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 28 January 2025.

Dashboard

Data for most of the harm and service indicators in this report are published in our 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 in Scotland remain stable at a high level, highlighting the continued urgency of addressing this public health crisis. The stability at a national level masks substantial variability in local trends and occasions of clustering of harms. Ongoing risks and emerging trends require sustained attention.

Key trends

  • Polysubstance use continues to drive the majority of harms, with high-risk combinations frequently involving cocaine, gabapentinoids, benzodiazepines (notably diazepam and bromazolam) and opioids.
  • Emerging synthetic drugs such as potent nitazene-type opioids and xylazine are increasingly reported in harms.
  • Cocaine continues to be the most common substance in both post-mortem toxicology and the ASSIST emergency department project.
  • Contamination of drugs remains prevalent, with substances often not containing what the purchaser intended; this spans across drug types, including powders, vapes and pills (even in apparent medicines like those in blister packs).

Data update

The following changes were observed compared to the previous reporting period (reported in quarterly report 8 – July 2024).

For harm indicators:

  • naloxone administration incidents (June to August 24): 7% increase
  • emergency department attendances (June to August 24): 3% increase
  • suspected drug deaths (June to August 24): 10% decrease
  • drug-related hospital admissions (April to June 24): 5% increase

For service indicators:

  • drug treatment referrals (May to August 24): 9% decrease
  • injecting equipment provision (April to June 24): 3% increase in transactions, 3% decrease in number of needles and syringes distributed
  • opioid substitution therapy (April to June 24): 2% decrease

Alerts

  • A public health alert about nitazene-type opioids was published in January 2023. It was updated in July 2024, due to increasing detections in drugs mis-sold as heroin and diazepam.
  • 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.
  • A public health alert about new benzodiazepines was published in July 2023 and remains current.

Harm indicators

  • Between June and August 2024, the total number of Scottish Ambulance Service naloxone administration incidents was 7% higher compared to the previous quarter. Incidents were similar to the same period in 2022 and 20% lower than in 2023.
  • Between June and August 2024, drug-related attendances at emergency departments were stable compared to the previous quarter. Attendances were similar to the same period in 2022 and 19% lower than in 2023.
  • Between April and June 2024, drug-related hospital admissions were 5% higher compared to the previous quarter. The total number of admissions was similar to the same period in 2022 and 12% lower than in 2023.
  • Between June and August 2024, there were 225 suspected drug deaths. The number of deaths was 10% lower than the previous quarter (249), 13% lower than the same period in 2022 (258) and 25% lower than in 2023 (301).

Toxicology indicators

  • Between June and August 2024, the most frequently detected drug in the ASSIST hospital toxicology project was cocaine (13%), followed by desmethyldiazepam (11%) and temazepam (10%).
  • Between April and June 2024, the most common drug types detected in post-mortem toxicology were opioids (70%) and benzodiazepines (56%). Cocaine continued to be the most commonly detected individual drug (37%), followed by heroin/morphine (32%), diazepam (28%), codeine (26%) and methadone (25%).
  • Synthetic cannabinoids continue to be the most prevalent drug type detected in the Scottish Prisons Non-Judicial Drug Monitoring Project.

Service indicators

  • Between May and August 2024, the average weekly number of referrals to specialist drug treatment services was relatively stable. The total number of referrals recorded in this period (6,337) was 5% higher compared to the same period in 2022 (6,031) and 10% lower than in 2023 (7,043).
  • Between April and June 2024, opioid substitution therapy (OST) doses supplied per month was slightly lower compared to the same periods in 2022 and 2023. The average monthly number of methadone doses supplied continued to decrease while injectable buprenorphine doses increased over time.
  • Between April and June 2024, the average weekly number of injecting equipment provision transactions was similar (3% higher) to the previous quarter, 5% lower than the same period in 2022 and similar to 2023. The number of needles and syringes distributed was similar (3% lower) to the previous quarter, 6% lower than the same period in 2022 and 7% lower than in 2023.

Reporting trends

  • Between July and October 2024, 69 trend reports were received by RADAR.
  • The majority of reports related to benzodiazepines, heroin, cocaine, synthetic opioids and polydrug use.
  • 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 continue to be detected in substances and among people who have experienced drug-related harms.
  • There is an urgent need for coordination to improve Scotland's ability and agility in responding to polysubstance use and a continually evolving drug market. A focus is needed on development, implementation and evaluation of measures to prevent and reduce the harms of polysubstance use including specific interventions relevant for those who use cocaine and/or benzodiazepines.
  • 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. These harms and adverse effects should be considered as part of needs assessments when commissioning services and when planning workforce training. Further work may be needed to support the development of integrated approaches to prevention, treatment and physical rehabilitation of injuries and infections.
  • Contamination of illicit drugs with toxic substances is both common and widespread. 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 standardised approach to hospital-based toxicology testing across Scotland is essential to identify substances never detected before, such as newer street benzodiazepines and other synthetic drugs, to ensure a proportionate and informed response to reducing harms.
  • A system-wide approach that prevents drug harms and supports people affected to access 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.

Bromazolam

A public health alert about new benzodiazepines was published in July 2023. Bromazolam is the most common drug detected in 'street benzos'. 

Trends

Police drug trends bulletin

The purposes of the Police Scotland’s Statement of Opinion (STOP) bulletin are to raise awareness of drug trends and to demonstrate some of the substances present in Scotland's drugs market.

Xylazine

Officers from the STOP unit are now regularly seeing recoveries of diamorphine (heroin) which has been adulterated with xylazine (a non-opioid veterinary tranquiliser), as well as the usual paracetamol and caffeine. 

These cases were initially few and far between, however they are becoming a more common occurrence.

Street benzos

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

The most commonly encountered street benzo is bromazolam. The most common type is a round white tablet with ‘10’ on one side and half score on the reverse, followed by a round white tablet with ‘C/DC’ on one side and blank on the reverse.

There has been a slight increase in street benzos being recovered containing nitazene-type opioids.

Image caption Benzodiazepine tablets: white 10 with half score on reverse

Dimethyltryptamine (DMT)

Officers from the STOP Unit West recently attended an address which was suspected to be used for extracting dimethyltryptamine (DMT) from mimosa hostilis root bark (MHRB). This is uncommon and is only the second recorded incident that the STOP unit are aware of.

DMT is a hallucinogenic drug, of the tryptamine family. It is found in various plants, most commonly ayahuasca and MHRB, as is the case here.

Effects can include altered thinking, reality distortion and a sense of spiritual connection. It is ingested by smoking (commonly in vapes), drinking, snorting and less commonly injection. It is a class A controlled drug under the Misuse of Drugs Act 1971.

RADAR intelligence and reports

69 reports were validated by RADAR between 5 July and 4 October 2024.

RADAR has received over 350 reports of drug-related information and harms through the reporting form and mailbox. Our sincere thanks go to everyone who has contributed reports, enabling a more rapid and effective response to emerging public health harms.

A summary of key trends is shown below. Intelligence reports to RADAR can be filtered by drug type and region 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 July to 4 October 2024, QR9):

  • The majority of submissions report polydrug use – the use of more than one substance at a time.
  • The most common drugs or drug types reported were benzodiazepines, heroin, nitazenes and cocaine.
    • Benzodiazepines (benzos) were the most commonly reported drug of concern, accounting for 26% of all primary drugs reported. Between QR1 to QR5 (quarter dates shown on chart below), benzos accounted for 34% of all primary drugs reported before decreasing in QR6 and remaining static until QR8 (quarterly average 20%; QR6 to QR8).
    • Heroin accounted for 22% of primary drugs reported, this was stable compared to the previous quarter, but reports have increased throughout the time series, from 5% in QR1.
    • Nitazene/fentanyl-type opioids accounted for 9% of primary drugs reported, similar to the previous four quarters (quarterly average 11%; QR5 to QR8). Nitazenes continue to be the most common novel synthetic opioid detected in toxicology but several submissions reported drugs sold as ‘fentanyl’.
    • Cocaine accounted for 8% of primary drugs reported, a decrease on the 18% average between QR1 and QR8.
  • Most concerns were related to adverse effects (seizures, wounds and confusion), overdose (collapse, unconsciousness) and death.
  • Several intelligence reports concern drugs having different effects or appearance (colour, texture, shape) than expected.
Image caption Reports to RADAR by primary drug(s)

