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.

Close

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.

Close

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.

Close

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.

Close

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).