Rapid Action Drug Alerts and Response (RADAR) quarterly ​report
April 2023

Police drug trends bulletin

This bulletin contains photos of drugs.

This update provides information on cocaine and street benzodiazepines.

This information has been provided by Police Scotland’s STOP Unit to raise awareness of drug appearance and to demonstrate some of the substances present in Scotland’s drugs market.

Cocaine

STOP Unit (West) continue with their drug collection scheme in partnership with an events centre. At the conclusion of events, the STOP Unit are contacted and the drugs are collected for destruction.

If there are recoveries of significance, these will be sent for analysis and images obtained. There have been no significant recoveries of note requiring analysis, but, recently, the most commonly recovered drug has been cocaine hydrochloride (powder cocaine). This could simply reflect the demographic of those attending events.

Cocaine powder

The Scottish Police Authority Forensic Services laboratory have confirmed the street purity of cocaine to be slightly higher than that of last year.

Crack Cocaine

Crack cocaine (freebase cocaine) is regularly encountered throughout the West of Scotland, but cocaine hydrochloride is still the most common form of cocaine. Crack cocaine can vary in appearance, as shown below.

Visit NHS inform for more information on cocaine.

Street benzos

'Street benzos' is a term used to describe benzodiazepines that are unlicensed or illicitly produced.

Most common benzodiazepines

• The most commonly encountered street benzodiazepine tablet is still the white circular tablet marked ‘10’ on one side with a half score on the reverse, containing etizolam.
• We are now starting to see the regular occurrence of other active ingredients, such as bromazolam.
• Bromazolam is most commonly, but not exclusively, detected in small light blue/blue tablets marked ‘MSJ’ on one side with a half score on the reverse. (No images at present.)

Operation Borzoi continues to monitor the recovery of street benzodiazepine tablets in Scotland. 

Visit NHS inform for more information on benzodiazepines.

RADAR intelligence and reports

23 reports were validated by RADAR between 12 January and 4 April 2023.

A summary of validated reports is shown below for informational purposes.

These reports have been collected as part of intelligence gathering by RADAR.

Since July 2022, RADAR has validated over 50 reports of drug-related harms received through the reporting form and mailbox.

Emerging concerns

From these reports, several key trends have emerged. Over half of submissions report polydrug use – the use of more than one substance at a time. Mixing drugs increases the risk of drug harms and death, this includes mixing alcohol with other drugs.

RADAR is currently assessing the harms related to cocaine, benzodiazepines, pregabalin (and other fake medicines) and nitazene-type opioids.

Drug harm reports to RADAR

Shown below are 23 reports validated by RADAR between 12 January 2023 and 4 April 2023.

Please note, many of these reports have not been confirmed by toxicology and should be considered anecdotal.

Reports validated prior to 12 January, are shown in previous quarterly reports.

Reporting drug harms

The information in the regional breakdown can be used by local areas for their own drug trend surveillance. Please encourage people and services in your area to share information on trends, incidents and harms related to drugs, such as:

• adverse effects including overdose
• routes of administration
• new substances or patterns of use
• testing data.

Anyone can make a report by using our reporting form or by emailing phs.drugsradar@phs.scot

Naloxone administration by Scottish Ambulance Service

The average weekly number of naloxone administration incidents was broadly stable between December 2022 and February 2023 (61 incidents per week). The total number of incidents during this time period was lower (793) compared to the same time periods in 2020 (998) and 2021 (920).

Background

Naloxone is a medicine used to prevent fatal opioid overdoses. These data relate to the number of incidents in which naloxone was administered by Scottish Ambulance Service (SAS) clinicians.

While these data count multiple overdose patients at the same incident separately, multiple naloxone administrations to the same patient at the same incident are not counted separately.

The chart below shows the weekly number of SAS naloxone administration incidents from 28 November 2020 to 26 February 2023.
​

The chart shows the number of emergency naloxone incidents by the Scottish Ambulance Service. The number of incidents is on the y axis and the date, between 28 November 2020 and 26 February 2023, on the x axis. An overall decreasing trend was observed between November 2020 and January 2021 before an increase until July 2021, when the number of weekly incidents peaked (136). A decreasing trend was observed until April 2022, when a slight increase was recorded. The number of naloxone incidents then followed a gradual decreasing trend from May 2022 onwards.

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Naloxone administration by Scottish Ambulance Service

Summary

Historic trend

• Until winter 2021/22, the average weekly number of SAS naloxone administration incidents was similar to previous years, which have generally been characterised by lower numbers of incidents during winter months and higher numbers during summer months.
• In spring 2022, the trend diverged from previous years and, in spite of an increase in April, has followed a gradual decreasing trend from May 2022 onwards.

Update

For the most recent time period (28 November 2022 to 26 February 2023):

• 793 SAS naloxone incidents were recorded, at an average of 61 per week. Weekly numbers of incidents were generally stable throughout this period.
• The total number of incidents was 5% lower than in the previous time period (5 September to 27 November 2022) when 832 incidents were recorded, at an average of 69 per week.
• The total number of incidents was 21% lower than expected compared to the same time period in 2020 (998 attendances, average of 77 per week) and 14% lower than in 2021 (920 attendances, average of 71 per week).

Additional information

PHS was provided with these data by SAS.

For more information, or to analyse this data by NHS Board, visit the COVID-19 wider impacts dashboard.

Police Scotland is in the process of training and equipping all operational officers up to and including the rank of Police Inspector with intra-nasal naloxone kits. This roll-out began in August 2022 and is expected to be complete in early 2023. This should be taken into consideration when interpreting the data shown above. More information on the carriage of naloxone by Police Scotland is available on their website.

Why we use a 3-week moving average

As these data are highly variable over time, a 3-week moving average has been included in the graph to aid interpretation of trends over time.

Scotland’s Take-Home Naloxone Programme

The national Take-Home Naloxone Programme was launched by the Scottish Government in 2011 to prevent fatal opioid overdoses.

Naloxone is a medicine that can temporarily reverse the effects of an opioid overdose. It can be given to anyone who is non-responsive and displaying the signs of an overdose (unconsciousness, shallow breathing, snoring, blue lips, pale skin, pin-point pupils).

Anyone in Scotland can carry naloxone. It can be accessed through most local drug services or pharmacies and it can also be delivered to your home through the charity Scottish Families Affected by Alcohol and Drugs.

Naloxone is very easy to administer.

You can learn more about administering naloxone in a free e-learning module created by the Scottish Drugs Forum.

