National Mission: annual report 2024-2025

5. Outcomes 3 & 4: People at most risk have access to treatment and recovery & people receive high quality treatment and recovery services

5.1 Overview

Treatment is a protective factor against drug-related deaths and harms^[1], and it is vital that treatment is high-quality, evidence-based and promotes a recovery orientated system of care to get more people into the treatment they need by making sure services are accessible and effective. This includes the wide range of treatment provision available – both community-based and residential. All 10 MAT Standards are key elements in delivering these outcomes.

5.2 Progress in 2024-25

5.2.1 Medication Assisted Treatment Standards

In 2024-25, all local areas have made commendable strides in implementing all of the MAT Standards. The PHS based MAT Standards Implementation Support Team (MIST) have been supporting the roll out of the standards by ensuring that local areas have systems, protocols and procedures in place to be able to continuously improve services based on evidence, including experiential evidence from people who use services.

The fourth PHS National Benchmarking Report was published on 17 June 2025. In 2024-25, across all areas for MAT standards 1 to 5, 91% were assessed as fully implemented. For MAT standards 6 to 10, 75% were assessed as RAGB fully implemented. This was reflective of changes to the evidence requested by the programme for 2024/25.

The MAT Standards align closely with the Charter’s seven core rights, with experiential assessment drawing on lived and living experience to evaluate how well services reflect a human rights-based approach in practice. The FAIR model is used to assess and document this alignment, helping to embed rights-based values across care provision and incorporate the Charter meaningfully into everyday service delivery. To support this work, the National Collaborative has developed a practical Charter Toolkit for duty bearers, guiding implementation and improvement efforts.

5.2.2 Long-acting injectable buprenorphine

Long-acting injectable buprenorphine (brand name Buvidal) is a form of medicine which can be prescribed for opioid substitution therapy if clinically appropriate.

The intention of MAT standard 2 is to ensure that all people are supported to make an informed choice on what medication to use (if any) and having long-acting buprenorphine available as a choice of medication assisted treatment meets the criteria for implementation of this standard. IAs reported in the 2024-25, Benchmarking Report, published on 17 June 2025, MAT Standard 2 was fully implemented or sustained in 27 out of 29 (93%) ADP areas and partially implemented in 2 out of 29 (7%) ADP areas.

5.2.3 Benzodiazepines

The 2024-25 National Benchmarking Report on the Implementation of the MAT Standards notes the challenges around changing trends in substance use, with increasing benzodiazepine and cocaine use as well as continued higher volume of patients using alcohol to harmful or dependant levels and will be a focus for 2025-26.

In 2024-25 the Scottish Government published two prescribing guides:

• Quality Prescribing for Antidepressants: A Guide for Improvement 2024-2027.
• Quality Prescribing for Benzodiazepines and z-drugs - A Guide for Improvement 2024-2027.

The Guide for Benzodiazepines and z-drugs is intended to support key stakeholders and prescribers to deliver proactive person-centred medication reviews to ensure effective use of benzodiazepine and z-drugs and minimise risks associated with their use. The Guide for Antidepressants is intended to further improve the care of individuals receiving antidepressant medication and promote a holistic approach to person-centred care.

Although the guides do not cover the use of benzodiazepines in the treatment for problem substance use, the 7-Steps medicine review process to appropriate prescribing and polypharmacy should be used when reviewing treatment for harm reduction.

In 2024-25, National Mission funding was continued for a pilot benzodiazepine clinic in Fife. The purpose of the clinic is to deliver interventions and support, to reduce harm and ultimately drug deaths associated with benzodiazepine misuse. The service aims to bring an increase in the provision of psychological interventions and will be evaluated to share learning and any early results.

5.2.4 Primary Care

Primary Care support is a vital strand in delivering the National Mission. MAT standard 7 seeks to ensure that all people have the option of MAT shared with primary care.

In 2024-25, the National Benchmarking Report on the Implementation of the MAT Standards reported that MAT standard 7 was fully implemented in 18 out of 29 (62%) ADP areas and was partially implemented in 11 out of 29 (38%) ADP areas.

Community pharmacies continue to play an important role in the dispensing of opioid substitution treatment and other medicines. The Benchmarking Report on Implementation of the MAT Standards notes that this provision has enabled localities to reduce reliance on formal local enhanced service arrangements and broaden the provider base to community pharmacies and specialist-orientated practices.

