“If there is a war on drugs, then many of our family members are the enemy. And I don’t know how you wage war on your own family.” (Robert Wakefield / Traffic)

In 2023, 10,473 people died across the UK from alcohol-specific causes. The highest on record. The biggest drug–related issue many drug treatment services face, is alcohol. In 2024, 5,565 people lost their lives across the two nations as a result of substance use, excluding alcohol. The highest on record for a staggering 12th year running. Too many people are losing their lives to substance use. Too many families and loved ones are once again experiencing preventable and untold grief.

Twelve months ago, we were writing about record numbers of drug-related deaths across England and Wales. And yet here we are again. Across England and Wales, this has been going on for twelve years in a row. Questions have been raised year on year as to why this has been allowed to happen, with limited and stale answers being repeated in response. And in Wales, we continue to work within a Government-led delivery plan 3-years out of date.

So the first question that needs to be asked is why are we stuck in this cycle of continual rising drug deaths, and this battle with the powers that be, to listen and develop constructive policy that help mitigate against the former. It depends on who you ask as to the various responses you will receive, but one of the main issues is that substance use spreads across multiple domains. It is a political issue. It is a societal issue. It is a health issue. It is a criminal justice issue. It is also a contentious topic that at its core is marred by stigma, fear, racism and the continual effects of colonialism and capitalism.

Before we go on a deep dive on the issues at play and how to mitigate against them, let’s strip it back and outline where we are when it comes to substance use. One of the biggest concerns at present is the ever growing reports of cocaine use and subsequently the significant rise of cocaine-related deaths. In Wales, deaths associated from cocaine have risen from 7 in 2014, to 79 in 2024, representing over a 1028% increase. When I mean cocaine, I also mean crack cocaine too, yet official data does not allow us to disaggregate between powder and crack cocaine in relation to associated fatalities. But why are we seeing so much cocaine on these shores? One main reason is the cultivation and production of cocaine within Colombia, Peru and Bolivia is at its highest levels since records began. Since the US market for the stimulant drug started to shrink in the late 2010’s, the European, and subsequently the UK market, started to expand. The illicit drugs trade is still bound by the fundamental elements and principles of economics, namely supply and demand. More supply means cheaper prices, which often means more demand. 

The same can be said for ketamine too, another substance that has found itself in the middle of a media frenzy in the last 18 months. The use of these two drugs is causing widespread concern among professionals within the treatment field, due to the considerable rise in people seeking support for their use and presenting with significant health-related issues as a result. But we need to look wider and closer to home. We need to look through a societal and political lens to determine why. Why are people turning to substances and what benefits do they deem this behaviour to have on their life? While I won’t explain this per se here, it is important to consider these factors when looking at how to effectively reduce harm associated to such use.

Image: The Welsh coast

Over the next couple of days, there will be renewed calls to fund evidenced-based interventions to help stem the rising drug deaths and provide people, who really need it, the opportunity to live life to their fullest. Diamorphine-assisted-treatment; supervised  consumption facilities; community drug checking; safer supply; public access to naloxone; decriminalising the possession of drugs; and many other interventions and policy reforms, including those outlined in our Blueprint for Wales, will be called for. And quite rightly so, as they can all help reduce early mortality and improve prosperity across the whole of society. It is worth noting though, that certain legislative changes are hard to make, given the UK is bound by multiple UN conventions and subsequent international law. However, countries such as Canada and its legalisation of cannabis in 2018, have shown that the shackles of such restrictions can be undone. Additionally drug policy is too moralistic within its foundation. If drug policy was based on evidence, we would already be doing many of the interventions highlighted above. 

Consequently, substance use on a political level is a tough one to crack. Many Members of Parliament (MPs) often support innovation and embedding evidenced-based initiatives within policy and treatment. Therefore, the personal support is often there. However, transferring this to influence changes within policy and legislation is often hard to come by, especially if such changes are not part of the government’s manifesto (this would be the optimal scenario), or if it doesn’t align with a party’s view, or contravenes UN conventions. 

When it comes to which political parties propose reform within the drug policy space, many may acknowledge that the Green Party lead the way on a UK front, while in Wales, Plaid Cymru offer the most hope within the Senedd, within devolution limits. Private Member’s Bills (PMB) are an alternative opportunity to raise the issue, even if it means that the topic is only debated in parliament. But not only does it rely on the luck of the draw that the PMB is one that is picked at random at the start of that parliamentary session, but also that given its aim is to change that respective law, many fail to progress to such a stage. But they can have indirect effects on future developments and therefore can be incredibly useful. You just need MPs to actually stay in the chamber to take part in such debates. However, the crux of the matter is, we need to sway and convince voters of change. History tells us change often occurs through its citizens, not politicians. The late Peter Krykant showed us that. 

So where next? Essentially we need to go wider in our calls for action and we need additional collaboration across many sectors. We need to look at the structural drivers of drug related fatalities, that sit within policy and legislation that aren’t formally about drugs. Housing; mental health; health and social care; welfare and benefits; education; to name just a few. News of a £50 million boost for groundbreaking mental health research is welcome and hoped to have a positive impact upon many lives across the country, but questions will be raised as to whether it goes far enough and considering how many people are affected by poor mental health and the repercussions it has on their quality of life. The substance use field could also do its fair share in advocating for an increased roll-out of established models such as Housing First and high tolerance housing for people experiencing homelessness. By doing so could have significant knock on effects for the health and social care sector as a whole.

What Wales has shown over the years is that collaboration is often the heartbeat of the delivery of its services. But with everything in life, there is always room for improvement. The cumulative figure of 979 people who lost their lives across Wales in the last few years due to drug-related and alcohol-specific reasons, show us that. There needs to be more give and take across sectors, a bit more ‘if you scratch my back, I’ll scratch yours’. Only by strengthening cooperation and aligning our efforts across structural systems, can we truly pave the way to more meaningful, lasting change.

Rob Barker is the Campaigns and Communications Lead at Barod.