Information on take-home naloxone distribution can be found in the substance use section of the COVID-19 wider impacts dashboard and in the National Naloxone Programme Scotland Quarterly Monitoring Bulletin, both published by PHS.

Drug-related attendances at emergency departments

The average weekly number of drug-related attendances at emergency departments was stable between December 2022 and February 2023. A total of 1,118 attendances were recorded in this period – 13% lower than in the same time period in 2020/21 (1,284), but 11% higher than in 2021/22 (1,010).

Background

A drug-related emergency department (ED) attendance is an attendance for a drug intoxication or overdose, either alone, or combined with alcohol intoxication.

The chart below shows the weekly number of drug-related ED attendances between 16 November 2020 and 5 March 2023.

The chart shows the number of drug-related ED attendances in Scotland. The number of attendances is on the y axis and the date, between 16 November 2021 and 5 March 2023, on the x axis. An overall decreasing trend was observed from August 2021 to April 2022 (lowest levels in the week beginning 4 April – 53). Attendances then increased sharply peaking in May 2022 (highest levels in the week beginning 16 May – 123). The number of attendances decreased and remained broadly stable between June 2022 and February 2023 – 82 per week across the time period.

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Drug-related attendances at emergency departments

Summary

Historic trend

• An overall decreasing trend was observed in drug-related attendances at EDs between August 2021 and April 2022, with the lowest weekly levels in the time series observed in the week beginning 4 April 2022 (53).
• Drug-related ED attendances then increased sharply and peaked in May 2022, with the highest weekly levels in the time series observed in the week beginning 16 May 2022 (123).
• Attendances then decreased and remained stable, averaging 84 attendances per week from June to November 2022.

Update 

For the most recent time period (28 November 2022 to 5 March 2023):

• 1,118 ED attendances were recorded, at an average of 80 per week. This was 5% lower than the previous 14-week time period (22 August to 27 November 2022: 1,179 attendances, an average of 84 per week).
• Attendances were 13% lower compared to the same time period in 2020/21 (1,284 attendances, an average of 86 per week) and 11% higher than in 2021/22 (1,010 attendances, an average of 72 per week).

Additional information

These data are taken from our Accident and Emergency Data Mart.

Diagnosis and reason for attendance can be recorded in a variety of ways, including in free text fields. Therefore, the numbers presented in this report only give a high-level indication of attendances over time.

For more information, or to analyse these data by NHS Board, visit the COVID-19 wider impacts dashboard.

Why we use a 3-week moving average

As these data are highly variable over time, a 3-week moving average has been included in the graph to aid interpretation of trends over time.

Drug-related acute hospital admissions

The average weekly number of drug-related hospital admissions decreased between October and December 2022. The total number of admissions in this time period (1,815) was considerably lower than expected, compared to the same time period in 2020 (2,736) and 2021 (3,244) (decreases of 34% and 44% respectively).

Background

The data used in these statistics relate to all inpatient and day case admissions to general acute hospitals (excluding maternity, neonatal, geriatric long stay and admissions to psychiatric hospitals) where drug use was recorded as a diagnosis at some point during the patient’s hospital stay. Data are presented by date of admission.

The chart below shows the weekly number of drug-related admissions to Scotland’s general acute hospitals from 26 September 2020 to 1 January 2023.

The chart is interactive, allowing users to view data points on the chart as well as download the data. This is being piloted as an alternative to the static charts and if useful may be rolled out across other indicators. 

The second chart shows the top five drug types associated with admissions as a percentage of all drug-related admissions between 28 September 2020 to 1 January 2023.

The data presented on drug type is based on ICD-10 diagnostic codes and is not confirmed by toxicology analysis. 

The chart shows the main drug corresponding to the drug-related hospital admissions in Scotland’s general acute hospitals. The chart is a percentage breakdown across five categories – cannabinoids, cocaine, multiple/other, opioids and sedatives/hypnotics. The percentage of admissions is on the y axis and the date, between 26 September 2020 to 1 January 2023 on the x axis. The main drug involved in hospital admissions remains opioids across the time period, corresponding to approximately 50% of admissions, but this has been increasing slightly in recent months. Admissions related to sedative/hypnotics have been decreasing throughout 2022 (17% of admissions in January, falling to 11% in December 2022).

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Drug-related hospital admissions: drug category

Summary 

Historic trend 

• There was a long-term decreasing trend in the weekly number of drug-related hospital admissions from June 2021 to April 2022. Admissions briefly increased in April and May 2022 (peak of 208 during the week beginning 16 May), before decreasing again in June 2022. The average weekly number of drug-related hospital admissions remained relatively stable between July and September 2022. 
• The long-term decreasing trend in drug-related hospital admissions observed since June 2021 differs markedly from previous years, which have generally been characterised by lower numbers of admissions during winter months and higher numbers during summer months. 
• The most common drug category recorded in general acute hospital admissions was opioids: 
  • The percentage of opioid-related admissions decreased from 50% in November 2020 to 46% in August 2022, before increasing to an average of 50% of attendances between September and October 2022. 
  • The percentage of sedative/hypnotic admissions decreased across 2022 (17% of admissions in January, falling to 11% in December 2022). 

Update 

For the most recent time period (26 September 2022 to 1 January 2023): 

• 1,815 drug-related hospital admissions were recorded, at an average of 130 per week.
• Admissions followed a downward trend throughout this period, from 182 in the week beginning 12 September 2022 to 81 in the week beginning 26 December 2022. 
• The total number of admissions was lower than expected compared to previous years: 
  • 44% lower than the same period in 2020 (3,244, an average of 232 per week) 
  • 34% lower than the same period in 2021 (2,736, an average of 195 per week) 

Reasons for the decrease in numbers have not been examined. This decreasing trend should not be interpreted as a reduction in harms. The number of hospital admissions may be affected by issues accessing urgent care services and by the capacity of hospital services. 

• The most common substance type recorded in drug-related general acute hospital admissions was opioids. These were recorded at an average of 50% of admissions per month, which was broadly consistent over the time series. 

Additional information 

These data have been extracted from our SMR01 dataset. 

For more information on diagnostic coding, please refer to the drug-related hospital statistics publication methods page. 

To analyse the latest published information on drug-related hospital discharges by NHS Board or by Alcohol and Drug Partnership (ADP), go to our information on drug-related hospital statistics admissions. 

Please note our drug-related hospital statistics dashboard presents data by date of discharge, so figures will differ to those shown above. For more information, please see the metadata. 

