About this release

Our quarterly report

View a printable version of this report.

The Drugs Team at Public Health Scotland (PHS) has compiled this report of drug-related indicators in order to inform action to prevent drug harms and deaths.

The objectives of this report are to:

  • monitor changes in drug trends, harms and use of services to inform immediate and short-term actions that reduce drug harms
  • detect potential clusters of harms and recommend appropriate responses

Data and reporting period

  • 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.
  • This release reports on Scotland-level data. Analysis for some indicators is available by NHS Board in the substance use section of the COVID-19 wider impacts dashboard.
  • These data may be subject to change. Further analysis of these data will be made available in our Official and National Statistics publications on substance use.
  • Different time periods may be reported across the different indicators. In all cases, the most recently available data are used. Most charts are based upon a 2-year time series.
  • Key time periods, during which notable pandemic restrictions were in place, are indicated by reference lines and shaded areas on the charts.

Date of next report

The next release of this publication will be 25 July 2023.

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.

Update

There was a minor update to this publication on 27 July 2023, in the opioid substitution therapy indicator. The glossary was updated to state that injectable buprenorphine is administered as a subcutaneous injection (previously listed as an intramuscular injection).

Summary of indicators

Police Scotland drug trends bulletin

This update provides information on cocaine and street benzodiazepines.

RADAR intelligence and reports

23 reports were validated by RADAR between 12 January and 4 April 2023.

Naloxone administration by Scottish Ambulance Service

The average weekly number of naloxone administration incidents was broadly stable between December 2022 and February 2023 (61 incidents per week). The total number of incidents during this time period was lower (793) compared to the same time periods in 2020 (998) and 2021 (920).

Drug-related attendances at emergency departments

The average weekly number of drug-related attendances at emergency departments was stable between December 2022 and February 2023. A total of 1,118 attendances were recorded in this period – 13% lower than in the same time period in 2020/21 (1,284), but 11% higher than in 2021/22 (1,010).

Drug-related acute hospital admissions

The average weekly number of drug-related hospital admissions decreased between October and December 2022. The total number of admissions in this time period (1,815) was considerably lower than expected, compared to the same time period in 2020 (2,736) and 2021 (3,244) (decreases of 34% and 44% respectively).

Suspected drug deaths

The average weekly number of suspected drug deaths was broadly stable from December 2022 to the end of February 2023, compared to the fluctuating trends observed in October and November 2022. There was an average monthly total of 96 suspected drug deaths in December 2022 to February 2023. This was the same average monthly total of suspected drug deaths as in December 2021 to February 2022.

Emergency department toxicology: ASSIST

Between August and February 2022, the ASSIST emergency department pilot made 1,022 detections of 52 different illicit drugs in samples from 190 patients. More than one illicit substance was detected in 87% of attendances. The most commonly detected drug category was depressants (60%), followed by opiates (18%). The most commonly detected individual drug was cocaine (10%), followed by desmethyldiazepam (9%).

Post-mortem toxicology testing for controlled substances

In October and November 2022, the most common drug types detected in post-mortem toxicology were opioids (75%) and benzodiazepines (63%). The most common drugs detected were heroin/morphine (37%) and diazepam (37%). Bromazolam (a new ‘street’ benzodiazepine) was detected in 14% of deaths.

Drug seizures in Scottish prisons

Synthetic cannabinoids were the most prevalent drug type detected in the Scottish Prisons Non-Judicial Drug Monitoring Project between June to December 2022 (detected in 35% of samples). Benzodiazepines were the second most prevalent, detected in 27% of samples, with bromazolam being the most prevalent benzodiazepine detected.

Specialist drug treatment referrals

From November 2022 to February 2023, the average weekly number of referrals to specialist drug treatment services was highly variable and followed the seasonal fluctuation seen in previous years. The number of referrals during this time period (5,691) was lower compared to the same time periods in 2021 (6,074) and 2022 (6,322).

Opioid substitution therapy

The average number of opioid substitution therapy (OST) doses supplied per month was stable in the period from October to December 2022. The number of OST doses supplied during this period was slightly lower than in the same time period in 2020 and 2021.

Injecting equipment provision

The average weekly numbers of injecting equipment provision (IEP) transactions decreased between October and December 2022, while the number of needles and syringes distributed was broadly stable. The total numbers of IEP transactions and needles and syringes distributed during this time period were lower compared to the same time periods in 2020 and 2021. 

Main points

  • Healthcare indicators of harm and service use remained broadly stable. 
  • The predominant picture of drug harms in Scotland continues to be polydrug use involving benzodiazepines, stimulants and opioids. 

Alerts 

  • On 24 January 2023, RADAR published a public health alert – nitazene-type drugs in Scotland. This alert was updated on 29 March 2023 to reflect an increase in harms and further detections in the wider drugs market. 
  • Due to their unexpected presence in the drug supply and high potency, nitazenes pose a substantial risk of overdose, hospitalisation and death. 

Trends 

  • 23 reports were validated by RADAR between 12 January and 7 April 2023. 
  • The majority of reports received related to cocaine, benzodiazepines (such as bromazolam) and counterfeit pregabalin. RADAR is currently assessing the harms of these drugs. 
  • Half of reports mention mixing two or more substances (polydrug use). Mixing drugs can cause unexpected and unpredictable effects and is a major risk factor in drug-related deaths in Scotland. 

Harm indicators 

  • The number of Scottish Ambulance Service naloxone incidents between December 2022 and February 2023 was lower than the same time period in the previous year. The increase in the distribution of take-home naloxone kits from community outlets, peers and prisons and distribution to police officers in Scotland in recent quarters, should be taken into consideration when interpreting data on administration of naloxone by emergency services.    
  • Drug-related attendances at emergency departments were stable from December 2022 to February 2023 and higher than the same time period in the previous year. Meanwhile, the number of drug-related hospital admissions between October and December 2022 was considerably lower than the same time period in the previous year. This reduction in admissions should be interpreted with caution. The number of hospital admissions may be affected by issues accessing urgent care services and by the capacity of hospital services and is not necessarily an indicator of a reduction in harms.
  • Suspected drug deaths remained high and broadly stable from December 2022 to the end of February 2023, averaging 96 deaths per month. This was the same as in December 2021 to February 2022. 

Toxicology indicators 

  • As with drug-trend reports, toxicology results were dominated by the presence of benzodiazepines, opioids, cocaine and, in prisons, synthetic cannabinoids. 
  • In hospital toxicology (the ASSIST research pilot), two or more substances were detected in 87% of drug-related emergency department presentations. The most commonly detected individual drugs were cocaine, followed by desmethyldiazepam (a benzodiazepine and also a metabolite of diazepam), followed by temazepam.  
  • In post-mortem testing, the most detected drug type was opioids. The most commonly detected drugs were heroin/morphine (37%) and diazepam (37%). Bromazolam and protonitazene were detected in post-mortem tests for the first time in October to November 2022.  
  • In prisons, drug analysis showed a changing picture of drug use, as new synthetic cannabinoids and benzodiazepines continued to appear. Synthetic cannabinoids were the most prevalent drug type detected in June to December 2022. Benzodiazepines were the second most prevalent, with bromazolam being the most common benzodiazepine detected. 
  • The continuing evolution in the types of substances detected emphasises the importance of investment in drug checking, forensic post-mortem toxicology and hospital toxicology testing. 

Service indicators 

  • The average weekly number of specialist drug treatment referrals from November 2022 to February 2023 was highly variable and followed the seasonal fluctuations seen in previous years. The number of referrals during this period was lower than the same time period in the previous year. 
  • The average number of opioid substitution therapy (OST) doses supplied per month was stable in the period from October to December 2022. The number of doses supplied during this period was slightly lower than in the same time period in 2021. OST drugs include methadone, oral buprenorphine (typically taken daily) and injectable buprenorphine (taken weekly and monthly). While the overall number of OST doses supplied has slightly decreased, doses of injectable buprenorphine have continued to increase. 
  • The average weekly numbers of needles and syringes distributed was broadly stable between October and December 2022. The total numbers of needles and syringes distributed during this period was lower compared to the same time period in 2021.

