Rapid Action Drug Alerts and Response (RADAR) quarterly ​report
January 2025

Police drug trends bulletin

The purposes of the Police Scotland’s Statement of Opinion (STOP) bulletin are to raise awareness of drug trends and to demonstrate some of the substances present in Scotland's drugs market. This edition describes the diversification in the supply of cannabinoids.

Synthetic cannabinoid receptor agonists (SCRAs)

Officers from the STOP Unit West attended an address that was being used in the production of synthetic cannabinoid receptor agonists (SCRAs, also known as synthetic cannabinoids or ‘spice’), namely MDMB-4en-PINACA and ADB-INACA. This is the first known site attended by the STOP Unit in Scotland. The operation was notable for its highly sophisticated setup.

SCRAs are primarily associated with use in prisons, where they are consumed in various forms, including vapes, paper and powder. More information on drug use in prisons, can be found in the indicator: Drug seizures in Scottish prisons.

They have also been identified in community settings, appearing in products such as vapes, edibles or sprayed onto resin and plant material (commonly referred to as ‘bud’). Although less common, SCRAs have occasionally been detected in tablet form as well.

Most synthetic cannabinoids are deemed class B drugs under the Misuse of Drugs Act 1971. Newer ones are covered by the Psychoactive Substances Act 2016.

Semi-synthetic cannabinoids

STOP Unit West have recently seen a recovery of a drug that appeared to be cannabis resin. Laboratory analysis revealed the presence of the SCRA, MDMB-4en-PINACA, as well as hexahydrocannabinol (HHC). While the detection of a SCRA on cannabis resin is not unusual, the presence of HHC is uncommon.

HHC is a semi-synthetic cannabinoid, a compound that is derived from naturally occurring cannabinoids but is modified to enhance or alter the effects. It is controlled by the Psychoactive Substances Act 2016.

Tetrahydrocannabinol

Tetrahydrocannabinol (THC) is a class B drug under the Misuse of Drugs Act 1971. It is most commonly found in herbal form as one of the main cannabinoids in cannabis. It has also been detected in vape oils and in crystal form. Below is an image of a recent recovery of THC crystals.

Image showing a glass jar labelled ‘THC.A diamonds – 28 gram’, containing crystals. Next to the jar is a clear bag containing white/yellow crystals.

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THC crystals

Cannabidiol

STOP Unit West have seen a recent increase in the recovery of cannabis extracts being recovered containing cannabidiol (CBD) only (no THC). These have taken the form of crystals, similar to but larger than the THC crystals shown above, or as yellow/brown material with similar appearance to ‘shatter’.

CBD is a cannabinoid, but it is non-intoxicating and non-euphoric, meaning it is not psychoactive and does not produce a ‘high’. Unlike other cannabinoids, it is not controlled by the Misuse of Drugs Act or Psychoactive Substances Act. It is commonly sold as a food supplement and is advertised as helping with conditions such as inflammation, pain, nausea, migraines, seizures and anxiety, although further research is needed to establish a firmer evidence base for its use as a treatment for such conditions.

RADAR intelligence and reports

97 reports were validated by RADAR between 5 October 2024 and 4 January 2025.

RADAR has received over 450 reports of drug-related information and harms. Our sincere thanks to everyone who has contributed.

These reports have been invaluable in identifying early changes to trends and supply, enabling more rapid responses to emerging threats. This has been especially important as we currently navigate significant disruptions to several key drug markets. Anyone can make a report through the reporting form and mailbox.

Summary

A summary of key trends is shown below. Intelligence reports to RADAR can be filtered by drug type and region on the dashboard (external website).

Please note, many of these reports have not been confirmed by toxicology and should be considered anecdotal.

Trends by primary drug type

Quarterly dates are shown on the chart below. In the latest period (QR10; 5 October 2024 to 4 January 2025):

• The majority of submissions report polydrug use – the use of more than one substance at a time.
• Most concerns were related to adverse effects (seizures, wounds and confusion), overdose (collapse, unconsciousness) and death.
• The most common primary drugs or drug types reported were heroin and benzodiazepines.
  • Heroin was the most commonly reported drug of concern, accounting for 19% of drugs reported. This was stable compared to the previous quarter, but reports have increased throughout the time series, from 5% in QR1.
  • Benzodiazepines (benzos) accounted for 16% of all drugs reported. Between QR1 and QR5, benzos accounted for 34% of drugs reported, before decreasing to an average of 20% between QR6 and QR8 and increasing in QR9 (26%).
  • Synthetic opioids (nitazene/fentanyl-type drugs) accounted for 13% of drugs reported, similar to the previous five quarters (average 11%). Nitazenes continue to be the most common novel synthetic opioid detected in toxicology but several submissions reported drugs sold as ‘fentanyl’.
  • Cocaine accounted for 15% of drugs reported, similar to the 18% average between QR1 and QR8 and an increase from 8% in QR9. Reports of crack cocaine were more frequent than powder cocaine for the first time.
  • The most common drugs reported in the ‘other’ category were ketamine, MDMA, pregabalin, alcohol and zopiclone.

This stacked bar chart shows the percentage of reports by drug or drug type in submissions received by RADAR. Data is shown in 10 quarters, from QR1 (July to September 2022) to QR10 (October to December 2024). Percentage is on the y axis and date (by quarter) is on the x axis. The drugs are grouped into six main categories (benzodiazepines, cocaine, heroin, nitazenes/fentanyl, cannabinoids and other). The most common drug type reported in all quarters with the exception of QR8 and QR10 was benzos. Benzo reports start relatively high at 33% in QR1, reaching a high of 42% in QR4 and then gradually decreasing to 16% in QR8, before increasing to 26% in QR9 and decreasing again in QR10 to 16%. Cocaine made up 22% of reports in QR1 and fluctuated between 20-25% up to QR4, followed by a decrease in the later quarters, reaching a low of 8% by QR9 and increasing again in QR10 to 15%. Heroin reports started low (5% in QR2) before trending upwards, with intermittent increases across the quarters, peaking at 22% in QR9 and remaining stable in QR10. Nitazenes/fentanyls reports initially appear in QR2 at 5% and then fluctuate through the quarters, reaching its highest point of 13% in both QR5 and QR10. There were a low number of cannabinoid reports in the first six quarters. Reports peaked in QR8 at 20%, followed by a drop to 2% in QR10. Reports of ‘other’ drugs fluctuated throughout the series from 20-45%.

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Reports to RADAR by primary drug(s)

WEDINOS

WEDINOS (external website) is a harm reduction project, providing an anonymous testing service, to show trends in substance use.

Between September and November 2024, 142 samples from Scotland were tested by WEDINOS. Seven samples contained no active components.

Among the 135 samples testing positive for a controlled drug:

• There were 235 detections of 135 individual substances.
• The average number of substances detected per sample was two, with the number of substances ranging from one to eight per sample.
• Over half did not test positive for the intended purchase.

The following controlled drugs were the most common:

• bromazolam: 15 (6% of detections, 11% of samples)
• diazepam: 14 (6% of detections, 10% of samples)
• cocaine: 12 (5% of detections, 9% of samples)
• 6-MAM: 11 (5% of detections, 8% of samples)
• heroin: 10 (4% of detections, 7% of samples)

Scottish Drugs Forum (SDF) drug trends

SDF are funded by the Scottish Government to develop regional Living Experience Engagement Groups - safe spaces for those with living experience to express their views and share information about drug trends and harms. These groups typically meet weekly and are facilitated by staff with lived experience from the SDF Living Experience Engagement Team and local partner agencies.

Several groups are operational or in development across Scotland. Regional group members have the opportunity to contribute to a national group, which engages with strategic bodies, stakeholders and policymakers, such as the Scottish Government's National Collaborative. While the groups operate independently, they can provide valuable input to local Lived Experience Panels or Alcohol and Drug Partnership subgroups through member representation.

