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, there is a lack of robust evidence showing that long-term treatment of chronic pain with opioids is effective. Long-term use can lead to serious side effects, including the risk of overdose and 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, such as the escalating use of opioids among chronic pain patients, the increasing use of strong opioids in particular, and the rising number of overdoses caused by prescription opioids, indicate the potential beginning 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, enhance patients' quality of life, and reduce the disease burden.

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.

Status/Results

Together with the Department of Addictology of the First Faculty of Medicine at Charles University and the Norwegian Institute of Public Health, we have collaborated on a project aimed at identifying data sources for research and monitoring the use of psychoactive prescription medications culminating in a productive exchange of research experience between the Czech Republic and Norway.

One of the project’s main goals was to investigate the availability of data compiled by Czech state institutions and determine their openness and usability for research monitoring the use of psychoactive prescription medications. We aimed to answer two key questions: 1) Do we have data to monitor the use of psychoactive prescription medications and their health consequences in the population? 2) What is the quality and accessibility of these data? The initiative, “Studying psychoactive prescription medication misuse in the Czech population: Exchanging expertise in pharmacoepidemiological registry-based research and strengthening collaboration with Norway,” has been financed by the Fund for Bilateral Relations within the framework of the EEA and Norway Grants 2014-2021 (“Bilateral Fund”) and was conducted from March to July 2024.
Read more about the project

Financing

The Research Council of Norway

Collaboration

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

Collaboration with other projects

Hamina, Aleksi; Pinzón‐Espinosa, Justo; Taipale, Heidi; Schneider‐Thoma, Johannes; Radua, Joaquim & Efthimiou, Orestis [Show all 19 contributors for this article] (2026). Representation and outcomes of individuals with major depression in routine care who are ineligible for randomized controlled trials: a nationwide register‐based study. World Psychiatry. ISSN 1723-8617. 25(1), p. 117–124. doi: 10.1002/wps.70013. Full text in Research Archive Show summary
Randomized controlled trials (RCTs) are the foundation of current clinical treatment guidelines. However, they may not reflect real‐world populations, due to strict eligibility criteria. We determined the proportion of individuals with major depressive disorder (MDD) receiving maintenance antidepressant treatment in routine care who would be ineligible for RCTs, and compared their outcomes with those who were eligible. Utilizing specialized health care registers in Finland (2004‐2018) and Sweden (2006‐2021), we identified adults diagnosed with non‐psychotic MDD (ICD‐10: F32, F33) who were stabilized on maintenance antidepressant monotherapy. Through multidisciplinary expert consensus on latest meta‐analytic evidence, we derived a standardized list of RCT inclusion and exclusion criteria. These criteria were systematically applied to classify individuals as RCT‐eligible or RCT‐ineligible. We then used Cox proportional models to derive hazard ratios (HRs) of a composite primary outcome of hospitalization due to any psychiatric reason or suicide attempt, and all‐cause mortality, during a 6‐month follow‐up. Secondary outcomes were treatment changes (i.e., discontinuation, switch or augmentation) and psychiatric sick leave ≥2 weeks. A total of 73,720 individuals in Finland and 135,092 in Sweden were included. More than one third of patients with MDD (33.5% in Finland and 35.3% in Sweden) were found to be ineligible for RCTs. The most common reasons for ineligibility were comorbidities (serious somatic disease, other psychiatric disorders, or substance use disorder). RCT‐ineligible individuals had more than twice the risk of the composite primary outcome compared to eligible individuals (HR=2.44, 95% CI: 2.15‐2.76 in Finland; HR=2.61, 95% CI: 2.37‐2.87 in Sweden). Approximately one third of the composite primary outcome was attributable to RCT‐ineligibility factors (32.5%, 95% CI: 27.9‐37.1 for Finland; 36.2%, 95% CI: 32.6‐39.8 for Sweden). Risk of treatment change was slightly but significantly higher in ineligible individuals. Findings were consistent in a wide range of sensitivity analyses. We conclude that more inclusive eligibility criteria for RCTs, and their integration with real‐world data, are needed to improve the generalizability of antidepressant trial evidence and MDD clinical treatment guidelines.
Purra, Laura; Taipale, Heidi; Tiihonen, Miia; Lähteenvuo, Markku; Tiihonen, Jari & Hamina, Aleksi (2026). Incident low‐dose quetiapine use in adults newly diagnosed with depression in primary care: A nationwide register‐based study. British Journal of Clinical Pharmacology. ISSN 0306-5251. doi: 10.1002/bcp.70792. Full text in Research Archive Show summary
Aims This study aimed to investigate the incidence of low-dose quetiapine initiation and associated factors in adults newly diagnosed with depression in primary care. Methods We obtained medication dispensing records, primary and secondary care diagnoses and employment status for antipsychotic-naïve individuals aged 16–65 newly diagnosed with depression in primary healthcare from several national Finnish registers in 2016–2022. We then calculated the incidence of low-dose (≤50 mg) quetiapine initiation from 2 years before to 2 years after the depression diagnosis. Modified Poisson regression models derived adjusted risk ratios (aRRs) and 95% confidence intervals (CIs), assessing the association between covariates and low-dose quetiapine initiation. Results Of the 189 115 individuals with depression, 13.4% (25 373) initiated low-dose. The incidence of low-dose quetiapine peaked in the first 30 days following the depression diagnosis, constituting 14.8% of all initiations. Initiation had the strongest association with younger age (16–24 vs. 55–65 years: aRR 1.87, 95%CI 1.80–1.96) and psychiatric comorbidities, especially alcohol use disorder (1.44, 1.39–1.50) and other substance use disorders (1.27, 1.19–1.36). Ischaemic heart diseases had a positive association (1.13, 1.04–1.22), while hyperlipidaemia had a negative association (0.91, 0.86–0.97); other cardiometabolic conditions had no significant associations. Among other medications assessed, SSRI and hypnotic antidepressant use had the strongest associations with low-dose quetiapine initiation (1.81, 1.77–1.86 and 1.81, 1.77–1.85, respectively). Conclusions Low-dose quetiapine initiation is common among adults newly diagnosed with depression in primary care. The benefits of this practice should be weighed against cardiometabolic and other adverse effects.
Salmelainen, Janina; Tiihonen, Miia; Taipale, Heidi; Lieslehto, Johannes; Tanskanen, Antti & Tiihonen, Jari [Show all 7 contributors for this article] (2026). Medicine Use Preceding Fatal Poisonings Among Individuals With Bipolar Disorder. Basic & Clinical Pharmacology & Toxicology. ISSN 1742-7835. 139(4). doi: 10.1111/bcpt.70305. Full text in Research Archive Show summary
Pharmacotherapy may reduce overall suicide risk in bipolar disorder, but prescribed medicines can also be causative agents in suicidal and accidental poisonings. This nationwide, nested case–control study utilized data from several national registers in Finland in 1996–2018. In a cohort of 60 045 individuals aged 15–65 with bipolar disorder, cases with fatal poisoning due to medicines or illicit substances were matched by age and sex to four controls each. The association between fatal poisoning and medicine use in the prior 2 weeks was examined using conditional logistic regression. The 777 (1.3%) cases who died of poisoning due to medicines or illicit substances during the study period were matched to 3108 controls. Of cases, 56.5% ( n = 439) died of a suicidal poisoning and 38.4% ( n = 298) of an accidental poisoning. After adjusting for sociodemographic characters, comorbidities and other medicine use, tricyclic antidepressants (aOR 3.07, 95% CI 2.09–4.50), gabapentinoids (3.05, 2.08–4.47), opioids (2.65, 1.88–3.75), benzodiazepines (2.13, 1.71–2.64), Z‐drugs (2.19, 1.66–2.88) and antipsychotics (1.94, 1.56–2.40) were associated with fatal poisonings. While the associations may reflect clinical severity of the disorder among users of these medicines, increased caution is warranted when prescribing them to individuals at elevated risk of poisoning.
