Christian Tjagvad

• Melis, Francesca; Kvamme, Timo L.; Tjagvad, Christian; Eide, Desiree; Thylstrup, Birgitte & Clausen, Thomas [Show all 7 contributors for this article] (2025). Health-related quality of life measures as predictors for recurrent hospitalization and mortality among patients in heroin-assisted treatment. Quality of Life Research. ISSN 0962-9343. 34, p. 3365–3376. doi: 10.1007/s11136-025-04019-5. Full text in Research Archive Show summary

  Purpose Individuals with opioid use disorder face complex health needs often necessitating hospital-based care, and many reported low health-related quality of life (HRQoL). This study assessed HRQoL factors as predictors of recurrent hospital-based care and mortality among heroin-assisted treatment (HAT) patients, identified patient groups with distinct HRQoL trajectories, and compared their hospital contact hours and mortality rates with the general population. Methods A longitudinal cohort study was conducted, involving 541 HAT patients in Denmark from 2010 to 2018, along with a matched sample from the general Danish population. Using recurrent event regression and latent class growth analysis, we analyzed predictors of recurrent hospitalization and established trajectory groups. HRQoL was assessed using the 36-Item Short Form Health Survey (SF-36) and linked to multiple national registry data which provided demographic variables, hospital utilization, and mortality data. Results “General health” emerged as the largest and only significant predictor of recurrent hospitalization. Mortality was predicted by age and ‘role limitations due to emotional problems’. We identified four trajectory groups based on “general health ”, showing either a decreasing or stable trajectory. Groups differed significantly in terms of average hospital contact hours and mortality and all groups had lower ‘general health’ scores and greater mortality than the representative Danish sample. The most severe group had four times higher usage of hospitalization hours. Conclusion SF-36 ‘general health’ is a key risk stratification tool for HAT patients predicting outcomes like hospitalization and mortality. Identifying high-risk individuals can help clinicians implement timely (somatic) care, particularly for long-term patients.

• Melis, Francesca; Hesse, Morten; Eide, Desiree; Thylstrup, Birgitte; Tjagvad, Christian & Brummer, Julie Elizabeth [Show all 7 contributors for this article] (2023). Who receives heroin-assisted treatment? A comparison of patients receiving opioid maintenance treatment in Denmark. Drug and Alcohol Dependence. ISSN 0376-8716. 254. doi: 10.1016/j.drugalcdep.2023.111051. Full text in Research Archive Show summary

  Background Since 2010, heroin-assisted treatment (HAT) has been one of the treatment options available to people with opioid use disorder (OUD) in Denmark. This study aimed to characterize HAT patients at treatment start and compare their individual characteristics to those of patients entering traditional opioid maintenance treatment (OMT) with methadone or buprenorphine during the same period. Methods Patients who initiated HAT or OMT with methadone or buprenorphine in Denmark from 2010 to 2018 were included (n=6798). Multiple national registers were linked to compare treatment groups in terms of socio-demographic variables, previous OUD treatment episodes, hospital-based care, and criminal conviction history. Results Nearly all HAT patients had a history of methadone treatment (91%) and half had residential treatment experience (48%). In the year previous to admission, HAT patients recorded the highest percentages of non-fatal overdoses (12%) and chronic hepatitis C diagnoses (16%), and the lowest percentages of psychiatric disorders (11%) compared to traditional OMT patients. Criminal convictions were also common: 39% of the HAT group had committed a property crime and 18% a drug-related crime the year before HAT entry. During the study period, an overall reduction in OMT enrollments for each year was recorded. The HAT proportion to the total remained fairly stable (4%−10%), while the buprenorphine proportion increased. Conclusions In Denmark, OMT patients exhibited numerous vulnerabilities at treatment start, and among the patient groups, HAT patients were the most burdened. HAT seems to reach the target group and adhere to formulated eligibility criteria.