Each group sets its meeting agenda, ensuring a safe space to discuss their needs, opinions and the issues affecting them. An important part of this is learning and sharing information about current trends and the related risks and harms. SDF publishes regular trend bulletins based on group insights. Read the latest report at Resources - Scottish Drugs Forum (external website).

Reporting drug harms

Please encourage people and services in your area to share information on trends, incidents and harms related to drugs, such as:

• adverse effects including overdose and wounds
• routes of administration
• new substances or patterns of use
• testing data.

The information in the regional breakdown can be used by local areas for their own drug trend surveillance.

Anyone can make a report by using our reporting form (external website) or by emailing phs.drugsradar@phs.scot.

Naloxone administration by Scottish Ambulance Service

The average weekly number of naloxone administration incidents decreased between September (61) and November 2024 (47). The total number of naloxone administration incidents (700) was 30% lower than the previous quarter (998). This was 24% lower than the same period in 2022 (917) and 34% lower than in 2023 (1,058).

Background

Naloxone is a medicine used to prevent fatal opioid overdoses. These data relate to the number of incidents in which naloxone was administered by Scottish Ambulance Service (SAS) clinicians.

While these data count multiple overdose patients at the same incident separately, multiple naloxone administrations to the same patient at the same incident are not counted separately.

The chart below shows the weekly number of SAS naloxone administration incidents in Scotland from 22 August 2022 to 24 November 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.

The chart shows the number of emergency naloxone incidents attended by the Scottish Ambulance Service, from 22 August 2022 to 24 November 2024. The average number of incidents was broadly stable between August and November 2022, at 77 per week, before decreasing during December 2022 (weekly average 66). An increasing trend was observed from January (weekly average 67) to May 2023 (weekly average 86). Between June and August 2023, incidents remained broadly stable (weekly average 103), after which there was a decreasing trend to January 2024 (weekly average 68). Incidents then increased and remained stable at around 86 per week from April to July 2024. Since then, a generally decreasing trend has been observed, from 76 incidents per week on average in August, to 47 incidents per week on average in November.

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Naloxone administration by Scottish Ambulance Service

Summary

Historic trend

• The average weekly number of naloxone incidents was broadly stable, at 77 per week between August and November 2022. The average number of weekly incidents decreased to 66 per week in December 2022.
• During 2023, the normal seasonal pattern of lower numbers during winter months and higher numbers during summer months was observed, with an increasing trend in the average weekly number from January (67) to May 2023 (86).
• Between June and August 2023, incidents remained broadly stable at around 103 per week, after which there was a decreasing trend to January 2024.
• Between January and April 2024, the average number of weekly incidents fluctuated within a lower range of 47 to 86.
• Following a sharp increase in early May, the average number of weekly incidents remained stable at a higher level (90) between May and July 2024.
• During August 2024, a decreasing trend in the average weekly number of incidents was observed (76).

National update

For the most recent period (2 September to 24 November 2024):

• 700 SAS naloxone incidents were recorded, at an average of 58 per week. Average weekly numbers decreased between September (61) and November 2024 (47).
• The number of incidents was 30% lower than the previous 12-week period (10 June to 1 September 2024) when 998 incidents were recorded, at an average of 83 per week.
• The number of incidents was 24% lower than the same period in 2022 (917, weekly average 76) and 34% lower than in 2023 (1058, weekly average 88).

Local update

Comparing the most recent period (2 September to 24 November 2024) to the previous quarter, decreases in incidents were observed in all mainland NHS boards:

• NHS Lanarkshire (16%), NHS Lothian (21%), NHS Borders (25%), NHS Ayrshire and Arran (29%), NHS Greater Glasgow and Clyde (31%), NHS Grampian (35%), NHS Highland (35%), NHS Tayside (35%), NHS Forth Valley (36%), NHS Fife (44%) and NHS Dumfries and Galloway (53%).

To analyse these data further, please visit the RADAR dashboard (external website).

Additional information

PHS was provided with these data by SAS.

Scotland-level data for 1 January 2018 to 24 November 2024 are available on the RADAR dashboard (external website).

Information on the carriage of naloxone by Police Scotland officers can be found on Police Scotland’s website.

Information on take-home naloxone distribution can be found in the National Naloxone Programme Scotland Quarterly Monitoring Bulletin, published by PHS.

Scotland's Take-Home Naloxone Programme

The national Take-Home Naloxone Programme was launched by the Scottish Government in 2011 to prevent fatal opioid overdoses.

Naloxone is a medicine that can temporarily reverse the effects of an opioid overdose. It can be given to anyone who is non-responsive and displaying the signs of an overdose (such as unconsciousness, shallow breathing, snoring, blue lips, pale skin and pin-point pupils).

Anyone in Scotland can carry naloxone. It can be accessed through most local drug services or pharmacies, and it can also be delivered to your home through the charity Scottish Families Affected by Alcohol and Drugs (external website).

Naloxone is very easy to administer. You can learn more about administering naloxone in a free e-learning module 'Overdose Prevention, Intervention and Naloxone (external website)' created by the Scottish Drugs Forum.

Drug-related attendances at emergency departments

Between September and November 2024, the number of drug-related attendances at emergency departments (977) was 10% lower than the previous quarter (1,090). This was 14% lower than the same period in 2022 (1,130) and 16% lower than in 2023 (1,162).

Background

A drug-related emergency department (ED) attendance is an attendance for a drug intoxication or overdose, either alone or combined with alcohol intoxication.

The chart below shows the weekly number of drug-related ED attendances in Scotland between 29 August 2022 and 1 December 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.

The chart shows the number of drug-related emergency department attendances. The number of attendances is on the y axis and the date, between 29 August 2022 and 1 December 2024, is on the x axis. The average number of attendances was broadly stable at 84 per week, between September 2022 and March 2023. Between April and June 2023, the number of attendances gradually increased, peaking at 144 in the week beginning 19 June 2023. An overall decreasing trend was observed from June 2023 to October 2023. From November 2023 to September 2024, the number of attendances has been broadly stable in the range of 60 to 100 attendances per week. Since then, attendances have been roughly stable at an average of 76 attendances per week.

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Drug-related attendances at emergency departments

Summary

Historic trend

• The number of drug-related ED attendances per week was broadly stable between September 2022 until March 2023 (weekly average 84). Attendances generally increased between April and June 2023, with the highest weekly level in the series observed in June 2023 (144).
• From June 2023 to October 2024, despite variations in the number of attendances per week, an overall decreasing trend was observed, from an average of 106 in June 2023, to 91 in October 2023.
• From November 2023 to August 2024, the number of attendances has been broadly stable in the range of 60 to 100 attendances per week.

National update

For the most recent 13-week period (2 September to 1 December 2024):

• 977 emergency department attendances were recorded, at an average of 75 per week. This was 10% lower than the previous 13-week period (3 June to 1 September 2024, 1,090 attendances, weekly average 84).
• Attendances were 14% lower than the same period in 2022 (1,130 attendances, weekly average 87) and 16% lower than in 2023 (1,162 attendances, weekly average 89).

Local update

Comparing the most recent period (2 September to 1 December 2024) to the previous quarter, the key changes observed across mainland NHS boards were:

• Attendances increased in six areas: NHS Forth Valley (8%), NHS Dumfries and Galloway (10%), NHS Borders (21%), NHS Highland (21%), NHS Grampian (35%) and NHS Ayrshire and Arran (75%).
• Attendances decreased in four areas: NHS Lanarkshire (16%), NHS Tayside (22%), NHS Lothian (23%) and NHS Fife (24%).
• Attendances were broadly stable in NHS Greater Glasgow and Clyde.

To analyse further, please visit the RADAR dashboard (external website).

