About this release

Our quarterly report

View a printable version of this report.

The Drugs Team at Public Health Scotland (PHS) has compiled this report of drug-related indicators in order to inform action to prevent drug harms and deaths.

The objectives of this report are to:

  • monitor changes in drug trends, harms and use of services to inform immediate and short-term actions that reduce drug harms
  • detect potential clusters of harms and recommend appropriate responses.

Data and reporting period

  • Observed changes in indicators may reflect genuine trends in behaviours, but may also be influenced by factors such as the configuration of services, or data quality and completeness issues.
  • This release reports on Scotland-level data. Analysis for some indicators is available by NHS Board in the substance use section of the COVID-19 wider impacts dashboard.
  • These data may be subject to change. Further analysis of these data will be made available in our Official and National Statistics publications on substance use.
  • Different time periods may be reported across the different indicators. In all cases, the most recently available data are used. Most charts are based upon a 2-year time series.

Further information

After 20 July 2023, the substance use section in the COVID-19 wider impacts dashboard will no longer be updated. Alongside our publication of the next quarterly report, the relevant data for the harm indicators will accompany the report in a RADAR dashboard.

The next release of this publication will be 24 October 2023.

Acknowledgements

This report reflects the collective efforts of different organisations and hundreds of people in frontline and supporting roles who record, organise, analyse and interpret information from a range of sources and services.

We gratefully acknowledge the continued commitment and effort of all those involved.

Update

There was a minor update to this publication on 27 July 2023, in the opioid substitution therapy indicator. The glossary was updated to state that injectable buprenorphine is administered as a subcutaneous injection (previously listed as an intramuscular injection).

Summary of indicators

Police Scotland drug trends bulletin

This update provides information on street benzodiazepines and synthetic cannabinoids.

RADAR intelligence and reports

24 reports were validated by RADAR between 5 April and 4 July 2023.

Drug-related attendances at emergency departments

The average weekly number of drug-related attendances at emergency departments increased between March and May 2023. A total of 1,081 attendances were recorded in this period – similar to 2021 (1,058), and 13% higher than in the same time period in 2022 (954).

Drug-related acute hospital admissions

The average weekly number of drug-related hospital admissions decreased between January and March 2023. The total number of admissions in this time period (1,654) was considerably lower than expected, compared to the same time periods in 2022 (2,136) and 2021 (3,040) (decreases of 23% and 46% respectively).

Suspected drug deaths

The average weekly number of suspected drug deaths was broadly stable from the end of February to the beginning of May 2023 (23 per week) and then increased throughout May. There was an average monthly total of 100 suspected drug deaths from March to May 2023. This was similar to the average monthly total in March to May 2022 (102).

Emergency department toxicology: ASSIST

Between February and May 2023, the ASSIST emergency department pilot made 448 detections of 48 different illicit drugs in samples from 100 patients. The most detected drug category was depressants (60%), followed by opioids (17%). The most detected individual drug was cocaine (11%), followed by bromazolam and etizolam (both 8%).

Post-mortem toxicology testing for controlled substances

From October to December 2022, the most common drug types detected in post-mortem toxicology were opioids (75%) and benzodiazepines (62%). The most common drugs detected were heroin/morphine (38%), followed by diazepam (35%). Bromazolam was detected in 15% of deaths.

Drug seizures in Scottish prisons

Benzodiazepines were the most prevalent drug type detected in the Scottish Prisons Non-Judicial Drug Monitoring Project between January and March 2023, detected in 21% of samples, with bromazolam being the most prevalent benzodiazepine detected. Synthetic cannabinoids were the second most prevalent, detected in 19% of samples.

Specialist drug treatment referrals

From the end of February to the end of May 2023, the average weekly number of referrals to specialist drug treatment services was broadly stable. The number of referrals during this time period (5,573) was 15% lower compared to the same time period in 2021 (6,531) and similar to the same time period in 2022 (5,625).

Opioid substitution therapy

The average number of opioid substitution therapy (OST) doses supplied per month was stable in the period from January to March 2023, but slightly lower than in the same time periods in 2021 and 2022 (1% and 3% respectively). The average monthly number of methadone doses supplied continued to decrease while the number of injectable buprenorphine doses supplied increased over time.

Injecting equipment provision

The average weekly numbers of injecting equipment provision (IEP) transactions, and needles and syringes distributed, were broadly stable between January and March 2023, but lower than in the same time periods in 2021 and 2022 (17% and 5% respectively).

Main points

  • Overall healthcare indicators of harm and service utilisation remained stable up to May 2023. However, there was an increase in the number of emergency department attendances between March and May, along with an increase in the number of suspected drug deaths in May.
  • The predominant picture of drug harms in Scotland continues to be polydrug use involving benzodiazepines, stimulants and opioids.

Alerts 

Trends 

  • 24 reports were validated by RADAR between 5 April and 4 July 2023.
  • The majority of reports received related to cocaine and benzodiazepines.
  • Half of reports mention mixing two or more substances (polydrug use). Mixing drugs can cause unexpected and unpredictable effects and is a major risk factor in drug-related deaths in Scotland.

Harm indicators 

  • The average weekly number of Scottish Ambulance Service naloxone incidents increased between March and May 2023 (weekly average 66 and 79 respectively), but overall figures were lower than the same time period in 2022. These figures do not take account of naloxone administration by members of the public, service workers, or other emergency responders such as police officers.
  • Drug-related attendances at emergency departments increased between March and May 2023 and were slightly higher than the same period in 2022. Meanwhile, the number of drug-related hospital admissions between January and March 2023 was considerably lower than the same period in 2022. This reduction in admissions should be interpreted with caution. The number of admissions may be affected by issues accessing urgent care and by the capacity of hospital services and is not necessarily an indicator of a reduction in harms.
  • Suspected drug deaths remained high and broadly stable from the end of February to the beginning of May 2023, before increasing throughout May. Deaths averaged 100 per month from March to May 2023, similar to the same period in 2022 (102).

Toxicology indicators 

  • Toxicology results were dominated by the presence of cocaine, opioids and benzodiazepines, particularly bromazolam.
  • Prison drug analysis showed a changing picture of drug use, as paper detections decreased and e-cigarette detections increased. Benzodiazepines were the most frequently detected drug type between January to March 2023, with bromazolam being the most common benzo detected.
  • In the ASSIST hospital toxicology pilot, the most frequently detected drugs were cocaine (11%), followed by bromazolam and etizolam (both 8%).
  • The most frequently detected drug types in post-mortem testing were opioids (75%) and benzodiazepines (62%). The most common drugs detected were heroin/morphine (38%) and diazepam (35%). Bromazolam was detected in 15% of deaths.
  • The continuing evolution in the types of substances detected emphasises the importance of investment in drug checking, forensic post-mortem toxicology and hospital toxicology testing. 

Service indicators 

  • The average weekly number of specialist drug treatment referrals was broadly stable from the end of February to the end of May 2023, but lower than the same period in 2022.
  • The average number of opioid substitution therapy (OST) doses supplied per month was stable from January to March 2023, but slightly lower than in the same period in 2022. The average monthly number of methadone doses supplied continued to decrease, while the number of injectable buprenorphine doses supplied increased over time.
  • The average weekly number of injecting equipment provision (IEP) transactions, and needles and syringes distributed were broadly stable between January and March 2023, but lower compared to the same period in 2022.

Alerts

RADAR publishes ad-hoc alerts related to new drugs, trends and harms.

Current alerts

Bromazolam

A public health alert about new benzodiazepines was published on 5 July 2023.

Bromazolam is now the most common drug detected in 'street benzos'. Reports to RADAR indicate that bromazolam produces strong sedative and sleep-inducing effects. As a result, there is a substantial risk of overdose.

View the public health alert on bromazolam.

Nitazenes

A public health alert about nitazene-type drugs was published on 24 January 2023.

Nitazenes are potent synthetic opioids. Due to their unexpected presence in the drug supply and high potency, nitazenes pose a substantial risk of overdose, drug-related hospitalisation and drug-related death.

View the public health alert on nitazenes.

Trends

Police drug trends bulletin

This bulletin contains photos of drugs.

This update provides information on street benzodiazepines and synthetic cannabinoids.

This information has been provided by Police Scotland’s Statement of Opinion (STOP) Unit to raise awareness of drug appearance and to demonstrate some of the substances present in Scotland’s drugs market.

Street benzos

'Street benzos' is a term used to describe benzodiazepines that are unlicensed or illicitly produced.

Police Scotland continues to see a rise in the recoveries of bromazolam in various forms. Bromazolam is a class C controlled drug within the provisions of the Misuse of Drugs Act 1971. It is a depressant drug classed as a benzodiazepine.

Bromazolam tablets

The most commonly encountered street benzo is white and stamped '10', with a half score on the reverse. This tablet is now more commonly recovered containing bromazolam, than the previous etizolam.

Image caption Most common street benzo press, now commonly containing bromazolam
Two benzodiazepine tablets: white with ‘10’ and half score on reverse
Image caption Bromazolam tablets
Five benzodiazepine tablet containing bromazolam: blue with ‘10’ and half score on reverse
Bromazolam powder

Although most commonly recovered in tablet form, recent intelligence shows bromazolam is being smuggled into prisons throughout Scotland, predominantly in white, pink or tan powder form.

In a recent incident in the west of Scotland, multiple prisoners suffered a suspected overdose after consuming bromazolam powder. Less than five were hospitalised and admitted to intensive care. The symptoms included excessive vomiting, unresponsive, loss of verbal communication, memory loss and difficulty breathing.

Toxicology results from NHS services were positive for benzodiazepines. A recovery of powder was rapidly assessed by the Scottish Police Authority Forensic Services (SPA FS) laboratory and found to contain bromazolam.

It is assessed that bromazolam has a similar potency to other benzodiazepine-type drugs, such as clonazolam, but it is unclear how its potency compares to that of etizolam.

Image caption Bromazolam powder from West Scotland
Image showing a pile of tan coloured powder

Synthetic cannabinoids

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. They have various official chemical names, but they are known and marketed by names such as 'spice' and 'black mamba'.

ADB-BUTINACA

ADB-BUTINACA, a new synthetic cannabinoid, has been detected in recent overdoses.

ADB-BUTINACA first appeared in drugs markets in 2019. Online forum posts by people who self-report use suggest that its primary route of administration is inhalation by smoking after the chemical has been sprayed onto herbal material or impregnated onto paper destined for the prison environment. Oral use has also been reported. ADB-BUTINACA has previously been found in a small number of recoveries of 'street Valium' in Scotland.

In a recent incident in the east, two people suffered a suspected overdose and were hospitalised after having consumed an unknown cream or brown-coloured powder. One person was found unresponsive and the other person’s condition deteriorated rapidly upon police and ambulance service arrival.

