Landspitalinn, University Hospital, Department of Psychiatry, Reykjavik, Iceland
One of the hot topics in Iceland in recent years is the high proportion of Icelanders on psychotropic drugs compared to other Nordic countries as well as other European nations.
Besides psychotropics the general use of prescription drugs in Iceland is among the highest in Europe. The Directorate of Health has collected data on all prescriptions in a pharmaceutical database since 2006 to monitor the use of medication and encourage sensible prescriptions, not the least of drugs with addictive potential. All doctors now have direct electronic access to this database and can easily review the prescriptions received by their patients during a short consultation.
The Directorate has expressed concerns about the widespread use of psychotropic drugs with special focus on methylphenidate and antidepressants. Iceland holds the record for antidepressant prescriptions in the OECD with 126 DDD/1000 inhabitants in 2015, a 27% increase since 2010. While the figure had been more stable between 2005 and 2010 a large increase has been observed in due course since 2011 both among young people and people above 80 years and living in nursing homes. It was not until 2012 that figures for all mechanical dispensing of drugs to nursing homes were added to the Directorate´s database and explains the sharp increase for this population. For methylphenidate, Iceland is a world champion, with a steady rise in DDD/1000 inhabitants since 2006. In 2016, 2.7% of the population were prescribed psychostimulants, mainly methylphenidate, but also on a minor scale amphetamine, modafinil and atomoxetine. Methylphenidate has been shown to have high abuse potential and is now the drug of choice among i.v. drug addicts in Iceland. For sales of hypnotics and sedatives Iceland also holds the Nordic record although prescriptions have declined since 2011.
The Directorate of Health has argued for a system change, with more centralized services and less private clinics. This presentation will present data and discuss the situation and views of the Icelandic Psychiatric Association.