• Healthcare indicators of harm and service use remained broadly stable. 
• The predominant picture of drug harms in Scotland continues to be polydrug use involving benzodiazepines, stimulants and opioids. 

Alerts 

• On 24 January 2023, RADAR published a public health alert – nitazene-type drugs in Scotland. This alert was updated on 29 March 2023 to reflect an increase in harms and further detections in the wider drugs market. 
• Due to their unexpected presence in the drug supply and high potency, nitazenes pose a substantial risk of overdose, hospitalisation and death. 

Trends 

• 23 reports were validated by RADAR between 12 January and 7 April 2023. 
• The majority of reports received related to cocaine, benzodiazepines (such as bromazolam) and counterfeit pregabalin. RADAR is currently assessing the harms of these drugs. 
• Half of reports mention mixing two or more substances (polydrug use). Mixing drugs can cause unexpected and unpredictable effects and is a major risk factor in drug-related deaths in Scotland. 

Harm indicators 

• The number of Scottish Ambulance Service naloxone incidents between December 2022 and February 2023 was lower than the same time period in the previous year. The increase in the distribution of take-home naloxone kits from community outlets, peers and prisons and distribution to police officers in Scotland in recent quarters, should be taken into consideration when interpreting data on administration of naloxone by emergency services.    
• Drug-related attendances at emergency departments were stable from December 2022 to February 2023 and higher than the same time period in the previous year. Meanwhile, the number of drug-related hospital admissions between October and December 2022 was considerably lower than the same time period in the previous year. This reduction in admissions should be interpreted with caution. The number of hospital admissions may be affected by issues accessing urgent care services and by the capacity of hospital services and is not necessarily an indicator of a reduction in harms.
• Suspected drug deaths remained high and broadly stable from December 2022 to the end of February 2023, averaging 96 deaths per month. This was the same as in December 2021 to February 2022. 

Toxicology indicators 

• As with drug-trend reports, toxicology results were dominated by the presence of benzodiazepines, opioids, cocaine and, in prisons, synthetic cannabinoids. 
• In hospital toxicology (the ASSIST research pilot), two or more substances were detected in 87% of drug-related emergency department presentations. The most commonly detected individual drugs were cocaine, followed by desmethyldiazepam (a benzodiazepine and also a metabolite of diazepam), followed by temazepam.  
• In post-mortem testing, the most detected drug type was opioids. The most commonly detected drugs were heroin/morphine (37%) and diazepam (37%). Bromazolam and protonitazene were detected in post-mortem tests for the first time in October to November 2022.  
• In prisons, drug analysis showed a changing picture of drug use, as new synthetic cannabinoids and benzodiazepines continued to appear. Synthetic cannabinoids were the most prevalent drug type detected in June to December 2022. Benzodiazepines were the second most prevalent, with bromazolam being the most common benzodiazepine detected. 
• The continuing evolution in the types of substances detected emphasises the importance of investment in drug checking, forensic post-mortem toxicology and hospital toxicology testing. 

Service indicators 

• The average weekly number of specialist drug treatment referrals from November 2022 to February 2023 was highly variable and followed the seasonal fluctuations seen in previous years. The number of referrals during this period was lower than the same time period in the previous year. 
• 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 doses supplied during this period was slightly lower than in the same time period in 2021. OST drugs include methadone, oral buprenorphine (typically taken daily) and injectable buprenorphine (taken weekly and monthly). While the overall number of OST doses supplied has slightly decreased, doses of injectable buprenorphine have continued to increase. 
• The average weekly numbers of needles and syringes distributed was broadly stable between October and December 2022. The total numbers of needles and syringes distributed during this period was lower compared to the same time period in 2021.