Opioids in Denmark
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Drug-related poisonings have shown an increasing trend in the past decade, from 1 497 cases in 2008 to 2 523 in 2017. A decline is observed in the number of heroin poisonings since 2010, in parallel with an increase in poisonings related to opioids other than heroin, such as methadone, and stimulants (primarily amphetamines and cocaine). In both 2016 and 2017, an increase in poisonings by stimulants in general, and cocaine in particular, was observed.

In Denmark, drug-induced deaths are recorded in the Cause of Deaths Register of the Sundhedsdatastyrelsen and the National Police Register. The number of drug-induced deaths recorded in the Cause of Deaths Register in 2015 was the lowest in the last decade, and this was followed by a rebound in 2016. Toxicological results show that opioids were the principal drug involved in drug-induced deaths.

The majority of drug-induced deaths reported through the National Police Register involved more than one psychoactive substance, suggesting that polydrug use is a common cause of
death by poisoning in Denmark. The presence of opioids (primarily methadone, but also heroin and morphine) was detected in four out of five cases. Other drugs involved include cocaine, amphetamines and ecstasy.

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Interventions

Since 2010, several take-home naloxone programmes to prevent opioid-induced deaths have been implemented in Denmark and are currently covering six municipalities with high levels of drug use. Since their introduction, these programmes have trained more than 3 400 people in overdose response and given out more than 3 500 naloxone kits. The state-funded programme will be evaluated in 2019.

 

Five supervised drug consumption facilities operate in four municipalities. Over the period 2012-17, drug consumption rooms provided services to more than 11 700 drug users and supervised more than 1.3 million drug use episodes, without any fatal outcomes. In 2017 alone, 8 316 individuals used these facilities and were supervised during 431 102 consumption episodes.

 

Heroin-assisted treatment has been available for hard-to-treat opioid users in five locations across Denmark since 2010.

The most prevalent approaches to drug treatment in Denmark are cognitive, socio-educational and solution focused. Opioid
users are predominantly treated in opioid substitution treatment (OST) programmes, in which pharmacological treatment is
accompanied by psychosocial counselling.

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Opioid use in Denmark is decreasing

Danish Medicines Agency, November 2020

Total sales of opioids have decreased by more than 20 per cent in the past four years, and there are now fewer Danes who use the most common type of opioid, tramadol. So reveals two new studies from the Danish Health Data Authority and the Danish Medicines Agency.

A rise in consumption and concerns about dependence have in recent years put focus on the Danish people’s use of a number of morphine-like medicines, the so-called opioids, which are used to treat acute pain in particular.

Since 2015, the total opioid quantity consumed has fallen by more than 20 per cent, while the number of users has fallen by 9 per cent to 441,000 users in 2019. So reveals a new analysis from the Danish Health Data Authority. Most of the users are women, and the typical user is 65 years old.

The reduction in opioid consumption is confirmed by a study conducted jointly by the University of Southern Denmark, the Department of Clinical Pharmacology at Bispebjerg Hospital and the Data Analytics Center of the Danish Medicines Agency. The study looked at the most widely used opioid, tramadol, showing that 32 per 1,000 of the Danish population were treated with tramadol in January 2014. The consumption remained largely the same until 2017 when the media put focus on the consumption, followed up by the Danish Health Authority’s measures and the Danish Health Authority’s risk-minimisation actions, after which it dropped to 18 per 1,000 population as at end-2019.

The consumption of analgesics (painkillers) in Denmark has been high compared to most other Nordic countries. But consumption now seems to move in the right direction.

“The number of people having filled a prescription for opioids in the first nine months of 2020 is at 346,000. In comparison, this figure was about 372,000 in 2019. It indicates that the trend continues, and that the corona pandemic hasn’t necessarily affected consumption”, said Lars Eriksen Videbæk Head of Division in the Danish Health Data Authority.

2018: Fewer people have a long-term consumption of opioids

National Board of Health, August 2018

The number of people taking opioids, such as morphine, for more than six months has dropped. This is shown by the Danish Health and Medicines Authority's analysis of the consumption of opioids in Denmark in the years 2008 to 2017.

In 2011-2016, the number was stable at around 183,000 people, but in 2017 consumption has fallen to around 170,000 people. "It is positive that the number of people who have received opioids for both more than six months and more than five years is declining. This shows that doctors are aware of the area and take an active position on whether opioids are the right treatment for patients with chronic pain, ”says Casper Larsen, pharmacist at the National Board of Health. 

Focus on opioids
In recent years, the National Board of Health has focused on treating pain, including reducing the consumption of opioids. The effort was launched when a survey of consumption in 2016 showed that Denmark has a high consumption compared to other Nordic countries. 

 

As part of the effort, the IRF in the National Board of Health has recommended which drugs should be used for, for example, chronic low back pain, so-called chronic nociceptive pain, via a list of recommendations. The list showed that it is uncertain whether the balance between beneficial and harmful effects is positive for most patients when treated with opioids.

 

The National Board of Health therefore recommends that, for example, pain management, exercise or other non-pharmacological measures should be a central and integral part of the treatment for all types of chronic pain. Opioids should only be used in selected patients. 

Danish Medical Journal, December 2020

Methadone and heroin/morphine still account for most fatal poisonings. However, deaths due to stimulants, especially cocaine, have increased. The abuse pattern has changed and geographical differences have emerged.

Overall, fatal poisonings declined from a maximum of 226 in 2007 to 162 in 2017. Methadone (52%) was the most common cause of death, followed by heroin/morphine (25%). A marked increase in deaths was due to stimulants (13%), especially cocaine. The abuse pattern has changed since 2012. Methadone remained the most frequently detected drug, but clonazepam and cocaine surpassed heroin/morphine, diazepam and tetrahydrocannabinol as the second-most frequently detected drugs. Ketobemidone had disappeared, whereas buprenorphine, oxycodone, fentanyl, pregabalin and gabapentin had increased. Antidepressants/antipsychotics were detected in half (47%) of the cases. Cocaine was more frequent in the areas covered by Copenhagen and Aarhus, whereas heroin/morphine was most frequently detected in the area covered by Odense. Amphetamine was more frequent in the Aarhus area.

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