Thomas Clausen

• Bukten, Anne; Mehlum, Lars; Fazel, Seena; Lokdam, Nicoline Toresen; Tverborgvik, Torill & Skurtveit, Svetlana Ondrasova [Vis alle 12 forfattere av denne artikkelen] (2026). Sociodemographic, Criminological and Clinical Determinants in Suicide After Release From Prison: A 23‐Year National Cohort Study. Acta Psychiatrica Scandinavica. ISSN 0001-690X. doi: 10.1111/acps.70148. Fulltekst i vitenarkiv Vis sammendrag

  ABSTRACT Background Suicide risk is elevated after prison release, but population‐level evidence on temporal risk patterns and associated factors remains limited. We aimed to describe characteristics of individuals who die by suicide after release from Norwegian prisons, compare their suicide mortality with the general population, and examine risk factors over time. Material and Methods Data from the Norwegian Prison Release Study (nPRIS), including all people in prison in Norway (2000–2022), were linked to the Norwegian Cause of Death Registry, the Norwegian Prison Registry, the Norwegian Patient Registry, and Statistics Norway. We calculated crude mortality rates (CMR) per 100,000 person‐years, standardized mortality ratios (SMR), annual age‐standardized years of life lost rate (ASYR), and Cox proportional hazards models. Results From 2000 to 2022, 1183 suicides (9.1% of all deaths; CMR 81; 95% CI 76–85) occurred after release (90% male). The SMR was higher in women (SMR 8.64; 95% CI 7.17–10.34) than men (SMR 3.98; 95% CI 3.76–4.22). In multivariable models (2009–2022; n  = 57,034; 516 suicides), strong independent associations with suicide 6 months post‐release included self‐harm (adjusted HR [aHR] 4.76; 95% CI 2.60–8.72), severe mental illness (aHR 1.95; 95% CI 1.16–3.27), release from high‐security prisons (aHR 1.93; 95% CI 1.12–3.33), and pretrial detention (aHR 1.82; 95% CI 1.06–3.13). Conclusions Suicide risk is substantially and persistently elevated relative to the general population, peaks immediately after release, and is concentrated among people with prior self‐harm, severe mental illness, and those released from high‐security settings.

• Bodal, Elen; Olsen, Nora Marie Temte; Olsen, Thomas; Edvardsen, Hilde Marie Erøy; Clausen, Thomas & Skurtveit, Svetlana Ondrasova [Vis alle 8 forfattere av denne artikkelen] (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, s. 1–8. doi: 10.1016/j.forsciint.2026.113143. Fulltekst i vitenarkiv
• Jobling, Nina; Mjåland, Kristian; Clausen, Thomas; Heldal, Anne Taraldsen; Thylstrup, Birgitte & Vederhus, John-Kåre (2026). Medication transitions and predictors of illicit substance use during opioid agonist treatment: a three-year follow-up study. Addiction science & clinical practice. ISSN 1940-0632. 21. doi: 10.1186/s13722-026-00711-0. Fulltekst i vitenarkiv Vis sammendrag

  Background For opioid use disorder (OUD), pharmacological therapy using methadone or buprenorphine, plus psychosocial support, is the most effective opioid agonist treatment (OAT). Long-acting injectable buprenorphine (LAIB) is the newest buprenorphine formulation. This study evaluated LAIB within a naturalistic clinical setting, compared with standard OAT (sublingual buprenorphine and methadone). Methods This observational study included patients from an OAT outpatient clinic in Agder County, Norway. Data were extracted from hospital medical records in May 2022. The cohort was followed up in February 2025. Medication-group transitions and outcomes were assessed by examining switching, discontinuation, mortality, and illicit substance use over three years. Results The study included 424 patients. The LAIB group was significantly younger than the standard OAT groups. During the study period, 13.2% of patients switched medications, increasing the LAIB group from 17% to 22%. Comparable proportions of patients experienced negative outcomes: 10% discontinued treatment, and 4% died. At follow‑up, illicit substance-use problems were less frequent in the sublingual buprenorphine group than the other groups, a finding that appears to have been influenced by differential attrition. Baseline substance use was the strongest predictor of illicit substance use at follow‑up. Conclusions The LAIB group slightly increased during the study period. Transitions between medication groups appeared to yield better substance-use outcomes at follow-up in the sublingual buprenorphine group, compared to in other groups. Baseline substance use was the strongest predictor of illicit use at follow‑up, suggesting that individual clinical characteristics may contribute more to outcomes than the specific medication pathway.

• Grimsland, Frida; Gabrielsen, Karin Berle; Clausen, Thomas; Haugland, Siri Håvås & Vederhus, John-Kåre (2026). Child maltreatment and substance use: associations with alcohol use, nicotine use, and quality of life in a Norwegian population sample. Frontiers in Public Health. 14. doi: 10.3389/fpubh.2026.1821179. Fulltekst i vitenarkiv Vis sammendrag

  Background Child maltreatment (CM) is a significant public health concern with long-term consequences for the child, including an increased likelihood of engaging in risky health behaviors, such as substance use, as well as impaired quality of life (QoL). The relationship between CM and specific substance use patterns, particularly the use of nicotine products such as Swedish snus, remains understudied. We investigated the relationship between CM and the use of nicotine and alcohol, as well as whether use of these substances mediates the association between CM and adulthood QoL. Methods This study utilized data from the Norwegian Counties Public Health Survey for Agder in 2023. Latent regression analysis was employed to examine the association between CM and QoL, as well as potential mediated associations involving substance use, while controlling for sociodemographic factors. Results Nicotine use in the past year was significantly more prevalent among individuals with a history of CM compared to the group with no history of CM (35.8% vs. 25.6%, p < 0.001). Both smoking (24.3% vs. 15.6%, p < 0.001) and snus use (17.6% vs. 13.3%, p < 0.001) were more common in the CM group, with differences remaining significant after adjustment for sociodemographic factors. No significant differences were found in alcohol use across various measures, including frequency of use, AUDIT-C scores, and binge drinking. Latent regression analysis showed that CM had an overall negative association with QoL [β = −0.61; 95% confidence interval (CI) −0.71, −0.51; p < 0.001]. A significant mediated association involving nicotine use was also observed (β = −0.12; 95% CI −0.16, −0.07; p < 0.001). Conclusion CM is associated with a higher prevalence of smoking and snus use, which are negatively associated with QoL. The findings suggest that targeted efforts to support QoL among individuals with a history of CM, including attention to nicotine use, may be relevant within broader strategies addressing living conditions and psychological wellbeing.

• Hagene, Helene Storbråten; Clausen, Thomas & Gjersing, Linn (2026). High-risk injecting practices among people who inject drugs in Norway: Prevalence, characteristics and associated factors. Journal of Substance Use and Addiction Treatment. ISSN 2949-8767. 189, s. 1–7. doi: 10.1016/j.josat.2026.209999. Fulltekst i vitenarkiv
• Skeie, Ivar; Bech, Anne Berit; Clausen, Thomas; Hjemsæter, Arne Jan; Landheim, Anne Signe & Monsbakken, Bent Berntsen [Vis alle 8 forfattere av denne artikkelen] (2026). Comparison of mortality and causes of death between treatment-engaged individuals with severe alcohol or opioid use disorder: a prospective 19-year clinical cohort study. BMC Psychiatry. 26(1), s. 1–11. doi: 10.1186/s12888-026-07832-5. Fulltekst i vitenarkiv Vis sammendrag

  BACKGROUND: Comparisons of long-term mortality between alcohol-use-disorder (AUD) and opioid-use-disorder (OUD) groups within clinical cohorts are scarce. This study aimed to do this within one clinical cohort comprising groups suffering various severe substance use disorders. METHODS: Design: Observational cohort design. Prospective study of mortality 1998–2016, Cox regression. Sample/setting: 464 persons in specialist SUD treatment at start of observation period. Three subgroups defined by SUD characteristics at the beginning of the observation period, were studied: participants with 1) OUD, on opioid agonist treatment (OAT), (OUD/OAT-group), 2) AUD, no other SUDs (AUD-alone group), 3) AUD as part of a poly-substance-use disorder (AUD/PSUD group). Measures/covariates: Comparison of mortality risks and causes of death (somatic diseases/traumatic causes/substance-induced deaths/unknown cause) between OUD/OAT versus AUD-alone, and AUD-alone versus AUD/PSUD groups. Hazard ratio (HR) adjusted for baseline age (1 January 1998), sex, and socioeconomic/SUD characteristics. RESULTS: AUD-alone versus OUD/OAT: Unadjusted mortality risk was higher in the AUD-alone group [HR 1.99 (95% CI 1.33–2.99)]. However, in adjusted analysis type of SUD showed no statistically significant association with increased mortality [aHR 0.91 (0.54–1.54)], only male sex and increasing baseline age were independently associated with increased mortality risk. Cause-of-death distributions were very similar and somatic diseases caused over 50% of deaths in both groups. AUD-alone versus AUD/PSUD: Unadjusted mortality risk was higher in the AUD-alone group [(HR 2.57 (1.65–4.00)]. However, in adjusted analysis type of SUD showed no statistically significant association with increased mortality [aHR 1.40 (0.81–2.44)], only male sex, increasing baseline age, and “not being in work or education at study inclusion” were independently associated with increased mortality risk. Substance-induced deaths were most common in the AUD/PSUD group (43%). CONCLUSION: In adjusted analyses there were no statistically significant differences in mortality risk between the three subgroups. Somatic diseases were the main cause of death. Besides efforts to improve social rehabilitation and to treat the substance use disorders as such, early and targeted lifestyle interventions, and measures for early detection, treatment and follow-up of somatic disorders are essential to reduce mortality in both AUD and OUD populations. CLINICAL TRIAL NUMBER: Not applicable

• Gjersing, Linn; Edvardsen, Hilde Marie Erøy & Clausen, Thomas (2025). Overdoseforebyggende politikk. I Gjersing, Linn; Clausen, Thomas & Edvardsen, Hilde Marie Erøy (Red.), Overdoseboka. En helhetlig gjennomgang. Cappelen Damm Akademisk. ISSN 9788202852610. s. 92–100. Fulltekst i vitenarkiv Vis sammendrag

  Boken omhandler et bredt spekter av temaer knyttet til overdoseproblematikk. Den går i dybden på rusmidlers virkning, risikofaktorer og relaterte helseutfordringer. Politikkens og myndighetenes rolle i forebygging og behandling presenteres. Boken utforsker også skadereduksjon og oppfølging i tjenesteapparatet, og gir et innblikk i brukeres, pårørendes og helsepersonells opplevelser og erfaringer. Videre belyses politiets arbeid, obduksjoner og registrering av dødsfall. Målet er at boken kan bidra til en mer helhetlig forståelse, og dermed bedre tjenester og en reduksjon av overdoser.

• Gjersing, Linn; Edvardsen, Hilde Marie Erøy & Clausen, Thomas (2025). Overdose og psykisk helse. I Gjersing, Linn; Clausen, Thomas & Edvardsen, Hilde Marie Erøy (Red.), Overdoseboka. En helhetlig gjennomgang. Cappelen Damm Akademisk. ISSN 9788202852610. s. 65–69. Fulltekst i vitenarkiv Vis sammendrag

  Boken omhandler et bredt spekter av temaer knyttet til overdoseproblematikk. Den går i dybden på rusmidlers virkning, risikofaktorer og relaterte helseutfordringer. Politikkens og myndighetenes rolle i forebygging og behandling presenteres. Boken utforsker også skadereduksjon og oppfølging i tjenesteapparatet, og gir et innblikk i brukeres, pårørendes og helsepersonells opplevelser og erfaringer. Videre belyses politiets arbeid, obduksjoner og registrering av dødsfall. Målet er at boken kan bidra til en mer helhetlig forståelse, og dermed bedre tjenester og en reduksjon av overdoser.

• Gjersing, Linn; Edvardsen, Hilde Marie Erøy & Clausen, Thomas (2025). Forekomst. I Gjersing, Linn; Clausen, Thomas & Edvardsen, Hilde Marie Erøy (Red.), Overdoseboka. En helhetlig gjennomgang. Cappelen Damm Akademisk. ISSN 9788202852610. s. 47–53. Fulltekst i vitenarkiv Vis sammendrag

  Boken omhandler et bredt spekter av temaer knyttet til overdoseproblematikk. Den går i dybden på rusmidlers virkning, risikofaktorer og relaterte helseutfordringer. Politikkens og myndighetenes rolle i forebygging og behandling presenteres. Boken utforsker også skadereduksjon og oppfølging i tjenesteapparatet, og gir et innblikk i brukeres, pårørendes og helsepersonells opplevelser og erfaringer. Videre belyses politiets arbeid, obduksjoner og registrering av dødsfall. Målet er at boken kan bidra til en mer helhetlig forståelse, og dermed bedre tjenester og en reduksjon av overdoser.

