Rapid Action Drug Alerts and Response (RADAR) quarterly ​report
April 2025

Management information

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Published
29 April 2025 (Latest release)
Type
Statistical report
Author
Public Health Scotland
Topics

Drugs

About this release

Our quarterly report

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

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

View a printable version of this report.

Acknowledgements

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

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

Data and reporting period

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

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

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

For the first time, this report includes data from drug treatment toxicology including data on oral fluid samples tested by NHS Lothian and urine samples tested by NHS Greater Glasgow and Clyde.

A more detailed section has also been included on WEDINOS drug testing data.

The next release of this publication will be 29 July 2025.

Dashboard

Data for most of the harm and service indicators in this report are published in our RADAR dashboard.

For the first time, the dashboard includes data on post-mortem toxicology and WEDINOS drug testing.

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

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

Main points

Drug-related harms remained high during the most recent quarter (December 2024 to February 2025), with a notable rise in suspected drug deaths compared to the previous quarter.

Intelligence indicates Scotland’s drugs markets are likely to be contaminated. Contamination is likely to involve toxic synthetic substances which increase the risk of overdose and death. Harm reduction interventions should routinely advise about the risk of contamination in pills, powders and counterfeit medicines.

Key points

Polysubstance use

  • The majority of harm involves the use of more than one substance.
  • The average number of controlled drugs detected per sample was four in post-mortem and six in ASSIST toxicology.

Heroin

  • Adulteration of heroin with nitazene-type opioids continues to be reported through RADAR reports and WEDINOS.
  • Nitazenes are associated with rapid onset of overdose and difficulty reversing overdoses with naloxone. They have been detected in post-mortem and hospital toxicology in Scotland.

Benzodiazepines

  • Changes to the types of street benzos continue, with increasingly novel compounds contributing to harm and impacting both community and prison settings.
  • A continued decrease in bromazolam detections was observed in post-mortem toxicology.

Cocaine

  • Cocaine was the most frequently identified substance in national post-mortem toxicology, the NHS GGC ASSIST project and NHS Lothian Drug Treatment Testing, highlighting its leading role in harms.

Data update

The following changes were observed compared to the previous reporting period (reported in quarterly report 10 – January 2025).

For harm indicators:

  • naloxone administration incidents (December 24 to February 25): 1% increase
  • emergency department attendances (December 24 to February 25): 9% decrease
  • drug-related hospital admissions (October to December 24): 19% decrease
  • suspected drug deaths (December 24 to February 25): 17% increase

For service indicators:

  • drug treatment referrals (November 24 to February 25): 15% decrease
  • injecting equipment provision (October to December 24): 12% decrease in transactions, 11% decrease in needles and syringes distributed
  • opioid substitution therapy (October to December 24): similar to the previous quarter (<1% increase)

Alerts updates

Harm indicators

  • Between December 2024 and February 2025, the number of Scottish Ambulance Service naloxone administration incidents was similar to the previous quarter. Incidents were 15% lower than the same period commencing in December 2022 and 23% lower than the same period commencing in December 2023.
  • Between December 2024 and February 2025, drug-related attendances at emergency departments were 9% lower than the previous quarter. Attendances were 18% lower than the same period commencing in December 2022 and 14% lower than the same period commencing in 2023.
  • Between October and December 2024, drug-related hospital admissions were 19% lower than the previous quarter. Admissions were similar to the same period in 2022 and 17% lower than in 2023.
  • Between December 2024 and February 2025, there were 251 suspected drug deaths. The number of deaths was 17% higher than the previous quarter (215), 12% lower than the same period commencing in 2022 (285) and 17% lower than the same period commencing in 2023 (304).

Toxicology indicators

  • Between October and December 2024, the most common individual drugs detected in drug treatment toxicology was cocaine in NHS Lothian (50%) and diazepam in NHS Greater Glasgow and Clyde (GGC) (37%). The most commonly detected drug type was stimulants (52% NHS Lothian, 34% NHS GGC) and benzodiazepines (48% NHS Lothian, 47% NHS GGC).
  • Between November 2024 and February 2025, the most frequently detected drug in the ASSIST hospital toxicology project was cocaine (10%), followed by temazepam (8%) and desmethyldiazepam (7%). Etonitazene was detected for the first time in the project.
  • Between October and December 2024, the most common drug types detected in post-mortem toxicology were opioids (68%) and benzodiazepines (51%). Cocaine continued to be the most commonly detected individual drug (36%), followed by heroin/morphine (34%), diazepam (26%) and pregabalin (22%). Nitazenes increased slightly, being detected in 5% of deaths (27). Nitazenes have been detected in a total of 132 deaths (to 31 December 2024).

Testing indicators

Service indicators

  • Between November 2024 and February 2025, the average weekly number of referrals to specialist drug treatment services was relatively stable, aside from a seasonal fluctuation seen in previous years. The total number of referrals recorded (5,733) was 4% higher than the same period in 2022 (6,066) and 9% lower than in 2023 (6,294).
  • Between October and December 2024, opioid substitution therapy doses supplied per month was 6% lower than the same period in 2022 and 5% lower than 2023. The average monthly number of methadone doses supplied continued to decrease while injectable buprenorphine doses increased over time.
  • Between October and December 2024, the average weekly number of injecting equipment provision transactions was 12% lower than the previous quarter, 11% lower than the same period in 2022 and 15% lower than 2023. The number of needles and syringes distributed was 11% lower than the previous quarter, 12% lower than the same period in 2022 and 11% lower than in 2023.

Reporting trends

Between 5 January and 4 April 2025, 221 trend reports were received by RADAR.

The majority of reports related to heroin and described a range of concerns, including changes to the supply, adulteration with new potent synthetic drugs, adverse or unexpected effects, reduced tolerance, overdoses and deaths.

Trend reports can be viewed on our dashboard.

Implications

  • The harm caused by drugs is a significant public health issue for Scotland and there is a very high likelihood of sudden, localised spikes of severe drug-related harms. For information on responding to a drug harm incident see: Guidance on the management of clusters of drug related harms.
  • Contamination of illicit drugs with toxic substances is both common and widespread across drug types. There remains an urgent need for accessible drug checking services across the country.
  • The changes in the types of benzodiazepines detected, specifically the reduction in bromazolam and the emergence of novel benzodiazepines, followed international control. Given the dominance of bromazolam within the Scottish drug supply over the past 18 months, a reduction in availability is of concern. There is a risk that previously unseen and highly toxic benzodiazepines may emerge to dominate the supply in the near future.
    • There remains an urgent need for evidence-based benzodiazepine harm reduction and polysubstance treatment support interventions. These should be available for community and prison settings.
    • Toxicology services and Public Health Scotland should continue to collaborate to support timely identification and risk assessment of the health impact of emergent ‘street benzos’.
  • Cocaine continued to play a leading role in drug harms. Further work is needed to deliver harm reduction and treatment support. Injecting cocaine carries the highest risk of harm. Scaling up access to evidence-based interventions, including access to safer consumption facilities and provision of inhalation devices should be prioritised across Scotland.
  • As the availability and composition of substances change, so too does the profile of drugs contributing to harm. There is an urgent need for coordination to improve Scotland's ability and agility in responding to polysubstance use and a continually evolving drug market. A focus is needed on development, implementation and evaluation of measures to prevent and reduce the harms of polysubstance use.
  • A system-wide approach that prevents drug harms and supports people affected to access treatment, care and recovery remains critical.

Alerts

New messaging and resources were issued in March 2025, following reports of an increase in fatal and near fatal overdoses among people using heroin across multiple areas in Scotland.

Some overdoses have been characterised by sudden and rapid collapse, with many requiring multiple doses of naloxone to reverse the overdose. Rapid testing has identified nitazene-type opioids in some heroin samples linked to these overdoses.

Read the:

Current alerts

The legal status sections in our public health alerts were updated in January 2025 to reflect changes to the Misuse of Drugs Act (1971).

Trends

Police drug trends bulletin

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

Street benzos

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

Bromazolam and etizolam are equally common within the illicit benzo market. They are both class C drugs under the Misuse of Drugs Act 1971.

The most commonly encountered tablet is still a round white tablet with ‘10’ and a half score on the reverse, followed by a round white tablet with ‘C/DC’ and a blank reverse.

Street benzos continue to vary widely in content, with some tablets containing a variety of active ingredients (such as flualprazolam), precursor chemicals, or no active ingredient at all.

Synthetic cannabinoid receptor agonists

Officers from the STOP Unit West recently investigated a site used for the production of synthetic cannabinoid receptor agonists (SCRAs), also known as synthetic cannabinoids or ‘spice’. Testing of samples indicated the presence of ADB-INACA (which is not controlled by the Misuse of Drugs Act 1971 but is used as a starting product to make other synthetic cannabinoids) and MAB-CHMINACA (class B).

This is the second illicit SCRA laboratory identified in the west of Scotland in the last six months.

SCRAs are primarily associated with use in prisons, where they are consumed in various forms, including vapes, paper and powder. More information on drug use in prisons, can be found in the indicator: Drug seizures in Scottish prisons.

Methamphetamine

The STOP Unit West was recently contacted regarding the recovery of a significant quantity of white powder (852 grams). It was described as powder and ‘flakes’, though it did not resemble the typical appearance of cocaine or crystal meth (methamphetamine). Rapid analysis confirmed the presence of methamphetamine.

Methamphetamine is a class A drug under the Misuse of Drugs Act 1971. It is a long-acting stimulant that is usually found as clear, colourless crystals that can be smoked.

The majority of the recovered powder was subdivided into smaller quantities consistent with street-level distribution. Methamphetamine is not a drug commonly encountered by the STOP Unit.

Ketamine

Ketamine is a dissociative drug that is popular amongst the club and festival scene. It is often found as an off-white crystalline powder.

Ketamine is usually consumed by snorting but can also be rolled into paper and swallowed, known as ‘bombing.

