In January, the UK’s first safer drug consumption facility opened in Glasgow. At The Thistle – as it’s been christened – people can now come and inject their drugs in safer conditions, and under clinical supervision. The centre also provides access to a range of treatment and support.

While the Scottish government supports the full decriminalisation of drugs for personal supply, this facility isn’t that – drug classification is reserved to Westminster, and both Labour and Tory ministers have consistently preferred to pander to tabloid ‘tough on drugs’ authoritarianism than get a real grip of this public health crisis. But it is a good first step.

The opening of the facility raises a much deeper question, however. Why are Scotland’s drug death rates quite so high in the first place?

An epidemic.

In 2023, one in every 4,684 people in Scotland died of a drug overdose. This isn’t just the highest rate in Europe. It is three times higher than the next highest country, Ireland. These figures have gotten worse over the last two decades: the 2023 rate was 4.2 times higher than that in 2000.

The actual number which produces that first stat is 1,172. 1,172 people died, who didn’t have to. Tens of thousands of family members were bereaved. And that only expresses the most extreme end of a much deeper crisis: as Austin Smith, head of policy at the Scottish Drugs Forum tells me, about 1% of Scots have an opioid addiction.

Let’s first run through the clear material explanations which take us some of the way to understanding this problem. 

Drug deaths correlate closely with deprivation: people in the most deprived areas of Scotland are more than 15 times as likely to die from drug misuse as people in the least deprived areas. And Scotland has more deprived areas than many other European countries.

Similarly, there are two common explanations for the recent surge in deaths. First is that the so-called ‘Trainspotting generation’ – men who came of age during the Thatcher-induced de-industrialisation of the 1980s and 1990s and became addicts then – are hitting middle age, when their bodies are giving out, leading to increased death rates now. Since 2000, the average age of drug misuse deaths has increased from 32 to 45.

As David Liddell, former CEO of the Scottish Drugs Forum, has written: “Scotland’s drug problem has its roots in the harsh climate of 1980s deindustrialisation and the economic and social impact in the subsequent decades. Other countries chose a more interventionist approach by which the state created alternative employment and opportunity during these changes. This was not the policy in the UK.” As Liddell goes on to explain, this has multiplied down generations. 

The second explanation for the recent growth in drug deaths is austerity. Austerity policies had a brutal impact in Scotland, both in the general poverty they created and in decisions (now reversed) to include treatment centres in Scotland among the victims of cuts. 

But these can only be partial explanations. Both Thatcherism and Osbornomics hit some areas of England and Wales at least as hard as they hit Scotland, which has higher average wages and economic output than any region of the UK except London and the south east. Our drug death rate is almost 70% higher than that in north east England, the region with the highest rate in England, which is significantly poorer than Scotland. Likewise, while internationally, drug deaths correlate with income inequality, Scotland is more equal than the north east of England, and on a par with most of it.

So while some of the explanation certainly lies in economic data, these stats can only take us so far: Scotland is generally wealthier and no more unequal than most of England, yet has a much, much higher drug death rate. 

The other obvious partial explanation lies in physical geography. After Scotland, the counties with the next highest drug death rates are Ireland, Estonia, Norway, Finland, Sweden, Latvia and Lithuania. The long dark winters of northern Europe are depressing and vitamin D-depriving. It’s not surprising that many turn to drugs and alcohol to manage seasonal affective disorder.

But this surely isn’t a sufficient explanation, either. Glasgow is only around 50 miles north of Newcastle, and at the winter solstice, there’s only an 11 minute difference in daylight hours between thetwo cities. 

Smith adds another factor to this list. In 2008, the then-minority SNP administration gave the Tories a concession in exchange for supporting their budget: they would rewrite Scotland’s ten-year drug strategy to include less reliance on methadone, and a greater emphasis on abstinence – a change driven by a moral panic in the Scottish press at the time. The result of the policy – which included only counting people as ‘clean’ if they were fully off methadone – was, he argues, disastrous.

As Smith points out, this combination of prohibitionism and addiction is familiar from Scots’ historic use of alcohol, with low-church Protestantism aggressively promoting temperance, and shame, twinned with a hard drinking culture – as opposed to healthier attitudes to alcohol in southern Europe. 

It seems to me that there are two other parallel explanations, which lie less in the realm of current material factors, and more in those of history and culture. 

Cultural dislocation.

To think about the first, let’s go back further in history than the 1980s. In 1066, the Norman conquest replaced previous relationships of (still hierarchical) mutual obligation with formal feudalism in England. This evolved over a few centuries into early capitalism and, partly with the violent enclosure of land in spurts over centuries, people were pushed into towns and cities, producing a very early urbanised, nuclear-family based culture.

Some elements of this system were brought to the Scottish lowlands by King David I in what scholars call the Davidian revolution (1124-1153). But generally, and particularly in the Highlands, older systems remained in place for much longer. Clans, whose members had certain rights, were a primary forum for economic and social organisation. While much of modern Scottish history – from James VI’s Statues of Iona, through the Jacobite wars and the Clearances and into the 20th century – can be read as a struggle to force capitalism and modernity into the Highlands, a distinct culture remained around these structures. 

Gaelic was still spoken by one in 20 Scots when my grandad was born. When my parents inherited a farm on the edge of the Highlands in the 1980s, the stockman who came with it saw people from us and up into the Highlands as ‘Glenners’, meaning that we live in the steep glens between the hills, and survive by working together, with the whole community showing up to help each other round-up livestock or gather in the crops as needed in the unfolding seasons. The people on the wide, fertile strath south of us, as he saw it, were more competitive and individualistic. Indeed, across Scotland, there is still a two week ‘tattie holiday’ from school in the autumn, so that everyone could help bring in the potato harvest. These days, the farmer next door to my parents – only in his 50s – complains that these ‘old country ways’, still common in his childhood, have been lost, largely to harvesting machinery and quad bikes. And, to urbanisation.

