Problem drug use in Scotland follow-up: Glasgow’s Safer Drug Consumption Facility

We call on both Governments to adopt a balanced, evidence-based approach to problem drug use. (Conclusion, Paragraph 35)

We recognise that the opening of The Thistle on a pilot-basis presents an opportunity to test the effectiveness of SDCFs in Glasgow’s unique context. We believe the evidence provided by the independent evaluation panel should be determinative in discussions about The Thistle’s future beyond the three-year pilot. If the evaluation does not demonstrate the facility’s efficacy, it is difficult to see how The Thistle — or any other SDCFs in Scotland — could proceed. (Recommendation, Paragraph 36)

A range of rationales have been given for why there is a need for The Thistle and what effect it is intended to have. This has been unhelpful to public understanding of the facility and may result in unrealistic expectations of its impact. Moving forward, it is imperative that the rationale and objectives of the facility are clear, and articulated in a consistent, disciplined manner. (Conclusion, Paragraph 37) The legal position of The Thistle

The current Lord Advocate’s statement of prosecution policy has been pivotal in enabling The Thistle to open. However, the Lord Advocate’s prosecutorial discretion is not a substitute for a considered legal framework to enable and regulate safer drug consumption facilities. The Thistle’s current legal position creates potential risks for people operating and using the facility. While the operators of The Thistle have reassured the Lord Advocate that the possibility for offences other than possession can be mitigated through strict standard operating procedures, only a full legal framework can offer certainty to the people who are operating and using the facility. (Conclusion, Paragraph 67)

There has been interest in establishing SCDFs in other parts of Scotland, and the Lord Advocate has indicated that she will consider any such applications on their merits. Rather than having multiple facilities with individual 48 prosecution policy arrangements, it would be more appropriate for them to operate on a clear, legal basis, common to all. This would require legislative action from the UK Government and UK Parliament. (Conclusion, Paragraph 68) A gold standard service

Given the severity of problem drug use in Glasgow, it is clear that decisive, radical action is needed. The Thistle is a gold standard facility and represents an intervention that is commensurate with the scale of Glasgow’s drug problem. However, it is also expensive. The Thistle could prove good value by saving money elsewhere in the health service, but it will be for the Scottish Government and Glasgow City Council to determine this following the evaluation, and to decide whether to continue The Thistle’s funding beyond the three-year pilot. We note that The Thistle is described as ‘gold standard’, and consider that a less sophisticated model of the facility could potentially offer corresponding harm reduction benefits, at a reduced cost. But, given that the pilot is being run as the stated ‘gold standard’ model, the effectiveness and therefore value for money and harm reduction capability of a less sophisticated model would remain untested and therefore largely unknown. (Conclusion, Paragraph 82)

However, any discussion of the cost of The Thistle must be considered in the context of Scotland’s drugs crisis, with 1,172 people having died from drugs in 2023 alone. While it is right that the cost of The Thistle is properly considered, it must be recognised that the scale of Scotland’s emergency inevitably requires a commensurate response that must entail significant investment. (Conclusion, Paragraph 83)

It is also clear to us that SDCFs must not come at the cost of funding current recovery services. It is not an ‘either/or’. Rather, SDCFs are just one tool available to combat problem drug use, which is complementary to, and works in tandem with, recovery services. (Conclusion, Paragraph 84)

The Thistle is an example of just one model of a safer drug consumption facility, and it is possible that others — such as mobile units — could provide more cost-effective solutions, or interventions better suited to the needs of local populations. There could be merit in exploring other service models, such as mobile units, which would complement The Thistle, or be an alternative to the facility, particularly if funding for the site becomes a challenge. Alternative operating models may also be better suited to serving communities elsewhere in Scotland and could be part of any discussion if additional locations are to be considered. (Conclusion, Paragraph 91) 49 Local community