Effects include euphoria and detachment from reality. Side effects can include agitation, panic attacks and an out of body experience resulting in the inability to move, known as a ‘k-hole’.

Ketamine is a class B drug under the Misuse of Drugs Act 1971.

The STOP Unit have noted an increase in the recovery and identification of ketamine within the illicit drugs market.

Cathinones

The STOP Unit West recently completed a report involving the recovery of dipentylone, seized in powder form and subdivided into 1-gram deals.

Dipentylone is a cathinone (stimulant), more commonly encountered in tablet form; however, in this instance, it was a pink powder - consistent with substances sold as tussi (also known as tuci or ‘pink cocaine’). Tussi typically refers to a mixture of drugs such as ketamine, MDMA and caffeine. Reports indicate a slight increase in tussi recoveries.

Dipentylone is a class B drug under the Misuse of Drugs Act 1971.

 

RADAR intelligence and reports

221 reports were validated by RADAR between 5 January and 4 April 2025.

RADAR has received over 650 reports of drug-related information and harms.

These reports have been important in identifying early changes to trends and supply, enabling more rapid responses to emerging threats to health. Anyone can make a report through the reporting form and mailbox.

Send a report to RADAR  

Summary

A summary of key trends is shown below. Intelligence reports to RADAR can be filtered by drug type and region on the dashboard (external website).

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

View intelligence reports on the RADAR dashboard on ShinyApps.io  

Trends by primary drug type

Quarterly dates are shown on the chart below. In the latest period (QR11; 5 January to 4 April 2025), 221 reports were received:

  • The most common reason for reports was overdose (55%), followed by adverse effects (18%) and new trends (14%).

Of the 311 drugs mentioned in the 221 reports:

  • The most common drug was heroin, accounting for 37% of reported drugs, an increase from 19% in the previous quarter.
  • Benzodiazepines (benzos) accounted for 17% of reported drugs, similar to the previous quarter (16%). Between QR1 and QR5, benzos accounted for 34%, before decreasing to an average of 21% between QR6 and QR9.
  • Synthetic opioids (nitazene/fentanyl-type drugs) accounted for 7%, slightly less than the previous six quarters (average 11%). Nitazenes continued to be the most common novel synthetic opioid detected in toxicology but several submissions reported drugs sold as ‘fentanyl’.
  • 10% were for cocaine, slightly less than the previous six quarters (average 13%). 55% of these reports were for cocaine powder and 45% were for crack cocaine.
  • The most common drugs reported in the ‘other’ category were zopiclone, ketamine, methamphetamine, red apples (tapentadol/carisoprodol) and pregabalin.
Image caption Reports to RADAR by primary drug(s)
  • In the last quarter, RADAR received 115 reports about heroin from across all mainland NHS boards.
  • These reports describe a range of concerns, including changes to the supply, adulteration with new potent synthetic drugs, adverse or unexpected effects, reduced tolerance, overdoses and deaths.
  • Many reports noted the heroin had a different appearance (colour, texture, smell) than expected, with several noting the colour changes when heroin was prepared for injection.
  • People also reported experiencing stronger or unexpected effects despite using smaller-than-usual amounts.
  • Overdoses were reported after both smoking and injecting heroin.
  • Samples of heroin sent for testing identified adulterants including nitazenes. In some samples sold as heroin, no heroin was detected.
  • Overdose reports commonly involved people requiring multiple doses of naloxone and additional support (oxygen, ventilation).
  • Several local areas responded to clusters of increased drug harms involving rapid onset of near fatal or fatal overdoses. PHS supported information sharing and the coordination of responses.
  • Communications and resources were created to raise awareness among services and people who use drugs:
  • In the last quarter, several areas described changes in availability (this follows the introduction of international legal controls on bromazolam and other new benzodiazepine compounds).
  • Reports described tablets with a ‘chalky’ or ‘powdery’ consistency, with varying colours and logos.
  • Observations also varied in terms of quality and effects. Some reports indicated a decline in quality, and suspected adulteration, while others noted an increase in adverse or unusual effects - most commonly memory loss or blackouts, often referred to as ‘losing days’.
  • A small number of reports referred to prolonged and profound sedation requiring hospital admission.
  • RADAR is actively monitoring the emergence of several new benzodiazepines including gidazepam, clonazolam, meclonazepam and ethylbromazolam.
  • SDF are funded by the Scottish Government to develop regional Living Experience Engagement Groups, safe spaces for those with living experience to express their views and share information about drug trends and harms. These groups typically meet weekly and are facilitated by staff with lived experience from the SDF Living Experience Engagement Team and local partner agencies. An important part of this is learning and sharing information about current trends, and the related risks and harms. SDF publishes regular trend bulletins based on group insights.
  • The most recent report shares insights for July to December 2024. Key national trends include:
    • The most commonly reported drug across all groups are street benzos, cocaine or crack and heroin.
    • There is less heroin use being reported generally across groups (partly due to greater availability of drugs such as cocaine and more people being on buprenorphine).
    • There are reports of inconsistent drug quality which varies area to area, by drug type and sometimes individual batch.
    • Using phone lines or social media contact for drop-off of substances seems to be the most common method of purchase.
    • There is a wider range of drugs reported as part of polydrug use than previously.
  • For the full report, including breakdowns by local area, view the SDF drug trend bulletin (external website).

Reporting drug harms

Please encourage people and services in your area to share information on trends, incidents and harms related to drugs, such as:

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

The information in the regional breakdown can be used our dashboard can be used by local areas for their own drug trend surveillance.

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

Make a report to RADAR  

Harm indicators

Naloxone administration by Scottish Ambulance Service

The average weekly number of naloxone administration incidents increased between December 2024 (57) and February 2025 (64). The total number of incidents from 2 December 2024 to 23 February 2025 (697) was similar to the previous quarter (688). This was 15% lower than the same period commencing in December 2022 (820) and 23% lower than the same period commencing in December 2023 (903).

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.

These data count the number of SAS incidents where naloxone was administered on scene. Data processing issues mean that a) multiple naloxone administrations to the same patient at an incident; and b) the number of people to whom naloxone was administered in incidents involving multiple overdose patients, may not be accurately recorded. Please note this caveat differs from previous publications.

The chart below shows the weekly number of SAS naloxone administration incidents in Scotland from 21 November 2022 to 23 February 2025.

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

Image caption Naloxone administration by Scottish Ambulance Service

Summary

Historic trend
  • An increasing trend was observed in the average weekly number of incidents from December 2022 (66) to May 2023 (86).
  • Between June and August 2023, incidents remained broadly stable at around 103 per week, after which there was a decreasing trend to January 2024 (68).
  • Between February and March 2024, the average number of weekly incidents fluctuated within a range of 61 and 86 per week.
  • Following a sharp increase during April, the average number of weekly incidents remained stable at a higher level (90) between May and July 2024.
  • A decreasing trend in the average weekly number of incidents was observed from August (76) to November 2024 (49).
National update

For the most recent period (2 December 2024 to 23 February 2025):

  • 697 SAS naloxone incidents were recorded, at an average of 58 per week. Average weekly numbers increased between December 2024 (57) and February 2025 (64).
  • The number of incidents were similar to the previous 12-week period (9 September to 1 December 2024) when 688 incidents were recorded, at an average of 57 per week.
  • The number of incidents was 15% lower than the same period commencing in December 2022 (820, weekly average 68) and 23% lower than the same period commencing in 2023 (903, weekly average 75).
Local update

Comparing the most recent period (2 December 2024 to 23 February 2025) to the previous quarter, the key changes observed across mainland NHS boards were:

  • Incidents increased in six areas: NHS Dumfries and Galloway (7%), NHS Lothian (8%), NHS Forth Valley (14%), NHS Lanarkshire (15%), NHS Highland (17%) and NHS Fife (48%).
  • Incidents decreased in five areas: NHS Greater Glasgow and Clyde (8%), NHS Ayrshire and Arran (9%), NHS Tayside (10%), NHS Grampian (10%) and NHS Borders (33%).

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

Additional information

PHS was provided with these data by SAS.

Scotland-level data for 1 January 2018 to 23 February 2025 are available on the RADAR dashboard (external website).

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

Information on take-home naloxone distribution can be found in the National Naloxone Programme Scotland Quarterly Monitoring Bulletin, published by PHS.

Scotland's Take-Home Naloxone Programme

The national Take-Home Naloxone Programme was launched by the Scottish Government in 2011 to prevent fatal opioid overdoses.

Naloxone is a medicine that can temporarily reverse the effects of an opioid overdose. It can be given to anyone who is non-responsive and displaying the signs of an overdose (such as unconsciousness, shallow breathing, snoring, blue lips, pale skin and pin-point pupils).

Anyone in Scotland can carry naloxone. It can be accessed through most local drug services or pharmacies, and it can also be delivered to your home through the charity Scottish Families Affected by Alcohol and Drugs (external website).

Naloxone is very easy to administer. You can learn more about administering naloxone in a free e-learning module 'Overdose Prevention, Intervention and Naloxone (external website)' created by the Scottish Drugs Forum.

Drug-related attendances at emergency departments

Between December 2024 and February 2025, the number of drug-related attendances at emergency departments (888) was 9% lower than the previous quarter (977). This was 18% lower than the same period commencing in December 2022 (1,074) and 14% lower than in the same period commencing in December 2023 (1,035).

Background

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

The chart below shows the weekly number of drug-related ED attendances in Scotland between 28 November 2022 and 2 March 2025.