Why we use a 3-week moving average 

As these data are highly variable over time, a 3-week moving average has been included in the graph to aid interpretation of trends over time.

Glossary 

Suspected drug deaths

The average weekly number of suspected drug deaths was broadly stable from December 2022 to the end of February 2023, compared to the fluctuating trends observed in October and November 2022. There was an average monthly total of 96 suspected drug deaths in December 2022 to February 2023. This was the same average monthly total of suspected drug deaths as in December 2021 to February 2022.

Background 

Suspected drug death figures are based on reports from police officers attending scenes of death. The details of these events are recorded by Police Scotland and shared with Public Health Scotland. 

Following further investigation, these suspected drug deaths are either confirmed as a ‘drug-related death’ or determined ‘not to be a drug death’. This can take several months. 

Suspected drug death figures are used to provide a timely indication of trends and to detect any potential recent changes or clusters of harm to inform prevention activity. These figures are different to the National Statistics published by the National Records of Scotland (NRS) and do not provide a robust indication of the numbers of drug-related deaths occurring each year. 

The chart below shows the weekly number of suspected drug deaths in Scotland from 25 October 2020 to 25 February 2023. 

This time-series chart shows the weekly number of suspected drug deaths in Scotland on the y axis and the date, between 25 October 2020 and 25 February 2023, on the x axis. There was a large increase in suspected drug deaths in Scotland during December 2020, followed by a decreasing trend in the average weekly number of deaths until May 2021. The number of suspected drug deaths increased during summer 2021, peaking at 34 in the week beginning 7 June 2021. Between July 2021 and October 2022, the average weekly number of deaths fluctuated considerably but remained within a range of 17 to 28 deaths per week. The average weekly number was broadly stable at 22 deaths per week from December 2022 to February 2023, compared to the fluctuating trends observed in October and November 2022.

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Suspected drug deaths

Summary 

Historic trend 

• Following a large increase in suspected drug deaths in Scotland during December 2020, there was a decreasing trend in the average weekly number of deaths until May 2021. The number of suspected drug deaths increased during summer 2021, peaking at 34 in the week beginning 7 June 2021. 
• Between July 2021 and October 2022, the average weekly number of deaths fluctuated considerably but remained within a range of 17 to 28 deaths per week. 

Update 

For the most recent time period (28 November 2022 to 28 February 2023): 

• An average of 22 suspected drug deaths were recorded per week (ranging between 17 and 27). This weekly average was lower than the same 13-week period in 2020/21 (33 deaths per week) and similar to the same period in 2021/22 (23 deaths per week). 
• The average weekly number of suspected drug deaths was broadly stable from December 2022 to the end of February 2023, compared to the fluctuating trends observed in October and November 2022. There were 116 suspected drug deaths in November 2022, 93 in December 2022, 108 in January 2023 and 86 in February 2023. 
• There was an average monthly total of 96 suspected drug deaths in December 2022 to February 2023. This was the same average monthly total of suspected drug deaths as in December 2021 to February 2023.  

Additional information 

Data on suspected drug deaths in Scotland are provided by Police Scotland. 

The Scottish Government produce a quarterly report (Suspected drug deaths in Scotland) that presents Police Scotland data on suspected drug deaths and describes the age, sex and geographical location of deaths in each quarter. The analysis in this RADAR release is provided for the purpose of real-time detection and prevention of harms and is not comparable with the Scottish Government publication.

PHS will continue to publish data on suspected drug deaths in future RADAR releases. The Scottish Government, together with PHS and partners, are currently considering the future of the Suspected drug deaths in Scotland report. 

The information above is management information and not subject to the same validation and quality assurance as Official Statistics. The data provided in this release should not be viewed as indicative of the annual deaths reported by NRS. 

National statistics on drug-related deaths are published annually by the NRS during the summer. The latest report provides information on drug-related deaths in 2021 and earlier years, broken down by age, sex, substance implicated and the NHS Board and council areas.  

Detailed information on drug-related deaths is presented in the National Drug-Related Deaths Database, which is published by PHS every two years. The latest report describes deaths that occurred in 2017 and 2018, with trend data from 2009. 

Why we use a 3-week moving average 

As these data are highly variable over time, a 3-week moving average has been included in the graph to aid interpretation of trends over time. 

Glossary

Emergency department toxicology: ASSIST

Between August 2022 and February 2023, the ASSIST emergency department pilot made 1,022 detections of 52 different illicit drugs in samples from 190 patients. More than one illicit substance was detected in 87% of attendances. The most commonly detected drug category was depressants (60%), followed by opioids (18%). The most commonly detected individual drug was cocaine (10%), followed by desmethyldiazepam (a benzodiazepine and metabolite of diazepam) (9%).

Background

The ASSIST (A Surveillance Study in Illicit Substance Toxicity) pilot, conducted by the emergency department (ED) at the Queen Elizabeth University Hospital (QEUH), aims to assess the feasibility of prospective surveillance of ED attendances due to acute illicit drug toxicity.

The study collects anonymised data through the analysis of standard of care clinical data for patients attending QEUH ED due to illicit drug toxicity and surplus serum sample toxicology testing.

The use of the term ‘illicit drug’ encompasses any substance that is controlled. It excludes:

• legal substances such as alcohol, nicotine, caffeine and paracetamol
• medications recently prescribed to the individual
• drugs administered to the individual as part of treatment (by ambulance staff or in hospital)

The pilot enables full toxicological analysis through the biorepository approved surplus sampling. This allows drug profiling and the identification of emerging drugs or changing trends, to inform appropriate harm reduction measures and public health responses.

This pilot will run in the QEUH ED in Glasgow from August 2022 to August 2023, followed by a 3-month follow-up period.

Toxicology analysis of surplus serum samples

Surplus serum samples are left-over blood samples, which were taken as part of usual care. Drug detections presented here are of ‘illicit drugs’ only and were not prescribed to the individual.

The chart below shows the most common drug categories detected in toxicology analysis of surplus serum samples between 17 August 2022 and 16 February 2023.

The results are shown as the total number of detections. They are broken down by top five drug categories and then broken down further by drug name.

This bar chart shows the number of detections of drug types within QEUH ED. The drugs are grouped into five main categories of effect, with depressant, opioid, stimulant, cannabinoid and other, on the y axis and the number of detections along the x axis. The most common category was depressant, with 613 detections. This included 528 detections of benzodiazepines and 69 detections of gabapentinoids. The second most common category was opioid, with 180 detections, 46 of these were of morphine. The third most common category was stimulant, with 140 detections, 102 of these were of cocaine. There were 73 detections of cannabinoids, two of these were of synthetic cannabinoids. There were 14 detections of other drugs.

