Rapid Action Drug Alerts and Response (RADAR) quarterly ​report
July 2024

About this release

Our quarterly report

The Drugs Team at Public Health Scotland (PHS) has compiled this RADAR quarterly report of drug-related indicators.

The objective of this report is to monitor drug-related harms, service usage and toxicology data, in order to provide an early warning of emerging drug trends and identify actions to reduce and prevent drug harms and deaths.

View a printable version of this report.

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.

Data and reporting period

RADAR's emphasis is on reporting drug-related information as rapidly as possible, for the purpose of public health surveillance. This means that data may not be fully validated and may be subject to change. Further analysis of these data will be made available in our Accredited official statistics publications on substance use.

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.

Different time periods may be reported across the different indicators. In all cases, the most recently available data are used. Most charts show Scotland-level data based upon a two-year time series. Location and time series can be customised in the RADAR dashboard (external website).

The next release of this publication will be 29 October 2024.

Dashboard

Data for most of the harm and service indicators in this report are published in our new RADAR dashboard (external website).

In the dashboard, the time series can be adjusted and the data can be filtered by NHS board.

This dashboard supersedes the substance use section of the COVID-19 wider impacts dashboard (external website), which has now been decommissioned.

For optimal viewing and interaction, we recommend accessing the dashboard using a computer with a large screen. Accessing via a mobile phone may reduce the functionality.

Main points

• 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.

Alerts

Current alerts

Nitazenes

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.

Xylazine

A public health alert about xylazine was published on 9 May 2024, due to increasing detections, particularly in drugs mis-sold as heroin. Its use is associated with sedation, sudden collapse and severe wounds.

Scottish Drugs Forum has developed resources on xylazine and wounds (external website), including a factsheet, worker’s guide, poster and updated ‘check your sites’ e-learning module.

Bromazolam

A public health alert about new benzodiazepines was published in July 2023. Bromazolam is the most common drug detected in ‘street benzos’. Bromazolam produces strong sedative and sleep-inducing effects. As a result, there is a substantial risk of overdose.

Trends

Police drug trends bulletin

The purposes of the Police Scotland’s Statement of Opinion (STOP) bulletin are to raise awareness of drug appearance and to demonstrate some of the substances present in Scotland's drugs market. There is no new information for the latest time period (March to June 2024).

For previous police bulletins, please see our previous reports.

For information on RADAR drug trends, please see our intelligence and reports section.

RADAR intelligence and reports

85 reports were validated by RADAR between 5 April and 4 July 2024.

So far, RADAR has received over 290 reports of drug-related information and harms through the reporting form and mailbox.

A summary of key trends is shown below. Validated intelligence reports to RADAR can be found on the dashboard (external website).

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

Trends by primary drug type

In the latest period (5 April to 4 July 2024):

• The most common drugs or drug types reported were benzodiazepines, cocaine and heroin, broadly in keeping with the previous quarter.
• Reports of synthetic cannabinoids and THC vapes increased to 13, up from four in the last quarter.
• Most concerns were related to adverse effects. In the last quarter, there was an increase in the number of reports of overdose clusters, public overdoses, sudden collapse and wounds and infections (see below).
• RADAR has received several reports regarding young people. Some of these reports include adverse effects, hospitalisations and mental health concerns.
• The drug supply appears increasingly toxic and unpredictable. We have received reports and toxicology data highlighting that a range of drugs are suspected to be adulterated – meaning a substance is added to a drug product to either intentionally or unintentionally change its composition, quality or strength.

Synthetic drugs

• Reports to RADAR suggest the ongoing presence of new synthetic drugs.
• This is supported by increasing detections of nitazenes (most commonly metonitazene and protonitazene) and xylazine through toxicology and drug analysis since autumn 2023:
  • Based on post-mortem toxicology testing, nitazenes have been detected in 63 deaths and xylazine has been detected in 18 (to 31 March 2024).
  • They have been detected in 40 Scottish samples tested by WEDINOS in the last two years. 75% of detections were made in the last four months (February to May 2024), where nitazenes and xylazine were detected in samples sold as heroin, and bromazolam and metonitazene were detected in samples mis-sold as diazepam. Note: detections below have been simplified for the purpose of the chart. Other substances were detected in the mix on occasion including bromazolam, nitrazolam, MDMA, ketamine, cocaine, diphenhydramine and thebacon.
• Most common reports of xylazine and nitazenes in the last quarter concerned overdose clusters, sudden collapse, reduced consciousness, infections and wounds.

This stacked bar chart shows the number of synthetics in Scottish samples tested by WEDINOS between May 2022 and May 2024. Very few detections were made between May 2022 and Jan 2023 (1 detection of nitazene in May, August and December 2022, 1 detection of xylazine June 2022). In February 2023, two detections of nitazenes were made alongside one detection of heroin and nitazene. No further detections were made until September 2023, when one detection of bromazolam and nitazene was made followed by one detection of heroin, nitazene and xylazine. Detections then steadily increased, with two heroin and xylazine detections in January to seven in February 2024, followed by an average of three per month until May 2024. Heroin, xylazine and nitazene was detected on average two times per month between February and May 2024 and bromazolam and nitazene detections increased from one in March 2024 to three in April and then two in May.

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Synthetics in Scottish samples tested by WEDINOS

Other reports

Reporting drug harms

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 and wounds
• routes of administration
• new substances or patterns of use
• testing data.

The information in the regional breakdown can be used by local areas for their own drug trend surveillance.

Anyone can make a report by using our new reporting form (external website) 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 (62) and May 2024 (84). The total number of incidents during this period (926) was slightly higher (5%) than the previous quarter (885). This was slightly lower (5%) than the same period in 2022 (974) and 6% lower than in 2023 (988).

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 in Scotland from 28 February 2022 to 2 June 2024.

