Preventing Harm, Promoting Recovery: Scotland's Alcohol & Drugs Strategic Plan 2026 – 2035

Harm Reduction

Outcome: Harm is reduced for people who use alcohol and drugs.

Harm reduction focuses on minimising the negative consequences of alcohol and drug use – such as illness, injury and death – while promoting dignity, health and wellbeing. It plays an important role in making pathways to recovery available without being imposed, respecting individual choice. We remain firmly committed to evidence-based interventions that reduce the health and social harms associated with substance use.

Harm reduction support is a core part of Scotland’s approach to recovery and can often be the first step into wider treatment and care. Effective approaches include services, the use of digital technology and data but, most importantly, interpersonal relationships. Our approach is guided by the Charter of Rights, ensuring that harm reduction services are available, accessible, acceptable, and of high quality.

Our key priorities for harm reduction include:

• Building connection and outreach
• Optimising Scotland’s surveillance system and early warning response
• Enhancing the naloxone programme
• Reducing harms from injecting
• Supporting established and emerging ways to reduce drug harms
• Reducing alcohol related harms

Building connection and outreach

Non-judgmental advice, information and support are fundamental elements of harm reduction. Much of this essential harm reduction work is rooted in strong, trusted relationships. Progress has already been made through the establishment of near-fatal overdose pathways, implementation of MAT standard 3 (supporting assertive outreach) and 4 (offering harm reduction as part of treatment delivery) as well as through peer-led initiatives.^[73] It is crucial that we build on this by expanding opportunities to reach individuals through promoting harm reduction services and providing clear contact points for support. This includes targeted support for communities with heightened vulnerabilities.

Commitment: We will continue to promote harm reduction services and build and expand upon assertive outreach work through:

• Supporting the provision of tailored harm reduction information, advice and support.
• Clarifying the need for assertive outreach within alcohol and drug services as noted in the National Service Specification and in the development of standards of support for all drugs and alcohol treatment (covered in the Treatment and Care Chapter).

Optimising Scotland’s drugs surveillance system and early warning response

In an increasingly dynamic drug landscape, timely access to accurate information and harm reduction advice and support is essential. The establishment of the PHS Rapid Action Drug Alert & Response (RADAR) system has formed the backbone of our drugs early warning and response approach. At a national level, RADAR helps to: detect emerging drug threats quickly; assess risks from new substances and changing patterns; inform frontline services and communities of risks; and trigger rapid public health responses. It produces quarterly management information reports on a range of harms and service activity indicators. The RADAR system benefits from intelligence provided by local and national partners including Police Scotland and the NHS Greater Glasgow & Clyde ASSIST toxicology project.^[74]

Specific incident management guidance to respond to acute drug harm clusters has been established, supported by local reporting infrastructure developments to improve monitoring, reporting and response. When necessary, Problem Assessment Groups and Incident Management Teams are established within NHS boards to assess and manage responses to clusters and spikes in harm.

Commitment: We will continue to optimise processes and strengthen capabilities, to ensure that our surveillance and early warning systems are responsive to emerging threats through:

• Continuous improvement of data collection and analysis.
• A co-ordinated approach to local and national incident management.
• Enhancing dissemination of intelligence on emerging harms.

Enhancing the naloxone programme

Scotland was the first country in the world to introduce a national take-home naloxone programme in 2011. Since then, access has expanded significantly with an estimated more than 8 in 10 people at risk of opioid overdose being supplied with a lifesaving kit.^[75] Naloxone carriage is now standard among frontline police officers.^[76]

Commitment: We will continue to ensure naloxone access keeps up with changing demand in the context of emerging drug trends through:

• Providing national guidance to clarify legal practices, recent legislative changes, and dosage protocols.
• Interventions aimed at promoting carriage and recommended use of naloxone in response to changing drug supply and behaviours.
• Further expanding distribution, such as through pharmacies, community venues, the night-time economy and encouraging innovative new approaches such as applications showing where naloxone is available locally.
• Enhancing research and data collection methods, in alignment with the recommendations from the Naloxone Reporting Short-Life Working Group, convened by PHS.

Reducing harms from injecting

Injecting is a high-risk method due to the possibility of transmission of blood-borne viruses (BBVs), such as human immunodeficiency virus (HIV) and viral hepatitis, as well as injection site infections, injuries and increased risk of overdose. Cocaine injecting has substantially increased in recent years and typically involves more frequent injections per day than opioids.^[77] There are also increasing concerns around the scale of injecting of image and performance enhancing drugs,^[78][79] which puts a wider population at risk.

This brings increased risks of harms and new challenges for services. As outlined in Scotland’s Sexual Health and BBV Action Plan, there is a clear commitment to reducing BBV transmission among people who inject drugs through expanded testing, treatment access, and harm reduction initiatives. Engagement in BBV-related care has been demonstrated to protect against drug-related mortality.^[80] It is therefore important that services continue to support initiatives such as injecting equipment provision, WAND (Wound care, Assessment of injecting risk, Naloxone, Dry blood spot testing) and contingency management, which are effective in working with people who might not be engaging with any other treatment services.^[81] We are exploring the provision of safer inhalation pipes which can help to reduce harm by diverting away from injecting, or smoking using high risk homemade equipment.

Commitment: We will continue to support initiatives that reduce harms from injecting through:

• Working to eliminate HIV transmission and hepatitis C as a public health concern, including through delivery of new targets to increase annual testing in recovery services and prisons.
• Exploring, and responding to, the reasons for the recent decline in hepatitis B vaccination amongst people who inject drugs.
• Continuing provision of clinical harm reduction care for people who inject drugs including injecting equipment provision services.
• Continuing to collect data on injecting equipment provision and injecting harms, with ongoing review to ensure services are appropriately targeted.
• Exploring the provision of safer inhalation devices and the potential for safer inhalation spaces in safer drug consumption facilities.