Fake medicines

  • There has been an increase in the number of overdoses and adverse effects reported from drugs in medicinal packaging. Some of these cases related to fake/counterfeit drugs that are made to look like genuine medicines.
  • Legitimate looking packaging (including boxes and blister packs) is not confirmation of the contents and they can contain no active ingredients, or different active ingredients and concentrations than stated or expected.
  • Fake medicines and pills can sometimes be of poorer quality than genuine pharmaceuticals but it's not always easy or possible to tell.
  • Signs that a medicine is fake can include unsealed boxes, spelling mistakes and missing licensing/pharmacy information, as well as physical defects such as pills that are poorly pressed, discoloured, chipped, broken, powdery or crumbly.
  • Reports of fake medicines include tapentadol, pregabalin, alprazolam and diazepam.
  • In 2024, seven Scottish samples purchased as diazepam were found to contain bromazolam and metonitazene by WEDINOS:
    • Some were sold in blister packets with brand names including Accord, Martin Dow, Galenika, Bensedin and Actavis.
    • Samples were sent from Greater Glasgow and Clyde (G7, G14), Grampian (AB10, AB11), Lothian (EH41), Argyll and Bute (PA23) and Lanarkshire (ML3).
    • Appearance varied but most were blue tablets (occasionally purple or white). Some were stamped with a half score and ‘C/CD’ or ‘10’.
    • Adverse effects included memory loss, agitation, nausea and sweating.
  • For more information, visit the #FakeMeds campaign (external website), by the Medicines and Healthcare products Regulatory Agency (MHRA).
Image caption Pill found to contain bromazolam and metonitazene from Lanarkshire, March 2024, mis-sold as diazepam (photo credit: WEDINOS, W049531)

WEDINOS

WEDINOS (external website) is a harm reduction project, providing an anonymous testing service, to show trends in substance use.

Between July and August 2024, 117 samples from Scotland were tested by WEDINOS. Four samples contained no active components.

Among the 113 samples testing positive for a controlled drug:

  • There were 228 detections of 42 individual substances.
  • The average number of substances detected per sample was two, with the number of substances ranging from one to nine per sample.
  • Over half did not test positive for the intended purchase. Of the 16 samples positive for bromazolam, 56% (9) were purchased as diazepam, 38% (6) as alprazolam and (6%) (1) as heroin. 

The following drugs were the most common:

  • bromazolam: 16 (7% of detections, 14% of samples)
  • heroin: 16 (7% of detections, 14% of samples)
  • 6-MAM: 13 (6% of detections, 12% of samples)
  • cocaine: 13 (6% of detections, 12% of samples)
  • diazepam: 12 (5% of detections, 11% of samples)
  • etizolam: 12 (5% of detections, 11% of samples)

Scottish Drugs Forum (SDF) drug trends

SDF supports groups of people with living experience who meet regularly to offer peer support and information-sharing. An important part of this is learning and sharing information about current drug trends and the related risks and harms. Read the SDF trends report for April to June 2024 (external website).

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 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 (excluding NHS Fife and NHS Tayside*) decreased between June (73) and August 2024 (62). The total number of incidents during this period (861) was 7% higher than the previous quarter (802). This was similar to the same period in 2022 (839) and 20% lower than in 2023 (1,077).

*Due to issues with a clinical IT system update, data for NHS Fife and NHS Tayside are incomplete for the most recent quarter (3 June to 1 September 2024). Therefore, all NHS Fife and NHS Tayside data have been excluded from naloxone administration figures in this report. Anecdotal data provided by the Scottish Ambulance Service indicates stable naloxone administrations for both boards for the most recent time period.

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, excluding NHS Fife and NHS Tayside, from 30 May 2022 to 1 September 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.

Image caption Naloxone administration by Scottish Ambulance Service

Summary

Historic trend
  • Excluding NHS Fife and NHS Tayside, the average weekly number of naloxone incidents was broadly stable at 63 per week between June and November 2022. The average number of weekly incidents decreased to 47 in the week beginning 26 December 2022.
  • During 2023, the normal seasonal pattern of lower numbers during winter months and higher numbers during summer months was observed, with an increasing trend in the average weekly number from January (50) to May 2023 (69).
  • Between June and August 2023, the average weekly number of naloxone incidents remained broadly stable at around 82 per week, after which there was a decreasing trend to January 2024.
  • Between January and March 2024, the number of weekly incidents fluctuated within a range of 37 to 74.
  • In May 2024, the average number of weekly incidents remained higher and stable (72).  
National update

For the most recent 13-week period (3 June to 1 September 2024):

  • Excluding NHS Fife and NHS Tayside, 861 SAS naloxone incidents were recorded, at an average of 66 per week. Average weekly numbers fluctuated but generally decreased between June (73) and August 2024 (62).
  • The total number of incidents was 7% higher than the previous 13-week period (4 March to 2 June 2024) when 802 incidents were recorded, at an average of 62 per week.
  • The number of incidents was similar compared to the same period in 2022 (839, weekly average 65) and 20% lower than in 2023 (1,007, weekly average 83).
Local update

Comparing the most recent period (3 June to 1 September 2024) to the previous quarter, the key changes observed across mainland NHS boards (excluding NHS Fife and NHS Tayside) were:

  • Incidents increased in four areas: NHS Greater Glasgow and Clyde (20%), NHS Lanarkshire (22%), NHS Ayrshire and Arran (23%) and NHS Dumfries and Galloway (94%, 16 more incidents).
  • Incidents decreased in three areas: NHS Lothian (10%), NHS Grampian (14%) and NHS Forth Valley (17%).
  • Incidents were broadly stable in NHS Borders and NHS Highland.

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

Additional information

PHS was provided with these data by SAS.

Due to issues with a clinical IT system update, data for NHS Fife and NHS Tayside are incomplete for the most recent quarter (3 June to 1 September 2024). Therefore, NHS Fife and NHS Tayside have been excluded from SAS naloxone administration figures in this report. Scotland-level data for 1 January 2018 to 2 June 2024 are available on the RADAR dashboard (external website).

Information on the carriage of naloxone by Police Scotland officers can be found on Police Scotland’s website.

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 2024, the number of drug-related attendances at emergency departments (1,067) was similar to the previous quarter (1,033). This was similar to the same period in 2022 (1,065) and 19% lower than in 2023 (1,313).

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 30 May 2022 and 1 September 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.

Image caption Drug-related attendances at emergency departments

Summary

Historic trend
  • The number of drug-related ED attendances per week was broadly stable between June 2022 until March 2023 (weekly average 82). Attendances generally increased between April and June 2023, with the highest weekly level in the series observed in June 2023 (142).
  • From July 2023 to January 2024, despite variations in the number of attendances per week, an overall decreasing trend was observed, from an average of 93 in July 2023, to an average of 69 in January 2024.
  • A gradually increasing trend was observed from an average of 80 in February 2024, to an average of 85 in May.
National update

For the most recent 13-week period (3 June to 1 September 2024):

  • 1,067 emergency department attendances were recorded, at an average of 82 per week. This was similar to the previous 13-week period (4 March to 2 June 2024, 1,033 attendances, weekly average 79).
  • Attendances were similar to the same period in 2022 (1,065 attendances, weekly average 82) and 19% lower than in 2023 (1,313 attendances, weekly average 101).
Local update

Comparing the most recent period (3 June to 1 September 2024) to the previous quarter, the key changes observed across mainland NHS boards were:

  • Attendances increased in five areas: NHS Fife (8%), NHS Greater Glasgow and Clyde (14%), NHS Borders (19%), NHS Tayside (19%) and NHS Dumfries and Galloway (43%).
  • Attendances decreased in four areas: NHS Grampian (6%), NHS Forth Valley (11%), NHS Lanarkshire (15%) and NHS Highland (24%).
  • Attendances were broadly stable in two areas: NHS Ayrshire and Arran and NHS Lothian.

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 April and June 2024, 2,188 drug-related hospital admissions were recorded, 5% higher than the previous quarter (2,086). Admissions were similar to the same period in 2022 (2,247) and 12% lower than the same period in 2023 (2,498).

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 28 March 2022 to 30 June 2024. Data are taken from Public Health Scotland's - Scottish Morbidity Record (SMR). PHS expects to receive SMR data six weeks following the end of the month of discharge/clinic date and therefore the period presented here differs from our other harm indicators and 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.