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

Image caption Drug-related attendances at emergency departments

Summary

Historic trend
  • The number of drug-related ED attendances per week was broadly stable between September 2022 and March 2023 (weekly average 84). Attendances generally increased between April and June 2023, with the highest weekly level in the series observed in June 2023 (144).
  • From June to October 2023, despite variations in the number of attendances per week, an overall decreasing trend was observed, from an average of 106 in June 2023, to 91 in October 2024.
  • From November to 2023 to July 2024, the average number of attendances fluctuated within a range of 66 and 94 per week.
  • The number of attendances gradually decreased during August 2024. Between September and November 2024 there were an average of 75 attendances per week.
National update

For the most recent 13-week period (2 December 2024 to 2 March 2025):

  • 888 emergency department attendances were recorded, at an average of 68 per week. This was 9% lower than the previous 13-week period (2 September to 1 December 2024, 977 attendances, weekly average 75).
  • Attendances were 18% lower than the same period commencing in December 2022 (1,074 attendances, weekly average 83) and 14% lower than the same period commencing in December 2023 (1,035 attendances, weekly average 80).
Local update

Comparing the most recent period (22 December 2024 to 2 March 2025) to the previous quarter, the key changes observed across mainland NHS boards were:

  • Attendances increased in two areas: NHS Grampian (9%) and NHS Lanarkshire (26%).
  • Attendances decreased in seven areas: NHS Forth Valley (11%), NHS Tayside (17%), NHS Highland (18%) and NHS Greater Glasgow and Clyde (18%), NHS Borders (22%), NHS Ayrshire and Arran (33%) and NHS Dumfries and Galloway (45%).
  • Attendances were broadly stable in NHS Lothian and NHS Fife.

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

Additional information

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

Due to the quality of the data available, it is not possible to accurately report total attendances for specific conditions using the national Accident and Emergency dataset. The diagnosis or reason for attendance can be recorded in a variety of ways, including in free text fields and not all NHS boards submit this information. The numbers presented in this report are based on an experimental definition of drug-related ED attendances and have not been subject to extensive quality assurance. Therefore, they are provisional and may be subject to change in future releases. Further details can be found in the metadata and the Accident and Emergency Activity Data.

Drug-related acute hospital admissions

Between October and December 2024, 1,795 drug-related hospital admissions were recorded. This was 19% lower than the previous quarter (2,204). Admissions were similar to the same period in 2022 (1,799) and 17% lower than the same period in 2023 (2,166).

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.

Data are taken from Scottish Morbidity Record (SMR) records held by Public Health Scotland (PHS). PHS expects to receive complete SMR data six weeks after the end of the month of discharge/clinic date. Therefore, the period presented here differs from our other harm indicators - this should be taken into consideration when interpreting trends. Data for the most recent quarter are provisional and may change in future publications. For further information, see the data management section on our website.

The chart below shows the weekly number of drug-related admissions to Scotland’s general acute hospitals from 26 September 2022 to 29 December 2024.

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

 

Image caption Drug-related hospital admissions

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

Summary 

Historic trend 
  • Between October 2022 and March 2023, admissions remained broadly stable averaging 142 per week, with a seasonal decrease during December and January.
  • Admissions then increased until July 2023, averaging 203 per week, remaining relatively stable until September 2023, followed by a decrease in October 2023.
  • Between October 2023 and September 2024, admissions were roughly stable, averaging 168 per week.
  • Opioids were the most common drug category recorded. The percentage of admissions where opioids were recorded remained relatively stable until the end of 2023 (average 47% between July 2022 and December 2023), before following a decreasing trend to 41% in September 2024.
  • The second most common drug category was cocaine, with percentages increasing across the series, from 17% in July to September 2022, to 23% in July to September 2024.
National update

For the most recent period (30 September to 29 December 2024):

  • 1,795 drug-related hospital admissions were recorded, at an average of 138 per week. This was 19% lower than the previous 13-week period (2,204 admissions, weekly average 170).
  • The total number of admissions was similar to the same period in 2022 (1,799, weekly average 138) and 17% lower than in 2023 (2,166, weekly average 167).
  • Opioids continued to be the most common substance type. These were recorded in an average of 40% of admissions per month, similar to the previous quarter (41%). Admissions for cocaine (23%) were also similar to the previous quarter (23%).
Local update

Comparing the most recent period (30 September to 29 December 2024) to the previous quarter, the key changes observed across mainland NHS boards were:

  • Admissions increased in two areas: NHS Ayrshire and Arran (8%) and NHS Dumfries and Galloway (12%).
  • Admissions decreased in seven areas: NHS Borders (11%), NHS Greater Glasgow and Clyde (13%), NHS Forth Valley (20%), NHS Lothian (21%), NHS Lanarkshire (21%), NHS Tayside (23%) and NHS Highland (27%).

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

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

Additional information 

These data have been extracted from our Scottish Morbidity Records (SMR01 acute).

The data presented on drug type are based on ICD-10 diagnostic codes and are not confirmed by toxicology analysis, therefore patterns in substance type should be interpreted with caution.

The most recent accredited official statistics on drug-related hospital care, includes a range of further information on drug types and patient demographics. For details, see our information on drug-related hospital statistics (DRHS). Please note, our DRHS dashboard presents data by date of discharge, so figures will differ to those shown above.

Suspected drug deaths

In the latest period (2 December to 23 February 2025), the total number of suspected drug deaths was 251, averaging 21 per week. The average weekly number of deaths decreased between December 2024 (20) and February 2025 (18). The total number of deaths was 17% higher than the previous quarter (215), 12% lower than the same period commencing in December 2022 (285) and 17% lower than the same period commencing in December 2023 (304).

Background

A suspected drug death is a death where controlled drugs are suspected of being involved. Suspected drug death figures are based on reports, observations and initial enquiries from police officers attending scenes of death.

The details of these events are recorded by Police Scotland and shared with Public Health Scotland (PHS).

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

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

The chart below shows the weekly number of suspected drug deaths in Scotland from 21 November 2022 to 23 February 2025.

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

Image caption Suspected drug deaths

Summary 

Historic trend 
  • Between December 2022 and February 2025, the average weekly number of suspected drug deaths fluctuated considerably but generally remained within the range of 15 to 28 deaths per week.
Update 

For the most recent complete months (1 December 2024 to 28 February 2025):

  • There were 269 suspected drug deaths, 92 in December, 97 in January and 80 in February

For the most recent 12-week period (2 December 2024 to 23 February 2025):

  • There were 251 suspected drug deaths, 17% higher than in the previous 12-week period (215). This was 12% lower than the same period commencing in December 2022 (285) and 17% lower than in the same period commencing in December 2023 (304).
  • The average weekly number of deaths increased from December 2024 (20) to January 2025 (23) and then decreased in the first three weeks of February (18).
  • An average of 21 deaths were recorded per week. This was 17% higher than in the previous period (18), 13% lower than in the same period commencing in December 2022 (24) and 16% lower than the same period commencing in December 2023 (25).

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

Additional information

Data on suspected drug deaths are provided by Police Scotland.

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

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

Accredited official statistics on drug-related deaths are published annually by the NRS during the summer and provide information broken down by age, sex, substance implicated and geographical area. The latest NRS publication (external website) reported that there were 1,172 drug-related deaths in Scotland in 2023. This was a 12% increase compared to 2022 (1,051).

Detailed information on drug-related deaths is presented in the National Drug-Related Deaths Database, which is published by PHS every two years. The latest PHS drug-related deaths report describes deaths that registered in 2019 and 2020, with trend data from 2012.

Toxicology indicators

Drug treatment toxicology

Between October and December 2024, the most commonly detected drug type in samples from people receiving specialist drug treatment services was stimulants (52% NHS Lothian, 34% NHS Greater Glasgow and Clyde (GGC)) and benzodiazepines (48% NHS Lothian, 47% NHS GGC). The most common individual drug detected was cocaine in NHS Lothian (50%) and diazepam in NHS GGC (37%).

Background

Illicit and prescribed drugs can be detected in a range of biological samples using different testing methods. UK clinical guidance (2017) advises professionals to choose the most appropriate testing method to support the treatment of people who use drugs.

Samples are sent for laboratory testing:

  • when controlled drugs are detected through point of care testing, or
  • when point of care tests are unavailable.

It should also be noted that the UK clinical guidance (2017) does not recommend testing where a person has already disclosed details of drug use.

These data describe trends in drug use among a non-representative sample of people in drug treatment. These results are not representative of drug use among the wider population of people with problem drug use, or among those receiving specialist drug treatment.

Data overview  

This analysis is based on data from mass spectrometry toxicology testing of:

  • Oral fluid samples tested by the NHS Lothian Toxicology Laboratory based at the Royal Infirmary of Edinburgh from October 2022 to December 2024.
  • Urine samples tested by the NHS Greater Glasgow and Clyde (GGC) Toxicology Laboratory based at the Queen Elizabeth University Hospital from December 2023 to December 2024.

Data are split into two sections due to the differences in testing practices.

Methadone and buprenorphine have been excluded from the analysis due to their use in treatment. Cannabis has also been excluded, as it is not relevant to the majority of drug harms and is only tested for by NHS GGC.

Oral fluid samples tested by NHS Lothian Toxicology Laboratory

Between October 2022 and September 2024, the number of oral fluid samples tested per month fluctuated within a range of 1,020 to 1,600.

For the most recent period (1 October to 31 December 2024):

  • 3,962 samples were tested - an average of 1,321 per month.
  • 68% of samples were from males and 32% were from females.
  • 88% of samples were from patients aged 54 and under. The most common age category was 35 to 44 years (39%), followed by 45 to 54 years (35%).

Among the 3,962 samples tested:

  • There were 11,838 individual drug detections.
  • The average number of drugs detected per sample was three.

The charts below show detections of controlled substances between 1 October 2022 and 31 December 2024. Throughout the series, the sum of the percentages exceeds 100% due to the widespread detection of multiple substances in samples. The first chart shows the types of drugs present.

Image caption NHS Lothian, drug treatment toxicology detections, oral fluid samples: drug types by month

The following charts show specific depressants and opioids detected between 1 October 2022 and 31 December 2024.

