The Scottish government has published new ‘rights-based’ treatment standards for people who use drugs. Natalie Davies considers what it means to prioritise people’s rights, and whether this is compatible with an evidence-based approach to addressing substance use problems.
New standards for delivering medication–assisted treatment have been issued in Scotland – protecting citizens’ rights to access, and maximally benefit from, opioid substitution therapies such as methadone and buprenorphine. The word ‘rights’ is key here. These treatment standards, like the 2018 Scottish Government strategy before them, advocate for a rights-based approach to substance use problems, “ensuring individuals have choice in their treatment and are empowered to access the right support for where they are in their recovery journey”.
‘Know your rights’
Structural inequalities such as poverty and homelessness make people more vulnerable to developing substance use problems, which, in turn, can make it “harder to have their voice heard by others, to stay engaged with services, to exercise their rights, or to know where to turn to resolve issues”. A rights-based approach is one way of being proactive about addressing these inequalities.
According to the Scottish Human Rights Commission:
“A human rights based approach empowers people to know and claim their rights. It increases the ability of organisations, public bodies and businesses to fulfil their human rights obligations. It also creates solid accountability so people can seek remedies when their rights are violated.”
International Guidelines on Human Rights and Drug Policy, launched in 2019, include the foundational principles of human dignity, equality and non-discrimination, and meaningful participation. Endorsed by the International Centre on Human Rights and Drug Policy, United Nations Human Rights Office of the High Commissioner, UN AIDS, World Health Organization, and United Nations Development Programme, this set of standards does not attempt to set out new rights, but instead seeks to apply existing international human rights law to “one of the greatest social policy challenges of our time” – drug policy.
Speaking about these landmark international guidelines, Julie Hannah, Director of the International Centre on Human Rights and Drug Policy at the University of Essex, said:
“Human rights should not just inform critiques of the response to drugs worldwide, they should also be the main drivers of its reform, underpinning checks and balances to break cycles of abuse”.
“Fighting inequality and injustice is a more effective way of addressing the global drug problem than prisons and police”.
The rights-based approach in Scotland
In 2019, the Scottish Government established a Drug Deaths Taskforce to address the rising number of drug-related deaths in Scotland. One of the taskforce’s priorities was to optimise medication-assisted treatment for opioid dependence (i.e. methadone, oral buprenorphine, injectable buprenorphine, and diamorphine), which, as documented in an NHS Scotland rapid evidence review, can help prevent opioid overdose deaths. The taskforce took a big step forwards in May 2021, with the publication of ten standards for delivering medication-assisted treatment:
- All people accessing services have the option to start medication-assisted treatment from the same day of presentation.
- All people are supported to make an informed choice on what medication to use for medication-assisted treatment, and the appropriate dose.
- All people at high risk of drug-related harm are proactively identified and offered support to commence or continue medication-assisted treatment.
- All people are offered evidence-based harm reduction at the point of medication-assisted treatment delivery.
- All people will receive support to remain in treatment for as long as requested.
- The system that provides medication-assisted treatment is psychologically informed, routinely delivers evidence-based low-intensity psychosocial interventions, and supports individuals to grow social networks.
- All people have the option of medication-assisted treatment shared with primary care.
- All people have access to independent advocacy and support for housing, welfare and income needs.
- All people with co-occurring drug use and mental health difficulties can receive mental health care at the point of medication-assisted treatment delivery.
- All people receive trauma-informed care.
These treatment standards straddle two different – but ostensibly compatible – approaches: those of evidence-based policy, and rights-based policy. Evidence of effectiveness is the foundation of the treatment standards, but rather than simply reflecting the evidence base back to stakeholders, the Drug Deaths Taskforce’s treatment standards seek to embed access to evidence-based treatment within a policy that recognises people’s rights to potentially life-saving interventions.
To this end, a rights-based approach can protect adherence to the evidence base, as well as promote equal access to treatment. The benefits of this approach will only be seen, however, once these standards, rights and principles are integrated into all addiction treatment services.
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