Additional information

These data are taken from our Accident and Emergency Activity Data.

Due to the quality of the data available, it is not possible to accurately report total attendances for specific conditions using the national Accident and Emergency dataset. The diagnosis or reason for attendance can be recorded in a variety of ways, including in free text fields and not all NHS boards submit this information. The numbers presented in this report are based on an experimental definition of drug-related ED attendances and have not been subject to extensive quality assurance. Therefore, they are provisional and may be subject to change in future releases. Further details can be found in the metadata and the Accident and Emergency Activity Data.

Drug-related acute hospital admissions

Between July and September 2024, 2,071 drug-related hospital admissions were recorded, 8% lower than the previous quarter (2,253). Admissions were similar to the same period in 2022 (2,024) and 20% lower than in 2023 (2,577).

Background

The data used in these statistics relate to all inpatient and day-case admissions to general acute hospitals (excluding maternity, neonatal, geriatric long stay and admissions to psychiatric hospitals) where drug use was recorded as a diagnosis at some point during the patient’s hospital stay. Data are presented by date of admission.

The chart below shows the weekly number of drug-related admissions to Scotland’s general acute hospitals from 27 June 2022 to 29 September 2024. Data are taken from Scottish Morbidity Record (SMR) records held by Public Health Scotland (PHS). PHS expects to receive complete SMR data six weeks after the end of the month of discharge/clinic date. Therefore, the period presented here differs from our other harm indicators - this should be taken into consideration when interpreting trends. Data for the most recent quarter are provisional and may change in future publications. For further information, see the data management section on our website.

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 drug-related hospital admissions in Scotland’s general acute hospitals. The number of admissions is on the y axis and the date, between 27 June 2022 to 29 September 2024, is on the x axis. Between July 2022 and March 2023, admissions remained broadly stable averaging 147 per week, with a slight seasonal decrease during the end of December and beginning of January. Admissions increased between April and July 2023 (averaging 203 per week) and remained relatively stable until September before following a decreasing trend until October 2023. Between October 2023 and June 2024, admissions were roughly stable averaging 167 admissions per week. Admissions decreased between July to October (weekly average 159 per week).

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Drug-related hospital admissions

A further chart showing the top five drug types associated with admissions is available on the RADAR dashboard (external website).

Summary 

Historic trend 

• Between July 2022 and March 2023, admissions remained broadly stable averaging 147 per week, with a seasonal decrease during December and January.
• Admissions then increased until July 2023 (averaging 203 per week), remaining relatively stable until September 2023, followed by a decrease in October 2023.
• Between October 2023 and June 2024, admissions were roughly stable averaging 167 admissions per week.
• Opioids were the most common drug category recorded. The percentage of admissions where opioids were recorded remained relatively stable until the end of 2023 (average 47% between July 2022 and December 2023), before following a decreasing trend to 40% in June 2024. 
• The second most common drug type was cocaine, with admissions gradually increasing from 17% in July to September 2022, to 20% in April to June 2024. 

National update

For the most recent period (1 July to 29 September 2024):

• 2,071 drug-related hospital admissions were recorded, at an average of 159 per week. This was 8% lower than the previous 13-week period (2,253, weekly average 173).
• The total number of admissions was similar to the same period in 2022 (2,024, weekly average 156) and 20% lower than in 2023 (2,577, weekly average 198).
• Opioids continued to be the most common drug type. These were recorded in an average of 41% of admissions per month, a decrease from 43% in the previous quarter. Admissions for cocaine increased to 23%, from 20% in the previous quarter.

Local update

Comparing the most recent period (1 July to 29 September 2024) to the previous quarter, the key changes observed across mainland NHS boards were:

• Admissions increased in three areas: NHS Borders (11%), NHS Forth Valley (11%) and NHS Greater Glasgow and Clyde (11%).
• Admissions decreased in three areas: NHS Lanarkshire (11%), NHS Dumfries and Galloway (22%) and NHS Highland (22%).
• Admissions were broadly stable in three areas: NHS Ayrshire and Arran, NHS Lothian and NHS Tayside.

Due to completeness levels for the most recent period being below 90%, NHS Fife and NHS Grampian have been excluded from this local update. The data can be found on our dashboard. Caution is advised when interpreting local trends for these boards and comparing to other areas.

To analyse further, please visit the RADAR dashboard (external website).

Additional information 

These data have been extracted from our Scottish Morbidity Records (SMR01 acute).

The data presented on drug type are based on ICD-10 diagnostic codes and are not confirmed by toxicology analysis, therefore patterns in substance type should be interpreted with caution.

The most recent accredited official statistics on drug-related hospital care, includes a range of further information on drug types and patient demographics. For details, see our information on drug-related hospital statistics (DRHS). Please note, our DRHS dashboard presents data by date of discharge, so figures will differ to those shown above.

Suspected drug deaths

In the latest period (2 September to 24 November 2024), the total number of suspected drug deaths was 215, averaging 18 per week. The average weekly number of deaths decreased between September (21) and November 2024 (14). The total number of deaths was 10% lower than the previous quarter (238), 20% lower than the same period in 2022 (268) and 15% lower than in 2023 (254).

Background

A suspected drug death is a death where controlled drugs are suspected of being involved. Suspected drug death figures are based on reports, observations and initial enquiries from police officers attending scenes of death.

The details of these events are recorded by Police Scotland and shared with Public Health Scotland (PHS).

Following further investigation, these suspected drug deaths are either confirmed as a ‘drug-related death’ or determined ‘not to be a drug death’. This can take several months.

Suspected drug-death figures are used to provide a timely indication of trends and to detect any potential recent changes or clusters of harm to inform prevention activity. These figures are different to those published by the National Records of Scotland (NRS: external website) and do not provide a robust indication of the numbers of drug-related deaths occurring each year.

The chart below shows the weekly number of suspected drug deaths in Scotland from 22 August 2022 to 24 November 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.

The chart shows the weekly number of suspected drug deaths in Scotland on the y axis and the date, between 22 August 2022 and 24 November 2024, on the x axis. Between September 2022 and the end of August 2024, the average weekly number of deaths fluctuated considerably but generally remained within the range of 18 to 28 deaths per week. Between September and November 2024, the average weekly number of deaths followed a decreasing trend to a low of 14 in the week beginning 11 November 2024.

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Suspected drug deaths

Summary 

Historic trend 

• Between September 2022 and August 2024, the average weekly number of suspected drug deaths fluctuated considerably but generally remained within the range of 18 to 28 deaths per week.

Update 

For the most recent complete months (1 September to 30 November 2024):

• There were 237 suspected drug deaths, 92 in September, 84 in October and 61 in November.

For the most recent 12-week period (2 September to 24 November 2024):

• There were 215 suspected drug deaths, 10% lower than in the previous 12-week period (238). This was 20% lower than the same period in 2022 (268) and 15% lower than in 2023 (254).
• The average weekly number of deaths decreased from September (21) to October (18) and decreased further in the first three weeks of November 2024 (14).
• An average of 18 deaths were recorded per week. This was 10% lower than in the previous period (20), 18% lower than in the same period in 2022 (22) and 14% lower than in 2023 (21).

To analyse these data further, please visit the RADAR dashboard (external website).

Additional information

Data on suspected drug deaths are provided by Police Scotland.

The Scottish Government produce a quarterly report (Suspected drug deaths in Scotland) that presents Police Scotland data on suspected drug deaths and describes the age, sex and geographical location of deaths in each quarter. The analysis in this RADAR release is provided for the purpose of real-time detection and prevention of harms and is not comparable with the Scottish Government publication.

The information above is management information and not subject to the same validation and quality assurance as accredited official statistics. The data provided in this release should not be viewed as indicative of the annual deaths reported by NRS.

