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

Police drug trends bulletin

This bulletin contains photos of drugs.

This update provides information on detections of street benzodiazepines and new synthetic opioids.

This information has been provided by Police Scotland’s Statement of Opinion (STOP) Unit to raise awareness of drug appearance and to demonstrate some of the substances present in Scotland’s drugs market.

Street benzos

'Street benzos' is a term used to describe benzodiazepines that are unlicensed or illicitly produced.

The most commonly encountered street benzo is white and stamped '10', with a half score on the reverse.

Historically, the most commonly detected active ingredient contained within street benzodiazepine tablets was etizolam. Etizolam still features highly, but the trend has shifted with bromazolam now found to feature in the majority of tablets sent for analysis.

Bromazolam is a class C controlled drug within the provisions of the Misuse of Drugs Act 1971.

Police Scotland has also noticed the re-emergence of 'baby blues' – small, circular, light blue tablets stamped with 'MSJ', as per the image below.

Street benzodiazepines will continue to be monitored via Operation Borzoi and any new tablet markings identified will be captured for circulation.

New synthetic opioids

The above was provided to the STOP Unit West via the Scottish Police Authority Forensics Services laboratory. These are paper tabs which were found to contain metonitazene.

Metonitazene is a potent new synthetic opioid (NSO). The supply and importation of metonitazene is controlled by the Psychoactive Substances Act 2016, but it will soon be a class A controlled drug within the provisions of the Misuse of Drugs Act 1971.

The person in possession of these tabs believed them to contain etizolam (benzodiazepine) and was unaware of the presence of metonitazene. This is the first time the STOP Unit have encountered metonitazene in this form.

RADAR intelligence and reports

36 reports were validated by RADAR between 5 July and 4 October 2023. A summary of reports is shown below for information.

Trends by primary drug type

The majority of submissions report polydrug use – the use of more than one substance at a time.

In the latest time period (5 July to 4 October 2023):

• Benzodiazepines were the most commonly reported drug of concern in 33% of reports. This was similar to the 35% quarterly average reported between July 2022 and June 2023.
• Cocaine was reported as the primary drug in 14% of reports, a decrease on the 22% average between July 2022 and June 2023.
• Heroin was reported as the primary drug in 14% of reports, an increase on the 3% average between July 2022 and June 2023.
• There was an increase in reports of nitazenes in Scotland and across the wider UK during this quarter, to 14%, up from an average of 4% between July 2022 and June 2023.

Drug harm reports to RADAR

Shown below are 36 reports of drug harms received by RADAR between 5 July and 4 October 2023.

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

So far, RADAR has validated over 120 reports of drug-related information and harms received through the reporting form and mailbox. Reports validated prior to 5 July 2023 are shown in previous quarterly reports.

Reporting drug harms

The information in the regional breakdown can be used by local areas for their own drug-trend surveillance. Please encourage people and services in your area to share information on trends, incidents and harms related to drugs, such as:

• adverse effects including overdose
• routes of administration
• new substances or patterns of use
• testing data.

Anyone can make a report by using our reporting form or by emailing phs.drugsradar@phs.scot  

Naloxone administration by Scottish Ambulance Service

The average weekly number of naloxone administration incidents increased between June (89) and August 2023 (95). The total number of incidents during this time period (1,298) was 26% higher than in the previous time period (1,033). The number of incidents was 20% lower than the same period in 2021 (1,631) and 22% higher than in 2022 (1,062).

Background

Naloxone is a medicine used to prevent fatal opioid overdoses. These data relate to the number of incidents in which naloxone was administered by Scottish Ambulance Service (SAS) clinicians.

While these data count multiple overdose patients at the same incident separately, multiple naloxone administrations to the same patient at the same incident are not counted separately.

The chart below shows the weekly number of SAS naloxone administration incidents from 31 May 2021 to 3 September 2023.

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 31 May 2021 and 3 September 2023, is on the x axis. An increasing trend was observed between June and July 2021 where the number of weekly incidents peaked (136). Following this period, an uneven decreasing trend was observed until April 2022, when an isolated increase was recorded. The number of naloxone incidents followed a gradual decreasing trend from May to December 2022, after which an increasing trend was observed to August 2023.

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Naloxone administration by Scottish Ambulance Service

Summary

Historic trend

• Until winter 2021/22, the average weekly number of SAS naloxone administration incidents was similar to previous years, which have generally been characterised by lower numbers of incidents during winter months and higher numbers during summer months.
• In spring 2022, the trend diverged from previous years and, despite an increase in April, followed a gradual decreasing trend from May to December 2022.
• An increasing trend in the average weekly number of incidents was observed from January (60) to the end of May 2023 (79).

National update

For the most recent time period (29 May to 3 September 2023):

• 1,298 SAS naloxone incidents were recorded, at an average of 93 per week. Weekly numbers of incidents generally increased throughout this period.
• The total number of incidents was 26% higher than in the previous 14-week period (20 February to 28 May 2023) when 1,033 incidents were recorded, at an average of 74 per week.
• The total number of incidents was 20% lower than the same time period in 2021 (1,631, weekly average 117) and 22% higher than in 2022 (1,062, weekly average 76).

