced in 1995 and updated in 1998 provides a curriculum framework for health education with a special focus on drug education. There is also a good range of learning and teaching materials available free of charge to all schools.

The quality of drug education in Scottish schools is regularly monitored by HMI, who discuss policy and provision with education authorities. They have published a number of reports in recent years, which, in addition to evaluating provision, have given guidance on good practice in drug education and in managing incidents of drug misuse in schools. The findings of the most recent HMI report Drug and Nutrition Education indicated that there is still room for improvement in the provision of effective drug education for all pupils, in schools having policies for managing incidents of drug misuse and in education authorities working effectively in partnership with other council services.

School work is, of course, one of a wide range of educational influences on young people. Local authority community education staff and a number of voluntary sector youth organisations routinely engage with young people on issues such as drug and alcohol misuse. They use a number of different approaches such as peer education, mentoring and targeted diversionary activities.

The Health Education Board for Scotland (HEBS) is tackling drug misuse in a number of ways, including the use of mass media and the Internet, and in a number of settings, including schools. HEBS's work in developing health promotion more generally provides a foundation for more specific action on drugs.

The Scotland Against Drugs (SAD) Campaign, now refocused, is helping to prevent drug misuse and its consequences in local communities through a programme of information and community action achieved with the support of local organisations, including DATs and Scotland's business community. SAD is currently in partnership with Scotland's Health at Work (SHAW), the national workplace health award scheme, which was established in September 1998. SHAW is supported by a wide range of organisations and is committed to building a healthy workforce. The aim of the current partnership arrangements between SAD and SHAW is to encourage employers to develop drugs policies as part of their overall commitment to health at work.

Current Action: Young People

HELP curriculum framework, with special focus on drug education, available to all schools range of good quality drug education resources available regular monitoring of drug education by HMI roll out of SAD Primary School Initiative, which will ensure that teachers in every primary school in Scotland receive training on drug misuse issues establishment of Drug Safety Team to provide advice for schools on drug related incidents and to consider the effectiveness of drug education in schools a new national drug prevention resource to assist DATs and other local agencies development of the Excellence Fund which will provide new funding for schools, including for New Community Schools Scottish Community Education Council (SCEC) has set up a Health Issues Group to support more co-ordinated action on health promotion and drug related issues. distribution of Young Scot magazine on drug related issues to all S1 pupils by SAD and SCEC awareness raising campaigns and community initiatives by SAD, HEBS, SHAW and local organisations guidance on safety at dance venues

Social Work Services

Local authorities play a significant role in the care and rehabilitation of drug misusers through their own social work services, and by purchasing services from other agencies. Social work services are provided to adults, children and offenders. Services provided by voluntary organisations, specific to the needs of people who misuse drugs have grown considerably in recent years.

The Government have supported training for social work staff in the provision of knowledge and skills in working with people who misuse drugs.

The NHS and Community Care Act 1990 requires local authorities to take the lead in planning community services for, and in assessing the care needs of, adults, including those who misuse drugs. Joint working between local authorities, health trusts and voluntary agencies is a prerequisite to integrated services. In publishing Modernising Community Care: An Action Plan, the Government have moved to speed up decision making, to develop more care at home and to reduce the barriers to joint working.

The Children (Scotland) Act 1995 contains a number of provisions which can assist children of parents who misuse drugs, or children who misuse drugs and other substances themselves. These include establishing the misuse of legal or illegal substances - a new ground for referral to a Children's Hearing. Social work staff have significant responsibilities to safeguard the welfare of children who misuse drugs or other substances, or who live in families in which adults misuse drugs.

Criminal justice social work services have developed specialist programmes to address the problems associated with drug related offending. The National Standards identify substance misuse as an important area for intervention at key stages of social work involvement in a range of interventions - such as diversion, probation and through-care.

Current Action: Communities

tackling of drug misuse within wider social programme reducing drug related crime through substitute prescribing programmes evaluation of DATs in Scotland refocusing of Scotland Against Drugs Campaign, with emphasis on local communities resourcing of Scottish Drugs Challenge Fund funding of COSLA Drug Development Officer and Community Safety Adviser posts additional funds for new initiatives to cut drug crime totalling £3 million over the next 3 years, including Drug Treatment and Testing Orders (DTTOs) and boosts to Diversion from Prosecution, intensive drug related input to community based supervision, bail and supported accommodation services intervention work with women drug offenders establishing the misuse of legal or illegal substances as a new ground for referral to a Children's Hearing developing child protection plans, with health and education professionals education programmes for parents in the community and the workplace

Health Services and the Voluntary Sector

Significant progress has been made in providing appropriate treatment and care services for drug misusers across Scotland. This includes work to stem the spread of infections and to induce total abstinence in the misuser through detoxification, as well as residential care. However, drug misuse is a chronic relapsing condition and the difficulties in achieving successful outcomes in this area are considerable.

The voluntary sector has played an important role in these responses over the past few years. There are now over 100 specialist drug services in Scotland providing a wide range of services. Pharmacy needle exchanges have been developed in most parts of Scotland and these are co-ordinated with the specialist drug service needle exchanges.

A Government funded study in Glasgow into the impact of the methadone prescribing programme has shown some very positive results. It revealed that 2,900 heroin injectors treated with methadone committed roughly half the number of crimes, that is 380,000 fewer crimes a year than if they had not been treated. The researchers also found substantial benefits to health from the the treatment, including a 70% reduction in overdoses and large reductions in other serious health problems.

Methadone maintenance has now been shown to be a positive way of helping to deal with the problems of transmission of infection - hepatitis and HIV; and chaotic lifestyles - reducing crime and bringing people into contact with the services they need so badly. However, methadone is a powerful drug and rightly the public is concerned about its street use. Experience has shown that when methadone is used as part of a properly co-ordinated treatment programme, with supervised consumption, in front of a community pharmacist, supplies for treatment do not get diverted and become a risk for someone else.

Recent structural changes in the NHS in Scotland through Designed To Care have enabled drug misuse to be tackled more effectively. NHS spending is now planned on a three year timeframe, while the five year planning framework evidenced in the Health Improvement Programme (HIP) of each Health Board allows drug misuse services to be clearly prioritised and funded appropriately. The HIP is the key health planning and co-ordination mechanism and dovetails with a wide range of other partnership planning structures including Community Care, New Deal and Community Plans. Linkage of drug misuse and Health Board strategic objectives using these planning structures provides opportunities for national priorities to be implemented at local level.

The White Paper on Public Health Towards a Healthier Scotland, published in February 1999, recognises that there is a need for health and other authorities to influence individuals to adopt healthier lifestyles in order to achieve better health outcomes, including discouraging them from misusing drugs. It announced further work to tackle health inequalities, with efforts to tackle poor life circumstances and lifestyles which will aid this strategy.

Current Action: Treatment

comprehensive guidance for those planning and providing health and social services and a £6m boost to drug treatment funding over the next three years guidance on substitute prescribing for drug misusers and new community-based prescribing programmes funding for a broad range of community-based services, provided by the statutory and voluntary sectors, information, advice, counselling and day and residential care setting as a development priority for local authorities, services for those whose offending is associated with drug misuse, and the training in coping with misusers for all social work and social care staff action to review drug deaths and apply the lessons learned improved needle exchange services, including in pharmacies care programmes for pregnant women with a substance misuse problem specific services targeted on those working in the sex industry introducing new rehabilitation programmes in prisons hepatitis B mass immunisation programme piloted at HMPs Aberdeen, Greenock and Perth.