Accredited official statistics on drug-related deaths are published annually by the NRS during the summer and provide information broken down by age, sex, substance implicated and geographical area. The latest NRS publication (external website) reported that there were 1,172 drug-related deaths in Scotland in 2023. This was a 12% increase compared to 2022 (1,051).

Detailed information on drug-related deaths is presented in the National Drug-Related Deaths Database, which is published by PHS every two years. The latest PHS drug-related deaths report describes deaths that registered in 2019 and 2020, with trend data from 2012.

Emergency department toxicology: ASSIST

Between September and November 2024, the ‘A Surveillance Study of Illicit Substance Toxicity’ (ASSIST) emergency department project made 212 detections of 39 different illicit drugs, in samples from 48 patients. The most commonly detected drug category was depressants (58% of detections), followed by opioids (20%). The most commonly detected individual drug was cocaine (14%), followed by desmethyldiazepam (12%) and temazepam (10%).

Background

The ASSIST study is conducted by the emergency department (ED) at the Queen Elizabeth University Hospital (QEUH) in NHS Greater Glasgow and Clyde (GGC). This project has been funded by the Scottish Government since August 2022.

The aim of the study is to monitor drug trends and associated clinical features through the use of prospective surveillance of ED attendances due to acute illicit drug toxicity. For the most unwell patients, the study performs full toxicological analysis through the biorepository-approved surplus sampling.

The study allows drug profiling and the identification of emerging drugs or changing trends to inform appropriate harm reduction measures and public health responses.

Data collection

The study collects anonymised data through the analysis of standard-of-care clinical data and surplus serum sample toxicology testing for patients attending QEUH ED due to illicit drug toxicity. Surplus serum samples are leftover blood samples, which were taken as part of usual care.

Each ED attendance is counted once in these data. If the same person presented more than once, each attendance would be a separate data point.

Drug detections presented here are of ‘illicit drugs’ only and were not prescribed to the individual.

Illicit drug definition

The use of the term ‘illicit drug’ encompasses any substance that is controlled. It excludes:

• legal substances, such as alcohol, nicotine, caffeine and paracetamol
• medications recently prescribed to the individual (g. if methadone is detected for an individual prescribed methadone, it will not be included)
• drugs administered to the individual as part of treatment (by ambulance staff or in hospital)

Toxicology analysis of surplus serum samples

• Detections presented are for the substance only. If a metabolite (compound produced when a drug breaks down in the body) is detected, it will be presented as the substance only.
• If the metabolite and substance are detected, it will also be presented as the substance only.
• However, if a drug and a metabolite are both detected and the metabolite could also be a drug, the metabolite is included as it is not possible to say which has been used, if not both.
• Data from the study are presented in quarters, based on the date of ED presentation, and are provided in the table below.

*Due to a temporary pause in the study while funding was being confirmed, the start of Q9 was delayed. Recruitment was suspended from 17 August to 22 September 2024. Consequently, Q9 consists of only 55 study days, compared to the usual 90-92 days, resulting in fewer samples being tested. This discrepancy should be considered when interpreting the data and trends for the most recent quarter.

Results

The first chart shows the most common drug categories detected in toxicology analysis of surplus serum samples between 17 August 2022 and 16 November 2024 (Q1 to Q9).

The results are shown as the total number of detections. They are broken down by the top five drug categories and presented by study quarter.

This stacked bar chart shows the percentage of detections of drug types within QEUH ED across nine quarters - Q1 to Q9. The drugs are grouped into five categories (depressant, opioid, stimulant, cannabinoid and other (including dissociative and psychedelic drugs)). Percentage of detections by category is on the y axis and the time period is on the x axis. The most common category was depressants with 57%, 62%, 60%, 64%, 66%, 67%, 60%, 63% and 58% across the time series. The second most common category across Q1 to Q6 and Q9 was opioids with 17%, 18%, 16%, 16%, 15%, 13% and 21% across the time series. In Q7 stimulants were the second most common category (17%) and in Q8 both opioids and stimulant detections were recorded at 16%.

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ASSIST hospital toxicology analysis: drug categories by study quarter

Summary

Historic trend

Between 17 August 2022 and 16 August 2024:

• The most commonly detected drug type was depressants, making up 62% of all detections, followed by opioids (16%). The most commonly detected individual drug was cocaine (13%).
• 73% of attendances were male and 27% were female.
• 76% of attendances were aged 44 and under. The most common age category was 35 to 44 years (29%), followed by 25 to 34 (27%) and 16 to 24 (19%).
• The most common outcomes were discharged to home (39%), ward (30%) and police custody (11%).

Update

For the most recent period (23 September to 16 November 2024):

• 155 individual ED attendances related to illicit drug use were identified.
• 48 surplus serum samples were analysed for toxicology (as they were categorised as having a higher clinical severity of toxicity as per research inclusion criteria).

Drug type and category

Among the 48 samples analysed:

• There were 212 detections of 39 individual substances (found through the biological detection of the drug or its metabolite).
• The average number of drugs detected per sample was six.

Of the 215 detections, the following drugs were the most common:

• cocaine: 29 (14% of detections, 60% of samples)
• desmethyldiazepam: 25 (12% of detections, 52% of samples)
• temazepam: 22 (10% of detections, 46% of samples)
• oxazepam: 16 (8% of detections, 33% of samples)
• diazepam: 12 (5% of detections, 23% of samples)
• morphine: 11 (5% of detections, 23% of samples)
• bromazolam: 10 (5% of detections, 21% of samples)
• codeine: 9 (4% of detections, 19% of samples)
• etizolam: 9 (4% of detections, 19% of samples)
• pregabalin: 8 (4% of detections, 17% of samples)
• clonazolam: 6 (3% of detections, 13% of samples)

Please note: desmethyldiazepam, temazepam and oxazepam are all benzodiazepine drugs but can also be found as a metabolite of diazepam and other benzodiazepines.

The chart below shows the most common depressant drug detected in toxicology analysis of surplus serum samples between 17 August 2022 and 16 November 2024 (Q1 to Q9). The percentages are of all detections.

This line chart shows the percentage of detections of specific depressant drugs within QEUH ED across nine quarters - Q1 to Q9. Percentage of detections is on the y axis and the time period is on the x axis. The most common depressant drug in Q1, Q5, Q6, Q7, Q8 and Q9 was desmethyldiazepam (Q1; 10%, Q5; 11%, Q6; 10%; Q7: 9%, Q8: 11% and Q9: 12%). The most common depressant drug in Q2 was temazepam (8%). The most common depressant drug(s) in Q3 were bromazolam and etizolam (both 8%). The most common depressant drug in Q4 was bromazolam (Q4; 10%). Xylazine was detected in quarters Q4 to Q7 and Q9 (Q4: less than 1%, Q5 ,Q7 and Q9: 1%).

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ASSIST hospital toxicology analysis: depressant drugs by study quarter

Depressants were the most common drug category, making up 58% of detections (125).

• Benzodiazepines were detected 113 times (53% of all detections):
  • In total, 14 different types of benzodiazepines were detected, including desmethyldiazepam (12%), temazepam (10%), oxazepam (7%), diazepam (6%) and etizolam (4%).
  • Bromazolam made up 5% of all detections, a decrease from 8% in Q8 and the lowest levels observed since Q1.
  • Gidazepam/desalkylgidazepam made up 4% of detections and clonazolam made up 3%, similar to Q8.
• Gabapentinoids were detected 10 times (5% of all detections, similar to Q8). Pregabalin was the most common gabapentinoid detected.
• There were less than five detections of xylazine, an increase from no detections in the last quarter.

The chart below provides an indication of specific opioids detected in toxicology analysis of surplus serum samples between 17 August 2022 and 16 November 2024 (Q1 to Q9). The percentages are of all detections.

