National Mission on Drugs: annual monitoring report 2022-2023

Footnotes

1. Life Expectancy in Scotland, 2020 - 2022, National Records of Scotland, September 2023

2. 'Drug-misuse deaths' is the terminology used by the NRS in their 'Drug-related deaths in Scotland' statistical publication and is consistent with the terminology used in other parts of the UK. The term ‘misuse’ is seen by some as stigmatizing. The Scottish Government aims to use neutral language where possible unless referencing an official title, technically defined term or policy from a different organisation.

3. Suspected drug deaths in Scotland: July to September 2023, Scottish Government, December 2023

4. Rapid Action Drug Alerts and Response (RADAR) quarterly report - October 2023, Public Health Scotland, October 2023

5. RADAR Nitazenes alert 2023 - Rapid Action Drug Alerts and Response (RADAR) Alerts, Public Health Scotland, January 2023

6. RADAR Bromazolam alert 2023 - Rapid Action Drug Alerts and Response (RADAR) Alerts, Public Health Scotland, July 2023

7. New synthetic drugs on the RADAR, Public Health Scotland, October 2023

8. Prevalence of Problem Drug Use in Scotland 2015/16 Estimates, Information Services Division, March 2019

9. Prevalence of Problem Drug Use in Scotland 2015/16 Estimates, Information Services Division, March 2019

10. Scottish Health Survey 2021, Scottish Government, November 2022

11. Includes illegal drugs, drugs formerly known as legal highs, solvents or prescription drugs that were not prescribed to the pupil themselves.

12. Health and Wellbeing Census Scotland 2021-2022, Scottish Government, February 2023

13. There are 32 local authorities in Scotland.

14. Scottish Schools Adolescent Lifestyle and Substance Use Survey (SALSUS). Scottish Government, November 2019

15. Health Behaviour in School-Aged Children (HBSC) Scotland 2022, University of Glasgow, June 2023

16. Health Behaviour in School-Aged Children (HBSC) Scotland 2018, University of Glasgow, January 2020

17. School exclusion statistics, Scottish Government, March 2022. This survey is run biennially, which means the next wave of data (which are not currently available) will cover the period 2022/23.

18. The school year covered by the 2020/21 exclusions statistics was substantially affected by the COVID-19 pandemic – some of the decrease in exclusions observed between 2018/19 and 2020/21 was due to the pandemic limiting the amount of time that pupils were in school.

19. Total incidents over the 52 weeks to 26 March 2023.

20. Total incidents over the 52 weeks to 27 March 2022.

21. Total incidents over the 23 weeks to 28 August 2023 and total incidents over the 23 weeks to 4 September 2022.

22. Rapid Action Drug Alerts and Response (RADAR) quarterly report - October 2023, Public Health Scotland, October 2023. Data relates to all inpatient and day-case admissions to general acute hospitals (excluding psychiatric hospitals) where drug use was recorded as a diagnosis at some point during the patient’s hospital stay.

23. These statistics are limited to attendances when needle and syringes are provided. IEP outlets also distribute other equipment such as foil, wipes/swabs, citric acid and spoons. IEP services continue to evolve in response to legislative changes, changes in the drugs available and the way in which they are used, and blood borne virus outbreaks among people who inject drugs.

24. DAISy is a national database developed to collect drug and alcohol referrals, waiting times, treatment and outcome information from staff delivering specialist drug and alcohol interventions. DAISy was available in all NHS Boards from April 2021 and provides information on how Scotland is responding to demand for specialist drug and/or alcohol use services.

25. Scottish Drug Misuse Database Overview of Initial Assessments for Specialist Drug Treatment 2020/21, Public Health Scotland, May 2022

26. Drug and alcohol information system (DAISy) overview of initial assessments for specialist drug and alcohol treatment 2021/22 and 2022/23, Public Health Scotland, June 2023

27. This is done by counting only first supplies (i.e. excluding repeat and spare supplies) to people at risk of an opioid overdose (excluding supplies made to service workers and family/friends). Within a specific time period, ‘reach’ effectively corresponds to the number of ‘at risk’ individuals newly supplied with take home naloxone and is therefore lower than the number of kits distributed in that period. The number of individuals ‘at risk’ are the most recent drug prevalence data from 2015/16.

28. The 29 ADP areas were assessed against the 10 MAT standards using three streams of evidence: process, numerical and experiential. The scores for the evidence streams (three for MAT standards 1-5, two for 6-10) were combined and a Red, Amber, Green, or Blue (RAGB) score allocated by the MAT Implementation Support Team. ‘Green’ is defined as “There is evidence of full implementation and benefit to people in all unique combinations of setting and service that offer MAT and opioid substitution therapy across the ADP area”. ‘Provisional green’ is “There is evidence of implementation and benefit to people, however, full implementation is not confirmed by all three evidence streams – usually the experiential stream is lacking”. It should be noted that the category ‘provisional green’ was only used in 2023.

