Scotland's NHS
Here's a report from the BBC which tells you something about the prevailing culture within Scotland's NHS where, up until recently, drug addicts were provided with 'needle kits' in packs of 20 rather than just one at a time, resulting in huge waste.
Now I'm all in favour of imaginative policies to deal with drug abuse and the samples given from Canada seem well worth exploring, but at the same time surely the goal must always be getting people clean and off drugs altogether.
Although I see little evidence that this is really happening with Scotland's methadone programme, for example, which seems to have grown into a cottage industry, if you ask me.
Thousands of syringes found on Scotland's streets
By Marc Ellison & Eleanor Bradford
BBC Scotland
A bloodied syringe found discarded at Glasgow's Union Place, just metres from the bustling Gordon Street
More than 3,900 discarded needles were reported in nine of Scotland's largest towns and cities over two years.
The figure was revealed by a series of freedom of information requests to the local authorities covering Aberdeen, Cumbernauld, East Kilbride, Dundee, Edinburgh, Glasgow, Hamilton, Kirkcaldy, Livingston, and Paisley.
A total of 86 reports were made of needles in parks and close to schools.
The greatest numbers of needles were in Glasgow (2,438), and Aberdeen (532).
Despite having the tenth largest population in Scotland, Kirkcaldy reported the third highest number of discarded syringes (320).
You can see where the estimated 3,909 discarded needles were reported, as well as a description of where they were found, using the interactive map developed by BBC Scotland.
More than 3,900 discarded needles were reported in nine of Scotland's largest towns and cities over two years.
The figure was revealed by a series of freedom of information requests to the local authorities covering Aberdeen, Cumbernauld, East Kilbride, Dundee, Edinburgh, Glasgow, Hamilton, Kirkcaldy, Livingston, and Paisley.
A total of 86 reports were made of needles in parks and close to schools.
The greatest numbers of needles were in Glasgow (2,438), and Aberdeen (532).
Despite having the tenth largest population in Scotland, Kirkcaldy reported the third highest number of discarded syringes (320).
You can see where the estimated 3,909 discarded needles were reported, as well as a description of where they were found, using the interactive map developed by BBC Scotland.
Interactive map showing the location and number of discarded needle reports in Scotland's 10 largest towns and cities over a two-year period.
BBC Scotland asked Scotland's 10 largest local authorities how many reports they had received of discarded needles between 1 January 2012 and 31 December 2013.
The figures for the total number of needles reported to each of the local authorities have been deliberately under-estimated due to the vagueness or absence of descriptions in the reports. A report with an incomplete or missing description was treated as one needle, a report of "needles" as two, and if a range was given then the lower figure would be used.
Dundee was the only local authority not to provide data. The BBC was told it did not keep records of discarded needles. However, two of Dundee's eight local community planning partnerships recorded in their quarterly reports the recovery of 403 needles in the last 12 months.
The number of discarded needles in Edinburgh (193) and Paisley (217) are also likely to be higher because the data released did not include any report description.
The data reveals reports of discarded syringes between 2012 and 2013 declined significantly in Aberdeen, Edinburgh, Glasgow, Hamilton, and Livingston. But reports in Cumbernauld and Kirkcaldy increased by 150% and 7% respectively over the two-year period.
BBC reporters found seven discarded needles in just one half-hour period on Glasgow's back streets.
The bulk of syringes were reported in the heart of Glasgow - on St Vincent Street (55), Gordon Street (23), Trongate and Sauchiehall Lane (23 each), and Buchanan Street and Sauchiehall Street (20 each).
Number of needles reported (population ranking in brackets)
2,438 - Glasgow (1)
532 - Aberdeen (3)
320 - Kirkcaldy (10)
217 - Paisley (5)
193 - Edinburgh (2)
But David Liddell, director of the Scottish Drug Forum, said this discarded needle report data could serve to reinforce prejudice against a stigmatized and marginalized group.
"There are 60,000 people with drug problems [in Scotland] and within that you've got a proportion who continues to inject," he said.
"Those in this vulnerable population tend not to be that young and have been around for some time."
A recent NHS report stated that less than 3% of users had been using intravenous drugs for less than a year. By comparison, 40.9% of users had been using syringes for 11 to 19 years.
"Despite what the public might think, these users wouldn't just discard injecting equipment indiscriminately - they would be relatively careful about that," Mr Liddell said.
"If they were doing it, with the size of the population, then you would see a massive problem.