Image caption 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 an increase in admissions during April and May 2022, before an uneven decreasing trend between June and December 2022.
    • This decrease should not necessarily 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 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, before decreasing in October 2023.
  • Between November 2023 to March 2024 admissions remained broadly stable averaging 162 per week with a seasonal decrease during the week beginning 25 December 2023 to the week beginning 22 January 2024.
  • Opioids were the most common drug category recorded. The percentage of admissions where opioids were recorded remained relatively stable until the end of 2023 (average 47% between April 2022 and December 2023), before a slight decrease to 45% of admissions between January and March 2024.
  • The second most common drug category was cocaine, with percentages increasing across the series from 15% between April to June 2022, to 20% between January to March 2024.
National update

For the most recent period (1 April to 30 June 2024):

  • 2,188 drug-related hospital admissions were recorded, at an average of 168 per week. This was 5% higher than the previous 13-week period (2,086 admissions, weekly average 160).
  • The total number of admissions was similar to the same period in 2022 (2,247, weekly average 173) and 12% lower than in 2023 (2,498, weekly average 192).
  • Opioids continued to be the most common substance type. These were recorded in an average of 42% of admissions per month, a decrease compared to 45% in the previous quarter. Admissions for cocaine (20%) were stable compared to the previous quarter (20%).
Local update

Comparing the most recent period (1 April to 30 June 2024) to the previous quarter, the key changes observed across mainland NHS boards were: 

  • Admissions increased in five areas:  NHS Fife (8%), NHS Dumfries and Galloway (19%), NHS Grampian (24%), NHS Lothian (25%) and NHS Highland (30%).
  • Admissions decreased in three areas: NHS Lanarkshire (14%), NHS Forth Valley (18%) and NHS Borders (53%).
  • Admissions were broadly stable in three areas: NHS Ayrshire and Arran, NHS Greater Glasgow and Clyde and NHS Tayside.

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

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 (3 June to 25 August 2024), the total number of suspected drug deaths was 225, averaging 19 per week. The average weekly number of deaths decreased between June (22) and August 2024 (17). The total number of deaths was 10% lower than the previous quarter (249), 13% lower than the same period in 2022 (258) and 25% lower than in 2023 (301).

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 23 May 2022 to 25 August 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.

Image caption Suspected drug deaths

Summary 

Historic trend 
  • Between May 2022 and May 2024, the average weekly number of suspected drug deaths fluctuated considerably but generally remained within a range of 18 to 27 deaths per week.
Update 

For the most recent complete months (1 June to 31 August 2024):

  • There were 243 suspected drug deaths, 92 in June, 80 in July and 71 in August.

For the most recent period (3 June to 25 August 2024):

  • There were 225 suspected drug deaths, 10% lower than in the previous 12-week period (249). This was 13% lower than the same period in 2022 (258) and 25% lower than in 2023 (301).
  • The average weekly number of deaths decreased from June (22) to July (18) and remained roughly the same in August 2024 (17).
  • An average of 19 deaths were recorded per week. This was 10% lower than in the previous period (21), 14% lower than in the same period in 2022 (22) and 24% 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) 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 1,172 drug-related deaths in Scotland in 2023. This was a 12% increase compared to 2022 (1,051).

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 registered in 2019 and 2020, with trend data from 2012.

Toxicology indicators

Emergency department toxicology: ASSIST

Between June and August 2024, the ‘A Surveillance Study of Illicit Substance Toxicity’ (ASSIST) emergency department project made 669 detections of 43 different illicit drugs, in samples from 139 patients. The most commonly detected drug category was depressants (63% of detections), followed by stimulants and opioids (both 16%). The most commonly detected individual drug was cocaine (13%), followed by desmethyldiazepam (11%) and temazepam (10%).

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.

The study collects anonymised patient data through the analysis of standard-of-care clinical data. For the most unwell patients, the study performs full toxicological analysis through the biorepository-approved surplus serum sampling. Surplus serum samples are leftover blood samples, which were taken as part of usual care.

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
  • 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. For more definitions and inclusion criteria, see additional information below.
  • Data from the study are presented in quarters, based on the date of ED presentation, and are provided in the table below.

ASSIST quarter dates

Quarter Dates
Quarter 1 (Q1) 17/08/2022 to 16/11/2022
Quarter 2 (Q2) 17/11/2022 to 16/02/2023
Quarter 3 (Q3) 17/02/2023 to 16/05/2023
Quarter 4 (Q4) 17/05/2023 to 16/08/2023
Quarter 5 (Q5) 17/08/2023 to 16/11/2023
Quarter 6 (Q6) 17/11/2023 to 16/02/2024
Quarter 7 (Q7) 17/02/2024 to 16/05/2024
Quarter 8 (Q8) 17/05/2024 to 16/08/2024

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 2024 (Q1 to Q8).

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.

Image caption ASSIST hospital toxicology analysis: drug categories by study quarter

Summary

Historic trend

Between 17 August 2022 and 16 May 2024:

  • The most commonly detected drug type was depressants, making up 62% 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 35 to 44 years (29%), followed by 25 to 34 (28%) and 16 to 24 (19%).
  • The most common outcomes were discharged to home (38%), ward (28%) and police custody (12%).
Update

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

  • 344 individual ED attendances related to illicit drug use were identified.
  • 139 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 139 samples analysed:

  • There were 669 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 669 detections, the following drugs were the most common:

  • cocaine: 88 (13% of detections, 63% of samples)
  • desmethyldiazepam: 74 (11% of detections, 53% of samples)
  • temazepam: 64 (10% of detections, 46% of samples)
  • bromazolam: 55 (8% of detections, 40% of samples)
  • oxazepam: 46 (7% of detections, 33% of samples)
  • etizolam: 37 (6% of detections, 27% of samples)
  • diazepam: 35 (5% of detections, 25% of samples)
  • morphine: 34 (5% of detections, 24% of samples)
  • pregabalin: 33 (5% of detections, 24% of samples)
  • clonazolam: 24 (4% of detections, 17% 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 August 2024 (Q1 to Q8). The percentages are of all detections.

Image caption ASSIST hospital toxicology analysis: depressant drugs by study quarter

Depressants were the most common drug category, making up 63% of detections (420).

  • Benzodiazepines were detected 366 times (55% of all detections):
    • In total, 15 different types of benzodiazepines were detected, including desmethyldiazepam (11%), temazepam (10%), oxazepam (7%), etizolam (6%), diazepam (5%) and clonazolam (4%).
    • Bromazolam made up 8% of all detections, similar to 7% in Q7.
  • Gabapentinoids were detected 44 times (7% of all detections, similar to Q7). Of these detections, 11 were gabapentin and 33 were pregabalin.
  • There were no detections of xylazine, down from four in the last quarter.

The chart below provides an indication of specific opioids and nitazene drugs detected in toxicology analysis of surplus serum samples between 17 August 2022 and 16 August 2024 (Q1 to Q8). The percentages are of all detections.

Image caption ASSIST hospital toxicology analysis: opioid drugs by study quarter

Opioids were the second most common drug category, making up 16% of detections (110).

  • There were 34 detections of heroin/morphine (5%, similar to Q7), 19 for methadone (3%) and 19 for codeine (3%).
  • There were less than five detections of nitazenes, down from six in the last quarter.

Stimulants were the third most common drug category, making up 16% of detections (106).

  • The most common stimulant was cocaine, making up 13% of detections (88). This stable compared to the previous quarter.
Further findings

Complete clinical data were available for 344 attendances for the most recent period (17 May to 16 August 2024):

  • 79% of attendees were male (272) and 21% were female (72).
  • 74% of attendances were aged 44 and under. The most common age category was 35 to 44 years (30%, 104 attendees), 22% (75) were aged 16 to 24 years and 22% (74) were aged 25 to 34.
  • 26% of attendees were aged 45 years and over, with 18% (63) aged 45 to 54 and 8% (27) aged 55 years or older. Age was unknown for one attendance.
Image caption Attendances by age

ED outcome records show:

  • 126 (37%) patients were admitted to a ward – this was the highest percentage observed throughout the study (quarterly average 28%)
  • 135 patients (39%) were discharged home
  • 27 patients (8%) self-discharged
  • 22 patients (6%) were taken into police custody
  • 15 patients (4%) were admitted to an intensive care unit, high-dependency unit, critical care unit or died
  • 19 were recorded as ‘unknown’ or ‘other’.

Clinical severity outcome (after 28 days) recorded:

  • 337 (98%) patients were discharged following the attendance
  • six patients either died or remained an inpatient following the attendance.

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).

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

Toxicology analysis

  • 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.

Post-mortem toxicology testing for controlled substances

In Q2 of 2024, the most common drug types detected in post-mortem toxicology were opioids (70%) and benzodiazepines (56%). Cocaine continued to be the most commonly detected individual drug (37%), followed by heroin/morphine (32%), diazepam (28%), codeine (26%) and methadone (25%).

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 April to 30 June 2024, representing Q2 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.

The first chart provides an indication of controlled drugs detected at post-mortem, in deaths occurring between 1 January 2022 and 30 June 2024.

Image caption 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 30 June 2024.