An interactive version of this chart can be found in the RADAR dashboard (external website). The dashboard also allows users to download the data and filter by NHS board.

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 6 December 2021 and 3 March 2024, is on the x axis. An uneven slightly decreasing trend was observed from December 2021 until April 2022. Following an isolated increase in April 2022, the number of naloxone incidents followed a gradual decreasing trend from May to December 2022. An increasing trend was observed from January to May 2023. Between June and August 2023, the average weekly number of naloxone incidents remained broadly stable at around 93 per week, after which the weekly number of incidents followed a generally decreasing trend to January 2024, although an isolated increase was observed in week beginning 30 October (108).

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Naloxone administration by Scottish Ambulance Service

Summary

Historic trend

• During 2022, the seasonal pattern of lower numbers during winter months and higher numbers during summer months, was less pronounced than in previous years. Despite an increase in April, incidents followed a gradual decreasing trend from May to December 2022.
• During 2023, the normal seasonal pattern was observed again, with an increasing trend in the average weekly number from January (60) to May 2023 (79).
• Between June and August 2023, the average number of incidents remained high and broadly stable (93).
• Weekly incidents were highly variable between September and December 2023, ranging from 63 to 108.
• Between January and March 2024, the average number of weekly incidents ranged from 44 to 80.

National update

For the most recent 13-week period (4 March to 2 June 2024):

• 926 SAS naloxone incidents were recorded, at an average of 71 per week. Average weekly numbers fluctuated but generally increased between March (62) and May (84).
• The total number of incidents was slightly higher (5%) than the previous 13-week period (4 December to 3 March 2024) when 885 incidents were recorded, at an average of 68 per week.
• The number of incidents was slightly lower (5%) than the same period in 2022 (974, weekly average 75) and 6% lower than in 2023 (988, weekly average 76).

Local update

For the most recent period (4 March to 2 June 2024), naloxone administration incidents increased across most mainland NHS boards, compared to the previous quarter:

• Incidents increased in six areas: NHS Forth Valley (5%), NHS Grampian (6%), NHS Fife (9%), NHS Ayrshire and Arran (14%), NHS Tayside (19%) and NHS Highland (59%).
• Incidents decreased in two areas: NHS Lanarkshire (7%) and NHS Dumfries and Galloway (26%).
• Incidents were broadly stable in three areas: NHS Borders, NHS Greater Glasgow and Clyde and NHS Lothian.

To analyse these data further, please visit the RADAR dashboard (external website).

Additional information

PHS was provided with these data by SAS.

Information on take-home naloxone distribution can be found in the National Naloxone Programme Scotland Quarterly Monitoring Bulletin, published by PHS.

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 (external website).

Naloxone is very easy to administer. You can learn more about administering naloxone in a free e-learning module 'Overdose Prevention, Intervention and Naloxone (external website)' created by the Scottish Drugs Forum.

Drug-related attendances at emergency departments

Between March and May 2024, the number of drug-related attendances at emergency departments (1,032) was similar to the previous quarter (1,010). This was similar to the same period in 2022 (1,038) and 12% lower than in 2023 (1,173).

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 in Scotland between 28 February 2022 and 2 June 2024.

An interactive version of this chart can be found in the RADAR dashboard (external website). The dashboard also allows users to download the data and filter by NHS Board.

The chart shows the number of drug-related emergency department attendances. The number of attendances is on the y axis and the date, between 28 February 2022 and 2 June 2024, is on the x axis. Following a decreasing trend in March and April 2022, attendances increased sharply, peaking at 123 in the week beginning 16 May 2022. The number of attendances decreased and remained broadly stable at 82 per week between June 2022 and March 2023. Between April and June 2023, the number of attendances gradually increased, peaking at 142 in the week beginning 19 June 2023. An overall decreasing trend was observed from July 2023 to January 2024. This was followed by a generally increasing trend to the end of May 2024.

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Drug-related attendances at emergency departments

Summary

Historic trend

• Following a decreasing trend during March 2022, the lowest level in the series was observed in April 2022 (53). Attendances then increased sharply and peaked in May 2022 (123) before decreasing and remaining stable until March 2023 (weekly average 82).
• Between April and June 2023, attendances generally increased with the highest weekly levels in the series observed in June 2023 (142).
• From July 2023 to January 2024, despite large variations in the number of attendances per week, an overall decreasing trend was observed, from an average of 93 in July 2023 to 69 in January 2024.

National update

For the most recent 13-week period (4 March to 2 June 2024):

• 1,032 emergency department attendances were recorded, at an average of 79 per week. This was similar to the previous 13-week period (4 December 2023 to 3 March 2024, 1,010 attendances, weekly average 78).
• Attendances were similar to the same period in 2022 (1,038 attendances, weekly average 80) and 12% lower than in 2023 (1,173 attendances, weekly average 90).

Local update

For the most recent period (4 March to 2 June 2024) the number of emergency department attendances varied across the mainland NHS boards, compared to the previous quarter:

• Attendances increased in four areas: NHS Fife (6%), NHS Lothian (13%), NHS Grampian (20%) and NHS Highland (42%).
• Attendances decreased in four areas: NHS Greater Glasgow and Clyde (6%), NHS Dumfries and Galloway (22%), NHS Ayrshire and Arran (24%) and NHS Borders (30%).
• Attendances were broadly stable in three areas: NHS Forth Valley, NHS Lanarkshire and NHS Tayside.

To analyse further, please visit the RADAR dashboard (external website).

Additional information

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

Due to the quality of the data available, it is not possible to accurately report total attendances for specific conditions using the national Accident and Emergency dataset. The diagnosis or reason for attendance can be recorded in a variety of ways, including in free text fields and not all NHS boards submit this information. The numbers presented in this report are based on an experimental definition of drug-related ED attendances and have not been subject to extensive quality assurance. Therefore, they are provisional and may be subject to change in future releases. Further details can be found in the metadata and the Accident and Emergency Activity Data.

