• An increase in suspected drug deaths was observed in Scotland between October and November 2022. All other healthcare indicators of harm and service utilisation remained stable and below expected levels. The predominant picture of drugs harms in Scotland continues to be polydrug use involving benzodiazepines, stimulants and opioids. Partners are advised to strengthen harm reduction and support measures with particular consideration for those who may have limited contact with health and social care services.
• This report also contains an alert on nitazene-type opioids in Scotland, which requires action by people working and volunteering in drug and alcohol services, emergency services, health care settings and high-risk settings.

Alerts

• RADAR has published a public health alert called nitazene-type opioids in Scotland. This is in response to an increase in the availability of a new group of synthetic opioid drugs called nitazenes.
• Due to their unexpected presence in the drug supply and high potency, nitazenes pose a substantial risk of overdose, drug-related hospitalisation and drug-related death.
• This alert details the action required by people working and volunteering in drug and alcohol services, emergency services, health care and medical settings and high-risk settings, such as prisons and hostels.
• Actions required include sharing harm reduction information, promoting naloxone distribution and increasing awareness of the signs of an overdose.

Trends

• 18 reports were validated by RADAR between 24 September 2022 and 11 January 2023.
• Benzodiazepines were the most commonly reported drug type, with seven (39%) reports indicating a benzodiazepine as the ‘primary drug’. Three reports related to bromazolam. Bromazolam is a Class C benzodiazepine that is structurally similar to alprazolam.
• There were also seven reports where a stimulant was reported to be the ‘primary drug’. Four reports were about the adverse effects of both cocaine powder and crack cocaine.
• Half of reports mention mixing two or more substances (polydrug use). Mixing drugs can cause unexpected and unpredictable effects and is a major risk factor in drug-related deaths in Scotland.

Harm indicators

• Scottish Ambulance Service naloxone incidents between September and November 2022 (832) were lower compared to the same time period in 2020 (1,032) and 2021 (1,176).
• The number of drug-related hospital admissions between July and September 2022 (2,024) were considerably lower compared to the same time period in 2020 (3,643) and 2021 (3,033).
• Suspected drug deaths increased in October and November 2022, following a decreasing trend in recent months. There were 109 suspected drug deaths in November 2022. This is higher than in the same month in 2020 (93) and 2021 (89).

Toxicology indicators

• In the ASSIST hospital toxicology pilot, two or more substances were detected in 82% of drug-related emergency department presentations. The most commonly detected drug was cocaine (13%), followed by desmethyldiazepam (11%) and cannabis (9%).
• Changes were observed in post-mortem toxicology in quarter 3 of 2022, with the percentage of cases testing positive for etizolam (17%) falling below diazepam (24%) for the first time since before 2019. The most commonly detected drug type in post-mortem testing was opioids (74%). Heroin/morphine was detected in 35% of deaths.
• Prison drug analysis also shows a changing picture of drug use as new synthetic cannabinoids and benzodiazepines continue to appear. Synthetic cannabinoids were the most commonly detected drug type in April 2022, detected in 50% of samples. In contrast, benzodiazepines were the most common in May 2022, detected in 27% of samples.
• The constant evolution in the types of substances available emphasises the importance of investment in drug checking, forensic post-mortem toxicology and hospital toxicology testing.

Service indicators

• The number of specialist drug treatment referrals between August and November 2022 were lower compared to the same time periods in 2020 and 2021.
• The average number of opioid substitution therapy doses supplied per month decreased slightly in the period from July to September 2022. The number of doses supplied during this period was higher than in the same time period in 2018 and 2019, and lower than in the same time period in 2020 and 2021.
• The average weekly number of injecting equipment provision transactions, and needles and syringes were broadly stable between July and September 2022. The total numbers of transactions and needles and syringes distributed during this time period were lower compared to the same time periods in 2020 and 2021.