Stig Tore Bogstrand

• Bodal, Elen; Olsen, Nora Marie Temte; Olsen, Thomas; Edvardsen, Hilde Marie Erøy; Clausen, Thomas & Skurtveit, Svetlana Ondrasova [Show all 8 contributors for this article] (2026). Medical and non-medical gabapentinoid use in fatal drug poisonings in Norway: Linked postmortem toxicology and prescription data. Forensic Science International. ISSN 0379-0738. 389, p. 1–8. doi: 10.1016/j.forsciint.2026.113143. Full text in Research Archive
• Auestad, Nina; Jørgenrud, Benedicte Marie; Bogstrand, Stig Tore; Vallersnes, Odd Martin; Lerdal, Anners & Wüsthoff, Linda Elise Couessurel (2026). Using PEth and AUDIT-4 to Detect Harmful Alcohol Use Among People with Severe Substance Use. Substance Use & Misuse. ISSN 1082-6084. 61(11), p. 1984–1993. doi: 10.1080/10826084.2026.2634253. Full text in Research Archive
• Seferowicz, Maria; Lerdal, Anners; Edvardsen, Hilde Marie Erøy; Skråstad, Ragnhild Bergene; Valeur, Jørgen & Jørgenrud, Benedicte Marie [Show all 8 contributors for this article] (2025). Unveiling stages of change among medical inpatients with an increased-risk alcohol consumption—a cross-sectional study. Alcohol and Alcoholism. ISSN 0735-0414. 61(1). doi: 10.1093/alcalc/agaf067. Full text in Research Archive Show summary

  Abstract Aims Alcohol-related harm occurs at lower levels than previously recognized, warranting a need to identify mediators to reduce alcohol-associated risk in increased-risk drinkers. Stages of change (SOC) have been used to assess motivation for health behaviour alteration. The primary aim was to explore distribution on SOC among medical inpatients when comparing low-risk, increased-risk, and high-risk consumers as defined by Alcohol Use Disorder Identification Test-Consumption (AUDIT-C). Our secondary aim was to assess the distribution of SOC when consumption was stratified with a biomarker of alcohol use—phospatidylethanol 16:0/18:1. Methods Cross-sectional study with three participating hospitals. Recruiting consecutive medical inpatients ≥18 years with regular alcohol consumption as screened by score ≥2 on the first question in AUDIT-C (N = 888). AUDIT-C score and SOC were assessed by questionnaires, and phospatidylethanol concentration in a blood sample. Odds ratios and the 95% confidence intervals were calculated through a univariate logistic regression analysis for each variable, and multivariable logistic regression models were then fit to calculate the adjusted odds ratio and 95% confidence interval. Results Distributions of SOC differed between the three risk-groups. Distribution of SOC was comparable whether assessed by phospatidylethanol or AUDIT-C. Conclusions Increased-risk consumers constitute the majority of those in action—the only stage associated with consecutive reduction in drinking. Potentially, these results can aid in reducing perceived barriers among health care professionals in screening and offering health advice to those with increased-risk consumption and inform further research on mediators in this subgroup.

• Gamboa, Danil; Kabashi, Saranda; Jørgenrud, Benedicte Marie; Lerdal, Anners; Nordby, Gudmund & Bogstrand, Stig Tore (2025). Missed opportunities: the detection and management of at-risk drinking and illicit drug use in acutely hospitalized patients. Advances in Drug and Alcohol Research (ADAR). 5. doi: 10.3389/adar.2025.14149. Full text in Research Archive Show summary

  At-risk alcohol and illicit drug use are risk factors for disease and in-hospital complications. This study investigated whether clinicians document substance use in the electronic records of acutely hospitalized internal medicine patients. Alcohol and illicit drug positive patients were identified using prospectively gathered substance use data from a study sample comprising 2,872 patients included from November 2016 to December 2017 at an internal medicine hospital in Oslo, Norway. These data were unknown to hospital staff. Whether physicians recorded quantitative substance use assessments and interventions was examined in patients with study-verified alcohol use in excess of low-risk guidelines (Alcohol Use Disorder Identification Test-4 scores [AUDIT-4] of ≥5 for women and ≥7 for men) and/or illicit drug use (one or more illicit drug detected by liquid chromatography-mass spectrometry [LC-MS] analysis). Among 548 study-verified alcohol-positive patients, physicians documented quantity and frequency (QF) of use in 43.2% (n = 237) and interventions in 22.0% (n = 121). Alcohol interventions were associated with harmful drinking (AUDIT-4 ≥9 points; adjusted odds ratio [AOR] = 4.87; 95% CI: 2.54–9.31; p < 0.001) and QF assessments (AOR = 3.66; 95% CI: 1.13–11.84; p = 0.02). Among 157 illicit-positive patients, drug use was described quantitatively in 34.4% (n = 54) and interventions in 26.0% (n = 40). The rate of quantitative alcohol and illicit drug use assessment by hospital physicians is poor, with a correspondingly low intervention rate. Important opportunities for attenuating or intervening in at-risk alcohol and illicit drug use are missed.

• Nyman, Anna Armika Tussilago; Bogstrand, Stig Tore; Clausen, Thomas & Edvardsen, Hilde Marie Erøy (2025). Toksikologiske funn ved overdoseselvmord 2016–21. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 145(2). doi: 10.4045/tidsskr.23.0836. Full text in Research Archive
• Auestad, Nina; Bogstrand, Stig Tore; Vallersnes, Odd Martin; Lerdal, Anners & Wüsthoff, Linda Elise Couëssurel (2025). Cognitive Function among People with Severe Substance Use. European Addiction Research. ISSN 1022-6877. 31(2), p. 133–144. doi: 10.1159/000543755. Full text in Research Archive Show summary

  Introduction: Studies report a high variability of cognitive impairment in people who use drugs, ranging from 20% to 80%. Most research focuses on individuals who use drugs who are either admitted to treatment facilities or incarcerated and being abstinent from substances. The present study aimed to assess cognitive function among populations with ongoing, severe, habitual substance use, mimicking a real-world day-to-day situation. Methods: Cross-sectional design with 171 participants (70.2% male) with severe substance use, recruited from two sites in Oslo, Norway. All participants were screened for cognitive function using the Montreal Cognitive Assessment (MoCA). A cutoff of <26 points was used to classify possible cognitive impairment. Participants also provided information on their alcohol and substance use, as well as demographic data. Results: 74.9% of the participants scored below the MoCA cutoff for possible cognitive impairment. We did not find any associations between scoring below the MoCA cutoff <26 and the substance use variables (substance use, number of substances used, history of overdoses, injection drug use, and past substance use treatment). Conclusion: A high proportion of people with severe substance use may experience a functional cognitive impairment. This study provides novel insights into cognitive function within a population actively engaged in habitual substance use, offering a real-world perspective with high external validity. This knowledge is highly relevant for service providers who aim to deliver tailored follow-up services to this population outside of traditional treatment settings.

• Edvardsen, Hilde Marie Erøy; Clausen, Thomas; Bogstrand, Stig Tore & Skurtveit, Svetlana Ondrasova (2025). The role of prescribed opioids in Norwegian overdose deaths in 2005-2021. European Journal of Clinical Pharmacology. ISSN 0031-6970. 81, p. 1633–1641. doi: 10.1007/s00228-025-03897-5. Full text in Research Archive
• Jørgenrud, Benedicte Marie; Bråthen, Camilla Christin; Stenehjem, Jo; Kristiansen, Thomas; Rosseland, Leiv Arne & Bogstrand, Stig Tore (2024). Identifying excessive chronic alcohol use with phosphatidylethanol in patients with suspected severe injury-results from the IDART study. Alcohol and Alcoholism. ISSN 0735-0414. 59(3), p. 1–8. doi: 10.1093/alcalc/agae014. Full text in Research Archive Show summary

  Introduction: Acute and chronic alcohol use are well-known risk factors for accidents and injuries, and concurrent psychoactive drug use can increase injury risk further. Phosphatidylethanol (PEth) 16:0/18:1 is a biomarker used to determine alcohol consumption the previous 3-4 weeks. The aim was to investigate the prevalence of chronic alcohol use in trauma patients, as determined by PEth 16:0/18:1 concentrations, and how excessive chronic alcohol use relate to demographic variables, injury mechanisms and drug use. Setting: Patients received at Norwegian trauma hospitals from March 2019 to February 2020. The study is part of the Impairing Drugs and Alcohol as Risk factors for Traumatic Injuries study. Methods: All patients aged ≥ 16 years received with trauma team were included in the study. Data on injury date and mechanism, gender and age was registered. Blood samples were analyzed for 22 psychoactive medicinal and illicit drugs, ethanol and phosphatidylethanol 16:0/18:1. Regression analyses were conducted to assess associations between alcohol use and gender, age, injury mechanism and drug use. Results and conclusion: Of the 4845 patients included in the study, 10% had PEth 16:0/18:1 concentration ≥ 600 nM (~430 ng/mL), indicative of excessive chronic alcohol use. Being male, between 44-61 years old, involved in violence, and testing positive for medicinal drugs was associated with excessive chronic alcohol use.Excessive chronic alcohol use was common among males, middle-aged, patients with violence as injury mechanism and those with medicinal drug use. These findings emphasize the need to detect and treat excessive chronic alcohol use among trauma patients.

• Årving, Alexander Braadving; Hilberg, Thor; Vigerust, Elisabeth; Jørgenrud, Benedicte Marie; Bogstrand, Stig Tore & Mørland, Jørg Gustav [Show all 7 contributors for this article] (2024). Assessing alcohol consumption across phosphatidylethanol levels using HDL-cholesterol as a predictor. Alcohol and Alcoholism. ISSN 0735-0414. 60(1), p. 1–7. doi: 10.1093/alcalc/agae085. Full text in Research Archive Show summary

  Aims: Prior research has established a correlation between increases of High-Density Lipoprotein Cholesterol (HDL-C) levels and alcohol consumption. This study aimed to explore the association between phosphatidylethanol (PEth) levels and the amount of consumed ethanol, utilizing HDL-C as a surrogate marker on a population level. This endeavor offers an adjunct to other studies. Methods: PEth and HDL-C levels in 50 751 samples from 29 899 patients in Norway were measured simultaneously in whole blood and serum, respectively. Linear mixed model analyses were employed to assess HDL-C levels within different PEth intervals. Drawing on previous research indicating an increase of .0035 mmol/L in HDL-C per gram of pure ethanol consumed per day, and assuming no alcohol intake in the zero PEth group, we estimated mean daily ethanol intake at the group level for males in each PEth interval. Results: Results revealed a significant correlation between PEth and HDL-C levels (Spearman’s rho = .385 for women, .420 for men, P

• Tjelta, Thomas; Bogstrand, Stig Tore; Lerdal, Anners; Wüsthoff, Linda Elise Couëssurel; Edvardsen, Hilde Marie Erøy & Johannessen, Aud (2024). Screening and Following Up Harmful Alcohol Use “… is Not Necessarily Your Primary Focus”: A Qualitative Study Exploring Health Professionals’ Experiences Addressing Harmful Alcohol Use in a Norwegian Hospital. Journal of Multidisciplinary Healthcare. 17, p. 5189–5198. doi: 10.2147/JMDH.S475750. Full text in Research Archive Show summary

  Introduction: Alcohol use remains a leading cause of excess mortality and morbidity worldwide, and identifying and following up harmful alcohol use represents a key component of alcohol harm reduction policies. This article explores health professionals’ experiences implementing these policies in a Norwegian hospital. Aim: To explore health professionals’ views and experiences of systematic screening and tailored follow-up of harmful and hazardous alcohol use in a Norwegian hospital. Methods: We conducted semi-structured interviews with 13 specialty registrars and nurses working in the emergency department and observation ward of a hospital in Oslo, Norway. Interviews were carried out between May and December 2022, coded using NVivo v.14 and analyzed thematically. Results: We identified three themes: (i) standardized and clinical assessment, referring to tensions between standardized and clinical alcohol risk assessment; (ii) formal and informal treatment guidelines, encompassing the informal patient care practices enacted in the emergency department and on the wards, and; (iii) training delivery and barriers to implementation, referring to the training penetration rate and identified need for “clear and simple” alcohol treatment guidelines. Conclusion: This study highlights tensions between alcohol-related harm and alcohol-related norms as these pertain to screening and following up harmful and hazardous alcohol use in a Norwegian hospital. Results suggest training should focus on zero alcohol recommendations, the use of assessment tools, the acceptability of screening to patients and “clear and simple” patient follow-up procedures

• Gjerde, Hallvard; Jamt, Ragnhild Elén Gjulem; Stenehjem, Jo & Bogstrand, Stig Tore (2024). Substance use and driver fatality in Norway: An expanded case-control study. Traffic Injury Prevention. ISSN 1538-9588. 26(1). doi: 10.1080/15389588.2024.2392274. Full text in Research Archive Show summary

  Objective Using alcohol or psychoactive drugs before driving a motor vehicle may increase the risk of crash involvement, injury, and death. This is better documented for alcohol than for drugs. The aim of this study was to expand a previous case-control study on substance use and driver fatality by doubling the number of cases and controls, and hence improve the statistical power and enable the analysis of combined substance use. Methods We collected data on alcohol and drug use from all 1197 drivers of cars and vans who were fatally injured in road traffic crashes in Norway between 2005 and 2020 (‘cases’) by analyzing blood samples or reviewing other information on substance use. We also collected data on alcohol and drug use among 17,219 drivers in random road traffic (‘controls’) by analyzing oral fluid samples. Substance use was converted to dichotomous variables (no use/use). We used unconditional logistic regression to estimate adjusted odds ratios (aORs) with 95% confidence intervals (CIs) of driver fatality for mutually exclusive substance groups, adjusted for sex, age, geographic region, urban centrality class, and time interval of the week. Results Compared to no substance use, the aOR (95% CI) for driver fatality was for alcohol 91 (61-137), stimulants (primarily amphetamines) aOR 22 (9-56), benzodiazepines and z-hypnotics (BZDs) aOR 4.0 (2.7-5.9), tetrahydrocannabinol (THC) aOR 3.4 (1.7-6.7), and opioids aOR 1.4 (0.4-4.9). The aOR for any polysubstance use was 168 (96-297). The combinations of BZDs with stimulants or THC were associated with markedly higher aORs for driver fatality than the use of single substance groups. Conclusions Alcohol and polysubstance use are the most important predictors of fatal injury, followed by stimulants.

• Gamboa, Danil; Kabashi, Saranda; Jørgenrud, Benedicte Marie; Lerdal, Anners; Nordby, Gudmund & Bogstrand, Stig Tore (2024). Is alcohol and psychoactive medication use associated with excess hospital length-of-stay and admission frequency? A cross-sectional, observational study. BMC Emergency Medicine. 24(1). doi: 10.1186/s12873-024-00979-y. Full text in Research Archive Show summary

  Background Hospital length-of-stay and admission frequency are commonly used indicators of disease burden and health resource expenditures. However, the impact of psychoactive prescription medication use and harmful alcohol consumption on both the duration and frequency of hospital admissions is under-explored. Methods We conducted an analysis of data gathered from 2872 patients admitted to the Emergency Department at Lovisenberg Diaconal Hospital in Oslo, Norway. Psychoactive medicines (benzodiazepines, opioids, and z-hypnotics) were detected via liquid chromatography-mass spectrometry analysis of whole blood, while alcohol consumption was self-reported through the Alcohol Use Disorder Identification Test-4 (AUDIT-4). Using logistic regression, we examined associations with our primary outcomes, which were excess length-of-stay and admission frequency, defined as exceeding the sample median of 3.0 days and 0.2 admissions per year, respectively. Results Compared to the absence of psychoactive medication, and after adjusting for age, gender, malignant disease, pre-existing substance use disorder and admission due to intoxication, the detection of two or more psychoactive medicines was associated with both excess length-of-stay (odds ratio [OR], 1.60; 95% confidence interval [CI], 1.20 to 2.14) and yearly hospitalization rate (OR, 3.72; 95% CI, 2.64 to 5.23). This association persisted when increasing the definition for excess length-of-stay to 4 and 5 days and to 1.0 and 1.5 admissions per year for admission frequency. Harmful alcohol consumption (AUDIT-4 scores of 9 to 16) was not associated with excess length-of-stay, but with excess admission frequency when defined as more than 1.0 admission per year when compared to scores of 4 to 6 (OR, 2.68; 95% CI, 1.58 to 4.57). Conclusions Psychoactive medication use is associated with both excess length-of-stay and increased antecedent admission frequency, while harmful alcohol consumption may be associated with the latter. The utility of our findings as a causal factor should be explored through intervention-based study designs.

• Bråthen, Camilla Christin; Jørgenrud, Benedicte Marie; Bogstrand, Stig Tore; Gjerde, Hallvard; Rosseland, Leiv Arne & Kristiansen, Thomas (2023). Prevalence of use and impairment from drugs and alcohol among trauma patients: A national prospective observational study. Injury. ISSN 0020-1383. 54(12). doi: 10.1016/j.injury.2023.111160. Full text in Research Archive Show summary

  Background: Being under the influence of psychoactive substances increases the risk of involvement in and dying from a traumatic event. The study is a prospective population-based observational study that aims to determine the prevalence of use and likely impairment from psychoactive substances among patients with suspected severe traumatic injury. Method: This study was conducted at 35 of 38 Norwegian trauma hospitals from 1 March 2019 to 29 February 2020. All trauma admissions for patients aged ≥ 16 years admitted via trauma team activation during the study period were eligible for inclusion. Blood samples collected on admission were analysed for alcohol, benzodiazepines, benzodiazepine-like hypnotics (Z-drugs), opioids, stimulants, and cannabis (tetrahydrocannabinol). Results: Of the 4878 trauma admissions included, psychoactive substances were detected in 1714 (35 %) and in 771 (45 %) of these, a combination of two or more psychoactive substances was detected. Regarding the level of impairment, 1373 (28 %) admissions revealed a concentration of one or more psychoactive substances indicating likely impairment, and 1052 (22 %) highly impairment. Alcohol was found in 1009 (21 %) admissions, benzodiazepines and Z-drugs in 613 (13 %), opioids in 467 (10 %), cannabis in 352 (7 %), and stimulants in 371 (8 %). Men aged 27-43 years and patients with violence-related trauma had the highest prevalence of psychoactive substance use with respectively 424 (50 %) and 275 (80 %) testing positive for one or more compounds. Conclusion: The results revealed psychoactive substances in 35 % of trauma admissions, 80 % of which were likely impaired at the time of traumatic injury. A combination of several psychoactive substances was common, and younger males and patients with violence-related injuries were most often impaired. Injury prevention strategies should focus on high-risk groups and involve the prescription of controlled substances. We should consider toxicological screening in trauma admissions and incorporation of toxicological data into trauma registries.

• Jamt, Ragnhild Elén Gjulem; Bukten, Anne; Stavseth, Marianne Riksheim; Bogstrand, Stig Tore & Tverborgvik, Torill (2023). All-cause and cause-specific mortality among individuals imprisoned for driving under the influence of alcohol and drugs in Norway (2000–2016): a retrospective cohort study. BMJ Open. 13(12). doi: 10.1136/bmjopen-2023-078848. Full text in Research Archive Show summary

  Aims To describe all-cause and cause- specific mortality and to investigate factors associated with mortality among individuals imprisoned for driving under the influence (DUI) of alcohol and psychoactive drugs in the Norwegian prison population. Design Retrospective cohort study. The Norwegian prison registry was linked to the Norwegian Cause of Death Registry (2000–2016). Setting Norway. Participants/cases The cohort consisted of 96 856 individuals imprisoned in Norway over a 17-year period obtained from the Norwegian prison registry. Primary and secondary outcome measures Adjusted ORs (aOR) with 95% CI were calculated for death due to any, natural and unnatural causes of death. Analyses were stratified according to DUI convictions: no DUI convictions, only DUI convictions (DUI only), DUI and at least one other drug and alcohol conviction (DUI drug), and DUI and at least one conviction other than drug and alcohol conviction (DUI other). Results In total, 29.3% individuals had one or more imprisonments for DUI. The risk of all-cause mortality was elevated for those convicted for DUI, but only in combination with other types of crimes (DUI drug: aOR=1.5, 95% CI 1.4 to 1.6, DUI other: aOR=1.2, 95% CI 1.1 to 1.4). The risk of death from natural causes was significantly elevated for DUI drug (aOR: 1.8, 95% CI 1.6 to 2.0) and for DUI other (aOR=1.3, 95% CI 1.1 to 1.6). The risk of death from unnatural causes was lower for DUI only (aOR=0.8, 95% CI 0.7 to 0.9) and elevated for DUI drug (aOR=1.5, 95% CI 1.3 to 1.6). Conclusions The risk of all-cause mortality was significantly elevated for those convicted of DUI, but only in combination with other types of crimes.

• Gjerde, Hallvard; Bogstrand, Stig Tore; Jamt, Ragnhild Elén Gjulem & Vindenes, Vigdis (2023). Crash-involved THC-positive drivers in Norway have a high frequency of polysubstance use. Drug and Alcohol Dependence. ISSN 0376-8716. 244. doi: 10.1016/j.drugalcdep.2023.109800. Full text in Research Archive
• Wilson, Thomas; Wisborg, Torben; Vindenes, Vigdis; Jamt, Ragnhild Elén Gjulem & Bogstrand, Stig Tore (2023). Psychoactive substances and previous hospital admissions, triage and length of stay in rural injuries: a prospective observational study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 31(1). doi: 10.1186/s13049-023-01156-z. Full text in Research Archive Show summary

  Background - Patients admitted to hospital after an injury are often found to have used psychoactive substances prior to the injury. The aim of this study was to investigate the associations between psychoactive substances (alcohol, psychoactive medicinal drugs and illicit drugs) and previous hospital admissions, triage and length of stay in the arctic Norwegian county of Finnmark.<p> <p>Methods - Patients ≥ 18 years admitted due to injury to trauma hospitals in Finnmark from January 2015 to August 2016 were approached. Parameters regarding admittance and hospital stay were collected from 684 patients and blood was analysed for psychoactive substances. Using a prospective, observational design, time, triage, length of stay in hospital, use of intensive care unit (ICU), injury severity, Alcohol Use Disorder Identification Test—Consumption (AUDIT-C) and number of previous admittances were investigated by bivariable testing and logistical regression analysis.<p> <p>Results - Of 943 patients approached, 81% consented and 684 were included in the study. During the weekend, 51.5% tested positive for any substance versus 27.1% Monday–Friday. No associations were identified between testing positive and either triage or injury severity for any substance group although triage level was lower in patients with AUDIT-C ≥ 5. Short length of stay was associated with alcohol use prior to injury [odds ratio (OR) 0.48 for staying > 12 h, confidence interval (CI) 0.25–0.90]. The OR for staying > 24 h in the ICU when positive for an illicit substance was 6.33 (CI 1.79–22.32) while negatively associated with an AUDIT-C ≥ 5 (OR 0.30, CI 0.10–0.92). Patients testing positive for a substance had more often previously been admitted with the strongest association for illicit drugs (OR 6.43 (CI 1.47–28.08), compared to patients in whom no substances were detected.<p> <p>Conclusions - Triage level and injury severity were not associated with psychoactive substance use. Patients using alcohol are more often discharged early, but illicit substances were associated with longer ICU stays. All psychoactive substance groups were associated with having been previously admitted.

• Edvardsen, Hilde Marie Erøy; Aamodt, Carl Magnus Falla; Bogstrand, Stig Tore; Krajci, Peter; Vindenes, Vigdis & Rognli, Eline B. (2022). Concentrations of psychoactive substances in blood samples from non-fatal and fatal opioid overdoses. British Journal of Clinical Pharmacology. ISSN 0306-5251. 88(10), p. 4494–4504. doi: 10.1111/bcp.15365. Full text in Research Archive Show summary

  Aim The primary aim was to compare concentrations of psychoactive substances in blood in non-fatal and fatal opioid overdoses. The secondary aim was to assess the concentration levels of naloxone in blood in non-fatal overdoses and the association between naloxone findings and concomitantly detected drugs. Method Design Case-control study. Setting Norway. Fatal overdoses from 2017 and non-fatal overdoses from February 2018 to September 2019. Cases Thirty-one non-fatal and 160 fatal opioid overdose cases. Data from the non-fatal overdoses were collected from hospital records and blood samples, and data from the fatal overdoses were collected from autopsy reports. Concentrations of psychoactive substances (including ethanol) in blood samples were collected at the time of hospital admission for the non-fatal overdoses and during autopsy for the fatal overdoses. Results The median number of different substances detected was four for fatal and five for non-fatal overdoses. The fatal overdoses had higher pooled concentrations of opioids (188 vs 57.2 ng/mL, P < .001), benzodiazepines (5467 vs 2051 ng/mL, P = .005) and amphetamines (581 vs 121 ng/mL, P < .001) than the non-fatal overdoses. A linear relationship between naloxone and concomitant pooled opioid concentrations was found (95% confidence interval = 0.002-0.135, P < .05). Conclusion The total load of drug concentrations was associated with the fatal outcome of an overdose, while the number of drugs used, to a lesser extent, differentiated between those who survived and those who died from an overdose. Higher opioid concentrations were associated with treatment with higher naloxone doses.

• Årving, Alexander Braadving; Hilberg, Thor; Sovershaev, Michael; Bogstrand, Stig Tore & Høiseth, Gudrun (2022). Falsely low phosphatidylethanol may be associated with biomarkers of haemolytic disease. Basic & Clinical Pharmacology & Toxicology. ISSN 1742-7835. doi: 10.1111/bcpt.13814. Full text in Research Archive Show summary

  Aims Falsely lower or even negative phosphatidylethanol (PEth) levels may theoretically be seen in patients with haemolytic diseases, and the present study aimed to elucidate this hypothesis. Methods PEth and carbohydrate-deficient transferrin (CDT) from 9893 serum and whole blood samples were included along with markers of haemolysis (i.e. haptoglobin, HbA1c, reticulocytes, LD and Hb). Cases showing discrepancy between PEth and CDT, that is, a low PEth value and a high CDT value, were considered to be possibly caused by falsely lowered PEth despite high alcohol consumption. These cases (N = 233) were compared to the control group without PEth and CDT mismatch. Results The levels of haptoglobin were significantly lower in the cases showing low PEth and high CDT (estimate = −0.62, p = 0.002). The levels of HbA1c (estimate = −3.26, p = 0.001) and Hb (estimate = −0.507, p < 0.001) were also significantly lower in this group. These findings indicate haemolytic diseases in the low PEth/high CDT group. There were no significant differences for reticulocytes and LD concentrations between the low PEth/high CDT group and the control group. Conclusions These results indicate that falsely low PEth values could be associated with markers of haemolytic diseases, although more research is needed to highlight this further.

• Jamt, Ragnhild Elén Gjulem; Edvardsen, Hilde Marie Erøy; Middelkoop, Gerrit; Allevik, Anna S.K; Bogstrand, Stig Tore & Vevelstad, Merete [Show all 7 contributors for this article] (2022). Dødsfall assosiert med MDMA i perioden 2000–19. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 142(8), p. 697–701. doi: 10.4045/tidsskr.21.0547. Full text in Research Archive Show summary

  BAKGRUNN Bruk av MDMA (3,4-metylendioksymetamfetamin), også kjent som ecstasy, har økt i Norge de senere år. Ettersom MDMA potensielt kan være toksisk og forårsake dødsfall, har vi undersøkt om økt tilgjengelighet og bruk samvarierer med økningen i MDMA-assosierte dødsfall. MATERIALE OG METODE Studien inkluderer obduksjonssaker med funn av MDMA i blodet, koblet med informasjon om dødsårsak fra Dødsårsaksregisteret. Disse dataene ble sammenliknet med antallet pågrepne ruspåvirkede førere med påvist MDMA i blodet samt årlig beslagsstatistikk fra Kripos – den nasjonale enhet for bekjempelse av organisert og annen alvorlig kriminalitet i perioden 2000–19. RESULTATER I perioden 2000–19 ble MDMA påvist hos 142 døde, og for 132 av disse var dødsårsaken kjent. Antallet årlige MDMA-assosierte dødsfall varierte fra 1 til 18. Median MDMA-konsentrasjon blant de døde økte fra 1,9 µmol/L (interkvartilbredde (IQR) 0,9 til 5,0) i 2000–04 til 3,8 µmol/L (1,4 til 12,0) i 2015–19. I 47/132 (36 %) av sakene bidro MDMA og andre sentralstimulerende rusmidler til dødsfallet. Blant pågrepne ruspåvirkede førere med påvist MDMA var antallet årlige funn 7–262 i perioden, mens mediankonsentrasjonen holdt seg stabil. FORTOLKNING MDMA kan ha bidratt til flere dødsfall i Norge. Økt tilgjengelighet, økt bruk og økt styrke på innholdet ser ut til å være av betydning. Hovedfunn Antallet dødsfall assosiert med MDMA (3,4-metylendioksymetamfetamin) per år i Norge har økt fra 2014 og har steget parallelt med økt antall MDMA-beslag. Andelen døde med toksisk MDMA-konsentrasjon og andelen med kombinasjonsrus av fire eller flere andre rusmidler var dobbelt så høy i 2015–19 som i 2000–04. Antallet pågrepne ruspåvirkede førere med MDMA i blodet økte fra 2014, men MDMA-konsentrasjonen hos disse var stabil i perioden 2000–19.

• Jørgenrud, Benedicte Marie; Kabashi, Saranda; Nadezhdin, Aleksei; Bryun, Evgeny; Koshkina, Evgenya & Tetenova, Elena [Show all 15 contributors for this article] (2021). The Association between the Alcohol Biomarker Phosphatidylethanol (PEth) and Self-Reported Alcohol Consumption among Russian and Norwegian Medical Patients. Alcohol and Alcoholism. ISSN 0735-0414. 56(6), p. 726–736. doi: 10.1093/alcalc/agab013. Full text in Research Archive Show summary

  Abstract Aims Valid measures to identify harmful alcohol use are important. Alcohol Use Disorders Identification Test (AUDIT) is a validated questionnaire used to self-report harmful drinking in several cultures and settings. Phosphatidylethanol 16:0/18:1 (PEth) is a direct alcohol biomarker measuring alcohol consumption levels. The aim of this study was to investigate how PEth levels correlate with AUDIT-QF and weekly grams of alcohol consumed among patients in two urban hospitals. In addition, we wanted to investigate the predictive value of PEth in identifying harmful alcohol use as defined by AUDIT-QF and weekly grams of alcohol cutoffs. Methods A cross-sectional study comprising acute medically ill patients with measurable PEth levels (≥0.030 μM) admitted to two urban hospitals in Oslo, Norway (N = 931) and Moscow, Russia (N = 953) was conducted using PEth concentrations in whole blood, sociodemographic data and AUDIT-QF questionnaires. Results PEth levels from patients with measurable PEth were found to be positively correlated with AUDIT-QF scores, with PEth cutpoints of 0.128 μM (Oslo) and 0.270 μM (Moscow) providing optimal discrimination for harmful alcohol use defined by AUDIT-QF (the difference between cities probably reflecting different national drinking patterns in QF). When converting AUDIT-QF into weekly grams of alcohol consumed, the predictive value of PEth improved, with optimal PEth cutpoints of 0.327 (Oslo) and 0.396 (Moscow) μM discriminating between harmful and non-harmful alcohol use as defined in grams (≥350 grams/week). Conclusions By using PEth levels and converting AUDIT-QF into weekly grams of alcohol it was possible to get an improved rapid and sensitive determination of harmful alcohol use among hospitalized patients.

• Engebretsen, Stine; Bogstrand, Stig Tore; Jacobsen, Dag & Rimstad, Rune (2021). Quality of care, resource use and patient outcome by use of emergency response team compared with standard care for critically ill medical patients in the emergency department: a retrospective single-centre cohort study from Norway. Emergency medicine. ISSN 0013-6654. 11(8), p. 1–9. doi: 10.1136/bmjopen-2020-047264. Full text in Research Archive Show summary

  Objective The study aimed to investigate quality of care, resource use and patient outcome in management by an emergency response team versus standard care for critically ill medical patients in the emergency department (ED). The emergency response team was multidisciplinary and had eight members, with a registrar in internal medicine as team leader. Design Register-based retrospective cohort study. Setting Tertiary hospital in Norway. Participants The study included 1120 patients with National Early Warning Score 2 (NEWS2) 5–10 points from 2015 and 2016. Patients missing ≥3 NEWS2 part scores, &lt;18 years and with orders ‘Not for ICU’ or ‘Not for resuscitation’ were excluded. Outcome measures Quality of care: pain assessment documented, analgesics given within 20 min, complete set of vital signs documented and antibiotics within 60 min if sepsis. Resource use: &gt;3 diagnostic interventions, critical care in the ED and ED length of stay (LOS) &lt;180 min. Patient outcome: intensive care unit (ICU) admission, ICU LOS &lt;66 hours, hospital LOS &lt;194 hours and mortality. Results The median age was 66 years, 53.5% were male, 44.3% were admitted to the ICU and the mortality rate was 10.6%. Altogether 691 patients received team management and 429 standard care. Team management had a positive association with ‘complete set of vital signs documented’ (OR 1.720, CI 1.254 to 2.360), ‘analgesics given within 20 minutes’ (OR 3.268, CI 1.375 to 7.767) and ‘antibiotics within 60 minutes if sepsis’ (OR 7.880, CI 3.322 to 18.691), but a negative association with ‘ pain assessment documented’ (OR 0.068, CI 0.037 to 0.128). Team management was also associated with ‘critical care in the ED’ (OR 9.900, CI 7.127 to 13.751), ‘ED LOS &lt;180 min’ (OR 2.944, CI 2.070 to 4.187), ‘ICU admission’ (OR 2.763, CI 1.962 to 3.891) and ‘mortality’ (OR 1.882, CI 1.142 to 3.102). Conclusions Team management showed positive results for quality of care and resource use. The results for later outcomes such as mortality, ICU LOS and hospital LOS were more ambiguous.

• Bye, Elin Kristin; Bogstrand, Stig Tore & Rossow, Ingeborg Margrete (2021). The importance of alcohol in elderly’s hospital admissions for fall injuries: a population case-control study. Nordic Studies on Alcohol and Drugs (NAD). ISSN 1455-0725. p. 1–12. doi: 10.1177/14550725211015836. Full text in Research Archive Show summary

  Background: Fall injuries account for a substantial part of the health burden among elderly persons, and they often affect life quality severely and impose large societal costs. Alcohol intoxication is a well-known risk factor for accidental injuries, but less is known about this association among elderly people. In this study, our aim was to assess whether risk of fall injuries among the elderly is elevated with an intoxication-oriented drinking pattern. Method: We applied a population case-control design and data from persons aged 60 years and over in Norway. Cases comprised patients with fall injuries admitted to a hospital emergency department ( n = 424), and controls were participants in general population surveys ( n = 1859). Drinking pattern was assessed from self-reports of drinking frequency and intoxication frequency. Age and gender-adjusted association between fall injury and drinking pattern was estimated in logistic regression models. Fall injuries were considered alcohol-related if blood alcohol concentration exceeded 0.01% and/or the patient reported alcohol intake within six hours prior to injury. Results: The risk of fall injuries was highly elevated among those reporting drinking to intoxication monthly or more often ( OR = 10.2, 95% CI 5.5–19.0). Among cases, the vast majority of those with alcohol-related fall injuries (64 of 68) reported drinking to intoxication. Conclusions: A drinking pattern comprising alcohol intoxication elevated the risk of fall injuries among elderly people. As alcohol use is a modifiable risk factor, the findings suggest a potential to curb the number of fall injuries and their consequences by employing effective strategies to prevent intoxication drinking among the elderly.

• Kabashi, Saranda; Gamboa, Danil; Vindenes, Vigdis; Berg, Thomas; Hilberg, Thor Arthur & Jørgenrud, Benedicte Marie [Show all 8 contributors for this article] (2021). Multimorbidity, psychoactive substance use and psychological distress among acute medically ill patients: A cross-sectional study. BMJ Open. 11(11). doi: 10.1136/bmjopen-2021-052428. Full text in Research Archive
• Bombana, Henrique Silva; Bogstrand, Stig Tore; Gjerde, Hallvard; Jamt, Ragnhild Elén Gjulem; Carvalho, Heráclito Barbosa de & Andreuccetti, Gabriel [Show all 10 contributors for this article] (2021). Use of alcohol and illicit drugs by trauma patients in Sao Paulo, Brazil. Injury. ISSN 0020-1383. 53, p. 30–36. doi: 10.1016/j.injury.2021.10.032. Full text in Research Archive
• Høiseth, Gudrun; Hilberg, Thor; Trydal, Torleif; Husa, Asgeir; Vindenes, Vigdis & Bogstrand, Stig Tore (2021). The alcohol marker phosphatidylethanol is closely related to AST, GGT, ferritin and HDL-C. Basic & Clinical Pharmacology & Toxicology. ISSN 1742-7835. p. 1–9. doi: 10.1111/bcpt.13662. Full text in Research Archive Show summary

  Background The aim of this study was to evaluate the quantitative relation between common clinical chemical analyses and ethanol use, measured by a combination of the two alcohol markers phosphatidylethanol (PEth) and carbohydrate-deficient transferrin (CDT). Methods Results of PEth and CDT in whole blood and serum, respectively, were included, together with information on 10 different commonly measured clinical chemical analytes, as well as age and sex. PEth was analysed by UPC2-MS/MS and CDT was measured by capillary electrophoresis. Results Samples from 4873 patients were included. The strongest relation to alcohol consumption as measured by PEth, when correcting for age and sex, was found for HDL-C (standardized β = 0.472, p < 0.001), AST (standardized β = 0.372, p < 0.001), ferritin (standardized β = 0.332, p < 0.001) and GGT (standardized β = 0.325, p < 0.001). The relation to PEth was weak for total cholesterol, TG and ALP. No relation was found for Hb and LDL-C. Conclusions When using PEth as a marker for alcohol consumption, this study demonstrated the quantitative relation to commonly used test as AST or GGT, but also an important relation to ferritin or HDL-C. In clinical practice, elevated levels of these clinical chemical analytes should initiate further work-up on possibly harmful alcohol use.

• Wilson, Thomas; Wisborg, Torben; Vindenes, Vigdis; Jamt, Ragnhild G.; Furuhaugen, Håvard & Bogstrand, Stig Tore (2021). Psychoactive substances have major impact on injuries in rural arctic Norway – A prospective observational study. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. 65(6), p. 824–833. doi: 10.1111/aas.13807. Full text in Research Archive Show summary

  Background - Rural areas have increased injury mortality with a high pre-hospital death rate. Knowledge concerning the impact of psychoactive substances on injury occurrence is lacking for rural arctic Norway. These substances are also known to increase pre-, per- and postoperative risk. The aim was by prospective observational design to investigate the prevalence and characteristics of psychoactive substance use among injured patients in Finnmark county.<p> <p>Methods - From January 2015 to August 2016, patients ≥18 years admitted to hospitals in Finnmark due to injury were approached when competent. Blood was analysed for ethanol, sedatives, opioids, hypnotics and illicit substances in consenting patients, who completed a questionnaire gathering demographic factors, self-reported use/behaviour and incident circumstances.<p> <p>Results - In 684 injured patients who consented to participation (81% consented), psychoactive substances were detected in 35.7%, alcohol being the most prevalent (23%). Patients in whom substances were detected were more often involved in violent incidents (odds ratio 8.92 95% confidence interval 3.24-24.61), indicated harmful use of alcohol (odds ratio 3.56, 95% confidence interval 2.34-5.43), reported the incident being a fall (odds ratio 2.21, 95% confidence interval 1.47-3.33) and presented with a reduced level of consciousness (odds ratio 3.91, 95% confidence interval 1.58-9.67). Subgroup analysis revealed significant associations between testing positive for a psychoactive substance and being diagnosed with a head injury or traumatic brain injury.<p> <p>Conclusion - A significant proportion of injured patients had used psychoactive substances prior to admission. Use was associated with violence, falls, at-risk alcohol consumption, decreased level of consciousness on admittance and head injury.

• Nadezhdin, Aleksey; Jørgenrud, Benedicte Marie; Tetenova, Elena J.; Bryun, Evgeny A.; Koshkina, Evgenya A. & Petukhov, Alexei [Show all 9 contributors for this article] (2020). Predictors of tobacco smoking among acutely ill patients in a Moscow hospital: A cross-sectional study. Tobacco Prevention & Cessation. 6(March):18, p. 1–9. doi: 10.18332/tpc/117954. Full text in Research Archive
• Engebretsen, Stine; Bogstrand, Stig Tore; Jacobsen, Dag & Rimstad, Rune (2020). Characteristics, management and outcome of critically ill general medical patients in the Emergency Department: An observational study. International Emergency Nursing. ISSN 1755-599X. 54:100939, p. 1–6. doi: 10.1016/j.ienj.2020.100939. Full text in Research Archive Show summary

  Background Critically ill general medical patients are an increasing group in the Emergency Department (ED). This register-based cohort study aimed to examine these patients’ characteristics, ED management and outcome, and investigate factors associated with ICU admission. Methods The study comprised all adult medical triage 1 patients treated by a specialized multidisciplinary team in 2015 and 2016. Univariate and multivariate analysis were used. Results 1294 patients were included. Mean age was 59 years, 56% (n = 725) were male, mean National Early Warning Score 2 (NEWS2) was 7, intensive care unit (ICU) admission was 56.8% (n = 735) and mortality rate was 16.8% (n = 217). Median ED length of stay (LOS) was 1.6 h, 1.2 h if admitted to ICU. The most frequent discharge diagnosis was acute poisoning (24.0%, n = 308). Younger age, male gender, arriving at nighttime weekdays, higher NEWS2 at arrival, critical care interventions or medications in the ED was associated with ICU admission. Conclusion More than half of the patients were admitted to ICU, and the mortality rate was 16.8%. A large proportion was diagnosed with acute poisoning. Younger age, higher NEWS and critical care in ED were associated with ICU admission. The short ED LOS suggests that management by a multidisciplinary team is beneficial.

• Årving, Alexander Braadving; Høiseth, Gudrun; Hilberg, Thor; Trydal, Torleif; Husa, Asgeir & Djordjevic, Aleksandar [Show all 9 contributors for this article] (2020). Comparison of the Diagnostic Value of Phosphatidylethanol and Carbohydrate-Deficient Transferrin as Biomarkers of Alcohol Consumption. Alcoholism: Clinical and Experimental Research. ISSN 0145-6008. 45(1), p. 153–162. doi: 10.1111/acer.14503. Full text in Research Archive Show summary

  Background The aim of this study was to compare the results of Phosphatidylethanol (PEth) and carbohydrate‐deficient transferrin (CDT) in blood as biomarkers of alcohol consumption in a large clinical cohort and to evaluate concentrations in relation to age and sex. Methods Results of PEth 16:0/18:1 in blood and CDT in serum were included, together with information of age and sex, which were extracted from a clinical chemistry database containing samples mostly from patients of primary care physicians and social care institutions. PEth concentrations were determined using Ultra Performance Convergence chromatography mass spectrometer. CDT was quantified by electrophoretic Capillary System. CDT values ≥ 1.7 %‐units and PEth values ≥ 0.31 µmol/L were considered to indicate heavy alcohol consumption. Results Samples from 6705 patients were included. The median age was 54.5 years, and 34 % were females. Only 47 % of the patients with PEth ≥ 0.31 µmol/L had increased CDT ≥ 1.7 %‐units examined in the same specimen (Cohen’s kappa was 0.43, p < 0.001). Patients above 50 years had significantly higher concentrations for both CDT (1.0 %‐units vs. 0.9 %‐units, p < 0.001) and PEth (0.340 µmol/L vs. 0.200 µmol/L, p < 0.001) compared with younger patients. Concentrations of CDT were significantly higher in males compared with females (p = 0.002), while no significant sex differences were seen for PEth (p = 0.465). Conclusions A high fraction of the patients had PEth values above the suggested cutoff for heavy drinking and normal CDT values, verifying the superior sensitivity of PEth compared with CDT. The effect of age seems to be minor for both markers. Higher concentrations of CDT, but not PEth, were seen in males, indicating that PEth, as opposed to CDT, might be formed equally in men and women. Therefore, the bias due to sex is possibly present only for CDT, not for PEth.

• Jamt, Ragnhild Elén Gjulem; Gjerde, Hallvard; Furuhaugen, Håvard; Romeo, Giovanni; Vindenes, Vigdis & Ramaekers, Jan G [Show all 7 contributors for this article] (2020). Associations between psychoactive substance use and sensation seeking behavior among drivers in Norway. BMC Public Health. 20:23(1), p. 1–8. doi: 10.1186/s12889-019-8087-0. Full text in Research Archive Show summary

  Background/aim Drug use and risky driving is associated with sensation seeking. The aim of this study was to investigate the association between use of psychoactive substances and levels of the sensation seeking personality trait as measured with the Brief Sensation Seeking Scale 4 among drivers in Norway. Method A cross-sectional design was applied to estimate the association between psychoactive substance use and sensation seeking behavior. Drivers in normal traffic were included in two roadside surveys: one in the north (September 2014 – October 2015) and the other in the south-east of Norway (April 2016 – April 2017). Oral fluid was analyzed for alcohol and psychoactive drugs, and data on sex, age and time of participation were recorded. Participants filled in the Brief Sensation Seeking Scale 4 questionnaire. Results A total of 8053 drivers were included, of which 32% were women and 62% were under 40 years. The prevalence of alcohol was 0.3%, stimulants 0.6%, tetrahydrocannabinol 1.4%, benzodiazepines and/or z-hypnotics 2.0% and polydrug use 0.6%. Associations were found between the use of tetrahydrocannabinol or benzodiazepines and/or z-hypnotics and a low score on the “thrill and adventure seeking” domain of the Brief Sensation Seeking Scale 4 (OR = 1.723, 95% C.I. = 1.001–2.966). Associations were also found between the use of stimulants and the highest scores on the “experience seeking” (OR = 2.085, 95% C.I. = 1.084–4.009) and “disinhibition” (OR = 4.791, 95% C.I. =1.748–13.135) domains of the Brief Sensation Seeking Scale 4. No associations were found between sensation seeking behavior and alcohol or polydrug use. Conclusion A high degree of sensation seeking was found among drivers who had used stimulating drugs, in contrast to drives who had used tetrahydrocannabinol and benzodiazepines and/or z-hypnotics who showed a low degree of sensation seeking. The combination of sensation seeking behavior and the use of stimulants might lead to increased risky behavior and thus traffic crashes.

• Gamboa, Danil; Jørgenrud, Benedicte Marie; Bryun, Evgeny A.; Vindenes, Vigdis; Koshkina, Evgenya A. & Nadezhdin, Aleksei V. [Show all 17 contributors for this article] (2020). Prevalence of psychoactive substance use among acutely hospitalised patients in Oslo and Moscow: a cross-sectional, observational study. BMJ Open. 10:e032572(9), p. 1–15. doi: 10.1136/bmjopen-2019-032572. Full text in Research Archive Show summary

  Objectives The use of psychoactive prescription medication is increasing in the general population. This is a cause for concern, particularly among the elderly, where physiological changes related to senescence increase the risk for adverse effects. While previous studies regarding psychoactive substance use have generally been population based, we sought to determine the frequency of such use among acutely hospitalised patients. Setting Two emergency departments (EDs), one in Oslo and one in Moscow, admitting patients to Departments of Internal Medicine. Participants 5583 patients aged ≥18 years participated, distributed evenly between genders and study locations. Patients unable to give informed consent were excluded. The study sites did not admit patients with surgical conditions and/or injuries. Primary and secondary outcomes The presence of psychoactive substances was determined through blood analysis using liquid chromatography-mass spectrometry. Secondary outcomes comprised demographic data (including age, gender, employment and marital status), degree of psychological distress, concurrent alcohol use, and self-reported alcohol, psychoactive drug and illicit substance use. Results 32.3% in Oslo and 12% in Moscow were positive for one or more psychoactive medicinal drugs (benzodiazepines, z-hypnotics, opioids or barbiturates). In Oslo, medicinal drug use was associated with being aged 61 to 70 years (OR 2.40, 95% CI 1.61 to 3.58) compared with 18 to 40 years, and psychological distress (OR 2.61, 95% CI 2.06 to 3.30). In Moscow, psychoactive medicinal drug use was also associated with psychological distress (OR 1.68, 95% CI 1.18 to 2.39), and was less common among patients aged 41 to 60 years (OR 0.62, 95% CI 0.43 to 0.88) than among patients aged 18 to 40 years. Conclusion A significant proportion of admitted patients used one or more psychoactive medicinal drugs, in particular benzodiazepines (Oslo and Moscow) and opiates (Oslo). We suggest formalised screening for inappropriate prescription drug use and increased adherence to clinical prescription guidelines.

• Sundet, Mads; Kajombo, Chifundo; Mulima, Gift; Bogstrand, Stig Tore; Varela, Carlos & Young, Sven [Show all 8 contributors for this article] (2020). Prevalence of alcohol use among road traffic crash victims presenting to a Malawian Central Hospital: A cross-sectional study. Traffic Injury Prevention. ISSN 1538-9588. 21(8), p. 527–532. doi: 10.1080/15389588.2020.1819990. Full text in Research Archive Show summary

  Background Alcohol consumption is a well-known risk factor for sustaining road traffic injuries worldwide. Malawi is a low-income country with a large and increasing burden of road traffic injuries. It has generally been viewed as a country with relatively little alcohol consumption. This study investigates the role of alcohol in road traffic injuries in and around the capital Lilongwe. Methods All patients presenting to the emergency department of Kamuzu Central Hospital after being injured in road traffic crashes were asked to participate in the study. Alcohol testing was done with a breathalyzer or a saliva test. Participants were asked about alcohol use before the injury as well as hazardous drinking using the AUDIT-C questionnaire. Results Of 1347 patients age 18 years or older who were asked to participate, 1259 gave informed consent, and data on alcohol use (alcohol test results and/or self-reported intake) were available for 1251 participants. Of those, 251 (20.1%) tested positive for alcohol, whereas 221 (17.7%) reported alcohol use before the crash; in total 311 (24.9%, 95% CI 22.5–27.3) either tested positive, reported use, or both. Females had a low prevalence of alcohol use (2.5%), while 30.6% of males had consumed alcohol before the injuries. Pedestrians had the highest prevalence at 41.8% (95% CI 35.5–48.4), while car drivers had 23.8% (95% CI 18.2–30.5). Among male pedestrians, 49.5% had used alcohol before the injury. Alcohol-associated injuries had a peak in the evening and at night, especially in the weekends. Of the patients, 63.1% reported that they had not consumed alcohol during the last year, while 21.4% had an AUDIT-C score suggesting hazardous drinking, and 66.2% of those had used alcohol before the injury. Conclusions A large percentage of road traffic injured patients had been drinking alcohol before their injury, especially male pedestrians. A large proportion of the patients were abstaining from alcohol, but those not abstaining had a high prevalence both of alcohol use when injured and hazardous drinking identified by AUDIT-C. This has important implications for prevention.

• Engebretsen, Stine; Bogstrand, Stig Tore; Jacobsen, Dag; Vitelli, Valeria & Rimstad, Rune (2020). NEWS2 versus a single-parameter system to identify critically ill medical patients in the emergency department. Resuscitation Plus. 3. doi: 10.1016/j.resplu.2020.100020. Full text in Research Archive
• Rimstad, Rune; Jacobsen, Dag & Bogstrand, Stig Tore (2020). NEWS2 versus a single-parameter system to identify critically ill medical patients in the emergency department. Resuscitation Plus. doi: 10.1016/j.resplu.2020.100020. Full text in Research Archive
• Kabashi, Saranda; Vindenes, Vigdis; Bryun, Eugeniy Alekseevich; Koshkina, Evgenia A.; Nadezhdin, Alexey V. & Tetenova, Elena J. [Show all 16 contributors for this article] (2019). Harmful alcohol use among acutely ill hospitalized medical patients in Oslo and Moscow: A cross-sectional study. Drug and Alcohol Dependence. ISSN 0376-8716. 204:107588, p. 1–9. doi: 10.1016/j.drugalcdep.2019.107588. Full text in Research Archive Show summary

  Background The aim was to estimate the prevalence of harmful alcohol use in relation to socio-demographic characteristics among acutely ill medical patients, and examine identification measures of alcohol use, including the alcohol biomarker phosphatidylethanol 16:0/18:1 (PEth). Methods A cross-sectional study, lasting one year at one hospital in Oslo, Norway and one in Moscow, Russia recruiting acute medically ill patients (≥ 18 years), able to give informed consent. Self-reported data on socio-demographics, mental distress (Symptom Check List-5), alcohol use (Alcohol Use Disorder Identification Test-4 (AUDIT-4) and alcohol consumption past 24 h were collected. PEth and alcohol concentration were measured in whole blood. Results Of 5883 participating patients, 19.2% in Moscow and 21.1% in Oslo were harmful alcohol users, measured by AUDIT-4, while the prevalence of PEth-positive patients was lower: 11.4% in Oslo, 14.3% in Moscow. Men in Moscow were more likely to be harmful users by AUDIT-4 and PEth compared to men in Oslo, except of those being ≥ 71 years. Women in Oslo were more likely to be harmful users compared to those in Moscow by AUDIT-4, but not by PEth for those aged < 61 years. Conclusions The prevalence of harmful alcohol use was high at both study sites. The prevalence of harmful alcohol use was lower when assessed by PEth compared to AUDIT-4. Thus, self-reporting was the most sensitive measure in revealing harmful alcohol use among all groups except for women in Moscow. Hence, screening and identification with objective biomarkers and self-reporting might be a method for early intervention.

• Mentzoni, Ida; Bogstrand, Stig Tore & Faiz, Kashif Waqar (2019). Emergency department crowding and length of stay before and after an increased catchment area. BMC Health Services Research. 19(1). doi: 10.1186/s12913-019-4342-4. Full text in Research Archive
• Valen, Anja; Bogstrand, Stig Tore; Vindenes, Vigdis; Frost, Joachim; Larsson, Magnus & Holtan, Anders [Show all 7 contributors for this article] (2019). Fatally injured drivers in Norway 2005-2015 - Trends in substance use and crash characteristics. Traffic Injury Prevention. ISSN 1538-9588. 20(5), p. 460–466. doi: 10.1080/15389588.2019.1616700. Full text in Research Archive
• Valen, Anja; Bogstrand, Stig Tore; Vindenes, Vigdis; Frost, Joachim; Larsson, Magnus & Holtan, Anders [Show all 7 contributors for this article] (2019). Driver-related risk factors of fatal road traffic crashes associated with alcohol or drug impairment. Accident Analysis and Prevention. ISSN 0001-4575. 131, p. 191–199. doi: 10.1016/j.aap.2019.06.014. Full text in Research Archive
• Ponce, Julio; Andreuccetti, Gabriel; Gonçalves, Raphael Eduardo Marques; Gjerde, Hallvard; Bogstrand, Stig Tore & Valen, Anja [Show all 8 contributors for this article] (2019). Comparison of traffic data and blood alcohol concentration among fatally injured drivers in Norway and Sao Paulo, Brazil, 2005–2015. Traffic Injury Prevention. ISSN 1538-9588. 20(7), p. 673–678. doi: 10.1080/15389588.2019.1648797. Full text in Research Archive
• Jamt, Ragnhild Elén Gjulem; Gjerde, Hallvard; Romeo, Giovanni & Bogstrand, Stig Tore (2019). Association between alcohol and drug use and arrest for driving under the influence after crash involvement in a rural area of Norway: a case-control study. BMJ Open. 9(1), p. 1–8. doi: 10.1136/bmjopen-2018-023563. Full text in Research Archive Show summary

  The rate of deaths caused by road traffic crashes is particularly high in rural areas. It has been hypothesised that one factor that may contribute is differences in patterns of alcohol use. The aim was to compare the prevalence of psychoactive substances among crash-involved drivers arrested for suspicion of driving under the influence (DUI) who are tested for alcohol and drugs and recent random drivers in a rural area. Furthermore, we investigated the association between traffic crashes and driving after using alcohol, illicit or medicinal drugs either alone or in combination.A case–control study was carried out in which the case group consisted of crash-involved drivers arrested for suspicion of DUI from 2000 to 2015. This group was compared with a control group of randomly selected drivers recruited to a roadside survey in normal traffic from 2014 to 2015. The case group consisted of 612 individuals (542 men and 70 women) and the control group of 3027 individuals (2099 men and 927 women). Drug and alcohol screening was performed on blood samples from the cases and samples of oral fluid from the controls.The proportion of psychoactive substances was 81.7% among cases and 1.6% among the controls. The prevalence of combinations of psychoactive substances was 18% among the cases and 0.3% among the controls. The multivariate regression model analysis identified significant drug interactions.The prevalence of alcohol and drugs was high among the crash-involved drivers arrested for suspicion of DUI by the police. In contrast to earlier published research combinations of different psychoactive substances did not increase the OR for traffic crash involvement more than the single drug with highest OR. The statistical methodology presented in this study should be allied in future studies with greater statistical power to confirm these findings.

• Jørgenrud, Benedicte Marie; Bogstrand, Stig Tore; Furuhaugen, Håvard; Jamt, Ragnhild Elén Gjulem; Vindenes, Vigdis & Gjerde, Hallvard (2018). Association between speeding and use of alcohol and medicinal and illegal drugs and involvement in road traffic crashes among motor vehicle drivers. Traffic Injury Prevention. ISSN 1538-9588. 19(8), p. 779–785. doi: 10.1080/15389588.2018.1518577. Full text in Research Archive Show summary

  Objective: The objective of this study was to study the association between self-reported road traffic crashes (RTCs) and recent use of alcohol and medicinal and illicit drug use and self-reported speeding in the previous 2 years. Methods: During the period from April 2016 to April 2017, drivers of cars, vans, motorcycles, and mopeds were stopped in a Norwegian roadside survey performed in collaboration with the police. Participation was voluntary and anonymous. The drivers were asked to deliver an oral fluid sample (mixed saliva), which was analyzed for alcohol and 39 illicit and medicinal drugs and metabolites. In addition, data on age, sex, and self-reported speeding tickets and RTCs during the previous 2 years were collected. Results: A total of 5,031 participants were included in the study, and 4.9% tested positive for the use of one or more illicit or medicinal drugs or alcohol. We found a significant, positive association between the use of cannabis and RTC involvement (odds ratio [OR] = 1.93; 95% confidence interval [CI], 1.05–3.57; P = 0.035) and also between previous speeding tickets and RTC involvement (OR = 1.39; 95% CI, 1.08–1.80; P = 0.012). In addition, older age groups were found to have a significant, negative association with RTC involvement, with ORs equal to or less than 0.49, when using the age group 16–24 as reference. Conclusion: Speeding, as an indicator of risk behavior, and the use of cannabis were associated with previous RTC involvement, whereas increasing age was significantly associated with lower risk. This is consistent with previous studies on RTCs.

• Eriksen, Therese Rye; Shumba, Linnea; Ekeberg, Øivind & Bogstrand, Stig Tore (2018). The association between hospital admission and substance use among trauma patients. Journal of Substance Use. ISSN 1465-9891. 23(1), p. 79–85. doi: 10.1080/14659891.2017.1348557. Full text in Research Archive
• Berg, Thomas; Eliassen, Elin; Jørgenrud, Benedicte Marie; Kabashi, Saranda; Petukhov, Alexey & Bogstrand, Stig Tore (2018). Determination of phosphatidylethanol 16:0/18:1 in whole blood by 96-well supported liquid extraction and UHPLC-MS/MS. Journal of Clinical Laboratory Analysis. ISSN 0887-8013. 33(1). doi: 10.1002/jcla.22631. Full text in Research Archive
• Høiseth, Gudrun; Austdal, Linn Engeset; Wiik, Elisabeth; Bogstrand, Stig Tore & Mørland, Jørg (2017). Prevalence and concentrations of drugs in older suspected drugged drivers. Traffic Injury Prevention. ISSN 1538-9588. 18(3), p. 231–236. doi: 10.1080/15389588.2016.1247209. Full text in Research Archive
• Petukhov, AE; Nadezhdin, AV; Bogstrand, Stig Tore; Bryun, EA; Ramenskaya, GV & Koshkina, EA [Show all 9 contributors for this article] (2017). The comparative analysis of the methods for the determination of phosphatidylethanol in blood as a biological marker of alcohol abuse. Sudebno-meditsinskaia ekspertiza. ISSN 0039-4521. 60(5), p. 23–26. doi: 10.17116/sudmed201760523-26. Full text in Research Archive
• Valen, Anja; Bogstrand, Stig Tore; Vindenes, Vigdis & Gjerde, Hallvard (2017). Toxicological findings in suspected drug-impaired drivers in Norway - Trends during 1990-2015. Forensic Science International. ISSN 0379-0738. 280, p. 15–24. doi: 10.1016/j.forsciint.2017.09.010. Full text in Research Archive
• Valen, Anja; Bogstrand, Stig Tore; Vindenes, Vigdis & Gjerde, Hallvard (2017). Increasing use of cannabis among arrested drivers in Norway. Traffic Injury Prevention. ISSN 1538-9588. 18(8), p. 801–806. doi: 10.1080/15389588.2017.1321114. Full text in Research Archive Show summary

  Objective: The availability of cannabis in Norway seems to have increased according to seizures by customs and police. On the other hand, national population surveys have not found any increase in self-reported use of cannabis. This investigation aimed at studying trends in cannabis use among suspected drug-impaired drivers apprehended by the police in Norway. Methods: A time series observational study of cannabis use among all drivers tested for drugs during 2000–2015 was performed. Descriptive analyses of trends in frequencies and combined use of cannabis with other drugs or alcohol for different age groups and gender were conducted. Results: Tetrahydrocannabinol (THC) is the main psychoactive substance in cannabis and was detected in blood samples from 18,767 suspected drug-impaired drivers. The annual number of THC findings increased during the years 2000–2015 for all age groups. For cannabis-only users, young drivers aged 20–29 years dominated during the whole period, whereas for multidrug–cannabis users the median age increased steadily during 2000–2015. After 2009, the annual increase in THC findings escalated; THC-only findings increased the most. Conclusions: Increasing numbers of THC-positive drivers were found among all age groups and genders; the strongest trend was observed between 2009–2015 for young drivers testing positive only for THC. KEYWORDS: Cannabis, THC, high-risk drug users, trends, driving under the influence

• Jamt, Ragnnild Elen Gjulem; Gjerde, Hallvard; Normann, Per Trygve & Bogstrand, Stig Tore (2017). Roadside survey on alcohol and drug use among drivers in the Arctic county of Finnmark (Norway). Traffic Injury Prevention. ISSN 1538-9588. 18(7), p. 681–687. doi: 10.1080/15389588.2017.1283027. Full text in Research Archive Show summary

  OBJECTIVE: The objective of this study was to determine the prevalence of alcohol and potentially impairing drugs among the general driving population in Finnmark and to compare the prevalence among Norwegian, Russian, and other foreign drivers by analyzing samples of oral fluid. METHODS: In collaboration with local police, drivers were selected for a voluntary and anonymous study using a multistage cluster sampling procedure (selection of roads, time intervals, and drivers within each interval) from September 2014 to October 2015. Age, gender, citizenship, time, and geographical site were recorded. Samples of oral fluid were collected using the Quantisal device. The samples were analyzed for alcohol with an enzymatic method and for 12 illicit drugs and 16 medicinal drugs and some metabolites using ultra-high-performance liquid chromatography with tandem mass spectrometry detection. RESULTS: A total of 3,228 drivers were asked to participate in the study. The refusal rate was 6.2%. Of the 3,027 participants in the study, 111 (3.7%) were Russian and 204 (6.7%) had citizenship other than Norwegian or Russian. The total prevalence of psychoactive substances was 4.3%. Alcohol was detected in 0.3%, psychoactive medicinal drugs in 2.5%, and illicit drugs in 1.6% of the samples. The most commonly found substances were the sleeping agent zopiclone (1.1%), tetrahydrocannabinol (THC; 1.1%), and the analgesic agent codeine (0.6%). Illicit drugs were detected significantly more often in samples from drivers of citizenship other than Norwegian or Russian. The prevalence of alcohol was somewhat higher among Russian drivers but not statistically significant. There were large differences between age groups and genders concerning illicit drugs and psychoactive medicinal drugs; illicit drugs were more frequently in samples from young male drivers, whereas psychoactive medicinal drugs were more frequently in samples from elderly female drivers. CONCLUSION: The total prevalence of alcohol and drugs among the general driving population in Finnmark was low and similar to previous Norwegian roadside surveys. Illicit drugs were detected significantly more often in samples from drivers with citizenship other than Russian and Norwegian and among young male drivers. KEYWORDS: DUI; alcohol; drugs; epidemiology

• Bogstrand, Stig Tore; Skogstad, Laila & Ekeberg, Øivind (2016). The association between alcohol, medicinal drug use and posttraumatic stress symptoms among Norwegian rescue workers after the 22 July twin terror attacks. International Emergency Nursing. ISSN 1755-599X. 28, p. 29–33. doi: 10.1016/j.ienj.2016.03.003. Full text in Research Archive Show summary

  Background: The aim of this study was to assess whether the use of alcohol and medicinal drugs among rescue workers as a consequence of the 22 July terrorist attack was associated with post-traumatic stress symptoms, and explore if there were differences between affiliated and unaffiliated rescue workers. Methods: Ten months after the bombing in the Oslo government district and the shooting at the youth camp on Utøya Island, a cross-sectional study of 1790 rescue and healthcare workers was conducted. The questionnaire included information on medicinal drug and alcohol use, experiences during rescue work and PTSS. Results: Few rescue workers reported alcohol (6.8% n = 119) or medicinal drug (5.5% n = 95) use as a consequence of participation in the 22 July terror attacks. Alcohol and medicinal drug use was associated with an elevated level of PTSS among the rescue workers who reported to use medicinal drugs (11.1 95% CI: 5.7–21.8) or alcohol (10.0 95% CI: 5.2–19.0) as a consequence of the terror attacks. Conclusion: The study found a low level of post-traumatic stress symptoms (PTSS) and alcohol and medicinal drug use among the rescue workers after the terror attacks in Norway on 22 July 2011. There was a strong association between both medicinal drug and alcohol use and elevated PTSS.

• Alm-Kruse, Kristin; Kramer-Johansen, Jo & Bogstrand, Stig Tore (2016). Registrerer få hjertestanser. Sykepleien Forskning. ISSN 1890-2936. doi: 10.4220/Sykepleienf.2016.58523. Full text in Research Archive Show summary

  Bakgrunn: Studier fra andre land viser stor variasjon i forekomst og overlevelse etter hjerte- lunge-redning (HLR) på intensivavdelinger. Det foreligger få studier på dette området i Norge. Hensikt: Å kartlegge forekomst og overlevelse etter HLR samt få oversikt over hvordan HLR ble registrert. Metode: Vi foretok en tverrsnittsstudie av 14 intensivavdelinger på Oslo universitetssykehus gjennom hele 2013. Pasienter med diagnoser og prosedyrekoder for hjertestans, ventrikkelarytmier og HLR ble identifisert i pasientadministrative systemer. Vi inkluderte alle tilfellene der diagnoser og prosedyrekoder ble bekreftet i pasientjournalen, i studieutvalget. Deretter sammenliknet vi med de tilfellene som var registrert i det interne kvalitetsregisteret for hjertestans. Resultat: Blant 15 101 intensivinnleggelser fant vi 117 (0,8 prosent) tilfeller av HLR fordelt på 99 pasienter. Av 91 voksne (> 18 år) var 64 (70 prosent) menn. Gjennomsnittsalderen var 63 år. Antall voksne som overlevde til utskrivning fra sykehuset var 44 (48 prosent). Overlevelsen for kvinner var signifikant lavere enn for menn: 8 (30 prosent) kvinner overlevde mot 36 (56 prosent) menn, (p = 0,023). Kun 32 (32 prosent) av alle pasientene var registrert i vårt interne hjertestansregister. Konklusjon: Knapt én av hundre intensivinnleggelser fikk HLR. Halvparten av pasientene overlevde til utskrivning etter HLR. En tredjedel av disse pasientene var registrert i det interne hjertestansregisteret. Forekomst og registrering av HLR er lav, mens overlevelsen er høy sammenliknet med tilsvarende studier fra andre land.

• Bakke, Eirin; Bogstrand, Stig Tore; Normann, Per Trygve; Ekeberg, Øivind & Bachs, Liliana Casulleras (2016). Influence of alcohol and other substances of abuse at the time of injury among patients in a Norwegian emergency department. BMC Emergency Medicine. 16. doi: 10.1186/s12873-016-0085-2. Full text in Research Archive
• Austdal, Linn Engeset; Strand, Maren Cecilie; Vindenes, Vigdis & Bogstrand, Stig Tore (2015). Forekomst av skader i russetiden. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 135(7), p. 648–652. doi: 10.4045/tidsskr.14.0238. Full text in Research Archive
• Høiseth, Gudrun; Fosen, Jan Toralf; Liane, Veronica Horpestad; Bogstrand, Stig Tore & Mørland, Jørg (2015). Alcohol Hangover as a Cause of Impairment in Apprehended Drivers. Traffic Injury Prevention. ISSN 1538-9588. 16(4), p. 323–328. doi: 10.1080/15389588.2014.938324. Full text in Research Archive
• Bogstrand, Stig Tore; Larsson, Magnus; Holtan, Anders; Staff, Trine; Vindenes, Vigdis & Gjerde, Hallvard (2015). Associations between driving under the influence of alcohol or drugs, speeding and seatbelt use among fatally injured car drivers in Norway. Accident Analysis and Prevention. ISSN 0001-4575. 78, p. 14–19. doi: 10.1016/j.aap.2014.12.025. Full text in Research Archive Show summary

  Abstract Since 2005, all fatal road traffic crashes in Norway have been analyzed in-depth by multidisciplinary investigation teams organized by the Norwegian Public Roads Administration (NPRA). During the period 2005–2010, 608 drivers of cars or vans were killed in road traffic crashes. Blood samples were collected from 372 (61%) of the drivers and analyzed for alcohol and a large number of psychoactive drugs at the Norwegian Institute of Public Health (NIPH). After coupling the analytical results with the NPRA crash database, 369 drivers with a fatal outcome were identified and included. Alcohol or drug concentrations in blood above the legal limits were found in 39.8% of the drivers who were investigated for alcohol or drug impairment; 33.9% had blood alcohol concentrations above 0.5 g/L or concentrations of drugs above the equivalent Norwegian legal impairment limits or concentrations of amphetamines above 200 μg/L. Among drivers with a fatal outcome who had been impaired by alcohol or drugs, 64.6% were unbelted and 71.7% were speeding when the crash occurred; whereas 24.2% and 33.2% of the sober drivers were unbelted or speeding, respectively. Statistically significant associations were found between impairment by alcohol or amphetamines and driving unbelted or speeding. Excessive speeding is one of the main reasons for road traffic crashes and together with being unbelted the main reasons for a fatal outcome. This behavior might in many cases be due to increased risk-taking or negligence of safety measures as a result of alcohol or drug use.

• Bogstrand, Stig Tore & Gjerde, Hallvard (2014). Which drugs are associated with highest risk for being arrested for driving under the influence? A case-control study. Forensic Science International. ISSN 0379-0738. 240, p. 21–28. doi: 10.1016/j.forsciint.2014.03.027. Full text in Research Archive Show summary

  The aim of this study was to determine the association between drug type and arrest for driving under the influence of drugs (DUID) by calculating odds ratios (ORs) using a case–control design. A DUID arrest is in most cases related to aberrant or risky driving and might therefore be regarded as a proxy for a drug related traffic crash. The ‘cases’ were 2738 drivers arrested on suspicion of drugged driving from April 2008 to March 2009 with blood alcohol concentrations below the legal limit of 0.2 g/L; 794 were arrested due to involvement in road traffic crashes, whereas 1944 were arrested for other reasons, mainly dangerous driving, suspected impairment when stopped in traffic controls, or because of phone calls to the police from other road users or observers. The ‘controls’ were 9375 random drivers in normal traffic, also with alcohol concentrations below this limit. Blood samples from ‘cases’ and oral fluid samples from ‘controls’ were analyzed for 15 drugs that have legislative concentration limits in Norway, in addition to two other commonly detected psychoactive drugs. The most prevalent illicit drug in the control group was tetrahydrocannabinol (THC; 0.58%), which was also commonly found in samples from drivers arrested due to road crash (15.6%) or arrested for other reasons (21.8%). Amphetamine/methamphetamine was most prevalent among arrested drivers involved in crashes (30.6%) and drivers arrested for other reasons (56.9%), whereas only 0.18% of the control group was positive for amphetamine/methamphetamine. The single-use substances which gave highest OR for police arrest were amphetamine/methamphetamine, alprazolam, clonazepam and oxazepam. The majority of the alprazolam and clonazepam findings were probably due to non-therapeutic use of medicinal drugs purchased on the illegal market. Combinations of two or more drugs yielded higher ORs than the use of single substances; combinations of amphetamine/methamphetamine and benzodiazepines gave the highest risk. Keywords Case–control; Psychoactive substances; Road traffic crash; DUI

• Bogstrand, Stig Tore; Høiseth, Gudrun; Rossow, Ingeborg; Normann, Per Trygve & Ekeberg, Øivind (2014). Prevalence of ethyl glucuronide and ethyl sulphate among patients injured when driving or at work. Alcohol and Alcoholism. ISSN 0735-0414. 50(1), p. 68–73. doi: 10.1093/alcalc/agu070. Full text in Research Archive Show summary

  Presence of EtG or EtS among patients injured when driving or at work may indicate that very low BAC or residual effects of alcohol at the time of the accident may be associated with increased accident risk. The aim of this study was to assess: whether the alcohol metabolites EtG and EtS were present in a sample of patients injured when driving or injured at work, even if their blood alcohol concentration was negative; and, if EtG and EtS were present, what characterized these patients. Methods: Blood samples from patients admitted for treatment of injuries at a Norwegian emergency department were tested for alcohol, EtG and EtS. All samples were also analysed for medicinal and illicit psychoactive substances. Results: One hundred and ninety-two injured patients who were admitted <12 h after injury were included in the study. EtG or EtS were the most prevalent substances in the sample (17%), and a substantial proportion of the patients who tested negative for all other substances tested positive for EtG or EtS (8%). These patients were older than the rest of the sample and drank alcohol more often, according to their self-report. Conclusion: EtG and EtS were prevalent among patients injured when driving or injured at work, including patients negative for all other substances. EtG and EtS should be included in future case–control studies of psychoactive substance use among injured patients to investigate the possible association between residual alcohol effects and injuries.

• Gjerde, Hallvard; Bogstrand, Stig Tore & Lillsunde, Pirjo (2014). Commentary: Why Is the Odds Ratio for Involvement in Serious Road Traffic Accident Among Drunk Drivers in Norway and Finland Higher Than in Other Countries? Traffic Injury Prevention. ISSN 1538-9588. 15(1), p. 1–5. doi: 10.1080/15389588.2013.780651. Full text in Research Archive
• Rossow, Ingeborg; Bogstrand, Stig Tore; Ekeberg, Øivind & Normann, Per Trygve (2013). Associations between heavy episodic drinking and alcohol related injuries: a case control study. BMC Public Health. 13(1). doi: 10.1186/1471-2458-13-1076. Full text in Research Archive Show summary

  Alcohol is a significant risk factor for injuries. This study addresses 1) whether the risk of alcohol related injury increases with frequency of heavy episodic drinking (HED) in a linear fashion, and 2) whether a small group of high risk drinkers accounts for the majority of alcohol related injuries. We applied a case – control design. Cases were BAC positive injured patients (n = 534) and controls were respondents to a general population survey in Norway (n = 1947). Age and gender adjusted association between self-reported past year HED frequency and alcohol related injury risk was estimated in logistic regression models for all alcohol related injuries and for violence injuries and accident injuries separately. An increase in HED was associated with an increase in risk of alcohol related injury, resembling a linear risk function. The small fraction of high risk drinkers (6.6%) accounted for 41.6% of all alcohol related injuries, thus lending support to the validity of the prevention paradox. There is a strong relationship between frequency of heavy episodic drinking and risk of alcohol related injuries, yet the majority of alcohol related injuries are found among drinkers who are not in the high risk group.

• Bogstrand, Stig Tore; Rossow, Ingeborg; Normann, Per Trygve & Ekeberg, Øivind (2013). Studying psychoactive substance use in injured patients: Does exclusion of late arriving patients bias the results? Drug and Alcohol Dependence. ISSN 0376-8716. 127(1-3), p. 187–192. doi: 10.1016/j.drugalcdep.2012.06.029. Full text in Research Archive Show summary

  Most studies of the prevalence of psychoactive substances in injured emergency department patients have excluded those who arrive more than 6 h after injury. This may cause a selection bias. The aim of this study was: (1) to describe the characteristics of patients who arrive more than 6 h after injury, compared to patients who arrive sooner (2) to examine whether self-report can add to the assessment of alcohol use when the patient is assessed more than 6 h after injury. Blood sample analysis and self-report data were used to assess the prevalence of psychoactive substances in injured patients admitted to an emergency department within 48 h of injury (n = 1611). Discriminant function analysis was used to assess group differences. The patients who arrived more than 6 h after injury differed significantly from those who arrived earlier in several respects. They more often screened positive for hypnotics; they were older, they were more likely to have had a fall and they were more often injured at home and at night. Self reported use of alcohol showed good consistency with blood sample screening within 6 h of injury and could therefore be used to assess alcohol use more than 6 h after injury. Patients who arrive more than 6 h after injury differ significantly from those who arrive earlier. Future studies on the prevalence of psychoactive substances in emergency departments could expand the inclusion window.

• Bogstrand, Stig Tore; Gjerde, Hallvard; Normann, Per Trygve; Rossow, Ingeborg & Ekeberg, Øivind (2012). Alcohol, psychoactive substances and non-fatal road traffic accidents - a case-control study. BMC Public Health. 12. doi: 10.1186/1471-2458-12-734. Full text in Research Archive Show summary

  Background The prevalence of alcohol and other psychoactive substances is high in biological specimens from injured drivers, while the prevalence of these psychoactive substances in samples from drivers in normal traffic is low. The aim of this study was to compare the prevalence of alcohol and psychoactive substances in drivers admitted to hospital for treatment of injuries after road traffic accidents with that in drivers in normal traffic, and calculate risk estimates for the substances, and combinations of substances found in both groups. Methods Injured drivers were recruited in the hospital emergency department and drivers in normal conditions were taken from the hospital catchment area in roadside tests of moving traffic. Substances found in blood samples from injured drivers and oral fluid samples from drivers in moving traffic were compared using equivalent cut off concentrations, and risk estimates were calculated using logistic regression analyses. Results In 21.9% of the injured drivers, substances were found: most commonly alcohol (11.5%) and stimulants eg. cocaine or amphetamines (9.4%). This compares to 3.2% of drivers in normal traffic where the most commonly found substances were z-hypnotics (0.9%) and benzodiazepines (0.8%). The greatest increase in risk of being injured was for alcohol combined with any other substance (OR: 231.9, 95% CI: 33.3- 1615.4, p < 0.001), for more than three psychoactive substances (OR: 38.9, 95% CI: 8.2- 185.0, p < 0.001) and for alcohol alone (OR: 36.1, 95% CI: 13.2- 98.6, p < 0.001). Single use of non-alcohol substances was not associated with increased accident risk. Conclusion The prevalence of psychoactive substances was higher among injured drivers than drivers in normal moving traffic. The risk of accident is greatly increased among drivers who tested positive for alcohol, in particular, those who had also ingested one or more psychoactive substances. Various preventive measures should be considered to curb the prevalence of driving under the influence of psychoactive substances as these drivers constitute a significant risk for other road users as well as themselves.

• Bogstrand, Stig Tore; Normann, Per Trygve; Rossow, Ingeborg; Larsen, Margrete; Mørland, Jørg & Ekeberg, Øivind (2011). Prevalence of alcohol and other substances of abuse among injured patients in a Norwegian emergency department. Drug and Alcohol Dependence. ISSN 0376-8716. 117(2-3), p. 132–138. doi: 10.1016/j.drugalcdep.2011.01.007. Full text in Research Archive Show summary

  Studies have found a high prevalence of both alcohol and other impairing psychoactive drugs in injured patient populations. The aim of this study was to assess the prevalence of potentially impairing psychoactive substances in all patients admitted to a hospital emergency department with injuries from accidents, assault or deliberate self harm. A total of 1272 patients over 18 years of age, admitted to the hospital within 12h of injury, were included. Presence of alcohol was determined by an enzymatic method and other drugs by liquid chromatography-mass spectrometry (LC-MS) or gas chromatography-mass spectrometry (GC-MS), both highly specific analytical methods for determining recent intake. There were 510 (40%) women in the sample. Of the patients, 38% of the women and 48% of the men had a positive blood sample for psychoactive substances on admission. The most prevalent psychoactive substance was alcohol (27%) with an average concentration of 1.5g/kg. A further 21% of patients tested showed use of medicinal drugs, and 9% showed use of illicit substances. Cannabis was the most prevalent illicit drug (6.2%). Diazepam (7.4%) and zopiclone (5.3%) were the most prevalent medicinal drugs. In road traffic accidents, 25% of the car drivers had positive findings, about half of them for alcohol. Psychoactive substances were found in nearly half the patients admitted with injuries. The most common substance was alcohol. Alcohol was particularly related to violence, whereas medicinal drugs were most prevalent in accidents at home.

• Lund, Hilde Marie Erøy; Bogstrand, Stig Tore & Christophersen, Asbjørg S (2011). Results of workplace drug testing in Norway. Norsk Epidemiologi. ISSN 0803-2491. 21(1), p. 55–59. doi: 10.5324/nje.v21i1.1426. Full text in Research Archive
• Bogstrand, Stig Tore; Middelkoop, Gerrit & Christophersen, Asbjørg S (2011). Trends in amphetamine and benzodiazepine use among drivers arrested for drug impaired driving in Norway 2000-2009. Norsk Epidemiologi. ISSN 0803-2491. 21(1), p. 61–66. doi: 10.5324/nje.v21i1.1427. Full text in Research Archive

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• Bogstrand, Stig Tore; Auestad, Nina; Vallersnes, Odd Martin; Lerdal, Anners & Wüsthoff, Linda Elise Couëssurel (2024). COGNITIVE FUNCTION IN PEOPLE WITH SEVERE SUBSTANCE USE. Full text in Research Archive
• Bogstrand, Stig Tore (2023). Rusproblematikk blant akutt innlagte pasienter i somatikken. Full text in Research Archive
• Bogstrand, Stig Tore (2023). Rusmiddelproblematikk blant akutt innlagte pasienter i somatikken, AlcoTail. Full text in Research Archive
• Bogstrand, Stig Tore (2023). The Alcotail study. Full text in Research Archive
• Bogstrand, Stig Tore (2023). Use of PEth in epidemiological studies: comparing results from different populations. Full text in Research Archive
• Nyman, Anna Armika Tussilago; Vindenes, Vigdis; Strøm, Rune Tore; Katadzic, Sasa; Gustavsen, Ingebjørg G. & Bogstrand, Stig Tore (2022). Systematisk kartlegging av rusbruk ved innleggelse. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 142(14). doi: 10.4045/tidsskr.22.0481. Full text in Research Archive Show summary

  Ved Oslo universitetssykehus vil alle pasienter som innlegges akutt, bli stilt standardiserte spørsmål om alkoholforbruk (1). Ved indikasjon på høyt forbruk vil det gjøres videre utredning. For pasienter som står på minst ett vanedannende legemiddel, og der bruken kan ha en sammenheng med pasientens tilstand i forbindelse med innleggelsen, vil det utføres en serumanalyse og på bakgrunn av denne en legemiddelgjennomgang (2). Kartleggingen skal bidra til å gi bedre behandling, forebygge komplikasjoner under innleggelsen, som abstinenssymptomer eller delirium tremens, samt avverge at helseskadelig bruk fortsetter og fører til større helseskade. Pasienter som er bekymret for eget rusmiddelbruk og er motivert for å ta imot hjelp, vil bli henvist til Tverrfaglig spesialisert rusbehandling (TSB) i forbindelse med sykehusinnleggelsen.

