Scotland's drug-deaths crisis is a question of values in more ways than one – Karyn McCluskey

It’s that time of year again when we’re all thinking about cash, whether that’s our personal spending Christmas hangover, or organisations setting budgets for the next financial year.

Covid has highlight the importance of public health and lessons can be learned in how Scotland deals with drug addiction (Picture: Sean Bell)
Covid has highlight the importance of public health and lessons can be learned in how Scotland deals with drug addiction (Picture: Sean Bell)

And it’s also the time of year where we should reflect on how we want to spend our money, because where it end up tells a bigger story than a balanced budget.

Joe Biden said in 2008: “Don’t tell me what you value. Show me your budget and I’ll tell you what you value.”

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I’ve always liked this quote, and what it indicates at a strategic level about what we believe in; environment, prevention, Universal Basic Income, health, defence, prison building? Look at a budget and we learn much more about a country’s direction of travel than from fine speeches and column inches.

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Anyone involved in allocating budget has the most challenging of roles. Finance Secretary Kate Forbes’ life will be consumed by budgets, competing bids for money and the inevitability that however it’s sliced and diced, there won’t ever be enough.

Health will, of course, be at the forefront of her mind, as it should. And this, more than ever, includes public health – the science and art of preventing disease, prolonging life and improving quality of life.

I’ve always loved the discipline of public health, yet it’s always been the Cinderella at the health ball, never quite held in the same esteem as other specialties.

The pandemic changed that. But public health is about more than the pandemic.

In December when the drug-deaths figures were released, the terrible loss of life shook us. These deaths have continued, despite continued work, over the festive period. I’ve spoken to many who’ve found people dead or attended funerals. Just like Covid, this is a public health task that requires similar sustained effort.

Justice is full of people enslaved to drugs that we seem committed to punishing out of addiction, as if that ever worked. What’s needed is a range of treatments and opportunities that match the needs of those who require it. Opioid replacement therapy might be a first step; or rehab might be the solution as they address the addiction and the inextricably linked trauma or underlying issues.

I recently spoke to some drug-and-alcohol rehab units, asking about their service and costs. Jericho, Phoenix, Abbeycare, Leap, Turning Point and others have years of experience walking beside people to a better life.

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It’s not easy and not always successful, so perhaps around £8,000 for a three or six-month stay sounds expensive, but compared to what? A life in prison is around £37,000 a year, hits the public purse hard and failure to address the driving force of offending means the return of many back into the justice system.

The heartbeat of public health is prevention. The relief felt when a vaccine was announced was an expression of our innate understanding that prevention is better than cure. And that ‘value for money’ isn’t about balancing coins on a set of scales, because how do you weigh a human life? The debate can’t be “do we spend more on prisons or addiction treatment”, but rather what is more likely to restore life, heal families, instil hope. And how do you put a price on that?

Karyn McCluskey is chief executive of Community Justice Scotland

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