Drug use: Prescribing for drug use

People who experience problematic opioid use may benefit from being prescribed Opioid Substitution Therapy (OST). The aims of OST are to decrease or stop the use of illicit opioids, as well as reduce the risk of other serious consequences of drug use. This will help improve overall health and social functioning. 

Data on OST prescriptions dispensed in the community are recorded in the Prescribing Information System (PIS). Current OST prescribed in Scotland include methadone hydrochloride, buprenorphine, buprenorphine & naloxone and long-acting buprenorphine (including Buvidal© slow-release formulations). 

Please note that the September 2024 release of these statistics has been affected by changes to the Prescribing Information System. These workbooks now include revised figures for the period 2014/15 to 2022/23, which may differ from those presented in previous publications for the following reasons:  

  • The inclusion of additional OST formulations, which are described in the ‘Drugs Included’ tabs of individual workbooks.   
  • Consideration of more recent data related to the local authority and NHS Board of residence. 

Opioid Substitution Therapy (OST) Drug Prescribing - Community

Drugs used for the treatment of opioid dependence include all those in legacy British National Formulary (BNF) subsection 04.10.03. In Scotland, methadone hydrochloride is the most commonly used pharmacological treatment for opioid dependency. The Excel file Opioid Substitution Therapy in Scotland 2023/24 (259 Kb) contains information on all drugs used for Opioid Substitution Therapy (OST).

Table 1 – Scotland Summary Data shows, for each of the drugs, the number of paid items, gross ingredient costs, average daily quantity (ADQ), defined daily doses (DDDs) (see definitions in the ‘Introduction’ tab of the excel file), and the defined daily doses per 1,000 population per day for each year from 2014/15. Table 2 provides a similar breakdown by NHS Board. Table 3 shows the quantities of methadone hydrochloride dispensed at Scotland and NHS Board level.

When comparing use between medicines and over time, it is common to use World Health Organization (WHO) DDDs. The DDD is defined as the usual average daily maintenance dose used in adults for the main therapeutic use of the medicine. The WHO DDD is a global average and may not be representative of the doses used in clinical practice at a more local level. This is particularly the case for methadone, where the WHO DDD of 25 milligrams (mg) daily is between one-half and one-third of the normal maintenance dose used in Scotland.

We have therefore included both DDDs with ADQs in this report. ADQ values have been developed through a combination of prescription analyses and by consultation with the Specialist Pharmacists in Substance Misuse group. The ADQs agreed are outlined in ADQ Values tab of workbook.

OST prescribing analyses to 2017/18 included information on the costs of methadone prescribing. Due to quality and completeness issues for fees associated with the supervised consumption of methadone, this information has not been included in subsequent updates of the OST prescribing statistics. Following further investigations, it has become apparent that, due to the increasing use of buprenorphine and variations in the way that NHS Boards supply fee information, it is no longer possible to publish comprehensive or robust OST cost information. Therefore, until further notice, the OST prescribing statistics will no longer include methadone/OST cost information. All enquiries about the financial cost of OST prescribing should be addressed to territorial NHS Boards.

OST dispensing arrangements in some NHS Boards were modified as a consequence of the introduction of physical distancing measures during the COVID-19 pandemic. Such changes were implemented on the basis of local contingency plans, which (following appropriate risk assessment) endorsed changes to the supervision and/or instalment frequency, number and duration of prescription(s) on a case-by-case basis, where necessary and appropriate. Nationally, this is known to have led to a decrease in the number of OST items prescribed and a corresponding increase in the duration of OST prescriptions (for example, an increase in 56-day prescriptions). As the number of OST items prescribed has not returned to pre-pandemic levels it is possible that some of these arrangements remain in place.

Key Points:

In 2023/24, the number of paid items for OST drugs (including methadone) was 416,092. This was lower than the equivalent figure for 2022/23 (426,107) (Table 1 – Scotland Summary Data: BNF Subsection 04.10.03 - Opioid Dependence (all drugs)).

While a decreasing trend in the dispensing of OST drugs has been evident since 2014/15, the decrease in the number of items observed in 2020/21 was thought to reflect changes in OST dispensing due to the COVID-19 pandemic rather than underlying changes in prescribing activity. Given these contextual changes, the number of Defined Daily Doses (DDDs) per 1,000 population per day often used as a measure of OST dispensing over time is used throughout the following discussion.