Drug-related acute hospital admissions

Between January and March 2024, 1,906 drug-related hospital admissions were recorded, 11% lower than the previous quarter (2,138). Admissions were 8% lower than the same period in 2022 (2,081) and stable compared to 2023 (1,899).

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 27 December 2021 to 31 March 2024. Data are taken from Public Health Scotland's Scottish Morbidity Record (SMR).

PHS expects to receive SMR data six weeks after the end of the month of discharge/clinic date and therefore the period presented here differs from our other harm indicators. This should be taken into consideration when interpreting trends. For further information, see the data management section on our website.

An interactive version of this chart can be found in the RADAR dashboard (external website). The dashboard also allows users to download the data and filter by NHS board.

The chart shows the number of drug-related hospital admissions in Scotland’s general acute hospitals. The number of admissions is on the y axis and the date, between 27 December 2021 to 31 March 2024, is on the x axis. There was a brief increase in admissions in January 2022, before decreasing until April 2022. Admissions briefly increased again in April and May 2022 (peak of 201 admissions during the week beginning 16 May), before following an uneven decreasing trend from June to December 2022. Admissions increased between January and July 2023, reaching a peak in the week beginning 10 July (223), remaining relatively stable until September before following a decreasing trend until December 2023. Following a brief increase in January 2024, there was a decreasing trend to 31 March 2024.

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Drug-related hospital admissions

A further chart showing the top five drug types associated with admissions is available on the RADAR dashboard (external website).

Summary 

Historic trend 

• There was a brief increase in admissions in January 2022, before decreasing until April 2022. Admissions increased between April and May, before following an uneven decreasing trend between June and December 2022.
  • This decrease should not necessarily solely be interpreted as a reduction in harms. Admissions may have been affected by issues accessing urgent care services and by the capacity of hospital services.
• Admissions then increased, from 119 in the week beginning 26 December 2022, to 223 in the week beginning 10 July 2023. Admissions then remained relatively stable until September 2023, when the trend began to decrease until December 2023.
• Between October to December 2023, the most common drug category recorded was opioids (46% of admissions), followed by cocaine (18%).

National update

For the most recent period (1 January to 31 March 2024):

• 1,906 drug-related hospital admissions were recorded, at an average of 147 per week. This was 11% lower compared to the previous 13-week period (2,138 admissions, weekly average 164).
• Admissions generally decreased throughout this period, from 150 in the week beginning 1 January 2024, to 123 in the week beginning 25 March 2024.
• The total number of admissions was stable compared to 2023 (1,899, weekly average 146) and 8% lower than in 2022 (2,081, weekly average 160).
• Opioids continued to be the most common substance type. These were recorded in an average of 45% of admissions per month, which was broadly consistent over the time series. Admissions recorded for cocaine (20%) were stable compared to the previous quarter (18%).

Local update

For the most recent period (1 January to 31 March 2024), the number of drug-related hospital admissions varied across mainland NHS boards, compared to the previous quarter:

• Admissions increased in two areas: NHS Lanarkshire (5%) and NHS Dumfries and Galloway (27%).
• Admissions decreased in three areas: NHS Ayrshire and Arran (7%), NHS Greater Glasgow and Clyde (14%) and NHS Lothian (17%).
• Admissions were broadly stable in five areas: NHS Borders, NHS Forth Valley, NHS Grampian, NHS Highland and NHS Tayside.

Due to completeness levels for the most recent period being below 90%, NHS Fife has been excluded from the above narrative. The data can be found on our dashboard (external website). Caution is advised when interpreting local trends for this board and comparing to other areas.

Additional information 

These data have been extracted from our Scottish Morbidity Records (SMR01 acute).

The data presented on drug type are based on ICD-10 diagnostic codes and are not confirmed by toxicology analysis, therefore patterns in substance type should be interpreted with caution.

The most recent accredited official statistics on drug-related hospital care, includes a range of further information on drug types and patient demographics. For details, see our information on drug-related hospital statistics (DRHS). Please note, our DRHS dashboard presents data by date of discharge, so figures will differ to those shown above.

Suspected drug deaths

In the latest period (4 March to 26 May 2024), the total number of suspected drug deaths was 267, averaging 22 per week. The average weekly number of deaths decreased between March (26) and May (23). The total 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).

Background

A suspected drug death is a death where controlled drugs are suspected of being involved. Suspected drug-death figures are based on reports, observations and initial enquiries 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 those published by the National Records of Scotland (NRS: external website) 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 28 February 2022 to 26 May 2024.

An interactive version of this chart can be found in the RADAR dashboard (external website). The dashboard also allows users to download the data.

The chart shows the weekly number of suspected drug deaths in Scotland on the y axis and the date, between 28 February 2022 to 26 May 2024, on the x axis. Between March 2022 and the end of May 2024, the average weekly number of deaths fluctuated considerably but generally remained within a range of 18 to 28 deaths per week.

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Suspected drug deaths

Summary 

Historic trend 

• Between March 2022 and February 2024, the average weekly number of suspected drug deaths fluctuated considerably but generally remained within a range of 18 to 28 deaths per week.

Update 

For the most recent complete months (1 March to 31 May 2024):

• There were 291 suspected drug deaths, 116 in March, 77 in April and 98 in May.

For the most recent period (4 March to 26 May 2024):

• There were 267 suspected drug deaths, 8% lower than in the previous 12-week period (291). This was 6% lower than the same period in 2022 (283) and 11% lower than in 2023 (300).
• The average weekly number of deaths decreased sharply from March (26) to April (18) and increased in May (23).
• An average of 22 deaths were recorded per week. This was 9% lower than in the previous period (24), 9% lower than in the same period in 2022 (24) and 14% lower than in 2023 (25).

