About this release

Our quarterly report

The Drugs Team at Public Health Scotland (PHS) has compiled this RADAR quarterly report of drug-related indicators.

The objective of this report is to monitor drug-related harms, service usage and toxicology data, in order to provide an early warning of emerging drug trends and identify actions to reduce and prevent drug harms and deaths.

View a printable version of this report.

Acknowledgements

This report reflects the collective efforts of different organisations and hundreds of people in frontline and supporting roles who record, organise, analyse and interpret information from a range of sources and services.

We gratefully acknowledge the continued commitment and effort of all those involved.

Data and reporting period

RADAR's emphasis is on reporting drug-related information as rapidly as possible, for the purpose of public health surveillance. This means that data may not be fully validated and may be subject to change. Further analysis of these data will be made available in our Accredited official statistics publications on substance use.

Observed changes in indicators may reflect genuine trends in behaviours but may also be influenced by factors such as the configuration of services, or data quality and completeness issues.

Different time periods may be reported across the different indicators. In all cases, the most recently available data are used. Most charts show Scotland-level data based upon a two-year time series. Location and time series can be customised in the RADAR dashboard (external website).

The next release of this publication will be 30 April 2024.

Dashboard

Data for most of the harm and service indicators in this report are published in our new RADAR dashboard (external website).

In the dashboard, the time series can be adjusted and the data can be filtered by NHS board.

This dashboard supersedes the substance use section of the COVID-19 wider impacts dashboard (external website), which has now been decommissioned.

For optimal viewing and interaction, we recommend accessing the dashboard using a computer with a large screen. Accessing via a mobile phone may reduce the functionality.

Main points

  • Drug-related harms remained high in Scotland, but a decrease was observed during autumn 2023 compared with the previous reporting period (summer). Levels remain higher than in the spring (reported in quarterly report 4 – July 2023).
  • The following changes were observed compared to the previous reporting period (reported in quarterly report 5 – October 2023):

For harm indicators:

    • naloxone administration incidents: 17% decrease
    • emergency department attendances: 13% decrease
    • drug-related hospital admissions: stable (2% decrease)
    • suspected drug deaths: 19% decrease

For service indicators:

    • drug treatment referrals: 8% decrease
    • injecting equipment provision: stable (transactions - 4% decrease, number of needles and syringes - 2% decrease)
  • The pattern of drug use associated with most harms was polysubstance use involving benzodiazepines (most commonly diazepam and bromazolam), cocaine and opioids. Cocaine played an increasing role in drug-related harms.

Alerts

  • A public health alert about nitazene-type opioids (published in January 2023) was updated in December 2023 to include provisional data on detections of nitazenes in deaths in Scotland. Based on post-mortem toxicology testing, nitazenes were detected in 25 deaths (to 30 September 2023).
  • Scottish Drugs Forum (SDF) worked with service providers and other partners to launch a multi-agency alert and develop information resources for people at risk of overdose due to the introduction of synthetic opioids, including nitazenes into the drug supply.
  • A public health alert about new benzodiazepines was published on 5 July 2023 and remains current. Bromazolam is currently the most common 'street benzo' detected in Scotland.

Harm indicators

  • Between September and November 2023, the average weekly number of Scottish Ambulance Service naloxone administration incidents decreased (from 84 to 75). The total number of incidents was 19% lower than in the same period in 2021 and 14% higher than in 2022. These figures do not take account of naloxone administration by members of the public, service workers, or other emergency responders such as police officers.
  • Between September and November 2023, drug-related attendances at emergency departments were 13% lower than in the previous time period. The total number of attendances recorded was similar to the same period in 2021 and 2022.
  • Between July and September 2023, drug-related hospital admissions were similar to the high in the previous period. The total number of admissions was 16% lower than the same period in 2021 and 20% higher than in 2022. These data should be interpreted with caution, as the number of admissions may be affected by issues accessing urgent care and by the capacity of hospital services.
  • Between September and November 2023, there were 267 suspected drug deaths. The number of deaths was 8% lower than in the same period in 2021 (290) and 6% lower compared to 2022 (285).

Toxicology indicators

  • Between August and November 2023, the most frequently detected drugs in the ASSIST hospital toxicology project were desmethyldiazepam (11% of detections), followed by cocaine (11%), temazepam (10%) and bromazolam (10%). Nitazenes made up 2% of detections (detected 16 times, up from seven in the previous quarter).
  • Between July and September 2023, the most common drug types detected in post-mortem toxicology were opioids (67%) and benzodiazepines (59%), based on partial data available for September (provisional Q3 2023). The most common individual drug detected was cocaine (38%), followed by heroin/morphine (35%), diazepam (30%), methadone (25%) and bromazolam (24%). Xylazine was detected in post-mortem samples for the first time.
  • Scottish prison drug analysis data were not available for the latest period.

Service indicators

  • Between August and November 2023, the average weekly number of referrals to specialist drug treatment services varied widely within an overall decreasing trend. The total number of referrals recorded in this period was 8% lower than in the previous period. The number of referrals was 6% lower than the same period in 2021 and 6% higher than in 2022.
  • Between July and September 2023, the average weekly number of injecting equipment provision transactions, and needles and syringes distributed remained relatively stable. During this period, both the total number of transactions, and number of needles and syringes distributed, were lower than in the same period in 2021 (13% and 9% respectively) and similar to 2022.
  • Data for opioid substitution therapy is not available for the most recent period. Between April and June 2023, OST doses supplied per month was stable and similar to the same period in 2021 and 2022. The average monthly number of methadone doses supplied continued to decrease while the number of injectable buprenorphine doses increased over time.

Reporting trends

  • Between October and December 2023, 53 trend reports were received by RADAR.
  • The majority of reports related to benzodiazepines, cocaine and polydrug use.
  • Other commonly reported concerns relate to heroin, novel synthetic opioids (fentanyl and nitazenes), tapentadol and carisoprodol tablets (‘somas’ and ‘red apples’), ketamine and MDMA.
  • Trend reports can now be viewed on our dashboard (external website).

Actions

  • The harm caused by drugs is a significant public health issue for Scotland. The illicit drugs market is evolving and increasingly toxic substances are being detected with greater frequency.
  • These developments increase the risk of harm and death, particularly in the context of polysubstance use, stigma and exclusion. They emphasise the importance of timely and accurate hospital toxicology and forensic post-mortem toxicology services, as well as accessible drug checking.
  • A system-wide approach that prevents drug harms and supports people affected into treatment, care and recovery remains critical. Harm reduction interventions are a key part of a systems-wide approach.

Alerts

Scottish Drugs Forum has worked with service providers and other stakeholders to develop information resources for people at risk of overdose due to the introduction of synthetic opioids, including nitazenes into the drug supply.

Current alerts

Nitazenes

A public health alert about nitazene-type opioids was published in January 2023. This alert was further updated in December 2023 to include provisional data on detections of nitazene-type opioids in deaths in Scotland. Based on post-mortem toxicology testing, nitazenes were detected in 25 deaths (to 30 September 2023).