A number of small deals of the substance were recovered and urgent analysis carried out by the SPA FS laboratory confirmed the substance to be ADB-BUTINACA. The substance was packaged in a similar manner to street deals of diamorphine (heroin) and also has the visual appearance of diamorphine. It is further assessed that people may inadvertently consume this substance on the pretence of it being diamorphine.

Image caption Deals of ADB-BUTINACA powder
24 deals of brown powder wrapped in white plastic, alongside two empty yellow Kinder Egg capsules

RADAR intelligence and reports

24 reports were validated by RADAR between 5 April and 4 July 2023.

A summary of validated reports is shown below for informational purposes.

Emerging concerns

Over 50% of submissions report polydrug use – the use of more than one substance at a time. Mixing drugs increases the risk of drug harms and death, this includes mixing alcohol with other drugs. 

30% of reports relate to drugs being contaminated, 'laced' or stronger than expected. Although not all these reports are confirmed by toxicology, it highlights there are concerns about the unexpected effects of drugs in the market. 

RADAR is assessing the harms related to cocaine and has current alerts for nitazene-type opioids and new benzos - bromazolam.

Drug harm reports to RADAR

Since July 2022, RADAR has validated over 90 reports of drug-related information and harms received through the reporting form and mailbox

Shown below are 24 reports validated between 5 April and 4 July 2023. 

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

Reports validated prior to 5 April, are shown in previous quarterly reports

Report 2 

Local authority: National 

Reason for report: Adverse effects 

Drug: Cocaine          

Appearance: White powder 

Summary: Increase in cocaine use and harms (nasal problems, soft tissue damage, increase in PR3 antibodies). Concern that harms are increased by cutting agents, such as levamisole. 

 

Report 7 

Local authority: National 

Reason for report:  New drug 

Drug: Bromazolam   

Appearance: Various 

Summary: Ongoing prevalence of bromazolam in prisons in pill, powder and paper form. 

 

Report 17 

Local authority: National 

Reason for report: New drug 

Drug: Xylazine 

Appearance: Unknown 

Summary: RADAR has received multiple enquiries related to the emergence of xylazine, a new depressant drug. There have been two known detections of xylazine in Scotland by WEDINOS: 

  • January 2020, East Ayrshire, white crystalline powder, sold as ketamine 
  • June 2022, Fife, colourless liquid, sold as THC vape liquid 

RADAR will continue to monitor and assess the threat of new substances such as xylazine. 

Report 1 

Local authority: Fife 

Reason for report: New drug 

Drug: Bromazepam  

Appearance: Tablets 

Summary: 3 mg tablets sold as diazepam but contain bromazepam. 

 

Report 3 

Local authority: Dundee city 

Reason for report: Trend 

Drug: Ketamine 

Appearance: Unknown 

Summary: Use of ketamine in young people. 

 

Report 5 

Local authority: Fife 

Reason for report: New drug 

Drug: Tapentadol     

Appearance: Unknown 

Summary: First time seeing tapentadol [opioid] associated with death. Polydrug use with several other substances detected. 

 

Report 8 

Local authority: Fife 

Reason for report: Adverse effects, overdose 

Drug: Valium 

Appearance: Unknown 

Summary: Concern that Valium is contaminated after people overdosed, even after taking small amounts. Increase in patients presenting very sedated and other adverse effects including itchy skin, psychosis and hallucinations.  

 

Report 9 

Local authority: City of Edinburgh 

Reason for report: Adverse effects 

Drug: Heroin 

Appearance: Yellow crystal that turns to 'tar-like' substance when heated 

Summary: Heroin marketed as 'scab’ and sold as being double the strength of normal heroin. 

 

Report 10 

Local authority: Scottish Borders 

Reason for report: Adverse effects, overdose 

Drug: Heroin  

Appearance: Unknown 

Summary: Nausea and vomiting, memory loss and overdose after injecting 0.3 grams of heroin. Felt unwell, felt themselves 'going over', and woke up in hospital. Another person stated that they had smoked around 0.2 g and said it was strong and that they had not had heroin like this for a long time. 

 

Report 12 

Local authority: Falkirk 

Reason for report: Trend 

Drug: Cocaine          

Appearance: Liquid 

Summary: Cocaine administered using a liquid nasal spray. 

 

Report 13 

Local authority: Falkirk 

Reason for report: Adverse effects, overdose 

Drug: Spice   

Appearance: Orange powder 

Summary: Adverse effects from spice smoked in a pipe: difficulty breathing, memory loss, loss of consciousness and cardiac arrest.

 

Report 14 

Local authority: City of Edinburgh 

Reason for report: Concern 

Drug: Cocaine          

Appearance: Unknown 

Summary: Poor quality crack cocaine thought to be due to people buying prop [high purity cocaine powder] and making crack themselves with ammonia and bicarbonate [baking soda]. 

 

Report 15 

Local authority: Fife 

Reason for report: Photo 

Drug: Street benzo   

Appearance: White pill, half score on one side and a 10 on the other side 

Summary: Effects: increased energy. Pill was tested by WEDINOS and returned as etizolam. 

 

Report 16 

Local authority: Scottish Borders 

Reason for report: Photo 

Drug: Street benzo   

Appearance: Bright blue pill, score line on one side 

Summary: Adverse effects: confusion, really sleepy, could not keep eyes open and could not remember what had happened days later. Pill was tested by WEDINOS and returned as bromazolam. 

 

Report 18 

Local authority: City of Edinburgh 

Reason for report: Adverse effects 

Drug: Cocaine 

Appearance: Unknown 

Summary: Cocaine powder being mixed with legal high, magic [mephedrone]. Adverse effects: hallucinations and headaches. 

 

Report 19 

Local authority: City of Edinburgh 

Reason for report: Concern 

Drug: Valium 

Appearance: Blue circle pill 

Summary: Valium pill stamped with KB10, adverse effects were consistent for benzodiazepines but more intense. 

 

Report 21 

Local authority: Scottish Borders 

Reason for report: Adverse effects 

Drug: Tapentadol 

Appearance: Red or orange round pill, no markings 

Summary: Tablets known as red apples, confirmed by WEDINOS to contain tapentadol [opioid]. Adverse effects of swallowing one pill include: confusion, auditory and visual hallucinations and paranoia. Sold loose for £4 per pill. 

 

Report 23 

Local authority: City of Edinburgh 

Reason for report: Adverse effects 

Drug: Cocaine 

Appearance: Bright yellow crystal 

Summary: Crack cocaine mixed with legal high, magic [mephedrone]. 

 

Report 24 

Local authority: City of Edinburgh 

Reason for report: Adverse effects, trend 

Drug: Valium 

Appearance: Unknown 

Summary: Valium described as stronger. Reduced response to naloxone in overdoses in situations of polydrug use. 

Report 4

Local authority: Renfrewshire

Reason for report: Anti-social behaviour, littering

Drug: Nitrous oxide

Appearance: Unknown

Summary: Variety of large (600–650 g) branded nitrous oxide canisters left behind after use by young people.

 

Report 6

Local authority: East Ayrshire

Reason for report: New drug, adverse effects, overdose

Drug: Bromazolam

Appearance: Tan or pink powder

Summary: Adverse effects after consuming 'grains' of powder: overdose and hospitalisation. Confirmed by toxicology to be bromazolam.

 

Report 20 

Local authority: Renfrewshire

Reason for report: Adverse effects, trend

Drug: Cannabis

Appearance: Sweets: disguised as Chewits and Squashies

Summary: Use of cannabis (THC) edibles. Adverse effects after swallowing sweets: aggression, confusion, decreased energy, loose jaw, sedation, unusual behaviour and verbally hostile. Presented as a normal sweet and once the wrapper was removed there was a strong potent smell.

 

Report 22

Local authority: Glasgow City

Reason for report: Trend

Drug: Street benzo   

Appearance: White paper in 7x5cm (approximate) sections, with a square grid pattern 

Summary: Tabs of paper seized that looked similar to LSD but thought to contain etizolam. 

Report 11

Local authority: Aberdeen City

Reason for report: Adverse effects

Drug: Street benzos

Appearance: Unknown

Summary: Depressed breathing, unresponsiveness and overdose after swallowing benzos bought from a dealer. Concern about the drugs being contaminated after reports of overdoses and deaths in the area.

Reporting drug harms

The information in the regional breakdown can be used by local areas for their own drug trend surveillance. 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  
  • routes of administration  
  • new substances or patterns of use 
  • testing data.

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

Harm indicators

Naloxone administration by Scottish Ambulance Service

The average weekly number of naloxone administration incidents increased between March 2023 (weekly average 66) and May 2023 (weekly average 79). The total number of incidents during this time period (973) was lower compared to the same time period in 2021 (1,223) and similar to 2022 (959).

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 from 1 March 2021 to 28 May 2023.

Image caption Naloxone administration by Scottish Ambulance Service

Summary

Historic trend
  • Until winter 2021/22, the average weekly number of SAS naloxone administration incidents was similar to previous years, which have generally been characterised by lower numbers of incidents during winter months and higher numbers during summer months.
  • In spring 2022, the trend diverged from previous years and, despite an increase in April, followed a gradual decreasing trend from May to December 2022.
Update

For the most recent time period (27 February to 28 May 2023):

  • 973 SAS naloxone incidents were recorded, at an average of 75 per week. Weekly numbers of incidents generally increased throughout this period.
  • The total number of incidents was 23% higher than in the previous time period (28 November 2022 to 26 February 2023) when 793 incidents were recorded, at an average of 61 incidents per week.
  • The total number of incidents was 20% lower than the same time period in 2021 (1,223, weekly average 94), and similar (1% higher) to 2022 (959, weekly average 74).

Additional information

PHS was provided with these data by SAS.

For more information, or to analyse this data by NHS Board, visit the COVID-19 wider impacts dashboard.

Why we use a 3-week moving average

As these data are highly variable over time, the 3-week moving average has been included in the graph to account for this variability and provide an average line.

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.

Naloxone is very easy to administer.

You can learn more about administering naloxone in a free e-learning module created by the Scottish Drugs Forum.

Information on take-home naloxone distribution can be found in the substance use section of the COVID-19 wider impacts dashboard and in the National Naloxone Programme Scotland Quarterly Monitoring Bulletin, both published by PHS.

Drug-related attendances at emergency departments

The average weekly number of drug-related attendances at emergency departments increased between March and May 2023. A total of 1,081 attendances were recorded in this period – similar to 2021 (1,058), and 13% higher than in the same time period in 2022 (954).

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 between 1 March 2021 and 28 May 2023.

