National Mission on Drugs: Annual Monitoring Report 2023-2024

5. Outcome 1: Fewer people develop problem drug use

5.1 Summary

Outcome 1: Fewer people develop problem drug use

• New prevalence data pre-dates National Mission. Relevant data will be available in Spring 2025.
• 1% of people reported having a current problem with their drug use in 2023. Trend analysis not available.
• Progress towards fewer people developing problem drug use cannot be determined at this stage. New prevalence data will provide insight into trends in problem opioid use but there is a need for more work to inform our understanding of problem use of other drugs.

5.2 Background

Preventing people from developing problem drug use is integral to tackling drug related harms and deaths. This includes working with young people, providing early access to support, and understanding the supply of harmful drugs. There is also a large amount of work ongoing across government to improve the key building blocks of health and tackle inequalities.

To understand prevention and the efficacy of prevention-type initiatives over time it is useful to explore, where feasible, population prevalence of problem drug use, both at a local level and for specific demographics (e.g. children and young people).

5.3 Headline metrics

5.3.1 Headline metric: Prevalence of problem drug use

As a vulnerable, criminalised, partially hidden and comparatively small population, measuring how many people use drugs problematically is challenging. In March 2024, PHS published new estimates of the number of people aged 15 to 64 years old with opioid dependence, along with estimates of the prevalence of this group among Scotland’s general population. This was the first report from a public health surveillance collaboration between PHS, the University of Bristol and Glasgow Caledonian University using multiple linked data sources and a recently developed statistical modelling approach.

These newly published estimates refer to the period from 2014/15 to 2019/20 and therefore do not include the 2023/24 period applicable to this monitoring report. Furthermore, estimates are limited to describing opioid dependence and do not provide insight into the prevalence of use of other substances. However, this new data is included here to provide an indicative prevalence of problem drug use and trends before the National Mission.

In 2019/20, the estimated number of people with opioid dependence in Scotland was 47,100. This represents an estimated prevalence of 1.32% of 15- to 64-year-olds. Estimated prevalence among males was around twice that among females (2019/20: Males 1.85%, females 0.82%). Estimated prevalence was lowest among those aged 50 to 64 years and highest among those aged 35 to 49 years. The overall prevalence of opioid dependence was relatively stable from 2014/15 to 2019/20. These estimates suggest that prevalence of opioid dependence is high in Scotland compared to many other countries.^[15]

Plans to further develop these statistics include more detailed age group and regional estimates and the potential to generate estimates for populations using other types of drugs. The next release of the statistics in Spring 2025 will provide insight into the estimated number of people with opioid dependence in Scotland in the early years of the National Mission.

5.3.2 Headline metric: Percentage of people who have a current problem with their drug use

In the 2023 Scottish Health Survey, 1% of people reported having a current problem with their drug use. Males were more likely to report currently having a problem with drug use compared to females. In 2021, fewer than 0.5% of people reported a current problem. However, due to the small number of adults reporting current drug use it is not possible to monitor significant change over time.^[16]

5.4 Supporting metrics

5.4.1 Supporting metric: Prevalence of problem drug use among young people

As described in section 5.3.1, newly published prevalence estimates do not relate to the 2023/24 time period covered by this monitoring report and are limited to opioids only. However, the estimates for 15–34-year-olds do provide some insight into prevalence of problem drug use and trends before the National Mission.

In 2019/20, the prevalence of opioid dependence was estimated as 0.87% among people aged 15 to 34 years. Over the period 2014/15 to 2019/20, there was a reduction in the estimated number of people aged 15 to 34 with opioid dependence (2014/15: 1.24%, 2019/20: 0.87%). This reduction was observed among both males and females.

The next release of these statistics in Spring 2025 will provide insight into the estimated number of younger people with opioid dependence in Scotland in the early years of the National Mission.

5.4.2 Supporting metric: Percentage of young people who have a current problem with their drug use

In the 2023 Scottish Health Survey, fewer than 0.5% of young people (aged 16 to 24 years) reported having a current problem with their drug use. In 2021, 1% of young people (aged 16 to 24 years) reported having a current problem with their drug use. However, due to the small number of people reporting current drug use it is not possible to monitor significant change over time.^[17]

5.4.3 Supporting metric: Percentage of S4 pupils who have ever taken illegal drugs

No new data is available from the Health and Wellbeing Census or the Health Behaviour in School aged Children study to provide insight into progress for this metric for this 2023/24 monitoring report.

5.4.4 Supporting metric: Number of school exclusions involving substance misuse

There were 375 cases of exclusion from local authority schools involving substance misuse in the 2022/23 academic year, 3.2% of all known exclusions.^[18] This is an increase from the 2020/21 academic year (150 such exclusions, 1.8%),^[19] but is a similar level to 2018/19 (410 such exclusions, 2.7%).

