Ann Oldervoll

• Myklebust, Lars Henrik; Eide, Desiree; Wüsthoff, Linda Elise Couessurel; Melis, Francesca; Oldervoll, Ann & Pirro, Silvana De [Show all 7 contributors for this article] (2025). Changes in self-reported mental health, anxiety and depression among patients in heroin-assisted treatment: Findings from a Norwegian trial project. European Addiction Research. ISSN 1022-6877. 31, p. 286–296. doi: 10.1159/000547375. Full text in Research Archive Show summary

  Introduction: Norway’s heroin-assisted treatment (HAT) project started in 2022, aimed at targeting individuals with severe opioid use disorder (OUD) who did not benefit from first-line, conventional opioid agonist treatment. The use of pharmaceutical diacetylmorphine in HAT may particularly benefit patients with comorbid psychiatric disorders due to its structured nature, which includes daily contact with outpatient clinics. However, previous findings on mental health outcomes in HAT have been inconclusive. The main aim of this study was to explore changes in patients’ self-rated mental health and anxiety and depression over the first 12 months of HAT in Norway. Methods: We used data from 2 questions about patients’ self-rated mental health and anxiety and depression collected from 79 patients at the start of treatment (baseline) and at 3, 6, and 12 months into treatment. Ordinal logistic regression models were used to examine the changes in the responses over the observational period and to explore the potential effects of predictors such as gender and age, self-reported substance use, and clinic site. Results: We found a gradual improvement in self-rated mental health from baseline over the observational period, with a statistically significant shift in response distribution at the 12-month mark (p = 0.017). The distribution of responses indicating “good” mental health increased with a 35% improvement at 12 months, with a corresponding decline of 48% in “bad” mental health. For self-rated anxiety and depression, we found no change in severity of self-rated symptoms. A decline of 48% in the proportion of responses reporting severe symptoms at 12 months was aligned with a simultaneous increase of 17% reporting moderate symptoms. Age and previous suicide attempts were significant predictors of both outcomes; gender influenced anxiety and depression only, whereas clinic site influenced only mental health ratings. Conclusion: HAT appears to gradually improve patients’ self-rated mental health over time, possibly by enhancing overall psychological well-being. Self-rated symptoms of anxiety and depression may not be affected by this treatment, indicating that psychiatric conditions can persist in HAT for those struggling with them. This highlights the importance of specific psychiatric assessments and targeted interventions for at least a subset of patients, underscoring the need for integrated treatment approaches within HAT programs that address both substance use and co-occurring psychiatric disorders.

• Melis, Francesca; Clausen, Thomas; Castel, Charlotte Jocelyne Yvonne; Dadras, Omid; Pirro, Silvana De & Myklebust, Lars Henrik Ryther [Show all 9 contributors for this article] (2024). Patient Characteristics From Norway’s First Heroin-Assisted Treatment Clinics. Substance use & addiction journal. 46(1), p. 13–24. doi: 10.1177/29767342241271991. Full text in Research Archive Show summary

  Background: Heroin-assisted treatment (HAT) is an evidence-based treatment option for opioid use disorder (OUD), available in a limited number of countries. Norway implemented a 5-year HAT project in 2022, aiming to assess its effectiveness and its potential integration into the country’s OUD treatment system. This study describes and compares patients’ baseline characteristics from the Oslo and Bergen HAT clinics, providing a comprehensive picture of the unique population and the real-world application of HAT. Methods: This cross-sectional study examines the baseline characteristics of consenting HAT patients within the first 2 years of operation (n = 86). Self-reported questionnaires gathered sociodemographics, previous treatment experiences, self-reported crime, and substance use, as well as motivations and expectations for treatment. Comparisons between the clinics were carried out using t-tests, Mann–Whitney U tests, Chi-square, and Fisher’s exact test. Results: The majority of the patients were enrolled at the Oslo clinic (76%) and were male (80%). At admission, the average age was 45.9, with a significantly younger group in Bergen (42.5 vs 47.3, P < .05). While no patients reported being unhoused, 17% noted unstable housing within the preceding month. Unemployment was prevalent (91%) alongside previous treatment experiences (95%), with a median of 2 prior medication types. In the 3 months preceding HAT initiation, 78% of patients reported being victims of crime, and 44% committed at least one crime. Over their lifetime, 2 in 5 participants (41%) had experienced an unwanted overdose and 43% had shared syringes and equipment. Conclusion: This study reveals a cohort experiencing societal marginalization, including unstable housing, unsatisfactory prior OUD treatment, high-risk behaviors, and frequent interactions with criminal activities, predominantly as victims. While the Oslo and Bergen clinics serve a similar patient profile, notable differences emerged in the reasons for discontinuing past OUD treatment and crime-related factors.