To address the oral health improvement of people who use drugs, the Scottish Government is working with the University of Dundee, in partnership with Public Health Scotland on a project called ‘Creating Oral Health Resource Material for People Using Substances (COMPUS)’.

The intention of the project is to enable health professionals to meet the specific oral health needs of people who use drugs in Scotland, as well as considering the messaging and methodology for engaging these patients. The Tayside GP Redesign Project was supported to explore how to better design services to enable individuals who experience drug problems to access a full menu of services within primary care (which falls under MAT Standard 7 Primary Care). The project developed shared care protocols between specialist services, GP and community pharmacies for people who were on Medication Assisted Treatment and is continuing to expand and explore other pathways and patient groups.

There is a well-established Naloxone community pharmacy initiative embedded within primary care, which increased pharmacy involvement in both prescribed and non-prescribed supply routes, to improve access for individuals at risk of opioid overdose.

According to PHS Quarterly Report on Naloxone, community pharmacies supplied the following number of Take-Home Naloxone kits for Quarter 3 of 2024/25 (1 October – 31 December 2024):

• 752 kits, supplied via prescriptions.
• 156 kits, supplied via non-prescription.

This supply highlights how community pharmacies are expanding Naloxone access across Scotland.

5.2.5 Treatment Target

In the 12-month period ending 30 September 2024 (the end of 2024/25 Q2), Opioid Substitution Therapy (OST) was prescribed to an estimated minimum of 29,126 people in Scotland. This is 1.2% (350) fewer than in the 12 months to the end of the previous financial year quarter (2024/25 Q1) when an estimated minimum of 29,476 people were prescribed OST. Findings of Public Health Scotland's investigation into the reduction in referrals to specialist drug and alcohol treatment will help us understand the reasons for current treatment numbers.

OST is still the most common treatment for people with opioid dependence and has a substantial evidence base for effectiveness in achieving positive outcomes. Based on the most recent estimated prevalence of opioid dependence in Scotland, for 2022/23, an estimated 66% of people with opioid dependence received opioid agonist therapy (OAT) at least once during the year, while 79% had received OAT at some point during the five-year period 2018/19 to 2022/23. This was ‘high compared to many sites globally’. We continue to support take up of OST through our implementation of the Medication Assisted Treatment (MAT) standards.

5.2.6 Residential Rehabilitation

The National Mission includes a commitment to significantly increase the funding available for residential rehab and associated aftercare over this parliamentary term.

The Scottish Government in collaboration with our expert Residential Rehabilitation Working Group defines residential rehab as:

Residential facilities offering programmes which;

• Aim to support individuals to attain an alcohol or drug-free lifestyle and to be re-integrated into society,
• provide intensive psychosocial support and a structured programme of daily activities
• residents are required to attend over a fixed period of time

In a statement to Parliament in November 2021 the then Minister for Drugs Policy committed to increasing the number of statutory funded placements in Residential Rehabilitation by 300% and increasing the number of beds available by 50% so that by 2026 there are at least 650 beds and 1,000 people are publicly funded for their placement each year. There are three key parts to our national approach to achieving improvements in treatment options and recovery pathways: improving pathways into and from rehabilitation services, in particular for those with multiple complex needs; investing in a significant increase in the capacity of residential rehab services; and developing a standardised approach to commissioning residential rehab services.

Pathways

Healthcare Improvement Scotland continue to sustain regional improvement hubs across the country supporting ADPs and their wider system stakeholders to collaborate, share learning, and identify best practices.

All ADPs have now been supported to co-design improvements to their residential rehab pathways. This has included supporting ADPs to complete detailed self-assessment of their current pathway, preparing evidence based thematic analysis of their local data and key areas of improvement to expand capacity. Key areas of improvement will then be addressed through the co-production of a multi-disciplinary action plans to develop, define and prioritise short, medium and long term goals, that will ensure pathways are equitable, accessible, and easy to navigate.

Residential Rehab Capacity

In 2024-25, Lothians and Edinburgh Abstinence Programme (LEAP) maintained a high level of capacity throughout the year, with 64% of patients completing treatment. The development of LEAP’s Peer Bridging Programme has increased admissions and decreased the rate of discharges against medical advice. The aftercare group established in Mid and East Lothian is expected to further increase aftercare uptake for those living further from LEAP, leading to better outcomes for this group. Harper House, Phoenix Futures’ national family residential rehabilitation service, supported 35 placements in 2024-25, and has developed several local pathways and interventions to help prevent families from encountering barriers to accessing residential treatment.

