Scotland's Overdose Epidemic – Finding the Correct Solution

Scotland, UK

Here's an eye-catching headline: “Where the Nurse Prescribes Heroin." One might think it was the headline to a fictional piece, a dystopian essay or novel on what life would be like if full-scale drug use permeated our society.

Unfortunately, this is not a fictional headline. Rather, this is a true story, a recent story out of Scotland.

“Homeless drug users in Scotland will be allowed to inject pharmaceutical-grade heroin twice a day under the supervision of medical officials as part of a new program intended to reduce drug deaths and H.I.V. infection.”

“Homeless drug users in Scotland will be allowed to inject pharmaceutical-grade heroin twice a day under the supervision of medical officials as part of a new program intended to reduce drug deaths and H.I.V. infection.” That is the opening line of a New York Times article which brings us concerning news from one of our ally nations overseas. Scotland legalized supervised injection as a harm reduction tactic to combat a highly lethal drug addiction epidemic.

The only problem is, Scotland is making a huge mistake in legalizing supervised heroin injection. Scotland is making a bet that harm reduction tactics will save them. And while there is a general consensus that harm reduction works, there's a different side to that story that often gets ignored. By itself, harm reduction is not the way out of the drug problem, not here, and not in Scotland.

Scotland – Drug Deaths Approach Terrifying Levels

Scotland has one of the most severe drug overdose problems in the world. Some are even calling it the Drug Death Capital of the World. According to Schaverien and McCann, 1,187 people died from drug overdoses in that country in 2018, compared to only 244 such deaths in 1996.

According to the Centers for Disease Control and Prevention, about 70,237 people died from drug overdoses in 2017 in the United States. But the U.S. has a much larger population than Scotland. If Scotland lost 1,187 people from overdoses in just one year, that’s a massive loss in a country of just a little over five million people. In fact, the per capita rate of fatal overdoses in Scotland is higher than it is in the United States.

“Scotland’s 2018 drug-related death rate (241 per million population) was 2.8 times that of the UK (87 per million population).”

And when we compare Scotland's overdose crisis to, say, the U.K.'s, the disparity is shocking. According to the Scottish Public Health Observatory, “Scotland’s 2018 drug-related death rate (241 per million population) was 2.8 times that of the UK (87 per million population).”

Scottish researchers and medical experts cite the spread of HIV and unfettered intravenous drug use as being the major causes of such rampant death in a country with a relatively small population. That led to Scottish citizens and lawmakers alike proposing supervised injection as being a potential method for lowering the rate of fatal drug overdoses.

Another Side to the Harm Reduction Story

Regardless of the hopeful intentions behind harm reduction programs, these efforts do not create a drug-free society. Harm reduction does not solve the drug problem. Such programs are often positioned as “solutions” to the drug problem, but that is not the case. There is plenty of evidence that suggests that harm reduction helps reduce deaths. However, there is also evidence that suggests that harm reduction simply perpetuates the drug problem, often with disastrous consequences.

For example, some people argue for harm reduction because needle exchange programs and supervised injection sites allegedly reduce the spread of HIV. But one study says otherwise, effectively casting doubt on the sense in supporting needle exchange and supervised injection. According to Dr. Steffanie Strathdee of the Johns Hopkins University Bloomberg School of Public Health, “In the past, we assumed that IDUs [intravenous drug users] who were HIV-positive had been infected with the virus through needle-sharing. Our analysis indicates that sexual behaviors, which we thought were less important among IDUs, really carry a heavyweight in terms of risks for HIV seroconversion for both men and women.

Heroin addicts couple

Does sharing needles lead to the spread of HIV? Absolutely. But sexual behavior also plays a part in the spread of HIV, and that fact is often overlooked by proponents of harm reduction.

Others argue for harm reduction because such programs allegedly reduce overdose deaths. And there may be some evidence that supports it, but there's evidence contrary to that fact too. One group of researchers explored data connected to one of the longest-operating supervised injection sites in the world, a facility in Vancouver, BC, Canada called Insite. The Lancet reported on the research, publishing a brief article on the combined data of several key experts who explored Vancouver’s drug problem. The results? Again, skeptical.

The Lancet discovered that the drop in overdose statistics in the neighborhood around the Insite facility may have been the result of increased police patrolling. Around the same time that Insite was claiming that it was playing a part in reduced, local overdoses, the city had also recently added 48-66 police officers to patrol the 12 block area around Insite. It's possible that adding a law enforcement presence to the neighborhood had a more powerful impact on reducing drug use (and drug overdose) than Insite's operations did.

Harm reduction would be better thought of as a half measure at best. It's certainly not a solution to drug addiction. Thankfully, we know that residential drug treatment centers do have considerable success in helping addicts rid themselves of addiction. That is what Scotland needs to be focusing on. Scotland needs to invest in residential drug rehab centers that offer long-term programs, not supervised injection sites.

Investing in Residential Treatment – The Correct Method for Curbing a Drug Problem

Rather than spending public funds on harm reduction programs in Scotland, the country should be setting forth a bold initiative to curb drug use via getting addicts treatment. The best and safest way of doing this is with the help of residential drug treatment centers that offer long-term programs.

Harm reduction programs don’t seek to help an addict end his addiction, just to continue it in a “less-harmful” manner. That's why harm reduction is never a permanent solution and should not be supported as one. Residential drug rehab centers, on the other hand, are a far more effective investment, as these programs seek to help addicts break free from addiction for life.

Drug treatment centers offer a final solution. Harm reduction programs allow for a continuation of the fundamental problem.

Looking at what is occurring in Scotland reminds us, in a lot of ways, of what is happening right here in the United States. Sadly, the United States is not that far behind Scotland in terms of overdose death rates and overall severity of addiction crisis. That’s why it is so crucial that, here in the U.S. as well as in Scotland, those of us who know someone who is struggling with a drug habit must take whatever action necessary to help that individual get into treatment.


Reviewed by Claire Pinelli, ICAADC, CCS, LADC, RAS, MCAP



After working in addiction treatment for several years, Ren now travels the country, studying drug trends and writing about addiction in our society. Ren is focused on using his skill as an author and counselor to promote recovery and effective solutions to the drug crisis. Connect with Ren on LinkedIn.