The Scottish government remains under huge pressure to deliver on its “national mission” to save lives as new figures show drug-related deaths fell by just nine, or 1%, to 1,330 in 2021. Described as “heart-breaking” and “shameful” by politicians and campaigners, the latest figures from National Records of Scotland are the first decrease since 2013 but still the second highest annual total on record. They raise further questions about why attempts to address what has long been acknowledged as a public health emergency are making slow progress. Scotland continues to have by far the highest drug death rate recorded by any country in Europe and five times the rate in England. Campaigners denounced a “massive accountability gap” around quality and availability of services. Justina Murray, the chief executive of Scottish Families Affected by Alcohol and Drugs, said anything less than a zero drug deaths target was an “insult”. “We’ve had a raft of reports, policies and strategies that say what needs to change, there’s a lot of agreement, but when you speak to families on the ground they don’t understand what’s getting in the way of good words becoming good deeds.” The figures reveal a number of local spikes in the cities of Edinburgh and Glasgow, as well as Dumfries and Galloway, while deaths of women increased by 8% to 397 last year. Almost all deaths involve more than one drug and 84% involve opiates such as heroin or codeine. Angela Constance, the Scottish government’s minister for drugs policy, said the number of deaths remained “unacceptable” and that work would continue at pace to address the emergency with £250m invested over the course of this parliament. Her dedicated position was created by Nicola Sturgeon in December 2020 after the first minster said her government had “taken its eye off the ball”. Constance said she was particularly concerned about the rise in deaths among women and “will look to expand on current steps we are taking including the provision of two mother and child residential recovery houses”. Opposition leaders said the Scottish National party government had to accept a large share of the blame: it had been in government for 15 years and previously cut funding for drugs services. Advertisement Last week, Scotland’s drugs deaths taskforce published a hard-hitting report condemning “woefully inadequate” underfunding of services. It also suggested a revised timescale of two years for introducing new medically assisted treatment standards, which guarantee same-day treatment and a choice of treatment for addicts. Most recent estimates suggest fewer than 50% of those with a drug problem are accessing treatment. The Scottish Conservative leader, Douglas Ross, said the figures were “a badge of shame for Nicola Sturgeon, who has presided over a huge escalation in Scotland’s drug-deaths epidemic during her time in office”. He called on the Scottish government to support his party’s right to recovery bill, which would enshrine in law the right of everyone with an addiction problem to access the treatment they need. The bill goes before the Scottish parliament later this year. David Liddell, the chief executive of Scottish Drugs Forum, said the figures represented “an ongoing systemic failure in prevention”. While scrutiny of the treatment system was welcome, he added that these services represented “the sharp end” of provision. “We need to look at the capacity of treatment services in terms of the workforce. Too many of these essential workers are suffering the burnout that is common in working in under-resourced systems with very vulnerable people experiencing poverty”. Scottish Labour’s Paul Sweeney, who has launched his own members’ bill to establish overdose prevention centres – where addicts can take drugs with support and supervision – cautioned against celebrating the slight decrease in this year’s figures: “1,330 of our fellow Scots have died entirely preventable deaths … The solutions are no secret. We need action, not reports with recommendations that are never implemented.”