Drug misuse: treatment for drug misuse
NHS boards, local authorities 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) (23Kb) across Scotland form the focal point for local action on drug misuse, and receive strong support from the Scottish Government.
Scottish Drug Misuse Database
The Scottish Drug Misuse Database (SDMD), which is managed by ISD Scotland, was set up in 1990 to collect information about people with problem drug use, based on data obtained when individuals first made contact with services providing tier 3 and 4 interventions (i.e. structured community and residential treatment) or reinitiated contact following a gap of at least six months since last attendance. Services contributing to the SDMD include specialist drug services and some medical services. The dataset includes information on their drug use and injecting behaviours, along with information on their social situation (e.g. employment, education/training, housing etc.).
The SDMD is an important and widely used national information source on problem drug use in Scotland. It provides a range of information on individuals assessed for specialist drug treatment that members of the public, government and healthcare/Alcohol and Drug Partnership (ADP) staff may use to identify trends in activity over time, make comparisons between areas/groups, conduct research, improve services and influence policy in relation to service provision for problem drug use.
This report should be viewed in conjunction with the Scottish Drug Misuse Database Dashboard (replacing the Excel workbook published alongside previous reports). This dashboard is available to all users and provides accessible, interactive content based on data from 2006/07 to 2014/15.
In 2014/15, following extensive collaborative work between NHS Boards and ISD, the quality and completeness of data improved sufficiently to allow the first publication of a full national SDMD Annual Report since 2011/12. Section 1 of the report describes the findings of data quality and completeness investigations, concluding that:
‘nationally, SDMD provides data on a demographically representative group of individuals assessed for specialist drug treatment. The SDMD data collection includes a wide range of indicators (e.g. ‘illicit’ drug use, prescribed drug use, injecting behaviour) that are not available, on a national basis, from other drug treatment data sources. Therefore, while SDMD does not provide data on all individuals with problem drug use in Scotland, it is a unique data source that provides national level data on the characteristics of individuals who were assessed for specialist drug treatment’ (p.15).
Key Points from Section 2 (Scotland and NHS Board/ADP of Residence) of the report were:
- In 2014/15, initial assessments for specialist drug treatment relating to 12,402 individuals were recorded on SDMD.
- The ratio of male to females assessed in 2014/15 was approximately 3:1 (71% male); consistent with previous years.
- An increasing percentage of individuals recorded on SDMD were from older age groups; in 2006/07, almost one-third (30%) of individuals assessed for specialist drug treatment were aged 35 and over, compared with almost half (48%) in 2014/15.
- Among the 8,692 individuals providing information on recent ‘illicit’ drug use (including Novel Psychoactive Substances/legal highs), heroin(3,955; 46%) was the drug for which people most commonly sought treatment, followed by cannabis (1,762; 20%) and diazepam (868; 10%). The percentage of individuals reporting heroin as their main drug has decreased from 64% in 2006/07.
- Information about current prescriptions for the treatment of addiction was provided by 5,167 individuals. Among
these, methadone (an Opioid Replacement Therapy or ORT) was the most commonly prescribed drug; recorded in 60% (3,115) of assessments where a prescription drug was reported, followed by ‘other drugs’ (1,592; 31%) and diazepam (731; 14%).
- The percentage of under 25s reporting recent heroin use decreased from 58% (1,592/2,729) in 2006/07 to 23% (362/1,547) in 2014/15.
- Among individuals providing information on injecting (9,913), almost half (4,638; 47%) had never injected drugs, 33% (3,265) stated they had done so in the past and 20% (2,010) currently injected drugs. A general downward trend in the percentage of individuals reporting current injecting since 2006/07 (28%) was observed.
- Current sharing of needles/syringes and injecting paraphernalia was reported by 6% (282/5,067) and 8% (387/4,622) of individuals injecting drugs in the month prior to assessment; the lowest percentages recorded since 2006/07 (12% and 20% respectively).
Drug and Alcohol Treatment Waiting Times Database (DATWT)
Since 2011, data on waiting times for specialist drug and alcohol treatment have been collected in ISD’s Drug and Alcohol Treatment Waiting Times (DATWT) database. The system measures 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. 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 ISD website. The percentage of waits longer than 3 weeks is also an indicator included in the ScotPHO Drugs Profile, where data is shown at Scotland, NHS Board and Alcohol & Drug Partnership level.
Prescribing for Opioid Dependency
Opioid Replacement Therapy (ORT) Drug Prescribing
Drugs used for treatment of opioid dependence include all those in BNF section 04.10.03. Methadone hydrochloride is the most commonly used pharmacological treatment for opioid dependency in Scotland. The Excel file Drug Prescribing Scotland 2015/16 lists all drugs used for Opioid Replacement Therapy (ORT).Table 1 shows for each of the drugs the number of dispensed items, gross ingredient costs, defined daily doses (see definition under the Intro tab of the Excel file), and the defined daily doses per 1,000 population per day for each year from 2006/07 to 2015/16 in Scotland with Table 2 giving a breakdown by NHS Board. Table 3 shows costs and fees associated with methadone prescribing at Scotland and NHS Board level and Table 4 shows the quantities of methadone hydrochloride dispensed at Scotland and NHS Board level. Caution should be used in comparing relative costs across NHS Boards. Supervision costs and controlled drug fees are locally negotiated, and data is not available centrally for all NHS Health Boards.
