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.

​Update

The alert linked in this publication was updated on 20 December 2023, to add new data on post-mortem toxicology detections for nitazene-type opioids.​

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 official and national statistics publications on substance use.

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

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

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

Dashboard

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

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

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

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

Main points

  • An increase in drug-related harms was observed in Scotland during summer 2023, compared with the previous reporting period (spring, reported in quarterly report 4 – July 2023):
    • naloxone administration incidents: 26% increase
    • emergency department attendances: 13% increase
    • drug-related hospital admissions: 26% increase
    • suspected drug deaths: stable
  • Indicators of the use of drug-related services (injecting equipment provision and new drug treatment referrals) were broadly stable.
  • Harms were reported across a range of community settings (including homelessness and temporary accommodation) and custodial settings (including prisons).
  • Evidence from post-mortem toxicology, hospital toxicology and reports to RADAR, indicate that the pattern of drug use associated with most harms is polysubstance use involving benzodiazepines (including new substances such as bromazolam), stimulants and opioids.
  • During this quarter, nitazenes (new synthetic opioids) have been detected in post-mortem and hospital toxicology samples. During the same period, other UK nations reported increased overdoses and deaths linked to synthetic opioids.
  • More information on the emergence of new drugs can be found in our accompanying blog post 'New synthetic drugs on the RADAR'.

Alerts

Harm indicators 

  • Between June and August 2023, the average weekly number of Scottish Ambulance Service naloxone incidents increased (weekly average 89 and 95 respectively). The total number of incidents during this time period was 20% lower than the same period in 2021 and 22% higher than in 2022. These figures do not take account of naloxone administration by members of the public, service workers, or other emergency responders such as police officers.   
  • Between June and August 2023, drug-related attendances at emergency departments were 13% higher than the previous time period. The total number of attendances recorded in this period was similar to the same period in 2021 and 22% higher than in 2022.
  • Between April and June 2023, drug-related hospital admissions were 26% higher than the previous time period. The total number of admissions was 28% lower than the same period in 2021 and 6% higher than in 2022. These data should be interpreted with caution, as the number of admissions may be affected by issues accessing urgent care and by the capacity of hospital services.
  • Between June and August 2023, there were 307 suspected drug deaths. The number of deaths was similar to the same period in 2021 (317) and 7% higher compared to 2022 (286).

Toxicology indicators 

  • Between May and August 2023, in the ASSIST hospital toxicology pilot, the most frequently detected drugs were cocaine (11%), followed by bromazolam (10%) and temazepam (8%). Several new drugs, including protonitazene, metonitazene and xylazine were detected for the first time in the project.
  • Between April and May 2023, the most frequently detected drug types in post-mortem toxicology testing were opioids (72%) and benzodiazepines (60%). The most common drugs detected were cocaine (37%), diazepam (37%), followed by methadone (35%) and heroin/morphine (33%). Bromazolam was detected in 23% of deaths. Nitazenes were detected in 1% of deaths.
  • Between April and July 2023, prison drug analysis detected synthetic cannabinoids in 48% of samples. Benzodiazepines and steroids were the second most common drugs, both detected in 9% of samples.

Service indicators 

  • Between June and August 2023, the average weekly number of specialist drug-treatment referrals was stable. The number of referrals during this period was 6% lower than the same time period in 2021 and 14% higher than in 2022.
  • Between April and June 2023, the average weekly number of injecting equipment provision transactions, and needles and syringes distributed increased. During this period, the total numbers of transactions, and needles and syringes distributed, were lower than in the same period in 2021 (12% and 7% respectively) and similar to 2022.
  • Opioid substitution therapy prescribing data were not available for the latest time period.

Reporting trends

  • Between July and September 2023, 36 trend reports were received by RADAR.
  • The majority of reports related to benzodiazepines and polydrug use.
  • In comparison to previous quarters, there was an increase in the percentage of reports related to overdose clusters, heroin and nitazenes.

Actions

  • The harm caused by drugs is a significant public health issue for Scotland. The illicit drugs market is evolving and increasingly toxic substances are being detected with greater frequency.
  • These developments increase the risk of harm and death, particularly in the context of polysubstance use, stigma and exclusion. They emphasise the importance of timely and accurate drug checking, hospital toxicology and forensic post-mortem toxicology services.
  • A system-wide approach that prevents drug harms and supports people affected into treatment, care and recovery remains critical. Harm reduction interventions are a key part of a systems-wide approach.
  • Immediate responses to localised increases in harms have been deployed at a local level. In addition to general awareness raising, these approaches included:
    • Continued development of anticipatory care plans for people already in contact with treatment services, to identify and reduce risks associated with relapse or ongoing substance use (as part of MAT standard 3).
    • Development of pathways to care, support and harm reduction for people in settings identified as high risk.
    • Ensuring availability of naloxone and other appropriate harm reduction initiatives, such as wound care, assessment of injecting risk, dry blood-spot testing, in settings where high rates of harm have been reported.
    • Review of harm reduction interventions and approaches to take into account the risks posed by the availability of synthetic opioids (for further information see the nitazene alert).

Alerts

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

Current alerts

Bromazolam

A public health alert about new benzodiazepines was published on 5 July 2023. 

Bromazolam is now the most common drug detected in 'street benzos'. Reports to RADAR indicate that bromazolam produces strong sedative and sleep-inducing effects. As a result, there is a substantial risk of overdose.

Nitazenes

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

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

Update

The alert linked in this publication was updated on 20 December 2023 to add new, provisional data on post-mortem toxicology detections for nitazene-type opioids.

This data update has been published to support the winter messaging campaign (external website) and activities related to the risks of synthetic opioids.

Trends

Police drug trends bulletin

This bulletin contains photos of drugs.

This update provides information on detections of street benzodiazepines and new synthetic opioids.

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

Street benzos

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

The most commonly encountered street benzo is white and stamped '10', with a half score on the reverse.

Historically, the most commonly detected active ingredient contained within street benzodiazepine tablets was etizolam. Etizolam still features highly, but the trend has shifted with bromazolam now found to feature in the majority of tablets sent for analysis.

Bromazolam is a class C controlled drug within the provisions of the Misuse of Drugs Act 1971.

Police Scotland has also noticed the re-emergence of 'baby blues' – small, circular, light blue tablets stamped with 'MSJ', as per the image below.

Image caption 'Baby blue' bromazolam tablets
Two benzodiazepine tablets: white with '10' and half score on reverse

Street benzodiazepines will continue to be monitored via Operation Borzoi and any new tablet markings identified will be captured for circulation.

