CURRENT STATE OF THE SECTOR
Scotland faces one of the most significant drug challenges in Europe, with drug-related deaths and crime presenting complex, interconnected issues for communities across the country. The scale of the problem has prompted a fundamental shift in approach, moving from treating drug misuse primarily as a criminal justice issue to recognizing it as a public health emergency requiring compassionate, evidence-based interventions.
Since 2016, the Scottish Government has increasingly treated drug use as a public health issue rather than solely a criminal justice matter. This shift recognizes that substance misuse often stems from and contributes to complex social, economic, and health inequalities that cannot be addressed through enforcement alone.
Scotland’s drug-related death rate remains among the highest in Europe, with 1,330 drug-related deaths recorded in 2021. This sobering statistic underscores the urgency of developing more effective approaches to substance misuse that can both reduce harm and address associated criminal behavior.
THE PUBLIC HEALTH APPROACH
Person-Centered Strategies
At the heart of Scotland’s evolving approach is a commitment to person-centered care that recognizes the complex needs of individuals struggling with substance misuse. The Drug Deaths Taskforce response, published in January 2023, outlines a holistic approach that considers how different systems and services can work better together to serve the needs of specific groups.
This approach acknowledges that many people who misuse substances have experienced significant trauma, mental health challenges, and social disadvantage. Rather than focusing narrowly on substance use or criminal behavior in isolation, person-centered approaches seek to address the whole person and their circumstances.
Key elements of this approach include:
•Trauma-informed practice that recognizes and responds to the impact of adverse experiences
•Recognition of co-occurring mental health conditions
•Attention to social determinants such as housing, employment, and relationships
•Involvement of people with lived experience in service design and delivery
Justice System Innovations
The justice system plays a crucial role in Scotland’s public health approach to drug-related crime. Rather than relying primarily on incarceration, which often fails to address underlying substance use issues, Scotland has developed several innovative approaches:
Diversion from Prosecution
Prosecutors in Scotland have the option to divert appropriate cases away from the court system and toward support services. For individuals whose offending is linked to problematic substance use, this can provide an opportunity to address underlying issues without the additional burden of a criminal conviction.
Drug Treatment and Testing Orders (DTTOs)
These court-ordered interventions provide structured treatment and regular drug testing for individuals whose offending is directly linked to substance misuse. DTTOs aim to break the cycle of addiction and crime by addressing the root cause while maintaining accountability through court oversight.
Community Payback Orders with Drug Treatment Requirements
These orders combine community service with mandatory engagement in drug treatment services, providing both reparation to communities and support for recovery.
Prison to Rehab Pathway
Recognizing that the transition from prison back to the community is a particularly vulnerable time for people with substance use issues, Scotland has developed a Prison to Rehab protocol. This pathway, established in March 2023, allows access to residential rehabilitation immediately upon release from prison, supported by National Mission funding.
The protocol sets out processes for prison-based staff, rehabilitation providers, and individuals to ensure a seamless transition that supports recovery and reduces the risk of reoffending.
Strengthening Pathways Between Services
A key element of Scotland’s approach is strengthening pathways between prison, police custody, and community services. This ensures that consistent care can be offered as people move between different parts of the system, reducing the risk of disengagement and relapse.
These efforts include:
•Improved information sharing between criminal justice and healthcare services
•Naloxone provision in police custody and upon prison release to prevent overdose deaths
•Through-care support to help individuals navigate the transition from custody to community
•Rapid access to community-based treatment following contact with the justice system
ADDRESSING SUPPLY AND DEMAND
While the public health approach emphasizes treatment and support, Scotland maintains a balanced strategy that also addresses the supply of harmful substances.
Tackling Organized Crime
Disrupting drug supply and targeting serious organized crime groups remains a priority for the Scottish Government. Scotland’s Serious Organised Crime strategy, updated in February 2022, identifies the need to make greater use of the Scottish Multi-Agency Strategic Threat Assessment to ensure that enforcement efforts target the threats causing the most harm.
The Serious Organised Crime Taskforce coordinates work across public, private, and third sectors to implement this strategy, combining traditional enforcement with innovative approaches to community resilience and prevention.
Prevention and Early Intervention
Prevention forms a crucial part of Scotland’s approach to reducing drug-related harm and associated crime. This includes:
Education and Awareness
Scotland’s approach to prevention includes work with young people, providing early access to support and addressing the supply of harmful drugs. Education and prevention are integral to reducing the number of young people who use drugs, with evidence showing that many people in Scotland start their drug and alcohol use at an early age.
