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.

In Harm’s Way

Gunni Marís On Thursday, November 25, 2021, I left a COVID testing clinic near the Kringlan shopping centre in Reykjavík. Stepping into my car, the phone rang and an unknown number appeared on the screen. I listened as the voice of an old acquaintance, meek but quietly upbeat, worked its way through the speaker. We […]

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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.

Investigate 20 Prescription Drug-Related Deaths

Twenty deaths involving prescription drugs are under investigation by police in the capital area, RÚVreports. Detective Chief Superintendent Karl Steinar Valsson says that drug dealers are increasingly turning toward selling prescription drugs, not least because the penalties for selling them are far less severe than for selling illegal narcotics.

Opioids, and young people’s abuse of these drugs, have been a topic of much discussion of late, particularly as opioid use has increased in the last six months.

“This year, we have around 20 deaths investigations here in the capital,” said Karl Steinar. “In some instances, these are cases of suicide, in other cases not—or at any rate, the investigations haven’t shown that.”

The deaths have involved a wide variety of drugs and in some cases, a mixture of prescription drugs and illegal narcotics. Karl Steinar says that the landscape is changing.

“The people who have been selling narcotics have also been shifting over to selling prescription medications that they procure in a variety of ways. And maybe only because the market has in some way opened up to this—it’s both that the availability of prescriptions has increased and that users are prepared to buy these drugs. It seems like it must be very profitable, because otherwise, people wouldn’t do it. And then, of course, the sales model for this is naturally always shifting more and more to the internet.”

There is also the fact that penalties for selling prescription drugs are far less severe than those for selling illegal narcotics. “…That’s of course one reason that people involved in these kinds of illegal activities—often organized crime operations—look to this. Because the punishments are much lighter.”

It’s also clear that some people who are written prescriptions by their doctors are selling those medications on the black market. Karl Steinar says that this is on the increase in Iceland and is something that requires urgent attention.