The toll is getting worse again

After adjusting for age, NRS recorded 214 drug-use deaths per million people in 2025. For its European comparison, NRS uses deaths per million people aged 15 to 64. On that measure, Scotland’s rate was 277. The next country cited is Estonia, at 112 per million in 2024, the latest year published by the EU drugs agency. Scotland’s comparable rate in 2024 was 246, meaning the gap with the rest of Europe widened as the Scottish death toll rose.

Men accounted for the increase: male deaths rose by 19 per cent, while the female death rate fell by 5 per cent and the number of women who died reached its lowest level since 2017. The average age at death has also risen, from 32 in 2000 to 46 in 2025. This is a generation the state has failed twice: first as people were drawn into the trade, and again as that trade was allowed to poison what they were sold.

A market growing more lethal

Most of these deaths involved a mixture of substances: more than one drug was implicated in 78 per cent of cases. Opiates and opioids were implicated in 881 deaths, also 78 per cent of the total. That included heroin or morphine in 468 deaths and methadone, supplied through the treatment system, in 338. Cocaine was implicated in 589 deaths, or 52 per cent, the highest share since NRS began publishing the series in 2008. In 101 cases, it was the only drug implicated. The cocaine total was 23 per cent higher than in 2024, when it stood at 479.

The sharpest new threat comes from nitazenes, synthetic opioids potent enough to turn a familiar bag into a lethal one. They were implicated in 247 deaths, 22 per cent of the total and more than three times the 76 recorded a year earlier. Etonitazene alone was implicated in 215. Criminal gangs mix these chemicals into heroin, cocaine and fake Valium, so people buy one substance and die from another. NRS cautions that wider toxicology testing means some comparisons over time are not perfectly like-for-like. Even with that warning, the direction is clear: the supply has become more poisonous, while the punishment for selling it bears no relation to the body count.

Alcohol and Drugs Minister Maree Todd called the rise “deeply concerning and unacceptable”, but the response remains centred on public health. She pointed to more than 1,100 residential rehabilitation placements last year and a new plan linking treatment more closely with housing. She also announced that Scotland’s first local drug-checking service will open in Glasgow this October, building on the UK’s first safer drug consumption facility. The Thistle, on Hunter Street, opened on 13 January 2025; in its first full calendar year, deaths rose. A checking service can identify what has already been bought, and a consumption room can supervise its use. Neither stops the nitazene being mixed or sold. Only action against the dealer can do that.

The poorest postcodes are where the trade kills

The geography of the deaths is equally stark. In Scotland’s most deprived areas, the drug-use death rate is 15 times that of the least deprived; for deaths from all causes, the gap is only twofold. Over the five years from 2021 to 2025, the highest average rates were in Glasgow City, at 380 deaths per million, Dundee City, at 340, and North Ayrshire, at 310. Inverclyde, West Dunbartonshire and East Ayrshire were also above the Scottish average. In the latest year, deaths rose in 20 council areas and fell in 10.

Why is this happening?

The immediate cause is an illegal market that has been allowed to become more lethal. Nitazenes do not emerge from poverty by themselves: someone manufactures them, someone mixes them into heroin, cocaine or fake pills, and someone sells the result on a Scottish street. Cocaine is now implicated in more than half of all deaths, including 101 in which it was the only drug. This is a criminal business, and a public-health slogan will not dismantle it. The credible threat of a long sentence, actually served, might.

The SNP has pursued the opposite theory. Since launching the National Mission in 2021, ministers have treated the crisis principally as a health problem and used the death figures to measure success. Those figures have risen since the most recent low, while Scotland has moved further away from the next-worst European country. Yet the latest response offers more of the same: a strategic plan, closer links between treatment and housing, and a Glasgow checking service built on the consumption-room model. These measures begin after the sale has taken place. The Greens would go further through decriminalisation and legal regulation, reducing the risk to the seller instead of confronting the trade that killed 1,133 people.

That failure is reinforced by Scotland’s justice system. The Scottish Sentencing Council sits between Parliament and sentencing policy, while early release means the term announced in court is not necessarily the term served. Reform’s manifesto would also repeal the Hate Crime and Public Order Act so police can focus on real crime. Every officer diverted towards speech is an officer unavailable to pursue supply. A prolific dealer who expects a short tariff and an early release has little reason to stop. The chemistry in the bag may change every month; the incentive remains the same.

Deprivation explains who is most exposed, but it does not remove the people exploiting them. The fifteen-fold gap maps the victims, not the cause of the supply. England, Wales and Northern Ireland also have poor communities, yet on the latest comparable count Scotland recorded 216 drug-poisoning deaths per million people against 91 in England. Poverty cannot excuse a devolved justice system that supervises an injection without making the supplier fear the consequences. Families in Glasgow, Dundee, North Ayrshire and Inverclyde are not dying for lack of a leaflet. They are dying because the poison is profitable and the punishment is not.

