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We work alongside the individuals from the Thistle; Maggie Page might want to come in on that. We also work closely with the organisations that run the Thistle, but it is largely down to them to work with the Lord Advocate to meet the criteria that she might set to ensure that conditions within the unit can change. It is a long process to get those permissions and to persuade that the legislation that covers the rest of the country can be lifted under certain circumstances.

The Scottish Affairs Committee at Westminster recently reported on the Thistle and made some suggestions for different models. The challenge with that is that we have not been able to persuade the Westminster Government to review the Misuse of Drugs Act 1971 and, because of that, what is happening at the Thistle is a one-off situation. Each time the model is modified, it will have to be agreed locally with the Lord Advocate. That means that it is difficult and that careful steps must be taken to make any changes to the model that operates there. Maggie, do you want to say more?

RADAR gives us rapid information that can be disseminated out to exactly where it is needed across the country, and it is making a difference to the harms experienced across Scotland.

RADAR is not perfect. My sense, a few months into this job, is that the longer that it takes to produce the data, the more rich and robust it is. We get early data that tells us something, but, often, the longer we wait for the data, the richer it is. However, we do not have time to wait. We are in a drug deaths crisis and we need fast information, and we need to get that fast information out to the front line—out to the health boards and to the places where people are likely to go to receive treatment for overdose. We need to get it out to the front line so that the paramedics and the alcohol and drug services know what they are dealing with. That is vitally important.

Thank you—that is a really excellent question, and I think that Maggie Page will want to come in with a little bit more detail on it.

We think about three strands when we are thinking about the next steps around treatment and access to residential rehab. We focused a lot on providing funded places, and we are on track to reach the 1,000 funded places that we committed to. We also focused on increasing residential rehab capacity, and we have really increased the number of available beds. I think that we will get a report on where we are with that next November, but, again, there has been a substantial increase in provision.

The bit that will probably require a bit more focus in our strategy next year is the pathways around access to residential rehab, which is about access to stabilisation and detox, and how we get things lined up for people. Your previous panel of witnesses talked about access to abstinence-based residential rehab, for which people are required to go through medical detoxification before they can start. It would be ideal if the residential rehab lined up right at the end of the detox, without a gap or a long wait for detox, when somebody is ready for residential rehab and wants to get in. We are working hard on those pathways to improve access into services, because that is an area where we can achieve real improvement.

I agree that there is an issue with implementation, which is a challenge that all ministers face in all portfolio areas at all times. We often set out great ideas and produce fantastic policies and great legislation, but that is not how it feels on the ground for the people who access our services. As a minister, one of my challenges is to close that implementation gap, so that the reality meets the ambition.

I am the first to acknowledge that there is a gap. For me, one of the crucial ways in which to close it is through the involvement of people with lived experience. If we have the voices of lived experience at the heart of our policy and legislative development, it keeps us right. It means that we are usually on the right track, because we are listening to the right people.

That also holds our feet to the fire on delivery, which helps us to close the gap. The situation is always evolving. Nobody is saying that we get it 100 per cent right. Lived experience, particularly in this area, where there is a huge amount of passion, does not speak with one voice, but that approach helps us to get it right.

We get lots of data coming in, and lots of monitoring and supervision. In fact, some people feel quite overburdened by the reporting that we request from them, but we are pretty keen to understand what is going on out there. My sense is that we are very much aware of the challenges. We are providing support where we can, so that local areas can rise to those challenges.

Maggie, do you have anything to add?

It would concern me if we thought that the only measure of success was referral into treatment. We heard the statistic that more than 50 people have been referred to treatment. That is reasonable if we think about the level of chaos that the people who came through the door in the first six months were experiencing. To have 50 people referred for some form of treatment—not necessarily residential rehab—within six months is a reasonable number.

We have not explored that, because the barriers are not being removed and we have been unsuccessful thus far in removing them.

If I remember rightly, efforts to bring the Thistle to life started in 2015, so that means that it took 10 years until it opened this year. That predates the national mission. Those efforts began at the start of the rise in the number of drug-related deaths, but the reason behind considering whether to have a safer drug consumption facility at that time was to reduce the number of cases of HIV, because there had been an outbreak—a cluster—of HIV in the area, and such a facility was seen as a way of reducing that harm.

You are right that, at the moment, we are in the thick of a drug deaths emergency, and very early data shows that lives have definitely been saved in that unit. Therefore, it is understandable that we recognise that it is a life-saving facility; it definitely prevents deaths. We will do a more thorough evaluation of what happens there and what the benefits and disbenefits are, and we will consider where to go when we have a bit more information.

At the moment, I am not seeing barriers to scalability across Scotland, or even to sustainability, being removed. We had a change of Government in the UK last year, and I thought that there would be an opportunity for a change in approach, but I am not sensing that at all. I have to focus on the here and now and on the emergency that we are in, and find a way forward now.