• Foss, Hakan Safaralilo; Oldervoll, Ann Louise; Fretheim, Atle; Glenton, Claire & Lewin, Simon Arnold (2019). Communication around HPV vaccination for adolescents in low- and middle-income countries: a systematic scoping overview of systematic reviews. Systematic Reviews. 8(1). doi: 10.1186/s13643-019-1100-y. Full text in Research Archive Show summary

  Abstract Background: Human papillomavirus (HPV) infection causes cervical cancer. More than 80% of those diagnosed with cervical cancer live in low- and middle-income countries (LMICs). The World Health Organization recommends vaccination as a public health measure against cervical cancer. Communication interventions are able to change how people think about vaccination and are thus instrumental in addressing vaccine hesitancy. Our aim was to provide a broad scoping overview of the available evidence on communication with adolescents, parents, and other stakeholders around HPV vaccination for adolescents, with a specific focus on LMICs. Methods: We conducted a systematic scoping overview of systematic reviews addressing a range of questions regarding communication around HPV vaccination. We considered reviews published between 2007 and 2018 focusing on communication around HPV vaccination and that searched for qualitative or quantitative studies for inclusion. We searched the Epistemonikos database which includes reviews from multiple electronic databases. Two overview authors screened titles and abstracts and examined potentially eligible reviews in full text. Data extraction was performed by one overview author and verified by a second. We assessed the reliability of the included reviews using an adapted version of AMSTAR 2. Results: We included twelve reviews in our overview. Four reviews assessed the effectiveness of communication interventions. These interventions intended to inform or educate about HPV and HPV vaccination, such as videos and fact sheets, or to remind or recall, such as text message reminders. Eight reviews assessed factors associated with HPV vaccination uptake, including communication-related factors such as whether the vaccine was recommended by a physician and people’s knowledge regarding the vaccine. Nine reviews searched for studies from LMICs, but most found only a small number of studies from these countries. Conclusions: The small number of studies identified from LMICs is of concern as these countries face the largest burden of disease related to HPV. This scoping overview also found and excluded a number of reviews because of important methodological limitations, highlighting the need for future reviews to use appropriate methods. The overview indicates areas in which further primary studies are needed on HPV vaccination communication in LMICs. Systematic review registration: Open Science Framework https://osf.io/agzb4/ Keywords: HPV, Human papillomavirus, Vaccine, Communication, Intervention, Adolescents, Low-income countries, Middle-income countries, Low- and middle-income countries, Systematic scoping overview of systematic reviews

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• Myklebust, Lars Henrik Ryther; Eide, Desiree; Arnevik, Espen Ajo; Dadras, Omid; Pirro, Silvana De & Ellefsen, Rune [Show all 14 contributors for this article] (2024). Evaluation of heroin-assisted treatment in Norway: protocol for a mixed methods study. BMC Health Services Research. 24(1). doi: 10.1186/s12913-024-10767-w. Full text in Research Archive Show summary

