Rapid Action Drug Alerts and Response (RADAR) quarterly report
April 2024 (correction 4 June 2024)
- Published
- 04 June 2024
- Type
- Statistical report
- Author
- Public Health Scotland
- Topics
-
Drugs
About this release
Our quarterly report
The Drugs Team at Public Health Scotland (PHS) has compiled this RADAR quarterly report of drug-related indicators.
The objective of this report is to monitor drug-related harms, service usage and toxicology data, in order to provide an early warning of emerging drug trends and identify actions to reduce and prevent drug harms and deaths.
View a printable version of this report.
Update
The suspected drug death section in this publication was revised on 4 June 2024 to include updated data for January and February 2024 due to data quality and completeness issues. This means that the number of suspected drug deaths occurring in the period covered by this report was higher than previously stated. The revisions are as follows:
- January 2024: number of deaths was revised from 96 to 103
- February 2024: number of deaths was revised from 86 to 95
- December 2023 to February 2024: number of deaths was revised from 278 to 294
Updates are defined by R or (R).
Acknowledgements
This report reflects the collective efforts of different organisations and hundreds of people in frontline and supporting roles who record, organise, analyse and interpret information from a range of sources and services.
We gratefully acknowledge the continued commitment and effort of all those involved.
Data and reporting period
RADAR's emphasis is on reporting drug-related information as rapidly as possible, for the purpose of public health surveillance. This means that data may not be fully validated and may be subject to change. Further analysis of these data will be made available in our Accredited official statistics publications on substance use.
Observed changes in indicators may reflect genuine trends in behaviours but may also be influenced by factors such as the configuration of services, or data quality and completeness issues.
Different time periods may be reported across the different indicators. In all cases, the most recently available data are used. Most charts show Scotland-level data based upon a two-year time series. Location and time series can be customised in the RADAR dashboard (external website).
The next release of this publication will be 30 July 2024.
Dashboard
Data for most of the harm and service indicators in this report are published in our new RADAR dashboard (external website).
In the dashboard, the time series can be adjusted and the data can be filtered by NHS board.
This dashboard supersedes the substance use section of the COVID-19 wider impacts dashboard (external website), which has now been decommissioned.
For optimal viewing and interaction, we recommend accessing the dashboard using a computer with a large screen. Accessing via a mobile phone may reduce the functionality.
Main points
- 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% increaseR
- 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.
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.
Alerts
Current alerts
Nitazenes
A public health alert about nitazene-type opioids was published in January 2023. This alert was further updated in December 2023 to include provisional data on detections of nitazene-type opioids in deaths in Scotland. Based on provisional post-mortem toxicology testing, nitazenes were detected in 38 deaths (from the first detection in June 2022 to 31 December 2023).
Bromazolam
A public health alert about new benzodiazepines was published in July 2023. Bromazolam is the most common drug detected in ‘street benzos’. Bromazolam produces strong sedative and sleep-inducing effects. As a result, there is a substantial risk of overdose.
Trends
Police drug trends bulletin
This bulletin contains photos of drugs.
This update provides information on new synthetic drugs – nitazene-type opioids and xylazine.
This information has been provided by Police Scotland’s Statement of Opinion (STOP) Unit to raise awareness of drug appearance and to demonstrate some of the substances present in Scotland's drugs market.
Xylazine
Xylazine is a non-opioid veterinary tranquiliser, not approved for human use. Xylazine (often known as ‘tranq’) is used on its own, but more commonly it is found in combination with opioids. This may increase the effects experienced but also increases the risk of harms.
Limited research has been conducted on the effects of xylazine on the human body, but anecdotal reports indicate that users experience effects similar to opioids and other depressants (analgesia, decreased breathing, decreased heart rate, nausea, unconsciousness).
The supply and importation of xylazine is controlled by the Psychoactive Substances Act 2016. In February 2024, the Advisory Council on the Misuse of Drugs (ACMD) recommended xylazine be added to class C of the Misuse of Drugs Act 1971.
Police Scotland have encountered a small number of recoveries of diamorphine that contained xylazine both in the east and west of Scotland. One recovery of 925 grams was made in the west of Scotland and is depicted below. The seizure of light brown powder with grey flecks was analysed and found to contain diamorphine (heroin), bromazolam, metonitazene, protonitazene and xylazine.
![925 grams of a light brown and grey powder, pressed into a solid block.](/media/26595/police-seizure-containing-xylazine-nitazenes-bromazolam-and-diamorphine.png)
Nitazenes
As of 20 March 2024, the following fifteen synthetic opioids have been added as class A drugs to the Misuse of Drugs Act 1971:
- metonitazene
- protonitazene
- isotonitazene
- butonitazene
- flunitazene
- metodesnitazene (metazene)
- etodesnitazene (etazene)
- N-pyrrolidino-etonitazene (etonitazepyne)
- N-piperidinyl-etonitazene (etonitazepipne)
- N-pyrrolidino protonitazene
- ethyleneoxynitazene
- N-desethyl protonitazene
- N-desethylisotonitazene
- N-desethyl-etonitazene
- brorphine
There are several operation and threat assessment groups that have been set up throughout Scotland and the UK to monitor the threat, including Project Housebuilder run by the National Crime Agency (NCA).
To date, Police Scotland have had 16 cases in which nitazene-type opioids have been found.
RADAR intelligence and reports
43 reports were validated by RADAR between 5 January and 4 April 2024.
43 reports were validated by RADAR between 5 January and 4 April 2024.
So far, RADAR has received over 200 reports of drug-related information and harms through the reporting form and mailbox.
A summary of key trends is shown below. Validated intelligence reports to RADAR can be found on the dashboard (external website).
Please note, many of these reports have not been confirmed by toxicology and should be considered anecdotal.
Trends by primary drug type
In the latest period (5 January to 4 April 2024):
- The most common drugs or drug types reported were:
- benzodiazepines
- cocaine
- heroin
- new synthetic opioids, including nitazenes
- MDMA (ecstasy)
- Most concerns were related to adverse effects.
Synthetic drugs
RADAR is assessing the harms related to new synthetic drugs, including bromazolam, nitazene-type opioids and xylazine.
Bromazolam
Drug: Bromazolam. A benzodiazepine with sedative and anti-anxiety effects.
UK legal status: Bromazolam is classified as a class C drug under the Misuse of Drugs Act 1971.
Update
- Bromazolam continues to be the most common benzodiazepine detected in ‘street benzos’ in Scotland.
- In March 2024, the UN voted to add bromazolam to the United Nations Convention on Psychotropic Substances 1971, increasing regulations on the production and distribution. It is likely we will see further changes to the benzodiazepine market and more novel substances will emerge. If you notice changes, let us know using our reporting form or by emailing phs.drugsradar@phs.scot.
Nitazenes
Drug: Nitazenes. A group of potent synthetic opioids.
UK legal status: In March 2024, 15 new opioids were added to the Misuse of Drugs Act 1971. Now most nitazenes (including protonitazene, metonitazene, isotonitazene and n-pyrrolidino etonitazene) are classified as class A drugs.
Update
- Reports to RADAR show ongoing availability and detections of nitazenes, most commonly metonitazene and protonitazene.
- They have been found in drugs sold as heroin, benzodiazepines and oxycodone.
- Based on post-mortem toxicology testing, nitazenes have been detected in 38 deaths (to 31 December 2023).
Xylazine
Drug: Xylazine. A depressant drug used in veterinary medicine with sedative, analgesic and muscle relaxant properties.
Legal status: The supply and importation of xylazine is controlled by the Psychoactive Substances Act 2016. Xylazine is not controlled by the Misuse of Drugs Act 1971, but in February 2024, the Advisory Council on the Misuse of Drugs recommended xylazine be added as a class C drug.
Update
- Between October 2023 and March 2024, xylazine was detected by WEDINOS in 15 samples mis-sold as heroin in Lothian, Forth Valley and the Scottish Borders.