  • In 2023/24 the dispensing of methadone was equivalent to 9.4 DDDs per 1,000 population per day. This was the lowest rate in the recent time series, which has been gradually decreasing since 2014/15 (12.7). (Table 1 – Scotland Summary Data: Methadone Hydrochloride).
  • Oral buprenorphine remained stable in 2023/24, at 1.17 DDDs per 1,000 population per day, the same as 2022/23. The use of oral buprenorphine to treat opioid dependence has increased markedly since 2014/15 (0.10 DDDs per 1000 population per day) (Table 1 – Scotland Summary Data: Buprenorphine (oral)).
  • Prescribing of injectable buprenorphine continued to increase in 2023/24, rising to 0.94 DDDs per 1000 population per day. There has been an increasing trend in the use of injectable buprenorphine from 0.10 DDDs per 1000 population per day in 2020/21 to 0.66 DDDs per 1000 population per day in 2022/23 (Table 1 – Scotland Summary Data: Buprenorphine (injectable)).
  • In 2023/24, the dispensing of buprenorphine and naloxone combined (Suboxone) was equivalent to 0.18 DDDs per 1,000 population per day. This was the lowest figure in the times series and part of a gradually decreasing trend since 2015/16 (0.80 DDDs per 1,000 population per day) (Table 1 – Scotland Summary Data: Buprenorphine and Naloxone).
  • Since the beginning of the time series (2014/15), the distribution of drugs prescribed for opioid dependence in Scotland has changed. Based on numbers of Defined Daily Doses (DDDs), methadone decreased from 93% of all OST dispensing in 2014/15 to 80% in 2023/24. Over this time period, there were changes in the OST treatments offered by NHS Boards in Scotland.
  • In the period from 2014/15, oral buprenorphine accounted for approximately 6% of OST dispensing each year, but gradually increased to 19% in 2023/24. Injectable buprenorphine has seen year on year increase from 1% of all OST dispensing in 2020/21 to 8% in 2023/24 (Table 1 – Scotland Summary Data).
  • Buprenorphine and naloxone combined (Suboxone) decreased from 6% of OST dispensing in 2014/15 and 2015/16 before decreasing to 2% between 2018/19 and 2023/24.

Average daily quantity (ADQ) can also be used to provide alternative estimates of OST prescribing in Scotland, for specific drugs. As described above, ADQ values are based on local clinical practice and may provide a more accurate picture of the doses prescribed to patients.

  • In 2023/24, an estimated 6,087,517 doses of methadone were supplied. The supply of methadone doses has been gradually decreasing over the time series (Table 1 – Scotland Summary Data: Methadone Hydrochloride).  
  • Approximately 1,211,129 doses of oral buprenorphine were supplied in 2023/24. There has been a stable trend in the use of oral buprenorphine since 2020/21 (Table 1 – Scotland Summary Data: Buprenorphine (oral)).
  • In 2023/24, an estimated 977,644 doses of injectable buprenorphine were supplied. This was the highest figure in the time series and injectable buprenorphine has increased markedly since it was first distributed in 2019/20, when 3,571 doses were supplied (Table 1 – Scotland Summary Data: Buprenorphine (injectable)).
  • An estimated, 190,297 doses of buprenorphine and naloxone combined (Suboxone) were supplied in 2023/24. This was the lowest figure in the times series and part of a decreasing trend since 2015/16 (Table 1 – Scotland Summary Data: Buprenorphine and Naloxone). 

 

Patient Estimates - Community

The number of individuals prescribed specific drugs can be estimated using the Community Health Index (CHI) numbers captured on prescriptions. Since 2014/15, there has been an overall decrease in the number of Opioid Substitution Therapy (OST) items (including methadone hydrochloride and buprenorphine) dispensed in Scotland. However, differences in prescribing practices between NHS Boards, issues associated with CHI capture for OST prescriptions (for example, handwritten or poorly printed CHI numbers) and changes to dispensing practices associated with COVID-19 mean that such changes do not equate straightforwardly with increases or decreases in the number of people prescribed these medications and that, in general, it is challenging to provide robust counts of the number of people prescribed OST in Scotland.