Alerts

RADAR publishes ad-hoc alerts related to new drugs, trends and harms.

A public health alert about nitazene-type drugs in Scotland, was published on 24 January 2023.

This alert was updated on 29 March 2023 to reflect an increase in nitazene-related harms and further detections in the wider drugs market.

Nitazenes are potent synthetic opioids. Due to their unexpected presence in the drug supply and high potency, nitazenes pose a substantial risk of overdose, drug-related hospitalisation and drug-related death.

View the public health alert about nitazenes.

Trends

Police drug trends bulletin

This bulletin contains photos of drugs.

This update provides information on cocaine and street benzodiazepines.

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

Cocaine

STOP Unit (West) continue with their drug collection scheme in partnership with an events centre. At the conclusion of events, the STOP Unit are contacted and the drugs are collected for destruction.

If there are recoveries of significance, these will be sent for analysis and images obtained. There have been no significant recoveries of note requiring analysis, but, recently, the most commonly recovered drug has been cocaine hydrochloride (powder cocaine). This could simply reflect the demographic of those attending events.

Cocaine powder

The Scottish Police Authority Forensic Services laboratory have confirmed the street purity of cocaine to be slightly higher than that of last year.

 

Image caption Cocaine hydrochloride: white powder/crystalline powder
Images shows a plastic bag filled with white powder/crystalline powder.
Crack Cocaine

Crack cocaine (freebase cocaine) is regularly encountered throughout the West of Scotland, but cocaine hydrochloride is still the most common form of cocaine. Crack cocaine can vary in appearance, as shown below.

Image caption Crack cocaine: yellow/beige rock
Image shows a rock of crack cocaine that is yellow or beige in colour.
Image caption Crack cocaine: yellow/beige rock in £20 deal
Image shows a small rock of crack cocaine with the caption £20 rock. The rock is light yellow/beige in colour. It is shown next to a one pence coin. The rock is roughly one fifth of the size of the coin.
Image caption Crack cocaine: off-white rocks
Image shows four rocks of crack cocaine that are crumbly and white/off-white in colour.

Visit NHS inform for more information on cocaine.

Street benzos

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

Most common benzodiazepines

  • The most commonly encountered street benzodiazepine tablet is still the white circular tablet marked ‘10’ on one side with a half score on the reverse, containing etizolam.
  • We are now starting to see the regular occurrence of other active ingredients, such as bromazolam.
  • Bromazolam is most commonly, but not exclusively, detected in small light blue/blue tablets marked ‘MSJ’ on one side with a half score on the reverse. (No images at present.)
Image caption Benzodiazepine tablet containing etizolam: white with ‘10’ and half score on reverse
Image shows the front and back of a white circular pill. It is marked with the number 10 on the front, with a half score on the back.

Operation Borzoi continues to monitor the recovery of street benzodiazepine tablets in Scotland. 

Visit NHS inform for more information on benzodiazepines.

RADAR intelligence and reports

23 reports were validated by RADAR between 12 January and 4 April 2023.

A summary of validated reports is shown below for informational purposes.

These reports have been collected as part of intelligence gathering by RADAR.

Since July 2022, RADAR has validated over 50 reports of drug-related harms received through the reporting form and mailbox.

Emerging concerns

From these reports, several key trends have emerged. Over half of submissions report polydrug use – the use of more than one substance at a time. Mixing drugs increases the risk of drug harms and death, this includes mixing alcohol with other drugs.

RADAR is currently assessing the harms related to cocaine, benzodiazepines, pregabalin (and other fake medicines) and nitazene-type opioids.

Concern: Cocaine-related harms and increasing reports of crack cocaine use

Drug: Cocaine. A short-lasting stimulant drug.

Legal status: In the UK, cocaine is classified as a Class A drug under the Misuse of Drugs Act (1971).

Summary

  • Cocaine and adverse effects associated with cocaine were the most common type of drug report for a specific substance to RADAR.
  • Reports relate to the use of both cocaine powder and crack cocaine (two different forms of the same drug).
  • Physical health harms described in reports included heart problems, respiratory issues, soft-tissue damage and rashes.
  • Mental health harms described in reports included anxiety, depression and psychosis.

Further information

  • Cocaine powder is a white, crystalline powder that is typically snorted, while crack cocaine is a rock-like substance that is typically smoked.
  • When a drug is smoked, the effects are felt more quickly and are more intense and short-lived, than when snorted.
  • Injecting cocaine increases risk and is linked to more harmful effects.

Concern: Benzodiazepine-related harms and increasing use of bromazolam

Drug: Bromazolam. A benzodiazepine, similar in structure to alprazolam. Benzodiazepines are a group of depressant drugs with sedative and anxiolytic (anti-anxiety) effects.

Legal status: In the UK, many benzodiazepines (including bromazolam) are classified as Class C drugs under the Misuse of Drugs Act (1971).

Summary

  • Multiple reports submitted to RADAR related to ‘street benzos’. In particular, unexpected effects from drugs sold as diazepam and an increase in the availability of bromazolam.
  • This is supported by toxicology data that shows a decrease in detections of etizolam and an increase in detections of bromazolam (and other novel benzodiazepines such as bromazepam, flubromazepam and gidazepam).
  • Adverse benzodiazepine effects described in reports include drowsiness, confusion, memory problems and black-outs, impaired coordination and unconsciousness.

Further information

  • The decrease in etizolam may be due to international control. In 2021, etizolam and alprazolam were controlled under the United Nations Convention on Psychotropic Substances (1971), increasing regulations on production and distribution. The increase in bromazolam detections may be due to its availability and its potential to be used as a substitute.
  • As bromazolam is not licensed for medical use, all bromazolam is illicitly manufactured. It is common for bromazolam to be mis-sold as another drug (such as diazepam or etizolam) or contain unpredictable concentrations in each pill, increasing the likelihood of adverse reactions and overdose.
  • Mixing benzodiazepines with other depressants, such as alcohol, gabapentinoids or opioids, can increase the risk of overdose and respiratory depression.

Concern: Counterfeit pregabalin linked to adverse effects

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

Legal status: In the UK, pregabalin is classified as a Class C drug under the Misuse of Drugs Act (1971).

Summary

  • RADAR has received an increase in reports related to the use of non-prescribed pregabalin. We also received an alert on ‘capsules sold as pregabalin’ released by police in West Yorkshire. This was shared with the network for information. To receive future alerts, sign-up to the network.
  • Reports described physical effects including dizziness, drowsiness and unconsciousness.
  • Reports described psychological effects including confusion and memory problems.
  • Although many reports of ‘fake drugs’ in the last quarter were linked to pregabalin, the trend of counterfeit or fake medicines extends beyond gabapentinoids with fake opioids and benzodiazepines also reported.

Further information

  • Mixing pregabalin with other depressants such as alcohol, benzodiazepines or opioids, can increase the risk of overdose and respiratory depression.
  • Illicitly manufactured drugs carry additional risks, as it may be contaminated with other substances or have unpredictable potency levels, increasing the likelihood of adverse reactions and overdose.
  • Counterfeit pills can be designed to look identical to the real medication, but there are some potential signs that may indicate that a pill is fake, including differences in colour, size and shape compared to the real medication.
  • The packaging may be made from lower-quality materials, have spelling or grammatical errors, or lack information such as dosage instructions, expiry dates, serial numbers and tamper-proof seals. Pills purchased from illegitimate sources or online marketplaces may be more likely to be counterfeit.

Concern: Nitazenes increasing in availability and 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). In February 2023, the UK government announced 10 other nitazenes will soon be controlled as Class A drugs.

