National mission on drugs

In January 2021, the former First Minister announced a new National Mission to reduce drug deaths and harms supported by an additional £250 million funding between 2021 to 2026. Our outcomes framework and cross-cutting priorities (August 2022), developed with stakeholders, reflects our key objectives.

Harm reduction

The Drug Death Taskforce stressed that harm reduction was a key element of the strategy for reducing drug related deaths. The Scottish Government published a drug law reform paper (July 2023) proposing harm reduction as a key underlying principle for future drugs policy.

Naloxone

Naloxone is the emergency antidote for overdoses caused by heroin and other opiates. Scotland was the first country in the world to introduce a National Naloxone Programme to help prevent fatal opioid overdoses. The Click and Deliver service provides naloxone to anyone living in Scotland who is over the age of 16 (for injection kit) and 14 (for nasal kit).

Quarterly and annual monitoring on the number of take-home naloxone kits provided in Scotland is published by Public Health Scotland. Police Scotland completed their naloxone roll out in 2023 with more than 12,500 police officers routinely carrying naloxone. Naloxone kits have been made available in every community pharmacy across the country for use in an emergency. 

Non-fatal overdoses

Non-fatal overdoses are a good indicator that someone is at risk of going on to experience a fatal overdose, so these individuals need to be a priority for follow up and additional support. Non-Fatal Overdose Pathways and outreach work are crucial to connect people to the right services.

Safer Drug Consumption Facility

The first Safer Drug Consumption Facility (SDCF) in the UK opened in Glasgow on 13 January 2025, and it is hoped other areas of Scotland will follow. An extensive evaluation of The Thistle facility is planned.

The SDCF evidence paper (2021) outlined how facilities will aim to reduce the risks of disease transmission, prevent drug-related overdose deaths and connect high-risk drug users with treatment and other services.

Drug checking

Drug checking services allow people to anonymously submit samples of drugs for testing, enabling them to make more informed decisions, and put them in contact with support services.

The Scottish Drug Checking Project demonstrates how drug checking could be effective in Scotland. Applications to the Home Office for controlled drug licenses have been submitted, which will allow three separate pilot sites to open, along with a National Testing Laboratory.

Alongside the national testing laboratory they will feed additional information into our wider drug RADAR surveillance system. We intend to commission an independent evaluation that will cover the three sites and the National Testing Laboratory.

Treatment

We support people to make informed choices about the type of medication and help available to them. This is an essential part of respecting a person’s rights and dignity.

The Medication Assisted Treatment (MAT) standards (May 2021) define what is needed for the consistent delivery of safe and accessible drug treatment and support in Scotland.

Implementation of MAT standards is measured in the national benchmarking report published annually by Public Health Scotland. More information and resources on MAT are on the Public Health Scotland website.

We supported the opening of the first Heroin Assisted Treatment (HAT) service in Glasgow in 2019. An evaluation of HAT and a set of recommendations were made by the Chief Scientist’s Office.

Positive findings in the patient experience follow-up report for Long-acting injectable Buprenorphine (Buvidal) has meant it is now on all health board formularies and being made available nationally.

Opioid Substitution Therapy (OST) treatment can be effective in reducing drug deaths and harm, as outlined in the OST Evidence Review. PHS publish quarterly data on the number of people in OST.

Acknowledging that benzodiazepines are implicated in a high proportion of drug deaths, a benzodiazepine evidence review was published in March 2022. In December 2023, PHS published MAT standards informed response to benzodiazepine harm reduction guidance.

We published Benzodiazepine prescribing guidance (August 2024). We are funding a pilot benzodiazepine clinic in Fife, which offers completion of a safe and time limited benzodiazepine detoxification where appropriate.

We are concerned at the rise in numbers of deaths where cocaine has been implicated. We have asked local services to ensure pathways are in place to meet this increase in demand. Services provide a range of residential and community-based support for people including supervised detox, crisis care, psychosocial therapy, cognitive behavioural therapy and rehabilitation.

Drug Research Network Scotland published a stimulant dependence rapid review (September 2024) to examine evidence on treatments for stimulant use.