- Xylazine was first detected in both post-mortem toxicology and in the ASSIST hospital toxicology project in July 2023. Since then, it has been detected 21 times (8 post-mortem and 13 ASSIST). It is often co-detected alongside heroin, benzodiazepines, codeine, cocaine and nitazenes (most commonly metonitazene and protonitazene).
Reporting drug harms
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 and wounds
- routes of administration
- new substances or patterns of use
- testing data.
The information in the regional breakdown can be used by local areas for their own drug trend surveillance.
Anyone can make a report by using our reporting form or by emailing phs.drugsradar@phs.scot.
Harm indicators
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.
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.
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.
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.
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.
Toxicology indicators
Emergency department toxicology: ASSIST
Between November 2023 and February 2024, the ‘A Surveillance Study of Illicit Substance Toxicity’ (ASSIST) emergency department project made 496 detections of 40 different illicit drugs, in samples from 88 patients. The most commonly detected drug category was depressants (67% of detections), followed by opioids (13%). The most commonly detected individual drug was cocaine (11%), followed by desmethyldiazepam, temazepam and bromazolam (all 10%).
Background
The ASSIST study is conducted by the emergency department (ED) at the Queen Elizabeth University Hospital (QEUH) in NHS Greater Glasgow and Clyde (GGC). This project has been funded by the Scottish Government since August 2022.
The aim of the study is to monitor drug trends and associated clinical features through the use of prospective surveillance of ED attendances due to acute illicit drug toxicity. For the most unwell patients, the study performs full toxicological analysis through the biorepository-approved surplus sampling.
The study allows drug profiling and the identification of emerging drugs or changing trends to inform appropriate harm reduction measures and public health responses.
Data collection
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. Surplus serum samples are leftover blood samples, which were taken as part of usual care.
Each ED attendance is counted once in these data. If the same person presented more than once, each attendance would be a separate data point.
Drug detections presented here are of ‘illicit drugs’ only and were not prescribed to the individual.
Illicit drug definition
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 (e.g. if methadone is detected but the individual is prescribed methadone, it will not be included)
- drugs administered to the individual as part of treatment (by ambulance staff or in hospital).
Toxicology analysis of surplus serum samples
Detections presented are for the substance only. If a metabolite (compound produced when a drug breaks down in the body) is detected, it will be presented as the substance only. If the metabolite and substance are detected, it will also be presented as the substance only.
However, if a drug and a metabolite are both detected but the metabolite could also be a drug, we have included both as it is not possible to say which has been used, if not both.
Data from the study are presented in quarters, based on the date of ED presentation, and are provided in the table below:
Quarter | Dates |
---|---|
Quarter 1 (Q1) | 17/08/2022 to 16/11/2022 |
Quarter 2 (Q2) | 17/11/2022 to 16/02/2023 |
Quarter 3 (Q3) | 17/02/2023 to 16/05/2023 |
Quarter 4 (Q4) | 17/05/2023 to 16/08/2023 |
Quarter 5 (Q5) | 17/08/2023 to 16/11/2023 |
Quarter 6 (Q6) | 17/11/2023 to 16/02/2024 |
Results
The first chart shows the most common drug categories detected in toxicology analysis of surplus serum samples between 17 August 2022 and 16 February 2024 (Q1 to Q6).
The results are shown as the total number of detections. They are broken down by the top five drug categories and presented by study quarter.
Summary
Historic trend
Between 17 August 2022 and 16 November 2023:
- The most commonly detected drug type was depressants, making up 62% of all detections, followed by opioids (17%). The most commonly detected individual drug was cocaine (11%).
- 72% of attendances were male and 28% were female.
- 76% of attendances were aged 44 and under. The most common age category was 25 to 34 years (30%), followed by 35 to 44 (27%) and 16 to 24 (19%).
- The most common outcomes were discharged to home (39%), ward (28%) and police custody (11%).
Update
For the most recent period (17 November 2023 to 16 February 2024):
- 288 individual ED attendances related to illicit drug use were identified.
- 88 attendances qualified for surplus sampling toxicology testing (as they were categorised as having a higher clinical severity of toxicity as per research inclusion criteria).
Drug type and category
Among the 88 samples analysed:
- There were 496 detections of 40 individual substances (found through the biological detection of the drug or its metabolite).
- The average number of drugs detected per sample was six.
Of the 496 detections, the following drugs were the most common:
- cocaine: 55 (11% of detections, 63% of samples)
- desmethyldiazepam: 50 (10% of detections, 57% of samples)
- temazepam: 50 (10% of detections, 57% of samples)
- bromazolam: 49 (10% of detections, 56% of samples)
- etizolam: 38 (8% of detections, 43% of samples)
- oxazepam: 38 (8% of detections, 43% of samples)
- cannabis (tetrahydrocannabinol): 25 (5% of detections, 28% of samples)
- diazepam: 22 (4% of detections, 25% of samples)
- morphine: 19 (4% of detections, 22% of samples)
Please note: desmethyldiazepam, temazepam and oxazepam are all benzodiazepine drugs but can also be found as a metabolite of diazepam and other benzodiazepines.
The chart below shows the most common depressant drug detected in toxicology analysis of surplus serum samples between 17 August 2022 and 16 February 2024 (Q1 to Q6). The percentages are of all detections.
Depressants were the most common drug category, making up 67% of detections (334).
- Benzodiazepines were detected 296 times (60% of all detections):
- In total, 12 different types of benzodiazepines were detected, including bromazolam (10%) and etizolam (8%).
- Desmethyldiazepam made up 10% of all detections, down from 11% in Q5.
- Gabapentinoids were detected 30 times (6% of all detections, from 5% in Q5). Of these detections, 14 were gabapentin and 16 were pregabalin.
- There were four detections of xylazine (1%).
Opioids were the second most common drug category, making up 14% of detections (90).
- There were 19 detections of heroin/morphine (4%), 7 for methadone (1%) and six for codeine (1%).
- There were eight detections of nitazenes (1%).
Stimulants were the third most common drug category, making up 12% of detections (58).
- The most common stimulant was cocaine, making up 11% of detections (55).
Further findings
Complete clinical data were available for 288 attendances for the most recent period (17 November to 16 February 2024):
- 71% of attendees were male (205) and 30% were female (83).
- 19% (55) of attendees were aged 16 to 24 years and 22% (63) were aged 25 to 34.
- 58% of attendees were aged 35 years and over, with 34% (97) aged 35 to 44, 19% (55) aged 45 to 54 and 5% (14) aged 55 years or older.
ED outcome records show:
- 119 (41%) patients were discharged home
- 74 (26%) were admitted to a ward
- 42 (15%) were taken into police custody
- 34 (12%) self-discharged
- 15 (5%) were admitted to an intensive care unit, high-dependency unit, critical care unit or died
- less than five were recorded as ‘unknown’ or ‘other’.
Clinical severity outcome (after 28 days) recorded:
- 270 patients were discharged following the attendance
- less than five patients either died or remained an inpatient following the attendance
- outcomes for 13 patients were ‘unknown’.
Additional information
Public Health Scotland (PHS) was provided with these data by QEUH, NHS 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 (external website). 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 (external website).
Post-mortem toxicology testing for controlled substances
In Q4 of 2023, the most common drug types detected in post-mortem toxicology were opioids (70%) and benzodiazepines (58%). The percentage of deaths where cocaine was detected remained stable at 36% (37% in Q3 of 2023). It continued to be the most commonly detected individual substance, followed by heroin/morphine (29%), methadone (29%), diazepam (27%), and bromazolam (22%).
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, the COPFS commissions 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. It is not limited to deaths involving controlled drugs and includes suicides and natural deaths where there is no previous medical history.
Post-mortem toxicology testing is carried out by two services in Scotland:
- The Scottish Police Authority Forensic Services (SPA FS) covers deaths occurring in the west, east and parts of the north of Scotland.