Summary

  • Reports to RADAR indicate an increase in the availability of a new group of drugs called nitazenes, including N-pyrrolidino-etonitazene (etonitazepyne or NPE), metonitazene and protonitazene.

Further information

  • Due to their unexpected presence in the drug supply and high potency, nitazenes pose a substantial risk of overdose, drug-related hospitalisation and drug-related death.
  • A public health alert on ‘nitazene-type opioids in Scotland’ was published on 24 January 2023 and updated on 29 March 2023.

Drug harm reports to RADAR

Shown below are 23 reports validated by RADAR between 12 January 2023 and 4 April 2023.

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

Reports validated prior to 12 January, are shown in previous quarterly reports.

Report 1

Local authority: National

Reason for report: Adverse effects

Drug: Crack cocaine

Appearance: Unknown

Summary: Original report from Grampian but also similar reports from Glasgow, Fife and Dundee. Adverse effects from crack cocaine – skin irritation and rash on face, neck and body, particularly around the eyes and groin.

 

Report 2

Local authority: National

Reason for report: Alert

Drug: Pregabalin

Appearance: Red and white capsules with ‘signature’ branding

Summary: Alert from West Yorkshire police released after pregabalin capsules were suspected to be linked to multiple overdoses and hospitalisations.

Image shows a packet labelled ‘pregabalin capsules IP 300mg nervigesic’. The packet is made from clear plastic and silver foil and inside are 15 red and white gel capsules with the word signature printed on each capsule in black ink.

Report 3

Local authority: Fife

Reason for report: Adverse effects

Drug: Crack cocaine

Appearance: Yellow crystal or rock, spongey in texture

Summary: Reports of adverse effects after smoking a ‘very small amount’ of crack, sold as ‘synthetic crack’ – chest pains, confusion, hallucinations, overheating, pale skin, panic, paranoia and slurred speech.

 

Report 4

Local authority: Edinburgh

Reason for report: Adverse effects

Drug: Pregabalin

Appearance: Unknown

Summary: Pregabalin (thought to be fake) reported to be very strong and causing seizures in seasoned users.

 

Report 5

Local authority: Edinburgh

Reason for report: New drug, adverse effects

Drug: Diazepam     

Appearance: Pill stamped with ‘KB10’

Summary: Drug sold as diazepam or Valium suspected to be involved in deaths.

 

Report 6

Local authority: Stirling, Falkirk

Reason for report: New drug, adverse effects

Drug: Diazepam     

Appearance: White, hexagonal pill

Summary: Separate patients reporting the presence of a white hexagonal ‘Valium’ referred to as ‘hulk’, causing adverse effects – days of black-out, no recall of previous day(s’) events and loss of consciousness. Reported as stronger than any other Valium they have previously ingested. Purchased as loose pills from a dealer in Glasgow.

 

Report 7

Local authority: East Lothian

Reason for report: Adverse effects

Drug: Diazepam     

Appearance: White pill, stamped with letter 'Y' on tablet, small (similar to size of contraceptive pill)

Summary: Adverse effects after swallowing pills thought to be diazepam - unable to recall events (losing days), decreased energy and drowsiness. Purchased as loose pills for £1 per pill.

 

Report 8

Local authority: Edinburgh

Reason for report: Adverse effects

Drug: Crack cocaine

Appearance: Yellow rocks

Summary: Low priced, yellow crack cocaine causing serious side effects.

 

Report 9

Local authority: East Lothian

Reason for report: New trend, adverse effects

Drug: Codeine

Appearance: Unknown

Summary: Reports of young people drinking cough mixture with crushed up codeine.

 

Report 10

Local authority: Fife

Reason for report: New trend – changing drugs market

Drug: Diazepam

Appearance: Unknown

Summary: Use of online marketplaces to purchase drugs with buying incentives such as discounts and a range of payment options, including the use of bank transfers and cryptocurrencies.

 

Report 11

Local authority: Edinburgh

Reason for report: Adverse effects

Drug: Valium

Appearance: Unknown

Summary: Strong pills, sold as ‘Valium’, posing risk for inexperienced users, particularly in the homeless population.

 

Report 12

Local authority: Fife

Reason for report: New trend

Drug: Ketamine and cocaine

Appearance: White powder

Summary: Use of 'kit-kat' or ‘CK’ – ketamine along with cocaine or crack cocaine. Reports of snorting, injecting and swallowing. First reports a few years ago in homeless sector but now mainly younger people.

 

Report 13

Local authority: Edinburgh

Reason for report: New trend

Drug: Heroin

Appearance: Unknown

Summary: Heroin, referred to as ‘scab’ reported as being available. Strength reported as a concern for inexperienced users.

 

Report 14

Local authority: Edinburgh

Reason for report: New trend

Drug: Synthetic cannabinoids

Appearance: Unknown

Summary: Adverse effects (unknown) of synthetic cannabinoids suspected to be cut with opioids.

 

Report 15

Local authority: Edinburgh

Reason for report: New trend, adverse effects

Drug: Various

Appearance: Unknown

Summary: Adverse effects (unknown) related to fake Valium, Xanax (alprazolam) and pregabalin.

Report 16

Local authority: Ayrshire and Arran

Reason for report: New trend, adverse effects

Drug: Bromazolam

Appearance: White crystalline powder

Summary: Reports of adverse effects after swallowing bromazolam powder.

 

Report 17

Local authority: Glasgow

Reason for report: Adverse effects

Drug: Pregabalin, polydrug use

Appearance: Red and white capsules with ‘signature’ branding

Summary: Cluster of near-fatal overdoses. Those affected reported the use of multiple substances including alcohol, cocaine, benzodiazepines, gabapentin, opioid substitution therapy drugs and pregabalin. Several (not all) reported the use of pregabalin matching the alert – see national report 2.

 

Report 18

Local authority: Dumfries and Galloway

Reason for report: New drug

Drug: Pregabalin

Appearance: Red and white capsules with ‘signature’ branding

Summary: Reports of pregabalin use in the region.

Report 19

Local authority: Aberdeen City, Aberdeenshire and Moray

Reason for report: Adverse effects

Drug: Unknown, injecting

Appearance: Unknown

Summary: Slightly higher than average reports of bacterial infections in people who inject drugs.

 

Report 20

Local authority: Aberdeen

Reason for report: New drug, adverse effects

Drug: Pregabalin

Appearance: Red and white capsules with ‘signature’ branding

Summary: Drug service clients reporting use of illicit pregabalin called ‘signature’.

 

Report 21

Local authority: Highland

Reason for report: Adverse effects, suspected death

Drug: Pregabalin

Appearance: Red and white capsules with ‘signature’ branding

Summary: Capsules, thought to be pregabalin, found at the scene of a death where polydrug use suspected to be involved.

 

Report 22

Local authority: Aberdeen

Reason for report: Adverse effects

Drug: Pregabalin    

Appearance: Red and white capsules with ‘signature’ branding

Summary: Adverse effects after swallowing four capsules – over-sedated (passed out for 13 hours), overdose, loss of consciousness, memory loss, confusion, low mood, physical injury and unusual behaviour. Purchased in blister packet from street dealer.

 

Report 23

Local authority: Aberdeen

Reason for report: Adverse effects

Drug: Crack cocaine

Appearance: Unknown

Summary: Significant concerns related to crack cocaine. Adverse effects in multiple clients – memory problems, paranoia, psychosis and unusual behaviour. Reported to be due to a change in the way crack cocaine is cut. Some clients report crack cut with mephedrone (referred to as ‘magic’ and ‘crunch’).

Reporting drug harms

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

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

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

Harm indicators

Naloxone administration by Scottish Ambulance Service

The average weekly number of naloxone administration incidents was broadly stable between December 2022 and February 2023 (61 incidents per week). The total number of incidents during this time period was lower (793) compared to the same time periods in 2020 (998) and 2021 (920).

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 28 November 2020 to 26 February 2023.