To analyse these data further, please visit the RADAR dashboard (external website).

Additional information

Data on suspected drug deaths are provided by Police Scotland.

The Scottish Government produce a quarterly report (Suspected drug deaths in Scotland (external website)) 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.

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

Accredited official statistics on drug-related deaths are published annually by the NRS during the summer and provide information broken down by age, sex, substance implicated and geographical area. The latest NRS publication (external website) reported that there were 1,051 drug-related deaths in Scotland in 2022. This was a 21% decrease compared to 2021 (1,330). Data for 2023 is due to be published on 20 August 2024.

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.

Toxicology indicators

Emergency department toxicology: ASSIST

Between March and May 2024, the ‘A Surveillance Study of Illicit Substance Toxicity’ (ASSIST) emergency department project made 563 detections of 43 different illicit drugs, in samples from 116 patients. The most commonly detected drug category was depressants (60% of detections), followed by stimulants (17%). The most commonly detected individual drug was cocaine (13%), followed by temazepam (10%) and desmethyldiazepam (9%).

Background

The ASSIST study is conducted by the emergency department (ED) at the Queen Elizabeth University Hospital (QEUH) in NHS Greater Glasgow and Clyde (GGC). This project has been funded by the Scottish Government since August 2022.

The aim of the study is to monitor drug trends and associated clinical features through the use of prospective surveillance of ED attendances due to acute illicit drug toxicity. For the most unwell patients, the study performs full toxicological analysis through the biorepository-approved surplus sampling.

The study allows drug profiling and the identification of emerging drugs or changing trends to inform appropriate harm reduction measures and public health responses.

Data collection

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. Surplus serum samples are leftover blood samples, which were taken as part of usual care.

Each ED attendance is counted once in these data. If the same person presented more than once, each attendance would be a separate data point.

Drug detections presented here are of ‘illicit drugs’ only and were not prescribed to the individual.

Illicit drug definition

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 (e.g. if methadone is detected but the individual is prescribed methadone, it will not be included)
• drugs administered to the individual as part of treatment (by ambulance staff or in hospital).

Toxicology analysis of surplus serum samples

Detections presented are for the substance only. If a metabolite (compound produced when a drug breaks down in the body) 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.

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

Data from the study are presented in quarters, based on the date of ED presentation, and are provided in the table below.

Results

The first chart shows the most common drug categories detected in toxicology analysis of surplus serum samples between 17 August 2022 and 16 May 2024 (Q1 to Q7).

The results are shown as the total number of detections. They are broken down by the top five drug categories and presented by study quarter.

This stacked bar chart shows the percentage of detections of drug types within QEUH ED across seven quarters - Q1 to Q7. The drugs are grouped into five categories (depressant, opioid, stimulant, cannabinoid and other (including dissociative and psychedelic drugs)). Percentage of detections by category is on the y axis and the time period is on the x axis. The most common category was depressants with 57%, 62%, 60%, 64%, 66%, 67% and 60% across the time series. The second most common across quarters 1 to 6 was opioids with 17%, 18%, 16%, 16%, 15% and 13% across the time series and in quarter 7, stimulants (17%).

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ASSIST hospital toxicology analysis: drug categories by study quarter

Summary

Historic trend

Between 17 August 2022 and 16 February 2024:

• The most commonly detected drug type was depressants, making up 63% of all detections, followed by opioids (16%). The most commonly detected individual drug was cocaine (11%).
• 72% of attendances were male and 28% were female.
• 76% of attendances were aged 44 and under. The most common age category was 25 to 34 years (29%), followed by 35 to 44 (28%) and 16 to 24 (19%).
• The most common outcomes were discharged to home (40%), ward (28%) and police custody (12%).

Update

For the most recent period (17 February to 16 May 2024):

• 297 individual ED attendances related to illicit drug use were identified.
• 116 surplus serum samples were analysed for toxicology (as they were categorised as having a higher clinical severity of toxicity as per research inclusion criteria).

Drug type and category

Among the 116 samples analysed:

• There were 563 detections of 43 individual substances (found through the biological detection of the drug or its metabolite).
• The average number of drugs detected per sample was five.

Of the 563 detections, the following drugs were the most common:

• cocaine: 75 (13% of detections, 65% of samples)
• temazepam: 54 (10% of detections, 47% of samples)
• desmethyldiazepam: 53 (9% of detections, 46% of samples)
• etizolam: 41 (7% of detections, 35% of samples)
• bromazolam: 38 (7% of detections, 33% of samples)
• diazepam: 29 (5% of detections, 25% of samples)
• oxazepam: 29 (5% of detections, 25% of samples)
• pregabalin: 29 (5% of detections, 25% of samples)
• morphine: 22 (4% of detections, 19% of samples)
• cannabis (tetrahydrocannabinol): 21 (4% of detections, 18% of samples)

Please note: desmethyldiazepam, temazepam and oxazepam are all benzodiazepine drugs but can also be found as a metabolite of diazepam and other benzodiazepines.

The chart below shows the most common depressant drug detected in toxicology analysis of surplus serum samples between 17 August 2022 and 16 May 2024 (Q1 to Q7). The percentages are of all detections.

This line chart shows the percentage of detections of specific depressant drugs within QEUH ED across seven quarters - Q1 to Q7. Percentage of detections is on the y axis and the time period is on the x axis. The most common depressant drug in Q1, Q2, Q5, Q6 and Q7 was desmethyldiazepam (Q1; 10%, Q2; 8%, Q5; 11%, Q6; 10%); Q7: 9%). The most common depressant drug in Q4 was bromazolam (Q4; 10%). This was the fourth quarter in which xylazine was detected.

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ASSIST hospital toxicology analysis: depressant drugs by study quarter

Depressants were the most common drug category, making up 60% of detections (338).