• Gjersing, Linn; Clausen, Thomas & Edvardsen, Hilde Marie Erøy (2025). Risikofaktorer og kjennetegn. I Gjersing, Linn; Clausen, Thomas & Edvardsen, Hilde Marie Erøy (Red.), Overdoseboka. En helhetlig gjennomgang. Cappelen Damm Akademisk. ISSN 9788202852610. s. 56–62. Fulltekst i vitenarkiv Vis sammendrag

  Boken omhandler et bredt spekter av temaer knyttet til overdoseproblematikk. Den går i dybden på rusmidlers virkning, risikofaktorer og relaterte helseutfordringer. Politikkens og myndighetenes rolle i forebygging og behandling presenteres. Boken utforsker også skadereduksjon og oppfølging i tjenesteapparatet, og gir et innblikk i brukeres, pårørendes og helsepersonells opplevelser og erfaringer. Videre belyses politiets arbeid, obduksjoner og registrering av dødsfall. Målet er at boken kan bidra til en mer helhetlig forståelse, og dermed bedre tjenester og en reduksjon av overdoser.

• Gjersing, Linn; Edvardsen, Hilde Marie Erøy & Clausen, Thomas (2025). Hva er en overdose? I Gjersing, Linn; Clausen, Thomas & Edvardsen, Hilde Marie Erøy (Red.), Overdoseboka. En helhetlig gjennomgang. Cappelen Damm Akademisk. ISSN 9788202852610. s. 18–22. Fulltekst i vitenarkiv Vis sammendrag

  Boken omhandler et bredt spekter av temaer knyttet til overdoseproblematikk. Den går i dybden på rusmidlers virkning, risikofaktorer og relaterte helseutfordringer. Politikkens og myndighetenes rolle i forebygging og behandling presenteres. Boken utforsker også skadereduksjon og oppfølging i tjenesteapparatet, og gir et innblikk i brukeres, pårørendes og helsepersonells opplevelser og erfaringer. Videre belyses politiets arbeid, obduksjoner og registrering av dødsfall. Målet er at boken kan bidra til en mer helhetlig forståelse, og dermed bedre tjenester og en reduksjon av overdoser.

• Skurtveit, Svetlana Ondrasova; McDonald, Rebecca Silvia; Handal, Marte; Hamina, Aleksi; Clausen, Thomas & Odsbu, Ingvild (2025). A comparison between individuals who died of intentional versus accidental overdoses. Suicidologi. ISSN 1501-6994. 30(2), s. 4–19. doi: 10.5617/suicidologi.12703. Fulltekst i vitenarkiv Vis sammendrag

  The aim of the study was to describe differences between deaths from intentional versus accidental overdoses in Norway. This data linkage study comprised six nationwide health- and population registers. During the study period from 2011 to 2019, a total of 1,818 deaths from accidental and 363 deaths from intentional overdoses were registered. Pharmaceutically available opioids were more often found in post-mortem blood samples among intentional overdose deaths compared to accidental overdoses (73.0% vs 36.0%). Decedents in the intentional overdose group were on average eight years older, more frequently women with higher education and previous suicide attempts compared to accidental overdoses. Intentional overdose deaths more frequently had a lifetime history of chronic pain, cancer, as well as depression in the year prior to death. In the 30-day period prior to their death, a larger proportion of individuals in the intentional overdose group were dispensed opioids (43.0 % vs 21.4 %) and/or enzodiazepines (51.5 % vs. 38.7 %) compared to accidental overdoses. Intentional overdose deaths typically involve prescribed medicines and are more common among older, more often female individuals with a history of somatic disorders. This knowledge needs to be integrated into new and targeted prevention interventions.

• Melis, Francesca; Castel, Charlotte Jocelyne Yvonne; Eide, Desiree & Clausen, Thomas (2025). Health-related quality of life trajectories of patients in heroin-assisted treatment. Drug and Alcohol Dependence. ISSN 0376-8716. 275. doi: 10.1016/j.drugalcdep.2025.112839. Fulltekst i vitenarkiv Vis sammendrag

  Background This study investigates health-related quality of life (HRQoL) in individuals with opioid use disorder enrolled in heroin-assisted treatment (HAT). While HRQoL in opioid maintenance treatment has been studied, less is known while in HAT. This study aim is to describe HRQoL in HAT, identify different HRQoL trajectories, and examine factors associated with class memberships. Methods This longitudinal cohort study is based on the multi-center Norwegian HAT project. The sample includes all consenting individuals enrolled in treatment from January 2022 to October 2024 (n = 108). HRQoL was assessed using the EuroQol EQ-5D-5L, and demographics were collected at baseline and multiple time points. Latent class linear mixed models were employed to identify HRQoL trajectory classes and explore differences in class memberships. Results At admission, participants demonstrated significant HRQoL difficulties across all dimensions, with severity levels higher than those of the general Norwegian population, particularly in Pain/Discomfort and Anxiety/Depression. Latent class analysis identified three distinct groups: the largest group (82 %) had a stable HRQoL trajectory, while smaller groups (8 % and 10 %) showed decline and improvement, respectively. Social support, clinic location, parental origin and at least one chronic symptoms were significant predictors of class membership. Conclusion The diverse, lower HRQoL profiles emphasize the need for personalized healthcare and support, making the HAT setting potentially valuable for such tailored care. Treatment participation helps most maintain fairly high HRQoL. The findings confirm the critical role of supportive relationships and effective chronic condition management in HRQoL outcomes.

• Finstad, Jeanette; Clausen, Thomas; Røise, Olav; Rosseland, Leiv Arne & Havnes, Ingrid Amalia (2025). Challenges in pain management and opioid prescribing practices following traumatic injury: a focus group study with orthopedic surgeons and general practitioners. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 43(4), s. 864–879. doi: 10.1080/02813432.2025.2517769. Fulltekst i vitenarkiv
• Myklebust, Lars Henrik; Eide, Desiree; Wüsthoff, Linda Elise Couessurel; Melis, Francesca; Oldervoll, Ann & Pirro, Silvana De [Vis alle 7 forfattere av denne artikkelen] (2025). Changes in self-reported mental health, anxiety and depression among patients in heroin-assisted treatment: Findings from a Norwegian trial project. European Addiction Research. ISSN 1022-6877. 31, s. 286–296. doi: 10.1159/000547375. Fulltekst i vitenarkiv Vis sammendrag

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

• Nesse, Linda & Clausen, Thomas (2025). Treatment satisfaction among patients in opioid agonist treatment in Norway: A multicenter cohort study. Nordic Studies on Alcohol and Drugs (NAD). ISSN 1455-0725. 42(4), s. 353–364. doi: 10.1177/14550725251351711. Fulltekst i vitenarkiv Vis sammendrag

  Background: Treatment satisfaction is an important indicator of patients’ perceptions of opioid agonist treatment (OAT) for opioid dependence. In addition, treatment satisfaction may have implications for treatment outcomes. The present study aimed to explore treatment satisfaction among OAT patients one year after enrollment, as well as the role of different psychosocial and treatment characteristics in treatment satisfaction. Methods: The study was based on data from the NorComt project (2012–2016), which used a multicenter cohort design with structured questionnaire-based interviews. The sample consisted of 175 OAT patients in Norway who rated their treatment satisfaction (high, mixed, low) one year after enrollment in a new treatment episode in OAT. Treatment satisfaction (high versus mixed or low) was used as a dependent variable in logistic regression models, with demographic characteristics, well-being, substance use, and treatment characteristics as independent variables. Results: Overall, 54.9% of the participants reported high satisfaction with OAT one year after enrollment, while 25.7% reported mixed satisfaction and 19.4% low satisfaction. Of the 175 participants who reported on treatment satisfaction, 161 remained in treatment at follow-up. Reporting an active occupational status and an individual treatment plan in OAT was associated with increased odds for reporting treatment satisfaction, while reporting ongoing substance use was associated with decreased odds for reporting treatment satisfaction. Conclusions: Psychosocial, situational factors, as well as coordinated, integrated support, may play a role in OAT patients’ treatment satisfaction. To identify facilitators and barriers in OAT, it is vital to address relevant needs and goals for treatment from the perspectives of patients.

• Melis, Francesca; Kvamme, Timo L.; Tjagvad, Christian; Eide, Desiree; Thylstrup, Birgitte & Clausen, Thomas [Vis alle 7 forfattere av denne artikkelen] (2025). Health-related quality of life measures as predictors for recurrent hospitalization and mortality among patients in heroin-assisted treatment. Quality of Life Research. ISSN 0962-9343. 34, s. 3365–3376. doi: 10.1007/s11136-025-04019-5. Fulltekst i vitenarkiv Vis sammendrag

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

• Nyman, Anna Armika Tussilago; Bogstrand, Stig Tore; Clausen, Thomas & Edvardsen, Hilde Marie Erøy (2025). Toksikologiske funn ved overdoseselvmord 2016–21. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 145(2). doi: 10.4045/tidsskr.23.0836. Fulltekst i vitenarkiv
• 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, s. 1633–1641. doi: 10.1007/s00228-025-03897-5. Fulltekst i vitenarkiv
• Todd-Kvam, John James Rea; Sugahara, Gustavo Toshiaki Lopes; Muller, Ashley & Clausen, Thomas (2025). Quality of life whilst ageing in opioid agonist treatment: a narrative analysis. BMC Public Health. 25(1), s. 1–15. doi: 10.1186/s12889-025-22438-4. Fulltekst i vitenarkiv Vis sammendrag

  Background Norway has an increasing number of ageing opioid agonist treatment (OAT) patients, with 44% of the 8200 Norwegian OAT patients over 50 in 2023. Methods This study examines the narratives of ageing OAT patients through semi-structured interviews with twelve patients who had been in OAT for 10–20+ years. We used narrative analysis to understand what they experience as important in enhancing or diminishing their quality of life as they age. Results Positive relationships, treatment, and stable housing were narrated as enhancing quality of life, while loneliness and isolation, memory problems, comorbidities, and victimization were narrated as diminishing it. Conclusion Patients experience OAT as both lifesaving as well as potentially limiting their life-quality, illustrating the inbuilt dilemmas of OAT. The study suggests an age-informed treatment model and identifies three thematic implications for practice and further research (on memory issues, victimisation and network-building).

• Melis, Francesca; Clausen, Thomas; Castel, Charlotte Jocelyne Yvonne; Dadras, Omid; Pirro, Silvana De & Myklebust, Lars Henrik Ryther [Vis alle 9 forfattere av denne artikkelen] (2024). Patient Characteristics From Norway’s First Heroin-Assisted Treatment Clinics. Substance use & addiction journal. 46(1), s. 13–24. doi: 10.1177/29767342241271991. Fulltekst i vitenarkiv Vis sammendrag

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

• Hatlo, Cornelia Haarr; Clausen, Thomas; Muller, Ashley & Sugahara, Gustavo (2024). Pet ownership, physical activity and mental health among people in opioid maintenance treatment: A prospective, observational study. Heroin Addiction and Related Clinical Problems. ISSN 1592-1638. 26(1). doi: 10.62401/2531-4122-2024-11. Fulltekst i vitenarkiv
• Borschmann, Rohan; Keen, Claire; Spittal, Mathew J.; Preen, David; Pirkis, Jane & Larney, Sarah [Vis alle 52 forfattere av denne artikkelen] (2024). Rates and causes of death after release from incarceration among 1 471 526 people in eight high-income and middle-income countries: an individual participant data meta-analysis. The Lancet. ISSN 0140-6736. 403(10438), s. 1779–1788. doi: 10.1016/S0140-6736(24)00344-1. Fulltekst i vitenarkiv
• Ericson, Øystein Bruun; Eide, Desiree; Brendryen, Håvar; Lobmaier, Philipp Paul & Clausen, Thomas (2024). Scaling up! Staff e-learning for a national take-home naloxone program. Frontiers in Digital Health. 6. doi: 10.3389/fdgth.2024.1404646. Fulltekst i vitenarkiv
• Bjørnestad, Endre Dahlen; Vederhus, John-Kåre & Clausen, Thomas (2024). Change in substance use among patients in opioid maintenance treatment: baseline to 1-year follow-up. Harm Reduction Journal. 21(1), s. 101–101. doi: 10.1186/s12954-024-01005-x. Fulltekst i vitenarkiv Vis sammendrag

  Background Individuals with opioid use disorder (OUD) often have concurrent use of non-opioid substances. When patients enter opioid maintenance treatment (OMT), less is known about outcomes regarding the use of other types of drugs. Here we aimed to investigate changes in substance use among patients entering outpatient OMT, from treatment initiation to 1-year follow-up. Methods We used data from the prospective Norwegian Cohort of Patient in OMT and Other Drug Treatment Study (NorComt). Among 283 patients who entered OMT at participating facilities across Norway, 179 were assessed at follow-up. Of these patients, 131 were in a non-controlled environment, and were included in the present analysis. The main outcome was change in substance use. Logistic regression analysis was applied to identify factors associated with abstinence from all substances (other than agonist medication) at follow-up. Results Along with opioid use, most patients reported polysubstance use prior to entering treatment. No significant differences were found in baseline characteristics between the included and non-included groups when examining attrition. At the 1-year follow-up, reduced substance use was reported. While in treatment, around two-thirds of patients continued using other drugs to varying degrees. At follow-up, about one-third of patients reported abstinence from all drugs, apart from the agonist medication. Factors related to abstinence included a goal of abstinence at baseline (OR = 5.26; 95% CI 1.14–19.55; p = 0.013) and increasing age (OR = 1.05; 95% CI 1.00–1.09; p = 0.034). Conclusions The majority of patients entering OMT used other substances in addition to opioids. About one-third of patients reported abstinence at the 1-year follow up. Although the majority of patients continued co-use of other drugs while in treatment, for most substances, less than 10% reported daily use at follow-up, with the exception of cannabis which was used daily/almost daily by about 2 in 10. Higher age and treatment goal at the start of OMT were important factors related to reducing concomitant substance use during treatment. These findings suggest that many patients entering OMT are in need of treatment and support related to the use of other substances, to further improve prognosis. Clinical trial registration Clinicaltrials.gov no. NCT05182918. Registered 10/01/2022 (the study was retrospectively registered).

