Darren McGarvey: How can '˜world's best small country' be Europe's drug-death capital?

Why does Scotland continue to punch above its weight in some of the worst areas imaginable, despite being described by many as the 'world's best small country', asks Darren McGarvey.

Last week, we learned that Scotland is the drug-death capital of Europe. It’s the latest cultural feather in the cap of “the world’s best small country”, revealing that we continue to punch above our weight in some of the worst areas imaginable.

The latest figures showed 934 people died in Scotland as a direct result of taking drugs. That’s more than twice the number just ten years ago and two-and-a-half times the rate UK-wide.

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Many died by taking a lethal cocktail of substances, including sedatives like diazepam and Xanax – a powerful American sedative widely prescribed in the States, which is now available in the UK on the black market. While males still account for most drug-related deaths, there has been a sharp rise in the number of women not only using substances but perishing as a result.

The number of people who died for drug-related reasons rose to 934 last year, the highest rate of anywhere in the European Union.The number of people who died for drug-related reasons rose to 934 last year, the highest rate of anywhere in the European Union.
The number of people who died for drug-related reasons rose to 934 last year, the highest rate of anywhere in the European Union.

Recent research published by the Scottish Government has identified a variety of factors which may account for this trend. Evidence suggests mental and physical health problems play a role, as well as the impact of welfare reforms, such as stricter conditionality, not to mention a quite frankly inhuman sanctions regime. Much like the pronounced rise in foodbank use, notably in areas where the widely discredited Universal Credit has been rolled out, public sector austerity, while regarded by many affluent, politically enfranchised voters as a necessary evil, is having toxic social impact further down the food chain; creating conditions of permanent, chronic stress, which may drive people to seek emotional relief by self-medicating. This, while the services designed to support people struggling with mental health problems and addiction are either dangerously outmoded or being senselessly wound down.

These changes, typically enacted by a political class which, generally, has little experience of the issues for which they well-meaningly legislate, may exacerbate other risk factors like abusive or coercive relationships, commercial sex work, mental health difficulties and experiences of trauma – often the source of social exclusion, addiction and residential instability for many. Cuts to services, particularly those services the great and the good tend to access less, mean lower staffing levels, low morale within the workplace as well as an increasing lack of continuity in service provision.

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‘Staggering’ rise in drug-related deaths in Scotland

The key factor that often increases a person’s chances of recovering from multiple adversities is the rapport they build with the professionals supporting them. Relationships must be established over time, to cultivate the sort of trust and good faith that makes recovery possible. Austerity means those in need of assistance often have to deal with a rotating cast of support workers, mentors, professionals, often signposted from different organisations, each with their own pressures and ethos. The report urges that we “recognise the commonalities between men and women who use drugs as well as the differences; the diversity of experiences within each gender; and the intersections between gender and other axes of inequality, such as deprivation”.

Women in the grip of drug addiction are not necessarily more vulnerable than men. As we see from the data, men remain likelier to die as a direct result of substance misuse. However, women are vulnerable in very specific ways that most men won’t experience, which is why Scotland’s drug problem must incorporate a gender analysis. The differences between men and women, in relation to substance misuse, are underemphasised and misunderstood. For example, women tend to start using drugs later in life than men. Women are more likely to have partners or family members who use drugs and their patterns of drug abuse are often – though not always – influenced by those of their partner. Testimony from one woman revealed a perception that men and women turn to drugs for different reasons, and while this evidence is anecdotal, it warrants consideration.

Men are likelier to engage in health-risking drug-use to seek pleasure and novelty – before addictions develop. Women – though not always – turn to sedatives to alleviate physical or emotional pain later in life. For me, personally, this evidence is difficult to reconcile with my own experience, having developed a taste for sedatives at various points in my life. But regardless of that initial intuition, it’s clear, when you follow the evidence, that gender differences play a significant role in shaping the risk factors that lead to substance misuse.

“Anxiety, anxiety,” said one woman, “because my partners in the past have battered me, and I’ve got metal plates in my jaws, and just had bad experiences with guys, so.”

Drug misuse finds expression differently, depending on gender. This should not be a controversial notion to confront: hormones, menstruation, fertility, pregnancy, breastfeeding, and the menopause, have profound emotional and physical impacts on a woman’s mental health – though I’m sure for some reason, bros out there, fresh off the heels of the latest Rubin Report, will try to draw an equivalence between those inherently female disadvantages and their own male adversities, like having to put the toilet seat down after they pee. One review even speculated a potential equivalence between menopausal symptoms and those of opioid withdrawal; creating an additional risk factor, when women experiencing profound hormonal changes may regress into drug use because the physical and emotional symptoms of menopause can be trigger relapse.

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Then we have caring responsibilities to consider, whether it be children or elderly relatives, who tend to be looked after by women in families, though not in every case, obviously. Such responsibilities place tremendous strain on a woman’s time, given that many addiction support services operate within traditional office hours, making it harder to access support for drug or mental health problems. Given the current systemic context of austerity, some may even be forced to sell their grannies just to cover the cost of childcare which, incidentally, is even higher than many politicians’ opinions of themselves.

There are just so many basic practicalities that become barriers to women, that we can often overlook, either as men or as women who are fortunate enough to rely on familial or financial support. Simply boarding a bus with a pram can present the kind of logistical nightmare most motorists could never understand. As a father, I recognise that men face other challenges too and that sometimes it can be irritating or frustrating when they appear to be dismissed. But I’ve concluded that, while those frustrations are sometimes valid, it’s important not to hitch male issues onto what is clearly, in this case, an attempt to understand the barriers to recovery facing women.

While both sexes – and all genders – face barriers, women, it seems, continue to draw the shortest of straws. Nowhere is this more obvious, than in the socially corrosive nightmare of ideological austerity.