- The Department of Clinical Biochemistry at NHS Grampian covers deaths in the far north and north-east of Scotland.
The inclusion of data on deaths in the far north and north-east of Scotland (the areas covered by NHS Grampian) from January 2022 onwards, means that the figures presented after that point cover the whole of Scotland and are different from publications released before October 2023.
This report includes two new periods of data:
- Remaining outstanding data for September 2023, completing data for Q3 of calendar year 2023; and
- 1 October to 31 December 2023, representing data for Q4 of 2023. This period is the most recent data discussed below.
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.
The charts below show the prevalence of controlled substances detected in deaths which were subject to post-mortem toxicology screening. Drug detections were assigned to specific time periods based on the calendar year quarter of death. As indicated by the line on the chart, data for 2020 and 2021 are based on deaths in the west, east and parts of the north of Scotland. From January 2022, the data include all areas in Scotland. Throughout the time series, the sum of the percentages for each quarter exceeds 100% due to the widespread detection of multiple substances in deaths (multiple controlled drugs were detected in 96% of deaths in Q4 2023).
The first chart below provides an indication of controlled drugs detected at post-mortem, in deaths occurring between 1 January 2020 and 31 December 2023.
The following charts provide an indication of specific opioids and benzodiazepines detected at post-mortem, in deaths occurring between 1 January 2020 and 31 December 2023.
Summary
- The most commonly detected drug types were opioids and benzodiazepines, averaging 71% and 58% respectively between January 2022 to December 2023.
- The most commonly detected individual drug in the last three quarters was cocaine (averaging 37%). Before Q2 of 2023, the most common individual drug was heroin / morphine.
- Multiple drugs were detected in 629 (96%) of 654 deaths in Q4 of 2023.
- The following drugs or drug types were most commonly detected in deaths from Q4 of 2023:
- opioids: 458 (70%)
- benzodiazepines: 380 (58%)
- cocaine: 235 (36%)
- heroin/morphine: 189 (29%)
- methadone: 189 (29%)
- gabapentin and pregabalin: 188 (29%)
- diazepam: 175 (27%)
- bromazolam: 143 (22%)
Stimulants
- For the third quarter in a row, the most commonly detected drug was cocaine.
- The percentage of deaths where cocaine was detected was relatively stable until Q1 of 2023 (averaging 29%), with the exception of an isolated increase in Q2 of 2020 (38%). Detections recently increased from 29% of deaths in Q1 of 2023 to 36% of deaths in Q4 of 2023.
Opioids
- The percentage of deaths where opioids were detected has gradually decreased from a peak of 82% in Q2 of 2020, to 70% in Q4 of 2023:
- Heroin/morphine detections decreased from a peak of 45% in Q2 of 2020 to 29% in Q4 of 2023 (35% in Q3).
- Methadone detections reached 45% in Q2 of 2020, before gradually decreasing to 23% in Q3 of 2022. Since then, methadone detections have increased slightly (29% in Q4 of 2023).
- Buprenorphine detections remained low and stable (detected in an average of 6% of deaths throughout the time series).
- There was a gradual increase in the percentage of cases where fentanyl-type opioids were detected, from around 1% prior to Q2 of 2022, to 5% in Q4 of 2023.
- Nitazene-type opioids (detected for the first time in Q1 of 2022) have increased slightly but remained uncommon, detected in 2% of deaths (12) in Q4 of 2023 (also 2% in Q3 (12)).
Depressants
- Benzodiazepines were present in 74% of deaths in Q2 of 2020, but have gradually decreased over time, and have been present in 51% to 61% of deaths in each quarter since Q2 of 2022.
- Diazepam has been the most commonly detected benzodiazepine since Q2 of 2022. Since then, detections have fluctuated between 25% and 35%. Detections decreased to 27% in Q4 of 2023 (from 35% in Q2).
- Detections of bromazolam increased sharply throughout 2022, replacing etizolam as the most commonly detected ‘street’ benzodiazepine from Q1 of 2023 onwards. Bromazolam was detected in 22% of deaths in Q4 of 2023.
- Etizolam was the most common benzodiazepine detected for some time, before detections fell to 6% of deaths in Q4 of 2023.
- Temazepam detections were relatively stable (averaging 5%) until Q1 of 2022, when there was an increase to 9%. Since then, the percentage of temazepam detections have remained broadly similar (9% in Q4 of 2023).
- Clonazolam detections increased and peaked at 12% in Q3 of 2021, before decreasing to low levels from Q1 of 2022. In Q4 of 2023, clonazolam detections were 2% (from <1% in Q3 of 2023).
- Since Q1 of 2022, the percentage of deaths involving gabapentin and pregabalin has been relatively stable, averaging 31%.
- Xylazine (detected for the first time in Q3 of 2023) was detected in less than 1% of deaths (3) in Q4 of 2023 (from 1% (5) in Q3 of 2023). However, this is likely to be an undercount and should be interpreted with caution, as detections of xylazine in Q4 of 2023 may be subject to change once further testing information becomes available.
More detailed descriptions of historical changes can be found within our previous reports.
Additional (provisional) data
It is important to note that the information presented within this section is based on incomplete data. It is therefore provisional and subject to change once further toxicology data becomes available.
Data presented within this report has been based on the latest and most complete period for which toxicology data were available. However, in this section, more recent data (partial data for January 2024) is included to provide an early indication of emerging trends or detections of new substances.
Where available, provisional data received for January 2024 indicated the following:
- Deschloroetizolam (a ‘street’ benzodiazepine) was detected for the first time.
- There were a small number of nitazene and xylazine detections, but these continued to be relatively uncommon (<5).
Additional information
PHS was provided with post-mortem toxicology testing data for deaths occurring in the west, east and parts of the north of Scotland by Forensic Medicine and Science at the University of Glasgow and SPA FS.
In late 2022, post-mortem toxicology services for the west, east and parts of the north of Scotland were transferred from the University of Glasgow to the Scottish Police Authority Forensic Services (SPA FS). During the period of transition, tests were completed by other laboratory testing sites in the UK. Although testing has now been moved to SPA FS, these testing sites continued to provide support in 2023 and data from both SPA FS and outsourced sites have been included in this report.
Data on deaths occurring in the far north and north-east of Scotland from January 2022 onwards, was supplied by the Department of Clinical Biochemistry at NHS Grampian.
The table shows the total number of deaths testing positive for controlled substances, for each calendar year and quarter.
Calendar year | Q1 | Q2 | Q3 | Q4 |
---|---|---|---|---|
2020 | 528 | 584 | 474 | 568 |
2021 | 586 | 538 | 491 | 570 |
2022* | 565 | 632 | 534 | 705 |
2023* | 707 | 681 | 622 | 654 |
* From January 2022 onwards, figures presented cover the whole of Scotland. Data for 2020 and 2021 are based on deaths in the west, east and parts of the north of Scotland only.
New drugs (e.g. bromazolam, desalkylgidazepam, nitazene-type opioids and xylazine) were detected for the first time when screening was expanded or testing was outsourced to other laboratories. These drugs may have been present before this time but were not being tested for. Data for substances including nitazenes and bromazolam are considered to be more robust and reliable from January 2023 onwards. Xylazine is not currently routinely tested for. These data will develop further as new or emerging drugs are added to routine toxicology screening by the SPA FS and NHS Grampian.
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 it does not include consideration of wider causes of death.
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 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.
Additionally, it is important to note that small numbers of detections for specific substances may result in large percentage differences between quarters. Where it is felt that data should be interpreted with caution due to small numbers, the number of detections has also been provided for context.
As some of the data received from other laboratory testing sites 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:
- Date of the case being received or sent to other labs for toxicology testing.
- Date of toxicology test being completed.
Similarly, as date of death was unavailable for those tests conducted by the Department of Clinical Biochemistry at NHS Grampian, the date when the case was received from the Crown Office and Procurator Fiscal Service has been used instead.
These 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.