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
Štěpánka, Ptáčková,; Skurtveit, Svetlana Ondrasova; Roman, Gabrhelík,; Odsbu, Ingvild & Rolová, Gabriela (2026). Diagnostic pathways, healthcare utilization, and mortality in children and young people with early onset substance use disorders: a nationwide registry-based cohort study | Harm Reduction Journal | Springer Nature Link. Harm Reduction Journal. doi: 10.1186/s12954-026-01533-8. Full text in Research Archive Show summary
Longitudinal, population-based evidence on the clinical profiles and mortality of youth with substance use disorders (SUDs) is limited, despite significant health and social risks. This study aimed to (1) characterize initial SUD diagnoses, demographic and healthcare profiles, and diagnostic trajectories, and (2) estimate all-cause and external-cause mortality relative to the general population. This nationwide cohort study included 22,449 individuals aged 6–24 newly diagnosed with SUD in the Czech Republic, 2015–2019. Sex-specific crude mortality rates (CMRs) and age-standardized mortality ratios (SMRs) were calculated for children (< 18 years) and young adults (18–29 years) to estimate mortality. The most common initial diagnoses were alcohol use disorders (55%), followed by polysubstance use (14%), and cannabis use disorders (11%). The mean age at first diagnosis was 18.7 years, lower for females (17.9) than males (19.1). Females were more often diagnosed with opioid, sedative/hypnotic, and stimulant use disorders, whereas males with cannabis and polysubstance use disorders (p < 0.001). During follow-up, 137 individuals (0.6%) died. All-cause and external-cause CMRs were 242.1 and 171.4 per 100,000 person-years, both higher in males (1.9- and 2.6-fold). Excess mortality was observed in both age groups, with all-cause SMRs of 9.5 (95% CI 5.6–16.0) for children and 5.7 (4.8–6.8) for young adults; external-cause SMRs were 19.1 (10.8–33.6) and 6.6 (5.3–8.1), respectively. Early-onset SUD in clinical populations shows substantial sex differences and markedly elevated early, premature mortality. These findings underscore the need for early detection and targeted interventions for vulnerable youth.
Havig, Stine Marie; Høiseth, Gudrun; Thaulow, Cecilie Hasselø; Green, Henrik; Skurtveit, Svetlana Ondrasova & Edvardsen, Hilde Marie Erøy (2026). Prescription status and drug concentrations in methadone intoxications versus non-intoxications: A registry-linked study of autopsy cases. Forensic Science International. ISSN 0379-0738. 388. doi: 10.1016/j.forsciint.2026.113084. Full text in Research Archive Show summary
Aims Limited information exists on characteristics associated with methadone intoxication deaths. We therefore aimed to describe and explore differences in demographics, methadone prescription status, and drug concentrations in deaths with methadone, comparing intoxications with non-intoxications. Methods 1092 forensic autopsy cases with methadone detected in blood analyzed at Oslo University Hospital (2004–2021) were linked to the Norwegian Cause of Death Registry and the Norwegian Prescribed Drug Registry. Cases were grouped as methadone intoxication (n = 638), other intoxication (n = 252), and non-intoxication (n = 202). Non-parametric tests (Chi-squared, Mann–Whitney U) and logistic regression analyses were used to compare demographic variables, prescription status, and drug concentrations (opioids, benzodiazepines, stimulants, ethanol) between intoxications and non-intoxications. Results Methadone prescription was less common in methadone intoxications and other intoxications than in non-intoxications (28.8% and 27.4% vs. 59.9%, respectively; P < 0.001 for both). Methadone intoxications were associated with younger age (adjusted odds ratio [aOR] 0.96; 95% confidence interval [CI] 0.95–0.98) and no recent methadone prescription (aOR 3.01; 95% CI 2.04–4.44) compared with non-intoxications. Adjusted analyses revealed no significant difference in methadone concentration between these groups. However, among cases with prescription, methadone intoxications were associated with higher methadone concentration (aOR 1.20; 95% CI 1.09–1.32). Intoxications also involved more psychoactive drugs and more frequent detections of benzodiazepines and stimulants. Conclusion Our results support that the determination of fatal methadone intoxications cannot be based solely on interpretation of postmortem methadone concentrations in blood but is dependent on information about prescription status and degree of tolerance.
Rolová, Gabriela; Skurtveit, Svetlana Ondrasova; Bukten, Anne; Odsbu, Ingvild & Eide, Desiree (2026). Factors associated with changes in opioid analgesic prescribing after opioid agonist treatment initiation: A nationwide registry cohort study. Drug and Alcohol Dependence Reports. 19, p. 100426–100426. doi: 10.1016/j.dadr.2026.100426. Full text in Research Archive
Amundsen, Ellen Johanna; Skurtveit, Svetlana Ondrasova & Odsbu, Ingvild (2026). Risk and cause of overdose death after exposure to dispensed opioid analgesics. Scandinavian Journal of Public Health. ISSN 1403-4948. p. 1–9. doi: 10.1177/14034948261424666. Full text in Research Archive Show summary
Aims: Overdose deaths have been increasing in parts of Europe, including Norway, where opioid analgesics have been the leading cause since 2016. This study quantifies the risk of overdose death following exposure to dispensed opioid analgesics, stratified by sex and age, and examines associated causes of death. Methods: Nationwide data from 2010 to 2018 on overdose deaths were obtained from the Norwegian Cause of Death Registry and linked with the Norwegian Prescription Database to identify prior opioid analgesic dispensations. Aggregated prescription data and population figures from Statistics Norway were also used. Results: From 2010 to 2018, 42% of individuals who died from an overdose had been dispensed opioid analgesics in the previous year. Among those dispensed strong opioid analgesics, the overdose death rate was low but exceeded the population death rate among men aged 20–49 and women aged 20–39 years. The rate was higher in men and remained stable over time. Opioids other than heroin or methadone were listed as the cause of death in 62% of cases with prior dispensed opioid analgesics, compared with 24% among those without. Conclusions: The risk of overdose deaths following exposure to strong opioid analgesics was low but higher than population death rates for men under 50 and women under 40 years. Preventive strategies based on risk markers such as sex, age and opioid analgesic strengths, combined with other known risk markers, can help guide safer prescription of opioid analgesics and reduce overdose death.
Nestvold, Håkon Høydal; Haarr, Eirik; Hamina, Aleksi; Hjellvik, Vidar; Skurtveit, Svetlana Ondrasova & Odsbu, Ingvild (2025). Incidence of and Determinants for Substance Use Disorders Among Individuals With Long‐Term Prescription Opioid Use: A Population‐Based Cohort Study. Pharmacoepidemiology and Drug Safety. ISSN 1053-8569. 34(9). doi: 10.1002/pds.70212. Full text in Research Archive Show summary
Purpose: To assess the incidence of substance use disorders (SUDs) after long‐term prescription opioid use (LTOU) and to identify socioeconomic and clinical risk factors associated with SUD among individuals with LTOU. Methods: Cohort study using linked nationwide registers (2011–2019). We identified 114 916 individuals who used opioids for more than 3 months (LTOU) without previous LTOU or SUD diagnosis. Outcomes were any incident SUD diagnosed in primary or secondary care (ICPC‐2: P15‐P16, P18‐P19; ICD‐10: F10‐F16, F18‐F19) and opioid use‐related disorders (OUD) diagnosed in secondary care (ICD‐10: F11). We calculated age‐ and sex‐stratified incidence rates (IR), incidence rate ratios (IRR) and age‐standardized incidence rates (ASIR). Adjusted hazard ratios (aHR) were calculated using Cox proportional hazards regression. Results: In total, 5.3% (6069/114916) were diagnosed with SUD (ASIR = 28.7 per 1000 person‐years), and males had higher IRs compared to females (IRR). Males had higher risk of SUD in both the younger (aHR = 1.59, 95% CI 1.47–1.72) and older (1.66, 1.54–1.78) age group. Low education (1.87, 1.66–2.11) and unemployment (1.26, 1.15–1.38) had the strongest association with SUD in the younger age group versus low income (1.37, 1.21–1.57) and living alone (1.53, 1.41–1.65) in the older age group. Previously diagnosed mental disorders and use of benzodiazepines‐ or benzodiazepine‐related drugs (BZDRs) were associated with SUD in both age groups (1.85, 1.71–2.01; 2.37, 2.18–2.57). Being male and having used BZDRs were the covariates strongest associated with OUD. Conclusions: Being male, young, having low socioeconomic status, previous mental disorders or BZDR use were associated with SUD diagnosis among individuals with LTOU.