Local update

For the most recent time period (29 May to 3 September 2023), the number of naloxone administration incidents varied across mainland NHS Boards, compared to the previous time period:

• Incidents increased in eight areas: NHS Ayrshire and Arran (15%), NHS Fife (18%), NHS Grampian (18%), NHS Borders (20%), NHS Greater Glasgow and Clyde (29%), NHS Lothian (45%), NHS Highland (51%) and NHS Lanarkshire (63%).
• Incidents decreased in NHS Dumfries and Galloway (33%).
• Incidents were broadly stable in the remaining NHS Boards.

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 June and August 2023, drug-related attendances at emergency departments increased by 13%, compared to the previous time period. A total of 1,403 attendances were recorded in this period – similar to the same time period in 2021 (1,433) and 22% higher than in 2022 (1,149).

Background

A drug-related emergency department (ED) attendance is an attendance for a drug intoxication or overdose, either alone or combined with alcohol intoxication.

The chart below shows the weekly number of drug-related ED attendances between 31 May 2021 and 28 August 2023.

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 in Scotland. The number of attendances is on the y axis and the date, between 31 May 2021 and 28 August 2023, is on the x axis. An overall decreasing trend was observed from August 2021 to April 2022, with the lowest levels in the week beginning 4 April (53). Attendances then increased sharply, peaking at 123 in the week beginning 16 May. 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 before a peak of 142 in the week beginning 19 June. Attendances in July and August fluctuated between 86 and 119 per week.

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Drug-related attendances at emergency departments

Summary

Historic trend

• An overall decreasing trend was observed in drug-related attendances at EDs between August 2021 and April 2022, with the lowest weekly levels in the time series observed in the week beginning 4 April (53).
• Drug-related ED attendances increased sharply and peaked in May 2022, to 123 in the week beginning 16 May.
• Attendances then decreased and remained stable, averaging 83 per week from June 2022 to March 2023.

National update

For the most recent time period (29 May to 3 September 2023):

• 1,403 ED attendances were recorded, at an average of 100 per week. This was 13% higher than the previous 14-week period (20 February to 28 May 2023, 1,244, weekly average 89).
• Attendances were similar to 2021 (1,433, weekly average 102) and 22% higher compared to the same time period in 2022 (1,149, weekly average 82).

Local update

• For the most recent time period (29 May to 3 September 2023), the number of drug-related ED attendances varied across mainland NHS Boards, compared to the previous time period:
  • Attendances increased in eight areas: NHS Greater Glasgow and Clyde (11%), NHS Dumfries and Galloway (13%), NHS Lothian (16%), NHS Lanarkshire (26%), NHS Fife (29%), NHS Highland (31%), NHS Borders (33%) and NHS Forth Valley (45%).
  • Attendances decreased in two areas: NHS Ayrshire and Arran (6%) and NHS Tayside (10%).
  • Attendances were broadly stable in NHS Grampian.

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

Additional information

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

Diagnosis and reason for attendance can be recorded in a variety of ways, including in free text fields. Therefore, the numbers presented in this report only give a high-level indication of attendances over time.

Drug-related acute hospital admissions

The average weekly number of drug-related hospital admissions increased between April (695) and June 2023 (905). The total number of admissions in this time period (2,378) was 26% higher than in the previous time period (1,886). The number of admissions was 28% lower than the same time period in 2021 (3,287) and 6% higher than in 2022 (2,242).

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 29 March 2021 to 2 July 2023.

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 29 March 2021 to 2 July 2023, is on the x axis. Following a long-term-decreasing trend from June 2021 to April 2022, admissions briefly increased in April and May 2022 (peak of 200 admissions during the week beginning 16 May), before decreasing again in June 2022 and following an overall decrease until December 2022. Admissions increased between January and June 2023. More than 200 admissions per week were recorded in the weeks beginning 3 April (208), 15 May (203) and 22 May (207).

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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 long-term decreasing trend in the weekly number of drug-related hospital admissions from June 2021 to April 2022. Admissions briefly increased in April and May 2022, before decreasing again in June and remaining relatively stable between July and December 2022. Admissions then began to increase, from 118 in the week beginning 26 December 2022, to 151 in the week beginning 27 March 2023.
• The long-term decreasing trend in admissions observed in 2022 differs markedly from previous years, which have generally been characterised by lower numbers during winter months and higher numbers during summer months. The data can be explored further on our dashboard (external website).
  • This decreasing trend should not be interpreted as a reduction in harms. The number of admissions may be affected by issues accessing urgent care services and by the capacity of hospital services.
• In January to March 2023, the most common drug category recorded was opioids (48% of admissions), followed by cannabinoids (20%).

