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.

This chart shows the number of referrals to drug treatment services on the y axis and the date, between 23 May 2022 and 18 August 2024, on the x axis. In December and January each year, a seasonal reduction in referrals occurs. Throughout 2022 there was a fluctuating, but gradual, decrease in the average weekly number of referrals. After the seasonal reduction in December 2022, referrals returned to a weekly average of 512 per week in January 2023. A relatively stable trend was evident in 2023, with referrals ranging between 416 and 598 per week. After the seasonal reduction in December 2023, the weekly number of referrals ranged from 421 to 606 up to May 2024, followed by a fluctuating but gradual decrease to August 2024.

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Specialist drug treatment referrals

Summary

Historic trend

• Throughout 2022, there was a fluctuating, but gradual, decrease in the average weekly number of referrals.
• Following the seasonal reduction in December 2022, referrals returned to a weekly average of 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.

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

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Average total number of OST doses per month

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

The chart shows monthly trends in the number of doses supplied for specific OST medications dispensed in the community between April 2022 and June 2024. The number of doses per month is on the y axis and the month is on the x axis. Methadone was the most commonly prescribed medication. Following a gradual decrease since April 2022, approximately 475,000 doses per month were dispensed between April and June 2024. The average total number of injectable buprenorphine doses supplied has increased steadily since it was first licensed for use in Scotland in early 2020. Approximately 66,000 injectable buprenorphine doses were supplied between April and June 2022, increasing to around 125,000 per month between April and June 2024. The average monthly number of oral buprenorphine doses supplied was roughly stable, ranging between approximately 113,000 and 120,000 oral buprenorphine doses prescribed per month across the time period.

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Number of doses per month for OST medications

Summary

Historic trend

• There was a gradual decrease in the average monthly total number of OST doses supplied. This was likely associated with the decrease in the average monthly number of methadone doses supplied, which reduced by 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.

The chart shows the number of transactions at injecting equipment provision sites in Scotland. The number of transactions is on the y axis and the date, between 4 April 2022 and 30 June 2024, is on the x axis. In December and January each year, a seasonal reduction in transactions is observed. Between April and November 2022, the number of transactions varied but was broadly stable between 2,600 and 3,400 per week. After the seasonal reduction in January 2023, the number of transactions fluctuated until the end of June 2023, following an overall increasing trend. Between July and November 2023, the number of transactions was stable between 2,850 and 3,250 per week. After the seasonal reduction in December 2023, the number of transactions followed a decreasing trend from 3,025 in the week beginning 5 February 2024 to 2,233 in the week beginning 1 April 2024. The number of transactions increased during April 2024 and remained stable at approximately 2,850 transactions per week between May and June 2024.

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Injecting equipment provision: transactions

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

Summary

Historic trend

• The average number of transactions (approximately 2,900 per week) and the number of needles and syringes distributed (approximately 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).