Marte Handal

Background: Increasing oxycodone prescribing and its association with opioid‐related harms have raised concerns. In Norway, nearly 90% of opioids are prescribed in primary care, making primary care decisions important to overall opioid exposure. In‐hospital use may influence primary care practices through several mechanisms. This study analyses oxycodone and morphine use in Norwegian hospitals and its association with primary care prescribing from 2010 to 2021, alongside a review of tender agreements for these medications. Methods: Morphine and oxycodone, available in all relevant formulations, served as opioid proxies to compare covariation between hospitals and their catchment areas. We analyzed 2010–2021 procurement data from hospital pharmacies and primary care dispensing data from the Norwegian Prescription Database for all hospital trusts. Correlations between hospital and primary care morphine‐to‐oxycodone prescribing ratios were assessed using Pearson's r . Annual tender agreements were obtained from the national Hospital Procurement Organization. Results: Hospital oxycodone use increased by 67.0% and primary care prescribing rose by 86.5%. Morphine use increased by 12.6% in hospitals but decreased by 23.2% in primary care. A moderate covariation (Pearson's r = 0.48) between hospital use and primary care prescribing was observed. Hospital tender agreements for morphine declined by 80%, while those for oxycodone remained stable. Conclusions: Oxycodone use substantially increased relative to morphine in Norwegian hospitals and primary care. Prescription patterns show moderate covariation, suggesting a potential link between hospital and primary care prescribing, though causality remains uncertain. Tender agreements may contribute to prescribing trends in hospitals, with possible associations in primary care. Significance: This study is the first to provide quantitative evidence of covariation between in‐hospital use and primary care opioid prescribing across a national healthcare system. Despite recommendations favoring morphine, oxycodone prescribing continues to rise in Norway, with marked geographical variation. By linking procurement data, prescription patterns and tender agreements, our findings highlight the need to consider hospital practices and structural factors when addressing opioid prescribing. These results offer new insights into potential levers for opioid stewardship across care levels.

We have previously shown that the use of hypnotic drugs increased among young Scandinavians during 2012–2018. This study aimed to explore psychiatric and somatic morbidity among adolescent hypnotic drug users in a cohort study of 13–17-year-old individuals during 2008–2018 in Norway. Data sources were (i) prescription data from the Norwegian Prescription Database linked to specialist health care diagnoses from the Norwegian Patient Registry and (ii) sleep disorder diagnoses from the Primary Health Care Database. Hypnotic drugs were defined as the sedative antihistamine alimemazine and the ATC group “Hypnotics and Sedatives” (N05C), excluding midazolam. In 2017, 2519 girls (16.5/1000) and 1718 boys (10.7/1000) were incident (new) users of hypnotic drugs. Most of these new users (82% of girls, 77% of boys) were referred to secondary health care, where the most frequent diagnoses were mental and behavioral disorders (51.8% of girls, 46.2% of boys), while only 3.2% received a specific sleep disorder diagnosis. The most common mental and behavioral disorders were “Neurotic stress-related disorders” among girls (27.4%) and “Behavioral and emotional disorders” among boys (23.6%). In conclusion, the trend of increasing hypnotic drug use among adolescents reflects the initiation of hypnotic drugs in a subgroup of the population with a higher disease burden, mainly due to psychiatric disorders, than the general population.

Objectives: Since 2008, patients have had access to reimbursed analgesics, including opioids, for chronic pain in Norway. There is a need for knowledge on the occurrence and trends over time of substance use disorder (SUD) diagnoses among patients who receive reimbursed opioids for chronic pain. The primary aim of this study was to investigate the prevalence of SUD diagnoses in patients with chronic pain using reimbursed opioids from 2010 to 2019 in Norway. The secondary aim was to investigate the prevalence of other mental health diagnoses among those receiving reimbursed opioids in the subgroups with and without SUD diagnoses. Methods: A cross-sectional design utilising data from four Norwegian nationwide registries. Results: The annual number of individuals with SUD diagnoses increased from 377 to 932 from 2010 to 2019, while the annual prevalence of individuals with SUD remained relatively stable at around 5%. There was a higher prevalence for all categories of other mental health diagnoses among individuals with a SUD diagnosis, compared to those without a SUD diagnosis. Conclusion: The prevalence of SUD diagnoses was low in the population using reimbursed opioids for chronic pain in Norway, but the number of patients increased in the study period because the number of individuals receiving reimbursed opioids increased. Patients with a SUD used on average twice the daily doses of opioids compared to patients without a SUD. They were also more likely to have an additional mental health diagnosis.

