Rapid Action Drug Alerts and Response (RADAR) quarterly report
January 2023
A Management Information Statistics publication for Scotland
- Published
- 24 January 2023
- Type
- Statistical report
- Author
- Public Health Scotland
Service indicators
Specialist drug treatment referrals
The average weekly number of referrals to specialist drug treatment services was stable from August to November 2022. The number of referrals during this time period (4,620) was lower compared to the same time periods in 2020 (5,092) and 2021 (5,511).
Background
Specialist drug treatment referrals occur when a person comes into contact with services designed to support their recovery from problem 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 7 August 2020 and 13 November 2022.
Summary
Historic trend
- The average weekly number of referrals increased from September 2020 to May 2021, reaching a peak of 554 in week beginning 17 May 2021.
- Referrals decreased throughout June and July 2021, and then remained stable to January 2022 (between 400-480 referrals per week, apart from the seasonal decrease in December and January).
- From January 2022 onwards, there has been a gradual decrease in the average weekly number of referrals.
Update
For the most recent time period (22 August to 13 November 2022):
- 4,620 specialist drug treatment referrals were recorded, at an average of 385 per week.
- This was almost the same as the previous twelve-week time period (30 May to 21 August 2022) when 4,622 referrals were recorded, at an average of 385 per week.
- Referrals were 9% lower compared to the same time period in 2020 (5,092, at an average of 424 per week) and 16% less than those in 2021 (5,511, at an average of 459 per week).
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.
For more information, or to analyse these data by NHS Board, visit the COVID-19 wider impacts dashboard.
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.
For details of drug treatment services in your area, visit the Scottish Drug Services Directory.
The Medication Assisted Treatment (MAT) Standards are an improvement programme to strengthen access, choice and support within the drug treatment system in Scotland.
Why we use a 3-week moving average
As these data are highly variable over time, a 3-week moving average has been included in the graph to aid interpretation of trends over time.
Opioid substitution therapy
The average number of OST doses supplied per month decreased slightly in the period from July to September 2022. The number of OST 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.
Background
The data used in these statistics relate to the number of average daily quantity (ADQ) doses for opioid substitution therapy (OST) drugs dispensed in the community in Scotland. OST drugs include methadone, oral buprenorphine and injectable buprenorphine.
The first chart below shows the average total monthly number of ADQ doses supplied for OST medications in the community between January 2018 and September 2022.
The chart below shows monthly trends in the number of ADQ doses supplied for specific OST medications in the community between January 2018 and September 2022.
Summary
Historic trend
- From early 2018 to early 2020, the average total monthly number of OST doses supplied was broadly stable. In February 2020, the number of OST doses increased, peaking in June 2020. There was a decreasing trend in the average monthly total number of OST doses supplied between July 2020 and June 2022.
- The average monthly number of methadone doses supplied was stable from early 2018 to early 2020, increased between February 2020 and June 2020 and has gradually decreased since then.
- The average monthly number of oral buprenorphine doses supplied increased gradually from early 2018 to June 2020 and has remained broadly stable since.
- 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 63,000 in June 2022.
Update
For the most recent time period (July to September 2022):
- The average total monthly number of OST doses supplied was approximately 747,800.
- This was roughly the same as in the previous quarter (April to June 2022) when approximately 749,700 doses were supplied.
- The number of OST doses supplied was higher (both 3%) than in July to September in 2018 and 2019 and lower (5% and 3% respectively) than in the same time period in 2020 and 2021.
- The average monthly number of methadone doses supplied was approximately 563,900. Equivalent figures for oral buprenorphine and injectable buprenorphine were 118,300 and 65,700 respectively.
- The number of methadone doses was lower than in the previous quarter (April to June 2022) when approximately 569,000 doses were supplied.
- The number of methadone doses supplied was between 8% and 16% lower than in July to September in previous years (2018 to 2021).
- The number of oral buprenorphine doses supplied was roughly the same as in the previous quarter, higher than the same time period in 2018 and 2019 (21% and 12% higher respectively) and lower than the same time period in 2020 and 2021 (7% and 6% lower respectively).
- The number of injectable buprenorphine doses was 5% higher than in the previous quarter and 44% higher than in the same time period in 2021.
Additional information
These data have been extracted from Prescribing Information System (PIS) and the Hospital Medicines Utilisation Data Manual (HMUD).
The data shown on methadone and oral buprenorphine, and the majority of injectable buprenorphine data, relate to prescriptions dispensed to an individual from a community pharmacy in Scotland where a request for reimbursement of costs was processed. These community prescribing data are extracted from PIS. 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 reimbursed 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 30% of injectable buprenorphine doses supplied in Scotland are held in HMUD and have been combined with the community prescribing data to provide a comprehensive account of OST supply over time.
