Drug Consumption in Norway
People over 70 years of age consume the most medicines. Women use more drugs than men. Most prescriptions are for antibiotics and pain relief. Based on the number of doses, most drugs are used to prevent and treat cardiovascular disease.
Statistics about drug consumption in Norway are based on two sources:
- Sales of drugs from wholesalers to pharmacies and non-pharmacy outlets licensed to sell a selection of OTC drugs. Turnover is measured in both Norwegian kroner and number of defined daily doses (DDD). The statistics do not contain information about individuals. Published reports are available from the Norwegian Institute of Public Health (NIPH) and www.drugconsumption.no.
- Medicines dispensed by prescription. The Norwegian Prescription Database (NorPD) is based on dispensed prescriptions and contains pseudonymised information about the individual which can be followed over time. Published reports are available from the NIPH and www.norpd.no.
Statistics about drug consumption in Norway tell us that about two out of three people will have one or more prescriptions dispensed in the course of a year. Non-prescription drugs are also included, which in 2008 accounted for 18 per cent of total pharmaceutical sales measured in DDD.
Drug consumption increases with age
Nearly 60 per cent of children under 5 years of age consumed at least one prescription drug in 2008. There are more drug users among boys than girls.
From 5 years of age the number of drug users falls and then increases again after 15 years of age. Among adolescents and adults the number of drug users is higher in women than in men, even excluding the use of oral and other hormonal contraceptives.
The over-70 year age group has most drug users. About 90 per cent of over 70 year olds were dispensed prescription drugs in 2008. The proportion is probably higher than this because the NorPD’s statistics exclude elderly people resident in institutions.
Antibiotics and pain relief most used
Drug consumption reflects the diseases and conditions among the population. The majority use antibiotics.
During 2012, almost 30 per cent of women and about 20 per cent of men aged 0-79 years were dispensed at least one antibiotic prescription at the pharmacy, see Figure 1
25 and 20 per cent of women and men respectively were prescribed painkillers. Approximately 17 per cent of women and 10 per cent of men used a drug for mental disorders and about 15 per cent of both women and men used a drug for cardiovascular disease.
|Figure 1b: Other drug groups.|
Figure 1. The proportion of men and women who used different drug types in 2014, 0-79 years. Fig 1a, antibiotics, Fig 1b, other drug groups. Contraception, hormones for use in menopause and drugs for impotence are not included. Number of users per 1000. Interactive figure. To see the ATC codes for the drugs used in the different groups, click the icon "Create diagram” at the top left of the figure and select the Definitions tab. (The two figures have different x-axes due to different layout of the datasets.) Source: Norwegian Prescription Database. Diagram: Norhealth.
Cardiovascular drugs are used most, use is increasing
The Wholesale Drug statistics show that the individual drugs that are most sold in the number of doses are drugs used daily to treat and prevent long-term illnesses. Most drug doses are for the prevention and treatment of cardiovascular disease, but also hypnotics (zopiclone) and allergy medicines (ceterizin) are included on the list of the 10 best-selling drugs (Drug Consumption in Norway 2004-2008).
Consumption of drugs to prevent and treat cardiovascular disease, including agents that prevent high blood pressure and blood clotting (aspirin), has risen steadily in the period 1999-2007 and is now the most frequently used drug type measured in DDD, see Figure 2. The figure shows the trend in sales of drugs to treat and prevent cardiovascular disease.
Norway is a large consumer of statins for high cholesterol with 425 000 people (9 per cent of the population) being dispensed statins at the pharmacy in 2008.
|Figure 2. Consumption of drugs to treat and prevent cardiovascular diseases 1999-2007, (ATC code C except C10 for cholesterol-lowering drugs) and cholesterol-lowering drugs (ATC code C10). Use is measured in defined daily doses (DDD) per 1000 inhabitants per day and estimates what proportion of the population may receive a certain drug treatment. Interactive figure. Source: Drug Consumption in Norway.|
Drug consumption in children
The most commonly used drugs among children include penicillin and other agents against respiratory infections and ear infections, see Figure 3 which shows the so-called systemic antibiotic use (tablets, injection). Over 15 per cent in the age group 0-14 years used systemic agents for infections in 2013. Use is highest among 0-4 year olds.
Asthma medicines are frequently used by children under 15 years use asthma drugs (figure 3). Other commonly used medicines among children are antihistamines against allergy and medicines for skin disorders such as atopic dermatitis (eczema).