What would actually stop it

The answer begins by making dealing no longer worth the risk. Repeat suppliers need high sentences, and the sentence imposed must be the sentence served. Treatment remains a duty to people who are already addicted, but treatment alone is not a complete drugs policy. A market cannot be reduced by caring for its customers while leaving its suppliers in business.

Reform UK’s 2026 Scottish manifesto does not specify a prison term for drug supply, and this article will not invent one. Maximum penalties under the Misuse of Drugs Act are set in UK law, beyond Holyrood’s power to rewrite. Holyrood does, however, control Scottish sentencing policy, prison capacity and early-release rules. Those levers determine whether a supply conviction carries real consequences. The same distinction applies to possession: the manifesto contains no published zero-tolerance scheme, but the record makes the case for one.

Zero tolerance, starting with the warning

The present approach often treats possession as a minor matter. In 2023–24, Police Scotland issued 6,805 recorded police warnings for drug possession. That accounted for 29 per cent of all recorded police warnings, making possession the single most common reason for using one. Because a warning is an official alternative to referral to prosecutors, it signals that the offence is considered low level.

That signal was strengthened on 22 September 2021, when the Lord Advocate extended the scheme from Class B and Class C drugs to simple possession of Class A substances. Heroin and cocaine possession can now be met with a warning, although the Lord Advocate made clear that supply should still be prosecuted. Police Scotland described the change as another tool in a health-led approach. At the time, about two thirds of people reported to prosecutors for possession alone were already dealt with through an alternative to prosecution. Offers of diversion for a single possession charge had risen from 57 in 2017–18 to 1,000 in 2020–21. By 2023–24, recorded possession crimes had fallen by 33 per cent over a decade, to 21,121. The death toll did not fall with them.

A warning teaches that being caught is an inconvenience. Zero tolerance would teach the opposite. Possession is a crime, and the first offence should bring a consequence the person feels; a repeat offence should lead to prosecution, not another slip of paper. This distinction matters. People in addiction need treatment, while casual buyers who can still choose whether to purchase the next bag need to believe that the law is real. Scotland has spent years sending the opposite message, with deadly results.

The buyers who never appear in the death figures

The mortuary shows the cost of the market, not its full size. In the Scottish Crime and Justice Survey covering 2018 to 2020, 3 per cent of adults said they had taken cocaine in the previous year, up from 1.8 per cent in 2017–18. Cannabis use was higher still, at 7.9 per cent. Cocaine was implicated in 589 deaths in 2025, but the number buying it is far greater than the number dying from it. That wider customer base keeps dealers in business.

The most recent Scottish survey to ask cocaine users how they viewed their use is older, from 2014–15, and should be understood in that context. Of adults who had used cocaine in the previous year, 40.1 per cent said they had tried it once or twice. Another 58.6 per cent had used it more often but said they would have no difficulty stopping. Only 1.3 per cent said they needed it or were dependent on it. The recreational line bought at the weekend funds the same trade whose consequences appear in the death statistics.

That does not mean affluent suburbs use more drugs than deprived communities. On overall drug use, the same surveys show the reverse. In 2014–15, 10.2 per cent of adults in routine and manual jobs reported using drugs in the previous year, compared with 4.4 per cent in managerial and professional jobs. Between 2018 and 2020, adults in the most deprived areas were also more likely to report drug use than those elsewhere in Scotland. The death toll follows that pattern. What stood out among professional users was the social setting: 84.8 per cent said they had taken drugs and alcohol together, the highest proportion of any occupational group.

This is the customer with a salary, a mortgage and a reputation to protect. Such buyers may believe they are unlikely to become the next nitazene death, which is precisely why a leaflet is unlikely to deter them. A conviction could. Someone who risks losing a job, professional registration or visa has far more at stake than a warning held on a police database for two years. Reducing that demand is part of reducing supply. Every gram bought at a suburban party feeds the same criminal network that cuts and stretches drugs for sale in the streets where people are dying. A crackdown that follows the hearse but ignores the Friday-night buyer leaves the trade with its most reliable source of cash.

The published programme therefore provides a clear starting point: direct Police Scotland towards supply, remove repeat dealers from the streets with high sentences, expand prison capacity so early release is no longer the default escape route, and return sentencing policy to ministers who answer to voters. The argument of this article adds one further step: treat possession as a crime, including the cocaine bought by people who may never enter a treatment service. Then public-health work has a chance to succeed because fewer lethal bags will reach the communities bearing the heaviest toll. Without that shift, another checking counter will not prevent next September’s figures from carrying the same explanation as this year’s.

Get involved

Ask the SNP why 1,133 deaths produced another checking service but no plan to make repeat dealers fear the sentence they will serve. If you want a Holyrood opposition prepared to say that the soft-touch approach has failed, join the campaign.