• Odsbu, Ingvild; Hjellvik, Vidar; Handal, Marte; Hamina, Aleksi; Clausen, Thomas & Lid, Torgeir Gilje [Vis alle 8 forfattere av denne artikkelen] (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), s. 1–15. doi: 10.4045/tidsskr.23.0414. Fulltekst i vitenarkiv Vis sammendrag

  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.

• 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. Fulltekst i vitenarkiv Vis sammendrag

  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.

• 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), s. 1575–1584. doi: 10.1111/add.16524. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Gabrielsen, Karin Berle; Clausen, Thomas; Haugland, Siri Håvås & Vederhus, John-Kåre (2024). Gradual improvement in functioning and mental distress during long-term outpatient SUD treatment – A prospective pre-post study. Addictive Behaviors Reports. ISSN 2352-8532. 19, s. 1–8. doi: 10.1016/j.abrep.2024.100525. Fulltekst i vitenarkiv Vis sammendrag

  Background Globally, outpatient programs for substance use disorder (SUD) treatment have gained prominence. To assess the broader clinical implications of this trend we investigated shifts in functioning experienced by outpatients undergoing treatment. Methods We describe the clinical characteristics of a cohort of 93 SUD patients in a Norwegian outpatient treatment clinic. Using paired-samples t-tests, we examined changes in perceived functioning, mental distress, and other clinically relevant outcome variables in a 5-month time interval during the treatment course. Results We obtained follow-up data for 67 (72%) of the included patients, with no significant difference in patient-related factors between those who completed the treatment course and those who were not assessed at follow-up. Perceived functioning increased significantly from study inclusion (Time 0) (mean 19.8, standard deviation ± 8.8) to its conclusion (Time 1) (24.3, ±9.3; t (66) = 4.5, (95% CI: 2.5–6.5, p < 0.001). We also identified significant improvement in most other measured variables, including mental distress, self-reported sleep quality, restlessness, and obsessive thinking. Substance use–related variables showed a modest, non-significant improvement at T1. Conclusion During a 5-month course of outpatient treatment, patients’ subjective experience of functioning improved significantly. Those with the lowest functioning levels at T0 improved the most. Structured monitoring may be a valuable clinical tool for personalizing intervention, enhancing treatment outcomes, and supporting the clinical decision-making process.

• Ericson, Øystein Bruun; Eide, Desiree; Lobmaier, Philipp Paul & Clausen, Thomas (2024). Mortality risk and causes of death among people who use opioids in a take-home naloxone cohort. Drug and Alcohol Dependence. ISSN 0376-8716. 255. doi: 10.1016/j.drugalcdep.2024.111087. Fulltekst i vitenarkiv Vis sammendrag

  Background People who use opioids (PWUO) have an excess mortality from a range of causes. The cumulative effect of behavioral, social, and health risk factors complicates the interpretation of the effects of suitable interventions. This study explores mortality causes among a cohort of PWUO in the take-home naloxone (THN) program. Methods This was a prospective cohort study of PWUO who received THN between 2015 and 2023. Participant data was linked with death registry data. Crude mortality rates and standardized mortality ratios (SMRs) were calculated for all causes, internal causes, and accidental opioid overdoses (AOOs). In addition to age and gender, risk factors like main route of administration, polydrug use, self-experienced overdoses, and using while alone were fitted in a Cox Regression model to explore factors associated with mortality. Results The 2194 participants had a considerably higher mortality ratio for all causes investigated when compared to the general population (SMR=10.9, 95 % CI = 9.3,12.6). AOOs were the most prevalent cause of death (49 %). Those who reported frequent opioid use while alone had an elevated risk of dying of 2.6 (95 % CI = 1.1,6.4) compared to those who never used while alone. Conclusions Frequent opioid use while alone was associated with elevated mortality risk, supporting the importance of overdose prevention education with naloxone distribution, and additional efforts to improve environmental and social areas for safer drug-use practices among PWUO. The variety of mortality causes found in this study illustrates the need for multifaceted and targeted interventions for people at risk of overdosing.

• Finstad, Jeanette; Røise, Olav; Clausen, Thomas; Rosseland, Leiv Arne & Havnes, Ingrid Amalia (2024). A qualitative longitudinal study of traumatic orthopaedic injury survivors' experiences with pain and the long-term recovery trajectory. BMJ Open. 14(1). doi: 10.1136/bmjopen-2023-079161. Fulltekst i vitenarkiv Vis sammendrag

  Objectives To explore trauma patients’ experiences of the long-term recovery pathway during 18 months following hospital discharge. Design Longitudinal qualitative study. Setting and participants Thirteen trauma patients with injuries associated with pain that had been interviewed 6 weeks after discharge from Oslo University Hospital in Norway, were followed up with an interview 18 months postdischarge. Method The illness trajectory framework informed the data collection, with semistructured, in-depth interviews that were analysed thematically. Results Compared with the subacute phase 6 weeks postdischarge, several participants reported exacerbated mental and physical health, including increased pain during 18 months following discharge. This, andalternating periods of deteriorated health status during recovery, made the pathway unpredictable. At 18 months post-discharge, participants were coping with experiences of reduced mental and physical health and socioeconomic losses. Three main themes were identified: (1) coping with persistent pain and reduced physical function, (2) experiencing mental distress without access to mental healthcare and (3) unmet needs for follow-up care. Moreover, at 18 months postdischarge, prescribed opioids were found to be easily accessible from GPs. In addition to relieving chronic pain, motivations to use opioids were to induce sleep, reduce withdrawal symptoms and relieve mental distress. Conclusions and implications The patients’ experiences from this study establish knowledge of several challenges in the trauma population’s recovery trajectories, which may imply that subacute health status is a poor predictor of long-term outcomes. Throughout recovery, the participants struggled with physical and mental health needs without being met by the healthcare system. Therefore, it is necessary to provide long-term follow-up of trauma patients’ health status in the specialist health service based on individual needs. Additionally, to prevent long-term opioid use beyond the subacute phase, there is a need to systematically follow-up and reassess motivations and indications for continued use throughout the recovery pathway.

• Bjørnestad, Endre Dahlen; Vederhus, John-Kåre & Clausen, Thomas (2024). Change in self-reported somatic symptoms among patients in opioid maintenance treatment from baseline to 1-year follow-up. BMC Psychiatry. 24(1). doi: 10.1186/s12888-024-05590-w. Fulltekst i vitenarkiv Vis sammendrag

  Background High somatic comorbidity is common among patients in treatment for opioid use disorder (OUD). The present study aims to investigate changes in self-reported somatic health conditions and somatic symptoms among patients entering opioid maintenance treatment (OMT) programs. Methods We used data from the Norwegian Cohort of Patients in OMT and Other Drug Treatment (NorComt) study. Of 283 patients who entered OMT, 176 were included for analysis at a 1-year follow-up. Participants provided self-reported data during structured interviews on somatic conditions, somatic symptoms, substance use severity measures, and mental distress. A multivariable linear regression analysis identified factors associated with changes in the burden of somatic symptoms. Results Patients entering OMT reported a high prevalence of somatic conditions at the beginning of treatment, with 3 of 5 patients reporting at least one. The most prevalent condition was hepatitis C, followed by asthma and high blood pressure. Patients reported experiencing a high number of somatic symptoms. The intensity of these symptoms varied across a wide spectrum, with oral health complaints and reduced memory perceived as the most problematic. Overall, for the entire sample, there was no significant change in somatic symptoms from baseline to 1 year. Further analysis indicated that those who reported a higher burden of somatic symptoms at baseline had the greatest improvement at the 1-year follow-up. A higher number of somatic conditions and higher mental distress at baseline was associated with improvements in somatic symptoms burden at follow-up. Conclusions Patients in OMT report a range of somatic conditions and somatic symptoms. Given the wide range of symptoms reported by patients in OMT, including some at high intensity levels, healthcare providers should take into consideration the somatic healthcare needs of individuals in OMT populations. Clinical trial registration Clinicaltrials.gov no. NCT05182918. Registered 10/01/2022 (the study was retrospectively registered).

• Todd-Kvam, John James Rea & Clausen, Thomas (2024). Practitioner perspectives on working with older patients in opioid agonist treatment (OAT) in Norway: opportunities and challenges. Addiction science & clinical practice. ISSN 1940-0632. 19(1). doi: 10.1186/s13722-024-00473-7. Fulltekst i vitenarkiv Vis sammendrag

  Background Norway has a growing proportion of ageing opioid agonist treatment (OAT) patients, with 42% of the 8300 Norwegian OAT patients aged over 50 in 2022. This study aims to explore practitioners’ views and experiences from treatment of ageing OAT patients. Methods Data were collected as a series of semi-structured interviews with treatment staff (roles interviewed: doctor, psychologist, social worker, nurse, and learning disability nurse). Participants were recruited from three OAT outpatient clinics, one with an urban catchment area and two with a mix of urban and rural. The interviews incorporated questions on patients’ somatic and mental health, strengths and weaknesses of the service for this group, and patients’ quality of life. Results Older patients were perceived to be more often stable in terms of substance use and housing situation, but also experiencing some key challenges in terms of cognitive impairment, loneliness and isolation, and comorbidities. Both the practitioner-patient relationship and healthcare interactions outside OAT had the potential to impact treatment quality positively or negatively depending on how they were managed. Conclusions Treating older patients in a way that respects and enhances their dignity is important. We argue that this requires better services for those whose functioning is impacted by cognitive impairment/dementia, an age-informed treatment model for this patient group, along with urgent work to improve municipal-level services given practitioners describe them as unacceptable in certain areas.

• Nielsen, Suzanne; Horn, Freya; McDonald, Rebecca Silvia; Eide, Desiree; Walley, Alexander Y & Binswanger, Ingrid [Vis alle 11 forfattere av denne artikkelen] (2024). Development of pharmacy-based best practices to support safer use and management of prescription opioids based on an e-Delphi methodology. Research in Social and Administrative Pharmacy. ISSN 1551-7411. doi: 10.1016/j.sapharm.2024.09.001. Fulltekst i vitenarkiv Vis sammendrag

  Background Opioid utilization and related harm have increased in recent decades, notably in Australia, the United States, Canada, and some European countries. For people who are prescribed opioids, pharmacies offer an accessible, regular point-of-contact, providing a unique opportunity to address opioid prescription drugs risks. Objective This project aimed to develop consensus-based, best practice statements for improving the safer use of prescription opioids through community pharmacy settings. Methods The e-Delphi technique is used to obtain consensus from experts about issues where conclusive evidence is lacking, using multiple rounds of online participation. The investigator group identified an international group of potential participants with relevant expertise who were invited to the study, and asked to identify other experts for invitation. The e-Delphi process comprised three online rounds, involving (1) statement idea generation, (2) developing statement consensus, and (3) confirming and ranking statements. Results A diverse group of 42 experts (76 % female, 6 countries) participated, comprising pharmacists (n = 24, 57 %), medical doctors of differing specialties (n = 12, 29 %), and/or researchers (n = 28, 67 %), with a mean of 15 years’ professional experience (SD = 8.08). Eighty-five statements were initially developed in Round 1, and 78 were supported with amendments, with suggestions to merge and remove items in Round 2, resulting in 72 final statements which were all endorsed in Round 3. Items spanned seven themes: education, monitoring outcomes and risk, deprescribing and pain management, overdose education and naloxone, opioid agonist treatment, staff education, and overarching practices. Preferred terminology was determined in Round 2 and confirmed in Round 3. Conclusions Community pharmacies offer a unique opportunity to support the safer use of prescription opioids. These 72 best practice statements provide practical guidance on specific practices that pharmacists can undertake to support patients' safer use of prescription opioids and prevent or reduce harms from prescribed opioid use.

