National Mission on Drugs: Annual Monitoring Report 2023-2024

Footnotes

1 Life Expectancy in Scotland 2021-23, National Records of Scotland, October 2024

2 NRS uses the terminology “drug misuse deaths” in their ‘Drug-related deaths in Scotland’ statistical publication, which is consistent with the terminology used in other parts of the UK. However, due to the potential for this to be stigmatising language, this report uses the more neutral “drug deaths” to refer the same figures.

3 Drug-related deaths in Scotland in 2023, National Records of Scotland, August 2024

4 Age-standardised drug misuse mortality rate of 31.7 (males) and 13.6 (females) per 100,000 in 2023.

5 The definitions used for drug-related death statistics are consistent across the UK, but there are differences in data collection methods and death registration systems that affect these statistics and their comparability across nations. The ‘drug poisoning’ definition is the most accurate comparator across the UK. See What actually counts as a drug death?, National Records of Scotland, 22 August 2023

6 Deaths related to drug poisoning in England and Wales: 2023 registrations, Office for National Statistics, October 2024

7 Drug-related deaths in Scotland in 2023, National Records of Scotland, August 2024

8 Suspected drug deaths in Scotland: July to September 2024, Scottish Government, December 2024

9 Rapid Action Drug Alerts and Response (RADAR) quarterly report, Public Health Scotland, January 2025

10 Drug-related deaths in Scotland in 2023, National Records of Scotland, August 2024. In 2023, there were 479 drug misuse deaths where cocaine was implicated an increase of 29% (108 deaths) compared with 2022 when there were 371 such deaths.

11 Rapid Action Drug Alerts and Response (RADAR) quarterly report, Public Health Scotland, January 2025. The ASSIST study monitors drug trends and associated clinical features through the surveillance of Emergency Department attendances due to acute illicit drug toxicity.

12 Needle Exchange Surveillance Initiative (NESI): Monitoring blood-borne viruses and injecting risk behaviours among people who inject drugs in Scotland 2008-09 to 2022-23, Public Health Scotland, August 2024. Cocaine injecting has increased dramatically over time, with 60% of those who had injected in the past six months reporting it in 2022-23, up from 37% in 2019-20. Polydrug injection (injection of two or more drugs in the past six months) has increased from 12% in 2010 to 43% in 2022-23.

13 Drug-related deaths in Scotland in 2023, National Records of Scotland, August 2024

14 Evaluation of the 2021-2026 National Mission on Drugs Deaths: Evaluation Framework, Public Health Scotland, May 2024

15 Estimated Prevalence of Opioid Dependence in Scotland 2014/15 to 2019/20, Public Health Scotland, March 2024

16 Scottish Health Survey dashboard, Scottish Government, March 2025. The Scottish Health Survey may not capture a representative sample of people who have a current problem with drug use and is therefore likely to underestimate prevalence.

17 Scottish Health Survey dashboard, Scottish Government, March 2025. Note that due to the small sample size caution is advised when interpreting these statistics. The Scottish Health Survey may not capture a representative sample of people who have a current problem with drug use and is therefore likely to underestimate prevalence.

18 School exclusion statistics, Scottish Government, March 2024. These statistics are collected and published biennially. The next wave of data will cover the period 2024/25.

19 The school year covered by the 2020/21 exclusions statistics was substantially affected by the COVID-19 pandemic – some of the decrease in exclusions observed between 2018/19 and 2020/21 was due to the pandemic limiting the amount of time that pupils were in school.

20 Total incidents over the 52 weeks to 24 March 2024.

21 Total incidents over the 52 weeks to 26 March 2023.

22 Total incidents over the 26 weeks to 18 September 2023 and total incidents over the 26 weeks to 16 September 2024

23 Quarterly Policing Performance Report – Quarter 2 2024/25, Scottish Police Authority, December 2024

24 Drug-related Hospital Statistics, Public Health Scotland, April 2024.

25 A ‘stay’ refers to a continuous period spent in a hospital setting. A patient may have more than one hospital stay during a financial year therefore the number of stays may be higher than the number of patients. Each stay begins with a referral or admission and is ended by a discharge. The definition of a drug-related hospital stay includes drug poisonings/overdoses and mental & behavioural stays. Analysis is based on date of discharge.

26 European age-standardised rate – allows valid comparisons to be made over time and between local areas and other countries with different population age-sex structures.

