• 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 

• RADAR has two current alerts for new drugs that pose a high risk of overdose:
  • new benzodiazepines – bromazolam (published: July 2023)
  • nitazene-type opioids (updated: March 2023)

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.