Naloxone administration by Scottish Ambulance Service

The average weekly number of naloxone administration incidents decreased between December 2023 (72) and February 2024 (68). The total number of incidents during this time period (879) was 14% lower than in the previous period (1,020). The number of incidents was similar to the same period commencing in December 2021 (914) and 10% higher than in the same period commencing in December 2022 (801).

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 6 December 2021 to 3 March 2024.

An interactive version of this chart can be found in the RADAR dashboard (external website). The dashboard also allows users to download the data and filter by NHS board.

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 6 December 2021 and 3 March 2024, is on the x axis. An uneven slightly decreasing trend was observed from December 2021 until April 2022. Following an isolated increase in April 2022, the number of naloxone incidents followed a gradual decreasing trend from May to December 2022. An increasing trend was observed from January to May 2023. Between June and August 2023, the average weekly number of naloxone incidents remained broadly stable at around 93 per week, after which the weekly number of incidents followed a generally decreasing trend to January 2024, although an isolated increase was observed in week beginning 30 October (108).

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Naloxone administration by Scottish Ambulance Service

Summary

Historic trend

• Until winter 2021, 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.
• During 2022, the normal seasonal pattern was less pronounced than in previous years and, despite an increase in April, followed a gradual decreasing trend from May to December 2022.
• An increasing trend in the average weekly number of incidents was observed from January (60) to May 2023 (79).
• Between June and August 2023, the average number of incidents remained broadly stable (96), before generally decreasing to November 2023 (76). An isolated increase was observed in the week beginning 30 October (108).

National update

For the most recent 13-week period (4 December 2023 to 3 March 2024):

• 879 SAS naloxone incidents were recorded, at an average of 68 per week. Weekly numbers of incidents remained broadly stable, ranging between 56 and 86, although an isolated decrease was observed in the week beginning 1 January (44).
• The total number of incidents was 14% lower than in the previous 13-week period (4 September to 3 December 2023) when 1,020 incidents were recorded, at an average of 78 per week.
• The number of incidents was similar to the same period commencing in December 2021 (914, weekly average 70) and 10% higher than in the same period commencing in December 2022 (801, weekly average 62). 

Local update

For the most recent period (4 December 2023 to 3 March 2024), naloxone administration incidents decreased across most mainland NHS boards, compared to the previous period:

• Incidents decreased in eight areas: NHS Lothian (10%), NHS Ayrshire and Arran (10%), NHS Dumfries and Galloway (12%), NHS Lanarkshire (15%), NHS Tayside (16%), NHS Greater Glasgow and Clyde (22%), NHS Highland (24%) and NHS Fife (37%).
• Incidents increased in NHS Borders (42%) and NHS Forth Valley (58%).
• Incidents were broadly stable in NHS Grampian. 

To analyse these data further, please visit the RADAR dashboard (external website).

Additional information

PHS was provided with these data by SAS.

Information on take-home naloxone distribution can be found in the National Naloxone Programme Scotland quarterly monitoring bulletin, published by PHS.

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 (such as unconsciousness, shallow breathing, snoring, blue lips, pale skin and 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 (external website).

Naloxone is very easy to administer. You can learn more about administering naloxone in a free e-learning module 'Overdose Prevention, Intervention and Naloxone (external website)' created by the Scottish Drugs Forum.

Drug-related attendances at emergency departments

Between December 2023 and February 2024, the number of drug-related attendances at emergency departments (1,009) was 12% lower than in the previous time period. The number of attendances was 7% higher compared to the same period commencing in December 2021 (945) and similar to the same period commencing in December 2022 (1,044).

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 29 November 2021 and 3 March 2024.

An interactive version of this chart can be found in the RADAR dashboard (external website). The dashboard also allows users to download the data and filter by NHS Board.

The chart shows the number of drug-related emergency department attendances in Scotland. The number of attendances is on the y axis and the date, between 29 November 2021 and 3 March 2024, is on the x axis. An overall decreasing trend was observed from November 2021 to April 2022, with the lowest levels in the week beginning 4 April (53). Attendances then increased sharply, peaking at 123 in the week beginning 16 May. Attendances decreased and remained broadly stable at 82 per week between June 2022 and March 2023. Between April and June 2023, the number of attendances gradually increased before a peak of 142 in the week beginning 19 June. From July 2023 to February 2024, an overall decreasing trend was observed, in spite of large variations in the number of attendances per week.