27 This group of drugs includes ‘prescribable’ benzodiazepines, ‘street’ benzodiazepines and z-hypnotics.

28 Management information here describes data collated and used in the normal course of business for operational purposes. It is not subject to the same level of validation and quality assurance as official statistics but can provide useful insight into recent trends if used appropriately and with awareness of the associated limitations.

29 Rapid Action Drug Alerts and Response Quarterly Report, Public Health Scotland, January 2025. Data relates to all inpatient and day-case admissions to general acute hospitals (excluding psychiatric hospitals) where drug use was recorded as a diagnosis at some point during the patient’s hospital stay. Analysis is based on date of admission.

30 Surveillance of hepatitis C in Scotland – Progress on elimination of hepatitis C as a major public health concern: 2024 update, Public Health Scotland, January 2025.

31 Needle Exchange Surveillance Initiative (NESI): Monitoring blood-borne viruses and injecting risk behaviours among people who inject drugs in Scotland 2008-09 to 2022-23, Public Health Scotland, August 2024. NESI is a voluntary survey of people who inject drugs and are engaged with harm reduction services. As such, it may not be representative of all people who use drugs in Scotland.

32 Rapid Action Drug Alerts and Response Quarterly Report, January 2025, Public Health Scotland

33 Drug and Alcohol Information System (DAISy): Overview of initial assessments for specialist drug and alcohol treatment 2023/24, Public Health Scotland, November 2024. DAISy is a national database developed to collect drug and alcohol referrals, waiting times, treatment and outcome information from staff delivering specialist drug and alcohol interventions.

34 Surveillance of hepatitis C in Scotland – Progress on elimination of hepatitis C as a major public health concern: 2024 update, Public Health Scotland, January 2025. NESI is a voluntary survey of people who inject drugs and are engaged with harm reduction services. As such, it may not be representative of all people who use drugs in Scotland.

35 This is done by counting first supplies only (i.e. excluding repeat and spare supplies) to people at risk of an opioid overdose (excluding supplies made to service workers and family/friends). Within a specific time period, ‘reach’ effectively corresponds to the number of ‘at risk’ individuals newly supplied with take home naloxone and is therefore lower than the number of kits distributed in that period. The number of individuals ‘at risk’ is the drug prevalence data from 2015/16.

36 National benchmarking report on the implementation of the medication assisted treatment (MAT) standards: Scotland 2023/24, Public Health Scotland, July 2024

37 MAT standards are assessed for 29 rather than 30 ADP areas (Clackmannanshire, Stirling and Falkirk submit combined reporting).

38 Alcohol and Drug Partnerships (ADP) 2023/2024 Annual Survey, Scottish Government, November 2024

39 McAuley A, Fraser R, Glancy M, Yeung A, Jones HE, Vickerman P, Fraser H, Allen L, McDonald SA, Stone J, Liddell D. Mortality among individuals prescribed opioid-agonist therapy in Scotland, UK, 2011–20: a national retrospective cohort study. The Lancet Public Health. 2023 Jun 6.

40 Residential rehabilitation: literature review Scottish Government, May 2022

41 National drug and alcohol treatment waiting times, Public Health Scotland, December 2024 release, data extracted January 2025. Data sourced from DAISy, a national database developed to collect drug and alcohol referrals, waiting times, treatment and outcome information about delivery of specialist drug and alcohol interventions. DAISy was available in all NHS Boards from April 2021 and provides information on how Scotland is responding to demand for specialist drug and/or alcohol use services. Co-dependency was added as a new treatment category with the introduction of DAISy. As such there are no referrals for co-dependency prior to the introduction of the DAISy system.

42 National drug and alcohol treatment waiting times: 1 January to 31 March 2021, Public Health Scotland, June 2021. The spike in the first quarter of 2021/22 may be due to a post-pandemic catch-up effect of changes in service provision, assumptions around availability of services, and attendance during the COVID-19 lockdown period.

43 National drug and alcohol treatment waiting times, Public Health Scotland, December 2024 release, data extracted January 2025.

44 Alcohol and Drug Partnerships (ADP) 2023/2024 Annual Survey, Scottish Government, November 2024

45 Waiting times are a high-profile measure of how Scotland is responding to demand for services. Scottish Government has an established target that 90% of people referred for help with problematic drug or alcohol use will wait no longer than three weeks for specialist treatment that supports their recovery.

46 National drug and alcohol treatment waiting times - 1 July 2024 to 30 September 2024, Public Health Scotland, December 2024. Data downloaded January 2025.

