³ÉÈË¿ìÊÖ

Some of the work that we are actively engaged in is on updating prevalence information. We need to update our understanding of the extent, or prevalence, of drug use in our society. There is some existing data; just before Christmas, I announced funding to update it. We need to understand more about prevalence in Scotland. That information is important because it is crucial to introducing our treatment targets.

In direct answer to Gillian Martin’s question—I think that this is a fair critique—I will say that we do not have enough of our people in treatment and we do not do enough to retain them in treatment or to follow them up if they fall out of it; hence, our investment in, for example, non-fatal overdose pathways and outreach. The new treatment target and the indicators that underlie it will therefore be crucial in improving and scrutinising the number of people who are in treatment. As I said to Parliament, we will announce that in the spring

With regard to capacity, much of our work on MAT standards and residential rehabilitation is about not just improving our ways of working but increasing capacity. Workforce capacity is important, so right now we are mapping the shape and size of the workforce in order to identify gaps and to look more at training needs.

The issue of stigma is very pertinent to the workforce; workers, too, often feel quite stigmatised. We will consider a recruitment campaign, but that has to be joined up with other big national workforce strategies across the Government.

I am really excited about the national collaborative. I was committed to bringing it forward—in part due to my experience in social security and the work that we did around lived experience with experience panels, and in part because of my days in education, where I saw the benefits of the early years collaborative.

I think that it is absolutely crucial that there is a vehicle that is owned by the voices of the experienced—that it is theirs. I am delighted that Professor Alan Miller, who is Scotland’s leading human rights expert, has agreed to chair the national collaborative. He comes with independence. He is well placed to understand the impact of trauma and has worked with survivors of in-care abuse, through which he brought forward a programme of work that amplified their voices and ensured that change happened. I am thinking in particular of the redress scheme.

I am very confident about the national collaborative. Professor Miller is now involved in a series of engagements—introductory and one-to-one meetings with the sector and with people with lived and living experience. He will work with them to develop a programme of work, including milestones and timescales.

The national collaborative is a very important part of the national mission, because we need to ensure that voices of experience are plugged in to every aspect of that mission. It is also about enabling those voices to inform and drive change, and about what we do being informed by a human rights approach.

That is a really important question, Mr Gulhane; I know that you are a former GP. I often talk about our life-saving work being connected to the work to improve people’s lives. You and I may take the role of primary care for granted in our own lives, but I know that many general practices are the front line of our communities and are already doing great work to support people and their families who are struggling with drug use.

We are finding across Scotland that there are different pictures of the organisation of services. In some areas, GPs can offer more services to people who are affected by drug use, while in others pathways and routes point more towards specialist services. Regional variation is fine as long as it works.

However, in taking a public health approach, GPs can play an absolutely core role. Part of my job is to engage with clinicians from all backgrounds—psychiatrists, GPs and clinicians from specialist addiction services. The connection between the important issue of harm reduction and immediate access to treatment for a drug problem and primary care is made in standard 7 of the new medication-assisted treatment standards. People should have choice with regard to the connections between their MAT and primary care.

There are two important strands to that question, but the committee will appreciate that my work on reducing drug-related deaths focuses primarily, although not exclusively, on illicit drug use. My colleagues in public health focus more on how we reduce dependency on prescribed drugs.

The issue is of interest to me, however, because we know—I am not telling you anything that you do not know—that people can, and do, become addicted to prescribed drugs. A consultation took place on the recommendations of the short-life working group, and health colleagues are implementing an action plan about prescribing guidance and assessing, monitoring and recording prescriptions.

It is a side issue, but the Royal Pharmaceutical Society is interested in how it could work with Government to implement a tool that better records the amount of over-the-counter medications that people buy, because that is an issue for some people as well.

The prescribing guidance around proscribed drugs is complementary to the prescribing guidance around illicit benzodiazepine use. For the drugs policy division, the work to reduce dependency on and the use of illicit benzodiazepines in our communities is connected to the work around prescribed benzodiazepines, for example. We are involved in a range of work—in devolved and reserved areas—to tackle the issue around street Valium as well. I will stop here, convener. Someone might want to pick up the benzodiazepine issue later.

You are quite correct to be making all those connections. It is important that strategies and approaches complement and connect with one another. There is a lot to learn from other campaigns and approaches.

One example is the use of Buvidal, which was introduced into the prison estate during the pandemic. Buvidal is a long-acting buprenorphine that can be administered as an injection weekly or monthly; it does not require a daily dosage. The use of Buvidal in prisons was evaluated very positively. It will not suit everybody—it is important to stress that no treatment will meet the needs of everyone—but it had some benefits in terms of clarity of thought and of not tying people to daily dispensing. It is also rarely associated with overdose, because it is a protective factor in relation to how opioids attach to brain receptors. It is a bit like a blocker: if you take an opioid on top of your Buvidal, you do not get the high from the opioid.

Having looked at the results of Buvidal in some of our prison estate, I was keen to find out how we could introduce it to the community and widen access to treatment. That is why this financial year there is a £4 million investment in widening choice to people, and that includes Buvidal. Widening that choice of treatment is a change in practice that occurred in response to the pandemic, but it is one that we want to continue and to implement further.