New synthetic opioids

Image caption Metonitazene tabs
Sheets of blotter paper 'tabs' containing metonitazene. Roughly 180 squares that are half a centimetre wide, coloured beige on one side and white on the other.

The above was provided to the STOP Unit West via the Scottish Police Authority Forensics Services laboratory. These are paper tabs which were found to contain metonitazene.

Metonitazene is a potent new synthetic opioid (NSO). The supply and importation of metonitazene is controlled by the Psychoactive Substances Act 2016, but it will soon be a class A controlled drug within the provisions of the Misuse of Drugs Act 1971.

The person in possession of these tabs believed them to contain etizolam (benzodiazepine) and was unaware of the presence of metonitazene. This is the first time the STOP Unit have encountered metonitazene in this form.

RADAR intelligence and reports

36 reports were validated by RADAR between 5 July and 4 October 2023. A summary of reports is shown below for information.

Trends by primary drug type

The majority of submissions report polydrug use – the use of more than one substance at a time.

In the latest time period (5 July to 4 October 2023):

  • Benzodiazepines were the most commonly reported drug of concern in 33% of reports. This was similar to the 35% quarterly average reported between July 2022 and June 2023.
  • Cocaine was reported as the primary drug in 14% of reports, a decrease on the 22% average between July 2022 and June 2023.
  • Heroin was reported as the primary drug in 14% of reports, an increase on the 3% average between July 2022 and June 2023.
  • There was an increase in reports of nitazenes in Scotland and across the wider UK during this quarter, to 14%, up from an average of 4% between July 2022 and June 2023.
Image caption Reports to RADAR by primary drug type
This stacked bar chart shows the percentage of reports by drug type in submissions received by RADAR. Data is shown in five quarters from Q3 2022 (July to September 2022) to Q3 2023 (July to September 2023). Percentage is on the y axis and date (by quarter) is on the x axis. The drugs are grouped into seven main categories (benzodiazepines, cocaine, heroin, nitazenes, pregabalin, MDMA and other). The most common drug reported in all quarters was benzos. Benzo reports were stable across the time series, averaging 35%. Reports of cocaine were stable, averaging 22% of reports in the first four quarters, before falling to 14% in Q3 2023. Reports of ‘other’ drugs averaged at 18% across the time series. Reports of nitazenes, pregabalin, MDMA and nitazenes varied between quarters. Pregabalin was reported in 13% in Q3 2022, 5% in Q4 2022 and 29% in Q1 2023, before falling to 0% in Q2 and Q3 2023. Nitazene reports increased to 14% in Q3 2023, after being reported in 11% in Q4 2022 and 4% in Q1 2023. MDMA also increased to 14% in Q3 2023, after being reported in 13% in Q3 2022 and 3% in Q4 2022. Heroin reports increased in the last three quarters, from 4% in Q1 2023 to 14% in Q3 2023.

Drug harm reports to RADAR

Shown below are 36 reports of drug harms received by RADAR between 5 July and 4 October 2023.

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

So far, RADAR has validated over 120 reports of drug-related information and harms received through the reporting form and mailbox. Reports validated prior to 5 July 2023 are shown in previous quarterly reports.

Report 2

Local authority: National (UK)

Reason for report: Deaths

Drug: Nitazenes

Appearance: Various

Summary: Alert issued on 26 July, due to an elevated number of overdoses (and deaths) in people who use drugs, primarily heroin, in many parts of the UK. In some of these cases, nitazenes have been detected including, isotonitazene, metonitazene, N-pyrrolidino etonitazene (etonitazepyne) and N-desethyl isotonitazene. Concerned that nitazenes have been detected in drugs sold as heroin and oxycodone, and (less commonly) benzodiazepines and synthetic cannabinoids. Read the alert here.

 

Report 3

Local authority: National (Northern Ireland)

Reason for report: Overdoses

Drug: Nitazenes

Appearance: Yellow tablets

Summary: Alert issued after overdoses and deaths linked to metonitazene.

 

Report 11

Local authority: National (UK)

Reason for report: New drug

Drug: Nitazenes

Appearance: Unknown

Summary: UK-wide reports of increased overdose and deaths. Areas particularly affected include the West Midlands, Merseyside, Northern Ireland and Wales.

Report 1

Local authority: Midlothian

Reason for report: Deaths

Drug: Street benzos

Appearance: Tablets, crushed tablets and powder

Summary: Multiple suspected drug deaths. Reports mention use of potent benzos, in the form of tablets and powder. A sample of one of the drugs suspected to be involved was sent to WEDINOS for testing – confirmed as bromazolam.

 

Report 4

Local authority: West Lothian

Reason for report: Adverse effects

Drug: Heroin

Appearance: Black powder, grainy

Summary: Patient reports heroin was 'really strong', almost black in colour and unlike anything they've seen before. Used a whole sachet of VitC (ascorbic acid) to break down 0.2 grams of heroin. Adverse effects after injecting: immediate collapse, difficulty breathing and loss of consciousness.

 

Report 7

Local authority: Fife

Reason for report: Concern

Drug: Benzos

Appearance: Tablets

Summary: Benzodiazepine tablets advertised for sale on social media – found to contain clonazolam.

 

Report 8

Local authority: City of Edinburgh

Reason for report: Death

Drug: Protonitazene

Appearance: Unknown

Summary: Suspected drug death of person who reported they were buying protonitazene, pregabalin and diazepam online.

 

Report 10

Local authority: City of Edinburgh

Reason for report: Adverse effects

Drug: Cocaine

Appearance: Unknown

Summary: Increase in patients presenting with more severe injecting-related infections, as a consequence of injecting cocaine. Patients require longer admissions (several weeks, sometimes months). A rise in discitis (spine disc infection) has also been recorded.

 

Report 12

Local authority: City of Edinburgh

Reason for report: Adverse effects

Drug: Street benzos

Appearance: Unknown

Summary: Street Valium reported to be stronger than usual and involved in overdose. Unclear of pattern of use but it is believed that six tablets are enough to cause an overdose.

 

Report 15

Local authority: Scottish Borders

Reason for report: Trend

Drug: Street benzos

Appearance: White rectangular bar

Summary: Street benzos, sold as 'Xanax'. Sold as loose oblong bars stamped with 'XANAX'. Tested by WEDINOS – found to contain bromazolam. Adverse effects: confusion.

 

Report 16

Local authority: Scottish Borders

Reason for report: Trend

Drug: Street benzos

Appearance: White circular pill, half score on one side

Summary: Street benzo sold as loose pills. Tested by WEDINOS – found to contain lorazepam.

