Cranstoun’s response to 2024 Scottish drug death figures

Today, the National Records for Scotland (NRS) published their figures for the number of drug related deaths* in Scotland for the year of 2024. The total number of people who tragically died from drugs is 1,017 which marks a 13% decrease on the number in 2023, however Scotland remains the drug death capital of Europe for the 7th year in a row.

The figures mark a 65% increase from the 613 deaths in 2014 but are 24% less than the highest figure – 1,339 – recorded in 2020. Opioids were most prevalent, involved in four-fifths of deaths, followed by benzodiazepines which were involved in over half (56%) and cocaine which was involved in just under half (47%).

Most worryingly, deaths involving nitazenes, potent synthetic opioids which are up to 500 times stronger than heroin, and up to five times more potent than fentanyl, were involved in 76 deaths which is a significant increase of 230% on the year prior where only 23 deaths were recorded, with only 1 recorded in 2022. The rise in drug deaths involving nitazenes is indicative of increased prevalence and contamination within the opioid supply, and reflective of the decrease in opium production in Afghanistan, as highlighted in the recent UN World Drug Report.

It is further concerning that we are still not entirely sure on the level of nitazene harm as there may be a lag in data being recorded due to strenuous post-mortem examinations. In August 2023, Cranstoun warned of a potential public health emergency caused by increased prevalence of nitazenes, and we published an evidence-based plan underpinned by a joined up, whole system approach.

Positive steps but moving too slowly

There have been positive steps in Scotland to tackle the harms related to drugs, such as the implementation of diamorphine-assisted treatment and the UK’s first sanction overdose prevention centre (OPC), which are both in Glasgow. Whilst it is anticipated that there will be a second OPC in Edinburgh in due course, as well as drug checking pilots in several areas, harm reduction and recovery measures that tackle drug related harm are moving too slowly in Scotland, despite significant funding uplifts in recent years.

Well-documented issues related to the exacerbation of drug deaths in Scotland include the lower number of people who are dependent on opioids that are in substance use treatment (namely OST), difficulty in achieving same day prescriptions for opioid substation therapy and high levels of deprivation. Scotland is also among the highest numbers for alcohol related deaths.

There is clear political will from within the government, as demonstrated by the implementation of an OPC, sign offs on drug checking pilots and the expansion of drug warnings – although the latter was incorrectly labelled as “de facto decriminalisation”. Time is running out to make further positive impact ahead of the Scottish Elections in May next year although there are several measures and approaches that the government must consider to better handle the drug crisis, especially against the backdrop of increased nitazene prevalence and harm.

DATs and OPCs: an alternative model to tackle the crisis

Cranstoun has presented alternative models to diamorphine assisted treatment in Dundee and overdose prevention centres in Edinburgh, which are more cost effective without the sacrifice of clinical rigour. These could be rolled out at pace to provide a comparative analysis compared with the existing, NHS-led models which are also showing success in reducing harm and improving the lives of people who use drugs.  

We also believe that the shift in 2021 to expand the use of Drug Warnings for possession offences of any Class of drugs is a significant improvement, although more can be done to increase the number of people in treatment at every phase of the criminal justice system. Cranstoun’s Arrest Referral Service places trained treatment professionals in custody blocks, who work to increase the number of Drug Treatment Requirements, whilst being able to provide advice and holistic support to those who have been arrested for a drug related crime.  

Research in The Lancet shows that those who are in Opioid Substitution Therapy are around 3 times less likely to die from a drug death and we must use all tools available to support those who need help, CARS can be one such tool to reach people who may benefit from help. We must also continue to look at the best recovery options and appreciate that different approaches will work for different people struggling with dependency – who may wish to reduce, halt or better manage substance use. 

Lastly, our deepest thoughts and condolences are with those who have tragically lost a loved one to a drug death. There are solutions which will help to reduce the tragic level of suffering experienced by thousands in Scotland every year. We know the political will is there, and we know that steps are being taken, but we urge the Scottish Government to go further in following evidence based measures which we know will help to save lives.

*NRS use the term “drug misuse”. However, we are choosing to use a less stigmatising term.

Meg Jones, Director of New Business and Services at Cranstoun, said:

“Today’s figures are beyond tragic, and our most heartfelt thoughts and condolences are with all of those who have tragically lost a loved one to a drug death.

Despite a lot of discussion about how to solve the drugs crisis, real action and implementation of globally evidenced interventions is too slow, with the scale of measures brought in not at the level required to make a greater impact.

There is clear political will to solve this crisis and there have been positive developments including an overdose prevention centre, shifts towards diversion from prosecution, sign off on drug testing pilots and a diamorphine assisted treatment centre in Glasgow.

We urge the Scottish Government to consider proposals which both increase the number of people in treatment, whilst also keeping others alive. This includes stronger collaboration with the third sector to deliver alternative, more financially feasible models to overdose prevention centres, diamorphine assisted treatment, and arrest referral services which can be rolled out more widely. We have presented to government officials previously and remain keen to share our learnings from the work that we deliver.

It is particularly concerning to see a sharp rise in the number of fatalities which were linked to nitazenes. Cranstoun urges the UK and Scottish Government to implement our whole system plan, published in 2023, to keep ahead of the curve and mitigate the worst of a potential public health emergency.”

AI Meets Harm Reduction: Drugbot Launches across the UK

A new artificial intelligence chatbot has launched, providing people who use drugs with lifesaving information in what experts say is of an ever-changing and more dangerous drug market.

