Rapid Action Drug Alerts and Response (RADAR)
What is RADAR?
Rapid Action Drug Alerts and Response (RADAR) is Scotland’s drugs early warning system.
Using innovative data collection methods, RADAR validates, assesses and shares information to reduce the risk of drug-related harm by:
- identifying new and emerging harms
- recommending rapid and targeted interventions
- publishing accessible, up-to-date information on services, harms and emerging drug trends, including our quarterly report.
Find out more about the reporting form and how to get involved.
Who is involved?
Public Health Scotland (PHS) coordinates the national programme.
We use a partnership approach to support local services, community members and public health teams, to ensure the system is relevant and meets the needs of the people and places it serves.
RADAR involves people and services from across the country and it is made up of three multi-agency groups:
- The Development Group: formed of communication, data and intervention subgroups that support system design and development, including the creation of a communication and response toolkit.
- The Network: a wide and inclusive group that collects and shares drug trends and data, helps to validate information and processes outputs and communications.
- The Assessment Group: a specialist technical team that studies data, assesses potential threats and decides on action to reduce harm.
Optimising public health surveillance is a priority of the Drug Deaths Taskforce and is defined in the Scottish Government’s National Drugs Mission.
PHS have been working in collaboration with partners across the sector to establish RADAR and ensure it meets the needs of services and people in Scotland.
We are grateful for the development and assessment contributions from a range of key partners.
- Aberdeen in Recovery
- Crew 2000
- Fife Alcohol and Drug Partnership
- Glasgow Caledonian University
- Health Improvement Scotland
- Highland Alcohol and Drug Partnership
- Improvement Service
- Inverclyde Alcohol and Drug Partnership
- Moray Alcohol and Drug Partnership
- NHS Ayrshire and Arran
- NHS Borders
- NHS Education for Scotland
- NHS Fife
- NHS Grampian
- NHS Greater Glasgow and Clyde
- NHS Highland
- NHS Lanarkshire
- NHS Lothian
- NHS Tayside
- Patchwork Recovery Community
- Police Scotland
- REACH Advocacy Scotland
- Scottish Ambulance Service
- Scottish Borders Housing Association
- Scottish Drugs Forum
- Scottish Government
- Scottish Prison Service
- Scottish Recovery Consortium
- South Lanarkshire Alcohol and Drug Partnership
- University of Dundee
- University of Glasgow
- We Are With You
Why is RADAR needed?
Drug-related harms in Scotland are at record levels.
Drug deaths in Scotland are the highest in Europe and are several times the rate in England and Wales.
The reasons for these high numbers are complex and include a number of factors such as:
- an evolving drug supply
- the use of multiple drugs at the same time
- changes to treatment services
Drug harms are also closely linked to social and health inequalities.
People living in more deprived areas in Scotland are significantly more likely to experience drug-related harms and deaths than those living in less deprived areas.
To respond to this public health emergency, RADAR provides a structured way to collect, assess and communicate information about drugs.
This identifies risks quickly and informs rapid action to reduce harm and save lives.
RADAR aims to reduce the short, medium and long-term harms associated with drugs in the Scottish population by:
- identifying trends, risks and clusters of overdose and intoxication
- responding to new and emerging substances, changing harms and other relevant scenarios
- advising on and implementing immediate harm prevention and control measures
- providing high-quality current public health information
- informing decision-making about resource allocation, prevention and service design and delivery
How does RADAR work?
RADAR collects and shares essential information on drug trends and harms by using a consistent process to monitor, assess and respond.
We actively encourage services and local communities to share information such as drug related incidents or harms by using:
- RADAR reporting forms
- regular monitoring surveys
- the RADAR mailbox
RADAR routinely receives data from healthcare, prison, police and toxicology services. Where possible, statistical indicators are added to datasets to signal significant changes and quickly highlight threats to the system.
To understand the accuracy and importance of the information received, we check:
- other reports (including from the Network)
If information cannot be validated, we will continue to monitor and may investigate further through targeted requests or enhanced surveys.
If validated, a report is sent to the Assessment Group who consider the level of potential risk and decide on:
- threat level
- action needed
- type of response
The action and response agreed by the Assessment Group is shared widely, including to the Network who share the information with their contacts. Communications may take the form of:
- warnings or alerts
- information summaries
- risk assessments
The impact of these communications will be regularly evaluated for effectiveness.
How can I get involved?
Do you have a keen interest in reducing drug-related harm?
Would you like to share and receive information from RADAR?