Image caption Forensic toxicology cases testing positive for specific opioids
Image caption Forensic toxicology cases testing positive for specific benzodiazepines

Summary

  • The most commonly detected drug types throughout the series were opioids followed by benzodiazepines. Both have remained relatively stable averaging 71% and 57% respectively between Q1 of 2022 to Q2 of 2024.
  • The most commonly detected drug was cocaine (averaging 36% between Q2 of 2023 and Q2 of 2024). Before Q2 of 2023, the most common individual drug was heroin/morphine.
  • Multiple controlled drugs were detected in 573 of 598 deaths (96%) in Q2 of 2024. This is similar to previous quarters.
  • The following drugs/drug types were the most commonly detected in deaths in Q2 of 2024:
    • opioids: 421 (70%)
    • benzodiazepines: 332 (56%)
    • cocaine: 221 (37%)
    • heroin/morphine: 194 (32%)
    • gabapentin or pregabalin: 167 (28%)
    • diazepam: 166 (28%)
    • codeine: 153 (26%)
    • methadone: 147 (25%)

Stimulants

  • For the fifth 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 (37% in Q2 of 2024).
Opioids
  • The percentage of deaths where opioids were detected has remained relatively stable throughout the series, averaging 71%.
  • Heroin/morphine detections have been gradually decreasing, from 36% in Q1 of 2022 to 32% in Q2 of 2024.
  • Methadone was detected in 32% of deaths in Q1 of 2022 and has since generally fluctuated within a range of 25% to 29% of deaths.
  • Buprenorphine detections remained low and stable throughout the series, detected in an average of 6% of deaths.
  • Detections of fentanyl-type opioids have gradually increased, from 1% in Q1 of 2022 to 8% in Q2 of 2024. Fentanyl-type opioids are commonly used as medicines for pain relief.
  • Nitazene-type opioid substances were first detected in Q1 of 2022 and have increased slightly, being detected in 3% of deaths (16) in Q2 of 2024. In Q2 of 2024, metonitazene was the most common nitazene detected, followed by protonitazene. Two nitazenes were detected in 10 deaths. Nitazenes have been detected in a total of 79 deaths (to 30 June 2024).
Depressants
  • Benzodiazepines have remained broadly stable throughout the series, detected in an average of 57% 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 Q2 of 2024.
  • Etizolam was the most common benzodiazepine detected in Q1 of 2022, after which detections have followed a decreasing trend to 6% of deaths in Q2 of 2024.
  • Clonazolam detections remained low and stable throughout the series, detected in an average of 1% of deaths.
  • Gidazepam/desalkylgidazepam was first detected in Q4 of 2022 and has gradually increased, being detected in 2% of deaths in Q2 of 2024.
  • The percentage of deaths involving gabapentin or pregabalin has been relatively stable throughout the series, averaging 30%.  
  • Xylazine (detected for the first time in Q3 of 2023) detections remained stable compared to the previous quarter at 1% of deaths (5). Xylazine has been detected in a total of 23 deaths (to 30 June 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.

Table 1: Number of deaths testing positive for controlled substances, by calendar year and quarter

Calendar year Q1 Q2 Q3 Q4
2022 566 631 535 710
2023 710 680 619 663
2024 692 598

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.

Table 2: Initial and routine testing periods for new and emerging substances

Substance Initial testing (limited data available) Routine testing (data across Scotland)
Nitazenes Q1 of 2022 Q1 of 2023
Bromazolam Q1 of 2022 Q1 of 2023
Deschloroetizolam Q1 of 2023 Q1 of 2023
Xylazine Q2 of 2023 -
References

'-' denotes information is not available.

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

Synthetic cannabinoids continue to be the most prevalent drug type detected in the Scottish Prisons Non-Judicial Drug Monitoring Project.

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 non-attributable seizures (drugs that cannot be linked to a person or source) 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 December 2023.

Image caption 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 31 December 2023. This is based on the percentage of samples tested each month and uses 3-month moving average figures.

Image caption Drug seizures in Scottish prisons: drug type

Summary

Historic trend
  • The number of seizures analysed varied widely between April and December 2021, ranging from a low of 23 in June, to a high of 134 in September. In 2022, the monthly average remained relatively stable at 35. During 2023, numbers varied widely, ranging from a high of 60 in January to a low of 9 in December, with a monthly average of 40.
  • 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 72% in 2021, to 23% in 2022, to 7% in 2023. This is thought to be due to changes to prison rules that mean prisoners now receive photocopied correspondence rather than original items.
    • There were low numbers of e-cigarette samples until late 2022, when they made up an average of 30% of detections. Detections increased from a monthly average of 1% in 2021, to 18% in 2022, to 28% in 2023.
    • Powder samples were low throughout 2021 (monthly average 4%), before increasing and remaining relatively stable at approximately 20% per month throughout 2022, increasing to 27% in 2023.
    • The transition from synthetic cannabinoids in paper form to e-cigarette, powder or wax forms has introduced new methods of consumption. This variation in form and purity can make it challenging to achieve consistent dosing, potentially leading to unpredictable effects.
  • Drug-type seizure data were highly variable over time, so the following narrative is based on 3-month moving averages:
    • Synthetic cannabinoids were the most common substances detected.
    • In 2021, the percentage of seizures testing positive for synthetic cannabinoids was on average 43% 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 July, from 12% to 61%, before decreasing for the remainder of the year to 22% in December.
    • The percentage of seizures testing positive for benzodiazepines fluctuated throughout 2021 (monthly average 39%), before decreasing and remaining relatively stable in 2022 (monthly average 26%). In 2023, detections followed an uneven decreasing trend (monthly average 9%).
    • Detections of opioids increased in late 2023 (average 33% in December), however small sample numbers should be taken into consideration when interpreting the data. 
Update

Analysis of seizures from January to August 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 January 2025.

We have received data for a limited number of samples for 2024:

  • 31 samples contained a controlled drug.
  • Synthetic cannabinoids were the most prevalent drug type. They were detected in 12 samples, with ten samples containing two cannabinoids.
  • MDMB-4en-PINACA was the most common synthetic cannabinoid (10 detections), followed by MDMB-INACA (8).
  • In the latest period, three samples contained a benzodiazepine: two contained etizolam and one contained bromazolam. Please note that due to the limited number of samples received for testing for 2024, these detections do not fully represent all benzodiazepine seizures within this reporting period.
  • The most common sample type was powder (17 samples).
Further information

In September 2023, this drug analysis project detected hexahydrocannabinol (HHC), for the first time in prisons in Scotland. HHC is a semi-synthetic cannabinoid, a compound that is derived from naturally occurring cannabinoids but is modified to enhance or alter the effects.

  • HHC was detected four times between September 2023 and April 2024.

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.

Service indicators

Specialist drug treatment referrals

Between May and August 2024, the average weekly number of referrals to specialist drug treatment services was relatively stable. A total of 6,337 referrals were recorded, 9% lower than the previous quarter (6,946). This was 5% higher than the same period in 2022 (6,031) and 10% lower than in 2023 (7,043).

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 23 May 2022 and 18 August 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.

Image caption 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 512 per week in January 2023.
  • In 2023, referrals averaged 520 referrals per week, ranging between 416 and 598.
National update

For the most recent 13-week period (20 May to 18 August 2024):

  • The number of referrals ranged from 436 to 533 per week.
  • 6,337 specialist drug treatment referrals were recorded, at an average of 487 per week. This was 9% lower than the previous quarter (19 February to 19 May 2024) when 6,946 referrals were recorded, at an average of 534 per week.
  • The number of referrals was 5% higher than the same time period in 2022 (6,031) and 10% lower than in 2023 (7,043).
Local update

Comparing the most recent period (20 May to 18 August 2024) to the previous quarter, the key changes observed across mainland NHS boards were:

  • Referrals increased in one area: NHS Grampian (7%).
  • Referrals decreased in seven areas: NHS Ayrshire and Arran (7%), NHS Borders (8%), NHS Tayside (9%), NHS Greater Glasgow and Clyde (10%), NHS Lothian (15%), NHS Highland (23%) and NHS Fife (28%).
  • Referrals were broadly stable in three areas: NHS Dumfries and Galloway, NHS Forth Valley and NHS Lanarkshire.  

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.

DAISy is a dynamic source of data, which means the information above is a snapshot of the data that are on the system at the time of extraction. As such, data for previous quarters may not be the same as that in previous publications for the same period. Similarly, data for the most recent quarter are provisional and may change in future publications.

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).

PHS has a launched 10-minute survey (external website) to explore users' views of the current drug and alcohol treatment waiting times outputs. The survey also seeks views on the proposal to focus future work on the dashboard, ceasing production of the quarterly PDF report but continuing to provide the publication summary, workbooks and open data on a quarterly basis. This change is proposed in order to make the production of these statistics more efficient. We strongly encourage people who use these statistics to participate in the survey and share their views. After the survey closes on 17 October 2024, PHS will publish a summary of the responses and actions.

