Drug use: treatment for drug use

NHS Boards, councils and voluntary sector organisations provide a range of treatment options for people who experience problems related to drug misuse. In addition, 30 Alcohol & Drug Partnerships (ADPs)  across Scotland form the focal point for local action on drug misuse, and receive strong support from the Scottish Government. 

Drug and Alcohol Information System (DAISy)

• In 2021/22, a total of 10,204 initial assessments recorded on DAISy were for people starting specialist alcohol treatment in Scotland. In 2022/23 a total of 9,803 assessments were recorded.
• The median age at initial assessment was 46 years in 2021/22 and 47 years in 2022/23. Among people starting specialist alcohol treatment in Scotland, the percentage of women was 37% in 2021/22 and 36% in 2022/23.
• The most common alcohol type for which people reported needing treatment for was spirits in both years (36% in 2021/22 and 35% 2022/23)

Drugs:

• In 2021/22, a total of 7,288 initial assessments recorded on DAISy were for people starting specialist drug treatment in Scotland. In 2022/23 a total of 6,275 assessments were recorded.
• The median age at initial assessment was 36 years in 2021/22 and 2022/23. Among people starting specialist drug treatment in Scotland, the percentage of women was 29% in 2021/22 and 28% in 2022/23.
• Heroin was the most common drug for which people reported needing help in both years (32% in 2021/22 and 2022/23)

Co-dependency:

• In 2021/22, a total of 2,153 initial assessments recorded on DAISy were for people starting specialist co-dependency (alcohol and drug) treatment in Scotland. In 2022/23 a total of 2,017 assessments were recorded.
• The median age at initial assessment was 33 years in 2021/22 and 2022/23. Among people starting specialist alcohol and/or drug treatment in Scotland, the percentage of women was 22% in 2021/22 and 21% in 2022/23.
• Beer was the most commonly reported main alcohol type (2021/22: 33%; 2022/23: 31%) reported by people starting treatment for co-dependency.
• Cocaine was the most commonly reported main drug (2021/22 38%; 2022/23: 46%) reported by people starting treatment for co-dependency.    

Drug and Alcohol Treatment Waiting Times

Between 2011 and 2021, data on waiting times for specialist drug and alcohol treatment were collected in PHS’s Drug and Alcohol Treatment Waiting Times (DATWT) database. In December 2020, waiting times began to be recorded on the Drug and Alcohol Information System (DAISy) for four NHS Boards (NHS Ayrshire & Arran, NHS Dumfries and Galloway, NHS Grampian, and NHS Western Isles). The remaining NHS Boards transferred to DAISy in April 2021. Both DAISy and the DATWT systems measure the duration of the wait from referral to treatment for both drug and alcohol services, taking into account periods of unavailability and non-attendance for appointments. DAISy and DATWT supports delivery of the Scottish Government’s Local Delivery Plan Standard for drug and alcohol treatment which states that 90% of people who need help with their drug or alcohol problem will wait no longer than three weeks for treatment that supports their recovery.

All recent (quarterly) publications can be found in the Drug & Alcohol Publications section on the PHS website. The percentage of waits longer than three weeks is also an indicator included in the ScotPHO Drugs Profile, where data is shown at Scotland, NHS Board and ADP level.

For the publication that covers the quarter between 1 October and 31 December 2023 (2023/24 Quarter 3), the main points were:

• 10,534 referrals were made to community-based specialist drug and alcohol treatment services: 5,239 (49.7%) were for problematic use of alcohol, 3,885 (36.9%) for problematic use of drugs, and 1,410 (13.4%) for co-dependency.  
• 7,316 referrals to community-based services started treatment. Of these, 90.5% involved a wait of three weeks or less. Five NHS Boards did not meet the Standard (Highland, 89.8%; Lothian, 86.2%; Fife, 83.4%, Orkney, 83.3%; Forth Valley, 59.7%). 
• Nationally, the Standard was met for referrals to community-based services starting treatment for the problematic use of drugs (91.8%) and co-dependency (91.7%). The Standard was not met for those starting treatment for alcohol (89.3%).  
• 824 referrals were made to prison-based services. Of these, 674 (81.8%) were for people seeking help for problematic use of drugs. 
• 356 referrals to prison-based services started treatment. Of these, 92.1% involved a wait of three weeks or less (co-dependency, 100.0%; drugs, 90.6%; alcohol, 84.6%).  

As of 31 December 2023, 2,192 community-based service referrals had not started treatment. Of these, 445 (20.3%) involved a wait of more than three weeks. 