We have produced a network guide which explains terms of reference for the RADAR Network. View the network guide.
A flyer is also available about the RADAR network.
For enquiries about other groups (Development Group and Assessment Group) please email the Programme Team at: firstname.lastname@example.org
How can I send information?
You can use our reporting form if you would like to share information about:
- new drugs
- health harms related to drugs
- social harms related to drugs
This form contains questions on:
- drug use
- adverse effects
- drug deaths
This form should not be used in an emergency.
If someone is experiencing an overdose or a medical emergency where drugs may be involved, call 999.
Reports to RADAR can be made as soon as practicably possible.
Hard copies of the reporting form are available to print.
These can be scanned and returned to the RADAR mailbox.
The mailbox is monitored by the Public Health Scotland RADAR programme team Monday to Friday.
What type of information can I share?
RADAR collects information about trends, new drugs, incidents, health harms and social harms related to drugs.
This may include details such as:
- adverse effects
- drug appearance
- patterns of use
- routes of administration
- testing data
By providing as much information as possible you help us to develop a better response.
But you do not need to have all the information requested on the form to make a submission.
If you have incomplete information or if you are unsure if the report you have is useful, please submit the form anyway.
All information received helps us to develop a much-needed picture of drug use and harms in Scotland.
Please do not include any unrequested personal information such as a name, private address, date of birth or Community Health Index (CHI) number.
How will RADAR use my data?
Our reporting forms inform our public health response to drug harms.
Anonymised submissions may be shared with services and the public.
We will not share information for enforcement purposes, unless we have a legal obligation to do so.
We collect the minimum amount of personal information needed to identify the rough location of an incident (postcode sector, town or workplace) and contact the person who submitted the form by email should we need more information.
The submission of this information is optional.
This information is collected and stored in accordance with Public Health Scotland’s published privacy notice.
For further information, email email@example.com
For information on drugs and drug use, visit NHS inform (external website).
The Drugs Team at Public Health Scotland (PHS) compiles reports of drug-related indicators in order to inform action to prevent drug harms and deaths.
A quarterly report is available.
A leaflet about RADAR is available to download and print.
Drugs A to Z guide to common drug names in Scotland
A resource for emergency service call handlers to appropriately identify, categorise and coordinate the response to emergency call outs involving drugs.
It includes key street names of common drugs as well as brief descriptions of drug types and categories.
Alert 2023/04: Nitazenes
Public health alert for action: Nitazene-type drugs in Scotland
- Alert area:
- Action required by:
People working and volunteering in drug and alcohol services, emergency services, health care and medical settings and high-risk settings such as prisons and hostels
- Action required:
Follow harm reduction advice for opioids and polydrug use – promote and provide naloxone – see sections marked for specific actions
- Alert number:
- Version number:
- Release date:
24 January 2023
29 March 2023
- Valid until:
30 May 2023
This alert was updated on 29 March 2023 to reflect an increase in nitazene-related harms and further detections in the wider drugs market.
Post-mortem toxicology providers in Scotland have expanded screening to test for nitazenes and, for selected cases, retrospective post-mortem testing has been conducted.
As a result, protonitazene and N-pyrrolidino-etonitazene (etonitazepyne or NPE) have been detected in deaths. In these deaths, more than one drug was detected, reflecting polysubstance use patterns in Scotland.
The information contained in this alert should be re-shared and routinely discussed with people at risk of drug harms.
Due to the potential for nitazenes to be present in the wider drugs supply, we continue to encourage the use of the drug testing service WEDINOS.
There is an increase in the availability of a new group of drugs called nitazenes. Nitazenes are potent synthetic opioids. Due to their unexpected presence in the drug supply and high potency, nitazenes pose a substantial risk of overdose, drug-related hospitalisation and drug-related death.
Nitazenes have been seized in both Scottish communities and custodial settings.
These drugs have been detected in overdoses and deaths in Scotland.
The harm associated with nitazenes should be considered in the context of polysubstance use (mixing drugs), which is a common feature of drug use in Scotland.
Services supporting people who take drugs should promote and discuss realistic harm reduction measures that mirror those recommended for opioid and polydrug use.
Overdose signs and response actions for nitazenes are the same as for any other overdose involving opioids. Naloxone effectively reverses opioid-type drug overdoses. Services should increase and optimise the availability of naloxone in community and custody settings.
What are nitazenes?
Nitazenes are a category of new synthetic opioids (NSO), also known as 2-benzyl benzimidazole opioids.
