EXPERTS have agreed that public health initiatives like The Thistle are "without a doubt" saving lives, but say more radical change is needed to tackle Scotland's drug deaths crisis.
Scotland has grappled with some of Europe's highest rates of drug use since the 1980s and 1990s, and news of an 11% rise in drug deaths has sparked renewed scrutiny of the government's strategy.
At First Minister's Questions, John Swinney came under pressure from opposition parties over the latest figures, but despite criticism, there wasn't a clear solution from any party.
While the Scottish Government backs the legalisation of drugs, progress on that front remains limited. Despite this, last year, a more radical harm reduction step was taken when the first safe consumption room opened in Glasgow.
On Thursday, Conservative leader Russell Findlay said the units weren't working and criticised the spending of £2.5 million for a facility in Edinburgh.
Responding, Swinney said that without the facility, figures "would've been worse", citing 195 "medical emergencies" that staff had dealt with.
Speaking to The National, leading academics in addiction and substance use have welcomed The Thistle, with Professor Catriona Matheson and Professor Roy Robertson agreeing the work of staff there has saved lives.
Matheson said: "The evidence is really strong. We know that they do save lives; there's no doubt about that. The Thistle is clearly doing a good job.
"It's gold standard treatment; it's got everything, and other parts of the country can't afford that level of service. Other models need to be considered."
On the criticism that the policy has previously attracted, she said: "Some people are ideologically opposed to the idea that you're helping somebody use drugs.
"The way I would look at it, it's a public health approach; you're just trying to work with somebody where they're at in their life and their drug.
It's not about condoning drug use; it's about saying, okay, you're using drugs and trying to use that interaction as a way of bringing them into treatment."
She says the government could extend provision by considering smaller consumption rooms which could be established in Glasgow, Dundee and Edinburgh.
It's clear that 2026 drug threats are different to those of the past, and a synthetic drug surge has presented major challenges to policymakers, the NHS and charities dealing with cases.
But Robertson says it's not a uniquely Scottish issue.
"It's easier for the legal black market to make synthetics rather than bring opium in or bring heroin in across continents.
"It's a sort of modern development, and I don't think it is just Scotland. I think it's probably going to emerge across Europe," he said.
Matheson, a former chair of the Ministerial Drug Death Task Force, says there are strategies which are working. She says naloxone (the overdose-reversal drug) access has been widened, medical treatment is quick and strong overdose response plans are in place.
But the persisting problems are systemic poverty and family adversity, difficulty with individuals receiving GP care, and individuals being passed from-service to service.
It's clear from the experts that change needs to be big and bold, and to challenge the way we think about tackling these issues.
Robertson, a former GP who worked in one of Edinburgh's most deprived areas in the 80s, says much more research needs to be done; there needs to be a bigger priority on cross-service communication to "share responsibility."
He suggested palliative care as a response to those in the worst cases.
"We need to get some people into a sort of palliative care situation where we're expecting them not to get better. But we need to treat people, help them, monitor them and find out what's going on.
"What are the characteristics behind these figures? There's good research from Australia which estimates that for every one death we record, there's probably another two," he said.
On Matheson's views of legalisation as a way forward, she said: "I may have come round to that after many years of deliberating about this.
"I think that would take it out of the hands of these international drug markets. They're the ones who are causing such chaos, with people's lives here.
"We've got to be a bit more radical on drugs. I can't see that happening anytime soon, but it's something we need to have a serious debate about."
Robertson added: "I always feel a sense of sorrow every year; there's a lot of death- three per day; it's just terrible.
"I just hope that things will turn down eventually. They probably will, because we're going through this period of legacy of the group that started in the 1980s, so I think it'll go down slowly over the next few years."