Image caption Drug-related attendances at emergency departments

Summary

Historic trend
  • An overall decreasing trend was observed in drug-related attendances at EDs between August 2021 and April 2022, with the lowest weekly levels in the time series observed in the week beginning 4 April 2022 (53).
  • Drug-related ED attendances then increased sharply and peaked in May 2022, with the highest weekly levels in the time series observed in the week beginning 16 May 2022 (123).
  • Attendances then decreased and remained stable, averaging 83 attendances per week from June 2022 to February 2023.
Update

For the most recent time period (6 March to 28 May 2023):

  • 1,118 ED attendances were recorded, at an average of 90 per week. This was 10% higher than the previous 12-week period (12 December 2022 to 5 March 2023, 976 attendances, weekly average 81).
  • Attendances were similar to 2021 (1,058, weekly average 88) and 13% higher compared to the same time period in 2022 (954, weekly average 80).

Additional information

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

Diagnosis and reason for attendance can be recorded in a variety of ways, including in free text fields. Therefore, the numbers presented in this report only give a high-level indication of attendances over time.

For more information, or to analyse these data by NHS Board, visit the COVID-19 wider impacts dashboard.

Why we use a 3-week moving average

As these data are highly variable over time, the 3-week moving average has been included in the graph to account for this variability and provide an average line.

Drug-related acute hospital admissions

The average weekly number of drug-related hospital admissions decreased between January and March 2023. The total number of admissions in this time period (1,654) was considerably lower than expected, compared to the same time periods in 2022 (2,136) and 2021 (3,040) (decreases of 23% and 46% respectively).

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 4 January 2021 to 2 April 2023.

The chart is interactive, allowing users to view data points on the chart as well as download the data. This is being piloted as an alternative to the static charts and if useful may be rolled out across other indicators.

The second chart shows the top five drug types associated with admissions as a percentage of all drug-related admissions between 4 January 2021 to 2 April 2023.

These data on drug types are based on ICD-10 diagnostic codes and are not confirmed by toxicology analysis.

Image caption Drug-related hospital admissions: drug category

Summary 

Historic trend 
  • There was a long-term decreasing trend in the weekly number of drug-related hospital admissions from June 2021 to April 2022. Admissions briefly increased in April and May 2022 (peak of 208 during the week beginning 16 May), before decreasing again in June 2022. The average weekly number of drug-related hospital admissions remained relatively stable between July and December 2022.
  • The long-term decreasing trend in drug-related hospital admissions observed since June 2021 differs markedly from previous years, which have generally been characterised by lower numbers of admissions during winter months and higher numbers during summer months.
  • The most common drug category recorded was opioids:
    • The percentage of opioid-related admissions decreased from 48% in January 2021 to 46% in August 2022, before increasing to an average of 50% of attendances between September and November 2022 and peaking at 53% in December 2022.
    • The percentage of sedative/hypnotic admissions decreased across 2022, from 21% in January to 14% in December.
Update 

For the most recent time period (2 January to 2 April 2023):

  • 1,654 drug-related hospital admissions were recorded, at an average of 127 per week.
  • Admissions followed a downward trend throughout this period, from 134 in the week beginning 2 January 2023 to 63 in the week beginning 27 March 2023.
  • The total number of admissions was lower than expected compared to previous years:
    • 46% lower than the same period in 2021 (3,040 weekly average 234)
    • 23% lower than the same period in 2022 (2,136, weekly average 164)
  • Reasons for the decrease in numbers are being investigated. This decreasing trend should not be interpreted as a reduction in harms. The number of hospital admissions may be affected by issues accessing urgent care services and by the capacity of hospital services.
  • The most common substance type recorded in drug-related general acute hospital admissions was opioids. These were recorded at an average of 48% of admissions per month, which was broadly consistent over the time series.

Additional information 

For more information on diagnostic coding, please refer to the drug-related hospital statistics publication methods page.

To analyse the latest published information on drug-related hospital discharges by NHS Board or by Alcohol and Drug Partnership (ADP), go to our information on drug-related hospital statistics admissions.

Please note our drug-related hospital statistics dashboard presents data by date of discharge so figures will differ to those shown in this report. For more information, please see metadata.

Why we use a 3-week moving average 

As these data are highly variable over time, the 3-week moving average has been included in the graph to account for this variability and provide an average line.

Glossary 

Cannabinoids

Cannabinoids are compounds that interact with the endocannabinoid system. They are found in the cannabis plant or can be produced synthetically in a laboratory. This category includes admissions related to cannabis and synthetic cannabinoids (spice).

Cocaine

Cocaine is a short-lasting stimulant drug that increases heart rate and breathing. This group includes powder cocaine and crack cocaine.

Multiple/other

The 'multiple/other' drugs category includes volatile solvents (such as glue, gases or aerosols) and multiple drug use. This category may also be used to indicate multiple drug use when individual substances are not known or cannot be coded using existing diagnosis (ICD-10) codes.

Opioids

Opioid drugs act on opioid receptors to produce sedative and painkilling effects. They are respiratory depressants (reduce heart rate and breathing). Opioids include synthetic (lab-made) drugs such as methadone and buprenorphine, as well as opiates (drugs made from opium) such as heroin and morphine.

Sedatives/hypnotics

Sedatives/hypnotics are drugs that induce sedation and depress the central nervous system, which also decreases heart rate and breathing. They are also known as depressants. This group of drugs includes 'prescribable' benzodiazepines (such as diazepam), 'street' benzodiazepines (such as etizolam) and z-hypnotics (such as zopiclone).

Suspected drug deaths

The average weekly number of suspected drug deaths was broadly stable from the end of February to the beginning of May 2023, and then increased throughout May. There was an average monthly total of 100 suspected drug deaths from March to May 2023. This was similar to the average monthly total in March to May 2022 (102).

Background 

Suspected drug-death figures are based on reports 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 the National Statistics published by the National Records of Scotland (NRS) 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 1 March 2021 to 28 May 2023.

Image caption Suspected drug deaths

Summary 

Historic trend 
  • Between March and July 2021, the average weekly number of suspected drug deaths ranged from 21 to 37 deaths per week.
  • There was a sustained decrease in the number of deaths per week in August 2021. Between August 2021 and February 2023, the average weekly number of suspected drug deaths fluctuated considerably but remained within a range of 17 to 29 deaths per week.
Update 

For the most recent time period (between 27 February and 28 May 2023):

  • An average of 23 suspected drug deaths were recorded per week (ranging between 19 and 29). This weekly average was lower than the same 13-week period in 2021 (27 deaths per week) and the same as in 2022 (23 deaths per week).
  • The average weekly number of suspected drug deaths was broadly stable from the end of February to the beginning of May 2023, and then increased throughout May, with 30 deaths observed in the week beginning 15 May 2023.
  • There were 99 suspected drug deaths in March, 91 in April and 111 in May 2023.
  • There was an average monthly total of 100 suspected drug deaths in March to May 2023. This was similar to the average monthly total in March to May 2022 (102).

Additional information 

Data on suspected drug deaths in Scotland 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. PHS will continue to publish data on suspected drug deaths in future RADAR releases. The Scottish Government, together with PHS and partners, are currently considering the future of the ‘Suspected drug deaths in Scotland’ report.

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

National statistics on drug-related deaths are published annually by the NRS during the summer. The latest NRS drug-related deaths report provides information on drug-related deaths in 2021 and earlier years, broken down by age, sex, substance implicated and the NHS Board and council areas.

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 occurred in 2017 and 2018, with trend data from 2009.

Why we use a 3-week moving average 

As these data are highly variable over time, the 3-week moving average has been included in the graph to account for this variability and provide an average line.

Glossary

Drug-related death

A drug-related death (also referred to as drug-misuse death) is a death where the underlying cause was confirmed to be drug poisoning and where any of the substances that were implicated or potentially contributed to the death are controlled in the UK. National statistics on drug-related deaths are published by NRS. In 2021, there were 1,330 drug-related deaths in Scotland. This was a small decrease compared to 2020 (1,339), which saw the highest annual total on record.

Suspected drug death

A suspected drug death is a death where controlled drugs are suspected of being involved. This operational measure used by Police Scotland is based on the reports, observations and initial enquiries of officers attending the scene of death.

Toxicology indicators

Emergency department toxicology: ASSIST

Between February and May 2023, the ‘A Surveillance Study in Illicit Substance Toxicity’ (ASSIST) emergency department pilot made 448 detections of 48 different illicit drugs, in samples from 100 patients. The most detected drug category was depressants (60%), followed by opioids (17%). The most detected individual drug was cocaine (11%), followed by bromazolam and etizolam (both 8%).

Background

The ASSIST pilot, conducted by the emergency department (ED) at the Queen Elizabeth University Hospital (QEUH), aims to assess the feasibility of prospective surveillance of ED attendances due to acute illicit drug toxicity. 

The study collects anonymised data through the analysis of standard-of-care clinical data for patients attending QEUH ED due to illicit drug toxicity and surplus serum sample toxicology testing. 

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 
  • drugs administered to the individual as part of treatment (by ambulance staff or in hospital). 

The pilot enables full toxicological analysis through the biorepository-approved surplus sampling. This allows drug profiling and the identification of emerging drugs or changing trends, to inform appropriate harm reduction measures and public health responses. 

This pilot will run in the QEUH ED in Glasgow from August 2022 to August 2023, followed by a 3-month follow-up period. 

Toxicology analysis of surplus serum samples

Surplus serum samples are left-over blood samples, which were taken as part of usual care. Drug detections presented here are of 'illicit drugs' only and were not prescribed to the individual.

The chart below shows the most common drug categories detected in toxicology analysis of surplus serum samples between 17 August 2022 and 16 May 2023.

The total number of samples included for surplus serum sampling for the first 9 months of the ASSIST study was 291. Many of these involved multiple positive detections (total of 1471 detections), therefore the total number of detections listed below is greater than the total number of samples.

The results are shown as the total number of detections. They are broken down by top five drug categories and then broken down further by drug type or name.

Detections presented are for the substance only. If a metabolite 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.

All prescribed medications are removed from the detections list. For example, if methadone is detected but the individual is prescribed methadone, it will not be included.

Image caption Toxicology analysis of surplus serum samples: drug category

Summary

For the most recent time period (17 February to 16 May 2023):

  • 317 individual ED attendances related to illicit drug use were identified.
  • 100 attendances qualified for surplus sampling toxicology testing (as they were categorised as having a higher clinical severity of toxicity as per research inclusion criteria).
Drug type and category

Of the 100 individual samples with toxicology:

  • There was a total of 448 detections of 48 substances (found through the biological detection of the drug or its metabolite).

Of the 448 detections, the following drugs were the most common:

  • cocaine: 49 (11% of detections, 49% of samples)
  • bromazolam: 37 (8% of detections, 37% of samples)
  • etizolam: 37 (8% of detections, 37% of samples)
  • desmethyldiazepam: 34 (8% of detections, 34% of samples)
  • cannabis (tetrahydrocannabinol): 34 (8% of detections, 34% of samples)
  • diazepam: 25 (6% of detections, 25% of samples)

Note: desmethyldiazepam is a benzodiazepine, and also a metabolite of other benzodiazepines such as diazepam. 