The estimated number of patients prescribed 1) methadone, 2) oral buprenorphine 3) injectable buprenorphine and 4) any OST drug, are described in the sections below. These figures are counts of patient CHI numbers captured from prescriptions for relevant medications at any time in a financial year. These figures are not mutually exclusive. People who have been prescribed methadone will be counted in both the methadone and OST figures. Those prescribed oral buprenorphine will be counted in both the oral buprenorphine and OST figures. Individuals prescribed both methadone and oral buprenorphine in the same financial year will be counted in all three sets of figures. For this reason, the sum of the methadone and oral buprenorphine patient figures may be greater than the OST patient count for the same area and time period.

The estimates of the number of people prescribed methadone and oral buprenorphine include CHI capture statistics by NHS Board of prescription, form type and financial year. The OST patient figures provide CHI capture rates based on local authority and NHS Board of prescription and financial year.

National 'CHI capture' percentages for other OST drugs by prescription form type and year (2014/15 to 2023/24) are also provided in the Excel workbook Opioid Substitution Therapy in Scotland 2023/24 (259Kb) (Table 4 - CHI capture). More information regarding community dispensing can be found on the PHS Prescribing web pages.

 

Methadone

The Methadone Patient Estimates 2023/24 (67Kb) are a minimum count of individuals prescribed methadone hydrochloride 1mg/ml and 10mg/ml solution and defined as drugs used for the treatment of opioid dependence from legacy British National Formulary (BNF) subsection 04.10.03.

The national CHI capture for methadone increased from 73% in 2014/15 to 85% in 2023/24 (Tab 1 Patient Estimates). While national completeness is at the lower end of the threshold, data completeness remains variable at NHS Board level, these statistics are published as management information due to the ongoing public interest in drug treatment and OST prescribing.  

  • In 2023/24, methadone was prescribed to a minimum of 20,540 people (Tab 1 Patient Estimates) for the treatment of opioid dependence. 
  • The highest estimate in the observed time series was in 2016/17, when a minimum of 26,002 people were prescribed methadone. Since then, a gradual decrease in estimated numbers has occurred. Although CHI capture rates were stable or increasing throughout this period, the variable quality of the underlying data means that the figures (and comparisons between years) should be treated with caution. In particular, year-to-year variations in the minimum number of people prescribed methadone may have been associated with changes in CHI capture (Tab 1 Patient Estimates). 
  • In 2023/24 the NHS Boards with the highest estimated numbers of residents prescribed Methadone were Greater Glasgow and Clyde (6,279), Lothian (3,364) and Grampian (2,231). 
  • The above figures are based on prescriptions with valid CHI numbers. In 2023/24, 85.3% of methadone prescriptions had a valid CHI number. This represents a 5% increase from the previous year and remains highest methadone CHI capture percentage on record. Based on NHS Board of prescribing, the highest CHI capture percentage was observed in Dumfries & Galloway (95.7%) while the lowest was observed in Tayside (64.2%) (Tab 1 Patient Estimates). It is not possible to determine how many additional individuals prescribed methadone would have been identified if a higher percentage of prescriptions included valid CHI numbers.  
  • In 2023/24 a valid CHI number was captured on 87.9% of GP prescriptions and 82.1% of hospital prescriptions for methadone. CHI capture for both GP prescriptions and Hospital prescriptions increased markedly compared to 2022/23, (85.8% and 75.7% respectively) (Tab 2 CHI Capture by Form Type). 

Buprenorphine Tablets

The Oral Buprenorphine Patient Estimates 2023/24 (65Kb)are a minimum count of individuals prescribed buprenorphine tablets (including buprenorphine 400microgram, 1mg, 2mg, 4mg, 6mg, 8mg & naloxone 2mg/0.5mg, 5.7mg/1.4mg, 8mg/2mg, 8.6mg/2.1mg, 11.4mg/2.9mg, 16mg/4mg, but excluding injectable Buvidal© slow-release formulations).   
The national CHI capture for oral buprenorphine increased from 71% in 2014/15 to 85% in 2023/24 (Tab 1 Patient Estimates). While national completeness is at the lower end of the threshold, data completeness remains variable at NHS Board level, these statistics are published as management information due to the ongoing public interest in drug treatment and OST prescribing.  

