Prescriptions of medicinal products - monitoring and guidance

Drug Monitoring Procedures

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Suspected abuse

Prescription monitoring is primarily targeted at addictive drugs, those that are listed on the Icelandic Medicines Agency website, along with amphetamine, carisoprodol, gabapentin, pregabalin, SEM oral mixture, and buprenorphine. In addition, the Directorate of Health monitors the prescribing of medicinal products in specific other categories, such as antidepressants, thyroid medications, drugs for hypogonadism in men (testosterone), and also the prescribing of quetiapine.

The Directorate of Health emphasises that those responsible for prescribing medicinal products are the doctors, and they should ensure, as well as possible, that the use of the drugs is correct.

The Directorate of Health makes comments when many doctors prescribe the same or similar (addictive) drugs to the same individual at the same time so that the total amount is excessive.

Comments are made when doctors prescribe doses to individuals that exceed those recommended in the Special Medicines Register or when individuals receive medicinal products for which there are contraindications in the Special Medicines Register.

The Directorate of Health also comments when an individual with a recent addiction history is prescribed an addictive drug. It should be noted that in some instances, addictive drugs can be prescribed to individuals with a history of addiction, but this requires a lot of follow-up and supervision by a physician.

The obligation of reporting and processes

The Directorate of Health receives many suggestions about the abuse or misuse of medicines. If such a suggestion is considered credible, the physicians concerned are notified.

According to law, the Directorate of Health is required to pay special attention to prescriptions of addictive drugs for personal use. This is reviewed regularly, and comments are made when deemed necessary.

When information is received about hospitalisations or deaths due to drug poisoning, the drug history of the persons concerned is examined.

Comments are also made in the following cases:

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When people with a history of addiction are diagnosed with ADHD and are prescribed methylphenidate or amphetamine, more information is available in the Directorate of Health's clinical guidelines.
When hypnotics or sedatives are prescribed at the same time as a stimulant.
When long-acting drugs are prescribed late in the day.
When it is suspected that the ADHD diagnosis is not correct or when drugs are prescribed without a diagnosis by a specialist (psychiatrist or neurologist).
When older people are prescribed methylphenidate (due to uncertainty about safety and efficacy).
When people are prescribed long-term doses above the maximum dose based on the clinical guidelines of the Directorate of Health.

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It is important to try other methods and treatments before medication.
When individuals are prescribed sleeping pills for a long time or in doses exceeding what is recommended, examples of common medications include Imovane (zopiclone) and Stilnoct (zolpidem).
When children are prescribed sleeping pills intended only for adults (e.g. melatonin).
When older people are prescribed high doses of sleeping and sedative drugs.

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General comments are often made when several doctors prescribe the same or similar medicine simultaneously, but also when certain combinations of drugs are prescribed. Examples:

Opioids and benzodiazepines (hypnotics and sedatives) are prescribed at the same time to the same person.
Multiple opioids are prescribed at the same time to the same person.
Suboxone or similar treatment is used at the same time as other opioids are prescribed.
Stimulants and antipsychotics are prescribed at the same time.
If a person with an addiction problem is prescribed addictive drugs by several doctors at the same time, the doctors must cooperate closely on the treatment.

Service provider

Directorate of Health