BBC Scotland asked Scotland's 10 largest local authorities how many reports they had received of discarded needles between 1 January 2012 and 31 December 2013.
The figures for the total number of needles reported to each of the local authorities have been deliberately under-estimated due to the vagueness or absence of descriptions in the reports. A report with an incomplete or missing description was treated as one needle, a report of "needles" as two, and if a range was given then the lower figure would be used.
Dundee was the only local authority not to provide data. The BBC was told it did not keep records of discarded needles. However, two of Dundee's eight local community planning partnerships recorded in their quarterly reports the recovery of 403 needles in the last 12 months.
The number of discarded needles in Edinburgh (193) and Paisley (217) are also likely to be higher because the data released did not include any report description.
The data reveals reports of discarded syringes between 2012 and 2013 declined significantly in Aberdeen, Edinburgh, Glasgow, Hamilton, and Livingston. But reports in Cumbernauld and Kirkcaldy increased by 150% and 7% respectively over the two-year period.
BBC reporters found seven discarded needles in just one half-hour period on Glasgow's back streets.
The bulk of syringes were reported in the heart of Glasgow - on St Vincent Street (55), Gordon Street (23), Trongate and Sauchiehall Lane (23 each), and Buchanan Street and Sauchiehall Street (20 each).
Number of needles reported (population ranking in brackets)
2,438 - Glasgow (1)
532 - Aberdeen (3)
320 - Kirkcaldy (10)
217 - Paisley (5)
193 - Edinburgh (2)
But David Liddell, director of the Scottish Drug Forum, said this discarded needle report data could serve to reinforce prejudice against a stigmatized and marginalized group.
"There are 60,000 people with drug problems [in Scotland] and within that you've got a proportion who continues to inject," he said.
"Those in this vulnerable population tend not to be that young and have been around for some time."
A recent NHS report stated that less than 3% of users had been using intravenous drugs for less than a year. By comparison, 40.9% of users had been using syringes for 11 to 19 years.
"Despite what the public might think, these users wouldn't just discard injecting equipment indiscriminately - they would be relatively careful about that," Mr Liddell said.
"If they were doing it, with the size of the population, then you would see a massive problem.
A discarded needle found in Glasgow's Sauciehall Lane.
"Some of these needles could be from more recreational users who maybe don't know how to dispose of them safely."
Mr Liddell said needle exchanges have been working hard to encourage users to return their equipment and that, while still a public safety concern, the number of discarded needles is quite small.
Targeting communities
A report released by the NHS in June 2013 reported the distribution of 3.95 million needles in 2011-2012.
The number of needles reported in Glasgow eclipses the 571 reported over an 18-month period in the Canadian city of Toronto - a city with 2.2 million more residents.
Other Canadian cities like Vancouver have taken a proactive approach in dealing with its well-documented battle with drug use, particularly on its Downtown Eastside. The city provides a supervised injection site and conducts regular needle sweeps in high drug-use neighbourhoods.
Similarly in Ottawa, the country's capital, the health authority there has implemented a Needle Hunters program which recovered 7,645 needles and 1,421 crack pipes just last year. The number of needles retrieved by these sweeps is far greater than the 751 reported by citizens to the city council.
Dr Carole Hunter, lead addiction pharmacist with NHS Greater Glasgow and Clyde, said the Canadian model was certainly worth exploring.
She explained: "We also realised that a lot of the discarded equipment was actually unused, so we now supply just what they need in individual one hit kits rather than the packs of 20."
Dr Hunter added that there's been a reduction in the number of needle pickups, and an increase in returned needles due to targeted community outreach efforts.
A young man sidled up to me the other day as I walked along Argyll Street in Glasgow - he announced apropos nothing that he was 'shit-faced' out of his head on drugs and then struck up a conversation, during which he told me his name was John.
In my personal experience people on drugs are seldom belligerent or aggressive whereas the opposite is often true when too much alcohol is involved, but I had an amiable chat with John as we strolled along a busy street in the middle of another rainy Glasgow day.
My new chum wanted to know what i did for a living and he seemed genuinely interested in what I had to say.
I wanted to know why a smart and pleasant young man spent his days completely wasted on drugs and the answer was he didn't really know - he was in a rut and a way of life that he couldn't break away from, so it was easier just to carry on and fund his drug habit from thieving and begging.