Image caption NHS Lothian, drug treatment toxicology detections, oral fluid samples: depressant drugs by month
Image caption NHS Lothian, drug treatment toxicology detections, oral fluid samples: opioid drugs by month

Summary

The following narrative is based on data from October 2022 to December 2024.

  • The most commonly detected drug type throughout the time series was stimulants (averaging 52% per month) followed by benzodiazepines (45%).
  • The most commonly detected individual drug was cocaine, detected in half of all samples (averaging 49% per month).
  • The following drugs or drug types were the most common between October and December 2024:
    • cocaine: 1,978 (50%)
    • benzodiazepines: 1,887 (48%)
      • nordiazepam: 1,613 (41%)
      • diazepam: 1,508 (38%)
    • opioids: 1,183 (30%)
    • gabapentinoids: 1,092 (28%)
Stimulants
  • The most commonly detected drug type throughout the time series was stimulants (averaging 52% per month).
  • The majority of stimulant detections were for cocaine (averaging 49% per month) with detections of other stimulants remaining low and stable (averaging 3%).
Depressants
  • Detections of benzodiazepines remained broadly stable at an average of 45% between October 2022 and July 2024. Detections increased slightly in August 2024 (when bromazolam was added to screening) and have averaged at 47% since.
  • Detections of bromazolam have remained relatively stable since testing began (average of 6%).
  • Nordiazepam detections fluctuated throughout the time series, with average monthly detections ranging from 36% to 45%.
  • Diazepam remained relatively stable until the beginning of 2024 (average of 39% per month), before following a decreasing trend and reaching a low of 34% in September 2024. Detections have since began to increase again in recent months (average of 38% per month between October and December 2024).
  • Detections of etizolam have remained relatively stable throughout the time series (2%).
  • Detections of gabapentinoids increased from 24% in October 2022, to 30% in December 2024. This was mainly driven by an increase in detections of pregabalin, from 19% in October 2022, to 25% in December 2024. Gabapentin detections were broadly stable throughout the time series (7%).

Note: Nordiazepam is a metabolite of diazepam and other benzodiazepines and is also a controlled substance in its own right.

Opioids
  • Opioids followed a decreasing trend from 44% in October 2022, to 27% in December 2024.
  • 6-MAM and morphine have closely followed the same decreasing trend. They were both detected in 32% of samples in October 2022 and decreased to 16% in December 2024.
  • Codeine followed a generally decreasing trend, from 23% in October 2022 to 11% in December 2024.
  • Dihydrocodeine, tramadol and oxycodone remained relatively stable throughout the series, averaging 6%, 2% and 1% respectively.

Note: Morphine and 6-MAM (6-monoacetylmorphine) are metabolites of heroin, as well as controlled substances in their own right.

Urine samples tested by NHS Greater Glasgow and Clyde Toxicology Laboratory

Between December 2023 and December 2024, an average of 912 urine samples were tested per month.

For the most recent quarter (1 October to 31 December 2024):

  • 2,801 samples were tested - an average of 934 per month.
  • 67% of samples were from males and 32% were from females.
  • 80% of samples were from patients aged 54 years and under. The most common age category was 45 to 54 years (36%), followed by 35 to 44 years (25%).

 Among the 2,801 samples tested:

  • There were 9,444 individual drug detections.
  • The average number of drugs detected per sample was three.

The charts below show detections of controlled substances between 1 December 2023 and 31 December 2024. Throughout the series, the sum of the percentages exceeds 100% due to the widespread detection of multiple substances in samples. The first chart shows the types of drugs present.

Image caption NHS GGC, drug treatment toxicology detections, urine samples: drug types by month

The following charts show specific depressants and opioids detected between 1 December 2023 and 31 December 2024.

Image caption NHS GGC, drug treatment toxicology detections, urine samples: depressant drugs by month
Image caption NHS GGC, drug treatment toxicology detections, urine samples: opioid drugs by month

Summary

The following narrative is based on data from December 2023 to December 2024.

  • Benzodiazepines were the most commonly detected drug type (detected in an average of 47% of samples per month), followed by stimulants (34%).
  • Cocaine was the most commonly detected individual drug (32%).
  • The following drugs or drug types were the most commonly detected in samples between October and December 2024:
    • benzodiazepines: 1,309 (47%)
    • diazepam: 1,031 (37%)
    • gabapentinoids: 923 (33%)
    • cocaine: 892 (32%)
    • opioids: 770 (27%)
Depressants
  • Benzodiazepine detections have remained high, fluctuating within a range of 44% to 51% per month.
  • Diazepam was the most commonly detected depressant, fluctuating within a range of 35% to 42%.
  • Oxazepam detections increased from 21% in December 2023, to a peak of 26% in July 2024, before following a decreasing trend to 20% in December 2024.
  • Etizolam detections fluctuated between 10% to 13% between December 2023 and August 2024. Detections then decreased slightly to 8% in December 2024.
  • Bromazolam detections have remained relatively stable, averaging 5% since testing began in September 2024.
  • Detections of gabapentinoids increased from 25% in December 2023, to 30% in December 2024. This was mainly driven by an increase in detections of pregabalin, from 17% in December 2023, to 21% in December 2024. Gabapentin detections were broadly stable throughout this period (10%).

Note: Oxazepam is a metabolite of diazepam and other benzodiazepines and is also a controlled substance in its own right.

Stimulants
  • Stimulants were the second most commonly detected drug type (averaging 34% per month).
  • The majority of stimulant detections were for cocaine (averaging 32% per month) with detections of other stimulants remaining low and stable (averaging 2%).
Opioids
  • Detections of opioids decreased from 32% in December 2023, to 26% in December 2024.
  • Detections of morphine were stable between December 2023 and June 2024 (averaging 17% per month). In July 2024, detections increased to 20% and have since followed a decreasing trend to 14% in December 2024.
  • Detections of 6-MAM were stable between December 2023 and November 2024 (averaging 9% per month), before decreasing to 6% in December 2024.
  • Detections of codeine were stable between December 2023 and September 2024 (averaging 14% per month), before slightly decreasing to December 2024 (11%).
  • Dihydrocodeine, tramadol and oxycodone have remained relatively stable throughout the time series, detected in an average of 7%, 3% and 1% respectively.

Note: Morphine and 6-MAM are metabolites of heroin, as well as controlled substances in their own right. Following heroin use, morphine is typically present in higher concentrations than 6-MAM or unmetabolised heroin in urine samples, due to the body’s metabolic processes.

Additional information

Samples are provided by people receiving drug treatment services across NHS Lothian and NHS GGC. A small number of samples are also received from neighbouring NHS boards and are included in these data.

Results from NHS Lothian and NHS GGC are not directly comparable, as they use different sample types with differing detection windows. For example, opiates are detectable for approximately 48 hours in urine, but only around 24 hours in oral fluid.

Additionally, the prevalence of different drugs cannot be directly compared due to different detection windows. For example, in oral fluid tests, diazepam and its metabolites are detectable for up to five days, whereas etizolam is typically detectable for only around 24 hours.

NHS Lothian and NHS GGC laboratories currently test for 21 and 32 individual drugs respectively. A list of drugs included in testing can be found in the metadata.

Trends should be interpreted with caution, as some drugs - including nitazenes, xylazine and some benzodiazepines - are not tested for. The data within this report will continue to develop as new or emerging drugs are added to testing panels.

Emergency department toxicology: ASSIST

Between November 2024 and February 2025, the ‘A Surveillance Study of Illicit Substance Toxicity’ (ASSIST) emergency department project made 562 detections of 52 different illicit drugs, in samples from 81 patients. The most commonly detected drug category was depressants (57% of detections), followed by opioids (21%). The most commonly detected individual drug was cocaine (10%), followed by temazepam (8%) and desmethyldiazepam (7%).

Background

The ASSIST study is conducted by the emergency department (ED) at the Queen Elizabeth University Hospital (QEUH) in NHS Greater Glasgow and Clyde (GGC). This project has been funded by the Scottish Government since August 2022.

The aim of the study is to monitor drug trends and associated clinical features through the use of prospective surveillance of ED attendances due to acute illicit drug toxicity. For the most unwell patients, the study performs full toxicological analysis through the biorepository-approved surplus sampling.

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

Data collection

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

Each ED attendance is counted once in these data. If the same person presented more than once, each attendance would be a separate data point.

Drug detections presented here are of ‘illicit drugs’ only and were not prescribed to the individual.

Illicit drug definition

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

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

Toxicology analysis of surplus serum samples

  • Detections presented are for the substance only. If a metabolite (compound produced when a drug breaks down in the body) is detected, it will be presented as the substance only.
  • If the metabolite and substance are detected, it will also be presented as the substance only.
  • However, if a drug and a metabolite are both detected and the metabolite could also be a drug, the metabolite is included as it is not possible to say which has been used, if not both.
  • Data from the study are presented in quarters, based on the date of ED presentation, and are provided in the table below.

ASSIST quarter dates
Quarter Dates
Quarter 1 (Q1) 17/08/2022 to 16/11/2022
Quarter 2 (Q2) 17/11/2022 to 16/02/2023
Quarter 3 (Q3) 17/02/2023 to 16/05/2023
Quarter 4 (Q4) 17/05/2023 to 16/08/2023
Quarter 5 (Q5) 17/08/2023 to 16/11/2023
Quarter 6 (Q6) 17/11/2023 to 16/02/2024
Quarter 7 (Q7) 17/02/2024 to 16/05/2024
Quarter 8 (Q8) 17/05/2024 to 16/08/2024
Quarter 9 (Q9) 23/09/2024 to 16/11/2024*
Quarter 10 (Q10) 17/11/2024 to 16/02/2025

*Due to a temporary pause in the study while funding was being confirmed, the start of Q9 was delayed. Recruitment was suspended from 17 August to 22 September 2024. Consequently, Q9 consists of only 55 study days, compared to the usual 90-92 days, resulting in fewer samples being tested. This discrepancy should be considered when interpreting the data and trends.