Gjesdal, Kine; Skurtveit, Svetlana Ondrasova; Djuv, Ane; Paulsen, Aksel; Sevild, Cille Hagland & Lid, Torgeir Gilje (2025). A feasibility study of a co-developed, multidisciplinary, tailored intervention for chronic pain management in municipal healthcare services. Scandinavian Journal of Pain. ISSN 1877-8860. 25(1). doi: 10.1515/sjpain-2025-0028. Full text in Research Archive Show summary
Chronic pain represents a major public health challenge, substantially affecting daily functioning and overall well-being. While self-management strategies can be effective, they are often introduced only after pharmacological or surgical treatments have proven insufficient, highlighting the need for more personalized, accessible, and early interventions in primary care. However, the feasibility and practical implementation of such approaches remain insufficiently explored. Considering these challenges, the aims of this study were to co-create and to evaluate the feasibility of a personalized, multidisciplinary, and coordinated intervention for chronic pain management within municipal healthcare services. Methods The intervention included a generic pain management course (part one) and a personalized second part offering various group-based courses. Participants ( n = 70) were recruited through an orthopedic outpatient clinic and general practitioners. Individual consultations with course leaders were conducted before, during, and after the intervention. Questionnaires assessing health-related quality of life, alcohol consumption, medication use, and sleep were administered at baseline, midway, and post-intervention, along with a self-reported evaluation of the intervention after completion. Results Among the total participants ( n = 70), 81% completed Part 1 of the intervention, while 61% completed the entire intervention. At baseline, participants had a mean EQ-5D-5L score of 0.65 and an EQ-VAS score of 48.8. Regarding alcohol use, 47% were drinking once a month or less, and no participants were drinking alcohol four or more times a week. Insomnia was reported by 84%. Paracetamol was the most used daily medication (41%), followed by non-steroidal anti-inflammatory drugs and weak opioids (26% each). In Part 2 of the intervention, stress management courses were the most frequently selected (26%), followed closely by physical activity and body-mind activity at 23%. Most participants reported benefit, with 63% (Part 1) and 56% (Part 2) indicating good or very good benefit, and 98% would recommend it to others. Conclusion This feasibility study demonstrates the potential for addressing the complex needs of individuals with chronic pain through a personalized and multidisciplinary intervention in primary care. The high completion rates indicate feasibility and acceptability. The findings support further evaluation of resource use, implementation, and effectiveness in future controlled trials.
Haarr, Eirik; Handal, Marte; Skurtveit, Svetlana Ondrasova & Lid, Torgeir Gilje (2025). Oxycodone and Morphine Use in Hospitals and Primary Care in Norway 2010–2021: A Nationwide Study. European Journal of Pain. ISSN 1090-3801. 29(6). doi: 10.1002/ejp.70045. Full text in Research Archive Show summary
Background Increasing oxycodone prescribing and its association with opioid-related harms have raised concerns. In Norway, nearly 90% of opioids are prescribed in primary care, making primary care decisions important to overall opioid exposure. In-hospital use may influence primary care practices through several mechanisms. This study analyses oxycodone and morphine use in Norwegian hospitals and its association with primary care prescribing from 2010 to 2021, alongside a review of tender agreements for these medications. Methods Morphine and oxycodone, available in all relevant formulations, served as opioid proxies to compare covariation between hospitals and their catchment areas. We analyzed 2010–2021 procurement data from hospital pharmacies and primary care dispensing data from the Norwegian Prescription Database for all hospital trusts. Correlations between hospital and primary care morphine-to-oxycodone prescribing ratios were assessed using Pearson's r. Annual tender agreements were obtained from the national Hospital Procurement Organization. Results Hospital oxycodone use increased by 67.0% and primary care prescribing rose by 86.5%. Morphine use increased by 12.6% in hospitals but decreased by 23.2% in primary care. A moderate covariation (Pearson's r = 0.48) between hospital use and primary care prescribing was observed. Hospital tender agreements for morphine declined by 80%, while those for oxycodone remained stable. Conclusions Oxycodone use substantially increased relative to morphine in Norwegian hospitals and primary care. Prescription patterns show moderate covariation, suggesting a potential link between hospital and primary care prescribing, though causality remains uncertain. Tender agreements may contribute to prescribing trends in hospitals, with possible associations in primary care. Significance This study is the first to provide quantitative evidence of covariation between in-hospital use and primary care opioid prescribing across a national healthcare system. Despite recommendations favoring morphine, oxycodone prescribing continues to rise in Norway, with marked geographical variation. By linking procurement data, prescription patterns and tender agreements, our findings highlight the need to consider hospital practices and structural factors when addressing opioid prescribing. These results offer new insights into potential levers for opioid stewardship across care levels.
Engel, Sophia; Rosseland, Leiv Arne; Smits, Martijn Johannes Bernardus; Skurtveit, Svetlana Ondrasova; Gran, Jon Michael & Nordseth, Trond [Show all 8 contributors for this article] (2025). Population-based multistate modelling of peritraumatic opioid use among trauma patients from the Norwegian Trauma Registry. British Journal of Anaesthesia. ISSN 0007-0912. 135(2), p. 390–400. doi: 10.1016/j.bja.2025.05.008. Full text in Research Archive
Samuelsen, Per-Jostein; Hjellvik, Vidar; Odsbu, Ingvild; Stubhaug, Audun; Skurtveit, Svetlana Ondrasova & Vambheim, Sara Magelssen (2025). Trends in Postoperative Opioid Use in Norway 2011-2018: A Nationwide Registry-Based Study. Basic & Clinical Pharmacology & Toxicology. ISSN 1742-7835. 136(6). doi: 10.1111/bcpt.70040. Full text in Research Archive Show summary
Little is known about the overall trends in postoperative opioid use in a Nordic setting. We investigated the trends in Norway between 2011 and 2018. We linked the Norwegian Prescription Database, the Norwegian Patient Registry, the Cancer Registry of Norway and the Cause of Death Registry. Postoperative opioid use was defined as the first opioid dispensing per year within 14 days of a NOMESCO Classification of Surgical Procedure code. We excluded patients with cancer or opioid maintenance therapy. We calculated period prevalence (Norwegian population ≥ 15 years as the denominator), substance distribution, initial amount and proportion of long-acting formulations. Among 746 435 postoperative opioid users ≥ 15 years, the period prevalence increased from 27.0/1000 in 2011 to 30.0/1000 in 2018 (long-term use: 2.0 to 3.3/1000). Codeine was most frequent (67%) in 2011, while codeine and tramadol were equally dispensed (41% and 43%) in 2018; oxycodone increased from 3% to 12%. The initial amount increased for opioids as a group but declined for oxycodone (1236 morphine milligram equivalents [MME]/patient to 914 MME/patient) and tramadol (233 MME/patient to 219 MME/patient). Long-acting depot formulations increased from 5% to 12%. Over time, postoperative opioid use increased, with a shift toward more tramadol and oxycodone in lower initial amounts, and increased use of long-acting formulations.
Rolová, Gabriela; Engeland, Anders; Pedersen, Line; Odsbu, Ingvild; Hamina, Aleksi & Skurtveit, Svetlana Ondrasova (2025). Mortality among patients with long-term prescription opioid use in Norway: A nationwide registry-based cohort study. Pain. ISSN 0304-3959. 166(11), p. e555–e562. doi: 10.1097/j.pain.0000000000003653. Full text in Research Archive Show summary
The aim was to estimate all-cause and cause-specific mortality in long-term prescription opioid users compared to the general population. This nationwide registry–based cohort study used data of patients aged 15 to 69 years with no previous cancer diagnosis and a recorded episode of long-term opioid analgesics use (anatomical therapeutic chemical [ATC] group N02A; N = 116,006) in Norway between 2011 and 2019. Sex-specific crude mortality rates (CMR) and age-standardized mortality ratios (SMRs) were calculated for all-cause and cause-specific mortality, ie, natural and unnatural causes for the whole study population and for different age groups (15-34, 35-54, and 55-69 years). Overall, 4.6% (2491/54,535) of men and 2.7% (1680/61,471) of women died during the follow-up period. Crude mortality rates for all-cause mortality were 1194 and 724 deaths per 100,000 person-years (PY) in men and women, respectively. Men had higher CMRs across all causes, particularly unnatural causes (221 and 101 deaths per 100,000 PY in men and women, respectively). Patients with long-term opioid use had a 4 times higher all-cause mortality (SMR = 3.8 [95% CI = 3.6-3.9] in men and 3.7 [3.5-3.9] in women aged 15-69 years) compared to the general Norwegian population of the same age. Excess mortality was observed across all causes, particularly suicide, accidents, and accidental poisoning. Standardized mortality ratios decreased with age and were highest for the youngest age group (15-34 years), particularly among men. Long-term prescription opioid use is associated with an increased risk of death. Clinicians should weigh the risks of long-term opioid use against the benefits.
