A drug epidemic: „Fentanyl is the biggest killer on the streets“

A man who is an intravenous drug user says that there is a fent­anyl epidemic among drug users in Iceland today. He says that three young men he knew died due to a fent­anyl over­dose last year. He says there very well may have been more. Fentanyl is a prescription-only drug.

Kristján Hafberg Ein­ars­son, a 51-year-old man, claims to be an intravenous drug user who mainly uses amp­hetamine. With the help of doctors, he is trying to gain some control over his addiction. He is a reg­ular at the ER due to his diabetes, which he was diagnosed with in 2008. His amp­hetamine addiction has, und­er­standa­bly, made his condition worse. He says that there is a fent­anyl epidemic in Iceland.

„I knew three young men who passed away with not a lot of time in between them and I was just struck. I do not have a morp­hine addiction myself, but fent­anyl truly is the big­gest killer on the streets today. I really only know a fraction of the morp­hine addicts but I met these guys at the shelter and at half way houses.“

But what is this fent­anyl drug? According to Lyfja.is, website for one of the largest drug store chains in Iceland, the drug in question is a pain reli­ever, related to morp­hine. Here is Lyfja’s description of the drug:

Fentanyl Actavis is a pain-reli­ev­ing drug. The drug is related to morp­hine and works very strongly as a pain reli­ever, in addition to being a sedative. It is used for long-term pain that reacts well to morp­hine, for example pain due to cancer.

The drug should not be used to treat sudden pain or pain following sur­geries. A tolerance can be for­med, and increasingly larger doses of the drug ther­efore needed. It does however differ greatly between people how fast the tolerance builds up. There is some risk of addiction.

For Fentanyl Actavis, the active ingredi­ent, fent­anyl, is bound in a type of band aid that rel­e­a­ses the drug stea­dily through the skin and into the bloodstream. That way, an even pain relief is achieved.

Please reg­ard that if the pati­ent develops a fever, more of the drug may tra­vel from the band aid and into the bloodstream. If this happ­ens, the pati­ent needs to be kept under close watch and possi­bly a smaller dose is required. The area on which the band aid is placed should not heat up.

Kolbeinn Guð­munds­son, for­mer head doctor of the Icelandic Medicines Agency, stated in an interview with Vísir in 2016 that fent­anyl was one of the strongest pain reli­evers in Iceland. „This is one of the strongest pain reli­evers on the market. Fentanyl is about 100 times stron­ger than morp­hine, if we mea­sure it milli­gram to milli­gram, and about 50 times stron­ger than even her­oin. So obviously, this is a very powerful drug, and ther­efore a dangerous one.“

According to Kristján Hafberg, there is a lot of fent­anyl on the market. He sees it quite clearly on Telegram, which is a messag­ing app commonly used for black market business, where you can remain anonymous. „I know that there is quite a lot of oxycontin coming in from Spain, because the doctors there are very willing to prescribe it to people, so this may very well be coming from over there. But if these drugs are commonly being prescribed by Icelandic doctors and reaching the drug market from there, then that is of course a huge scandal.“ Kristján says that one can make large sums of money by sell­ing morp­hine-related drugs on the black market. „I could easily sell the drugs that I own for a few hund­red thousand, this is big money.“

In 2018, Svandís Svav­ars­dóttir, Iceland’s Healthcare mini­ster at the time, was asked by a journalist at RÚV whether requests for doctors not to over-prescribe had not been fully heard, and whether it was being mon­itored which doctors are over-prescribing these morp­hine-related drugs.

„This is one of the things that we are looking at, and even though we try to main­tain that we are deal­ing with comparable issues to the countries closest to us, it has become quite clear that we are prescribing way too much of psychiatric drugs and pain reli­evers in Iceland. The quantity may even be double compared to the other Nordic countries. It does not matter how much we try to explain the rea­sons that these drugs are being prescribed, no matter what, this cannot be the situation we want to be in. So yes, this is somet­hing that needs to be exa­mined,“ Svandís said.

She also added that there were examp­les of doctors in Iceland los­ing their license for overprescribing these drugs.

This article was orig­inally written in Icelandic by Björgvin Gunn­ars­son.