Scotland recorded 1,133 drug-use deaths in 2025, with nitazenes implicated in 247 and cocaine in 589. The figures do not show that wastewater surveillance would have prevented individual deaths, but they provide new context for the decision not to spend £20,675 restoring five Scottish monitoring sites.
Nitazenes were implicated in 247 drug-use deaths registered in Scotland during 2025, more than three times the previous year’s total, as the country’s overall number of drug-use deaths rose to 1,133.
The new National Records of Scotland figures add a further layer to a decision reported by Modern Scot in August, when internal government records showed that Scotland had declined an opportunity to restore five wastewater sites used to monitor illicit-drug consumption for a further sampling cycle at a cost of £20,675.
In Scotland Declined £20,675 to Restore Five Drug-Wastewater Monitoring Sites, Modern Scot established that the Home Office had removed all eight Scottish sites from its Wastewater Analysis for Narcotics Detection programme after withdrawing funding. When money later became available for another sampling round, the Scottish Government was offered five sites back if it met the £20,675 cost. Officials described the amount as relatively small and affordable but recommended against paying it. Drugs and Alcohol Policy Minister Maree Todd accepted that recommendation.
The final 2025 mortality figures were not available when that decision was made. They now show a drug market in which synthetic opioids, cocaine and combinations of substances continue to alter the pattern of harm.
The national figures changed sharply in 2025
National Records of Scotland recorded 1,133 drug-use deaths in 2025, an increase of 116, or 11 per cent, from 1,017 in 2024. The age-standardised mortality rate was 21.4 deaths per 100,000 people, compared with 19.1 the previous year.
The annual movement in the age-standardised rate should be treated carefully. National Records of Scotland said the confidence intervals around the figures overlap, meaning the year-to-year rate increase was not statistically significant on that measure.
The composition of the deaths nevertheless changed in ways that are important to drug surveillance.
An opiate or opioid was implicated in 881 deaths, equivalent to 78 per cent of the total. Cocaine was implicated in 589 deaths, or 52 per cent, the highest number recorded since the current series began in 2008. That was 110 more cocaine-implicated deaths than in 2024.
Nitazenes were implicated in 247 deaths, representing 22 per cent of all drug-use deaths. Etonitazene alone was implicated in 215.
That increase cannot be read as a simple measure of how much nitazene use rose during the year. National Records of Scotland has warned that testing expanded during 2025. Etonitazene was added to routine post-mortem testing across Scotland in May, meaning some of the increase reflects a greater ability to detect the substance as well as changes in the illicit drug supply.
The wider pattern is one of extensive polydrug use. More than one drug was implicated in 78 per cent of drug-use deaths.
The average age of those who died was 46. The mortality rate for males remained around three times the rate for females, and people living in Scotland’s most deprived areas continued to experience a dramatically higher death rate than those in the least deprived areas.
What wastewater surveillance could — and could not — have shown
Wastewater surveillance operates at population level. It analyses untreated sewage for drugs and their metabolites and can identify changes in the chemical signal produced by communities served by a treatment works.
It does not identify individual users. It cannot tell public-health teams who took a substance, the dose consumed by a particular person or whether an individual is in immediate danger. Nor can the 2025 death statistics be used retrospectively to show that keeping the five Scottish sites would have prevented any specific death.
The policy question is narrower.
Wastewater monitoring can add another source of intelligence to systems that already use toxicology, drug seizures, emergency-department information, treatment data, alerts from frontline services and direct drug testing. Because the samples are collected from populations rather than from people who voluntarily present to a service, wastewater can reveal broad changes in consumption without depending on individual contact with health or justice agencies.
The Home Office WAND programme had operated since 2021. Scotland originally had eight monitoring locations within the UK programme before the funding change removed them.
When the five-site restoration was offered, Scottish Government officials acknowledged that another cycle would provide further information about drug-consumption patterns and the future potential of wastewater surveillance. They nevertheless concluded that the additional value did not justify taking over the funding.
A Scottish Government Freedom of Information response published in August said it was not then undertaking, supporting, funding or considering wastewater monitoring relating to illicit drugs or psychoactive substances and was unaware of another current Scottish programme doing so.
Scotland is expanding a different kind of drug intelligence
The absence of wastewater monitoring does not mean Scotland has abandoned drug surveillance.
Public Health Scotland’s Rapid Action Drug Alerts and Response system brings together information from toxicology, emergency departments, police and other sources. Scotland is also moving into direct drug checking.
The first local drug-checking service is due to open in Glasgow on 5 October. The Scottish Government says more than £1.7 million has been invested in the development of drug-checking services, with Aberdeen and Dundee also licensed and Edinburgh preparing an application.
The Glasgow service will allow eligible people to submit a small sample of an illicit drug for analysis, with the results feeding both individual harm-reduction advice and wider intelligence about the substances circulating in Scotland. Samples are to be tested through a national laboratory at the University of Dundee.
Its reach is constrained by the Home Office licence under which the service operates. The Scottish Government says the licence limits access to adults aged over 18 who are dependent on one or more illicit drugs.
Drug checking and wastewater surveillance therefore answer different questions. One analyses a particular sample brought into a service and can tell the person using it what has been found. The other looks for chemical evidence across a large population regardless of whether individual users have made contact with a service.
Neither replaces post-mortem toxicology or the other systems used to understand Scotland’s drug deaths.
The £20,675 decision was made before the full mortality picture
The importance of the new figures is not that they overturn the Government’s earlier assessment automatically. They do not.
The decision not to fund the five WAND sites was taken against the evidence available at the time. The Government concluded that Scotland’s existing surveillance arrangements meant the wastewater programme would not add sufficient value.
What has changed is the evidence against which that conclusion can now be reviewed.
Scotland now knows that 1,133 people died from drug use in 2025; that cocaine was implicated in more than half of those deaths; that nitazenes were detected in more than one in five; and that combinations of drugs were implicated in more than three-quarters.
Those figures do not demonstrate that wastewater monitoring would have provided an earlier warning about every substance involved. The detection of emerging synthetic drugs depends on laboratory methods, the compounds being tested for and the sampling design. Nor do they show what intervention would have followed had a change been observed.
They do show that the market the surveillance system is trying to understand is not static.
Scotland is now expanding direct drug checking while continuing to rely on RADAR and other intelligence systems. The five wastewater sites offered for £20,675 were not restored.
The question created by the 2025 figures is therefore a practical one for the next stage of policy: whether the mix of surveillance Scotland has chosen remains sufficient for a drug supply in which rapidly changing synthetic opioids, record cocaine involvement and polydrug use are appearing in the same mortality statistics.
Sources
- National Records of Scotland — Drug-related deaths in Scotland, 2025, 23 September 2026. Read the national statistics.
- Scottish Government — Information relating to wastewater monitoring for illicit drugs in Scotland: FOI release, 13 August 2026. Read the FOI release and disclosed records.
- Scottish Government — Drug checking service, 23 September 2026. Read the announcement.
- Modern Scot — Scotland Declined £20,675 to Restore Five Drug-Wastewater Monitoring Sites, 20 August 2026. Read the earlier Modern Scot investigation.