• Hamina, Aleksi; Odsbu, Ingvild; Hjellvik, Vidar; Lid, Torgeir Gilje; Clausen, Thomas & Skurtveit, Svetlana Ondrasova (2023). Fatal drug overdoses in individuals treated pharmacologically for chronic pain: a nationwide register-based study. British Journal of Anaesthesia. ISSN 0007-0912. 132(1), s. 86–95. doi: 10.1016/j.bja.2023.10.016. Fulltekst i vitenarkiv Vis sammendrag

  Introduction Chronic pain patients may be at an increased risk for drug overdoses as a result of comorbid psychiatric disorders and treatment with risk-increasing prescription medications, such as opioids. We aimed to characterise fatal drug overdoses and investigate factors associated with the deaths among individuals who had been treated pharmacologically for chronic pain. Methods We included all individuals who received analgesics reimbursed for chronic pain in Norway during 2010–9 (n=569 047). Among this population, we identified all individuals with drug overdoses as cause of death (cases). Extracting data from national registries on diagnoses, filled prescriptions, and socioeconomic variables, we used a nested case-control design to compare the cases with age- and sex-matched controls from the study population. Results Overall, 623 (0.11%) individuals in the study population died of an overdose. Most, 66.8%, had overdosed accidentally, and 61.9% as a result of pharmaceutically available opioids. Compared with the controls (n=62 245), overdoses overall were associated strongly with substance use disorders (adjusted odds ratio 7.78 [95% confidence interval 6.20–9.77]), use of combinations of opioids, benzodiazepines and related drugs and gabapentinoids (4.60 [3.62–5.85]), previous poisoning with pharmaceuticals (2.78 [2.20–3.51]), and with living alone the last year of life (2.11 [1.75–2.54]). Intentional overdoses had a stronger association with previous poisonings with pharmaceuticals whereas accidental overdoses were strongly associated with substance use disorders. Conclusions This study shows the need for better identification of overdose and suicide risk in individuals treated for chronic pain. Extra caution is needed when treating complex comorbid disorders, especially with overdose risk-increasing medications.

• Eide, Desiree; Mcdonald, Rebecca Silvia; Hamina, Aleksi; Clausen, Thomas; Odsbu, Ingvild & Skurtveit, Svetlana Ondrasova (2023). Prescription high-risk polysubstance use among opioid maintenance treatment patients. International journal of drug policy. ISSN 0955-3959. doi: 10.1016/j.drugpo.2023.104196. Fulltekst i vitenarkiv Vis sammendrag

  Background Among individuals receiving buprenorphine or methadone as opioid maintenance treatment (OMT), concomitant use of other central nervous system depressants, including prescription drugs, can increase risk of overdose. We aimed to 1) determine the prevalence of use of high-risk prescription drugs (opioid analgesics, benzodiazepines, benzodiazepine-related drugs, and gabapentinoids) among OMT patients, 2) calculate its associations with different mental health and pain-related diagnoses, and 3) compare prevalence of concomitant use with the general population. Methods A national sample comprising all individuals filling at least one prescription of OMT drugs in Norway in 2019 was formed. Healthcare registry data were linked to investigate high-risk prescription drug use and different diagnoses. We calculated one-year prevalence of use, amount dispensed in defined daily doses (DDDs), and the number of prescribers for the different high-risk prescription drugs. Logistic regression was used to determine associations (adjusted odds ratios; aOR, 95% confidence intervals (CIs)) between diagnoses and use. Prevalence of use was calculated both in the OMT patient sample and the general population. Results Among the OMT patient sample (n=7,299), 47.6% (n=3,476) filled prescriptions for benzodiazepines. For each high-risk prescription drug group, there was a median of 1-2 prescribers. Musculoskeletal diagnoses were the strongest factor for concomitant high-risk prescription drug use for both males (aOR 3.23, CI: 2.72-3.85) and females (aOR 3.07, CI: 2.42- 3.90). The 1-year prevalence of benzodiazepine use was 11.4 times higher for males and 7.1 times higher for females in OMT than the general population. The amount in DDDs was higher for every drug for OMT patients than the general population, particularly for benzodiazepines. Conclusions OMT patients frequently filled prescriptions for high-risk drugs, and in higher dosages than the general population. However, we found little evidence of ‘doctor shopping.’ Given that these prescription drugs carry overdose risk, particularly when combined with OMT drugs, our findings emphasize the continued need for education and caution to both prescribers and patients on their concomitant use with OMT.

• Rolova, Gabriela; Eide, Desiree; Gabrhelík, Roman; Odsbu, Ingvild; Clausen, Thomas & Skurtveit, Svetlana Ondrasova (2023). Gender differences in physical morbidity in opioid agonist treatment patients: population-based cohort studies from the Czech Republic and Norway. Substance Abuse Treatment, Prevention, and Policy. 18(1). doi: 10.1186/s13011-023-00557-8. Fulltekst i vitenarkiv Vis sammendrag

  Background Physical diseases represent a significant burden for opioid agonist treatment (OAT) patients. This study described physical morbidity in two national cohorts of OAT patients focusing on gender differences. Methods This population-based cohort study linking multiple health registers investigated physical diseases (ICD-10) in patients receiving OAT in the Czech Republic (N = 4,280) and Norway (N = 11,389) during 2010–2019. Gender-stratified analysis was performed. Results Overall, we found a large burden of physical morbidity across gender groups in OAT patients. In the Czech Republic and Norway, women in OAT had a significantly higher prevalence of physical diseases across most diagnostic chapters, notably genitourinary diseases and neoplasms. Injuries/external causes and infectious/parasitic diseases were among the most common diseases in both women and men. Viral hepatitis accounted for over half of infectious morbidity in women and men in both cohorts. Conclusions Our findings support the need for early screening, detection, and treatment of diseases and conditions across organ systems and the integration of health promotion activities to reduce physical morbidity in OAT patients. The gender differences underline the need for a tailored approach to address specific medical conditions.

• Ellingsen, Maren Mikkelsen; Clausen, Thomas; Johannesen, Sunniva Launes; Martinsen, Egil Wilhelm & Hallgren, Mats (2023). Effects of Acute Exercise on Affect, Anxiety, and Self-Esteem in Poly-Substance Dependent Inpatients. European Addiction Research. ISSN 1022-6877. 29(4), s. 285–293. doi: 10.1159/000531042. Fulltekst i vitenarkiv Vis sammendrag

  Introduction: Negative affect and anxiety frequently precede the onset of drug use in those with substance use disorder (SUD). Low self-esteem may increase the risk of relapse. We examined the short-term effects of exercise on affect, anxiety, and self-esteem in inpatients with poly-SUD. Methods: This is a multicenter randomized control trial (RCT) with a crossover design. Thirty-eight inpatients (37.3 ± 6.4 years; 84% male) from three clinics participated in 45 min of soccer, circuit training, and control condition (psychoeducation) in a random order. Positive and negative affect (PANAS), state anxiety (single item), and self-esteem (Rosenberg SE-scale) were measured immediately before, immediately after, 1-h, 2-h, and 4-h post-exercise. Heart rate and ratings of perceived exertion were taken. Effects were assessed using linear mixed effects models. Results: Compared to the control condition, there were significant post-exercise improvements in positive affect (β = 2.99, CI = 0.39: 5.58), self-esteem (β = 1.84, CI = 0.49: 3.20), and anxiety (β = −0.69, CI = −1.34: −0.04) after circuit training (shown) and soccer. Effects persisted 4-h post-exercise. Reductions in negative affect were observed 2-h (circuit training: β = −3.39, CI = −6.35: −1.51) and 4-h (soccer: β = −3.71, CI = −6.03: −1.39) post-exercise, respectively. Conclusion: Moderately strenuous exercise undertaken in naturalistic settings may improve mental health symptoms in poly-SUD inpatients for up to 4-h post-exercise.

• Mcdonald, Rebecca Silvia; Bech, Anne Berit & Clausen, Thomas (2023). Flexible delivery of opioid agonist treatment during COVID-19 in Norway: qualitative and quantitative findings from an online survey of provider experiences. BMC Health Services Research. 23(1). doi: 10.1186/s12913-023-09959-7. Fulltekst i vitenarkiv Vis sammendrag

  Background For patients receiving daily opioid agonist treatment (OAT) for opioid dependence, several countries relaxed treatment guidelines at the beginning of the COVID-19 pandemic. This involved longer take-home intervals for methadone and buprenorphine doses as well as a reduction in supervised dosing and drug screening. To date, little is known about the medium or long-term experience of OAT deregulation. Therefore, we conducted a survey to explore how OAT providers perceived greater flexibility in OAT service delivery at the end of the second year of the pandemic. Methods Nationwide cross-sectional study of twenty-three OAT units in 19 publicly funded hospital trusts in Norway. OAT units were sent a 29-item online questionnaire comprising closed-format and open-ended questions on treatment provider experiences and changes in OAT service delivery during the past 12 months (January to December 2021). Results Twenty-three (of whom female: 14; 60.8%) managers or lead physicians of OAT units completed the questionnaire reporting that, in 2021, most OAT units (91.3%, n = 21) still practiced some adjusted approaches as established in the beginning of the pandemic. The most common adaptions were special protocols for COVID-19 cases (95.7%, n = 22), increased use of telephone- (91.3%, n = 21) and video consultations (87.0%, n = 20), and longer take-home intervals for OAT medications (52.2%, n = 12). The use of depot buprenorphine also increased substantially during the pandemic. According to the OAT providers, most patients handled flexible treatment provision well. In individual cases, patients’ substance use was identified as key factor necessitating a reintroduction of supervised dosing and drug screening. Collaboration with general practitioners and municipal health and social services was generally perceived as crucial for successful treatment delivery. Conclusions Overall, the Norwegian OAT system proved resilient in the second year of the COVID-19 pandemic, as its healthcare workforce embraced innovation in technology (telemedicine) and drug development (depot buprenorphine). According to our nationally representative sample of OAT providers, most patients were compliant with longer take-home doses of methadone and buprenorphine. Our findings suggest that telemedicine can be useful as adjunct to face-to-face treatment and provide greater flexibility for patients.

• Melis, Francesca; Hesse, Morten; Eide, Desiree; Thylstrup, Birgitte; Tjagvad, Christian & Brummer, Julie Elizabeth [Vis alle 7 forfattere av denne artikkelen] (2023). Who receives heroin-assisted treatment? A comparison of patients receiving opioid maintenance treatment in Denmark. Drug and Alcohol Dependence. ISSN 0376-8716. 254. doi: 10.1016/j.drugalcdep.2023.111051. Fulltekst i vitenarkiv Vis sammendrag

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

• Haugom, Espen Woldsengen; Benth, Jurate Saltyte; Stensrud, Bjørn; Ruud, Torleif; Clausen, Thomas & Landheim, Anne Signe (2023). Shared decision making and associated factors among patients with psychotic disorders: a cross-sectional study. BMC Psychiatry. 23(1). doi: 10.1186/s12888-023-05257-y. Fulltekst i vitenarkiv Vis sammendrag

  Background: Shared decision making is a process where patients and clinicians collaborate to make treatment choices based on the patients' preferences and best available evidence. The implementation of shared decision making remains limited for patients with psychotic disorders despite being recommended at policy level, being advocated as ethical right and wanted by the patient's. A barrier to implementation that is often mentioned is reduced decision-making capacity among patients. The challenges of implementing shared decision making highlights a need for more knowledge on shared decision making for these patients. Moreover, the association between patient-related characteristics and shared decision making is unclear, and further research have been suggested. More knowledge of factors associated with involvement in shared decision making can enhance understanding and help to empower patients in the decision-making process. The current study examined the extent of reported shared decision making among patients with a psychotic disorder in mental health care and factors associated with shared decision making. Methods: This study included 305 participants with a psychotic disorder from 39 clinical inpatient and outpatient sites across Norway. Shared decision making was assessed using the CollaboRATE survey. A linear mixed model was estimated to assess characteristics associated with shared decision making scores. Results: The CollaboRATE mean score was 6.3 (ranging from 0 to 9), the top score was 14.1% and increased global satisfaction with services was significantly associated with a higher level of shared decision making (regression coefficient 0.27, 95% confidence interval (0.23; 0.32), p < 0.001). Conclusions: The low top score shows that few patients felt that they received the highest possible quality of shared decision making, indicating that many patients found room for improvement. This suggests that services for patients with psychotic disorders should be designed to give them a greater role in decision making. Shared decision making might play a key role in mental health care, ensuring that patients with psychotic disorders are satisfied with the services provided. Trial registration: NCT03271242, date of registration: 5 Sept. 2017.