• Benzodiazepines were detected 291 times (52% of all detections):
  • In total, 16 different types of benzodiazepines were detected, including temazepam (10%), desmethyldiazepam (9%), etizolam (7%), clonazolam (3%), gidazepam (2%) and flubromazepam (2%).
  • Bromazolam made up 7% of all detections, down from 10% in Q6.
• Gabapentinoids were detected 40 times (7% of all detections, from 6% in Q6). Of these detections, 11 were gabapentin and 29 were pregabalin.
• There were four detections of xylazine (1%), the same as in the previous quarter.

Stimulants were the second most common drug category, making up 17% of detections (93).

• The most common stimulant was cocaine, making up 13% of detections (75).

Opioids were the third most common drug category, making up 14% of detections (90).

• There were 23 detections of heroin/morphine (4%), 15 for methadone (3%) and 11 for codeine (2%).
• There were six detections of nitazenes (1%), down from eight detections in the previous quarter.

This line chart shows the percentage of detections of specific opioid drugs within QEUH ED across seven quarters - Q1 to Q7. Percentage of detections is on the y axis and the time period is on the x axis. The most common opioid drug across the time series was heroin/morphine (Q1: 4%, Q2: 5%, Q3: 6%, Q4: 5%, Q5: 5%, Q6; 4% and Q7; 4%). Nitazenes were detected for the first time in Q4 (seven detections) and increased to 2% of detections (16 detections) in Q5. They were detected 8 times in Q6 and 6 times in Q7. Detections of noscapine decreased from 3% in Q1 to 0 in Q5 and increased to 1% in Q6 and 2% in Q7.

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ASSIST hospital toxicology analysis: opioid drugs by study quarter

Further findings

Complete clinical data were available for 297 attendances for the most recent period (17 February to 16 May 2024):

• 72% of attendees were male (213) and 28% were female (84).
• 19% (57) of attendees were aged 16 to 24 years and 25% (74) were aged 25 to 34.
• 55% of attendees were aged 35 years and over, with 34% (101) aged 35 to 44, 15% (44) aged 45 to 54 and 6% (18) aged 55 years or older. Age was unknown for three attendances.

This stacked bar chart shows the percentage of QEUH ED ASSIST attendees by age group across seven time periods - Q1 to Q7. Percentage of attendees is on the y axis and the time period is along the x axis. The most common age group in Q1, Q2 and Q4 was 25 to 34 years (34%, 34% and 29% respectively). In Q3, patients aged 25 to 34 years and 35 to 44 were equally common (both 29%). The most common age group in Q5, Q6 and Q6 was 35 to 44 years (30%, 34% and 34% respectively).

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Attendances by age

ED outcome records show:

• 96 (32%) patients were admitted to a ward – this is the highest proportion observed throughout the study (quarterly average – 28%)
• 94 (32%) patients were discharged home
• 42 (14%) were taken into police custody
• 37 (9%) self-discharged
• 14 (6%) were admitted to an intensive care unit, high-dependency unit, critical care unit or died
• 14 were recorded as ‘unknown’ or ‘other’.

Clinical severity outcome (after 28 days) recorded:

• 278 (94%) patients were discharged following the attendance
• five patients either died or remained an inpatient following the attendance
• outcomes for 14 patients were ‘unknown’.

Additional information

Public Health Scotland (PHS) was provided with these data by QEUH, NHS 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 (external website). 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 (external website).

Post-mortem toxicology testing for controlled substances

In Q1 of 2024, the most common drug types detected in post-mortem toxicology were opioids (72%) and benzodiazepines (60%). The percentage of deaths where cocaine was detected remained stable (36%). It continued to be the most commonly detected individual substance, followed by heroin/morphine (31%), diazepam (30%) and methadone (28%).

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, the COPFS commissions post-mortem toxicology and pathology services.

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.

Post-mortem toxicology testing is carried out by two services in Scotland:

• The Scottish Police Authority Forensic Services (SPA FS) covers deaths occurring in the west, east and parts of the north of Scotland.
• The Department of Clinical Biochemistry at NHS Grampian covers deaths in the far north and north-east of Scotland.

This report presents data on deaths covering the whole of Scotland, which became available from January 2022. It includes new data for the period from 1 January to 31 March 2024, representing Q1 of 2024.

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.

The charts below show the prevalence of controlled substances detected in deaths which were subject to post-mortem toxicology screening. Drug detections were assigned to specific time periods based on the calendar year quarter of death. Throughout the series, the sum of the percentages for each quarter exceeds 100%, due to the widespread detection of multiple substances in deaths (multiple controlled drugs were detected in 95% of deaths in Q1 of 2024).

The first chart below provides an indication of controlled drugs detected at post-mortem, in deaths occurring between 1 January 2022 and 31 March 2024.

The chart shows the percentage of forensic toxicology cases testing positive for controlled substances (opioids, benzodiazepines, gabapentin and pregabalin, cocaine). The percentage of cases is on the y axis and the calendar year and quarter of death, between Q1 of 2022 and Q1 of 2024 is on the x axis. The most commonly detected drug types were opioids and benzodiazepines. The percentage of deaths where opioids, benzodiazepines, and gabapentin and pregabalin were detected has remained relatively stable throughout the time series averaging 71% for opioids, 58% for benzodiazepines and 31% for gabapentin and pregabalin. The percentage of deaths where cocaine was detected was relatively stable until Q1 of 2023 (averaging 29%). Detections increased to 36% in Q2 of 2023, after which they remained stable.

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Forensic toxicology cases testing positive for controlled substances

The following charts provide an indication of specific opioids and benzodiazepines detected at post-mortem, in deaths occurring between 1 January 2022 and 31 March 2024.