In Scotland, we tend to think of the process of rural depopulation and the destruction of Highland Gaelic culture as ending with the end of the Highland Clearances, in the 1870s. But in practice, it’s got a much longer tail. 

While researching my forthcoming book Abolish Westminster, I dug out some stats to try to explain this phenomenon. 13.3% of people in England and Wales in 1700 lived in large towns or cities. In Scotland, that was just 5.3%. In 1890, Scotland had just passed 50%, while England and Wales, it was 62%. Today, Scotland is 83% urban, England is 79%. In other words, since my great-grandparents were born, the portion of the Scottish population that lives in urban areas has grown by 33%. In England and Wales, that’s just 17%.  

These people weren’t just moving house. They were experiencing major cultural shifts, seen partly in the rapid decline of the Gaelic language over the 20th and 21st centuries, but also in the cultural yearning: it’s not uncommon for people to know where their ‘clan’ is from, or where their grandad’s croft was. Often, these feelings are packaged up and sold to tourists through the worst kind of tat, but they are also, for many, deeply felt. 

The more-rapid urbanisation produced more crowded cities, which was then dealt with through brutal post-war slum clearance which ripped apart the urban communities which had only recently glued themselves back together. And then Thatcherism came a generation after that, and Osbornism another generation later, producing stacking stresses. 

Sometimes analogies can be dangerous. While Gaelic culture in Scotland was vandalised, comparing this process to the widespread slaughter involved in the colonisation of the Americas or Australia is inappropriate – though they were, in a sense, part of the same process – in 1850, Gaelic (of both Scots and Irish varieties) was the third most common European language in North America as Gaels were forced from their homes and, in turn, forced indigenous Americans from theirs. But while accepting that they are different, we can also perhaps learn from the latter that generational cultural dislocation is often at the root of substance abuse. It’s not surprising that Dundee and Glasgow – two of the main cities that Highlanders moved to – house thousands of people who suffer from the sorts of profound feelings of multigenerational alienation which come from cultural uprooting, in a way that just isn’t true in England.

When I put to Smith that this is a contributing factor to the drug crisis, he passionately agrees.

“A lot of people in Glasgow will have ancestors who are Highlanders, and Irish, who came over with the potato famine and settled in the West of Scotland, and Dundee, and mining towns – all of those people were dispossessed,” Smith added – a fact he connects to “a kind of nihilistic use of substances”.

Scottish masculinity.

Another stark element of the Scottish drug death statistics is their harsh gender divide. In 2023, men were twice as likely to die from drug deaths as women. This difference is fairly consistent worldwide, despite the fact that studies have found no biological difference between cis male and female bodies when it comes to vulnerability to craving and relapse. In other words, men die more of drug overdoses for socio-cultural reasons, and total differences in death rates between different countries must surely in part come down to how masculinity is constructed in those countries – as well as how that interacts with the shifting material realities of (impoverished) male existence. 

Clearly, in Scotland, much of this relates to deindustrialisation: the jobs lost in factories and mines were largely done by men. But again, this doesn’t explain differences with much of England. 

On the other hand, it does seem to me that there are, again, clear cultural-historical factors which are often ignored in this debate. Working-class Scottish maleness has long been constructed as particularly violent. Some of this comes from history. Scotland is Scotland rather than northern England because we’re the ‘unconquered north’ – a sentiment which produces a violent element with Scottish self-perception, often contrasted culturally with a (sometimes homophobic) treatment of the English as effete. 

Throughout the imperial era, much of Scottish identity – as a distinct element within British identity – was constructed around images of the Scottish soldier, and specifically those from the kilt-wearing, Highland regiments. Scottish regiments in the British army often talk about their “hard won reputation as fighting soldiers” over the centuries. The SAS was founded by two upper-class Scottish brothers, and is often culturally depicted as consisting largely of Scots to this day (its actual composition is secret, but rumours suggest this depiction is true). 

The notion of Scotland or Scots as violent isn’t just mythical. Until the 2020s, the murder rate in Scotland was higher than that in England and Wales, though the last few years has seen that situation reverse, largely because of the kind of active and thoughtful policy intervention which Westminster and the tabloids despise. As Scotland’s national football fans, the ‘Tartan Army’, have shown in recent years, it’s possible to consciously work to transform national self-perceptions.

These ideas of men as fighters tessellate with Presbyterian notions of masculinity as dour and emotionless which, while rapidly fading, still form one structure of feeling within a distinctively Scottish maleness. And which likely drives people to drugs to numb suppressed pain.

Again, I put this to Smith, who adds another point: the deprived communities at risk of drug addiction in Scotland are significantly less likely to veer to the far right than their equivalents in England. There is perhaps, he suggests, a cultural distinction where Scottish men are encouraged to internalise hatred and blame, where English men are encouraged to externalise it – and push it down. 

Decriminalisation, which in reality will most likely come about with independence, is certainly necessary to address Scotland’s drug-death epidemic, as is a radical break from economic systems which impoverish, dispose of and destroy people. But I suspect that, alongside all of that vital work, there needs to be a cultural project which appreciates some distinctively Scottish nuances, which considers the way that Highland society was – really quite recently – ripped apart, and which encourages us Scottish men to continue inventing a new more open version of Scottish masculinity.