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.

Close

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.

Close

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.

Close

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).