For more information on initial assessments for specialist drug and alcohol treatment services in Scotland, please see: 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 April to June 2024, the average number of opioid substitution therapy (OST) doses supplied per month was similar to the previous quarter and slightly lower (5%) than the same time periods in 2022 and 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).

Due to the inclusion of additional OST formulations, the number of ADQ doses is slightly higher than is shown in previous quarterly reports. For more information, see the metadata.

The chart below shows the average total monthly number of ADQ doses supplied for OST medications in the community between 1 April 2022 and 30 June 2024.

Image caption Average total number of OST doses per month

The chart below shows trends in the monthly number of ADQ doses for specific OST medications dispensed in the community between 1 April 2022 and 30 June 2024.

Image caption 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 14%, from 569,800 between April and June 2022, to 492,400 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. The average monthly number of doses supplied increased nearly two-fold, from 65,800 between April and June 2022, to 122,700 between January and March 2024. Dispensing of injectable buprenorphine has been more common than oral buprenorphine since August 2023.
  • The average monthly number of oral buprenorphine doses supplied was roughly stable between April and June 2022 (118,300) and January and March 2024 (117,200).
Update

For the most recent period (1 April to 30 June 2024):

  • The average total monthly number of OST doses supplied was approximately 714,300. This was similar to the previous quarter (January to March 2024; 732,000 doses) and slightly lower (5%) compared to the same periods in 2022 and 2023.
  • The average monthly number of methadone doses supplied was approximately 475,400. This was similar to the previous quarter, 17% lower than the same period in 2022 and 11% lower than in 2023.
  • The average monthly number of oral buprenorphine doses supplied was approximately 114,000. This was similar to the previous quarter, and the same periods in 2022 and 2023.
  • The average monthly number of injectable buprenorphine doses supplied was approximately 124,900. This was similar to the previous quarter, 90% higher than the same period in 2022 and 23% 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 the case in Scotland, where the WHO DDD of 25 milligrams (mg) daily for methadone is between one-half and one-third of the normal maintenance dose used.

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 April and June 2024, the average weekly number of injecting equipment provision (IEP) transactions increased by 9% and the average weekly number of needles and syringes increased by 6%. The number of transactions was 5% lower than the same period in 2022 and similar to 2023. The number of needles and syringes distributed was 6% lower than the same period in 2022 and 7% lower than 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.

Information on the ratio of needles and syringes per transaction is also presented. This provides the number of needles and syringes distributed per visit which can be an indication of the number of injecting episodes.

The chart below shows the weekly number of IEP transactions from 4 April 2022 to 30 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.

Image caption 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 41,000 per week) remained broadly stable from April 2022 to March 2024, with seasonal fluctuations during December and January each year.
  • The ratio of needles and syringes distributed was stable between April 2022 to March 2024, at an average of 14.3 needles and syringes distributed per transaction.
National update

For the most recent period (1 April to 30 June 2024):

IEP transactions

  • 36,112 transactions were recorded, at an average of 2,778 per week.
  • This was similar to the previous quarter (1 January to 31 March 2024) when a total of 35,182 transactions were recorded (weekly average 2,706).
  • The number of transactions was 5% lower than the same period in 2022 (38,102, weekly average 2,931) and similar to 2023 (37,959, weekly average 2,920).

Needles and syringes distributed

  • 506,850 needles and syringes were distributed, at an average of 38,988 per week.
  • This was similar to the previous quarter when a total of 521,889 needles and syringes were distributed, at an average of 40,145 per week.
  • The number of needles and syringes distributed was 6% lower than the same period in 2022 (537,632, weekly average 41,356) and 7% lower than 2023 (547,151, weekly average 42,089).

Ratio of needles and syringes distributed

  • There was a weekly average of 14.0 needles and syringes distributed per transaction.
  • This was lower than in the previous quarter (14.9) and similar to the same period in 2022 (14.1) and 2023 (14.5).
Local update

Comparing the most recent period (1 April to 30 June 2024) to the previous quarter, the key changes observed across mainland NHS boards were:

  • The ratio increased in NHS Grampian (17%, ratio 23.9).
  • The ratio decreased in six areas: NHS Greater Glasgow and Clyde (6%; ratio 9.9), NHS Lanarkshire (8%; ratio 13.4), NHS Lothian (9%; ratio 22.8), NHS Ayrshire and Arran (11%; ratio 16.1), NHS Forth Valley (12%; ratio 16.5) and NHS Dumfries and Galloway (20%; ratio 6.6).
  • The ratio was stable in three areas: NHS Fife (13.6), NHS Borders (14.8) and NHS Tayside (15.6).

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 period presented, NHS Highland is excluded from the transaction and needle and syringe data and the ratio figures. This is the first RADAR quarterly report to include needle and syringe data and ratio figures for NHS Fife. Needle and syringe data is missing for NHS Fife between February and August 2021.

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:

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:

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

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

Publication title

Rapid Action Drug Alerts and Response (RADAR) quarterly report – October 2024

Theme

Substance use surveillance

Topic

Drugs

Format

HTML

Release date

29 October 2024

Frequency

Quarterly

Relevance and key uses of the statistics

Data are collected as part of public health surveillance on substance use in Scotland.
The most up-to-date data available are published in this report to provide a timely indicator of drug trends as part of RADAR, Scotland’s Drugs Early Warning System.

Revisions statement

Data are provisional and may be revised as a result of planned quality improvements or to reflect data quality and completeness issues.

There are no planned revisions. The data shown in the most recent quarterly update supersede data shown in previous reports.

Revisions relevant to this publication

N/A

Comparability

Data are not comparable outwith Scotland.

Accuracy

The data are considered accurate.

Data are validated locally by data suppliers, partnerships and sources, and then checked by PHS.

Where relevant, data quality and completeness issues are described in the text associated with each indicator.

The Code of Practice for Statistics has been followed to ensure a high standard of data value, trustworthiness and quality.

Accessibility

It is the policy of PHS to make its websites and products accessible according to our accessibility statement. Graphs and tables have been assessed against PHS accessibility standards.

Accessibility of the report and findings are of continuous consideration throughout the report development.

Coherence and clarity

The report is available as HTML web pages.

Wherever possible, plain English descriptions have been used within the narrative and any technical words or phrases explained.

Disclosure

Our Statistical Disclosure Protocol has been followed.

Official Statistics designation

Management information report

UK Statistics Authority Assessment

N/A

Last published

30 July 2024

Next published

28 January 2025

Date of first publication

11 October 2022

Help email

phs.drugsradar@phs.scot

Date form completed

28 October 2024

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

Description

This indicator provides a summary of the drug trend bulletin from the Police Scotland Statement of Opinion (STOP) Unit.

Data source(s)

Police Scotland STOP Unit

Date that data were acquired

2 October 2024

Timeframe of data and timeliness

This section includes the most notable drug trends in recent months.

Continuity of data

The Police Scotland drug-trend bulletins are designed to provide drug-trend information, highlighting some of the current trends identified by the police in Scotland and other parts of the UK. The bulletin has and will evolve through time to provide timely distribution of drug-related information.

Concepts and definitions

Xylazine is a depressant drug used in veterinary medicine with sedative, analgesic and muscle relaxant properties. 

Benzodiazepines are depressant drugs with sedative and anxiolytic (anti-anxiety) effects. They are also known as tranquilisers. 

Dimethyltryptamine (DMT) is a hallucinogenic drug, of the tryptamine family. It is found in various plants, most commonly ayahuasca and MHRB. 

Completeness

The Police Scotland drug trend bulletin highlights some of the current trends identified by the police in Scotland and other parts of the UK.

Value type and unit of measurement

Police seizures positive for controlled substances displayed as drug type.

Description

This indicator provides a summary of the drug reports received by RADAR.

Data source(s)

Public Health Scotland

Date that data were acquired

Various between 5 July 2024 and 4 October 2024. Data were collated on 10 October 2024. 

Timeframe of data and timeliness

This section includes the most notable drug trends in recent months.

Continuity of data

Since July 2022, data in this indicator have been collected consistently using reporting forms and email. The indicator has and will continue to evolve through time to provide timely distribution of drug-related information.