 

Report 18

Local authority: City of Edinburgh

Reason for report: Trend

Drug: MDMA

Appearance: Unknown

Summary: Report of reduced availability of MDMA powder in Lothians.

 

Report 19

Local authority: City of Edinburgh

Reason for report: Concern

Drug: Ecstasy

Appearance: Bright yellow pill, hard pressed with Bitcoin symbol

Summary: Reports of pills being promoted and sold via Telegram app. Concerned that amid a shortage of MDMA powder, pills may contain cathinones such as 4-CMC. A warning was issued in February 2023 in Greater Manchester, after Bitcoin pills were found to be 'variable' and contain MDMA, 4-CMC and caffeine – sometimes alone, sometimes in combination.

 

Report 21

Local authority: City of Edinburgh

Reason for report: Adverse effects, overdose

Drug: Cocaine

Appearance: Unknown

Summary: Multiple overdoses resulting in very unwell patients related to cocaine use. Overdoses were geographically widespread. Presentations included: seizures and cardiac arrest.

 

Report 22

Local authority: Falkirk

Reason for report: Adverse effects

Drug: Benzos

Appearance: White tablets

Summary: Increase in hospital presentations after taking benzos in the community. Loose pills with no markings sold as street Valium by street dealers. Patients overdosed after swallowing half of the number of pills they would usually consume. Adverse effects include: memory loss, loss of consciousness and renal failure.

 

Report 24

Local authority: Fife

Reason for report: Deaths

Drug: Ketamine

Appearance: Unknown

Summary: Multiple suspected drug deaths in people aged under 25. No obvious link. Reports mention ketamine, alcohol and MDMA.

 

Report 27

Local authority: Various (Clackmannanshire, Falkirk, Stirling, Midlothian, West Lothian)

Reason for report: New trend

Drug: Bromazolam

Appearance: Pinkish brown powder

Summary: Pink coloured powder sold as bromazolam for injecting. Sold in £10 bags – similar in size to usual tenner bag of heroin (0.2 grams). Linked to overdoses and adverse effects including: aggression or violence, amnesia, anxiety or panic, depression or low mood, difficulty breathing, injury, loss of consciousness, unusual behaviours and wounds.

 

Report 28

Local authority: City of Edinburgh

Reason for report: Adverse effects

Drug: Benzos

Appearance: Blue tablets, stamped 'MSJ'

Summary: Tablets sold as 'Valium' but with different and unexpected non-specified adverse effects. Shades of blue varied throughout batch – believed to be dyed with food colouring. Pills described as being smaller than standard benzos and inscribed with 'MSJ' on one side. Report mentions people swallowing eight or nine tablets.

 

Report 32

Local authority: Fife

Reason for report: Death

Drug: Unknown

Appearance: Unknown

Summary: Suspected drug death of a person aged under 25.

 

Report 34

Local authority: West Lothian

Reason for report: Adverse effects, overdose

Drug: Unknown

Appearance: Unknown

Summary: Individuals aged under 25, hospitalised with unspecified symptoms.

 

Report 35

Local authority: Fife and Tayside

Reason for report: Concern, trend

Drug: Ketamine

Appearance: Unknown

Summary: Concern over numbers of young people using ketamine.

Report 13

Local authority: West Scotland

Reason for report: Overdose

Drug: Cannabis edible

Appearance: Chocolate bar in 'Freddo'-like wrapper

Summary: Overdose after accidental ingestion.

 

Report 14

Local authority: North Lanarkshire, Glasgow City

Reason for report: Deaths

Drug:  Unknown

Appearance: Unknown

Summary: Suspected drug deaths and increase in harms in people aged under 25.

 

Report 20

Local authority: Lanarkshire

Reason for report: Adverse effects, death

Drug: Cocaine

Appearance: Unknown

Summary: Death suspected to be related to cocaine use. Presented to hospital with serotonin syndrome-type symptoms, seizures, agitation and overheating.

 

Report 25

Local authority: Renfrewshire

Reason for report: New trend

Drug:  Cocaine

Appearance: Unknown

Summary: Service reporting strong cocaine in circulation, estimated to be about 'twice as strong as usual prop' (high purity cocaine). Sold for the same price for the same quantity as usual – 0.2 grams sold for £20. This is usually enough for a short hit (20-30 mins) but now able to be used for multiple doses when injecting or smoking and the effects are lasting twice as long. Easy to take too much and overdose – effects were immediate and intense.

 

Report 26

Local authority: Renfrewshire, Glasgow City

Reason for report: Deaths

Drug:  Various

Appearance: Unknown

Summary: Multiple suspected drug deaths. Reports mention cocaine alongside alcohol, heroin and benzos. Report also highlights possible seasonality in overdoses as they also spiked in August 2022.

 

Report 29

Local authority: Glasgow City

Reason for report: Adverse effects, new drug

Drug: Benzos, heroin

Appearance: Unknown

Summary: Increase in presentation of tissue necrosis in individuals with no evidence of recent substance injection – individuals report exclusive consumption of street benzos (swallowed) or heroin (smoked). Difficulty reversing overdose presentation with naloxone – suspected synthetic opioid or xylazine involvement. Adverse effects include: anxiety or panic, difficulty breathing, loss of consciousness, pinpoint pupils and wounds.

 

Report 30

Local authority: Glasgow City

Reason for report: Adverse effects, overdose

Drug: Street benzos

Appearance: Unknown

Summary: Increase in overdoses observed in homeless service. Mainly related to street benzos (but in context of polydrug use). On average, reports mention consuming 5 to 14 pills. There has been a change in the overdose presentations in recent months including:

  • more intensive emergency care required – cardiopulmonary resuscitation (CPR), oxygen, intubation
  • increased vomiting and aspiration of vomit
  • vitals and responses fluctuating from normal to low, and back again
  • breathing more unusual – longer time between breaths
  • more pressure needed on pressure points to get responses
  • drifting in and out of consciousness – more difficult to keep them conscious
  • more naloxone required and going back into overdose after naloxone is administered
  • after effects last longer (tired, grouchy, just not 100%)
  • not making sense when speaking, plus other unusual effects – hallucinations and psychosis.

 

Report 33

Local authority: Argyll and Bute

Reason for report: Trend

Drug: Nitazenes, street benzos

Appearance: White circular pill

Summary: Street benzo sold as diazepam in blister packs labelled Bensedin. Tested by WEDINOS – found to contain bromazolam and metonitazene.

Report 5

Local authority: Highland

Reason for report: Concern, adverse effects

Drug: Heroin, benzos

Appearance: Unknown

Summary: Reports of increased overdoses and harms from police custody and hospital emergency departments, potentially related to benzodiazepines and heroin. Concerned that drugs are contaminated with opioids like fentanyl, but not confirmed by testing.