Pedersen, Line; Borchgrevink, Petter Christian & Skurtveit, Svetlana Ondrasova (2025). Vedvarende bruk av høye doser opioider og andre vanedannende legemidler. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 145. doi: 10.4045/tidsskr.24.0173. Full text in Research Archive
Rolová, Gabriela; Skurtveit, Svetlana Ondrasova; Handal, Marte; Kurita, Geana Paula; Lid, Torgeir Gilje & Odsbu, Ingvild [Show all 7 contributors for this article] (2025). Trends in opioid prescribing in Scandinavian countries from 2010 to 2023: Insights from multi-metric evaluation. British Journal of Clinical Pharmacology. ISSN 0306-5251. 91(12), p. 3341–3352. doi: 10.1002/bcp.70177. Full text in Research Archive Show summary
Aims Monitoring opioid prescribing across different healthcare systems is essential to understanding population-level exposure and informing global health policies. This study examined opioid utilization in Scandinavian countries between 2010 and 2023 using multiple complementary metrics, addressing the limitations of single-metric comparisons. Methods A repeated cross-sectional study utilizing publicly available drug use statistics on opioid analgesics (ATC group N02A) dispensed in pharmacies from Denmark, Norway and Sweden. We assessed annual changes in utilization based on four metrics: 1-year prevalence (users/1000 inhabitants/year), defined daily doses (DDD)/1000 inhabitants/day (TID), morphine milligram equivalents (MMEs)/TID, and MMEs/user/year. Results Opioid use declined in Denmark and Sweden—in both 1-year user prevalence and volumes of MMEs—while stabilizing in Norway. Norway consistently had a higher and stable prevalence of opioid users. Denmark led in total amounts of MMEs dispensed, likely due to more frequent morphine and oxycodone use, whereas Norway ranked highest in DDDs. Denmark and Sweden showed increasing preference for “strong opioids”, while codeine-paracetamol and tramadol remained predominant in Norway. The prevalence of oxycodone users increased in Norway and Sweden, with Sweden having the highest prevalence of users but the lowest annual average volumes per user. Conclusions This study found major differences in total opioid use and substance-specific prescribing patterns, reflecting diverse pain management strategies across Scandinavia. Changing use patterns suggest evolving prescribing strategies and possible shifts in the target group for opioid pain therapy. In addition, metric-dependent variation underscores the need for using multiple complementary metrics to accurately interpret opioid utilization trends.
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
Rolová, Gabriela; Skurtveit, Svetlana Ondrasova; Gabrhelik, Roman; Mravčík, Viktor & Odsbu, Ingvild (2024). Exploring dual diagnosis in opioid agonist treatment patients: a registry-linkage study in Czechia and Norway. Addiction science & clinical practice. ISSN 1940-0632. 19(37). doi: 10.1186/s13722-024-00467-5. Full text in Research Archive Show summary
Background Knowledge of co-occurring mental disorders (termed ‘dual diagnosis’) among patients receiving opioid agonist treatment (OAT) is scarce. This study aimed (1) to estimate the prevalence and structure of dual diagnoses in two national cohorts of OAT patients and (2) to compare mental disorders between OAT patients and the general populations stratified on sex and standardized by age. Methods A registry-linkage study of OAT patients from Czechia (N = 4,280) and Norway (N = 11,389) during 2010– 2019 was conducted. Data on mental disorders (F00-F99; ICD-10) recorded in nationwide health registers were linked to the individuals registered in OAT. Dual diagnoses were defined as any mental disorder excluding substance use disorders (SUDs, F10-F19; ICD-10). Sex-specific age-standardized morbidity ratios (SMR) were calculated for 2019 to compare OAT patients and the general populations. Results The prevalence of dual diagnosis was 57.3% for Czechia and 78.3% for Norway. In Czechia, anxiety (31.1%) and personality disorders (25.7%) were the most prevalent, whereas anxiety (33.8%) and depression (20.8%) were the most prevalent in Norway. Large country-specific variations were observed, e.g., in ADHD (0.5% in Czechia, 15.8% in Norway), implying differences in screening and diagnostic practices. The SMR estimates for any mental disorders were 3.1 (females) and 5.1 (males) in Czechia and 5.6 (females) and 8.2 (males) in Norway. OAT females had a significantly higher prevalence of co-occurring mental disorders, whereas SMRs were higher in OAT males. In addition to opioid use disorder (OUD), other substance use disorders (SUDs) were frequently recorded in both countries. Conclusions Results indicate an excess of mental health problems in OAT patients compared to the general population of the same sex and age in both countries, requiring appropriate clinical attention. Country-specific differences may stem from variations in diagnostics and care, reporting to registers, OAT provision, or substance use patterns.
Høibo, Trond; Skurtveit, Svetlana Ondrasova & Lid, Torgeir Gilje (2024). Is general practitioner involvement in the initiation of opioids for chronic non-cancer pain associated with opioid dose and concurrent drug use? Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 43(1), p. 96–99. doi: 10.1080/02813432.2024.2404053. Full text in Research Archive Show summary
Objective Is the involvement of the regular general practitioner (GP) in the decision to initiate opioid treatment for chronic non-cancer pain (CNCP) associated with two main risk factors for serious adverse events: increased opioid dose and the concomitant use of prescribed benzodiazepines or benzodiazepine-related medications? Design and setting An anonymous web-based survey was conducted in the county of Rogaland, Norway, during the spring of 2021. Subjects GPs who self-reported applying at least once for reimbursement of opioids prescribed to treat CNCP. They were asked to answer the survey based on the last patient for whom they recalled submitting a reimbursement application. Main outcome measures 1) Total opioid dose in daily oral morphine equivalents (OMEQ). 2) Concurrent use of benzodiazepines and/or benzodiazepine-related drugs. Results The daily opioid dose was lower when the surveyed GPs initiated the opioid treatment (36 OMEQ, n = 25), than when others had initiated the treatment (108 OMEQ, n = 31, p = 0.001). For concurrent use of benzodiazepine or benzodiazepine-related drugs, no significant difference was found (33%, n = 9 with GP involvement vs. 47%, n = 16, p = 0.279 with no GP involvement). Conclusions GP involvement in the initiation of opioid medication for CNCP was associated with a lower opioid dose being prescribed. Implications GP involvement in the initiation of opioid prescriptions may facilitate safer prescribing. KEY POINTS Opioid treatment against chronic non-cancer pain (CNCP) can be reimbursed in Norway. High opioid doses and the concomitant use of other medications with addictive properties, particularly benzodiazepines, increase the risk of serious adverse events. When the general practitioner (GP) in the survey had initiated the opioid treatment, this was associated with a lower opioid dose, but not with less concomitant use of benzodiazepines.