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, in spite of an increase in April, has followed a gradual decreasing trend from May 2022 onwards.
Update

For the most recent time period (28 November 2022 to 26 February 2023):

  • 793 SAS naloxone incidents were recorded, at an average of 61 per week. Weekly numbers of incidents were generally stable throughout this period.
  • The total number of incidents was 5% lower than in the previous time period (5 September to 27 November 2022) when 832 incidents were recorded, at an average of 69 per week.
  • The total number of incidents was 21% lower than expected compared to the same time period in 2020 (998 attendances, average of 77 per week) and 14% lower than in 2021 (920 attendances, average of 71 per week).

Additional information

PHS was provided with these data by SAS.

For more information, or to analyse this data by NHS Board, visit the COVID-19 wider impacts dashboard.

Police Scotland is in the process of training and equipping all operational officers up to and including the rank of Police Inspector with intra-nasal naloxone kits. This roll-out began in August 2022 and is expected to be complete in early 2023. This should be taken into consideration when interpreting the data shown above. More information on the carriage of naloxone by Police Scotland is available on their website.

Why we use a 3-week moving average

As these data are highly variable over time, a 3-week moving average has been included in the graph to aid interpretation of trends over time.

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 (unconsciousness, shallow breathing, snoring, blue lips, pale skin, 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.

Naloxone is very easy to administer.

You can learn more about administering naloxone in a free e-learning module created by the Scottish Drugs Forum.

Information on take-home naloxone distribution can be found in the substance use section of the COVID-19 wider impacts dashboard and in the National Naloxone Programme Scotland Quarterly Monitoring Bulletin, both published by PHS.

Drug-related attendances at emergency departments

The average weekly number of drug-related attendances at emergency departments was stable between December 2022 and February 2023. A total of 1,118 attendances were recorded in this period – 13% lower than in the same time period in 2020/21 (1,284), but 11% higher than in 2021/22 (1,010).

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 16 November 2020 and 5 March 2023.

Image caption Drug-related attendances at emergency departments

Summary

Historic trend
  • An overall decreasing trend was observed in drug-related attendances at EDs between August 2021 and April 2022, with the lowest weekly levels in the time series observed in the week beginning 4 April 2022 (53).
  • Drug-related ED attendances then increased sharply and peaked in May 2022, with the highest weekly levels in the time series observed in the week beginning 16 May 2022 (123).
  • Attendances then decreased and remained stable, averaging 84 attendances per week from June to November 2022.
Update 

For the most recent time period (28 November 2022 to 5 March 2023):

  • 1,118 ED attendances were recorded, at an average of 80 per week. This was 5% lower than the previous 14-week time period (22 August to 27 November 2022: 1,179 attendances, an average of 84 per week).
  • Attendances were 13% lower compared to the same time period in 2020/21 (1,284 attendances, an average of 86 per week) and 11% higher than in 2021/22 (1,010 attendances, an average of 72 per week).

Additional information

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

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.

For more information, or to analyse these data by NHS Board, visit the COVID-19 wider impacts dashboard.

Why we use a 3-week moving average

As these data are highly variable over time, a 3-week moving average has been included in the graph to aid interpretation of trends over time.

Drug-related acute hospital admissions

The average weekly number of drug-related hospital admissions decreased between October and December 2022. The total number of admissions in this time period (1,815) was considerably lower than expected, compared to the same time period in 2020 (2,736) and 2021 (3,244) (decreases of 34% and 44% respectively).

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 26 September 2020 to 1 January 2023.

The chart is interactive, allowing users to view data points on the chart as well as download the data. This is being piloted as an alternative to the static charts and if useful may be rolled out across other indicators. 

The second chart shows the top five drug types associated with admissions as a percentage of all drug-related admissions between 28 September 2020 to 1 January 2023.

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

Image caption Drug-related hospital admissions: drug category

Summary 

Historic trend 
  • There was a long-term decreasing trend in the weekly number of drug-related hospital admissions from June 2021 to April 2022. Admissions briefly increased in April and May 2022 (peak of 208 during the week beginning 16 May), before decreasing again in June 2022. The average weekly number of drug-related hospital admissions remained relatively stable between July and September 2022. 
  • The long-term decreasing trend in drug-related hospital admissions observed since June 2021 differs markedly from previous years, which have generally been characterised by lower numbers of admissions during winter months and higher numbers during summer months. 
  • The most common drug category recorded in general acute hospital admissions was opioids: 
    • The percentage of opioid-related admissions decreased from 50% in November 2020 to 46% in August 2022, before increasing to an average of 50% of attendances between September and October 2022. 
    • The percentage of sedative/hypnotic admissions decreased across 2022 (17% of admissions in January, falling to 11% in December 2022). 
Update 

For the most recent time period (26 September 2022 to 1 January 2023): 

  • 1,815 drug-related hospital admissions were recorded, at an average of 130 per week.
  • Admissions followed a downward trend throughout this period, from 182 in the week beginning 12 September 2022 to 81 in the week beginning 26 December 2022. 
  • The total number of admissions was lower than expected compared to previous years: 
    • 44% lower than the same period in 2020 (3,244, an average of 232 per week) 
    • 34% lower than the same period in 2021 (2,736, an average of 195 per week) 

Reasons for the decrease in numbers have not been examined. This decreasing trend should not be interpreted as a reduction in harms. The number of hospital admissions may be affected by issues accessing urgent care services and by the capacity of hospital services. 

  • The most common substance type recorded in drug-related general acute hospital admissions was opioids. These were recorded at an average of 50% of admissions per month, which was broadly consistent over the time series. 

Additional information 

These data have been extracted from our SMR01 dataset

For more information on diagnostic coding, please refer to the drug-related hospital statistics publication methods page

To analyse the latest published information on drug-related hospital discharges by NHS Board or by Alcohol and Drug Partnership (ADP), go to our information on drug-related hospital statistics admissions

Please note our drug-related hospital statistics dashboard presents data by date of discharge, so figures will differ to those shown above. For more information, please see the metadata

Why we use a 3-week moving average 

As these data are highly variable over time, a 3-week moving average has been included in the graph to aid interpretation of trends over time.

Glossary 

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/hypnotics

Sedatives/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 substances or 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 (ICD10) codes.

Suspected drug deaths

The average weekly number of suspected drug deaths was broadly stable from December 2022 to the end of February 2023, compared to the fluctuating trends observed in October and November 2022. There was an average monthly total of 96 suspected drug deaths in December 2022 to February 2023. This was the same average monthly total of suspected drug deaths as in December 2021 to February 2022.

Background 

Suspected drug death figures are based on reports from police officers attending scenes of death. The details of these events are recorded by Police Scotland and shared with Public Health Scotland. 

Following further investigation, these suspected drug deaths are either confirmed as a ‘drug-related death’ or determined ‘not to be a drug death’. This can take several months. 

Suspected drug death figures are used to provide a timely indication of trends and to detect any potential recent changes or clusters of harm to inform prevention activity. These figures are different to the National Statistics published by the National Records of Scotland (NRS) and do not provide a robust indication of the numbers of drug-related deaths occurring each year. 

The chart below shows the weekly number of suspected drug deaths in Scotland from 25 October 2020 to 25 February 2023. 

Image caption Suspected drug deaths

Summary 

Historic trend 
  • Following a large increase in suspected drug deaths in Scotland during December 2020, there was a decreasing trend in the average weekly number of deaths until May 2021. The number of suspected drug deaths increased during summer 2021, peaking at 34 in the week beginning 7 June 2021. 
  • Between July 2021 and October 2022, the average weekly number of deaths fluctuated considerably but remained within a range of 17 to 28 deaths per week. 
Update 

For the most recent time period (28 November 2022 to 28 February 2023): 

  • An average of 22 suspected drug deaths were recorded per week (ranging between 17 and 27). This weekly average was lower than the same 13-week period in 2020/21 (33 deaths per week) and similar to the same period in 2021/22 (23 deaths per week). 
  • The average weekly number of suspected drug deaths was broadly stable from December 2022 to the end of February 2023, compared to the fluctuating trends observed in October and November 2022. There were 116 suspected drug deaths in November 2022, 93 in December 2022, 108 in January 2023 and 86 in February 2023. 
  • There was an average monthly total of 96 suspected drug deaths in December 2022 to February 2023. This was the same average monthly total of suspected drug deaths as in December 2021 to February 2023.  

