Risk of Overdose Rises Following Closure of Iceland’s Only Safe Injection Site

Iceland’s only safe injection site, a temporary project operated by the Icelandic Red Cross, shuttered on March 6. A Red Cross employee told RÚV such sites decrease the risk of overdose among intravenous drug users in addition to saving funding within the healthcare and social service system. Over 100 individuals used the safe injection site within the last year, many of them unhoused, during over 1,200 visits.

Ylja, as the safe injection site was called, opened in May of last year and was a temporary pilot project operated by the Icelandic Red Cross. Like safe injection sites abroad, Ylja offered a safe environment for those 18 years of age and older to inject intravenous drugs under the supervision of trained nurses, who ensured sanitation, safety, and infection prevention practices were followed. Safe injection sites are a harm reduction service that can prevent overdose and death among users of intravenous drugs. They can also connect clients to other essential services they may require.

Assists a marginalised group and saves public funds

“We need housing and the funding to pay for it, in order to operate a safe injection site. There is a lack of political will to approve it,” stated Marín Þórsdóttir, the department head of the Icelandic Red Cross’ capital area department. In 2015 and 2022, the Icelandic parliament shelved bills to decriminalise drug possession for personal use. Minister of Health Willum Þór Þórsson promised to submit a new, revised bill last autumn but has yet to do so.

Marín adds that with Ylja’s closure, the Red Cross loses staff that is specialised in harm reduction, primarily nurses. While operating a safe injection site requires considerable funding, Marín says it ultimately saves public funds. “We are tending to a very marginalised group that receives little service, experiences perpetual discrimination in society, and it’s just savings, both within our healthcare and social services system by having a safe injection site and assisting people with harm reduction resources.”

Read more: In Harm’s Way

Economic and social factors appear to impact drug use in Iceland, according to the research of Dr. Arndís Sue-Ching Löve, an assistant professor at the University of Iceland. Her studies show that cocaine use decreased in Iceland during the COVID-19 pandemic, but increased again last year to around pre-pandemic levels. The increase may be partially explained by increased prosperity: a similar pattern was seen before the banking collapse in Iceland.

Opioid Admissions to Detox Centre on the Rise

The Vogur detox centre and rehabilitation hospital has seen a steady rise in admissions due to opioids. Vísir reports that a recent survey conducted by National Centre of Addiction Medicine (SÁÁ) found the supply of opioids in Iceland has increased in recent years and police seized large quantities of OxyContin last year, a situation that has doctors at Vogur particularly concerned.

The percentage of patients admitted to Vogur for opioid addiction has gone up from 22.5% to 27.3% in the last three years. In 2011, the percentage of admissions for opioids was just 10.3%.

Proscribed use of OxyContin has also gone up significantly, even though doctors have more awareness of the risks the drug poses for addiction. At the beginning of 2022, there were 3,500 people registered with OxyContin prescriptions in Iceland. Ten years ago, there were only 500. Ragnheiður Hulda Friðriksdóttir, quality control manager and assistant to the director of Vogur, says that steps are being taken to reduce the number of patients proscribed with the drug, as well as limit its distribution among nonprescription users.

“There are, of course, plenty of people who need these medications, but it’s also common knowledge that people sell medication they don’t need. I know the Icelandic Medicine Agency and the Directorate of Health have been enacting various measures to cut back on this,” stated Ragnheiður Hulda Friðriksdóttir, director of quality control and assistant to the director of Vogur.

Suðurnes Police have seized ever-larger quantities of black-market OxyContin in recent years, but there is strong indication that the drug is widely available to non-prescription users. SÁÁ conducts an annual survey on the price of various narcotics. There has been no noticeable increase in the price of OxyContin in five years, which indicates that the supply is stable and has even gotten bigger in recent years.

The most important thing remains access to treatment, says Ragnheiður Hulda. “That and a limit on access to [opioids] such that they are only proscribed when absolutely necessary. So it’s important that we think about how to wean people off them when they are prescribed.”

Ragnheiður Hulda concluded by saying that Vogur needs additional funds from the Icelandic Health Insurance Office to support the treatment of patients with opioid addiction. The current funding supports the treatment of 90 patients.