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 (Tidsskriftet). ISSN 0029-2001. 144(2), p. 1–15. doi: 10.4045/tidsskr.23.0414. Full text in Research Archive Show summary
Bakgrunn Kunnskap om psykiske lidelser blant pasienter med vedvarende opioidbruk for behandling av langvarige ikke-kreftrelaterte smerter er viktig, da psykiske lidelser og plager kan bidra til å forsterke eller vedlikeholde smerte og påvirke evnen til å håndtere egen sykdom. Vi har undersøkt forekomst av psykiske lidelser og plager, inkludert rusmiddellidelser, hos pasienter med vedvarende opioidbruk i 2019. Materiale og metode Personer ≥ 18 år med vedvarende opioidbruk og personer ≥ 18 år med minst én registrert psykisk lidelse i spesialisthelsetjenesten i 2019 ble inkludert. Data ble hentet fra nasjonale helseregistre. Pasienter som fikk opioider for langvarige smerter på blå resept ble sammenlignet med dem som fikk opioider utelukkende på hvit resept. Resultater Forekomsten av psykiske lidelser og plager var 34 % blant 14 403 personer som fikk opioidene forskrevet på blå resept, og 42 % blant 38 001 personer som fikk opioidene på hvit resept. Dette tilsvarer 2–3 ganger økt forekomst sammenlignet med den generelle befolkningen. Det var spesielt høyere forekomst av angstlidelser og rusmiddellidelser. Det var høyest forekomst av psykiske lidelser og plager i aldersgruppen 18–44 år (49–55 %). Fortolkning Blant pasienter med vedvarende opioidbruk var det en stor andel med psykiske lidelser og plager, som er kjente risikofaktorer for å utvikle problematisk opioidbruk og avhengighetssyndrom. HOVEDFUNN Forekomst av diagnostiserte psykiske lidelser og plager blant pasienter med vedvarende opioidbehandling av langvarige ikke-kreftrelaterte smerter i 2019 var høyest i den yngste aldersgruppen (18–44 år) og blant dem som fikk opioider utelukkende på hvit resept. Pasienter med vedvarende opioidbruk hadde 2–3 ganger høyere forekomst av psykiske lidelser, inkludert rusmiddellidelser, diagnostisert i spesialisthelsetjenesten sammenlignet med den generelle befolkningen. Rusmiddellidelser var hyppigst blant unge menn.
Høibo, Trond; Skurtveit, Svetlana Ondrasova & Lid, Torgeir Gilje (2024). Opioider på blå resept mot langvarige smerter – en spørreundersøkelse til fastleger. Norsk Farmaceutisk Tidsskrift (NFT). ISSN 0029-1935. 8(8), p. 40–44. Full text in Research Archive Show summary
Hensikt: Fastleger har muligheten til å søke om individuell refusjon av opioider mot langvarige ikke-kreftrelaterte smertetilstander. Gitte kriterier skal sikre forsvarlig og god behandling. Vi ville undersøke om pasientene er sikret forsvarlig og hensiktsmessig behandling i praksis, ved å se på viktige risikofaktorer for overdose og avhengighet og fastlegens holdning til behandlingen. Materiale og metode: Alle fastleger i Rogaland som oppga å minst én gang ha søkt om individuell refusjon av opioider mot langvarig smertetilstand, ble invitert via e-post til en nettbasert, anonym spørreundersøkelse. Det ble mottatt 61 svar, responsraten var 32 %. Fastlegene besvarte spørsmålene ut fra én konkret pasient de hadde søkt refusjon for. Resultater: Gjennomsnittlig dosering per dag var 76 mg orale morfinekvivalenter (OMEQ). Samtidig bruk av legemidler fra reseptgruppe A eller B i tillegg til opioider forekom hos 53 % (n = 31) av pasientene. I gruppen der pasienten hadde slik samtidig bruk var 41 % (n = 13) av fastlegene enig eller delvis enig i at den medikamentelle behandlingen var hensiktsmessig. I gruppen der pasienten kun brukte opioider, mente 72 % av fastlegene det samme. Konklusjon: Ordningen med individuell refusjon av opioider på blå resept mot langvarige smertetilstander er ingen garanti for at pasienten er sikret forsvarlig eller hensiktsmessig medikamentell behandling.
Nøst, Torunn Hatlen; Skurtveit, Svetlana Ondrasova; Odsbu, Ingvild; Pedersen, Line; Borchgrevink, Petter Christian & Handal, Marte (2024). Prevalence of substance use disorder diagnoses in patients with chronic pain receiving reimbursed opioids: An epidemiological study of four Norwegian health registries. Scandinavian Journal of Pain. ISSN 1877-8860. 24(1), p. 1–9. doi: 10.1515/sjpain-2024-0059. Full text in Research Archive Show summary
Objectives Since 2008, patients have had access to reimbursed analgesics, including opioids, for chronic pain in Norway. There is a need for knowledge on the occurrence and trends over time of substance use disorder (SUD) diagnoses among patients who receive reimbursed opioids for chronic pain. The primary aim of this study was to investigate the prevalence of SUD diagnoses in patients with chronic pain using reimbursed opioids from 2010 to 2019 in Norway. The secondary aim was to investigate the prevalence of other mental health diagnoses among those receiving reimbursed opioids in the subgroups with and without SUD diagnoses. Methods A cross-sectional design utilising data from four Norwegian nationwide registries. Results The annual number of individuals with SUD diagnoses increased from 377 to 932 from 2010 to 2019, while the annual prevalence of individuals with SUD remained relatively stable at around 5%. There was a higher prevalence for all categories of other mental health diagnoses among individuals with a SUD diagnosis, compared to those without a SUD diagnosis. Conclusion The prevalence of SUD diagnoses was low in the population using reimbursed opioids for chronic pain in Norway, but the number of patients increased in the study period because the number of individuals receiving reimbursed opioids increased. Patients with a SUD used on average twice the daily doses of opioids compared to patients without a SUD. They were also more likely to have an additional mental health diagnosis.
Mcdonald, Rebecca Silvia; Eide, Desiree; Skurtveit, Svetlana Ondrasova & Clausen, Thomas (2024). Pills and the damage done: the opioid epidemic as man-made crisis. Frontiers in Public Health. 11. doi: 10.3389/fpubh.2023.1241404. Full text in Research Archive Show summary
The prescription opioid epidemic has slowly evolved over the past quarter century with increasingly detrimental consequences for public health. Man-made crises are often unforeseen and characterized by a situation without natural causes where – because of human intent, error, negligence, or the failure of manmade systems – the level of needs in the population exceeds available resources to counter the problem. This paper presents the prescription opioid epidemic as a man-made crisis and explores the public health impact of opioid manufacturers and other industries producing commodities with addictive potential as a shared vulnerability among countries. We examine this concept within the framework of the commercial determinants of health. We address three key aspects of the commercial determinants of health: (1) Cross-industry mechanisms, (2) policy inertia, and (3) the role of industry in science. Within cross-industry mechanisms, we explore parallels between prescription opioid epidemic and unhealthy commodity industries in terms of marketing, corporate use of misinformation, and diversionary tactics. Next, we examine how policy inertia has dominated the slow response to this man-made crisis. Lastly, we discuss how results from clinical trials are used as a key marketing strategy for drugs. The origins of the prescription opioid epidemic may be traced to innovations in drug development with the promise of improved pain management. However, through multiple factors, including fraudulent marketing from pharmaceutical industry and policy inertia, the resulting crisis represents a multi-system failure of regulation exploited by corporate greed.
Ørnskov, Mark Puch; Kurita, Geana Paula; Herling, Suzanne Forsyth; Sjøgren, Per; Skurtveit, Svetlana Ondrasova & Odsbu, Ingvild [Show all 8 contributors for this article] (2024). Opioid use after surgical treatment in the Danish population—Protocol for a register-based cohort study. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. 68(10), p. 1565–1572. doi: 10.1111/aas.14506. Full text in Research Archive Show summary
Background: Over the past 25 years, global opioid consumption has increased. Denmark ranks fifth in opioid use globally, exceeding other Scandinavian countries. Postsurgical pain is a common reason for opioid prescriptions, but opioid use patterns after patient discharge from the hospital are unclear. This study examines trends in opioid prescription among Danish surgical patients over a year. Methods: This register-based cohort study will use data from Danish governmental databases related to patients undergoing the 10 most frequent surgical procedures in 2018, excluding cancer-related and minor procedures. The primary outcome will be the dispensed postoperative opioid prescriptions at retail pharmacies over four quar- ters. Secondary analyses will include associations with sex, age, education attainment, and oral morphine equivalent quotient. Surgical treatments and diagnoses will be identified using NOMESCO procedure codes and ICD-10 codes. Opioids will be iden- tified by ATC codes N02A and R05DA04. Subjects will be classified as preoperative opioid consumers or non-opioid consumers based on opioid prescriptions redeemed in the 6 months before surgery. Discussion: The study will use extensive national register-based data, ensuring con- sistent data collection and enhancing the generalizability of the findings to similar healthcare systems. The study may identify high-risk populations for long-term opi- oids and provide information to support opioid prescribing guidelines and public health policies.
