Main Points
- In 2024, there were 1,017 drug misuse deaths registered in Scotland, a decrease of 13% (155 deaths) compared with 2023.
- Drug misuse deaths increased over the last two decades to their peak in 2020. They have generally decreased since then, with the exception of a 12% increase in 2023. The latest figure is the lowest number registered in any year since 2017.
- After adjusting for age, there were 19.1 drug misuse deaths per 100,000 people in 2024. This is 3.6 times as high as when the series began in 2000.
- In 2024, males were more than twice as likely to have a drug misuse death as females. Both male and female deaths decreased in the past year.
- The age profile of drug misuse deaths has become older over time. The average age of drug misuse deaths has increased from 32 years in 2000 to 45 years in 2024.
- In 2024, people in the most deprived areas of Scotland were 12 times as likely to have a drug misuse death compared to people in the least deprived areas. In contrast, for all causes of death, people in the most deprived areas are around twice as likely to die as those in the least deprived areas.
- After adjusting for age, Glasgow City, Dundee City and Inverclyde had the highest rates of drug misuse deaths in the period 2020-2024.
- The most common drugs implicated in drug misuse deaths in 2024 were opiates/opioids (80% of deaths), benzodiazepines (56%) and cocaine (47%).
- The number of drug misuse deaths which implicated opiates/opioids and benzodiazepines fell in 2024. The number which implicated cocaine remained the highest in the series (479 deaths in both 2023 and 2024).
- The majority (91%) of drug misuse deaths were classified as accidental poisonings, with 6% classed as intentional self-poisonings.
A note on the term ‘drug misuse death’
Throughout this report the term ‘drug misuse death’ is used. This refers to a specific definition of drug death defined by the Advisory Council on the Misuse of Drugs (ACMD) cross UK working group in 2000. The term drug misuse is used to be consistent with other UK statistics producers and differentiate from other definitions of drug death (e.g. drug poisoning deaths and drug induced deaths) and also to be clear that the death involves drugs defined under the Misuse of Drugs Act 1971.
NRS are seeking feedback from users of our data on the terminology used in our drug-related death statistics.
Drug misuse deaths in Scotland
In 2024, there were 1,017 drug misuse deaths registered in Scotland. This is a decrease of 13% (155 deaths) compared with 2023 (Figure 1).
Drug misuse deaths in Scotland have increased over the last two decades. The number increased in each year from 2014 to 2020, which was the highest number in the series (1,339 deaths). Overall, the number of deaths has decreased since then with a large decrease (-21%) between 2021 and 2022, followed by an increase (12%) between 2022 and 2023. The latest figure is the lowest number of drug misuse deaths registered in any year since 2017.
Figure 1: Drug misuse deaths decreased in 2024
Number of drug misuse deaths and 5-year rolling average, 1996 to 2024
After adjusting for age, there were 19.1 drug misuse deaths for every 100,000 people in Scotland in 2024. This is a decrease from the rate of 22.3 in 2023.
The rate of drug misuse deaths was 3.6 times as high in 2024 than the start of the series in 2000.
Drug misuse deaths by sex
The latest decrease in drug misuse deaths was driven by a reduction in male deaths (Figure 2). In 2024, there were 699 male drug misuse deaths, a decrease of 13% (106 deaths) from 2023. There were 318 female drug misuse deaths in 2024, a decrease of 13% (49 deaths) from the previous year.
After adjusting for age, there were 27.1 deaths per 100,000 males and 11.6 deaths per 100,000 females in 2024. Males were more than twice as likely to have a drug misuse death as females.
The gap between sexes has narrowed over time. In the early 2000s, males were four or five times as likely to have a drug misuse death as females.
Figure 2: Decrease in drug misuse deaths driven by male deaths
Number of drug misuse deaths by sex, 2000 to 2024
Drug misuse deaths by age
The age profile of drug misuse deaths has become older over time. The average age of drug misuse deaths has increased from 32 years in 2000 to 45 years in 2024 (Figure 3).
Female drug misuse deaths had a slightly older average age at 46 years in 2024, compared to males at 45 years. The average age of females has been higher than males in most years since the series began in 2000.
Figure 3: The average age of drug misuse deaths has increased
Average age of drug misuse deaths by sex, 2000 to 2024
In 2024, most drug misuse deaths were aged 35 to 54 (63%) followed by those aged under 35 (19%). In comparison, in 2000, most drug misuse deaths were aged under 35 (68%) with 29% of deaths aged 35 to 54. The proportion of drug misuse deaths which were aged 55 and over has increased over time from 3% in 2000 to 17% in 2024.
The rate of drug misuse deaths is highest in those aged 35 to 54 and has generally increased over the last two decades (Figure 4). The rate in those aged 35 to 54 is more than five times as high as those aged under 35 or those aged 55 and over.