National update

For the most recent time period (3 April to 2 July 2023):

• 2,378 drug-related hospital admissions were recorded, at an average of 183 per week.
• Admissions generally increased throughout this period, from 158 in the week beginning 10 April, to 182 in the week beginning 26 June.
• The total number of admissions in this time period (2,378) was 26% higher than in the previous 13-week period (1,886).
• The total number of admissions was 28% lower than in 2021 (3,287, weekly average 253) and 6% higher than in 2022 (2,242, weekly average 172).
• The most common substance type recorded continued to be opioids. These were recorded in an average of 46% of admissions per month, which was broadly consistent over the time series. Admissions recording cocaine and multiple/other drugs increased to a monthly average of 19% each.

Local update

• For the most recent time period (3 April to 2 July 2023), the number of drug-related hospital admissions increased in all 11 mainland NHS Boards compared to the previous 13-week period – ranging from 5% in NHS Fife, to 51% in NHS Lothian.

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

Additional information 

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

The data presented on drug type are based on ICD-10 diagnostic codes and are not confirmed by toxicology analysis.

The most recent 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

The average weekly number of suspected drug deaths increased between June (22) and August 2023 (25), averaging 23 per week. The total number of suspected drug deaths was 307. The number of deaths was similar to the same time period in 2021 (317) and 7% higher compared to 2022 (286).

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 the national statistics published by the National Records of Scotland (NRS) and do not provide a robust indication of the numbers of drug-related deaths occurring each year.

The chart below shows the weekly number of suspected drug deaths in Scotland from 31 May 2021 to 27 August 2023.

The chart shows the weekly number of suspected drug deaths in Scotland on the y axis and the date, between 31 May 2021 and 27 August 2023, on the x axis. Between mid-August 2021 and the end of May 2023, the average number of suspected drug deaths was relatively stable overall, fluctuating within the range of 17 to 29 deaths per week. The average weekly number of suspected drug deaths decreased at the end of May (24) and remained broadly stable until the end of August 2023 (week beginning 14 August; 27).

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Suspected drug deaths

Summary 

Historic trend 

• Between March and July 2021, the average weekly number of suspected drug deaths ranged from 21 to 37 deaths per week.
• There was a sustained decrease in the number of deaths per week in August 2021. Between August 2021 and February 2023, the average weekly number of suspected drug deaths fluctuated considerably but remained within a range of 17 to 29 deaths per week.

Update 

For the most recent time period (29 May to 27 August 2023):

• There were 100 suspected drug deaths in June, 89 in July and 118 in August. The number of suspected deaths in August was the highest monthly total observed since November 2022 (118).
• There was a total of 307 suspected drug deaths, similar to the previous time period (309). This was similar to the same time period in 2021 (317) and 7% higher than in 2022 (286).
• The average weekly number of suspected drug deaths decreased at the end of May and remained broadly stable until the end of August 2023.
• For the most recent time period, an average of 23 suspected drug deaths were recorded per week. This weekly average was the same as the previous time period (23), and similar to the same periods in 2021 (24) and 2022 (22).

Additional information 

Data on suspected drug deaths are provided by Police Scotland.

The Scottish Government produce a quarterly report (Suspected drug deaths in Scotland) that presents Police Scotland data on suspected drug deaths and describes the age, sex and geographical location of deaths in each quarter. The analysis in this RADAR release is provided for the purpose of real-time detection and prevention of harms and is not comparable with the Scottish Government publication. PHS will continue to publish data on suspected drug deaths in future RADAR releases. The Scottish Government, together with PHS and partners, are currently considering the future of the ‘Suspected drug deaths in Scotland’ report.

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

National statistics on drug-related deaths are published annually by the NRS during the summer and provide information broken down by age, sex, substance implicated and geographical area. The latest NRS publication reported that there were 1,051 drug-related deaths in Scotland in 2022. This was a 21% decrease compared to 2021 (1,330).

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.

Emergency department toxicology: ASSIST

Between May and August 2023, the 'A Surveillance Study of Illicit Substance Toxicity' (ASSIST) emergency department project made 810 detections of 52 different illicit drugs, in samples from 157 patients. The most detected drug category was depressants (63%), followed by opioids (15%). The most detected individual drug was cocaine (11%), followed by bromazolam (10%) and temazepam (8%).

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 assess the feasibility of prospective surveillance of ED attendances due to acute illicit drug toxicity, using 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.

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

The total number of surplus serum sample results available for the first 12 months of the study was 448. Many of these involved multiple positive detections, therefore the total number of detections (2,281) is greater than the total number of 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 but the metabolite could also be a drug, we have included both as it is not possible to say which has been used, if not both.

Results

The first chart shows the most common drug categories detected in toxicology analysis of surplus serum samples between 17 August 2022 and 16 August 2023.

The results are shown as the total number of detections. They are broken down by top five drug categories and then broken down further by drug type or name.

This stacked bar chart shows the number of detections of drug types within QEUH ED. The drugs are grouped into five main categories of effect, with depressant, opioid, stimulant, cannabinoid and other, on the y axis and the number of detections on the x axis. The most common category was depressant, with 1,391 detections. This included 1,205 detections of benzodiazepines and 159 detections of gabapentinoids. The second most common category was opioid, with 381 detections, 114 of these were of morphine. The third most common category was stimulant, with 299 detections. 242 of these were of cocaine. There were 170 detections of cannabinoids, 19 of these were of synthetic cannabinoids. There were 48 detections of other drugs.