Additional information 

Data on suspected drug deaths in Scotland are provided by Police Scotland. 

The Scottish Government produce a quarterly report (Suspected drug deaths in Scotland) that presents Police Scotland data on suspected drug deaths and describes the age, sex and geographical location of deaths in each quarter. The analysis in this RADAR release is provided for the purpose of real-time detection and prevention of harms and is not comparable with the Scottish Government publication.

PHS will continue to publish data on suspected drug deaths in future RADAR releases. The Scottish Government, together with PHS and partners, are currently considering the future of the Suspected drug deaths in Scotland report. 

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

National statistics on drug-related deaths are published annually by the NRS during the summer. The latest report provides information on drug-related deaths in 2021 and earlier years, broken down by age, sex, substance implicated and the NHS Board and council areas.  

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 report describes deaths that occurred in 2017 and 2018, with trend data from 2009. 

Why we use a 3-week moving average 

As these data are highly variable over time, a 3-week moving average has been included in the graph to aid interpretation of trends over time. 

Glossary

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 that were implicated or potentially contributed to the death are controlled in the UK. National statistics on drug-related deaths are published by NRS. In 2021, there were 1,330 drug-related deaths in Scotland. This was a small decrease compared to 2020 (1,339), which saw the highest annual total on record.

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.

Toxicology indicators

Emergency department toxicology: ASSIST

Between August 2022 and February 2023, the ASSIST emergency department pilot made 1,022 detections of 52 different illicit drugs in samples from 190 patients. More than one illicit substance was detected in 87% of attendances. The most commonly detected drug category was depressants (60%), followed by opioids (18%). The most commonly detected individual drug was cocaine (10%), followed by desmethyldiazepam (a benzodiazepine and metabolite of diazepam) (9%).

Background

The ASSIST (A Surveillance Study in Illicit Substance Toxicity) pilot, conducted by the emergency department (ED) at the Queen Elizabeth University Hospital (QEUH), aims to assess the feasibility of prospective surveillance of ED attendances due to acute illicit drug toxicity.

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.

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
  • drugs administered to the individual as part of treatment (by ambulance staff or in hospital)

The pilot enables full toxicological analysis through the biorepository approved surplus sampling. This allows drug profiling and the identification of emerging drugs or changing trends, to inform appropriate harm reduction measures and public health responses.

This pilot will run in the QEUH ED in Glasgow from August 2022 to August 2023, followed by a 3-month follow-up period.

Toxicology analysis of surplus serum samples

Surplus serum samples are left-over blood samples, which were taken as part of usual care. Drug detections presented here are of ‘illicit drugs’ only and were not prescribed to the individual.

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

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

Image caption Toxicology analysis of surplus serum samples: drug category

Summary

For the most recent time period (17 August 2022 to 16 February 2023), there were 481 individual ED attendances related to illicit drug use identified. 190 attendances qualified for surplus sampling toxicology testing (as they were categorised as ‘more unwell’ as per research inclusion criteria).

Drug type and category

Of the 190 individual attendances:

  • There was a total of 1,022 detections of 52 substances (found through the biological detection of the drug or its metabolite).

Of the 1,022 detections:

  • The following drugs were the most common:
    • cocaine: 102 (10%)
    • desmethyldiazepam: 91 (9%)
    • temazepam: 84 (8%)
    • etizolam: 76 (7%)
    • cannabis (tetrahydrocannabinol): 73 (7%)

Note: desmethyldiazepam and temazepam are benzodiazepines and also metabolites of other benzodiazepines such as diazepam.

  • Depressants were the most common drug category, detected in 60% of all detections (613 times):
    • Benzodiazepines were detected 528 times (52% of all detections).
    • In total, 17 different types of benzodiazepines were detected, including bromazolam (53 detections), gidazepam (31) and flubromazepam (27).
    • Gabapentinoids were detected 69 times (7%), 29 of these were gabapentin and 40 were pregabalin.
  • Opioids were the second most common drug category, detected in 18% of all detections (180 times):
    • There were 46 detections of morphine (an opioid and metabolite of heroin and other opioids). There were 32 detections for codeine, 21 for methadone, 16 for dihydrocodeine and five for buprenorphine.
  • Stimulants were the third most common drug category, detected 140 times, making up 14% of all detections. The most common stimulant was cocaine, detected 102 times (10%).
    • There were 16 detections for amphetamine, eight for MDMA, six for MDA (a stimulant and also a metabolite of MDMA) and four for methamphetamine.
Polydrug use

Of the 190 attendances, for which complete toxicology and clinical data are available, polydrug use is a prevailing feature:

  • 165 samples (87%) had more than one illicit drug or metabolite detected, even after legal substances (such as alcohol) and known prescribed medicines (including prescribed benzodiazepines, gabapentinoids and opioids) were removed.
  • The number of illicit drugs detected per sample ranged between one and 16, with a mean of five.
  • Benzodiazepines were detected in 155 samples (82%), with more than one type of benzodiazepine detected in 117 of these samples. Detections ranged between one and eight, with a mean of three.
  • Of the benzodiazepine positive samples, 51% were also positive for an opioid and 46% were also positive for cocaine.
  • Of the opioid positive samples, 87% were also positive for a benzodiazepine.
  • Of the cocaine positive samples, 81% were also positive for a benzodiazepine.
Further findings

Complete clinical data are available for 481 attendances, with results described below:

  • 351 were male (73%) and 130 were female (27%).
  • Over half were 16 to 34 years old.
Age category (years) Total Percentage
16 to 24 100 21%
25 to 34 162 34%
35 to 44 123 26%
45 to 54 62 13%
55 and over 29 6%
Unknown 5 1%
  • ED outcome records show that:
    • 215 patients were discharged home
    • 118 were admitted to a ward
    • 58 were taken into police custody
    • 28 were transferred to a psychiatric unit
    • 24 self-discharged
    • 20 were admitted to an intensive care unit
    • 10 were admitted to a high dependency or critical care unit
    • Eight were recorded as ‘unknown’ or ‘other’
  • Clinical severity outcome (after 28 days) recorded that:
    • 455 patients were discharged
    • Eight patients died
    • Six were ongoing inpatient admissions
    • 12 outcomes were recorded as ‘unknown’ or ‘other’

Additional information

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

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

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

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

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

The testing has been carried out by the LGC Group. LGC analyse pseudonymised samples using mass spectrometry and screen against a database of over 3,500 analytes. This testing can detect drugs and metabolites, but this analysis does not imply that specific drugs were implicated in harms.

Further information on the study can be found at Clinical Trials UK.

Glossary

Cannabinoids

Cannabinoids are compounds that interact with the endocannabinoid system. They are found in the cannabis plant (such as tetrahydrocannabinol – THC) or can be produced synthetically in a laboratory (synthetic cannabinoids). Two synthetic cannabinoids were detected in this project. All other cannabinoid detections are for cannabis.

Depressants

Depressant drugs depress the central nervous system, which also decreases heart rate and breathing. Depressant drugs include substances such as benzodiazepines, gabapentinoids, Z-drugs and GHB/GBL.

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

Benzodiazepines (and metabolites) detected in this project include desmethyldiazepam, etizolam, temazepam, oxazepam, diazepam, bromazolam, gidazepam, flubromazepam, flualprazolam, lorazepam, nitrazepam, nordiazepam, clonazolam, flubromazolam, midazolam, clonazepam and alprazolam. Please note that desmethyldiazepam, temazepam and oxazepam are all benzodiazepine drugs but can also be found as a metabolite of diazepam.