Bromazolam

A public health alert about new benzodiazepines was published in July 2023. Bromazolam is the most common drug detected in ‘street benzos’. Bromazolam produces strong sedative and sleep-inducing effects. As a result, there is a substantial risk of overdose.

Trends

Police drug trends bulletin

This bulletin contains photos of drugs.

This update provides information on detections of MDMA and 'tusi', and legal changes related to nitrous oxide.

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

MDMA

The STOP Unit continues to see recoveries of both MDMA crystal and tablets (ecstasy) on a regular basis. MDMA is a class A controlled drug within the provisions of the Misuse of Drugs Act 1971.

The below are images of MDMA tablets recovered in August 2023 by events venue security staff in the West of Scotland. Some of these tablets have been reported to be linked to the deaths of young people.

Image caption Popsmoke
Blue tablet branded with the Popsmoke logo. Star in an oval on one side, half-score and the words 'Popsmoke' and '300mg' on the other.
Image caption Netflix
White tablet branded with the Netflix logo. Rectangular with a concave curve at the base.
Image caption Bear
Blue teddy bear-shaped tablet.
Image caption Twitter
Square, blue tablet branded with the Twitter logo. Letter 't' on one side and the Twitter bird on the other.
Image caption Pharaoh
Pink tablet shaped as a pharaoh head. Pharoah head on one side, half-score and the words ‘Warning’ and ‘Pharaoh’ on the other.
Image caption Donald Trump
Green tablet shaped as Donald Trump’s head. Trump’s face on one side, half-score and the words ‘Trump’ and ‘NL’ on the other.

2-CB

2-CB tablets were also seized in the West of Scotland. 2-CB is a psychedelic. It is a class A controlled drug within the provisions of the Misuse of Drugs Act 1971.

Image caption NASA
Pink tablet shaped as a rocket, stamped with ‘2cb’.

Nitrous oxide

On 8 November 2023, nitrous oxide was classified as a class C controlled drug within the provisions of the Misuse of Drugs Act 1971, having previously been governed under the Psychoactive Substances Act 2016.

Nitrous oxide is also known as 'laughing gas'. It is a colourless gas that is commonly found in metal pressurised canisters, known as chargers or tanks. The gas is released into a balloon using a dispenser, nozzle or cracker and then inhaled.

Image caption 8-gram chargers
Three small canisters, one white, one silver, one grey.
Image caption 615-gram tanks
Two large blue tanks, one branded Smartwhip and one branded Miami Magic Infusions.

'Tusi'

'Tusi,' also known as 'tusibi', 'tuci', and 'pink cocaine', is a pre-mixed combination of drugs. The composition of 'tusi' varies widely in the illicit market. It may include a variety of drugs such as MDMA, 2-CB, LSD, ketamine, cathinones and cocaine, mixed with pink food colouring.

This is a drug that has been in and around the illicit drugs market for some time, however, it is not very common. Some Drug Trend Monitoring Groups in Scotland have reported that they have seen a rise in this commodity recently. The STOP Unit will continue to liaise with partner agencies on any emerging trends and recoveries.

Image caption Pink tusi
Two small plastic ziplock bags. One bag is made of blue plastic and contains pink powder, the other ‘outer’ bag has a green and white Playboy bunny design.

RADAR intelligence and reports

53 reports were validated by RADAR between 5 October 2023 and 4 January 2024.

So far, RADAR has received over 150 reports of drug-related information and harms received through the reporting form and mailbox.

A summary of key trends is shown below. Validated intelligence reports to RADAR can be found 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 October 2023 to 4 January 2024)
  • The most common drugs or drug types reported were:
    • benzodiazepines
    • cocaine
    • heroin
    • new synthetic opioids including nitazenes
    • tapentadol and/or carisoprodol tablets ('somas' and 'red apples')
    • ketamine
    • MDMA (ecstasy)
  • Half of reports mentioned polydrug use – the use of more than one substance at a time.
  • The most commonly reported concerns were related to adverse effects, overdose and deaths.

Key trends

RADAR is currently assessing the harms related to cocaine and ketamine, nitazene-type opioids and xylazine.

Concern: Cocaine and ketamine being taken together and more reports of ketamine use among young people.

Drug(s): Cocaine is a short-lasting stimulant drug. Ketamine is a dissociative drug.

Legal status: In the UK, cocaine is a class A drug and ketamine is class B, under the Misuse of Drugs Act 1971.

Summary

Reports from several areas of cocaine and ketamine being taken together called 'Calvin Klein', 'CK' or 'CK1', or 'KitKat' less commonly. This is reported to have been particularly prevalent among young people since the start of 2022.

Further information

  • The concurrent use of ketamine and cocaine can lead to adverse effects including mental health issues such as anxiety, paranoia and hallucinations.
  • Long-term ketamine use can result in urinary tract problems.
  • Cocaine can result in cardiovascular problems.
  • Cocaine can dull the effects of ketamine resulting in higher doses being taken. This can increase the risk of negative side effects from both drugs and can increase strain on the body, especially on the heart.

Harm reduction

  • Avoid mixing substances including alcohol. If mixing, take less of each substance than if you were only taking one. Don’t mix them in the same bag or line.
  • Leave a long gap between doses.
  • Be mindful of the environment you are in. Ketamine can affect your coordination.
  • Have someone not taking drugs around who can respond in an emergency.
  • If experiencing chest pain, abdominal pain, difficulty urinating or blood in urine, seek medical help.

Concern: Nitazenes increasingly detected in overdoses and deaths in Scotland

Drug: Nitazenes. A group of potent synthetic opioids.

Legal status: In the UK, clonitazene and etonitazene are classified as class A drugs under the Misuse of Drugs Act 1971. The UK government plans to soon control another 15 nitazenes as class A drugs.

Summary

  • Reports to RADAR show an ongoing increase in the availability and detections of nitazenes, most commonly metonitazene and protonitazene.
  • They are increasingly detected in the wider drugs market, including in drugs sold as benzos, heroin and oxycodone.

Further information

  • A public health alert about nitazene-type opioids (published in January 2023) was updated in December 2023 to include provisional data on detections of nitazenes in deaths in Scotland. Based on post-mortem toxicology testing, nitazenes were detected in 25 deaths (to 30 September 2023).

Concern: Xylazine increasingly detected in overdoses and deaths in Scotland

Drug: Xylazine. A depressant drug used in veterinary medicine with sedative, analgesic and muscle relaxant properties.

Legal status: In the UK, xylazine is not controlled by the Misuse of Drugs Act 1971. The supply and importation of xylazine is controlled by the Psychoactive Substances Act 2016.

Summary

  • Toxicology reports to RADAR show a rapid increase in detections of xylazine.
  • Until 2023 there were only two reports of xylazine in Scotland:
    • January 2020, East Ayrshire, white powder, sold as ketamine 
    • June 2022, Fife, colourless liquid, sold as THC vape liquid 
  • Xylazine was first detected in both post-mortem toxicology and in the ASSIST hospital toxicology project in July 2023. Since then, it has been detected 14 times.
  • It is commonly co-detected alongside heroin, benzodiazepines, codeine and nitazenes (most commonly protonitazene and metonitazene).
  • Xylazine has also been detected by WEDINOS in samples mis-sold as heroin in Lothian and the Scottish Borders.