Community support and the impact of the SDCF on the local community is of paramount importance to the success of The Thistle. While we are reassured that the ongoing independent evaluation is monitoring the levels of discarded paraphernalia and the wider impact on the local community, and recognising the international evidence suggesting that SDCFs reduce levels of publicly discarded drug litter and antisocial behaviour, the concerns of the local community need to be taken seriously. (Conclusion, Paragraph 103)

A responsive communication strategy must be developed by The Thistle, agreed by the Community Forum, and put in place as soon as possible in order to support the community engagement and partnership working that is crucial to the success of the project. (Conclusion, Paragraph 104)

It is vital that key stakeholders of The Thistle are engaged to address concerns about the impact of the facility and continue to work with the local community on how to address any concerns raised. We recognise that it may take time for the local effects of The Thistle to be fully understood and assessed. We therefore await the independent evaluation to objectively understand the impact on the local community. (Recommendation, Paragraph 105) Expansion of services

Drug trends in Scotland have changed and are changing. For The Thistle to be effective, it must be able to meet the needs of the population it is trying to help, which it cannot do without an inhalation room. As well as making the facility accessible to those who inhale drugs, encouraging visitors to change their method of consuming drugs from injecting to inhaling can be an important harm reduction step. Legal barriers currently prevent an inhalation room operating at The Thistle. (Conclusion, Paragraph 115)

The Lord Advocate believes that widening the statement of prosecution policy to allow an inhalation room to operate is undesirable and we understand the reasons she has given. However, given that expert medical advice suggests that allowing the inhalation of drugs would increase opportunities for harm reduction, any future application for an inhalation room should be considered on its merits by the Lord Advocate and Scottish Government. (Conclusion, Paragraph 116)

Having access to equipment such as single-use tourniquets, testing drugs onsite, and allowing visitors to inhale drugs have all been highlighted as key to The Thistle achieving its maximum effectiveness. Without these, a full and fair evaluation of The Thistle will be inhibited. (Conclusion, Paragraph 126) 50

If an application for exemptions from the Misuse of Drugs Act 1971 to enable the provision of medical equipment at The Thistle were made by Glasgow City HSCP or the Scottish Government, the UK Government should consider such an application on its merits, as evidence suggests this could enable The Thistle to maximise its effectiveness. (Recommendation, Paragraph 127)

The Home Office should urgently complete its assessment of The Thistle for a drug checking licence and should ensure any necessary support is provided to ensure The Thistle is successful in its application. The Home Office should provide an update on the progress of the drug checking license in its response to this report. (Recommendation, Paragraph 128) The future of SDCFs in Scotland

The Minister has stated that the UK Government will consider the evidence emerging from the pilot. However, it was clear from the Minister’s evidence that the Home Office will not make legislative changes, even if the evaluation finds that the facility has been effective in meeting its aims. The UK Government should not approach the evaluation having already made up its mind about the future of The Thistle. The UK Government should seriously consider the evaluation and, if the outcomes are positive, should consider the merits of SDCFs alongside consideration of other interventions to tackle problem drug use. (Conclusion, Paragraph 135)

The UK Government must demonstrate that it has an evidence-based approach to policy making and will consider the independent evaluation of The Thistle. Any intervention found to be effective at saving lives and reducing harm should not be dismissed. (Recommendation, Paragraph 136)

Without the UK Government’s approval or a change in legislation, The Thistle and potential other Safer Drug Consumption Facilities could, theoretically, continue to operate in Scotland indefinitely but this is not a desirable situation as their status would be precarious and uncertain. (Conclusion, Paragraph 137)

If the independent evaluation of The Thistle deems the pilot a success, and the Scottish Government proceeds to make The Thistle permanent, and perhaps to open further SDCFs, the UK Government should work with the Scottish Government to make the necessary changes to reserved legislation to ensure there is a full, sustainable legal framework for Safer Drug Consumptions Facilities in Scotland. (Recommendation, Paragraph 138) 51