Publikasjoner
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Marciuch, Anne; Birkeland, Bente; Saltyte Benth, Jurate; Solli, Kristin Klemmetsby; Tanum, Lars Håkon Reiestad & Mathisen, Ida
[Vis alle 7 forfattere av denne artikkelen]
(2023).
Personal recovery among people with opioid use disorder during treatment with extended-release naltrexone.
Heliyon.
ISSN 2405-8440.
9(7).
doi:
10.1016/j.heliyon.2023.e17516.
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Background and aims:
Recovery from substance use disorders (SUD) has traditionally been equated with abstinence. “Personal recovery” however emphasizes recovery as a unique and personal process, supported by changes in connectedness, hope, identity, meaning and empowerment. This study aimed to examine personal recovery in people receiving extended-release naltrexone (XR-NTX); specifically investigate changes in personal recovery during treatment, identify groups of participants following distinct trajectories of recovery, and characteristics predicting group-belonging.
Methods:
Overall change in recovery (Questionnaire about the Process of Recovery, QPR) score was assessed by linear mixed model in a subsample of 135 people with opioid use disorder (OUD) participating in a 24 + 28-week trial of XR-NTX. Growth mixture model was used to identify potential groups of people following distinct trajectories of personal recovery.
Results:
Overall, there was a significant change in QPR score during treatment. Four groups with distinct recovery trajectories were identified: “initially low– increase” (G1), “initially average– no change” (G2), “initially high– no change” (G3) and “initially high– increase” (G4). The groups were different with regards to level of psychological distress, social support, and the use of benzodiazepines. In addition, previous participation in opioid agonist treatment programs, current pain, life satisfaction, employment, heroin craving and previous use of heroin also differed between groups.
Conclusions:
Personal recovery among people receiving XR-NTX follows different trajectories, and various factors are associated with personal recovery. Particular attention regarding psychological distress, social support and heroin use among patients commencing XR-NTX treatment is important to facilitate successful recovery trajectories.
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Weimand, Bente Margrethe; Karlsson, Ann Tarja; Solli, Kristin Klemmetsby; Vederhus, John-Kåre; Mordal, Jon & Digranes, Linn Camilla Wergeland
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(2023).
Characteristics of opioid-dependent patients choosing antagonist treatment with extended-release naltrexone compared with patients in opioid maintenance treatment in Norway.
Heroin Addiction and Related Clinical Problems.
ISSN 1592-1638.
25(4),
s. 5–14.
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Background: Opioid dependency is a risk factor for several negative life events and conditions. The opioid receptor inhibitor extended-release naltrexone (XR-NTX) is safe and effective in reducing illicit substance use. Here, we report results of a naturalistic, multicentre, open-label trial of XR-NTX for 24 weeks, with an optional 28-week treatment extension (NaltRec study). Aims: The study aims were to compare sociodemographic and clinical variables between patients choosing XR-NTX (n=162) and those in opioid agonist treatment (OAT) (n= 155), and to compare these variables in the XR-NTX group between patients who were (n= 103) and were not (n= 59) in OAT before study inclusion. Methods: To measure objective-related factors, we used a structured interview at inclusion. Results: The XR-NTX group had fewer women, was younger and reported poorer living and social conditions than the OAT group. Both groups had serious health conditions. Across groups, 40% percent reported lifetime suicide attempts, and 60% reported abusive experiences, with 47% women and 17% men reporting sexual abuse. Age at onset of polydrug use was 20 years. Patients preferring XR-NTX to OAT reported poorer social conditions compared with those choosing OAT. Conclusions: Women and patients who are not stabilized before enrolment need specific attention to tailored supportive measures during treatment with extended-release naltrexone.
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Karlsson, Ann Tarja; Vederhus, John-Kåre; Clausen, Thomas; Weimand, Bente Margrethe; Solli, Kristin Klemmetsby & Tanum, Lars Håkon Reiestad
(2022).
Impact of Impulsivity, Hyperactivity, and Inattention on Discontinuation Rate among Opioid-Dependent Patients Treated with Extended-Release Naltrexone.
International Journal of Environmental Research and Public Health (IJERPH).
ISSN 1661-7827.
19(18),
s. 1–8.
doi:
10.3390/ijerph191811435.