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Drug-related attendances at emergency departments

Summary

Historic trend

• A decreasing trend was observed from November 2021 to April 2022, from an average of 73 attendances per week in November 2021, to the lowest level in the series in the week beginning 4 April 2022 (53).
• Attendances then increased sharply and peaked in the week beginning 16 May 2022 (123) before decreasing and remaining stable until March 2023 (weekly average 82).
• Between April and June 2023 attendances generally increased, with the highest weekly levels in the series observed in the week beginning 19 June (142).
• From July to November 2023, an overall decreasing trend was observed in the number of attendances per week (from 94 to 76).

National update

For the most recent 13-week period (4 December 2023 to 3 March 2024):

• 1,009 emergency department attendances were recorded, at an average of 78 per week. This was 13% lower than the previous 13-week period (4 September to 3 December 2023, 1,142 attendances, weekly average 88). 
• Attendances were 7% higher than the same period commencing in December 2021 (945 attendances, weekly average 73) and similar to the same period commencing in December 2022 (1,044 attendances, weekly average 80).

Local update

For the most recent period:

• Attendances decreased in five NHS boards compared to the previous period: NHS Lanarkshire (14%), NHS Lothian (16%), NHS Greater Glasgow and Clyde (17%), NHS Ayrshire and Arran (23%) and NHS Highland (43%).
• Attendances increased in two areas: NHS Borders (35%) and NHS Grampian (67%).
• Attendances were broadly stable in the other mainland boards.

To analyse further, please visit the RADAR dashboard (external website).

Additional information

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

Due to the quality of the data available, it is not possible to accurately report total attendances for specific conditions using the national Accident and Emergency dataset. The diagnosis or reason for attendance can be recorded in a variety of ways, including in free text fields and not all NHS boards submit this information. The numbers presented in this report are based on an experimental definition of drug-related ED attendances and have not been subject to extensive quality assurance. Therefore, they are provisional and may be subject to change in future releases. Further details can be found in the metadata and the Accident and Emergency Activity Data.

Drug-related acute hospital admissions

Between October and December 2023, 1,942 drug-related hospital admissions were recorded, 24% lower than the previous quarter (2,561). Admissions were 26% lower than the same period in 2021 (2,438) and 7% higher than in 2022 (1,798).

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 27 September 2021 to 31 December 2023.

An interactive version of this chart can be found in the RADAR dashboard (external website). The dashboard also allows users to download the data and filter by NHS board.

The chart shows the number of drug-related hospital admissions in Scotland’s general acute hospitals. The number of admissions is on the y axis and the date, between 27 September 2021 to 31 December 2023, is on the x axis. Following a decreasing trend from October 2021 to April 2022, admissions briefly increased in April and May 2022 (peak of 201 admissions during the week beginning 16 May), before following an uneven decreasing trend from June to December 2022. Admissions increased between January and July 2023, reaching a peak in week beginning 10 July (221), remaining relatively stable until September before following a decreasing trend until December 2023.

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Drug-related hospital admissions

A further chart showing the top five drug types associated with admissions is available on the RADAR dashboard (external website).

Summary 

Historic trend 

• There was a decreasing trend in the weekly number of drug-related hospital admissions from October 2021 to April 2022. Admissions briefly increased between April and May 2022, before following an uneven decreasing trend between June and December 2022.
  • The decrease seen in 2022 should not necessarily be interpreted as a reduction in harms. Hospital admissions may have been affected by issues accessing urgent care services and by the capacity of hospital services.
• Admissions then increased, from 119 in the week beginning 26 December 2022, to 221 in the week beginning 10 July 2023.
• Between July to September 2023, the most common drug category recorded was opioids (45% of admissions), followed by cocaine (20%).

