What Britain can learn from other countries about reducing drug deaths

I have spent more than 20 years around people struggling with addiction, mental health problems and trauma, and one thing I have learnt is that addiction is rarely simply about the drug. Behind it there is often pain. There can be childhood trauma, loneliness, homelessness, grief, abuse, mental illness or simply a person who has lost any sense of meaning in their life. Yet we still have a tendency to deal with addiction once it has reached crisis point. 

The figures should make us uncomfortable. In England and Wales, 5,565 drug-poisoning deaths were registered in 2024, the highest number since records began in 1993. The mortality rate has risen every year since 2012, and almost half of those deaths involved an opiate or opioid.

Scotland has an even more disturbing problem. In 2025 there were 1,133 registered drug-use deaths, an increase of 11% from the previous year. These aren’t statistics to me. They represent families receiving the telephone call nobody wants to receive. 

So perhaps we need to ask a different question: what are other countries doing differently? Portugal provides an important example. In 2001 it decriminalised possession of small quantities of drugs for personal use. This did not mean that Portugal legalised drugs. Instead, people caught possessing them could be referred into an administrative and health system rather than automatically being processed through the criminal courts.

But decriminalisation was only part of the story. Portugal also expanded treatment and harm reduction via outreach teams, needle exchanges, substitution treatment, shelters and other health and social services. 

European monitoring subsequently documented major reductions in drug-related deaths and HIV following these changes, although researchers rightly caution that we cannot simply attribute every improvement to decriminalisation itself.

Treatment, harm reduction and wider social changes happened alongside it. That distinction matters. There is no magic law that suddenly cures addiction. 

The more interesting lesson is a change in emphasis: seeing somebody with a serious addiction not simply as a problem to remove from society, but as a human being who may need medical treatment, psychological support and somewhere meaningful to go with their life. 

Modern harm reduction has developed much further than many people realise. Across Europe it now includes opioid substitution treatment, naloxone programmes, sterile injecting equipment and, in some countries, supervised drug-consumption facilities. These approaches are not necessarily glamorous or revolutionary, but they are based on a very practical principle: keep somebody alive long enough for recovery to remain possible. 

There is another, much more controversial frontier that deserves careful scientific investigation: psychedelic medicines. Researchers are studying substances including psilocybin and compounds related to ibogaine for mental illness and substance-use disorders. Ibogaine particularly interests me because of its extraordinary history. It originates from the central African plant Tabernanthe iboga and has longstanding ceremonial use within African spiritual traditions. 

Some research has reported reductions in opioid withdrawal and craving following ibogaine treatment. The interesting question is whether carefully controlled medical research can learn something from these traditions while applying modern standards of screening, monitoring, psychological care and follow-up. America is already reconsidering parts of this territory.

In April 2026, following an executive order from President Donald Trump concerning treatments for serious mental illness, the US Food and Drug Administration announced measures intended to accelerate research into psychedelic medicines. The FDA specifically referred to substance-use disorders and ibogaine was among the areas attracting attention. It means they are considered sufficiently promising to investigate. 

Read more:

• Drug-related deaths in Scotland: Here’s what can be done now
• Safer drug consumption rooms that reduce overdose deaths green-lit by Scotland’s top lawyer
• Inside the UK’s first drugs consumption room – and how it can save lives amid soaring drug deaths

There is also something deeper that medicine sometimes struggles to measure: human beings need meaning. Traditional healing systems often combine medicine with community, ritual, reflection and a sense that the individual belongs to something larger than themselves. We shouldn’t have to accept the supernatural claims of every tradition to ask whether some of those human elements matter. A tablet can reduce withdrawal, but it cannot give somebody a family, a purpose or a reason to get up tomorrow morning. 

Nor should this become a false choice between conventional medicine and alternative medicine. We need evidence, and we need safety. Opioid substitution treatments, naloxone, psychotherapy, rehabilitation and social support save lives. New treatments should have to demonstrate their value alongside them. But when thousands of people continue to die, curiosity is not recklessness. The real question is whether we are willing to examine approaches that challenge our assumptions about addiction while being rigorous enough to reject those that don’t work. 

Perhaps the most useful lesson from abroad is quite simple. Before asking, ‘Do we punish this behaviour?’ we should ask what happened to this person – and what might actually help them come back? 

Dr Kamalroop Singh is an academic, detox specialist and yoga practitioner

Do you have a story to tell or opinions to share about this? Get in touch and tell us more. 

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