New figures from Public Health Scotland reveal that more than 27,000 people across Scotland were prescribed opioid substitute therapy during the year ending June 2025, though the numbers show a slight decline from previous quarters.

The data, released in December 2025, provides a sobering picture of opioid dependency across the country. Between July 2024 and June 2025, an estimated 27,696 individuals received medications such as methadone and buprenorphine as part of their treatment for opioid dependence. Opioid substitute therapy Scotland programs continue to serve tens of thousands, though emerging challenges persist.

Glasgow and Edinburgh Lead Treatment Numbers

Glasgow City recorded the highest concentration of people on opioid substitute therapy, with 5,373 individuals – representing roughly one in five of all those receiving treatment across Scotland. The City of Edinburgh followed with 2,616 people, whilst Fife registered 1,693.

When examined by NHS Board areas, Greater Glasgow & Clyde topped the figures with 8,145 people (29% of the national total), followed by Lothian with 4,376 (16%) and Lanarkshire with 2,961 (11%). These figures highlight the geographic concentration of opioid substitute therapy Scotland delivers across major urban centers.

Concerning Trends in Scotland’s Drug Landscape

The latest quarterly report from Public Health Scotland’s RADAR (Rapid Action Drug Alerts and Response) system paints a troubling picture of the broader drugs situation. Between June and August 2025, drug-related harms remained elevated, with emergency department attendances up 8% compared to the previous quarter.

Most concerning is the continued detection of nitazene-type opioids – synthetic substances far more potent than traditional heroin. These dangerous compounds were found in 12% of post-mortem toxicology samples, marking the highest level recorded to date. The emergence of such powerful synthetic opioids presents significant challenges for those struggling with addiction and accessing opioid substitute therapy Scotland provides.

Polysubstance Use Complicates Treatment

Medical professionals report that the majority of drug-related incidents now involve multiple substances. Post-mortem toxicology revealed an average of four controlled drugs detected per sample, reflecting the complex nature of modern drug use patterns.

Cocaine has emerged as particularly prominent, identified as the most common drug among people seeking specialist drug treatment. The substance also featured heavily in hospital toxicology reports and post-mortem examinations across Scotland. Despite the complexity of modern drug use, opioid substitute therapy Scotland offers remains a cornerstone of treatment approaches.

New Threats Emerging

Public health officials have raised alarms about ethylbromazolam, a street benzodiazepine detected for the first time in Scottish samples during 2025. This sedating substance has now appeared in seven different NHS board areas, adding to concerns about the constantly evolving nature of Scotland’s drug market.

Reports to RADAR’s surveillance system highlighted ongoing issues with heroin supply, with numerous incidents describing changes in appearance, suspected contamination with synthetic opioids, and unexpected overdoses. Between July and October 2025 alone, RADAR received 152 reports of drug-related concerns, with heroin accounting for 44% of all reported substances.

Treatment Starts Decline Slightly

Opioid substitute therapy Scotland initiations declined by 4% in the June to August 2025 quarter compared to the previous three months. During this period, 2,929 treatment episodes commenced, with powder cocaine cited as the primary drug of concern in 33% of assessments.

Injectable buprenorphine provision through opioid substitute therapy increased by 7% between April and June 2025, though overall therapy doses remained relatively stable. Methadone prescriptions saw a marginal 1% decrease during the same period.

Data Quality Challenges

Public Health Scotland acknowledged limitations in the accuracy of these figures. The statistics represent minimum estimates, as issues with data capture mean the true number of people receiving opioid substitute therapy may be higher. National data completeness currently stands at 82.7%, below the 85-90% threshold typically required for robust patient counting.

The variable quality of prescription records and the 12-month rolling timeframe mean changes in prescribing patterns may not be reflected immediately in the published statistics for opioid substitution treatment Scotland services.

Looking Ahead

Scotland faces an increasingly complex challenge in addressing opioid dependency and broader substance use issues. The contamination of street drugs with toxic substances, the rise of powerful synthetic opioids, and widespread polysubstance use all contribute to heightened risks for vulnerable individuals.

The latest figures on opioid substitute therapy provision suggest that whilst thousands continue to receive medical support for their dependencies, the wider drug landscape presents evolving threats that demand ongoing vigilance and coordinated responses across health services, law enforcement and support organisations throughout Scotland. Expanding opioid substitute therapy Scotland capacity whilst addressing emerging synthetic threats remains crucial for public health outcomes.

Source: dbrecoveryresources