29. McAuley A, Fraser R, Glancy M, Yeung A, Jones HE, Vickerman P, Fraser H, Allen L, McDonald SA, Stone J, Liddell D. Mortality among individuals prescribed opioid-agonist therapy in Scotland, UK, 2011–20: a national retrospective cohort study. The Lancet Public Health. 2023 Jun 6.

30. Residential rehabilitation: literature review Scottish Government, May 2022

31. Data sourced from DAISy, a national database developed to collect drug and alcohol referrals, waiting times, treatment and outcome information from staff delivering specialist drug and alcohol interventions. DAISy was available in all NHS Boards from April 2021 and provides information on how Scotland is responding to demand for specialist drug and/or alcohol use services. Co-dependency was added as a new treatment category with the introduction of DAISy in April 2021. As such there are no referrals for co-dependency prior to the introduction of the DAISy system.

32. National Drug and Alcohol Treatment Waiting Times: 1 January to 31 March 2021 Public Health Scotland, June 2021

33. This spike may be due to a post-pandemic catch-up effect of changes in service provision, assumptions around availability of services, and attendance during the COVID-19 lockdown period.

34. Alcohol and Drug Partnership (ADP) 2022/23 Annual Survey, Scottish Government, September 2023

35. Previous iterations of the ADP Survey asked about near-fatal overdoses but only in the context of criminal justice: Alcohol and Drug Partnerships (ADP) 2021/22 annual returns: summary report, Scottish Government, November 2022

36. Waiting times are a high-profile measure of how Scotland is responding to demand for services. Scottish Government has an established target that 90% of people referred for help with problematic drug or alcohol use will wait no longer than three weeks for specialist treatment that supports their recovery.

37. National drug and alcohol treatment waiting times 1 April 2023 to 30 June 2023, Public Health Scotland, September 2023

38. NHS Ayrshire & Arran, Dumfries & Galloway, Forth Valley and Lanarkshire.

39. The 29 ADP areas were assessed against the 10 MAT standards using three streams of evidence: process, numerical and experiential. The scores for the evidence streams (three for MAT standards 1-5, two for 6-10) were combined and a RAGB score allocated by the MAT Implementation Support Team. ‘Green’ is defined as “There is evidence of full implementation and benefit to people in all unique combinations of setting and service that offer MAT and opioid substitution therapy across the ADP area”. ‘Provisional green’ is “There is evidence of implementation and benefit to people, however, full implementation is not confirmed by all three evidence streams – usually the experiential stream is lacking”. It should be noted that the category ‘provisional green’ was only used in 2023.

40. Questions in the ADP Survey were intended to report on areas of ADP activity that are not published elsewhere, and so do not reflect the totality of work that ADPs undertake. Noting the diversity of ADP provision, the multiple choice options available to respondents were provided for ease of completion and did not necessarily imply expectations of what should be in place.

41. See National benchmarking report on implementation of the medication assisted treatment (MAT) standards 2022/23, Public Health Scotland, June 2023

42. Treatment target for people with problematic drug use, Scottish Government, March 2023

43. Expanding access to Residential Rehabilitation in Scotland, Scottish Government, November 2021

44. McAuley A, Fraser R, Glancy M, Yeung A, Jones HE, Vickerman P, Fraser H, Allen L, McDonald SA, Stone J, Liddell D. Mortality among individuals prescribed opioid-agonist therapy in Scotland, UK, 2011–20: a national retrospective cohort study. The Lancet Public Health. 2023 Jun 6.

45. Residential rehabilitation: literature review Scottish Government, May 2022

46. Medication Assisted Treatment (MAT) standards: access, choice, support, Scottish Government, May 2021

47. An ‘episode of care’ is first recorded on DAISy when people engage with a service provider for specialist alcohol and/or drug treatment. ‘Episodes of care’ are eligible to have an initial assessment recorded once a treatment start date has been agreed and entered into the system. Initial assessments must be submitted within eight weeks of the treatment start date. It should be noted that a person may start multiple episodes of care during a financial year.

48. Methadone hydrochloride, buprenorphine, buprenorphine & naloxone and long-acting buprenorphine including Buvidal© slow-release formulations. These figures are described as ‘estimates’ or ‘minimum numbers’ due to issues associated with the capture of Community Health Index numbers from OST prescriptions, which means it is challenging to provide a robust count of the number of people prescribed these medications.

49. It should be noted these data only capture the number of approved placements and do not provide insight into outcomes.

50. The 29 ADP areas were assessed against the MAT standards using three streams of evidence: process, numerical and experiential. The scores for the evidence streams (three for MAT standards 1-5, two for 6-10) were combined and a RAGB score allocated by the MAT Implementation Support Team. ‘Green’ is defined as “There is evidence of full implementation and benefit to people in all unique combinations of setting and service that offer MAT and opioid substitution therapy across the ADP area”. ‘Provisional green’ is “There is evidence of implementation and benefit to people, however, full implementation is not confirmed by all three evidence streams – usually the experiential stream is lacking”. It should be noted that the category ‘provisional green’ was only used in 2023.

