Why a ‘methadone or nothing mentality’ is a mistake – Tom Wood

The Scottish Government’s new Drug Death Task Force faces a tough job but there are pinpricks of light if they look carefully, writes Tom Wood.

Reducing Scotland's drug-related death rate will be a difficult task

Two important developments in the past weeks illustrate hopeful developments in our seemingly endless death struggle with addictions. The Dundee Drug Commission, an independent expert group set up to examine the ongoing drug death crises in the city reported last week. Yes Dundee, for while Glasgow and Edinburgh usually make the shock-horror drug death headlines, Dundee has been overtaking fast, last year recording a drug-related death every week, per capita – the worst in Europe.

The Commission’s report makes for uncomfortable reading with a strong ‘groundhog day’ feel about it. It highlights a lack of leadership, disjointed inconsistent and ineffective management and poor performance monitoring. The Commission’s well-regarded chair Robert Peat summarises what he found as “a fractured system of treatment and support“.

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The report comes with a comprehensive list of recommendations, let’s hope an adequately funded and performance-managed implementation plan follows. Too often first-class policy fails to be a catalyst for action for want of poor delivery.

But it goes further highlighting wider issues that affect the rest of Scotland. It refers to a ‘methadone or nothing mentality’ in many agencies, focussed only on heroin and opiate substitution therapy.

Now let’s be clear, opiates, mainly heroin, are our old enemy and continue to feature significantly in our addiction landscape but they are far from the only substance in town. Cocaine and a host of other drugs new and old contribute to a toxic mix. The dangers of the methadone or nothing approach are evident, most of our drug death victims die from taking a mix of substances.

Just as drug misuse is wide and varied so the responses and treatments must be likewise, with a range of services tailored to local needs. But it’s far from easy – there is a reluctance to change, described in the report as “a resistance to introduce policies that worked elsewhere” – the “Not Invented Here” syndrome writ large.

And on that subject, I recently noted with regret the retiral of Dr David McCartney from his role as head of the Lothian and Edinburgh Abstinence Programme (Leap). As the name suggests, it is a tough abstinence programme designed to help patients take control of their lives and addictions to begin the journey to recovery. It’s far from easy – a lifelong journey, but under Dr McCartney’s inspirational leadership, Leap has over the last decade helped guide hundreds of people suffering from addictions onto the road of recovery. I’m pleased to report that the programme is in good heart going forward but it has been far from plain sailing. Incredibly, despite its success, Leap still meets resistance, so entrenched is the antipathy to new and different approaches.

The definition of a task force is “an organisation created to solve a particular problem”. We must wish the new Scottish Drug Death Task Force every success and hope it is equipped with the teeth to do the job.

First and foremost, it must confront some of the dogmas of the past and the resistance to change that have paralysed our addiction services for so long.

The report of the Dundee Drug Commission and the shining example of Leap’s success show there are ways forward, and they come in many shapes and sizes. It’s not all about methadone.

Tom Wood is a writer, former deputy chief constable and from 2005-8 independent chair of Edinburgh’s Alcohol & Drug Action Team