What happens when a drug crisis becomes ordinary?

Scotland has had a drug crisis for so long that we have learned to live alongside it. But 1,133 deaths in a year should not be something we simply learn to accept.

I lived in Dundee for eight years, and for a lot of that time, drug use was simply part of the landscape.

My old flat was down an alley where people bought and injected drugs. People would sometimes use the close as somewhere to shelter. People were sleeping rough, people passed out near shops daily, people wandered into traffic, and people shouted to one another across the street. I saw people collecting methadone from Boots, stealing food from Greggs, and doing deals at bus stops in front of everyone. You gradually became familiar with them. When they were sober, they wouldn’t badger you; they’d smile and tell you to have a nice day, calling you “sweetheart” as they sat on their piece of cardboard.

Later, when I lived further out of the city centre, multiple people were found dead from drug-related causes on my street. None of this felt particularly extraordinary after a while. That, I think, is one of the most disturbing things about Scotland's drug crisis. We have become very good at living alongside it.

We have a language for the people affected by it, too. “Junkies” is still used casually, often as a joke. People complain about them in the same way they complain about seagulls: they're noisy, they're in the way, they're stealing things, they're making the place look bad.

And then, occasionally, one of them dies.

The latest figures from the National Records of Scotland tell us that 1,133 people died from drug use in Scotland in 2025. That is 116 more deaths than the previous year, an increase of 11%. The rate is now four times what it was when the current series began in 2000. The average age of someone dying has risen from 32 to 46.

These are enormous numbers. But numbers have a strange capacity to make enormous things feel abstract.

One thousand one hundred and thirty-three people means one thousand one hundred and thirty-three families, friendships, arguments, birthdays, stupid jokes, unfinished plans and people who were expected to be there next week.

Instead, we have become accustomed to saying “drug deaths” as though it describes a natural phenomenon rather than the end of somebody's life.

The geography of those deaths tells us something important, too. In 2025, the drug death rate in Scotland's most deprived areas was 15 times the rate in the least deprived. For deaths from all causes, the equivalent gap was around twice as large. Over the five years from 2021 to 2025, Dundee was among the council areas with a significantly higher drug death rate than Scotland as a whole, alongside Glasgow, North Ayrshire, Inverclyde, West Dunbartonshire and East Ayrshire.

That does not mean that poverty mechanically produces addiction, or that everyone who uses drugs is poor. It does mean that drug deaths are profoundly patterned by the circumstances in which people live.

And those circumstances are not just about drugs.

They are about housing, mental health, trauma, poverty, homelessness, insecure work, physical health, and the availability of treatment. They are about what happens when a person has very little stability in their life and then encounters a drug market that has become increasingly unpredictable.

Because this is not quite the same drug crisis Scotland was dealing with twenty years ago. More than one drug was implicated in 78% of drug use deaths in 2025. Cocaine was implicated in 589 deaths, more than half of the total, and 23% more than in 2024. Nitazenes, a group of potent synthetic opioids, were implicated in 247 deaths, more than three times the number recorded in 2024.

The old image of the Scottish drug death – heroin, a needle, a person in a doorway – is therefore incomplete.

The reality is a complicated and changing market in which substances are mixed, adulterated, replaced, and consumed in combinations that can be difficult for the person taking them to understand. The people most exposed to that market are often already living with circumstances that make them vulnerable to harm.

That should change how we think about the problem.

There is a tendency to divide people into those who are making sensible choices and those who are not. If someone knowingly takes an illegal drug, the reasoning goes, they have accepted the consequences. If they are homeless, perhaps they should have made better choices. If they are spending money on drugs, perhaps they should have spent it on food.

“Responsibility is divided. The deaths aren’t.”

But addiction does not become less deadly because we disapprove of the person experiencing it. 

I remember once giving a homeless man £5. A friend told me that I shouldn't, because he would probably spend it on drugs. My response was, essentially: I quite frankly don't give a fuck what he does with it. It was the middle of winter. It was going to drop below zero that night. He was outside. I had five pounds. Maybe he bought food. Maybe he bought drugs. Maybe he bought both. I don't know.

But I have never understood why the moral question becomes whether someone has demonstrated that they deserve the assistance before we decide whether they should receive it.

That instinct, to make people prove that they will use help correctly, is particularly strange when we are talking about addiction. The whole point of a public health response is that people do not need to have their lives together before they are allowed to survive.

This is where harm reduction matters. Scotland is now introducing local drug checking, with the first service due to open in Glasgow in October. People will be able to submit drugs for rapid checking and receive harm-reduction advice, while samples will also feed into national monitoring of emerging substances. The Scottish Government has invested more than £1.7 million in the pilot.

That is useful. But the existence of a service is not the same thing as the existence of a solution. The test will be whether these services actually understand the people they are intended to reach.

People do not take drugs in laboratories. They take them in bedrooms, toilets, stairwells, hostels, nightclubs, streets and parks. They take them while homeless. They take them while frightened, grieving, withdrawing, exhausted or surrounded by other people who are using. Their decisions are not always made in the calm, rational conditions imagined by policy.

A harm-reduction system, therefore, has to keep changing as drug markets and patterns of use change. It has to meet people where they actually are, rather than designing services around how we would like them to behave.

There is also an uncomfortable constitutional problem here. The Scottish Government controls much of the health and social-care response to drug use, but the criminal law governing controlled drugs remains reserved to Westminster. The Scottish Government has itself argued that the Misuse of Drugs Act limits the scope of Scotland's public-health approach.

That division of responsibility matters. But it cannot become an excuse. Westminster controls the criminal framework. Holyrood controls substantial parts of treatment and harm reduction. Neither controls the fact that 1,133 people died.

Responsibility is divided. The deaths aren't.

Perhaps that is why the language we use matters so much. The National Records of Scotland has itself moved away from the phrase “drug misuse deaths” to “drug use deaths”, following concerns that the former was stigmatising. The underlying definition of the statistics has not changed.

That may seem like a small change. It isn't. Words determine what kind of person we imagine when we hear the statistics. “Drug misuse” subtly invites a judgment about behaviour. “Drug use” describes an activity. Neither tells us everything about a person, but one asks us to begin with their supposed failure and the other leaves room to ask what happened to them.

And perhaps that is the bigger failure of Scotland's response. We have become so used to the crisis that we have stopped being shocked by the people inside it.

In Dundee, I learned where people slept. I learned where they bought drugs. I learned where they collected methadone. I learned which shops they went into and which streets they tended to gather on. Eventually, I stopped seeing it. That is what normalisation does. It does not make something less terrible. It makes us less likely to notice that it is terrible at all.

The people sleeping in the close become part of the close. The person passed out on the pavement becomes an inconvenience to walk around. The person asking for money becomes somebody to distrust. The death becomes another statistic.

Scotland cannot control every substance entering the country. It cannot eliminate addiction by passing another law. It cannot make deprivation disappear with a new treatment programme.

But it can decide whether people who use drugs are treated as citizens whose lives are worth protecting, or as an unpleasant feature of the streets we would rather not look at. We should probably start by looking. Because Scotland has had a drug crisis for so long, we have learned how to walk around it.

We know the jokes. We know the language. We know where the people sleeping rough will be. We know how to step over them. The statistics are telling us that we have become far too comfortable doing so.