Naloxone

Accidental overdose is a common cause of death among users of heroin, morphine and similar drugs, which are referred to as opioids. Naloxone is a drug which reverses the effects of a potentially fatal overdose with these drugs. Available as an intramuscular injection, or intranasal product since April 2019, naloxone provides time for emergency services to arrive and for further treatment to be given. Following suitable training, ‘take home’ naloxone kits (hereafter referred to as ‘THN’ or ‘kits’) are issued to people at risk of opioid overdose in order to help prevent overdose deaths. The monitoring report for 2019/20 and 2020/21 was released in May 2022, which reports on annual numbers of ‘take home’ naloxone distributed via the national naloxone programme since 2011/12.

Key points:                                       

• A total of 22,366 take-home naloxone kits were issued in Scotland in 2020/21, an increase of 67% from the previous year (13,414). A total of 94,170 take-home naloxone kits were supplied in Scotland between 2011/12 and 2020/21.
• In 2020/21, there were 13,933 take-home naloxone kits issued from community outlets, 1,240 kits issued in prisons upon release,  7,045 kits dispensed via community prescription, and 77 kits distributed by the Scottish Ambulance Service (SAS).
• In 2020/21, repeat supplies accounted for 6,447 take-home naloxone kits distributed from community outlets, prisons and SAS. Of these, 1,377 (21%) were made because the previous kit was reported as having been used to treat an opioid overdose.
• In 2020/21, it is estimated that 4,222 take-home naloxone kits were issued as a first supply to an individual at risk of opioid overdose. Cumulatively, 32,969 at risk individuals are estimated to have been issued with a first supply of take-home naloxone between 2011/12 and 2020/21.
• At the end of 2020/21, the ‘reach’ of take-home naloxone (based on the number of at risk individuals supplied with kits between 2011/12 and 2020/21) was estimated to be 575 kits per 1,000 ‘problem drug users’.

Quarterly monitoring bulletins of the distribution of ‘take home’ naloxone kits are also available, the most recent of which covered 1 April to 30 June 2023.

Key points:

During 2023/24 Quarter 1 (1 April 2023 to 30 June 2023): 

• 6,960 Take-Home Naloxone (THN) kits were issued. 
• 5,763 THN kits were issued by services based in the community. 
• Community THN supplies included 1,931 kits issued by non-drug treatment services. Of these, 60% (1,163) were supplied by Scottish Families Affected by Alcohol and Drugs (SFAD). 
• 435 kits were issued by prisons in Scotland. 
• 500 kits were dispensed by community pharmacies. 
• 225 THN kits were provided by the Scottish Ambulance Service. 
• A total of 820 kits were supplied by peers (621 in the community and 199 in prisons). 

At the end of 2023/24 Quarter 1, the 'reach' of the NNP (percentage of people at risk of opioid overdose who have been supplied with THN) was estimated to be 71.7%, an increase of 1.2 percentage points compared to 2022/23 Quarter 4 (70.5%). 

Residential Rehabilitation

Residential rehabilitation is a well-established intervention for the treatment of problematic drug and alcohol use and is recognised as an important option for some people requiring treatment.  

As part of the National Mission on Drugs, the Scottish Government has committed to invest £100M for residential rehabilitation between 2021 and 2026. The latest quarterly Interim monitoring report on statutory funded residential rehabilitation placements was published in December 2023, covering the period from April 2021 to September 2023.  

Key points: 

• Overall, between 1 April 2021 and 30 September 2023, 1,829 statutory funded placements (including ADP approved placements, National Mission funded placements and data from other sources) for residential rehabilitation were approved in Scotland. The total estimated cost over this time frame was £15,981,643. 
• Of the 1,829 statutory-funded placements, 1,533 were ADP-approved placements. 

 Between 1 April 2023 and 30 September 2023: 

• 477 statutory funded placements were approved for residential rehabilitation in Scotland. This was an increase of 126 placements when compared to April 2022 to September 2022 (351), and a slight increase of 16 placements when compared to October 2022 to March 2023 (461). 
• Of the 477 placements approved, 386 placements were approved by ADPs, 39 placements were approved by Ward 5 Woodland View in NHS Ayrshire and Arran, and 52 placements were approved through the Scottish Government's National Mission Programme.  
• The total estimated cost for 477 placements was £5,196,784. This cost was made up of £3,912,944 from 386 ADP-approved placements, £585,468 for 39 placements to Ward 5 Woodland View, and £698,372 for 36 prison-to-rehab placements, which were included under the National Mission programme. Cost information was not available for Aberlour Mother and Child Recovery House; River Garden Auchincruive and Phoenix Future Harper House - Specialist Family Service Scotland. 
• Of the 386 ADP-approved placements, 62% (233) were for males and 38% (143) were for females. The remaining were unknown or individuals preferred not to say. 
• Of the 386 ADP-approved placements, 48% (187) were for people with problematic alcohol use, 31% (121) were for problematic drug use and 20% (78) were for people with co-dependency.