• Gabrhelík, Roman; Hesse, Morten; Nechanská, Blanka; Handal, Marte; Mravčík, Viktor & Tjagvad, Christian [Show all 11 contributors for this article] (2023). Large variations in all-cause and overdose mortality among >13,000 patients in and out of opioid maintenance treatment in different settings: a comparative registry linkage study. Frontiers in Public Health. 11. doi: 10.3389/fpubh.2023.1179763. Full text in Research Archive Show summary

  Background Opioid maintenance treatment (OMT) has the potential to reduce mortality rates substantially. We aimed to compare all-cause and overdose mortality among OMT patients while in or out of OMT in two different countries with different approaches to OMT. Methods Two nation-wide, registry-based cohorts were linked by using similar analytical strategies. These included 3,637 male and 1,580 female patients enrolled in OMT in Czechia (years 2000–2019), and 6,387 male and 2,078 female patients enrolled in OMT in Denmark (years 2007–2018). The direct standardization method using the European (EU-27 plus EFTA 2011–2030) Standard was employed to calculate age-standardized rate to weight for age. All-cause and overdose crude mortality rates (CMR) as number of deaths per 1,000 person years (PY) in and out of OMT were calculated for all patients. CMRs were stratified by sex and OMT medication modality (methadone, buprenorphine, and buprenorphine with naloxone). Results Age-standardized rate for OMT patients in Czechia and Denmark was 9.7/1,000 PY and 29.8/1,000 PY, respectively. In Czechia, the all-cause CMR was 4.3/1,000 PY in treatment and 10.8/1,000 PY out of treatment. The overdose CMR was 0.5/1,000 PY in treatment and 1.2/1,000 PY out of treatment. In Denmark, the all-cause CMR was 26.6/1,000 PY in treatment and 28.2/1,000 PY out of treatment and the overdose CMR was 7.3/1,000 PY in treatment and 7.0/1,000 PY out of treatment. Conclusion Country-specific differences in mortality while in and out of OMT in Czechia and Denmark may be partly explained by different patient characteristics and treatment systems in the two countries. The findings contribute to the public health debate about OMT management and may be of interest to practitioners, policy and decision makers when balancing the safety and accessibility of OMT.

• Eide, Desiree; Skurtveit, Svetlana Ondrasova; Clausen, Thomas; Hesse, Morten; Mravčík, Viktor & Nechanská, Blanka [Show all 12 contributors for this article] (2023). Cause-Specific Mortality among Patients in Treatment for Opioid Use Disorder in Multiple Settings: A Prospective Comparative Cohort Study. European Addiction Research. ISSN 1022-6877. 29(4), p. 272–284. doi: 10.1159/000530822. Full text in Research Archive Show summary

  Introduction: Among people receiving current or previous opioid maintenance treatment (OMT), the leading cause of premature death is an opioid overdose. However, other causes of mortality remain high in this group. An understanding of causes of deaths across multiple settings can be useful in informing more comprehensive prevention responses. The aim of this study was to describe all non-overdose causes of death in three national cohorts (Czechia, Denmark, and Norway) among OMT patients and to explore associations of non-overdose mortality with age and gender. Methods: This prospective comparative cohort study used national mortality registry databases for OMT patients from Czechia (2000–2019), Denmark (2000–2018), and Norway (2010–2019). Crude mortality rates and age-standardized mortality rates (ASMRs) were calculated as deaths per 1,000 person years for cause-specific mortality. Results: In total, 29,486 patients were included, with 5,322 deaths recorded (18%). We found variations in causes of death among the cohorts and within gender and age groups. The leading non-overdose causes of death were accidents in Czechia and Denmark, and neoplasms in Norway. Cardiovascular deaths were highest in Czechia, particularly for women in OMT (ASMR 3.59 vs. 1.24 in Norway and 1.87 in Denmark). Conclusion: This study found high rates of preventable death among both genders and all age groups. Different demographic structures, variations in risk exposure, as well as variations in coding practices can explain the differences. The findings support increased efforts towards screening and preventative health initiatives among OMT patients specific to the demographic characteristics in different settings.

