Specialist drug treatment referrals

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 (5,664) in this time period was 8% lower than in the previous period (6,131), 6% lower than in the same period in 2021 (6,008) and 6% higher than in 2022 (5,354).

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 16 August 2021 and 19 November 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.

This chart shows the number of referrals to drug treatment services in Scotland on the y axis and the date, between 16 August 2021 and 19 November 2023, on the x axis. In December and January each year, a seasonal reduction in referrals occurs. Referrals decreased throughout June and July 2021, and then remained broadly stable to January 2022 (400 to 480 referrals per week). 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 fluctuating, downward trend has been evident since then, with referrals ranging between 400 and 500 per week.

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Specialist drug treatment referrals

Summary

Historic trend

• Referrals decreased throughout June and July 2021 and then remained broadly stable to January 2022 (400 to 480 referrals per week, apart from the seasonal decreases in December and January).
• Throughout 2022, there was a fluctuating, but gradual, decrease in the average weekly number of referrals.
• Following the seasonal reduction in December 2022, the number of referrals returned to a weekly average of approximately 450 per week in January 2023. A fluctuating, downward trend has been evident since then, with referrals ranging between 400 and 500 per week.

National update

For the most recent 13-week period (21 August to 19 November 2023):

• 5,664 specialist drug treatment referrals were recorded, at an average of 436 per week.
• This was 8% lower than the previous 13-week period (22 May to 20 August 2023) when 6,131 referrals were recorded, at an average of 472 per week.
• Referrals were 6% lower compared to the same period in 2021 (6,008, weekly average 462) and 6% higher than in 2022 (5,354, weekly average 412).

Local update

For the most recent period (21 August to 19 November 2023), the number of weekly referrals decreased across most mainland NHS boards, compared to the previous period:

• Referrals decreased in seven areas: NHS Lanarkshire (6%), NHS Greater Glasgow and Clyde (7%), NHS Highland (7%), NHS Lothian (12%), NHS Dumfries and Galloway (17%), NHS Forth Valley (17%) and NHS Ayrshire and Arran (18%).
• Referrals were broadly stable in the other mainland NHS 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 (external website).

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.

The Medication Assisted Treatment (MAT) standards (gov.scot) is an improvement programme to strengthen access, choice and support within the drug treatment system in Scotland.

Opioid substitution therapy

From April to June 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 April 2021 and 30 June 2023.

The stacked area chart shows the three-month rolling average number of doses supplied for OST medications in the community between April 2021 and June 2023. 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. The chart below shows trends in the monthly number of ADQ doses supplied for specific OST medications in the community between 1 April 2021 and 30 June 2023.

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Average total number of OST doses per month

The chart shows monthly trends in the number of doses supplied for specific OST medications in the community between April 2021 and June 2023. Methadone was the most commonly prescribed, at approximately 540,000 doses per month between April and June 2023. Buprenorphine was less frequently prescribed. The average monthly number of oral buprenorphine doses supplied was roughly stable over time, with approximately 119,000 oral buprenorphine doses prescribed per month between April and June 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 102,000 per month between April and June 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 10%, from 603,600 between April and June 2021, to 542,300 between January and March 2023.
• The average monthly number of oral buprenorphine doses supplied was broadly stable between April to June 2021 (123,100) and January to March 2023 (118,200).
• 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 27,300 between April and June 2021, to 88,200 between January and March 2023.

Update

OST prescribing data for July to September 2023 has been delayed due to changes in the primary data source for PHS's Prescribing Information System. We anticipate that data for July to September 2023 will be available for the next release of this report in April 2024.

For the most recent period (1 April to 30 June 2023):

• The average total monthly number of OST doses supplied was approximately 750,900. This was roughly the same as in the previous quarter (January to March 2023; approximately 748,700 doses) and similar to the same period in 2021 and 2022.
• The average monthly number of methadone doses supplied was approximately 530,700. Equivalent figures for oral buprenorphine and injectable buprenorphine were 118,700 and 101,500, respectively.
• The number of methadone doses was approximately the same as in the previous quarter, 12% lower than the same period in 2021 and 7% lower than in 2022.
• The number of oral buprenorphine doses supplied was approximately the same as the previous quarter and similar to the same period in 2021 and 2022.
• The number of injectable buprenorphine doses was 15% higher than in the previous quarter, 272% higher than the same period in 2021 and 54% higher than in 2022.

Additional information

These data have been extracted from the Prescribing Information System (PIS) (external website) 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 numbers of injecting equipment provision (IEP) transactions, and needles and syringes distributed, remained relatively stable between July and September 2023. During this time period, both the 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.

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 5 July 2021 to 1 October 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 5 July 2021 and 1 October 2023, is on the x axis. An overall decreasing trend was observed from July 2021 to January 2022. Between February 2022 and December 2022, the number of transactions was broadly stable before a large decrease in January 2023. The number of transactions increased in February and fluctuated until the end of June 2023, following an overall increasing trend. Between July and September 2023 transactions were relatively stable. A seasonal dip in transactions in December and January was observed in each year.

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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

• There was an overall decrease in the average weekly number of IEP transactions from July 2021 to January 2022. The average number of transactions remained broadly stable (approximately 3,000 per week) from February 2022 to June 2023.
• An overall decreasing trend in the average weekly number of needles and syringes distributed was observed from July 2021 to January 2022. Between January 2022 and June 2023, the average number of needles and syringes distributed has been broadly stable (approximately 37,000 per week).
• The ratio of needles and syringes distributed was stable from July 2021 to June 2023, at an average of 14 needles and syringes distributed per transaction.
• For each indicator, seasonal fluctuations were observed during December and January each year.

National update

For the most recent period (3 July to 1 October 2023):

IEP transactions

• 39,376 transactions were recorded, at an average of 3,029 per week.
• This was similar to the previous period (3 April to 2 July 2023) when a total of 37,959 transactions were recorded (weekly average 2,920).
• The number of transactions was 13% lower than the same period in 2021 (45,221, weekly average 3,479) and similar to 2022 (38,644, weekly average 2,973).

Needles and syringes distributed

• 504,464 needles and syringes were distributed, at an average of 38,805 per week.
• This was similar to the previous period when a total of 494,660 needles and syringes were distributed, at an average of 38,051 per week.
• The number of needles and syringes distributed was 9% lower compared to the same period in 2021 (554,021, weekly average 42,617) and similar to 2022 (492,782, weekly average 37,906).

Ratio of needles and syringes distributed

• There was a weekly average of 14 needles and syringes distributed per transaction.
• This was equal to the previous period and the same period in 2022 (14), and similar to 2021 (13).

Local update

For the most recent period (3 July to October 2023), the ratio of needles and syringes distributed per transaction varied across mainland NHS boards, compared to the previous period:

• The ratio increased in two areas: NHS Forth Valley (6%) and NHS Tayside (27%).
• The ratio decreased in three areas: NHS Grampian (5%), NHS Lanarkshire (7%) and NHS Greater Glasgow and Clyde (9%).
• The ratio was stable in four areas: NHS Ayrshire and Arran, NHS Borders, NHS Dumfries and Galloway and NHS Lothian.

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 website.