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Toxicology analysis of surplus serum samples: drug category

Summary

Historic trend

Between 17 August 2022 and 16 May 2023:

• The most detected drug category was depressants, making up 60% of all detections, followed by opioids (17%). The most detected individual drug was cocaine (10%).
• 73% of attendances were male and 27% were female.
• 51% were aged 34 and under. The most common age category was 25-24 (32%), followed by 35-44 (27%) and 16-24 (19%).
• The most common outcomes were discharged to: home (41%), ward (26%) and police custody (11%).

Update

For the most recent time period (17 May to 16 August 2023):

• 372 individual ED attendances related to illicit drug use were identified
• 157 surplus serum samples with toxicological analysis results are presented.

Drug type and category

Of the 157 samples analysed:

• there was a total of 810 detections of 52 substances (found through the biological detection of the drug or its metabolite)
• the average number of drugs detected per sample was five.

Of the 810 detections, the following drugs were the most common:

• cocaine: 91 (11% of detections, 58% of samples)
• bromazolam: 85 (10% of detections, 54% of samples)
• temazepam: 64 (8% of detections, 41% of samples)
• desmethyldiazepam: 61 (8% of detections, 39% of samples)
• etizolam: 54 (7% of detections, 34% of samples)
• oxazepam: 52 (6% of detections, 33% of samples)
• diazepam: 46 (6% of detections, 29% of samples)
• pregabalin: 44 (5% of detections, 28% of samples)
• cannabis (tetrahydrocannabinol): 42 (5% of detections, 27% 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.

This stacked bar chart shows the percentage of detections of drug types within QEUH ED across four time periods - 17/08/22 to 16/11/22, 17/11/22 to 16/02/23, 17/02/23 to 16/05/23 and 17/05/23 to 16/08/23. The drugs are grouped into six categories (other depressant, bromazolam, etizolam, opioid, cocaine and other drug). Percentage of detections by category is on the y axis and the time period is on the x axis. The most common category was other depressant with 45%, 49% ,43% and 46% across the time periods. The second most common is opioids with 17%, 18%, 17% and 15% across the time periods. An increase in bromazolam detections has been seen across the time period, increasing from 4% in the first quarter to 10% in the most recent.

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Toxicology analysis by drug type: per quarter

Depressants were the most common drug category, making up 63% of all detections (511).

• Benzodiazepines were detected 449 times (55% of all detections).
• In total, 30 different types of benzodiazepines were detected, including bromazolam, temazepam, diazepam and etizolam.
• Bromazolam detections increased from 8% of all detections in the previous quarter, to 10% in the most recent period. The number of bromazolam-positive samples increased, from 37% of samples in the previous quarter, to 54% in the most recent period.
• There was also an increase in detections of gidazepam (28, 3% of detections), flubromazepam (16, 2% of detections) and clonazolam (10, 1% of detections).
• Gabapentinoids were detected 56 times (7%). Of these detections, 12 were gabapentin and 44 were pregabalin.
• There was a small number of detections (< 5) of zopiclone, zolpidem, xylazine and meprobamate.

Opioids were the second most common drug category, making up 15% of all detections (126).

• There were 44 detections of morphine (an opioid and metabolite of heroin and other opioids). There were 29 detections for codeine and 19 for methadone.
• There was a small number of detections (< 5) of protonitazene, tapentadol, metonitazene, tramadol and buprenorphine.

Stimulants were the third most common drug category, making up 13% of all detections (104).

• The most common stimulant was cocaine, making up 11% of all detections (91 times). The number of cocaine-positive samples increased, from 49% of samples in the previous quarter, to 58% in the most recent period.
• The second most common stimulant was amphetamine, detected 7 times (1%).
• There was a small number of detections (< 5) of MDMA, methamphetamine, 4-CEC (cathinone) and n-ethylpentylone (cathinone).

Further findings

Complete clinical data are available for 372 attendances for the most recent period (17 May to 16 August 2023):

• 73% were male (272) and 27% were female (100).
• 19% (69) were aged 16 to 24 and 29% (107) were aged 24 to 34.
• Just over half were aged 35 and over, with 24% (89) aged 35 to 44, 20% (74) aged 45 to 54 and 7% (27) aged 55 years or older.

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

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Attendances by age

ED outcome records show:

• 131 (35%) patients were discharged home
• 131 (35%) were admitted to a ward
• 35 (9%) were taken into police custody
• 34 (9%) self-discharged
• 21 (6%) were admitted to an intensive care unit, high-dependency unit or critical care unit
• 20 (6%) were recorded as 'unknown' or 'other'

Clinical severity outcome (after 28 days) recorded:

• 354 patients were discharged
• nine patients either died or remained an inpatient
• outcomes for nine 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. 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.

Post-mortem toxicology testing for controlled substances

From April to May 2023, the most common drug types detected in post-mortem toxicology were opioids (72%) and benzodiazepines (60%). The most common individual drugs detected were cocaine (37%) and diazepam (37%), followed by methadone (35%) and heroin/morphine (33%). Bromazolam (a new benzodiazepine) was detected in 23% of deaths.

