Posted on: 2 September, 2025

Today, the National Records for Scotland (NRS) published their figures for the number of drug related deaths* in Scotland for the year of 2024. The total number of people who tragically died from drugs is 1,017 which marks a 13% decrease on the number in 2023, however Scotland remains the drug death capital of Europe for the 7th year in a row.

The figures mark a 65% increase from the 613 deaths in 2014 but are 24% less than the highest figure – 1,339 – recorded in 2020. Opioids were most prevalent, involved in four-fifths of deaths, followed by benzodiazepines which were involved in over half (56%) and cocaine which was involved in just under half (47%).

Most worryingly, deaths involving nitazenes, potent synthetic opioids which are up to 500 times stronger than heroin, and up to five times more potent than fentanyl, were involved in 76 deaths which is a significant increase of 230% on the year prior where only 23 deaths were recorded, with only 1 recorded in 2022. The rise in drug deaths involving nitazenes is indicative of increased prevalence and contamination within the opioid supply, and reflective of the decrease in opium production in Afghanistan, as highlighted in the recent UN World Drug Report.

It is further concerning that we are still not entirely sure on the level of nitazene harm as there may be a lag in data being recorded due to strenuous post-mortem examinations. In August 2023, Cranstoun warned of a potential public health emergency caused by increased prevalence of nitazenes, and we published an evidence-based plan underpinned by a joined up, whole system approach.

Positive steps but moving too slowly

There have been positive steps in Scotland to tackle the harms related to drugs, such as the implementation of diamorphine-assisted treatment and the UK’s first sanction overdose prevention centre (OPC), which are both in Glasgow. Whilst it is anticipated that there will be a second OPC in Edinburgh in due course, as well as drug checking pilots in several areas, harm reduction and recovery measures that tackle drug related harm are moving too slowly in Scotland, despite significant funding uplifts in recent years.

Well-documented issues related to the exacerbation of drug deaths in Scotland include the lower number of people who are dependent on opioids that are in substance use treatment (namely OST), difficulty in achieving same day prescriptions for opioid substation therapy and high levels of deprivation. Scotland is also among the highest numbers for alcohol related deaths.

There is clear political will from within the government, as demonstrated by the implementation of an OPC, sign offs on drug checking pilots and the expansion of drug warnings – although the latter was incorrectly labelled as “de facto decriminalisation”. Time is running out to make further positive impact ahead of the Scottish Elections in May next year although there are several measures and approaches that the government must consider to better handle the drug crisis, especially against the backdrop of increased nitazene prevalence and harm.

DATs and OPCs: an alternative model to tackle the crisis

Cranstoun has presented alternative models to diamorphine assisted treatment in Dundee and overdose prevention centres in Edinburgh, which are more cost effective without the sacrifice of clinical rigour. These could be rolled out at pace to provide a comparative analysis compared with the existing, NHS-led models which are also showing success in reducing harm and improving the lives of people who use drugs.  

We also believe that the shift in 2021 to expand the use of Drug Warnings for possession offences of any Class of drugs is a significant improvement, although more can be done to increase the number of people in treatment at every phase of the criminal justice system. Cranstoun’s Arrest Referral Service places trained treatment professionals in custody blocks, who work to increase the number of Drug Treatment Requirements, whilst being able to provide advice and holistic support to those who have been arrested for a drug related crime.  

Research in The Lancet shows that those who are in Opioid Substitution Therapy are around 3 times less likely to die from a drug death and we must use all tools available to support those who need help, CARS can be one such tool to reach people who may benefit from help. We must also continue to look at the best recovery options and appreciate that different approaches will work for different people struggling with dependency – who may wish to reduce, halt or better manage substance use. 

Lastly, our deepest thoughts and condolences are with those who have tragically lost a loved one to a drug death. There are solutions which will help to reduce the tragic level of suffering experienced by thousands in Scotland every year. We know the political will is there, and we know that steps are being taken, but we urge the Scottish Government to go further in following evidence based measures which we know will help to save lives.

*NRS use the term “drug misuse”. However, we are choosing to use a less stigmatising term.

Meg Jones, Director of New Business and Services at Cranstoun, said:

“Today’s figures are beyond tragic, and our most heartfelt thoughts and condolences are with all of those who have tragically lost a loved one to a drug death.

Despite a lot of discussion about how to solve the drugs crisis, real action and implementation of globally evidenced interventions is too slow, with the scale of measures brought in not at the level required to make a greater impact.

There is clear political will to solve this crisis and there have been positive developments including an overdose prevention centre, shifts towards diversion from prosecution, sign off on drug testing pilots and a diamorphine assisted treatment centre in Glasgow.

We urge the Scottish Government to consider proposals which both increase the number of people in treatment, whilst also keeping others alive. This includes stronger collaboration with the third sector to deliver alternative, more financially feasible models to overdose prevention centres, diamorphine assisted treatment, and arrest referral services which can be rolled out more widely. We have presented to government officials previously and remain keen to share our learnings from the work that we deliver.

It is particularly concerning to see a sharp rise in the number of fatalities which were linked to nitazenes. Cranstoun urges the UK and Scottish Government to implement our whole system plan, published in 2023, to keep ahead of the curve and mitigate the worst of a potential public health emergency.”