Further information

  • Due to its unexpected presence in the drug supply and depressant effects, xylazine poses a substantial risk of overdose, hospitalisation and death, especially when taken in combination with other depressants.
  • Xylazine use is associated with the development of severe wounds and skin damage, regardless of how it is administered. Wounds can appear anywhere on the body and look like blisters, bruises or open sores. Medical care is required if the wound continues to grow or does not heal. Any increase in wound-related presentations can be reported to NHS Health Protection Teams and RADAR.

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 or by emailing the mailbox.

Harm indicators

Naloxone administration by Scottish Ambulance Service

The average weekly number of naloxone administration incidents decreased between September (84) and November 2023 (75). The total number of incidents during this time period (1,017) was 17% lower than in the previous period (1,220). The number of incidents was 14% higher than the same period in 2022 (890) and 19% lower than in 2021 (1,249).

Background

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

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

The chart below shows the weekly number of SAS naloxone administration incidents from 6 September 2021 to 27 November 2023.

An interactive version of this chart can be found in the RADAR dashboard (external website). The dashboard also allows users to download the data and filter by NHS board.

Image caption Naloxone administration by Scottish Ambulance Service

Summary

Historic trend
  • Until winter 2021/22, the average weekly number of SAS naloxone administration incidents was similar to previous years, which have generally been characterised by lower numbers of incidents during winter months and higher numbers during summer months.
  • In spring 2022, the trend diverged from previous years and, despite an increase in April, followed a gradual decreasing trend from May to December 2022.
  • An increasing trend in the average weekly number of incidents was observed from January (60) to the end of May 2023 (79).
  • Between June and August 2023, the average number of incidents remained broadly stable (96).
National update

For the most recent 13-week period (4 September to 3 December 2023):

  • 1,017 SAS naloxone incidents were recorded, at an average of 78 per week. Weekly numbers of incidents generally decreased throughout this period, although an isolated increase was observed in week beginning 30 October (108 incidents).
  • The total number of incidents was 17% lower than in the previous 13-week period (5 June to 3 September 2023) when 1,220 incidents were recorded, at an average of 94 per week.
  • The total number of incidents was 19% lower than the same period in 2021 (1,249, weekly average 96) and 14% higher than in 2022 (890, weekly average 68).
Local update

For the most recent period (4 September to 3 December 2023), the number of naloxone administration incidents decreased across most mainland NHS boards, compared to the previous period:

  • Incidents increased in NHS Fife (8%) and NHS Dumfries and Galloway (44%).
  • Incidents decreased in eight areas: NHS Lothian (10%), NHS Greater Glasgow and Clyde (19%), NHS Forth Valley (23%), NHS Grampian (23%), NHS Ayrshire and Arran (23%), NHS Borders (25%), NHS Highland (31%) and NHS Lanarkshire (33%).
  • Incidents were broadly stable in NHS Tayside.

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

Additional information

PHS was provided with these data by SAS.

Information on take-home naloxone distribution can be found in the National Naloxone Programme Scotland quarterly monitoring bulletin, published by PHS.

Police Scotland have also trained and equipped all operational officers up to and including the rank of Police Inspector with intra-nasal naloxone kits. New data published by Police Scotland (external website) brings the total number of administrations by the police (since naloxone was first provided to officers as part of a national test of change in March 2021) to at least 353. This should be taken into consideration when interpreting the data shown above.

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 September and November 2023, drug-related attendances at emergency departments decreased by 13%, compared to the previous time period. A total of 1,138 attendances were recorded in this period, similar to the same period in 2021 (1,130) and 2022 (1,101).

Background

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

The chart below shows the weekly number of drug-related ED attendances between 30 August 2021 and 3 December 2023.

An interactive version of this chart can be found in the RADAR dashboard (external website). The dashboard also allows users to download the data and filter by NHS Board.

Image caption Drug-related attendances at emergency departments

Summary

Historic trend
  • An overall decreasing trend was observed in drug-related attendances at EDs between October 2021 and April 2022, with the lowest weekly levels in the time series observed in the week beginning 4 April (53).
  • Drug-related ED attendances increased sharply and peaked in May 2022, to 123 in the week beginning 16 May.
  • Attendances decreased and remained stable from June 2022 to March 2023, averaging 82 per week.
  • Between April and August 2023 attendances generally increased, averaging 98 per week.
National update

For the most recent 13-week period (4 September to 3 December 2023):

  • 1,138 ED attendances were recorded, at an average of 88 per week. This was 13% lower than the previous 13-week period (5 June to 3 September 2023, 1,313, weekly average 101).
  • Attendances were similar to the same periods in 2021 (1,130, weekly average 87) and 2022 (1,101, weekly average 85).
Local update

For the most recent period (4 September to 3 December 2023), most mainland NHS boards saw a decrease in the number of drug-related ED attendances, compared to the previous period:

  • Attendances increased in two areas: NHS Borders (13%) and NHS Ayrshire and Arran (34%).
  • Attendances decreased in eight areas: NHS Greater Glasgow and Clyde (5%), NHS Forth Valley (7%), NHS Lanarkshire (10%), NHS Tayside (14%), NHS Lothian (15%), NHS Fife (27%), NHS Dumfries and Galloway (47%) and NHS Grampian (64%).
  • Attendances were broadly stable in NHS Highland.

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

Additional information

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

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

Drug-related acute hospital admissions

Between July and September 2023, 2,423 drug-related hospital admissions were recorded, similar to the previous quarter (2,484). Admissions were 16% lower than the same period in 2021 (2,889) and 20% higher than in 2022 (2,021).

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 June 2021 to 1 October 2023.

An interactive version of this chart can be found in the RADAR dashboard (external website). The dashboard also allows users to download the data and filter by NHS board.

Image caption Drug-related hospital admissions

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

Summary 

Historic trend 
  • There was a long-term decreasing trend in the weekly number of drug-related hospital admissions from June 2021 to April 2022. Admissions briefly increased between April and May 2022, before following an uneven decreasing trend between June and December 2022. Admissions then increased, from 118 in the week beginning 26 December 2022, to 209 in the week beginning 26 June 2023.
  • The long-term decreasing trend in drug-related hospital admissions observed in 2022 differed from previous years, which have generally been characterised by lower numbers of admissions during winter months and higher numbers during summer months. The decrease seen in 2022 should not necessarily be interpreted as a reduction in harms. Hospital admissions may have been affected by issues accessing urgent care services and by the capacity of hospital services.
  • Between April to June 2023, the most common drug category recorded was opioids (47% of admissions), followed by cocaine (19%).
National update

For the most recent period (3 July to 1 October 2023):

  • 2,423 drug-related hospital admissions were recorded, at an average of 186 per week. This was similar to the previous 13-week period (2,484 admissions, weekly average 191).
  • Admissions generally decreased throughout this period, from 204 in the week beginning 3 July 2023, to 144 in the week beginning 25 September 2023.
  • The total number of admissions was 16% lower than in 2021 (2,889, weekly average 222) and 20% higher than in 2022 (2,021, weekly average 155).
  • Opioids continued to be the most common substance type. These were recorded in an average of 45% of admissions per month, which was broadly consistent over the time series. Admissions recording cocaine remained stable (20%).
Local update

For the most recent period (3 July to 1 October 2023), the number of drug-related hospital admissions varied across mainland NHS boards, compared to the previous quarter:

  • Admissions increased in four areas: NHS Greater Glasgow and Clyde (11%), NHS Grampian (18%), NHS Ayrshire and Arran (22%) and NHS Borders (60%).
  • Admissions decreased in two areas: NHS Dumfries and Galloway (11%) and NHS Tayside (27%).
  • Admissions were broadly stable in three areas: NHS Forth Valley, NHS Lothian and NHS Lanarkshire.