Background

All sudden or unexpected deaths in Scotland are investigated by the Crown Office and Procurator Fiscal Service (COPFS) to determine the cause of death and the need for criminal proceedings. To inform these decisions, the COPFS commissions post-mortem toxicology and pathology services across Scotland.

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.

The analysis in this report 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.

New data included in analysis

For the first time in a RADAR quarterly report, data are available for the whole of Scotland. Previous reports only included data on deaths in the west, east and parts of the north of Scotland (the areas covered by SPA FS).

The inclusion of data on deaths in the far north and north-east of Scotland (the areas covered by NHS Grampian) from January 2022 onwards, means that the figures presented after that point cover the whole of Scotland and are different from those shown in previous publications.

Reporting period

This report includes two new periods of data:

• 1 January to 31 March 2023, representing Q1 of calendar year 2023
• 1 April to 31 May 2023 (most recent data discussed in the ‘Update’ section), representing partial data for Q2 of 2023.

More recent data are not yet available due to the transition of testing to SPA FS and the complexities of establishing a new service within a different organisation.

Controlled drugs detected at post-mortem

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 new or emerging drugs are added to toxicology screening.

The first chart provides an indication of controlled drugs detected at post-mortem, in deaths occurring between 1 January 2020 and 31 May 2023.

As indicated by the dotted vertical line on the chart, data for 2020 and 2021 are based on deaths in the west, east and parts of the north of Scotland. From January 2022 (Q1), the data include all areas in Scotland.

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 2020 (1 January to 31 March) and 31 May 2023, is on the x axis. The percentage of deaths positive for opioids increased, from 78% in Q1 of 2020 to 81% in Q2 of 2020, but has gradually decreased since then to 69% in Q1 of 2023. A sharp increase in the percentage of deaths where benzodiazepines were present occurred between Q1 and Q2 of 2020. This percentage remained high throughout 2020, before gradually falling from 72% in Q1 of 2021 to 50% in Q3 of 2022. Recently, an increasing trend in benzodiazepine detections was observed, from 50% in Q3 of 2022, to 60% in April and May 2023. The percentage of deaths where gabapentin and pregabalin was present remained relatively stable across the time series (averaging 33%), though an isolated increase was observed in Q2 of 2021 (42%). The percentage of deaths where cocaine was present increased markedly during Q2 of 2020 (to 38%) and was otherwise relatively stable over the time series (averaging 30%). An increase in the percentage of deaths where cocaine was present has been observed in the most recent time period (37% in April and May 2023).

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Forensic toxicology cases testing positive for controlled substances

Opioids and benzodiazepines

The next two charts provide an indication of specific opioids and benzodiazepines detected at post-mortem, in deaths where controlled drugs were detected, occurring between 1 January 2020 and 31 May 2023.

The chart shows the percentage of forensic toxicology cases testing positive for specific individual 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 2020 (1 January to 31 March) and 31 May 2023, is on the x axis. Heroin/morphine has been the most common substance since Q3 of 2021, with the percentage of deaths that tested positive for heroin/morphine remaining relatively stable over the time series (averaging 37%). Methadone detections increased sharply to 45% in Q2 of 2020 but have been gradually decreasing since then (35% between 1 April to 31 May 2023). There was a small but gradual increase in the number of cases where fentanyls were detected from 1% in Q1 of 2022 to 6% Q1 of 2023. Deaths with buprenorphine present remained relatively low and stable throughout the time series (averaging 6%). Similarly, nitazene-type opioid substances (detected for the first time in Q2 of 2022) have remained low, detected in 1% of deaths in the most recent time period (1 April to 31 May 2023).

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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 individual 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 2020 (1 January to 31 March) and 31 May 2023, is on the x axis. The percentage of deaths that tested positive for etizolam increased sharply, from 34% in Q1 of 2020 to 56% in Q2 of 2020, remaining high until Q3 of 2021. Since then, etizolam detections have decreased (12% in April and May 2023). In Q4 of 2022, diazepam detections increased markedly, becoming the most common substance detected in the most recent time period (37% in April and May 2023). Deaths with clonazolam present increased in Q2 of 2020, peaking at 12% in Q3 of 2021, before falling to low levels from early 2022. Bromazolam (detected for the first time in Q3 of 2022) has increased and was detected in 23% of deaths in the most recent time period (April to May 2023).