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Previous studies have indicated elevated levels of impulsivity, hyperactivity, and inattention (IHI) among opioid-dependent patients seeking outpatient treatment with extended-release naltrexone (XR-NTX). This led us to hypothesize that IHI may be associated with a higher discontinuation rate for XR-NTX treatment. In a group of 162 patients with opioid dependence, discontinuation prior to the full 24 weeks of the study period (six injections and attending the study visit at 24 weeks) occurred in 49% of the patients, primarily in the early stage of treatment. IHI above the clinical cut-off on the adult ADHD self-report scale (ASRS) was not associated with a risk of premature discontinuation. This finding was not altered when controlling for socio-demographics, substance, use and mental health severity. Conclusively, high levels of IHI per se is not contradictive for XR-NTX treatment in regard to concern for premature discontinuation.
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Marciuch, Anne; Brenna, Ida Halvorsen; Weimand, Bente; Solli, Kristin Klemmetsby; Tanum, Lars Håkon Reiestad & Røstad, Bente
[Vis alle 7 forfattere av denne artikkelen]
(2022).
Patients’ experiences of continued treatment with extended-release naltrexone: a Norwegian qualitative study.
Addiction science & clinical practice.
ISSN 1940-0632.
17(1),
s. 1–14.
doi:
10.1186/s13722-022-00317-2.
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Background: The opioid antagonist extended-release naltrexone (XR-NTX) in the treatment of opioid use disorder
(OUD) is efective in terms of safety, abstinence from opioid use and retention in treatment. However, it is unclear how
patients experience and adjust to losing the possibility of achieving an opioid efect. This qualitative study is the frst
to explore how people with opioid dependence experience XR-NTX treatment, focusing on the process of treatment
over time.
Methods: Using a purposive sampling strategy, semi-structured interviews were undertaken with 19 persons with
opioid use disorder (15 men, four women, 22–55 years of age) participating in a clinical trial of XR-NTX in Norway. The
interviewees had received at least three XR-NTX injections. Qualitative content analysis with an inductive approach
was used.
Findings: Participants described that XR-NTX treatment had many advantages. However they still faced multiple
challenges, some of which they were not prepared for. Having to fnd a new foothold and adapt to no longer gaining
an efect from opioids due to the antagonist medication was challenging. This was especially true for those struggling
emotionally and transitioning into the harmful use of non-opioid substances. Additional support was considered
crucial. Even so, the treatment led to an opportunity to participate in society and reclaim identity. Participants had
strong goals for the future and described that XR-NTX enabled a more meaningful life. Expectations of a better life
could however turn into broken hopes. Although participants were largely optimistic about the future, thinking about
the end of treatment could cause apprehension.
Conclusions: XR-NTX treatment ofers freedom from opioids and can facilitate the recovery process for people with
OUD. However, our fndings also highlight several challenges associated with XR-NTX treatment, emphasizing the
importance of monitoring emotional difculties and increase of non-opioid substances during treatment. As opioid
abstinence in itself does not necessarily equal recovery, our fndings underscore the importance of seeing XR-NTX as
part of a comprehensive, individualized treatment approach.
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Brenna, Ida Halvorsen; Marciuch, Anne; Birkeland, Bente; Veseth, Marius; Røstad, Bente & Løberg, Else-Marie
[Vis alle 9 forfattere av denne artikkelen]
(2021).
‘Not at all what I had expected’: Discontinuing treatment with extended-release naltrexone (XR-NTX): A qualitative study.
Journal of Substance Abuse Treatment.
ISSN 0740-5472.
s. 1–11.
doi:
10.1016/j.jsat.2021.108667.
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Background:
Extended-release naltrexone (XR-NTX), an opioid antagonist, has demonstrated equal treatment outcomes, in terms of safety, opioid use, and retention, to the recommended OMT medication buprenorphine. However, premature discontinuation of XR-NTX treatment is still common and poorly understood. Research on patient experiences of XR-NTX treatment is limited. We sought to explore participants' experiences with discontinuation of treatment with XR-NTX, particularly motivation for XR-NTX, experiences of initiation and treatment, and rationale for leaving treatment.