• Gabrhelík, Roman; Hesse, Morten; Nechanská, Blanka; Handal, Marte; Mravčík, Viktor & Tjagvad, Christian [Vis alle 11 forfattere av denne artikkelen] (2023). Large variations in all-cause and overdose mortality among >13,000 patients in and out of opioid maintenance treatment in different settings: a comparative registry linkage study. Frontiers in Public Health. 11. doi: 10.3389/fpubh.2023.1179763. Fulltekst i vitenarkiv Vis sammendrag

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

• Eide, Desiree; Skurtveit, Svetlana Ondrasova; Clausen, Thomas; Hesse, Morten; Mravčík, Viktor & Nechanská, Blanka [Vis alle 12 forfattere av denne artikkelen] (2023). Cause-Specific Mortality among Patients in Treatment for Opioid Use Disorder in Multiple Settings: A Prospective Comparative Cohort Study. European Addiction Research. ISSN 1022-6877. 29(4), s. 272–284. doi: 10.1159/000530822. Fulltekst i vitenarkiv Vis sammendrag

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

• Gjerde, L. C.; Skurtveit, S.; Handal, M.; Nesvåg, R.; Clausen, T. & Lid, T. G. [Vis alle 9 forfattere av denne artikkelen] (2023). Mental disorder prevalence in chronic pain patients using opioid versus non-opioid analgesics: A registry-linkage study. European Journal of Pain. ISSN 1090-3801. 27(7), s. 884–895. doi: 10.1002/ejp.2121. Fulltekst i vitenarkiv Vis sammendrag

  Background Chronic pain and mental disorders are leading causes of disability worldwide. Individuals with chronic pain are more likely to experience mental disorders compared to individuals without chronic pain, but large-scale estimates are lacking. We aimed to calculate overall prevalence of mental health diagnoses from primary and secondary care among individuals treated for chronic pain in 2019 and to compare prevalence among chronic pain patients receiving opioid versus non-opioid analgesics, according to age and gender. Methods It is a population-based cohort study. Linked data from nationwide health registers on dispensed drugs and diagnoses from primary (ICPC-2) and secondary (ICD-10) health care. Chronic pain patients were identified as all patients over 18 years of age filling at least one prescription of an analgesic reimbursed for non-malignant chronic pain in both 2018 and 2019 (N = 139,434, 69.3% women). Results Prevalence of any mental health diagnosis was 35.6% (95% confidence interval: 35.4%–35.9%) when sleep diagnoses were included and 29.0% (28.8%–29.3%) when excluded. The most prevalent diagnostic categories were sleep disorders (14% [13.8%–14.2%]), depressive and related disorders (10.1% [9.9%–10.2%]) and phobia and other anxiety disorders (5.7% [5.5%–5.8%]). Prevalence of most diagnostic categories was higher in the group using opioids compared to non-opioids. The group with the highest overall prevalence was young women (18–44 years) using opioids (50.1% [47.2%–53.0%]). Conclusions Mental health diagnoses are common in chronic pain patients receiving analgesics, particularly among young individuals and opioid users. The combination of opioid use and high psychiatric comorbidity suggests that prescribers should attend to mental health in addition to somatic pain. Significance This large-scale study with nation-wide registry data supports previous findings of high psychiatric burden in chronic pain patients. Opioid users had significantly higher prevalence of mental health diagnoses, regardless of age and gender compared to users of non-opioid analgesics. Opioid users with chronic pain therefore stand out as a particularly vulnerable group and should be followed up closely by their physician to ensure they receive sufficient care for both their mental and somatic symptoms.

• Eshrati, Sahar; Saberizafarghandi, MohammadBagher; Vameghi, Meroe; Arezoomandan, Reza; Ranjbar, Hadi & Clausen, Thomas [Vis alle 7 forfattere av denne artikkelen] (2023). Main problems experienced by the neighbors of open drug scenes, Tehran, Iran: a mixed-method study. Harm Reduction Journal. 20(1). doi: 10.1186/s12954-023-00880-0. Fulltekst i vitenarkiv Vis sammendrag

  Background Despite law enforcement and health interventions, open drug scenes have led to problems in many countries. The problems are, however, insufficiently explored. There are different types of drug scenes in Iran. This study aimed to explore the issues related to neighbors of one of the drug scenes in Tehran known as Farahzad. Methods Data were generated via semi-structured interviews in the first step of the current mixed-method study (2020–2021). Interviewees were people who use drugs (PWUDs), residents and business owners (N = 25). In the next step, a quantitative observation was conducted for eight days. The results were analyzed using conventional content analysis and descriptive statistics. Results The perceived problems were ambivalent attitudes about drug scene-related activities, violate of the territory of the self of the effected residents, and everyday concerns. The observation results indicated that men who use drugs are involved in drug scene-related activities more than women are. PWUDs try to hide their activities from the public view. Their efforts were considered “self-regulatory strategies” in the drug scene. Conclusions Despite efforts of PWUDs to keep their activities invisible, drug scene-related issues are intolerable for neighbors. Neighbors and PWUDs have ambivalent attitudes. While they are concerned about the human rights of each other, drug scene-related activities have disturbed the neighbor’s daily life and economic activities. Although law enforcement and harm reduction interventions reduce some of the problems, one of the approaches should be improving the coexistence between the neighbors and the residents of the drug scene to achieve broader and more sustainable compromises.

• Finstad, Jeanette; Clausen, Thomas; Rosseland, Leiv Arne; Røise, Olav & Havnes, Ingrid Amalia (2022). Patient experiences after physical trauma: The negative effect of the COVID-19 pandemic on recovery. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 19:12258(19), s. 1–9. doi: 10.3390/ijerph191912258. Fulltekst i vitenarkiv Vis sammendrag

  The coronavirus disease 2019 (COVID-19) pandemic generated a crisis within the healthcare system, during which acute, COVID-19-related health needs were prioritized over less urgent needs, including vulnerable subgroups. This study explored experiences of recovery among survivors of physical injuries associated with severe pain during the COVID-19 pandemic in Norway. In-depth interviews were conducted among 13 participants. Findings generated by a thematic analysis revealed that the pandemic, including the contagion control measures and interrupted healthcare, were of negative consequence for the participants’ recovery experiences and mental and physical health. Despite experiencing severe pain and perceived needs for support, the participants experienced being deprioritized by the healthcare system. They experienced a reduced capacity to cope with pandemic-related stress and to perform everyday tasks, which they perceived as generating an additional burden for their loved ones. Alcohol was reported to be used in an effort to relieve the associated mental distress. As suggested by this study, injury survivors constitute a vulnerable subgroup for whom the continuity of rehabilitation services during a national crisis, as well as the integration of mental health support, can be essential for mitigating the negative impact of the crisis on recovery and for promoting optimal long-term health outcomes. Keywords: COVID-19; pandemic; physical trauma; recovery; rehabilitation; mental health; substance use; qualitative research

• 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. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Gabrielsen, Karin Berle; Clausen, Thomas; Haugland, Siri Håvås; Hollup, Stig Arvid & Vederhus, John-Kåre (2022). Infralow neurofeedback in the treatment of substance use disorders: a randomized controlled trial. Journal of Psychiatry & Neuroscience. ISSN 1180-4882. 47(3), s. 222–229. doi: 10.1503/jpn.210202. Fulltekst i vitenarkiv Vis sammendrag

  Background Infralow neurofeedback (ILF-NF) was recently developed as a subtype of traditional, frequency-based neurofeedback that targets cerebral rhythmic activity below 0.5 Hz and improves brain self-regulation. The efficacy of ILF-NF in the treatment of substance use disorder has not yet been evaluated, but clinical evidence suggests that it may prevent relapse by improving functioning in various life domains. The current study aimed to fill this research gap and extend empirical evidence related to this issue. Methods Ninety-three patients with substance use disorders at an outpatient unit in Norway were randomized to receive 20 sessions (30 minutes each) of ILF-NF training combined with treatment as usual (TAU), or TAU alone. The primary outcome was quality of life post-treatment as an overall measure of functioning. We analyzed between-group differences using Student t tests. Results We found no significant differences in quality of life between groups. We found similar nonsignificant results for most of the secondary outcome measures, including drug use, sleep, anxiety and depression. Compared to TAU, the ILF-NF + TAU group reported significantly lower restlessness scores post-treatment (mean difference −1.8, 95 % confidence interval −3.1 to −0.5; p = 0.006). Limitations: This study was limited by broad inclusion criteria and a lack of placebo control (sham neurofeedback treatment). Conclusion ILF-NF offered limited additional benefit when combined with TAU, except in the area of restlessness. Future studies could further investigate the relationship between ILF-NF, restlessness and substance use in targeted subpopulations to illuminate relapse mechanisms.

• Vederhus, John-Kåre; Rørendal, Malin; Skårdal, Madelene; Næss, Marianne Otterstad; Clausen, Thomas & Kristensen, Øistein (2022). Successful outcomes with low–threshold intervention for cannabis use disorders in Norway - an observational study. PLOS ONE. 17(6), s. 1–12. doi: 10.1371/journal.pone.0269988. Fulltekst i vitenarkiv Vis sammendrag

  Aims Cannabis is the most commonly used regulated drug by European youths. Yet, few cannabis-specific interventions have been examined in Europe. The Cannabis Cessation Program (CCP) was developed in Sweden in the 1990s and has been implemented in some Norwegian municipalities. The present study aimed to examine outcomes of this intervention in the Norwegian setting. Method The respondents (N = 102) were recruited in four community-based CCPs in Norway. We examined their changes in cannabis use, other substance use, mental distress, well-being, sense of coherence (SoC), and social networks, from baseline (T0) to post-treatment (T1) and up to a 3-month follow-up period (T2). Changes were evaluated with pair-wise t-tests. Result Seventy-six participants (75%) completed the 8-week program, according to plan. All participants reported a significant reduction in cannabis use at T1 (average reduction ~16 days per month) and at T2 (N = 59; ~13 days per month). Among those that completed the program, 67% was abstinent from cannabis at T1 and 37% was abstinent at T2. An intention-to-treat analysis showed that 50% (51/102) and 22% (22/102) were abstinent from cannabis use at T1 and T2, respectively. In parallel to abstinence, we observed a substantial reduction in mental distress and an increase in well-being and SoC. Respondents socialized with fewer friends with current substance use, but drug-free social networks were not expanded. Conclusion Our findings suggested that the CCP was a valuable, low-threshold manual-based intervention for cannabis use disorders. It showed considerable potential for reducing individuals’ cannabis use. Clinical trial registration Clinicaltrials.gov no. NCT04989205. Registered 12 July 2021, i.e., the study was retrospectively registered.

• Hamina, Aleksi; Muller, Ashley Elizabeth; Clausen, Thomas; Skurtveit, Svetlana Ondrasova; Hesse, Morten & Tjagvad, Christian [Vis alle 11 forfattere av denne artikkelen] (2022). Prescription opioids among older adults: ten years of data across five countries. BMC Geriatrics. 22(429). doi: 10.1186/s12877-022-03125-0. Fulltekst i vitenarkiv Vis sammendrag

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

• Hamina, Aleksi; Odsbu, Ingvild; Borchgrevink, Petter Chr.; Chen, Li-Chia; Clausen, Thomas & Espnes, Ketil Arne [Vis alle 18 forfattere av denne artikkelen] (2022). Cohort Description: Preventing an Opioid Epidemic in Norway – Focusing on Treatment of Chronic Pain (POINT) – A National Registry-Based Study. Clinical Epidemiology. 14, s. 1477–1486. doi: 10.2147/CLEP.S382136. Fulltekst i vitenarkiv Vis sammendrag

  Aim: The POINT project aims to provide evidence to optimise chronic pain management, prevent adverse consequences of opioids, and improve chronic pain patients’ pain relief, functional capacity, and quality of life. We describe the outline of the project and its work packages. More specifically, we describe a cohort of persons with chronic pain and a cohort of long-term opioid users identified from a national registry linkage. Data Sources: The project utilises data from nationwide healthcare and population registers in Norway. Using the Norwegian Prescription Database, we identified a cohort of persons who have been dispensed drugs reimbursed for chronic pain and a cohort of persons who used opioids long term from 2010 to 2019. Data from the Norwegian Registry for Primary Health Care and the Norwegian Patient Registry (2008– 2019), Cancer Registry (1990– 2018) Cause of Death Registry (2010– 2019) and demographic and socioeconomic registers from Statistics Norway (2010– 2019) were linked to the cohorts. Study Population: There were 568,869 participants with chronic pain. Sixty-three percent of the cohort was women, and the mean age was 57.1 years. There were 336,712 long-term opioid users (58.6% women; 60.9 years). In chronic pain and long-term opioid user cohorts, the most frequent musculoskeletal diagnosis was back pain diagnosed in primary care (27.6% and 30.7%). Psychiatric diagnoses were also common. Main Variables: Upcoming studies will utilise psychiatric and somatic diagnoses from the patient registers, drug use from the prescription register, causes of death, demographics, and socioeconomic status (eg, education, income, workability, immigrant status) as exposures or outcomes. Conclusion and Future Plans: The two cohorts have numerous pain-related diagnoses, especially in the musculoskeletal system, and noticeably frequent somatic and psychiatric morbidity. The POINT project also includes later work packages that explore prescriber and patient perspectives around safe and effective treatment of chronic pain.