The children’s charity Aberlour opened their second Mother and Child House in Falkirk in August 2024. In 2024-25, a total of 12 women received support over both recovery houses, with 3 babies being born in-service.

In addition to the first round of RRRCP projects, we have supported the second round of projects to opening. Phoenix Futures’ new 27 bed core service in Alford, Aberdeenshire – Rae House – opened for referrals in January 2025 and had supported 29 placements by the end of March Phoenix have also developed the second phase of this project, which is a Therapeutic Community Dayhab model in Aberdeen, with the first units coming online in April and more to follow in summer 2025.

The expansion at the Maxie Richards Foundation’s service in Tighnabruaich opened in November 2024, providing an additional bed and renovated facilities, and the expansion to CrossReach’s Beechwood House in Inverness, providing 6 additional beds, has been completed and is scheduled to have an official opening in summer 2025.

Progress against our target to increase the number of RR beds to 650 was published by the Scottish Government in November 2024. These statistics showed that since the start of the National Mission, Residential Rehabilitation capacity in Scotland had increased by 88 beds or 21%. This is still short of our target to increase capacity to 650 by 2026 however several new facilities noted above have opened since the publication with more scheduled to open in the coming months.

Residential Rehab Placements

As part of their wider evaluation of the residential rehabilitation programme, Public Health Scotland (PHS) published a report in December 2024 on the number of people who started a residential rehabilitation placement between 2019/20 and 2022/23. The report shows that in 2022/23 1,670 individuals were recorded as having started a residential rehabilitation placement in Scotland. Of these placements, 1,033 (62%) individuals started a placement which was publicly funded and 637 (38%) started a placement which was solely privately funded. We are encouraged to see that this first batch of data suggests that the Scottish Government achieved its objective of 1000 people per year receiving public funding for their residential rehab placement in 2022/23.

As data on people starting a residential rehabilitation placement is only currently available up to 2022/23 (and so is outwith the reporting period of this annual report), data provided by statutory funders on the number of approved statutory funded placements may be used in the interim to provide an indication of activity. These data include all placements approved for funding under the Scottish Government Residential Rehabilitation programme. From April 2024 up until March 2025, a total of 913 residential rehabilitation placements were approved for statutory funding in Scotland. PHS will provide an update on the number of individuals who started a residential rehabilitation placement in Scotland later this year which will inform on progress made toward the objective of 1000 people per year in 2024/25.

Scotland Excel continue to engage with ADPs and providers on the provisions of rehabilitation in Scotland. A quarterly review process has been established, where information is gathered from both purchasers and providers and are discussed during quarterly review meetings. In addition, the National Flexible Framework has been reopened to new applicants and will remain open until the end of the flexible frame agreement. Scotland Excel receive, evaluate and award applications as they are made, using the same evaluation and award criteria as for the original process.

Scotland Excel is also responsible for managing and reporting on the £2 million Additional Placement Fund (APF), which was announced on 07 August 2024. The APF was designed to allow ADPs to access funding for additional residential rehabilitation placement once their own budget has been exhausted. This targeted and demand led approach ensures that areas with the highest demand as a result of individual circumstances or efficient RR pathways are able to access the funding they need to ensure that those who seek abstinence based residential treatment are able to access it. The APF had a positive impact in helping meet our commitment to increasing the number of people receiving public funding for Residential Rehabilitation (RR) to 1000 by 2026.

Dual Housing Support Fund (DHSF)

The Dual Housing Support Fund (DHSF) has been in operation since summer 2021, to provide immediate support to individuals who want to keep their tenancies whilst in residential rehabilitation services that are funded by social security payments, namely Housing Benefit or the housing element of Universal Credit.

A review of the DHSF protocol has now concluded, and as a result we have streamlined the process to make it easier for eligible individuals to access the fund. We are currently engaging with key stakeholders on finalisation of the new process and look forward to the publication of the revised protocol.

The website – rehab.scot – was publicly launched in August 2024. The directory provides a nationwide list of residential rehabilitation providers for the first time, empowering individuals and their loved ones to learn about and access quality residential rehabilitation and identify the best service to support them.