National Mission on Drugs: annual report 2025 to 2026

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.

It is vital that treatment is high-quality, evidence-based and promotes a recovery orientated system of care. This includes a wide range of treatment provision, with a range of medical, psychological, social and peer-led community-based supports.

5.2 Progress in 2025-26

5.2.1 Medication Assisted Treatment (MAT) Standards

Over the five-year programme, there has been clear progress in embedding the MAT standards. In the 2025/26 National benchmarking report on the implementation of the medication assisted treatment (MAT) standards, 23 ADPs (77%) were assessed as green (fully implemented) or blue (implemented and sustained) for MAT standards 1, 2, 3 and 5. For MAT standards 6 to 10, 14 ADPs (47%) were assessed as green or blue across all five standards. MAT 4 showed more mixed results following the introduction of revised criteria on hepatitis B vaccination at the point of MAT delivery, 17 ADPs (57%) were assessed as green or blue and 13 ADPs (43%) as provisional green. MAT 7 and MAT 9 remained the most challenging standards, reflecting reliance on wider system collaboration, with 87% of ADPs achieving at least provisional green for MAT 7 and 97% for MAT 9.

Initial benchmarking submissions for Scottish prisons were completed in 2025/26.

In addition to the main Benchmarking Report, PHS have published a report on the Baseline Implementation of Medication Assisted Treatment (MAT) standards in Scottish Prison. This focuses on strengthening pathways between prison, police custody and community services, so that consistent care can be offered as people move between locations.

The alcohol and drugs landscape within Scotland is changing and action will be taken to expand the principles and approach of the MAT standards. The Strategic Plan details a commitment to work with stakeholders, to develop standards of support for all alcohol and drug treatment, which will ensure the appropriate care and support for people is available.

5.2.2 Psychological Support

MAT standards 6, 9 and 10 focus more on wider determinants of positive treatment outcomes such as psychological support and mental health co-morbidity. The 2025-26 benchmarking assessment indicates high levels of MAT compliance for wider determinants, showing progress from earlier years of MAT implementation.

We have continued to focus on working with frontline staff, third sector organisations, recovery organisations, service users and local governments, to create sustainable solutions that deliver real change for service users.

5.2.3 Changing drug trends

The rapidly changing drug landscape continues to present challenges. This is due to the contamination of drugs with toxic substances which is both common and widespread. Public health alerts for nitazene-type opioids and new benzodiazepines highlight ongoing and evolving risks, with the majority of harms involving the use of more than one substance.

These shifts highlight the need for psychosocial support, as there are no equivalent pharmacological treatment options available at present for some substances. Some of the specific challenges identified throughout the reporting period are:

Cocaine: There is evidence of increasing cocaine-related harms in Scotland. In 2024, cocaine was implicated in almost half (47%) of all drug deaths, up from 41% in 2023 and the highest proportion recorded to date. Cocaine-related hospital stays have also risen over recent years, and cocaine is the most commonly reported main drug among people starting specialist drug treatment in Scotland. These trends are reflected in findings from PHS’s RADAR drugs early warning system, which identified cocaine as the substance most frequently detected in post-mortem and emergency department toxicology samples.

Ketamine: Intelligence suggests a rise in non-medical use of ketamine and seizures of ketamine increased year-on-year in Scotland from 2018 to 2024. Ketamine was implicated in 21 drug deaths in Scotland in 2024, an increase compared to 2023. Reports from multiple areas of Scotland suggest growing ketamine use among young people, with concerns around perceived increasing prevalence. Multiple reports concerned young people taking ketamine and cocaine together, possibly as an alternative to taking ecstasy. Reports from a local group found that ketamine-related harms were often experienced by young people with diagnosed or non-diagnosed mental health conditions who used ketamine regularly, often while alone.

Benzodiazepines: The benzodiazepine market continues to change with growing reports of novel substances and changing tablet types. Throughout the Mission we have seen examples of where alternative approaches to support can make a difference, as shown in the case study in the following page.

Case Study

The National Mission funded a pilot benzodiazepine clinic in Fife to address harms associated with illicit use. The pilot tested a model combining prescribing and psychological therapies, delivered through dedicated nursing and psychology input within a defined locality.

The service used a matched care model of service delivery, taking a psychological, formulation-driven approach to providing care and treatment for those wishing to reduce their use of benzodiazepines.

Overall, the data collected from the pilot has demonstrated that the service was operating as intended: providing targeted, specialist psychosocial intervention to service-users who were ready, willing, and able to address their substance use and underlying issues.

The model of care being used is transferable and can be applied to any substance, meaning it has the potential to be used more widely within and by services.

5.2.4 Primary Care

2025/26 saw the continuation of substance use initiatives involving GPs within primary care settings and included the development of flexible models of partnership working, primary care facilitation teams and piloting of Advanced Nurse Practitioners based in GP practices. The NHS Tayside GP Redesign project developed shared care protocols between specialist services, GPs and community pharmacies for people who are on Medication Assisted Treatment (MAT).

A small number of local areas were able to influence the development of pre-existing local enhanced service contracts in general practice (whereby GPs are incentivised to provide shared care).

MAT 7 (Primary Care involvement in treatment and support) remained one of the most challenging standards, reflecting reliance on wider system collaboration. Despite this, in the 2025/26 Benchmarking report, 87% of ADPs achieved at least provisional green for MAT 7.

The primary setting for dispensing treatment remains with Community pharmacies, who continue to play an important role in the dispensing of opioid agonist treatment and other medicines.

The Scottish Government funded a project to help improve the oral health of people who use drugs. The project was taken forward by the University of Dundee in partnership with Public Health Scotland, who also worked alongside NHS Education for Scotland and the Scottish Drugs Forum. The project concluded in December 2025 and delivered three key educational resources which have been published for use by healthcare professionals, social care professionals and people who use drugs. These are provided in the table of publications at page 8.