Background: There is a lack of studies on methamphetamine (MA) exposure and morbidity in children beyond the perinatal period. Objectives: We compared morbidity in children (0–3 years) with prenatal MA exposure to opioid-exposed and to non-exposed children. Methods: We used data from a Czech nationwide, registry-based cohort study (2000–2014). Children, who reached 3 years of age, of mothers hospitalized with (i) MA use disorder during pregnancy (MA; n = 194), (ii) opioid use disorder during pregnancy (opioids; n = 166), and (iii) general population (GP; n = 1,294,349) with no recorded history of substance use disorder (SUD). Information on inpatient contacts, length of stay, and diagnoses (International Statistical Classification of Diseases and Related Health Problems 10th Revision [ICD-10]) were assessed. Crude and adjusted odds ratios (aOR), 95% confidence interval (CI) for the risk of hospitalization, and for getting diagnosis from the ICD-10 diagnosis chapters were calculated using binary logistic regression. A stratified analysis on hospitalizations with SUD of mothers was performed. Results: No significant differences were found in the measures of hospitalization between the MA and opioid groups. Children prenatally exposed to MA and opioids had higher numbers of hospitalizations and diagnoses and longer stays in hospital than children in the GP. Increased risks of certain infectious and parasitic diseases were found in both MA (aOR = 1.6; CI: 1.1–2.3) and opioid (aOR = 1.9; 1.3–2.8) groups as compared to the GP group. The most pronounced difference in stratified analysis on maternal hospitalizations related to SUD after birth was observed for injury, poisoning, and certain other consequences of external causes in the strata of the MA group who had hospitalized mothers (aOR 6.3, 1.6–24.6) compared to the strata without maternal hospitalizations (aOR 1.4, 0.9–2.3). Conclusion: This study suggests that children born to mothers using MA during pregnancy have similar morbidity during the first 3 years of life but higher than the GP. The excess of risk was primarily due to infections and injuries in the MA group.

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.

The ongoing opioid epidemic has been a global concern for years, increasingly due to its heavy toll on young people’s lives and prospects. Few studies have investigated trends in use of the wider range of drugs prescribed to alleviate pain, psychological distress and insomnia in children, adolescents and young adults. Our aim was to study dispensation as a proxy for use of prescription analgesics, anxiolytics and hypnotics across age groups (0–29 years) and sex over the last 15 years in a large, representative general population. The study used data from a nationwide prescription database, which included information on all drugs dispensed from any pharmacy in Norway from 2004 through 2019. Age-specific trends revealed that the prevalence of use among children and adolescents up to age 14 was consistently low, with the exception of a substantial increase in use of melatonin from age 5. From age 15–29, adolescents and young adults used more prescription drugs with increasing age at all time points, especially analgesics and drugs with higher potential for misuse. Time trends also revealed that children from age 5 were increasingly dispensed melatonin over time, while adolescents from age 15 were increasingly dispensed analgesics, including opioids, gabapentinoids and paracetamol. In contrast, use of benzodiazepines and z-hypnotics slightly declined in young adults over time. Although trends were similar for both sexes, females used more prescription drugs than their male peers overall. The upsurge in use of prescription analgesics, anxiolytics and hypnotics among young people is alarming.Trial registration The study is part of the overarching Killing Pain project. The rationale behind the Killing Pain research was pre-registered through ClinicalTrials.gov on April 7, 2020. Registration number NCT04336605; https://clinicaltrials.gov/ct2/show/record/NCT04336605.

