POINT - Preventing an opioid epidemic in Norway: Focusing on treatment of chronic pain

We research chronic pain treatment to minimize the risks associated with opioids.

About the project

We know that patients suffering from chronic pain need good treatment. The use of opioids for chronic, non-cancer related pain may seem appropriate in the short term, but can often have negative consequences for both the individual and society in the long term.

In addition, we lack a robust knowledge base showing that long-term treatment of chronic pain with opioids has a good effect. Negative consequences associated with long-term use lead to serious side effects, such as the risk of overdose and the development of addiction.

The ongoing opioid epidemic in the USA – caused by inappropriate prescribing of opioids to pain patients – has led to serious health and societal consequences.

Several factors—the escalating use of opioids to chronic pain patients, the increasing use of strong opioids in particular, and the increasing number of overdoses caused by prescription opioids—point to the start of an opioid epidemic in Norway.

Objectives

The overall goal of the POINT project is to provide knowledge to optimize treatment of patients with chronic pain in order to avoid unnecessary escalation of opioid treatment, improve their quality of life and reduce the burden of disease.

In the long run our objective is to prevent the unwanted consequences of opioid treatment and improve patients' quality of life.

Ultimately, through this project we hope to prevent an opioid epidemic in Norway.

To achieve our main goal, we will focus on pain patients and their doctors, as increasing opioid use may occur through the patient-doctor interaction.

Methods

Data from national registers will be used to identify risk factors for long-term use of opioids and consequences of long-term use.

Using qualitative methods we will systematize, describe and explain the patients' and treating physicians' perspectives on opioid treatment to improve communication between patient and physician.

The project will evaluate the effect of a knowledge-based training intervention aimed at general practitioners.

In addition, the project will develop and test two non-drug interventions that consist of an interdisciplinary group treatment and an e-health program with a focus on communication between patient and doctor as well as between other caregivers.

Financing

The Research Council of Norway

Cooperation

Alcohol and Drug Research Western Norway (KORFOR)
City of Stavanger
Foreningen for kroniske smertepasienter (FKS)
National Institute of Public Health (FHI)
Norwegian Forum of Disabled Peoples’ Organizations (SAFO)
St. Olavs Hospital
Stavanger Hospital Trust

