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Drug misuse: treatment for drug misuse

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) (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 (SDMD)

The SDMD, which is managed by ISD Scotland, was set up in 1990 to collect information about people with problem drug use. Services contributing to the SDMD include specialist drug services and some medical services. Data is collected when individuals make contact with services providing tier 3 and 4 interventions (i.e. structured community and residential treatment) or reinitiate contact following a gap of at least six months since last attendance. This provides us with insights into their substance misuse needs and aspects of their social circumstances and behaviours at the point when they were seeking help in relation to their problem drug use.

The SDMD is an important and widely used national data 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/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.

SDMD data are released via the SDMD electronic dashboard, which is publicly available and provides users with accessible, interactive content based on data from 2006/07 (the year in which the current data collection form (SMR25a) was introduced) to 2015/16.

Main Points

  • In 2015/16, initial assessments for specialist drug treatment relating to 11,954 individuals were recorded on the SDMD.
  •  Of the 8,567 individuals who had information on recent ‘illicit’ drug use recorded, 47% sought treatment for heroin. The percentage of individuals reporting heroin as their main drug has decreased from 64% in 2006/07.
  •  In 2015/16, one in four (25%) under 25s reported recent heroin use compared to over half (58%) in 2006/07.
  • A general downward trend in the percentage of individuals who reported that they were currently injecting was observed (from 28% in 2006/07 to 18% in 2015/16).
  • Between 2006/07 and 2015/16 current sharing of needles/syringes decreased from 12% to six per cent, whilst sharing of injecting paraphernalia fell from 20% to eight per cent.
  •  The percentage of individuals assessed for specialist drug treatment who were aged 35 and over increased from 30% in 2006/07 to 50% in 2015/16. 

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 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 three weeks is also an indicator included in the ScotPHO Drugs Profile, where data is shown at Scotland, NHS Board and ADP level.

Prescribing for Opioid Dependency

Opioid Replacement Therapy (ORT) Drug Prescribing

Drugs used for the 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 2016/17 (218Kb) 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 ‘Introduction’ tab of the excel file), and the defined daily doses per 1,000 population per day for each year from 2007/08. Table 2 provides a similar breakdown by NHS Board. Table 3 shows costs and fees associated with methadone prescribing at Scotland and NHS Board level. Table 4 shows the quantities of methadone hydrochloride dispensed at Scotland and NHS Board level. Controlled drug fees and the costs associated with the supervised consumption of methadone and are agreed locally and the way in which these payments are shown in Table 3 may vary between NHS Boards. Therefore comparison of methadone costs across NHS Boards is not appropriate.

Key Points:

  • For the sixth successive year there has been a decrease in the dispensing of Opioid Replacement Therapy (ORT) drugs (including methadone). From 2010/11 to 2016/17, the number of items dispensed decreased by 12% from 574,420 to 508,236 and the number of defined daily doses decreased by 17% from 26.3 million to 21.8 million (Table 1 – Scotland Summary Data: BNF Subsection 4.10.03 - Opioid Dependence (all drugs)).
  • From 2010/11 to 2016/17, the number of methadone items dispensed decreased by 19% from 534,674 to 432,493 and the number of defined daily doses decreased by 20% from 25.6 million to 20.4 million (Table 1 – Scotland Summary Data: Methadone Hydrochloride).
  • From 2010/11 to 2016/17, the cost of methadone dispensing decreased from £6,382 to £5,051 per 1,000 adult population (Table 3 – Methadone Costs & Fees).
  • 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) with a further 26% decrease in 2016/17 (54,198). The number of defined daily doses decreased by 22% from 1.3 million in 2015/16 to 1.0 million in 2016/17 (Table 1 – Scotland Summary Data: Buprenorphine and Naloxone).
  • Since the beginning of the time series (2007/08), a wider range of drugs have been prescribed for opioid dependence in Scotland. Based on numbers of dispensed items, methadone prescriptions decreased from 95% of all ORT prescriptions in 2007/08 to 85% in 2016/17. Prescriptions for Suboxone (buprenorphine and naloxone) increased from 1% of all ORT prescriptions in 2007/08 (the first year dispensed) to 14% in 2014/15 and 2015/16, before decreasing to 11% in 2016/17 (Table 1 – Scotland Summary Data).

Methadone Patient Estimates

Between 2010/11 and 2016/17, there was an observed decrease in the number of Opioid Replacement Therapy (ORT) items dispensed (including methadone hydrochloride) in Scotland. However, differences in prescribing practices between NHS Boards and issues with the completeness of personal identifiers in prescribing data mean that such changes may not equate straightforwardly with increases or decreases in the number of individuals receiving methadone 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. However, issues associated with CHI capture for methadone prescriptions means 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 77.3% in 2016/17, it remains below the agreed threshold of reliability (individual analysis is usually reported only when CHI completeness is above 85-90%). However, as a result of ongoing public interest in methadone prescribing, these statistics are published as management information.

The Methadone Patient Estimates 2016/17 (56Kb) are a minimum count of individuals prescribed methadone hydrochloride 1mg/ml solution (the most commonly prescribed ORT formulation in Scotland).

  • In 2016/17, methadone 1mg/ml solution was prescribed to a minimum of 26,017 individuals (Tab 1 Patient Estimates).
  • The minimum number of people prescribed methadone 1mg/ml solution in 2011/12 was 26,197 individuals. The variable quality of the underlying data means that the figures (and comparisons between years) should be treated with caution. In particular, increases in the minimum number of people prescribed methadone since 2014/15 (25,169) may be due to the increase in CHI capture (Tab 1 Patient Estimates).
  • The above figures are based on prescriptions with valid CHI numbers. In 2016/17, 98,031 (22.7%) 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 if a higher percentage of prescriptions included valid CHI numbers (Tab 2 CHI Capture by Form Type).
  • A valid CHI number was captured from 86% of GP prescriptions and 66% of hospital prescriptions for methadone 1mg/ml solution in 2016/17. CHI capture for GP prescriptions was approximately same as in 2015/16 (87%), while hospital prescription CHI capture increased from 56% (Tab 2 CHI Capture by Form Type).

The ‘CHI capture’ percentage for other ORT drugs by prescription form type and year (2011/12 to 2016/17) is shown in Drug Prescribing Scotland 2016/17 (218Kb) (Table 5 - CHI capture).

More information regarding community dispensing can be found on the ISD Prescribing web pages.


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. 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.

Key points:

  • 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 six per cent 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.

Page last updated: 15 September 2017

© Scottish Public Health Observatory 2014