Drug seizures in Scottish prisons
The Scottish Prisons Non-Judicial Drug Monitoring Project is a collaboration between the Scottish Prison Service and the Leverhulme Research Centre for Forensic Science at the University of Dundee (external website). The 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'.
Analysis of the drug seizures in Scottish prisons from November 2023 to January 2024 is ongoing and is not included in this report. We anticipate the updated data will be available for the next release in July 2024.
Since the last quarterly report, we have received data for a limited number of samples for the latest period (1 August to 31 October 2023):
- 33 samples were tested. 27 contained an illegal substance and six contained nicotine.
- Synthetic cannabinoids were the most prevalent drug type. They were detected in 36% of samples (12), compared to 33% between January and July 2023.
- MDMB-INACA was the most common synthetic cannabinoid (four detections), followed by MDMB-4en-PINACA (three).
- In the latest period, only two samples contained a benzodiazepine (diazepam, alprazolam). Please note that due to the limited number of samples received for testing since August 2023, these detections do not fully represent all benzodiazepine seizures in this reporting period. Between January and July 2023, benzodiazepines were detected in 16% of samples, with bromazolam being the most common.
- The most common sample type was powder (30%), followed by tablets and e-cigarettes (both 24%). Synthetic cannabinoids were detected in 50% of e-cigarettes.
Complete data to July 2023 are available in a previous quarterly report.
Service indicators
Specialist drug treatment referrals
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 (5,351) recorded in this period was 10% lower than in the previous period (5,934). The number of referrals was broadly similar to the same period commencing December 2021 (5,458) and 2022 (5,150).
Background
Specialist drug treatment referrals occur when a person comes into contact with services designed to support their recovery from problematic 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 8 November 2021 and 11 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 and filter by NHS board.
Summary
Historic trend
- Throughout 2022, there was a fluctuating, but gradual, decrease in the average weekly number of referrals.
- Following the seasonal reduction in December 2022, referrals returned to a weekly average of approximately 450 per week in January 2023.
- Referrals were broadly stable in 2023, ranging between 400 and 500 per week.
National update
For the most recent 13-week period (13 November 2023 to 11 February 2024):
- Following the seasonal reduction in December 2023, the average weekly number of referrals ranged from 400 to 450 until February 2024.
- 5,351 specialist drug treatment referrals were recorded, at an average of 412 per week. This was 10% lower than the previous 13-week period (14 August to 12 November 2023) when 5,934 referrals were recorded, at an average of 456 per week.
- The number of referrals was broadly similar to the same period commencing in December 2022 (5,150) and 2021 (5,458).
Local update
For the most recent period:
- The weekly number of referrals increased in six mainland NHS boards compared to the previous period: NHS Fife (10%), NHS Tayside (10%), NHS Forth Valley (14%), NHS Lanarkshire (18%), NHS Borders (27%) and NHS Highland (29%).
- Referrals decreased in three areas: NHS Grampian (7%), NHS Lothian (8%) and NHS Ayrshire & Arran (12%).
- Referrals were broadly stable in the other mainland boards.
To analyse these data further, please visit the RADAR dashboard (external website).
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.
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 which also includes a new interactive drug and alcohol treatment waiting times dashboard (external website).
Additionally, for more information on initial assessments for specialist drug and alcohol treatment services in Scotland, visit our new report: Drug and Alcohol Information System (DAISy): Overview of initial assessments for specialist drug and alcohol treatment 2021/22 and 2022/23.
For details of drug treatment services in your area, visit the Scottish Drug Services Directory website (external website).
The Medication Assisted Treatment (MAT) standards (external website) is an improvement programme to strengthen access, choice and support within the drug treatment system in Scotland.
Opioid substitution therapy
From October to December 2023, the average number of opioid substitution therapy (OST) doses supplied per month was stable and similar to the same time 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.
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. Methadone and oral buprenorphine are usually taken once every day. Injectable buprenorphine is long-acting and is administered once every week or month (depending on the formulation).
The chart below shows the average total monthly number of ADQ doses supplied for OST medications in the community between 1 October 2021 and 31 December 2023.
The chart below shows trends in the monthly number of ADQ doses supplied for specific OST medications in the community between 1 October 2021 and 31 December 2023.
Summary
Historic trend
- There was a gradual decrease in the average monthly total number of OST doses supplied. This was likely to have been associated with a decreasing trend in the average monthly number of methadone doses supplied, which reduced by 15%, from 595,200 between October and December 2021, to 504,100 between July and September 2023.
- The average monthly number of oral buprenorphine doses supplied fell by 8% between October to December 2021 (123,400) and July to September 2023 (113,700).
- Injectable buprenorphine was first licensed for use in Scotland in early 2020. The average monthly number of doses supplied increased more than two-fold, from 49,400 between October and December 2021, to 115,600 between July and September 2023.
Update
Data from PHS's Prescribing Information System was subject to delay in recent RADAR reports. This has now been rectified and data are available approximately three months in arrears. While data for most medications up to December 2023 have been successfully validated, October to December 2023 data for injectable buprenorphine remain provisional and may be subject to change in future reports. We anticipate the data for this period to be validated for the next release of this report in July 2024.
For the most recent period (1 October to 31 December 2023):
- The average total monthly number of OST doses supplied was approximately 732,000. This was roughly the same as in the previous quarter (July to September 2023; approximately 733,400 doses) a slight decrease compared to the same period in 2021 and similar to the same period in 2022.
- The average monthly number of methadone doses supplied was approximately 493,100. Equivalent figures for oral buprenorphine and injectable buprenorphine were 116,100 and 122,800, respectively.
- The number of methadone doses was approximately the same as in the previous quarter, 17% lower than the same period in 2021 and 10% lower than in 2022.
- The number of oral buprenorphine doses supplied was approximately the same as the previous quarter, 6% lower than the same time period in 2021 and similar to the same period in 2022.
- The number of injectable buprenorphine doses was 6% higher than in the previous quarter, 148% higher than the same period in 2021 and 47% higher than the same time period in 2022.
Additional information
These data have been extracted from the Prescribing Information System (PIS) and the Hospital Medicines Utilisation Data Manual (HMUD) (external website).
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. 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 28% 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, visit the RADAR dashboard (external website).
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 Management group. The ADQs agreed are:
- methadone (oral): 65 mg
- buprenorphine (oral): 13 mg
- buprenorphine (injection): 3.4 mg
Glossary
For detailed definitions on the terms used above, visit the RADAR dashboard (external website).
Injecting equipment provision
The average weekly number of injecting equipment provision (IEP) transactions, and needles and syringes distributed, remained relatively stable between October and December 2023. 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 similar to the same period in 2021 and 2022.
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 and syringe transactions at IEP sites and the total number of needles and syringes distributed.
The chart below shows the weekly number of IEP transactions from 4 October 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.
Further charts showing the weekly number of needles and syringes distributed, and the ratio of needles and syringes per transaction, are available on the RADAR dashboard (external website).
Summary
Historic trend
- The average number of transactions remained broadly stable (approximately 3,000 per week) from February 2022 to September 2023.
- For each indicator, seasonal fluctuations were observed during December and January each year.
- Between October 2021 and September 2023, the average number of needles and syringes distributed was broadly stable (approximately 37,000 per week).
- The ratio of needles and syringes distributed was stable from October 2021 to September 2023, at an average of 14.2 needles and syringes distributed per transaction.
National update
For the most recent period (2 October to 31 December 2023):
IEP transactions
- 38,221 transactions were recorded, at an average of 2,940 per week.
- This was similar to the previous period (3 July to 1 October 2023) when a total of 39,376 transactions were recorded (weekly average 3,029).
- The number of transactions was similar to the same period in 2021 (38,073, weekly average 2,929) and 6% lower than in 2022 (36,191, weekly average 2,784).
Needles and syringes distributed
- 471,780 needles and syringes were distributed, at an average of 36,291 per week.