The time period shown for HMUD data reflects the month in which medication was purchased. For injectable buprenorphine, the length of time between the purchase and administration of medication is thought to be generally short. Therefore, the differences in the basis of the time periods shown in PIS and HMUD data are not thought to negatively impact the reliability of this analysis.
To analyse information on methadone and oral buprenorphine dispensing by NHS Board or by Alcohol and Drug Partnership, go to the COVID-19 wider impacts dashboard.
Why we use a 3-month moving average
As these data are highly variable over time, a 3-month moving average has been included in the charts to aid interpretation of trends over time.
Even if all other factors are constant (for example, the number of treated patients), the total number of ADQ doses supplied will vary according to the number of days in each month. Averaging over three months minimises the impact of that variability.
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 Misuse group. The ADQs agreed are:
- methadone (oral): 65 mg
- buprenorphine (oral): 13 mg
- buprenorphine (parenteral/injectable): 3.4 mg
Glossary
- Methadone
Methadone is an opioid drug commonly prescribed as an opioid substitution therapy. Methadone is a full opioid agonist – it is most commonly seen as a green liquid, which is swallowed. These data refers to methadone prepared as a 1 mg/ml solution.
- Buprenorphine
Buprenorphine is an opioid drug commonly prescribed as an opioid substitution therapy. Buprenorphine is a partial opioid agonist – it is available in oral and injectable forms:
- Oral buprenorphine is buprenorphine in tablet form that is administered orally (by mouth, usually sub-lingual – under the tongue). It is also known by brand names such as Subutex. These data include 2 mg, 8 mg and 16 mg tablets.
- Injectable buprenorphine is buprenorphine in liquid form that is administered as a subcutaneous injection. It is also known by brand names such as Buvidal. These data include various weekly and monthly prolonged release formulations
- Defined daily dose (DDD)
As defined by the World Health Organization, the DDD is ‘the assumed average maintenance dose per day for drug use for its main indication in adults’.
- Average daily quantity (ADQ)
ADQ is similar to the DDD but adjusted to reflect how medication is used in Scotland.
Injecting equipment provision
The average weekly numbers of Injecting Equipment Provision (IEP) transactions and needles and syringes distributed were broadly stable between July and September 2022. The total numbers of IEP transactions and needles and syringes distributed during this time period were lower compared to the same time periods in 2020 and 2021.
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/syringe transactions at IEP sites and the total number of needles and syringes distributed.
The first chart below shows the weekly number of IEP transactions from 29 June 2020 to 2 October 2022.
The second chart shows the weekly number of needles and syringes distributed from 29 June 2020 to 2 October 2022.
Summary
Historic trend
- There was an overall decrease in the average weekly number of IEP transactions from June 2020 to February 2022. This trend included seasonal fluctuations during December and January each year. Since February 2022, average numbers of IEP transactions have been relatively stable (approximately 3,000 per week).
- A fluctuating decreasing trend in the average weekly number of needles and syringes distributed was observed from June 2020 to July 2021. Since July 2021, the average number distributed has remained relatively stable (approximately 37,500 per week).
Update
For IEP transactions in the most recent time period (4 July 2022 to 2 October 2022):
- 38,644 transactions were recorded, at an average of 2,973 per week.
- This was comparable to the previous time period (4 April to 3 July 2022) when a total of 38,102 were recorded, at an average of 2,931 per week.
- The total number of transactions was 17% lower compared to the same time period in 2020 (46,365, at an average of 3,567 per week), and 15% lower compared to those in 2021 (45,221, at an average of 3,230 per week).
For needles and syringes distributed in the most recent time period (4 July 2022 to 2 October 2022):
- 492,782 needles and syringes were distributed, at an average of 37,906 per week.
- This was comparable to the previous time period (4 April to 3 July 2022) when a total of 483,377 needles and syringes were distributed, at an average of 37,183 per week.
- The total number of needles and syringes distributed in the most recent time period was 14% lower compared to the same time period in 2020 (571,559, at an average of 43,966 per week), and 11% lower compared to those in 2021 (554,021, at an average of 39,573 per week).
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 figures.
For more information, or to analyse these data by NHS board, visit the COVID-19 wider impacts dashboard.
For details of injecting equipment providers in your area, visit the Scottish Needle Exchange Directory.
Why we use a 3-week moving average
As these data are highly variable over time, a 3-week moving average has been included in the graph to aid interpretation of trends over time.
Glossary
- Transaction
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.