  • In 2023/24 oral buprenorphine was prescribed to a minimum of 7,415 people (Tab 1 Patient Estimates) for the treatment of opioid dependence. 
  • In 2014/15 a minimum of 4,644 people were prescribed buprenorphine tablets for the treatment of opioid dependence. Since then, a gradual increase in estimated numbers has occurred while CHI capture rates have improved. The variable quality of the underlying data means that the figures (and comparisons between years) should be treated with caution. Variations in the minimum number of people prescribed oral buprenorphine may have been associated with changes in CHI capture (Tab 1 Patient Estimates).  
  • In 2023/24 the NHS Boards with the highest estimated numbers of residents prescribed oral buprenorphine were Greater Glasgow and Clyde (1,781), Lanarkshire (1,182) and Lothian (1,045).  
  • The above figures are based on prescriptions with valid CHI numbers. In 2023/24, there were 85% of oral buprenorphine prescriptions with a valid CHI number. This was the highest oral buprenorphine CHI capture percentage on record. Based on NHS Board of prescribing, the highest CHI capture percentage was observed in Dumfries & Galloway (95.4%) while the lowest was observed in Western Isles (40.3%) (Tab 1 Patient Estimates. It is not possible to determine how many additional individuals prescribed oral buprenorphine would have been identified if a higher percentage of prescriptions included valid CHI numbers.   
  • In 2023/24 a valid CHI number was captured on 86.1% of GP prescriptions and 83.9% of hospital prescriptions for buprenorphine tablets. CHI capture for GP and hospital prescriptions increased substantially in 2023/24 compared to 2022/23 (84.2% and 78.6% respectively) (Tab 2 CHI Capture by Form Type). 

Injectable Buprenorphine

The Injectable Buprenorphine Patient Estimates 2023/24 (48KB) describe the number of people prescribed injectable buprenorphine in Scotland per financial year quarter, based on data from both primary care (from Prescribing Information System: PIS) and secondary care (Hospital Medicines Utilisation Database: HMUD) systems.  

As approximately 30% of injectable buprenorphine prescribing is via hospital stock order (from HMUD), which does not provide patient identifiers, it is not possible to provide an estimate of the number of patients prescribed this medication by counting unique CHI numbers observed in PIS data (as for methadone and oral buprenorphine). Instead, after discussion with specialist Pharmacists, it has been assumed that the number of monthly (28 day) injectable buprenorphine formulations dispensed approximates to the number of prescribed patients. Monthly injectable buprenorphine formulations are given to patients who are ‘stable’ on this medication (i.e., who are prescribed a suitable monthly dose, having initially followed a weekly dosing regimen designed to assess their tolerance for this medication).  

The estimates provided here are based on financial year quarters and cover financial years 2021/22 to 2023/24. Totals for financial year quarters are based on averaged monthly data. As HMUD data are based on stock orders of medication, there can be wide variation in the amounts of specific medications ordered from month to month. Averaging the data over a 3-month period helps to reduce this variation. Additionally, the quarterly analysis shown here is more useful than an annual analysis for highlighting the rapid expansion in the use of injectable buprenorphine, which was first licensed for use in 2020.  

Key points:

  • In 2023/24 Q4, it was estimated that 3,716 people were prescribed injectable buprenorphine in Scotland. This represents a 38% increase compared to 2022/23 Q4 when an estimated 2,698 people were prescribed injectable buprenorphine (Tab 1 Quarterly Buprenorphine). 
  • In 2023/24 Q4, the NHS Boards with the highest estimated numbers of residents prescribed injectable buprenorphine were Greater Glasgow and Clyde (1,119), Lothian (511) and Tayside (383). 

 

Opioid Substitution Therapy

Annual OST patient estimates

The OST Patient Estimates 2023/24(95Kb) describe the minimum number of individuals prescribed drugs used for the treatment of opioid dependence, by their local authority of residence. This is based on legacy British National Formulary (BNF) subsection 04.10.03 and includes methadone hydrochloride, buprenorphine, buprenorphine & naloxone, and long-acting buprenorphine (including Buvidal© slow-release formulations). Please note that additional formulations have been included in this release of these statistics - formulations included are outlined in the Drugs Included tab of the workbook. Lofexidine hydrochloride and naltrexone hydrochloride (both primarily used for the management of opioid withdrawals) are not included.

