Exclusive:Scotland's spend on methadone plummets - but campaigners say trend masks a new drug problem

Despite millions of pounds still being spent to treat Scotland’s opioids crisis, data released by the Scottish Government shows a fall in costs of nearly £3 million since 2020/21.

However, experts say the drop is not because of success in supporting more people to end their reliance on methadone. Instead, it is attributed to the introduction of Buvidal, a long-acting injection that decreases the number of visits to pharmacies and subsequently cuts supervision costs.

A breakdown of costs per health board also shows an inconsistency in the increase and decrease in spending on methadone. Glasgow has spent the most at £1.3 million in 2023/24, up slightly on £1.25m from the year before. The money spent by all Scotland's health boards has fallen from £8.5m to £5.8m.

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Experts say the uptake of Buvidal remains “patchy” and accounts for only 2 per cent of drug substitution therapy, meaning that while costs have decreased, the system is still overwhelmingly dependent on methadone while drug death numbers remain high.

The figures were released from the Scottish Government to Alba MSP Ash Regan, who requested the data ahead of the publication of Tuesday’s drug deaths statistics.

“Every single drug death and family ruined by addiction is a tragedy, but if we keep going the same thing and expect a different outcome we are doomed to the same sad results for years to come,” Ms Regan said. “The Scottish Government must start listening to the voices of those advocating far greater investment in rehabilitation as the path to recovery.”

Methadone, a heroin substitute in liquid form, was used to encourage drug users into the health system to give them care, advice and clean needles around 40 years ago. It was a significant public health intervention that reduced HIV infection rates in places like Dundee and Edinburgh, which had the biggest problems.

Ms Regan added: “Now we have a different situation from that of the 1980s and far too many people are trapped in a cycle in which they are just as dependent on a substance that was intended to help them recover.

“We need to understand if the decrease in use of methadone due to the increase in the use of Buvidal, which removes the need for regular doses of methadone and reduces supervision costs, will lead to better outcomes in the long term.

“However, part of any national mission to reduce drug deaths must start asking the question of, despite its original intention, is the continued prescription of methadone a failed programme that introduces more harm to patients and communities than the addiction to opioids such as heroin that it was introduced to address.“

In 2023, Scotland recorded 1,172 drug deaths - up 12 per cent on the previous year and the worst in Europe. Around 80 per cent of those involved opioids and included methadone.

Annemarie Ward, chief executive of charity Voices and Faces of Recovery UK, said: “The reliance on substitution treatment has not translated into reduced mortality. Hopefully we see a fall this year, but it’s still horrendous compared to the rest of the UK because of ideology.

“Falling spend does not equal progress. A lower pharmacy bill doesn’t mean fewer funerals.”

Ms Ward described Buvidal use as “tokenistic”, given the low numbers of uptake. Methadone is implicated in around half of all drug deaths each year, she said, pointing to Scotland’s figures for 2020 when methadone was present in 53 per cent of deaths.

Ms Ward said: “That doesn’t mean it is always the direct cause, but it does mean that thousands of families know it was in the bloodstream when their loved one died. To present methadone as the cornerstone of ‘saving lives’ while it features so heavily in the death toll is not just misleading, it’s obscene.”

Scotland, she added, does not publish meaningful treatment outcomes so there are no public statistics detailing how many people prescribed methadone achieve abstinence or move into sustained recovery.

Ms Ward added: “Methadone has become the default, the door that never closes, while detox, rehab, and long-term recovery supports are rationed, mislabelled, or redefined out of existence.

“Tethering tens of thousands of people to a green syrup for decades, with no genuine exit route, is not a strategy, it's a holding pattern. And too often, that holding pattern ends not in recovery, but in an early grave.

“To call this ‘treatment’ is like calling a tourniquet a cure for haemorrhage. It may stop the immediate bleeding, but leave it on long enough and you lose the limb and eventually the patient.

“Families will go on burying their loved ones while the state congratulates itself on keeping the pharmacy tills ringing.”

Louise Stewart is director of operations in Scotland for the addiction charity WithYou.

She said methadone was a medicine that should be available to anyone who would benefit from it. But she said it worked best alongside “recovery communities, counselling, peer support, housing assistance, and other services that address the underlying causes of drug use”.

Ms Stewart added: ”Effective treatment for drugs and alcohol requires multiple approaches working together - no single intervention works in isolation. We must see continued long-term investment to effect change.

"At WithYou we focus on the individual and their unique needs, meeting people wherever they are in their journey, and providing whatever combination of support will help them move forward.”

The Scottish Government has been contacted for comment.