Scotland needs a fix
Sunday Times - Scotland, June 11, 2006
Professor Neil McKeganey, Scotland's leading
drugs expert Neil McKeganey says it's time for
radical solutions to the epidemic set to overwhelm
this country, reports Gillian Bowditch
The year is 2020, the time 10.30am. In the
centre of Glasgow a man lies slumped in a shop
doorway, a needle sticking out of his leg. A
couple of yards down the road a prostitute in a
drug-induced stupor sways on the pavement. The
newsstands in George Square announce Holyrood has
passed the controversial "ghettos for junkies
bill". There are syringes in the gutter.
This vision does not spring from the pen of Irvine
Welsh. According to Professor Neil McKeganey,
Scotland's leading drugs expert, this will be the
daily reality on the streets of our towns and
cities if we do not find an effective way of
tackling the drugs problem, which is threatening
to spiral out of control.
What makes his vision so chilling is that he is
one of the few Scots with a handle on the extent
of the drugs crisis facing Scotland.
McKeganey, who founded Glasgow University's Centre
for Drug Misuse Research in 1994, has frequently
found himself out of step with mainstream thought.
Last year, however, George W Bush's advisers in
the White House called on his expertise.
The Scottish executive's lack of understanding of
the drugs situation was revealed six months ago
when Jack McConnell, the first minister, was
forced to admit he did not know how many drug
rehabilitation places there were in Scotland and
his ministers admitted they had no idea how many
addicts were prescribed methadone.
McKeganey is on such intimate terms with the
statistics, he could recite them in his sleep. One
in 100 Scots is addicted to heroin. Of the 50,000
Scottish heroin addicts, more than half live in
Strathclyde, and the drugs trade in Glasgow is
worth more than the combined assets of Rangers and
Celtic football clubs. In proportional terms,
double the number of children live in
drug-addicted families in Scotland than in
"For many years there has been a perception that
society would always be able to accommodate the
drug problem," he says over coffee in his
bunker-like office on Glasgow's Dumbarton Road.
Born in Sussex and brought up in Aberdeen, he
measures his words carefully. There is a
diffidence in his voice completely at odds with
the urgency of his message. He believes we have
been fooling ourselves and are sleepwalking to
Only 2% of the adult population of Scotland is
addicted, but their impact is enormous. They are
responsible for almost 70% of crime in Glasgow.
Five hundred million pounds is spent annually on
services for addicts, an average of £10,000 a
head. At a time when National Health Service
budgets are being cut and patients are going to
court to secure access to life-saving cancer
drugs, it's a phenomenal amount of money.
"The scale of the problem is small relative to its
impact," explains McKeganey. "You are talking
about only 2% of the population creating an
enormous problem. But what if it were 3% or 4%?
That is still a tiny number of people, but the
problems they would generate could overwhelm our
"In 30 years the drugs problem has gone from
nonexistent to an epidemic. If that can happen in
a generation, what more can happen in the next 10
or 20 years? If we are at the margins of what our
society can cope with now, what would our society
look like if instead of 50,000 addicts we had
There is, he believes, no reason to assume drug
addiction in Scotland has reached a plateau.
"Just look at the figures for young people who
feel disenfranchised," says McKeganey. "I think it
is eminently feasible that it will creep up to 3%
or 4%, and many of the things we take for granted
now will have to change."
McKeganey, always a radical thinker, believes the
country must be prepared to contemplate radical
solutions. "We might have to create drug-free
communities using drug testing or restrict addicts
from retail areas between certain hours. It would
effectively create ghettos. But if we can't
control the addiction, all we can do is control
the movement of people.
"We have to consider how sustainable family life
would be in our communities if the level of
addiction goes much beyond 2%. Already you can go
to parts of Scotland where the drug problem is so
prevalent it is shaping communities. This gives
you a glimpse of what other communities might look
like in the future and it is a shocking prospect.
I think every aspect of our drugs policy should be
aimed at stopping this."
All of this begs the question: what are we getting
for the billions of pounds that have been sunk
into drug treatments in the past decade? Listen to
McKeganey and the answer is, not a lot. In
Strathclyde alone drug deaths are up 70% in a
"We're spending £500m a year on a maximum of
50,000 people," he says. "Most of them are not
even in programmes, so we're talking about a
massive amount of funding being targeted on a tiny
number of people."
McKeganey's research shows that where addicts are
enrolled in programmes that focus on abstinence,
they do well. If the principal aim is merely to
stabilise their drug use, by prescribing methadone
for example, the success rates are "pretty
meagre". Yet Scotland's response to the drug
problem is methadone. One-third of addicts are on
it. Last year 411,399 prescriptions were issued.