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Forensic toxicology cases testing positive for specific benzodiazepines

Summary

Historic trend

• In total, 2,425 deaths occurred in 2022 where controlled drugs were detected in post-mortem toxicology across Scotland.
• The most commonly detected drug types were opioids and benzodiazepines.
• The percentage of deaths where opioids were detected have been gradually decreasing from a peak of 81% in Q2 of 2020, to 69% in Q1 of 2023:
  • Heroin/morphine and methadone were the most common opioids
  • Methadone detections increased sharply from 28% in Q1 of 2020, to 45% in Q2 of 2020, before decreasing to 25% in Q1 of 2023.
  • There has been a small but gradual increase in the number of cases where fentanyl-type opioids were detected, from around 1% before Q2 of 2022, to 6% in Q1 of 2023.
  • Deaths with buprenorphine present remained relatively low and stable throughout the time series (averaging 6%).
  • Nitazene-type opioids were first detected in Q2 of 2022. Routine testing on all samples from across Scotland was available from early 2023. In Q1 of 2023, nitazenes were detected in <1% of deaths.
• The percentage of deaths where benzodiazepines were detected increased sharply between Q1 and Q2 of 2020. They remained high before gradually falling from 72% in Q1 of 2021, to 50% in Q3 of 2022. A slight increase was observed in Q1 of 2023.
  • Diazepam has been the most commonly detected benzodiazepine since Q2 of 2022 and, although there was a slight increase in Q4 of 2022, has remained relatively stable since Q1 of 2020.
  • Bromazolam (detected for the first time in Q3 of 2022) has increased sharply, replacing etizolam as the second most common benzodiazepine detected in Q1 of 2023.
  • Etizolam was the most common benzodiazepine detected for some time, increasing sharply in Q2 of 2020, before decreasing in Q3 2021. Since then, there has been a continued reduction in etizolam detections.
  • Clonazolam detections peaked at 12% in Q3 of 2021, decreasing to 1% in Q1 of 2023.
• The percentage of deaths involving other opioids, gabapentin and pregabalin, or cocaine has remained relatively stable over time.

Update

For the most recent time period (1 April to 31 May 2023):

• The total number of deaths testing positive for controlled substances was 380. Many of these deaths involved multiple positive detections, therefore the total number of detections listed below is greater than the total number of deaths.
• The following drugs or drug types were most commonly detected:
  • opioids: 273 (72%)
  • benzodiazepines: 228 (60%)
  • cocaine: 142 (37%)
  • diazepam: 140 (37%)
  • methadone: 132 (35%)
  • gabapentin and pregabalin: 131 (34%).
• The percentage of deaths where opioids were detected was relatively stable at 72% (from 69% in Q1):
  • Methadone detections increased to 35% (from 25% in Q1), replacing heroin/morphine as the most commonly detected opioid.
  • Heroin/morphine remained stable, detected in 33% of cases (from 32% in Q1).
  • Fentanyl-type opioids were detected in 3% of deaths (from 6% in Q1).
  • Nitazene-type opioids were detected in 1% of deaths (from <1% in Q1).
• The percentage of deaths where benzodiazepines were detected increased to 60% (from 54% in Q1):
  • Diazepam detections increased to 37% (from 29% in Q1).
  • Bromazolam continued to increase sharply and was detected in 23% of deaths (from 18% in Q1).
  • Etizolam remained stable and was detected in 12% of cases (from 12% in Q1).
• The percentage of deaths where cocaine was detected increased to 37% (from 29% in Q1), also making it the most commonly detected substance, alongside diazepam.
• The percentage of deaths involving gabapentin and pregabalin remained relatively stable at 34% (from 32% in Q1).

Additional information

Toxicology services

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 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 SPA FS and outsourced sites have been included in this report.

Data on deaths occurring in the far north and north-east of Scotland from January 2022 onwards was supplied by the Department of Clinical Biochemistry at NHS Grampian.

New drugs

New drugs (bromazolam, desalkylgidazepam and nitazene-type opioids) were detected for the first time when screening was expanded or testing was outsourced to other laboratories. These drugs may have been present before this time but were not being tested for, as they have only recently emerged in drug markets.

These data will develop further as new or emerging drugs are added to routine toxicology screening by the SPA FS and NHS Grampian.

Scope

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.

Date of death analysis

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 COPFS has been used instead.

The dates listed 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

Synthetic cannabinoids were the most prevalent drug type detected in the Scottish Prisons Non-Judicial Drug Monitoring Project between April and July 2023, detected in 48% of samples. Benzodiazepines and steroids were the second most prevalent, both detected in 9% of samples, with bromazolam being the most prevalent benzodiazepine.

Background 

The Leverhulme Research Centre for Forensic Science (LRCFS) is currently undertaking research with the Scottish Prison Service (SPS). The Scottish Prisons Non-Judicial Drug Monitoring Project tests drug seizures made across the Scottish prison estate in order to understand the changing characteristics of synthetic drugs, including synthetic cannabinoids, often referred to as 'spice'.

The chart shows the number and type of non-attributable samples seized in Scottish prisons between 1 April 2021 and 31 July 2023.

The chart shows the percentage of SPS drug seizures broken down by sample type (e-cigarette, paper or card, tablet, powder and other). The percentage of samples is on the y axis and the date, between April 2021 and July 2023, is on the x axis. Sample types are highly variable over the time period. Seizure numbers varied during 2021, ranging from a low of 23 in June, to a high of 134 in September. In 2022, the average number of seizures analysed remained relatively stable, at 35 per month. During 2023, the average monthly number of seizures was 38. Paper and card detections decreased across the time series, with an average of 73% per month in 2021, compared to 24% per month in 2022. In 2023, paper or card detections fell to an average of 6% per month, before rising to 47% in July. There were low numbers of e-cigarette detections until June 2022 (50%). E-cigarette detections then remained stable until December 2022, before decreasing and remaining relatively stable at 24% per month between January and March 2023. The percentage of e-cigarettes fluctuated from 18% in April, to 70% in June, to 18% in July 2023. Powder samples remained relatively stable, detected in approximately 19% of samples per month in 2022 and 23% of samples per month in 2023.