The chart shows the percentage of forensic toxicology cases testing positive for specific opioids (heroin/morphine, fentanyls, methadone, buprenorphine and nitazenes). The percentage of cases is on the y axis and the calendar year and quarter of death, between Q1 of 2022 and Q1 of 2024 is on the x axis. Heroin/morphine has been the most commonly detected opioid throughout the series; however, detections have been gradually decreasing from 36% in Q1 of 2022 to 31% in Q1 of 2024. Methadone detections decreased to 23% in Q3 of 2022 (from 32% in Q1 of 2022). Since then, methadone detections have increased slightly to 28% in Q1 of 2024. Deaths with buprenorphine present remained relatively low and stable throughout the time series (averaging 5%). There was a gradual increase in the percentage of cases where fentanyl-type opioids were detected, from 1% in Q1 of 2022, to 7% in Q4 of 2023. Nitazene-type opioid substances were first detected in Q1 of 2022 and, have continued to increase, being detected in 4% of deaths in Q1 of 2024.

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Forensic toxicology cases testing positive for specific opioids

The chart shows the percentage of forensic toxicology cases testing positive for specific benzodiazepines (diazepam, etizolam, clonazolam and bromazolam). The percentage of cases is on the y axis and the calendar year and quarter of death, between Q1 of 2022 and Q1 of 2024 is on the x axis. Diazepam has been the most commonly detected benzodiazepine since Q2 of 2022. Since then, detections have fluctuated between 25% and 35%. Bromazolam detections increased sharply between Q3 of 2022 (1%) and Q3 of 2023 (24%). Detections of bromazolam then decreased to 20% in Q1 of 2024. Etizolam was the most common benzodiazepine detected in Q1 of 2022 (31%), after which detections have followed a decreasing trend to 7% of deaths in Q1 of 2024. The percentage of temazepam detections have remained broadly stable throughout the time series, detected in an average of 8% of deaths. Clonazolam detections remained low and stable throughout the time series, detected in an average of 2% of deaths.

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Forensic toxicology cases testing positive for specific benzodiazepines

Summary

• The most commonly detected drug types were opioids and benzodiazepines, averaging 71% and 58% respectively between January 2022 to March 2024.
• The most commonly detected individual drug in the last year was cocaine (averaging 36%). Before Q2 of 2023, the most common individual drug was heroin/morphine.
• Multiple controlled drugs were detected in 662 of 694 deaths (95%) in Q1 of 2024.
• The following drugs or drug types were the most commonly detected in deaths in Q1 of 2024:
  • opioids: 499 (72%)
  • benzodiazepines: 418 (60%)
  • cocaine: 248 (36%)
  • heroin/morphine: 214 (31%)
  • diazepam: 209 (30%)
  • gabapentin and pregabalin: 198 (29%)
  • methadone: 197 (28%)
  • codeine: 155 (22%)

Stimulants

• For the fourth quarter in a row, the most commonly detected drug was cocaine.
• The percentage of deaths where cocaine was detected was relatively stable until Q1 of 2023 (averaging 29%). Detections increased in Q2 of 2023 to 36% and have remained stable since.

Opioids

• The percentage of deaths where opioids were detected has remained relatively stable throughout the time series, averaging 71%.
• Heroin/morphine detections have been gradually decreasing from 36% in Q1 of 2022 to 31% in Q1 of 2024.
• Methadone detections decreased from 32% in Q1 2022 to 23% in Q3 of 2022. Since then, detections have increased slightly (28% in Q1 of 2024).
• Buprenorphine detections remained low and stable throughout the time series, detected in an average of 5% of deaths.
• Fentanyl-type opioid detections increased, from 1% in Q1 of 2022 to 6% in Q1 of 2023. Since then, detections have remained stable averaging 5% in the last four quarters.
• Nitazene-type opioid detections increased, from 2% of deaths (12) in Q4 of 2023 to 4% (25) in Q1 of 2024. Metonitazene was the most common nitazene detected, followed by protonitazene. Two nitazenes were detected in 17 deaths.

Depressants

• Benzodiazepines have remained broadly stable throughout the time series, detected in an average of 58% of deaths.
• Diazepam has been the most commonly detected benzodiazepine since Q2 of 2022. Since then, detections have fluctuated between 25% and 35%.
• Detections of bromazolam increased sharply between Q3 of 2022 and Q3 of 2023, replacing etizolam as the most commonly detected ‘street’ benzodiazepine from Q1 of 2023 onwards. Bromazolam was detected in 20% of deaths in Q1 of 2024.
• Etizolam was the most common benzodiazepine detected in Q1 of 2022, after which detections have followed a decreasing trend to 7% of deaths in Q1 of 2024.
• The percentage of temazepam detections have remained broadly stable throughout the series, detected in an average of 8% of deaths.
• Clonazolam detections remained low and stable throughout the series, detected in an average of 1% of deaths.
• Several other novel benzodiazepines were detected in deaths. Of note is gidazepam, which increased from <1% of deaths (6) in Q4 of 2023 to 1% of deaths (8) in Q1 of 2024.
• The percentage of deaths involving gabapentin and pregabalin has been relatively stable throughout the series, averaging 31%.
• Xylazine (detected for the first time in Q3 of 2023) detections increased, from <1% (3) in Q4 of 2023 to 1% of deaths (10) in Q1 of 2024.

More detailed descriptions of historical changes can be found within our previous reports.

Additional information

PHS was provided with post-mortem toxicology testing data for deaths occurring in the west, east and parts of the north of Scotland by Forensic Medicine and Science at the University of Glasgow and SPA FS.

In late 2022, post-mortem toxicology services for the west, east and parts of the north of Scotland were transferred from the University of Glasgow to the Scottish Police Authority Forensic Services (SPA FS). During the period of transition, tests were completed by other laboratory testing sites in the UK. Although testing has now been moved to SPA FS, these testing sites continued to provide support in 2023 and data from both SPA FS and outsourced sites have been included in this report.

