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Scotland reported a significant rise in drug-related fatalities last year, with deaths increasing by 11% to total 1,133. This figure marks an increase of 116 deaths compared to the previous year, pushing the total number of drug-related deaths over the past decade to more than 11,000. According to the National Records of Scotland (NRS), after adjusting for age, there were 214 drug-related deaths per million inhabitants, highlighting the severity of the crisis in the country. NRS classifies drug-related deaths as those caused by drug poisoning where controlled substances were present in the body at the time, and where drug use was directly responsible for the death.
A concerning factor in this upward trend is the involvement of synthetic opioids known as nitazenes, which have been mixed by criminal gangs with other drugs such as heroin, cocaine, and counterfeit Valium tablets. Deaths involving nitazenes accounted for 247 cases in 2025, representing more than 22% of the total and marking a more than threefold increase from 76 deaths the previous year. Despite this rise, opiates and opioids like heroin remain the most frequently implicated drugs, linked to 78% of fatalities. The data also shows cocaine’s involvement in 52% of deaths—a record high since NRS began tracking this data in 2008.
The increase in deaths was primarily driven by a 19% rise in male fatalities, while the rate of female deaths decreased by 5%. The disparity in drug-related death rates between Scotland’s most deprived communities and its least deprived areas remains stark, with the rate in the poorest areas being fifteen times higher. Another notable trend is the aging of those dying from drug-related causes, with the average age rising from 32 in 2000 to 46 in 2025.
Geographically, Glasgow experienced the highest average death rate over the five-year period from 2021 to 2025, with 380 deaths per million people. This was followed by Dundee with 340 per million and North Ayrshire with 310 per million. When compared with other European countries, Scotland’s age-adjusted death rate among 15-64 year olds stood at 277 per million in 2025, substantially higher than Estonia, which had the next highest rate at 112 per million in 2024 according to the European Union Drugs Agency. Scotland’s drug death rate remains notably higher than elsewhere in the UK, with 2024 figures showing an age-adjusted death rate of 216 per million in Scotland compared to 91 in England, 140 in Wales, and 135 in Northern Ireland.
Commenting on the crisis, Professor Catriona Matheson from Stirling University highlighted the dangers posed by nitazenes, noting their unpredictable potency, with some compounds being up to fifty times stronger than heroin. She pointed out how drug users may unknowingly consume mixtures containing several unidentified substances, increasing the risk of fatal overdoses. Matheson also emphasized the role of polydrug use—taking multiple drugs simultaneously—in exacerbating the problem. Kirsteen Horsburgh, chief executive of the Scottish Drugs Forum, drew attention to the deep connections between deprivation, health inequalities, and drug-related deaths. She warned against focusing solely on the substances themselves without addressing the broader social issues, stating that drug deaths are a visible reflection of underlying inequality and societal disparities
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