Opioids in Iceland

The Icelandic Opioid Crisis: Iceland Approaching U.S. Numbers In Drug-Related Deaths

Reykjavik Grapevine, August 2018

In the first half of 2018, 29 recorded deaths in Iceland were likely to be related to drug overdoses. This is a heavy increase compared to last year’s numbers, when 32 people died due to illicit substance consumption over the entire year. Ólafur B. Einarsson from the Directorate Of Health believes there is a potential drug crisis developing in the country.

“There have been 29 deaths that are probably related to drugs from January to the middle of June this year,” Ólafur says, “but it remains to be confirmed whether they are all directly linked to drugs.”

The most pressing issue, however, is the abuse of prescription drugs. “Compared to other Nordic countries, Iceland has a 30% higher consumption rate of nervous system medication like oxycodone,” Ólafur says. This statistic spurred the Directorate Of Health to start an online prescription database in 2016 for physicians to prevent people from receiving multiple prescriptions for medication from different doctors. Similar programs have been implemented in other Western countries.

There is another more dangerous trend present, though. “This year, we discovered that more young people consumed a mix of strong opioid analgesics and cannabis or alcohol,” Ólafur says. Opioids are incredibly addictive and easy to overdose on. In Iceland, they are consumed in pill form and also smoked from Fentanyl patches, which is considered to be many times more potent than heroin.

“In my opinion, the current situation is a crisis and if the numbers will continue to rise this year, we will in fact be very close to the figures of the United States, proportionally speaking,” Ólafur says. While there has been roughly one drug-related death per 10,000 people in Iceland last year, the U.S. has had to face one death per 4,500 people.

Opioid use in Iceland

Icelandic Medicines Agency, October 2016

Table 1 summarizes all opioid-containing and analgesic drugs. It is interesting to note that over the past nine years, the use of these drugs has grown in Iceland by 18%, but has decreased in Denmark by 14% and in Norway by 4%.

In 2015, the total use of drugs in the opioid category, N02A, was highest in Iceland and lowest in Norway. Deviations of individuals sub-categories are, however, prominent when their use is examined.

In Iceland, the use of natural opioids is higher than in Denmark and Norway, but what is more interesting is that here the use increases but decreases in the other countries (Figure 1 and Table 4). The increase primarily affects codeine in mixtures and increases most after 2012, but at the end of that year, the opioid derivative tramadol, N02AX02, was made subject to prescription in Iceland. In Denmark, use is declining due to restrictions on the sale of codeine medicines in 2013.

The NOMESCO report, Health Statistics for the Nordic countries 2014, compares the Nordic countries' use of opioids. It clearly states that the growth in the use of opioid drugs is most significant in Iceland, even though the difference in total use is similar to that of the other Nordic countries. In Figure 3, only opioids classified under N02A are calculated, but outside that category is codeine, less than 10 mg in unit form, N02BA51 and N02BE51 and codeine alone, R05DA04. In Iceland, this use accounts for 25% of the total opioid use and 29% in Denmark.

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Growing use of strong painkillers in Iceland

Direcorate of Health, October 2017

From 2012 to 2016, the prescribed daily dose of strong painkillers (opioids) increased by 11% in Iceland. The increase can be attributed to the fact that proportionately more Icelanders are prescribed strong painkillers, and many receive large doses.


This is the opposite trend compared to what has happened in Norway, Sweden and Denmark. 

See Graph 1, which shows the defined daily allowance (DDD) prescribed for every 1000 inhabitants in the countries.

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Opioid use in Iceland is much higher than in Scandinavia

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Kjarninn miðlar, January 2021

Icelanders use much more neuropsychiatric drugs than Danes, Norwegians and Swedes. In the category of opioids, Iceland consumption is more than twice as high as in Scandinavia, but Icelanders also use more sedatives, hypnotics, antidepressants, stimulants and antiepileptics. However, the proportion of users has decreased somewhat in recent years.

According to the Medical Director of Health, the difference is partly explained by the fact that more individuals are prescribed neurological and psychiatric drugs in Iceland. 36 per cent of Icelanders were prescribed such drugs in 2019, while the corresponding proportion was between 27 and 29 per cent in the other Nordic countries. On the other hand, the proportion in Iceland has decreased somewhat since 2017, when about 38 per cent used such drugs. 

National Center of Addiction Medicine: The use of cocaine and opioids is increasing, but the number of deaths is decreasing

Fréttablaðið, May 2019

The use of opioids and cocaine has increased in the last two years, but the number of deaths has decreased. This is what Valgerður Rúnarsdóttir, chief physician at the National Center of Addiction Medicine, said in a conversation with Fréttablaðið.

 

Valgerður said that more patients were diagnosed with opioid and cocaine addiction in 2019 than two years before.
"It was a significant increase before the turn of the century, then it reached a peak, and the increase of the number of new patients stopped. Around this time, the Medical Director of Health's drug database was established and our maintenance treatment began. Many went into that treatment and stopped consuming. But in the last two years, there has been an increase."
 

Valgerður says that the number of deaths under the age of 40 from those who have been at Vogur Hospital has decreased again in the last 10 months.

Valgerður says that the opioid problem is multifaceted and that there is no quick fix.

 

"First of all, the supply of medicines needs to be reduced, among other things, by looking at prescriptions, how they can be different and how we can use other painkillers, as well as preventing illegal imports. Secondly, it is public awareness. People need to be aware of the dangers of using medicines that are not prescribed for you. They can be fatal because they are sedative for the brain, these powerful painkillers. "Thirdly, there are interventions when consumption has become a problem, such as addiction, then treatment and sometimes special medication is needed."