• Drug-related harms remained high in Scotland, but a decrease was observed during autumn 2023 compared with the previous reporting period (summer). Levels remain higher than in the spring (reported in quarterly report 4 – July 2023).
• The following changes were observed compared to the previous reporting period (reported in quarterly report 5 – October 2023):

For harm indicators:

• • naloxone administration incidents: 17% decrease
  • emergency department attendances: 13% decrease
  • drug-related hospital admissions: stable (2% decrease)
  • suspected drug deaths: 19% decrease

For service indicators:

• • drug treatment referrals: 8% decrease
  • injecting equipment provision: stable (transactions - 4% decrease, number of needles and syringes - 2% decrease)
• The pattern of drug use associated with most harms was polysubstance use involving benzodiazepines (most commonly diazepam and bromazolam), cocaine and opioids. Cocaine played an increasing role in drug-related harms.

Alerts

• A public health alert about nitazene-type opioids (published in January 2023) was updated in December 2023 to include provisional data on detections of nitazenes in deaths in Scotland. Based on post-mortem toxicology testing, nitazenes were detected in 25 deaths (to 30 September 2023).
  • PHS alert: nitazene-type opioids in Scotland
• Scottish Drugs Forum (SDF) worked with service providers and other partners to launch a multi-agency alert and develop information resources for people at risk of overdose due to the introduction of synthetic opioids, including nitazenes into the drug supply.
  • SDF synthetic opioid resources (external website)
• A public health alert about new benzodiazepines was published on 5 July 2023 and remains current. Bromazolam is currently the most common 'street benzo' detected in Scotland.
  • PHS alert: new benzodiazepines - bromazolam

Harm indicators

• Between September and November 2023, the average weekly number of Scottish Ambulance Service naloxone administration incidents decreased (from 84 to 75). The total number of incidents was 19% lower than in the same period in 2021 and 14% higher than in 2022. These figures do not take account of naloxone administration by members of the public, service workers, or other emergency responders such as police officers.
• Between September and November 2023, drug-related attendances at emergency departments were 13% lower than in the previous time period. The total number of attendances recorded was similar to the same period in 2021 and 2022.
• Between July and September 2023, drug-related hospital admissions were similar to the high in the previous period. The total number of admissions was 16% lower than the same period in 2021 and 20% 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 September and November 2023, there were 267 suspected drug deaths. The number of deaths was 8% lower than in the same period in 2021 (290) and 6% lower compared to 2022 (285).

Toxicology indicators

• Between August and November 2023, the most frequently detected drugs in the ASSIST hospital toxicology project were desmethyldiazepam (11% of detections), followed by cocaine (11%), temazepam (10%) and bromazolam (10%). Nitazenes made up 2% of detections (detected 16 times, up from seven in the previous quarter).
• Between July and September 2023, the most common drug types detected in post-mortem toxicology were opioids (67%) and benzodiazepines (59%), based on partial data available for September (provisional Q3 2023). The most common individual drug detected was cocaine (38%), followed by heroin/morphine (35%), diazepam (30%), methadone (25%) and bromazolam (24%). Xylazine was detected in post-mortem samples for the first time.
• Scottish prison drug analysis data were not available for the latest period.

Service indicators

• Between August and November 2023, the average weekly number of referrals to specialist drug treatment services varied widely within an overall decreasing trend. The total number of referrals recorded in this period was 8% lower than in the previous period. The number of referrals was 6% lower than the same period in 2021 and 6% higher than in 2022.
• Between July and September 2023, the average weekly number of injecting equipment provision transactions, and needles and syringes distributed remained relatively stable. During this period, both the total number of transactions, and number of needles and syringes distributed, were lower than in the same period in 2021 (13% and 9% respectively) and similar to 2022.
• Data for opioid substitution therapy is not available for the most recent period. Between April and June 2023, 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 October and December 2023, 53 trend reports were received by RADAR.
• The majority of reports related to benzodiazepines, cocaine and polydrug use.
• Other commonly reported concerns relate to heroin, novel synthetic opioids (fentanyl and nitazenes), tapentadol and carisoprodol tablets (‘somas’ and ‘red apples’), ketamine and MDMA.
• Trend reports can now be viewed on our dashboard (external website).

Actions

• 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.
• These developments increase the risk of harm and death, particularly in the context of polysubstance use, stigma and exclusion. They emphasise the importance of timely and accurate hospital toxicology and forensic post-mortem toxicology services, as well as accessible drug checking.
• A system-wide approach that prevents drug harms and supports people affected into treatment, care and recovery remains critical. Harm reduction interventions are a key part of a systems-wide approach.