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The business case will go through its process. The Thistle will need to work with the Lord Advocate on how that interacts with the 1971 act and the statement of prosecution policy that was developed for the safer drug consumption facility. The Lord Advocate will need to give a view on how possible such a space is and what legal exemptions from prosecution would be required to develop the facility in that way.

We have heard clearly from the clinicians who operate the Thistle about the issue of not allowing inhalation. It is about being agile—my frustration is that we need to be able to be agile to the changing pattern of drug use. We have heard loud and clear that one of the barriers to coming in and using drugs in the Thistle is that people like to smoke at the same time as they inject. We need to think carefully about how, in this challenging area of harm reduction, we best meet the needs of the people who would benefit most from coming across the Thistle’s threshold. My officials and I will support, in any way that we can, any changes that need to be made.

There is a broader challenge with the 1971 act and harm reduction when it comes to paraphernalia. We have spoken about inhalation pipes, which cannot be supplied. What is happening at the moment, as you have heard in evidence today, is that people are injecting cocaine, and there are real risks because of the frequency of injection. There are real risks of increased levels of blood-borne viruses from sharing needles, and there are significant risks—to the extent of amputation—from injection site reactions; people can run into real difficulty from injecting 10-plus times a day, particularly if they become more intoxicated during the day. Being able to supply alternative, safer and less harmful means of using a drug—such as inhalation pipes—would be a significant step towards harm reduction that we could take but, currently, the 1971 act prevents us from doing that.

I also heard from the people at the Thistle about tourniquets. Even to laypeople, it is obvious that having injection procedures that are as sterile as possible would be a good harm-reduction intervention but, at the moment, the Thistle cannot supply sterile tourniquets for injections, because the 1971 act bars that.

Absolutely. I advocate for that, but I am not sure that it is listening to me.

Tara Shivaji might want to come in on this, but I will give a first response. All of us will, like me, welcome that substantial decrease—we are very pleased to see it. However, in the earlier evidence session, you heard from other witnesses about the changing market and the differences in the way in which people are taking drugs. That is bringing new threats, which indicates to me that we need to be agile in how we respond to those harms.

When we started the national mission back in 2020, we were largely dealing with the injecting of opioids and heroin. Now, in 2025, we have a significantly increased threat from injecting cocaine, which, as your medical witness described, requires more frequent injecting episodes. There is also a real risk from injection harm. The market is undoubtedly contaminated, so the bulk of what people are buying in Scotland is not what they think that they are buying. There has been a recent spike in harm in Glasgow caused by cocaine contaminated with synthetic cannabinoids, and we have also found heroin contaminated with nitazenes. That is causing real challenges for how we respond to the situation. We have seen a difference in the way in which people are taking drugs. As well as the increase in the number of injecting episodes from cocaine, we are seeing more smoking than we had before, and there are more inhalation routes.

We need to remain agile. It is quite a dynamic situation—things are not static. We have brilliant systems in place to understand what is happening out there, and to learn quickly where the harms are coming from and get good, high-quality information out across the country. However, it is a challenging situation to stay ahead of. Tara Shivaji might want to say more about RADAR.

Are you talking specifically about post-mortem toxicology?

It made a suggestion about mobile units being more cost effective, and I can think of certain areas where that might meet the pattern of need better than a fixed unit. However, the challenges with the 1971 act as it is and the conditions that have been set by the Lord Advocate mean that the model of a safer drug consumption unit is not scalable and not sustainable.

We need the legislation to change, and I think that it is reasonable to ask for it to be reviewed. The legislation is more than 50 years old. It is older than I am, and I am a granny. I do not think that it is fit for modern purposes and for the threats and harms that we face as a population today, so it is reasonable for us to look at modifying it to see whether it can be made more effective and, in particular, enable us to better take a public health harm reduction approach.

There are a number of barriers—that is the challenge with this whole issue. You will be well aware, having been involved for a number of years, just how complex and difficult the subject is. Stigma is a big issue. There are lots of reasons why services are set up in such a way that people struggle to get through the door even just to access them. There is no simple answer to fixing the problem. If there were, we would have done it—all of us would have pushed to have done that. I do not think that there is a simple, straightforward way around it; we just have to work hard to understand what is happening out there and what the barriers and challenges are in each local area. We have heard about some of the challenges that women face in accessing services. We need to understand why certain cohorts find it difficult to access the services that we provide, and we need to make it easier for them to access those services.

The charter of rights will help us to make progress in this area, because stigma is a big part of the problem—every day, it prevents people from accessing help. We have a lot to do, but I do not think that there is a simple answer. If there were, we would have implemented it.