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Toxicology analysis of surplus serum samples: drug category

Summary

For the most recent time period (17 August 2022 to 16 February 2023), there were 481 individual ED attendances related to illicit drug use identified. 190 attendances qualified for surplus sampling toxicology testing (as they were categorised as ‘more unwell’ as per research inclusion criteria).

Drug type and category

Of the 190 individual attendances:

• There was a total of 1,022 detections of 52 substances (found through the biological detection of the drug or its metabolite).

Of the 1,022 detections:

• The following drugs were the most common:
  • cocaine: 102 (10%)
  • desmethyldiazepam: 91 (9%)
  • temazepam: 84 (8%)
  • etizolam: 76 (7%)
  • cannabis (tetrahydrocannabinol): 73 (7%)

Note: desmethyldiazepam and temazepam are benzodiazepines and also metabolites of other benzodiazepines such as diazepam.

• Depressants were the most common drug category, detected in 60% of all detections (613 times):
  • Benzodiazepines were detected 528 times (52% of all detections).
  • In total, 17 different types of benzodiazepines were detected, including bromazolam (53 detections), gidazepam (31) and flubromazepam (27).
  • Gabapentinoids were detected 69 times (7%), 29 of these were gabapentin and 40 were pregabalin.
• Opioids were the second most common drug category, detected in 18% of all detections (180 times):
  • There were 46 detections of morphine (an opioid and metabolite of heroin and other opioids). There were 32 detections for codeine, 21 for methadone, 16 for dihydrocodeine and five for buprenorphine.
• Stimulants were the third most common drug category, detected 140 times, making up 14% of all detections. The most common stimulant was cocaine, detected 102 times (10%).
  • There were 16 detections for amphetamine, eight for MDMA, six for MDA (a stimulant and also a metabolite of MDMA) and four for methamphetamine.

Polydrug use

Of the 190 attendances, for which complete toxicology and clinical data are available, polydrug use is a prevailing feature:

• 165 samples (87%) had more than one illicit drug or metabolite detected, even after legal substances (such as alcohol) and known prescribed medicines (including prescribed benzodiazepines, gabapentinoids and opioids) were removed.
• The number of illicit drugs detected per sample ranged between one and 16, with a mean of five.
• Benzodiazepines were detected in 155 samples (82%), with more than one type of benzodiazepine detected in 117 of these samples. Detections ranged between one and eight, with a mean of three.
• Of the benzodiazepine positive samples, 51% were also positive for an opioid and 46% were also positive for cocaine.
• Of the opioid positive samples, 87% were also positive for a benzodiazepine.
• Of the cocaine positive samples, 81% were also positive for a benzodiazepine.

Further findings

Complete clinical data are available for 481 attendances, with results described below:

• 351 were male (73%) and 130 were female (27%).
• Over half were 16 to 34 years old.

• ED outcome records show that:
  • 215 patients were discharged home
  • 118 were admitted to a ward
  • 58 were taken into police custody
  • 28 were transferred to a psychiatric unit
  • 24 self-discharged
  • 20 were admitted to an intensive care unit
  • 10 were admitted to a high dependency or critical care unit
  • Eight were recorded as ‘unknown’ or ‘other’
• Clinical severity outcome (after 28 days) recorded that:
  • 455 patients were discharged
  • Eight patients died
  • Six were ongoing inpatient admissions
  • 12 outcomes were recorded as ‘unknown’ or ‘other’

Additional information

Public Health Scotland (PHS) was provided with these data by QEUH, NHS Greater Glasgow and Clyde (GGC).

The ASSIST trial is registered with Clinical Trials UK (ID: NCT05329142).

Ethical approval has been granted by the West of Scotland Research Ethics Service (IRAS ref: 313616, REC ref: 22/WS/0047) and surplus sampling methodology through Biorepository Ethics (ref: 22/WS/0020).

The West of Scotland Safe Haven research database hosts the electronic clinical data under IRAS ref: 321198 or REC ref: 22/WS/0163.

This study is sponsored by NHS GGC Research and Innovation and is funded by the Scottish Government.

The testing has been carried out by the LGC Group. LGC analyse pseudonymised samples using mass spectrometry and screen against a database of over 3,500 analytes. This testing can detect drugs and metabolites, but this analysis does not imply that specific drugs were implicated in harms.

Further information on the study can be found at Clinical Trials UK.

Glossary

Post-mortem toxicology testing for controlled substances

In October and November 2022, the most common drug types detected in post-mortem toxicology were opioids (75%) and benzodiazepines (63%). The most common drugs detected were heroin/morphine (37%) and diazepam (37%). Bromazolam (a new ‘street’ benzodiazepine) was detected in 14% of deaths.

Background

All sudden or unexpected deaths in Scotland are subject to investigation by the Crown Office and Procurator Fiscal Service (COPFS) to determine the cause of death and the need for criminal proceedings. In order to inform these decisions, COPFS commission post-mortem toxicology and pathology services across Scotland.

This analysis is based on data from toxicology testing conducted at post-mortem for sudden and unexplained deaths or where there was suspicion of involvement of controlled drugs.

The majority of testing was performed by the Forensic Toxicology Service based within Forensic Medicine and Science (FMS) at the University of Glasgow, on behalf of COPFS. In late 2022, post-mortem toxicology services were transferred from the University of Glasgow to Scottish Police Authority (SPA) Forensic Services.

During this period, post-mortem tests were completed by other laboratory testing sites in the United Kingdom. Data from those sites have been included in this report and cover the most recent period reported. Future testing will be completed within a laboratory based within SPA Forensic Services.

The range of substances routinely analysed is extensive and includes the detection of alcohol, prescribed medicines and controlled drugs. The data within this report will develop further as other new or emerging drugs are added to toxicology screening in the coming months.

The first chart below provides an indication of controlled drugs found present at post-mortem in deaths occurring between 1 January 2020 and 30 November 2022.