Image caption Toxicology analysis by drug type: per quarter

For the most recent time period (17 February to 16 May 2023):

  • Depressants were the most common drug category, making up 60% of all detections (267 times):
    • Benzodiazepines were detected 228 times (51% of all detections).
    • In total, 14 different types of benzodiazepines were detected, including bromazolam (8%, 37 detections) and etizolam (8%, 37 detections).
    • Bromazolam detections have increased over the study, from 4% between August and November 2022, to 8% in the most recent time period.
    • Gabapentinoids were detected 34 times (8%). 11 of these were gabapentin and 23 were pregabalin.
  • Opioids were the second most common drug category, making up 17% of all detections (75 times).
    • There were 25 detections of morphine (an opioid and metabolite of heroin and other opioids). There were 17 detections for codeine and 15 for methadone.
  • Stimulants were the third most common drug category, making up 14% of all detections (52 times).
    • The most common stimulant was cocaine, making up 11% of all detections (49 times).
Further findings

Complete clinical data are available for 317 attendances for the most recent time period (17 February to 16 May 2023): 

  • 230 were male (73%) and 87 were female (27%).
  • Over half were over 35 years old, with 29% aged 35 to 44 years.
    • A decrease in the number of patients aged 34 and under was observed, from 54% in the first two quarters of the study, to 46% in the most recent time period.
Image caption Attendances by age
  •  ED outcome records show that: 
    • 109 (34%) patients were discharged home 
    • 93 (29%) were admitted to a ward 
    • 43 (14%) self-discharged 
    • 31 (10%) were taken into police custody 
    • 15 (5%) were admitted to an intensive care unit, high dependency or critical care unit 
    • 26 (8%) were recorded as 'unknown' or 'other'. 
  • Clinical severity outcome (after 28 days) recorded that: 
    • 313 patients were discharged 
    • less than five patients died 
    • less than five patients were ongoing inpatient admissions 
    • one outcome was 'unknown'.

Additional information

Public Health Scotland (PHS) was provided with these data by QEUH, NHS Greater Glasgow and Clyde (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. 

The testing has been carried out by the LGC Group. 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 UK

Glossary

Cannabinoids

Cannabinoids are compounds that interact with the endocannabinoid system. They are found in the cannabis plant (such as THC) or can be produced synthetically in a laboratory (synthetic cannabinoids). Two synthetic cannabinoids were detected in this project. All other cannabinoid detections are for cannabis.

Depressants

Depressant drugs depress the central nervous system, which also decreases heart rate and breathing. Depressant drugs include substances such as benzodiazepines and gabapentinoids. 

Benzodiazepines are a group of drugs with depressant and anxiolytic (anti-anxiety) effects. They are also known as tranquilisers. 

Benzodiazepines (and metabolites) detected in this project include desmethyldiazepam, etizolam, temazepam, oxazepam, diazepam, bromazolam, gidazepam, flubromazepam, flualprazolam, lorazepam, nitrazepam, nordiazepam, clonazolam, flubromazolam, midazolam, clonazepam and alprazolam. Please note that desmethyldiazepam, temazepam and oxazepam are all benzodiazepine drugs but can also be found as a metabolite of diazepam. 

Gabapentinoids (pregabalin and gabapentin) are a group of drugs with depressant and painkilling effects.

Opioids

Opioid drugs act on opioid receptors to produce sedative and painkilling effects. They are respiratory depressants (reduce heart rate and breathing). Opioids detected in this project include codeine, methadone, dihydrocodeine, tramadol, dihydromorphine, buprenorphine, fentanyl, alfentanil, oxycodone, tapentadol and morphine.

Stimulants

Stimulant drugs stimulate the central nervous system, which also increases heart rate and breathing. 

Stimulant drugs include substances such as cocaine and amphetamines. 

Cocaine is a short-lasting stimulant drug that increases heart rate and breathing. This group includes powder cocaine and crack cocaine. 

Other stimulants detected in this project include amphetamine, methamphetamine, MDMA, mephedrone and MDA (a drug and also a metabolite of MDMA). 

Illicit drug

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 
  • drugs administered to the individual as part of treatment (by ambulance staff or in hospital). 
Metabolite

A drug metabolite is a compound produced when a drug breaks down in the body.

In this study, if either a drug or metabolite are detected, this will only be included as one substance – the drug.

However, if a drug and a metabolite are both detected but the metabolite could also be a drug, we have included both as it is not possible to say which has been used, if not both.

For example, if both diazepam and its metabolite desmethyldiazepam (also a drug in its own right) are detected then they would both be included.

However, if a drug and a metabolite that has no drug form have been detected, then we would include this as one drug.

For example, if both ketamine and norketamine (a metabolite of ketamine) were found in a sample then only ketamine would be recorded.

Due to this we are unable to determine the source of some substances. For example, oxazepam is a benzodiazepine, but it is also a metabolite of a range of other benzodiazepines, so we cannot determine whether oxazepam or another benzodiazepine was consumed.

Unique ED attendances

In this reporting period there was a total of 317 unique attendances to the emergency department related to illicit drug use. Each separate attendance is counted as one. If the same person presented more than once, each attendance would be a separate data point. 

Post-mortem toxicology testing for controlled substances

From October to December 2022, the most common drug types detected in post-mortem toxicology were opioids (75%) and benzodiazepines (62%). The most common drugs detected were heroin/morphine (38%), followed by diazepam (35%). Bromazolam (a new ‘street’ benzodiazepine) was detected in 15% of deaths.

This indicator update provides complete data for Q4 of 2022 (1 October 2022 to 31 December 2022), revising the partial Q4 information included in RADAR quarterly report 3.

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, COPFS commission post-mortem toxicology and pathology services across Scotland.

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.

The majority of testing was performed by the Forensic Toxicology Service based within Forensic Medicine and Science (FMS) at the University of Glasgow, on behalf of COPFS. In late 2022, post-mortem toxicology services were transferred from the University of Glasgow to Scottish Police Authority Forensic Services (SPA FS).

During this period, post-mortem tests were completed by other laboratory testing sites in the United Kingdom. Data from those sites have been included in this report and cover the most recent period reported. Future testing will be completed within a laboratory based within SPA FS.

The data presented below is a revision of the previous RADAR publication, which included data for the period 1 October to 30 November 2022 only. The revised information presented in this report now also includes tests for deaths occurring in December 2022 and therefore completes the reporting period for Q4 of 2022 (1 October to 31 December 2022). More recent data are not yet available due to the transition of testing to SPA FS and the complexities of establishing a new service within a different organisation.

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 in the coming months.

The first chart below provides an indication of controlled drugs found present at post-mortem in deaths occurring between 1 January 2020 and 31 December 2022.

Image caption Forensic toxicology cases testing positive for controlled substances

The second chart provides an indication of specific opioids and benzodiazepines found present at post-mortem in deaths occurring between 1 January 2020 and 31 December 2022.

Image caption Forensic toxicology cases testing positive for specific opioids and benzodiazepines

Summary

Historic trend
  • In total, 1,942 deaths occurred in 2022 where controlled drugs were found present in post-mortem toxicology, which was 11% lower than in 2021 (2,179) and 10% lower than in 2020 (2,147).
  • The most commonly detected drug types were opioids and benzodiazepines.
  • The percentage of deaths with benzodiazepines present remained high throughout 2020 to Q2 of 2021, before a decreasing trend between Q3 of 2021 and Q3 of 2022. The decrease in benzodiazepine presence could be partly due to a lack of testing for new and emerging drugs.
  • The specific drugs most commonly present throughout the time series (from Q1 of 2020 to Q2 of 2022) were etizolam, methadone and heroin/morphine. Etizolam and methadone detections both increased sharply in Q2 of 2020, before both reducing in Q3 2021, etizolam most notably.
  • Tests positive for clonazolam peaked at 12% of deaths in Q3 of 2021, before decreasing to zero in Q3 of 2022.
  • Since Q2 of 2020 there has been a gradual reduction in the percentage of deaths where methadone was detected.
  • The percentage of deaths involving diazepam, other opioids, gabapentin and pregabalin or cocaine has remained relatively stable over time.
Update

For the most recent time period (1 October to 31 December 2022):

  • The total number of deaths testing positive for controlled substances was 478. Many of these deaths involved multiple positive detections, therefore the total number of detections listed below is greater than the total number of deaths.
  • The following drugs or drug types were most commonly detected:
    • opioids: 358 (75%)
    • benzodiazepines: 296 (62%)
    • gabapentin and pregabalin: 174 (36%)
    • cocaine: 136 (28%)
  • Heroin/morphine remained the most commonly detected substance, with 38% of cases testing positive (from 35% in Q3). Methadone was detected in 29% of cases (from 25% in Q3).
  • Diazepam detections increased markedly to 35% of cases (from 25% in Q3). Etizolam was detected in 17% of cases (from 18% in Q3).
  • Due to expanded toxicology testing, there were new detections of the following substances (detected for the first time when testing was outsourced to other laboratories):
    • Bromazolam (a new 'street' benzodiazepine) was detected in 15% of deaths (70).
    • Desalkylgidazepam (a new 'street' benzodiazepine, also known as bromonordiazepam) was detected in 1% of deaths (4).
    • Protonitazene (a nitazene-type opioid) was detected in 1% of deaths (<3).

Additional information

PHS was provided with these data by FMS, University of Glasgow and SPA FS.

The data above are for deaths occurring in the west, east and parts of the north of Scotland. It does not include a small number of cases in the far north and north-east of Scotland where post-mortem toxicology testing is conducted by the Aberdeen Royal Infirmary (ARI).

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.

New drugs (bromazolam, desalkylgidazepam and protonitazene) were detected for the first time when testing was outsourced to other laboratories. 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 bromazolam, nitazenes and other new or emerging drugs are added to routine toxicology screening by the SPA FS.

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 FMS 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.

As part of the interim period, prior to post-mortem tests being completed at SPA FS, other laboratories testing data from around the UK have been included in this report (September to December 2022). As these data 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.

The 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.

Glossary

Benzodiazepines

Benzodiazepines are a group of drugs with depressant and anxiolytic (anti-anxiety) effects. They are also known as tranquilisers.

Diazepam is a 'prescribable benzodiazepine'.

Etizolam, clonazolam and bromazolam are 'street benzos', benzodiazepines that are not licensed for prescription in the UK.

Visit NHS inform for information on benzodiazepines.

Cocaine

Cocaine is a short-lasting stimulant drug that increases heart rate and breathing.

This group includes powder cocaine and crack cocaine.

Visit NHS inform for information on cocaine.

Gabapentin and pregabalin

Gabapentin and pregabalin are gabapentinoids, a group of drugs with depressant and painkilling effects.

