Rapid Action Drug Alerts and Response (RADAR) quarterly report
July 2023
A Management Information Statistics publication for Scotland
- Published
- 25 July 2023
- Type
- Statistical report
- Author
- Public Health Scotland
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.
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 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.
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.
The second chart shows the weekly number of needles and syringes distributed from 4 January 2021 to 2 April 2023.
The third chart shows the weekly ratio of needles and syringes distributed per transaction from 4 January 2021 to 2 April 2023.
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.