  • QR1 (Jul – Sep 22) - Number of reports 8; number of primary drugs reported 9 
  • QR2 (Oct – Dec 22) - Number of reports 18; number of primary drugs reported 20 
  • QR3 (Jan – Mar 23) - Number of reports 23; number of primary drugs reported 24 
  • QR4 (Apr – Jun 23) - Number of reports 24; number of primary drugs reported 24 
  • QR5 (Jul – Sep 23) - Number of reports 36; number of primary drugs reported 38 
  • QR6 (Oct – Dec 23) - Number of reports 53; number of primary drugs reported 64 
  • QR7 (Jan – Mar 24) - Number of reports 43; number of primary drugs reported 57 
  • QR8 (Apr – Jun 24) - Number of reports 85; number of primary drugs reported 128 
  • QR9 (Jul – Sep 24) - Number of reports 69; number of primary drugs reported 85 

Accuracy

Analysis on the reports received (such as number and type) are considered to be accurate. The individual reports have been validated to check their credibility and likelihood. Reports that we were unable to validate are not shown in this indicator.

Reports accurately represent the individual submissions made, although they have been summarised to ensure anonymity. Unless otherwise specified, these reports have not been confirmed by toxicology and should be considered anecdotal.

Concepts and definitions

Cocaine is a short-lasting stimulant drug. Cocaine powder and crack cocaine are two different forms of the same drug.

Benzodiazepines are depressant drugs with sedative and anxiolytic (anti-anxiety) effects. They are also known as tranquilisers.

Nitazenes are a group of potent synthetic opioids.

Heroin is an opioid drug usually found as a brown powder.

Xylazine is a depressant drug used in veterinary medicine with sedative, analgesic and muscle relaxant properties.

WEDINOS (The Welsh Emerging Drugs and Identification of Novel Substances) project is a harm reduction project, providing an anonymous drug testing service to members of the public, along with information about substance use. This service is provided to all residents of the UK who would like to receive further information about the substances they are in possession of. WEDINOS results are based on substances submitted by people who may have experienced harms or unusual effects from substances they have taken. As such, they provide useful information about emerging substances in circulation in Scotland but may not be representative of all the substances used or harms experienced by the wider population of people who use drugs.

Completeness

The indicator highlights report by area: National, North Scotland, East Scotland and West Scotland. Reports received are not representative of the level of harms in an area.

Value type and unit of measurement

Report number, type of report, drug appearance and report summary are displayed by NHS Board or local authority area.

Description

This indicator provides information on emergency naloxone administration by Scottish Ambulance Service (SAS) clinicians in Scotland.

Data source(s)

Scottish Ambulance Service

Date that data were acquired

4 September 2024

Timeframe of data and timeliness

20 May 2022 to 1 September 2024, approximately two months in arrears.

Continuity of data

SAS clinicians have been administering naloxone directly to patients experiencing symptoms of an opioid overdose since around 1998. There have been no changes in the guidance given to SAS clinicians regarding the administration of naloxone over the time series shown in the analysis. From April 2024, a new clinical IT system used for recording administration of naloxone started to be rolled out across Scotland.

Scotland's National Naloxone Programme has been operational since 2011 and continues to facilitate the supply of take-home naloxone to people at risk of opioid overdose, members of the public, service workers and professionals (PHS quarterly monitoring bulletin on naloxone). Since August 2023, all Police Scotland officers below the rank of Inspector have carried naloxone. Naloxone kits are also available on all emergency vehicles operated by the Scottish Fire & Rescue Service (SFRS).

This overall increase in the supply of naloxone kits in community settings should be taken into consideration when interpreting figures on the administration of naloxone by SAS clinicians. However, it cannot be assumed that changes in the amount of naloxone supplied to members of the public or other emergency services will result in comparable changes in the amount of naloxone administered by those individuals (kits obtained in case an opioid overdose is witnessed may remain unused). Data on the use of naloxone by Police Scotland officers are available on the Police Scotland website. Currently, no national data are available on naloxone administration by members of the public or SFRS staff.

As overdose awareness training guidelines clearly state that SAS clinicians should be called to opioid overdoses regardless of whether naloxone has already been administered by a third party, it cannot be assumed that the prior administration of naloxone will influence the likelihood of SAS clinicians attending an overdose or administering a further dose of naloxone. While it cannot be assumed that the SAS naloxone administration figures presented here provide a complete count of all opioid overdoses, the number of opioid overdoses not attended by SAS was unknown.

Concepts and definitions

Naloxone is a medicine used to prevent fatal opioid overdoses. Opioid overdoses are commonly associated with drug-related deaths. These data on the numbers of incidents in which naloxone was administered by SAS clinicians provide an indication of numbers of suspected opioid overdoses.

A small percentage of these administrations will have been due to circumstances other than an illicit opioid overdose (for example, some may relate to prescribed opioid overdoses or to adverse reactions associated with medications administered in the course of emergency treatment).

Also, in a small number of cases, naloxone may be administered to someone who is unconscious for unconfirmed reasons, which may be confirmed at a later point not to have been an opioid overdose.

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.

Under some circumstances, naloxone administration will not successfully reverse an opioid overdose (for example, if administered too late) and these statistics should not be interpreted as equating to numbers of lives saved.

Completeness

SAS data on numbers of naloxone incidents are collated from data entered by ambulance clinicians recording medications administered to patients via an electronic tablet in the vehicle. Data recording is typically completed within 30 minutes of the end of an incident.

Due to issues with a clinical IT system replacement, data for NHS Fife and NHS Tayside are incomplete for the most recent quarter (3 June to 1 September 2024). Therefore, all NHS Fife and NHS Tayside data have been excluded from naloxone administration figures.

Value type and unit of measurement

Number of incidents in which naloxone was administered by SAS clinicians and moving averages.

Description

This indicator provides information on drug overdose or intoxication attendances at emergency departments in Scotland.

Data source(s)

Public Health Scotland – Accident & Emergency Datamart

Date that data were acquired

10 September 2024

Timeframe of data and timeliness

30 May 2022 and 1 September 2024, approximately two months in arrears.

Continuity of data

There have been no changes in the national recording mechanisms or processes over the time series shown in the analysis.

Concepts and definitions

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

Completeness

It is not possible to accurately report total attendances for specific conditions using the national A&E dataset, due to the quality of the data available. 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 therefore only give a high–level indication of attendances over time. Further details can be found in the Accident and Emergency Activity Data.

Value type and unit of measurement

Number of drug overdose or intoxication attendances at emergency departments and moving averages.

Description

This indicator provides information on drug-related acute hospital admissions in Scotland.

Data source(s)

Public Health Scotland – Scottish Morbidity Record – general, acute inpatient and day case records (SMR01)

Date that data were acquired

22 October 2024

Timeframe of data and timeliness

28 March 2021 to 30 June 2024, approximately three months in arrears. 

Continuity of data

There have been no changes in the recording mechanisms or processes over the time series shown in the analysis. Further detail can be found in the 'Drug-related hospital statistics' publication background information.

Concepts and definitions

Opioids       

Opioid drugs act on opioid receptors to produce sedative and painkilling effects. They are respiratory depressants (reduce heart rate and breathing). Opioids include synthetic (lab-made) drugs such as methadone and buprenorphine, as well as opiates (drugs made from opium) such as heroin and morphine.

Cannabinoids

Cannabinoids are compounds that interact with the endocannabinoid system. They are found in the cannabis plant (such as THC) or can be produced synthetically in a laboratory (synthetic cannabinoids).

Cocaine

Cocaine is a short-lasting stimulant drug that increases heart rate and breathing. This group includes powder cocaine and crack cocaine.

Sedatives and hypnotics

Sedatives and hypnotics are drugs that induce sedation and depress the central nervous system, which also decreases heart rate and breathing. They are also known as depressants. This group of drugs includes 'prescribable' benzodiazepines (drugs such as diazepam), 'street' benzodiazepines (such as etizolam and alprazolam) and z-hypnotics (such as zopiclone).

Multiple/other

The 'multiple/other' drugs category includes volatile solvents (such as glue, gases or aerosols) and multiple drug use. This category may also be used to indicate multiple drug use when individual substances are not known or cannot be coded using existing diagnosis codes (International Classification of Diseases 10th Revision – ICD10).

Completeness

The data is routinely drawn from hospital administrative systems and ICD10 diagnosis codes used to identify admissions related to drug use. Some caution is necessary when using these data as drug use may only be suspected and may not always be recorded by the hospital. Further details can be found in the PHS drug-related hospital statistics report, and information on hospital administrative systems (Scottish Morbidity Records – SMR) data completeness can be found on the 'SMR completeness' webpage. 

Completeness levels for NHS Fife were below 90% as of 12 October 2024 for the most recent time period (April June 2024), therefore caution is advised when interpreting trends in these areas on the dashboard. 

