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

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 showing two white, circular, benzodiazepine tablets, one stamped ‘10’, the other with a half score.

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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.

This stacked bar chart shows the percentage of reports by drug or drug type in submissions received by RADAR. Data is shown in eight quarters from Q1 (July to September 2022) to Q8 (July to September 2024). Percentage is on the y axis and date (by quarter) is on the x axis. The drugs are grouped into six main categories (benzodiazepines, cocaine, heroin, nitazenes/fentanyl, cannabinoids and other). The most common drug type reported in all quarters was benzos. Benzo reports start relatively high at 33% in QR1, reaching a high of 42% in QR4 and then gradually decreasing to 16% in QR8, before increasing to 26% in QR9. Cocaine made up 22% of reports in QR1 and fluctuated between 20-25% up to QR4, followed by a decrease in the later quarters, reaching a low of 8% by QR9. Heroin reports started low (5% in QR2) before trending upwards, with intermittent increases across the quarters, peaking at 22% in QR9. Nitazene/fentanyl-type opioid reports initially appear in QR2 at 5% and then fluctuate through the quarters, reaching its highest point of 13% in QR5. By QR9, it decreased slightly to 9%. There were a low number of cannabinoid reports in the first six quarters. Reports peaked in QR8 at 20%, followed by a drop to 5% in QR9. Reports of ‘other’ drugs fluctuated throughout the series from 20-45%.

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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 showing a blue circular tablet, marked ‘10’, next to plastic and foil packaging

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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.

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.

The chart shows the number of emergency naloxone incidents by the Scottish Ambulance Service in Scotland, excluding NHS Fife and NHS Tayside. The average weekly number of naloxone incidents was broadly stable between June and November 2022 at 63 per week before decreasing during December 2022 (47 incidents in the week beginning 26 December 2022). An increasing trend was observed from January to May 2023. Between June and August 2023, the average weekly number of naloxone incidents remained broadly stable at around 82 per week, after which there was a decreasing trend to January 2024. The weekly number of incidents fluctuated between January and March 2024, ranging from a low of 37 to a high of 74. The average weekly number of naloxone incidents increased and remained stable at around 71 per week from March to June 2024. Since then, a decreasing trend has been observed.

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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.

The chart shows the number of drug-related emergency department attendances. The number of attendances is on the y axis and the date, between 30 May 2022 and 1 September 2024, is on the x axis. The number of attendances remained broadly stable at 82 per week between June 2022 and March 2023. Between April and June 2023, the number of attendances gradually increased, peaking at 142 in the week beginning 19 June 2023. An overall decreasing trend was observed from July 2023 to January 2024. This was followed by a generally increasing trend to a peak of 97 in the week beginning 22 July 2024, after which attendances fluctuated between 70 to 94 per week until the end of August 2024.

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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.

The chart shows the number of drug-related hospital admissions in Scotland’s general acute hospitals. The number of admissions is on the y axis and the date, between 28 March 2022 to 30 June 2024, is on the x axis. There was an increase in admissions during April and May 2022 (peak of 201 admissions during the week beginning 16 May), before an uneven decreasing trend from June to December 2022. Admissions increased between January and July 2023, reaching a peak in the week beginning 10 July (223), remaining relatively stable until September before following a decreasing trend until October 2023. Between October 2023 and April 2024, admissions remained broadly stable averaging 162 admissions per week, with a seasonal decrease during the end of December and beginning of January. Admissions increased during May to a peak of 198 before following a decreasing trend to 30 June 2024.

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Drug-related hospital admissions

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

Summary 

Historic trend 

• There was 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.

The chart shows the weekly number of suspected drug deaths in Scotland on the y axis and the date, between 23 May 2022 to 25 August 2024, on the x axis. Between May 2022 and the end of August 2024, the average weekly number of deaths fluctuated considerably but generally remained within a range of 18 to 27 deaths per week.

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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.

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.

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.

This stacked bar chart shows the percentage of detections of drug types within QEUH ED across eight quarters - Q1 to Q8. The drugs are grouped into five categories (depressant, opioid, stimulant, cannabinoid and other (including dissociative and psychedelic drugs)). Percentage of detections by category is on the y axis and the time period is on the x axis. The most common category was depressants with 57%, 62%, 60%, 64%, 66%, 67%, 60% and 63% across the time series. The second most common category across Q1 to Q6 was opioids with 17%, 18%, 16%, 16%, 15% and 13% across the time series. In Q7 stimulants were the second most common category (17%) and in Q8 both opioids and stimulant detections were recorded at 16%.