Figure 4: Rate of drug misuse deaths highest in age group 35 to 54
Rate of drug misuse deaths by age group, 2000 to 2024
Drug misuse deaths by deprivation
People in the most deprived areas of Scotland were 12 times more likely to have a drug misuse death than people in the least deprived areas in 2024, after adjusting for age. For all causes of death, people in the most deprived areas are around twice as likely to die as those in the least deprived areas.
The ratio of drug misuse deaths in the most and least deprived quintiles has changed over time (Figure 5). The lowest ratio was 8 times as likely in 2011. The highest was 19 in 2019, and it has fallen since then.
In 2024, the rate of drug misuse deaths decreased for all deprivation quintiles, except in the least deprived.
Figure 5: Rate of drug misuse deaths 12 times as high in the most deprived areas
Age standardised mortality rate of drug misuse deaths by SIMD quintile, 2001 to 20241
1: Deprivation quintiles are based on the Scottish Index of Multiple Deprivation
Drug misuse deaths across areas in Scotland
Glasgow City council area had the highest rate of drug misuse death with 41.1 deaths per 100,000 people for the period 2020-2024, after adjusting for age. The rate of drug misuse death was above the Scotland average in: Glasgow City, Dundee City, Inverclyde, West Dunbartonshire, North Ayrshire, East Ayrshire, Renfrewshire (Figure 6).
East Renfrewshire and Aberdeenshire had the lowest rates of drug misuse deaths over the same period, with 7.5 and 11.1 deaths per 100,000 people, respectively.
Orkney Islands had fewer than 10 deaths during 2020-2024, so no rates were calculated as these would have low reliability. Since relatively few people die of drug misuse, we calculate rates for areas across Scotland by grouping five years of data together to compare areas.
Figure 6: The rate of drug misuse deaths varies across Scotland
Age standardised mortality rate of drug misuse deaths by council area, 2020-20242, 3
2 : Error bars represent 95% confidence intervals
3 : Orkney Islands had fewer than 10 deaths, so no rates were calculated and it is not shown in the above chart.
The latest decrease in the number of drug deaths was not seen across all areas of Scotland (Figure 7). The number of drug misuse deaths decreased in 21 council areas, increased in nine areas and was unchanged in two areas.
The largest decreases in drug misuse between 2023 and 2024 were in Glasgow City (-61 deaths), City of Edinburgh (-19 deaths) and North Lanarkshire (-18 deaths). These areas also have the highest number of drug misuse deaths, as well as larger populations.
Figure 7: Drug misuse deaths fell in 21 council areas, and increased in 9
Drug misuse deaths by council area, 2023 and 2024
Similar data by health board area can be found in main tables HB1 to HB5 available at the links below.
Drug misuse deaths by substances implicated
More than one drug was implicated in 80% of all drug misuse deaths in 2024.
Of all drug misuse deaths in 2024, the most common substances which were implicated in deaths were:
- Opiates/opioids: 810 deaths, or 80%
- Benzodiazepines: 574 deaths, or 56%
- Cocaine: 479 deaths, or 47%
- Gabapentin and/or pregabalin: 374 deaths, or 37%
The number of drug misuse deaths which implicated opiates/opioids, benzodiazepines, and gabapentin and/or pregabalin fell over the latest year (Figure 8a). The number of deaths which implicated cocaine was the highest in the series in 2023, and remained unchanged in 2024.
Figure 8a: Opiates/opioids were implicated in 80% of drug misuse deaths in 2024
Drug misuse deaths by most common drugs implicated, 2008 to 2024
The majority of drug misuse deaths which implicated opiates/opioids involved heroin/morphine and/or methadone (Figure 8b). We report heroin and morphine as one category because it is not possible to tell which form the drug was in from a post-mortem.
Of all drug misuse deaths in 2024, opiates/opioids which were implicated in deaths were:
- Methadone: 412 deaths, or 41%
- Heroin/morphine: 317 deaths, or 31%
- Dihydrocodeine or a d.h.c-containing compound: 93 deaths, or 9%
- Buprenorphine: 87 deaths, or 9%
- Codeine or a codeine-containing compound: 53 deaths, or 5%
Drug misuse deaths which implicated methadone, heroin/morphine, dihydrocodeine and codeine fell over the latest year. The number of deaths which implicated buprenorphine increased between 2023 and 2024 (increase of 15 deaths).
Nitazenes are a category of potent new synthetic opioids. Some are hundreds of times more potent than heroin. Nitazenes were implicated in 76 drug misuse deaths in 2024. This is more than three times the number of deaths in 2023.