Gabapentinoids (pregabalin and gabapentin) 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 detected in this project include codeine, methadone, dihydrocodeine, tramadol, dihydromorphine, buprenorphine, fentanyl, alfentanil, oxycodone, tapentadol and morphine.

Stimulants

Stimulant drugs stimulate the central nervous system, which also increases heart rate and breathing.

Stimulant drugs include substances such as cocaine and amphetamines.

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

Other stimulants detected in this project include amphetamine, methamphetamine, MDMA, mephedrone and MDA (a drug and also a metabolite of MDMA).

Illicit drug

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 or
  • drugs administered to the individual as part of treatment (by ambulance staff or in hospital).
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.

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

For example, if both diazepam and its metabolite desmethyldiazepam (also a drug in its own right) are detected then they would both be included.

However, if a drug and a metabolite that has no drug form have been detected, then we would include this as one drug.

For example, if both ketamine and norketamine (a metabolite of ketamine) were found in a sample then only ketamine would be recorded.

Due to this we are unable to determine 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.

Unique ED attendances

In this reporting period there was a total of 481 unique attendances to the emergency department related to illicit drug use. Each separate attendance is counted as one. If the same person presented more than once, each attendance would be a separate data point.

Post-mortem toxicology testing for controlled substances

In October and November 2022, the most common drug types detected in post-mortem toxicology were opioids (75%) and benzodiazepines (63%). The most common drugs detected were heroin/morphine (37%) and diazepam (37%). Bromazolam (a new ‘street’ benzodiazepine) was detected in 14% of deaths.

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, COPFS commission 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.

The majority of testing was performed by the Forensic Toxicology Service based within Forensic Medicine and Science (FMS) at the University of Glasgow, on behalf of COPFS. In late 2022, post-mortem toxicology services were transferred from the University of Glasgow to Scottish Police Authority (SPA) Forensic Services.

During this period, post-mortem tests were completed by other laboratory testing sites in the United Kingdom. Data from those sites have been included in this report and cover the most recent period reported. Future testing will be completed within a laboratory based within SPA Forensic Services.

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 in the coming months.

The first chart below provides an indication of controlled drugs found present at post-mortem in deaths occurring between 1 January 2020 and 30 November 2022.

Image caption Forensic toxicology cases testing positive for controlled substances

The second chart provides an indication of specific opioids and benzodiazepines found present at post-mortem in deaths occurring between 1 January 2020 and 30 November 2022.

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

Summary

Historic trend
  • In total, 2,179 deaths occurred in 2021 where controlled drugs were found present via FMS toxicology testing, which was 2% higher than in 2020 (2,147).
  • The most commonly found drug types were opioids and benzodiazepines. The percentage of deaths with these drugs present remained high throughout 2020 to Q2 of 2021, before a decreasing trend between Q3 of 2021 and Q3 of 2022.
  • The specific drugs most commonly present throughout the time series (from Q1 of 2020 to Q2 of 2022) were etizolam, methadone and heroin/morphine. The percentage of etizolam and methadone detections both increased sharply in Q2 of 2020, before both reducing in Q3 2021, etizolam most notably.
  • Deaths positive for clonazolam peaked at 12% of deaths in Q3 of 2021, before decreasing to zero in Q3 of 2022. The increase in deaths where clonazolam was found present indicates that, rather than a reduction in street benzodiazepine deaths, a shift towards alternative substances may have occurred.
  • Since Q2 of 2020 there has been a gradual reduction in the percentage of deaths where methadone was found present. The percentage of deaths involving diazepam, other opioids, gabapentin and pregabalin or cocaine has remained relatively stable over time.
Update

For the most recent time period (1 October 2022 to 30 November 2022):

  • The total number of deaths testing positive for controlled substances was 326. Many of these deaths involved multiple positive detections, therefore the total number of detections listed below is greater than the total number of deaths.
  • The following drugs or drug types were most commonly detected:
    • opioids: 246 (75%)
    • benzodiazepines: 207 (63%)
    • gabapentin and pregabalin: 124 (38%)
    • cocaine: 99 (30%)
  • Heroin/morphine remained the most commonly detected substance, with 37% of cases testing positive (from 35% in Q3). Methadone was detected in 29% of cases (from 25% in Q3).
  • Diazepam detections increased markedly to 37% of cases (from 25% in Q3), making it was the most commonly detected substance alongside heroin/morphine. Etizolam was detected in 20% of cases (from 17% in Q3).
  • Due to expanded toxicology testing, there were new detections of the following substances (detected for the first time when testing was outsourced to other laboratories):
    • Bromazolam (a novel ‘street’ benzodiazepine) was detected in 14% of deaths (45).
    • Protonitazene (a nitazene-type opioid) was detected in 1% of deaths (<3).

Additional information

PHS was provided with these data by FMS, University of Glasgow and SPA Forensic Services.

The data above are for deaths occurring in the west, east and parts of the north of Scotland. It does not include a small number of cases in the far north and north-east of Scotland where post-mortem toxicology testing is conducted by the Aberdeen Royal Infirmary (ARI). Nitazene-type opioids have been added to toxicology testing at the ARI and retrospective sampling has resulted in the identification of nitazene-type opioids in deaths. Further details will be added to RADAR reports and alerts once available.

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.

New drugs (bromazolam and protonitazene) were detected for the first time when 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 the drugs markets. These data will develop further as bromazolam, nitazenes and other new or emerging drugs are added to routine toxicology screening by the SPA Forensic Services.

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 FMS 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.

As part of the interim period, prior to post-mortem tests being completed at SPA Forensic Services, other laboratories testing data from around the UK have been included in this report (September 2022 to November 2022). As these data 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.

The 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.

Glossary

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.

Visit NHS inform for information on benzodiazepines.

Cocaine

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

This group includes powder cocaine and crack cocaine.

Visit NHS inform for information on 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.

Drug seizures in Scottish prisons

Synthetic cannabinoids were the most prevalent drug type detected in the Scottish Prisons Non-Judicial Drug Monitoring Project between June to December 2022 (detected in 35% of samples). Benzodiazepines were the second most prevalent, detected in 27% of samples, with bromazolam being the most prevalent benzodiazepine detected.

Background 

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

The first chart shows the number and type of samples seized in Scottish prisons between 1 September 2020 and 31 December 2022. 

Image caption Drug seizures in Scottish prisons: sample type

The second chart shows the three most detected drug types from seizures in Scottish prisons between 1 September 2020 and 31 December 2022. This is based on the percentage of all samples tested and is presented with a month moving average.

Image caption Drug seizures in Scottish prisons: drug type

Summary 

Historic trend  
  • The number of seizures analysed fluctuated in 2021, ranging from a low of 23 in June and peaking at 134 in September. Between January and May 2022, the average number of seizures analysed remained relatively stable with an average of 40 per month. 
  • Sample type data were highly variable over time, but changes were observed in sample type detections during 2022:
    • Paper/card detections decreased, making up an average of 30% of samples per month in 2022, compared to an average of 73% per month in 2021. This is assessed to be due to changes to prison rules that now allows SPS to photocopy general correspondence, with recipients being given photocopies rather than original items. 
  • Synthetic cannabinoids were the most common substances detected, followed by benzodiazepines. Drug type seizure data were highly variable over time, so the following narrative is based on the 3-week moving average: 
    • The percentage of seizures testing positive for synthetic cannabinoids was on average 42% per month in 2021. Between January and May 2022, the percentage was variable, averaging at 30% per month. 
    • The percentage of seizures testing positive for benzodiazepines fluctuated throughout 2021 with a monthly average of 38%, before decreasing and remaining stable from January to May 2022 (monthly average of 29%). 
Update 

This update provides analysis of samples seized from June to December 2022 (205 samples). For the most recent time period (1 June 2022 to 31 December 2022): 

Sample type 
  • An increasing trend in the percentage of e-cigarette and powder sample types was observed: 
    • Over half of seizures were e-cigarettes in June 2022. In July to November, e-cigarettes made up an average of 32% of samples per month before decreasing to 5% in December. 
    • Synthetic cannabinoids were detected in 41% of the e-cigarettes analysed.  
    • Powder samples have remained relatively stable with a monthly average of 19% between January and November 2022, before increasing to 60% in December. 
Drug type 
  • The three most detected controlled drugs were ADB-BUTINACA (synthetic cannabinoid), bromazolam (benzodiazepine) and etizolam (benzodiazepine).
  • During recent months, bromazolam overtook etizolam as the most detected benzodiazepine in prison seizures. In the most recent time period 39% of benzodiazepine samples contained bromazolam, versus 35% containing etizolam. 