My equivalent in the UK Government is a Home Office justice minister, and although the public health minister also attended the UK four-nations meeting, she was brand new that week. I do not think that those ministers will have had a chance to visit the Thistle yet, but I would certainly recommend that to them.

I worked in a hospital for 20 years, so I am used to a clinical environment. I worked in a mental health hospital, so I am used to working with people who are often stigmatised and on the edge of society, and I was hugely impressed by the facility. I was impressed by the professionalism of the staff, the warm welcome that they gave and the thoroughness of the work that goes on there. I have absolutely no doubt that the Thistle is life saving.

As I have said before, I agree with much of what the Scottish Affairs Committee said; it is right to encourage us to look at more cost-efficient models—I agree with all that. The legal environment in which we are operating is very challenging and, without a wholesale review of the Misuse of Drugs Act 1971, we have challenges with scaling and sustainability for facilities such as the safer drug consumption facility. That is my main takeaway from the inquiry. It is frustrating that, although people agree with us, we still do not have the power to change the situation that we are in.

Will you remind me what the second part of your question was?

Thank you for the opportunity to appear before this joint meeting of the committees today. I look forward to updating you on the vital work that is under way to address the harms and deaths that are caused by alcohol and drugs.

Since the previous joint meeting of the committees, in February, updated statistics have been published by the National Records of Scotland. In 2024, 1,017 drug misuse deaths were registered in Scotland. That is a decrease of 13 per cent compared to 2023. It is also important to note that alcohol-specific deaths statistics showed a 7 per cent decrease in deaths, falling to 1,185, which is the lowest number since 2019.

Let me be absolutely clear that, although it is welcome that both of those statistics show a decline, the figures are still far too high. We know from recent surveillance that there are new threats, and the drug-related harms in Scotland are still high. Every death is a profound tragedy, and every death is one too many. Crucially, every death is preventable, so we must use every tool available to address this crisis.

In that spirit, I very much welcome the work of the committees and the recommendations of the people’s panel and Audit Scotland, and those in “Changing Lives”, the 2022 Drug Deaths Taskforce report. Collectively, 164 recommendations were offered, and I am reassured by the many common themes and alignment. Our written evidence to the committees details our response to and progress against each recommendation, and how the recommendations have helped to shape our approach to the national mission.

Since launching the national mission in 2021, we have taken a range of actions. We have made £38 million available between eight projects across Scotland to provide additional residential rehabilitation beds; we have invested more than £4 million in widening access to life-saving naloxone; and we have opened the Thistle, the globally recognised safer drug consumption facility in Glasgow, which is the first in the United Kingdom. Since opening, it has overseen more than 4,000 injecting episodes, and has responded to more than 50 on-site overdose incidents. I have absolutely no doubt that lives have been saved. Those achievements were hard won, and I extend my gratitude to those who made them possible, especially individuals with lived experience.

I would like to highlight some of the key progress that has been made since the previous joint meeting.

We are helping to build a skilled and resilient workforce through the publication of new guiding principles and two employability toolkits. We are also seeing good progress in MAT implementation. The June benchmarking report indicated that 91 per cent of MAT standards 1 to 5 were assessed as fully implemented, and that 75 per cent of standards 6 to 10 were assessed as fully implemented. We have also seen progress in residential rehab. In August, we saw the official opening of the new CrossReach facility in Inverness. That is the latest of eight new or extended facilities that have been supported through our funding of £38 million.

I recognise that we need to go further, and I have heard the calls for further and faster action. We are developing a refreshed alcohol and drug strategic plan, in consultation with key stakeholders, including people with lived and living experience.

After five years of emergency response to the drug deaths crisis, it is time to build on our progress, to move to a model of sustainability and to embed long-term change. We are committed to change, driven by the belief that progress is both necessary and possible.

I welcome your questions and look forward to discussing the findings further.

As I said in my opening statement, I am confident that lives have been saved in the unit, which I visited in June. The evidence is anecdotal at the moment but data is being collected and it is being well analysed by excellent academics in Scotland. As time goes on, we will get a better understanding of the work that is going on at the Thistle. The staff who I spoke to were clear with me that people would undoubtedly have died during the cluster of overdose incidents in March and April had they not been using in the Thistle. Across Scotland, other people took similar drugs and died.

There is no doubt that there is concern in the community. I was pleased to hear from the witnesses today that some of those concerns are being allayed as they, along with the people who run the Thistle, are working to tackle the concerns of the community and businesses.

I was pleased to hear about the holistic and person-centred approaches that they are taking to the individuals who come through the door. There is not a set path for those people; they meet them where they are, encourage them in and, for example, help to find them accommodation, which, for many people, can be the very first step on the road to recovery.