This line chart shows the percentage of detections of specific opioid drugs within QEUH ED across nine quarters - Q1 to Q9. Percentage of detections is on the y axis and the time period is on the x axis. The most common opioid drug across the time series was heroin/morphine (Q1: 4%, Q2: 5%, Q3: 6%, Q4: 5%, Q5: 5%, Q6; 4%, Q7; 4%, Q8; 5% and Q9; 5%). Nitazenes were detected for the first time in Q4 (seven detections) and increased to 2% of detections (16 detections) in Q5. They were detected 8 times in Q6 ,6 times in Q7 and less than 5 times in both Q8 and Q9. Detections of noscapine decreased from 3% in Q1 to 0 in Q5, 1% in Q6, 2% in Q7, 1% in Q8 and 2% in Q9. Codeine detections remained fairly static ranging from 3 to 4% in Q1 to Q5, before decreasing to 1% in Q6 then increasing to a high of 4% in Q9.

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ASSIST hospital toxicology analysis: opioid drugs by study quarter

Opioids were the second most common drug category, making up 21% of detections (44).

• There were 11 detections of heroin/morphine (5%; stable compared to Q8) and 9 of codeine (4%; from 3% in Q8).
• There were less than five detections of nitazenes, similar to the previous quarter. N-desethyl etonitazene was detected for the first time in the study.

Stimulants were the third most common drug category, making up 15% of detections (32).

• The most common stimulant was cocaine, making up 14% of detections (29); stable compared to Q8.

Further findings

Complete clinical data were available for 155 attendances for the most recent period (23 September to 16 November 2024):

• 72% of attendees were male (112) and 28% were female (43).
• 71% of attendances were aged 44 and under. The most common age category was 25 to 34 years (28%, 43 attendees), 26% (40) were aged 35 to 44 years and 17% (27) were aged 16 to 24.
• 29% of attendees were aged 45 years and over, with 17% (26) aged 45 to 54 and 12% (19) aged 55 years or older.

This stacked bar chart shows the percentage of QEUH ED ASSIST attendees by age group across nine time periods - Q1 to Q9. Percentage of attendees is on the y axis and the time period is along the x axis. The most common age group in Q1, Q2, Q4 and Q9 was 25 to 34 years (34%, 34%, 29% and 28% respectively). In Q3, patients aged 25 to 34 years and 35 to 44 were equally common (both 29%). The most common age group in Q5, Q6, Q7 and Q8 was 35 to 44 years (30%, 34%, 34% and 30% respectively).

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Attendances by age

ED outcome records show:

• 72 patients (46%) were discharged home
• 35 patients (23%) were admitted to a ward
• 16 patients (10%) were taken into police custody
• 11 patients (7%) self-discharged
• 19 were recorded as ‘unknown’ or ‘other’
• less than five patients were admitted to an intensive care unit, high-dependency unit, critical care unit or died.

Clinical severity outcome (after 28 days) recorded:

• 139 (90%) patients were discharged following the attendance
• six patients either died or remained an inpatient following the attendance.

Additional information

Public Health Scotland (PHS) was provided with these data by QEUH, NHS GGC.

The ASSIST trial is registered with Clinical Trials UK (ID: NCT05329142).

Ethical approval has been granted by the West of Scotland Research Ethics Service (IRAS ref: 313616, REC ref: 22/WS/0047) and surplus sampling methodology through Biorepository Ethics (ref: 22/WS/0020).

The West of Scotland Safe Haven research database hosts the electronic clinical data under IRAS ref: 321198 or REC ref: 22/WS/0163.

This study is sponsored by NHS GGC Research and Innovation and is funded by the Scottish Government. A temporary pause in funding led to suspension of recruitment to the study from 17 August to 22 September 2024.

The testing has been carried out by the LGC group (external website). LGC analyse pseudonymised samples using mass spectrometry and screen against a database of over 3,500 analytes. This testing can detect drugs and metabolites, but this analysis does not imply that specific drugs were implicated in harms.

Further information on the study can be found at Clinical Trials (external website).

Post-mortem toxicology testing for controlled substances

In Q3 of 2024, the most common drug types detected in post-mortem toxicology were opioids (73%) and benzodiazepines (54%). Cocaine continued to be the most commonly detected drug (34%), followed by heroin/morphine (31%), diazepam (23%) and methadone (23%).

Background

All sudden or unexpected deaths in Scotland are subject to investigation by the Crown Office and Procurator Fiscal Service (COPFS) to determine the cause of death and the need for criminal proceedings. In order to inform these decisions, the COPFS commissions post-mortem toxicology and pathology services.

This analysis is based on data from toxicology testing conducted at post-mortem for sudden and unexplained deaths, or where there was suspicion of involvement of controlled drugs.

Post-mortem toxicology testing is carried out by two services in Scotland:

• The Scottish Police Authority Forensic Services (SPA FS) covers deaths occurring in the west, east and parts of the north of Scotland.
• The Department of Clinical Biochemistry at NHS Grampian covers deaths in the far north and north-east of Scotland.

This report presents data on deaths covering the whole of Scotland, which became available from January 2022. It includes new data for the period from 1 July to 30 September 2024, representing Q3 of 2024.

The range of substances routinely analysed is extensive and includes the detection of alcohol, prescribed medicines and controlled drugs. The data within this report will develop further as other new or emerging drugs are added to toxicology screening.

The charts below show the prevalence of controlled substances detected in deaths which were subject to post-mortem toxicology screening. Drug detections were assigned to specific time periods based on the calendar year quarter of death. Throughout the series, the sum of the percentages for each quarter exceeds 100%, due to the widespread detection of multiple substances in deaths.

The first chart provides an indication of controlled drugs detected at post-mortem, in deaths occurring between 1 January 2022 and 30 September 2024.

The chart shows the percentage of forensic toxicology cases testing positive for controlled substances (opioids, benzodiazepines, gabapentin/pregabalin and cocaine). The percentage of cases is on the y axis and the calendar year and quarter of death, between Q1 of 2022 and Q3 of 2024, is on the x axis. The most commonly detected drug type was opioids, followed by benzodiazepines. The percentage of deaths where opioids, benzodiazepines, or gabapentin/pregabalin were detected has remained relatively stable throughout the time series, averaging 71% for opioids, 56% for benzodiazepines and 30% for gabapentin/pregabalin. The percentage of deaths where cocaine was detected was relatively stable until Q1 of 2023 (averaging 29%). Cocaine detections increased to 36% in Q2 of 2023, after which they remained relatively stable (averaging 36%).

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Forensic toxicology cases testing positive for controlled substances

The following charts provide an indication of specific opioids and benzodiazepines detected at post-mortem, in deaths occurring between 1 January 2022 and 30 September 2024.

The chart shows the percentage of forensic toxicology cases testing positive for specific opioids (heroin/morphine, methadone, buprenorphine, fentanyl/alfentanil and nitazenes). The percentage of cases is on the y axis and the calendar year and quarter of death, between Q1 of 2022 and Q3 of 2024, is on the x axis. Heroin/morphine has been the most commonly detected opioid throughout the time series; however, detections have been gradually decreasing from 36% in Q1 of 2022 to 31% in Q3 of 2024. Methadone was detected in 32% of deaths in Q1 of 2022 and has since fluctuated within a range of 23% to 29% of deaths. Deaths with buprenorphine present remained relatively low and stable throughout the series (averaging 6%). There was a gradual increase in the percentage of cases where fentanyl/alfentanil was detected, from 1% in Q1 of 2022, to 8% in Q3 of 2024. Nitazene-type opioids were first detected in Q1 of 2022 and have gradually increased to 4% of deaths in Q3 of 2024.