Methods:
We conducted qualitative, semi-structured interviews with participants from a clinical trial of XR-NTX. The study participants (N = 13) included seven women and six men with opioid dependence, who had received a minimum of one and maximum of four injections of XR-NTX. The study team analyzed transcribed interviews, employing thematic analysis with a critical realist approach.
Findings:
The research team identified three themes, and we present them as a chronological narrative: theme 1: Entering treatment – I thought I knew what I was going into; theme 2: Life with XR-NTX – I had something in me that I didn't want; and theme 3: Leaving treatment – I want to go somewhere in life. Patients' unfulfilled expectations of how XR-NTX would lead to a better life were central to decisions about discontinuation, including unexpected physical, emotional, or mental reactions as well as a lack of expected effects, notably some described an opioid effect from buprenorphine. A few participants ended treatment because they had reached their treatment goal, but most expressed disappointment about not achieving this goal. Some also expressed renewed acceptance of OMT. The participants' motivation for abstinence from illegal substances generally remained.
Conclusion:
Our findings emphasize that a dynamic understanding of discontinuation of treatment is necessary to achieve a long-term approach to recovery: the field should understand discontinuation as a feature of typical treatment trajectories, and discontinuation can be followed by re-initiation of treatment.
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Karlsson, Ann Tarja; Vederhus, John-Kåre; Clausen, Thomas; Weimand, Bente; Solli, Kristin Klemmetsby & Tanum, Lars Håkon Reiestad
(2021).
Levels of impulsivity, hyperactivity, and inattention and the association with mental health and substance use severity in opioid-dependent patients seeking treatment with extended-release naltrexone.
Journal of Clinical Medicine.
ISSN 2077-0383.
10(19),
s. 1–9.
doi:
10.3390/jcm10194558.
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The level of impulsivity, hyperactivity, and inattention (IHI) is higher among patients
with substance use disorder (SUD) than in the general population. However, the prevalence of
such symptoms in patients seeking treatment with an opioid antagonist, such as extended-release
naltrexone (XR-NTX), is unknown. We screened 162 patients with opioid use disorder (OUD) seeking
treatment with XR-NTX in Norway using the Adult ADHD Self-Report Scale (ASRS) to estimate
the prevalence of IHI alongside an assessment of mental and physical health and substance use.
Sixty-six patients scored above the clinical cut-off on the ASRS. Higher levels of IHI were significantly
associated with a longer history of frequent amphetamine use, current alcohol use, and greater
mental distress. Mental distress was the strongest factor associated with higher levels of IHI. The
introduction of screening for IHI and mental distress in opioid maintenance treatment and XR-NTX
would likely improve the quality of care and enable clinicians to tailor interventions to the needs of
patients with high levels of IHI to prevent treatment discontinuation
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Gaulen, Zhanna; Brenna, Ida Halvorsen; Fadnes, Lars T.; Saltyte Benth, Jurate; Solli, Kristin Klemmetsby & Kunøe, Nikolaj
[Vis alle 8 forfattere av denne artikkelen]
(2021).
The Predictive Value of Degree of Preference for Extended-Release Naltrexone for Treatment Adherence, Opioid Use, and Relapse.
European Addiction Research.
ISSN 1022-6877.
28(1).
doi:
10.1159/000518436.
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Opheim, Arild; Gaulen, Zhanna; Solli, Kristin Klemmetsby; Latif, Zill-E-Huma; Fadnes, Lars T. & Saltyte Benth, Jurate
[Vis alle 8 forfattere av denne artikkelen]
(2021).
Risk of Relapse Among Opioid-Dependent Patients Treated With Extended-Release Naltrexone or Buprenorphine-Naloxone: A Randomized Clinical Trial.
American Journal on Addictions.
ISSN 1055-0496.
30(5),
s. 453–460.
doi:
10.1111/ajad.13151.
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Background and Objectives
Compare the risk of relapse to heroin and other illicit opioids among opioid-dependent patients receiving treatment with extended-release naltrexone (XR-NTX) or buprenorphine-naloxone (BP-NLX).
Methods
Re-analyzed data from a 12-week multicenter, open-label, randomized treatment study with a subsequent 36-week open-label follow-up study. All patients, N = 143, had completed detoxification and received at least one dose of study medication.
