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.

This chart shows the number of referrals to drug treatment services in Scotland on the y axis and the date, between 8 November 2021 and 11 February 2024, on the x axis. In December and January each year, a seasonal reduction in referrals occurs. Throughout 2022, there was a fluctuating, but gradual, decrease in the average weekly number of referrals. After the seasonal reduction in December 2022, referrals returned to a weekly average of approximately 450 per week in January 2023. A relatively stable trend was evident in 2023, with referrals ranging between 400 and 500 per week. After the seasonal reduction in December 2023, the average weekly number of referrals ranged from 400 to 450 until February 2024.

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Specialist drug treatment referrals

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 stacked area chart shows the three-month rolling average number of doses supplied for OST medications in the community between October 2021 and December 2023. The number of doses per month is on the y axis and the calendar month is on the x axis. There was a gradual decrease in the average monthly total number of OST doses supplied over the time series, which is likely associated with a decreasing trend in the number of methadone doses supplied.

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Average total number of OST doses per month

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.

The chart shows monthly trends in the number of doses supplied for specific OST medications in the community between October 2021 and December 2023. The number of doses per month is on the y axis and the calendar month is on the x axis. Methodone was the most commonly prescribed throughout the time series. Methadone prescriptions were stable at an average of approximately 592,000 prescriptions between October 2021 and April 2022 before following a decreasing trend to approximately 493,000 doses per month between October and December 2023. Injectable buprenorphine was first licensed for use in Scotland in early 2020. The average total number of doses supplied has increased steadily since then, to approximately 123,000 per month between October and December 2023, making it more common than oral buprenorphine since November 2023. The average monthly number of oral buprenorphine doses supplied was roughly stable over time, with approximately 116,000 oral buprenorphine doses prescribed per month between October and December 2023.

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Number of doses per month for OST medications

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.

The chart shows the number of transactions at injecting equipment provision sites in Scotland. The number of transactions is on the y axis and the date, between 4 October 2021 and 31 December 2023, is on the x axis. In December and January each year, a seasonal reduction in transactions is observed. Between October 2021 and December 2022, outwith the seasonal reduction, the number of transactions varied but was broadly stable between 2,600 and 3,450 per week. After the seasonal reduction in January 2023, the number of transactions fluctuated until the end of June 2023 (3,277), following an overall increasing trend. Between July and November 2023, the number of transactions was stable between 2,900 and 3,200 per week. In December 2023, a seasonal reduction in the number of transactions was observed (2,446 in the week beginning 25 December 2023).

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Injecting equipment provision: transactions

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).