Kostovski, Emil; Hamina, Aleksi; Hjellvik, Vidar; Clausen, Thomas & Skurtveit, Svetlana Ondrasova (2024). Increased cancer incidence and mortality among people with opioid use-related disorders: A nation-wide cohort study. Addiction. ISSN 0965-2140. 119(9), p. 1575–1584. doi: 10.1111/add.16524. Full text in Research Archive Show summary
Background and aims Studies on cancer incidence and mortality among people with opioid use-related disorders are lacking. We aimed to measure cancer-specific incidence, mortality and survival among people diagnosed with opioid use-related disorders in Norway during 2010–18. Design and setting This was a cohort study conducted in Norway during 2010–18. Participants Individuals (n = 20 710) diagnosed with opioid use-related disorders. Measurements We conducted a cohort study utilizing a data-linkage of national health and population registers. Information on opioid use-related disorders was extracted from specialized healthcare, malignancies from the Cancer Registry of Norway and deaths from Cause of Death Registry. Cancer incidence and mortality were compared with the general population by calculating sex-specific age-standardized incidence (SIR) and mortality (SMR) ratios. One-year survival rates were computed. Findings Compared with the general population, people with opioid use-related disorders were at an increased risk of developing cancer overall [SIR = 1.2, 95% confidence interval (CI) = 1.1–1.3] with a higher than twofold cancer mortality rate (SMR = 2.3, 95% CI = 2.0–2.7). Excess risk was observed for liver (12.6, 95% CI = 9.1–17.0), larynx (4.7, 95% CI = 1.7–10.2), lung (3.5, 95% CI = 2.8–4.3) and pancreas cancer (2.6, 95% CI = 1.6–4.0), whereas reduced risk was found for melanoma (0.5, 95% CI = 0.3–0.9), breast (0.6, 95% CI = 0.4–0.9) and prostate cancers (0.3, 95% CI = 0.1–0.4). Site-specific SMRs were significantly elevated for liver (12.3, 95% CI = 8.5–17.2), lung (3.9, 95% CI = 3.0–5.0), pancreas (3.0, 95% CI = 1.7–4.8) and colon cancers (1.9, 95% CI = 1.1–3.1). The average 1-year survival rate after a cancer diagnosis was low in liver, pancreas and colon cancer, ranging from 10 to 15% less than that of the general population. Conclusions In Norway, cancer incidence and cancer-related mortality appear to be elevated among individuals with opioid use-related disorders.
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. Full text in Research Archive Show summary
Purpose: Opioid analgesics (OA) and other pharmaceuticals have been associated with drug-induced deaths. However, there is a lack of knowledge regarding patterns of use of these pharmaceuticals in the population and regarding such associations. We identify and describe subgroups of people with different patterns of filled prescriptions of OA and other relevant pharmaceuticals and examine associations with drug-induced deaths. In addition, we estimate the proportion of drug-induced deaths with a filled OA prescription and OA as cause of death. Methods: A Norwegian population-based nested case-control register study with cases (drug-induced deaths 2010–2018, N = 2388) and population controls matched for age, gender and year of inclusion (N = 21 465). Patterns of filled prescriptions for opioid analgesics (OA), benzodiazepines and benzodiazepine-related drugs, gabapentinoids, ADHD medication and antidepressants/antipsychotics were explored by k-means cluster analysis. Associations with drug-induced deaths were estimated by conditional logistic regression adjusted for sociodemographic characteristics. Overlap of filled OA prescriptions and OA as cause of death was estimated. Results: Five clusters were identified: ‘few prescriptions’, ‘weak OA’, ‘ADHD medication’, ‘sedative/psychiatric morbidity’ and ‘strong OA’. The ‘strong OA’ cluster had higher socioeconomic status compared to the other groupings. The risk of drug-induced death was also highest in this cluster (OR = 35.5; CI 25.6–49.3) and, for 68% (CI 64–73) of cases, filled prescriptions for OA was indicated as the underlying cause of death. Conclusions: The cluster analysis identified a subgroup with filled prescriptions of OA and other pharmaceuticals and a higher socioeconomic status than othersubgroups. This subgroup had a high risk of drug-induced death that needs to be addressed.
Nestvold, Håkon Høydal; Skurtveit, Svetlana Ondrasova; Hamina, Aleksi; Hjellvik, Vidar & Odsbu, Ingvild (2024). The risk of long-term opioid use among immigrants: a national registry-linkage study. Scandinavian Journal of Public Health. ISSN 1403-4948. doi: 10.1177/14034948241266744. Full text in Research Archive Show summary
Aims: We aimed to investigate the association between being an immigrant and long-term prescription opioid use in Norway in 2010–2019. Methods: Nested case–control study. The cases were all persons 18 years of age or older with long-term opioid use – that is, the use of prescription opioids longer than 3 months (N=215,642). Cases were matched to four controls who filled at least one opioid prescription, but never developed long-term opioid use in the study period (N=862,568) on sex, age and year of starting long-term/short-term opioid use. Being an immigrant was defined as being born outside of Norway to two foreign-born parents and four foreign-born grandparents. Adjusting for socioeconomic variables and clinical confounders, analyses were stratified on three age groups (18-44 years, 45-67 years and ⩾68 years). Results: For the youngest age group, being an immigrant was inversely associated with long-term opioid use (adjusted odds ratio 0.75; 95% confidence interval [0.72–0.77]) compared with being native-born people. For this age group, the odds ratio differed between people born in Africa (0.56 [0.52–0.62]), Central or South America (0.70 [0.62–0.79]), Europe outside the European Union (EU) (0.71 [0.65–0.77]), Asia including Turkey (0.80 [0.77–0.84]) and EU/European Economic Area (EEA) (0.81 [0.77–0.85]). For the middle age group, increased odds were found for immigrants versus natives (1.05 [1.02–1.08]) in particular for those born in North America (1.26 [1.13–1.40]) and the EU/EEA (1.13 [1.09–1.18]). There was no association in the oldest group. Conclusions: Compared with native-born people, immigrants had lower odds of long-term opioid use among younger adults, higher odds among middle-aged and similar odds among older adults.
Vambheim, Sara Magelssen; Hjellvik, Vidar; Odsbu, Ingvild; Skurtveit, Svetlana Ondrasova; Ekholdt, Christopher & Granan, Lars-Petter Ness [Show all 8 contributors for this article] (2024). Postoperative opioid use in Norway-a population-based observational study on patterns of long-term use. BMC Pharmacology and Toxicology. 25(1), p. 1–9. doi: 10.1186/s40360-024-00805-y. Full text in Research Archive Show summary
Background The utilization patterns of opioid analgesics and the proportion of long-term opioid use after surgery in Norway is largely unknown. Methods This study aimed to estimate the proportion of one-year long-term prescription opioid use among all Norwegian postoperative opioid users. Complete data from central health registries (NPR, NorPD, Statistics Norway, CoDR) were linked via the personal identification number unique to all citizens. The study period was January 1st 2010 until December 31st 2019. Long-term opioid use was defined as at least two opioid dispensings within two subsequent 90-day periods, with a minimum average use of 10 MME/day for the first 90 days. Results The study population consisted of 693 495 post-operative opioid users (53.6% women), whereof 73.2% had not used opioids the year before surgery (new users). Among the postoperative opioid users, 3.8% were one-year long-term opioid users. The corresponding figures for new and previous opioid users were 0.4% and 13.1%, respectively. The highest proportions of long-term opioid use were found after transluminal endoscopy, eye surgery and assessments related to surgical procedures. In previous opioid users, the proportion of one-year long-term use was higher among women than men in all age groups, a difference that increased with age. Conclusions The proportion of postoperative long-term opioid use in Norway is generally low. We detected higher proportions of long-term opioid use after certain types of surgery, but our crude surgery definition warrants further examination. Previous opioid users pose a particular challenge in the management of postoperative pain. Trial registration The study used national health registry data from the period 2010–2019. A pre-registered analysis plan is available at Open Science Framework.