 

Report 6

Local authority: Shetland Islands

Reason for report: Overdose

Drug: Heroin

Appearance: Unknown

Summary: Multiple overdoses suspected to be related to heroin.

 

Report 9

Local authority: Aberdeen City

Reason for report: Deaths

Drug: Heroin

Appearance: Unknown

Summary: Multiple suspected drug deaths. No obvious links. Reports mention tablets and injecting drug use – heroin.

 

Report 17

Local authority: Shetland Islands

Reason for report: Adverse effects

Drug: Street benzos

Appearance: Unknown

Summary: Reports of adverse effects from the use of 'fake Valium'.

 

Report 23

Local authority: Aberdeen City

Reason for report: Deaths

Drug: Various

Appearance: Unknown

Summary: Multiple suspected drug deaths. No obvious link. Reports mention crack cocaine, oxycontin, pregabalin and prescription medicines.

 

Report 31

Local authority: Aberdeenshire

Reason for report: Adverse effects, overdoses

Drug: Various

Appearance: Unknown

Summary: Multiple suspected drug deaths. No obvious links. Reports mention polydrug use – heroin, methadone, crack cocaine, dihydrocodeine, Valium and other street-bought tablets.

 

Report 36

Local authority: Aberdeen City

Reason for report: Deaths

Drug: Various

Appearance: Unknown

Summary: Multiple suspected drug deaths of people aged under 25. Reports mention cocaine, alcohol and pink pills.

Reporting drug harms

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

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

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

Harm indicators

Naloxone administration by Scottish Ambulance Service

The average weekly number of naloxone administration incidents increased between June (89) and August 2023 (95). The total number of incidents during this time period (1,298) was 26% higher than in the previous time period (1,033). The number of incidents was 20% lower than the same period in 2021 (1,631) and 22% higher than in 2022 (1,062).

Background

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

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

The chart below shows the weekly number of SAS naloxone administration incidents from 31 May 2021 to 3 September 2023.

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

Image caption Naloxone administration by Scottish Ambulance Service

Summary

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

For the most recent time period (29 May to 3 September 2023):

  • 1,298 SAS naloxone incidents were recorded, at an average of 93 per week. Weekly numbers of incidents generally increased throughout this period.
  • The total number of incidents was 26% higher than in the previous 14-week period (20 February to 28 May 2023) when 1,033 incidents were recorded, at an average of 74 per week.
  • The total number of incidents was 20% lower than the same time period in 2021 (1,631, weekly average 117) and 22% higher than in 2022 (1,062, weekly average 76).
Local update

For the most recent time period (29 May to 3 September 2023), the number of naloxone administration incidents varied across mainland NHS Boards, compared to the previous time period:

  • Incidents increased in eight areas: NHS Ayrshire and Arran (15%), NHS Fife (18%), NHS Grampian (18%), NHS Borders (20%), NHS Greater Glasgow and Clyde (29%), NHS Lothian (45%), NHS Highland (51%) and NHS Lanarkshire (63%).
  • Incidents decreased in NHS Dumfries and Galloway (33%).
  • Incidents were broadly stable in the remaining NHS Boards.

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

Additional information

PHS was provided with these data by SAS.

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

Scotland's Take-Home Naloxone Programme

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

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

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

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

Drug-related attendances at emergency departments

Between June and August 2023, drug-related attendances at emergency departments increased by 13%, compared to the previous time period. A total of 1,403 attendances were recorded in this period – similar to the same time period in 2021 (1,433) and 22% higher than in 2022 (1,149).

Background

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

The chart below shows the weekly number of drug-related ED attendances between 31 May 2021 and 28 August 2023.

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

Image caption Drug-related attendances at emergency departments

Summary

Historic trend
  • An overall decreasing trend was observed in drug-related attendances at EDs between August 2021 and April 2022, with the lowest weekly levels in the time series observed in the week beginning 4 April (53).
  • Drug-related ED attendances increased sharply and peaked in May 2022, to 123 in the week beginning 16 May.
  • Attendances then decreased and remained stable, averaging 83 per week from June 2022 to March 2023.
National update

For the most recent time period (29 May to 3 September 2023):

  • 1,403 ED attendances were recorded, at an average of 100 per week. This was 13% higher than the previous 14-week period (20 February to 28 May 2023, 1,244, weekly average 89).
  • Attendances were similar to 2021 (1,433, weekly average 102) and 22% higher compared to the same time period in 2022 (1,149, weekly average 82).
Local update
  • For the most recent time period (29 May to 3 September 2023), the number of drug-related ED attendances varied across mainland NHS Boards, compared to the previous time period:
    • Attendances increased in eight areas: NHS Greater Glasgow and Clyde (11%), NHS Dumfries and Galloway (13%), NHS Lothian (16%), NHS Lanarkshire (26%), NHS Fife (29%), NHS Highland (31%), NHS Borders (33%) and NHS Forth Valley (45%).
    • Attendances decreased in two areas: NHS Ayrshire and Arran (6%) and NHS Tayside (10%).
    • Attendances were broadly stable in NHS Grampian.

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

Additional information

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

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

Drug-related acute hospital admissions

The average weekly number of drug-related hospital admissions increased between April (695) and June 2023 (905). The total number of admissions in this time period (2,378) was 26% higher than in the previous time period (1,886). The number of admissions was 28% lower than the same time period in 2021 (3,287) and 6% higher than in 2022 (2,242).

Background

The data used in these statistics relate to all inpatient and day-case admissions to general acute hospitals (excluding maternity, neonatal, geriatric long stay and admissions to psychiatric hospitals) where drug use was recorded as a diagnosis at some point during the patient's hospital stay. Data are presented by date of admission.

The chart below shows the weekly number of drug-related admissions to Scotland’s general acute hospitals from 29 March 2021 to 2 July 2023.