Results
Of 143 patients (72% men), mean age 36 years, 71 received XR-NTX and 72 BP-NLX. The risk of first relapse and the risk of any relapse to heroin and other illicit opioids were both significantly lower in the XR-NTX group compared with the BP-NLX group (hazard ratio [HR], 0.46; 95% confidence interval [CI], 0.28-0.76; P = .002, and HR, 0.11; 95% CI, 0.04-0.29; P < .001, respectively) and (HR, 0.15; 95% CI, 0.09-0.27; P < .001 and HR, 0.05; 95% CI, 0.03-0.09; P < .001, respectively). There was a stable low risk of relapse among participants receiving XR-NTX in the follow-up.
Discussion and Conclusions
Compared to BP-NLX, patients on XR-NTX had a substantially reduced risk of relapse to illicit opioids and showed a stable low risk of relapse over time in longer-term treatment.
Scientific Significance
Our data support XR-NTX as a first-line treatment option for patients with opioid addiction both in short and longer-term treatment. This is the first European study showing that XR-NTX significantly reduces the risk of first and any relapse to heroin use in opioid-dependent patients compared to BP-NLX. Our data contradict previous data from the X:BOT study, showing no significant difference in relapse risk between the groups in a 6-month randomised controlled trial.
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Latif, Zill-E-Huma; Skjærvø, Ingeborg; Solli, Kristin Klemmetsby & Tanum, Lars Håkon Reiestad
(2021).
Chronic Pain Among Patients With an Opioid Use Disorder.
American Journal on Addictions.
ISSN 1055-0496.
30(4),
s. 366–375.
doi:
10.1111/ajad.13153.
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Background and objectives: Chronic pain is not well understood in opioid-dependent populations. We report the prevalence of chronic pain and pain characteristics in an opioid-dependent population by treatment type and gender.
Methods: This cross-sectional study opportunistically recruited 569 patients (32% women) receiving treatment for opioid use disorder (DSM-5) in Norway during 2016-2018 (83% received opioid maintenance treatment, 17% received treatment without medication). We asked about chronic pain (≥3 months; ICD-11), pain severity (NRS-11), and other pain characteristics.
Results: Overall, 55% reported chronic pain (≥3 months), with a higher prevalence among women (61% vs 52%, P = .041) and patients receiving methadone (66%) compared with buprenorphine or no medication (46% and 45%, P < .001). Chronic pain was associated with higher age (P < .001) and higher doses of methadone (P = .048). The average duration of pain was 11 years. The most frequently reported pain locations were the lower extremities (59%) and the back (54%), and 69% reported more than one pain location. Constant pain and migrating pain were significantly associated with both moderate (adjusted odds ratio [aOR]: 2.04, confidence interval [CI]: 1.12-3.74 and aOR: 2.44, CI: 1.09-5.43) and severe pain intensity (aOR: 2.08, CI: 1.14-3.80 and aOR: 2.46, CI: 1.10-5.47). Reporting no effect of analgesics was associated with severe pain intensity (aOR: 0.54, CI: 0.29-0.99).
Conclusions and scientific significance: Over half reported chronic pain, and rates were highest among women and patients receiving methadone. New contributions to the field are descriptions of pain characteristics by gender and pain severity, and interactions between medication type and age.
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Weimand, Bente; Solli, Kristin Klemmetsby; Reichelt, Wenche Helleren & Tanum, Lars Håkon Reiestad
(2021).
Enablers and hindrances for longer-term abstinence in opioid dependent individuals receiving treatment with extended-release naltrexone: A Norwegian longitudinal recovery trial (NaltRec study) .
Contemporary Clinical Trials Communications.
ISSN 2451-8654.
21.
doi:
10.1016/j.conctc.2021.100728.
