As many as 325 people lost their lives in 2012 despite having recently been in drug treatment or police or prison custody, in what experts warn reveals shortcomings in harm reduction efforts.
The new statistics come from the National Forum on Drug Related Deaths, an annual independent analysis of Scotland's rising tide of fatalities, mostly of older users of opiates such as heroin.
The report's authors said the sheer number of addicts who died despite being known to authorities showed there was "considerable potential to reduce the number of drug-related deaths by undertaking targeted harm reduction measures".
A total of 60% of all those who died in the year had been in contact with a drug treatment service in the six months before death.
More than one quarter - 27% - had been in police custody and 12% had been in prison in the six months prior to death.
Campaigners believe more could have been done to ensure that these people had access to help, including the overdose treatment naloxone, which is now being more widely distributed.
The Scottish Government has, for the past six years, adopted an official policy of "recovery" rather than harm reduction - although in reality it continues to champion measures such as naloxone and the heroin replacement drug methadone.