The chart shows the percentage of forensic toxicology cases testing positive for controlled substances (opioids, benzodiazepines, gabapentin and pregabalin, cocaine). The percentage of toxicology cases is on the y axis and the calendar year and quarter of death, between Q1 2020 (1 January to 31 March) and 30 November 2022, on the x axis. The percentage of deaths that tested positive for opioids increased from Q1 to Q2 of 2020, but otherwise remained relatively stable over the time series. A sharp increase in the percentage of deaths where benzodiazepines were present occurred between Q1 and Q2 of 2020. This percentage remained high throughout 2020, before gradually falling from Q1 of 2021 onwards. The percentage of deaths where gabapentin and pregabalin was present remained relatively stable across the time series, though an isolated increase was observed in Q2 of 2021. The percentage of deaths where cocaine was present increased markedly during Q2 of 2020 but was otherwise relatively stable over the time series.

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Forensic toxicology cases testing positive for controlled substances

The second chart provides an indication of specific opioids and benzodiazepines found present at post-mortem in deaths occurring between 1 January 2020 and 30 November 2022.

The chart shows the percentage of forensic toxicology cases testing positive for specific individual opioids (heroin/morphine, methadone, buprenorphine) and benzodiazepines (diazepam, etizolam, clonazolam and bromazolam). The percentage of toxicology cases is on the y axis and the calendar year and quarter of death, between Q1 of 2020 (1 January to 31 March) and 30 November 2022, on the x axis. The percentage of deaths that tested positive for etizolam and methadone increased sharply in Q2 of 2020 and remained high until Q3 of 2021 when a sharp decrease occurred. Similar patterns were observed for both drugs. Etizolam presence was higher than for methadone throughout the time series, until Q2 of 2022, when the presence of these substances in toxicology cases both decreased. Although there has been a slight increase in October and November 2022 for both substances, the percentage of cases testing positive for etizolam remains below methadone. The percentage of deaths where methadone was present was consistently lower than for heroin/morphine. Although both decreased gradually throughout 2021 and 2022, heroin/morphine remained relatively stable and became the most common substance present since Q3 of 2021. However, a marked increase in the percentage of cases testing positive for diazepam in October and November 2022, has meant that diazepam has jointly become the most commonly found substances, alongside heroin/morphine. Although very few deaths with clonazolam present were observed across most quarters in the time series, increases occurred in Q2 of 2020 and, more notably, in early 2021, remaining uncharacteristically high at the end of 2021. However, the percentage of deaths where clonazolam was detected decreased in early 2022 to lower levels. Percentage of deaths with buprenorphine present remained relatively low and stable throughout the time series. Data included for the first time in October and November 2022 indicate that 14% of deaths tested positive for bromazolam in this time period.

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Forensic toxicology cases testing positive for specific opioids and benzodiazepines

Summary

Historic trend

• In total, 2,179 deaths occurred in 2021 where controlled drugs were found present via FMS toxicology testing, which was 2% higher than in 2020 (2,147).
• The most commonly found drug types were opioids and benzodiazepines. The percentage of deaths with these drugs present remained high throughout 2020 to Q2 of 2021, before a decreasing trend between Q3 of 2021 and Q3 of 2022.
• The specific drugs most commonly present throughout the time series (from Q1 of 2020 to Q2 of 2022) were etizolam, methadone and heroin/morphine. The percentage of etizolam and methadone detections both increased sharply in Q2 of 2020, before both reducing in Q3 2021, etizolam most notably.
• Deaths positive for clonazolam peaked at 12% of deaths in Q3 of 2021, before decreasing to zero in Q3 of 2022. The increase in deaths where clonazolam was found present indicates that, rather than a reduction in street benzodiazepine deaths, a shift towards alternative substances may have occurred.
• Since Q2 of 2020 there has been a gradual reduction in the percentage of deaths where methadone was found present. The percentage of deaths involving diazepam, other opioids, gabapentin and pregabalin or cocaine has remained relatively stable over time.

Update

For the most recent time period (1 October 2022 to 30 November 2022):

• The total number of deaths testing positive for controlled substances was 326. Many of these deaths involved multiple positive detections, therefore the total number of detections listed below is greater than the total number of deaths.
• The following drugs or drug types were most commonly detected:
• opioids: 246 (75%)
• benzodiazepines: 207 (63%)
• gabapentin and pregabalin: 124 (38%)
• cocaine: 99 (30%)
• Heroin/morphine remained the most commonly detected substance, with 37% of cases testing positive (from 35% in Q3). Methadone was detected in 29% of cases (from 25% in Q3).
• Diazepam detections increased markedly to 37% of cases (from 25% in Q3), making it was the most commonly detected substance alongside heroin/morphine. Etizolam was detected in 20% of cases (from 17% in Q3).
• Due to expanded toxicology testing, there were new detections of the following substances (detected for the first time when testing was outsourced to other laboratories):
• Bromazolam (a novel ‘street’ benzodiazepine) was detected in 14% of deaths (45).
• Protonitazene (a nitazene-type opioid) was detected in 1% of deaths (<3).

Additional information

PHS was provided with these data by FMS, University of Glasgow and SPA Forensic Services.

The data above are for deaths occurring in the west, east and parts of the north of Scotland. It does not include a small number of cases in the far north and north-east of Scotland where post-mortem toxicology testing is conducted by the Aberdeen Royal Infirmary (ARI). Nitazene-type opioids have been added to toxicology testing at the ARI and retrospective sampling has resulted in the identification of nitazene-type opioids in deaths. Further details will be added to RADAR reports and alerts once available.

Detailed interpretation of the levels of drugs found present, drug interactions, co-morbidities or other factors relating to death are outside the scope of this analysis. This analysis does not imply that specific drugs were implicated in deaths nor that deaths were classified as ‘drug-related’ and does not include consideration of wider causes of death.

New drugs (bromazolam and protonitazene) were detected for the first time when testing was outsourced to other laboratories. These drugs may have been present before this time but were not being tested for, as they have only recently emerged in the drugs markets. These data will develop further as bromazolam, nitazenes and other new or emerging drugs are added to routine toxicology screening by the SPA Forensic Services.

It should be noted that increases observed in specific substances within this report may be due to differences in toxicology test approaches (e.g. detection of concentration levels of a particular drug) between outsourced laboratories and previous FMS screening. This may result in increases in substance detection. Further data will be required and monitored to determine the impact of any differences in toxicology screening across laboratories.

As part of the interim period, prior to post-mortem tests being completed at SPA Forensic Services, other laboratories testing data from around the UK have been included in this report (September 2022 to November 2022). As these data did not include date of death, other date variables have been used as a proxy to improve data completeness and enable the inclusion of these deaths within this report. Two separate date variables have been used to approximate date of death information, where this information was unavailable:

1. Date of the case being received or sent to other labs for toxicology testing.
2. Date of toxicology test being completed.