Torp, Henrik Andreas; Skurtveit, Svetlana Ondrasova; Gustavsen, Ingebjørg G.; Gran, Jon Michael & Rosseland, Leiv Arne (2024). Post-injury use of opioid analgesics in patients with traumatic injury: A registry-based study. European Journal of Pain. ISSN 1090-3801. 29(3). doi: 10.1002/ejp.4743. Full text in Research Archive Show summary
Background Opioid analgesics are commonly used to treat acute and chronic pain following traumatic injury. Psychiatric comorbidity has been reported to be associated with increased pain and persistent opioid use. Our aims were to determine the extent of post-injury opioid use and assess whether pre-injury antidepressant, benzodiazepine, and z-hypnotic drug use is associated with increased post-injury opioid use. Methods Data on trauma patients aged 15 years and older included in the Oslo University Hospital Trauma Registry between 2005 and 2014 was linked to data from the Norwegian Prescription Database. We identified opioid dispensing within the first 90 and 365 days following trauma and determined subsequent persistent use. Multivariable logistic regression was applied to examine associations between pre- and post-injury drug use. Results 3912 of 11,057 patients (35.4%) had opioids dispensed within 90 days after trauma, and 4644 (42.0%) within 365 days. Among 9800 previously opioid-naïve, the proportions were 33.0% and 39.0%, respectively. One year after the first post-injury opioid dispensing, 9.6% of all opioid users and 4.5% of new users were defined as persistent users. Pre-injury benzodiazepine use and z-hypnotic use was associated with new persistent opioid use (adjusted odds ratio [aOR] 2.25; 95% confidence interval [CI] 1.47–3.45, and aOR 2.04; 95% CI 1.33–3.13, respectively), whereas pre-injury antidepressant use was not (aOR 1.49; 95% CI 0.97–2.30). Conclusions Opioid use after trauma is widespread. Development of persistent use is limited, particularly in previously opioid-naïve patients. Pre-injury benzodiazepine or z-hypnotic use seem to increase odds of new persistent use. Significance statement This large registry-based study adds to the body of knowledge on opioid use beyond in-hospital care in patients having sustained traumatic injury, a field which is scarcely investigated and not yet fully understood. It suggests that both previous drug therapy and the nature of opioid treatment initiation may affect outcome. This will help guide clinicians in selecting the appropriate pain management in this patient group.

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Skurtveit, Svetlana Ondrasova (2026). Preventing an Opioid epidemic In Norway: Focusing on Treatment of chronic pain foredrag. Full text in Research Archive
Skurtveit, Svetlana Ondrasova (2026). Vanedannende legemidler – trender og bruk. Full text in Research Archive
Skurtveit, Svetlana Ondrasova (2026). Vanedannende legemidler – trender og bruk. doi: https:/www.akan.no/kursoversikt. Full text in Research Archive
Skurtveit, Svetlana Ondrasova & Odsbu, Ingvild (2026). Rekvirenttilbakemeldinger (tiltak 10.2) og kunnskap (tiltak 10.5). Full text in Research Archive
Odsbu, Ingvild (2026). Legemiddelavhengighet og overdoser. Full text in Research Archive
Pedersen, Line (2026). Smertens Patofysiologi? doi: https:/relis.no/kurs_og_seminar/44920/. Full text in Research Archive
Skurtveit, Svetlana Ondrasova (2026). Har vi en opioid-epidemi? doi: https:/relis.no/kurs_og_seminar/44920/. Full text in Research Archive
Odsbu, Ingvild (2025). Oversikt over opioidbruk i Norge. Full text in Research Archive
Pedersen, Line (2025). Smertens patofysiologi? doi: https:/relis.no/kurs_og_seminar/44756/. Full text in Research Archive
Pedersen, Line (2025). Smertens patofysiologi? doi: https:/relis.no/kurs_og_seminar/44756/. Full text in Research Archive
Skurtveit, Svetlana Ondrasova (2025). Har vi en opioid-epidemi? doi: https:/relis.no/kurs_og_seminar/44756/. Full text in Research Archive
Pedersen, Line (2025). Smertens patofysiologi. Full text in Research Archive
Borchgrevink, Petter Christian (2025). Mer helhetlig behandling av smertepasienter. Full text in Research Archive
Borchgrevink, Petter Christian (2025). Mer helhetlige behandling av smerte pasienter. doi: https:/relis.no/kurs_og_seminar/44756/. Full text in Research Archive
Skurtveit, Svetlana Ondrasova (2025). Opioider og bruksmønstre. Full text in Research Archive
Rolová, Gabriela (2025). What Do We Know About the Risks of Long-Term Use of Opioid Analgesics? Lessons from Norway and Challenges for the Czech Republic. doi: https:/dialogy2025.cz/program/. Full text in Research Archive
Skurtveit, Svetlana Ondrasova (2025). Results of the Project on Preventing the Opioid Epidemic in Norway. doi: https:/dialogy2025.cz/program/. Full text in Research Archive
Borchgrevink, Petter Christian (2025). Nonmedical, coping-oriented, achievable treatment-concept as an alternative to opioids for chronic pain (NOMED). doi: https:/dialogy2025.cz/program/. Full text in Research Archive
Skurtveit, Svetlana Ondrasova (2025). Vedvarende bruk av reseptbelagte sterkesmertestillende legemidler og konsekvenser. Full text in Research Archive
Haarr, Eirik (2025). Studie: Forskriving av oksykodon økte mye – og mest blant fastlegene. [Journal]. internett. doi: https:/www.dagensmedisin.no/allmennmedisin-fastlege-forskning/studie-forskriving-av-oksykodon-okte-mye-og-mest-blant-fastlegene/705079. Full text in Research Archive
Skurtveit, Svetlana Ondrasova (2025). Har vi en opioid-epidemi? Full text in Research Archive
Borchgrevink, Petter Christian (2025). Mer helhetlig behandling av smertepasienter. Full text in Research Archive
Pedersen, Line (2025). Smertens patofysiologi. Full text in Research Archive
Edvardsen, Hilde Marie Erøy (2025). Overdoser med reseptbelagte opioider – et varsko om tryggere forskrivning - Oslo universitetssykehus HF. [Internet]. OUS-nettside. doi: https:/www.oslo-universitetssykehus.no/fag-og-forskning/nasjonale-og-regionale-tjenester/rettsmedisinske-fag/nyheter-og-artikler-fra-rmf/overdoser-med-reseptbelagte-opioider--et-varsko-om-tryggere-forskrivning/. Full text in Research Archive Show summary
En ny studie av overdosedødsfall i Norge avslører at en betydelig andel av de avdøde hadde fått opioidene som ble påvist ved obduksjon på resept. Dette utfordrer forestillingen om at overdoser hovedsakelig skyldes illegale rusmidler – og peker mot helsevesenet som en viktig aktør i forebygging.