47 NHS Ayrshire and Arran, NHS Borders, NHS Dumfries and Galloway and NHS Shetland. Based on data available – data for NHS Shetland is not included in the PHS report for some quarters due to challenges with meeting compliance sign-off processes within the required timescale.

48 National benchmarking report on the implementation of the medication assisted treatment (MAT) standards: Scotland 2023/24, Public Health Scotland, July 2024

49 MAT standards are assessed for 29 rather than 30 ADP areas (Clackmannanshire, Stirling and Falkirk submit combined reporting).

50 Alcohol and Drug Partnerships (ADP) 2023/2024 Annual Survey, Scottish Government, November 2024

51 Pre-arrest: services for police to refer people into without making an arrest. In police custody: services available in police custody suites to people who have been arrested. In courts: services delivered in collaboration with the courts (e.g. services only available through a specialist drug court, services only available to people on a Drug Testing and Treatment Order). In prison: services available to people in prisons or young offenders’ institutions in the ADP areas (if applicable); not all ADPs have prisons in their area. Upon release: services aimed specifically at supporting people transitioning out of custody.

52 Alcohol and Drug Partnerships (ADP) 2022/23 Annual Survey, Scottish Government, September 2023

53 Expanding access to Residential Rehabilitation in Scotland, Scottish Government, November 2021

54 McAuley A, Fraser R, Glancy M, Yeung A, Jones HE, Vickerman P, Fraser H, Allen L, McDonald SA, Stone J, Liddell D. Mortality among individuals prescribed opioid-agonist therapy in Scotland, UK, 2011–20: a national retrospective cohort study. The Lancet Public Health. 2023 Jun 6.

55 Residential rehabilitation: literature review Scottish Government, May 2022

56 Medication Assisted Treatment (MAT) standards: access, choice, support, Scottish Government, May 2021

57 Drug and alcohol information system (DAISy) overview of initial assessments for specialist drug and alcohol treatment 2023/24, Public Health Scotland, November 2024. An ‘episode of care’ is first recorded on DAISy when people engage with a service provider for specialist alcohol and/or drug treatment. ‘Episodes of care’ are eligible to have an initial assessment recorded once a treatment start date has been agreed and entered into the system. Initial assessments must be submitted within eight weeks of the treatment start date. It should be noted that a person may start multiple episodes of care during a financial year.

58 Estimated number of people prescribed Opioid Substitution Therapy (OST) in Scotland, by local authority of residence and NHS Board, 2014/15 to 2023/24 (annual OST patient estimates), Public Health Scotland, July 2024. Methadone hydrochloride, buprenorphine, buprenorphine & naloxone, and long-acting buprenorphine including Buvidal© slow-release formulations. These figures are described as ‘estimates’ or ‘minimum numbers’ due to issues associated with the capture of Community Health Index numbers from OST prescriptions, which means it is challenging to provide a robust count of the number of people prescribed these medications. Data are sourced from the Prescribing Information System and the Hospital Medicine Utilisation Database. Estimates include patients supplied with injectable buprenorphine via hospital stock order systems.

59 Rapid Action Drug Alerts and Response Quarterly Report, Public Health Scotland, January 2025

60 Interim monitoring report on statutory funded residential rehabilitation placements, Public Health Scotland, December 2024. Note that these data only capture the number of approved placements and do not provide insight into outcomes.

61 Evaluation of the Scottish Government Residential Rehabilitation Programme: number of individuals starting a residential rehabilitation placement per financial year, Public Health Scotland, December 2024

62 Residential rehabilitation bed capacity in Scotland, Scottish Government, November 2024

63 National benchmarking report on the implementation of the medication assisted treatment (MAT) standards: Scotland 2023/24, Public Health Scotland, July 2024

64 Medication Assisted Treatment: evaluation of current practice in 8 health board areas across Scotland Scottish Drugs Forum, August 2024

65 National benchmarking report on the implementation of the medication assisted treatment (MAT) standards: Scotland 2023/24, Public Health Scotland, July 2024

66 MAT standards are assessed for 29 rather than 30 ADP areas (Clackmannanshire, Stirling and Falkirk submit combined reporting).

67 Rapid Action Drug Alerts and Response Quarterly Report, Public Health Scotland, January 2025

68 The ASSIST study is conducted by the emergency department at the Queen Elizabeth University Hospital in NHS Greater Glasgow and Clyde. The aim of the study is to monitor drug trends and associated clinical features using prospective surveillance of emergency department attendances due to acute illicit drug toxicity. The study allows drug profiling and the identification of emerging drugs or changing trends to inform appropriate harm reduction measures and public health responses. Study data are reported via RADAR.

