AUDIT Scotland 10 years on: explaining how funding decisions link to increased risk for drug related deaths among the poor: explaining how funding decisions link to increased risk for drug related deaths among the poor

Purpose of research
In response to Scottish Government assertions that an ageing cohort explained increases in DRD our previous research established that socio-economic inequalities were additional risk factors explaining the significant increases in drug related death in Scotland. In this paper we subject the drug policy narratives provided by Scottish Government in relation to the governance of drug and alcohol services to critical scrutiny and reveal the social consequences of the funding formula used to direct funding to services via NHS Scotland Boards, and Alcohol and Drug Partnerships (ADP).

Methods
The paper provides a narrative review in the context of the AUDIT Scotland reports "Drug and Alcohol Services in Scotland" from 2009 and follow up report published in 2019. We refer to the recommendations made in the 2009 report on effectiveness of drug and alcohol services and subject Scottish Government funding processes, and governance of drug and alcohol services to critical scrutiny.

Results
Our analysis provides robust evidence that Scottish Government funding processes and governance of drug and alcohol services increased risk to vulnerable drug users and document evidence that link these risk factors to increased drug related death.

Limitations
We have focused on Scottish drug policy and drug services funding. Alcohol services funding is not subject to critical analysis due to limitations of time and resources.

Practical implications
Our case study investigates AUDIT Scotland’s recommendations in 2009 to Scottish Government to provide researchers, government policy advisors and media with robust critical analysis that links drug policy decisions to increased Drug Related Death (DRD).

Social implications
Drug policy governance by the Scottish Government and NHS Scotland since 2009 have disproportionately affected communities of interest and communities of place already experiencing stark inequalities. These budget decisions have resulted in widening inequalities, and increased drug related deaths within communities in Scotland. We conclude that in diverging politically and ideologically from Public Health England, and the Westminster Parliament, Scottish Government drug policy and financial governance of drugs services contributes to increased risk factors explaining DRD within deprived communities.

Originality/value
The 2009 AUDIT Scotland recommendations to Scottish Government subject their governance of drug services to critical scrutiny. This analysis provides a counterpoint to the explanations that rising DRD are unconnected to drug policy and drug services governance.