Data on deaths occurring in the far north and north-east of Scotland, was supplied by the Department of Clinical Biochemistry at NHS Grampian.

The total number of deaths testing positive for controlled substances, for each calendar year and quarter, are provided in table 1.

A number of drugs were detected for the first time when screening was expanded or testing was outsourced to other laboratories. Table 2 provides information on the initial screening period new or emerging substances, from which limited testing data was available, and also when testing is considered to have become routine across Scotland.

Note that 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 new or emerging drugs are added to routine toxicology screening by the SPA FS and NHS Grampian.

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.

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 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.

Additionally, it is important to note that small numbers of detections for specific substances may result in large percentage differences between quarters. Where it is felt that data should be interpreted with caution due to small numbers, the number of detections has also been provided for context.

As some of the data received from other laboratory testing sites 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.

Similarly, as date of death was unavailable for those tests conducted by the Department of Clinical Biochemistry at NHS Grampian, the date when the case was received from the Crown Office and Procurator Fiscal Service has been used instead.

These 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.

Drug seizures in Scottish prisons

The Scottish Prisons Non-Judicial Drug Monitoring Project is a collaboration between the Scottish Prison Service and the Leverhulme Research Centre for Forensic Science at the University of Dundee (external website). The 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'.

Analysis of the drug seizures in Scottish prisons from August 2023 to April 2024 is ongoing and not all data can be included in this report. We anticipate the updated data will be available for the next release in October 2024.

Since the last quarterly report, we have received data for a limited number of samples for the latest period (1 November 2023 to 30 April 2024):

• 23 samples were tested and contained an illegal substance.
• Synthetic cannabinoids were the most prevalent drug type. They were detected in 11 samples, with seven samples containing two cannabinoids.
• MDMB-4en-PINACA was the most common synthetic cannabinoid (9 detections), followed by MDMB-INACA (6).
• In the latest period, one sample contained a benzodiazepine (bromazolam). Please note that due to the limited number of samples received for testing since August 2023, these detections do not fully represent all benzodiazepine seizures within this reporting period.
• The most common sample type was powder (16 samples).

Complete data to July 2023 are available in a previous quarterly report.

Service indicators

Specialist drug treatment referrals

Between February and May 2024, the average weekly number of referrals to specialist drug treatment services was stable. A total of 5,556 referrals were recorded, similar to the previous quarter (5,494). This was similar to the same period in 2022 (5,594) and 5% lower than in 2023 (5,855).

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 drug treatment services in Scotland between 14 February 2022 and 19 May 2024.

An interactive version of this chart can be found in the RADAR dashboard (external website). The dashboard also allows users to download the data and filter by NHS board.

This chart shows the number of referrals to drug treatment services in Scotland on the y axis and the date, between 14 February 2022 and 19 May 2024, on the x axis. In December and January each year, a seasonal reduction in referrals occurs. 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 441 per week in January 2023. A relatively stable trend was evident in 2023, with referrals ranging between 166 and 517 per week. After the seasonal reduction in December 2023, the average weekly number of referrals ranged from 261 to 515 up to February 2024, followed by a fluctuating but gradual decrease to May 2024.

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Specialist drug treatment referrals

Summary

Historic trend

• Throughout 2022, there was a fluctuating, but gradual, decrease in the average weekly number of referrals.
• Following the seasonal reduction in December 2022, referrals returned to a weekly average of 441 per week in January 2023.
• In 2023, the average was 454 referrals per week, ranging between 166 and 517.
• Following the seasonal reduction in December 2023, the average weekly number of referrals ranged from 261 to 515 up to February 2024.

National update

For the most recent 13-week period (19 February to 13 May 2024):

• The average number of referrals ranged from 306 to 497 per week.
• 5,556 specialist drug treatment referrals were recorded, at an average of 427 per week. This was broadly similar to the previous 13-week period (20 November 2023 to 18 February 2024) when 5,494 referrals were recorded, at an average of 423 per week.
• The number of referrals was also broadly similar to the same time period in 2022 (5,594) and 5% lower than in 2023 (5,855).

Local update

Comparing the weekly number of referrals in mainland NHS boards between the most recent and the previous quarter:

• Referrals increased in three areas: NHS Fife (5%), NHS Greater Glasgow and Clyde (6%) and NHS Tayside (11%).
• Referrals decreased in three areas: NHS Borders (5%), NHS Highland (5%) and NHS Dumfries and Galloway (8%).
• Referrals were broadly stable in five areas: NHS Ayrshire and Arran, NHS Forth Valley, NHS Grampian, NHS Lanarkshire and NHS Lothian.

To analyse these data further, please visit the RADAR dashboard (external website).

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.

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 drug and alcohol treatment waiting times report which also includes a new interactive drug and alcohol treatment waiting times dashboard (external website).

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 website (external website).

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

Opioid substitution therapy

From January to March 2024, the average number of opioid substitution therapy (OST) doses supplied per month was stable compared to the 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 the number of injectable buprenorphine doses 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 administered 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 2022 and 31 March 2024.

The stacked area chart shows the three-month rolling average number of doses supplied for OST medications in the community between January 2022 and March 2024. The number of doses is on the y axis and the month is on the x axis. There was a gradual decrease in the average monthly total number of OST doses supplied over the time series, which is likely associated with a decreasing trend in the number of methadone doses supplied.

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Average total number of OST doses per month

The chart below shows trends in the monthly number of ADQ doses supplied for specific OST medications in the community between 1 January 2022 and 31 March 2024.