The personal and social education review published in 2019 identified substance use as one of the priority areas school nurses can support young people with. Additionally, Scotland is supporting partners like Winning Scotland to deliver Planet Youth, an evidence-based model that encourages cultural and structural change for substance use prevention.
Supporting Families
Scotland made “The Promise” in 2020, following the Independent Care Review, outlining that the government must take a more flexible, whole-family approach to supporting children and young people living with parents with substance use dependency.
The “improving holistic family support framework” published in 2021 sets out that family members affected by a loved one’s substance use should receive consistent support in their own right, recognizing the intergenerational impact of substance misuse.
ADDRESSING SPECIFIC NEEDS
Scotland’s public health approach recognizes that different groups may have specific needs that require tailored responses:
Women
As outlined in the Drug Deaths Taskforce women’s report (November 2021), women affected by substance use often have poor physical and mental health and face additional barriers and stigma when trying to access support. This can be particularly acute for women with children.
Scotland is taking specific steps to implement a gendered approach across the National Mission on drugs, including developing a good practice guide for anyone working with women and infants affected by substance use during the perinatal period.
Mental Health
The co-occurrence of substance use and mental health problems presents particular challenges for effective intervention. Many people affected by substance use are also struggling with their mental health and wellbeing, and accessing treatment for co-occurring conditions can sometimes be extremely difficult.
Scotland commissioned a rapid review into mental health and substance use services, “The Way Ahead,” which identified key recommendations to improve care for people with co-occurring mental health and substance use issues. This work recognizes the need for integrated approaches that address both mental health and substance use simultaneously rather than treating them as separate issues.
Housing
Stable housing is fundamental to recovery from substance use problems and reducing associated offending. Scotland is working to strengthen partnerships between health, homelessness, and frontline services to improve outcomes.
The Housing Bill includes new prevention duties on public bodies, including justice, health, and social care. These new duties seek to improve case coordination where a person has multiple and complex needs, including drug dependency.
Scotland also provides grant funding under the Dual Housing Support Fund, offering immediate support to people in receipt of social security payments who want to keep their core tenancy when going into residential rehabilitation.
CHALLENGES AND OPPORTUNITIES
Despite significant progress in developing a public health approach to drug-related crime, several challenges remain:
Legislative Constraints
The Scottish Government and consecutive Scottish Ministers have called on the UK Government for a review of the Misuse of Drugs Act (1971) and how it could be changed to enable a more comprehensive public health approach to the drugs emergency in Scotland. As drug policy remains largely reserved to Westminster, Scotland’s ability to implement certain harm reduction measures is limited.
Resource and Capacity Issues
Implementing a truly integrated public health approach requires substantial resources and capacity across multiple systems. Scotland’s 31 Alcohol and Drug Partnerships, responsible for developing local strategies to tackle harm from substance use disorders, face varying challenges in terms of funding, workforce, and service provision.
Stigma and Public Perception
Stigma remains a significant barrier to effective engagement with services for many people who use drugs. Changing public perceptions and reducing stigma is essential for creating an environment where people feel able to seek help without judgment.
THE WAY FORWARD
Scotland’s journey toward a more effective, compassionate approach to drug-related crime continues to evolve. Several key developments point the way forward:
Rights-Based Approaches
In December 2024, Scotland launched a Charter of Rights for People Affected by Substance Use, a first-of-its-kind document aimed at ensuring that individuals are treated with dignity and respect across all services. This rights-based approach represents an important shift in how society views and responds to substance use issues.
Enhanced Collaboration
Continued strengthening of partnerships across health, social care, housing, justice, and other sectors will be essential for delivering truly integrated support. This includes developing shared outcomes, joint commissioning arrangements, and collaborative workforce development.
Evidence-Based Innovation
Ongoing evaluation and research will be crucial for refining approaches and identifying effective interventions. Scotland’s commitment to evidence-based policy provides a foundation for continuous improvement and innovation.
CONCLUSION
Scotland’s shift toward a public health approach to drug-related crime represents a progressive, evidence-based response to a complex social challenge. By recognizing the interconnected nature of substance misuse, health inequalities, and criminal behavior, this approach offers the potential for more effective, sustainable solutions.
The journey is not complete, and significant challenges remain. However, the direction of travel is clear: toward a more compassionate, integrated approach that addresses the root causes of drug-related harm while maintaining community safety.
As this approach continues to develop and mature, the potential exists to create a system that truly serves the needs of individuals, families, and communities affected by substance misuse—one that offers pathways to recovery, reintegration, and reduced offending through support rather than punishment alone.
Scotland’s experience offers valuable lessons for other jurisdictions grappling with similar challenges, highlighting both the potential of public health approaches and the complexity of implementing them effectively in the context of existing systems and structures.