We are developing a national specification following a recommendation made by the Taskforce. It will set out the types of treatment and recovery services for drugs and alcohol that should be available across Scotland. We will publish the specification in 2025.

Residential rehabilitation

We have made £100 million available to support residential rehabilitation from 2021 to 2026.

We have made two key commitments regarding residential rehabilitation. We have committed to:

increasing residential rehabilitation capacity from the estimated 425 beds in this report to 650 beds by 2026
ensure that by 2026, at least 1000 people are publicly funded to go to rehab every year. This would represent a 300% increase on the number prior to the launch of the National Mission.

Progress towards these targets are reported in the interim monitoring reports on statutory funded residential rehab placements published by Public Health Scotland (PHS). As part of the National Mission evaluation, PHS published the first residential rehab evaluation report in February 2024.

The Residential Rehabilitation Development Group (RRDWG), established in June 2020, to advise on the provision of drug and alcohol residential rehabilitation services across Scotland. The RRDWG published recommendations on drug and alcohol residential treatment services (December 2020).

As part of this program a range of research has been commissioned, including:

a review of the international evidence on residential rehabilitation (May 2022)
a survey of residential rehabilitation providers (Nov 2021)
a review of international literature on recovery housing in (Nov 2023)
a mapping exercise for stabilisation, detoxification and other crisis support in Scotland (March 2024)
a mapping and capacity survey of providers in Scotland (August 2024).

We have worked with Scotland Excel to develop a flexible framework (January 2024), which seeks to standardise approaches to commissioning placements in residential rehabilitation, including detox and aftercare.

The national service directory provides a nationwide list of residential rehabilitation providers.

Workforce

A resilient and skilled workforce is a cross-cutting priority underpinning the National Mission. We established a Workforce Expert Delivery Group in September 2022. The group consider the challenges facing the drugs and alcohol workforce and advise on how best to support the sector’s workforce.

We published a mixed-methods research compendium (March 2022) evaluating issues concerning the drugs and alcohol workforce in Scotland.

As recommended by the Drug Deaths Taskforce, we published the drugs and alcohol workforce action plan 2023 to 2026 in December 2023. This sets out the actions to be taken to develop a sustainable, trauma informed, skilled workforce with the capacity to deliver a person centred, rights-based approach.

The Workforce Expert Delivery Group provides oversight and advice on the delivery of those actions outlined within the action plan.

Data and surveillance

We are committed to improving data and surveillance around drugs and alcohol. Developments have included a drug prevalence estimate, supporting further developments of the Drug and Alcohol Information System (DAISy) and investing in the Rapid Action Drug Alerts and Response (RADAR).

The Glasgow City WAND initiative is a wound management assessment of injecting risk. It was designed to address issues including drug related death, injecting related complications and blood-borne viruses and is aimed specifically at people injecting street drugs.

The Needle Exchange Surveillance Initiative (NESI) monitors the prevalence of blood-borne viruses – hepatitis C virus and HIV – and injecting risk behaviours among people who inject drugs in Scotland.

A new substance of significant concern, a group of synthetic opioids called nitazenes, have been detected in a range of locations in Scotland in 2024 and have also been detected in post-mortem toxicology results.

Regular updates on nitazenes are on are on the Public Health Scotland website.

National Records of Scotland publish a fully evidenced report on Drug Related Deaths in Scotland annually. Police Scotland provides a timely indication of broad drug death trends in Scotland through quarterly suspected drug death reports.

Public Health Scotland publish Drug Related Hospital Statistics, the Scottish Drug Misuse Database and the Scottish Public Health Drug Linkage Programme.

Monitoring and evaluation

We publish a National Mission on Drugs annual report, outlining progress against the outcomes framework set out in the National Mission Plan.

The National Mission annual monitoring report provides a robust statistical backdrop to monitor progress made towards the Mission outcomes. It is complemented by monitoring metrics, which outlines key data sources, rationale for inclusion and limitations.

Public Health Scotland (PHS) are conducting an independent evaluation of the National Mission. Their evaluation framework (May 2024) sets out key questions and proposal for the evaluation.

Alcohol and drugs