This group of chemical compounds exert broadly similar effects on the body, with varying levels of potency.
The first detection of this drug family in European drug markets was in 2019 and the first detection in Scotland was in mid-2021.
Nitazenes detected in Scotland include:
- N-pyrrolidino-etonitazene (etonitazepyne or NPE)
Areas in which nitazenes have been identified
This alert applies to all of Scotland.
To date there have been detections in at least six areas of Scotland, with multiple detections specifically reported in Lothian, Grampian and Greater Glasgow and Clyde.
NSOs are extremely potent opioid receptor agonists. This means that they have a significant effect on opioid receptors in the body and in turn depress the central nervous system. For example, N-pyrrolidino etonitazene is several hundred times more potent than heroin and 20 times more potent than other synthetic opioids like fentanyl. This means a significantly smaller amount is required to get the desired effect and this poses an increased risk of respiratory depression and death.
Nitazenes have been known to be administered by many routes including intravenous, oral, sublingual, nasal and vaping.
- reduced breathing
- reduced heart rate
- pain relief
- reduced digestion (constipation)
- constricted pupils
In Scotland, nitazenes are often mis-sold as other drugs and have been detected in paper, powder and tablet form.
To date, most detections have fallen into one of two groups:
1. N-pyrrolidino-etonitazene and metonitazene in counterfeit tablets
- sold as oxycodone but no oxycodone detected
- visually similar to genuine oxycodone
- blue (sometimes yellow)
- letter M stamped on one side, half score and number 30 on the other
2. Metonitazene in paper form
- detected mainly in prison seizures
- white or cream paper or blotter
- detected in samples that also contained synthetic cannabinoids and benzodiazepines
Due to the limited testing of drugs in circulation in Scotland, this is likely to be an under-representation of the presence of nitazenes and there is a significant risk these drugs may appear in the wider drugs supply.
People are encouraged to use the drug testing service WEDINOS. Between 1 February and 20 March 2023, WEDINOS detected nitazenes seven times in drugs sold as alprazolam/Xanax in the UK
Recognising and responding to a possible nitazene overdose
The signs and the response actions for nitazenes are the same as for any other overdose involving opioids.
Opioid overdose signs
- unconsciousness (won’t wake with a shout or a shake)
- unable to speak or respond
- shallow (or slowed) breathing
- snoring or rasping breaths
- blue lips
- pale skin
- pin-point pupils
Be aware: people may be taking a combination of drugs with different effects and the signs may not be as clear cut as the above. Some people may display all overdose signs, others will have one or two.
In an emergency
- Check if the person is conscious by shaking them and loudly calling their name or asking if they’re okay.
- If the person does not respond, check they are breathing.
- If there’s no response, stay calm and call 999.
- Ask for an ambulance. Give as much information as you can and be honest about what was taken – you won’t get in trouble for getting help.
- The call handler will stay on the line and talk you through what to do. If you are by yourself, put them on speakerphone to leave your hands free.
- Administer naloxone if you have it (see naloxone guidance below).
- For people who are unresponsive and breathing, put them in the recovery position (on their side with their head tilted back) and monitor breathing.
- For people who are unresponsive and not breathing, start chest compressions. If you have someone there, ask them to get a defibrillator.
- Stay with the person until help arrives.
Learn more about emergency first aid with these tutorials from the British Red Cross:
Naloxone should be administered to anyone who is displaying overdose signs and is unresponsive and breathing or unresponsive and not breathing. Even if it doesn’t help, it will do no harm.
In Scotland, naloxone is available at some pharmacies and drug services. It can also be ordered online for home delivery from Scottish Families Affected by Alcohol and Drugs.
- Naloxone is very easy to administer. You can learn how to administer naloxone in a free e-learning module by the Scottish Drugs Forum (SDF).
- For more information and tutorial videos, visit naloxone.org.uk:
- Naloxone effectively reverses opioid-type drug overdoses, but due to the high potency of nitazenes multiple doses may be required before the overdose is reversed.
- Ideally, doses should be administered one at a time, waiting 2–3 minutes between each dose while watching for a response.
- If there’s no response after using a kit and further kits are available, they can also be used. This may be necessary to reverse overdoses from large doses of potent opioids.
- Administration should continue until:
- the person comes round
- emergency services arrive and take over
- you have no naloxone left
- If multiple kits have been administered but they are having no effect, it may be that this is a different type of medical emergency. This is one reason an ambulance is called immediately, so that professional assistance can be offered as soon as possible.