Icelandic Police Struggle to Reach Marginalised Group Exposed to COVID-19

Police officers in masks

A group of active drug users gathered in a house that later caught fire last week, Vísir reports. Two in the group tested positive for COVID-19 after the incident and police are working to find others in the group who may have been exposed. It’s proved a challenging task, as some of the individuals are homeless.

Capital area police have been working to find and contact nearly 20 individuals who could have been exposed to the SARS-CoV-2 virus at the apartment. “We’ve been contacting their groups and trying to meet them, invite them to get tested and try to explain to them what resources are available and then also try to inform them if they have been exposed and should be in quarantine, what that means and so on,” stated Ásgeir Þór Ásgeirsson, Chief Superintendent of the Capital Area Police.

Police have offered housing to those who must quarantine in a newly-opened government quarantine facility, the third to be established in the capital area. The new facility is specifically intended to house marginalised groups such as homeless individuals and those struggling with addiction. Ásgeir stated that police are doing everything they can to reach members of the group and ensure they receive the same service as others.

Healthcare Limited for Marginalised Groups

Guðmundur Ingi Þóroddsson, chairman of prisoner’s association Afstaða is concerned about the situation of active drug users, homeless people, and former prisoners in Iceland, particularly in light of the pandemic. “They have limited access to general health services and there are no treatments available for this group,” he stated, adding that there are indications that drug use has increased, illegal drugs have become more expensive and it has become more difficult for those using drugs to access healthcare. Though he says the opening of the quarantine facility for marginalised groups is a step in the right direction, the state and other municipalities need to follow suit.

Harm Reduction Initiative Expands to Suðurnes Peninsula

frú ragnheiður á suðurnesjum - skaðaminnkun red cross

A harm-reduction initiative run by the Icelandic Red Cross has now expanded its services beyond the capital area – to the Suðurnes peninsula, Southwest Iceland. Frú Ragnheiður, as the project is called, provides healthcare services, needle exchange services, and counselling to individuals with addiction. A statistic on the project’s Facebook page states that 61% of the initiative’s clients are homeless and another 10% live in subsidised or temporary housing.

Frú Ragnheiður’s services are mobile, operating out of an ambulance which will now be servicing the Suðurnes peninsula in addition to the capital area. The ambulance will travel around the peninsula on Monday and Thursday evenings from 6.30pm-9.00pm. Individuals located on the Suðurnes peninsula who would like to access its services are encouraged to send a message to (+354) 783 4747 as early as possible on those days to make an appointment. The ambulance meets clients at a location of their choice and its services are confidential.

In 2019, the initiative provided services to 514 individuals, an increase of 20% from 2018. Many of those visited more than once, and total visits numbered 4,149. The Suðurnes peninsula is the second-largest population centre in Iceland after the Reykjavík capital area, with around 20,000 residents.

Alþingi Legalizes Safe Injection Sites

Alþingi Icelandic parliament

Alþingi has passed a bill which will make it legal for municipalities around the country to open safe injection sites (SIS) for intravenous drug users, Vísir reports. Heiða Björg Hilmisdóttir, chair of the City of Reykjavík’s Welfare Committee, has praised the bill as a step in the right direction and believes that in Reykjavík, such a facility would do the greatest good if opened downtown. According to the SIS bill, around 700 people use intravenous drugs in Iceland each year. It’s estimated that somewhere between 25 and 40 people would use the Reykjavík SIS initially.

Safe injection sites (also referred to as overdose prevention centres, supervised injection facilities, or drug consumption rooms) are facilities where individuals over the age of 18 can use intravenous drugs in a safe environment, under the supervision of healthcare professionals and without fear of arrest or legal repercussions. They are intended to provide sterile injection supplies, provide healthcare guidance, referrals to rehabilitation and social services, and monitor for overdose, thus decreasing overdose-related expense and pressures on the healthcare system, increasing the likeliness of users seeking treatment and social aid, and reducing behaviours that put users at risk of contracting HIV and Hepatitis C, such as needle sharing.

“This is a really good step,” remarked Heiða Björg on the passing of the new bill, “but we would have liked to maybe see the report more clearly indicate that there would be low-cost healthcare services there [at the SIS]—that it would be a health clinic.”

Heiða Björg also believes that the government should bear the financial burden of healthcare services in safe injection facilities, not the local municipalities that open them. “It really isn’t fair to completely pass the ball to the municipalities,” she continued. “There needs to be a guarantee of funding for such operations.” The Minister of Health has yet to fully outline what services SISs will offer.