• Hamina, Aleksi; Muller, Ashley Elizabeth; Clausen, Thomas; Skurtveit, Svetlana Ondrasova; Hesse, Morten & Tjagvad, Christian [Show all 11 contributors for this article] (2022). Prescription opioids among older adults: ten years of data across five countries. BMC Geriatrics. 22(429). doi: 10.1186/s12877-022-03125-0. Full text in Research Archive Show summary

  Background Opioid use has increased globally in the recent decade. Although pain remains a significant problem among older adults, susceptibility to opioid-related harms highlights the importance of careful opioid therapy monitoring on individual and societal levels. We aimed to describe the trends of prescription opioid utilisation among residents aged ≥65 in all Nordic countries during 2009–2018. Methods We conducted cross-sectional measurements of opioid utilisation in 2009–2018 from nationwide registers of dispensed drugs in Denmark, Finland, Iceland, Norway, and Sweden. The measures included annual opioid prevalence, defined daily doses (DDDs) per 1000 inhabitants per day (DIDs), and morphine milligram equivalents (MMEs) per user per day. Results From 2009 to 2018, an average of 808,584 of adults aged ≥65 used opioids yearly in all five countries; an average annual prevalence of 17.0%. During this time period, the prevalence decreased in Denmark, Norway, and Sweden due to declining codeine and/or tramadol use. Iceland had the highest opioid prevalence in 2009 (30.2%), increasing to 31.7% in 2018. In the same period, DIDs decreased in all five countries, and ranged from 28.3 in Finland to 58.5 in Denmark in 2009, and from 23.0 in Finland to 54.6 in Iceland in 2018. MMEs/user/day ranged from 4.4 in Iceland to 19.6 in Denmark in 2009, and from 4.6 in Iceland to 18.8 in Denmark in 2018. In Finland, Norway, and Sweden, MMEs/user/day increased from 2009 to 2018, mainly due to increasing oxycodone utilisation. Conclusions The stable or decreasing opioid utilisation prevalence among a majority of older adults across the Nordic countries coincides with an increase in treatment intensity in 2009–2018. We found large cross-national differences despite similarities across the countries’ cultures and healthcare systems. For the aged population, national efforts should be placed on improving pain management and monitoring future trends of especially oxycodone utilisation.

• Kruckow, Line; Tjagvad, Christian; Clausen, Thomas & Banner, Jytte (2021). Psychiatric disorders in a population of deceased drug users. Nordic Journal of Psychiatry. ISSN 0803-9488. doi: 10.1080/08039488.2021.1887350. Full text in Research Archive Show summary

  Purpose To estimate the prevalence of psychiatric morbidity and dual diagnosis in a population of decedents with positive drug toxicology and evaluate changes over time between 2001–2002 and 2011–2012. Materials and methods A total of 520 autopsied drug users with positive toxicology were included in the study from 2001 to 2002 and from 2011 to 2012. Materials included autopsy reports, toxicological screening during autopsy and data from the Danish national health registers, including psychiatric diagnoses from psychiatric hospitals and ambulatory functions, dispensed prescription use from pharmacies and registered treatment for drug use disorders. Results In 2001–2002, 63.3% of the decedents had only positive toxicology, 22.5% also had psychiatric morbidity, and 14.2% had a dual diagnosis. In 2011–2012, 56.4% had only positive toxicology, 26.1% also had psychiatric morbidity, and 17.5% had a dual diagnosis. None of the changes were significant. Decedents with only positive toxicology became older at time of death over time; decedents with psychiatric morbidity and a dual diagnosis did not. The prevalence of nonprescribed psychotropic medication, methadone and benzodiazepines increased. Conclusion Decedents with psychiatric morbidity and dual diagnosis did not increase their lifespan over a 10-year period. Decedents with only positive toxicology increasingly consumed nonprescribed psychotropic medication and may have suffered from undiagnosed psychiatric disorders. The prevalence of prescribed and nonprescribed benzodiazepines and methadone increased and may have contributed to premature mortality.

• Farhoudian, Ali; Radfar, Seyed Ramin Radfar; Ardabili, Hossein Mohaddes; Rafei, Parnian; Ebrahimi, Mohsen & Zonoozi, Arash Khojasteh [Show all 9 contributors for this article] (2021). A Global Survey on Changes in the Supply, Price, and Use of Illicit Drugs and Alcohol, and Related Complications During the 2020 COVID-19 Pandemic. Frontiers in Psychiatry. doi: 10.3389/fpsyt.2021.646206. Full text in Research Archive
• Radfar, Seyed Ramin & Tjagvad, Christian (2021). Reorganization of Substance Use Treatment and Harm Reduction Services During the COVID-19 Pandemic: A Global Survey. Frontiers in Psychiatry. doi: 10.3389/fpsyt.2021.639393. Full text in Research Archive
• Hesse, Morten; Thylstrup, Birgitte; Seid, Abdu Kedir; Tjagvad, Christian & Clausen, Thomas (2021). A retrospective cohort study of medication dispensing at pharmacies: Administration matters! Drug and Alcohol Dependence. ISSN 0376-8716. 225. doi: 10.1016/j.drugalcdep.2021.108792. Full text in Research Archive
• Gabrhelík, Roman; Handal, Marte; Mravčík, Viktor; Nechanská, Blanka; Tjagvad, Christian & Thylstrup, Birgitte [Show all 12 contributors for this article] (2021). Opioid maintenance treatment in the Czech Republic, Norway and Denmark: a study protocol of a comparative registry linkage study. BMJ Open. 11(5), p. 1–8. doi: 10.1136/bmjopen-2020-047028. Full text in Research Archive Show summary