5.4.5 Supporting metric: Number of drug supply crimes

In 2023/24, 4,223 crimes related to drug supply were recorded in Scotland (Figure 3). This is an increase of 136 crimes (3%) compared to 2022/23 when there were 4,087 such crimes. Recorded drug supply crimes are lower than they were at the start of the National Mission. However, the COVID-19 pandemic and associated measures to limit physical contact affected both the type and volume of crime recorded since March 2020 which may, in part, explain these trends. These data also underestimate the scale of drug supply crimes because not all crimes are reported to the police. The number of recorded crimes may also be affected by police activity and operational decisions.

Source: Recorded Crime in Scotland 2023-24, Scottish Government, June 2024

5.4.6 Supporting metric: Amount of (a) heroin, (b) benzodiazepines, and (c) cocaine seized

No new data is available for this metric for 2023/24. The most recent data available is for 2021/22 and was described in detail in the National Mission on Drugs: Monitoring Report 2022/23. That analysis concluded that the quantity of drugs seized from supply crimes fluctuates considerably between years and the amount of drugs seized may not necessarily correspond with the amount of drugs in illicit markets at any given time.

5.5 Discussion

Progress towards fewer people developing problem drug use cannot be determined at this stage. New prevalence data will provide insight into trends in problem opioid use but there is a need for more work to inform our understanding of problem use of other drugs.

Recently published statistical modelling from PHS provides insight into problem opioid use in Scotland for the period between 2014/15 and 2019/20. The figures show an estimated prevalence of opioid dependence of 1.32% of 15- to 64-year-olds in 2019/20 (the most recent year available) and that prevalence was estimated to have remained relatively stable between 2014/15 and 2019/20. This indicates a large number of people in Scotland with opioid dependence and suggests that prevalence of opioid dependence is high in Scotland compared to many other countries. This data provides a useful picture of estimated prevalence of problem opioid use prior to the National Mission. New analysis is expected to be published in Spring 2025 that will provide a more recent picture of trends in problematic opioid use.

Available data on estimated prevalence of problematic drug use are limited to opioids - the prevalence of problem drug use including cocaine, benzodiazepines and polydrug use are unclear. Indicators of harms relating to cocaine in particular suggest that there may be a growing number of people using cocaine, but the extent of this is currently unknown and it is difficult to ascertain which populations this is likely to impact. It is particularly important to understand who the populations of people using drugs other than opioids are in order to understand how harm reduction, treatment and support services need to adapt and be accessible to different groups.

The Scottish Health Survey includes questions around drug use, which indicate that 1% of people reported having a current problem with their drug use in 2023. While this was an increase since 2021, it is not possible to use this to monitor significant change over time primarily due to the small number of adults reporting current drug use in this survey and the likelihood that people who use drugs tend to be part of hidden populations who are often poorly represented in population-level surveys. Furthermore, it may be unreasonable to rely on self-reporting of illicit activity, which may also be impacted by stigma and other societal perceptions.

There are similar limitations in understanding prevalence of drug use amongst young people. Estimates from 2019/20 indicate a prevalence of opioid dependence at 0.87% among people aged 15 to 34 years, a reduction since 2014/15. This echoes the 2022 evidence from the Health & Wellbeing Census which showed that there may be a decrease in drug use among young people. However, there is no new evidence from the Health & Wellbeing Census to provide insight into more recent trends. Updated prevalence figures will be essential to understand any changes since the start of the National Mission.

School exclusions involving substance use increased from 2020/21 to 2022/23, to 3.2% of all known exclusions. However, this is difficult to contextualise to determine whether it is directly reflective of higher rates of substance use amongst young people given the impact of the pandemic and recovery on schools and school exclusions.

Drug supply is linked to demand. However, there are limited conclusions which can be drawn from the available data. Rates of drug supply crimes are similar to last year and are lower than at the start of the National Mission. There is no new evidence available relating to the quantities of drugs seized, though analysis last year indicated that there had been fluctuation over several years with no clear trends that might correspond with the amount of drugs in illicit drugs markets at any given time.

Overall, there are significant limitations on our understanding of the data relating to this outcome and progress towards fewer people developing problem drug use. While prevalence data from PHS may provide some insight, it is not available for this reporting period and is restricted to opioids. It also does not allow us to understand the number of new people who have developed problematic drug use. Other measures where there is updated data are largely based around crime and school exclusions, which do not reflect the current public health approach to substance use, and which are likely to be impacted by a range of factors including the pandemic, levels of police/operational activity and public reporting of crimes.