Objective: To determine the association between child attention‐deficit/hyperactivity disorder (ADHD) and prenatal exposure to selective serotonin (SSRI) and serotonin‐norepinephrine (SNRI) reuptake inhibitor antidepressants, by timing and duration, with quantification of bias due to exposure misclassification.Design: Norwegian Mother, Father and Child Cohort Study and national health registries.Setting: Nationwide, Norway.Population: A total of 6395 children born to women who reported depression/anxiety in pregnancy and were either medicated with SSRI/SNRI in pregnancy (n = 818) or non‐medicated (n = 5228), or did not report depression/anxiety but used antidepressants 6 months before pregnancy (discontinuers, n = 349).Main outcome measure: Diagnosis of ADHD or filled prescription for ADHD medication in children, and mother‐reported symptoms of ADHD by child age 5 years.Results: When the hazard was averaged over the duration of the study follow up, there was no difference in ADHD risk between ever in utero SSRI/SNRI‐exposed children and comparators (weighted hazard ratio [wHR] 1.07, 95% CI 0.76–1.51 versus non‐medicated; wHR 1.53, 95% CI 0.77–3.07 versus discontinuers). Underestimation of effects due to exposure misclassification was modest. In early childhood, the risk for ADHD was lower with prenatal SSRI/SNRI exposure compared with no exposure, and so were ADHD symptoms (weighted β −0.23, 95% CI −0.39 to −0.08); this risk became elevated at child age 7–9 years (wHR 1.93, 95% CI 1.22–3.05). Maternal depression/anxiety before pregnancy was independently associated with child ADHD.Conclusion: Prenatal SSRI/SNRI exposure is unlikely to considerably increase the risk of child ADHD beyond that posed by maternal depression/anxiety. The elevated risk at child age 7–9 years needs to be elucidated.Tweetable Women with depression who use antidepressants in pregnancy do not have greater risk of having children with ADHD. Findings in school‐age children needs follow up.

Purpose: To estimate the association between Attention‐Deficit/Hyperactivity Disorder (ADHD) in children in preschool and primary school, and prenatal exposure to non‐steroidal anti‐inflammatory drugs (NSAIDs) by timing and duration.Methods: This study was based on the Norwegian Mother, Father and Child Cohort Study linked to the Medical Birth Registry of Norway, the Norwegian Patient Registry (NPR) and the Norwegian Prescription Database (NorPD). NSAID exposure was identified by maternal self‐report in pregnancy. Child diagnosis of ADHD was obtained from NPR and NorPD. Symptoms of ADHD at age 5 years were measured using Conners' Parent Rating Scale‐Revised, where higher scores correspond to more symptoms. To account for time‐varying exposure and confounders, marginal structural models were fitted to estimate hazard ratios and mean difference in z‐scores.Results: The analyses on ADHD diagnosis and ADHD symptoms included 56 340 and 34 961 children respectively. Children exposed to NSAIDs prenatally had no increased risk of ADHD diagnosis (first trimester: HR 1.12, 95% CI 0.86;1.45, second trimester: HR 0.98, 95% CI 0.69;1.38, third trimester: HR 0.68, 95% CI 0.31; 1.46) or ADHD symptoms (first trimester: standardized mean difference 0.03, 95% CI −0.03;0.09, second trimester: standardized mean difference 0.03, 95% CI −0.04;0.11, third trimester: standardized mean difference 0.11, 95% CI −0.03; 0.25). There was no duration‐response relationship for either outcome.Conclusion: Though non‐differential misclassification of the exposure may have attenuated results, these findings are reassuring and suggest no substantially increased risk of ADHD diagnosis or symptoms in children prenatally exposed to NSAIDs, regardless of timing or duration.

We examined the risk of developing a future alcohol use disorder (AUD) among offspring of families with different constellations of parental risk factors. We analyzed a sample of 8,774 offspring (50.2% male) from 6,696 two-parent families who participated in the Nord-Trøndelag Health Study in Norway when offspring were 13-19 years old in 1995-1997 or 2006-2008. Based on population registry information and parental Nord-Trøndelag Health Study self-reports, families were classified via Latent Profile Analysis into fiver risk constellations reflecting parents' education, drinking quantities and frequencies, and mental health. Information about AUD-related diagnoses, treatments, and prescriptions for all offspring in the period between 2008 and 2016 was obtained from 3 national health registries and pooled to reflect any AUD. The likelihood of AUD in offspring was examined with a set of nested logistic regression models. Registry records yielded 186 AUD cases (2.1%). Compared with the lowest-risk constellation, offspring from two constellations were more likely to present with AUD in unadjusted analyses. After adjusting for all covariates, including offspring's alcohol consumption and witnessing parental intoxication during adolescence, AUD risk remained elevated and statistically significant (adjusted odds ratio = 2.34, 95% confidence interval = 1.14, 4.85) for offspring from the constellation characterized by at least weekly binge drinking, low education, and poor mental health in both parents. Weekly binge drinking by both parents was associated with future AUD risk among community offspring in Norway when clustered with additional parental risks such as poor mental health and low educational attainment. (PsycInfo Database Record (c) 2022 APA, all rights reserved).