Now I said to myself afterwards that John was bound to have encountered the criminal justice system at different points in his relatively young life, so the obvious question to me was why was he not required to get clean at some point and break the cycle of drug taking, as a hard headed alternative to a long spell in prison?
My impression of the criminal justice system is that people like John are in and out of prison through short sentences which have no deterrent effect and no impact on his drug habit - either because he can access drugs in jail or is offered the methadone, as an artificial alternative to heroin.
In other words it's a cycle of despair that doesn't change anyone's life and instead allows hopeless drug addicts like John to remain at large where they spread misery within their local communities as a result of their chaotic lifestyles and habitual thieving.
So it seems to me that if anyone wants to do anything about the situation, the only strategy that will work is more direct intervention which combines very tough love as well as kindness towards the poor souls involved - because just writing your hands or wearing your political heart on your sleeve won't make a jot of difference to someone like John.
"Some of these needles could be from more recreational users who maybe don't know how to dispose of them safely."
Mr Liddell said needle exchanges have been working hard to encourage users to return their equipment and that, while still a public safety concern, the number of discarded needles is quite small.
Targeting communities
A report released by the NHS in June 2013 reported the distribution of 3.95 million needles in 2011-2012.
The number of needles reported in Glasgow eclipses the 571 reported over an 18-month period in the Canadian city of Toronto - a city with 2.2 million more residents.
Other Canadian cities like Vancouver have taken a proactive approach in dealing with its well-documented battle with drug use, particularly on its Downtown Eastside. The city provides a supervised injection site and conducts regular needle sweeps in high drug-use neighbourhoods.
Similarly in Ottawa, the country's capital, the health authority there has implemented a Needle Hunters program which recovered 7,645 needles and 1,421 crack pipes just last year. The number of needles retrieved by these sweeps is far greater than the 751 reported by citizens to the city council.
Dr Carole Hunter, lead addiction pharmacist with NHS Greater Glasgow and Clyde, said the Canadian model was certainly worth exploring.
She explained: "We also realised that a lot of the discarded equipment was actually unused, so we now supply just what they need in individual one hit kits rather than the packs of 20."
Dr Hunter added that there's been a reduction in the number of needle pickups, and an increase in returned needles due to targeted community outreach efforts.
The Drugs Don't Work (27 March 2014)
A young man sidled up to me the other day as I walked along Argyll Street in Glasgow - he announced apropos nothing that he was 'shit-faced' out of his head on drugs and then struck up a conversation, during which he told me his name was John.
In my personal experience people on drugs are seldom belligerent or aggressive whereas the opposite is often true when too much alcohol is involved, but I had an amiable chat with John as we strolled along a busy street in the middle of another rainy Glasgow day.
My new chum wanted to know what i did for a living and he seemed genuinely interested in what I had to say.
I wanted to know why a smart and pleasant young man spent his days completely wasted on drugs and the answer was he didn't really know - he was in a rut and a way of life that he couldn't break away from, so it was easier just to carry on and fund his drug habit from thieving and begging.
Now I said to myself afterwards that John was bound to have encountered the criminal justice system at different points in his relatively young life, so the obvious question to me was why was he not required to get clean at some point and break the cycle of drug taking, as a hard headed alternative to a long spell in prison?
My impression of the criminal justice system is that people like John are in and out of prison through short sentences which have no deterrent effect and no impact on his drug habit - either because he can access drugs in jail or is offered the methadone, as an artificial alternative to heroin.
In other words it's a cycle of despair that doesn't change anyone's life and instead allows hopeless drug addicts like John to remain at large where they spread misery within their local communities as a result of their chaotic lifestyles and habitual thieving.
So it seems to me that if anyone wants to do anything about the situation, the only strategy that will work is more direct intervention which combines very tough love as well as kindness towards the poor souls involved - because just writing your hands or wearing your political heart on your sleeve won't make a jot of difference to someone like John.
Crazy Policy (12 March 2014)
I've been critical of methadone programmes in the past, but the death of a two-year old girl who ingested this drug in her own home where she was supposed to be safe convinces me that this is a policy which has lost its way.
Why would anyone trust drug addicts to take such a dangerous substance back into their own homes, especially one where young children live?
Expensive Medicine (8 March 2012)
The Daily Record may be turning over a new leaf .
For years the newspaper has been a boring cheerleader for the Scottish Labour party - still is sometimes - but the are encouraging signs that things are changing.
Just the other day the Daily Record ran an interesting article on the cost of Scotland's methadone habit - which raised some serious issues.