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

Image caption Drug-related hospital admissions

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

Summary 

Historic trend 
  • There was a long-term decreasing trend in the weekly number of drug-related hospital admissions from June 2021 to April 2022. Admissions briefly increased in April and May 2022, before decreasing again in June and remaining relatively stable between July and December 2022. Admissions then began to increase, from 118 in the week beginning 26 December 2022, to 151 in the week beginning 27 March 2023.
  • The long-term decreasing trend in admissions observed in 2022 differs markedly from previous years, which have generally been characterised by lower numbers during winter months and higher numbers during summer months. The data can be explored further on our dashboard (external website).
    • This decreasing trend should not be interpreted as a reduction in harms. The number of admissions may be affected by issues accessing urgent care services and by the capacity of hospital services.
  • In January to March 2023, the most common drug category recorded was opioids (48% of admissions), followed by cannabinoids (20%).
National update

For the most recent time period (3 April to 2 July 2023):

  • 2,378 drug-related hospital admissions were recorded, at an average of 183 per week.
  • Admissions generally increased throughout this period, from 158 in the week beginning 10 April, to 182 in the week beginning 26 June.
  • The total number of admissions in this time period (2,378) was 26% higher than in the previous 13-week period (1,886).
  • The total number of admissions was 28% lower than in 2021 (3,287, weekly average 253) and 6% higher than in 2022 (2,242, weekly average 172).
  • The most common substance type recorded continued to be opioids. These were recorded in an average of 46% of admissions per month, which was broadly consistent over the time series. Admissions recording cocaine and multiple/other drugs increased to a monthly average of 19% each.
Local update
  • For the most recent time period (3 April to 2 July 2023), the number of drug-related hospital admissions increased in all 11 mainland NHS Boards compared to the previous 13-week period ranging from 5% in NHS Fife, to 51% in NHS Lothian.

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

Additional information 

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

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

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

Suspected drug deaths

The average weekly number of suspected drug deaths increased between June (22) and August 2023 (25), averaging 23 per week. The total number of suspected drug deaths was 307. The number of deaths was similar to the same time period in 2021 (317) and 7% higher compared to 2022 (286).

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 the national statistics published by the National Records of Scotland (NRS) and do not provide a robust indication of the numbers of drug-related deaths occurring each year.

The chart below shows the weekly number of suspected drug deaths in Scotland from 31 May 2021 to 27 August 2023.

Image caption Suspected drug deaths

Summary 

Historic trend 
  • Between March and July 2021, the average weekly number of suspected drug deaths ranged from 21 to 37 deaths per week.
  • There was a sustained decrease in the number of deaths per week in August 2021. Between August 2021 and February 2023, the average weekly number of suspected drug deaths fluctuated considerably but remained within a range of 17 to 29 deaths per week.
Update 

For the most recent time period (29 May to 27 August 2023):

  • There were 100 suspected drug deaths in June, 89 in July and 118 in August. The number of suspected deaths in August was the highest monthly total observed since November 2022 (118).
  • There was a total of 307 suspected drug deaths, similar to the previous time period (309). This was similar to the same time period in 2021 (317) and 7% higher than in 2022 (286).
  • The average weekly number of suspected drug deaths decreased at the end of May and remained broadly stable until the end of August 2023.
  • For the most recent time period, an average of 23 suspected drug deaths were recorded per week. This weekly average was the same as the previous time period (23), and similar to the same periods in 2021 (24) and 2022 (22).

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

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

National statistics on drug-related deaths are published annually by the NRS during the summer and provide information broken down by age, sex, substance implicated and geographical area. The latest NRS publication reported that there were 1,051 drug-related deaths in Scotland in 2022. This was a 21% decrease compared to 2021 (1,330).

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

Toxicology indicators

Emergency department toxicology: ASSIST

Between May and August 2023, the 'A Surveillance Study of Illicit Substance Toxicity' (ASSIST) emergency department project made 810 detections of 52 different illicit drugs, in samples from 157 patients. The most detected drug category was depressants (63%), followed by opioids (15%). The most detected individual drug was cocaine (11%), followed by bromazolam (10%) and temazepam (8%).

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 assess the feasibility of prospective surveillance of ED attendances due to acute illicit drug toxicity, using 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.

Illicit drug definition

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

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

The total number of surplus serum sample results available for the first 12 months of the study was 448. Many of these involved multiple positive detections, therefore the total number of detections (2,281) is greater than the total number of samples.

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

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

Results

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

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

Image caption Toxicology analysis of surplus serum samples: drug category

Summary

Historic trend

Between 17 August 2022 and 16 May 2023:

  • The most detected drug category was depressants, making up 60% of all detections, followed by opioids (17%). The most detected individual drug was cocaine (10%).
  • 73% of attendances were male and 27% were female.
  • 51% were aged 34 and under. The most common age category was 25-24 (32%), followed by 35-44 (27%) and 16-24 (19%).
  • The most common outcomes were discharged to: home (41%), ward (26%) and police custody (11%).
Update

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

  • 372 individual ED attendances related to illicit drug use were identified
  • 157 surplus serum samples with toxicological analysis results are presented.
Drug type and category

Of the 157 samples analysed:

  • there was a total of 810 detections of 52 substances (found through the biological detection of the drug or its metabolite)
  • the average number of drugs detected per sample was five.

Of the 810 detections, the following drugs were the most common:

  • cocaine: 91 (11% of detections, 58% of samples)
  • bromazolam: 85 (10% of detections, 54% of samples)
  • temazepam: 64 (8% of detections, 41% of samples)
  • desmethyldiazepam: 61 (8% of detections, 39% of samples)
  • etizolam: 54 (7% of detections, 34% of samples)
  • oxazepam: 52 (6% of detections, 33% of samples)
  • diazepam: 46 (6% of detections, 29% of samples)
  • pregabalin: 44 (5% of detections, 28% of samples)
  • cannabis (tetrahydrocannabinol): 42 (5% of detections, 27% 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.

Image caption Toxicology analysis by drug type: per quarter

Depressants were the most common drug category, making up 63% of all detections (511).

  • Benzodiazepines were detected 449 times (55% of all detections).
  • In total, 30 different types of benzodiazepines were detected, including bromazolam, temazepam, diazepam and etizolam.
  • Bromazolam detections increased from 8% of all detections in the previous quarter, to 10% in the most recent period. The number of bromazolam-positive samples increased, from 37% of samples in the previous quarter, to 54% in the most recent period.
  • There was also an increase in detections of gidazepam (28, 3% of detections), flubromazepam (16, 2% of detections) and clonazolam (10, 1% of detections).
  • Gabapentinoids were detected 56 times (7%). Of these detections, 12 were gabapentin and 44 were pregabalin.
  • There was a small number of detections (< 5) of zopiclone, zolpidem, xylazine and meprobamate.

Opioids were the second most common drug category, making up 15% of all detections (126).

  • There were 44 detections of morphine (an opioid and metabolite of heroin and other opioids). There were 29 detections for codeine and 19 for methadone.
  • There was a small number of detections (< 5) of protonitazene, tapentadol, metonitazene, tramadol and buprenorphine.

Stimulants were the third most common drug category, making up 13% of all detections (104).