  Introduction Opioid maintenance treatment (OMT) varies across settings and between countries. We plan to use data from several nationwide health and population registers to further improve the knowledge base established from earlier studies. Our aim is to study OMT adherence trajectories and to identify factors associated with improved outcomes for OMT patients across the Czech Republic, Norway and Denmark, in order to further improve OMT and our understanding of the key elements of treatment success. Methods and analysis The registry-based cohort approach across the three countries allows us to link data from a range of registers on the individual level, by using personal identifiers in nationwide cohorts of OMT and non-OMT patients and the general non-using populations. A total of ~21 500 OMT patients over the last two decades in all three countries will be included in the study. The following outcome variables (based on the International Classification of Diseases, 10th Revision codes) will be obtained from relevant registers: treatment adherence to OMT, comorbidity (somatic and mental health), and all-cause and cause-specific mortality. Outcomes of the country-specific analyses will be pooled. Ethics and dissemination The national OMT cohorts have been approved by the ethics committees in the respective countries. Data will be stored according to national and local guidelines and treated confidentially, and all data will be analysed separately for each country and compared across countries. Findings will be disseminated in peer-reviewed scientific journals, national and international conferences, and in briefings to inform clinical decision-making.

• Handal, Marte; Skurtveit, Svetlana; Mahic, Milada; Øhman, Inger; Wikner, Birgitta Norstedt & Tjagvad, Christian [Show all 9 contributors for this article] (2020). Opioid maintenance treatment of pregnant women in the Scandinavian countries. Nordic Studies on Alcohol and Drugs (NAD). ISSN 1455-0725. doi: 10.1177/1455072520914114. Full text in Research Archive Show summary

  Background: WHO guidelines emphasise the need for descriptions of clinical practice and observational studies on risk and benefits of pharmacotherapies in pregnancy. The aims of the present study were to: (1) Describe opioid maintenance treatment (OMT) in the Scandinavian countries in general, and specifically for pregnant women, (2) Describe a project which utilises a new approach using registry-linkage data to examine associations between prenatal exposure to OMT and child outcomes: a Scandinavian cohort study of pregnant women in OMT during pregnancy (ScopeOMT). Data: Guidelines describing the treatment of persons with opioid use disorders in general, and specifically for pregnant women. Scandinavian registry-linkage data from ScopeOMT. Results: Registry data show that approximately 800 pregnant women received OMT during pregnancy in the period of the ScopeOMT study. Similarities across the Scandinavian countries include access to free healthcare and treatment; multidisciplinary teams trained to support pregnant women in OMT; buprenorphine as the recommended drug when initiating therapy; and a holistic focus on the patients’ lives. An important difference is that Norwegian women who use illegal substances that may harm the foetus may be admitted – voluntarily, or against their will – for parts of, or the remainder of the pregnancy to inpatient treatment at specialised clinics. Conclusion: Many similarities in the treatment provided to opioid-dependent persons in the Scandinavian countries place this area in an excellent position to combine the efforts and carry out observational studies concerning the safety of OMT during pregnancy.