Here's an extract of what the paper had to say - but the key point is that the methadone programme is supposed to be weaning people off drugs for good - not replacing one habit with another.
Apparently you can get methadone in prison as well - which may be a good idea in certain circumstances - but I wonder if that's still the case for the repeat offenders who make up much of the prison population.
In any event it can only be a good thing if people are questioning the effectiveness of the policy.
Because there's no doubt that methadone programme is a very expensive business - in more ways than one.
Scottish GPs are raking in more than £8million writing methadone prescriptions for drug addicts, the Record can reveal.
Government stats released last week claimed the heroin substitute cost taxpayers £28million a year.
But the figure didn’t take into account the annual £372.93p GPs are handed for every patient still on the drug.
A further flat fee of £1000 a year is also paid to every surgery that deals with methadone users.
The hidden cost – that Scottish Government health officials don’t even add up on a national basis – takes the true cost of keeping 22,000 Scots on methadone to £36million.
A spokesman for the British Medical Association in Scotland didn’t dispute the Record’s figure last night.
He said: “The fee is based on a contract negotiated in 2004 and the price hasn’t increased since then.
“It would be much more expensive to deliver these services in hospitals or at dedicated health centres.”
This week the Record revealed how drug companies charged £8.68million last year for the raw ingredients in methadone.
Pharmacies then claimed £19.2million for buying in the liquid and dishing it out in plastic cups.
Medics say methadone cuts crime and stabilises addicts.
But former users claimed it stole years of their life and left them more addicted to drugs than ever.
Mum-of-one Louisa Semple, 31, of Barrhead, Renfrewshire, said: “I was addicted to heroin by the age of 16. My doctor put me on methadone when I was 17 and I started off on 40mls and ended up on 105mls.
“When I told my doctor I wanted to quit at 26 he told me there was no way and that I was on the drug for the rest of my life. He told me he’d give me some antipsychotics as well.
“But I finally did quit and I haven’t taken any drugs for three years.”
A spokesman for Community Pharmacy Scotland last night defended their members.
He said: “Pharmacists are paid for dispensing methadone to patients for whom it is prescribed by their GP or addiction team as they would be for any NHS prescription they dispense.
“Pharmacists for whom this is a significant task will invariably require to invest in additional staff, additional training and in alterations to premises and sometimes investment in additional technology.
Yesterday, MSP Greame Pearson called for details to be collected to see if the methadone programme was actually working.
The Daily Record may be turning over a new leaf .
For years the newspaper has been a boring cheerleader for the Scottish Labour party - still is sometimes - but the are encouraging signs that things are changing.
Just the other day the Daily Record ran an interesting article on the cost of Scotland's methadone habit - which raised some serious issues.
Here's an extract of what the paper had to say - but the key point is that the methadone programme is supposed to be weaning people off drugs for good - not replacing one habit with another.
Apparently you can get methadone in prison as well - which may be a good idea in certain circumstances - but I wonder if that's still the case for the repeat offenders who make up much of the prison population.
In any event it can only be a good thing if people are questioning the effectiveness of the policy.
Because there's no doubt that methadone programme is a very expensive business - in more ways than one.
Scottish GPs are raking in more than £8million writing methadone prescriptions for drug addicts, the Record can reveal.
Government stats released last week claimed the heroin substitute cost taxpayers £28million a year.
But the figure didn’t take into account the annual £372.93p GPs are handed for every patient still on the drug.
A further flat fee of £1000 a year is also paid to every surgery that deals with methadone users.
The hidden cost – that Scottish Government health officials don’t even add up on a national basis – takes the true cost of keeping 22,000 Scots on methadone to £36million.
A spokesman for the British Medical Association in Scotland didn’t dispute the Record’s figure last night.
He said: “The fee is based on a contract negotiated in 2004 and the price hasn’t increased since then.
“It would be much more expensive to deliver these services in hospitals or at dedicated health centres.”
This week the Record revealed how drug companies charged £8.68million last year for the raw ingredients in methadone.
Pharmacies then claimed £19.2million for buying in the liquid and dishing it out in plastic cups.
Medics say methadone cuts crime and stabilises addicts.
But former users claimed it stole years of their life and left them more addicted to drugs than ever.
Mum-of-one Louisa Semple, 31, of Barrhead, Renfrewshire, said: “I was addicted to heroin by the age of 16. My doctor put me on methadone when I was 17 and I started off on 40mls and ended up on 105mls.