The dates listed above have been used in the analysis as they are considered to provide a close approximation to the month and year of death. It is anticipated that missing information on date of death will be improved over time, as further information becomes available.

Glossary

Drug seizures in Scottish prisons

Synthetic cannabinoids were the most prevalent drug type detected in the Scottish Prisons Non-Judicial Drug Monitoring Project between June to December 2022 (detected in 35% of samples). Benzodiazepines were the second most prevalent, detected in 27% of samples, with bromazolam being the most prevalent benzodiazepine detected.

Background 

The Leverhulme Research Centre for Forensic Science (LRCFS) is currently undertaking research with the Scottish Prison Service (SPS). The Scottish Prisons Non-Judicial Drug Monitoring Project tests drug seizures made across the Scottish prison estate in order to understand the changing characteristics of synthetic drugs, including synthetic cannabinoids, often referred to as ‘spice’. 

The first chart shows the number and type of samples seized in Scottish prisons between 1 September 2020 and 31 December 2022. 

The chart shows the percentage of SPS drug seizures broken down by sample type (e-cigarette, paper or card, tablet, powder and other). The percentage of samples is on the y axis and the date, between September 2020 and December 2022, on the x axis. Sample types are highly variable over the time period. Paper or card detections decreased across the time series with an average of 73% per month being detected in 2021 compared to 23% per month in 2022. There were low detections of e-cigarettes throughout the study. Over half of seizures were e-cigarettes in June 2022. Between July to November, an average of 32% of samples per month were e-cigarettes before a decrease to 5% in December 2022. Powder samples remained relatively stable with approximately 19% per month being detected in 2022, peaking at 60% in December.

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Drug seizures in Scottish prisons: sample type

The second chart shows the three most detected drug types from seizures in Scottish prisons between 1 September 2020 and 31 December 2022. This is based on the percentage of all samples tested and is presented with a month moving average.

The chart shows the percentage of SPS drug seizures broken down by drug type (synthetic cannabinoids, benzodiazepines and opioids) and presented alongside the three-month moving average. The percentage of samples is on the y axis and the date, between September 2020 and December 2022, on the x axis. Synthetic cannabinoids are the most prevalent drug throughout the time series. The percentage of seizures testing positive for synthetic cannabinoids was, on average, 43% per month in 2021, decreasing to 27% between January and May 2022. The second most common drug type detected is benzodiazepines. The percentage of seizures testing positive for benzodiazepines fluctuated throughout 2021 with an average of 39% per month, before decreasing and remaining stable from January to May 2022 (average of 28%). Opioid detections have remained relatively stable remaining between 0% and 11% across the time series.

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Drug seizures in Scottish prisons: drug type

Summary 

Historic trend  

• The number of seizures analysed fluctuated in 2021, ranging from a low of 23 in June and peaking at 134 in September. Between January and May 2022, the average number of seizures analysed remained relatively stable with an average of 40 per month. 
• Sample type data were highly variable over time, but changes were observed in sample type detections during 2022:
  • Paper/card detections decreased, making up an average of 30% of samples per month in 2022, compared to an average of 73% per month in 2021. This is assessed to be due to changes to prison rules that now allows SPS to photocopy general correspondence, with recipients being given photocopies rather than original items. 
• Synthetic cannabinoids were the most common substances detected, followed by benzodiazepines. Drug type seizure data were highly variable over time, so the following narrative is based on the 3-week moving average: 
  • The percentage of seizures testing positive for synthetic cannabinoids was on average 42% per month in 2021. Between January and May 2022, the percentage was variable, averaging at 30% per month. 
  • The percentage of seizures testing positive for benzodiazepines fluctuated throughout 2021 with a monthly average of 38%, before decreasing and remaining stable from January to May 2022 (monthly average of 29%). 

Update 

This update provides analysis of samples seized from June to December 2022 (205 samples). For the most recent time period (1 June 2022 to 31 December 2022): 

Sample type 

• An increasing trend in the percentage of e-cigarette and powder sample types was observed: 
  • Over half of seizures were e-cigarettes in June 2022. In July to November, e-cigarettes made up an average of 32% of samples per month before decreasing to 5% in December. 
  • Synthetic cannabinoids were detected in 41% of the e-cigarettes analysed.  
  • Powder samples have remained relatively stable with a monthly average of 19% between January and November 2022, before increasing to 60% in December. 

Drug type 

• The three most detected controlled drugs were ADB-BUTINACA (synthetic cannabinoid), bromazolam (benzodiazepine) and etizolam (benzodiazepine).
• During recent months, bromazolam overtook etizolam as the most detected benzodiazepine in prison seizures. In the most recent time period 39% of benzodiazepine samples contained bromazolam, versus 35% containing etizolam. 

Drug type seizure data were again highly variable from June to December 2022, so the following narrative is based on the 3-week moving average: 

• Synthetic cannabinoids were the most common drug type, detected in an average of 38% of seizures per month: 
  • The detection of synthetic cannabinoids has been fluctuating in recent months, increasing to 50% of seizures in July 2022 before falling to an average of 28% in October and November 2022. 
  • Detections of synthetic cannabinoids were on average 41% per month during the same time period in 2021. 
• Benzodiazepines were the second most common drug type, detected in an average of 25% of seizures per month: 
  • Figures followed an increasing trend between July and November (approximately 27% per month) and peaked at 40% in December 2022. 
  • Detections of benzodiazepines were on average 37% per month during the same time period in 2021. 

Further information 

Between September and December 2022, this drug analysis project detected the following drugs for the first time in prisons in Scotland, demonstrating a constantly evolving drugs market: 

• ADB-5’Br-BUTINACA (synthetic cannabinoid)  
• bromonordiazepam (desalkylgidazepam, benzodiazepine) 
• nitrazepam (benzodiazepine) 

Metonitazene (a nitazene-type opioid) was detected twice in August 2022. For further information on nitazenes, please see our latest alert.  

From preliminary findings for seizures obtained in January 2023, dipentylone (cathinone, stimulant) was detected for the first time in Scottish prisons. 

Additional information 

PHS was provided with these data by SPS and LRCFS. 

The Scottish Prisons Non-Judicial Drug Monitoring Project is a collaboration between the SPS and the LRCFS at the University of Dundee. 

An initial pilot project ran between September 2018 and January 2021. The project has been directly funded by SPS since February 2021. 

Why we use a 3-month moving average 

As these data are highly variable over time, the 3-month moving average has been included in the graph to account for this variability and provide an average line. 