  Background Opioid agonist treatment (OAT) for patients with opioid use disorder (OUD) has a convincing evidence base, although variable retention rates suggest that it may not be beneficial for all. One of the options to include more patients is the introduction of heroin-assisted treatment (HAT), which involves the prescribing of pharmaceutical heroin in a clinical supervised setting. Clinical trials suggest that HAT positively affects illicit drug use, criminal behavior, quality of life, and health. The results are less clear for longer-term outcomes such as mortality, level of function and social integration. This protocol describes a longitudinal evaluation of the introduction of HAT into the OAT services in Norway over a 5-year period. The main aim of the project is to study the individual, organizational and societal effects of implementing HAT in the specialized healthcare services for OUD. Methods The project adopts a multidisciplinary approach, where the primary cohort for analysis will consist of approximately 250 patients in Norway, observed during the period of 2022–2026. Cohorts for comparative analysis will include all HAT-patients in Denmark from 2010 to 2022 (N = 500) and all Norwegian patients in conventional OAT (N = 8300). Data comes from individual in-depth and semi-structured interviews, self-report questionnaires, clinical records, and national registries, collected at several time points throughout patients’ courses of treatment. Qualitative analyses will use a flexible inductive thematic approach. Quantitative analyses will employ a wide array of methods including bi-variate parametric and non-parametric tests, and various forms of multivariate modeling. Discussion The project’s primary strength lies in its comprehensive and longitudinal approach. It has the potential to reveal new insights on whether pharmaceutical heroin should be an integral part of integrated conventional OAT services to individually tailor treatments for patients with OUD. This could affect considerations about drug treatment even beyond HAT-specific topics, where an expanded understanding of why some do not succeed with conventional OAT will strengthen the knowledge base for drug treatment in general. Results will be disseminated to the scientific community, clinicians, and policy makers. Trial registration The study was approved by the Norwegian Regional Committee for Medical and Health Research Ethics (REK), ref.nr.:195733.

• Eide, Desiree; Pirro, Silvana De; Myklebust, Lars Henrik Ryther; Melis, Francesca; Oldervoll, Ann & Clausen, Thomas (2024). Norway's first heroin-assisted treatment clinics: initial impact of the intervention. Full text in Research Archive
• Lunde, Rose Elisabeth; Oldervoll, Ann; Clausen, Thomas & Eide, Desiree (2025). Evaluering av brukerrom i Oslo og Bergen. Senter for rus- og avhengighetsforskning. doi: https:/www.med.uio.no/klinmed/forskning/sentre/seraf/publikasjoner/rapporter/2025/seraf-rapport-4-2025-evaluering-av-brukerrom-i-oslo-og-bergen.pdf. Full text in Research Archive Show summary

  Brukerromsordningen tilbyr hygieniske og trygge rammer for inntak av illegale rusmidler. Formålet med ordningen er å redusere skader knyttet til rusbruk, samt redusere faren for overdose og smittespredning. Det første brukerrommet i Norge ble åpnet i 2005 i Oslo. I årene som har gått, har det skjedd betydelige fremskritt på feltet, blant annet gjennom lovendringer og en utvidelse av tilbudet til å inkludere andre rusmidler enn heroin og andre inntaksformer enn injisering. I dag finnes det brukerrom både i Oslo og Bergen. Tidligere evalueringer, utført av Statens institutt for rusmiddelforskning (SIRUS) i 2007 og 2009, belyste utfordringene ved oppstarten av brukerromsordningen og ga flere anbefalinger. Denne evalueringen er utført etter oppdrag fra Helsedirektoratet og har som mål å bidra med økt og oppdatert kunnskap på feltet. Dette gjøres gjennom å analysere sentrale utviklingsområder og ved å inkludere perspektivene til både ansatte og brukere. Evalueringen har tatt i bruk et blandet metodedesign («mixed methods»). Metodologien inkluderer kvantitativ data om drift, trender og erfaringer i brukerrommene, samlet inn via spørreskjemaer besvart av ledelse og ansatte. I tillegg ble det gjennomført dybdeintervjuer med registrerte brukere ved Prindsen mottakssenter i Oslo. Sistnevnte gir et kvalitativt innblikk i brukernes perspektiver og erfaringer.

• 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.

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