By 2012 the figure is expected to be more than 1m.
The policy is currently under review. McKeganey
says it is a legacy of the early 1990s, when
politicians, concerned that Scotland faced an HIV
epidemic fuelled by intravenous drug users,
switched from drug prevention and the treatment of
addicts to preventing the spread of HIV.
"People are now beginning to ask how effective
these services are in reducing criminality," he
says. "The evidence is that they are not
effective. I don't think our methadone programme
"When addicts look for help they say they want to
be free of drugs. What we are offering them is
methadone. We are substituting a drug they buy on
the street for a drug we prescribe. In what other
area of treatment would the medical profession get
away with that approach to patient care?"
McKeganey, who turned 50 this year, says he has
not used drugs and wonders whether people will
think his lack of experience diminishes his
A father to Rebecca, 17, Gabriel, 12, and
Danielle, 7, he is a strong advocate of discussing
drugs and their capacity to wreck lives with
children from an early age. He would like to see
more recovered addicts visiting schools.
His call, in The Sunday Times last February, for
addicts to lose custody of their children caused
outrage in some quarters. He remains unapologetic.
The treatment of these children is, he believes,
one of the biggest scars on our society.
"Simply stabilising addicts is not enough," he
says. "You have to get the drugs out of the home
or the children out of the home. People don't like
There are 60,000 Scottish children living in
drug-addicted families, according to his research,
and their experience of childhood is
unrecognisable to most of us.
"Their lives are literally being sacrificed to
their parents' drug addiction," he says. "These
children don't come second to the drugs; they come
sixth or seventh, if they register at all. Are we
really saying we have no better way of looking
after these children than their experience within
a negligent, chaotic, addict household?
"There seems to be an unfathomable acceptance of
just how bad our childcare provision is. That is
intolerable. The only thing worse than having a
childcare system that doesn't protect children is
knowing you have a childcare system that doesn't
protect children and not doing anything about it."
McKeganey believes that at the heart of any debate
about drugs policy must be an acknowledgment of
the moral dimension of drug use, whether it is
Kate Moss snorting cocaine at a party,
middle-class professionals smoking the occasional
spliff or hardened crack addicts shooting up in
None of these activities is morally neutral, he
"People talk about illegal drug use as if it is a
morally free domain," he says. "You get the
feeling it is unacceptable to raise the question
about morality. In the past 15 years we've said
drug use is neither good nor bad but addiction is
a problem. Therefore, if you have middle-class
individuals whose drug use does not appear to
generate addiction, it is not seen as a problem."
Our moral agnosticism is perhaps best seen in
regard to policy on cannabis.
Downgraded to a class C drug in 2004 by the then
home secretary, David Blunkett, it has been
subjected to more U-turns than a motorcycle stunt
team. Last week it was announced that those caught
with more than 5g could in future be jailed for up
to 14 years.
"I think cannabis is one of our most dangerous
drugs," says McKeganey.
"That's not because the medical harm is so acute -
although it clearly is for some users - but
because it has achieved what no other illegal drug
It has divested itself of its association with
illegality. It has become so commonplace and that
has opened up a portal of willingness to consume
mind-altering substances way beyond the drug
"Ecstasy is going the same way. It is associated
with lifestyle rather than pharmacology. But if
you want to tackle the drugs problem, you have to
tackle it at source and that source isn't heroin
but cannabis. If the 40% of teenagers now using
cannabis increases, that is not something we can
It could be of enormous significance."
He is wary of the clamour of voices, from Lord
McCluskey to Ben Elton, calling for heroin to be
decriminalised. Last week the former justice
minister, Richard Simpson, called for heroin to be
made available to addicts on the NHS. "Giving
heroin to drug addicts is not a treatment unless
it is decreased gradually with a view to their
abstinence. Anything else is state-sponsored drug
addiction," he says.
He also remains unconvinced it would halt the drug
barons. It could lead them instead to seek out new
markets, and be the ultimate quick fix with
disastrous consequences. So what should we be
doing about drugs in Scotland?
McKeganey believes policy should focus on three
areas: prevention, treatments that lead to
abstinence, and the vigorous pursuit of criminals
deriving income from the drugs trade. "Without
success on all three fronts this problem is going
to escalate," he says.
We are dangerously close to reaching a point where
we will be unable to distinguish between the legal
economy and the drugs economy, he believes.
"Colombia is a country shaped by its drug trade.
People say that could never happen here and they
might be right, but where are the impediments?"
As I rise to leave, McKeganey's grim prognosis
ringing in my ears, he says
apologetically: "I don't want to be a prophet of
doom." But the nature of the problem means he is
doomed to prophesise.
Whether he is fated to be a latter-day Cassandra
remains to be seen.