“Trainspotting” shed light on the heroin problem in Scotland. 25 years later, it is the European capital of drug death

“But why would I want to do such a thing? McGregor’s character, Mark Renton, continues. “I chose not to choose life. I chose something else. And the reasons? There are no reasons. Who needs reasons when you have heroin?”

The dark comedy drama with a stunning Britpop soundtrack was an international success that shed light on the Scottish drug scene.

“Irvine Welsh has done us a favor,” said Roy Robertson, professor of addiction medicine at the University of Edinburgh who worked as a physician in the city for more than 40 years.

The original publication of the book in 1993 was “a historic moment,” said Robertson. “For those of us who worked and lived in this industry at the time, that was really a very accurate description of the problem. This very young, very dynamic and very aggressive marketing of very pure heroine – and all the consequences of this. “

But 25 years after the film’s release, Scotland’s drug problem is, in some ways, worse than ever.

The drug-related death rate in the country is the highest in Europe, according to a recent report by the national statistics agency. Scotland’s death rate far exceeds the nearest countries – Sweden and Norway – and is more than three and a half times the rate for the UK as a whole, according to the report.

Many of those deaths are from older drug addicts who were in their teens or twenties when Welsh’s novel-turned-film came out – part of what has come to be dubbed the “Trainspotting Generation”. After a life of drug addiction, their physical health is not what it used to be.

But experts say there is also a more complicated history to the drug problem in Scotland, involving generations of deprivation, government underinvestment and shifting supply chains.

Last year, 1,339 drug-related deaths were recorded in Scotland, according to the annual report. That’s the equivalent of more than three deaths a day, in a country of just 5.4 million people.

Drug-related deaths in Scotland are now at their highest since those records began in 1996, the report said.

Meanwhile, Slovakia, which has a population similar to Scotland, recorded 34 overdose deaths in 2019 – although Robertson points to “the huge underestimation of deaths in many European countries” where statistics on drug problems may not be as strong as in Scotland. .
Scotland has the highest per capita drug death rate in Europe. Its death rate was 318 per million of the population (aged 15-64) in 2019. The following countries, Sweden and Norway, both recorded 77 deaths per million, according to the national agency’s report. statistics.

Over the past two decades, the average age of drug-related deaths in Scotland has steadily increased from 32 to 43 years old. Almost two-thirds of all drug-related deaths were among people aged 35 to 54, according to the report.

What the report does not examine are the additional deaths from drug-related causes such as violence, suicide, HIV infection, hepatitis C and lung cancer – which could be numbering 1,000 a year, said Robertson.

And then there are those drug addicts who went through treatment and came to the other side, said Austin Smith, spokesperson for the Scottish Drugs Forum. “It is because of their massive resilience and the health services they have survived,” he said.

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‘Trainspotting’ takes place in 1980s Edinburgh and draws on Welsh’s first-hand experience of the drug scene in his hometown. It was a momentous period in Scottish and European drug culture.

In the early 1980s, there was a “wave of Afghan and Iranian heroin that entered Western Europe, which was very pure by anyone’s standards,” Robertson said. Even today, older drug addicts “still speak volumes about the beauty of this 50% pure heroine. She didn’t need to be mixed in with anything else.”

Nowadays, heroin users are more likely to supplement their dose with other drugs, in an attempt to “supplement the drug’s euphoric effect,” said Robertson. Indeed, last week’s report found that in 93% of all drug-related deaths, tests found more than one drug was present in the body of the deceased.

Opiates such as heroin and methadone, and benzodiazepines – a type of sedative – were the most commonly found drugs.

Multiple drug use is extremely dangerous, Smith said. “Maybe in the morning they used heroin, then in the afternoon they took benzodiazepines, and it’s the combined effects of these drugs that are killing people,” he said. .

Over the past two decades, the illegal supply of drugs has also grown larger and more complex. Previously, people would steal or, as Smith says, “borrow” benzodiazepines from others who legitimately prescribed them. Now he said there was a “massive importation of plastic jars filled with pharmaceutical grade benzodiazepines… and criminal gangs were pressing them in the palms locally.”

Generations of trauma

The common factor among Scots struggling with drug use is poverty, Smith said.

“They were brought up in poverty,” he said. “They are not in poverty because they spent all their money on drugs – they never had any money.”

Trauma such as domestic violence, abuse and neglect are passed down from generation to generation, Smith said. Indeed, Robertson has said that these days he is treating patients with the same drug issues he witnessed in their parents.

These people have a lower engagement with health services, Smith said. And those who might suffer from sleep disturbances and anxiety end up healing themselves with benzodiazepines.

“There’s this stereotype, some of which is true, that Scots drink a lot,” Smith said. “There is an appetite within Scottish culture for depressant drugs,” he added.

Scotland has even been dubbed “the sick man of Europe”, due to its higher death rate than other Western European countries. Robertson said it’s no secret that “Scotland is a poorer country, there are more people who use drugs and alcohol, there always have been”.

And this, in turn, leads to more deaths.

A human tragedy

But last week’s record numbers are yet another cause of shame for Scottish Prime Minister Nicola Sturgeon. The leader of the Scottish National Party was also Health Secretary from 2007 to 2012.

“The number of lives lost to drugs is unacceptable, each a human tragedy”, Sturgeon wrote on Twitter. The Scottish government “is not shirking its responsibility and we are determined to make changes that will save lives”, she added.
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The Scottish government appointed a dedicated Drugs Policy Minister Angela Constance to help tackle the issue last year, and earlier this year pledged £ 250million ($ 348million) in funding to face the health emergency posed by drug addiction.

But critics say the Scottish government has in the past heavily divested from drug, alcohol and mental health treatment services. Others point to the UK government in Westminster’s opposition to safe drug consumption rooms.
The answer is to improve access and the quality of treatment, Smith said. Scotland has around 60,000 problem drug addicts, and around 40% of them are in treatment at some point, according to the Scottish Drugs Forum. This is compared to around 60% in treatment in England.

The past two decades have seen at least one positive change, Smith said: the way politicians talk about drug addicts. Previously, “politicians from all parties were reluctant to stand up for a group of people as marginalized and stigmatized as people who inject drugs,” he said.

“Now the tone has been, ‘This is our whole problem and in a way, our whole responsibility.'”

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