Value type and unit of measurement

Number of inpatient and day case admissions to general acute hospitals (excluding maternity, neonatal, geriatric long stay and admissions to psychiatric hospitals), presented by month of admission with moving averages.

Description

This indicator provides information on suspected drug deaths in Scotland.

Data source(s)

Police Scotland

Date that data were acquired

17 September 2024 

Timeframe of data and timeliness

1 June 2022 to 25 August 2024, approximately two months in arrears.

Continuity of data

There have been no changes in the national Police Scotland recording mechanisms or processes over the time series shown in the analysis.

Concepts and definitions

Drug-related death

A drug-related death (also referred to as drug-misuse death) is a death where the underlying cause was confirmed to be drug poisoning and where any of the substances which were implicated, or potentially contributed to death, are controlled in the UK. National Statistics on drug-related deaths are published by the National Records of Scotland (NRS).

Suspected drug death

A suspected drug death is a death where controlled drugs are suspected of being involved. This operational measure used by Police Scotland is based on the reports, observations and initial enquiries of officers attending the scene of death.

Completeness

This indicator includes data on suspected drug deaths as recorded by all Police Scotland Divisions across Scotland.

Value type and unit of measurement

Numbers of suspected drug deaths in Scotland and moving averages.

Description

This indicator provides information on the number of attendances, length of stay and toxicology of presentations due to acute illicit drug toxicity at the Queen Elizabeth University Hospital (QEUH) emergency department (ED), Glasgow, Scotland. This study assesses the feasibility of prospective surveillance of ED presentations due to acute illicit drug toxicity.

Data source(s)

QEUH, NHS Greater Glasgow and Clyde

Date that data were acquired

14 October 2024 

Timeframe of data and timeliness

17 August 2022 to 16 August 2024, approximately two months in arrears.

Continuity of data

'ASSIST: A Surveillance Study of Illicit Substance Toxicity' is a study by the ED at the QEUH.

QEUH will provide Public Health Scotland with toxicology screening data on a quarterly and ad-hoc basis for the purposes of public health surveillance.

Because the sample size is small, some of the variables are combined in a different way to the data shared in previous releases of the RADAR quarterly report, to ensure the information are not disclosive. Categories may be revised in future as sample size increases.

Concepts and definitions

Unique ED attendances

Each separate attendance is a count of one. If the same person presented more than once, each attendance was counted.

Illicit drug

'Illicit drug' encompasses any substance that is a controlled drug as per the Misuse of Drugs Act 1971 and Misuse of Drugs Regulations 2001. It excludes legal substances such as alcohol, nicotine, caffeine and paracetamol, as well as medications recently prescribed to the individual or drugs administered to the individual as part of treatment (by ambulance or hospital).

Benzodiazepines

Benzodiazepines are a group of drugs with depressant and anxiolytic (anti-anxiety) effects. They are also known as tranquilisers.

Metabolite

A drug metabolite is a compound produced when a drug breaks down in the body.

In this study, if either a drug or metabolite are detected, this will only be included as one substance – the drug. For example, if both diazepam and its metabolite desmethyldiazepam are detected, only diazepam is recorded.

Due to this we are unable to ascertain the source of some substances, for example, oxazepam is a benzodiazepine, but it is also a metabolite of a range of other benzodiazepines, so we cannot determine whether oxazepam or another benzodiazepine was consumed.

Cocaine

Cocaine is a short-lasting stimulant drug that increases heart rate and breathing.

Gabapentinoids

Gabapentinoids are a group of drugs with depressant and painkilling effects.

Opioids

Opioid drugs act on opioid receptors to produce sedative and painkilling effects. They are respiratory depressants (reduce heart rate and breathing).

Cannabinoids

Cannabinoids are compounds that interact with the endocannabinoid system. They are found in the cannabis plant (such as THC) or can be produced synthetically in a laboratory (synthetic cannabinoids).

Other stimulants

Other stimulants are stimulant drugs apart from cocaine. They increase heart rate, breathing and energy.

Completeness

Not all data identified for all ED attendances is available for analysis, due to the time required to send and receive toxicology results and to link patient and clinical data. A differing proportion of the total attendances recruited for this study are available for each of the data sources:

  • completed clinical notes made by research nurses (Castor)
  • completed electronic clinical records (West of Scotland Safe Haven)
  • toxicology results
  • toxicology results with corresponding clinical (Castor) notes

Toxicology testing has been carried out by the LGC Group, formerly the Laboratory of the Government Chemist. LGC screen against a database of over 3,500 chemical substances including illicit drugs, novel psychoactive substances, synthetic cannabinoid receptor agonists, benzodiazepines and medications. This analysis does not, however, imply that specific drugs were implicated in harms.

This study includes patients aged 16 or over attending QEUH adult ED directly related to acute illicit drug use. It excludes patients where the condition is more likely due to a cause other than acute illicit drug use, due to withdrawal, primarily related to alcohol use or where the attendance is due to a complication of previous drug use, i.e. infected injection site.

Value type and unit of measurement

Number of ED attendances related to illicit drug use, destination on discharge from the ED, number of hours in the ED, number of hours in hospital, toxicology results of surplus serum sampling by drug type and drug category.

Description

This indicator provides information on forensic toxicology testing for controlled substances completed at post-mortem in Scotland.

Data source(s)

Forensic Toxicology Service within Forensic Medicine and Science (FMS), University of Glasgow, on behalf of the Crown Office and Procurator Fiscal Service (COPFS).

Other laboratory testing sites in the United Kingdom, outsourced by the Scottish Police Authority (SPA) Forensic Services.

The Department of Clinical Biochemistry at NHS Grampian, on behalf of the Crown Office and Procurator Fiscal Service (COPFS).

Date that data were acquired

4 October 2024 

Timeframe of data and timeliness

Between 1 January 2022 and 30 June 2024, approximately three months in arrears. 

Continuity of data

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 from January 2022 onwards, was supplied by the Department of Clinical Biochemistry at NHS Grampian.

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.

Concepts and definitions

Post-mortem toxicology testing where controlled drugs (as defined in the Misuse of Drugs Act 1971 - external website) were detected is carried out, on behalf of the COPFS, 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.

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 does not include consideration of wider causes of death.

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.

Benzodiazepines

Benzodiazepines are a group of drugs with depressant and anxiolytic (anti-anxiety) effects. They are also known as tranquilisers. Diazepam is a ‘prescribable benzodiazepine’. Etizolam, clonazolam and bromazolam are ‘street benzos’, benzodiazepines that are not licensed for prescription in the UK.

Cocaine

Cocaine is a short-lasting stimulant drug that increases heart rate and breathing. This group includes powder cocaine and crack cocaine.

Gabapentin and pregabalin

Gabapentin and pregabalin are gabapentinoids, a group of drugs with depressant and painkilling effects.

Opioids

Opioid drugs act on opioid receptors to produce sedative and painkilling effects. They are respiratory depressants (reduce heart rate and breathing). This category includes buprenorphine, fentanyl, heroin/morphine and methadone.

Completeness

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.

Value type and unit of measurement

Number and percentage of forensic toxicology cases testing positive for controlled substances by drug type.

Description

This indicator provides information on drug types most commonly detected in drug seizures in Scottish prisons.

Data source(s)

Scottish Prison Service (SPS) and the Leverhulme Research Centre for Forensic Science (LRCFS), University of Dundee.

Date that data were acquired

18 September 2024 

Timeframe of data and timeliness

27 September 2021 to 1 August 2024, approximately three months in arrears.

Continuity of data

There have been no changes in the seizures recording mechanisms or processes over the time series shown in the analysis.

Data for a limited number of samples for the latest period (1 January 2024 to 01 August 2024). Analysis is available within the report. Analysis of the drug seizures in Scottish prisons from January 2024 to August 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 January 2025.

Concepts and definitions

Benzodiazepines

Benzodiazepines are a group of drugs with depressant and anxiolytic (anti-anxiety) effects. They are also known as tranquilisers. Benzodiazepines detected in this project include etizolam, flubromazepam, bromazolam, diazepam and flualprazolam.

Cocaine

Cocaine is a short-lasting stimulant drug that increases heart rate and breathing. This group includes powder cocaine and crack cocaine.

Gabapentinoids

Gabapentinoids are a group of drugs with depressant and painkilling effects.

Opioids

Opioid drugs act on opioid receptors to produce sedative and painkilling effects. They are respiratory depressants (reduce heart rate and breathing). Opioids include synthetic (lab-made) drugs such as methadone and opiates (drugs made from opium) such as heroin. Opioids detected in this project include buprenorphine, heroin, tramadol, codeine, dihydrocodeine, metonitazene, oxycodone and methadone.