- For the fifth successive year there has been a decrease in the dispensing of Opioid Replacement Therapy drugs (including methadone). From 2010/11 to 2015/16, the number of items dispensed decreased by 9% from 574,420 to 522,956 and the number of defined daily doses decreased by 16% from 26.3 million to 22.0 million (Table 1 – Scotland Summary Data: BNF Subsection 4.10.03 - Opioid Dependence (all drugs)).
- Based on numbers of dispensed items, methadone prescriptions decreased from 96% of all ORT prescriptions in 2006/07 to 83% in 2015/16. Prescriptions for Suboxone (buprenorphine and naloxone) increased from 1% of all ORT prescriptions in 2007/08 (the first year dispensed) to 14% in 2015/16 (Table 1 – Scotland Summary Data).
- From 2010/11 to 2015/16, the number of methadone items dispensed decreased by 19% from 534,674 to 433,448 and the number of defined daily doses decreased by 20% from 25.6 million to 20.5 million (Table 1 – Scotland Summary Data: Methadone Hydrochloride).
- The number of prescriptions for Suboxone (buprenorphine and naloxone) increased year on year from 6,945 in 2007/08 to 75,567 in 2014/15. In 2015/16, there was a 3% decrease in the number of dispensed items (73,070). The number of defined daily doses remained roughly the same from 2014/15 to 2015/16 (both 1.3 million) (Table 1 – Scotland Summary Data: Buprenorphine and Naloxone).
- From 2010/11 to 2015/16, the cost of methadone dispensing decreased from £6,382 to £4,972 per 1,000 adult population (Table 3 – Methadone Costs & Fees).
Methadone Patient Estimates
There was an observed decrease between 2010/11 and 2015/16 in the number of Opioid Replacement Therapy (ORT) items dispensed (including methadone hydrochloride). It should be noted, however, that this may not reflect a reduction in the number of individuals receiving ORT for the treatment of drug misuse.
The number of individuals prescribed specific drugs can be estimated using the Community Health Index (CHI) numbers captured on prescriptions and is usually reported only when CHI completeness is above 85-90%. However, there are issues associated with the CHI capture rate for methadone prescriptions which mean it is not possible to provide a robust count of the number of individuals prescribed methadone as an ORT in Scotland. While the national CHI capture for methadone increased from 64.1% in 2011/12 to 74.0% in 2015/16, it remains below this threshold of reliability. However, as a result of ongoing public interest in methadone prescribing, these statistics are published as management information.
The Methadone Patient Estimates 2015/16 (55Kb) are a minimum count of individuals prescribed methadone hydrochloride 1mg/ml solution (the most commonly prescribed ORT formulation in Scotland).
- In 2015/16, methadone 1mg/ml solution was prescribed to a minimum of 25,569 individuals (Tab 1).
- The minimum number of people prescribed methadone 1mg/ml solution in 2011/12 was 26,197 individuals. While the minimum number of individuals prescribed methadone was higher in 2011/12 than in 2015/16, the variable quality of the underlying data means that the figures (and comparisons between years) should be treated with caution (Tab 1).
- The above figures are based on prescriptions with valid CHI numbers. In 2015/16, 112,480 (26%) of prescriptions did not have a valid CHI number. It is not possible to determine how many additional individuals prescribed methadone 1mg/ml solution would have been identified had these data been complete (Tab 2).
- A valid CHI number was captured from 87% of GP prescriptions and 56% of hospital prescriptions for methadone 1mg/ml solution in 2015/16. CHI capture for GP prescriptions was the same as in 2014/15, while hospital prescription CHI capture increased from 54% (Tab 2).
The ‘CHI capture’ percentage for other ORT drugs by prescription form type and year (2011/12 to 2015/16) is shown in Drug Prescribing Scotland 2015/16 (Table 5 - CHI capture).
More information regarding community dispensing can be found on the ISD Prescribing web pages.
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. Intramuscular injection of naloxone provides time for emergency services to arrive and for further treatment to be given. The aim of the National Naloxone Programme is to prevent overdose deaths in Scotland by issuing (following suitable training) ‘take home’ naloxone kits to people at risk of opioid overdose in the community or on liberation from prison. The fifth annual report, monitoring ‘take home’ naloxone distribution via the National Naloxone Programme was released in October 2016.
- A total of 8,146 take-home naloxone kits were issued in Scotland in 2015/16, an increase of 10% on the previous year. For Scotland as a whole, supply of kits more than doubled, from 52 kits per 1,000 problem drug users in 2011/12 to 132 per 1,000 in 2015/16.
- In 2015/16, 7,214 kits were issued in the community (an 11% increase on the previous year) and 932 kits were issued by prisons upon release (a 6% increase).
- The percentage of THN kits distributed as repeat supply increased each year from 12% in 2011/12 to 38% in 2015/16. In 2015/16, 748 repeat kit supplies were made because the previous kit was reported as having been used to treat an opioid overdose.
- In 2015, of all opioid-related deaths, 4.7% occurred among people who had been released from prison in the previous four weeks. This was significantly lower than the 9.8% observed before the programme, though the figures should be treated with caution because of the relatively small number of opioid-related deaths within four weeks of prison release.
- The percentage of all opioid-related deaths that occurred among people who had been discharged from hospital in the previous four weeks showed no consistent trend, changing from 9.7% before the programme (2006-10) to 10.3% in 2015.
Please note: If you require the most up-to-date data available, please check the data sources directly as new data may have been published since these data pages were last updated. Although we endeavour to ensure that the data pages are kept up-to-date, there may be a time lag between new data being published and the relevant ScotPHO web pages being updated.