- This was 6% lower than the previous period when a total of 504,464 needles and syringes were distributed, at an average of 38,805 per week.
- The number of needles and syringes distributed was similar to the same period in 2021 (481,381, weekly average 37,029) and 2022 (471,583, weekly average 36,276).
Ratio of needles and syringes distributed
- There was a weekly average of 13.3 needles and syringes distributed per transaction.
- This was slightly lower than in the previous time period (14.0) and the same periods in 2021 (14.0) and 2022 (14.3).
Local update
For the most recent period, the ratio of needles and syringes distributed per transaction varied across mainland NHS boards, compared to the previous period:
- The ratio increased in three areas: NHS Lanarkshire (7%; ratio 14.4), NHS Forth Valley (28%; ratio 20.3) and NHS Borders (67%; ratio 16.0).
- The ratio decreased in four areas: NHS Tayside (5%; ratio 18.2), NHS Greater Glasgow and Clyde (10%; ratio 9.2), NHS Ayrshire and Arran (14%; ratio 20.4) and NHS Dumfries and Galloway (14%; ratio 6.7).
- The ratio was stable in NHS Grampian (ratio 18.8) and NHS Lothian (ratio 22.3).
To analyse these data further, please visit the RADAR dashboard (external website).
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 details of injecting equipment providers in your area, visit the Scottish Needle Exchange Directory (external website).
Contact
General enquiries
If you have an enquiry relating to this publication, please email:
- Nicole Jarvie | Principal Information Analyst | phs.drugsteam@phs.scot
- Vicki Craik | Public Health Intelligence Adviser | phs.drugsradar@phs.scot
Reporting a drug harm
To make a report to RADAR and share information such as trends, incidents and harms related to drugs you can either:
Media enquiries
If you have a media enquiry relating to this publication, please contact the Communications and Engagement team.
Requesting other formats and reporting issues
If you require publications or documents in other formats, please email phs.otherformats@phs.scot.
To report any issues with a publication, please email phs.generalpublications@phs.scot.
Further information
RADAR
Find out more about RADAR – Scotland's drugs early warning system.
Data and intelligence
View our wider drug data and intelligence.
Public health information
Visit Scottish Public Health Observatory (ScotPHO) for further drug-related public health information.
Metadata
- Publication title
Rapid Action Drug Alerts and Response (RADAR) quarterly report – April 2024
- Theme
Substance use surveillance
- Topic
Drugs
- Format
HTML
- Release date
4 June 2024
- Frequency
Quarterly
- Relevance and key uses of the statistics
Data are collected as part of public health surveillance on substance use in Scotland.
The most up-to-date data available are published in this report to provide a timely indicator of drug trends as part of RADAR, Scotland’s Drugs Early Warning System.- Revisions statement
Data are provisional and may be revised as a result of planned quality improvements or to reflect data quality and completeness issues.
There are no planned revisions. The data shown in the most recent quarterly update supersede data shown in previous reports.
- Revisions relevant to this publication
The suspected drug death section in this publication was revised on 4 June 2024 to include updated data for January and February 2024 due to data quality and completeness issues. This means that the number of suspected drug deaths occurring in the period covered by this report was higher than previously stated. The revisions are as follows:
- January 2024: number of suspected drug deaths was revised from 96 to 103
- February 2024: number of suspected drug deaths was revised from 86 to 95
- December 2023 to February 2024: number of suspected drug deaths was revised from 278 to 294.
- Comparability
Data are not comparable outwith Scotland.
- Accuracy
The data are considered accurate.
Data are validated locally by data suppliers, partnerships and sources, and then checked by PHS.
Where relevant, data quality and completeness issues are described in the text associated with each indicator.
The Code of Practice for Statistics has been followed to ensure a high standard of data value, trustworthiness and quality.
- Accessibility
It is the policy of PHS to make its websites and products accessible according to our accessibility statement. Graphs and tables have been assessed against PHS accessibility standards.
Accessibility of the report and findings are of continuous consideration throughout the report development.
- Coherence and clarity
The report is available as HTML web pages.
Wherever possible, plain English descriptions have been used within the narrative and any technical words or phrases explained.
- Disclosure
Our Statistical Disclosure Protocol has been followed.
- Official Statistics designation
Management information report
- UK Statistics Authority Assessment
N/A
- Last published
30 January 2024
- Next published
30 July 2024
- Date of first publication
11 October 2022
- Help email
- Date form completed
12 April 2024
- Date form updated
4 June 2024
The remaining metadata for this document has been split into sections as there are some differences between the indicators.
Police Scotland drug trends bulletin
Description
This indicator provides a summary of the drug trend bulletin from the Police Scotland Statement of Opinion (STOP) Unit.
Data source(s)
Police Scotland STOP Unit
Date that data were acquired
2 April 2024
Timeframe of data and timeliness
This section includes the most notable drug trends in recent months.
Continuity of data
The Police Scotland drug-trend bulletins are designed to provide drug-trend information, highlighting some of the current trends identified by the police in Scotland and other parts of the UK. The bulletin has and will evolve through time to provide timely distribution of drug-related information.
Concepts and definitions
Nitazenes are a group of potent synthetic (lab-made) opioids.
Xylazine is a depressant drug used in veterinary medicine with sedative, analgesic and muscle relaxant properties.
Completeness
The Police Scotland drug trend bulletin highlights some of the current trends identified by the police in Scotland and other parts of the UK.
Value type and unit of measurement
Police seizures positive for controlled substances displayed as drug type.
RADAR intelligence and reports
Description
This indicator provides a summary of the drug reports received by RADAR.
Data source(s)
Public Health Scotland
Date that data were acquired
Various between 5 January 2024 and 4 April 2024. Data were collated on 11 April 2024.
Timeframe of data and timeliness
This section includes the most notable drug trends in recent months.
Continuity of data
Since July 2022, data in this indicator have been collected consistently using reporting forms and email. The indicator has and will continue to evolve throug h time to provide timely distribution of drug-related information.
Accuracy
Analysis on the reports received (such as number and type) are considered to be accurate. The individual reports have been validated to check their credibility and likelihood. Reports that we were unable to validate are not shown in this indicator.
Reports accurately represent the individual submissions made, although they have been summarised to ensure anonymity. Unless otherwise specified, these reports have not been confirmed by toxicology and should be considered anecdotal.
Concepts and definitions
Cocaine is a short-lasting stimulant drug. Cocaine powder and crack cocaine are two different forms of the same drug.
Benzodiazepines are depressant drugs with sedative and anxiolytic (anti-anxiety) effects. They are also known as tranquilisers.
Pregabalin is a gabapentinoid drug with depressant effects. It can be prescribed as a medicine to treat epilepsy and nerve pain.
Nitazenes are a group of potent synthetic opioids.
Heroin is an opioid drug usually found as a brown powder.
Xylazine is a depressant drug used in veterinary medicine with sedative, analgesic and muscle relaxant properties.
Completeness
The indicator highlights report by area: National, North Scotland, East Scotland and West Scotland. Reports received are not representative of the level of harms in an area.
Value type and unit of measurement
Report number, type of report, drug appearance and report summary are displayed by NHS Board or local authority area.
Naloxone administration by Scottish Ambulance Service
Description
This indicator provides information on emergency naloxone administration by Scottish Ambulance Service (SAS) clinicians in Scotland.
Data source(s)
Scottish Ambulance Service
Date that data were acquired
4 March 2024
Timeframe of data and timeliness
6 December 2021 to 3 March 2024, approximately two months in arrears.
Continuity of data
SAS clinicians have been administering naloxone directly to patients experiencing symptoms of an opioid overdose since around 1998. There have been no changes in the guidance given to SAS clinicians regarding the administration of naloxone nor in the recording mechanisms or processes over the time series shown in the analysis.
