• Drug-related harms remained high in Scotland.
• The following changes were observed compared to the previous reporting period (reported in quarterly report 6 – January 2024):

For harm indicators:

• • suspected drug deaths: 17% increase^R
  • naloxone administration incidents: 14% decrease
  • emergency department attendances: 12% decrease
  • drug-related hospital admissions: 24% decrease

For service indicators:

• • drug treatment referrals: 10% decrease
  • injecting equipment provision: transactions - stable, number of needles and syringes - 6% decrease
• Patterns of polysubstance use remain the key driver of harms. The combinations most associated involve benzodiazepines (most commonly diazepam and bromazolam), cocaine and opioids.
• Cocaine played an increasing role in harms.

Alerts

• A public health alert about nitazene-type opioids was updated in December 2023. Based on the latest post-mortem toxicology testing, nitazenes were detected in 38 deaths (from the first detection in June 2022 to 31 December 2023).
  • PHS alert: nitazene-type opioids in Scotland
  • SDF synthetic opioid resources (external website)
• A public health alert about new benzodiazepines was published in July 2023 and remains current. Bromazolam is currently the most common 'street benzo' detected in Scotland.
  • PHS alert: new benzodiazepines - bromazolam

Harm indicators

• Between December 2023 and February 2024, the average weekly number of Scottish Ambulance Service naloxone administration incidents decreased (from 72 to 68). The total number of incidents was 14% lower than in the same period in 2021/22 and 10% higher than in 2022/23.
• Between December 2023 and February 2024, drug-related attendances at emergency departments were 12% lower than in the previous period. The number of attendances was 7% higher compared to the same period in 2021/22 and similar to 2022/23.
• Between October and December 2023, drug-related hospital admissions were 24% lower than in the previous period. The total number of admissions was 26% lower than the same period in 2021 and 7% higher than in 2022. These data should be interpreted with caution, as the number of admissions may be affected by issues accessing urgent care and by the capacity of hospital services.
• Between December 2023 and February 2024, there were 294 suspected drug deaths. The number of deaths was 10% higher than the same period commencing in December 2021 (268) and similar to the same period commencing in December 2022 (285).^R

Toxicology indicators

• Between November 2023 and February 2024, the most frequently detected drug in the ASSIST hospital toxicology project was cocaine (11%) followed by desmethyldiazepam, temazepam and bromazolam (all 10%). Nitazenes made up 1% of detections (detected eight times, down from 16 in the previous quarter).
• Between October and December 2023, the most common drug types detected in post-mortem toxicology were opioids (70%) and benzodiazepines (58%). The most common individual drug detected was cocaine (36%), followed by heroin/morphine (29%), methadone (29%), diazepam (27%) and bromazolam (22%). Nitazenes were detected in 2% of deaths (12).
• Limited Scottish Prison Service drug analysis data for August to October 2023, showed the most common drug type was synthetic cannabinoids.

Service indicators

• Between November 2023 and February 2024, the average weekly number of referrals to specialist drug treatment services was relatively stable, aside from a seasonal fluctuation seen in previous years. The total number of referrals recorded in this period (5,351) was broadly similar to the same period commencing December 2022 (5,150) and 2021 (5,458).
• Between October and December 2023, the average weekly number of injecting equipment provision transactions, and needles and syringes distributed remained relatively stable. During this time period, the number of transactions was similar to the same period in 2021 and 6% higher than in 2022. The number of needles and syringes distributed was 16% higher than the same period in 2021 and similar to 2022.
• Between October and December 2023, opioid substitution therapy (OST) doses supplied per month was stable and similar to the same period in 2021 and 2022. The average monthly number of methadone doses supplied continued to decrease while the number of injectable buprenorphine doses increased over time.

Reporting trends

• Between January and April 2024, 43 trend reports were received by RADAR.
• The majority of reports related to benzodiazepines, cocaine, heroin and polydrug use.
• Other commonly reported concerns related to synthetic opioids (nitazenes), cannabinoids (cannabis and synthetic cannabinoids), ketamine and MDMA.
• Trend reports can be viewed on our dashboard (external website).

Implications

The harm caused by drugs is a significant public health issue for Scotland. The illicit drugs market is evolving and increasingly toxic substances are being detected with greater frequency, most notably nitazenes and xylazine.

The risk of harm and death are increased in the context of polysubstance use, stigma and exclusion.

The increasing frequency of cocaine involvement in drug harms indicates the need for appropriate evidence-based prevention, harm reduction and treatment measures to reduce this risk.

The results of limited drug checking from Scotland indicate that contamination of illicit drugs with toxic substances is common. This finding emphasises the importance of timely and accurate hospital toxicology and forensic post-mortem toxicology services, as well as accessible drug checking.