The Editor, Saturday 25 April 2020

A study by Glasgow Caledonian University has found that three quarters of drug users would make use of Drug Consumption Rooms (DCRs) were they to become available in Scotland.

The facilities, piloted in other EU countries, aim to provide a judgement-free space for addicts to inject themselves and minimise the risks posed by the sharing of needles by offering free sterile equipment.

The fact that drug users would avail of such a scheme is not surprising. Indeed, it’s perplexing that just three quarters of respondents to the study would take advantage of free equipment and a ‘safe’, legal place to shoot up. Blood borne diseases like hepatitis and HIV are common amongst heroin addicts and the proliferation of discarded needles in parks and other public areas of Glasgow demonstrates the acute level of drug consumption going on outdoors.

The drugs statistics in Scotland communicate the urgency of helping drug users. In certain parts of Scotland drug abuse has been prevalent for decades but in the last two years it has reached an an all time high. In February, it was reported that 1,187 people died of drug misuse in 2018 – a 27% increase on the previous year – and it is expected that the figures for 2019 (not yet released) will be even higher. The below chart from the BBC illustrates the stark contrast between Scotland and other nations.

February’s reports saw the issue being labelled a ‘public health emergency’ and resulted in separate summits by the Scottish Government and the UK Government. Over the last couple of months their deliberations have fallen out of the news agenda given the wider public health emergency of COVID-19 but Ministers do intend to set out a strategy for reducing drug deaths in the coming months.

The type of strategy they adopt will either see Scotland pursuing a more liberal harm reduction approach to drugs, with schemes like DCRs, or a conventional approach which promotes abstinence and rehabilitation.

The harm reduction approach goes something like this: ‘drug misuse is happening, it is at endemic levels and people are dying because they overdose or mix drugs. We stop users dying by allowing them to inject in supervised facilities. There may be an offer of help to quit drugs at the facilities but the main thing is to stop people dying.’

On the other hand, the more conventional abstinence approach supposes: ‘Drug use is happening and will continue to happen unless we get people off drugs. It is only by freeing people from addiction and rehabilitating them that we will effectively prevent drug abuse and drug deaths in the future.’

This is the logic behind both of these positions but it says nothing about the ethics of each.

You might say the harm reduction approach is ‘compassionate’. It recognises the shocking number of deaths happening, as well as the immense grip addiction has on people and offers an immediate solution; ‘safe’ injection, legal injection and the minimisation of risks associated with drug use. But is this really ethical? 

For one thing, it involves the state actively participating in drug use. Addicts are supplied with needles and allowed to ‘get high’ in a state facility. Furthermore, whether intentionally or not, the approach does lend drug use a measure of acceptability. Currently, persons found consuming illegal drugs in public would be arrested for breaking the law. Authorising drug use in this way could lead to a growing acceptance of it and lead to more people using.

Abstinence-based treatments present no such ethical dilemma. In this approach the state offers users support to quit drugs if they enrol in an abstinence programme. Usually drug users are provided accommodation, medical support and counselling over a period of weeks until they have managed to free themselves from dependence on a substance. They are then offered advice and guidance on getting a job, staying clear of drugs and a network of others who have conquered addiction to help them to stay drug free.

For Christians, the abstinence approach accords with Jesus’ teaching. It recognises that drug abuse does immense harm to individuals created in the image of God, and in society more widely, and neither commends nor facilitates it. Instead, it honours the Biblical exhortation to love one’s neighbour by helping people be free from addiction and suffering – even if the process is hard and painful.

Harm reduction, though motivated by compassion, doesn’t owe our neighbours the respect they deserve. In facilitating drug use, or normalising it, we participate in harming people and society at large. Even if the intention is to help people off drugs gradually, this end does not justify harm reduction’s means.

To tackle the drug death crisis properly, politicians must adopt an approach that frees people from addiction without participating in drug use. Drug Consumption Rooms, and the harm reduction approach more widely, are neither an ethical nor an effective solution to the problem. It is only through well-funded, abstinence-based programmes that Scotland will begin to recover from the current crisis.

It’s a hard truth that abstinence and rehabilitation is by far the more expensive option. Rather than setting up a few facilities like DCRs, it requires significant infrastructure, medical interventions, trained counsellors and ongoing support for users over months if not years. Will politicians be prepared to invest in this? Time will tell.

Whether or not they do the church has a role to play. Historically, it has offered the hand of friendship, support and guidance to those trapped in a cycle of addiction whilst the authorities looked helplessly on. Before long the church in Scotland may be called on to do the same. Are we willing?