Experts Alarmed by Surge in Daily Drinking Rates

bar beer alcohol

According to a physician at the National Centre of Addiction Medicine (SÁÁ), the surge in online alcohol sales poses a concern for public health. Over the past four decades, the daily alcohol consumption rates among patients admitted to the Vogur Detox Centre and Rehabilitation Hospital with alcohol-related issues has more than tripled, Vísir reports.

Improved access, increased consumption

At a Nordic conference on alcohol and public health held yesterday, the impact of increased access to alcohol on consumption rates was a focal point of discussion.

In his opening remarks, Health Minister Willum Þór Þórsson expressed concerns over the rising levels of alcohol consumption, emphasising the irrefutable evidence that greater accessibility leads to higher usage rates. “Undeniably, better access results in increased consumption. This is an empirical fact that we must acknowledge and confront, particularly in our preventive efforts,” Minister Willum asserted.

Daily alcohol consumption on the rise

Lára G. Sigurðardóttir, a physician at the National Centre of Addiction Medicine (SÁÁ), echoed the minister’s sentiments in an interview with Vísir. She highlighted statistics that indicate a significant surge in daily alcohol consumption.

Read More: IR speaks to Dr. Lára Sigurðardóttir about nicotine pouches

Data from the Vogur Detox Centre and Rehabilitation Hospital reveals that around 1990, approximately 17% of patients admitted for alcohol-related issues consumed alcohol daily. Fast forward to last year, and that figure has skyrocketed to 66%. “Moreover, over 70% of patients aged 50 and above are daily alcohol consumers. The trend is particularly pronounced among older demographics,” Dr. Lára noted.

Dr. Lára also expressed concerns over legislative pressures to privatise alcohol sales, a move she and other experts warn could exacerbate the issue. “That’s the alarm that all the experts today have been sounding,” she added, noting that the online sale of alcohol has greatly increased public access.

In conclusion, Dr. Lára advocated for the retention of a state monopoly on alcohol sales, citing its proven efficacy in preventive measures. “A state monopoly remains the most effective sales model for mitigating the public health risks associated with alcohol consumption,” she stated.

This article was updated at 08:56

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.”

More Support for Children’s Mental Health Services

In a recent government announcement, an agreement has been reached to increase mental health services for children.

Ásmundur Einar Daðason, Minister of Education and Children’s Affairs, has signed an agreement with SÁÁ, an Icelandic organisation that offers treatment and counselling for individuals suffering from addiction.

The agreement is intended to increase support for SÁÁ’s services for children after the difficulties posed in the last years by the COVID-19 pandemic, including increasing services and reducing wait times for children who live with relatives suffering from addiction.

The agreement is one point in the measures taken by the government to increase government support for children and their families, consistent with laws on integrated services for children’s wellbeing.

Regarding the new agreement, Minister Ásmundur Einar Daðason stated: “To promote children’s success, it is not enough to focus only on them, but also the environment in which children grow up. The problems of relatives can become the problem of children in one way or another if the children and their families are not considered in a wider context with effective and early support.”

Projects to be supported in the agreement include an additional psychologist for children with parents served by SÁÁ, parents admitted to care facilities or receiving outpatient services will receive more information on children’s psychological services, and children’s psychological services are now set to begin at the same time as the parents’ alcohol and drug treatment.

Read more about mental health and Icelandic youth here.

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.

National Centre Of Addiction Medicine No Longer Profitting From Slots Machines

Gambling addiction

The National Centre of Addiction Medicine (SÁÁ) has ceased its participation in Íslandsspil. Íslandsspil is one of two parties that have a license to operate electronic gambling machines in Iceland according to Icelandic legislation.  SÁÁ’s director states that this step shows that they value compassion over money.

According to Icelandic legislation, gambling is illegal except for a few choice operators, operating within a tight framework. For close to 30 years, Íslandsspil was run by three non-governmental organisations who play a large part in Icelandic society’s infrastructure: SÁÁ, the Icelandic Search-and-rescue Association (ICE-SAR), and the Icelandic Red Cross. While their involvement with slots machines was criticised, the revenue was an important source of income. In particular, the Centre of Addiction Medicine was criticised for benefitting from the slots machines as they offer treatment for gambling addicts.

Director of the National Centre of Addiction Medicine (SÁÁ) Einar Hermannsson stated that exiting the Íslandsspil operation on April 8 allowed SÁÁ to participate in the debate on the morality of slots machines and gambling with the sole goal of representing their wards and helping them get better.

In a post on SÁÁ’s website, Einar states that the decision received a warm response, both in the form of a positive debate but also the more tangible form of increased donations. In the year’s first quarter, donations went up almost 60% compared to the first quarter of 2020. Additionally, a single individual who wishes to remain anonymous donated 10 million ISK to SÁÁ because of their exit from Íslandsspil, writing: “As gambling is a form of addiction, the centre has now made the moral and communal decision to not accept funds originating in slots machines. This means a loss of revenue for the association, something I want to help combat while also honouring the memory of my wife and my own 40-year sobriety.”

Íslandsspil is now run by two non-governmental organisations, the Icelandic Red Cross own 68.75% of the company and Ice-Sar with 31.25%. All proceeds from the operation of the company go to its owners in proportion to their holdings. Íslandspil’s website claims that revenue from Íslandsspil is one of the Red Cross in Iceland’s most important sources of income.

Read more on gambling in Iceland

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.

Debate Over Waitlists at Rehab Centre Continues

Minister of Health Svandís Svavarsdóttir is calling for a proactive response to the lengthy patient waitlist at Vogur, Iceland’s government-sponsored detoxification clinic and hospital, RÚV reports. Vogur’s chief physician says this waitlist has never been longer, meaning that individuals who are seeking help with their addiction problems have increasingly long waits for treatment.

Svandís says the rationale for the waitlist must be better explained, as must the steps that a person has to take to get on said waitlists. “I think it’s very important that it’s clear what the waitlists are and what they stand for, such that the requirements for getting on the waitlist are common knowledge. That’s not the case right now and so we also need to look at that.”

The director of the National Center of Addiction Medicine (SÁÁ), which manages Vogur, has stated that it is the Health Minister herself who is responsible for taking action (or not) on long-term budget cuts at their facility.

One notable example revolves around the treatment of minors at Vogur. In April, SÁÁ announced that they would no longer be able to admit patients under 18 because it had become clear, they said, that minors should not be sharing facilities with adults who were in rehab. The decision was made in the wake of allegations that a 60-year-old patient at Vogur sexually assaulted a 16-year-old who was also in treatment there. However, Vogur has continued to treat minors while new age-specific protocols and facilities are established for these patients.

Svandís has said that the Ministry is still working on a solution but says that the working group is expected to deliver a plan no later than December 15th.