The COVID-19 pandemic and lockdowns had a significant impact on mental well-being and (mental) healthcare systems globally.

To describe trends and dynamics of out-patient prescribing of psychotropic medications during the COVID-19 pandemic in The Netherlands.

Dispensed psychotropic medication prescriptions during the COVID-19 pandemic from March 2020 to March 2022 were retrieved from national registry data. Numbers of total and incident dispensed prescriptions and defined daily doses (DDDs) were identified for six medication groups. Overall pandemic-related changes in prescribing trends were analysed using interrupted time-series analyses. Lockdown-related prescribing dynamics were described using monthly risk ratios.

No overall pandemic-related changes in prescribing were detected, except for alcohol addiction medication, for which a pre-pandemic decline in total dispensed prescriptions and DDDs levelled off during the pandemic: +10 prescriptions per week (95% CI 7–11, P ≤ 0.001) and +111 DDDs per week (95% CI 56–165, P = 0.001). Monthly prescribing dynamics showed transient increases in all medication groups during the second and third lockdown periods. There were decreases in dispensed incident antidepressant and opioid addiction medication prescriptions during the first lockdown (average risk ratios: 0.87 and 0.88 respectively), and DDDs of dispensed incident and total attention-deficit hyperactivity disorder medication prescriptions and incident benzodiazepine prescriptions were elevated from the end of the second lockdown (average risk ratios: 1.40, 1.12 and 1.17, respectively).

These findings raise concerns regarding possible over- and under-prescribing during the pandemic. Further understanding of specific factors driving these changes is necessary to help prepare for future mental health(care) challenges.

The aim of this study is to investigate incident and total benzodiazepine prescribing in the Netherlands during the COVID-19 pandemic, including the impact of lockdown periods.

A national Dutch pharmacological registry was used, investigating extramural psychiatric drug prescriptions, between March 2020 and March 2022. Data included incident and total prescriptions as well as daily defined doses (DDDs) of benzodiazepines. The data covered 96% out of a total Dutch population of 17.5 million people. This was compared with the previous calendar year as a reference expressed as a monthly risk ratio (RR) and was corrected for population growth. Changes over time will be discussed if the RR was above 1.1 or below 0.9.

A total of 13.4 million prescriptions over a period of three years were included of which 5.8% were incident prescriptions. Three lockdown periods were identified during pandemic.

When analysing the total benzodiazepine prescription group, prescriptions and DDDs remained mostly stable throughout the pandemic. A brief relative increase in prescription DDD amounts was found during the second lockdown (RR: 1.11). When viewing the incident benzodiazepine prescriptions, there was a short period between the first and second lockdown when both prescription numbers and DDDs decreased (RR: 0.86 and RR: 0.83 respectively). The DDDs of incident prescriptions increased sharply during the second and third lockdown period and remained elevated between both, with an average RR of 1.13.

Total monthly benzodiazepine prescriptions and DDDs remained mostly stable during the COVID-19 pandemic in the Netherlands. COVID-19 related lockdowns seem to have mainly influenced incident benzodiazepine DDDs dispensed during the second and third lockdown. Increased incident DDDs, but not prescription numbers, imply that new patients on average received larger benzodiazepine prescriptions. The increase in incident prescription DDDs could be indicative of decreased accessibility to (psychiatric) healthcare. It could also have been driven by an increase of the incidence and/or severity of sleep and anxiety symptoms during the second and third lockdown. A better understanding of exact causes and mechanisms behind these changes is relevant in order to limit the psychiatric repercussions of future (inter)national emergencies.

Although manual-based treatments are widely available in mental health care, they are often not delivered according to protocol. Treatment-, therapist- and organizational-related determinants are known to affect therapist adherence to treatment protocols, and subsequently treatment success. This study examined which determinants are associated with therapist adherence to the Community Reinforcement Approach (CRA) manual, an evidence-based behavioural treatment programme commonly used in addiction care. Using a cross-sectional design, adherence to the CRA manual and potential contributing determinants were assessed through a self-report survey among therapists (N = 69) working in out-patient addiction care. Correlation analysis and backward stepwise regression analysis were used to examine which treatment-, therapist- and organizational-related determinants were associated with CRA adherence. Significant associations with self-reported CRA adherence were found for nine out of 16 determinants examined. Three independent determinants explained 43% of the variance in CRA manual adherence, namely compatibility with the working method therapists were used to, perceived outcome expectations, and perceived adoption of CRA procedures by colleagues. These determinants should be considered when implementing CRA in addiction care, for example by investing in training and taking into account therapists’ previous treatment experience. This also accounts for creating positive outcome expectations and the use of descriptive norms by making experiences explicit of therapists and teams that excel. Future research should investigate which other determinants contribute to therapists’ adherence and focus on clarifying causality between determinants and adherence.