Scotland's National Naloxone Programme has been operational since 2011 and continues to facilitate the supply of take-home naloxone to people at risk of opioid overdose, members of the public, service workers and professionals (PHS quarterly monitoring bulletin on naloxone). Since August 2023, all Police Scotland officers below the rank of Inspector have carried naloxone. Naloxone kits are also available on all emergency vehicles operated by the Scottish Fire & Rescue Service (SFRS).
This overall increase in the supply of naloxone kits in community settings should be taken into consideration when interpreting figures on the administration of naloxone by SAS clinicians. However, it cannot be assumed that changes in the amount of naloxone supplied to members of the public or other emergency services will result in comparable changes in the amount of naloxone administered by those individuals (kits obtained in case an opioid overdose is witnessed may remain unused). Data on the use of naloxone by Police Scotland officers are available on the Police Scotland website. Currently, no national data are available on naloxone administration by members of the public or SFRS staff.
As overdose awareness training guidelines clearly state that SAS clinicians should be called to opioid overdoses regardless of whether naloxone has already been administered by a third party, it cannot be assumed that the prior administration of naloxone will influence the likelihood of SAS clinicians attending an overdose or administering a further dose of naloxone. While it cannot be assumed that the SAS naloxone administration figures presented here provide a complete count of all opioid overdoses, the number of opioid overdoses not attended by SAS was unknown.
Concepts and definitions
Naloxone is a medicine used to prevent fatal opioid overdoses. Opioid overdoses are commonly associated with drug-related deaths. These data on the numbers of incidents in which naloxone was administered by SAS clinicians provide an indication of numbers of suspected opioid overdoses.
A small percentage of these administrations will have been due to circumstances other than an illicit opioid overdose (for example, some may relate to prescribed opioid overdoses or to adverse reactions associated with medications administered in the course of emergency treatment).
Also, in a small number of cases, naloxone may be administered to someone who is unconscious for unconfirmed reasons, which may be confirmed at a later point not to have been an opioid overdose.
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.
Under some circumstances, naloxone administration will not successfully reverse an opioid overdose (for example, if administered too late) and these statistics should not be interpreted as equating to numbers of lives saved.
Completeness
SAS data on numbers of naloxone incidents are collated from data entered by ambulance clinicians recording medications administered to patients via an electronic tablet in the vehicle. Data recording is typically completed within 30 minutes of the end of an incident.
Value type and unit of measurement
Number of incidents in which naloxone was administered by SAS clinicians and moving averages.
Drug-related attendances at emergency departments
Description
This indicator provides information on drug overdose or intoxication attendances at emergency departments in Scotland.
Data source(s)
Public Health Scotland – Accident & Emergency Datamart
Date that data were acquired
14 March 2024
Timeframe of data and timeliness
29 November 2021 and 3 March 2024, approximately two months in arrears.
Continuity of data
There have been no changes in the national recording mechanisms or processes over the time series shown in the analysis.
Concepts and definitions
A drug–related emergency department (ED) attendance is an attendance for a drug intoxication or overdose, either alone, or combined with alcohol intoxication.
Completeness
It is not possible to accurately report total attendances for specific conditions using the national A&E dataset, due to the quality of the data available. 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 therefore only give a high–level indication of attendances over time. Further details can be found in the Accident and Emergency Activity Data.
Value type and unit of measurement
Number of drug overdose or intoxication attendances at emergency departments and moving averages.
Drug-related acute hospital admissions
Description
This indicator provides information on drug-related acute hospital admissions in Scotland.
Data source(s)
Public Health Scotland – Scottish Morbidity Record – general, acute inpatient and day case records (SMR01)
Date that data were acquired
8 April 2024
Timeframe of data and timeliness
27 September 2021 to 31 December 2023, approximately four months in arrears.
Continuity of data
There have been no changes in the recording mechanisms or processes over the time series shown in the analysis. Further detail can be found in the 'Drug-related hospital statistics' publication background information.
Concepts and definitions
Opioids
Opioid drugs act on opioid receptors to produce sedative and painkilling effects. They are respiratory depressants (reduce heart rate and breathing). Opioids include synthetic (lab-made) drugs such as methadone and buprenorphine, as well as opiates (drugs made from opium) such as heroin and morphine.
Cannabinoids
Cannabinoids are compounds that interact with the endocannabinoid system. They are found in the cannabis plant (such as THC) or can be produced synthetically in a laboratory (synthetic cannabinoids).
Cocaine
Cocaine is a short-lasting stimulant drug that increases heart rate and breathing. This group includes powder cocaine and crack cocaine.
Sedatives and hypnotics
Sedatives and hypnotics are drugs that induce sedation and depress the central nervous system, which also decreases heart rate and breathing. They are also known as depressants. This group of drugs includes 'prescribable' benzodiazepines (drugs such as diazepam), 'street' benzodiazepines (such as etizolam and alprazolam) and z-hypnotics (such as zopiclone).
Multiple/other
The 'multiple/other' drugs category includes volatile solvents (such as glue, gases or aerosols) and multiple drug use. This category may also be used to indicate multiple drug use when individual substances are not known or cannot be coded using existing diagnosis codes (International Classification of Diseases 10th Revision – ICD10).
Completeness
The data is routinely drawn from hospital administrative systems and ICD10 diagnosis codes used to identify admissions related to drug use. Some caution is necessary when using these data as drug use may only be suspected and may not always be recorded by the hospital. Further details can be found in the PHS drug-related hospital statistics report, and information on hospital administrative systems (Scottish Morbidity Records – SMR) data completeness can be found on the 'SMR completeness' webpage.
Completeness levels for NHS Fife, Highland and Lanarkshire were below 90% as of 8 April 2024 for the most recent time period (October – December 2023), therefore caution is advised when interpreting trends in these areas on the dashboard.
Value type and unit of measurement
Number of inpatient and day case admissions to general acute hospitals (excluding maternity, neonatal, geriatric long stay and admissions to psychiatric hospitals), presented by month of admission with moving averages.
Suspected drug deaths
Description
This indicator provides information on suspected drug deaths in Scotland.
Data source(s)
Police Scotland
Date that data were acquired
Data were first aquired on 21 March 2024
Revised data were acquired on 21 May 2024.
Timeframe of data and timeliness
22 November 2021 to 25 February 2024, approximately two months in arrears.
Continuity of data
There have been no changes in the national Police Scotland recording mechanisms or processes over the time series shown in the analysis.
Concepts and definitions
Drug-related death
A drug-related death (also referred to as drug-misuse death) is a death where the underlying cause was confirmed to be drug poisoning and where any of the substances which were implicated, or potentially contributed to death, are controlled in the UK. National Statistics on drug-related deaths are published by the National Records of Scotland (NRS).
Suspected drug death
A suspected drug death is a death where controlled drugs are suspected of being involved. This operational measure used by Police Scotland is based on the reports, observations and initial enquiries of officers attending the scene of death.
Completeness
This indicator includes data on suspected drug deaths as recorded by all Police Scotland Divisions across Scotland.
Value type and unit of measurement
Numbers of suspected drug deaths in Scotland and moving averages.
Emergency department toxicology: ASSIST
Description
This indicator provides information on the number of attendances, length of stay and toxicology of presentations due to acute illicit drug toxicity at the Queen Elizabeth University Hospital (QEUH) emergency department (ED), Glasgow, Scotland. This study assesses the feasibility of prospective surveillance of ED presentations due to acute illicit drug toxicity.
Data source(s)
QEUH, NHS Greater Glasgow and Clyde
Date that data were acquired
8 April 2024
Timeframe of data and timeliness
17 August 2022 to 16 February 2024, approximately two months in arrears.
Continuity of data
'ASSIST: A Surveillance Study of Illicit Substance Toxicity' is a study by the ED at the QEUH.
QEUH will provide Public Health Scotland with toxicology screening data on a quarterly and ad-hoc basis for the purposes of public health surveillance.
Because the sample size is small, some of the variables are combined in a different way to the data shared in previous releases of the RADAR quarterly report, to ensure the information are not disclosive. Categories may be revised in future as sample size increases.