  • The most common stimulant was cocaine, making up 11% of all detections (91 times). The number of cocaine-positive samples increased, from 49% of samples in the previous quarter, to 58% in the most recent period.
  • The second most common stimulant was amphetamine, detected 7 times (1%).
  • There was a small number of detections (< 5) of MDMA, methamphetamine, 4-CEC (cathinone) and n-ethylpentylone (cathinone).
Further findings

Complete clinical data are available for 372 attendances for the most recent period (17 May to 16 August 2023):

  • 73% were male (272) and 27% were female (100).
  • 19% (69) were aged 16 to 24 and 29% (107) were aged 24 to 34.
  • Just over half were aged 35 and over, with 24% (89) aged 35 to 44, 20% (74) aged 45 to 54 and 7% (27) aged 55 years or older.
Image caption Attendances by age

ED outcome records show:

  • 131 (35%) patients were discharged home
  • 131 (35%) were admitted to a ward
  • 35 (9%) were taken into police custody
  • 34 (9%) self-discharged
  • 21 (6%) were admitted to an intensive care unit, high-dependency unit or critical care unit
  • 20 (6%) were recorded as 'unknown' or 'other'

Clinical severity outcome (after 28 days) recorded:

  • 354 patients were discharged
  • nine patients either died or remained an inpatient
  • outcomes for nine patients were 'unknown'

Additional information

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

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

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

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

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

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

Post-mortem toxicology testing for controlled substances

From April to May 2023, the most common drug types detected in post-mortem toxicology were opioids (72%) and benzodiazepines (60%). The most common individual drugs detected were cocaine (37%) and diazepam (37%), followed by methadone (35%) and heroin/morphine (33%). Bromazolam (a new benzodiazepine) was detected in 23% of deaths.

Background

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

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

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

The analysis in this report 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.

New data included in analysis

For the first time in a RADAR quarterly report, data are available for the whole of Scotland. Previous reports only included data on deaths in the west, east and parts of the north of Scotland (the areas covered by SPA FS).

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

Reporting period

This report includes two new periods of data:

  • 1 January to 31 March 2023, representing Q1 of calendar year 2023
  • 1 April to 31 May 2023 (most recent data discussed in the ‘Update’ section), representing partial data for Q2 of 2023.

More recent data are not yet available due to the transition of testing to SPA FS and the complexities of establishing a new service within a different organisation.

Controlled drugs detected at post-mortem

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 first chart provides an indication of controlled drugs detected at post-mortem, in deaths occurring between 1 January 2020 and 31 May 2023.

As indicated by the dotted vertical line on the chart, data for 2020 and 2021 are based on deaths in the west, east and parts of the north of Scotland. From January 2022 (Q1), the data include all areas in Scotland.

Image caption Forensic toxicology cases testing positive for controlled substances

Opioids and benzodiazepines

The next two charts provide an indication of specific opioids and benzodiazepines detected at post-mortem, in deaths where controlled drugs were detected, occurring between 1 January 2020 and 31 May 2023.

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

Summary

Historic trend
  • In total, 2,425 deaths occurred in 2022 where controlled drugs were detected in post-mortem toxicology across Scotland.
  • The most commonly detected drug types were opioids and benzodiazepines.
  • The percentage of deaths where opioids were detected have been gradually decreasing from a peak of 81% in Q2 of 2020, to 69% in Q1 of 2023:
    • Heroin/morphine and methadone were the most common opioids
    • Methadone detections increased sharply from 28% in Q1 of 2020, to 45% in Q2 of 2020, before decreasing to 25% in Q1 of 2023.
    • There has been a small but gradual increase in the number of cases where fentanyl-type opioids were detected, from around 1% before Q2 of 2022, to 6% in Q1 of 2023.
    • Deaths with buprenorphine present remained relatively low and stable throughout the time series (averaging 6%).
    • Nitazene-type opioids were first detected in Q2 of 2022. Routine testing on all samples from across Scotland was available from early 2023. In Q1 of 2023, nitazenes were detected in <1% of deaths.
  • The percentage of deaths where benzodiazepines were detected increased sharply between Q1 and Q2 of 2020. They remained high before gradually falling from 72% in Q1 of 2021, to 50% in Q3 of 2022. A slight increase was observed in Q1 of 2023.
    • Diazepam has been the most commonly detected benzodiazepine since Q2 of 2022 and, although there was a slight increase in Q4 of 2022, has remained relatively stable since Q1 of 2020.
    • Bromazolam (detected for the first time in Q3 of 2022) has increased sharply, replacing etizolam as the second most common benzodiazepine detected in Q1 of 2023.
    • Etizolam was the most common benzodiazepine detected for some time, increasing sharply in Q2 of 2020, before decreasing in Q3 2021. Since then, there has been a continued reduction in etizolam detections.
    • Clonazolam detections peaked at 12% in Q3 of 2021, decreasing to 1% in Q1 of 2023.
  • The percentage of deaths involving other opioids, gabapentin and pregabalin, or cocaine has remained relatively stable over time.
Update

For the most recent time period (1 April to 31 May 2023):

  • The total number of deaths testing positive for controlled substances was 380. Many of these deaths involved multiple positive detections, therefore the total number of detections listed below is greater than the total number of deaths.
  • The following drugs or drug types were most commonly detected:
    • opioids: 273 (72%)
    • benzodiazepines: 228 (60%)
    • cocaine: 142 (37%)
    • diazepam: 140 (37%)
    • methadone: 132 (35%)
    • gabapentin and pregabalin: 131 (34%).
  • The percentage of deaths where opioids were detected was relatively stable at 72% (from 69% in Q1):
    • Methadone detections increased to 35% (from 25% in Q1), replacing heroin/morphine as the most commonly detected opioid.
    • Heroin/morphine remained stable, detected in 33% of cases (from 32% in Q1).
    • Fentanyl-type opioids were detected in 3% of deaths (from 6% in Q1).
    • Nitazene-type opioids were detected in 1% of deaths (from <1% in Q1).
  • The percentage of deaths where benzodiazepines were detected increased to 60% (from 54% in Q1):
    • Diazepam detections increased to 37% (from 29% in Q1).
    • Bromazolam continued to increase sharply and was detected in 23% of deaths (from 18% in Q1).
    • Etizolam remained stable and was detected in 12% of cases (from 12% in Q1).
  • The percentage of deaths where cocaine was detected increased to 37% (from 29% in Q1), also making it the most commonly detected substance, alongside diazepam.
  • The percentage of deaths involving gabapentin and pregabalin remained relatively stable at 34% (from 32% in Q1).

Additional information

Toxicology services

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 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 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.

New drugs

New drugs (bromazolam, desalkylgidazepam and nitazene-type opioids) were detected for the first time when screening was expanded or testing was outsourced to other laboratories. These drugs may have been present before this time but were not being tested for, as they have only recently emerged in drug markets.