The figures shown in Tab 1, Tab 2 and Tabs 3a and 3b are based on the number of unique Community Health Index (CHI) numbers captured from named community prescriptions for relevant medications at any time in a financial year from Prescribing Information System (PIS) data. These figures are described as 'estimates' or 'minimum numbers' due to issues associated with CHI capture for OST prescriptions which mean that it is challenging to provide a robust count of the number of people prescribed these medications. While national completeness is at the lower end of the threshold, data completeness remains variable at NHS Board level. Therefore, we have released a limited range of demographic statistics, which should be interpreted carefully with reference to the discussion on CHI capture.

The OST Patient Estimates shown in Tab 1 are based on patients’ local authority of residence and include totals for groups of local authorities which correspond to NHS Board areas. The OST Patient Estimates on Tab 2 provide a breakdown of annual OST patients by sex (male and female).

Tabs 3a and 3b provide a summary of CHI capture percentages for OST medications by financial year in local authority of prescribing and NHS Board of prescribing respectively. Although most people will be prescribed community medications in the area in which they live, CHI capture rates based on the area of prescription cannot be assumed to apply to the area of residence as individual prescribers may treat people resident in other areas (for example, people who are on holiday). On that basis, these figures are included for indicative purposes only.

As described in the ‘Injectable buprenorphine’ section above, some long-acting buprenorphine treatments administered in community settings are prescribed via hospital stock order forms (captured in the Hospital Medicines Utilisation Database (HMUD)) which do not provide patient identifiers. It is therefore not possible to provide an estimate of the number of patients prescribed injectable buprenorphine via this route by counting unique CHI numbers. After discussion with specialist Pharmacists, a new combined OST estimate has been developed which includes patients prescribed injectable buprenorphine via hospital stock order.

The Combined OST Patient Estimates shown in Tab 4 provide details of the number of patients prescribed methadone, oral buprenorphine, and injectable buprenorphine (inclusive of PIS and HMUD data) by NHS Board of residence for financial years 2020/21 to 2023/24.

In Tab 4, for each financial year and NHS Board of residence:

  • The ‘PIS’ column shows the count of unique Community Health Index (CHI) numbers captured from named community prescriptions for relevant medications at any time in a financial year from Prescribing Information System (PIS) data, as per Tab 1.
  • The ‘HMUD’ column shows the highest quarterly injectable buprenorphine patient estimate within the relevant financial year based on hospital stock order (HMUD) data only. As per the ‘Injectable buprenorphine’ estimates, it has been assumed that the number of monthly (28 day) injectable buprenorphine formulations dispensed approximates to the number of patients who are ‘stable’ on this medication (i.e. who are prescribed a suitable monthly dose, having initially followed a weekly dosing regimen designed to assess their tolerance for this medication). Due to monthly variations in stock orders, quarterly averages of the number of monthly (28 day) injectable buprenorphine formulations supplied per month are used. For HMUD data, it is assumed that NHS Board of supply is the same as NHS Board of residence. HMUD data are available at NHS Board level only and are therefore not shown by local authority of residence.
  • The ‘Total’ column shows the combined total OST patient estimate (the sum of the PIS and HMUD columns). These figures are described as 'estimates' and are published as management information.

Key points:

Based on data from the Prescribing Information System (PIS) only:

  • In 2023/24, OST was prescribed to an estimated minimum of 28,537 people in Scotland. This was a small decrease compared to the 2022/23 estimate (29,176) and the lowest annual estimate in the available time series (Tab 1 OST patients by LA res).
  • The variable quality of the underlying data means that the figures (and comparisons between years or areas) should be treated with caution. However, the estimated minimum number of people prescribed OST in Scotland has been in the range of 28,500 to 29,800 people in each year since 2014/15.
  • In 2023/24, the local authorities with the highest estimated numbers of residents prescribed OST were Glasgow City (5,780), City of Edinburgh (2,828) and Fife (1,820).
  • In 2023/24, the NHS Boards with the highest estimated numbers of residents prescribed OST (based on figures for their constituent local authorities) were Greater Glasgow & Clyde (8,655), Lothian (4,330) and Lanarkshire (2,976).
  • In 2023/24, the 28,537 estimated OST patients, 19,343 (68%) were male, and 9,194 (32%) were female. These percentages were consistent with previous years.
  • The above figures are based on prescriptions with valid CHI numbers. In 2023/24 there were 85.8% of OST prescriptions with a valid CHI number – the highest percentage across the time series (Tab 3a CHI capture by LA treat).