Glossary

Specialist drug treatment referrals

From November 2022 to February 2023, the average weekly number of referrals to specialist drug treatment services was highly variable and followed the seasonal fluctuation seen in previous years. The number of referrals during this time period (5,691) was lower compared to the same time periods in 2021 (6,074) and 2022 (6,322).

Background 

Specialist drug treatment referrals occur when a person comes into contact with services designed to support their recovery from problem drug use.

Figures shown are for referrals relating to either drug use or co-dependency (people seeking help for both drug and alcohol use). Figures include new referrals for treatment and referrals between services.

The chart below shows the weekly number of referrals to specialist drug treatment services between 26 October 2020 and 26 February 2023.

This time-series chart shows the number of referrals to drug treatment services in Scotland on the y axis and the date, between 26 October 2020 and 26 February 2023 on the x axis. In December and January each year, a seasonal reduction in referrals occurs, which is not described in detail here. There was an upward trend in the average weekly number of referrals from October 2020 to May 2021. Referrals decreased throughout June and July 2021, and then remained broadly stable to January 2022 (between 400 to 480 referrals per week). From January to September 2022, there was a gradual decrease in the average weekly number of referrals. Since October 2022, the trend has been highly variable. In February 2023, there were an average of 358 referrals per week.

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Specialist drug treatment referrals

Summary

Historic trend

• The average weekly number of referrals generally increased from October 2020 to May 2021, reaching a peak of 554 in the week beginning 17 May 2021. 
• Referrals decreased throughout June and July 2021 and then remained broadly stable to January 2022 (between 400 to 480 referrals per week, apart from the seasonal decreases in December and January). 
• From January to September 2022, there was a gradual decrease in the average weekly number of referrals. 

Update 

For the most recent 15-week time period (14 November 2022 to 26 February 2023): 

• 5,691 specialist drug treatment referrals were recorded, at an average of 379 per week. 
• This was slightly lower than the previous 15-week time period (8 August to 13 November 2022) when 6,027 referrals were recorded, at an average of 402 per week. 
• Referrals were 6% lower compared to the same time period in 2021 (6,074, an average of 405 per week) and 10% lower than in 2022 (6,322, an average of 421 per week). 

Additional information 

These data are taken from the Drug and Alcohol Information System (DAISy) and its predecessor, the Drug and Alcohol Treatment Waiting Times (DATWT) database.  

For more information, or to analyse these data by NHS Board, visit the COVID-19 wider impacts dashboard. 

PHS publishes further information on waiting times for people accessing specialist drug and alcohol treatment services. The latest data can be viewed in our National Drug and Alcohol Treatment Waiting Times report. 

For details of drug treatment services in your area, visit the Scottish Drug Services Directory. 

The Medication Assisted Treatment (MAT) Standards are an improvement programme to strengthen access, choice and support within the drug treatment system in Scotland. 

Why we use a 3-week moving average 

As these data are highly variable over time, a 3-week moving average has been included in the graph to aid interpretation of trends over time.

Opioid substitution therapy

The average number of opioid substitution therapy (OST) doses supplied per month was stable in the period from October to December 2022. The number of OST doses supplied during this period was slightly lower than in the same time period in 2020 and 2021.

Background 

The data used in these statistics relate to the number of average daily quantity (ADQ) doses for OST drugs dispensed in the community in Scotland. OST drugs include methadone, oral buprenorphine and injectable buprenorphine. 

The first chart below shows the average total monthly number of ADQ doses supplied for OST medications in the community between 1 October 2020 and 31 December 2022. 

The stacked area chart shows the average total monthly number of ADQ doses supplied for OST medications in the community between October 2020 and November 2022. There was a gradual decrease in the average monthly total number of OST doses supplied over the time series, largely due to a decreasing trend in the average monthly number of methadone doses supplied.

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Average total number of OST doses per month

The chart below shows monthly trends in the number of ADQ doses supplied for specific OST medications in the community between 1 October 2020 and 31 December 2022.

The chart below shows monthly trends in the number of ADQ doses supplied for specific OST medications in the community between October 2020 and December 2022. Methadone was the most commonly prescribed OST at approximately 546,000 doses per month between October and December 2022. Buprenorphine was less frequently prescribed. The average monthly number of oral buprenorphine doses supplied decreased gradually between October 2020 and December 2022. Approximately 119,000 doses of oral buprenorphine doses were prescribed per month between October and December 2022. Injectable buprenorphine was first licensed for use in Scotland in early 2020. The average total number of doses supplied has increased steadily since then, to approximately 81,500 per month between October and December 2022.

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Number of doses per month for OST medications

Summary 

Historic trend 

• For an analysis of trends prior to October 2020, please see the RADAR Quarterly Report - January 2023. 
• There was a gradual decrease in the average monthly total number of OST doses supplied. This was largely due to a decreasing trend in the average monthly number of methadone doses supplied from 637,500 between October and December 2020, to 563,900 between July and September 2022. 
• The average monthly number of oral buprenorphine doses supplied was broadly stable between October to December 2020 (125,500) and July to September 2022 (118,300). 
• Injectable buprenorphine was first licensed for use in Scotland in early 2020. The average monthly number of doses supplied increased steadily from 15,700 between October and December 2020 to 70,100 between July and September 2022. 

Update 

For the most recent time period (1 October to 31 December 2022): 

• The average total monthly number of OST doses supplied was approximately 747,100. 
• This was roughly the same as in the previous quarter (July to September 2022) when approximately 752,200 doses were supplied. The number of OST doses supplied was 4% and 3% lower than in October to December 2020 and 2021 respectively. 
• The average monthly number of methadone doses supplied was approximately 546,300. Equivalent figures for oral buprenorphine and injectable buprenorphine were 119,300 and 81,500 respectively. 
• The number of methadone doses was 3% lower than in the previous quarter (July to September 2022) and 8% and 14% lower than in October to December 2020 and 2021 respectively. 
• The number of oral buprenorphine doses supplied was approximately the same as in the previous quarter (July to September 2022) and 5% and 3% lower than in October to December 2020 and 2021 respectively. 
• The number of injectable buprenorphine doses was 16% higher than in the previous quarter (July to September 2022) and 65% higher than in October to December 2021. 

Additional information 

These data have been extracted from the Prescribing Information System (PIS) and the Hospital Medicines Utilisation Data Manual (HMUD). 