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Forensic toxicology cases testing positive for specific opioids

The chart shows the percentage of forensic toxicology cases testing positive for specific benzodiazepines (diazepam, bromazolam, etizolam, clonazolam and gidazepam). The percentage of cases is on the y axis and the calendar year and quarter of death, between Q1 of 2022 and Q3 of 2024 is on the x axis. Diazepam has been the most commonly detected benzodiazepine since Q2 of 2022. Between then and Q2 of 2024, detections have fluctuated between 25% and 35%. In Q3 of 2024 detections decreased to 23%. Bromazolam detections increased sharply between Q3 of 2022 (1%) and Q3 of 2023 (24%) and then decreased to 14% in Q3 of 2024. Etizolam was the most common benzodiazepine detected in Q1 of 2022 (31%), after which detections followed a decreasing trend to 7% of deaths in Q3 of 2023 and has remained relatively stable detected in an average of 7% of deaths since. Clonazolam detections remained low and stable throughout the time series, detected in an average of 1% of deaths. Gidazepam was first detected in Q4 of 2022 and has gradually increased, being detected in 2% of deaths in Q3 of 2024.

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Forensic toxicology cases testing positive for specific benzodiazepines

Summary

• The most commonly detected drug types throughout the series were opioids, followed by benzodiazepines. Both have remained relatively stable averaging 71% and 56% respectively between Q1 of 2022 to Q3 of 2024.
• The most commonly detected individual drug was cocaine (averaging 36% between Q2 of 2023 and Q3 of 2024). Before Q2 of 2023, the most common individual drug was heroin/morphine.
• Multiple controlled drugs were detected in 540 of 574 deaths (94%) in Q3 of 2024. This was similar to previous quarters.
• The following drugs/drug types were the most commonly detected in deaths in Q3 of 2024:
  • opioids: 418 (73%)
  • benzodiazepines: 308 (54%)
  • cocaine: 197 (34%)
  • heroin/morphine: 180 (31%)
  • gabapentin or pregabalin: 165 (29%)
  • diazepam: 132 (23%)  
  • methadone: 132 (23%)

Stimulants

• For the sixth quarter in a row, the most commonly detected drug was cocaine (34% in Q3 of 2024).
• The percentage of deaths where cocaine was detected was relatively stable until Q1 of 2023 (averaging 29%). Detections increased in Q2 of 2023 to 36% and have remained relatively stable (averaging 36%) since.

Opioids

• The percentage of deaths where opioids were detected has remained relatively stable throughout the time series, averaging 71%.
• Heroin/morphine detections have been gradually decreasing, from 36% in Q1 of 2022 to 31% in Q3 of 2024.
• Methadone was detected in 32% of deaths in Q1 of 2022 and has since generally fluctuated within a range of 23% to 29% of deaths.
• Buprenorphine detections remained low and stable throughout the series, detected in an average of 6% of deaths.
• Detections of fentanyl/alfentanil have gradually increased, from 1% in Q1 of 2022 to 8% in Q3 of 2024. Fentanyl-type opioids are commonly used as medicines for pain relief.
• Nitazene-type opioids were first detected in Q1 of 2022 and have increased slightly, being detected in 4% of deaths (25) in Q3 of 2024.
  • Two nitazenes were detected in six of the 25 deaths.
  • In Q3 of 2024, protonitazene was the most common nitazene detected, overtaking metonitazene which had been the most prevalent since Q2 of 2023.
  • Nitazenes have been detected in a total of 105 deaths (to 30 September 2024).

Depressants

• Benzodiazepines have remained broadly stable throughout the series, detected in an average of 56% of deaths.
  • Diazepam has been the most commonly detected benzodiazepine since Q2 of 2022, with detections fluctuating between 23% and 35%.
  • Detections of bromazolam increased sharply between Q3 of 2022 and Q3 of 2023, replacing etizolam as the most commonly detected ‘street benzo’ from Q1 of 2023 onwards. Since Q3 of 2023, detections of bromazolam have been decreasing, detected in 14% of deaths in Q3 of 2024.
  • Etizolam was the most common benzodiazepine detected in Q1 of 2022. Since then, detections have followed a decreasing trend to 7% of deaths in Q3 of 2023 and have remained stable (averaging 7%) since.
  • Clonazolam detections remained low and stable throughout the series, detected in an average of 1% of deaths.
  • Gidazepam/desalkylgidazepam was first detected in Q4 of 2022 and has gradually increased, being detected in 2% of deaths (14) in Q3 of 2024.
• The percentage of deaths involving gabapentin or pregabalin has been relatively stable throughout the time series, averaging 30%. 
• Xylazine (detected for the first time in Q3 of 2023) detections remained stable compared to the previous quarter at 1% of deaths (4). Xylazine has been detected in a total of 27 deaths (to 30 September 2024). 

More detailed descriptions of historical changes can be found within our previous reports.

Additional information

PHS was provided with post-mortem toxicology testing data for deaths occurring in the west, east and parts of the north of Scotland by Forensic Medicine and Science at the University of Glasgow and SPA FS.

In late 2022, post-mortem toxicology services for the west, east and parts of the north of Scotland were transferred from the University of Glasgow to the Scottish Police Authority Forensic Services (SPA FS). During the period of transition, tests were completed by other laboratory testing sites in the UK. Although testing has now been moved to SPA FS, these testing sites continued to provide support in 2023 and data from both SPA FS and outsourced sites have been included in this report.

Data on deaths occurring in the far north and north-east of Scotland, was supplied by the Department of Clinical Biochemistry at NHS Grampian.

The total number of deaths testing positive for controlled substances, for each calendar year and quarter, are provided in table 1.

A number of drugs were detected for the first time when screening was expanded or testing was outsourced to other laboratories. Table 2 provides information on the initial screening period new or emerging substances, from which limited testing data was available, and also when testing is considered to have become routine across Scotland.

Note that these drugs may have been present before this time but were not being tested for, as they have only recently emerged in drug markets. These data will develop further as new or emerging drugs are added to routine toxicology screening by the SPA FS and NHS Grampian.

Detailed interpretation of the levels of drugs found present, drug interactions, co-morbidities, or other factors relating to death, are outside the scope of this analysis. This analysis does not imply that specific drugs were implicated in deaths nor that deaths were classified as ‘drug-related’, and it does not include consideration of wider causes of death.

It should be noted that increases observed in specific substances within this report may be due to differences in toxicology test approaches (e.g. detection of concentration levels of a particular drug) between outsourced laboratories and previous screening. This may result in increases in substance detection. Further data will be required and monitored to determine the impact of any differences in toxicology screening across laboratories.

Additionally, it is important to note that small numbers of detections for specific substances may result in large percentage differences between quarters. Where it is felt that data should be interpreted with caution due to small numbers, the number of detections has also been provided for context.

As some of the data received from other laboratory testing sites did not include date of death, other date variables have been used as a proxy to improve data completeness and enable the inclusion of these deaths within this report. Two separate date variables have been used to approximate date of death information, where this information was unavailable:

1. Date of the case being received or sent to other labs for toxicology testing.
2. Date of toxicology test being completed.

Similarly, as date of death was unavailable for those tests conducted by the Department of Clinical Biochemistry at NHS Grampian, the date when the case was received from the Crown Office and Procurator Fiscal Service has been used instead.

These dates listed above have been used in the analysis as they are considered to provide a close approximation to the month and year of death. It is anticipated that missing information on date of death will be improved over time, as further information becomes available.

Drug seizures in Scottish prisons

Synthetic cannabinoids continue to be the most prevalent drug type detected in the Scottish Prisons Non-Judicial Drug Monitoring Project.

Background

The Leverhulme Research Centre for Forensic Science (LRCFS) is currently undertaking research with the Scottish Prison Service (SPS). The Scottish Prisons Non-Judicial Drug Monitoring Project tests non-attributable seizures (drugs that cannot be linked to a person or source) made across the Scottish prison estate in order to understand the changing characteristics of synthetic drugs, including synthetic cannabinoids, often referred to as ‘spice’.

