Sources & methods

NRS recorded 1,133 drug use deaths (21.4 per 100,000, age-standardised); the increase from 19.1 in 2024 was not statistically significant. There were 830 male and 303 female deaths; average age was 46. Rates were highest at ages 35–44 and 45–54 and around 15 times higher in the most deprived than the least deprived areas. Deaths rose in 20 council areas, fell in 10 and were unchanged in two. Five-year rates (2021–2025) exceeded the Scotland average in Glasgow City, Dundee City, North Ayrshire, Inverclyde, West Dunbartonshire and East Ayrshire.

Substances implicated: opioids 881; heroin/morphine 468; methadone 338; nitazenes 247 (etonitazene 215); cocaine 589; benzodiazepines 433 (street benzodiazepines 300; bromazolam 103); gabapentin and/or pregabalin 330; alcohol 132; amphetamines 38; ketamine 33; ecstasy-type drugs 24; xylazine 4. More than one drug was implicated in 78% of deaths. Counts overlap and implication does not establish sole causation. Expanded nitazene testing, including etonitazene from May 2025, and routine xylazine testing only since 2024 limit trend comparison. For four-country drug-poisoning comparisons the latest common year is 2024: NRS reports Scotland at about 2.4 times England, 1.6 times Northern Ireland and 1.5 times Wales. Registration delays and nation-specific definitions require care.

PHS reported 388 injecting equipment outlets, 131,931 attendances, approximately 2.3 million needles and syringes and 1.6 million foil items in 2025–26. Its naloxone bulletin recorded 7,729 take-home kits in January–March 2026 and 36,955 across 2025–26. These count service activity, not people using drugs or deaths; attendance definitions changed in 2023 and reporting completeness varies. PHS also published a residential rehabilitation programme evaluation (15 September) and a drug-harms summit report (22 September). They are linked in the source register; neither provides a like-for-like mortality revision.