The data shown on methadone and oral buprenorphine, and the majority of injectable buprenorphine data, relate to prescriptions dispensed to individuals from a community pharmacy in Scotland, where a request for reimbursement of costs was processed. These community prescribing data are extracted from the PIS. The time period reflects the month for which reimbursement was claimed. This is regarded as the most comprehensive and reliable way of reporting community prescribing data. There can be a lag of approximately three months from a prescription being written to reimbursement data becoming available. 

As a consequence of the direct administration of injectable buprenorphine within clinics, some NHS Boards do not request the reimbursement of costs for all of the OST treatments they provide. Data for approximately 24% of injectable buprenorphine doses supplied in Scotland are held in the HMUD and have been combined with the community prescribing data to provide a comprehensive account of OST supply over time. 

To analyse information on methadone and oral buprenorphine dispensing by NHS Board or by Alcohol and Drug Partnership, go to the COVID-19 wider impacts dashboard. 

Why we use a 3-month moving average 

As these data are highly variable over time, a 3-month moving average has been included in the charts to aid interpretation of trends over time. 

Even if all other factors are constant (for example, the number of treated patients), the total number of ADQ doses supplied will vary according to the number of days in each month. Averaging over three months minimises the impact of that variability. 

What is average daily quantity (ADQ)? 

When comparing use between medicines and over time, it is common to use World Health Organization (WHO) defined daily doses (DDDs). The DDD is defined as the usual average daily maintenance dose used in adults for the main therapeutic use of the medicine. The WHO DDD is a global average and may not be representative of the doses used in clinical practice at a more local level. This is particularly the case for methadone, where the WHO DDD of 25 milligrams (mg) daily is between one-half and one-third of the normal maintenance dose used in Scotland. 

We have therefore replaced DDDs with ADQs, which are more representative of the daily maintenance doses used within Scotland. These values have been developed through a combination of prescription analyses and by consultation with the Specialist Pharmacists in Substance Misuse group. The ADQs agreed are: 

• methadone (oral): 65 mg 
• buprenorphine (oral): 13 mg 
• buprenorphine (injection): 3.4 mg 

Injecting equipment provision

The average weekly numbers of injecting equipment provision (IEP) transactions decreased between October and December 2022, while the number of needles and syringes distributed was broadly stable. The total numbers of IEP transactions and needles and syringes distributed during this time period were lower compared to the same time periods in 2020 and 2021.

Background 

IEP is a form of harm reduction that helps to reduce the transmission of blood borne viruses among people who inject drugs. These data relate to the number of needle/syringe transactions at IEP sites and the total number of needles and syringes distributed. 

The first chart below shows the weekly number of IEP transactions from 28 September 2020 to 1 January 2023. 

The chart shows the number of transactions at IEP sites in Scotland. The number of transactions is on the y axis and the date, between 28 September 2020 and 1 January 2023, on the x axis. An overall decreasing trend was observed from October 2020 to the end of 2021. In 2022, the number of transactions was broadly stable but remained lower than the comparable periods in previous years. A seasonal dip in transactions in late November and December each year was observed.

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Injecting equipment provision: transactions

The second chart shows the weekly number of needles and syringes distributed from 28 September 2020 to 1 January 2023.

The chart shows the number of needles and syringes distributed by IEP sites in Scotland. The number of needles and syringes is on the y axis and the date, between 28 September 2020 and 1 January 2023, on the x axis. An overall decreasing trend was observed from October 2020 to October 2021. The number of needles and syringes distributed was broadly stable since October 2021 but remained lower than the comparable periods in previous years.

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Injecting equipment provision: needles and syringes distributed

The third chart shows the weekly ratio of needles and syringes distributed per transaction from 28 September 2020 to 1 January 2023.

The chart shows the ratio of needles and syringes distributed per transaction by IEP sites in Scotland. The ratio of needles and syringes per transaction is on the y axis and the date, between 28 September 2020 and 1 January 2023, on the x axis. The ratio was broadly stable at an average of 14 needles and syringes distributed per transaction, but seasonal fluctuations were observed during December 2021 and 2022.

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Injecting equipment provision: ratio of needles and syringes distributed per transaction

Summary

Historic trend

• There was an overall decrease in the average weekly number of IEP transactions from September 2020 to February 2022. This trend included seasonal fluctuations during December and January each year. From February to October 2022, the average number of IEP transactions was relatively stable (approximately 3,000 per week).
• A fluctuating decreasing trend in the average weekly number of needles and syringes distributed was observed from September 2020 to October 2021. Since October 2021, the average number of needles and syringes distributed has remained broadly stable (approximately 37,000 per week).
• The ratio of needles and syringes distributed per transaction was relatively stable from September 2020 to December 2022, at an average of 14 needles and syringes distributed per transaction. Seasonal fluctuations were observed during December 2021 and 2022.

Update

For the most recent time period (3 October 2022 to 1 January 2023):

IEP transactions

• 36,191 transactions were recorded, at an average of 2,784 per week.
• This was 6% lower compared to the previous time period (4 July to 2 October 2022) when a total of 38,644 were recorded, at an average of 2,973 per week.
• The total number of transactions was 20% lower compared to the same time period in 2020 (45,337, an average of 3,238 per week), and 5% lower than in 2021 (38,073, an average of 2,929 per week).

Needles and syringes distributed

• 471,583 needles and syringes were distributed, at an average of 36,276 per week.
• This was approximately the same as the previous time period (4 July to 2 October 2022) when a total of 492,782 needles and syringes were distributed, at an average of 37,906 per week.
• The total number of needles and syringes distributed was 16% lower compared to the same time period in 2020 (561,189, an average of 40,085 per week), and similar to 2021 (481,381, an average of 37,029 per week).

Ratio of needles and syringes distributed

• The weekly average of 14 needles and syringes distributed per transaction was the same as in the previous time period (4 July to 2 October 2022) and the same time periods in 2020 and 2021.

Additional information 

These data are taken from the Needle Exchange Online 360 database (neo360). 

The 11 mainland NHS Boards use neo360 routinely, but due to missing data for part of the time period presented, NHS Highland is excluded from the transaction data, and both NHS Fife and NHS Highland are excluded from the needle and syringe and ratio figures. 

For more information, or to analyse these data by NHS Board, visit the COVID-19 wider impacts dashboard. 

For details of injecting equipment providers in your area, visit the Scottish Needle Exchange Directory. 

Why we use a 3-week moving average 

As these data are highly variable over time, a 3-week moving average has been included in the graph to aid interpretation of trends over time. 

Glossary