• Thylstrup, Birgitte; Seid, Abdu; Tjagvad, Christian & Hesse, Morten (2020). Incidence and predictors of drug overdoses among a cohort of >10,000 patients treated for substance use disorder. Drug and Alcohol Dependence. ISSN 0376-8716. 206, p. 1–7. doi: 10.1016/j.drugalcdep.2019.107714. Full text in Research Archive
• Kruckow, Line; Tjagvad, Christian; Clausen, Thomas; Linnet, Kristian & Banner, Jytte (2019). Treatment Status and Use of Psychoactive Substances in Deceased Drug Users. European Addiction Research. ISSN 1022-6877. doi: 10.1159/000503285. Full text in Research Archive Show summary

  Background: Studies on drug use are limited by the study populations available, which usually only include drug users in treatment settings. Therefore, the knowledge base is limited on drug users not entering treatment for drug use disorder (DUD). Using registers from departments of forensic medicine enables research on decedents with DUD, irrespective of treatment status. Objectives: The aim of this study is to characterize and compare drug users not receiving treatment and drug users receiving treatment, in relation to cause of death, toxicological findings, and use of nonprescribed medication. Methods: Retrospective register-based study on deceased drug users with supplemental data from the Registry of Drug Abusers Undergoing Treatment and the Register of Medicinal Product Statistics in 2 observation periods: 2001–2002 and 2011–2012. Results: Two-thirds of the population were not receiving treatment at the time of death in both observation periods. Drug users receiving treatment were more likely to die from accidental poisonings than drug users not receiving treatment. There was no difference in mean age at the time of death between the 2 groups, and both groups were older in the second observation period. There was no difference in toxicological findings according to treatment status and the 2 groups did not differ in the presence of nonprescribed medication found in the blood at the time of death. Discussion/Conclusions: The proportion of drug users that received treatment prior to death has not increased, and deceased drug users are mostly not in treatment for their drug use at the time of death.

• Tjagvad, Christian; Clausen, Thomas; Handal, Marte & Skurtveit, Svetlana (2016). Benzodiazepine prescription for patients in treatment for drug use disorders: A nationwide cohort study in Denmark, 2000-2010. BMC Psychiatry. 16(1). doi: 10.1186/s12888-016-0881-y. Full text in Research Archive Show summary

  Background Benzodiazepines are frequently prescribed to patients with drug use disorders. However, it has previously been difficult to distinguish whether this frequent prescribing was due to underlying psychiatric disorders or inappropriate prescribing. In a nationwide cohort study, we investigated the prescribing of benzodiazepines to patients with drug use disorders in connection with treatment admission. Methods Benzodiazepine prescriptions to patients (N = 33203) aged 18 to 67 years admitting for outpatient treatment for drug use disorders in Denmark, 2000 to 2010, were studied by using linked data from nationwide health registries. Factors associated with increasing amounts of benzodiazepine use within the first year after admission were assessed by multinomial logistic regression. Proportions of very long-term benzodiazepine prescription were calculated. Results During the first year after admission to treatment, 26.2 % of patients were prescribed benzodiazepines. Of these, 35.5 % were prescribed benzodiazepines at dose levels that might indicate inappropriate use (>365 Defined Daily Dose per year), and 34.6 % were prescribed more than one type of benzodiazepines. Diazepam was the most commonly prescribed type. Among patients with opioid use, 43.2 % were prescribed benzodiazepines which were three times higher than for patients with cannabis (12.2 %) or central stimulating drugs (13.8 %) as their primary drug use. Admitting to treatment for a drug use disorder did not increase the specialized psychiatric treatment coverage of this patient group, disregarding use of prescribed benzodiazepines. 29.5 % were new users of prescribed benzodiazepines, and of these, 27.5 % continued into very long-term use (≥4 years after admission) during the study period. Conclusions Benzodiazepines were commonly prescribed to patients admitting to treatment for drug use disorders, and included prescription of multiple and non-optimal types, high doses, and very long-term prescriptions. These findings point towards inappropriate prescribing of benzodiazepines in many cases more than treatment for psychiatric disorders.