Results

The first chart shows the most common drug categories detected in toxicology analysis of surplus serum samples between 17 August 2022 and 16 February 2025 (Q1 to Q10).

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

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

Summary

Historic trend

Between 17 August 2022 and 16 November 2024:

  • The most commonly detected drug type was depressants, making up 62% of all detections, followed by opioids (16%). The most commonly detected individual drug was cocaine (12%).
  • 73% of attendances were male and 27% were female.
  • 75% of attendances were aged 44 and under. The most common age category was 35 to 44 years (29%), followed by 25 to 34 (27%) and 16 to 24 (19%).
  • The most common outcomes were discharged to home (39%), ward (29%) and police custody (11%).
Update

For the most recent period (17 November 2024 to 16 February 2025):

  • 199 individual ED attendances related to illicit drug use were identified.
  • 81 surplus serum samples were analysed for toxicology (as they were categorised as having a higher clinical severity of toxicity as per research inclusion criteria).
Drug type and category

Among the 81 samples analysed:

  • There were 562 detections of 52 individual substances (found through the biological detection of the drug or its metabolite).
  • The average number of drugs detected per sample was six.

Of the 562 detections, the following drugs were the most common:

  • cocaine: 54 (10% of detections, 67% of samples)
  • temazepam: 44 (8% of detections, 54% of samples)
  • desmethyldiazepam: 41 (7% of detections, 51% of samples)
  • oxazepam: 40 (7% of detections, 49% of samples)
  • diazepam: 38 (7% of detections, 47% of samples)
  • bromazolam: 30 (5% of detections, 37% of samples)
  • morphine: 29 (5% of detections, 36% of samples)
  • pregabalin: 29 (5% of detections, 36% of samples)
  • methadone: 26 (5% of detections, 32% of samples)
  • THC: 25 (4% of detections, 31% of samples)

Please note: desmethyldiazepam, temazepam and oxazepam are all benzodiazepine drugs but can also be found as a metabolite of diazepam and other benzodiazepines.

The chart below shows the most common depressant drugs detected in toxicology analysis of surplus serum samples between 17 August 2022 and 16 February 2025 (Q1 to Q10). The percentages are of all detections.

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

Depressants were the most common drug category, making up 57% of detections (323).

  • Benzodiazepines were detected 285 times (51% of all detections):
    • In total, 18 different types of benzodiazepines were detected, including temazepam (8%), desmethyldiazepam (7%), oxazepam (7%) and diazepam (6%).
    • Bromazolam made up 5% of all detections, similar to Q9.
    • Gidazepam/desalkylgidazepam made up 3%, an increase from 2% in Q9.
    • Clonazolam made up 3% of detections, similar to Q9.
    • Etizolam made up 1%, a decrease from Q9 (4%).
  • Gabapentinoids were detected 37 times (7% of all detections, an increase from Q9 and similar to Q8). Pregabalin was the most common gabapentinoid detected.
  • There were no detections of xylazine, a decrease from the last quarter.

The chart below provides an indication of specific opioids detected in toxicology analysis of surplus serum samples between 17 August 2022 and 16 February 2025 (Q1 to Q10). The percentages are of all detections.

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

Opioids were the second most common drug category, making up 21% of detections (120).

  • There were 29 detections of heroin/morphine (5%; stable compared to Q9) and 26 of methadone (5%; from 2% in Q9).
  • There were nine detections of nitazenes (2%), an increase from 1% in the previous quarter. Etonitazene was detected for the first time in the study.

Stimulants were the third most common drug category, making up 10% of detections (58).

  • The most common stimulant was cocaine, making up 10% of detections (54); a decrease compared to Q9.
Further findings

Complete clinical data were available for 199 attendances for the most recent period (17 November 2024 to 16 February 2025):

  • 73% of attendees were male (146) and 27% were female (53).
  • 71% of attendances were aged 44 and under. The most common age category was 35 to 44 years (28%, 55 attendees), 26% (51) were aged 25 to 34 years and 18% (35) were aged 16 to 24.
  • 25% of attendees were aged 45 years and over, with 17% (34) aged 45 to 54 and 8% (16) aged 55 years or older.
Image caption Attendances by age

ED outcome records show:

  • 85 patients (43%) were discharged home
  • 43 patients (22%) were admitted to a ward
  • 20 patients (11%) were admitted to an intensive care unit, high-dependency unit, critical care unit or died
  • 19 patients (10%) were taken into police custody
  • 15 patients (8%) self-discharged
  • 17 were recorded as ‘unknown’ or ‘other’.

Clinical severity outcome (after 28 days) recorded:

  • 190 (95%) patients were discharged following the attendance
  • Six patients either died or remained an inpatient following the attendance
  • Three were ‘unknown’ or 'other'

Additional information

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

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

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

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

This study is sponsored by NHS GGC Research and Innovation and is funded by the Scottish Government. A temporary pause in funding led to suspension of recruitment to the study from 17 August to 22 September 2024.

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

Further information on the study can be found at Clinical Trials (external website).

Post-mortem toxicology testing for controlled substances

In Q4 of 2024, the most common drug types detected in post-mortem toxicology were opioids (68%) and benzodiazepines (51%). Cocaine continued to be the most commonly detected drug (36%), followed by heroin/morphine (34%), diazepam (26%) and pregabalin (22%).

Background

All sudden or unexpected deaths in Scotland are subject to investigation by the Crown Office and Procurator Fiscal Service (COPFS) to determine the cause of death and the need for criminal proceedings. In order to inform these decisions, the COPFS commissions post-mortem toxicology and pathology services.

This analysis is based on data from toxicology testing conducted at post-mortem for sudden and unexplained deaths, or where there was suspicion of involvement of controlled drugs.

Post-mortem toxicology testing is carried out by two services:

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

This report presents data on deaths covering the whole of Scotland. It includes new data for the period from 1 October to 31 December 2024, representing Q4 of 2024.

The range of substances routinely analysed is extensive and includes the detection of alcohol, prescribed medicines and controlled drugs. The data within this report will develop further as new or emerging drugs are added to toxicology screening.

The charts below show the prevalence of controlled substances detected in deaths which were subject to post-mortem toxicology screening. Drug detections were assigned to specific time periods based on the calendar year quarter of death. Throughout the time series, the sum of the percentages for each quarter exceeds 100%, due to the widespread detection of multiple substances in deaths. A full breakdown of results can be found in the ‘Toxicology Indicators’ section of the RADAR dashboard, where users can also download the data and filter by drug type or individual drug.

The first chart provides an indication of controlled drugs detected at post-mortem, in deaths occurring between 1 January 2022 and 31 December 2024.

Image caption Forensic toxicology cases testing positive for controlled substances

The following charts provide an indication of specific opioids and benzodiazepines detected at post-mortem, in deaths occurring between 1 January 2022 and 31 December 2024.

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

Summary

  • The most commonly detected drug types throughout the time series were opioids, followed by benzodiazepines. Both have remained relatively stable averaging 71% and 56% respectively between Q1 of 2022 to Q4 of 2024.
  • The most commonly detected individual drug was cocaine (averaging 36% between Q2 of 2023 and Q4 of 2024). Before Q2 of 2023, the most common individual drug was heroin/morphine.
  • Multiple controlled drugs were detected in 518 of 581 deaths (89%) in Q4 of 2024. This was similar to previous quarters.
  • The most commonly detected drugs/drug types in deaths during Q4 of 2024 were:
    • opioids: 395 (68%)
    • benzodiazepines: 294 (51%)
    • cocaine: 209 (36%)
    • heroin/morphine: 195 (34%)
    • gabapentinoids: 167 (29%)
    • diazepam: 151 (26%)
    • pregabalin: 129 (22%)
Stimulants
  • For the seventh quarter in a row, the most commonly detected drug was cocaine (36% in Q4 of 2024).
  • The percentage of deaths where cocaine was detected was relatively stable until Q1 of 2023 (averaging 29%). Detections increased in Q2 of 2023 to 36% and have remained relatively stable (averaging 36%) since.
Opioids
  • The percentage of deaths where opioids were detected has remained relatively stable throughout the time series, averaging 71%.
  • Heroin/morphine detections remained relatively stable, detected in an average of 35% of deaths until Q3 of 2023. In Q4 of 2023 detections decreased to 29% and then gradually increased to 34% in Q4 of 2024.
  • Methadone was detected in 32% of deaths in Q1 of 2022 and then fluctuated within a range of 23% to 29% of deaths until Q3 of 2024. In the most recent quarter, methadone detections decreased to 21% of deaths.
  • Buprenorphine detections remained low and stable throughout the series, detected in an average of 6% of deaths.
  • Detections of fentanyl/alfentanil have gradually increased, from 1% in Q1 of 2022 to 8% in Q3 of 2024. However, detections decreased to 4% in Q4 of 2024. Fentanyl-type opioids are commonly used as medicines for pain relief.
  • Nitazene-type opioids were first detected in Q1 of 2022 and have increased gradually to 5% of deaths (27) in Q4 of 2024.
    • Two nitazenes were detected in 18 of the 27 deaths.
    • Protonitazene was the most common nitazene detected, followed by metonitazene.
    • Nitazenes have been detected in a total of 132 deaths (to 31 December 2024).
Depressants
  • Benzodiazepines have remained broadly stable throughout the series, detected in an average of 56% of deaths per quarter.
    • Diazepam has been the most commonly detected benzodiazepine since Q2 of 2022, with detections fluctuating within a range of 23% and 35%.
    • Detections of bromazolam increased sharply between Q3 of 2022 and Q3 of 2023, replacing etizolam as the most commonly detected ‘street benzo’ from Q1 of 2023 onwards. Since Q3 of 2023, detections of bromazolam have been decreasing, detected in 11% of deaths in Q4 of 2024.
    • Etizolam was the most commonly detected benzodiazepine in Q1 of 2022 (31%). Since then, detections have followed a decreasing trend to 2% in Q4 of 2024.
    • Clonazolam detections fluctuated have since increased to 5% in Q4 of 2024.
    • Gidazepam/desalkylgidazepam was first detected in Q4 of 2022 and has remained low and relatively stable, detected in an average of 1% of deaths per quarter.
  • The percentage of deaths involving gabapentinoids has been relatively stable throughout the time series, with pregabalin averaging 23% and gabapentin averaging 10% of deaths.
  • Xylazine (detected for the first time in Q2 of 2023) detections decreased compared to the previous quarter to less than 1% of deaths (2). Xylazine has been detected in a total of 29 deaths (to 31 December 2024).