Based on data from the Prescribing Information System (PIS) and Hospital Medicines Utilisation Database (HMUD):

  • In 2023/24, including patients supplied with injectable buprenorphine via hospital stock order systems, it is estimated that OST was prescribed to an estimated minimum of 29,817 people in Scotland. This was a small decrease compared to the 2022/23 estimate (29,942) (Tab 4 Combined Pat OST Estimated).

Quarterly OST patient estimates (12-month rolling period)

The Quarterly OST patient estimates (60Kb) describe the minimum number of individuals prescribed drugs used for the treatment of opioid dependence, by their local authority of residence. This is based on legacy British National Formulary (BNF) subsection 04.10.03 and includes methadone hydrochloride, buprenorphine, buprenorphine & naloxone, and long-acting buprenorphine (including Buvidal© slow-release formulations). Please note that additional formulations have been included since the 2023/24 Q4 release of these statistics - formulations included are outlined in the Drugs Included tab of the workbook. Lofexidine hydrochloride and naltrexone hydrochloride (both primarily used for the management of opioid withdrawals) are not included. 

The Quarterly OST Patient Estimates shown in Tab 1 are based on patients’ local authority of residence and include totals for groups of local authorities which correspond to NHS Board areas. These estimates are based on the number of unique Community Health Index (CHI) numbers captured from named community prescriptions from Prescribing Information System (PIS) data for relevant medications at any time within 12 months of each financial year quarter. Generally, patient numbers and characteristics are only provided when CHI completeness is 85-90% or higher. While national completeness is at the lower end of the threshold, data completeness remains variable at NHS Board level. The purpose of publishing these quarterly updates is to provide regular and frequent surveillance of trends in the numbers of people prescribed OST.

It is recognised that some long-acting buprenorphine treatments administered in community settings are prescribed via hospital stock order forms (captured in the Hospital Medicines Utilisation Database (HMUD)) and do not include patient details. It is therefore not possible to provide an estimate of the number of patients prescribed injectable buprenorphine via this route by counting unique CHI numbers. After discussion with specialist Pharmacists, a new combined OST estimate has been developed which includes patients prescribed injectable buprenorphine via hospital stock order.

The Combined OST Patient Estimates shown in Tab 2 provide details of the number of patients prescribed methadone, oral buprenorphine, and injectable buprenorphine (inclusive of PIS and HMUD data) by NHS Board of residence for 2023/24 Q2 to 2024/25 Q1.

By showing the estimates on the basis of a rolling 12-month period, which is updated each quarter, it is possible to observe changes in the numbers of people prescribed OST in a timelier manner than in the annual figures shown above. The most recent estimate covering the four preceding financial year quarters up to 2024/25 Q1, shows the number of unique CHI numbers recorded in OST prescriptions from 1 July 2023 to 30 June 2024. The previous estimate (2023/24 Q4) represents the four financial year quarters from 1 April 2023 to 31 March 2024.

In Tab 2, for each rolling-12-month period and NHS Board of residence:

  • The ‘PIS’ column shows the count of unique Community Health Index (CHI) numbers captured from named community prescriptions for relevant medications at any time in a financial year from Prescribing Information System (PIS) data, as per Tab 1.
  • The ‘HMUD’ column shows the highest quarterly injectable buprenorphine patient estimate within the relevant rolling 12-month period based on hospital stock order (HMUD) data only. It has been assumed that the number of monthly (28 day) injectable buprenorphine formulations dispensed approximates to the number of patients receiving this medication. Due to monthly variations in stock orders, quarterly averages of the number of monthly (28 day) injectable buprenorphine formulations supplied per month are used. For HMUD data, it is assumed that NHS Board of supply is the same as NHS Board of residence. HMUD data are available at NHS Board level only and are therefore not shown by local authority of residence.
  • The ‘Total’ column shows the combined total OST patient estimate (the sum of the PIS and HMUD columns). These figures are described as 'estimates' and are published as management information.