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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.

This line chart shows the percentage of detections of specific depressant drugs within QEUH ED across eight quarters - Q1 to Q8. Percentage of detections is on the y axis and the time period is on the x axis. The most common depressant drug in Q1, Q2, Q5, Q6, Q7 and Q8 was desmethyldiazepam (Q1; 10%, Q2; 8%, Q5; 11%, Q6; 10%; Q7: 9% and Q8: 11%). The most common depressant drug in Q4 was bromazolam (Q4; 10%). Xylazine was detected in quarters Q4 to Q7 (Q4:<1%, Q5 to Q7: 1%).

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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.

This line chart shows the percentage of detections of specific opioid drugs within QEUH ED across eight quarters - Q1 to Q8. Percentage of detections is on the y axis and the time period is on the x axis. The most common opioid drug across the time series was heroin/morphine (Q1: 4%, Q2: 5%, Q3: 6%, Q4: 5%, Q5: 5%, Q6; 4%, Q7; 4% and Q8; 5%). Nitazenes were detected for the first time in Q4 (seven detections) and increased to 2% of detections (16 detections) in Q5. They were detected 8 times in Q6 ,6 times in Q7 and once in Q8. Detections of noscapine decreased from 3% in Q1 to 0 in Q5, 1% in Q6, 2% in Q7 and 1% in Q8.

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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.

This stacked bar chart shows the percentage of QEUH ED ASSIST attendees by age group across eight time periods - Q1 to Q8. Percentage of attendees is on the y axis and the time period is along the x axis. The most common age group in Q1, Q2 and Q4 was 25 to 34 years (34%, 34% and 29% respectively). In Q3, patients aged 25 to 34 years and 35 to 44 were equally common (both 29%). The most common age group in Q5, Q6, Q7 and Q8 was 35 to 44 years (30%, 34%, 34% and 30% respectively).

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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.

The chart shows the percentage of forensic toxicology cases testing positive for controlled substances (opioids, benzodiazepines, gabapentin and pregabalin, cocaine). The percentage of cases is on the y axis and the calendar year and quarter of death, between Q1 of 2022 and Q2 of 2024 is on the x axis. The most commonly detected drug types were opioids and benzodiazepines. The percentage of deaths where opioids, benzodiazepines, or gabapentin/pregabalin were detected has remained relatively stable throughout the series averaging 71% for opioids, 57% for benzodiazepines and 30% for gabapentin/pregabalin. The percentage of deaths where cocaine was detected was relatively stable until Q1 of 2023 (averaging 29%). Cocaine detections increased to 36% in Q2 of 2023, after which they remained stable.

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Forensic toxicology cases testing positive for controlled substances

The following charts provide an indication of specific opioids and benzodiazepines detected at post-mortem, in deaths occurring between 1 January 2022 and 30 June 2024.

The chart shows the percentage of forensic toxicology cases testing positive for specific opioids (heroin/morphine, fentanyls, methadone, buprenorphine and nitazenes). The percentage of cases is on the y axis and the calendar year and quarter of death, between Q1 of 2022 and Q2 of 2024 is on the x axis. Heroin/morphine has been the most commonly detected opioid throughout the series; however, detections have been gradually decreasing from 36% in Q1 of 2022 to 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. Deaths with buprenorphine present remained relatively low and stable throughout the series (averaging 6%). There was a gradual increase in the percentage of cases where fentanyl-type opioids were detected, from 1% in Q1 of 2022, to 8% in Q4 of 2023. Nitazene-type opioid substances were first detected in Q1 of 2022 and have gradually increased, being detected in 3% of deaths in Q2 of 2024.