Cooperation with other projects

Amundsen, Ellen Johanna; Odsbu, Ingvild; Skurtveit, Svetlana Ondrasova & Gjersing, Linn (2024). Patterns of filled prescriptions and the association with risk of drug-induced death. A population-based nested case-control register study. Pharmacoepidemiology and Drug Safety. ISSN 1053-8569. 33(2). doi: 10.1002/pds.5763.
Odsbu, Ingvild; Hjellvik, Vidar; Handal, Marte; Hamina, Aleksi; Clausen, Thomas & Lid, Torgeir Gilje [Show all 8 contributors for this article] (2024). Psykiske lidelser og plager ved vedvarende opioidbruk for langvarige ikke-kreftrelaterte smerter - en registerstudie. Tidsskrift for Den norske legeforening. ISSN 0029-2001. 144(2), p. 1–15. doi: 10.4045/tidsskr.23.0414. Full text in Research Archive
Nestvold, Håkon Høydal; Skurtveit, Svetlana Ondrasova; Hamina, Aleksi; Hjellvik, Vidar & Odsbu, Ingvild (2023). Socioeconomic risk factors for long-term opioid use: A national registry-linkage study. European Journal of Pain. ISSN 1090-3801. 28(1), p. 95–104. doi: 10.1002/ejp.2163. Full text in Research Archive
Gjerde, L. C.; Skurtveit, S.; Handal, M.; Nesvåg, R.; Clausen, T. & Lid, T. G. [Show all 9 contributors for this article] (2023). Mental disorder prevalence in chronic pain patients using opioid versus non-opioid analgesics: A registry-linkage study. European Journal of Pain. ISSN 1090-3801. 27(7), p. 884–895. doi: 10.1002/ejp.2121. Full text in Research Archive Show summary
Background Chronic pain and mental disorders are leading causes of disability worldwide. Individuals with chronic pain are more likely to experience mental disorders compared to individuals without chronic pain, but large-scale estimates are lacking. We aimed to calculate overall prevalence of mental health diagnoses from primary and secondary care among individuals treated for chronic pain in 2019 and to compare prevalence among chronic pain patients receiving opioid versus non-opioid analgesics, according to age and gender. Methods It is a population-based cohort study. Linked data from nationwide health registers on dispensed drugs and diagnoses from primary (ICPC-2) and secondary (ICD-10) health care. Chronic pain patients were identified as all patients over 18 years of age filling at least one prescription of an analgesic reimbursed for non-malignant chronic pain in both 2018 and 2019 (N = 139,434, 69.3% women). Results Prevalence of any mental health diagnosis was 35.6% (95% confidence interval: 35.4%–35.9%) when sleep diagnoses were included and 29.0% (28.8%–29.3%) when excluded. The most prevalent diagnostic categories were sleep disorders (14% [13.8%–14.2%]), depressive and related disorders (10.1% [9.9%–10.2%]) and phobia and other anxiety disorders (5.7% [5.5%–5.8%]). Prevalence of most diagnostic categories was higher in the group using opioids compared to non-opioids. The group with the highest overall prevalence was young women (18–44 years) using opioids (50.1% [47.2%–53.0%]). Conclusions Mental health diagnoses are common in chronic pain patients receiving analgesics, particularly among young individuals and opioid users. The combination of opioid use and high psychiatric comorbidity suggests that prescribers should attend to mental health in addition to somatic pain. Significance This large-scale study with nation-wide registry data supports previous findings of high psychiatric burden in chronic pain patients. Opioid users had significantly higher prevalence of mental health diagnoses, regardless of age and gender compared to users of non-opioid analgesics. Opioid users with chronic pain therefore stand out as a particularly vulnerable group and should be followed up closely by their physician to ensure they receive sufficient care for both their mental and somatic symptoms.
Rolova, Gabriela; Eide, Desiree; Gabrhelík, Roman; Odsbu, Ingvild; Clausen, Thomas & Skurtveit, Svetlana Ondrasova (2023). Gender differences in physical morbidity in opioid agonist treatment patients: population-based cohort studies from the Czech Republic and Norway. Substance Abuse Treatment, Prevention, and Policy. ISSN 1747-597X. 18(1). doi: 10.1186/s13011-023-00557-8. Full text in Research Archive
Eriksen, Astrid M.A.; Melhus, Marita; Schei, Berit; Skurtveit, Svetlana Ondrasova & Broderstad, Ann Ragnhild (2023). Opioid prescriptions among Sami and non-Sami with chronic pain: The SAMINOR 2 Questionnaire Survey and the Norwegian Prescription Database. International Journal of Circumpolar Health. ISSN 1239-9736. 82. doi: 10.1080/22423982.2023.2241202. Full text in Research Archive
Hamina, Aleksi; Odsbu, Ingvild; Hjellvik, Vidar; Lid, Torgeir Gilje; Clausen, Thomas & Skurtveit, Svetlana Ondrasova (2023). Fatal drug overdoses in individuals treated pharmacologically for chronic pain: a nationwide register-based study. British Journal of Anaesthesia. ISSN 0007-0912. 132(1), p. 86–95. doi: 10.1016/j.bja.2023.10.016. Full text in Research Archive
Espnes, Ketil Arne; Nøst, Torunn Hatlen; Handal, Marte; Skurtveit, Svetlana Ondrasova & Langaas, Harald Chr. (2023). Can academic detailing reduce opioid prescriptions in chronic non‑cancer pain? BMC Primary Care. ISSN 2731-4553. 24. doi: 10.1186/s12875-023-02040-6. Full text in Research Archive Show summary