An important commitment in the Strategic Plan is that work will be undertaken to ensure that the wider health system is accessible and responsive, by continuing to address the specific needs of people who use substances within wider healthcare improvement work, including in primary care and acute and specialist services.

Building on the progress made through the National Mission, the Strategic Plan places an increased focus on ensuring services operate as part of a joined-up, accessible and responsive system. Primary care will continue to be central to this effort, supporting prevention, early intervention and continuity of care across the wider system.

5.2.5 Opioid Substitution Therapy (OST)

In the 12 months to March 2026, there were an estimated 26,616 patients prescribed opioid substitution therapy. This was stable (1% lower) compared to the 12 months to December 2025, 5% lower than in the 12 months to March 2025 and 11% lower than in the 12 months to March 2024.

We know from international and Scotland-based evidence that OST is effective in reducing drug deaths and harms. We asked Public Health Scotland to investigate the reduction in referrals to specialist drug and alcohol treatment and continue to monitor treatment numbers.

The Strategic Plan includes a commitment to continuing to support OST as an evidence-based treatment for opiate dependence, while continuing to expand access to alternatives to methadone, such as Buvidal.

5.2.6 Residential Rehabilitation

The National Mission committed to increasing the funding available for residential rehab and aftercare over the parliamentary term 2021-2026. As announced by the then Minister for Drugs Policy in 2021, the commitment was to increase publicly funded placements to 1000 per year (a 300% increase over the course of the National Mission) and to increase the number of beds available to 650.

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.

Throughout the National Mission there were 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.

Evaluation of Scottish Government’s Residential Rehabilitation programme

In October 2025, PHS published an evaluation of the residential rehabilitation expansion programme including analysis of an experimental dataset capturing outcomes. Although based on only a single year of data, the analysis does provide useful early evidence on treatment outcomes that may help inform future development of pathways into residential rehabilitation. The data indicate that for individuals starting a residential rehabilitation placement in 2023, those whose placement lasted 61 to 90 days were nine times more likely to achieve a ‘treatment complete’ status than those who only remained in rehab for 0 to 30 days. Individuals referred by an alcohol and drug service were seven times more likely to achieve a ‘treatment complete’ status at discharge than those who self-referred.

Pathways

Through the pathways improvement work led by Healthcare Improvement Scotland (HIS), ADPs have been supported throughout 2025/26 to undertake self-assessment of their current residential rehabilitation pathways. HIS used the self-assessments to prepare Thematic Analysis reports for each ADP (excluding Shetland and Orkney due to constraints on applying the work in remote areas). The reports identified key areas for improvement, including integrated care, support for families and carers, and removing barriers to equitable access to residential rehabilitation.

Following completion of the thematic analysis reports, HIS supported ADPs to develop multidisciplinary action plans setting out short-, medium- and long-term actions to improve and sustain access to residential rehabilitation and ensure pathways are fair, accessible and easy to navigate.

Residential Rehab Capacity

Throughout 2025/26, access to residential rehabilitation was expanded through the opening of Phoenix Futures’ new 27-bed Rae House facility in Aberdeen, increasing available treatment capacity. Alongside this, the dispersed residential rehabilitation programme enabled people to receive structured recovery support while living in supported accommodation or remaining in their own homes, helping to provide flexible pathways into recovery.

CrossReach opened Nevis House, Inverness in August 2025 which offers 6 additional rehabilitation beds, and up to 22 placements per year in Highland. River Garden Auchincruive has continued to overcome challenges and expand capacity.

Scottish Government supported the continued operation of Jericho House facilities in Greenock and Dundee during a transfer of operations from the Jericho Benedictine Society to Abbeycare, maintaining bed capacity across the three facilities. The transfer of the Greenock facilities was completed in March with the Dundee purchase completing in April 2026.

Children’s charity Aberlour continues to help mothers through recovery with their Mother and Child Houses in Falkirk and Dundee by providing 24/7 support that enables children to remain with their mothers during recovery, helping to keep families together.

Progress against the target to increase the number of residential rehabilitation beds to 650 by 2026 was published by the Scottish Government in December 2025. As of October 2025, there was a maximum capacity of 574 residential rehabilitation beds in Scotland across 28 facilities. This is an increase of 78 beds (16%) compared to September 2024 (496 beds). New facilities are expected to be opened throughout 2026, along with additional capacity in some existing facilities.

Residential Rehab Placements

Public Health Scotland (PHS) published a report in December 2025 on residential rehabilitation placements started between April 2019 and March 2025.

Based on submitted data for Scottish residents only, the Scottish Government appears to have come close to, and may already have achieved, its 2026 placements target in 2024/25, with at least 993 individuals recorded.

Access to publicly funded residential rehab in Scotland has substantially improved: it is estimated to have broadly doubled between 2019/20 and 2024/25.

Scotland Excel continues to work with ADPs and providers to support the provision of residential rehabilitation in Scotland. The National Flexible Framework remains open to new applicants for the duration of the agreement, with applications assessed and awarded on an ongoing basis.

Scotland Excel also manages and reports on the Additional Placement Fund (APF), which provides ADPs with additional funding for residential rehabilitation placements where local budgets have been exhausted. Since the fund was launched in August 2024, the APF has funded 290 additional placements.

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.

The revised DHSF protocol – published following the review in 2024-25, is now available on the Scottish Government’s website. This has resulted in a streamlined process, making it easier for eligible individuals to access the fund. In 2025-26, the DHSF received 36 referrals.

The website rehab.scot was publicly launched in August 2024 and continues to provide a nationwide list of residential rehabilitation providers.