Heiða Björg says the city is prepared to help identify a suitable location for an SIS in Reykjavík but thinks that it’s clear that such a facility needs to be centrally located. “I think most professionals agree that it would be preferable for it to be somewhere central, where people are coming and going. We’ve really been looking at downtown.”

Wherever it’s located, the Reykjavík SIS will likely not open until next year. “If I tell it exactly like it is, then I think that this will take at least a year—based on my experience, for instance, finding [housing] for people who have been, or currently are, homeless. I think we have to just give this time but we are ready to get this done quickly and correctly if the funds for the project are guaranteed,” she concluded.

Not Everyone on Waitlist for Detox Clinic Needs to Be, Says Minister

As of March, 530 people were on the waitlist for admission to Vogur, the hospital and detoxification clinic run by Iceland’s National Center of Addiction Medicine (SÁÁ), RÚV reports. Of those 530, 115 individuals were slated to be admitted within the next three weeks. Minister of Health Svandís Svavarsdóttir says, however, that the list could be significantly shortened, as not everyone on the list has a genuine need for inpatient treatment.

Svandís outlined her reasoning in her response to an inquiry from Centre Party MP Sigurður Páll Jónsson.

A least a third of those who go on Vogur’s waitlist opt not to enter treatment for a variety of reasons. As such, Svandís says that it’s likely that not everyone currently on the list needs inpatient treatment to address their addiction problems. In some cases, she asserted, milder solutions may suffice, and these could be employed where appropriate to reduce the waitlist.

There are also people on the list, reported Svandís, who registered without a prior professional assessment. The Minister wants to change this and require that anyone on the waitlist for inpatient treatment first undergo a professional assessment to confirm that they do indeed need to enter the inpatient facility. Doing so, she concluded, would ensure that only those who truly need to undergo inpatient treatment make use of these limited services.

Multiple Incidents of Drugged Drinks

Police are investigating an incident in which a young woman was believed to have been drugged in a bar in Reykjavík at around midnight on Thursday evening, RÚV reports. The woman was taken to the National and University Hospital for care.

Recently, Suðurnes police issued an advisory urging people not to accept drinks from people they don’t know after some incidents of drugged drinks in Reykjanesbær.

Capital-area police were busy on Thursday night, also reported that there were a number of incidents involving drug and/or alcohol use . Two individuals also had to be taken to the hospital for drug-related reasons.

This article has been updated

Steroids Use Growing in Iceland

A recent episode of news program Kveikur brought to light just how common steroid use is in Iceland, particularly among young men. Testosterone prescriptions have increased dramatically over the last decade, and are double the rate prescribed elsewhere in the Nordic region. Icelanders are also 50% more likely than individuals in other western nations to suffer from body dysmorphic disorder.

Hafrún Kristjánsdóttir is a psychologist and sociologist, as well as former athlete, who researches the behaviour of young men and athletes. She says men get the message from a young age that it’s important to be big and strong. “You are a five-year-old boy and your heroes in life are Superman, Batman, and Hulk, and men like that, and they are all on steroids. If you look at them. They have a big six-pack and they are swollen. And it’s not uncommon to see little boys in playschool flex their muscles and when they draw themselves, they’re drawing a six pack.”

Icelanders had such a role model in Jón Páll Sigarmsson, a strongman, powerlifter, and bodybuilder who was first in the world to win the World’s Strongest Man title four times. Steroid use is widely considered a factor in his early death at the age of 32. His son Sigmar Freyr Jónsson spoke frankly about his own use of steroids in the episode, saying although they first made him feel energised and confident, they quickly began to affect his quality of life. “When I was at my strongest and heaviest, I didn’t feel like I was strong,” Sigmar stated, describing negative side effects such as loss of sex drive and even breast development, which led him to undergo several surgeries. “I stopped using steroids for a whole year, and I was a little worried because I wasn’t yet 30 but I felt that my sex drive and virility didn’t come back for a whole year.” Sigmar stated. “It wasn’t a direct fear of death that made me stop. It was more just wanting a better quality of life.”

Brigir Sverrisson, CEO of the Doping Control Committee of the National Olympic and Sports Association of Iceland, says the organisation wants to work with gyms to combat steroid use. “Gyms have expressed interest in taking a stand against drug abuse and they have a lot of power to do so,” he stated.