Linn Gjersing

Background and Objectives: More knowledge is needed to identify and reach those at overdose risk with preventive measures. We examined past 12‐month health service utilization, identified the most frequently utilized service, explored this utilization in more detail, and examined correlates of overdose death.Methods: A population‐based nested case–control registry study including all drug overdose deaths (1 January 2010 to 31 December 2018) in Norway through the Cause of Death Registry (n = 2388). The year‐, age‐ and gender‐matched controls included through a population registry (n = 21,465). Data cross‐linked with population and patient registries. Multivariable conditional logistic regression analyses estimated the likelihood of overdose death.Results: The cases (vs. controls) attended a higher median number of services (3 vs. 1). The General Practitioner (GP) was the most utilized service. The majority (55.7%) of cases had 11–50 encounters, while the majority (60.7%) of the controls had 1–5 encounters. No high school diploma, no employment, urban living, social welfare benefits/disability pension, single‐person household, recent incarceration, multiple health service utilization and frequent GP encounters, as well psychological and certain physical diagnoses were correlates of overdose death among the GP attenders.Discussion and Conclusions: The cases had utilized more services than the controls and the GP was the most frequently utilized service. In addition to low socioeconomic status, psychological and certain physical diagnoses were correlates of overdose death.Scientific Significance: This is the first national case–control registry study to document the high utilization of multiple primary and secondary health care services before drug overdose death, as well as reasons for attendance and correlates of overdose death.

Aims: To measure all‐cause mortality risk after an ambulance‐attended non‐fatal opioid overdose and associations with number of days following attendance, and individual and clinical characteristics.Design: A prospective observational study.Setting: Oslo, Norway.Participants: Patients treated with naloxone for opioid overdose by Oslo Emergency Services between 1 June 2014 and 31 December 2018.Measurements: Medical records were linked to the national Cause of Death Registry (1 June 2014–31 December 2019). Crude mortality rates (CMR) and incidence risk ratios (IRR) with 95% confidence intervals (CI) were estimated for the time periods (0–7 days, 8–31 days, 32–91 days, 92–183 days, >183 days) using multivariate Poisson regression analysis. IRR were estimated for sex, age, Glasgow Coma Scale (GCS), respiration rate, place of attendance and non‐transportation following treatment. Robust variance estimates applied due to multiple risk periods. Standardized Mortality Rates (SMR) were estimated.Findings: Overall, 890 patients treated for 1764 overdoses contributed to a total time at risk of 3142 person‐years (PY). Median number of attendances was 1 (range 1–27). The majority were male (75.5%) and the mean age was 37.7 years. In total, 112 (12.6%) died; 5.2% within 183 days and 2.2% between 184 and 365 days. Acute poisoning was the most common single cause of death (52.7%). The CMR was 3.6 (95% CI = 3.0–4.2) per 100‐PY. The women had a SMR of 32 (95% CI = 15.8–57.9) and the men 24.9 (95% CI = 17.7–34.2). The CMR (22.2, 95% CI = 10.6–46.8) was particularly high in the first 7 days, and significantly higher than in the following periods. However, this finding was only valid for those with severe overdose symptoms (GCS score = 3/15 and/or respiratory rate ≤6/min). Except for increasing age, no other indicators were associated with the mortality risk.Conclusion: Patients treated by Oslo Emergency Services between June 2014 and December 2018 for a non‐fatal opioid overdose with severe overdose symptoms at attendance had an overall high mortality risk compared with the general population, but particularly during the first 7 days after attendance.

Purpose: Opioid analgesics (OA) and other pharmaceuticals have been associated with drug‐induced deaths. However, there is a lack of knowledge regarding patterns of use of these pharmaceuticals in the population and regarding such associations. We identify and describe subgroups of people with different patterns of filled prescriptions of OA and other relevant pharmaceuticals and examine associations with drug‐induced deaths. In addition, we estimate the proportion of drug‐induced deaths with a filled OA prescription and OA as cause of death.Methods: A Norwegian population‐based nested case‐control register study with cases (drug‐induced deaths 2010–2018, N = 2388) and population controls matched for age, gender and year of inclusion (N = 21 465). Patterns of filled prescriptions for opioid analgesics (OA), benzodiazepines and benzodiazepine‐related drugs, gabapentinoids, ADHD medication and antidepressants/antipsychotics were explored by k‐means cluster analysis. Associations with drug‐induced deaths were estimated by conditional logistic regression adjusted for sociodemographic characteristics. Overlap of filled OA prescriptions and OA as cause of death was estimated.Results: Five clusters were identified: ‘few prescriptions’, ‘weak OA’, ‘ADHD medication’, ‘sedative/psychiatric morbidity’ and ‘strong OA’. The ‘strong OA’ cluster had higher socioeconomic status compared to the other groupings. The risk of drug‐induced death was also highest in this cluster (OR = 35.5; CI 25.6–49.3) and, for 68% (CI 64–73) of cases, filled prescriptions for OA was indicated as the underlying cause of death.Conclusions: The cluster analysis identified a subgroup with filled prescriptions of OA and other pharmaceuticals and a higher socioeconomic status than other subgroups. This subgroup had a high risk of drug‐induced death that needs to be addressed.