Supporting established and emerging ways to reduce drug harms

It is crucial that we learn from best practice internationally and continue to pursue innovative approaches and digital technologies to reduce harms as we respond to new threats and challenges. In 2025, we supported the opening of the UK’s first Safer Drug Consumption Facility (SDCF) in Glasgow, The Thistle. This pioneering service provides a safe, supervised environment for people who inject drugs, offering a vital first step into wider treatment and care. The facility has already contributed valuable intelligence to the national surveillance response on nitazenes and has demonstrably prevented fatal overdoses within its service.^[82] A number of other cities are also considering the possibility of SDCFs. Due to the constraints of the Misuse of Drugs Act 1971, any area considering a SDCF must undertake substantial preparatory work and engage with the Scottish Government, Police Scotland, and the Crown Office and Procurator Fiscal Service.

Other initiatives include drug checking services, which allow people to submit drug samples for testing and receive information about their contents to help them make more informed choices. We are currently implementing a pilot drug checking service in Scotland, with point of care facilities in four cities. These will be supported by a National Testing and Research Laboratory at the University of Dundee which will contribute vital information to our national early warning system.

The Thistle and the drug checking pilots will be fully evaluated, and the findings will help shape future policy. While we await these results, international evidence already supports these approaches.^[83][84] Given the urgency of the challenge, we will not delay in exploring how to expand access to SDCFs and drug checking, working closely with partners and learning from the pilots as they progress.

Many internationally recognised, evidence-based harm reduction interventions for drugs remain prohibited under the Misuse of Drugs Act 1971. We will continue to work with the UK Government and other devolved administrations to pursue further harm reduction measures.

Commitment: We will continue to support established and innovative drug harm reduction measures through:

• Supporting more local areas to develop proposals for safer drug consumption facilities where appropriate.
• Exploring options to expand access to drug checking, including alternative delivery models such as mobile units or postal services.
• Exploring opportunities to utilise new innovations such as wearable devices to monitor heart/breath rates.
• Supporting continued research on harm reduction measures including drugs to reverse benzodiazepine overdoses.

Reducing alcohol related harms

The Scottish Government has contributed to the development of UK-wide Clinical Guidelines for Alcohol Treatment which include specific harm reduction guidance setting out the considerations for people with alcohol dependence who are not ready, or do not wish, to pursue abstinence. This covers options such as medically assisted withdrawal to achieve temporary abstinence before working towards low-risk drinking. A harm reduction approach requires clear information on risks, support for gradual reduction goals, ongoing risk assessment, and access to thiamine and folic acid to reduce neurological harm.

Referral for liver screening tests is a key harm reduction measure for alcohol. We know that chronic liver disease - of which alcohol is a significant factor - is projected to rise significantly in Scotland over the coming decades.^[58] We are continuing to support initiatives to improve early detection of liver disease, including the promotion of non-invasive testing, which utilises modern scanning technology, and the scheduled roll-out of the Intelligent Liver Function Test (iLFT) pathway pioneered in NHS Tayside. The iLFT pathway includes Enhanced Liver Fibrosis (ELF) testing to improve diagnosis.^[86] The integration of ELF into iLFT has been shown to reduce waiting lists and improve patient outcomes. Early detection can be a powerful motivator for behaviour change and engagement with support services.

We have supported a pilot Managed Alcohol Programme – a comprehensive harm reduction programme which aims to support people with alcohol dependence or people who are drinking at harmful levels. The pilot programme in Scotland is a residential, non-abstinence-based approach aimed at significantly reducing daily alcohol intake. International evidence shows positive outcomes from similar programmes,^[87] and an independent evaluation of the Scottish pilot will report in March 2026.

Commitment: We will continue to support initiatives to reduce alcohol related harms through:

• Promoting the recommended harm reduction initiatives in the Clinical Guidelines for Alcohol Treatment.
• Promoting earlier detection of liver disease through wider use of fibrosis and liver function testing, broader rollout of the iLFT pathway, and increased use of non-invasive mobile liver scanning.
• Reviewing the residential Managed Alcohol Programme pilot to investigate the effectiveness of programmes supporting controlled alcohol intake.

Case Study: UK’s 1st official Safer Drug Consumption Facility - The Thistle

The Thistle was opened by Glasgow Health & Social Care Partnership in January 2025. SDCFs are hygienic environments where pre-obtained drugs can be consumed under clinical supervision. They provide people who inject drugs with sterile injecting equipment and advice on injecting technique. Where any individual using the Thistle requests access to other health, treatment or social services, staff will signpost as appropriate.

The SDCF can provide medical attention in the event of an overdose. For example, they can provide naloxone to combat an opioid overdose and a defibrillator and oxygen are available on site for use in the event of a cocaine overdose.

The primary goal of the SDCF is to prevent the transmission of blood-borne diseases and the reduction of injection-related wounds and infections, but the SDCF also fulfils other harm reduction needs:

• Preventing overdoses from becoming fatal;
• Reaching people who might otherwise not engage with any type of treatment service; and
• Providing valuable insight into trends and patterns of drug use.

As of January 2026, the service has been accessed by 599 service users and has witnessed over 8,300 injecting episodes. It has intervened in 97 medical emergencies, undoubtably saving lives in the process. The service already provides valuable insight into drug use trends. For example, through the ability of staff to have paraphernalia tested following a number of adverse events, important information about dangerous substances in the drug supply was shared nationwide.