National update

For the most recent period (2 October to 31 December 2023):

• 1,942 drug-related hospital admissions were recorded, at an average of 149 per week. This was 24% lower compared to the previous 13-week period (2,561 admissions, weekly average 197).
• Admissions generally decreased throughout this period, from 162 in the week beginning 2 October 2023, to 104 in the week beginning 25 December 2023.
• The total number of admissions was 26% lower than in 2021 (2,438, weekly average 188) and 7% higher than in 2022 (1,798, weekly average 138).
• Opioids continued to be the most common substance type. These were recorded in an average of 47% of admissions per month, which was broadly consistent over the time series. There was a slight decrease in the average monthly cocaine admissions recorded (17%) compared to the previous 13-week period.

Local update

For the most recent period (2 October to 31 December 2023), the number of drug-related hospital admissions decreased across most mainland NHS boards, compared to the previous quarter:

• Admissions decreased in six areas: NHS Ayrshire and Arran (9%), NHS Greater Glasgow and Clyde (15%), NHS Forth Valley (28%), NHS Lothian (29%), NHS Grampian (30%) and NHS Dumfries and Galloway (39%).
• Admissions were broadly stable in two areas: NHS Borders and NHS Tayside.
• Due to completeness levels for the most recent time period being below 90%, NHS Fife, NHS Highland and NHS Lanarkshire have been excluded from the above narrative. The data can be found on our dashboard. Caution is advised when interpreting local trends for these boards and comparing to other areas.

To analyse further, please visit the RADAR dashboard (external website).

Additional information 

These data have been extracted from our Scottish Morbidity Records (SMR01 acute).

The data presented on drug type are based on ICD-10 diagnostic codes and are not confirmed by toxicology analysis, therefore patterns in substance type should be interpreted with caution.

The most recent Official Statistics on drug-related hospital care, includes a range of further information on drug types and patient demographics. For details, see our information on drug-related hospital statistics (DRHS). Please note, our DRHS dashboard presents data by date of discharge, so figures will differ to those shown above.

Suspected drug deaths

The total number of suspected drug deaths between December 2023 and February 2024 was 294, averaging 25 per week. The average weekly number of deaths was roughly stable between December 2023 (24) and February 2024 (24). The total number of deaths (294) was 17% higher than the previous period (251), 10% higher than the same period commencing in December 2021 (268) and similar to the same period commencing December 2022 (285).(R)

Background

A suspected drug death is a death where controlled drugs are suspected of being involved. Suspected drug-death figures are based on reports, observations and initial enquiries from police officers attending scenes of death.

The details of these events are recorded by Police Scotland and shared with Public Health Scotland (PHS).

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 those published by the National Records of Scotland (NRS: external website) 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 22 November 2021 to 25 February 2024.

An interactive version of this chart can be found in the RADAR dashboard (external website). The dashboard also allows users to download the data.

The chart shows the weekly number of suspected drug deaths in Scotland on the y axis and the date, between 22 November 2021 to 25 February 2024, on the x axis. Between December 2021 and the end of February 2024, the average weekly number of deaths fluctuated considerably but remained within a range of 17 to 31 per week.

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Suspected drug deaths

Summary 

Historic trend 

• Between December 2021 and November 2023, the average weekly number of suspected drug deaths fluctuated considerably but remained within a range of 17 to 31 per week.

Update 

For the most recent period (December 2023 to February 2024):

• There was a total of 294 suspected drug deaths, 17% higher than the previous period (251). This was 10% higher than the same period commencing in December 2021 (268) and similar to the same period commencing December 2022 (285).
• There were 96 deaths in December, 103 in January and 95 in February.
• The average weekly number of deaths remained broadly stable throughout December 2023 (24), January 2024 (26) and February 2024 (24).
• An average of 25 deaths were recorded per week. This was 19% higher than the previous period (21),14% higher than the same period commencing in December 2021 (22) and similar to the same period commencing in December 2022 (24)

To analyse these data further, please visit the RADAR dashboard (external website).

Additional information 

Data on suspected drug deaths are provided by Police Scotland.

The Scottish Government produce a quarterly report (Suspected drug deaths in Scotland (external website)) 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.

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

Accredited official statistics on drug-related deaths are published annually by the NRS during the summer and provide information broken down by age, sex, substance implicated and geographical area. The latest NRS publication (external website) reported that there were 1,051 drug-related deaths in Scotland in 2022. This was a 21% decrease compared to 2021 (1,330).

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 PHS drug-related deaths report describes deaths that occurred in 2017 and 2018, with trend data from 2009.