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

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

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 

• 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.

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.

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.

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.

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. 

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.

The chart shows the number of emergency naloxone incidents by the Scottish Ambulance Service. The number of incidents is on the y axis and the date, between 1 March 2021 and 28 May 2023, is on the x axis. An overall increasing trend was observed between March 2021 and July 2021 where the number of weekly incidents peaked (136). A decreasing trend was observed until April 2022, when a slight increase was then recorded. The number of naloxone incidents followed a gradual decreasing trend from May 2022 to December 2022, after which an increasing trend was observed until May 2023.

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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.

The chart shows the number of drug-related emergency department attendances in Scotland. The number of attendances is on the y axis and the date, between 1 March 2021 and 28 May 2023, is on the x axis. An overall decreasing trend was observed from August 2021 to April 2022, with the lowest levels in the week beginning 4 April (53). Attendances then increased sharply peaking in May 2022, with the highest levels in the week beginning 16 May (123). The number of attendances decreased and remained broadly stable between June 2022 and February 2023 at 82 per week. Between March and May 2023, the number of attendances gradually increased to a peak of 108 in the week beginning 22 May 2023.

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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.

The chart shows the main drug type recorded for drug-related hospital admissions in Scotland’s general acute hospitals. The chart is a percentage breakdown across five categories – cannabinoids, cocaine, multiple/other, opioids and sedatives/hypnotics. The percentage of admissions is on the y axis and the date, between 4 January 2021 to 2 April 2023, is on the x axis. The main drug involved in hospital admissions remains opioids, recorded in approximately 50% of admissions, increasing slightly in December 2022 to 53%, before falling to an average of 48% between January and March 2023. Admissions related to sedatives/hypnotics decreased throughout 2022 (21% of admissions in January, falling to 14% in December 2022) and have remained stable throughout 2023.

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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 

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.

This time-series chart shows the weekly number of suspected drug deaths in Scotland on the y axis and the date, between 1 March 2021 and 28 May 2023, on the x axis. Between March 2021 and July 2021, the average weekly number of suspected drug deaths ranged from 21 to 37 deaths per week. Between July 2021 and February 2023, the average weekly number of deaths fluctuated considerably but remained within a range of 17 to 29 deaths per week. The average weekly number of suspected drug deaths was broadly stable from the end of February 2023 to the beginning of May 2023, and then increased throughout May, with 30 deaths observed in the week beginning 15 May 2023.

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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

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.

This stacked bar chart shows the number of detections of drug types within QEUH ED. The drugs are grouped into five main categories of effect, with depressant, opioid, stimulant, cannabinoid and other, on the y axis and the number of detections along the x axis. The most common category was depressant, with 880 detections. This included 756 detections of benzodiazepines and 103 detections of gabapentinoids. The second most common category was opioid, with 255 detections, 71 of these were of morphine. The third most common category was stimulant, with 194 detections. 151 of these were of cocaine. There were 118 detections of cannabinoids, nine of these were of synthetic cannabinoids. There were 26 detections of other drugs.

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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. 

This stacked bar chart shows the percentage of detections of drug types within QEUH ED across three time periods - 17/08/22 to 16/11/22, 17/11/22 to 16/02/23 and 17/02/23 to 16/05/23. The drugs are grouped into six categories other depressant, bromazolam, etizolam, opioid, cocaine and other, on the y axis and the time period along the x axis. The most common category was other depressant with 45%, 49% and 43% across the time periods. The second most common is opioids with 17,18 and 17% across the time periods. An increase in bromazolam detections has been seen across the time period, increasing from 4% in the first quarter to 8% in the most recent.

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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.

This stacked bar chart shows the percentage within QEUH ED across three time periods - 17/08/22 to 16/11/22, 17/11/22 to 16/02/23 and 17/02/23 to 16/05/23. Age is grouped into six categories (16 to 24, 25 to 34, 35 to 44, 45 to 54,over 55 and age unknown) on the y axis and the time period along the x axis. The most common category age group is 25 to 34 in the first two quarters at 34%. The most common age groups in the most recent quarter are 25 to 34 and 35 to 44 years at 29% each.

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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

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.

The chart shows the percentage of forensic toxicology cases testing positive for controlled substances (opioids, benzodiazepines, gabapentin and pregabalin, cocaine). The percentage of toxicology cases is on the y axis and the calendar year and quarter of death, between Q1 of 2020 and Q4 of 2022, is on the x axis. The percentage of deaths that tested positive for opioids increased from Q1 to Q2 of 2020, but otherwise remained relatively stable over the time series. A sharp increase in the percentage of deaths where benzodiazepines were present occurred between Q1 and Q2 of 2020. This percentage remained high throughout 2020, before gradually falling from Q1 of 2021 onwards. The percentage of deaths where gabapentin and pregabalin was present remained relatively stable across the time series, though an isolated increase was observed in Q2 of 2021. The percentage of deaths where cocaine was present increased markedly during Q2 of 2020 but was otherwise relatively stable over the time series.

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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.