These data will develop further as new or emerging drugs are added to routine toxicology screening by the SPA FS and NHS Grampian.

Scope

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.

Date of death analysis

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 COPFS has been used instead.

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

Drug seizures in Scottish prisons

Synthetic cannabinoids were the most prevalent drug type detected in the Scottish Prisons Non-Judicial Drug Monitoring Project between April and July 2023, detected in 48% of samples. Benzodiazepines and steroids were the second most prevalent, both detected in 9% of samples, with bromazolam being the most prevalent benzodiazepine.

Background 

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

The chart shows the number and type of non-attributable samples seized in Scottish prisons between 1 April 2021 and 31 July 2023.

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 April 2021 and 30 June 2023. 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 varied widely between April and December 2021, ranging from 23 in June, to 134 in September. In 2022, the monthly average remained relatively stable at 35. During Q1 of 2023, the monthly average number of seizures was 50.
  • Sample-type data were highly variable over time. Changes were observed in sample-type detections during 2022 and 2023:
    • Paper and card detections decreased, from a monthly average of 73% in 2021, to 24% in 2022, to 6% in Q1 of 2023. This is thought to be due to changes to prison rules that mean prisoners now receive photocopied correspondence rather than original items.
    • E-cigarette detections increased from June 2022 onwards, making up an average of 30% of samples per month in 2022. This fell slightly to 25% in Q1 2023.
  • Drug-type data were highly variable over time, so the following narrative is based on averages:
    • Synthetic cannabinoids were the most common substances detected, followed by benzodiazepines.
    • In 2021, the percentage of seizures testing positive for synthetic cannabinoids was on average 42% per month. Percentages varied throughout 2022, averaging 33% per month, with higher percentages observed during the summer months. In 2023, monthly averages increased between January and March, from 19% to 33%.
  • The percentage of seizures testing positive for benzodiazepines fluctuated throughout 2021 (monthly average 38%), before decreasing and remaining relatively stable in 2022 (monthly average 26%). In 2023, monthly averages decreased between January and March, from 30% to 15%.
Update

This update provides analysis of 113 samples tested in the most recent time period (1 April to 31 July 2023):

Sample type
  • The most common sample type was e-cigarette (37% of samples).
    • The percentage of e-cigarettes fluctuated across the time period, from 18% in April to 70% in June.
    • Synthetic cannabinoids were detected in 57% of the e-cigarettes analysed.
  • Paper or card detections were the second most common sample type detected (16% of samples).
    • The percentage of paper or card detections fluctuated, from 6% in April to 47% in June.
Drug type
  • The three most detected controlled drug types were synthetic cannabinoids, benzodiazepines and steroids.
  • Synthetic cannabinoids were the most common drug type, detected in an average of 44% of seizures per month – similar to the average of 41% observed during the same time period in 2022.
  • Benzodiazepines and steroids were the second most common drug types.
    • 80% of benzodiazepine samples contained bromazolam. View our bromazolam alert.
    • Benzodiazepines were detected in an average of 9% of seizures per month – lower than the average of 21% during the same time period in 2022.
    • Steroids were detected in an average of 9% of seizures per month – similar to the average of 10% during the same time period in 2022.

Further information 

Between January and July 2023, this drug analysis project detected the following drugs for the first time in prisons in Scotland, demonstrating a constantly evolving drugs market: 

  • dipentylone (cathinone, stimulant)
  • MDMB-INACA (synthetic cannabinoid)

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 June and August 2023, the average weekly number of referrals to specialist drug treatment services was broadly stable. A total of 5,923 attendances were recorded in this period – 6% lower than in the same time period in 2021 (6,290) and 14% higher than in 2022 (5,183).

Background 

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

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

The chart below shows the weekly number of referrals to specialist drug treatment services between 24 May 2021 and 20 August 2023.

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

Image caption Specialist drug treatment referrals

Summary

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

For the most recent period (22 May to 20 August 2023):

  • 5,923 specialist drug treatment referrals were recorded, at an average of 456 per week.
  • This was 2% higher than the previous 13-week period (20 February to 21 May 2023) when 5,803 referrals were recorded, at an average of 446 per week.
  • Referrals were 6% lower compared to the same time period in 2021 (6,290, weekly average 484) and 14% higher than in 2022 (5,183, weekly average 399).
Local update

For the most recent period (22 May to 20 August 2023), the number of weekly drug treatment referrals varied across mainland NHS Boards, compared to the previous period:

  • Referrals increased in four areas: NHS Dumfries and Galloway (5%), NHS Ayrshire and Arran (7%), NHS Lanarkshire (12%) and NHS Forth Valley (50%).
  • Referrals decreased in two areas: NHS Borders (27%) and NHS Grampian (28%).
  • Referrals were broadly stable in the other mainland NHS Boards.

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

Additional information

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

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

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

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

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

Opioid substitution therapy

Opioid substitution therapy (OST) prescribing data for April to June 2023 has been delayed due to issues affecting PHS's Prescribing Information System.

We anticipate that updated OST prescribing data will be available for the next release of this report in January 2024.

OST prescribing data to March 2023 are available in the previous quarterly report and in the RADAR dashboard.

Our annual update on the Estimated numbers of people prescribed opioid substitution therapy in Scotland in 2022/23, can be viewed on our website.

Injecting equipment provision

The average weekly numbers of injecting equipment provision (IEP) transactions, and needles and syringes distributed, increased between April and June 2023. During this period, the total numbers of transactions, and needles and syringes distributed, were lower than in the same period in 2021 (12% and 7% respectively) and similar to 2022.

Background 

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

The chart below shows the weekly number of IEP transactions from 5 April 2021 to 2 July 2023.

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

Image caption Injecting equipment provision: transactions

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

Summary

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

For the most recent time period (3 April to 2 July 2023):

IEP transactions

  • 37,959 transactions were recorded, at an average of 2,920 per week.
  • This was 6% higher than the previous 13-week period (2 January to 2 April 2023) when a total of 35,667 transactions were recorded (weekly average 2,744).
  • The number of transactions was 12% lower than the same time period in 2021 (43,046, weekly average 3,311) and similar to 2022 (38,102, weekly average 2,931).

Needles and syringes distributed

  • 494,660 needles and syringes were distributed, at an average of 38,051 per week.
  • This was similar to the previous time period when a total of 484,967 needles and syringes were distributed, at an average of 37,305 per week.
  • The number of needles and syringes distributed was 7% lower compared to the same time period in 2021 (529,960, weekly average 40,766) and similar to 2022 (483,377, weekly average 37,183).

