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.