“When I told my doctor I wanted to quit at 26 he told me there was no way and that I was on the drug for the rest of my life. He told me he’d give me some antipsychotics as well.
“But I finally did quit and I haven’t taken any drugs for three years.”
A spokesman for Community Pharmacy Scotland last night defended their members.
He said: “Pharmacists are paid for dispensing methadone to patients for whom it is prescribed by their GP or addiction team as they would be for any NHS prescription they dispense.
“Pharmacists for whom this is a significant task will invariably require to invest in additional staff, additional training and in alterations to premises and sometimes investment in additional technology.
Yesterday, MSP Greame Pearson called for details to be collected to see if the methadone programme was actually working.
Evil Weed (10 June 2013)
I heard a report the other day which suggests to me that smoking cessation is turning into something of a 'cottage industry' these days.
One that provides a heathy living for people who can find ever more ingenious ways of dealing with the smoking habit - but without ever insisting that, at some point, smokers just have to make up their minds to stop.
The report suggested that maybe smokers should continue slapping on patches and taking nicotine tablets and whatnot - even while they are still smoking - because that will help cut down their the amount of 'bad' nicotine they absorb through smoking cigarettes.
Now the report didn't say who was paying for all these patches and tablets and multiple smoking cessation treatments - although I imagine it involves the public purse, as usual.
Speaking as an ex-smoker myself I have to say it's completely bonkers if public money is involved in this madcap plan - because the only way to give up the 'evil weed' is because you really want to at the end of the day.
And while I can see the sense in giving people a bit of help to quite the nasty habit - there has to be some real personal commitment at the end of the day - otherwise it's a complete waste of time, effort and resources.
I am a great supporter of the NHS but I don't admire everything it does and here's a good example of where money could be spent on other, far more sensible things.
Instead of expanding a 'smoking cessation' service without any convincing analysis to explain how more public money can replace the level of personal commitment required to give up their cigarettes.
The whole thing smacks to me of Scotland's hopelessly inadequate and depressing 'methadone' programme - which was supposed to be a relatively short-term way to help wean people off of their heroin addiction.
Instead many of the people are still on the heroin substitute many years later - and with little evidence to show that the methadone programme has actually helped them get to grips with and make some real changes to their chaotic lives.
So it seems to me that the 'programme' has become an end in itself - a little cottage industry which has become lazy, complacent and no longer interested in achieving an outcome.
Now nicotine and heroin are two very different drugs, but the principle of dealing with addiction has to be the same - and surely the number one objective has to be to draw a line and stop for good.
I heard a report the other day which suggests to me that smoking cessation is turning into something of a 'cottage industry' these days.
One that provides a heathy living for people who can find ever more ingenious ways of dealing with the smoking habit - but without ever insisting that, at some point, smokers just have to make up their minds to stop.
The report suggested that maybe smokers should continue slapping on patches and taking nicotine tablets and whatnot - even while they are still smoking - because that will help cut down their the amount of 'bad' nicotine they absorb through smoking cigarettes.
Now the report didn't say who was paying for all these patches and tablets and multiple smoking cessation treatments - although I imagine it involves the public purse, as usual.
Speaking as an ex-smoker myself I have to say it's completely bonkers if public money is involved in this madcap plan - because the only way to give up the 'evil weed' is because you really want to at the end of the day.
And while I can see the sense in giving people a bit of help to quite the nasty habit - there has to be some real personal commitment at the end of the day - otherwise it's a complete waste of time, effort and resources.
I am a great supporter of the NHS but I don't admire everything it does and here's a good example of where money could be spent on other, far more sensible things.
Instead of expanding a 'smoking cessation' service without any convincing analysis to explain how more public money can replace the level of personal commitment required to give up their cigarettes.
The whole thing smacks to me of Scotland's hopelessly inadequate and depressing 'methadone' programme - which was supposed to be a relatively short-term way to help wean people off of their heroin addiction.
Instead many of the people are still on the heroin substitute many years later - and with little evidence to show that the methadone programme has actually helped them get to grips with and make some real changes to their chaotic lives.
So it seems to me that the 'programme' has become an end in itself - a little cottage industry which has become lazy, complacent and no longer interested in achieving an outcome.
Now nicotine and heroin are two very different drugs, but the principle of dealing with addiction has to be the same - and surely the number one objective has to be to draw a line and stop for good.