• McDonald, Rebecca; Breidahl, Sibella; Abel-Ollo, Katri; Akhtar, Shabana; Clausen, Thomas & Day, Ed [Vis alle 12 forfattere av denne artikkelen] (2022). Take-Home Naloxone Kits: Attitudes and Likelihood-Of-Use Outcomes from a European Survey of Potential Overdose Witnesses. European Addiction Research. ISSN 1022-6877. doi: 10.1159/000521197. Fulltekst i vitenarkiv Vis sammendrag

  Background: Injectable naloxone is already provided as take-home naloxone (THN), and new concentrated intranasal naloxone is now being introduced in Europe. Despite evidence of the effectiveness and cost-effectiveness of THN, little is known about the attitudes of key target populations: people who use opioids (PWUO), family/friends, and staff. We examined the acceptability of different naloxone devices (ampoule, prefilled syringe, and concentrated nasal spray) across 5 European countries. Objectives: The aim of this study was to compare THN target groups (PWUO vs. family/friends vs. staff) in their past rates of witnessed overdose and THN administration (as indicators of future use), current THN device preference, and THN carriage on the day of survey. Method: Cross-sectional survey of respondents (age ≥18) in addiction treatment, harm reduction, and recovery services in Denmark, England, Estonia, Norway, and Scotland. A purpose-developed questionnaire (59 items) was administered in the local language electronically or in a pen-and-paper format. Results: Among n = 725 participants, 458 were PWUO (63.2%), 214 staff (29.5%), and 53 (7.3%) family members. The groups differed significantly in their likelihood-of-future THN use (p < 0.001): PWUO had the highest rate of previously witnessing overdoses (352; 77.7%), and staff members reported the highest past naloxone use (62; 30.1%). Across all groups, most respondents (503; 72.4%) perceived the nasal spray device to be the easiest to use. Most reported willingness to use the spray in an overdose emergency (508; 73.5%), followed by the prefilled syringe (457; 66.2%) and ampoules (64; 38.2%). Average THN carriage was 18.6%, ranging from 17.4% (PWUO) to 29.6% (family members). Conclusion: Respondents considered the concentrated naloxone nasal spray the easiest device to use. Still, most expressed willingness to use the nasal spray as well as the prefilled syringe in an overdose emergency. Carriage rates were generally low, with fewer than 1 in 5 respondents carrying their THN kit on the day of the survey.

• Ericson, Øystein Bruun; Eide, Desiree; Lobmaier, Philipp Paul & Clausen, Thomas (2022). Staff preferences towards electronic data collection from a national take-home naloxone program: a cross-sectional study. Substance Abuse Treatment, Prevention, and Policy. 17(1). doi: 10.1186/s13011-022-00440-y. Fulltekst i vitenarkiv
• Skurtveit, Svetlana Ondrasova; Odsbu, Ingvild; Gjersing, Linn; Handal, Marte; Lid, Torgeir Gilje & Clausen, Thomas [Vis alle 7 forfattere av denne artikkelen] (2022). Individuals Dying of Overdoses Related to Pharmaceutical Opioids Differ from Individuals Dying of Overdoses Related to Other Substances: A Population-Based Register Study. European Addiction Research. ISSN 1022-6877. 28(6). doi: 10.1159/000526145. Fulltekst i vitenarkiv Vis sammendrag

  Background: Pharmaceutical opioid (PO) overdose deaths have increased in many Western countries. There are indications that those dying from a PO overdose differ from those dying from other types of overdoses. These differences might pose a challenge as the majority of current preventive measures are tailored toward those with the characteristics of "conventional" overdose deaths. Objective: We investigated differences in the characteristics of persons who died from PO overdoses compared to all other overdoses. Material and methods: Using the Norwegian Cause of Death Registry, we retrieved information on overdoses classified according to ICD-10 and identified PO overdoses (T40.2; T40.4) and all other overdoses (T40.X; T43.6) in 2010-2019. By linking data from nationwide registers, we analyzed data on opioid dispensations and the history of mental and behavioral disorders. 1,224 persons were registered with PO overdoses and 1,432 persons with other overdoses. Results: Persons in the PO overdose group were older and were more frequently women (35.0% vs. 20.5%) than persons with other overdoses. They had a higher prevalence of chronic pain (35.8% vs. 13.2%), history of cancer (8.1% vs. 1.8%), filled prescriptions of analgetic opioids more frequently the month before death (38.8% vs. 12.0%), and used threefold higher doses of prescribed opioids compared to individuals in all other overdose group (66 vs. 26 oral morphine equivalents/day). In the PO overdose group, oxycodone and fentanyl were more frequently dispensed, while codeine was more frequently dispensed in the other overdose groups. A lower proportion of those in the PO overdose group had recorded diagnoses of substance use disorders, schizophrenia, and hyperkinetic disorder compared to the other overdose groups. Conclusion: Persons dying from overdoses on POs often differ from the population targeted by existing prevention strategies, as they are more frequently older women with chronic pain and using high doses of prescription opioids.

• Hamina, Aleksi; Hjellvik, Vidar; Handal, Marte; Odsbu, Ingvild; Clausen, Thomas & Skurtveit, Svetlana Ondrasova (2022). Describing long-term opioid use utilizing Nordic Prescription Registers - A Norwegian example. Basic & Clinical Pharmacology & Toxicology. ISSN 1742-7835. 130(4), s. 481–491. doi: 10.1111/bcpt.13706. Fulltekst i vitenarkiv Vis sammendrag

  Previous studies have defined long-term opioid use in varying ways, decreasing comparability, reproducibility and clinical applicability of the research. Based on recommendations from recent systematic reviews, we aimed to develop a methodology to estimate the prevalence of use persisting more than three months utilizing one of the Nordic prescription registers. We used the Norwegian Prescription Register (NorPD) to extract data on all opioid dispensations between 1 January 2004 and 31 October 2019. New users of opioids (washout 365 days) were defined as long-term users if they fulfilled two criteria: (1) they had ≥2 dispensations of opioids, 91–180 days apart; (2) days 0–90 included ≥90 dispensed administration units (e.g., tablets) of opioids. Overall, there were 2,543,224 new users of opioids during the study period. Of these, 354,666 (13.9%) fulfilled the criteria for long-term opioid use at least once. Compared with those who did not fulfil the criteria (short-term users), long-term users were older, more likely women and used tramadol, oxycodone and buprenorphine more frequently as their first opioid. In conclusion, we found that 1/7 of opioid users continued use longer than 3 months. Future outcome research should identify the clinically most important dose requirements for long-term opioid use criteria.

• Eide, Desiree; Lobmaier, Philipp Paul & Clausen, Thomas (2022). Who is using take-home naloxone? An examination of supersavers. Harm Reduction Journal. 19(1). doi: 10.1186/s12954-022-00647-z. Fulltekst i vitenarkiv Vis sammendrag

  Background As the opioid overdose crisis persists and take-home naloxone (THN) programmes expand, it is important that the intervention is targeted towards those most likely to use it. We examined THN program participants to 1) describe those that return for refills, specifically those that reported multiple use (supersavers), and 2) to examine what rescuer characteristics were associated with higher rates of THN use. Methods This study included a cohort of consenting THN recipients from June 2014–June 2021 who completed initial and refill questionnaires from a widespread program in Norway. Age, gender, number of witnessed and experienced overdoses were assessed for associations with higher reported rates of THN use. ‘Supersavers’ reported 3 or more THN uses. Results A total of 1054 participants returned for a THN refill during the study period. Of these, 558 reported their last THN to have been used on an overdose. Supersavers (those that reported 3 or more THN uses) were younger, primarily reported current opioid use, and had witnessed higher rates of overdoses at the time of initial training when compared to non-supersavers (those that reported 0–2 THN uses). Conclusions THN programs should continue to emphasize and prioritize THN for people actively using drugs, particularly those who have witnessed overdoses previously.

• Ericson, Øystein Bruun; Eide, Desiree; Lobmaier, Philipp Paul & Clausen, Thomas (2022). Risks and overdose responses: Participant characteristics from the first seven years of a national take-home naloxone program. Drug and Alcohol Dependence. ISSN 0376-8716. 240:109645, s. 1–7. doi: 10.1016/j.drugalcdep.2022.109645. Fulltekst i vitenarkiv Vis sammendrag

  Background In 2014, the Norwegian government funded a large-scale take-home naloxone (THN) program to address high overdose mortality rates. The aims of this study are to describe characteristics among persons trained to receive THN, describe actions taken following THN use at an overdose event and to explore factors associated with naloxone use. Methods This was a prospective cohort study of individuals who received THN from 2014 to 2021. Descriptive characteristics were collected at initial training. When returning for refill, participants reported on their previous naloxone use. In a multivariable logistic regression model exploring associations with naloxone use: gender, age, opioid use history, concomitant drug use, injecting, history of experienced or witnessed overdose were included. Results In total, 3527 individuals were included in this study. There were 958 individuals who returned for refills 2303 times. Most participants were male (63.6%), with a history of opioid use (77.5%). Those who reported naloxone use were more likely to have a history of opioid use (aOR= 4.1; 95% CI=2.77,6.1), were younger (aOR=0.98; 95% CI=0.97,0.99) and had witnessed overdoses (aOR=3.3; 95% CI=1.98,5.34). Among current opioid users, the odds were higher for injectors (aOR=1.57; 95% CI=1.18,2.1). Naloxone use was reported 1282 times. Additional actions such as waking the person and calling the ambulance were frequently reported. Survival was reported in almost all cases (94%). Conclusion People who use drugs are a suitable target group for THN-programs, as they seem to be willing and capable to reverse overdoses effectively. Given their personal risk factors for overdosing, recipients will likely also benefit from overdose prevention education.

• Welle-Strand, Gabrielle; Gjersing, Linn; Olsen, Ida Keihl & Clausen, Thomas (2022). A COVID-19 Survey among People Who Use Drugs in Norway. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 19(12). doi: 10.3390/ijerph19127002. Fulltekst i vitenarkiv Vis sammendrag

  Background: to combat the COVID-19 pandemic, adherence to COVID-19 recommendations and vaccination against COVID-19 have been important. Among people who use drugs (PWUD), little is known regarding compliance towards COVID-19 recommendations, COVID-19 testing, or attitudes towards COVID-19 vaccination. We aimed to examine these issues in a sample of PWUD. Methods: a cross-sectional study was conducted between January and March 2021. Through users’ organizations and different low-threshold services for substance users, we recruited former drug users and professionals to include participants and perform the interviews. Participants completed an interviewer-administered questionnaire. Any person above 16 years of age who used substances were recruited. Results: 477 Norwegian PWUD participated in the study. The mean age was 43.8 (SD 12.8) years and 77% were males. Thirty-four percent had injected drugs the past four weeks. Alcohol (41%) and cannabis (41%) were the most common drugs used the past four weeks, followed by tranquilizers (37%), central stimulants (35%) and opioids (30%). The majority (90%) had washed their hands frequently, used alcohol sanitizer during the past two weeks, had used face masks, kept one-meter distance to other people and stayed at home if feeling unwell. Fifty-four percent had been COVID-19 tested. More than half the sample (58%) had positive attitudes to COVID-19 vaccination, while 26% were fairly or very unlikely to accept vaccination. Those older (OR = 0.96, 95% CI 0.94; 0.98) and using face masks (OR = 0.49, 95% CI 0.30; 0.79) were more likely to have positive attitudes towards vaccination, while those reporting low life-satisfaction (OR = 3.86, 95% CI 1.43; 10.40), using opioids (OR = 2.97, 95% CI 1.43; 6.18) or almost never staying at home when feeling unwell (OR = 2.76, 95% 1.39; 5.45) expressed more negative attitudes towards vaccination. Conclusion: there was generally a high compliance towards COVID-19 recommendations, but one quarter of the sample was sceptical towards COVID-19 vaccination. This indicates a need for targeted and tailored information and well-designed vaccination roll-out programs to reach all PWUD.

• Odsbu, Ingvild; Handal, Marte; Hjellvik, Vidar; Borchgrevink, Petter Chr.; Clausen, Thomas & Nesvåg, Ragnar [Vis alle 7 forfattere av denne artikkelen] (2022). Vedvarende bruk av opioider og samtidig bruk av andre vanedannende legemidler. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 142(3), s. 1–8. doi: 10.4045/tidsskr.21.0659. Fulltekst i vitenarkiv Vis sammendrag

  BAKGRUNN<p> Vedvarende bruk av opioider kan ha uheldige konsekvenser. Vi har undersøkt vedvarende opioidbruk i pasientgruppersom fikk forskrevet opioider på ulike indikasjoner(langvarig smerte, palliativ behandling, andre (hvitresept)),samt gruppenessamtidige bruk av enkelte andre vanedannende legemidler.<p> MATERIALE OG METODE<p> <p>Personer med minst én utlevering av et opioid i Reseptregisteret i perioden 2011–19 ble inkludert. Vedvarende bruk i et kalenderår ble definertsom uthenting av > 180 definerte døgndoser eller > 4 500 mg orale morfinekvivalenterfordelt på minst tre kvartaler.<p> <p>RESULTATER Antall vedvarende opioidbrukere var 50 422 i 2011 og 59 996 i 2019 (10,1 % og 10,7 % av alle opioidbrukere). I perioden økte antalletsom fikk opioider på blå resept forlangvarige smerter, med 9 952 personer, men flertallet (n = 38 006, 63,3 %) fikk fortsa utlevert opioider utelukkende på hvitresept i 2019. Henholdsvis15 623 (41,1 %) og 14 881 (39,2 %) av de vedvarende opioidbrukerne som fikk utlevert opioider kun på hvitresept i 2019, fikk også utlevert benzodiazepiner og z-hypnotika samme år. Av de 23 967 vedvarende brukerne som også fikk utlevert benzodiazepiner, fikk 88 % utlevert opioider og benzodiazepiner på samme dag minst én gang i løpet av 2019.<p> <p>FORTOLKNING Vedvarende forskrivning av opioider på hvitresept og samtidig forskrivning av andre vanedannende legemidler kan tyde på uheldig bruk uten klarindikasjon.