Drug type seizure data were again highly variable from June to December 2022, so the following narrative is based on the 3-week moving average: 

  • Synthetic cannabinoids were the most common drug type, detected in an average of 38% of seizures per month: 
    • The detection of synthetic cannabinoids has been fluctuating in recent months, increasing to 50% of seizures in July 2022 before falling to an average of 28% in October and November 2022. 
    • Detections of synthetic cannabinoids were on average 41% per month during the same time period in 2021. 
  • Benzodiazepines were the second most common drug type, detected in an average of 25% of seizures per month: 
    • Figures followed an increasing trend between July and November (approximately 27% per month) and peaked at 40% in December 2022. 
    • Detections of benzodiazepines were on average 37% per month during the same time period in 2021. 

Further information 

Between September and December 2022, this drug analysis project detected the following drugs for the first time in prisons in Scotland, demonstrating a constantly evolving drugs market: 

  • ADB-5’Br-BUTINACA (synthetic cannabinoid)  
  • bromonordiazepam (desalkylgidazepam, benzodiazepine) 
  • nitrazepam (benzodiazepine) 

Metonitazene (a nitazene-type opioid) was detected twice in August 2022. For further information on nitazenes, please see our latest alert.  

From preliminary findings for seizures obtained in January 2023, dipentylone (cathinone, stimulant) was detected for the first time in Scottish prisons. 

Additional information 

PHS was provided with these data by SPS and LRCFS. 

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

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

Why we use a 3-month moving average 

As these data are highly variable over time, the 3-month moving average has been included in the graph to account for this variability and provide an average line. 

Glossary

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. 

Visit NHS inform for information on benzodiazepines. 

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. 

The prevalence of synthetic cannabinoids in seizures is higher in prisons than in the general population. 

People working and living in prisons should be aware of the harmful effects and risks of synthetic cannabinoid use. 

Visit NHS inform for more information on synthetic cannabinoids.

Service indicators

Specialist drug treatment referrals

From November 2022 to February 2023, the average weekly number of referrals to specialist drug treatment services was highly variable and followed the seasonal fluctuation seen in previous years. The number of referrals during this time period (5,691) was lower compared to the same time periods in 2021 (6,074) and 2022 (6,322).

Background 

Specialist drug treatment referrals occur when a person comes into contact with services designed to support their recovery from problem 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 26 October 2020 and 26 February 2023.

Image caption Specialist drug treatment referrals

Summary

Historic trend
  • The average weekly number of referrals generally increased from October 2020 to May 2021, reaching a peak of 554 in the week beginning 17 May 2021. 
  • Referrals decreased throughout June and July 2021 and then remained broadly stable to January 2022 (between 400 to 480 referrals per week, apart from the seasonal decreases in December and January). 
  • From January to September 2022, there was a gradual decrease in the average weekly number of referrals. 
Update 

For the most recent 15-week time period (14 November 2022 to 26 February 2023): 

  • 5,691 specialist drug treatment referrals were recorded, at an average of 379 per week. 
  • This was slightly lower than the previous 15-week time period (8 August to 13 November 2022) when 6,027 referrals were recorded, at an average of 402 per week. 
  • Referrals were 6% lower compared to the same time period in 2021 (6,074, an average of 405 per week) and 10% lower than in 2022 (6,322, an average of 421 per week). 

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.  

For more information, or to analyse these data by NHS Board, visit the COVID-19 wider impacts dashboard

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

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

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

Why we use a 3-week moving average 

As these data are highly variable over time, a 3-week moving average has been included in the graph to aid interpretation of trends over time.

Opioid substitution therapy

The average number of opioid substitution therapy (OST) doses supplied per month was stable in the period from October to December 2022. The number of OST doses supplied during this period was slightly lower than in the same time period in 2020 and 2021.

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. 

The first chart below shows the average total monthly number of ADQ doses supplied for OST medications in the community between 1 October 2020 and 31 December 2022. 

Image caption Average total number of OST doses per month

The chart below shows monthly trends in the number of ADQ doses supplied for specific OST medications in the community between 1 October 2020 and 31 December 2022.

Image caption Number of doses per month for OST medications

Summary 

Historic trend 
  • For an analysis of trends prior to October 2020, please see the RADAR Quarterly Report - January 2023
  • There was a gradual decrease in the average monthly total number of OST doses supplied. This was largely due to a decreasing trend in the average monthly number of methadone doses supplied from 637,500 between October and December 2020, to 563,900 between July and September 2022. 
  • The average monthly number of oral buprenorphine doses supplied was broadly stable between October to December 2020 (125,500) and July to September 2022 (118,300). 
  • Injectable buprenorphine was first licensed for use in Scotland in early 2020. The average monthly number of doses supplied increased steadily from 15,700 between October and December 2020 to 70,100 between July and September 2022. 
Update 

For the most recent time period (1 October to 31 December 2022): 

  • The average total monthly number of OST doses supplied was approximately 747,100. 
  • This was roughly the same as in the previous quarter (July to September 2022) when approximately 752,200 doses were supplied. The number of OST doses supplied was 4% and 3% lower than in October to December 2020 and 2021 respectively. 
  • The average monthly number of methadone doses supplied was approximately 546,300. Equivalent figures for oral buprenorphine and injectable buprenorphine were 119,300 and 81,500 respectively. 
  • The number of methadone doses was 3% lower than in the previous quarter (July to September 2022) and 8% and 14% lower than in October to December 2020 and 2021 respectively. 
  • The number of oral buprenorphine doses supplied was approximately the same as in the previous quarter (July to September 2022) and 5% and 3% lower than in October to December 2020 and 2021 respectively. 
  • The number of injectable buprenorphine doses was 16% higher than in the previous quarter (July to September 2022) and 65% higher than in October to December 2021. 

Additional information 

These data have been extracted from the Prescribing Information System (PIS) and the Hospital Medicines Utilisation Data Manual (HMUD)

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. These community prescribing data are extracted from the PIS. 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 24% 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, go to the COVID-19 wider impacts dashboard

Why we use a 3-month moving average 

As these data are highly variable over time, a 3-month moving average has been included in the charts to aid interpretation of trends over time. 

Even if all other factors are constant (for example, the number of treated patients), the total number of ADQ doses supplied will vary according to the number of days in each month. Averaging over three months minimises the impact of that variability. 

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 Misuse group. The ADQs agreed are: 

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

Methadone is an opioid drug commonly prescribed as an opioid substitution therapy. Methadone is a full opioid agonist – it is most commonly seen as a green liquid, which is taken orally (swallowed) on a daily basis. These data refer to methadone prepared as a 1 mg/ml solution. 

