Rapid Action Drug Alerts and Response (RADAR) quarterly report
April 2023
A Management Information Statistics publication for Scotland
- Published
- 25 April 2023
- Type
- Statistical report
- Author
- Public Health Scotland
Service indicators
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.
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 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.
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
- Methadone
Methadone is an opioid drug commonly prescribed as an opioid substitution therapy. Methadone is a full opioid agonist – it is most commonly seen as a green liquid, which is taken orally (swallowed) on a daily basis. These data refer to methadone prepared as a 1 mg/ml solution.
- Buprenorphine
Buprenorphine is an opioid drug commonly prescribed as an opioid substitution therapy. Buprenorphine is a partial opioid agonist – it is available in oral and injectable forms:
- Oral buprenorphine is buprenorphine in tablet form that is administered orally (by mouth, usually sub-lingual – under the tongue) on a daily basis. It is also known by brand names such as Subutex. These data include 2 mg, 8 mg and 16 mg tablets.
- Injectable buprenorphine is buprenorphine in liquid form that is administered as a subcutaneous injection. It is also known by brand names such as Buvidal. These data include various weekly and monthly prolonged release formulations.
- Defined daily dose (DDD)
As defined by the World Health Organization, the DDD is ‘the assumed average maintenance dose per day for drug use for its main indication in adults’.
- Average daily quantity (ADQ)
ADQ is similar to the DDD but adjusted to reflect how medication is used in Scotland.
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 second chart shows the weekly number of needles and syringes distributed from 28 September 2020 to 1 January 2023.
The third chart shows the weekly ratio of needles and syringes distributed per transaction from 28 September 2020 to 1 January 2023.
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
- Transaction
A transaction is an episode in which a client received equipment relating to an injecting episode (i.e. a barrel and/or fixed needle and syringe). People who inject drugs may attend IEP outlets at any time, whether or not they are undertaking specialist treatment for problematic drug use.