• Drug-related harms remain high in Scotland.
• The following changes were observed compared to the previous reporting period (reported in quarterly report 7 – April 2024).

For harm indicators:

• • naloxone administration incidents (March to May 24): 5% increase
  • emergency department attendances (March to May 24): 2% increase
  • suspected drug deaths (March to May 24): 8% decrease
  • drug-related hospital admissions (January to March 24): 11% decrease

For service indicators:

• • drug treatment referrals (February to May 24): 1% increase
  • injecting equipment provision (January to March 24): transactions – 8% decrease, number of needles and syringes – 2% decrease
  • opioid substitution therapy (January to March 24): 1% decrease.
• Patterns of polysubstance use remain the key driver of harms. The most common combinations associated with risk of harm involve benzodiazepines (most commonly diazepam and bromazolam), cocaine and opioids.
• New synthetic drugs (particularly nitazene-type opioids and xylazine) played an increasing role in harms.

Alerts

• A public health alert about nitazene-type opioids was published in January 2023. It was updated on 9 July 2024, due to increasing detections in drugs mis-sold as heroin and diazepam.
  
  • PHS alert: nitazenes
• A public health alert about xylazine was published in May 2024, due to increasing detections, particularly in drugs mis-sold as heroin. Its use is associated with sedation, sudden collapse and severe wounds.
  • PHS alert: xylazine
• A public health alert about new benzodiazepines was published in July 2023 and remains current. 
  • PHS alert: bromazolam 

Harm indicators

• Between March and May 2024, the average weekly number of Scottish Ambulance Service naloxone administration incidents increased (from 62 to 84). The total number of incidents (926) was slightly higher (5%) than the previous quarter (885). Incidents were 5% lower than the same period in 2022 and 6% lower than in 2023.
• Between March and May 2024, drug-related attendances at emergency departments were stable (2% higher) compared to the previous period. The number of attendances was similar to the same period in 2022 and 12% lower compared to 2023.
• Between January and March 2024, drug-related hospital admissions were 11% lower than in the previous period. The total number of admissions was 8% lower than the same period in 2022 and stable compared to 2023. These data should be interpreted with caution, as admissions may be affected by issues accessing urgent care and by the capacity of hospital services.
• Between March and May 2024, there were 267 suspected drug deaths. The number of deaths was 8% lower than the previous quarter (291). 6% lower than the same period in 2022 (283) and 11% lower than in 2023 (300).

Toxicology indicators

• Between March and May 2024, the most frequently detected drug in the ASSIST hospital toxicology project was cocaine (11% of all detections) followed by temazepam (10%) and desmethyldiazepam (9%). Nitazenes made up 1% of detections (detected in six samples, down from eight in the previous quarter).
• Between January and March 2024, the most common drug types detected in post-mortem toxicology were opioids (in 72% of deaths) and benzodiazepines (60%). The most common individual drug detected was cocaine (36%), followed by heroin/morphine (31%), diazepam (30%) and methadone (28%). Nitazenes were detected in 4% of deaths (25), up from 2% (12) in the previous quarter.
• Limited Scottish Prison Service drug analysis identified synthetic cannabinoids and street benzodiazepines (bromazolam).

Service indicators

• Between February and May 2024, the average weekly number of referrals to specialist drug treatment services was stable (1% increase compared to previous quarter). The total number of referrals recorded in this period (5,556) was broadly similar to the same period in 2022 (5,594) and 5% lower compared to 2023 (5,855).
• Between January and March 2024, the average weekly number of injecting equipment provision transactions increased by 13% and the average weekly number of needles and syringes distributed remained relatively stable. During this period, the number of transactions was 6% lower than the same period in 2022 and similar to 2023. The number of needles and syringes distributed was similar to the same period in 2022 and 2023.
• Between January and March 2024, the number of opioid substitution therapy (OST) doses supplied per month was stable (1% decrease compared to previous quarter), 6% lower than the same time period in 2022 and similar to 2023. The average monthly number of methadone doses supplied continued to decrease while injectable buprenorphine doses increased over time.

Reporting trends

• Between April and July 2024, 85 trend reports were received by RADAR.
• The majority of reports related to benzodiazepines, cocaine, heroin and polydrug use.
• Other commonly reported concerns related to new synthetics (nitazenes and xylazine), cannabinoids (cannabis, THC vapes and synthetic cannabinoids) and ketamine.
• Trend reports can be viewed on our dashboard (external website).

Implications

• The harm caused by drugs is a significant public health issue for Scotland and there is a high likelihood of sudden, localised spikes of drug-related harms.
• The risk of harm and death are increased in the context of polysubstance use, stigma and exclusion.
• Highly potent and toxic novel drugs such as nitazenes and xylazine are increasingly being detected in substances and among people who have experienced drug-related harms in Scotland.
• Prevention, harm reduction and treatment interventions should be adapted to respond to the high prevalence of cocaine and benzodiazepine involvement in drug harms.
• There is increasing recognition of the adverse health consequences associated with injecting-related injuries, vascular injury and soft tissue infections amongst people who use drugs. Further work is needed at both local and national level to support the development of integrated approaches to prevention, treatment and physical rehabilitation of drug-related injuries and infections.
• Contamination of illicit drugs with toxic substances appears to be common in Scotland. There continues to be an urgent need for timely and accurate hospital toxicology and forensic post-mortem toxicology services, as well as accessible drug checking.
• A system-wide approach that prevents drug harms and supports people affected into treatment, care and recovery remains critical.