The chart shows monthly trends in the number of doses supplied for specific OST medications in the community between January 2022 and March 2024. The number of doses per month is on the y axis and the month is on the x axis. Methadone was the most commonly prescribed, following a gradual decrease since January 2022, approximately 485,000 doses per month between January and March 2024. The average total number of injectable buprenorphine doses supplied has increased steadily since it was first licensed for use in Scotland in early 2020. Approximately 84,000 injectable buprenorphine doses were supplied between January and March 2022, increasing to approximately 120,000 per month between January and March 2024, making it more common than oral buprenorphine since August 2023. The average monthly number of oral buprenorphine doses supplied was roughly stable, ranging between approximately 114,000 and 120,000 oral buprenorphine doses prescribed per month across the time period.

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Number of doses per month for OST medications

Summary

Historic trend

• There was a gradual decrease in the average monthly total number of OST doses supplied. This was likely associated with the decrease in the average monthly number of methadone doses supplied, which reduced by 17%, from 594,600 between January and March 2022, to 493,100 between October and December 2023.
• Injectable buprenorphine was first licensed for use in Scotland in early 2020. The average monthly number of doses supplied increased more than two-fold, from 53,900 between January and March 2022, to 122,800 between October and December 2023.
• The average monthly number of oral buprenorphine doses supplied was broadly stable between January and March 2022 (121,200) and October and December 2023 (116,100).

Update

Data from PHS's Prescribing Information System was subject to a delay in recent RADAR reports. This has now been rectified and data are available approximately three months in arrears. Data for all medications have now been successfully validated for all months up to March 2024. We anticipate that data for April to June will be available for the next release of this report in October 2024.

For the most recent period (1 January to 31 March 2024):

• The average total monthly number of OST doses supplied was approximately 722,000, similar to the previous quarter (October to December 2023; 732,000 doses). This was a decrease of 6% compared to the same period in 2022 and similar to 2023.
• The average monthly number of methadone doses supplied was approximately 484,700. Equivalent figures for oral buprenorphine and injectable buprenorphine were 117,200 and 119,600, respectively.
• The number of methadone doses was similar to the previous quarter, 17% lower than the same period in 2022 and 11% lower than in 2023.
• The number of oral buprenorphine doses was similar to the previous quarter, and the same periods in 2022 and 2023.
• The number of injectable buprenorphine doses was similar to the previous quarter, 122% higher than the same period in 2022 and 36% higher than in 2023.

Additional information

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

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, visit the RADAR dashboard (external website).

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 Management group. The ADQs agreed are:

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

Glossary

For detailed definitions on the terms used above, visit the RADAR dashboard (external website).

Injecting equipment provision

Between January and March 2024, the average weekly number of injecting equipment provision (IEP) transactions increased by 13% and the average weekly number of needles and syringes distributed remained relatively stable. 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.

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 chart below shows the weekly number of IEP transactions in Scotland from 3 January 2022 to 31 March 2024.

An interactive version of this chart can be found in the RADAR dashboard (external website). The dashboard also allows users to download the data and filter by NHS board.

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 3 January 2022 and 31 March 2024, is on the x axis. In December and January each year, a seasonal reduction in transactions is observed. Between February 2022 and November 2022, the number of transactions varied but was broadly stable between 2,600 and 3,400 per week. After the seasonal reduction in January 2023, the number of transactions fluctuated until the end of June 2023, following an overall increasing trend. Between July and November 2023, the number of transactions was stable between 2,850 and 3,250 per week. After the seasonal reduction in December 2023, the number of transactions followed a decreasing trend from 3,025 in the week beginning 5 February, to 2,643 in the week beginning 25 March.

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Injecting equipment provision: transactions

Further charts showing the weekly number of needles and syringes distributed, and the ratio of needles and syringes per transaction, are available on the RADAR dashboard (external website).

Summary

Historic trend

• The average number of transactions (approximately 2,900 per week) and the number of needles and syringes distributed (approximately 37,000 per week) remained broadly stable from February 2022 to December 2023, with seasonal fluctuations during December and January each year.
• The ratio of needles and syringes distributed was stable between February 2022 to December 2023, at an average of 14.0 needles and syringes distributed per transaction.

National update

For the most recent period (1 January to 31 March 2024):

IEP transactions

• 35,182 transactions were recorded, at an average of 2,706 per week.
• This was 8% lower than the previous quarter (2 October to 31 December 2023) when a total of 38,221 transactions were recorded (weekly average 2,940).
• The number of transactions was 6% lower than the same period in 2022 (37,589, weekly average 2,891) and similar to 2023 (35,667, weekly average 2,744).

Needles and syringes distributed

• 480,461 needles and syringes were distributed, at an average of 36,959 per week.
• This was similar to the previous period when a total of 471,780 needles and syringes were distributed, at an average of 36,291 per week.
• The number of needles and syringes distributed was similar to the same period in 2022 (475,475, weekly average 36,575) and 2023 (484,967, weekly average 37,305).

Ratio of needles and syringes distributed

• There was a weekly average of 15.0 needles and syringes distributed per transaction.
• This was higher than in the previous quarter (13.3), higher than in the same period in 2022 (14.0) and similar to the same period in 2023 (14.8).

Local update

For the most recent period, the ratio of needles and syringes distributed per transaction varied across mainland NHS boards, compared to the previous period:

• The ratio increased in four areas: NHS Grampian (8%, ratio 20.4), NHS Lothian (11%; ratio 25.0), NHS Greater Glasgow and Clyde (22%; ratio 10.5) and NHS Dumfries and Galloway (30%; ratio 8.7).
• The ratio decreased in four areas: NHS Ayrshire and Arran (6%; ratio 18.1), NHS Tayside (9%; ratio 16.2), NHS Forth Valley (18%; ratio 18.7) and NHS Borders (27%; ratio 14.3).
• The ratio was stable in NHS Lanarkshire (ratio 14.6).

To analyse these data further, please visit the RADAR dashboard (external website). 

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 details of injecting equipment providers in your area, visit the Scottish Needle Exchange Directory (external website).

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 new 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

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