This is my interpretation of this new article:
James Nicholls, Wulf Livingston, Andy Perkins, Beth Cairns, Rebecca Foster, Kirsten M. A. Trayner, Harry R. Sumnall, Tracey Price, Paul Cairney, Josh Dumbrell, and Tessa Parkes (2022) ‘Drug Consumption Rooms and Public Health Policy: Perspectives of Scottish Strategic Decision-Makers’, International Journal of Environmental Research and Public Health, 19(11), 6575; https://doi.org/10.3390/ijerph19116575
Q: if stakeholders in Scotland express high support for drug consumption rooms, and many policymakers in Scotland seem sympathetic, why is there so little prospect of policy change?
My summary of the article’s answer is as follows:
- Although stakeholders support DCRs almost unanimously, they do not support them energetically.
They see this solution as one part of a much larger package rather than a magic bullet. They are not sure of the cost-effectiveness in relation to other solutions, and can envisage some potential users not using them.
The existing evidence on their effectiveness is not persuasive for people who (1) adhere to a hierarchy of evidence which prioritizes evidence from randomized control trials or (2) advocate alternative ways to use evidence.
There are competing ways to frame this policy solution. It suggests that there are some unresolved issues among stakeholders which have not yet come to the fore (since the lack of need to implement something specific reduces the need to engage with a more concrete problem definition).
2. A common way to deal with such uncertainty in Scotland is to use ‘improvement science’ or the ‘improvement method’.
This method invites local policymakers and practitioners to try out new solutions, work with stakeholders and service users during delivery, reflect on the results, and use this learning to design the next iteration. This is a pragmatic, small-scale, approach that appeals to the (small-c conservative) Scottish Government, which uses pilots to delay major policy changes, and is keen on its image as not too centralist and quite collaboration minded.
3. This approach is not politically feasible in this case.
Some factors suggest that the general argument has almost been won, including positive informal feedback from policymakers, and increasingly sympathetic media coverage (albeit using problematic ways to describe drug use).
However, this level of support is not enough to support experimentation. Drug consumption rooms would need a far stronger steer from the Scottish Government.
In this case, it can’t experiment now and decide later. It needs to make a strong choice (with inevitable negative blowback) and stay the course, knowing that one failed political experiment could set back progress for years.
4. The multi-level policymaking system is not conducive to overcoming these obstacles.
The issue of drugs policy is often described as a public health – and therefore devolved – issue politically (and in policy circles)
However, the legal/ formal division of responsibilities suggests that UK government consent is necessary and not forthcoming.
It is possible that the Scottish Government could take a chance and act alone. Indeed, the example of smoking in public places showed that it shifted its position after a slow start (it described the issue as reserved to the UK took charge of its own legislation, albeit with UK support).
However, the Scottish Government seems unwilling to take that chance, partly because it has been stung by legal challenges in other areas, and is reluctant to engage in more of the same (see minimum unit pricing for alcohol).
Local policymakers could experiment on their own, but they won’t do it without proper authority from a central government.
This experience is part of a more general issue: people may describe multi-level policymaking as a source of venues for experimentation (‘laboratories of democracy’) to encourage policy learning and collaboration. However, this case, and cases like fracking, show that they can actually be sites of multiple veto points and multi-level reluctance.
If so, the remaining question for reflection is: what would it take to overcome these obstacles? The election of a Labour UK government? Scottish independence? Or, is there some other way to make it happen in the current context?
What does it take to turn scientific evidence into policy? Lessons for illegal drugs from tobacco
Drug deaths are rising and overdose prevention centres save lives, so why is the UK unwilling to introduce them?