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Opioid-dependence is a comprehensive, relapsing disorder with negative individual, - family, - and societal consequences. Recovery is difficult to achieve. Research has shown reduced substance use and improved healthand psychosocial factors with extended-release naltrexone (XR-NTX) treatment. Pharmacological treatment should include psychosocial interventions to improve longer-term recovery. This study explores how voluntary monthly treatment with extended-release naltrexone hydrochloride (Vivitrol®) will influence longer-term recovery, health and psychosocial relationships in opioid-dependent patients. Close relatives’ experiences and societal costs will be assessed. This Norwegian naturalistic, multicenter, open-label study includes 150 opioid dependent patients. Patients are assessed every four weeks for 24 weeks, with 28 weeks optional follow-up treatment-period, and at three, six and 12 months posttreatment. Controls are opioid-dependent patients enrolled in Opioid Maintenance Treatment programs (n = 150). Data on recovery will be collected from participants, close relatives, and community health service providers. Genetic analyses of major signaling pathways and national registries on prescriptions and health care use will be analyzed. Recruitment period is September 2018 to September 2020. The assessment of medical, psychological, relational and societal factors may provide novel in-depth knowledge on the complexity of personal recovery-processes. The results are expected to have
impact on priorities in treatment and follow-up for opioid dependent patients.
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Solli, Kristin Klemmetsby; Opheim, Arild; Latif, Zill-E-Huma; Krajci, Peter; Saltyte Benth, Jurate & Kunøe, Nikolaj
[Vis alle 7 forfattere av denne artikkelen]
(2020).
Adapting treatment length to opioid-dependent individuals' needs and preferences: A 2-year follow-up to a 1-year study of extended-release naltrexone.
Addiction.
ISSN 0965-2140.
s. 1–10.
doi:
10.1111/add.15378.
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Background and aim: Extended-release naltrexone (XR-NTX) is an underused treatment option for opioid dependence, today only available in a few countries in the world. Although effective, safe and feasible in short-term treatment, long-term data are scarce and there is no recommendation for required treatment length. The aims of the study were to determine the perceived need of long-term XR-NTX treatment and to examine long-term treatment outcomes.
Design: In this prospective cohort study, following a parent 1-year study of XR-NTX, participants received treatment with XR-NTX at their own discretion for a maximum of 104 weeks.
Setting: Five urban, outpatient addiction clinics in Norway.
Participants: Opioid-dependent adults 18-60 years old (n=50) already participating in the parent study.
Intervention: XR-NTX administrated as intra-muscular injections (380 mg) every 4 weeks.
Measurements: Time in the study, use of opioids and other illicit substances, opioid craving, and treatment satisfaction reported every 4 weeks.
Findings: Among 58 participants who completed the 1-year parent study, 50 chose to continue the treatment with XR-NTX. Median prolonged treatment time was 44.0 weeks (95% CI: 25.5-62.5), ranging from 8 to 104 weeks. Most participants (35, 70%) reported no relapse to opioid use during treatment while a subgroup (15, 30%) reported relapses to opioids during the study. Scores for mean treatment satisfaction and recommending treatment to others were very high (>9) and mean opioid craving score was very low (<1) on a scale ranging from 0 to 10.
Conclusions: Extended-release naltrexone (XR-NTX) was well tolerated in long-term treatment of opioid dependent individuals in Norway already in XR-NTX treatment. On average, the participants chose to continue treatment for almost 1 year beyond the initial 9 to 12 months of treatment. Participants reported high treatment satisfaction and 70% showed no relapse to opioids during the treatment period.
Keywords: Extended-release naltrexone; antagonist treatment; long-term treatment; opioid use; recovery; treatment duration; treatment of opioid dependence.
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Drivenes, Karin; Haaland, Vegard Øksendal; Hauge, Yina Luk; Vederhus, John-Kåre; Irgens, Audun Campbell & Solli, Kristin Klemmetsby
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(2020).
Discrepancy in ratings of shared decision making between patients and health professionals: A cross sectional study in mental health care.
Frontiers in Psychology.
ISSN 1664-1078.
11:443,
s. 1–10.
doi:
10.3389/fpsyg.2020.00443.
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Background: A defined goal in mental health care is to increase the opportunities for patients to more actively participate in their treatment. This goal includes integrating aspects of user empowerment and shared decision-making (SDM) into treatment courses. To achieve this goal, more knowledge is needed about how patients and therapists perceive this integration.
Objective: To explore patient experiences of SDM, to describe differences between patient and therapist experiences, and to identify patient factors that might reduce SDM experiences for patients compared to the experiences of their therapists.