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Forensic toxicology cases testing positive for specific opioids

The chart shows the percentage of forensic toxicology cases testing positive for specific benzodiazepines (diazepam, etizolam, clonazolam, gidazepam and bromazolam). The percentage of cases is on the y axis and the calendar year and quarter of death, between Q1 of 2022 and Q2 of 2024 is on the x axis. Diazepam has been the most commonly detected benzodiazepine since Q2 of 2022. Since then, detections have fluctuated between 25% and 35%. Bromazolam detections increased sharply between Q3 of 2022 (1%) and Q3 of 2023 (24%) and then slightly decreased to 20% in Q2 of 2024. Etizolam was the most common benzodiazepine detected in Q1 of 2022 (31%), after which detections have followed a decreasing trend to 6% of deaths in Q1 of 2024. Clonazolam detections remained low and stable throughout the series, detected in an average of 1% of deaths. Gidazepam was first detected in Q4 of 2022 and has gradually increased, being detected in 2% of deaths in Q2 of 2024.

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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.

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

Note that these drugs may have been present before this time but were not being tested for, as they have only recently emerged in drug markets. These data will develop further as new or emerging drugs are added to routine toxicology screening by the SPA FS and NHS Grampian.

Detailed interpretation of the levels of drugs found present, drug interactions, co-morbidities, or other factors relating to death, are outside the scope of this analysis. This analysis does not imply that specific drugs were implicated in deaths nor that deaths were classified as ‘drug-related’, and it does not include consideration of wider causes of death.

It should be noted that increases observed in specific substances within this report may be due to differences in toxicology test approaches (e.g. detection of concentration levels of a particular drug) between outsourced laboratories and previous screening. This may result in increases in substance detection. Further data will be required and monitored to determine the impact of any differences in toxicology screening across laboratories.

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

As some of the data received from other laboratory testing sites did not include date of death, other date variables have been used as a proxy to improve data completeness and enable the inclusion of these deaths within this report. Two separate date variables have been used to approximate date of death information, where this information was unavailable:

1. Date of the case being received or sent to other labs for toxicology testing.
2. Date of toxicology test being completed.

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

These dates listed above have been used in the analysis as they are considered to provide a close approximation to the month and year of death. It is anticipated that missing information on date of death will be improved over time, as further information becomes available.

Drug seizures in Scottish prisons

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.

The chart shows the percentage of SPS drug seizures broken down by sample type (e-cigarette, paper or card, tablet, powder and other). The percentage of samples is on the y axis and the date, between April 2021 and December 2023, is on the x axis. Sample types were highly variable over the time period. Seizure numbers varied during 2021, ranging from a low of 23 in June, to a high of 134 in September. In 2022, the number of seizures analysed remained relatively stable, averaging 35 per month. During 2023, numbers varied widely, ranging from a high of 60 in January to a low of 9 in December. Paper and card detections decreased across the time series, with an average of 72% per month in 2021, compared to 23% per month in 2022 and 7% per month in 2023. There were low numbers of e-cigarette detections until late 2022, when they made up an average of 30% of detections. E-cigarette detections fluctuated throughout 2023, averaging 28% per month. In both December 2022 and 2023 there were very low or zero e-cigarette detections. Powder samples remained relatively stable, detected in approximately 20% of samples per month in 2022 and followed an increasing trend from 22% of samples in January 2023 to 67% in December 2023.

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Drug seizures in Scottish prisons: sample type

The chart below shows the five most detected drug types from seizures in Scottish prisons between 1 April 2021 and 31 December 2023. This is based on the percentage of samples tested each month and uses 3-month moving average figures.

The chart shows the three-month moving average percentage of SPS drug seizures broken down by drug type (synthetic cannabinoids, benzodiazepines, opioids, cannabis and steroids). The percentage of samples is on the y axis and the date, between May 2021 and December 2023, is on the x axis. The percentage of seizures testing positive for synthetic cannabinoids was on average 43% per month in 2021, decreasing to 33% per month in 2022. Percentages increased from 12% in January to 61% in July 2023 and then decreased throughout the remainder of the year (22% in December). The second most common drug type detected was benzodiazepines, following an uneven trend across the time series. The percentage of seizures testing positive for benzodiazepines fluctuated throughout 2021, with an average of 39% per month, before decreasing and remaining relatively stable in 2022 (average of 26%). Benzodiazepine detections decreased further in 2023, from 33% in February, to 11% in December. Detections of opioids increased in late 2023 (average 33%

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Drug seizures in Scottish prisons: drug type

Summary

Historic trend

• The number of seizures analysed varied widely between April and December 2021, ranging from 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.

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.

Close

Injecting equipment provision: transactions

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

Summary

Historic trend

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