Due to completeness levels below 90% for the most recent time period for both NHS Fife and NHS Highland, the boards have been excluded from the above narrative. The data can be found on our dashboard. Caution is advised when interpreting local trends for these boards and comparing to other areas.

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.

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

The average weekly number of suspected drug deaths remained stable between September (19) and November 2023 (19), averaging 21 per week. The total number of suspected drug deaths between September and November 2023 was 267. The number of deaths was 8% lower than in the same time period in 2021 (290) and 6% lower compared to 2022 (285).

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 30 August 2021 to 26 November 2023.

An interactive version of this chart can be found in the RADAR dashboard (external website). The dashboard also allows users to download the data.

Image caption Suspected drug deaths

Summary 

Historic trend 
  • Between September 2021 and August 2023, the average weekly number of suspected drug deaths fluctuated considerably but remained within a range of 17 to 30 deaths per week.
Update 

For the most recent period (September to November 2023):

  • There were 80 suspected drug deaths in September, 105 in October and 82 in November.
  • There was a total of 267 suspected drug deaths, 19% lower than the previous period (330). This was 8% lower than the same period in 2021 (290) and 6% lower than in 2022 (285).
  • The average weekly number of suspected drug deaths decreased throughout September and remained broadly stable through October and November 2023.
  • There was an average of 21 suspected drug deaths recorded per week. This weekly average was 13% lower than the previous period (24), and similar to the same periods in 2021 and 2022 (both 22).

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 (external website)) 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 1,051 drug-related deaths in Scotland in 2022. This was a 21% decrease compared to 2021 (1,330).

Detailed information on drug-related deaths is presented in the National Drug-Related Deaths Database, which is published by PHS every two years. The latest PHS drug-related deaths report describes deaths that occurred in 2017 and 2018, with trend data from 2009.

Toxicology indicators

Emergency department toxicology: ASSIST

Between August and November 2023, the 'A Surveillance Study of Illicit Substance Toxicity' (ASSIST) emergency department project made 715 detections of 36 different illicit drugs, in samples from 131 patients. The most detected drug category was depressants (66% of detections), followed by opioids (15%). The most detected individual drug was desmethyldiazepam (11%), followed by cocaine (11%), temazepam (10%) and bromazolam (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 uses full toxicological analysis through the biorepository-approved surplus sampling.

The study allows drug profiling and the identification of emerging drugs or changing trends to inform appropriate harm reduction measures and public health responses.

Data collection

The study collects anonymised data through the analysis of standard-of-care clinical data for patients attending QEUH ED due to illicit drug toxicity and surplus serum sample toxicology testing. Surplus serum samples are leftover blood samples, which were taken as part of usual care.

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.

Illicit drug definition

The use of the term 'illicit drug' encompasses any substance that is controlled. It excludes:

  • legal substances, such as alcohol, nicotine, caffeine and paracetamol
  • medications recently prescribed to the individual (e.g. if methadone is detected but the individual is prescribed methadone, it will not be included)
  • drugs administered to the individual as part of treatment (by ambulance staff or in hospital).
Toxicology analysis of surplus serum samples

Detections presented are for the substance only. If a metabolite (compound produced when a drug breaks down in the body) is detected, it will be presented as the substance only. If the metabolite and substance are detected, it will also be presented as the substance only.

However, if a drug and a metabolite are both detected but the metabolite could also be a drug, we have included both as it is not possible to say which has been used, if not both.

Data from the study are presented in quarters, based on the date of ED presentation, and are provided in the table below:

ASSIST quarter dates

Quarter Dates
Quarter 1 (Q1) 17/08/2022 to 16/11/2022
Quarter 2 (Q2) 17/11/2022 to 16/02/2023
Quarter 3 (Q3) 17/02/2023 to 16/05/2023
Quarter 4 (Q4) 17/05/2023 to 16/08/2023
Quarter 5 (Q5) 17/08/2023 to 16/11/2023

Results

The first chart shows the most common drug categories detected in toxicology analysis of surplus serum samples between 17 August 2022 and 16 November 2023 (Q1 to Q5).

The results are shown as the total number of detections. They are broken down by the top five drug categories and presented by study quarter.

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

Summary

Historic trend

Between 17 August 2022 and 16 August 2023:

  • The most commonly detected drug type was depressants, making up 61% of all detections, followed by opioids (17%). The most commonly detected individual drug was cocaine (11%).
  • 73% of attendances were male and 27% were female.
  • 50% of attendances were aged 34 and under. The most common age category was 25 to 34 years (31%), followed by 35 to 44 (26%) and 16 to 24 (19%).
  • The most common outcomes were discharged to home (39%), ward (29%) and police custody (10%).
Update

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

  • 332 individual ED attendances related to illicit drug use were identified.
  • 131 attendances qualified for surplus sampling toxicology testing (as they were categorised as having a higher clinical severity of toxicity as per research inclusion criteria).
Drug type and category

Of the 131 samples analysed:

  • there was a total of 715 detections of 36 substances (found through the biological detection of the drug or its metabolite).
  • the average number of drugs detected per sample was six.

Of the 715 detections, the following drugs were the most common:

  • desmethyldiazepam: 80 (11% of detections, 61% of samples)
  • cocaine: 79 (11% of detections, 60% of samples)
  • temazepam: 73 (10% of detections, 56% of samples)
  • bromazolam: 71 (10% of detections, 54% of samples)
  • oxazepam: 59 (8% of detections, 45% of samples)
  • diazepam: 47 (7% of detections, 36% of samples)
  • etizolam: 42 (6% of detections, 32% of samples)
  • cannabis (tetrahydrocannabinol): 36 (5% of detections, 27% of samples)
  • morphine: 33 (5% of detections, 25% of samples)
  • gidazepam: 32 (4% of detections, 24% 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 November 2023 (Q1 to Q5). The percentages are of all detections.

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

Depressants were the most common drug category, making up 66% of detections (473).

  • Benzodiazepines were detected 422 times (59% of all detections):
    • In total, 14 different types of benzodiazepines were detected, including bromazolam (10%) and etizolam (6%).
    • Desmethyldiazepam made up 11% of all detections, up from 8% in Q5.
  • Gabapentinoids were detected 36 times (5% of all detections, from 7% in Q4). Of these detections, 11 were gabapentin and 25 were pregabalin.
  • There were seven detections of xylazine (1%).
Image caption ASSIST hospital toxicology analysis: opioid drugs by study quarter

Opioids were the second most common drug category, making up 15% of detections (108).