The chart shows the number and type of non-attributable samples seized in Scottish prisons between 1 June 2021 and 31 July 2024.

The chart shows the percentage of SPS drug seizures broken down by sample type (e-cigarette, paper or card, tablet, powder and other). The percentage of samples is on the y axis and the date, between June 2021 and July 2024, is on the x axis. Sample types were highly variable over the time period. Seizure numbers varied from 23 to 134 during 2021. In 2022, the number remained relatively stable, averaging 35 per month. In 2023, numbers varied from 18 to 60 seizures analysed. Paper and card detections decreased across the time series, with an average of 76% per month in 2021, 23% per month in 2022 and 6% per month in 2023. There were no paper/card detections in 2024, with the exception of 4 in February and 2 in July. There were low numbers of e-cigarette detections until mid-2022, when they made up an average of 30% of detections per month between June and December. E-cigarette detections fluctuated throughout 2023 and 2024, averaging 28% per month in 2023 and 14% in 2024. Approximately 22% of samples per month were powder-based in 2022. Powder samples increased to 67% in December 2023, before remaining high but fluctuating in 2024, averaging at 52% per month.

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Drug seizures in Scottish prisons: sample type

The chart below shows the five most detected drug types from seizures in Scottish prisons between 1 June 2021 and 30 June 2024. This is based on the percentage of samples tested each month and uses 3-month moving average figures.

The chart shows the three-month moving average percentage of SPS drug seizures broken down by drug type (synthetic cannabinoids, benzodiazepines, opioids, cannabis and steroids). The percentage of samples is on the y axis and the date, between June 2021 and June 2024, is on the x axis. The percentage of seizures testing positive for synthetic cannabinoids was on average 43% per month in 2021, decreasing to 33% per month in 2022. Percentages increased from 12% in January 2023, to 61% in July 2023 and then decreased throughout the remainder of the year (22% in December). Synthetic cannabinoids were the most prevalent drug type in 2024, detected in 52 samples (42%). The second most common drug type detected was benzodiazepines. The percentage of seizures testing positive for benzodiazepines fluctuated throughout 2021, with an average of 39% per month, before decreasing and remaining relatively stable in 2022 (average of 26%). Benzodiazepine detections decreased further in 2023, from 33% in February, to 11% in December. In 2024, 18 samples (15%) contained a benzodiazepine. Detections of opioids increased in late 2023 (average 33% in December) before decreasing in 2024 (average 1% per month). Please note small sample numbers should be taken into consideration when interpreting the data.

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Drug seizures in Scottish prisons: drug type

Summary

Historic trend

• The number of seizures analysed varied widely between June and December 2021, ranging from a low of 23 in June, to a high of 134 in September. In 2022, the monthly average remained relatively stable at 35. During 2023, numbers varied, ranging from a high of 60 in January to a low of 18 in December, with a monthly average of 43.
• Sample-type data were highly variable over time. Changes were observed in detections during 2022 and 2023:
  • Paper and card detections decreased, from a monthly average of 72% in 2021, to 23% in 2022, to 6% in 2023. This is due to changes to prison rules that mean prisoners now receive photocopied correspondence rather than original items.
  • There were low numbers of e-cigarette samples until late 2022. Detections increased from a monthly average of 1% in 2021, to 18% in 2022, to 28% in 2023.
  • Powder samples were low throughout 2021 (monthly average 5%), before increasing and remaining relatively stable at approximately 20% per month throughout 2022, increasing to 29% in 2023.
  • The transition from synthetic cannabinoids in paper form to e-cigarette, powder or wax forms has introduced new methods of consumption. This variation in form and purity can make it challenging to achieve consistent dosing, potentially leading to unpredictable effects.
• Drug-type seizure data were highly variable over time, so the following narrative is based on 3-month moving averages:
  • Synthetic cannabinoids were the most common substances detected. In 2021, seizures testing positive for synthetic cannabinoids averaged 43% per month. Percentages varied throughout 2022 and 2023, averaging 33% per month in 2022 and 35% in 2023, with higher percentages observed during the summer months.
  • Benzodiazepine seizures fluctuated throughout 2021 (monthly average 39%), before decreasing and remaining relatively stable in 2022 (monthly average 26%). In 2023, detections followed an uneven decreasing trend (monthly average 13%). 
  • Opioid seizures increased in late 2023 (average 33% in December), however sample numbers were small. 

Update

Data has been provided from January to July 2024 but may be subject to change, so caution is advised when interpreting. We anticipate complete data will be available for the next release in April 2025.

PHS has received data for 123 samples seized between 1 January and 31 July 2024:

• The average number of samples per month varied widely – from four in May 2024 to 44 in April 2024.
• Synthetic cannabinoids were the most prevalent drug type. They were detected in 52 samples (42%), with 43 samples (35%) containing two cannabinoids.
• MDMB-4en-PINACA was the most common synthetic cannabinoid (41 detections), followed by MDMB-INACA (35).
• 18 samples (15%) contained a benzodiazepine: nine contained bromazolam, five etizolam, three diazepam and one alprazolam.
• 63 samples (51%) were powder, 22 were tablets (18%) and 20 were e-cigarettes (16%).

Further information

In September 2023, this drug analysis project detected hexahydrocannabinol (HHC), for the first time in prisons in Scotland. HHC is a semi-synthetic cannabinoid, a compound that is derived from naturally occurring cannabinoids but is modified to enhance or alter the effects.

• HHC has now been detected ten times between September 2023 and July 2024.

Additional information

PHS was provided with these data by the SPS and the LRCFS.

The Scottish Prisons Non-Judicial Drug Monitoring Project is a collaboration between the SPS and the LRCFS at the University of Dundee.

An initial pilot project ran between September 2018 and January 2021. The project has been funded directly by the SPS since February 2021.

Specialist drug treatment referrals

Between August and November 2024, the average weekly number of referrals to specialist drug treatment services was relatively stable. A total of 6,578 referrals were recorded, similar to the previous quarter (6,605). This was 7% higher than the same period in 2022 (6,166) and 5% lower than in 2023 (6,910).

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 drug treatment services in Scotland between 22 August 2022 and 17 November 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 on the y axis and the date, between 22 August 2022 and 17 November 2024, on the x axis. In December and January each year, a seasonal reduction in referrals occurs. From September to November 2022, the weekly average number of referrals was 473. After the seasonal reduction in December 2022, referrals returned to an average of 534 per week in January 2023. Though there was considerable variation over time, a broadly stable trend was evident in 2023 and 2024, with average referrals ranging between 466 and 572 per week between January 2023 and May 2024. This was followed by a slight decrease and a period with less variation, with the average ranging from 481 to 552 between May and November 2024.

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Specialist drug treatment referrals

Summary

Historic trend

• From September to November 2022, the weekly average number of referrals was 473.
• Following the seasonal reduction in December 2022, referrals returned to a weekly average of 534 per week in January 2023.
• Though there was considerable variation over time, a broadly stable trend was evident in 2023 and 2024, with average referrals ranging between 466 and 572 per week between January 2023 and May 2024.
• This was followed by a slight decrease and a period with less variation, with the average ranging from 481 to 552 from May to August 2024.

National update

For the most recent 13-week period (19 August to 17 November 2024):

• The weekly number of referrals ranged from 426 to 594 per week.
• 6,578 specialist drug treatment referrals were recorded, at an average of 506 per week, similar to the previous quarter (20 May to 18 August 2024) when 6,605 referrals were recorded, at an average of 508 per week.
• The number of referrals was 7% higher than the same period in 2022 (6,166) and 5% lower than in 2023 (6,910).