Background: Pharmaceutical opioid (PO) overdose deaths have increased in many Western countries. There are indications that those dying from a PO overdose differ from those dying from other types of overdoses. These differences might pose a challenge as the majority of current preventive measures are tailored toward those with the characteristics of “conventional” overdose deaths. Objective: We investigated differences in the characteristics of persons who died from PO overdoses compared to all other overdoses. Material and Methods: Using the Norwegian Cause of Death Registry, we retrieved information on overdoses classified according to ICD-10 and identified PO overdoses (T40.2; T40.4) and all other overdoses (T40.X; T43.6) in 2010–2019. By linking data from nationwide registers, we analyzed data on opioid dispensations and the history of mental and behavioral disorders. 1,224 persons were registered with PO overdoses and 1,432 persons with other overdoses. Results: Persons in the PO overdose group were older and were more frequently women (35.0% vs. 20.5%) than persons with other overdoses. They had a higher prevalence of chronic pain (35.8% vs. 13.2%), history of cancer (8.1% vs. 1.8%), filled prescriptions of analgetic opioids more frequently the month before death (38.8% vs. 12.0%), and used threefold higher doses of prescribed opioids compared to individuals in all other overdose group (66 vs. 26 oral morphine equivalents/day). In the PO overdose group, oxycodone and fentanyl were more frequently dispensed, while codeine was more frequently dispensed in the other overdose groups. A lower proportion of those in the PO overdose group had recorded diagnoses of substance use disorders, schizophrenia, and hyperkinetic disorder compared to the other overdose groups. Conclusion: Persons dying from overdoses on POs often differ from the population targeted by existing prevention strategies, as they are more frequently older women with chronic pain and using high doses of prescription opioids.

Background: to combat the COVID-19 pandemic, adherence to COVID-19 recommendations and vaccination against COVID-19 have been important. Among people who use drugs (PWUD), little is known regarding compliance towards COVID-19 recommendations, COVID-19 testing, or attitudes towards COVID-19 vaccination. We aimed to examine these issues in a sample of PWUD. Methods: a cross-sectional study was conducted between January and March 2021. Through users’ organizations and different low-threshold services for substance users, we recruited former drug users and professionals to include participants and perform the interviews. Participants completed an interviewer-administered questionnaire. Any person above 16 years of age who used substances were recruited. Results: 477 Norwegian PWUD participated in the study. The mean age was 43.8 (SD 12.8) years and 77% were males. Thirty-four percent had injected drugs the past four weeks. Alcohol (41%) and cannabis (41%) were the most common drugs used the past four weeks, followed by tranquilizers (37%), central stimulants (35%) and opioids (30%). The majority (90%) had washed their hands frequently, used alcohol sanitizer during the past two weeks, had used face masks, kept one-meter distance to other people and stayed at home if feeling unwell. Fifty-four percent had been COVID-19 tested. More than half the sample (58%) had positive attitudes to COVID-19 vaccination, while 26% were fairly or very unlikely to accept vaccination. Those older (OR = 0.96, 95% CI 0.94; 0.98) and using face masks (OR = 0.49, 95% CI 0.30; 0.79) were more likely to have positive attitudes towards vaccination, while those reporting low life-satisfaction (OR = 3.86, 95% CI 1.43; 10.40), using opioids (OR = 2.97, 95% CI 1.43; 6.18) or almost never staying at home when feeling unwell (OR = 2.76, 95% 1.39; 5.45) expressed more negative attitudes towards vaccination. Conclusion: there was generally a high compliance towards COVID-19 recommendations, but one quarter of the sample was sceptical towards COVID-19 vaccination. This indicates a need for targeted and tailored information and well-designed vaccination roll-out programs to reach all PWUD.

Introduction: Little international comparative work exists describing pandemic-related spikes in overdose and related implications for drug and public health policy. We compared increases in overdose deaths during the pandemic in Norway and the United States, two countries in the top 10 for per-capita overdose mortality, yet with very different approaches to the pandemic, healthcare and drug policy. Methods: We examined monthly overdoses in 2020 versus baseline rates (the monthly average across 2017–2019). We compared excess overdose mortality to shifts in human mobility and social interaction, measured using cellphone-based mobility data, an indicator of the societal response to the pandemic. Results: Both the US and Norway saw large magnitude exacerbations in overdose mortality during the pandemic-related lockdowns, reaching 46.8% and 57.0% above baseline, respectively. Maximum increases occurred 2–3 months after peak reductions in mobility, suggesting lagged mechanisms. While overdose mortality returned to baseline relatively quickly in Norway, rates remained elevated in the US to the end of 2020. Conclusions: Spikes in overdose mortality in both contexts may relate to disruptions in healthcare access and the drug supply becoming more potent. Norway’s quicker return to baseline may reflect more robust access to harm reduction and addiction-related healthcare services. Nevertheless, it is notable that even in Norway – with universal access to high-quality services, low COVID-19 rates, and a highly effective public health infrastructure – a greater than 50% spike in overdose deaths was still seen at the onset of lockdown measures. This may have important implications for future pandemic and disaster planning.

Injecting alone increases the risk of a fatal overdose. We examined the extent of such behavior in a sample of people who inject drugs (PWID) and the typical characteristics of those injecting alon...