  • There were 34 detections of heroin/morphine (5%), 22 of methadone and 19 of codeine (3% of detections respectively).
  • The presence of noscapine (a compound found in opium) can suggest exposure to opium-derived substances. There were no detections in Q5, down from 11 in Q4.
  • There were 16 detections of nitazenes (2%).

Stimulants were the third most common drug category, making up 13% of detections (90).

  • The most common stimulant was cocaine, making up 11% of detections (79).
  • The second most common stimulant was MDMA, which was detected in seven samples (1%).
Further findings

Complete clinical data are available for 332 attendances for the most recent period (17 August to 16 November 2023):

  • 70% of attendees were male (234) and 30% were female (98).
  • 18% (60) of attendees were aged 16 to 24 years and 27% (90) were aged 25 to 34.
  • 54% of attendees were aged 35 years and over, with 30% (98) aged 35 to 44, 16% (53) aged 45 to 54 and 8% (28) aged 55 years or older.
Image caption Attendances by age

ED outcome records show:

  • 134 (40%) patients were discharged home
  • 82 (25%) were admitted to a ward
  • 44 (13%) were taken into police custody
  • 28 (8%) self-discharged
  • 28 (8%) were admitted to an intensive care unit, high-dependency unit, critical care unit or died
  • 16 (5%) were recorded as 'unknown' or 'other'

Clinical severity outcome (after 28 days) recorded:

  • 313 patients were discharged following the attendance
  • seven patients either died or remained an inpatient following the attendance
  • outcomes for 10 patients were 'unknown'

Additional information

Public Health Scotland (PHS) was provided with these data by QEUH, NHS GGC.

The ASSIST trial is registered with Clinical Trials UK (ID: NCT05329142).

Ethical approval has been granted by the West of Scotland Research Ethics Service (IRAS ref: 313616, REC ref: 22/WS/0047) and surplus sampling methodology through Biorepository Ethics (ref: 22/WS/0020).

The West of Scotland Safe Haven research database hosts the electronic clinical data under IRAS ref: 321198 or REC ref: 22/WS/0163.

This study is sponsored by NHS GGC Research and Innovation and is funded by the Scottish Government.

The testing has been carried out by the LGC group (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).

Post-mortem toxicology testing for controlled substances

In provisional data for Q3 of 2023, the most common drug types detected in post-mortem toxicology were opioids (67%) and benzodiazepines (59%). The percentage of deaths where cocaine was detected continued to increase to 38% (from 36% in Q2 of 2023), making it the most commonly detected individual substance, followed by heroin/morphine (35%), diazepam (30%), methadone (25%) and bromazolam (24%).

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 across Scotland.

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.

The inclusion of data on deaths in the far north and north-east of Scotland (the areas covered by NHS Grampian) from January 2022 onwards, means that the figures presented after that point cover the whole of Scotland and are different from publications released before October 2023.

This report includes two new periods of data:

  • 1 June to 30 June 2023, completing data for Q2 of calendar year 2023; and
  • July to September (complete period for 1 July to 31 August 2023, with inclusion of available partial data for September 2023), representing data for Q3 of 2023. This period is the most recent data discussed below and is referred to as 'provisional Q3 2023' throughout.

Remaining outstanding data for deaths occurring in September, which will complete the period Q3 of 2023, will be included in the next RADAR publication. More recent data are not yet available due to the overall time it takes to complete toxicology testing and the transition of testing to SPA FS.

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 first chart below provides an indication of controlled drugs detected at post-mortem, in deaths occurring between 1 January 2020 and the most recent time period for which data are available (provisional Q3 2023). As indicated by the line on the chart, data for 2020 and 2021 are based on deaths in the west, east and parts of the north of Scotland. From January 2022, the data include all areas in Scotland.

Image caption Forensic toxicology cases testing positive for controlled substances

The following charts provide an indication of specific opioids and benzodiazepines detected at post-mortem, in deaths where controlled drugs were detected, occurring between 1 January 2020 and the most recent time period for which data are available (provisional Q3 2023).

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

Summary

Historic trend
  • The most commonly detected drug types were opioids and benzodiazepines.
  • The percentage of deaths where opioids were detected have been gradually decreasing from a peak of 82% in Q2 of 2020, to 72% in Q2 of 2023:
    • Heroin/morphine and methadone were the most common opioids detected.
    • Methadone detections increased sharply from 28% in Q1 of 2020, to 45% in Q2 of 2020, before decreasing to 30% in Q2 of 2023.
    • There has been a small but gradual increase in the number of cases where fentanyl-type opioids were detected, from around 1% prior to Q2 of 2022, to 4% in Q2 of 2023.
    • Deaths with buprenorphine present remained relatively low and stable throughout the time series (averaging 6%).
    • Nitazene-type opioids (detected for the first time in Q1 of 2022) increased but remained uncommon, with 7 (1%) cases detected in Q2 of 2023.
  • The percentage of deaths where benzodiazepines were detected increased sharply between Q1 and Q2 of 2020, remaining high before gradually falling from 73% in Q4 of 2020, to 51% in Q3 of 2022. A gradual increase (to 61% in Q2 of 2023) has been observed since then.
    • Diazepam has been the most commonly detected benzodiazepine since Q2 of 2022, remaining relatively stable until Q4 of 2022, when detections increased markedly (to 35%) and remained high (35% in Q2 of 2023).
    • Bromazolam (detected for the first time in Q1 of 2022) has increased sharply (21% in Q2 of 2023), replacing etizolam as the second most common benzodiazepine detected from Q1 of 2023.
    • Etizolam was the most common benzodiazepine detected for some time, averaging 51% between Q2 of 2020 and Q2 of 2021. Since then, there has been a gradual reduction in etizolam detections (13% in Q2 of 2023).
    • Clonazolam detections peaked at 12% in Q3 of 2021, decreasing to 1% in Q2 of 2023.
  • The percentage of deaths involving other opioids and benzodiazepines have remained relatively stable over time
  • Following an isolated increase to a peak of 42% in Q2 of 2021, the percentage of deaths involving gabapentin and pregabalin followed a decreasing trend to Q2 of 2022 (27%), before gradually increasing again to Q2 of 2023 (34%).
  • The percentage of deaths with cocaine present was relatively stable over the time series (average 30%), with the exception of an isolated increase in Q2 of 2020 (38%) and an increase to 36% in Q2 of 2023.
Update

For the most recent time period (complete period for 1 July to 31 August 2023, with inclusion of available partial data for September 2023):

