140.Throughout our inquiry we repeatedly heard about the role stigma plays in perpetuating problem drug use, preventing people seeking treatment, and causing those who do enter treatment to drop out. Martin Powell, Transform, told us that “stigma and fear of arrest discourages people from coming forward to get help and kills people”. As well as preventing people seeking help for their drug use, stigma can also prevent people accessing treatment for health conditions that their drug use may be exacerbating. Norma Howarth, Signpost Recovery, explained:
A lot of our service users are very late presenting for basic health and social support because of what they think somebody will perceive of them. We have got late presentations with people in advanced ill health, with diseases, [like] COPD [Chronic Obstructive Pulmonary Disease], emphysema or even early stage cancers.
141.Criminalisation, which is addressed in the previous chapter, is one of the main causes of stigma. If the UK Government adopts a policy of decriminalisation, that would go a long way to addressing the stigma associated with drug use. However, there are additional steps which can be taken to help address stigma, which we discuss below.
142.Language is an important driver of stigma. Patricia Tracey, Turning Point Scotland, added that “a lot of stigmatising language is used, even within the system. We don’t yet have a consistent language, which is something we should work towards”. Dr Budd provided one such example:
In Edinburgh and Lothian, our drug and alcohol services are called the substance misuse directorate. That, in itself, is stigmatising because, as colleagues have said, people use drugs and alcohol often as a means of coping, as a means of self-medicating for their mental health issues, so for many that is actually a logical thing to do. It’s not misuse; it’s use.
143.Many witnesses called for the media, politicians, and other public commentators to be more robustly challenged when they use stigmatising language and rhetoric. As Colin Hepburn, a person recovering from problem drug use, put it, “the stigma is always going to be present, but we can challenge it”. This point was also made repeatedly during the public engagement events we held in Scotland. For example, during a visit to the Scottish Drugs Forum in June 2019, we heard that the quality of public debate on drugs policy is hampered by stigma, which has historically prevented the implementation of evidence-based policies which would be more effective in addressing problem drug use.
144.Sharon Brand, an individual with lived experience of problem drug use who is now in recovery, told us that:
The media have a huge part to play, with the language they use and how they portray people who use drugs. […] The language and the images the media sometimes use are horrendous. They dehumanise people. They do not treat people as human beings; they treat them as less than that. That has been the case for a long time—since the war on drugs, I think.
145.We have unfortunately seen stigmatising language for ourselves in the coverage of this inquiry. For example, safe consumption facilities have often been referred to by the media as ‘fix rooms’ and ‘shooting galleries’. Detective Chief Inspector Kew argued these terms misrepresent the nature of these facilities by giving an impression of a “loose” arrangement, that did not reflect the reality of how these medically-supervised facilities operate:
They are not like that. They are nothing like that at all. An overdose prevention centre is a medical facility to look after those most in need.
Dr Tweed argued that stigmatising language is driven by, and reinforces the view, that “problem drug use is a moral failing”, rather than a complex health issue.
146.The Home Office minister told us that “I do not think we are necessarily doing anything to reduce the stigma as such”, although Mr Malthouse MP did highlight investment in school education, and upcoming changes in the curriculum to educate young people on the health implications of drug use. We also noted that the minister inadvertently used stigmatising language during his evidence session with us, for example, referring to the objective of drug treatment programmes being to make people “clean” (which implies that people who use drugs are inherently ‘unclean’).
147.We heard that changing how we talk about drugs could reduce stigma and help people who use drugs “gain access to the services they need without fear”. For example, we heard from parents of a person recovering from problem drug use that, “the biggest obstacle to families attending the [support] groups and family support is actually shame and stigma”. Turning Point Scotland called for public debate to find a way to talk about drugs that:
captures the social dimension of the issue rather than reinforcing ideas of individual weakness, failings or ‘otherness’. Talking about drug abuse or misuse plays on the ‘fault’ of the individual; if we talk instead about problematic drug use, we are focussing on the problem that can be fixed rather than on the person who has failed.
148.The UK Government should be doing everything it can to reduce the stigma surrounding problem drug use. The UK Government must lead by example by ensuring it promotes appropriate and non-stigmatising language when discussing drugs. The Government should also be proactively challenging stigmatising language and misrepresentation, in order to improve the quality of public and political understanding of drug-related issues.