Pedersen, Line (2025). Vanedannenede medikamenter. doi: https:/www.smertenettverk.no/single-post/nasjonalt-smerteklinikknettverksm%C3%B8te-28-08-25. Full text in Research Archive Show summary
Vitenskapeligforedrag
Skurtveit, Svetlana Ondrasova (2025). Vedvarende bruk av reseptbelagte sterke smertestillende legemidler og konsekvenser. Full text in Research Archive
Skurtveit, Svetlana Ondrasova & Borchgrevink, Petter Christian (2025). Denne gruppen har fire ganger høyere risiko for å dø. [Internet]. TV2. Full text in Research Archive
Hamina, Aleksi; McDonald, Rebecca Silvia & Skurtveit, Svetlana Ondrasova (2025). Pregabalin is associated with a higher overdose risk but the risk with gabapentin is not negligible. Pain. ISSN 0304-3959. 166(2), p. 463–464. doi: 10.1097/j.pain.0000000000003453. Full text in Research Archive
Skurtveit, Svetlana Ondrasova & Odsbu, Ingvild (2025). Handlingsplanen mot overdoser, del B. Full text in Research Archive
Skurtveit, Svetlana Ondrasova (2025). Suget etter pillene ble for stort. Daniel «måtte» rane apoteket. [Journal]. Dagsavisen. Full text in Research Archive
Skurtveit, Svetlana Ondrasova (2025). Opioider til smertepasienter: Forsker på hvem som blir avhengige. [Journal]. Dagens Medisin. Full text in Research Archive
Haarr, Eirik (2025). Increased use of oxycodone in hospitals and primary health care in Norway. [Internet]. nhi.no. Full text in Research Archive
Odsbu, Ingvild (2025). Opioidepidemi i Norge? Full text in Research Archive
Engel, Sophia; Rosseland, Leiv Arne; Smits, Martijn; Skurtveit, Svetlana Ondrasova; Gran, Jon Michael & Nordseth, Trond [Show all 8 contributors for this article] (2024). Peritraumatic patterns of opioid use among trauma patients: A national retrospective cohort study. Full text in Research Archive
Handal, Marte (2024). Langvarig smerte som folkehelseproblem. Full text in Research Archive
Skurtveit, Svetlana Ondrasova (2024). Differences in use of prescribed opioid analgesics between Norway, Denmark, and Sweden. Full text in Research Archive
Gjesdal, Kine (2024). Point – et samskapende prosjekt for å bedre behandlingen av langvarige smerter- det nye forebyggende helsearbeid? Full text in Research Archive
Skurtveit, Svetlana Ondrasova (2024). Point studien (forskrivning av reseptbelagte opioider). Full text in Research Archive
Skurtveit, Svetlana Ondrasova (2024). Smertestillende medikamenter og eldre kvinner. Full text in Research Archive
Haarr, Eirik (2024). Hospital use of opioids matter in primary care. Full text in Research Archive
Hamina, Aleksi (2024). Opioids, cancer and mortality with Aleksi Hamina. [Internet]. Addiction Audio. Full text in Research Archive
Kostovski, Emil (2024). Increased Cancer Incidence and Mortality among people with opioid use-related disorders – a nationwide cohort study. Full text in Research Archive
Lid, Torgeir Gilje (2024). POINT. Full text in Research Archive
Skurtveit, Svetlana Ondrasova; Hamina, Aleksi & Hoffmann, Mikael (2024). Drugs utilization research in specific therapeutic areas – opioids. In Elseviers, Monique; Wettermark, Björn; Mueller, Tanja; Benko, Ria; Bennie, Marion; Gvozdanovic, Katarina; Hoffmann, Mikael; Iaru, Irina; Ivanovska, Verica; Macbride-Stewart, Sean; Poluzzi, Elisabetta; Pont, Lisa; Blix, Hege Salvesen; Sanfelix-Gimeno, Gabriel; Selke, Gisbert; Taxis, Katja; Petrovic, Ana Tomas; Treciokiene, Indre & Vogler, Sabine (Ed.), Drug Utilization Research: Methods and Applications, 2nd Edition. Wiley-Blackwell. ISSN 9781119911661. p. 352–362. Full text in Research Archive
Engel, Sophia; Rosseland, Leiv Arne; Smits, Martijn; Skurtveit, Svetlana Ondrasova; Gran, Jon Michael & Nordseth, Trond [Show all 8 contributors for this article] (2024). Peritraumatic patterns of opioid use among trauma patients: A national retrospective cohort study. Full text in Research Archive
Engel, Sophia; Rosseland, Leiv Arne; Smits, Martijn; Skurtveit, Svetlana Ondrasova; Gran, Jon Michael & Nordseth, Trond [Show all 8 contributors for this article] (2024). Peritraumatic patterns of opioid use among trauma patients: A national retrospective cohort study. Full text in Research Archive
Engel, Sophia; Rosseland, Leiv Arne; Smits, Martijn; Skurtveit, Svetlana Ondrasova; Gran, Jon Michael & Nordseth, Trond [Show all 8 contributors for this article] (2024). Peritraumatic patterns of opioid use among Norwegian trauma patients: A national retrospective cohort study. Full text in Research Archive
Nestvold, Håkon Høydal; Skurtveit, Svetlana Ondrasova & Odsbu, Ingvild (2024). Sosioøkonomiske vansker øker sjansen for utvikle langvarig opioidbruk uavhengig av smertetilstander. Glimt. ISSN 1890-8489. 1-2024, p. 14–15. Full text in Research Archive
Rolová, Gabriela; Engeland, Anders; Odsbu, Ingvild; Hjellvik, Vidar & Skurtveit, Svetlana Ondrasova (2024). Mortality among patients with long-term prescription opioid use in Norway. Full text in Research Archive
Holter, Marianne Therese Smogeli (2024). Digital hjelp til smertebehandling. Glimt. ISSN 1890-8489. p. 20–21. Full text in Research Archive
Mcdonald, Rebecca Silvia (2024). Prescription High-Risk Polysubstance Use Among OST Patients and Implications for Clinical Practice. Full text in Research Archive
Odsbu, Ingvild (2024). Kan bli milliardbelønning for fentanyl-vaksine. [Journal]. VG. Full text in Research Archive
Skurtveit, Svetlana Ondrasova (2024). Mortality among patients with long-term prescription opioid use in Norway: A nationwide registry-based cohort study. Full text in Research Archive
Odsbu, Ingvild & Skurtveit, Svetlana Ondrasova (2024). Opioidepidemi i Norge? Full text in Research Archive
Haarr, Eirik; Høibø, Trond; Gjesdal, Kine; Lid, Torgeir Gilje & Skurtveit, Svetlana Ondrasova (2024). Smertepasienter må bli tatt på alvor. Full text in Research Archive
Hamina, Aleksi (2024). Increased cancer incidence and mortality among people with opioid use-related disorders: A nation-wide cohort study. Full text in Research Archive
Kostovski, Emil (2024). Opioidavhengighet og kreft. Full text in Research Archive
Borchgrevink, Petter Christian; Trydal, Heidi; Landmark, Tormod; Bjertnæs, Jacob; Sundby, Harald & Woodhouse, Astrid (2024). NOMED: Et mestringsorientert behandlingskonsept mot langvarige smerter. Utposten. ISSN 0800-5680. Full text in Research Archive
Borchgrevink, Petter Christian; Bjernæs, Jacob; Woodhouse, Astrid; Trydal, Heidi; Jost, Peter Dietrich & Landmark, Tormod [Show all 11 contributors for this article] (2024). Fastlegers respons på et mestringsorientert behandlingskonsept (NOMED). Utposten. ISSN 0800-5680. Full text in Research Archive
Skurtveit, Svetlana Ondrasova (2024). Da medisinene sluttet å virke. [Internet]. TV2. Full text in Research Archive
Gjesdal, Kine; Lid, Torgeir Gilje & Vestreheim, Ingvild Dugstad (2024). POINT. Full text in Research Archive
Odsbu, Ingvild (2024). Socioeconomic risk factors for long-term prescription opioid use: A national registry-linkage study. Full text in Research Archive
Haarr, Eirik (2024). Oxycodone and Morphine use in hospitals and primary healthcare in Norway 2010-2021. Full text in Research Archive
Edvardsen, Hilde Marie Erøy (2024). Codeine, oxycodone, and tramadol prescription prior to overdose deaths compared to toxicological findings. Full text in Research Archive
Skurtveit, Svetlana Ondrasova (2024). Exploring dual diagnosis in opioid agonist treatment: A comparative study between the Czech Republic and Norway. Full text in Research Archive
Nyman, Anna Armika Tussilago (2024). Prevalence of Benzodiazepine Prescription Prior to Overdose Deaths Compared to Toxicological Findings. Full text in Research Archive
McDonald, Rebecca Silvia (2024). Accidental versus intentional overdose death: national register linkage study. Full text in Research Archive
Rolova, Gabriela (2024). Mortality among long-term prescription opioid users. Full text in Research Archive
Kostovski, Emil (2024). Ny forskning viser at personer med lidelser relatert til opioidbruk har høyere risiko for kreft. [Internet]. Manifestsenteret.no. Full text in Research Archive
Borchgrevink, Petter Christian (2024). Langvarige smerter med ukjent årsak er ikke innbilning, viser studie. [Internet]. NRK Distriktsnyheter Rogaland. Full text in Research Archive
Clausen, Thomas & Skurtveit, Svetlana Ondrasova (2024). Bruken øker kraftig blant unge. Ingen vet hvorfor. [Internet]. TV2. Full text in Research Archive