Drugbot, delivered by the social justice charity Cranstoun, which works with thousands of people who use drugs each year, with technology partners Substancy have launched the free and confidential chat service across the UK to help to reduce the harms caused by drugs to people and communities.

The AI bot can take basic and complex questions about drugs and provide accurate and essential information to ensure that if people are using drugs, that they are reducing the risks to themselves and others.

Director of Services Megan Jones from Cranstoun said: “Whilst we know that not taking drugs is always safer, we know that that is not the reality for many people in our communities.

“This new service will allow people to make more informed choices and ultimately reduce the harms caused by drugs.”

“As we see the drugs market in the UK change rapidly, with availability of illicit substances more available than ever, and with contaminants appearing in a range of drugs, it’s essential that we can reach more people and provide them with accessible information, that could save their lives.”

“We’ve invested and partnered with Substancy to launch this service so we can support people in a unique way – as we know that for many people it can take a lot of confidence to come and speak to someone in one of our drug and alcohol services about their drug and alcohol use.

“The Drugbot is seeking to break down some of those barriers and will be able to suggest that people do seek in person face-to-face help too.

“It’s really important that our drug and alcohol services aren’t left behind by the rapidly changing technology landscape, and the ways in which many people communicate. Drugbot will help to provide meaningful drug related education and advice to many people who would struggle to access or talk about their drug use.”

The bot has undergone rigorous testing as part of a pilot, responding to more than 20,000 questions and developers are pleased with the high levels of accuracy and detailed responses, which have been rigorously checked and assessed by drug services experts.

It can provide information on safety when using drugs, dosage and aftercare, all essential to safer behaviours and reducing the harm of drugs. There are a number of safety measures which have been put in place to ensure the safety of its responses. The bot has a behavioural safety filter in place which detects questions which could encourage or assist illegal activities such as the purchase of drugs and encourages users of the tool to seek clarification and will suggest that people speak to expert drug workers where particularly risky behaviour is identified.

Dr Ivan Ezquerra Romano, Founder of Substancy added: “The Drugbot database draws on a diverse array of trusted sources, from crowdsourced information to insights written by domain experts.

“Each record is rigorously curated and prepared for the AI system. The information is overseen by a dedicated team whose combined decades of experience in the substance use and harm reduction field ensure that every user receives the most accurate, up-to-date guidance to reduce risk and save lives.”

Drugbot will be continuously improved through the feedback from people accessing the service and as it gains access to a greater number of credible sources which will help to shape its responses going forwards. We will also enhance its capabilities with new features.

Drugbot is currently available in the UK, with plans to phase a wider rollout soon. It is for people aged 18 and up and is available at drugbot.cranstoun.org  

Response to “Local preparedness for synthetic opioids in England” report

Following the publication of the Local preparedness for synthetic opioids in England – GOV.UK, Cranstoun has welcomed further recommendation and guidance for Combatting Drugs Partnerships, but have continued the call for further measures which will help to prevent drug related harm and deaths.

In North America, both the US and Canada called public health emergencies because of the severity of the issue of synthetic opioids, and we believe that recommendations to make us better prepared are still being missed. The crisis there is so severe that the former Homeland Security Secretary in the US described synthetic opioid overdoses as “the single greatest challenge we face as a country.”

In the US, drug deaths there have risen by around 147% in just a decade from 2013-2023 – with 115,592 dying from drugs in 2023 alone across both countries – and there is no sign that this problem is going away.

The latest data available for the UK shows that nitazenes were linked to 179 deaths over a 12 month period between 1 June 2023 and 31 May 2024. This is a marked increase on the first 6 months where just 54 deaths were recorded. It is known there is a lag in the recording of data, and that deaths related to nitazenes were likely not logged as such, given that they were not tested for routinely in postmortem examinations.

Commenting on the report, Director of New Business & Services at Cranstoun, Megan Jones has said:

“We welcome the measures in this report, so far as they relate to reporting and data sharing, and working to expand the carriage of naloxone.

“However, it is disappointing that there seems to be a lack of ambition when it comes to really getting upstream and preventing the harm which synthetic opioids pose to our communities.

“Some simple recommendations, which we announced back in the summer of 2023, would allow all organisations working to prevent harm caused by drugs to work more effectively. The Home Affairs Select Committee published a comprehensive report on drugs in 2023, which made some similar recommendations which have not been acknowledged in this report.

“Expanding drug checking and testing services would go a long way to provide more rapid responses to changes in local drug supplies, allowing all partners to respond effectively.

“We welcome discussions which providers had as part of the exercises around  overdose prevention sites in areas where there are significant issues. We believe that these sites, as all of the global evidence suggests, would save lives and prevent harm.

“We note that the UK Government currently has no plans to change the Misuse of Drugs Act, however these facilities could still operate without changes to this legislation. There are also several evidence-based schemes which in the UK, have been evaluated positively, yet are not being considered for expansion.

“We’re concerned that – given drug deaths impact the people from the most deprived areas significantly more – this could lead to greater pressure on emergency and wider health services. This is why we need to see more measures put in place to help us prevent harm from these highly dangerous substances.”

“Without having a greater number of tools in our arsenal to respond to synthetic opioids, it can feel like we are trying to reduce harm with our hands tied behind our backs. Getting ahead of the curve is essential and it feels that time is slipping away unless we see rapid changes in our national response.”