Opioids

Opioid drugs act on opioid receptors to produce sedative and painkilling effects. They are respiratory depressants (reduce heart rate and breathing). This category includes buprenorphine, fentanyl, heroin/morphine and methadone.

Drug seizures in Scottish prisons

Benzodiazepines were the most prevalent drug type detected in the Scottish Prisons Non-Judicial Drug Monitoring Project between January and March 2023, detected in 21% of samples, with bromazolam being the most prevalent benzodiazepine detected. Synthetic cannabinoids were the second most prevalent, detected in 19% of samples.

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 drug seizures 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 samples seized in Scottish prisons between 1 January 2021 and 31 March 2023.

Image caption Drug seizures in Scottish prisons: sample type

The chart below shows the three most detected drug types from seizures in Scottish prisons between 1 January 2021 and 31 March 2023. This is based on the percentage of samples tested each month and includes raw data and 3-month moving averages.

Image caption Drug seizures in Scottish prisons: drug type

Summary 

Historic trend
  • The number of seizures analysed fluctuated in 2021, ranging from a low of 23 in June and peaking at 134 in September. Between January and December 2022, the average number of seizures analysed remained relatively stable with an average of 35 per month, ranging from a low of 10 in June and peaking at 52 in March. The number of seizures is not indicative of a change in the total number of drug seizures each month in Scottish prisons, as this project only analyses non-judicial (or non-attributable) samples.
  • Sample type data were highly variable over time, but changes were observed in sample type detections during 2022:
    • Paper and card detections decreased, making up an average of 24% of samples per month in 2022, compared to an average of 73% per month in 2021. This is thought to be due to changes to prison rules that mean prisoners now receive photocopied correspondence rather than original items.
    • E-cigarette detections increased from June 2022 onwards, making up an average of 30% of samples per month.
  • Synthetic cannabinoids were the most common substances detected, followed by benzodiazepines. Drug type seizure data were highly variable over time, so the following narrative is based on the 3-month moving average:
    • The percentage of seizures testing positive for synthetic cannabinoids was on average 42% per month in 2021. Percentages varied throughout 2022; between January and April 2022 the percentage remained relatively stable (average of 27% per month), increasing to 43% between May and September. The percentage decreased for the remainder of the year, averaging 26% per month.
  • The percentage of seizures testing positive for benzodiazepines fluctuated throughout 2021 (monthly average 38%), before decreasing and remaining relatively stable from January to December 2022 (monthly average 26%).
Update

This update provides analysis of 101 samples tested in the most recent time period (1 January to 31 March 2023):

Sample type
  • An increasing trend in the percentage of e-cigarette and tablet sample types was observed:
    • The most common sample types were e-cigarettes and tablets (each accounting for 27% of samples).
    • Synthetic cannabinoids were detected in 30% of the e-cigarettes analysed.
Drug type
  • The three most detected controlled drugs were cannabis, bromazolam (benzodiazepine) and pregabalin.
  • Benzodiazepines were the most common drug type.
    • They were detected in an average of 21% of seizures per month (average of 27% during the same time period in 2022).
    • 69% of benzodiazepine samples contained bromazolam. View our bromazolam alert.
  • Synthetic cannabinoids were the second most common drug type.
    • They were detected in an average of 19% of seizures per month (average of 33% during the same time period in 2022).
  • Cannabis was the third most common drug type.
    • Cannabis was detected in an average of 7% of seizures per month (average of 2% during the same time period in 2022).

Further information 

Between January and March 2023, this drug analysis project detected the following drugs for the first time in prisons in Scotland, demonstrating a constantly evolving drugs market: 

  • dipentylone (cathinone, stimulant)
  • MDMB-INACA (synthetic cannabinoid)

Additional information 

PHS was provided with these data by SPS and 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 SPS since February 2021.

Why we use a 3-month moving average 

As these data are highly variable over time, the 3-week moving average has been included in the graph to account for this variability and provide an average line.

Glossary

Benzodiazepines

Benzodiazepines are a group of drugs with depressant and anxiolytic (anti-anxiety) effects. They are also known as tranquilisers. Benzodiazepines detected in this project include etizolam, flubromazepam, bromazolam, diazepam and flualprazolam.

Visit NHS inform for information on benzodiazepines.

Opioids

Opioid drugs act on opioid receptors to produce sedative and painkilling effects. They are respiratory depressants (reduce heart rate and breathing). Opioids include synthetic (lab-made) drugs such as methadone and opiates (drugs made from opium) such as heroin. Opioids detected in this project include buprenorphine, heroin, tramadol, codeine, dihydrocodeine, metonitazene, oxycodone and methadone.

Synthetic cannabinoids

'Synthetic cannabinoids' is a term used to describe over 200 lab-made drugs that interact with the endocannabinoid system.

The prevalence of synthetic cannabinoids in seizures is higher in prisons than in the general population.

People working and living in prisons should be aware of the harmful effects and risks of synthetic cannabinoid use.

Visit NHS inform for more information on synthetic cannabinoids.

Service indicators

Specialist drug treatment referrals

From the end of February to the end of May 2023, the average weekly number of referrals to specialist drug treatment services was broadly stable. The number of referrals during this time period (5,573) was lower compared to the same time period in 2021 (6,531) and similar to the same time period in 2022 (5,625).

Background 

Specialist drug treatment referrals occur when a person comes into contact with services designed to support their recovery from problematic drug use.

Figures shown are for referrals relating to either drug use or co-dependency (people seeking help for both drug and alcohol use). Figures include new referrals for treatment and referrals between services.

The chart below shows the weekly number of referrals to specialist drug treatment services between 1 March 2021 and 28 May 2023.

Image caption Specialist drug treatment referrals

Summary

Historic trend
  • From March to June 2021, there was an increase in the weekly number of referrals, with a notable peak at the end of March (762 referrals week beginning 29 March).
  • Referrals decreased throughout June and July 2021 and then remained broadly stable to January 2022 (between 400 to 480 referrals per week, apart from the seasonal decreases in December and January).
  • Throughout 2022, there was a fluctuating, but gradual, decrease in the average weekly number of referrals.
  • The number of referrals returned to a weekly average of approximately 450 per week, following the seasonal reduction in December 2022.
Update 

For the most recent 13-week time period (27 February to 4 July 2023):

  • 5,573 specialist drug treatment referrals were recorded, at an average of 429 per week.
  • This was 8% higher than the previous 13-week time period (28 November 2022 to 26 February 2023) when 5,163 referrals were recorded, at an average of 397 per week. This time period includes a seasonal reduction in referrals typically observed in December and January.
  • Referrals were 15% lower compared to the same time period in 2021 (6,531, weekly average 502) and similar to 2022 (5,625, weekly average 433).

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.

For more information, or to analyse these data by NHS Board, visit the COVID-19 wider impacts dashboard.

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 DATWT report.

Additionally, for more information on initial assessments for specialist drug and alcohol treatment services in Scotland, visit our new report: Drug and Alcohol Information System (DAISy): Overview of initial assessments for specialist drug and alcohol treatment 2021/22 and 2022/23.

For details of drug treatment services in your area, visit the Scottish Drug Services Directory.

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

Why we use a 3-week moving average 

As these data are highly variable over time, the 3-week moving average has been included in the graph to account for this variability and provide an average line.

Opioid substitution therapy

The average number of opioid substitution therapy (OST) doses supplied per month was stable in the period from January to March 2023, but slightly lower than in the same time period in 2021 and 2022. The average monthly number of methadone doses supplied continued to decrease while the number of injectable buprenorphine doses supplied 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 taken once every week or month (depending on the formulation).

The chart below shows the average total monthly number of ADQ doses supplied for OST medications in the community between 1 January 2021 and 31 March 2023.

Image caption Average total number of OST doses per month

The chart below shows monthly trends in the number of ADQ doses supplied for specific OST medications in the community between 1 January 2021 and 31 March 2023.

Image caption Number of doses per month for OST medications

Summary 

Historic trend 
  • For an analysis of trends prior to 2021, please see the RADAR Quarterly Report 2 – January 2023.
  • There was a gradual decrease in the average monthly total number of OST doses supplied. This is likely to be associated with a decreasing trend in the average monthly number of methadone doses supplied, which reduced by 11%, from 615,800 between January and March 2021, to 546,300 between October and December 2022.
  • The average monthly number of oral buprenorphine doses supplied was broadly stable between January to March 2021 (123,700) and October to December 2022 (119,300).
  • Injectable buprenorphine was first licensed for use in Scotland in early 2020. The average monthly number of doses supplied increased more than four-fold, from 19,600 between January and March 2021, to 83,300 between October and December 2022.
Update 

For the most recent time period (1 January to 31 March 2023):

  • The average total monthly number of OST doses supplied was approximately 748,700. This was roughly the same as in the previous quarter (October to December 2022) when approximately 749,000 doses were supplied. The number of OST doses supplied was 1% and 3% lower than in January to March 2021 and 2022 respectively.
  • The average monthly number of methadone doses supplied was approximately 542,300. Equivalent figures for oral buprenorphine and injectable buprenorphine were 118,200 and 88,200 respectively.
  • The number of methadone doses was approximately the same as in the previous quarter, and 12% and 9% lower than in January to March 2021 and 2022 respectively.
  • The number of oral buprenorphine doses supplied was approximately the same as in the previous quarter and 4% and 2% lower than in January to March 2021 and 2022 respectively.
  • The number of injectable buprenorphine doses was 6% higher than in the previous quarter and 64% higher than in January to March 2022.

Additional information 

These data have been extracted from the Prescribing Information System (PIS) and the Hospital Medicines Utilisation Data Manual (HMUD).

The data shown on methadone and oral buprenorphine, and the majority of injectable buprenorphine data, relate to prescriptions dispensed to individuals from a community pharmacy in Scotland, where a request for reimbursement of costs was processed. The time period reflects the month for which reimbursement was claimed. This is regarded as the most comprehensive and reliable way of reporting community prescribing data. There can be a lag of approximately three months from a prescription being written to reimbursement data becoming available.

As a consequence of the direct administration of injectable buprenorphine within clinics, some NHS Boards do not request the reimbursement of costs for all of the OST treatments they provide. Data for approximately 28% of injectable buprenorphine doses supplied in Scotland are held in the HMUD and have been combined with the community prescribing data to provide a comprehensive account of OST supply over time.

To analyse information on methadone and oral buprenorphine dispensing by NHS Board or by Alcohol and Drug Partnership, visit the COVID-19 wider impacts dashboard.

Why we use a 3-month moving average 

As these data are highly variable over time, the 3-month moving average has been included in the graph to account for this variability and provide an average line.

Even if all other factors are constant (for example, the number of treated patients), the total number of ADQ doses supplied will vary according to the number of days in each month. Averaging over three months minimises the impact of that variability.