  • The total number of deaths testing positive for controlled substances was 603. Many of these deaths involved multiple positive detections, therefore the total number of detections is greater than the number of deaths.
  • The following drugs or drug types were most commonly detected:
    • opioids: 402 (67%)
    • benzodiazepines: 357 (59%)
    • cocaine: 227 (38%)
    • heroin/morphine: 211 (35%)
    • gabapentin and pregabalin: 210 (35%)
    • diazepam: 183 (30%)
    • methadone: 149 (25%)
    • bromazolam: 142 (24%)
  • The percentage of deaths where opioids were detected decreased to 67% (from 72% in Q2):
    • Heroin/morphine detections remained stable at 35% (also 35% in Q2).
    • Methadone detections decreased to 25% (from 30% in Q2).
    • Fentanyl-type opioids remained relatively stable, detected in 5% of deaths (4% in Q2).
    • Nitazene-type opioids increased, but remained uncommon, detected in 2% of deaths (11) (from 1% in Q2 (7)).
  • The percentage of deaths where benzodiazepines were detected decreased slightly to 59% (from 61% in Q1):
    • Diazepam detections decreased to 30% (from 35% in Q2).
    • Bromazolam continued to increase and was detected in 24% of deaths (from 21% in Q2).
    • Etizolam has continued to decrease and was detected in 8% of deaths (from 13% in Q2).
  • The percentage of deaths where cocaine was detected continued to increase to 38% (from 36% in Q2), making it the most commonly detected individual substance.
  • The percentage of deaths involving gabapentin and pregabalin was relatively stable at 35% (from 34% in Q2).
  • For the first time in post-mortem toxicology testing, there were detections of xylazine (a veterinary medicine with sedative, analgesic and muscle relaxant properties). This substance was detected in 1% of deaths (5).

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

The table shows the total number of deaths testing positive for controlled substances, for each calendar year and quarter.

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

Calendar year Q1 Q2 Q3 Q4
2020 527 584 474 567
2021 586 538 491 570
2022** 564 632 533 702
2023** 710 680 603* -
References

* Provisional: includes partial data available for September 2023.

** From January 2022 onwards, figures presented cover the whole of Scotland. Data for 2020 and 2021 are based on deaths in the west, east and parts of the north of Scotland only.

New drugs (bromazolam, desalkylgidazepam, nitazene-type opioids and xylazine) were detected for the first time when screening was expanded or testing was outsourced to other laboratories. These drugs may have been present before this time but were not being tested for, as they have only recently emerged in drug markets. These data will develop further as new or emerging drugs are added to routine toxicology screening by the SPA FS and NHS Grampian.

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

The Scottish Prisons Non-Judicial Drug Monitoring Project is a collaboration between the Scottish Prison Service and the Leverhulme Research Centre for Forensic Science at the University of Dundee. The project tests drug seizures made across the Scottish prison estate in order to understand the changing characteristics of synthetic drugs, including synthetic cannabinoids, often referred to as 'spice'.

Analysis of the drug seizures in Scottish prisons from August to October 2023 is ongoing and is unable to be included in this report.

We anticipate the updated data will be available for the next release of this report in April 2024. Data to July 2023 are available in the previous quarterly report.

Service indicators

Specialist drug treatment referrals

Between August and November 2023, the average weekly number of referrals to specialist drug treatment services varied widely within an overall decreasing trend. The total number of referrals (5,664) in this time period was 8% lower than in the previous period (6,131), 6% lower than in the same period in 2021 (6,008) and 6% higher than in 2022 (5,354).

Background 

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

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

The chart below shows the weekly number of referrals to specialist drug treatment services between 16 August 2021 and 19 November 2023.

An interactive version of this chart can be found in the RADAR dashboard (external website). The dashboard also allows users to download the data and filter by NHS board.

Image caption Specialist drug treatment referrals

Summary

Historic trend
  • Referrals decreased throughout June and July 2021 and then remained broadly stable to January 2022 (400 to 480 referrals per week, apart from the seasonal decreases in December and January).
  • Throughout 2022, there was a fluctuating, but gradual, decrease in the average weekly number of referrals.
  • Following the seasonal reduction in December 2022, the number of referrals returned to a weekly average of approximately 450 per week in January 2023. A fluctuating, downward trend has been evident since then, with referrals ranging between 400 and 500 per week.
National update

For the most recent 13-week period (21 August to 19 November 2023):

  • 5,664 specialist drug treatment referrals were recorded, at an average of 436 per week.
  • This was 8% lower than the previous 13-week period (22 May to 20 August 2023) when 6,131 referrals were recorded, at an average of 472 per week.
  • Referrals were 6% lower compared to the same period in 2021 (6,008, weekly average 462) and 6% higher than in 2022 (5,354, weekly average 412).
Local update

For the most recent period (21 August to 19 November 2023), the number of weekly referrals decreased across most mainland NHS boards, compared to the previous period:

  • Referrals decreased in seven areas: NHS Lanarkshire (6%), NHS Greater Glasgow and Clyde (7%), NHS Highland (7%), NHS Lothian (12%), NHS Dumfries and Galloway (17%), NHS Forth Valley (17%) and NHS Ayrshire and Arran (18%).
  • Referrals were broadly stable in the other mainland NHS boards.

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

Additional information

These data are taken from the Drug and Alcohol Information System (DAISy) and its predecessor, the Drug and Alcohol Treatment Waiting Times (DATWT) database (external website).

PHS publishes further information on waiting times for people accessing specialist drug and alcohol treatment services. The latest data can be viewed in our National drug and alcohol treatment waiting times report which also includes a new interactive drug and alcohol treatment waiting times dashboard (external website).

Additionally, for more information on initial assessments for specialist drug and alcohol treatment services in Scotland, visit our new report: Drug and Alcohol Information System (DAISy): Overview of initial assessments for specialist drug and alcohol treatment 2021/22 and 2022/23.

For details of drug treatment services in your area, visit the Scottish Drug Services Directory website.

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

Opioid substitution therapy

From April to June 2023, the average number of opioid substitution therapy (OST) doses supplied per month was stable and similar to the same time period in 2021 and 2022. The average monthly number of methadone doses supplied continued to decrease while the number of injectable buprenorphine doses increased over time.

Background

The data used in these statistics relate to the number of average daily quantity (ADQ) doses for OST drugs dispensed in the community in Scotland. OST drugs include methadone, oral buprenorphine and injectable buprenorphine. Methadone and oral buprenorphine are usually taken once every day. Injectable buprenorphine is long-acting and is administered once every week or month (depending on the formulation).

The chart below shows the average total monthly number of ADQ doses supplied for OST medications in the community between 1 April 2021 and 30 June 2023.

Image caption Average total number of OST doses per month
Image caption Number of doses per month for OST medications

Summary

Historic trend
  • There was a gradual decrease in the average monthly total number of OST doses supplied. This was likely to have been associated with a decreasing trend in the average monthly number of methadone doses supplied, which reduced by 10%, from 603,600 between April and June 2021, to 542,300 between January and March 2023.
  • The average monthly number of oral buprenorphine doses supplied was broadly stable between April to June 2021 (123,100) and January to March 2023 (118,200).
  • Injectable buprenorphine was first licensed for use in Scotland in early 2020. The average monthly number of doses supplied increased more than two-fold, from 27,300 between April and June 2021, to 88,200 between January and March 2023.
Update

OST prescribing data for July to September 2023 has been delayed due to changes in the primary data source for PHS's Prescribing Information System. We anticipate that data for July to September 2023 will be available for the next release of this report in April 2024.