1. (1) To understand the importance of treatment, therapist and organizational determinants influencing therapist adherence to the CRA manual.

2. (2) To explain the three determinants that make the largest contribution to self-reported therapists’ adherence to the CRA manual, namely: compatibility with the working method, perceived outcome expectations, and perceived adoption of CRA procedures by colleagues.

3. (3) To reflect on the clinical implications regarding therapist training, implementation of manual-based treatments and future research.

Chronic high-dose (CHD) prescription opioid use is a major public health concern. Although CHD opioid use has been associated with psychiatric disorders, the causality could go both ways. Some studies have already linked psychiatric disorders to an increased risk of transitioning to chronic opioid use, and longitudinal data identifying psychiatric disorders as predictors of CHD opioid use could shed further light on this issue.

To prospectively examine the relationship between the presence of a psychiatric disorder and subsequent development of CHD opioid use in primary care patients newly receiving opioids.

Data were included from 137 778 primary care patients in The Netherlands. Cox regression modelling was used to examine the association between psychiatric disorders prior to a new opioid prescription and subsequent CHD opioid use (≥90 days; ≥50 mg/day oral morphine equivalents) in the subsequent 2 years.

Of all patients receiving a new opioid prescription, 2.0% developed CHD opioid use. A psychiatric disorder before the start of an opioid prescription increased the risk of CHD opioid use (adjusted hazard ratio HR = 1.74; 95% CI 1.62–1.88), specifically psychotic disorders, substance use disorders, neurocognitive disorders and multiple co-occurring psychiatric episodes. Similarly, pharmacotherapy for psychosis, substance use disorders and mood and/or anxiety disorders increased the risk of CHD opioid use. Psychiatric polypharmacy conferred the greatest risk of developing CHD opioid use.

Psychiatric disorders increase the risk of developing CHD opioid use in patients newly receiving prescription opioids. To reduce the public health burden of CHD opioid use, careful monitoring and optimal treatment of psychiatric conditions are advised when opioid therapy is initiated.

Given the ongoing opioid crisis in the United States (US), we investigated the opioid situation in Europe. The aims of the study are to provide an overview of trends in prescription opioid (PO) use and opioid-related adversities between 2010 and 2018 for different opioids in 19 European countries and to present a comparison with similar data from the US.

A multisource database study with national data from 19 European countries evaluating trends between 2010 and 2018 in (a) PO consumption, (b) high-risk (HR) opioid users, (c) opioid-related hospital admissions, (d) opioid-related overdose deaths, (e) opioid use disorder treatment entries, and (f) patients in opioid substitution therapy (OST). Within and between-country comparisons and comparisons with data from the US were made.

There was considerable variation between European countries. Most countries showed increased PO consumption with the largest increase and the highest consumption in the United Kingdom (UK) compared to the rest of Europe and the US in 2018 (UK: 58,088 defined daily doses for statistical purposes/1000 population/day). In 2018, Scotland had the highest rates (per 100,000 population) of HR opioid users (16·2), opioid-related hospital admissions (118), opioid-related deaths (22·7), opioid use disorder treatment admissions (190), and OST patients (555) of all included European countries. These rates were similar or even higher than those in the US in 2018. Other countries with high rates of opioid-related adversities were Northern Ireland (synthetic and “other” opioids), Ireland (heroin and methadone), and England (all opioids). All other countries had no or little increase in opioid-related adversities.

Apart from the British Isles and especially Scotland, there is no indication of an opioid crisis comparable to that in the US in the 19 European countries that were part of this study. More research is needed to identify drivers and develop interventions to stop the emerging opioid crisis in the UK and Ireland.