In the 12 months to 2024/25 Quarter 1:

Based on data from the Prescribing Information System (PIS) only:

  • OST was prescribed to an estimated minimum of 28,161 people in Scotland. This was a small decrease compared to the 2023/24 Q4 estimate (28,537) and the lowest estimate in the available time series (Tab1 Q OST Estimates (PIS)).
  • The local authorities where the highest estimated numbers of people prescribed OST lived were Glasgow City (5,698), City of Edinburgh (2,818) and Fife (1,798).
  • The NHS Board areas where the highest estimated numbers of people prescribed OST lived (based on figures for their constituent local authorities) were Greater Glasgow & Clyde (8,521), Lothian (4,316) and Lanarkshire (3,030).

Based on combined data from the Prescribing Information System (PIS) and the Hospital Medicines Utilisation Database (HMUD):

  • OST (inclusive of injectable buprenorphine prescribing) was prescribed to an estimated minimum of 29,470 people in Scotland. This was a small decrease compared to the 2023/24 Q4 estimate (29,817) (Tab2 Q Combined OST Estimates).
  • The NHS Board areas where the highest estimated numbers of people prescribed OST (inclusive of injectable buprenorphine prescribing) lived were Greater Glasgow & Clyde (8,579), Lothian (4,570) and Lanarkshire (3,032).

 OST patient estimates validity exercise

In order to assess the accuracy of the estimates produced by PHS, a validity exercise was carried out prior to the first release of these statistics in March 2022. OST prescribers in each of the territorial NHS Boards were invited to provide independent counts of the number of people receiving OST in 2020/21. The results of this exercise are available in OST Patient Estimates 2020/21 (82KB) (Tab C NHS Board OST counts)

Key points:

  • Counts of the number of people prescribed OST in 2020/21 were provided by pharmacists in all territorial NHS Boards except for NHS Shetland. The information provided by NHS Boards indicated that OST was prescribed to a minimum of 29,483 people in 2020/21 (Tab C NHS Board OST counts). If PHS’s OST patient estimate (Tab A OST Patients by LA res) was used for NHS Shetland (105), the 2020/21 Scotland total would have been 29,588.
  • In 2020/21, the largest numerical discrepancies between the NHS Board OST counts and the PHS OST patient estimates were observed in NHS Lanarkshire (3,036 compared to 2,647) and NHS Ayrshire & Arran (2,068 compared to 2,389) (Tab A OST patients by LA res & Tab C NHS Board OST counts). NHS Board OST patient counts were provided using a variety of local systems, with some excluding specific prescriber types or not covering the entire financial year. However, the overall similarity between the NHS Board OST counts and the PHS OST patient estimates provides some reassurance about the validity of OST prescribing data published on ScotPHO.

OST Drug Prescribing - Prisons

The National Prisoner Healthcare Network collects data on the number of prisoners prescribed Opioid Substitution Therapy drugs by prison establishment. The latest data can be found in the PHS Prison Health Information Dashboard.

Key points:

  • On 14 July 2021, approximately 30.8% of prisoners in Scotland were receiving Opioid Substitution Therapy, an increase compared to previous years (26.3% on 9 February 2020, and 22.0% on 6 June 2018)
  • Methadone was prescribed to 22% (1,512) of prisoners, 6% (396) were prescribed Buprenorphine, 3% (214) were prescribed Buvidal, and 0.1% (5) were prescribed buprenorphine/naloxone on that day.
  • The highest percentage of prisoners prescribed methadone was observed in HMP Greenock (37%), HMP Kilmarnock (32%) and HMP Edinburgh (29%). The lowest percentages of prisoners prescribed methadone were observed in HMP Polmont, HMP Castle Huntly, and HMP Dumfries (8%, 7% and 6% respectively).
  • Prescribing of Buvidal in prisons in Scotland was introduced as a contingency measure response to the COVID-19 pandemic, as it is a sustained release injectable form of OST and available in 7-day or 28-day doses, compared to daily oral doses of methadone. HMP Cornton Vale, HMP Inverness and HMP Glenochil were the establishments with the highest percentages of prisoners prescribed Buvidal (11%, 7% and 6% respectively).
  • The prison establishments with the highest percentage of prisoners prescribed Buprenorphine  were HMP Perth (20%), HMP Castle Huntly (8%) and HMP Inverness (8%).
  • Buprenorphine/naloxone was prescribed in just two prisons: HMP Inverness (3% of prisoners) and HMP Grampian (0.5%)

 Previous findings can be found here: