Trine Bjørner

• Tvete, Ingunn Fride; Bjørner, Trine & Skomedal, Tor (2018). Mental Health and Disability Pension Onset: Changes in Consumption of Antianxiety and Hypnotic Drugs. Health Services Research and Managerial Epidemiology.  ISSN 2333-3928.  5, s 1- 5 . doi: 10.1177/2333392818792683 Fulltekst i vitenarkiv. Vis sammendrag

  Introduction: In Norway, disability pension (DP) has been more prevalent over the later years, with mental disorders being a frequent cause. Previous analyses have questioned whether receiving DP is beneficial for mental health by considering changes in antidepressant drug consumption. To explore this further, we examined changes in antianxiety and hypnotic drug consumption following DP onset. Methods: Based on national Norwegian register data, this retrospective study encompassed 8617 working-age individuals (25-50 years) who became DP during 2005 to 2013. We compared their benzodiazepines (BZD) and Z-hypnotic consumption 1 year pre- and postdisability pension onset. Results: About 80% of the individuals did not change their altogether benzodiazepine/Z-hypnotic consumption. Among individuals with an initial consumption ≤1 defined daily dose (DDD), 18.9% increased their consumption to above 1 DDD. Individuals in the age-group 45 to 50 versus 24 to 34 years had a lower risk of dose escalation (odds ratio [OR], 0.756, 95% confidence interval [CI]: 0.601-0.957). Individuals who used Z-hypnotics only had a higher risk of dose escalation compared to the joint benzodiazepine/Z-hypnotic user group (OR, 1.594, 95%CI: 1.284-1.970). Conclusion: In general, we cannot see that DP is associated with changes in benzodiazepine/Z-hypnotic consumption, but younger users and individuals using Z-hypnotics only had a greater risk of dose escalation compared to the older users and users with combined BZD and Z-hypnotic use.

• Tvete, Ingunn Fride; Bjørner, Trine & Skomedal, Tor (2017). New benzodiazepine and Z-hypnotic users and disability pension: an eight-year nationwide observational follow-up study.. Scandinavian Journal of Primary Health Care.  ISSN 0281-3432.  35(3), s 240- 246 . doi: 10.1080/02813432.2017.1358436 Vis sammendrag

  Objective: To compare how newly initiated treatment with benzodiazepines, Z-hypnotics or both associates with the reception of disability pension among 40,661 individuals of a working age. Design: Prescription register study. Setting: Norwegian nationwide prescriptions socio-economic and disability status data. Methods: Cox regression analyses. Subjects: New benzodiazepine or Z-hypnotic users. Main outcome measure: Time to receive disability pension given benzodiazepine or Z-hypnotic use or both. Additional analyses focused on the benzodiazepine first redeemed. Results: Among new users 8.65% of Z-hypnotic users, 12.29% of benzodiazepines users and 13.96% of combined Z-hypnotic and benzodiazepine users became disability pensioners. Z-hypnotic users were weaker associated with becoming disability pensioners (HR = 0.78, CI: 0.73–0.84) and combined users were stronger associated (HR = 1.09, CI: 1.01–1.17), than benzodiazepine users. Women had higher risk than men for becoming disability pensioners. Higher age, lower education, previous drug use and psychiatrist as first prescriber were risk factors. Comparing first benzodiazepine redeemed; clonazepam initiators were stronger associated with becoming disability pensioners than diazepam initiators were (HR = 2.22, CI: 1.81–2.71). No differences between other benzodiazepine users were found. Conclusions: Adjusting for known risk factors gave lower risk for Z-hypnotic users compared to benzodiazepine users for receiving disability pension. Combined use increased the risk further. Clonazepam initiators are especially at risk. These findings may be helpful in prescribing situations to identify and guide individuals at risk for becoming disability pensioners.

• Larun, Lillebeth; Bjørner, Trine; Fretheim, Atle & Brurberg, Kjetil Gundro (2016). Bruk av skjema i oppfølgingen av diabetes i allmennpraksis. Tidsskrift for Den norske legeforening.  ISSN 0029-2001.  136(5), s 417- 422 . doi: 10.4045/tidsskr.15.1174
• Tvete, Ingunn Fride; Bjørner, Trine & Skomedal, Tor (2016). A 5-year follow-up study of users of benzodiazepine: starting with diazepam versus oxazepam. British Journal of General Practice.  ISSN 0960-1643.  66(645), s e241- e247 . doi: 10.3399/bjgp16X684385 Vis sammendrag

  Background Drug dependency may develop during long-term benzodiazepine use, indicated, for example, by dose escalation. The first benzodiazepine chosen may affect the risk of dose escalation. Aim To detect possible differences in benzodiazepine use between new users of diazepam and oxazepam over time. Design and setting This 5-year prescription database study included 19 747 new benzodiazepine users, inhabitants of Norway, aged 30–60 years, with first redemption for diazepam or oxazepam. Method Individuals starting on diazepam versus oxazepam were analysed by logistic regression with sex, age, other drug redemptions, prescriber’s specialty, household income, education level, type of work, and vocational rehabilitation support as background variables. Time to reach a daily average intake of ≥1 defined daily doses (DDD) over a 3-month period was analysed using a Cox proportional hazard regression model. Results New users of oxazepam had a higher risk for dose escalation compared with new users of diazepam. This was true even when accounting for differences in sociodemographic status and previous drug use (hazard ratio [HR] 1.33, 95% confidence interval = 1.17 to 1.51). Conclusion Most doctors prescribed, according to recommendations, oxazepam to individuals they may have regarded as prone to and at risk of dependency. However, these individuals were at higher risk for dose escalation even when accounting for differences in sociodemographic status and previous drug use. Differences between the two user groups could be explained by different preferences for starting drug, DDD for oxazepam being possibly too low, and some unaccounted differences in illness.

• Bjørner, Trine; Anwar, Tayyaba; Brede, wenche Rødseth; Hemmersbach, Peter J & Slørdal, Lars (2015). En mann med endret utseende [A man with a changed appearance]. Tidsskrift for Den norske legeforening.  ISSN 0029-2001.  135(3), s 243- 245 . doi: 10.4045/tidsskr.14.0886
• Bramness, Jørgen Gustav; Bjørner, Trine & Sexton, Joseph (2015). Betydning av legers alder for forskrevet mengde benzodiazepiner. Norsk Farmaceutisk Tidsskrift.  ISSN 0029-1935.  123(3), s 24- 27
• Tvete, Ingunn Fride; Bjørner, Trine & Skomedal, Tor (2015). Risk factors for excessive benzodiazepine use in a working age population – a nationwide 5-year survey in Norway. Scandinavian Journal of Primary Health Care.  ISSN 0281-3432.  33(4), s 252- 259 . doi: 10.3109/02813432.2015.1117282 Vis sammendrag

  OBJECTIVE: To identify risk factors for becoming an excessive user over time. SETTING: Prescription database study over five years. SUBJECTS AND METHOD: Norwegians between 30 and 60 years with a first dispensation of a benzodiazepine during 2006, encompassing 23 227 individuals. A Cox hazard regression model was defined, initially stratifying on gender, age, county, previous relevant drug dispensations, household income, education level, and vocational rehabilitation support. MAIN OUTCOME MEASURE: The time from the first redemption until excessive use was defined as using more than two DDDs per day on average within a three-month period. RESULTS: Women's risk was lower than men's for excessive use (HR = 0.42, CI 0.35-0.51). Initial oxazepam, alprazolam, or nitrazepam/flunitrazepam use indicated higher risk compared with diazepam (HR = 1.51, CI 1.24-1.85, HR = 2.75, CI 1.54-4.91, HR = 1.67, CI 1.29-2.16). Previous antidepressants or lithium, antipsychotics or opioids, anti-alcohol and smoke cessation treatment indicated a higher risk compared with no such use (HR = 1.4, CI 1.16-1.69, HR = 1.92, CI 1.54-2.4, and HR = 2.88, CI 2-4.15). Higher education and average or high household income were associated with a low risk compared with low education and income (HR = 0.68, CI 0.57-0.81, HR = 0.58, CI 0.46-0.73, and HR = 0.37, CI 0.26-0.54). Working in the private or public sector was associated with a low risk compared with no registered work (HR = 0.53, CI 0.4-0.71 and HR = 0.57, CI 0.45-0.74). CONCLUSION: The prevalence of excessive use over a five-year observation period was 2.34%. Risk factors were indications of psychiatric illness, first benzodiazepine choice, low income, and education. Excessive users were also characterized by a more severe disease, indicated by having prescription fulfilments by a psychiatrist and by switching benzodiazepines. Key points Guidelines state that benzodiazepines should be used for a short time and excessive use indicates drug dependency. Of all new benzodiazepine users 2.34% became excessive users, defined as consuming above two defined daily doses (DDDs) per day on average over three months, within a five-year period. Previous use of other psychotropic drugs, opioids and anti-alcohol and smoke cessation drugs, first benzodiazepine prescribed, low household income, and low education were risk factors for excessive use. Excessive users were characterized by switching benzodiazepines and having prescription fulfilments by a psychiatrist suggesting a more severe disease.

• Bjørner, Trine; Tvete, Ingunn Fride; Aursnes, Ivar & Skomedal, Tor (2013). Utlevering av benzodiazepiner og z-hypnotika fra norske apotek 2004-2011. Tidsskrift for Den norske legeforening.  ISSN 0029-2001.  133(20), s 2149- 2153 . doi: 10.4045/tidsskr.11.0543 Vis sammendrag

  BAKGRUNN Totalsalget av benzodiazepiner og z-hypnotika (zopiklon og zolpidem) i Norge har økt siden midten av 1990-årene. Vi har med utgangspunkt i reseptregisterdata studert medikamentvalg og forbruksmønstre over år i forskjellige aldersgrupper og for begge kjønn. MATERIALE OG METODE Tall for utlevering av benzodiazepiner og z-hypnotika ved norske apotek for årene 2004 – 11 ble innhentet fra Reseptregisteret. Befolkningstall ble innhentet fra Statistisk sentralbyrå. Forbruk er regnet i antall definerte døgndoser (DDD). RESULTATER Av dem som fikk utlevert benzodiazepiner eller z-hypnotika utgjorde mottakere av mer enn 2 DDD daglig (storbrukerne) en liten gruppe. Vi registrerte et omfattende forbruk av z-hypnotika blant eldre kvinner, og mange fikk forskrevet en mengde tilsvarende en fast daglig dose på 1 – 2 DDD. Totalforskrivningen av alprazolam og nitrazepam/flunitrazepam var lav, men hos dem som fikk utlevert disse medikamentene, var høye doser ikke uvanlig. Bare en liten del av pasientene som fikk forskrevet klonazepam, fikk dette forskrevet med refusjonspunkt. Forskrivning av flere benzodiazepiner og z-hypnotika samtidig er fortsatt ikke uvanlig. FORTOLKNING Forskrivingen av z-hypnotika til eldre, spesielt kvinner, kan tyde på at mange i denne gruppen bruker sovemidler fast, hvilket er i strid med retningslinjene. En betydelig andel av klonazepamforskrivningen skjer utenfor godkjent indikasjon. For de studerte medikamentene er storbrukerandelen lav, men siden bruken er utbredt, angår dette likevel et betydelig antall mennesker.

• Tvete, Ingunn Fride; Bjørner, Trine; Aursnes, Ivar & Skomedal, Tor (2013). A 3-year survey quantifying the risk of dose escalation of benzodiazepines and congeners to identify risk factors to aid doctors to more rationale prescribing. BMJ Open.  ISSN 2044-6055.  3(10) . doi: 10.1136/bmjopen-2013-003296 Vis sammendrag

  Objectives This study investigated and quantified risk factors of dose escalation, as an indication of drug misuse and dependency of benzodiazepines and congeners, among presumably drug naïve patients in the Norwegian drug prescription database, observed over 3 years. Design Observational study. Setting Prescription database study. Participants We defined an excessive user as one redeeming more than two defined daily doses per day in 3 months. Primary and secondary outcome measures We examined the risk of excessive use over time and the effect of risk factors through multistate logistic regression and scenarios. Results Most of the 81 945 patients had zopiclone or zolpidem as the initial drug (63.8%), followed by diazepam (25.3%), oxazepam (6.1%), nitrazepam/flunitrazepam (2.9%), hydroxyzine/buspirone (1.6%) and alprazolam (0.3%). At any time 23% redeemed prescriptions, about 34% did not redeem any prescriptions beyond any 3-month period and 0.9% ended up as excessive users. Patients previously using drugs, such as opioids, antialcohol or smoke cessation treatment, had a higher risk to become excessive users compared to patients who had not. Patients whose first prescription was for oxazepam or nitrazepam/flunitrazepam had a higher risk of becoming an excessive user compared to those who started with diazepam. A specialist in general practice as the first-time prescriber was associated with a lower risk compared to doctors without specialty. Conclusions Most benzodiazepine use occurred according to guidelines. Still, some experienced dose escalation over time, and risk factors were previous use of other psychotropic drugs, long time use, choice of first-time drug and prescriber's specialty. This could incite doctors to have a cessation plan when issuing first-time prescriptions.

• Brekke, Mette; Rognstad, Sture; Straand, Jørund; Furu, Kari; Gjelstad, Svein; Bjørner, Trine & Dalen, Ingvild (2008). Pharmacologically inappropriate prescriptions for elderly patients in general practice: How common? Baseline data from The Prescription Peer Academic Detailing (Rx-PAD) study. Scandinavian Journal of Primary Health Care.  ISSN 0281-3432.  26(2), s 80- 85 . doi: 10.1080/02813430802002875
• Bjørner, Trine (2003). Hva er god behandling av angsttilstander i allmennpraksis?. Utposten.  ISSN 0800-5680.  (7)
• Bjørner, Trine & Lærum, Even (2003). Factors associated with high prescribing of benzodiazepines and minor opiates A survey among general practitioners in Norway. Scandinavian Journal of Primary Health Care.  ISSN 0281-3432.  21, s 115- 120
• Bjørner, Trine & Kjølsrød, Lise (2002). How GPs understand patients´stories. A qualitative study of benzodiazepine and minor opiate prescribing in Norway. European Journal of General Practice.  ISSN 1381-4788.  8, s 25- 30 Vis sammendrag

  The objective is to understand the decision-making of doctors when prescribing benzodiazepine (BZDs) in general practice, by analyzing the doctors interpretation of patients´stories. Semi structured interviews were undertaken with 38 general practitioners with previously known level of prescribing. The last three patients who had been given BZDs were specifically discussed. There seems to exist a set of models that serve to facilitate doctors´precribing decisions. In daily practice such models might have a place, but it is important for doctors to be aware that simplification might occur at rthe cost of more complete treatments including councellng and enabling.

• Bjørner, Trine; Johannesen, Arne; Aasland, Olaf Gjerløw & Mouland, Gunnar (1997). Pasient med rus- og avhengighetsproblemer, I: Steinar Hunskår (red.),  Allmennmedisin. Klinisk arbeid.  Ad Notam. Gyldendal.  kapittel 5.4.  s 760 - 770

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• Tvete, Ingunn Fride; Skomedal, Tor & Bjørner, Trine (2018). Use and abuse of benzodiazepines in Norway and determinants of drug dependency.
• Tvete, Ingunn Fride; Bjørner, Trine & Skomedal, Tor (2016). Nye brukere av benzodiazepiner og Z-hypnotika og uførhet. NR-notat. SAMBA/21/16.
• Tvete, Ingunn Fride; Bjørner, Trine & Skomedal, Tor (2015). Benzodiazepinbruk over tid og risiko for doseeskalering: å starte med diazepam versus oxazepam. NR-notat. SAMBA/10/15.
• Tvete, Ingunn Fride; Bjørner, Trine & Skomedal, Tor (2015). Differences in starting with diazepam versus oxazepam: a five year follow-up prescription registry study.
• Tvete, Ingunn Fride; Bjørner, Trine & Skomedal, Tor (2015). Long-term benzodiazepine use and risk factors for dose escalation.
• Tvete, Ingunn Fride; Bjørner, Trine & Skomedal, Tor (2015). Risiko for å utvikle et høyt benzodiazepinforbruk.
• Tvete, Ingunn Fride; Bjørner, Trine & Skomedal, Tor (2015). Risiko for å utvikle et høyt benzodiazepinforbruk over tid.
• Tvete, Ingunn Fride; Bjørner, Trine & Skomedal, Tor (2014). Benzodiazepine drug dispensing and risk of abuse.
• Tvete, Ingunn Fride; Bjørner, Trine & Skomedal, Tor (2014). Bruk av benzodiazepiner og risikofaktorer for overforbruk.
• Tvete, Ingunn Fride; Bjørner, Trine & Skomedal, Tor (2014). Risk of excessive Benzodiazepine redeeming over time -a nationwide observational study.
• Bjørner, Trine (2013, 29. oktober). Så farlig er sovemepillene.  Dagbladet.
• Tvete, Ingunn Fride; Bjørner, Trine; Aursnes, Ivar & Skomedal, Tor (2013). Bruk av benzodiazepiner og risiko for doseeskalering.
• Tvete, Ingunn Fride; Bjørner, Trine & Skomedal, Tor (2013). Benzodiazepinbruk i Norge over tid.
• Tvete, Ingunn Fride; Bjørner, Trine; Skomedal, Tor & Aursnes, Ivar (2013). En flerårig studie av benzodiazepinbruk i Norge - risikofaktorer for doseøkning.
• Tvete, Ingunn Fride; Bjørner, Trine; Skomedal, Tor & Aursnes, Ivar (2012). Dose Escalation of Benzodiazepines and Congeners.
• Tvete, Ingunn Fride; Bjørner, Trine & Aursnes, Ivar Andreas (2011). Dose Escalation of Benzodiazepines and Congeners.
• Tvete, Ingunn Fride; Bjørner, Trine & Aursnes, Ivar Andreas (2010). Dose escalation of benzodiazepines in Norway: a cohort study.
• Tvete, Ingunn Fride; Bjørner, Trine & Aursnes, Ivar Andreas (2010). Features of the benzodiazepine usage pattern in Norway.
• Tvete, Ingunn Fride; Bjørner, Trine & Aursnes, Ivar Andreas (2010). Risk factors for unwanted benzodiazepine use.
• Bjørner, Trine (2008). Leger og sovemedisin. Tidsskrift for Den norske legeforening.  ISSN 0029-2001.  128(2), s 159
• Bjørner, Trine; Brekke, Mette; Fetveit, Arne; Gjelstad, Svein & Straand, Jørund (2007). Training peer academic dettailers in general practice in Norway. The Prescription Peer Academic Detailing (Rx-PAD) Study. (oral presentation by Trine Bjørner).
• Nilsen, Ellen M; Bachs, Liliana Casulleras; Bjørner, Trine; Høiseth, Gudrun; Johnsen, Jon; Ørbeck, Anne-Lill; Waal, Helge; Ormstad, Sari Susanna; Kornør, Hege; Paulsen, Elizabeth J. & Hofmann, Bjørn (2007). Benzodiazepiner i behandling av personer med rusmiddelproblemer. Rapport fra Kunnskapssenteret. 6/2007. Fulltekst i vitenarkiv. Vis sammendrag

  Nasjonalt kunnskapssenter for helsetjenesten har oppsummert kunnskap om bruk av benzodiazepiner i behandling av personer med rusmiddelproblemer. Rapporten er utarbeidet i samarbeid med en ekstern utredningsgruppe, og utført på oppdrag fra Universitetet i Oslo.

• Rognstad, Sture; Brekke, Mette; Bjørner, Trine; Gjelstad, Svein & Straand, Jørund (2007). Level of inappropriate prescrioption patterns for elderly patients in general practice. Baseline data from the Prescription Peer Academic Detailing (Rx-PAD) Study. (Oral presentation - by Mette Brekke).
• Bjørner, Trine (2003). Behandling av benzodiazepinavhengighet i allmennpraksis.
• Bjørner, Trine (2003). Benzodiazepine and minor opiate prescribing in primary health care.
• Bjørner, Trine (2003). Benzodiazepine and minor opiate prescribing in primary health care.
• Bjørner, Trine (2003). Bruk av vanedannende medikamenter.
• Bjørner, Trine (2003). Bruk av vanedannende medikamenter i primærhelsetjenesten.
• Bjørner, Trine (2003). En pille til plage? Benzodiazepinavhengighet i allmennpraksis.
• Bjørner, Trine (2003). Hva er god behandling av angsttilstander i allmennpraksis?.
• Bjørner, Trine (2003). Pillevhengighet i allmennpraksis.
• Bjørner, Trine (2003). Presentasjon av doktorarbeid: Benzodiazepine and minor opiate prescribing in primary helath care.
• Bjørner, Trine (1999, 13. oktober). Er leger for slepphendte med medisiner?. [Radio].  Østlandssendingen NRK TV : NRK TV.
• Bjørner, Trine (1999). Forskrivning av B-preparater.
• Bjørner, Trine (1999). Forskrivning av vanedannende medikamenter.
• Bjørner, Trine (1999). Kvalitativ forskning.
• Bjørner, Trine (1998). Forskrivning av vanedannende medikamenter i primærhelsetjenesten.
• Bjørner, Trine (1998). Forskrivning og bruk av vanedannende medikamenter i primærhelsetjenesten.
• Bjørner, Trine (1998). GP's understanding of benzodiazepine prescribing. Vis sammendrag

  GPs UNDERSTANDING OF BENZODIAZEPINE PRESCRIBING . A prescribing registration containing 93.ooo BZD prescriptions performed in Norway 1993 showed. great variations in prescribing volume and prescribing patterns . This registration study represents the sample for the following qualitative study. Interviews were performed using a semistructured questionnaire, taped and transcribed verbatim. Interpretation focused on the doctors self explanation, legitimating and working strategies. Results: All doctors regarded the task of prescribing as one of the most difficult in primary health care, and the great majority, regardless of their prescribing volume strongly advocated to be restrictive in prescribing To live with a high prescribing pattern GPs manage by applying certain working strategies.. These strategies are: ascribing responsibility to the previous doctor, granting patient-autonomy and -responsibility and making excuses for patient's age, and to concomitant diseases. On the basis of doctor patient-agreement prescribing was continued for long term use, often without GPs contact with the patient. An allocation of responsibility to other persons or to other circumstances delimits the doctor's professional discretion in the matter. The perspective of role relations reveals GP's different options in clinical work and how patterns of choices in these options consequently leads to high or low prescribing. GPs UNDERSTANDING OF BENZODIAZEPINE PRESCRIBING . A prescribing registration containing 93.ooo BZD prescriptions performed in Norway 1993 showed. great variations in prescribing volume and prescribing patterns . This registration study represents the sample for the following qualitative study. Interviews were performed using a semistructured questionnaire, taped and transcribed verbatim. Interpretation focused on the doctors self explanation, legitimating and working strategies. Results: All doctors regarded the task of prescribing as one of the most difficult in primary health care, and the great majority, regardless of their prescribing volume strongly advocated to be restrictive in prescribing To live with a high prescribing pattern GPs manage by applying certain working strategies.. These strategies are: ascribing responsibility to the previous doctor, granting patient-autonomy and -responsibility and making excuses for patient's age, and to concomitant diseases. On the basis of doctor patient-agreement prescribing was continued for long term use, often without GPs contact with the patient. An allocation of responsibility to other persons or to other circumstances delimits the doctor's professional discretion in the matter. The perspective of role relations reveals GP's different options in clinical work and how patterns of choices in these options consequently leads to high or low prescribing. GPs UNDERSTANDING OF BENZODIAZEPINE PRESCRIBING . A prescribing registration containing 93.ooo BZD prescriptions performed in Norway 1993 showed. great variations in prescribing volume and prescribing patterns . This registration study represents the sample for the following qualitative study. Interviews were performed using a semistructured questionnaire, taped and transcribed verbatim. Interpretation focused on the doctors self explanation, legitimating and working strategies. Results: All doctors regarded the task of prescribing as one of the most difficult in primary health care, and the great majority, regardless of their prescribing volume strongly advocated to be restrictive in prescribing To live with a high prescribing pattern GPs manage by applying certain working strategies.. These strategies are: ascribing responsibility to the previous doctor, granting patient-autonomy and -responsibility and making excuses for patient's age, and to concomitant diseases. On the basis of doctor patient-agreement prescribing was continued for long term use, often without GPs c...

• Bjørner, Trine (1998). Hvodan narkomane får tak i B-preparater.
• Bjørner, Trine (1998). Hvordan kan legemiddelavhengighet forebygges? Primærlegens rolle og ansvar.
• Bjørner, Trine (1998). Kvalitativ forskning.
• Bjørner, Trine (1998, 26. august). Legemiddelavhengighet. [Radio].  Tromsø : NRK wok.

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