• Tjagvad, Christian; Skurtveit, Svetlana; Linnet, Kristian; Andersen, Ljubica Vukelic; Christoffersen, Dorte J. & Clausen, Thomas (2016). Methadone-related overdose deaths in a liberal opioid maintenance treatment program. European Addiction Research. ISSN 1022-6877. 22(5), p. 249–258. doi: 10.1159/000446429. Full text in Research Archive
• Tjagvad, Christian; Skurtveit, Svetlana; Bramness, Jørgen Gustav; Gjersing, Linn Renathe; Gossop, Michael & Clausen, Thomas (2016). Misuse of prescription drugs and overdose deaths. Journal of Substance Use. ISSN 1465-9891. 21(5), p. 515–520. doi: 10.3109/14659891.2015.1077280. Full text in Research Archive

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• Bukten, Anne; Lokdam, Nicoline; Skjærvø, Ingeborg; Ugelvik, Thomas; Skurtveit, Svetlana Ondrasova & Gabrhelík, Roman [Show all 20 contributors for this article] (2022). PriSUD-Nordic—Diagnosing and Treating Substance Use Disorders in the Prison Population: Protocol for a Mixed Methods Study. JMIR Research Protocols. 11(3). doi: 10.2196/35182. Full text in Research Archive Show summary

  Background: A large proportion of the prison population experiences substance use disorders (SUDs), which are associated with poor physical and mental health, social marginalization, and economic disadvantage. Despite the global situation characterized by the incarceration of large numbers of people with SUD and the health problems associated with SUD, people in prison are underrepresented in public health research. Objective: The overall objective of the PriSUD (Diagnosing and Treating Substance Use Disorders in Prison)-Nordic project is to develop new knowledge that will contribute to better mental and physical health, improved quality of life, and better life expectancies among people with SUD in prison. Methods: PriSUD-Nordic is based on a multidisciplinary mixed method approach, including the methodological perspectives of both quantitative and qualitative methods. The qualitative part includes ethnographic fieldwork and semistructured interviews. The quantitative part is a registry-based cohort study including national registry data from Norway, Denmark, and Sweden. The national prison cohorts will comprise approximately 500,000 individuals and include all people imprisoned in Norway, Sweden, and Demark during the period from 2000 to 2019. The project will investigate the prison population during three different time periods: before imprisonment, during imprisonment, and after release. Results: PriSUD-Nordic was funded by The Research Council of Norway in December 2019, and funding started in 2020. Data collection is ongoing and will be completed in the first quarter of 2022. Data will be analyzed in spring 2022 and the results will be disseminated in 2022-2023. The PriSUD-Nordic project has formal ethical approval related to all work packages. Conclusions: PriSUD-Nordic will be the first research project to investigate the epidemiology and the lived experiences of people with SUD in the Nordic prison population. Successful research in this field will have the potential to identify significant areas of benefit and will have important implications for ongoing policy related to interventions for SUD in the prison population.

• Melis, Francesca; Clausen, Thomas; Thylstrup, Birgitte; Tjagvad, Christian & Eide, Desiree (2025). Evaluering af behandling med lægeordineret heroin i Danmark. University of Oslo (UiO). doi: https:/www.med.uio.no/klinmed/forskning/sentre/seraf/aktuelt/aktuelle-saker/2025/seraf-rapport-2025.pdf. Full text in Research Archive Show summary

  The purpose of the report is to conduct an evaluation of the Danish HAT program. The report includes how the program has evolved since its implementation in 2010, program challenges from different perspectives and potential areas for improvement, particularly as it relates to patient dignity. The evaluation offers insights into patient outcomes while in treatment, staff and patient impressions on treatment, staff opinions on the treatment guidelines, and operational differences between the five clinics. This evaluation did not conduct a cost-benefit analysis, nor does it offer recommendations for how to update clinical practices guidelines. Such evaluations are outside the scope of this report.

• Eide, Desiree; Bjørnestad, Ronny; Brummer, Julie Elizabeth; Dadras, Omid; Pirro, Silvana De & Ellefsen, Rune [Show all 17 contributors for this article] (2024). Midtveisrapport om heroinassistert behandling fra 2022-2023 (SERAF rapport 4/2024). Senter for rus- og avhengighetsforskning. Full text in Research Archive Show summary

  Denne midtveisrapporten tar for seg de to første årene av Norges første heroinassisterte behandlingsprogram (HAB) som er planlagt å vare ut 2026 som et tidsavgrenset klinisk forsøksprosjekt. Forsøksprosjektet HAB ble etablert som del av legemiddelassistert rehabilitering (LAR) i Oslo og Bergen. Fra 1. januar 2022 til 31. desember 2023 ble 92 av totalt 97 pasienter inkludert i forskningsprosjektet som skal evaluere de to nyetablerte HABklinikkene. Denne rapporten beskriver etableringen av klinikkene, pasienterfaringer og pasientrapporterte resultater mens de var i heroinassistert behandling. Denne rapporten gir en midtveisevaluering av forsøksprosjektet. En endelig og utvidet evalueringsrapport vil bli levert i løpet av første halvdel av 2026.