Methods: This cross-sectional study included 992 patients that had appointments with 267 therapists at Sørlandet Hospital, Division of Mental Health during a 1-week period. Both patients and therapists completed the CollaboRATE questionnaire, which was used to rate SDM experiences. Patients reported demographic and treatment-related information. Therapists provided clinical information.
Results: The analysis included 953 patient-therapist responder pairs that completed the CollaboRATE questionnaire. The mean SDM score was 80.7 (SD 20.8) among patients, and 86.6 (SD 12.1) among therapists. Females and patients that did not use medication for mental health disorders reported higher SDM scores than males and patients that used psychiatric medications (83.3 vs. 77.7; p < 0.001 and 82.6 vs. 79.8; p = 0.03, respectively). Patients with diagnoses involving psychotic symptoms reported lower SDM scores than all the other patients (66.8 vs. 82.3; p < 0.001). The probability that a patient would report lower SDM scores than their therapist was highest among patients that received involuntary treatment (OR 3.2, p = 0.02), patients with treatment durations longer than 2.2 years (OR 1.9, p = 0.001), and patients that required day care or in-patient care (OR 3.2, p = 0.01 and OR 3.2, p < 0.001, respectively).
Conclusion: We showed that both therapists and patients reported good SDM experiences in decisional situations, which indicated that SDM was implemented well. However, the SDM scores reported by in-patients and patients with prolonged or involuntary treatments were significantly lower than scores reported by their therapists. Our findings suggested that it remains a struggle in mental health care to establish a common understanding between patients and therapists in decisional processes regarding treatments for some patient groups
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Solli, Kristin Klemmetsby; Kunøe, Nikolaj; Latif, Zill-E-Huma; Haase, Kamni Sharma; Opheim, Arild & Krajci, Peter
[Vis alle 9 forfattere av denne artikkelen]
(2019).
Availability of extended-release naltrexone may increase the number of opioid-dependent individuals in treatment: Extension of a randomized clinical trial.
European Addiction Research.
ISSN 1022-6877.
25(6),
s. 1–7.
doi:
10.1159/000501931.
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Solli, Kristin Klemmetsby; Latif, Zill-E-Huma; Opheim, Arild; Krajci, Peter; Haase, Kamni Sharma & Saltyte Benth, Jurate
[Vis alle 8 forfattere av denne artikkelen]
(2018).
Effectiveness, safety and feasibility of extended-release naltrexone for opioid dependence: a nine-month follow-up to a three-month randomized trial.
Addiction.
ISSN 0965-2140.
113(10),
s. 1840–1849.
doi:
10.1111/add.14278.
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Tanum, Lars; Solli, Kristin Klemmetsby; Latif, Zill-E-Huma; Saltyte Benth, Jurate; Opheim, Arild & Haase, Kamni Sharma
[Vis alle 8 forfattere av denne artikkelen]
(2017).
Effectiveness of Injectable Extended-Release Naltrexone vs Daily Buprenorphine-Naloxone for Opioid Dependence. A Randomized Clinical Noninferiority Trial.
JAMA psychiatry.
ISSN 2168-6238.
74(12),
s. 1197–1205.
doi:
10.1001/jamapsychiatry.2017.3206.
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Haase, Kamni Sharma; Kunøe, Nikolaj; Opheim, Arild; Gaulen, Zhanna; Njå, Anne-Lill Mjølhus & Zill E, Huma Latif
[Vis alle 8 forfattere av denne artikkelen]
(2016).
Interest in extended release naltrexone among opioid users.
European Addiction Research.
ISSN 1022-6877.
22(6),
s. 301–305.
doi:
10.1159/000447964.
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Solli, Kristin Klemmetsby
(2013).
Er det bare tiden som vil vise? En analyse av hvilke formål som ligger bak bruk av tvang overfor mennesker med rusmiddelmisbruk.
Fontene forskning.
ISSN 1890-9868.
1(1),
s. 46–61.
Se alle arbeider i Cristin
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Skjærvø, Ingeborg; Latif, Zill-E-Huma; Solli, Kristin Klemmetsby & Tanum, Lars Håkon Reiestad
(2019).
Forekomst av kronisk smerte blant opioidavhengige.
Se alle arbeider i Cristin
Publisert
15. nov. 2018 12:47
- Sist endret
15. nov. 2018 12:47