51. 2023 was the first year for which data definitions, data sources and recording rules were defined for MAT standards 6-10.

52. Partial implementation comprises the categories ‘amber’ (‘there is evidence of partial implementation of the standard in MAT services including benefit to people’) and ‘provisional amber’ (‘there is evidence that implementation is beginning but no evidence of benefit to people’). It should be noted that the category ‘provisional amber’ was only used in 2023.

53. Episodes of care that are eligible to have an initial assessment entered onto DAISy are those with a completed waiting time and a treatment start date. In 2022/23, there were 27,534 episodes of care eligible for initial assessment, of which 18,095 (66%) were completed and entered into DAISy.

54. Wellbeing measured by the Warwick Edinburgh Mental Wellbeing Scale (WEMWBS). The WEBWMS scale ranges from 14 to 70. Higher scores indicate greater mental wellbeing.

55. Scottish Health Survey 2021, Scottish Government, November 2022

56. 'Drug-misuse deaths' is the terminology used by the NRS in their 'Drug-related deaths in Scotland' statistical publication and is consistent with the terminology used in other parts of the UK. The term ‘misuse’ is seen by some as stigmatizing. The Scottish Government aims to use neutral language where possible unless referencing an official title, technically defined term or policy from a different organisation.

57. As measured by the Scottish Index of Multiple Deprivation (SIMD), a ‘relative’ measure of deprivation. If an area is identified as ‘deprived’, this can relate to people having a low income, but it can also mean fewer resources or opportunities. SIMD looks at the extent to which an area is deprived across seven domains: income, employment, education, health, access to services, crime, and housing.

58. As measured by the Scottish Index of Multiple Deprivation (SIMD).

59. Acute hospital activity and NHS beds information (annual) – year ending 31 March 2023, Public Health Scotland, September 2023

60. Deaths of people experiencing homelessness are difficult to count. These are official statistics in development from the NRS and represent the best estimate of the number of deaths of people experiencing homelessness derived from a combination of death registration records and statistical modelling.

61. 'Drug-misuse deaths' is the terminology used by the NRS in their 'Drug-related deaths in Scotland' statistical publication and is consistent with the terminology used in other parts of the UK. The term ‘misuse’ is seen by some as stigmatizing. The Scottish Government aims to use neutral language where possible unless referencing an official title, technically defined term or policy from a different organisation.

62. A ‘household’ refers to anyone applying for homelessness support with the intention of living together. A household can therefore be comprised of a single individual, but more often includes multiple people including adults and children.

63. Support needs are self-declared and may therefore be an under or overestimate.

64. Alcohol and Drug Partnership (ADP) 2022/23 Annual Survey, Scottish Government, September 2023

65. Scottish Alcohol and Drug Partnerships (ADP) 2021/22 Annual Returns: Summary Report, Scottish Government, November 2022

66. Whole Family Approach: rapid review of literature, Scottish Government, July 2023

67. Alcohol and Drug Partnership (ADP) 2022/23 Annual Survey, Scottish Government, September 2023

68. Holistic whole family support: routemap and national principles, Scottish Government, July 2022

69. Scottish Social Attitudes Survey 2021/22: Public Attitudes Towards People with Problem Drug Use, Scottish Government, November 2022. ‘Comfortable’ refers to total percentage of respondents who said they felt ‘very comfortable’ or ‘fairly comfortable’.

70. Scottish Social Attitudes Survey 2021/22: Public Attitudes Towards People with Problem Drug Use, Scottish Government, November 2022.

71. The result from the 2009 survey is not directly comparable to that in 2021 due to differences in survey methodology.

72. Alcohol and Drug Partnership (ADP) 2022/23 Annual Survey, Scottish Government, September 2023

73. Alcohol and Drug Partnership (ADP) 2022/23 Annual Survey, Scottish Government, September 2023

74. The ADP Annual Survey 2022/23 asked ADPs to report whether the treatment or support service was in place for a range of age groups: 0-4 years (early years), 5-12 years (primary), 13-15 years (secondary S1-S4), 16-24 years (young people). For the purposes of reporting, responses have been combined.

75. Scottish Alcohol and Drug Partnerships (ADP) 2021/22 Annual Returns; Summary Report, Scottish Government, October 2022. Note that data collection and methodology changes between 2021/22 and 2022/23 may affect the comparability of the data.

76. Scottish Household Survey 2021, Scottish Government, April 2023

77. 'Drug misuse' is the terminology used in the statistical publication. The term ‘misuse’ is seen by some as stigmatizing. The Scottish Government aims to use neutral language where possible unless referencing an official title, technically defined term or policy from a different organisation.

78. Child protection processes start when a concern about harm (or risk of harm) from abuse or neglect to a child has been raised, and police or social work have been notified. This may lead to an investigation which may in turn lead to a case conference. A case conference may lead to a registration. Note that multiple concerns can be recorded at Case Conferences, meaning that the total number of concerns will be greater than the total number of registrations.

79. Children’s Social Work Statistics Scotland: 2021 to 2022, Scottish Government, April 2023