• Tjagvad, Christian; Clausen, Thomas & Skurtveit, Svetlana (2016). Addictive medication in relation to drug treatment and overdose death. Universitetet i Oslo. Full text in Research Archive Show summary

  Background The involvement of the addictive medications, benzodiazepines (BZDs) and prescription opioids, including opioid maintenance treatment (OMT) medications, have increasingly contributed to the high overdose death rates in Denmark and Norway during the past decades. Investigating prescription patterns and patient behavior in relation to drug treatment and overdose deaths is important to increase our knowledge on how these addictive medications are used, misused, and how they may contribute to overdose deaths. Study aims The overall aim of the thesis was to acquire new knowledge of the involvement of addictive medications in the treatment of populations with drug use disorders (DUDs) and also in overdose deaths to improve treatment approaches and reduce detrimental outcomes in a vulnerable group of individuals. More specifically the aim was to investigate prescription patterns and use of addictive medication in relation to drug treatment and overdose deaths among populations in Denmark and Norway. Furthermore, to compare overdose cases with and without detection of legally prescribed addictive medications and investigate factors associated with having detection of non-prescribed addictive medication. Materials and methods This thesis was based on three different cohorts/samples from two countries: A Danish nationwide cohort including individuals admitted for treatment for DUDs in 2000-2010 (n=33,203); a Norwegian sample including overdose deaths in the capital city, Oslo, in 2006-2008 (n=167), and; a Danish sample including overdose deaths in Copenhagen, Aarhus, and Odense Municipality in 2008-2011 (n=130). The cohorts/samples were linked with data from population registries, local based registries, and journal reviews by using a unique identification number assigned to all Danish and Norwegian citizens. Results Overall, in the period after entering treatment and in the period prior to overdose death, addictive medication was often prescribed to individuals with DUD. In both periods, inappropriate prescription patterns were identified. During the first year after admission to DUD treatment, about one-quarter of the individuals (26.2%) were prescribed BZDs. Of these, about one-third (35.5%) were prescribed BZDs at dose levels that might indicate inappropriate use, and about one-third (34.6%) were prescribed more than one type of BZDs. Particularly individuals with opioid use (43.2%) were commonly prescribed BZDs. Admitting to treatment for a DUD did not increase the specialized psychiatric treatment coverage of this patient group, disregarding use of prescribed BZDs. Among overdose deaths in Denmark and Norway, the prescribed doses of the addictive medications among the deceased were in general higher than recommended. Further, the control/monitoring measures were insufficient and allowing use of multiple prescribing physicians (Norway), low levels of supervised intake of OMT medication (Denmark), and use of multiple prescribed addictive medications (Denmark). We investigated the deceased with detection of prescribed vs. non-prescribed addictive medication. In the Norwegian sample, we found that a lower proportion of the deceased (with detection of the target medications) had been prescribed BZDs (28.1%), strong analgesics (33.3%), or BZDs plus strong analgesics (50.0%) four weeks prior to death. However, in Denmark the majority of deceased with methadone-related overdose deaths (63.1%) were prescribed methadone as part of OMT at the time of death. In the Norwegian sample, detection of non-prescribed BZDs and/or strong analgesics was associated with younger age (a-OR=4.9; 95% CI, 1.4-18.0) and to have a permanent place of residence outside Oslo (a- OR=2.9; 1.1-8.1). In the Danish sample, detection of non-prescribed methadone was associated with younger age of 30 years or below (a-OR=9.5; 1.8-50.5), concomitant detection of 6-MAM/heroin (a-OR=3.1; 1.2-7.8), and non-prescribe

• Tjagvad, Christian; Petersen, Helle; Thylstrup, Birgitte; Biong, Stian & Clausen, Thomas (2014). Forgiftningsdødsfald og øvrige narkotikarelaterede dødsfald i Danmark 2008-2011. SERAF - Senter for rus- og avhengighetsforskning. ISSN 9788293019046. Full text in Research Archive

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