Synthetic cannabinoids

'Synthetic cannabinoids' is a term used to describe over 200 lab-made drugs that interact with the endocannabinoid system.

Completeness

Data is provided to PHS by the LCRFS. LCRFS does not analyse all seizures from the SPS. However, LCRFS data is a sizeable subset of all national prison seizures.

Value type and unit of measurement

Percentage of drug seizures analysed by the LRCFS by drug type and sample type (card, paper, powder or tablet).

Description

This indicator provides information on specialist drug treatment referrals in Scotland.

Data source(s)

Public Health Scotland – Drug and Alcohol Information System (DAISy) and Drug and Alcohol Treatment Waiting Times (DATWT) database

Date that data were acquired

5 September 2024 

Timeframe of data and timeliness

23 May 2022 to 18 August 2024, approximately two months in arrears.

Continuity of data

These data have been extracted from the Drug and Alcohol Information System (DAISy) and its predecessor, the Drug and Alcohol Treatment Waiting Times (DATWT) database. DAISy was available in all NHS boards from April 2021.

DAISy introduced a new way of recording referrals, a continuation of care process which affects how referrals are recorded when people have started treatment and move from one service to another without a break or change in their treatment (for instance, when moving between community-based and prison-based services). The number of referrals remain comparable between DATWT and DAISy, but how waits are recorded against the initial and receiving services has changed for referrals transferred by the continuation of care process. These data report on the number of referrals rather than waits so the new continuation of care process should not impact the number of referrals.

DAISy introduced an additional 'co-dependency' service user type, where the referral relates to treatment for both drug and alcohol use. Co-dependency has only been recorded since the introduction of DAISy (April 2021) so is not available as a separate client type in the DATWT database. These data report the number of referrals where the service user type is recorded as either 'drugs' or 'co-dependency' in DAISy and as 'drugs' in DATWT.

Concepts and definitions

These data relate to the number of referrals to specialist drug and alcohol treatment services in Scotland delivering tier 3 and 4 interventions (community-based specialised drug assessment and co-ordinated care-planned treatment, and residential specialised drug treatment). These data are for community-based drug and alcohol treatment services and exclude prison-based and hospital-based services.

Completeness

Drug and alcohol treatment services are required to submit accurate and up-to-date waiting times information to PHS. These referrals data are management information and includes all services that enter data on DAISy and its predecessor, the DATWT database. This contrasts with the figures reported in the 'National drug and alcohol treatment waiting times' statistics release for Scotland where data from services that were unable to confirm their data were accurate and up-to-date within specified timescales are excluded. Further details can be found in the data quality section of the Drug and Alcohol Treatment Waiting Times dashboard.

Value type and unit of measurement

Number of specialist drug treatment referrals and moving averages.

Description

This indicator provides information on opioid substitution therapy prescribing in Scotland.

Data source(s)

Public Health Scotland – Prescribing Information System (PIS) and Hospital Medicines Utilisation Database (HMUD)

Date that data were acquired

26 September 2024 

Timeframe of data and timeliness

1 April 2024 to 30 June 2024.

Data from the PIS are available approximately three months in arrears.

HMUD data availability can vary by NHS board. However, the injectable buprenorphine data shown in this release are considered complete.

Continuity of data

The data shown are considered to provide a comprehensive account of OST prescribing for the time series presented, including data from GP and hospital prescribing systems.

Buvidal data for October to December 2023 is provisional and we anticipate the data for this period to be validated for the next release of this report in July 2024.

Concepts and definitions

Defined daily dose

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.

Average daily quantity

Due to differences between the average OST doses used in Scotland and the rest of the world, the analysis presented here is based on average daily quantities (ADQs). These are more representative of the daily maintenance doses used within Scotland and were developed via analysis of prescriptions and by consultation with the Specialist Pharmacists in Substance Misuse group. The ADQs agreed are:

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

Buprenorphine

Buprenorphine is a synthetic partial opioid agonist used to treat acute pain, chronic pain and opioid dependence. Prescribed for daily use (oral) or weekly or monthly prolonged release (injectable), buprenorphine relieves opioid cravings and withdrawal symptoms and blocks the effects of other opioids. As with other opioids, buprenorphine can result in sedation, respiratory depression and death. These statistics relate to the prescribing of oral (2 mg, 8 mg and 16 mg buprenorphine or buprenorphine and naloxone tablets) and injectable buprenorphine (various strengths) for the treatment of opioid dependence.

Opioids

Opioid drugs act on opioid receptors to produce sedative and painkilling effects. They are respiratory depressants (reduce heart rate and breathing). Opioids include synthetic (lab-made) drugs such as methadone and buprenorphine, as well as opiates (drugs made from opium) such as heroin and morphine.

Methadone

Methadone is a synthetic opioid agonist used to treat chronic pain and opioid dependence. Prescribed for daily use, methadone relieves opioid cravings and withdrawal symptoms. As with other opioids, methadone can result in sedation, respiratory depression and death. These statistics include data on the prescribing of methadone 1mg/1ml solution for the treatment of opioid dependence.

Accuracy

There are differences between community prescribing data from the Prescribing Information System (PIS) and hospital prescribing data from the Hospital Medicines Utilisation Database (HMUD) in the way that dates are allocated to medications supplied. The basis for date allocation in PIS data is the month in which the costs associated with dispensing medication were reimbursed. The basis for date allocation in HMUD data is the month in which medications were supplied to the NHS Board for onward administration to patients. While useful to note, these differences are not thought to have a significant impact on the reliability of this analysis.

For the 2022/23 Q3 and Q4 reports, there were revisions to the injectable buprenorphine data, which means that the number of ADQ doses associated with that medication from April 2022 onwards was slightly higher than shown in previous reports. These changes were associated with the addition of data on Buvidal 160mg/0.45ml prolonged release injections to the PIS data extract in 2022/23 Q3 and to the HMUD data extract in 2022/23 Q4.

For the 2024/25 Q1 reports, there were revisions to the methadone and oral buprenorphine data, which means that the number of ADQ doses associated with these medications from February 2018 onwards was slightly higher than shown in previous reports. These changes were associated with the addition of data on the doses outlined in the table below to the PIS data extract.  

Methadone 

  • methadone 10mg/ml oral solution sugar free 

Buprenorphine 

  • buprenorphine 5.7mg / naloxone 1.4mg sublingual tablets sugar free 
  • buprenorphine 8.6mg / naloxone 2.1mg sublingual tablets sugar free 
  • buprenorphine 11.4mg / naloxone 2.9mg sublingual tablets sugar free 
  • buprenorphine 16mg / naloxone 4mg sublingual tablets sugar free  
  • buprenorphine 400microgram sublingual tablets sugar free  
  • buprenorphine 1mg sublingual tablets sugar free 
  • buprenorphine 4mg sublingual tablets sugar free 
  • buprenorphine 6mg sublingual tablets sugar free      

Completeness

The data shown are considered to provide a comprehensive account of OST prescribing for the time series presented, including data from GP and hospital prescribing systems.

Value type and unit of measurement

Total number of ADQ doses of methadone, oral buprenorphine and injectable buprenorphine supplied in Scotland, based on community and hospital prescribing data.

Description

This indicator provides information on injecting equipment provision (IEP) in Scotland.

Data source(s)

Needle Exchange Online (neo360)

Date that data were acquired

3 October 2024 

Timeframe of data and timeliness

4 April 2022 to 30 June 2024, approximately three months in arrears.

Continuity of data

Caution is recommended when interpreting these statistics. Service provision in some areas has changed over time. Some outlets will have closed, and others will have opened.

The methods used by areas to count or estimate some of the figures may also have changed.

Concepts and definitions

Transactions

A transaction is an episode in which a client received equipment relating to an injecting episode (i.e. a barrel and/or fixed needle and syringe). People who inject drugs may attend IEP outlets at any time, whether or not they are undertaking specialist treatment for problematic drug use.

Further details can be found in the PHS Injecting Equipment Provision in Scotland report.

Completeness

This indicator includes data on transactions and needle and syringe distribution by injecting equipment providers in mainland Scotland NHS Boards.

It does not include data for NHS Shetland, NHS Orkney and NHS Western Isles.

The 11 mainland NHS boards use neo360 routinely, but due to missing data for part of the period presented, NHS Highland is excluded from the transaction and needle and syringe data and the ratio figures. This is the first RADAR quarterly report to include needle and syringe data and ratio figures for NHS Fife. Needle and syringe data is missing for NHS Fife between February and August 2021.

Value type and unit of measurement

Number of IEP transactions, number of needles and syringes distributed, the ratio of the number of needles and syringes per IEP transaction and moving averages.

Last updated: 15 October 2024
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