Concepts and definitions
Unique ED attendances
Each separate attendance is a count of one. If the same person presented more than once, each attendance was counted.
Illicit drug
'Illicit drug' encompasses any substance that is a controlled drug as per the Misuse of Drugs Act 1971 and Misuse of Drugs Regulations 2001. It excludes legal substances such as alcohol, nicotine, caffeine and paracetamol, as well as medications recently prescribed to the individual or drugs administered to the individual as part of treatment (by ambulance or hospital).
Benzodiazepines
Benzodiazepines are a group of drugs with depressant and anxiolytic (anti-anxiety) effects. They are also known as tranquilisers.
Metabolite
A drug metabolite is a compound produced when a drug breaks down in the body.
In this study, if either a drug or metabolite are detected, this will only be included as one substance – the drug. For example, if both diazepam and its metabolite desmethyldiazepam are detected, only diazepam is recorded.
Due to this we are unable to ascertain the source of some substances, for example, oxazepam is a benzodiazepine, but it is also a metabolite of a range of other benzodiazepines, so we cannot determine whether oxazepam or another benzodiazepine was consumed.
Cocaine
Cocaine is a short-lasting stimulant drug that increases heart rate and breathing.
Gabapentinoids
Gabapentinoids are a group of drugs with depressant and painkilling effects.
Opioids
Opioid drugs act on opioid receptors to produce sedative and painkilling effects. They are respiratory depressants (reduce heart rate and breathing).
Cannabinoids
Cannabinoids are compounds that interact with the endocannabinoid system. They are found in the cannabis plant (such as THC) or can be produced synthetically in a laboratory (synthetic cannabinoids).
Other stimulants
Other stimulants are stimulant drugs apart from cocaine. They increase heart rate, breathing and energy.
Completeness
Not all data identified for all ED attendances is available for analysis, due to the time required to send and receive toxicology results and to link patient and clinical data. A differing proportion of the total attendances recruited for this study are available for each of the data sources:
- completed clinical notes made by research nurses (Castor)
- completed electronic clinical records (West of Scotland Safe Haven)
- toxicology results
- toxicology results with corresponding clinical (Castor) notes
Toxicology testing has been carried out by the LGC Group, formerly the Laboratory of the Government Chemist. LGC screen against a database of over 3,500 chemical substances including illicit drugs, novel psychoactive substances, synthetic cannabinoid receptor agonists, benzodiazepines and medications. This analysis does not, however, imply that specific drugs were implicated in harms.
This study includes patients aged 16 or over attending QEUH adult ED directly related to acute illicit drug use. It excludes patients where the condition is more likely due to a cause other than acute illicit drug use, due to withdrawal, primarily related to alcohol use or where the attendance is due to a complication of previous drug use, i.e. infected injection site.
Value type and unit of measurement
Number of ED attendances related to illicit drug use, destination on discharge from the ED, number of hours in the ED, number of hours in hospital, toxicology results of surplus serum sampling by drug type and drug category.
Post-mortem toxicology testing for controlled substances
Description
This indicator provides information on forensic toxicology testing for controlled substances completed at post-mortem in Scotland.
Data source(s)
Forensic Toxicology Service within Forensic Medicine and Science (FMS), University of Glasgow, on behalf of the Crown Office and Procurator Fiscal Service (COPFS).
Other laboratory testing sites in the United Kingdom, outsourced by the Scottish Police Authority (SPA) Forensic Services.
The Department of Clinical Biochemistry at NHS Grampian, on behalf of the Crown Office and Procurator Fiscal Service (COPFS).
Date that data were acquired
18 March 2024
Timeframe of data and timeliness
Between 1 January 2020 and January 2024 (complete period for 1 October to 31 December 2023, with inclusion of available partial data for January 2024), approximately three months in arrears.
Continuity of data
PHS was provided with post-mortem toxicology testing data for deaths occurring in the west, east and parts of the north of Scotland by Forensic Medicine and Science at the University of Glasgow and SPA FS.
In late 2022, post-mortem toxicology services for the west, east and parts of the north of Scotland were transferred from the University of Glasgow to the Scottish Police Authority Forensic Services (SPA FS). During the period of transition, tests were completed by other laboratory testing sites in the UK. Although testing has now been moved to SPA FS, these testing sites continued to provide support in 2023 and data from both SPA FS and outsourced sites have been included in this report.
Data on deaths occurring in the far north and north-east of Scotland from January 2022 onwards, was supplied by the Department of Clinical Biochemistry at NHS Grampian.
For the first time in a RADAR quarterly report, data are available for the whole of Scotland. Previous reports only included data on deaths in the west, east and parts of the north of Scotland (the areas covered by SPA FS). The inclusion of data on deaths in the far north and north-east of Scotland (the areas covered by NHS Grampian) from January 2022 onwards, means that the figures presented after that point cover the whole of Scotland and are different from those shown in previous publications.
Concepts and definitions
Post-mortem toxicology testing where controlled drugs (as defined in the Misuse of Drugs Act 1971 - external website) were detected is carried out, on behalf of the COPFS, by two services in Scotland:
- The Scottish Police Authority Forensic Services (SPA FS) covers deaths occurring in the west, east and parts of the north of Scotland.
- The Department of Clinical Biochemistry at NHS Grampian covers deaths in the far north and north-east of Scotland.
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.
As some of the data received from other laboratory testing sites 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:
- Date of the case being received or sent to other labs for toxicology testing.
- Date of toxicology test being completed.
Similarly, as date of death was unavailable for those tests conducted by the Department of Clinical Biochemistry at NHS Grampian, the date when the case was received from the Crown Office and Procurator Fiscal Service has been used instead.
Benzodiazepines
Benzodiazepines are a group of drugs with depressant and anxiolytic (anti-anxiety) effects. They are also known as tranquilisers. Diazepam is a ‘prescribable benzodiazepine’. Etizolam, clonazolam and bromazolam are ‘street benzos’, benzodiazepines that are not licensed for prescription in the UK.
Cocaine
Cocaine is a short-lasting stimulant drug that increases heart rate and breathing. This group includes powder cocaine and crack cocaine.
Gabapentin and pregabalin
Gabapentin and pregabalin are gabapentinoids, a group of drugs with depressant and painkilling effects.
Opioids
Opioid drugs act on opioid receptors to produce sedative and painkilling effects. They are respiratory depressants (reduce heart rate and breathing). This category includes buprenorphine, fentanyl, heroin/morphine and methadone.
Completeness
For the first time in a RADAR quarterly report, data are available for the whole of Scotland. Previous reports only included data on deaths in the west, east and parts of the north of Scotland (the areas covered by SPA FS). The inclusion of data on deaths in the far north and north-east of Scotland (the areas covered by NHS Grampian) from January 2022 onwards, means that the figures presented after that point cover the whole of Scotland and are different from those shown in previous publications.
Value type and unit of measurement
Number and percentage of forensic toxicology cases testing positive for controlled substances by drug type.
Drug seizures in Scottish prisons
Description
This indicator provides information on drug types most commonly detected in drug seizures in Scottish prisons.
Data source(s)
Scottish Prison Service (SPS) and the Leverhulme Research Centre for Forensic Science (LRCFS), University of Dundee.
Date that data were acquired
11 March 2024
Timeframe of data and timeliness
27 September 2021 to 31 October 2023, approximately three months in arrears.
Continuity of data
There have been no changes in the seizures recording mechanisms or processes over the time series shown in the analysis.
Data for a limited number of samples for the latest period (1 August to 31 October 2023). Analysis is available within the report. Analysis of the drug seizures in Scottish prisons from November 2023 to January 2024 is ongoing and is not included in this report. We anticipate the updated data will be available for the next release in July 2024. Drug seizures data to July 2023 are available in the RADAR quarterly report – October 2023.