• Høiseth, Gudrun; Vindenes, Vigdis; Hilberg, Thor & Bogstrand, Stig Tore (2022). Høyt nivå av ferritin og HDL-kolesterol er assosiert med høyt alkoholforbruk. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 142(17), p. 1–3. doi: 10.4045/tidsskr.22.0431. Full text in Research Archive
• Jørgenrud, Benedicte Marie; Bogstrand, Stig Tore; Vindenes, Vigdis; Johannessen, Aud; Wüsthoff, Linda Elise & Kunøe, Nikolaj [Show all 9 contributors for this article] (2021). Implementering av intervensjon for skadelig alkohol- og legemiddelbruk blant medisinske pasienter. Full text in Research Archive
• Kabashi, Saranda; Vindenes, Vigdis; Bryun, E.A.; Koshkina, E.A.; Nadezhdin, A.V. & Tetenova, E.J. [Show all 16 contributors for this article] (2020). Corrigendum to “Harmful alcohol use among acutely ill hospitalized medical patients in Oslo and Moscow: A cross-sectional study” [Drug Alcohol Depend. 204 (2019) 107588] (Drug and Alcohol Dependence (2019) 204, (S0376871619303655), (10.1016/j.drugalcdep.2019.107588)). Drug and Alcohol Dependence. ISSN 0376-8716. 213. doi: 10.1016/j.drugalcdep.2020.108073. Full text in Research Archive
• Bråthen, Camilla Christin; Jørgenrud, Benedicte Marie; Skadberg, Eline; Bogstrand, Stig Tore; Gjerde, Hallvard & Rosseland, Leiv Arne [Show all 7 contributors for this article] (2019). IDART: Impairing drug and alcohol as risk factors for traumatic injuries. Full text in Research Archive
• Christophersen, Asbjørg S.; Wyller, Elin; Bogstrand, Stig Tore & Gjerde, Hallvard (2019). Road Traffic Injuries in Malawi – the role of Alcohol. Full text in Research Archive
• Valen, Anja; Bogstrand, Stig Tore; Vindenes, Vigdis; Frost, Joachim & Gjerde, Hallvard (2019). Alcohol and drug use among fatally injured drivers in Norway during 2005-2015. Full text in Research Archive
• Valen, Anja; Bogstrand, Stig Tore; Vindenes, Vigdis; Frost, Joachim; Larsson, Magnus & Holtan, Anders [Show all 7 contributors for this article] (2019). Driver-related risk factors for fatal road traffic crashes associated with alcohol or drug impairment. Full text in Research Archive
• Gjerde, Hallvard; Valen, Anja; Furuhaugen, Håvard & Bogstrand, Stig Tore (2018). Trends in driving under the influence of alcohol or drugs in Norway. Full text in Research Archive
• Jamt, Ragnhild Elén Gjulem; Gjerde, Hallvard & Bogstrand, Stig Tore (2017). Survey of alcohol and drug use among drivers in the arctic county of Finnmark (Norway). Full text in Research Archive
• Valen, Anja; Bogstrand, Stig Tore; Vindenes, Vigdis & Gjerde, Hallvard (2016). Driving under the influence of cannabis - Trends in Norway during 1990-2015. Full text in Research Archive
• Bogstrand, Stig Tore; Jamt, Ragnhild Elén Gjulem; Nilsson, Galina; Eliassen, Elin; Normann, Per Trygve & Gjerde, Hallvard (2016). Associations between sensation seeking behavior and alcohol, medicinal and illicit drug use among Norwegian drivers in Normal traffic. Full text in Research Archive
• Jamt, Ragnhild Elén Gjulem; Nilsson, Galina; Eliassen, Elin; Normann, Per Trygve; Gjerde, Hallvard & Bogstrand, Stig Tore (2016). Roadside survey of alcohol and drug use among drivers in the arctic county of Finnmark (Norway). Full text in Research Archive
• Gjerde, Hallvard; Valen, Anja; Larsson, Magnus; Holtan, Anders; Budalen, Anne Beate & Bogstrand, Stig Tore (2016). Which driver errors are associated with alcohol or drug use in fatal crashes? Full text in Research Archive
• Jamt, Ragnhild Elén Gjulem; Nilsson, Galina; Bogstrand, Stig Tore; Eliassen, Elin; Normann, Per Trygve & Gjerde, Hallvard (2015). Roadside survey on alcohol and drug use among drivers in the arctic county of Finnmark (Norway). Full text in Research Archive
• Øiestad, Elisabeth Leere; Nordfjærn, Trond; Edland-Gryt, Marit; Bretteville-Jensen, Anne Line; Hovda, Knut Erik & Persett, Per Sverre [Show all 9 contributors for this article] (2015). Use of oral fluid for analysis of new psychoactive substances. Full text in Research Archive
• Persett, Per Sverre; Vallersnes, Odd Martin; Øiestad, Elisabeth Leere; Karinen, Ritva Anneli; Bogstrand, Stig Tore & Heyerdahl, Fridtjof [Show all 7 contributors for this article] (2015). Laboratory confirmation of recreational drugs in Oslo, Norway. Full text in Research Archive
• Bogstrand, Stig Tore (2014). Alcohol, drugs and injury. Full text in Research Archive
• Bogstrand, Stig Tore; Larsson, Magnus; Holtan, Anders; Staff, Trine; Vindenes, Vigdis & Gjerde, Hallvard (2014). Associations between driving under the influence of alcohol or drugs, speeding and seat-belt use among fatally injured car drivers in Norway. Full text in Research Archive
• Bogstrand, Stig Tore & Gjerde, Hallvard (2014). Which drugs are associated with highest risk for being arrested for drugged driving? Full text in Research Archive
• Bogstrand, Stig Tore & Gjerde, Hallvard (2014). Alcohol, Psychoactive Substances and Road Traffic Accidents: A case- Control approach. Full text in Research Archive
• Bogstrand, Stig Tore (2013). Associations between substance use and arrest for drugged driving: A case-control study. Full text in Research Archive
• Bogstrand, Stig Tore; Normann, Per Trygve; Rossow, Ingeborg; Gjerde, Hallvard & Ekeberg, Øivind (2010). Combinations of psychoactive substances are equally common as alcohol in Norwegian road traffic accidents. Full text in Research Archive
• Bogstrand, Stig Tore; Normann, Per Trygve; Rossow, Ingeborg & Ekeberg, Øivind (2009). High prevalence of alcohol among patients admitted to hospital after injuries and accidents. Full text in Research Archive
• Jørgenrud, Benedicte Marie; Gjerde, Hallvard; Bråthen, Camilla Christin; Bogstrand, Stig Tore; Rosseland, Leiv Arne & Kristiansen, Thomas (2022). Rusmiddel- og legemiddelbruk som risikofaktorer for alvorlige ulykker. Oslo universitetssykehus HF. Full text in Research Archive
• Christophersen, Asbjørg S.; Wyller, Elin H.; Sundet, Mads; Bogstrand, Stig Tore & Gjerde, Hallvard (2021). Trafikkulykker og alkohol i Malawi. Folkehelseinstituttet. Full text in Research Archive Show summary

  Oppsummering Målet med studien var å undersøke omfang av alkoholpåvirkning blant trafikanter som ble skadet i trafikkulykker i Malawis hovedstad Lilongwe og å registrere ulykkeomstendigheter. Dette er den første studien som har samlet inn slik data. Et langsiktig mål er å bidra til å realisere bærekraftsmål 3.6, å halvere antall dødsfall og skader i verden forårsaket av trafikkulykker. I en tre-måneders periode i 2019 ble pasienter skadd i trafikkulykker og innlagt ved akuttmottaket på Kamuzu Central Hospital spurt om å delta i denne studien, som var frivillig og anonym. Totalt deltok 1251 pasienter i studien, og 25 % testet positivt på alkohol, eller rapportert alkoholbruk før ulykken. Det ble oftest påvist alkohol hos menn og hos pasienter skadet i ulykker på kvelden og natten. Blant skadde syklister hadde 19 % brukt alkohol, blant førere av busser og lastebiler 21 %, blant motorsyklister og bilførere 24 %, og blant skadde fotgjengere 42 %. Ved tilbakeberegning fant vi at ca. 15 % av de skadde motorførerne hadde alkohol i blodet over straffegrensen på 0,8 promille på ulykkestidspunktet. Andelen av trafikkskadde pasienter med alkohol som medvirkende årsak var høyere enn forventet. Dataene fra studien kan brukes av myndighetene i Malawi til forebyggende arbeid for trafikksikkerhet og til å utarbeide kunnskapsbaserte politiske prioriteringer. Flere konkrete tiltak foreslås for å redusere antallet skader.

• Christophersen, Asbjørg S.; Bogstrand, Stig Tore; Gjerde, Hallvard; Sundet, Mads & Wyller, Elin H. (2021). Road Traffic Injuries in Malawi: with special focus on the role of alcohol. Norwegian Institute of Public Health, Division for Health Services, Cluster for Global Health. ISSN 9788284061917. Full text in Research Archive Show summary

  Driving under the influence of alcohol is one of the principal causes of road traffic crashes (RTCs) [1]. The use of alcohol is also a risk factor for other road users, such as pedestrians and bicyclists. The association of alcohol in injurious and fatal RTCs has been well documented in most high-income countries, but data for low- and middle-income countries is scarce, particularly for African countries [2]. The study was a collaborative effort between Kamuzu Central Hospital (KCH), the Norwegian Institute of Public Health (NIPH) and Oslo University Hospital (OUH), with the financial support of UK Aid through the Global Road Safety Facility (GRSF) hosted by the World Bank, the International Council on Alcohol Drugs and Traffic Safety (ICADTS) and the Norwegian Council for Road Safety (Trygg Trafikk). The objective of the study was to generate new knowledge about road traffic injuries in Malawi and the extent of traffic accidents related to alcohol use, to increase capacity to conduct alcohol testing, and develop a database for the findings, which in turn will form the basis for future policymaking to reduce traffic accidents. The objectives were achieved through collecting data on patients who sought treatment after road traffic crashes and admitted to the Emergency Department at KCH in Lilongwe, Malawi. A questionnaire was developed for data collection in cooperation between the project groups in Norway and Malawi. The data included basic information about the patients, alcohol use before the injury, and information about accident circumstances, including types of road users and vehicles involved. Participation was voluntary and anonymous. All weekdays, weekends and nights were covered. Alcohol was measured using a breathalyzer or saliva test for those who were not able to blow. Knowledge and training of local KCH employees to perform alcohol testing and record data were an important aspect of this study. The project was approved by the National Health Science Research Committee (NHSRC) in Malawi. The Regional Committee for Medical and Health Research Ethics in Norway was consulted, and their conclusion was that no formal application was needed, with reference to the Norwegian Health Research Act Section, §2 and 4a. A Data Protection Impact Assessment was performed as required by NIPH. There were 1251 patients in the study, representing nearly 95 per cent of those who were asked to participate. The results show a rather high prevalence of alcohol use among several injured road user groups (totally about 25 percent), particularly among those injured during weekend nights and evenings, but also during weekday evenings and nights. It was estimated that about 15 per cent of injured motor vehicle drivers and riders had BACs above the legal limit of 0.8 grams/L at the time of the crash. The findings also show that it is important to focus on bus/minibus/lorry drivers who often carry passengers, where about one out of five tested positive for alcohol. It is worth noting that pedestrians had the highest prevalence of alcohol use before being injured. They constitute a vulnerable group; they often walk in the dark with no road lighting, no pavements, walkways or safe places to cross the road. Combined with alcohol use their injury risk is even higher. The collected data can contribute to future road traffic safety procedures and measures. The long-term goal is to contribute to sustainable development goal 3, target 3.6, to reduce by half the number of global RTC deaths and injuries. Road Traffic Inuries in Malawi • Norwegian Institute of Public Health 5 This study shows the importance of collecting adequate and relevant data for health authorities particularly in low- and middle-income countries in battling the challenge of alcohol-related road traffic crashes, deaths and injuries. Due to the COVID-19 pandemic, a number of recommendations were presented to Malawian authorities at a virtual seminar held in autumn 2020.

• Christophersen, Asbjørg S.; Bogstrand, Stig Tore; Gjerde, Hallvard; Sundet, Mads & Wyller, Elin H. (2021). Road Traffic Injuries in Malawi: With Special Focus on the Role of Alcohol. World Bank Publications. Full text in Research Archive
• Nyman, Anna Armika Tussilago; Jamt, Ragnhild Elén Gjulem; Nilsson, Galina; Gjerde, Hallvard & Bogstrand, Stig Tore (2019). Rusmidler og trafikkfarlige legemidler blant bilførere i Finnmark fylke og Murmansk-regionen. Oslo universitetssykehus HF. Full text in Research Archive
• Bogstrand, Stig Tore; Ekeberg, Øivind; Rossow, Ingeborg & Normann, Per Trygve (2013). Alcohol, psychoactive substances and injuries in the emergency department. University of Oslo. ISSN 9788282642323. Full text in Research Archive

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