69 Hard Edges Scotland, The Robertson Trust, November 2020

70 Scottish Health Survey 2023, Scottish Government, November 2024

71 Scottish Health Survey 2023, Scottish Government, November 2024. Wellbeing measured by the Warwick Edinburgh Mental Wellbeing Scale (WEMWBS). The WEMWBS scale ranges from 14 to 70. Higher scores indicate greater mental wellbeing.

72 NRS uses the terminology “drug misuse deaths” in their ‘Drug-related deaths in Scotland’ statistical publication, which is consistent with the terminology used in other parts of the UK. However, due to the potential for this to be stigmatising language, this report uses the more neutral “drug deaths” to refer the same figures.

73 As measured by the Scottish Index of Multiple Deprivation (SIMD), a ‘relative’ measure of deprivation. If an area is identified as ‘deprived’ this can relate to people having a low income, but it can also mean fewer resources or opportunities. SIMD looks at the extent to which an area is deprived across seven domains: income, employment, education, health, access to services, crime and housing.

74 As measured by the Scottish Index of Multiple Deprivation (SIMD)

75 Deaths of people experiencing homelessness are difficult to count. These are official statistics in development from the NRS and represent the best estimate of the number of deaths of people experiencing homelessness derived from a combination of death registration records and statistical modelling.

76 'Drug-misuse deaths' is the terminology used by the NRS in their 'Drug-related deaths in Scotland' statistical publication and is consistent with the terminology used in other parts of the UK. The term ‘misuse’ is seen by some as stigmatizing. The Scottish Government aims to use neutral language where possible unless referencing an official title, technically defined term or policy from a different organisation.

77 NRS uses the terminology “drug misuse deaths” in their Homeless Deaths statistical publication, which is consistent with the terminology used for drug deaths in other parts of the UK. However, due to the potential for this to be stigmatising language, this report uses the more neutral “drug deaths” to refer the same figures.

78 A ‘household’ refers to anyone applying for homelessness support with the intention of living together. A household can therefore be a single individual, but more often includes multiple people including adults and children.

79 Support needs are self-declared and may therefore be an under or overestimate.

80 Alcohol and Drug Partnerships (ADP) 2023/24 Annual Survey, Scottish Government, November 2024

81 Alcohol and Drug Partnerships (ADP) 2022/23 Annual Survey, Scottish Government, September 2023

82 Alcohol and Drug Partnerships (ADP) 2023/24 Annual Survey, Scottish Government, November 2024

83 Whole Family Approach: rapid review of literature, Scottish Government, July 2023

84 Impact of parents’ substance misuse on children: an update, R Velleman and L Templeton, BJPsych Advances, April 2018

85 Alcohol and Drug Partnerships (ADP) 2023/24 Annual Survey, Scottish Government, November 2024

86 Scottish Social Attitudes Survey 2021/22: Public Attitudes Towards People with Problem Drug Use, Scottish Government, November 2022. ‘Comfortable’ refers to total percentage of respondents who said they felt ‘very comfortable’ or ‘fairly comfortable.’

87 Alcohol and Drug Partnerships (ADP) 2023/2024 Annual Survey, Scottish Government, November 2024

88 Alcohol and Drug Partnerships (ADP) 2023/2024 Annual Survey, Scottish Government, November 2024

89 The ADP Annual Survey 2023/24 asked ADPs to report whether the treatment or support service was in place for a range of age groups: up to 12 years (early years and primary), 13-15 years (secondary S1-S4) and 16-24 years (young people). For the purpose of reporting here, responses have been combined.

90 ‘Drug misuse’ is the terminology used in the statistical publication. The term ‘misuse’ is seen by some as stigmatizing. The Scottish Government aims to use neutral language where possible unless referencing an official title, technically defined term or policy from a different organisation.

91 Scottish Household Survey 2023, Scottish Government, December 2024

92 Child protection processes start when a concern about harm (or risk of harm) from abuse or neglect to a child has been raised, and police or social work have been notified. This may lead to an investigation which may in turn lead to a case conference. A case conference may lead to a registration. Note that multiple concerns can be recorded at Case Conferences, meaning that the total number of concerns will be greater than the total number of registrations.

93 Children’s Social Work Statistics 2022-23, Scottish Government, March 2024