Ratio of needles and syringes distributed

  • There was a weekly average of 14 needles and syringes distributed per transaction.
  • This was similar to the previous time period (15) and equal to the same time periods in 2021 and 2022 (both 14).

For visualisations of all IEP indicators and breakdowns by NHS Board, please see the RADAR dashboard (external website).

Additional information 

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

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

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

Contact

General enquiries

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

Reporting a drug harm

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

Media enquiries

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

Requesting other formats and reporting issues

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

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

Further information

Data and intelligence

View our wider drug data and intelligence.

Public health information

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

Metadata

Publication title

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

Theme

Substance use surveillance

Topic

Drugs

Format

HTML

Release date

24 October 2023

Frequency

Quarterly

Relevance and key uses of the statistics

Data are collected as part of public health surveillance on substance use in Scotland.

The most up–to–date data available is published in this report to provide a timely indicator of drug trends as part of RADAR, Scotland’s Drugs Early Warning System.

Revisions statement

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

Revisions relevant to this publication

N/A

Comparability

Data are not comparable outwith Scotland.

Accuracy

The data are considered accurate.

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

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

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

Accessibility

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

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

Coherence and clarity

The report is available as HTML web pages.

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

Disclosure

Our protocol on statistical disclosure is followed.

Official Statistics designation

Management Information Report

UK Statistics Authority Assessment

N/A

Last published

25 July 2023

Next published

30 January 2024

Date of first publication

11 October 2022

Help email

phs.drugsradar@phs.scot

Date form completed

11 October 2023

 

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

Description

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

Data source(s)

Police Scotland STOP Unit

Date that data were acquired

20 September 2023

Timeframe of data and timeliness

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

Continuity of data

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

Concepts and definitions

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

Nitazenes are a group of potent synthetic (lab-made) opioids. Opioids are drugs that act on the opioid receptors to produce painkilling and depressant effects.

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 July and 4 October 2023. Data were collated on 5 October 2023.

Timeframe of data and timeliness

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

Continuity of data

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

Accuracy

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

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

Concepts and definitions

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

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

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

Nitazenes are a group of potent synthetic opioids.

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

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. Data are also displayed by quarter in a stacked bar chart. This chart shows the percentage of reports by drug type. The number of reports varied by quarter: Q3 2022 – 8, Q4 2022 – 19, Q1 2023 – 24, Q2 2023 – 24 and Q3 2023 – 42. 

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 September 2023

Timeframe of data and timeliness

31 May 2021 to 3 September 2023, approximately two months in arrears.

Continuity of data

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

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

Concepts and definitions

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

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

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

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

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

Completeness

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

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

12 September 2023

Timeframe of data and timeliness

31 May 2021 and 3 September 2023, approximately two months in arrears.

Continuity of data

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

Concepts and definitions

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

Completeness

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

Value type and unit of measurement

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

Description

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

Data source(s)

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

Date that data were acquired

26 September 2023

Timeframe of data and timeliness

29 March 2021 to 2 July 2023, approximately four months in arrears.

Continuity of data

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

Concepts and definitions

Opioids       

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

Cannabinoids

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

Cocaine

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

Sedatives and hypnotics

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

Multiple/other

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

Completeness

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

Completeness levels for NHS Fife, Highland and Shetland were below 90% as of 11 September 2023 for the most recent time period (April – June 2023), therefore caution is advised when interpreting trends in these areas on the dashboard.

Value type and unit of measurement

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

Description

This indicator provides information on suspected drug deaths in Scotland.

Data source(s)

Police Scotland

Date that data were acquired

18 September 2023

Timeframe of data and timeliness

31 May 2021 to 27 August 2023, approximately two months in arrears.

Continuity of data

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

Concepts and definitions

Drug-related death

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

Suspected drug death

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

Completeness

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

Value type and unit of measurement

Numbers of suspected drug deaths in Scotland and moving averages.

Description

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

Data source(s)

QEUH, NHS Greater Glasgow and Clyde

Date that data were acquired

12 October 2023

Timeframe of data and timeliness

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

Continuity of data

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

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

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

Concepts and definitions

Unique ED attendances

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

Illicit drug

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

Benzodiazepines

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

Metabolite

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

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

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

Cocaine

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

Gabapentinoids

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

Opioids

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

Cannabinoids

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

Other stimulants

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

Completeness

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

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

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

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

Value type and unit of measurement

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

Description

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

Data source(s)

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

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

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

Date that data were acquired

20 September 2023

Timeframe of data and timeliness

1 January 2020 and 31 May 2023, approximately four months in arrears.

Continuity of data

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

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

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

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

Concepts and definitions

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

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

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

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

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

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

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

Benzodiazepines

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

Cocaine

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

Gabapentin and pregabalin

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

Opioids

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

Completeness

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

Value type and unit of measurement

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

Description

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

Data source(s)

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

Date that data were acquired

12 September 2023

Timeframe of data and timeliness

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

Continuity of data

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

Concepts and definitions

Benzodiazepines

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

Cocaine

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

Gabapentinoids

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

Opioids

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

Synthetic cannabinoids

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

Completeness

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

Value type and unit of measurement

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

Description

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

Data source(s)

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

Date that data were acquired

13 September 2023

Timeframe of data and timeliness

24 May 2021 to 20 August 2023, approximately two months in arrears.

Continuity of data

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

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

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

Concepts and definitions

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

Completeness

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

Value type and unit of measurement

Number of specialist drug treatment referrals and moving averages.

Description

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

Data source(s)

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

Date that data were acquired

22 June 2023

Timeframe of data and timeliness

1 January 2021 to 31 March 2023. Data from the PIS are available approximately three months in arrears.

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

Continuity of data

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

OST prescribing data for the period from April to June 2023 has been delayed due to issues affecting PHS's Prescribing Information System. We anticipate that updated OST prescribing data should be available for the next release of this report in January 2024. OST prescribing data to March 2023 are available in the RADAR quarterly report – July 2023 and in the RADAR dashboard.

Concepts and definitions

Defined daily dose

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

Average daily quantity

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

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

Buprenorphine

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

Opioids

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

Methadone

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

Accuracy

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

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

Completeness

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

Value type and unit of measurement

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

Description

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

Data source(s)

Needle Exchange Online (neo360)

Date that data were acquired

16 August 2023

Timeframe of data and timeliness

5 April 2021 to 2 July 2023

Data are available approximately three months in arrears.

Continuity of data

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

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

Concepts and definitions

Transactions

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

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

Completeness

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

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

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

Value type and unit of measurement

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

Last updated: 20 November 2023
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