Fentanyls are another category of potent synthetic opioids. This includes fentanyl and compounds with similar chemical structures (fentanyl analogues). In 2024, fentanyls were implicated in 12 drug misuse deaths.
Figure 8b: Methadone is the most commonly implicated opiate/opioid
Drug misuse deaths by drugs implicated, opiates and opioids, 2008 to 20244
4: There was limited testing of nitazenes in post-mortems carried out prior to 2023. Caution is advised when making comparisons with earlier periods.
Benzodiazepines can be separated into prescribable (e.g. diazepam) and street (e.g. etizolam and bromazolam) benzodiazepines which are novel benzodiazepine-type substances (Figure 8c). Prescribable benzodiazepines are often medications for anxiety or insomnia. The vast majority of drug misuse deaths which implicate a benzodiazepine involve street benzodiazepines. More information on the split between prescribable and street benzodiazepines can be found in methodology Annex H.
The number of drug misuse deaths which implicated street benzodiazepines increased rapidly from one death in 2008 to a peak of 879 deaths in 2020. This number has fallen since then, and they were implicated in 474 deaths (47% of all drug misuse deaths) in 2024.
Etizolam was previously the most common street benzodiazepine implicated in drug misuse deaths. Detections of etizolam fell rapidly in recent years and bromazolam replaced it as the most common street benzodiazepine implicated in drug misuse deaths. Bromazolam was implicated in 346 drug misuse deaths in 2024, down from 426 in 2023.
The number of drug misuse deaths which implicated prescribable benzodiazepines has increased since series began in 2008 but has been fairly stable for the last five years.
Figure 8c: Deaths which implicated bromazolam fell in 2024
Drug misuse deaths in Scotland by drugs implicated, benzodiazepines, 2008 to 20245
5: There was limited testing for bromazolam in post-mortems carried out prior to 2023 so caution is advised when making comparisons over time.
Of all drug misuse deaths in 2024, other significant drugs which were implicated in deaths were:
- Alcohol: 97 deaths
- Amphetamines: 42 deaths
- Ketamine: 21 deaths
- Xylazine: 20 deaths
- Ecstasy type: 19 deaths
The number of drug misuse deaths which implicated alcohol and ecstasy type drugs fell over the latest year. Deaths which implicated amphetamines, ketamine and xylazine increased between 2023 and 2024.
Figure 8d: There were increases in detections of some other significant drugs
Drug misuse deaths by drugs implicated, other significant drugs, 2008 to 20246
6: Routine testing of xylazine began in 2024 so caution is advised when making comparisons over time.
Most NRS statistics about individual drugs are based on whether the drug was implicated in or contributed to the death. We also record which drugs were present but not thought to have contributed to the death. The number of deaths for all drugs implicated or present are listed in the substance tables below.
Methodology Annex C includes more details on how drugs are recorded in NRS statistics.
Drug misuse deaths by cause of death
In 2024, the vast majority (91%) of drug misuse deaths were classified as accidental poisonings. This proportion has increased in recent years.
Of all drug misuse deaths, 6% were due to intentional self-poisoning, and less than 1% were poisonings of undetermined intent. In 3% of drug misuse deaths, the underlying cause of death was classed as mental and behavioural disorders due to psychoactive substance use.
Figure 9: The majority of drug misuse deaths are accidental poisonings
Drug misuse deaths by underlying cause of death, 2011 to 2024
Comparisons within the UK
In 2023, the rate of drug poisoning deaths in Scotland was around two to three times the rate of other UK countries. This is similar to the longer term trend, with Scotland having a higher rate than other parts of the UK for the last decade.
After adjusting for age, the drug poisoning mortality rate in Scotland was 2.8 times as high as the rates in England and Northern Ireland, and 1.9 times as high as the rate in Wales. Data for 2023 is the most recent year that data is available across the UK.
There were 1,330 drug poisoning deaths in Scotland, a rate of 25.1 deaths per 100,000 people in 2023. The UK region with the next highest rate of drug poisoning deaths was the North East of England with a rate of 17.4. The region with the lowest rate was London, with 5.8 deaths per 100,000 people.
Figure 10: Scotland had the highest rate of drug poisoning deaths across the UK in 2023
Age standardised mortality rate of drug poisoning deaths, UK countries and regions, 2023
Source: National Records of Scotland, Office for National Statistics, Northern Ireland Statistics and Research Agency
Figure 10 is based on the drug poisoning definition of drug deaths. This is a wider definition than drug misuse deaths used in the rest of the report, but it is a more appropriate way to compare drug deaths between UK countries. Both the ONS and NRS have published blog posts explaining why this is.
Provide feedback on the terminology used in these statistics
NRS are seeking feedback from users of our data on the terminology used in these statistics. Background information and instructions for providing feedback can be found on our website .
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