Concepts and definitions
Benzodiazepines
Benzodiazepines are a group of drugs with depressant and anxiolytic (anti-anxiety) effects. They are also known as tranquilisers. Benzodiazepines detected in this project include etizolam, flubromazepam, bromazolam, diazepam and flualprazolam.
Cocaine
Cocaine is a short-lasting stimulant drug that increases heart rate and breathing. This group includes powder cocaine and crack cocaine.
Gabapentinoids
Gabapentinoids are a group of drugs with depressant and painkilling effects.
Opioids
Opioid drugs act on opioid receptors to produce sedative and painkilling effects. They are respiratory depressants (reduce heart rate and breathing). Opioids include synthetic (lab-made) drugs such as methadone and opiates (drugs made from opium) such as heroin. Opioids detected in this project include buprenorphine, heroin, tramadol, codeine, dihydrocodeine, metonitazene, oxycodone and methadone.
Synthetic cannabinoids
'Synthetic cannabinoids' is a term used to describe over 200 lab-made drugs that interact with the endocannabinoid system.
Completeness
Data is provided to PHS by the LCRFS. LCRFS does not analyse all seizures from the SPS. However, LCRFS data is a sizeable subset of all national prison seizures.
Value type and unit of measurement
Percentage of drug seizures analysed by the LRCFS by drug type and sample type (card, paper, powder or tablet).
Specialist drug treatment referrals
Description
This indicator provides information on specialist drug treatment referrals in Scotland.
Data source(s)
Public Health Scotland – Drug and Alcohol Information System (DAISy) and Drug and Alcohol Treatment Waiting Times (DATWT) database
Date that data were acquired
4 March 2024
Timeframe of data and timeliness
13 November 2023 to 11 February 2024, approximately two months in arrears.
Continuity of data
These data have been extracted from the Drug and Alcohol Information System (DAISy) and its predecessor, the Drug and Alcohol Treatment Waiting Times (DATWT) database. DAISy was available in all NHS boards from April 2021.
DAISy introduced a new way of recording referrals, a continuation of care process which affects how referrals are recorded when people have started treatment and move from one service to another without a break or change in their treatment (for instance, when moving between community-based and prison-based services). The number of referrals remain comparable between DATWT and DAISy, but how waits are recorded against the initial and receiving services has changed for referrals transferred by the continuation of care process. These data report on the number of referrals rather than waits so the new continuation of care process should not impact the number of referrals.
DAISy introduced an additional 'co-dependency' service user type, where the referral relates to treatment for both drug and alcohol use. Co-dependency has only been recorded since the introduction of DAISy (April 2021) so is not available as a separate client type in the DATWT database. These data report the number of referrals where the service user type is recorded as either 'drugs' or 'co-dependency' in DAISy and as 'drugs' in DATWT.
Concepts and definitions
These data relate to the number of referrals to specialist drug and alcohol treatment services in Scotland delivering tier 3 and 4 interventions (community-based specialised drug assessment and co-ordinated care-planned treatment, and residential specialised drug treatment). These data are for community-based drug and alcohol treatment services and exclude prison-based and hospital-based services.
Completeness
Drug and alcohol treatment services are required to submit accurate and up-to-date waiting times information to PHS. These referrals data are management information and includes all services that enter data on DAISy and its predecessor, the DATWT database. This contrasts with the figures reported in the 'National drug and alcohol treatment waiting times' statistics release for Scotland where data from services that were unable to confirm their data were accurate and up-to-date within specified timescales are excluded. Further details can be found in the data quality section of the Drug and Alcohol Treatment Waiting Times dashboard.
Value type and unit of measurement
Number of specialist drug treatment referrals and moving averages.
Opioid substitution therapy
Description
This indicator provides information on opioid substitution therapy prescribing in Scotland.
Data source(s)
Public Health Scotland – Prescribing Information System (PIS) and Hospital Medicines Utilisation Database (HMUD)
Date that data were acquired
21 March 2024
Timeframe of data and timeliness
1 July 2023 to 31 December 2023.
Data from the PIS are available approximately three months in arrears.
HMUD data availability can vary by NHS board. However, the injectable buprenorphine data shown in this release are considered complete.
Continuity of data
The data shown are considered to provide a comprehensive account of OST prescribing for the time series presented, including data from GP and hospital prescribing systems.
Buvidal data for October to December 2023 is provisional and we anticipate the data for this period to be validated for the next release of this report in July 2024.
Concepts and definitions
Defined daily dose
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.
Average daily quantity
Due to differences between the average OST doses used in Scotland and the rest of the world, the analysis presented here is based on average daily quantities (ADQs). These are more representative of the daily maintenance doses used within Scotland and were developed via analysis of prescriptions 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
Buprenorphine
Buprenorphine is a synthetic partial opioid agonist used to treat acute pain, chronic pain and opioid dependence. Prescribed for daily use (oral) or weekly or monthly prolonged release (injectable), buprenorphine relieves opioid cravings and withdrawal symptoms and blocks the effects of other opioids. As with other opioids, buprenorphine can result in sedation, respiratory depression and death. These statistics relate to the prescribing of oral (2 mg, 8 mg and 16 mg buprenorphine or buprenorphine and naloxone tablets) and injectable buprenorphine (various strengths) for the treatment of opioid dependence.
Opioids
Opioid drugs act on opioid receptors to produce sedative and painkilling effects. They are respiratory depressants (reduce heart rate and breathing). Opioids include synthetic (lab-made) drugs such as methadone and buprenorphine, as well as opiates (drugs made from opium) such as heroin and morphine.
Methadone
Methadone is a synthetic opioid agonist used to treat chronic pain and opioid dependence. Prescribed for daily use, methadone relieves opioid cravings and withdrawal symptoms. As with other opioids, methadone can result in sedation, respiratory depression and death. These statistics include data on the prescribing of methadone 1mg/1ml solution for the treatment of opioid dependence.
Accuracy
There are differences between community prescribing data from the Prescribing Information System (PIS) and hospital prescribing data from the Hospital Medicines Utilisation Database (HMUD) in the way that dates are allocated to medications supplied. The basis for date allocation in PIS data is the month in which the costs associated with dispensing medication were reimbursed. The basis for date allocation in HMUD data is the month in which medications were supplied to the NHS Board for onward administration to patients. While useful to note, these differences are not thought to have a significant impact on the reliability of this analysis.
For the 2022/23 Q3 and Q4 reports, there were revisions to the injectable buprenorphine data, which means that the number of ADQ doses associated with that medication from April 2022 onwards was slightly higher than shown in previous reports. These changes were associated with the addition of data on Buvidal 160mg/0.45ml prolonged release injections to the PIS data extract in 2022/23 Q3 and to the HMUD data extract in 2022/23 Q4.
Completeness
The data shown are considered to provide a comprehensive account of OST prescribing for the time series presented, including data from GP and hospital prescribing systems.
Value type and unit of measurement
Total number of ADQ doses of methadone, oral buprenorphine and injectable buprenorphine supplied in Scotland, based on community and hospital prescribing data.
Injecting equipment provision
Description
This indicator provides information on injecting equipment provision (IEP) in Scotland.
Data source(s)
Needle Exchange Online (neo360)
Date that data were acquired
26 March 2024
Timeframe of data and timeliness
4 October 2021 to 31 December 2023, approximately three months in arrears.
Continuity of data
Caution is recommended when interpreting these statistics. Service provision in some areas has changed over time. Some outlets will have closed, and others will have opened.
The methods used by areas to count or estimate some of the figures may also have changed.
Concepts and definitions
Transactions
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.
Further details can be found in the PHS Injecting Equipment Provision in Scotland report.
Completeness
This indicator includes data on transactions and needle and syringe distribution by injecting equipment providers in mainland Scotland NHS Boards.
It does not include data for NHS Shetland, NHS Orkney and NHS Western Isles.
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.
Value type and unit of measurement
Number of IEP transactions, number of needles and syringes distributed, the ratio of the number of needles and syringes per IEP transaction and moving averages.