More detailed descriptions of historical changes can be found within our previous reports.

Additional information

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

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

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

The total number of deaths testing positive for controlled substances, for each calendar year and quarter, are provided in table 1.

Table 1: Number of deaths testing positive for controlled substances, by calendar year and quarter
Calendar year Q1 Q2 Q3 Q4
2022 566 631 536 710
2023 711 682 617 664
2024 691 599 575 581

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

Table 2: Initial and routine testing periods for new and emerging substances
Substance Initial testing (limited data available) Routine testing (data across Scotland)
Metonitazene Q1 of 2022 Q1 of 2023
Protonitazene Q1 of 2022 Q1 of 2023
Isotonitazene Q1 of 2022 Q1 of 2023
N-pyrrolidino etonitazene Q1 of 2022 Q1 of 2023
Bromazolam Q1 of 2022 Q1 of 2023
Deschloroetizolam Q1 of 2023 Q1 of 2023
Xylazine Q2 of 2023 Q2 of 2024

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

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

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

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

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

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

Similarly, as date of death was unavailable for tests conducted by the Department of Clinical Biochemistry at NHS Grampian, the date when the case was received from the COPFS has been used instead.

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

Testing indicators

WEDINOS drug testing

Between December 2024 and February 2025, Welsh Emerging Drugs and Identification of Novel Substances (WEDINOS) tested 173 samples from Scotland. The most commonly detected individual drugs were diazepam (9% of detections), 6-MAM (5%) and heroin (5%).

Background

WEDINOS is a harm reduction project managed by Public Health Wales. It provides an anonymous drug testing service to show trends in substance use.

WEDINOS receives samples from across the UK. Further information including sample results, drug images, harm reduction information and submission instructions is available on the WEDINOS website.

This indicator provides an update on samples submitted from Scotland. A full breakdown of results, including data going back to January 2024, can be found in the ‘Testing Indicators’ section of the RADAR dashboard, where users can also download the data and filter by drug type and location.

Summary

Between December 2024 and February 2025, 173 samples from Scotland were tested by WEDINOS. 11 samples contained no active components.


Among the 162 samples testing positive for a controlled drug:

  • There were 255 detections of 50 individual substances.
  • The average number of substances detected per sample was two, with the number ranging from one to eight per sample.
  • 45% did not test positive for only the intended purchase substance.
  • One sample tested positive for xylazine and two samples tested positive for nitazenes (two nitazenes detected in both samples). Heroin was the intended purchase for all these drugs.
  • 69 samples were purchased as a benzodiazepine, six (9%) did not contain any benzodiazepine, 41 (59%) contained only the benzodiazepine intended and 22 (32%) contained a different benzodiazepine to the intended purchase.


The following controlled drugs were the most common detected:

  • diazepam: 24 (9% of detections, 15% of samples)
  • 6-MAM: 14 (5% of detections, 9% of samples)
  • heroin: 12 (5% of detections, 7% of samples)
  • ketamine: 12 (5% of detections, 7% of samples)

Additional information

PHS was provided with these data by WEDINOS.

Drug seizures in Scottish prisons

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

Background

The Leverhulme Research Centre for Forensic Science (LRCFS) is currently undertaking research with the Scottish Prison Service (SPS). The Scottish Prisons Non-Judicial Drug Monitoring Project tests non-attributable seizures (drugs that cannot be linked to a person or source) made across the Scottish prison estate in order to understand the changing characteristics of synthetic drugs, including synthetic cannabinoids, often referred to as ‘spice’.

The chart shows the number and type of non-attributable samples seized in Scottish prisons between 1 December 2022 and 31 December 2024.

Please note the decline shown in the chart below is due to a reduction in samples submitted and does not reflect wider drug availability in prisons.

Image caption Drug seizures in Scottish prisons: sample type

The chart below shows the five most detected drug types from seizures in Scottish prisons between 1 December 2022 and 30 November 2024. This is based on the percentage of samples tested each month and uses 3-month moving average figures.

Image caption Drug seizures in Scottish prisons: drug type

Summary

Historic trend

The number of seizures analysed in 2023 varied, ranging from a high of 83 in March to a low of 19 in December, with a monthly average of 44.

Sample-type data were variable throughout 2023:

  • Paper and card seizures were low (monthly average 6%). This is thought to have been due to changes to prison rules that mean prisoners receive photocopied correspondence rather than original items.
  • Over a quarter of samples were powder or e-cigarettes (both 28%).
  • The transition from synthetic cannabinoids in paper form to e-cigarette, powder or wax forms has introduced new methods of consumption. This variation in form and purity can make it challenging to achieve consistent dosing, potentially leading to unpredictable effects.

Drug-type seizure data were highly variable over time, so the following narrative is based on 3-month moving averages:

  • Synthetic cannabinoids were the most commonly detected substances. In 2023, seizures testing positive for synthetic cannabinoids averaged 35% per month, with higher percentages observed during the summer months.
  • In 2023, benzodiazepine seizures followed an uneven decreasing trend (monthly average 13%).
  • Opioid seizures increased in late 2023 (average 19% in November), however sample numbers were small.
Update

Further data has been provided from January to July 2024, alongside data from August to December 2024. However, these data may be subject to change, so caution is advised when interpreting. We anticipate complete data will be available for the next release in July 2025.

PHS has received data for 135 samples seized between 1 January and 31 July 2024:

  • The average number of samples per month varied widely – from 45 in April to six in May.
  • Synthetic cannabinoids were the most prevalent drug type. They were detected in 58 samples (43%), with 46 samples (34%) containing two cannabinoids.
  • MDMB-4en-PINACA was the most common cannabinoid (44 detections), followed by MDMB-INACA (38).
  • 18 samples (13%) contained a benzodiazepine: nine bromazolam, five etizolam, three diazepam and one alprazolam.
  • Just under half of samples were powder (67 samples; 50%), followed by tablets (23; 17%) and e-cigarettes (23; 17%).

PHS has received data for 51 samples seized between 1 August and 31 December 2024:

  • The average number of samples per month varied widely – from 19 in August to four in October.
  • Synthetic cannabinoids were the most prevalent drug type. They were detected in 22 samples (43%), with 17 samples (33%) containing two cannabinoids.
  • MDMB-INACA (15 detections) was the most common synthetic cannabinoid, followed by MDMB-4en-PINACA (13).
  • Four samples contained a benzodiazepine: two bromazolam, one diazepam and one etizolam.
Further information

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

  • HHC has now been detected 12 times between September 2023 and December 2024.

Additional information

PHS was provided with these data by the SPS and the LRCFS.

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

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

Service indicators

Specialist drug treatment referrals

Between November 2024 and February 2025, the average weekly number of referrals to specialist drug treatment services was relatively stable, aside from an annual reduction in referrals during December. Due to reduced referral numbers in December 2024, the quarterly total of 5,733 was lower than in the previous quarter (6,764). Referrals were 4% lower than the same period commencing in 2022 (6,066) and 9% lower than the same period commencing in 2023 (6,294).

Background 

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

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

The chart below shows the weekly number of referrals to drug treatment services in Scotland between 7 November 2022 and 16 February 2025

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

Image caption Specialist drug treatment referrals

Summary

Historic trend
  • From November to December 2022, the weekly average number of referrals was 425.
  • Each December, a seasonal reduction in referrals occurs (December 2023: average 421 referrals per week; December 2024: 361), followed by an increase during January.
  • Disregarding these seasonal reductions, broadly stable trends with some variation were evident during 2023 (521 average weekly referrals) and 2024 (510).
National update

For the most recent 13-week period (18 November 2024 to 16 February 2025):

  • The weekly number of specialist drug treatment referrals ranged from 189 to 531 per week.
  • Referrals decreased in December 2024 (weekly average 361), before increasing again in January and February 2025 (weekly average 496).
  • 5,753 referrals were recorded, at an average of 443 per week. This was fewer than the previous quarter (19 August to 17 November 2024) when 6,764 referrals were recorded, at an average of 520 per week).
  • The number of referrals was 4% lower than the same period commencing in 2022 (6,003) and 9% lower than in 2023 (6,294).
Local update

Comparing the most recent period (18 November 2024 to 16 February 2025) to the previous quarter, the key changes observed across mainland NHS boards were:

  • Referrals decreased in the majority of areas: NHS Highland (9%), NHS Greater Glasgow and Clyde (11%), NHS Lanarkshire (14%), NHS Forth Valley (16%), NHS Fife (17%), NHS Tayside (17%), NHS Lothian (21%), NHS Ayrshire and Arran (28%) and NHS Dumfries and Galloway (38%).
  • Referrals increased in NHS Borders (31%).
  • Referrals were broadly stable in NHS Grampian.

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

Further information

The above information is limited to specialist drug treatment referrals, but further details on information provided by people presenting for initial assessment for specialist alcohol and drug treatment services in Scotland can be found within the Drug and Alcohol Information System (DAISy): Overview of initial assessments for specialist drug and alcohol treatment 2023/24 publication. 

In 2023/24, initial assessments for 16,507 people accessing specialist alcohol and/or drug treatment were recorded on DAISy.