A small proportion of children under 15 years used medication for ADHD, figure 3 shows number of users per 1000.
Figure 3. The proportion of children under 15 years who used different drug groups in 2014: antibiotics (J01), left, and ADHD drugs (N06BA01, -02, -04 and -09) and asthma drugs (R03), right. Age group 0-14 years, for antibiotics also 0-4 years. Number of users per 1000. Interactive figure. Source: Norwegian Prescription Database. Diagram: Norhealth.
Elderly often use various drugs
People over 70 years often use various drugs and at higher doses than younger people. Nearly 60 per cent of drug users over 70 years were dispensed more than five different drugs from pharmacies in 2008. One in five people were dispensed more than 10 different drugs.
Guidelines often recommend the use of several drugs to treat or prevent a disease. Since the elderly are often treated for multiple disorders simultaneously, it may explain why the total number of drugs is high.
A variety of drugs increases the risk of misuse, but we do not have data about the overuse, underuse or incorrect use of medicines.
The elderly mostly use drugs to prevent and treat cardiovascular disease. Other agents used frequently by the elderly include cholesterol-lowering agents, pain relief, antibiotics and drugs for mental disorders, particularly hypnotics, see figures 4 and 5.
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|Figure 4. The proportion of the population in the 65-79 year age group using different types of drugs. 2014, number of users per 1000, both genders together. Interactive figure. To see the ATC codes for drugs used in the different groups, click the icon "Create diagram" at the top left of the figure and select the Definitions tab. Source: Norwegian Prescription Database. Diagram: Norhealth.|
The use of hormonal agents in women
50 per cent of 15-24 year old women and 25 per cent of 25-44 year old women used contraceptive pills or other contraceptives in 2008. Less than 5 per cent used the spiral as a contraceptive.
Nearly one in seven or 15 per cent of women aged 45-64 years used a hormonal remedy for menopausal problems. In the period 2002-2008 sales of estrogen-progestin preparations decreased by 70 per cent and sales of estrogen preparations by 20 per cent, measured in DDD. This reflects revised recommendations for the use of such agents. In 2008 approximately 83 000 women over 45 years used hormone patches or pills for menopausal symptoms.
Drug consumption during pregnancy
Over half of pregnant women use prescription medications during pregnancy. This is shown in a study conducted by the Norwegian Institute of Public Health of over 100 000 pregnancies in the period 2004-2007. Mainly, penicillin and other antibiotics are used during pregnancy. Penicillin is considered to be safe for use by pregnant women.
2 out of 100 pregnant women used asthma medication. Less than 2 out of 100 used opioids and antidepressants. 1 out of 200 used medication for epilepsy (Egeland 2008).
The use of addictive drugs (restricted drugs)
Addictive agents include hypnotics, sedatives, anxiolytics, strong pain relievers such as opiates and opioids, and certain other medicines.
Addictive and narcotic drugs are defined as drugs that can provide:
- intoxication or euphoria
- development of tolerance with a need for increasing doses to achieve the desired effect
- withdrawal problems
Addictive drugs are divided into two prescription groups, A and B: A is used for narcotics prescription requires an authorized form. B-preparations are other addictive drugs. They can be prescribed on a standard prescription form, but can only be dispensed once.
The proportion using drugs in the B-group increases with age and women use more of these drugs than men. These drugs have many users in the over 45 age group, see figure 5 that shows number of users per 1000. People residing in institutions are not included.
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|Figure 5. Use of sleeping medication/sedatives (N05C, N05B). Age groups 45-64 years and 65-79 years, 2014. Number of users per 1000 inhabitants of the same age. Interactive figure. Source: Norwegian Prescription Database. Diagram: Norhealth.|
The Wholesale Drug statistics show that sleeping medication and sedatives accounted for more than half (53 per cent) of the sales of B-listed drugs in 2008, calculated by DDD.
- Engeland A, Bramness JG, Daltveit AK, Rønning M, Skurtveit S, Furu K. Prescription drug use among fathers and mothers before and during pregnancy. A population-based cohort study of 106,000 pregnancies in Norway 2004-06. British Journal of Clinical Pharmacology 2008;65:653-60.
- Norwegian Institute of Public Health 2009:1. Drug Consumption in Norway 2004-2008 (pdf). www.legemiddelforbruk.no