What is average daily quantity (ADQ)? 

When comparing use between medicines and over time, it is common to use World Health Organization (WHO) defined daily doses (DDDs). The DDD is defined as the usual average daily maintenance dose used in adults for the main therapeutic use of the medicine. The WHO DDD is a global average and may not be representative of the doses used in clinical practice at a more local level. This is particularly the case for methadone, where the WHO DDD of 25 milligrams (mg) daily is between one-half and one-third of the normal maintenance dose used in Scotland.

We have therefore replaced DDDs with ADQs, which are more representative of the daily maintenance doses used within Scotland. These values have been developed through a combination of prescription analyses and by consultation with the Specialist Pharmacists in Substance Use Management group. The ADQs agreed are:

  • methadone (oral): 65 mg
  • buprenorphine (oral): 13 mg
  • buprenorphine (injection): 3.4 mg

Glossary

Methadone

Methadone is an opioid drug commonly prescribed as an opioid substitution therapy. Methadone is a full opioid agonist – it is most commonly seen as a green liquid, which is taken orally (swallowed) on a daily basis. These data refer to methadone prepared as a 1 mg/ml solution.

Buprenorphine

Buprenorphine is an opioid drug commonly prescribed as an opioid substitution therapy. Buprenorphine is a partial opioid agonist – it is available in oral and injectable forms:

  • Oral buprenorphine is buprenorphine in tablet form that is administered orally (by mouth, usually sub-lingual – under the tongue) on a daily basis. It is also known by brand names such as Subutex. These data include 2 mg, 8 mg and 16 mg tablets.
  • Injectable buprenorphine is buprenorphine in liquid form that is administered as a subcutaneous injection. It is also known by brand names such as Buvidal. These data include various weekly and monthly prolonged release formulations.
Defined daily dose (DDD)

As defined by the World Health Organization, the DDD is 'the assumed average maintenance dose per day for drug use for its main indication in adults'.

Average daily quantity (ADQ)

ADQ is similar to the DDD but adjusted to reflect how medication is used in Scotland.

Injecting equipment provision

The average weekly numbers of injecting equipment provision (IEP) transactions, and needles and syringes distributed, were broadly stable between January and March 2023. The total numbers of IEP transactions, and needles and syringes distributed, during this time period were lower compared to the same time periods in 2021 and 2022 (17% and 5% respectively).

Background 

IEP is a form of harm reduction that helps to reduce the transmission of blood-borne viruses among people who inject drugs. These data relate to the number of needle and syringe transactions at IEP sites and the total number of needles and syringes distributed.

The first chart below shows the weekly number of IEP transactions from 4 January 2021 to 2 April 2023.

Image caption Injecting equipment provision: transactions

The second chart shows the weekly number of needles and syringes distributed from 4 January 2021 to 2 April 2023.

Image caption Injecting equipment provision: needles and syringes distributed

The third chart shows the weekly ratio of needles and syringes distributed per transaction from 4 January 2021 to 2 April 2023.

Image caption Injecting equipment provision: ratio of needles and syringes distributed per transaction

Summary

Historic trend
  • There was an overall decrease in the average weekly number of IEP transactions from January 2021 to February 2022. Since February 2022, the average number of IEP transactions was relatively stable (approximately 3,000 per week). This trend included seasonal fluctuations during December and January each year.
  • A fluctuating decreasing trend in the average weekly number of needles and syringes distributed was observed from January to October 2021. Since October 2021, the average number of needles and syringes distributed has remained broadly stable (approximately 37,000 per week). A seasonal fluctuation was observed during December 2022 and January 2023.
  • The ratio of needles and syringes distributed per transaction was relatively stable from January 2021 to December 2022, at an average of 14 needles and syringes distributed per transaction. Seasonal fluctuations were observed during December 2021 and 2022.
Update

For the most recent time period (2 January 2023 to 2 April 2023):

IEP transactions

  • 35,667 transactions were recorded, at an average of 2,744 per week.
  • This was similar to the previous time period (3 October 2022 to 1 January 2023) when a total of 36,191 transactions were recorded, at an average of 2,784 per week.
  • The total number of transactions was 17% lower compared to the same time period in 2021 (42,728, weekly average 3,287), and 5% lower than in 2022 (37,589, weekly average 2,891).

Needles and syringes distributed

  • 484,967 needles and syringes were distributed, at an average of 37,305 per week.
  • This was similar to the previous time period (3 October 2022 to 1 January 2023) when a total of 471,583 needles and syringes were distributed, at an average of 36,276 per week.
  • The total number of needles and syringes distributed was 14% lower compared to the same time period in 2021 (560,967, weekly average 43,151), and similar to 2022 (475,475, weekly average 36,575).

Ratio of needles and syringes distributed

  • There was a weekly average of 15 needles and syringes distributed per transaction.
  • This was similar to the 14 needles and syringes distributed per transaction in the previous time period (3 October 2022 to 1 January 2023) and the same time periods in 2021 and 2022.

Additional information 

These data are taken from the Needle Exchange Online 360 database (neo360).

The 11 mainland NHS Boards use neo360 routinely, but due to missing data for part of the time period presented, NHS Highland is excluded from the transaction data, and both NHS Fife and NHS Highland are excluded from the needle and syringe and ratio figures.

For more information, or to analyse these data by NHS Board, visit the COVID-19 wider impacts dashboard.

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

Why we use a 3-week moving average 

As these data are highly variable over time, the 3-week moving average has been included in the graph to account for this variability and provide an average line.

Glossary

Transaction

A transaction is an episode in which a client received equipment relating to an injecting episode (i.e. a barrel and/or fixed needle and syringe). People who inject drugs may attend IEP outlets at any time, whether or not they are undertaking specialist treatment for drug use.

Contact

General enquiries

If you have an enquiry relating to this publication, please email:

Reporting a drug harm

To make a report to RADAR and share information such as trends, incidents and harms related to drugs you can either:

Media enquiries

If you have a media enquiry relating to this publication, please contact the Communications and Engagement team.

Requesting other formats and reporting issues

If you require publications or documents in other formats, please email phs.otherformats@phs.scot.

To report any issues with a publication, please email phs.generalpublications@phs.scot.

Further information

Data and intelligence

View our wider drug data and intelligence.

Public health information

Visit Scottish Public Health Observatory (ScotPHO) for further drug-related public health information.

Metadata

Publication title 

Rapid Action Drug Alerts and Response (RADAR) quarterly report – July 2023  

Theme 

Substance use surveillance 

Topic 

Drugs 

Format 

HTML  

Release date 

25 July 2023 

Frequency 

Quarterly 

Relevance and key uses of the statistics 

Data are collected as part of public health surveillance on substance use in Scotland. 

The most up–to–date data available is published in this report to provide a timely indicator of drug trends as part of RADAR, Scotland’s Drugs Early Warning System.  

Revisions statement 

Data in the most recent quarterly updates supersedes data reported in previous reports. 

Revisions relevant to this publication 

N/A 

Comparability 

Data are not comparable outwith Scotland. 

Accuracy 

The data are considered accurate. 

Data are validated locally by data suppliers/partnerships/sources and checked by PHS. 

Where relevant, data quality and completeness issues are described in the text associated with each indicator. 

The Code of Practice for Statistics has been followed to ensure a high standard of data value, trustworthiness and quality.  

Accessibility 

It is the policy of PHS to make its websites and products accessible according to our accessibility statement. Graphs and tables have been assessed against PHS accessibility standards. 

Accessibility of the report and findings are of continuous consideration throughout the report development. 

Coherence and clarity 

The report is available as HTML web pages. 

Wherever possible, plain English descriptions have been used within the narrative and any technical words or phrases explained. 

Disclosure 

Our protocol on statistical disclosure is followed. 

Official Statistics designation 

Management Information Report 

UK Statistics Authority Assessment 

N/A 

Last published 

25 April 2023 

Next published 

24 October 2023 

Date of first publication 

11 October 2022 

Help email 

phs.drugsradar@phs.scot 

Date form completed 

12 July 2023 

 

The remaining metadata for this document has been split into sections as there are some differences between the indicators. 

Description

This indicator provides a summary of the drug trend bulletin from the Police Scotland Statement of Opinion (STOP) Unit.

Data source(s)

Police Scotland STOP Unit

Date that data were acquired

28 March 2023

Timeframe of data and timeliness

This section includes the most notable drug trends in recent months.

Continuity of data

The Police Scotland drug-trend bulletins are designed to provide drug-trend information, highlighting some of the current trends identified by the police in Scotland and other parts of the UK. The bulletin has and will evolve through time to provide timely distribution of drug-related information.

Concepts and definitions

Benzodiazepines are depressant drugs with sedative and anxiolytic (anti-anxiety) effects. They are also known as tranquilisers.

Synthetic cannabinoids is a term used to describe over 200 lab-made drugs that interact with the endocannabinoid system.

Completeness

The Police Scotland drug trend bulletin highlights some of the current trends identified by the police in Scotland and other parts of the UK.

Value type and unit of measurement

Police seizures positive for controlled substances displayed as drug type.

Description

This indicator provides a summary of the drug reports received by RADAR.

Data source(s)

Public Health Scotland

Date that data were acquired

Various between 5 April and 4 July 2023. Data were collated on 6 July 2023.

Timeframe of data and timeliness

This section includes the most notable drug trends in recent months.

Continuity of data

Since July 2022, data in this indicator have been collected consistently using reporting forms and email. The indicator has and will continue to evolve throug h time to provide timely distribution of drug-related information.

Accuracy

Analysis on the reports received (such as number and type) are considered to be accurate. The individual reports have been validated to check their credibility and likelihood. Reports that we were unable to validate are not shown in this indicator.

Reports accurately represent the individual submissions made, although they have been summarised to ensure anonymity. Unless otherwise specified, these reports have not been confirmed by toxicology and should be considered anecdotal.

Concepts and definitions

Cocaine is a short-lasting stimulant drug. Cocaine powder and crack cocaine are two different forms of the same drug.

Benzodiazepines are depressant drugs with sedative and anxiolytic (anti-anxiety) effects. They are also known as tranquilisers.

Pregabalin is a gabapentinoid drug with depressant effects. It can be prescribed as a medicine to treat epilepsy and nerve pain.

Nitazenes are a group of potent synthetic opioids.

Completeness

The indicator highlights report by area: National, North Scotland, East Scotland and West Scotland. Reports received are not representative of the level of harms in an area.

Value type and unit of measurement

Report number, type of report, drug appearance and report summary are displayed by NHS Board or local authority area.

Description

This indicator provides information on emergency naloxone administration by Scottish Ambulance Service (SAS) clinicians in Scotland.