Local update

Comparing the most recent period (19 August to 17 November 2024) to the previous quarter, the key changes observed across mainland NHS boards were:

• Referrals increased in two areas: NHS Highland (5%) and NHS Fife (25%).
• Referrals decreased in four areas: NHS Lanarkshire (5%), NHS Forth Valley (6%), NHS Grampian (8%) and NHS Dumfries and Galloway (19%).
• Referrals were broadly stable in five areas: NHS Ayrshire and Arran, NHS Borders, NHS Greater Glasgow and Clyde, NHS Lothian and NHS Tayside.

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.

DAISy is a dynamic source of data, which means the information above is a snapshot of the data that are on the system at the time of extraction. As such, data for previous quarters may not be the same as that in previous publications for the same period. Similarly, data for the most recent quarter are provisional and may change in future publications.

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).

PHS has published a report (external website) summarising the responses to the recent customer survey on drug and alcohol treatment waiting times outputs. PHS’s proposal to discontinue production of the report element of the publication was broadly supported by respondents. The report also provides details of planned publication developments and timescales.

For more information on initial assessments for specialist drug and alcohol treatment services in Scotland, please see: Drug and Alcohol Information System (DAISy): Overview of initial assessments for specialist drug and alcohol treatment 2023/24.

For details of drug treatment services in your area, visit the Scottish Drug Services Directory (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 July to September 2024, the average number of opioid substitution therapy (OST) doses supplied per month was similar to the previous quarter, 7% lower than the same period in 2022, and similar to 2023. 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 uses 3-month moving average figures to show the average total monthly number of ADQ doses supplied for OST medications in the community, between 1 July 2022 and 30 September 2024.

The stacked area chart shows the three-month rolling average number of doses supplied for OST medications dispensed in the community between July 2022 and September 2024. The number of doses is on the y axis and the month is on the x axis. There was a gradual decrease in the average monthly total number of OST doses supplied over the series, due to a decrease in the number of methadone doses.

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Average total number of OST doses per month

The chart below shows trends in the monthly number of ADQ doses for specific OST medications dispensed in the community between 1 July 2022 and 30 September 2024.

The chart shows monthly trends in the number of doses supplied for specific OST medications dispensed in the community between July 2022 and September 2024. The number of doses per month is on the y axis and the month is on the x axis. Methadone was the most commonly prescribed medication, but the number of doses has decreased throughout the observed time series. Approximately 457,000 doses per month were dispensed between July and September 2024. The average total number of injectable buprenorphine doses supplied has increased steadily since it was first licensed for use in Scotland in early 2020. Approximately 71,000 injectable buprenorphine doses per month were dispensed between July and September 2022, increasing to around 132,000 per month between July and September 2024. The average monthly number of oral buprenorphine doses supplied was roughly stable, ranging between approximately 113,000 and 120,000 oral buprenorphine doses dispensed per month across the time series.

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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 due to the decrease in the average monthly number of methadone doses supplied, which reduced by 16%, from 564,800 between July and September 2022, to 475,400 between April and June 2024.
• The average total number of injectable buprenorphine doses supplied has increased steadily since it was first licensed for use in Scotland in early 2020. The average monthly number of doses supplied increased steadily, from 71,500 between July and September 2022, to 126,100 between April and June 2024. Dispensing of injectable buprenorphine has been more common than oral buprenorphine since August 2023.
• The average monthly number of oral buprenorphine doses supplied remained broadly stable between July and September 2022 (118,300) and April and June 2024 (114,100).

Update

For the most recent period (1 July to 30 September 2024):

• The average total monthly number of OST doses supplied was approximately 702,100. This was similar to the previous quarter (April to June 2024; 715,500 doses), 7% lower than the same period in 2022 and similar to 2023.
• The average monthly number of methadone doses supplied was approximately 456,700. This was similar to the previous quarter, 19% lower than the same period in 2022 and 10% lower than in 2023.
• The average monthly number of injectable buprenorphine doses supplied was approximately 132,300. This was slighter higher (5%) compared to the previous quarter, 85% higher than the same period in 2022 and 16% higher than in 2023.
• The average monthly number of oral buprenorphine doses supplied was approximately 113,100. This was similar to the previous quarter and the same periods in 2022 and 2023.

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, 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 the case in Scotland, where the WHO DDD of 25 milligrams (mg) daily for methadone is between one-half and one-third of the normal maintenance dose used.

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

Between July and September 2024, the average weekly number of injecting equipment provision (IEP) transactions and the number of needles and syringes, remained stable compared to the previous quarter. The number of transactions was similar to the same period in 2022 and 6% lower than in 2023. The number of needles and syringes distributed was 6% lower than the same period in 2022 and 7% lower than in 2023.

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.

Information on the ratio of needles and syringes per transaction is also presented. This provides the number of needles and syringes distributed per visit which can be an indication of the number of injecting episodes.

The chart below shows the weekly number of IEP transactions from 27 June 2022 to 29 September 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.

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 27 June 2022 and 29 September 2024, is on the x axis. In December and January each year, a seasonal reduction in transactions is observed. The average weekly number of transactions (approximately 2,900) remained broadly stable from July 2022 to February 2024, with seasonal fluctuations in December and January each year, and again in March and April each year. From April 2024, transactions increased and remained stable (approximately 2,850).

Close

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 weekly number of transactions (approximately 2,900) remained broadly stable from July 2022 to February 2024, with seasonal fluctuations in December and January and again in March and April each year. Transactions increased following April 2024 and remained stable to June (approximately 2,850).
• The average weekly number of needles and syringes distributed (approximately 41,250) remained broadly stable between July 2022 to February 2024, with seasonal fluctuations in December and January and again in March and April each year. Following April 2024, the number of needles and syringes increased and remained stable to June (approximately 39,750).
• The ratio of needles and syringes distributed between July 2022 and June 2024 was broadly stable, generally between 13 and 16 needles and syringes per transaction.

National update

For the most recent period (1 July to 29 September 2024):

IEP transactions

• 36,950 transactions were recorded, at an average of 2,842 per week.
• This was similar to the previous quarter (1 April to 30 June 2024) when a total of 36,112 transactions were recorded (weekly average 2,778).
• The number of transactions was similar to the same period in 2022 (38,644, weekly average 2,973) and 6% lower than in 2023 (39,376, weekly average 3,029).

Needles and syringes distributed

• 514,795 needles and syringes were distributed, at an average of 39,600 per week.
• This was similar to the previous quarter when a total of 506,850 needles and syringes were distributed, at an average of 38,988 per week.
• The number of needles and syringes distributed was 6% lower than the same period in 2022 (548,969, weekly average 42,228) and 7% lower than in 2023 (551,469, weekly average 42,421).

Ratio of needles and syringes distributed

• There was a weekly average of 13.9 needles and syringes distributed per transaction.
• This was similar to the previous quarter (14.0) and similar to the same period in 2022 (14.2) and 2023 (14.0).

Local update

Comparing the ratio of needles and syringes distributed in the most recent period (1 July to 29 September 2024) to the previous quarter, the key changes observed across mainland NHS boards were:

• The ratio increased in three areas: NHS Tayside (7%; ratio 16.7), NHS Dumfries and Galloway (9%; ratio 7.2) and NHS Borders (17%; ratio 17.3).
• The ratio decreased in two areas: NHS Fife (6%; ratio 12.8) and NHS Lanarkshire (18%; ratio 11.0).
• The ratio was stable in five areas: NHS Greater Glasgow and Clyde (9.9), NHS Ayrshire and Arran (15.5), NHS Forth Valley (16.6), NHS Lothian (23.7) and NHS Grampian (24.5)

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 period presented, NHS Highland is excluded from the transaction and needle and syringe data and the ratio figures.

For details of injecting equipment providers in your area, visit the Scottish Needle Exchange Directory (external website).