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Drug seizures in Scottish prisons: sample type

The chart below shows the five most detected drug types from seizures in Scottish prisons between 1 April 2021 and 30 June 2023. This is based on the percentage of samples tested each month and uses 3-month moving average figures.

The chart shows the three-month moving average percentage of SPS drug seizures broken down by drug type (synthetic cannabinoids, benzodiazepines, opioids, cannabis and steroids). The percentage of samples is on the y axis and the date, between May 2021 and June 2023, is on the x axis. Synthetic cannabinoids were the most prevalent drug type throughout the time series. The percentage of seizures testing positive for synthetic cannabinoids was on average 42% per month in 2021, decreasing to 33% per month in 2022. Percentages increased from 19% in January to 51% in June 2023. The second most common drug type detected was benzodiazepines. The percentage of seizures testing positive for benzodiazepines fluctuated throughout 2021, with an average of 37% per month, before decreasing and remaining relatively stable in 2022 (average of 26%). Benzodiazepine detections decreased further in 2023, from 30% in January, to 10% in June.

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Drug seizures in Scottish prisons: drug type

Summary 

Historic trend

• The number of seizures analysed varied widely between April and December 2021, ranging from 23 in June, to 134 in September. In 2022, the monthly average remained relatively stable at 35. During Q1 of 2023, the monthly average number of seizures was 50.
• Sample-type data were highly variable over time. Changes were observed in sample-type detections during 2022 and 2023:
  • Paper and card detections decreased, from a monthly average of 73% in 2021, to 24% in 2022, to 6% in Q1 of 2023. This is thought to be due to changes to prison rules that mean prisoners now receive photocopied correspondence rather than original items.
  • E-cigarette detections increased from June 2022 onwards, making up an average of 30% of samples per month in 2022. This fell slightly to 25% in Q1 2023.
• Drug-type data were highly variable over time, so the following narrative is based on averages:
  • Synthetic cannabinoids were the most common substances detected, followed by benzodiazepines.
  • In 2021, the percentage of seizures testing positive for synthetic cannabinoids was on average 42% per month. Percentages varied throughout 2022, averaging 33% per month, with higher percentages observed during the summer months. In 2023, monthly averages increased between January and March, from 19% to 33%.
• The percentage of seizures testing positive for benzodiazepines fluctuated throughout 2021 (monthly average 38%), before decreasing and remaining relatively stable in 2022 (monthly average 26%). In 2023, monthly averages decreased between January and March, from 30% to 15%.

Update

This update provides analysis of 113 samples tested in the most recent time period (1 April to 31 July 2023):

Sample type

• The most common sample type was e-cigarette (37% of samples).
  • The percentage of e-cigarettes fluctuated across the time period, from 18% in April to 70% in June.
  • Synthetic cannabinoids were detected in 57% of the e-cigarettes analysed.
• Paper or card detections were the second most common sample type detected (16% of samples).
  • The percentage of paper or card detections fluctuated, from 6% in April to 47% in June.

Drug type

• The three most detected controlled drug types were synthetic cannabinoids, benzodiazepines and steroids.
• Synthetic cannabinoids were the most common drug type, detected in an average of 44% of seizures per month – similar to the average of 41% observed during the same time period in 2022.
• Benzodiazepines and steroids were the second most common drug types.
  • 80% of benzodiazepine samples contained bromazolam. View our bromazolam alert.
  • Benzodiazepines were detected in an average of 9% of seizures per month – lower than the average of 21% during the same time period in 2022.
  • Steroids were detected in an average of 9% of seizures per month – similar to the average of 10% during the same time period in 2022.

Further information 

Between January and July 2023, this drug analysis project detected the following drugs for the first time in prisons in Scotland, demonstrating a constantly evolving drugs market: 

• dipentylone (cathinone, stimulant)
• MDMB-INACA (synthetic cannabinoid)

Additional information 

PHS was provided with these data by the SPS and the LRCFS.

The Scottish Prisons Non-Judicial Drug Monitoring Project is a collaboration between the SPS and the LRCFS at the University of Dundee.

An initial pilot project ran between September 2018 and January 2021. The project has been funded directly by the SPS since February 2021.

Specialist drug treatment referrals

Between June and August 2023, the average weekly number of referrals to specialist drug treatment services was broadly stable. A total of 5,923 attendances were recorded in this period – 6% lower than in the same time period in 2021 (6,290) and 14% higher than in 2022 (5,183).

Background 

Specialist drug treatment referrals occur when a person comes into contact with services designed to support their recovery from problematic drug use.