149.Some witnesses argued that problem drug use should be recognised as a disability in the UK. Dr Budd, Edinburgh Access Partnership, told us that “having substance dependence recognised as a long-term disability would be a big step forward in terms of addressing stigma and discrimination”. Iain Clunie, SMART Recovery UK, Patricia Tracey, Turning Point Scotland, and Norma Howarth, Signpost Recovery, amongst many others, agreed with this point.
150.The International Classification of Diseases , which is issued by the World Health Organisation, is used by the NHS when diagnosing mental health disorders. It classifies drug and/or alcohol dependence as a mental health disorder. The Diagnostic and Statistical Manual of Mental Disorders, the equivalent classification system in the USA, also defines substance misuse as a mental disorder. Despite this recognition, individuals with alcohol and drug addiction issues are currently explicitly excluded from protection under the Equality Act 2010. The Equality Act 2010 is a law which identifies certain ‘protected characteristics’ (such as age, disability, race, sex, and sexual orientation), and makes it unlawful for individuals to be discriminated against (directly, or indirectly) on the basis of these characteristics. The Equality Act (Disability) Regulations 2010 explicitly excludes an individual’s drug or alcohol dependence from creating an impairment qualifying for protection under the 2010 Act, unless that addiction “was originally the result of administration of medically prescribed drugs or other medical treatment”. Without this explicit exemption, drug or alcohol dependence could most likely be protected under the Equality Act 2010. There are very few explicit exemptions to the Equality Act—others include, tendencies “to set fires”, “to steal”, and to physically and sexually abuse people.
151.We heard calls from some witnesses for this exclusion to be removed from equality legislation. This would have the effect of expanding the Public Sector Equality Duty (PSED) to those experiencing drug or alcohol dependence which would, in turn, ensure public authorities properly consider the impact policy can have on people with problematic drug use. Extending the PSED to cover drug or alcohol dependence could potentially also result in increased protection of funding for addiction services, and greater consideration to the suitability of public sector housing for people with problematic drug use. NHS Health Scotland argued that the removal of the exemption would “enhance access to recovery support and tackle a significant example of institutional stigma getting in the way of recovery”. This point was also made by the Aberdeen Alcohol and Drug Partnership, who argued that the exclusion exemplifies the “institutional stigma” which needs to be tackled.
152.Elinor Dickie, NHS Health Scotland, outlined some of the real-life impacts the exemption from the Equality Act 2010 has for many people who use drugs. Concessionary access to transport was raised as a key example of something which is “impacted by the understanding of disability within our statutory legislation and guidance”. The Aberdeenshire Alcohol and Drug Partnership also noted the importance of concessionary travel. We saw the importance of this during our visit to the Scottish Drugs Forum (SDF) in June 2019. When we asked one current SDF service user what policy change would best aid his recovery, he said a free bus pass. The individual explained that this would allow him to travel to the designated pharmacy to pick up his methadone prescription. This is something he cannot consistently afford, thereby causing him to drop out of treatment.
153.In oral evidence, the Home Office minister said the UK Government would not consider removing the exemption. He argued that removing the exemption:
Would possibly interfere with the generally accepted definition of disability, which is that it requires some impairment. […] We are generally, necessarily, indifferent to the cause of that impairment, but there are people who are drug addicts who operate at a very high level and who do not exhibit any impairment of any sort. I do not think that anybody would maintain that they were disabled in some way just because of their addiction.
While the Minister is right that the general definition of disability “is indifferent to what causes the impairment”, this is not the case with impairments caused by drug use, as the Equality Act explicitly prevents an impairment being caused by drug use being considered a disability—this is why there have been calls for the Government to change the law. The response from the government therefore does not appear to demonstrate a complete understanding of the current law or criticisms of it.
154.It is unacceptable that drug dependence is excluded from the Equality Act 2010, despite it being fully recognised (in the UK and internationally) as a health condition. This can have damaging real-life consequences for many people who use drugs—often by preventing them fully accessing recovery services. The UK Government must immediately review the exemption of substance dependence from equality legislation and assess the impact it has on people who use drugs.
383 Dr Emily Tweed ()
388 Dr Emily Tweed ()
393 Turning Point Scotland ()
396 Equality Act 2010
397 Reg 3(2) Equality Act 2010 (Disability) Regulations 2010
398 Part 2, Equality Act 2010 (Disability) Regulations 2010
399 NHS Health Scotland/NHS National Services Scotland ()
400 Aberdeenshire Alcohol and Drug Partnership ()
402 Aberdeenshire Alcohol and Drug Partnership ()
Published: 4 November 2019