• Mcdonald, Rebecca Silvia; Eide, Desiree; Abel-Ollo, Katri; Barnsdale, Lee; Carter, Ben & Clausen, Thomas [Vis alle 24 forfattere av denne artikkelen] (2022). A rapid assessment of take-home naloxone provision during COVID-19 in Europe. International journal of drug policy. ISSN 0955-3959. 107. doi: 10.1016/j.drugpo.2022.103787. Fulltekst i vitenarkiv Vis sammendrag

  Background In March 2020, the World Health Organization declared COVID-19 a global pandemic. In the following weeks, most European countries implemented national lockdowns to mitigate viral spread. Services for people who use drugs had to quickly revise their operating procedures to rearrange service provision while adhering to lockdown requirements. Given the scarcity of literature published on overdose prevention during COVID-19 in Europe, we aimed to examine how these changes to service provision affected take-home naloxone (THN) programmes and naloxone availability across Europe. Methods Between November 2020 and January 2021, we conducted a rapid assessment with country experts from European countries that provide THN. We sent country experts a template to report monthly THN distribution data (January 1, 2019-October 31, 2020) and a structured 6-item survey for completion. Results Responses were received from 14 of the 15 European countries with THN provision of which 11 participated in the rapid assessment: Austria, Denmark, England, Estonia, Lithuania, Northern Ireland, Norway, Scotland, Spain (Catalonia only), Sweden, and Wales. All reported reduced organisational capacity during COVID-19, and some put into place a range of novel approaches to manage the restrictions on face-to-face service provision. In six countries, the introduction of programme innovation occurred alongside the publication of government guidelines recommending increased THN provision during COVID-19. Eight of the eleven participating countries managed to maintain 2019-level monthly THN distribution rates or even increase provision during the pandemic. Conclusion Through programme innovation supported by public guidelines, many European THN programmes managed to ensure stable or even increased THN provision during the pandemic, despite social distancing and stay-at-home orders affecting client mobility.

• Skeie, Ivar; Clausen, Thomas; Hjemsæter, Arne Jan; Landheim, Anne Signe; Monsbakken, Bent Berntsen & Thoresen, Magne [Vis alle 7 forfattere av denne artikkelen] (2022). Mortality, Causes of Death, and Predictors of Death among Patients On and Off Opioid Agonist Treatment: Results from a 19-Year Cohort Study. European Addiction Research. ISSN 1022-6877. 28(5), s. 358–367. doi: 10.1159/000525694. Fulltekst i vitenarkiv Vis sammendrag

  Background: Mortality is increased among people with opioid use disorder but reduced while on opioid agonist treatment (OAT). However, the impact of patient and treatment characteristics on mortality and causes of death is insufficiently studied. Objectives: The objective of this study was to explore mortality and causes of death and examine the impact of patient and treatment characteristics on mortality in an OAT cohort with high retention in treatment. Methods: Design: longitudinal cohort study. Setting: Norway. Observation period: time from OAT start as of 1998 until death or end of 2016, 2,508 person-years (PY) in total. Sample: 200 persons starting OAT 1998–2007. Data sources: hospital records, interviews, the Norwegian Cause of Death Registry, Statistics Norway. Results: Retention: 86.4% of the observation period was on OAT, 9.0% off, 4.6% unknown OAT status. All-cause crude mortality rate per 100 PY during the whole observation period was 1.64 (95% CI: 1.19–2.20), for deaths of somatic cause 0.88 (0.56–1.31), for drug-induced deaths 0.44 (0.23–0.76), and traumatic deaths 0.24 (0.10–0.50). Off-versus-on-OAT all-cause mortality ratio was 2.31 (1.00–4.85). On OAT, 58% of the deaths were of somatic cause and 21% drug-induced; off OAT, 38% of somatic cause and 50% drug-induced. Increasing baseline age and rate of somatic hospital treatment episodes were independently associated with increased all-cause mortality risk, while increasing rate of in-patient psychiatric treatment episodes was associated with reduced risk. Increasing duration of nicotine and cannabis use and alcohol dependence as well as increasing severity of polydrug use were associated with increased all-cause and somatic mortality adjusted for age and sex. Conclusion: The long observation period made it possible to demonstrate the importance of long-term retention in OAT to reduce mortality. Further, the preponderance of somatic and reduction of drug-induced causes of death during OAT underlines the need for follow-up of chronic diseases and health-promoting lifestyle changes. These findings add to the knowledge about long-term OAT effects, not least in ageing OAT populations. © 2022 The Author(s). This article is licensed under the Creative Commons Attribution 4.0 International License (CC BY) (http://www.karger.com/Services/OpenAccessLicense). Usage, derivative works and distribution are permitted provided that proper credit is given to the author and the original publisher.

• Bjørnestad, Endre Dahlen; Vederhus, John-Kåre & Clausen, Thomas (2022). High smoking and low cessation rates among patients in treatment for opioid and other substance use disorders. BMC Psychiatry. 22(1), s. 1–8. doi: 10.1186/s12888-022-04283-6. Fulltekst i vitenarkiv Vis sammendrag

  Background: Smoking is a well-documented cause of health problems among individuals with substance use disorders. For patients in opioid maintenance treatment (OMT), the risk for somatic health problems, including preventable diseases associated with tobacco smoking, increases with age. Our aim was to describe smoking among patients entering substance use disorder (SUD) treatment, investigate changes in smoking from the start of treatment to 1-year follow-up, and explore factors related to smoking cessation. Methods: We employed data from the Norwegian Cohort of Patient in Opioid Maintenance Treatment and Other Drug Treatment Study (NorComt). Participants were 335 patients entering SUD treatment at 21 participating facilities across Norway. They were interviewed at the start of treatment and at 1-year follow-up. The main outcomes were smoking and smoking cessation by treatment modality. A logistic regression identified factors associated with smoking cessation. Results: High levels of smoking were reported at the start of treatment in both OMT (94%) and other SUD inpatient treatment patients (93%). At 1-year follow-up most patients in OMT were still smoking (87%), and the majority of the inpatients were still smoking (69%). Treatment as an inpatient was positively associated and higher age was negatively associated with smoking cessation. Most patients who quit smoking transitioned to smokeless tobacco or kept their existing smokeless habit. Conclusion: As illustrated by the high smoking prevalence and relatively low cessation levels in our sample, an increased focus on smoking cessation for patients currently in OMT and other SUD treatment is warranted. Harm-reduction oriented smoking interventions may be relevant.

• Edvardsen, Hilde Marie Erøy & Clausen, Thomas (2022). Opioid related deaths in Norway in 2000–2019. Drug and Alcohol Dependence. ISSN 0376-8716. 232. doi: 10.1016/j.drugalcdep.2022.109281. Fulltekst i vitenarkiv
• Gallefoss, Lisbeth; Gabrielsen, Karin Berle; Haugland, Siri Håvås; Clausen, Thomas & Vederhus, John-Kåre (2022). Effects of a brief pre‑admission telephone reminder on no‑show and dropout rates in substance use disorder treatment: a quasi‑experimental study. Substance Abuse Treatment, Prevention, and Policy. 17(1). doi: 10.1186/s13011-022-00489-9. Fulltekst i vitenarkiv Vis sammendrag

  Background Appointment no-show and early dropout from treatment represent major challenges in outpatient substance use disorder treatment, adversely affecting clinical outcomes and health care productivity. In this quasi-experimental study, we examined how a brief reminder intervention for new patients before their first appointment affected treatment participation and retention. No-shows (not attending any sessions) and dropouts (discontinuation of initiated treatment because of three consecutively missed appointments) were compared between a period with pre-admission telephone calls (intervention) and a period without such reminders (non-intervention). Methods Participants were all eligible patients (N = 262) admitted to a Norwegian specialist clinic for substance use disorder treatment. We used the Chi-square test for the no-show analysis. Of the eligible patients, 147 were included in a subsequent dropout analysis. We used the number of visits up to 10 appointments as a measure for time to event. Group differences were analyzed using a Kaplan–Meier plot and the log-rank test. To control for relevant sociodemographic variables, as well as substance use and mental distress severity, we used Cox regression. Results No-show rates did not differ between the two periods (12% for non-intervention vs. 14% for intervention; χ2 = 0.20, p = 0.653). Of those consenting to participate in the dropout analysis (n = 147), 28 (19%) discontinued treatment within the time frame of 10 appointments, with no differences between the two periods (log-rank test = 0.328, p = 0.567). Controlling for baseline characteristics did not alter this finding. In fact, of the registered covariates at baseline, only higher education level was associated with attrition, linked to a reduced risk for dropout (hazard ratio = 0.85, 95% CI = 0.74–0.98, p = 0.025). Conclusion These findings do not provide support for the systematic use of a brief pre-admission telephone reminder in the current treatment setting. Trial registration The study was retrospectively registered 13 Jan 2021 at ClinicalTrials.gov, NCT04707599.

• Finstad, Jeanette; Røise, Olav; Rosseland, Leiv Arne; Clausen, Thomas & Havnes, Ingrid Amalia (2021). Discharge from the trauma centre: exposure to opioids, unmet information needs and lack of follow up—a qualitative study among physical trauma survivors. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 29(1), s. 1–12. doi: 10.1186/s13049-021-00938-7. Fulltekst i vitenarkiv Vis sammendrag

  Background Physical trauma is associated with mortality, long-term pain and morbidity. Effective pain management is fundamental in trauma care and opioids are indispensable for treating acute pain; however, the use and misuse of prescribed opioids is an escalating problem. Despite this, few studies have been directed towards trauma patients in an early phase of rehabilitation with focusing on experiences and perspectives of health and recovery including pain and persistent use of prescribed opioids with abuse potential. To explore pre- and post-discharge trauma care experiences, including exposure to opioids, physical trauma survivors were recruited from a major trauma centre in Norway that provides the highest level of surgical trauma care. Method Qualitative exploratory study. Individual semi-structured interviews were conducted among 13 trauma patients with orthopedic injuries, known to be associated with severe pain, six weeks post-discharge. The interviews were recorded, transcribed verbatim, and thematically analyzed with an interdisciplinary approach. Results The overarching theme was that discharge from the trauma centre and the period that immediately followed were associated with feelings of insecurity. The three main themes that were identified as contributing to this was (a) unmet information needs about the injury, (b) exposure to opioids, and (c) lack of follow-up after discharge from the hospital. Participants experienced to be discharged with prescribed opioids, but without information about their addictive properties or tapering plans. This, and lack of attention to mental health and psychological impact of trauma, gave rise to unmet treatment needs of pain management and mental health problems during hospitalization and following discharge. Conclusion The findings from this study suggest that in addition to delivery of high-quality biomedical trauma care, health professionals should direct more attention to psychosocial health and safe pain management, including post-discharge opioid tapering and individually tailored follow-up plans for physical trauma survivors.

• Ellingsen, Maren Mikkelsen; Clausen, Thomas; Johannesen, Sunniva Launes; Martinsen, Egil W. & Hallgren, Mats (2021). Effects of acute exercise on drug craving in adults with poly-substance use disorder. A randomized controlled trial. Mental Health and Physical Activity. ISSN 1755-2966. 21, s. 1–9. doi: 10.1016/j.mhpa.2021.100423. Fulltekst i vitenarkiv Vis sammendrag

  Objectives To examine the short-term effects of exercise on drug craving in poly-drug-dependent inpatients, duration of effects, differences between exercise types, explore the relationship between craving and mood, and possible moderators. Design Multicenter randomized control trial (RCT) with a crossover design. Methods 38 (25 completed) inpatients (37.3 ± 6.4 years; 84 % male) from three treatment centers participated in soccer, circuit training and control condition in random order for 45-min. Craving was assessed with a self-rated visual analog scale (VAS), mood with Feeling scale (FS), immediately before and after each condition and 1, 2, and 4 h post interventions. Ratings of perceived exertion (RPE) and heart rate were assessed. Intervention effects were assessed using linear mixed effects model, including moderator analyses. Results Exercise sessions were perceived as “somewhat hard” to “hard”. Compared to control, there was an immediate reduction in craving after soccer and circuit training (β = −1.35, 95 %CI: 1.96, −0.75, p = 0.000; β = -1.44, 95 %CI: 2.06, −0.83, p = 0.000) that persisted for 4 h (β = −1.11, 95 %CI: 1.72, −0.49, p = 0.000; β = -0.85, 95 %CI: 1.49, −0.22, p = 0.008). Elevations in mood after soccer (β = 1.08, 95 %CI: 0.41, 1.76, p = 0.002) and circuit training (β = 0.99, 95 %CI: 0.32, 1.67, p = 0.004) were significantly larger than control. Depressive disorder and primary drug of use might moderate the effect. Conclusion Reduced drug cravings and elevated mood following soccer and circuit training were observed in people with poly-SUDs. Single exercise sessions can be an effective strategy to alleviate craving and potentially prevent relapse and treatment drop-out.