The committee has already spoken about our work around naloxone as well and how its distribution has widened during the pandemic. We do not want to detract from that change.

I outlined those in my previous answers. Perhaps Ms McNair’s connection is not very good. I talked about our work on Buvidal and naloxone. I did not talk about our £1.9 million investment in our work on prison to rehab.

The work and contribution of the lived-experience and recovery community throughout the pandemic should remind us well of the value of engaging meaningfully with—not just paying lip service to—the recovery community and those with lived and living experience. That is why we want to take that work further forward with our work on a national collaborative.

The £5 million in additional resource was released in the final quarter of the previous financial year, which was the first quarter of this calendar year. Of that, £3 million went to alcohol and drug partnerships—as I mentioned, we published their returns on how that was invested—£1 million was put into a grass-roots fund, and £1 million went into a service improvement fund.

At the turn of the financial year—after Easter, on 18 March—I announced four new funds totalling £18 million. I hasten to add that they are multiyear funds. Those four new funds opened in May. There is a £5 million recovery fund; a £5 million service improvement fund; a £5 million local fund, which again is geared towards grass-roots organisations; and a £3 million families and children fund. Those are available via the Corra Foundation for all non-profit organisations to apply for. We have worked really hard to make the application process accessible and quick. To date, we have funded in excess of 50 projects through that. Adding in other funding—for example, through work that the task force has done—I think that we have funded over 80 specific projects.

This year, we will invest around £13.5 million in residential rehab. That money will come from ADPs and from the recovery fund and other sources of funding within Government. I will outline to the Parliament in more detail the profile of that funding, because we have a commitment to provide £100 million for residential rehab and aftercare over five years.

On the £50 million for this year, there is also the specific £13.5 million uplift to ADPs that I have mentioned, and around £14 million is going on £3 million for outreach, £3 million for non-fatal overdose, £4 million on widening the distribution of Buvidal, and £4 million on implementing the MAT standards. I hope that that gives an overview.

A small amount of resource is going on research. Resources have also been set aside for the national stigma campaign and our lived and living experience strategy work on establishing the national collaborative.

Our commitment to increasing the capacity and the reach of drug services and to improving access to residential rehab applies very much to aftercare, too. We must recognise that drug addiction can be a chronic condition—it should be no surprise to anyone who is involved in the provision of drug services that people sometimes relapse. Progress in life is rarely linear, and it should not be that people run out of chances; we should give people as many chances as they need to get onto the road to recovery. The work that we do with local services and that integration with aftercare is crucial.

We also need to think about rehabilitation in a community context, as well as in a residential one. We know that risk can be elevated in times of transition, such as when someone leaves residential rehab, so people must have wraparound person-centred support that meets their needs. That approach also applies to people who leave prison or move from, or leave services. Our work and investments around outreach are particularly important in that area. We also need to be far better at following up when people disengage from services.

There is a lot in that question, but the member is quite right to make all of those connections. The point about access to residential rehabilitation is important. The work that the residential rehab development working group has undertaken is about the development of clearer pathways, because pathways vary across the country. I think that I am on record as saying that sometimes, pathways into residential rehab are as clear as mud, which is neither right nor acceptable.

There is also an issue about access to community services. There can be many barriers to people getting into treatment: you have to do this; you have to be on this level of treatment; you have to be abstinent and so on. With regard to residential rehab, which is an abstinence-based model, there are certain expectations around people’s personal commitment, detox and lowering substances to facilitate the process, but it is fair to point out that there are perhaps too many barriers to accessing other services.

An early action that I took was the result of information that Shelter provided. There is a bit of confusion about housing benefit rules. Anyone who knows anything about housing benefit will know about the minutiae of detail that often have to be unravelled. Different things were happening in different local authority areas to apply rules. I was not going to put up with people having to choose between keeping their tenancy and going into residential rehab. Funds have been allocated and are available to address that while we sort out the complexities of regulation or whatever. That is one example of how we can invest resource. We will sort out the situation, but we are not putting up with people facing that choice.

I have always been a big fan of the housing first approach and other housing models that do not put up barriers. We should take people as they are; the priority is to get them into a home, and we will work out the rest, whether that involves people’s drug use, health problems or other issues. I have spoken about parents and in particular mothers with caring responsibilities, so I will not repeat that.

The naloxone issue is important. Naloxone helps to save lives; it buys time for the emergency services because it temporarily reverses the impact of an opioid overdose. It is safe and easy to use. Because of the pandemic, the previous Lord Advocate issued guidance that enabled us to widen the distribution of naloxone to third sector settings.

I must give a shout-out to Scottish Families Affected by Alcohol and Drugs. As a result of our national naloxone campaign and people going to the Stop the Deaths website, more than 460 people have applied to that organisation for the naloxone kits that it provides through its click and deliver service. Families who have a loved one at risk can have naloxone to hand. More than two thirds of ambulance technicians are trained in naloxone use and can give out take-home kits to people they come across. It is important that people who distribute naloxone in non-drug services make the connections, support people and refer them to drug services.

I apologise for the length of my reply, but I hope that I have at least outlined some important connections.