With reference to the national testing laboratory at the Leverhulme centre, the Government as a whole has been working closely with the University of Dundee since last year on the challenges that it has faced, and the Government has been providing a great deal of support, including financial support. We are pretty close to a resolution on the issues that the Leverhulme was facing in getting the national testing laboratory up and running, so I am confident that things are on track. Maggie, do you have more to say about where we are?

I would like to hope that those efforts will have a positive impact on that gentleman’s life. We heard from the previous witnesses about the outreach work that is going on from the Thistle centre. We heard from the community representatives about the lengths that the staff go to in order to meet people and encourage them to access help and support. I am confident that, if the Thistle is not the place for him, it could help him to access help and support in other places.

We heard from the previous panel that, anecdotally, there are concerns about an increase in the number of people in the area and about faces that are not recognised. It is quite difficult to capture that. As both community representatives on your previous panel said, it is undoubtedly an area where drug consumption was happening anyway. The drug consumption happens close to the market. It is long established that this is an area where people come to buy their drugs, so it is difficult to capture how much change there has been since the Thistle opened its doors in January.

In general, safer drug consumption facilities reduce the levels of crime, drug paraphernalia and street litter in the areas that they are sited in. As well as being a life-saving intervention, part of their purpose is to reduce the harm that is experienced by individuals and by the community because of drug use happening in it.

I can certainly check what our recent data shows. We are able to get access to some toxicology almost instantaneously. I have spoken before in the chamber about the incident that we faced in March, in which a batch of opiates contaminated with synthetic opiates came in to Scotland and there quickly began to be overdose incidents in our community, including in the Thistle centre in Glasgow.

Because those people were using in a supervised drug-consumption facility, it was possible to resuscitate them. They provided samples of the drugs that they had been using, which were very quickly analysed, and that meant that detailed information went out very quickly, using the Public Health Scotland rapid action drug alerts and response system, to ensure that every part of Scotland was aware of the risks from synthetic opioids.

With regard to drug testing, we are able to access information quite quickly, but there might be challenges with regard to post-mortem toxicology, which is slightly different, because there are often challenges with identifying substances. These nitazenes are incredibly potent, so they are present in very small quantities in a person’s bloodstream. The detection threshold has to be very low, so detection can be difficult. There are also challenges in that the ever-evolving synthetic market means that, even as we develop a test for them, more nitazenes are always appearing.

Richard Foggo has something to say specifically on the toxicology, but I will go back to your point about the increasing drugs deaths in prisons. I think that other witnesses at this inquiry have said that the use of drugs in prisons often mirrors what is happening in the community, and what we are seeing in the community is a really significant threat from the rise in synthetics. Looking back over the past five years that the mission has been on-going, we can see that, initially, we were very much up against opiates, but quite quickly, synthetic benzodiazepines came on to the market, caused challenges and contributed to deaths.

We have also had a rise in synthetic cannabinoids, which are significantly more potent and cause harm and can cause sudden death. We now have these exceptionally potent synthetic opioids—nitazenes. They were developed about 60 years ago, but it has never been possible for them to be used safely because they pose such an incredible overdose risk. They are causing real challenges for us. The thing to understand is that they cause challenges in how we disrupt supply, too. It is not just that they have different effects on our bodies when they are taken but that, as one paramedic said to me when they were training me in the use of naloxone, the potency is such that what used to fit into a suitcase now fits into a matchbox. That means that we now need an approach that is different to the traditional way in which we disrupted supply, and that is the case in our prisons as well as in the community.

With regard to how we deal with that, we have a naloxone programme in prisons. There are challenges with benzodiazepine overdoses. There is not a straightforward antidote that can be used outside a clinical setting, although that is being investigated and trialled—the University of Edinburgh is doing research into that. There are certainly challenges with the impact of taking synthetic cannabinoids and reversing the effects that those have on your body. However, we have an antidote that can be used for opiates. We have ensured that that is available throughout the prison service, and it is being used, at times, in prisons, so prison officers are trained in naloxone administration.

However, that is a solution to only one drug, and members will have heard, in relation to all the alerts that have been in the public domain over the past few months, that nitazenes are so potent and so dangerous that people are needing repeated doses of naloxone, which means that anyone who is administering naloxone is having to administer quite a lot more of it for quite a lot longer than they would have had to do for conventional opiates. As I keep saying in my role, we need to be agile and to recognise that things change, and we need to respond to those changes—and that is exactly the same in the prison system as in the community system.

It is probably useful to put on record that the Scottish Government is developing a national service specification for drug and alcohol treatment in Scotland, alongside guidance that has been informed by the UK-wide clinical guidance for alcohol treatment. That will aim to provide clarity on the types of treatment that should be available. The national specification will set out the types of treatment and recovery service that should be available across Scotland. It will also provide impetus for improved joint working between the public sector, third sector partners and everyone who needs to collaborate in order to improve outcomes for the individuals who are affected. That will apply in custody in prisons, as well as in our hospitals and primary care.