Abstract Background One measure to support optimal opioid prescription is academic detailing (AD) with one-to-one visits by trained professionals (academic detailers) to general practitioners (GPs). Objective: To investigate the usefulness of AD visits on GPs’ opioid prescribing patterns in Norway, and academic detailers’ experiences with AD visits to GPs on opioid prescription. Methods Design: A quantitative registry study on opioid prescriptions and a qualitative focus group interview study with academic detailers. Participants: For the registry study, municipalities where more than 75% of the GPs had received an AD visit were considered intervention municipalities, whereas in the non-intervention municipalities no GPs had received AD-visits. In the focus groups, academic detailers who had conducted three or more AD-visits were invited to participate. Intervention: A campaign on opioid prescription with AD visits using a brochure with key messages based on the national guideline for treatment of chronic non-cancer pain and updated evidence on the potential benefts and risks of prescribing opioids. The AD visits in the campaign were planned for 20–25 min in a one-to-one setting in the GP’s ofce. Main Measures: The Norwegian Prescription Database (NorPD) was utilized for registry data. Data on amount of drugs dispensed are recoded as Defned Daily Doses (DDDs). Results Compared to non-intervention, the intervention resulted in a decrease in the number of prevalent and incident users of opioids and incident users of reimbursed opioids for chronic non-cancer pain in municipalities in Central Norway. The results from the focus group interviews were categorized into the themes: “To get in position”, “Adjusting messages”, “What did the GPs struggle with, in relation to opioid prescription?” and “Did we reach the right recipients with the visits?”. Conclusions In Central Norway, the intervention resulted in a desired efect on number of opioid users. According to the academic detailers, the GPs’ length of working experience and familiarity with the topic gave diferent presumptions for making use of the information presented in the AD-visits. Keywords Chronic non-cancer pain, Academic detailing, Primary care, Opioids
Eide, Desiree; Mcdonald, Rebecca Silvia; Hamina, Aleksi; Clausen, Thomas; Odsbu, Ingvild & Skurtveit, Svetlana Ondrasova (2023). Prescription high-risk polysubstance use among opioid maintenance treatment patients. International journal of drug policy. ISSN 0955-3959. doi: 10.1016/j.drugpo.2023.104196. Full text in Research Archive
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. ISSN 2296-2565. 11. doi: 10.3389/fpubh.2023.1179763. Full text in Research Archive
Holmberg, Siril T.; Skurtveit, Svetlana; Gulati, Sasha; Salvesen, Øyvind; Nygaard, Øystein P. & Solberg, Tore K. [Show all 7 contributors for this article] (2023). Persistent Use of Prescription Opioids Before and After Lumbar Spine Surgery: Observational Study With Prospectively Collected Data From Two Norwegian National Registries. Spine. ISSN 0362-2436. 48(14), p. 969–977. doi: 10.1097/BRS.0000000000004710. Full text in Research Archive Show summary
Study design. Prospective pharmacoepidemiologic study Objective. To investigate clinical and sociodemographic factors associated with persistent opioid use in the years following spine surgery among patients with persistent opioid use preceding lumbar spine surgery. Summary of background data. It is unknown whether successful spine surgery leads to a cessation of preoperative persistent opioid use. Methods. Data from the Norwegian Registry for Spine Surgery and the Norwegian Prescription Database were linked for patients operated for degenerative lumbar spine disorders between 2007 and 2017. The primary outcome measure was persistent opioid use in the second year after surgery. Functional disability was measured with the Oswestry Disability Index (ODI). Factors associated with persistent opioid use in the year before, and two years following, surgery were identified using multivariable logistic regression analysis. The variables included in the analysis were selected based on their demonstrated role in prior studies. Results. The prevalence of persistent opioid use was 8.7% in the year before surgery. Approximately two-thirds of patients also met the criteria for persistent opioid use the second year after surgery. Among patients who did not meet the criteria for persistent opioid use the year before surgery, 991 (3.3%) patients developed persistent opioid use in the second year following surgery. The strongest association was exhibited by high doses of benzodiazepines in the year preceding surgery (OR 1.7, 95% CI 1.26 to 2.19, P
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
Baumann, Monica; Storheim, Kjersti; Stangeland, Helle; Zwart, John Anker Henrik; Wentzel-Larsen, Tore & Skurtveit, Svetlana Ondrasova [Show all 8 contributors for this article] (2023). Childhood trauma and the use of opioids and other prescription analgesics in adolescence and young adulthood. The HUNT study. Pain. ISSN 0304-3959. p. 1–10. doi: 10.1097/j.pain.0000000000003131. Full text in Research Archive
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. ISSN 1471-2318. 22. doi: 10.1186/s12877-022-03125-0. Full text in Research Archive
Hamina, Aleksi; Hjellvik, Vidar; Handal, Marte; Odsbu, Ingvild; Clausen, Thomas & Skurtveit, Svetlana Ondrasova (2022). Describing long-term opioid use utilizing Nordic Prescription Registers - A Norwegian example. Basic & Clinical Pharmacology & Toxicology. ISSN 1742-7835. 130(4), p. 481–491. doi: 10.1111/bcpt.13706. Full text in Research Archive
Højlund, Mikkel; Gudmundsson, Larus S.; Andersen, Jacob H.; Saastamoinen, Leena K.; Zoega, Helga & Skurtveit, Svetlana Ondrasova [Show all 9 contributors for this article] (2022). Use of benzodiazepines and benzodiazepine-related drugs in the Nordic countries between 2000 and 2020. Basic & Clinical Pharmacology & Toxicology. ISSN 1742-7835. 132(1), p. 60–70. doi: 10.1111/bcpt.13811. Full text in Research Archive
Skurtveit, Svetlana Ondrasova; Odsbu, Ingvild; Gjersing, Linn; Handal, Marte; Lid, Torgeir Gilje & Clausen, Thomas [Show all 7 contributors for this article] (2022). Individuals Dying of Overdoses Related to Pharmaceutical Opioids Differ from Individuals Dying of Overdoses Related to Other Substances: A Population-Based Register Study. European Addiction Research. ISSN 1022-6877. 28(6). doi: 10.1159/000526145. Full text in Research Archive
Odsbu, Ingvild; Handal, Marte; Hjellvik, Vidar; Borchgrevink, Petter Chr.; Clausen, Thomas & Nesvåg, Ragnar [Show all 7 contributors for this article] (2022). Vedvarende bruk av opioider og samtidig bruk av andre vanedannende legemidler. Tidsskrift for Den norske legeforening. ISSN 0029-2001. 142(3), p. 1–8. doi: 10.4045/tidsskr.21.0659. Full text in Research Archive

View all works in Cristin

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