Buprenorphine

Buprenorphine is an opioid drug commonly prescribed as an opioid substitution therapy. Buprenorphine is a partial opioid agonist – it is available in oral and injectable forms: 

  • Oral buprenorphine is buprenorphine in tablet form that is administered orally (by mouth, usually sub-lingual – under the tongue) on a daily basis. It is also known by brand names such as Subutex. These data include 2 mg, 8 mg and 16 mg tablets. 
  • Injectable buprenorphine is buprenorphine in liquid form that is administered as a subcutaneous injection. It is also known by brand names such as Buvidal. These data include various weekly and monthly prolonged release formulations. 
Defined daily dose (DDD)

As defined by the World Health Organization, the DDD is ‘the assumed average maintenance dose per day for drug use for its main indication in adults’. 

Average daily quantity (ADQ)

ADQ is similar to the DDD but adjusted to reflect how medication is used in Scotland. 

Injecting equipment provision

The average weekly numbers of injecting equipment provision (IEP) transactions decreased between October and December 2022, while the number of needles and syringes distributed was broadly stable. The total numbers of IEP transactions and needles and syringes distributed during this time period were lower compared to the same time periods in 2020 and 2021.

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/syringe transactions at IEP sites and the total number of needles and syringes distributed. 

The first chart below shows the weekly number of IEP transactions from 28 September 2020 to 1 January 2023. 

Image caption Injecting equipment provision: transactions

The second chart shows the weekly number of needles and syringes distributed from 28 September 2020 to 1 January 2023.

Image caption Injecting equipment provision: needles and syringes distributed

The third chart shows the weekly ratio of needles and syringes distributed per transaction from 28 September 2020 to 1 January 2023.

Image caption Injecting equipment provision: ratio of needles and syringes distributed per transaction

Summary

Historic trend
  • There was an overall decrease in the average weekly number of IEP transactions from September 2020 to February 2022. This trend included seasonal fluctuations during December and January each year. From February to October 2022, the average number of IEP transactions was relatively stable (approximately 3,000 per week).
  • A fluctuating decreasing trend in the average weekly number of needles and syringes distributed was observed from September 2020 to October 2021. Since October 2021, the average number of needles and syringes distributed has remained broadly stable (approximately 37,000 per week).
  • The ratio of needles and syringes distributed per transaction was relatively stable from September 2020 to December 2022, at an average of 14 needles and syringes distributed per transaction. Seasonal fluctuations were observed during December 2021 and 2022.
Update

For the most recent time period (3 October 2022 to 1 January 2023):

IEP transactions
  • 36,191 transactions were recorded, at an average of 2,784 per week.
  • This was 6% lower compared to the previous time period (4 July to 2 October 2022) when a total of 38,644 were recorded, at an average of 2,973 per week.
  • The total number of transactions was 20% lower compared to the same time period in 2020 (45,337, an average of 3,238 per week), and 5% lower than in 2021 (38,073, an average of 2,929 per week).
Needles and syringes distributed
  • 471,583 needles and syringes were distributed, at an average of 36,276 per week.
  • This was approximately the same as the previous time period (4 July to 2 October 2022) when a total of 492,782 needles and syringes were distributed, at an average of 37,906 per week.
  • The total number of needles and syringes distributed was 16% lower compared to the same time period in 2020 (561,189, an average of 40,085 per week), and similar to 2021 (481,381, an average of 37,029 per week).
Ratio of needles and syringes distributed
  • The weekly average of 14 needles and syringes distributed per transaction was the same as in the previous time period (4 July to 2 October 2022) and the same time periods in 2020 and 2021.

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 more information, or to analyse these data by NHS Board, visit the COVID-19 wider impacts dashboard

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

Why we use a 3-week moving average 

As these data are highly variable over time, a 3-week moving average has been included in the graph to aid interpretation of trends over time. 

Glossary

Transaction

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. 

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

This section is the same for all indicators, pull out information into main page, to avoid duplication in each indicator.

Publication title 

Rapid Action Drug Alerts and Response (RADAR) quarterly report – April 2023  

Theme 

Substance use surveillance 

Topic 

Drugs 

Format 

HTML  

Release date 

25 April 2023 

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 is 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/sources and 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 protocol on statistical disclosure is followed. 

Official Statistics designation 

Management Information Report 

UK Statistics Authority Assessment 

N/A 

Last published 

24 January 2023 

Next published 

25 July 2023 

Date of first publication 

11 October 2022 

Help email 

phs.drugsradar@phs.scot 

Date form completed 

14 April 2023 

 

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

28 March 2023

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

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.

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 12 January 2023 and 4 April 2023. Data were collated on 5 April 2023.

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.

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 March 2023

Timeframe of data and timeliness

2 November 2020 to 26 February 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.

Over the time period the take-home naloxone program has continued to distribute kits to the public. Police Scotland is also in the process of training and equipping officers with nasal naloxone. This increase in the distribution of naloxone kits should be taken into consideration when interpreting administration of naloxone by emergency services.

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. Further details can be found in the substance use section of the COVID-19 wider impacts dashboard.

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

13 March 2023

Timeframe of data and timeliness

16 November 2020 to 5 March 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 ‘Data management – hospital activity’ webpage.

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

3 March 2023

Timeframe of data and timeliness

26 September 2020 to 1 January 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.

Value type and unit of measurement

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

Description

This indicator provides information on suspected drug deaths in Scotland.

Data source(s)

Police Scotland

Date that data were acquired

17 March 2023

Timeframe of data and timeliness

25 October 2020 to 25 February 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). In 2021 there were 1,330 drug-related deaths in Scotland. This was a small decrease compared to 2020 (1,339), which saw the highest annual total on record.

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

06 April 2023

Timeframe of data and timeliness

19 August 2022 to 16 February 2023

Continuity of data

‘ASSIST: A Surveillance Study in Illicit Substance Toxicity’ is a pilot by the ED at the QEUH. It will run from August 2022 to August 2023, followed by a three-month follow-up period.

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.

Date that data were acquired

8 February 2022

Timeframe of data and timeliness

1 January 2020 to 30 November 2022, approximately three months in arrears.

Continuity of data

The majority of testing was performed by the Forensic Toxicology Service based within FMS at the University of Glasgow, on behalf of COPFS. In late 2022, post-mortem toxicology services were transferred from the University of Glasgow to the Scottish Police Authority (SPA) Forensic Services

During this period, post-mortem tests were completed by other laboratory testing sites in the United Kingdom. Data from those sites have been included in this report and cover the most recent period reported. Future testing will be completed within a laboratory based within SPA Forensic Services. 

Concepts and definitions

Forensic Medicine and Science and the SPA Forensic Services undertakes toxicology testing on behalf of the COPFS for post-mortem cases where controlled drugs (as defined in the Misuse of Drugs Act 1971) were found present.

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.

The analysis presented is based on the date of death, where available. Data received from outsourcing laboratory services did not include this information and therefore 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 and sent to other labs for toxicology testing.
  2. Date of toxicology test being completed.

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

The data are for deaths occurring in the west, east and parts of the north of Scotland. Apart from a very small number of cases analysed at the University of Glasgow, post-mortem toxicology testing for deaths occurring in Aberdeen and the far north of Scotland is conducted by a similar service at the Aberdeen Royal Infirmary (ARI). Results from the ARI are not included in this report.

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

07 March 2023

Timeframe of data and timeliness

1 September 2020 to 31 December 2022, approximately four 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. On average, in this project 16% of gabapentinoid detections are for gabapentin and 84% are for pregabalin.

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

09 March 2023

Timeframe of data and timeliness

26 October 2020 to 26 February 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 substance use section of the COVID-19 wider impacts 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

17 March 2023 and 3 April 2023

Timeframe of data and timeliness

1 October 2020 to 31 December 2022. 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.

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 report, there was a revision 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 the 2022/23 Q2 report. This change was associated with the omission of Buvidal 160mg/0.45ml prolonged release injections from the data extract provided for the 2022/23 Q2 report.

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

22 February 2023

Timeframe of data and timeliness

28 September 2020 to 1 January 2023

Data are available 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

Refers to an attendance at an injecting equipment provider, which involved provision of syringe and needles. 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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