For the most recent period (1 April to 30 June 2023):

  • The average total monthly number of OST doses supplied was approximately 750,900. This was roughly the same as in the previous quarter (January to March 2023; approximately 748,700 doses) and similar to the same period in 2021 and 2022.
  • The average monthly number of methadone doses supplied was approximately 530,700. Equivalent figures for oral buprenorphine and injectable buprenorphine were 118,700 and 101,500, respectively.
  • The number of methadone doses was approximately the same as in the previous quarter, 12% lower than the same period in 2021 and 7% lower than in 2022.
  • The number of oral buprenorphine doses supplied was approximately the same as the previous quarter and similar to the same period in 2021 and 2022.
  • The number of injectable buprenorphine doses was 15% higher than in the previous quarter, 272% higher than the same period in 2021 and 54% higher than in 2022.

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 or by Alcohol and Drug Partnership, visit the RADAR dashboard (external website).

What is average daily quantity (ADQ)?

When comparing use between medicines and over time, it is common to use World Health Organization (WHO) defined daily doses (DDDs). The DDD is defined as the usual average daily maintenance dose used in adults for the main therapeutic use of the medicine. The WHO DDD is a global average and may not be representative of the doses used in clinical practice at a more local level. This is particularly the case for methadone, where the WHO DDD of 25 milligrams (mg) daily is between one-half and one-third of the normal maintenance dose used in Scotland.

We have therefore replaced DDDs with ADQs, which are more representative of the daily maintenance doses used within Scotland. These values have been developed through a combination of prescription analyses and by consultation with the Specialist Pharmacists in Substance Management group. The ADQs agreed are:

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

For detailed definitions on the terms used above, visit the RADAR dashboard (external website).

Injecting equipment provision

The average weekly numbers of injecting equipment provision (IEP) transactions, and needles and syringes distributed, remained relatively stable between July and September 2023. During this time period, both the number of transactions, and number of needles and syringes distributed were lower than in the same period in 2021 (13% and 9% respectively) and similar to 2022.

Background 

IEP is a form of harm reduction that helps to reduce the transmission of blood-borne viruses among people who inject drugs. These data relate to the number of needle and syringe transactions at IEP sites and the total number of needles and syringes distributed.

The chart below shows the weekly number of IEP transactions from 5 July 2021 to 1 October 2023.

An interactive version of this chart can be found in the RADAR dashboard (external website). The dashboard also allows users to download the data and filter by NHS board.

Image caption Injecting equipment provision: transactions

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

Summary

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

For the most recent period (3 July to 1 October 2023):

IEP transactions

  • 39,376 transactions were recorded, at an average of 3,029 per week.
  • This was similar to the previous period (3 April to 2 July 2023) when a total of 37,959 transactions were recorded (weekly average 2,920).
  • The number of transactions was 13% lower than the same period in 2021 (45,221, weekly average 3,479) and similar to 2022 (38,644, weekly average 2,973).

Needles and syringes distributed

  • 504,464 needles and syringes were distributed, at an average of 38,805 per week.
  • This was similar to the previous period when a total of 494,660 needles and syringes were distributed, at an average of 38,051 per week.
  • The number of needles and syringes distributed was 9% lower compared to the same period in 2021 (554,021, weekly average 42,617) and similar to 2022 (492,782, weekly average 37,906).

Ratio of needles and syringes distributed

  • There was a weekly average of 14 needles and syringes distributed per transaction.
  • This was equal to the previous period and the same period in 2022 (14), and similar to 2021 (13).
Local update

For the most recent period (3 July to October 2023), the ratio of needles and syringes distributed per transaction varied across mainland NHS boards, compared to the previous period:

  • The ratio increased in two areas: NHS Forth Valley (6%) and NHS Tayside (27%).
  • The ratio decreased in three areas: NHS Grampian (5%), NHS Lanarkshire (7%) and NHS Greater Glasgow and Clyde (9%).
  • The ratio was stable in four areas: NHS Ayrshire and Arran, NHS Borders, NHS Dumfries and Galloway and NHS Lothian.

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

Additional information

These data are taken from the Needle Exchange Online 360 database (neo360).

The 11 mainland NHS Boards use neo360 routinely, but due to missing data for part of the time period presented, NHS Highland is excluded from the transaction data, and both NHS Fife and NHS Highland are excluded from the needle and syringe and ratio figures.

For details of injecting equipment providers in your area, visit the Scottish Needle Exchange Directory website.

Contact

General enquiries

If you have an enquiry relating to this publication, please email:

Reporting a drug harm

To make a report to RADAR and share information such as trends, incidents and harms related to drugs you can either:

Media enquiries

If you have a media enquiry relating to this publication, please contact the Communications and Engagement team.

Requesting other formats and reporting issues

If you require publications or documents in other formats, please email phs.otherformats@phs.scot.

To report any issues with a publication, please email phs.generalpublications@phs.scot.

Further information

Data and intelligence

View our wider drug data and intelligence.

Public health information

Visit Scottish Public Health Observatory (ScotPHO) for further drug-related public health information.

Metadata

Publication title

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

Theme

Substance use surveillance

Topic

Drugs

Format

HTML

Release date

30 January 2024

Frequency

Quarterly

Relevance and key uses of the statistics

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

Revisions statement

Data in the most recent quarterly updates supersedes data reported in previous reports.

Revisions relevant to this publication

N/A

Comparability

Data are not comparable outwith Scotland.

Accuracy

The data are considered accurate.

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

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

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

Accessibility

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

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

Coherence and clarity

The report is available as HTML web pages.

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

Disclosure

Our Statistical Disclosure Protocol has been followed.

Official Statistics designation

Management information report

UK Statistics Authority Assessment

N/A

Last published

24 October 2023

Next published

30 April 2024

Date of first publication

11 October 2022

Help email

phs.drugsradar@phs.scot

Date form completed

18 January 2024

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

Description

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

Data source(s)

Police Scotland STOP Unit

Date that data were acquired

9 January 2024

Timeframe of data and timeliness

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

Continuity of data

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

Concepts and definitions

MDMA: a stimulant drug that produces feelings of empathy and euphoria. It is commonly found in tablet or crystal forms.

2-CB: a psychedelic drug with stimulant effects.

'Tusi': a pre-mixed combination of drugs, often containing drugs such as MDMA, 2-CB, LSD, ketamine, cathinones and cocaine, mixed with pink food colouring.

Nitrous oxide: a clear, colourless gas that gives short-lasting dissociative effects. It is sometimes known as laughing gas.

Completeness

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

Value type and unit of measurement

Police seizures positive for controlled substances displayed as drug type.

Description

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

Data source(s)

Public Health Scotland

Date that data were acquired

Various between 5 October 2023 and 4 January 2024. Data were collated on 17 January 2024.

Timeframe of data and timeliness

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

Continuity of data

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

Accuracy

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

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

Concepts and definitions

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

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

Pregabalin is a gabapentinoid drug with depressant effects. It can be prescribed as a medicine to treat epilepsy and nerve pain.

Nitazenes are a group of potent synthetic opioids.

