2023 Could See a Record Number of Addiction-Related Deaths

The Medical Director of SÁÁ (National Centre of Addiction Medicine) fears that 2023 could see a record number of addiction-related deaths. Among former clients of the Vogur detox centre and rehabilitation hospital, thirty-five people have died so far this year, RÚV reports. The Minister of Health says that action must be taken.

Thirty-five addiction-related deaths this year

As reported by RÚV yesterday, 35 people struggling with substance use have died so far this year. Dr. Valgerður Rúnarsdóttir, the Medical Director of SÁÁ (National Centre of Addiction Medicine), fears that a record number of deaths could occur this year.

As noted by RÚV, social media has been abuzz with rumours about drug-related deaths recently, with some rumours suggesting that 15 people have died from addiction-related problems in the past two weeks, while others maintain that there have been 36 addictio-related deaths since the start of the year.

No confirmed figures for this period are available from the Directorate of Health, which collects statistics on causes of death in Iceland. It is, however, known that thirty-five former clients of the Vogur detox centre and rehabilitation hospital – aged fifty and younger – have died this year.

“We know that these people are struggling with addiction, and there is every chance that these deaths are related to their addiction, Valgerður Rúnarsdóttir, the Medical Director of SÁÁ (National Centre of Addiction Medicine), told RÚV.

Read More: In Harm’s Way (Opioid Addiction in Iceland)

When asked if these figures, which have done the rounds on social media, were accurate, Valgerður responded thusly: “Yes, I think these figures are real. But I hope that they don’t reflect an ongoing trend for the rest of 2023.

Valgerður fears that if this trend continues, many more people will die this year than when compared to the last five. It is difficult to say what explains the rising numbers.

“However, we know that there is a large increase in opioid addiction, especially among this younger group. It is a very dangerous addiction. These strong painkillers, Oxycontin and Contalgin, which are primarily being used in Iceland, they’re extremely lethal.”

Harm reduction

Frú Ragnheiður is a specially-equipped medical reception vehicle that cruises the capital area six evenings a week and operates according to the philosophy of “harm reduction.” It focuses on the consequences and risks of drug abuse over abstinence. The past few days have seen an uptick in the number of people seeking Frú Ragnheiður’s services, according to Hafrún Elísa Sigurðardóttir, harm reduction team leader at the Red Cross.

“People are scared and want to be informed. We try to educate our clients as much as we can regarding dose sizes and the effects that these substances have on users. We also encourage them to carry Naloxone (a drug designed to rapidly reverse opioid overdose) with them at all times,” Hafrún told RÚV.

Rumours on social media have also claimed that there are now substances in circulation where the morphine-related drug Fentanyl is being mixed with other substances, such as LSD, Oxycontin, and cocaine. Such drugs have proven extremely dangerous, for example, in the United States.

Hafrún told RÚV that it was impossible to confirm that such substances were in circulation, but that the team at Frú Ragnheiður was concerned. As were its clients.

“We need to listen”

When asked to respond to the rising number of addiction-related deaths, Minister of Health Willum Þór Þórsson told RÚV that it was “sad.”

“We have to listen. Something in our society is changing. It’s obvious,” Willum observed.

The minister also stated that more needed to be done. For example, the withdrawal treatment provided at the Vogur detox centre and rehabilitation hospital ​​needed to be strengthened.

“We have been talking about decriminalisation for a long time. I think we need to go a step further in harm reduction measures; we have discussed morphine clinics. It is an obvious prevention against the risk of infection and a great support for people to have a consumption space. We need to find a place for that.”

Alcohol Consumption On the Rise Among Icelanders

The consumption of alcohol among Icelanders has increased significantly and cases of cirrhosis are on the rise, Dr. Valgerður Rúnarsdóttir, the Medical Director of SÁÁ, has stated in an interview. Dr. Valgerður encourages individuals to seek treatment before problems get out of hand.

A new year, a new opportunity

In an interview with Vísir today, Dr. Valgerður Rúnarsdóttir, the Medical Director of SÁÁ (National Centre of Addiction Medicine), stated that many people see the new year as an opportunity to deal with addiction-related issues. About 600 people are currently on a waiting list for treatment at SÁÁ, which is similar to the past few months.

Valgerður noted, however, that most people don’t have to wait that long for admission. Valgerður added that many people were hesitant to seek help because they were unsure that their problems were “big enough.” According to Valgerðar, however, the right time to seek help is when the thought occurs that there might be a problem.

Read More: In Harm’s Way: Harm Reduction in the Age of Opioids

“The most numerous group of people that needs help is precisely that group of people who, because of their addiction, are about to miss out: whether on school, work, or connections with their family. It’s best to intervene while they’re still functional.”

A growing problem

Although patients at SÁÁ’s Vogur detox and rehabilitation centre are seeking help for various kinds of addiction-related issues, alcohol abuse remains, by far, the most common. Dr. Valgerður observed that alcohol consumption was “constantly increasing” and that, generally speaking, Icelanders “tend to drink a lot.”

“It has huge consequences. Hepatologists, for example, have observed that cirrhosis of the liver has greatly increased in Iceland. And we see that many people are in poor health from heavy alcohol consumption.”

Valgerður repeated her point about people not waiting too long to seek help: “I’d like to encourage people, who’ve been considering it for some time, to seize the opportunity now, during the beginning of 2023. Address the issues. We welcome everyone who comes to us.”

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.

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.

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.