Figures shown are for referrals relating to either drug use or co-dependency (people seeking help for both drug and alcohol use). Figures include new referrals for treatment and referrals between services.

The chart below shows the weekly number of referrals to specialist drug treatment services between 24 May 2021 and 20 August 2023.

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 24 May 2021 and 20 August 2023, on the x axis. In December and January each year, a seasonal reduction in referrals occurs. Referrals decreased throughout June and July 2021, and then remained broadly stable to January 2022 (between 400 and 480 referrals per week). Throughout 2022, there was a fluctuating, but gradual, decrease in the average weekly number of referrals. After the seasonal reduction in December 2022, referrals returned to a weekly average of approximately 450 per week in January 2023. A downward trend has been evident since then, with referrals ranging between 400 and 500 per week.

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Specialist drug treatment referrals

Summary

Historic trend

• Referrals decreased throughout June and July 2021 and then remained broadly stable to January 2022 (between 400 to 480 referrals per week, apart from the seasonal decreases in December and January).
• Throughout 2022, there was a fluctuating, but gradual, decrease in the average weekly number of referrals.
• Following the seasonal reduction in December 2022, the number of referrals returned to a weekly average of approximately 450 per week, apart from decreases in April and May 2023.

National update

For the most recent period (22 May to 20 August 2023):

• 5,923 specialist drug treatment referrals were recorded, at an average of 456 per week.
• This was 2% higher than the previous 13-week period (20 February to 21 May 2023) when 5,803 referrals were recorded, at an average of 446 per week.
• Referrals were 6% lower compared to the same time period in 2021 (6,290, weekly average 484) and 14% higher than in 2022 (5,183, weekly average 399).

Local update

For the most recent period (22 May to 20 August 2023), the number of weekly drug treatment referrals varied across mainland NHS Boards, compared to the previous period:

• Referrals increased in four areas: NHS Dumfries and Galloway (5%), NHS Ayrshire and Arran (7%), NHS Lanarkshire (12%) and NHS Forth Valley (50%).
• Referrals decreased in two areas: NHS Borders (27%) and NHS Grampian (28%).
• Referrals were broadly stable in the other mainland NHS Boards.

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) (external website) and its predecessor, the Drug and Alcohol Treatment Waiting Times (DATWT) database (external website).

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.

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

Opioid substitution therapy

Opioid substitution therapy (OST) prescribing data for April to June 2023 has been delayed due to issues affecting PHS's Prescribing Information System.

We anticipate that updated OST prescribing data will be available for the next release of this report in January 2024.

OST prescribing data to March 2023 are available in the previous quarterly report and in the RADAR dashboard.

Our annual update on the Estimated numbers of people prescribed opioid substitution therapy in Scotland in 2022/23, can be viewed on our website.

Injecting equipment provision

The average weekly numbers of injecting equipment provision (IEP) transactions, and needles and syringes distributed, increased between April and June 2023. During this period, the total numbers of transactions, and needles and syringes distributed, were lower than in the same period in 2021 (12% and 7% respectively) and similar to 2022.

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 from 5 April 2021 to 2 July 2023.

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 5 April 2021 and 2 July 2023, is on the x axis. An overall decreasing trend was observed from April 2021 to the end of 2021. Between February 2022 and March 2023, the number of transactions was broadly stable. There was a decrease in the number of transactions in April 2023, followed by an increase from May to the end of June 2023. A seasonal dip in transactions in December and January was observed in each year.

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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

• There was an overall decrease in the average weekly number of IEP transactions from April 2021 to February 2022. Since February 2022, the average number of transactions has been broadly stable (approximately 3,000 per week).
• An overall decreasing trend in the average weekly number of needles and syringes distributed was observed from April 2021 to January 2022. Since January 2022, the average number of needles and syringes distributed has been broadly stable (approximately 37,000 per week).
• The ratio of needles and syringes distributed per transaction was stable from April 2021 to March 2023, at an average of 14 needles and syringes distributed per transaction.
• For each indicator, seasonal fluctuations were observed during December and January each year.

Update

For the most recent time period (3 April to 2 July 2023):

IEP transactions

• 37,959 transactions were recorded, at an average of 2,920 per week.
• This was 6% higher than the previous 13-week period (2 January to 2 April 2023) when a total of 35,667 transactions were recorded (weekly average 2,744).
• The number of transactions was 12% lower than the same time period in 2021 (43,046, weekly average 3,311) and similar to 2022 (38,102, weekly average 2,931).

Needles and syringes distributed

• 494,660 needles and syringes were distributed, at an average of 38,051 per week.
• This was similar to the previous time period when a total of 484,967 needles and syringes were distributed, at an average of 37,305 per week.
• The number of needles and syringes distributed was 7% lower compared to the same time period in 2021 (529,960, weekly average 40,766) and similar to 2022 (483,377, weekly average 37,183).

Ratio of needles and syringes distributed

• There was a weekly average of 14 needles and syringes distributed per transaction.
• This was similar to the previous time period (15) and equal to the same time periods in 2021 and 2022 (both 14).

For visualisations of all IEP indicators and breakdowns by NHS Board, please see 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 website.