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

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

Completeness

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

Value type and unit of measurement

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

Description

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

Data source(s)

Scottish Ambulance Service

Date that data were acquired

4 December 2023

Timeframe of data and timeliness

6 September 2021 to 3 December 2023, approximately two months in arrears.

Continuity of data

SAS clinicians have been administering naloxone directly to patients experiencing symptoms of an opioid overdose since around 1998. There have been no changes in the guidance given to SAS clinicians regarding the administration of naloxone nor in the recording mechanisms or processes over the time series shown in the analysis.

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

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

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

Concepts and definitions

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

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

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

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

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

Completeness

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

Value type and unit of measurement

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

Description

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

Data source(s)

Public Health Scotland – Accident & Emergency Datamart

Date that data were acquired

8 December 2023

Timeframe of data and timeliness

30 August 2021 and 3 December 2023, approximately two months in arrears.

Continuity of data

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

Concepts and definitions

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

Completeness

It is not possible to accurately report total attendances for specific conditions using the national A&E dataset, due to the quality of the data available. The diagnosis or reason for attendance can be recorded in a variety of ways, including in free text fields and not all NHS boards submit this information. The numbers presented in this report therefore only give a high–level indication of attendances over time. Further details can be found in the Accident and Emergency Activity Data.

Value type and unit of measurement

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

Description

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

Data source(s)

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

Date that data were acquired

8 January 2024

Timeframe of data and timeliness

28 June 2021 to 1 October 2023, approximately four months in arrears.

Continuity of data

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

Concepts and definitions

Opioids       

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

Cannabinoids

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

Cocaine

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

Sedatives and hypnotics

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

Multiple/other

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

Completeness

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

Completeness levels for NHS Fife and Highland were below 90% as of 8 January 2024 for the most recent time period (July to September 2023), therefore caution is advised when interpreting trends in these areas on the dashboard.

Value type and unit of measurement

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

Description

This indicator provides information on suspected drug deaths in Scotland.

Data source(s)

Police Scotland

Date that data were acquired

11 January 2024

Timeframe of data and timeliness

30 August 2021 to 26 November 2023, approximately two months in arrears.

Continuity of data

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

Concepts and definitions

Drug-related death

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

Suspected drug death

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

Completeness

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

Value type and unit of measurement

Numbers of suspected drug deaths in Scotland and moving averages.

Description

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

Data source(s)

QEUH, NHS Greater Glasgow and Clyde

Date that data were acquired

16 January 2024

Timeframe of data and timeliness

17 August 2022 to 16 November 2023, approximately two months in arrears.

Continuity of data

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

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

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

Concepts and definitions

Unique ED attendances

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

Illicit drug

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

Benzodiazepines

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

Metabolite

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

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

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

Cocaine

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

Gabapentinoids

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

Opioids

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

Cannabinoids

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

Other stimulants

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

Completeness

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

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

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

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

Value type and unit of measurement

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

Description

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

Data source(s)

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

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

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

Date that data were acquired

4 December 2023

Timeframe of data and timeliness

Between 1 January 2020 and July to September (complete period for 1 July to 31 August 2023, with inclusion of available partial data for September 2023), approximately three months in arrears.

Continuity of data

PHS was provided with post-mortem toxicology testing data for deaths occurring in the west, east and parts of the north of Scotland by Forensic Medicine and Science at the University of Glasgow and SPA FS.

In late 2022, post-mortem toxicology services for the west, east and parts of the north of Scotland were transferred from the University of Glasgow to the Scottish Police Authority Forensic Services (SPA FS). During the period of transition, tests were completed by other laboratory testing sites in the UK. Although testing has now been moved to SPA FS, these testing sites continued to provide support in 2023 and data from both SPA FS and outsourced sites have been included in this report.

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

For the first time in a RADAR quarterly report, data are available for the whole of Scotland. Previous reports only included data on deaths in the west, east and parts of the north of Scotland (the areas covered by SPA FS). The inclusion of data on deaths in the far north and north-east of Scotland (the areas covered by NHS Grampian) from January 2022 onwards, means that the figures presented after that point cover the whole of Scotland and are different from those shown in previous publications.

Concepts and definitions

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

  • The Scottish Police Authority Forensic Services (SPA FS) covers deaths occurring in the west, east and parts of the north of Scotland.
  • The Department of Clinical Biochemistry at NHS Grampian covers deaths in the far north and north-east of Scotland.

Detailed interpretation of the levels of drugs found present, drug interactions, co–morbidities or other factors relating to death are outside the scope of this analysis.

This analysis does not imply that specific drugs were implicated in deaths nor that deaths were classified as 'drug–related' and does not include consideration of wider causes of death.

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

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

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

Benzodiazepines

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

Cocaine

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

Gabapentin and pregabalin

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

Opioids

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

Completeness

For the first time in a RADAR quarterly report, data are available for the whole of Scotland. Previous reports only included data on deaths in the west, east and parts of the north of Scotland (the areas covered by SPA FS). The inclusion of data on deaths in the far north and north-east of Scotland (the areas covered by NHS Grampian) from January 2022 onwards, means that the figures presented after that point cover the whole of Scotland and are different from those shown in previous publications.

Value type and unit of measurement

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

Description

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

Data source(s)

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

Date that data were acquired

12 September 2023

Timeframe of data and timeliness

1 April 2021 and 31 July 2023, approximately three months in arrears.

Continuity of data

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

Concepts and definitions

Benzodiazepines

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

Cocaine

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

Gabapentinoids

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

Opioids

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

Synthetic cannabinoids

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

Completeness

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

Value type and unit of measurement

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

Description

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

Data source(s)

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

Date that data were acquired

5 December 2023

Timeframe of data and timeliness

21 August 2023 to 19 November 2023, approximately two months in arrears.

Continuity of data

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

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

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

Concepts and definitions

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

Completeness

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

Value type and unit of measurement

Number of specialist drug treatment referrals and moving averages.

Description

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

Data source(s)

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

Date that data were acquired

5 December 2023

Timeframe of data and timeliness

1 April 2021 to 30 June 2023.

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

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

Continuity of data

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

OST prescribing data for the period from July to September 2023 have been delayed due to issues affecting PIS. We anticipate that updated data should be available for the next release of this report in April 2024.

Concepts and definitions

Defined daily dose

When comparing use between medicines and over time it is common to use World Health Organization (WHO) defined daily doses (DDDs). The DDD is defined as the usual average daily maintenance dose used in adults for the main therapeutic use of the medicine. The WHO DDD is a global average and may not be representative of the doses used in clinical practice at a more local level.

Average daily quantity

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

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

Buprenorphine

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

Opioids

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

Methadone

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

Accuracy

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

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

Completeness

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

Value type and unit of measurement

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

Description

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

Data source(s)

Needle Exchange Online (neo360)

Date that data were acquired

5 December 2023

Timeframe of data and timeliness

5 July 2021 to 1 October 2023, approximately three months in arrears.

Continuity of data

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

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

Concepts and definitions

Transactions

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

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

Completeness

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

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

The 11 mainland NHS boards use neo360 routinely, but due to missing data for part of the time period presented, NHS Highland is excluded from the transaction data, and both NHS Fife and NHS Highland are excluded from the needle and syringe, and ratio figures.

Value type and unit of measurement

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

Last updated: 21 March 2024
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