Of those presenting for initial assessment for specialist drug treatment, cocaine (30%) was the most commonly reported main drug, overtaking heroin (28%) for the first time since reporting began.

Currently, this information is only available on an annual basis. However, work is underway to include initial assessment data on drug type, alongside referrals information, within future releases of this report.

Additional information

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

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

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

PHS has published a report (external website) summarising the responses to the recent customer survey on drug and alcohol treatment waiting times outputs. PHS’s proposal to discontinue production of the report element of the publication was broadly supported by respondents. The report also provides details of planned publication developments and timescales.

For more information on initial assessments for specialist drug and alcohol treatment services in Scotland, please see: Drug and Alcohol Information System (DAISy): Overview of initial assessments for specialist drug and alcohol treatment 2023/24.

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

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

Opioid substitution therapy

From October to December 2024, the average number of opioid substitution therapy (OST) doses supplied per month was similar to the previous quarter, 6% lower than the same period in 2022 and 5% lower than in 2023. The average monthly number of methadone doses supplied continued to decrease while the number of injectable buprenorphine doses increased over time.

Background

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

The chart below uses 3-month moving average figures to show the average total monthly number of ADQ doses supplied for OST medications in the community, between 1 October 2022 and 31 December 2024.

Image caption Average total number of OST doses per month

The chart below shows trends in the monthly number of ADQ doses for specific OST medications dispensed in the community between 1 October 2022 and 31 December 2024.

Image caption Number of doses per month for OST medications

Summary

Historic trend
  • There was a gradual decrease in the average monthly total number of OST doses supplied. This was due to the decrease in the average monthly number of methadone doses supplied, which reduced by 17%, from 547,200 between October and December 2022, to 456,700 between July and September 2024.
  • The average total number of injectable buprenorphine doses supplied has increased steadily since it was first licensed for use in Scotland in early 2020. The average monthly number of doses supplied increased steadily, from 83,300 between October and December 2022, to 132,400 between July and September 2024. Dispensing of injectable buprenorphine has been more common than oral buprenorphine since August 2023.
  • The average monthly number of oral buprenorphine doses supplied was slightly lower (5%) between October and December 2022 (119,300) and July and September 2024 (113,100).
Update

For the most recent period (1 October to 31 December 2024):

  • The average total monthly number of OST doses supplied was approximately 702,900. This was similar to the previous quarter, 6% lower than the same period in 2022, and 5% lower than 2023.
  • The average monthly number of methadone doses supplied was approximately 445,700. This was similar to the previous quarter, 19% lower than the same period in 2022, and 10% lower than in 2023.
  • The average monthly number of injectable buprenorphine doses supplied was approximately 144,700. This was 9% higher compared to the previous quarter, 74% higher than the same period in 2022, and 18% higher than in 2023.
  • The average monthly number of oral buprenorphine doses supplied was approximately 112,600. This was similar to the previous quarter and the same period in 2023, and 6% lower than 2022.

Additional information

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

The data shown on methadone and oral buprenorphine, and the majority of injectable buprenorphine data, relate to prescriptions dispensed to individuals from a community pharmacy in Scotland, where a request for reimbursement of costs was processed. The time period reflects the month for which reimbursement was claimed. This is regarded as the most comprehensive and reliable way of reporting community prescribing data. There can be a lag of approximately three months from a prescription being written to reimbursement data becoming available.

As a consequence of the direct administration of injectable buprenorphine within clinics, some NHS boards do not request the reimbursement of costs for all of the OST treatments they provide. Data for approximately 28% of injectable buprenorphine doses supplied in Scotland are held in the HMUD and have been combined with the community prescribing data to provide a comprehensive account of OST supply over time.

To analyse information on methadone and oral buprenorphine dispensing by NHS board, visit the RADAR dashboard (external website).

What is average daily quantity (ADQ)?

When comparing use between medicines and over time, it is common to use World Health Organization (WHO) defined daily doses (DDDs). The DDD is defined as the usual average daily maintenance dose used in adults for the main therapeutic use of the medicine.

The WHO DDD is a global average and may not be representative of the doses used in clinical practice at a more local level. This is the case in Scotland, where the WHO DDD of 25 milligrams (mg) daily for methadone is between one-half and one-third of the normal maintenance dose used.

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

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

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

Injecting equipment provision

Between October and December 2024, the average weekly number of injecting equipment provision (IEP) transactions was 12% lower, and the number of needles and syringes distributed was 11% lower, than in the previous quarter. The number of transactions was 11% lower than the same period in 2022 and 15% lower than in 2023. The number of needles and syringes distributed was 12% lower than the same period in 2022 and 11% lower than in 2023.

Background 

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

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

The chart below shows the weekly number of IEP transactions from 26 September 2022 to 29 December 2024.

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

Image caption Injecting equipment provision: transactions

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

Summary

Historic trend
  • The average weekly number of transactions (approximately 2,900) remained broadly stable from October 2022 to February 2024, with seasonal fluctuations in December and January and again in March and April each year. Transactions increased following April 2024 and remained stable to September (approximately 2,850).
  • The average weekly number of needles and syringes distributed (approximately 41,250) remained broadly stable between October 2022 to February 2024, with seasonal fluctuations in December and January and again in March and April each year. Following April 2024, the number of needles and syringes increased and remained stable to September (approximately 39,600).
  • The ratio of needles and syringes distributed between October 2022 and September 2024 was broadly stable, generally around 14 needles and syringes per transaction.
National update

For the most recent period (30 September to 29 December 2024):

IEP transactions

  • 32,390 transactions were recorded, at an average of 2,492 per week.
  • This was 12% lower than the previous quarter (1 July to 29 September 2024) when a total of 36,950 transactions were recorded (weekly average 2,842).
  • The number of transactions was 11% lower than the same period in 2022 (36,191, weekly average 2,784) and 15% lower than in 2023 (38,221, weekly average 2,940).

Needles and syringes distributed

  • 460,527 needles and syringes were distributed, at an average of 35,425 per week.
  • This was 11% lower than the previous quarter when a total of 514,795 needles and syringes were distributed, at an average of 39,600 per week.
  • The number of needles and syringes distributed was 12% lower than the same period in 2022 (524,265, weekly average 40,328) and 11% lower than in 2023 (515,008, weekly average 39,616).

Ratio of needles and syringes distributed

  • There was a weekly average of 14.2 needles and syringes distributed per transaction.
  • This was similar to the previous quarter (13.9), similar to the same period in 2022 (14.5) and 6% higher than 2023 (13.4).
Local update

Comparing the ratio of needles and syringes distributed in the most recent period (30 September to 29 December 2024) to the previous quarter, the key changes observed across mainland NHS boards were:

  • The ratio increased in two areas: NHS Lanarkshire (15%; ratio 12.6) and NHS Forth Valley (7%; ratio 17.8).
  • The ratio decreased in two areas: NHS Dumfries and Galloway (17%; ratio 6.0) and NHS Borders (31%; ratio 11.9).
  • The ratio was stable in six areas: NHS Great Glasgow and Clyde (9.8), NHS Fife (13.1), NHS Ayrshire and Arran (16.2), NHS Tayside (17.1), NHS Lothian (23.9) and NHS Grampian (25.5).

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

Additional information

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

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

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

Contact

General enquiries

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

Reporting a drug harm

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

Media enquiries

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

Requesting other formats and reporting issues

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

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

Further information

RADAR

Find out more about RADAR – Scotland's drugs early warning system.

Data and intelligence

View our wider drug data and intelligence.

Public health information

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

Metadata

Publication title

Rapid Action Drug Alerts and Response (RADAR) quarterly report – April 2025

Theme

Substance use surveillance

Topic

Drugs

Format

HTML

Release date

29 April 2025

Frequency

Quarterly

Relevance and key uses of the statistics

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

Revisions statement

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

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

Revisions relevant to this publication

N/A

Comparability

Data are not comparable outwith Scotland.

Accuracy

The data are considered accurate.

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

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

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

Accessibility

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

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

Coherence and clarity

The report is available as HTML web pages.

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

Disclosure

Our Statistical Disclosure Protocol has been followed.

Official Statistics designation

Management information report

UK Statistics Authority Assessment

N/A

Last published

28 January 2025

Next published

29 July 2025

Date of first publication

11 October 2022

Help email

phs.drugsradar@phs.scot

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

1 April 2025

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

Cannabinoids are compounds that interact with the endocannabinoid system. They are found in the cannabis plant or can be produced synthetically in a laboratory.

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

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

Methamphetamine is a long-acting stimulant that is usually found as clear, colourless crystals that can be smoked.

Ketamine is a dissociative drug that is popular amongst the club and festival scene. It is often found as an off-white crystalline powder.

Completeness

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

Value type and unit of measurement

Police seizures positive for controlled substances displayed as drug type.

Description

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

Data source(s)

Public Health Scotland

Date that data were acquired

Various between 5 January 2024 and 4 April 2025. Data were collated on 14 April 2025.

Timeframe of data and timeliness

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

Continuity of data

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

  • QR1 (Jul – Sep 22) - Number of reports 8; number of primary drugs reported 9 
  • QR2 (Oct – Dec 22) - Number of reports 18; number of primary drugs reported 20 
  • QR3 (Jan – Mar 23) - Number of reports 23; number of primary drugs reported 24 
  • QR4 (Apr – Jun 23) - Number of reports 24; number of primary drugs reported 24 
  • QR5 (Jul – Sep 23) - Number of reports 36; number of primary drugs reported 38 
  • QR6 (Oct – Dec 23) - Number of reports 53; number of primary drugs reported 64 
  • QR7 (Jan – Mar 24) - Number of reports 43; number of primary drugs reported 57 
  • QR8 (Apr – Jun 24) - Number of reports 85; number of primary drugs reported 128 
  • QR9 (Jul – Sep 24) - Number of reports 69; number of primary drugs reported 85 
  • QR10 (Oct – Dec 24) - Number of reports 97; number of primary drugs reported 143
  • QR11 (Jan – Mar 25) - Number of reports 221; number of primary drugs reported 310

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

Nitazenes and fentanyls are groups of potent synthetic opioids.