- Naloxone will start to wear off after 20–30 minutes. The duration of action of naloxone is shorter than that of opioid drugs, which means there is a risk of repeat overdose.
- Stay with the person and monitor. When they wake up provide reassurance and explain who you are and what has happened.
- If they go back into overdose administer further doses of naloxone as required.
Learn more about overdose
- Drugs: what you need to know (NHS inform)
- Stop The Deaths (SDF)
- Overdose (Crew)
Information for people who take drugs and community members
- The unregulated drug supply is increasingly toxic and unpredictable. Getting into drug treatment reduces the risk of experiencing harm or dying from an overdose. Click here to find a drug service in your area.
- There are ways to reduce the risk of harm and overdose when taking drugs, but there is no safe way to take nitazenes. Even when following all harm reduction advice, there is still a significant risk involved in taking them.
- Due to their potency, it’s almost impossible to accurately measure the right dose. The contents in a single pill can vary widely even within the same batch.
- If you buy tablets that are of poor quality or crumble easily, this may be an indicator that they have been illicitly produced. Be aware that even if a tablet looks authentic, it may be fake and it can be difficult to distinguish between genuine and counterfeit medication.
- Any medicine obtained without a prescription should be treated with caution.
PHS strongly recommends people do not take oxycodone tablets from any source unless they have been prescribed to them.
Although many nitazene detections have been in drugs sold as oxycodone, there is a risk these drugs may appear in the wider drugs supply and be sold as something else. Great caution is advised. Everyone taking drugs – not just oxycodone or other opioids – should be aware of the information below.
Follow harm reduction practices
Harm reduction advice for opioids is relevant for synthetic opioids, with greater vigilance advised due to the potency and difficulty of dosing nitazenes.
- Drug testing is the only way to confirm drug contents.
To get a sample tested, use the free, anonymous postal service provided by WEDINOS:
- Visit www.wedinos.org and click sample testing.
- Print off a sample form.
- Follow the instructions to generate a reference code and make a note of the code.
- Fill in the form completely or the sample won’t be accepted.
- Put the form and drug sample (double wrapped in something leakproof) into an envelope with a stamp on it and post it to WEDINOS.
- Results will be posted online a few days later.
- Take a test dose – a small amount or part of a pill.
- The drug purchased may not always be the drug that it’s expected to be. It may contain adulterants or cutting agents, be mis-sold or contain a different amount than anticipated.
- If someone who takes opioids regularly has stopped or cut down use, their tolerance will have reduced. This increases the risk of overdose as they will not need to take as much to get the same effect.
- Leave as long as you can between doses – at least two hours.
- Some drugs have a very long half-life (over 24 hours), which means they stay in the body long after the initial effects have worn off and can increase risk when other drugs are taken.
- Redosing too quickly can cause drugs to build up in the body.
- Avoid injecting if possible. This route of administration poses the highest risk and it’s more difficult to judge the dose if injecting.
- Avoid mixing drugs (including alcohol and medicines).
- Mixing drugs can cause unexpected and unpredictable results. This is a major risk factor in drug-related deaths in Scotland.
- If you do mix drugs, research potential interactions between substances, ensure you are somewhere safe and take much less of both substances than you would if you were only taking one.
- Drugs such as benzodiazepines, gabapentinoids and alcohol have similar effects to opioids. They slow down heart rate and breathing. Combining them significantly increases the risk of overdose.
- Make sure that there are people around who can respond in the event of an emergency.
- Tell someone what you have taken, how much and when.
- Naloxone (see above) is an effective, life-saving medicine that can temporarily reverse the effects of an opioid overdose including synthetic opioids such as nitazenes.
- Pick up naloxone from a drug service or order online from Scottish Families Affected by Alcohol and Drugs.
Actions for high-risk settings
High-risk settings are places where people may take more drugs than average, often at the same time and from shared batches. Places at higher risk include prisons, hostels, supported accommodation, nightlife venues, festivals, care homes and educational settings.
People living and working in these settings should:
- Ensure their setting is prepared and ready to respond to overdose situations.
- Be vigilant to opioid use and aware of the signs of an overdose. Encourage people to report overdose signs immediately. In an emergency, stay calm and call 999 straight away.
- Carry and promote naloxone.
- Ensure the setting has multiple naloxone kits available and trained people able to respond.
- Check that kits have not expired and that they are easy to access in the event of an emergency.
- Provide regular refresher training on drug-related emergencies, including information on risk factors, identifying an overdose, basic life support and how to administer naloxone.