The chart shows the percentage of forensic toxicology cases testing positive for specific individual opioids (heroin/morphine, methadone and buprenorphine) and benzodiazepines (diazepam, etizolam, clonazolam and bromazolam). The percentage of toxicology cases is on the y axis and the calendar year and quarter of death, between Q1 of 2020 and Q4 of 2022, is on the x axis. The percentage of deaths that tested positive for etizolam and methadone increased sharply in Q2 of 2020 and remained high until Q3 of 2021. Since Q3 of 2021, etizolam and methadone detections have decreased. Heroin/morphine remained relatively stable and has been the most common substance since Q3 of 2021. In Q4 of 2022 diazepam reached similar levels to heroin/morphine, after a marked increase in detections. Deaths with clonazolam present increased in Q2 of 2020, peaking in Q3 of 2021, before falling to zero in early 2022. Deaths with buprenorphine present remained relatively low and stable throughout the time series. Data included for the first time in Q4 of 2022, shows that 15% of deaths tested positive for bromazolam.

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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

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.

The chart shows the percentage of SPS drug seizures broken down by sample type (e-cigarette, paper or card, tablet, powder and other). The percentage of samples is on the y axis and the date, between January 2021 and March 2023, is on the x axis. Sample types are highly variable over the time period. Paper or card detections decreased across the time series with an average of 73% per month being detected in 2021, compared to 23% per month in 2022. There were low detections of e-cigarettes until June 2022, when they made up over half of the seizures that month. Between July to November, an average of 32% of the samples per month were e-cigarettes. This briefly decreased to 5% in December 2022, before increasing and remaining relatively stable at 24% per month between January and March 2023. Powder samples remained relatively stable, with approximately 19% per month being detected in 2022, peaking at 50% in December.

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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.

The chart shows the percentage of SPS drug seizures broken down by drug type (synthetic cannabinoids, benzodiazepines and opioids). The percentage of samples is on the y axis and the date, between January 2021 and March 2023, is on the x axis. Synthetic cannabinoids are the most prevalent drug throughout the time series. The percentage of seizures testing positive for synthetic cannabinoids was on average 43% per month in 2021, decreasing to 33% per month in 2022. The second most common drug type detected is benzodiazepines. The percentage of seizures testing positive for benzodiazepines fluctuated throughout 2021 with an average of 38% per month, before decreasing and remaining relatively stable in 2022 (average of 26%).

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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

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.

This time-series chart shows the number of referrals to drug treatment services in Scotland on the y axis and the date, between 1 March 2021 and 28 May 2023, on the x axis. In December and January each year, a seasonal reduction in referrals occurs. There was an upward trend in the average weekly number of referrals from mid-March 2021 to June 2021. Referrals decreased throughout June and July 2021, and then remained broadly stable to January 2022 (between 400 to 480 referrals per week). Throughout 2022, there was a fluctuating, but gradual decrease in the average weekly number of referrals. After the seasonal reduction in December 2022, referrals returned to a weekly average of approximately 450 per week in January 2023. A fluctuating downward trend has been evident since then, with a weekly average of 425 referrals in May 2023.

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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.

The stacked area chart shows the three-month rolling average total for the monthly number of doses supplied for OST medications in the community, between January 2021 and March 2023. There was a gradual decrease in the average monthly total number of OST doses supplied over the time series, largely due to a decreasing trend in the average monthly number of methadone doses supplied.

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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.

The chart below shows monthly trends in the number of doses supplied for specific OST medications in the community between January 2021 and March 2023. Methadone was the most commonly prescribed, at approximately 542,300 doses per month between January and March 2023. Buprenorphine was less frequently prescribed. The average monthly number of oral buprenorphine doses supplied decreased gradually between January 2021 and March 2023. Approximately 118,200 oral buprenorphine doses were prescribed per month between January and March 2023. Injectable buprenorphine was first licensed for use in Scotland in early 2020. The average total number of doses supplied has increased steadily since then, to approximately 88,200 per month between January and March 2023.

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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

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.

The chart shows the number of transactions at injecting equipment provision sites in Scotland. The number of transactions is on the y axis and the date, between 4 January 2021 and 2 April 2023, is on the x axis. An overall decreasing trend was observed from January 2021 to the end of 2021. Since February 2022, the number of transactions was broadly stable but remained lower than the comparable periods in previous years. A seasonal dip in transactions in December and January each year was observed.

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Injecting equipment provision: transactions

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

The chart shows the number of needles and syringes distributed by injecting equipment provision sites in Scotland. The number of needles and syringes is on the y axis and the date, between 4 January 2021 and 2 April 2023, is on the x axis. An overall decreasing trend was observed from October 2020 to October 2021. The number of needles and syringes distributed has been broadly stable since October 2021, with a seasonal dip observed in December 2022 and January 2023.

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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.

The chart shows the ratio of needles and syringes distributed per transaction by injecting equipment provision sites in Scotland. The ratio of needles and syringes per transaction is on the y axis and the date, between 4 January 2021 and 2 April 2023, is on the x axis. The ratio was broadly stable at an average of 14 needles and syringes distributed per transaction, but seasonal fluctuations were observed during December 2021 and 2022.

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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

Contact

General enquiries

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

• Nicole Jarvie | Principal Information Analyst | phs.drugsteam@phs.scot
• Vicki Craik | Public Health Intelligence Adviser | phs.drugsradar@phs.scot

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:

• fill in our reporting form
• email phs.drugsradar@phs.scot

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

RADAR

Find out more about RADAR – Scotland’s drugs early warning system.

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.