Cannabinoids are substances that interact with the endocannabinoid system, which is involved in regulating processes including movement, motor skills, mood, appetite and pain.

Other: The most common drugs reported in the ‘other’ category were zopiclone, ketamine, methamphetamine, red apples (tapentadol/carisoprodol) and pregabalin

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 2024

Timeframe of data and timeliness

21 November 2022 to 23 February 2025, approximately two months in arrears.

Continuity of data

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

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

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

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

Concepts and definitions

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

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

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

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

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

Completeness

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

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

6 March 2025

Timeframe of data and timeliness

28 November 2022 and 2 March 2025, 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.

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.

Completeness

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

Value type and unit of measurement

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

Description

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

Data source(s)

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

Date that data were acquired

27 March 2025

Timeframe of data and timeliness

26 September to 29 December 2024, approximately three months in arrears. 

Continuity of data

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

Concepts and definitions

Opioids       

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

Cannabinoids

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

Cocaine

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

Sedatives and hypnotics

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

Multiple/other

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

Completeness

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

Completeness levels for NHS Fife and NHS Grampian were below 90% as of 14 March 2025 for the most recent time period (October– December 2024), therefore caution is advised when interpreting trends in these areas on the dashboard.

Value type and unit of measurement

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

Description

This indicator provides information on suspected drug deaths in Scotland.

Data source(s)

Police Scotland

Date that data were acquired

21 March 2025

Timeframe of data and timeliness

22 August 2022 to 23 February 2025, approximately two months in arrears.

Continuity of data

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

Concepts and definitions

Drug-related death

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

Suspected drug death

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

Completeness

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

Value type and unit of measurement

Numbers of suspected drug deaths in Scotland and moving averages.

Description

This indicator provides information on 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

26 February 2025

Timeframe of data and timeliness

1 June 2021 and 31 December 2024, 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.

Data is available for samples for the latest period (1 January 2024 to 31 December 2024). Analysis is available within the report. Analysis of the drug seizures in Scottish prisons for 2024 is still ongoing and not all data can be included in this report. We anticipate the updated data will be available for the next release in July 2025.

Concepts and definitions

Benzodiazepines

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

Cocaine

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

Gabapentinoids

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

Opioids

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

Synthetic cannabinoids

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

Completeness

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

Value type and unit of measurement

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

Description

This indicator provides information on WEDINOS drug testing results from samples sent from Scotland.

Data source(s)

WEDINOS (Welsh Emerging Drugs and Identification of Novel Substances), Public Health Wales

Date that data were acquired

19 March 2025

Timeframe of data and timeliness

1 January 2024 to 28 February 2025, approximately two months in arrears.

Continuity of data

The WEDINOS project is a harm reduction project, providing an anonymous drug testing service to members of the public, along with information about substance use. This service is provided to all residents of the UK who would like to receive further information about the substances they are in possession of. WEDINOS has been testing samples since 2013. There have been no changes in the methodology used. 

Concepts and definitions

These data are based on WEDINOS results from testing of substances submitted by people resident in Scotland.

Completeness

WEDINOS results are based on substances submitted by people who may have experienced harms or unusual effects from substances they have taken. As such, they provide useful information about emerging substances in circulation in Scotland but may not be representative of all the substances used or harms experienced by the wider population of people who use drugs.

Value type and unit of measurement

Number of samples from Scotland tested by WEDINOS.

Description

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

Data source(s)

QEUH, NHS Greater Glasgow and Clyde

Date that data were acquired

14 April 2025

Timeframe of data and timeliness

17 August 2022 to 16 February 2025, approximately two months in arrears.

Continuity of data

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

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

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

Due to a temporary pause in the study while funding was being confirmed, the start of Q9 was delayed. Recruitment was suspended from 17 August to 22 September 2024. Consequently, Q9 consists of only 55 study days, compared to the usual 90-92 days, resulting in fewer samples being tested. This discrepancy should be considered when interpreting the data and trends.

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.

Due to a temporary pause in the study while funding was being confirmed, the start of Q9 was delayed. Recruitment was suspended from 17 August to 22 September 2024. Consequently, Q9 consists of only 55 study days, compared to the usual 90-92 days, resulting in fewer samples being tested. This discrepancy should be considered when interpreting the data and trends for the most recent quarter.

Value type and unit of measurement

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

Description

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

Data source(s)

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

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

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

Date that data were acquired

12 March 2025

Timeframe of data and timeliness

Between 1 January 2022 and 31 December 2024, approximately three months in arrears. 

Continuity of data

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

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

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

Concepts and definitions

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

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

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

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

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

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

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

Benzodiazepines

Benzodiazepines are a group of drugs with depressant and anxiolytic (anti-anxiety) effects. They are also known as tranquilisers. Diazepam is a ‘prescribable benzodiazepine’. Etizolam, clonazolam, gidazepam 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, methadone and nitazenes.

Completeness

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

Value type and unit of measurement

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

Description

This indicator provides information on toxicology testing for controlled substances in samples provided by people receiving specialist drug treatment services via GPs and specialist services across NHS Lothian and NHS Greater Glasgow and Clyde (GGC). A small number of samples are also received from neighbouring NHS boards.

Data source(s)

The NHS Lothian Toxicology Laboratory based at the Royal Infirmary of Edinburgh and the NHS GGC Toxicology Laboratory based at the Queen Elizabeth University Hospital.

Date that data were acquired

27 January 2025

Timeframe of data and timeliness

  • Oral fluid samples tested by the NHS Lothian Toxicology Laboratory from October 2022 to December 2024.
  • Urine samples tested by the NHS Greater Glasgow and Clyde (GGC) Toxicology Laboratory from December 2023 to December 2024.

Approximately three months in arrears.

Continuity of data

In December 2023, the NHS Greater Glasgow and Clyde Toxicology Laboratory changed testing method from immunoassay testing to liquid chromatography–mass spectrometry (LC-MS). Changes in the number of drug detections from December 2023 may be due the change in threshold values used in the LC-MS method rather than changing drug use in the patient population, therefore this section only included data from December 2023 onwards.

Concepts and definitions

The list below shows the drug and metabolites tested for by NHS Lothian and NHS GGC toxicology labs and in what drug class they are grouped into for analysis.

NHS Lothian (Drugs tested for in oral fluid - drug type)

• 6-MAM (heroin) - Opioid
• Alprazolam - Benzodiazepine
• Amphetamine - Other stimulant
• Bromazolam - Benzodiazepine
• Buprenorphine - Excluded
• Cocaine - Cocaine
• Codeine - Opioid
• Diazepam - Benzodiazepine
• Dihydrocodeine - Opioid
• Etizolam - Benzodiazepine
• Gabapentin - Gabapentinoid
• MDMA - Other stimulant
• Methadone - Excluded
• Methamphetamine - Other stimulant
• Morphine - Opioid
• Nitrazepam - Benzodiazepine
• Nordiazepam - Benzodiazepine
• Oxycodone - Opioid
• Pregabalin - Gabapentinoid
• Temazepam - Benzodiazepine
• Tramadol - Opioid

NHS GGC (Drugs tested for in urine since December 2023 - drug type)

• 6-MAM (heroin) - Opioid
• Alprazolam - Benzodiazepine
• Amphetamine - Other stimulant
• Bromazolam - Benzodiazepine
• Buprenorphine - Excluded
• Cannabis - Excluded
• Chlordiazepoxide - Benzodiazepine
• Clonazepam - Benzodiazepine
• Cocaine - Cocaine
• Codeine - Opioid
• Delorazepam - Benzodiazepine
• Diazepam - Benzodiazepine
• Diclazepam - Benzodiazepine
• Dihydrocodeine - Opioid
• Etizolam - Benzodiazepine
• Fentanyl - Opioid
• Flualprazolam - Benzodiazepine
• Gabapentin - Gabapentinoid
• Ketamine - Ketamine
• Lorazepam - Benzodiazepine
• MDMA - Other stimulant
• Methadone - Excluded
• Methamphetamine - Other stimulant
• Morphine - Opioid
• Nitrazepam - Benzodiazepine
• Nordiazepam (to inform diazepam result) - Benzodiazepine
• Oxazepam - Benzodiazepine
• Oxycodone - Opioid
• Phenazepam - Benzodiazepine
• Pregabalin - Gabapentinoid
• Temazepam - Benzodiazepine
• Tramadol - Opioid
• Zopiclone - Zopiclone

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

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

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

Completeness

Samples are only sent for testing if point of care tests are unavailable, or controlled drugs were detected in the results of tests carried out at the point of treatment. Therefore, these results cannot be seen as indicative of drug use among the wider population of people receiving specialist drug treatment, many of whom will not be using illicit drugs.

Value type and unit of measurement

Number and percentage of samples testing positive for controlled substances by drug type.

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

10 March 2025

Timeframe of data and timeliness

7 November 2024 to 16 February 2025, approximately two months in arrears.

Continuity of data

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

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

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

Concepts and definitions

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

Completeness

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

Value type and unit of measurement

Number of specialist drug treatment referrals and moving averages.

Description

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

Data source(s)

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

Date that data were acquired

11 March 2025

Timeframe of data and timeliness

1 October 2024 to 31 December 2024

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

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

Methadone 

  • methadone 10mg/ml oral solution sugar free 

Buprenorphine 

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

Completeness

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

Value type and unit of measurement

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

Description

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

Data source(s)

Needle Exchange Online (neo360)

Date that data were acquired

25 March 2025

Timeframe of data and timeliness

26 September 2022 to 30 December 2024, approximately three months in arrears.

Continuity of data

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

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

Concepts and definitions

Transactions

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

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

Completeness

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

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

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

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: 14 April 2025
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