Opioid Crisis: Over 1,730 Doses of Naloxone Distributed

A procedural change to the delivery of naloxone, a medication used to reverse or reduce the effects of opioids, has greatly increased its distribution; over 1,730 doses of naloxone nasal spray have been distributed to companies and organisations assisting individuals struggling with opioid addiction since the new procedure was implemented last year.

“Life-saving” medicine

As noted in a press release on the government’s website, a life-saving nasal spray containing naloxone is now more accessible nationwide as a first response to opioid overdoses. The revised delivery arrangement allows individuals to obtain the medicine at no cost. Opioid-containing substances, such as heroin, methadone, fentanyl, oxycodone, buprenorphine, and morphine, are examples of drugs where naloxone can be administered.

As noted by the press release, naloxone previously required a prescription directly from a doctor to the patient. Following a modification to the procedure last year, doctors have been allowed to prescribe the drug to companies or organisations assisting individuals struggling with opioid addiction and/or their relatives.

Furthermore, the Ministry of Health has covered all costs of the drug through a tender by the National University Hospital (Landspítali), responsible for inventory and distribution. Various entities, including health institutions, police departments, homeless shelters, the Icelandic Red Cross, and Reykjavík City’s Welfare Division, have benefitted from this arrangement. “Over 1,730 doses of naloxone nasal spray have been distributed to these parties since the new procedure was implemented.”

The press release further notes that to combat the growing problem of opioid overuse, the government recently announced that it had approved Minister of Health Willum Þórs Þórsson’s proposals, including an increased budget for expanded distribution of naloxone nasal spray.

“Following successful examples from other countries, the Ministry of Health aims to replicate their success in reducing opioid overdose deaths. Emergency responders and service providers assisting individuals with opioid addiction are encouraged to keep emergency doses of naloxone on hand for immediate treatment while emphasising the importance of seeking medical care afterwards for further treatment.”

Enrollment in Opioid-Substitution Treatment on the Rise

Individuals receiving opioid-substitution treatment have significantly increased over the past years. According to Minister of Health Willum Þór Þórsson, 276 people were enrolled in the treatment in 2019, compared to 438 in 2021.

A formal enquiry before parliament

Following a formal enquiry by MP Diljá Mist Einarsdóttir – on whether doctors would be granted greater authority to prescribe opioids to those struggling with addiction – Minister of Health Willum Þór Þórsson gave no indication before Parliament that greater authority would be granted.

Read more: In Harm’s Way: Opioid Addiction in the Age of Harm Reduction

Willum Þór explained that opioid-substitution treatment is provided primarily by three institutions in Iceland: SÁÁ (the National Centre of Addiction Medicine), the University Hospital of Iceland (Landspítalinn), and the Akureyri Hospital in North Iceland. The main drug employed during treatment in Iceland is Buprenorphine, both in tablet and injectable form, which is a licensed drug (“costly and/or must be treated with care”) administered at no cost to patients and supervised by the University Hospital’s Medicines Advisory Board.

The use of Buprenorphine in injectable form, Willum noted, is restricted to healthcare institutions (H-label) while Buprenorphine in tablet form must be prescribed by doctors with knowledge and experience of addiction (Z-label). This means that physicians specialising in addiction treatment, who have secured a license and can demonstrate experience, outnumber psychiatrists when it comes to the prescription of Buprenorphine.

Willum also noted that Buprenorphine is primarily administered to patients at Vogur’s MAT (medication-assisted treatment) clinic in Reykjavík (in accordance with an agreement regarding opioid substitution treatment signed by Icelandic Health Insurance and SÁÁ) although a number of patients retrieve their drugs in tablet-form at pharmacies.

As noted by the National Library of Medicine, opioid-substitution therapy (OST) is an “evidence-based intervention” for opiate-dependent individuals, which replaces “illicit drug use with medically prescribed, orally administered opiates such as buprenorphine and methadone.”

OST/MAT programme responsible for reducing overdose rates

As noted in the Minister’s response before Parliament, individuals receiving opioid-substitution treatment (OST) have “increased significantly over the past years.” According to the minister, 276 people were enrolled in the treatment in 2019, compared to 438 in 2021.

SÁÁ’s medication-assisted treatment (MAT) clinic at the Vogur treatment centre has gradually expanded over the years and as of late summer treats 250 patients – most of whom have injected opioids or have suffered serious consequences as a result of their addiction. According to Dr Valgerður Rúnarsdóttir, the Medical Director of SÁÁ, MAT patients receive methadone, buprenorphine pills, or injections, which reduce withdrawal symptoms and cravings for opioids.

“There’s a low threshold for participation,” Valgerður stated. ‘We’d be seeing a much higher overdose rate if it weren’t for this programme. We also collaborate with other healthcare and social services to help people become sober. If we want to improve the lives of these people, these factors must be entwined.”

Although most of the patients in Vogur’s MAT are either sober or aspiring toward abstinence, there are also some who are not ready to quit. It is important to provide services to these individuals, and the City of Reykjavík, according to Valgerður, has greatly improved access to housing for this group of people over the past years. “Things are much better today compared to ten years ago,” she stated, adding that besides offering treatment and other services, removing stigma is also vital.