Data source(s)

Scottish Ambulance Service

Date that data were acquired

13 June 2023

Timeframe of data and timeliness

1 March 2021 to 28 May 2023, approximately two months in arrears.

Continuity of data

SAS clinicians have been administering naloxone directly to patients experiencing symptoms of an opioid overdose since around 1998. There have been no changes in the guidance given to SAS clinicians regarding the administration of naloxone nor in the recording mechanisms or processes over the time series shown in the analysis.

Over the time period the take-home naloxone program has continued to distribute kits to the public. Police Scotland is also in the process of training and equipping officers with nasal naloxone. This increase in the distribution of naloxone kits should be taken into consideration when interpreting administration of naloxone by emergency services.

Concepts and definitions

Naloxone is a medicine used to prevent fatal opioid overdoses. Opioid overdoses are commonly associated with drug-related deaths. These data on the numbers of incidents in which naloxone was administered by SAS clinicians provide an indication of numbers of suspected opioid overdoses.

A small percentage of these administrations will have been due to circumstances other than an illicit opioid overdose (for example, some may relate to prescribed opioid overdoses or to adverse reactions associated with medications administered in the course of emergency treatment).

Also, in a small number of cases, naloxone may be administered to someone who is unconscious for unconfirmed reasons, which may be confirmed at a later point not to have been an opioid overdose.

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.

Under some circumstances, naloxone administration will not successfully reverse an opioid overdose (for example, if administered too late) and these statistics should not be interpreted as equating to numbers of lives saved.

Completeness

SAS data on numbers of naloxone incidents are collated from data entered by ambulance clinicians recording medications administered to patients via an electronic tablet in the vehicle. Data recording is typically completed within 30 minutes of the end of an incident. Further details can be found in the substance use section of the COVID-19 wider impacts dashboard.

Value type and unit of measurement

Number of incidents in which naloxone was administered by SAS clinicians and moving averages.

Description

This indicator provides information on drug overdose or intoxication attendances at emergency departments in Scotland.

Data source(s)

Public Health Scotland – Accident & Emergency Datamart

Date that data were acquired

19 June 2023

Timeframe of data and timeliness

1 March 2021 and 28 May 2023, approximately two months in arrears.

Continuity of data

There have been no changes in the national recording mechanisms or processes over the time series shown in the analysis.

Concepts and definitions

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

Completeness

It is not possible to accurately report total attendances for specific conditions using the national A&E dataset, due to the quality of the data available. 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 therefore only give a high–level indication of attendances over time. Further details can be found in the 'Data management – hospital activity' webpage.

Value type and unit of measurement

Number of drug overdose or intoxication attendances at emergency departments and moving averages.

Description

This indicator provides information on drug-related acute hospital admissions in Scotland.

Data source(s)

Public Health Scotland – Scottish Morbidity Record – general, acute inpatient and day case records (SMR01)

Date that data were acquired

12 June 2023

Timeframe of data and timeliness

4 January 2021 to 2 April 2023, approximately four months in arrears.

Continuity of data

There have been no changes in the recording mechanisms or processes over the time series shown in the analysis. Further detail can be found in the 'Drug-related hospital statistics' publication background information.

Concepts and definitions

Opioids       

Opioid drugs act on opioid receptors to produce sedative and painkilling effects. They are respiratory depressants (reduce heart rate and breathing). Opioids include synthetic (lab-made) drugs such as methadone and buprenorphine, as well as opiates (drugs made from opium) such as heroin and morphine.

Cannabinoids

Cannabinoids are compounds that interact with the endocannabinoid system. They are found in the cannabis plant (such as THC) or can be produced synthetically in a laboratory (synthetic cannabinoids).

Cocaine

Cocaine is a short-lasting stimulant drug that increases heart rate and breathing. This group includes powder cocaine and crack cocaine.

Sedatives and hypnotics

Sedatives and hypnotics are drugs that induce sedation and depress the central nervous system, which also decreases heart rate and breathing. They are also known as depressants. This group of drugs includes 'prescribable' benzodiazepines (drugs such as diazepam), 'street' benzodiazepines (such as etizolam and alprazolam) and z-hypnotics (such as zopiclone).

Multiple/other

The 'multiple/other' drugs category includes volatile solvents (such as glue, gases or aerosols) and multiple drug use. This category may also be used to indicate multiple drug use when individual substances are not known or cannot be coded using existing diagnosis codes (International Classification of Diseases 10th Revision – ICD10).

Completeness

The data is routinely drawn from hospital administrative systems and ICD10 diagnosis codes used to identify admissions related to drug use. Some caution is necessary when using these data as drug use may only be suspected and may not always be recorded by the hospital. Further details can be found in the PHS drug-related hospital statistics report, and information on hospital administrative systems (Scottish Morbidity Records ­– SMR) data completeness can be found on the ’SMR completeness’ webpage.

Value type and unit of measurement

Number of inpatient and day case admissions to general acute hospitals (excluding maternity, neonatal, geriatric long stay and admissions to psychiatric hospitals), presented by month of admission with moving averages.

Description

This indicator provides information on suspected drug deaths in Scotland.

Data source(s)

Police Scotland

Date that data were acquired

16 June 2023

Timeframe of data and timeliness

1 March 2021 to 28 May 2023, approximately two months in arrears.

Continuity of data

There have been no changes in the national Police Scotland recording mechanisms or processes over the time series shown in the analysis.

Concepts and definitions

Drug-related death

A drug-related death (also referred to as drug-misuse death) is a death where the underlying cause was confirmed to be drug poisoning and where any of the substances which were implicated, or potentially contributed to death, are controlled in the UK. National Statistics on drug-related deaths are published by the National Records of Scotland (NRS). In 2021 there were 1,330 drug-related deaths in Scotland. This was a small decrease compared to 2020 (1,339), which saw the highest annual total on record.

Suspected drug death

A suspected drug death is a death where controlled drugs are suspected of being involved. This operational measure used by Police Scotland is based on the reports, observations and initial enquiries of officers attending the scene of death.

Completeness

This indicator includes data on suspected drug deaths as recorded by all Police Scotland Divisions across Scotland.

Value type and unit of measurement

Numbers of suspected drug deaths in Scotland and moving averages.

Description

This indicator provides information on the number of attendances, length of stay and toxicology of presentations due to acute illicit drug toxicity at the Queen Elizabeth University Hospital (QEUH) emergency department (ED), Glasgow, Scotland. This study assesses the feasibility of prospective surveillance of ED presentations due to acute illicit drug toxicity.

Data source(s)

QEUH, NHS Greater Glasgow and Clyde

Date that data were acquired

22 June 2023

Timeframe of data and timeliness

19 August 2022 to 16 May 2023

Continuity of data

'ASSIST: A Surveillance Study in Illicit Substance Toxicity' is a pilot by the ED at the QEUH. It will run from August 2022 to August 2023, followed by a three-month follow-up period.

QEUH will provide Public Health Scotland with toxicology screening data on a quarterly and ad-hoc basis for the purposes of public health surveillance.

Because the sample size is small, some of the variables are combined in a different way to the data shared in previous releases of the RADAR quarterly report, to ensure the information are not disclosive. Categories may be revised in future as sample size increases.

Concepts and definitions

Unique ED attendances

Each separate attendance is a count of one. If the same person presented more than once, each attendance was counted.

Illicit drug

'Illicit drug' encompasses any substance that is a controlled drug as per the Misuse of Drugs Act 1971 and Misuse of Drugs Regulations 2001. It excludes legal substances such as alcohol, nicotine, caffeine and paracetamol, as well as medications recently prescribed to the individual or drugs administered to the individual as part of treatment (by ambulance or hospital).

Benzodiazepines

Benzodiazepines are a group of drugs with depressant and anxiolytic (anti-anxiety) effects. They are also known as tranquilisers.

Metabolite

A drug metabolite is a compound produced when a drug breaks down in the body.

In this study, if either a drug or metabolite are detected, this will only be included as one substance – the drug. For example, if both diazepam and its metabolite desmethyldiazepam are detected, only diazepam is recorded.

Due to this we are unable to ascertain the source of some substances, for example, oxazepam is a benzodiazepine, but it is also a metabolite of a range of other benzodiazepines, so we cannot determine whether oxazepam or another benzodiazepine was consumed.

Cocaine

Cocaine is a short-lasting stimulant drug that increases heart rate and breathing.

Gabapentinoids

Gabapentinoids are a group of drugs with depressant and painkilling effects.

Opioids

Opioid drugs act on opioid receptors to produce sedative and painkilling effects. They are respiratory depressants (reduce heart rate and breathing).

Cannabinoids

Cannabinoids are compounds that interact with the endocannabinoid system. They are found in the cannabis plant (such as THC) or can be produced synthetically in a laboratory (synthetic cannabinoids).

Other stimulants

Other stimulants are stimulant drugs apart from cocaine. They increase heart rate, breathing and energy.

Completeness

Not all data identified for all ED attendances is available for analysis, due to the time required to send and receive toxicology results and to link patient and clinical data. A differing proportion of the total attendances recruited for this study are available for each of the data sources:

  • completed clinical notes made by research nurses (Castor)
  • completed electronic clinical records (West of Scotland Safe Haven)
  • toxicology results
  • toxicology results with corresponding clinical (Castor) notes

Toxicology testing has been carried out by the LGC Group, formerly the Laboratory of the Government Chemist. LGC screen against a database of over 3,500 chemical substances including illicit drugs, novel psychoactive substances, synthetic cannabinoid receptor agonists, benzodiazepines and medications. This analysis does not, however, imply that specific drugs were implicated in harms.

This study includes patients aged 16 or over attending QEUH adult ED directly related to acute illicit drug use. It excludes patients where the condition is more likely due to a cause other than acute illicit drug use, due to withdrawal, primarily related to alcohol use or where the attendance is due to a complication of previous drug use, i.e. infected injection site.

Value type and unit of measurement

Number of ED attendances related to illicit drug use, destination on discharge from the ED, number of hours in the ED, number of hours in hospital, toxicology results of surplus serum sampling by drug type and drug category.

Description

This indicator provides information on forensic toxicology testing for controlled substances completed at post-mortem in Scotland.

Data source(s)

Forensic Toxicology Service within Forensic Medicine and Science (FMS), University of Glasgow, on behalf of the Crown Office and Procurator Fiscal Service (COPFS).

Other laboratory testing sites in the United Kingdom, outsourced by the Scottish Police Authority (SPA) Forensic Services.

Date that data were acquired

26 June 2023

Timeframe of data and timeliness

1 January 2020 and 31 December 2022, approximately three months in arrears.

Continuity of data

The majority of testing was performed by the Forensic Toxicology Service based within FMS at the University of Glasgow, on behalf of COPFS. In late 2022, post-mortem toxicology services were transferred from the University of Glasgow to the Scottish Police Authority (SPA) Forensic Services

During this period, post-mortem tests were completed by other laboratory testing sites in the United Kingdom. Data from those sites have been included in this report and cover the most recent period reported. Future testing will be completed within a laboratory based within SPA Forensic Services. 

Concepts and definitions

Forensic Medicine and Science and the SPA Forensic Services undertakes toxicology testing on behalf of the COPFS for post-mortem cases where controlled drugs (as defined in the Misuse of Drugs Act 1971) were found present.

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 does not include consideration of wider causes of death.

The analysis presented is based on the date of death, where available. Data received from outsourcing laboratory services did not include this information and therefore 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 and sent to other labs for toxicology testing.
  2. Date of toxicology test being completed.

Benzodiazepines

Benzodiazepines are a group of drugs with depressant and anxiolytic (anti-anxiety) effects. They are also known as tranquilisers. Diazepam is a ‘prescribable benzodiazepine’. Etizolam, clonazolam and bromazolam are ‘street benzos’, benzodiazepines that are not licensed for prescription in the UK.

Cocaine

Cocaine is a short-lasting stimulant drug that increases heart rate and breathing. This group includes powder cocaine and crack cocaine.

Gabapentin and pregabalin

Gabapentin and pregabalin are gabapentinoids, a group of drugs with depressant and painkilling effects.

Opioids

Opioid drugs act on opioid receptors to produce sedative and painkilling effects. They are respiratory depressants (reduce heart rate and breathing). This category includes buprenorphine, fentanyl, heroin/morphine and methadone.

Completeness

The data are for deaths occurring in the west, east and parts of the north of Scotland. Apart from a very small number of cases analysed at the University of Glasgow, post-mortem toxicology testing for deaths occurring in Aberdeen and the far north of Scotland is conducted by a similar service at the Aberdeen Royal Infirmary (ARI). Results from the ARI are not included in this report.

Value type and unit of measurement

Number and percentage of forensic toxicology cases testing positive for controlled substances by drug type.

Description

This indicator provides information on drug types most commonly detected in drug seizures in Scottish prisons.

Data source(s)

Scottish Prison Service (SPS) and the Leverhulme Research Centre for Forensic Science (LRCFS), University of Dundee.

Date that data were acquired

20 June 2023

Timeframe of data and timeliness

1 January 2021 and 31 March 2023, approximately three months in arrears.

Continuity of data

There have been no changes in the seizures recording mechanisms or processes over the time series shown in the analysis.

Concepts and definitions

Benzodiazepines

Benzodiazepines are a group of drugs with depressant and anxiolytic (anti-anxiety) effects. They are also known as tranquilisers. Benzodiazepines detected in this project include etizolam, flubromazepam, bromazolam, diazepam and flualprazolam.

Cocaine

Cocaine is a short-lasting stimulant drug that increases heart rate and breathing. This group includes powder cocaine and crack cocaine.

Gabapentinoids

Gabapentinoids are a group of drugs with depressant and painkilling effects. On average, in this project 16% of gabapentinoid detections are for gabapentin and 84% are for pregabalin.

Opioids

Opioid drugs act on opioid receptors to produce sedative and painkilling effects. They are respiratory depressants (reduce heart rate and breathing). Opioids include synthetic (lab-made) drugs such as methadone and opiates (drugs made from opium) such as heroin. Opioids detected in this project include buprenorphine, heroin, tramadol, codeine, dihydrocodeine, metonitazene, oxycodone and methadone.

Synthetic cannabinoids

'Synthetic cannabinoids' is a term used to describe over 200 lab-made drugs that interact with the endocannabinoid system.

Completeness

Data is provided to PHS by the LCRFS. LCRFS does not analyse all seizures from the SPS. However, LCRFS data is a sizeable subset of all national prison seizures.

Value type and unit of measurement

Percentage of drug seizures analysed by the LRCFS by drug type and sample type (card, paper, powder or tablet).

Description

This indicator provides information on specialist drug treatment referrals in Scotland.

Data source(s)

Public Health Scotland – Drug and Alcohol Information System (DAISy) and Drug and Alcohol Treatment Waiting Times (DATWT) database

Date that data were acquired

15 June 2023

Timeframe of data and timeliness

1 March 2021 to 28 May 2023, approximately two months in arrears.

Continuity of data

These data have been extracted from the Drug and Alcohol Information System (DAISy) and its predecessor, the Drug and Alcohol Treatment Waiting Times (DATWT) database. DAISy was available in all NHS Boards from April 2021.

DAISy introduced a new way of recording referrals, a continuation of care process which affects how referrals are recorded when people have started treatment and move from one service to another without a break or change in their treatment (for instance, when moving between community-based and prison-based services).The number of referrals remain comparable between DATWT and DAISy, but how waits are recorded against the initial and receiving services has changed for referrals transferred by the continuation of care process. These data report on the number of referrals rather than waits so the new continuation of care process should not impact the number of referrals.

DAISy introduced an additional ‘co-dependency’ service user type, where the referral relates to treatment for both drug and alcohol use. Co-dependency has only been recorded since the introduction of DAISy (April 2021) so is not available as a separate client type in the DATWT database. These data report the number of referrals where the service user type is recorded as either ‘drugs’ or ‘co-dependency’ in DAISy and as ‘drugs’ in DATWT.

Concepts and definitions

These data relate to the number of referrals to specialist drug and alcohol treatment services in Scotland delivering tier 3 and 4 interventions (community-based specialised drug assessment and co-ordinated care-planned treatment, and residential specialised drug treatment). These data are for community-based drug and alcohol treatment services and exclude prison-based and hospital-based services.

Completeness

Drug and alcohol treatment services are required to submit accurate and up-to-date waiting times information to PHS. These referrals data are management information and includes all services that enter data on DAISy and its predecessor, the DATWT database. This contrasts with the figures reported in the 'National drug and alcohol treatment waiting times' statistics release for Scotland where data from services that were unable to confirm their data were accurate and up-to-date within specified timescales are excluded. Further details can be found in the substance use section of the COVID-19 wider impacts dashboard.

Value type and unit of measurement

Number of specialist drug treatment referrals and moving averages.

Description

This indicator provides information on opioid substitution therapy prescribing in Scotland.

Data source(s)

Public Health Scotland – Prescribing Information System (PIS) and Hospital Medicines Utilisation Database (HMUD)

Date that data were acquired

22 June 2023

Timeframe of data and timeliness

1 January 2021 to 31 March 2023. Data from the PIS are available approximately three months in arrears.

HMUD data availability can vary by NHS Board. However, the injectable buprenorphine data shown in this release are considered complete.

Continuity of data

The data shown are considered to provide a comprehensive account of OST prescribing for the time series presented, including data from GP and hospital prescribing systems.

Concepts and definitions

Defined daily dose

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.

Average daily quantity

Due to differences between the average OST doses used in Scotland and the rest of the world, the analysis presented here is based on average daily quantities (ADQs). These are more representative of the daily maintenance doses used within Scotland and were developed via analysis of prescriptions and by consultation with the Specialist Pharmacists in Substance Misuse group. The ADQs agreed are:

  • methadone (oral): 65 mg
  • buprenorphine (oral): 13 mg
  • buprenorphine (injection): 3.4 mg

Buprenorphine

Buprenorphine is a synthetic partial opioid agonist used to treat acute pain, chronic pain and opioid dependence. Prescribed for daily use (oral) or weekly or monthly prolonged release (injectable), buprenorphine relieves opioid cravings and withdrawal symptoms and blocks the effects of other opioids. As with other opioids, buprenorphine can result in sedation, respiratory depression and death. These statistics relate to the prescribing of oral (2 mg, 8 mg and 16 mg buprenorphine or buprenorphine and naloxone tablets) and injectable buprenorphine (various strengths) for the treatment of opioid dependence.

Opioids

Opioid drugs act on opioid receptors to produce sedative and painkilling effects. They are respiratory depressants (reduce heart rate and breathing). Opioids include synthetic (lab-made) drugs such as methadone and buprenorphine, as well as opiates (drugs made from opium) such as heroin and morphine.

Methadone

Methadone is a synthetic opioid agonist used to treat chronic pain and opioid dependence. Prescribed for daily use, methadone relieves opioid cravings and withdrawal symptoms. As with other opioids, methadone can result in sedation, respiratory depression and death. These statistics include data on the prescribing of methadone 1mg/1ml solution for the treatment of opioid dependence.

Accuracy

There are differences between community prescribing data from the Prescribing Information System (PIS) and hospital prescribing data from the Hospital Medicines Utilisation Database (HMUD) in the way that dates are allocated to medications supplied. The basis for date allocation in PIS data is the month in which the costs associated with dispensing medication were reimbursed. The basis for date allocation in HMUD data is the month in which medications were supplied to the NHS Board for onward administration to patients. While useful to note, these differences are not thought to have a significant impact on the reliability of this analysis.

For the 2022/23 Q3 and Q4 reports, there were revisions to the injectable buprenorphine data, which means that the number of ADQ doses associated with that medication from April 2022 onwards was slightly higher than shown in previous reports. These changes were associated with the addition of data on Buvidal 160mg/0.45ml prolonged release injections to the PIS data extract in 2022/23 Q3 and to the HMUD data extract in 2022/23 Q4.

Completeness

The data shown are considered to provide a comprehensive account of OST prescribing for the time series presented, including data from GP and hospital prescribing systems.

Value type and unit of measurement

Total number of ADQ doses of methadone, oral buprenorphine and injectable buprenorphine supplied in Scotland, based on community and hospital prescribing data.

Description

This indicator provides information on injecting equipment provision (IEP) in Scotland.

Data source(s)

Needle Exchange Online (neo360)

Date that data were acquired

26 May 2023

Timeframe of data and timeliness

4 January 2021 to 2 April 2023

Data are available approximately three months in arrears.

Continuity of data

Caution is recommended when interpreting these statistics. Service provision in some areas has changed over time. Some outlets will have closed, and others will have opened.

The methods used by areas to count or estimate some of the figures may also have changed.

Concepts and definitions

Transactions

A transaction is an episode in which a client received equipment relating to an injecting episode (i.e. a barrel and/or fixed needle and syringe). People who inject drugs may attend IEP outlets at any time, whether or not they are undertaking specialist treatment for problematic drug use.

Further details can be found in the PHS Injecting Equipment Provision in Scotland report.

Completeness

This indicator includes data on transactions and needle and syringe distribution by injecting equipment providers in mainland Scotland NHS Boards.

It does not include data for NHS Shetland, NHS Orkney and NHS Western Isles.

The 11 mainland NHS Boards use neo360 routinely, but due to missing data for part of the time period presented, NHS Highland is excluded from the transaction data, and both NHS Fife and NHS Highland are excluded from the needle and syringe, and ratio figures.

Value type and unit of measurement

Number of IEP transactions, number of needles and syringes distributed, the ratio of the number of needles and syringes per IEP transaction and moving averages.

Last updated: 20 November 2023
Was this page helpful?