To arrange naloxone training for your service, speak to your local Alcohol and Drug Partnership or visit the SDF webpage on take-home naloxone training.
Actions for drug and alcohol service staff
- When asking patients about substance use, also enquire about any potential use of oxycodone or other pain-relief medicines. Oxycodone may be referred to by brand names such as OxyContin and Percocet, or street names such as ‘oxy’ and ‘30s’.
- Use the opportunity to raise awareness on the risks of taking counterfeit medication.
- Discuss harm reduction approaches including the risk of mixing drugs and the importance of drug checking.
- Service staff can help people access the drug testing service WEDINOS. Staff should not handle any substances but can facilitate service access by providing printed sample submission forms, stamped addressed envelopes and by sharing online results.
- Share reminders of the signs of an overdose and the importance of getting help in an emergency.
- Provide people with naloxone and offer regular refresher training for those previously trained.
- Services and Alcohol and Drug Partnerships should share this alert with local partners who are likely to be in contact with people who take drugs.
Actions for emergency service and health care staff
All staff working in emergency services and healthcare should be vigilant for the presentation of patients with opioid toxicity:
- decreased respiration
- decreased pulse
- decreased mental activity
- decreased pupil size (miosis)
- decreased blood pressure
- decreased temperature
- decreased gastrointestinal motility
A progression of signs and symptoms includes drowsiness with eventual pin-point pupils, loss of consciousness, airway compromise and respiratory arrest, which can be rapidly fatal if untreated.
Build links with your local drug services and liaison team and encourage patients to access support and take-home naloxone wherever the opportunity presents.
All organisations that provide emergency care for opioid overdose should ensure staff are able to:
- Treat suspected cases as for any opioid overdose, using naloxone and appropriate supportive care (including airway and breathing support).
- Recognise that the duration of effect of naloxone is shorter than that of opioid drugs and appropriate monitoring and further doses of naloxone may be required.
- In the community this could include injectable or intranasal naloxone. Doses should be administered one at a time, waiting 2–3 minutes between each dose while watching for a response.
Actions for specialist medical staff
In specialist medical settings only
- Where hospital-based toxicology services are available, physicians are encouraged to submit specimens of unusual opioid toxidromes to ascertain the presence of nitazene compounds.
- Treatment may involve the intravenous naloxone titration regimen recommended by the National Poisons Information Service (see below).
Naloxone dosing in acute medical care
For adults and children aged 12 years or over, in acute hospitals the standard naloxone dosing regimen where potent opioid overdose is suspected, subject to clinical assessment of the individual case, is:
- Give an initial dose of 400 micrograms (0.4 mg) intravenously (IV).
- If there’s no response after 60 seconds, give a further 800 micrograms (0.8 mg).
- If there’s still no response after another 60 seconds, give another 800 micrograms (0.8 mg).
- If still no response, give a further 2 mg dose. Large doses (more than 4 mg) may be required in patients exposed to highly potent opioids and those who are severely poisoned.
- Aim for reversal of respiratory depression and maintenance of airway protective reflexes, not full reversal of unconsciousness.
- Failure of a definite opioid overdose to respond to large doses of naloxone suggests that another central nervous system (CNS) depressant drug or brain damage is present.
- Once an adequate response has occurred, monitor blood gases, oxygen saturation and respiratory rate.
- Intramuscular naloxone is an alternative in the event that IV access is not possible or is delayed.
- Observe the patient carefully for recurrence of CNS and respiratory depression. The duration of action of naloxone is shorter than that of all opioid analgesics and repeated doses of naloxone may be required.
For further advice, medical professionals can use the National Poisons Information Service 24-hour telephone service on 0344 892 0111 or its online database, TOXBASE.
- Clonitazene and etonitazene are Class A drugs controlled by the Misuse of Drugs Act 1971 (MDA).
- The supply and importation of other nitazenes is controlled by the Psychoactive Substances Act 2016.
- In February 2023, the UK government announced 10 nitazenes will soon be added to the MDA as Class A drugs. New compounds may emerge as the market adapts to legislative changes.
- For more information on nitazenes, read this briefing from the Advisory Council on the Misuse of Drugs.
- For more information on opioid overdose, visit Stop the Deaths.
- For help and support or information on drugs, visit NHS inform.
- To order naloxone, visit Scottish Families Affected by Drugs and Alcohol: Take Home Naloxone.
- To make a report use our reporting form or email firstname.lastname@example.org