• Kruckow, Line; Tjagvad, Christian; Clausen, Thomas & Banner, Jytte (2021). Psychiatric disorders in a population of deceased drug users. Nordic Journal of Psychiatry. ISSN 0803-9488. doi: 10.1080/08039488.2021.1887350. Fulltekst i vitenarkiv Vis sammendrag

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

• Bech, Anne Berit; Clausen, Thomas; Waal, Helge; Delaveris, Gerd Jorunn Møller & Skeie, Ivar (2021). Organ pathologies detected post-mortem in patients receiving opioid agonist treatment for opioid use disorder: a nation-wide 2-year cross-sectional study. Addiction. ISSN 0965-2140. s. 1–9. doi: 10.1111/add.15705. Fulltekst i vitenarkiv Vis sammendrag

  Aims: To document organ pathologies detected post-mortem in patients receiving opioid agonist treatment for opioid use disorder and estimate the extent to which individual characteristics are associated with pulmonary, cardiovascular, hepatic or renal pathologies. Design: Two-year cross-sectional nation-wide study. Setting: Norway. Participants: Among all 200 patients who died during opioid agonist treatment between 1 January 2014 and 31 December 2015, 125 patients (63%) were autopsied. Among these, 122 patients (75% men) had available autopsy reports and were included. The mean age at the time of death was 48 years. Measurements: Information on pulmonary, cardiovascular, hepatic and renal pathologies were retrieved from forensic or medical autopsy reports, with no (0) and yes (1) as outcome variables and age, sex and body mass index as covariates in logistic regression analyses. Findings: Pathologies in several organs were common. Two-thirds (65%) of the decedents had more than two organ system diseases. The most common organ pathologies were chronic liver disease (84%), cardiovascular disease (68%) and pulmonary emphysema (41%). In bivariate analyses, only older age was associated with any pulmonary pathology [odds ratio (OR) = 1.06; 95% confidence interval (CI) = 1.01-1.10], cardiovascular pathology (OR = 1.11; 95% CI = 1.05-1.17) and renal pathology (OR = 1.05; 95% CI = 1.00-1.11). Older age remained independently associated with cardiovascular pathology (OR = 1.10; 95% CI = 1.04-1.16) and renal pathology (OR = 1.06; 95% CI = 1.01-1.12) adjusted for body mass index and sex. Conclusions: Among autopsied Norwegians who died during opioid agonist treatment in 2014 and 2015, two-thirds had more than two organ system diseases, despite their mean age of 48 years at the time of death. Older age was independently associated with at least one cardiovascular or renal pathology after adjusting for sex and body mass index. Keywords: Ageing; autopsy; buprenorphine; forensic; methadone; multi-morbidity; opioid substitution treatment; pathology; postmortem. © 2021 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.

• 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. 10(19), s. 1–9. doi: 10.3390/jcm10194558. Fulltekst i vitenarkiv Vis sammendrag

  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

• Odsbu, Ingvild; Handal, Marte; Hjellvik, Vidar; Borchgrevink, Petter Chr.; Clausen, Thomas & Hamina, Aleksi [Vis alle 9 forfattere av denne artikkelen] (2021). Bruk av andre vanedannende legemidler blant opioidbrukere med langvarige smerter. Norsk Epidemiologi. ISSN 0803-2491. 29(1-2), s. 45–53. doi: 10.5324/nje.v29i1-2.4045. Fulltekst i vitenarkiv Vis sammendrag

  Bakgrunn: Opioider for behandling av langvarige smerter kan forskrives på blå resept, men bør ikke brukes samtidig med andre vanedannende legemidler. Hensikt: Å undersøke bruk av opioider på blå resept i perioden 2009-2019, samt å studere bruk av andre vanedannende legemidler (benzodiazepiner og z-hypnotika) blant dem som fikk opioider på blå resept i 2019. Metode: Data ble hentet fra Reseptregisteret. En prevalent opioidbruker i 2019 ble definert som en person med minst én utlevering av et smertestillende opioid på blå resept for langvarige smerter også i 2018. Bruk av andre vanedannende legemidler ble definert som minst én utlevering av et annet vanedannende legemiddel i løpet av samme år. Resultater: Totalt 18 443 personer (67% kvinner) fikk utlevert opioider på blå resept i 2019, en økning fra 5 568 i 2009 via 10 693 i 2016 og 16 133 i 2017. Av de 18 443 var 14 202 (77%) prevalente opioidbrukere. Blant de prevalente brukerne fikk 88% utlevert 100 mg orale morfinekvivalenter (OMEQ) eller mindre per dag. Totalt fikk 54% av de prevalente opioidbrukerne utlevert minst ett annet vanedannende legemiddel i 2019. Z-hypnotika var oftest forekommende blant de som brukte 100 mg OMEQ eller mindre per dag, mens benzodiazepiner alene eller i kombinasjon med z-hypnotika dominerte blant opioidbrukerne som fikk utlevert mer enn 100 mg OMEQ per dag. Mengden utlevert av andre vanedannende legemidler økte med mengden opioider brukt per dag. En større andel kvinner enn menn fikk utlevert andre vanedannende legemidler i 2019. Konklusjon: Studien indikerer at bruk av andre vanedannende legemidler forekommer hos en stor andel av dem som får forskrevet opioider på blå resept. Dette er tegn på et uheldig forskrivningsmønster som bør studeres nærmere.

• Hamina, Aleksi; Handal, Marte; Fredheim, Olav; Clausen, Thomas; Chen, Li-Chia & Skurtveit, Svetlana Ondrasova (2021). Filled prescriptions for opioids among children and adolescents – A nationwide study from 2010 to 2018. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. 65(10), s. 1475–1483. doi: 10.1111/aas.13968. Fulltekst i vitenarkiv Vis sammendrag

  Objectives Treatment-free remission (TFR) has emerged as a treatment goal in chronic myeloid leukemia in the chronic phase (CML-CP). Attempts to increase proportion of patients achieving TFR include combination of tyrosine kinase inhibitors (TKI) and other drugs. Interferon-α in addition to TKI has shown promising efficacy but with dose-dependent toxicity and discontinuations. NordCML007 was initiated to study the efficacy and safety of low dose pegylated IFN-α (PegIFN-α) in combination with dasatinib (DAS) in CML-CP. Methods Forty patients with newly diagnosed CML-CP were given DAS upfront. After month 3 (M3) 15 μg/wk of PegIFN-α was added and increased to 25 μg/wk from M7 until M15. DAS treatment was continued and adverse events and BCR-ABL1 qRT-PCR values were reported yearly after M24. Results from M1 to M18 have previously been published, and here we present long-term data. Results After 5 years of follow-up, there were no suspected unexpected serious adverse reactions, no increase in serosal effusions, no disease progressions and no CML-related deaths. Rates of MR3.0 (MMR), MR4.0 and MR4.5 were 84.6%, 64.1% and 51.3% respectively at M60, and 95% of patients reached MMR at some point during the study. Conclusion Initial addition of PegIFN-α to DAS shows good long-term efficacy without increased toxicity.

• Røgeberg, Ole; Bergsvik, Daniel & Clausen, Thomas (2021). Opioid overdose deaths and the expansion of opioid agonist treatment: a population-based prospective cohort study. Addiction. ISSN 0965-2140. s. 1–9. doi: 10.1111/add.15739. Fulltekst i vitenarkiv
• Zafarghandi, Mohammad Bagher Saberi; Eshrati, Sahar; Rashedi, Vahid; Vameghi, Meroe; Arezoomandan, Reza & Clausen, Thomas [Vis alle 7 forfattere av denne artikkelen] (2021). Indicators of Drug-Related Community Impacts of Open Drug Scenes: A Scoping Review. European Addiction Research. ISSN 1022-6877. 28(2), s. 87–102. doi: 10.1159/000519886. Fulltekst i vitenarkiv
• McDonald, Rebecca; Parkin, Stephen; Eide, Desiree Soraya; neale, joanne; Clausen, Thomas & Metrebian, Nicola [Vis alle 8 forfattere av denne artikkelen] (2021). Rethinking 'carriage' of take-home naloxone. International journal of drug policy. ISSN 0955-3959. doi: 10.1016/j.drugpo.2021.103253. Fulltekst i vitenarkiv
• Skjærvø, Ingeborg; Clausen, Thomas; Skurtveit, Svetlana Ondrasova & Bukten, Anne (2021). Desistance from crime following substance use treatment: the role of treatment retention, social network and self-control. BMC Psychiatry. 21(1), s. 1–12. doi: 10.1186/s12888-021-03518-2. Fulltekst i vitenarkiv Vis sammendrag

  Background Reductions in crime are often reported following substance use treatment. We explore the relationship between desistance from crime, treatment type, treatment retention and positive changes in known risk factors for crime. Methods We used data from the NorComt-study; a longitudinal study of substance users (n = 341) enrolled in comprehensive treatment in Norway (2012–2015). At treatment initiation (T0) and 1 year later (T1), we collected self-reported data on criminal involvement, treatment, substance use, social network and self-control. We calculated adjusted odds ratios (aOR) and 95% confidence intervals (CI) with multinomial logistic regression analysis. Results Overall, 1 year following treatment initiation 69% reported desistance from crime, 18% reported continued crime and 12% reported no crime at all in the study period. Desistance was high for OMT patients in ongoing treatment (79% desisted) and for inpatients regardless of treatment status (79–93% desisted), while not as high among OMT patients with interrupted treatment (47% desisted). For participants that continued crime during follow-up, the average number of criminal acts per month was reduced (p < 0.001). Desistance at follow-up was associated with being older (aOR: 1.05, CI: 1.00–1.10), inpatient treatment (aOR: 3.71, CI: 1.12–12.29), being in ongoing treatment (inpatient or OMT) (aOR: 2.90, CI: 1.01–8.36), having no stimulant use in the study period (aOR: 4.86, CI: 1.72–13.70), leaving a substance using social network (aOR 2.87, CI: 1.15–7.18) and improvement in self-control score (aOR: 1.08, CI: 1.04–1.13). Conclusions Retention in treatment is particularly important for crime outcomes among OMT patients. Positive changes in social network and self-control are potential contributors to desistance from crime. Targeted interventions towards crime reduction are recommended for patients with stimulant use, which appears to be a persistent risk factor for crime over time.

• Hesse, Morten; Thylstrup, Birgitte; Seid, Abdu Kedir; Tjagvad, Christian & Clausen, Thomas (2021). A retrospective cohort study of medication dispensing at pharmacies: Administration matters! Drug and Alcohol Dependence. ISSN 0376-8716. 225. doi: 10.1016/j.drugalcdep.2021.108792. Fulltekst i vitenarkiv
• Stenehjem, Jo Steinson; Røise, Olav; Nordseth, Trond; Clausen, Thomas; Natvig, Bård & Skurtveit, Svetlana Ondrasova [Vis alle 10 forfattere av denne artikkelen] (2021). Injury Prevention and long-term Outcomes following Trauma - The IPOT project: a protocol for prospective nationwide registry-based studies in Norway. BMJ Open. 11(5). doi: 10.1136/bmjopen-2020-046954. Fulltekst i vitenarkiv Vis sammendrag

  Introduction Traumatic injuries constitute a major cause of mortality and morbidity. Still, the public health burden of trauma in Norway has not been characterised using nationwide registry data. More knowledge is warranted on trauma risk factors and the long-term outcomes following trauma. The Injury Prevention and long-term Outcomes following Trauma project will establish a comprehensive research database. The Norwegian National Trauma Registry (NTR) will be merged with several data sources to pursue the following three main research topics: (1) the public health burden of trauma to society (eg, excess mortality and disability-adjusted life-years (DALYs)), (2) trauma aetiology (eg, socioeconomic factors, comorbidity and drug use) and (3) trauma survivorship (eg, survival, drug use, use of welfare benefits, work ability, education and income). Methods and analysis The NTR (n≈27 000 trauma patients, 2015–2018) will be coupled with the data from Statistics Norway, the Norwegian Patient Registry, the Cause of Death Registry, the Registry of Primary Health Care and the Norwegian Prescription Database. To quantify the public health burden, DALYs will be calculated from the NTR. To address trauma aetiology, we will conduct nested case–control studies with 10 trauma-free controls (drawn from the National Population Register) matched to each trauma case on birth year, sex and index date. Conditional logistic regression models will be used to estimate trauma risk according to relevant exposures. To address trauma survivorship, we will use cohort and matched cohort designs and time-to-event analyses to examine various post-trauma outcomes.

• Gabrhelík, Roman; Handal, Marte; Mravčík, Viktor; Nechanská, Blanka; Tjagvad, Christian & Thylstrup, Birgitte [Vis alle 12 forfattere av denne artikkelen] (2021). Opioid maintenance treatment in the Czech Republic, Norway and Denmark: a study protocol of a comparative registry linkage study. BMJ Open. 11(5), s. 1–8. doi: 10.1136/bmjopen-2020-047028. Fulltekst i vitenarkiv Vis sammendrag

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

• Welle-Strand, Gabrielle; Skurtveit, Svetlana; Clausen, Thomas; Sundal, Christine & Gjersing, Linn (2020). COVID-19 survey among people who use drugs in three cities in Norway. Drug and Alcohol Dependence. ISSN 0376-8716. 217, s. 1–4. doi: 10.1016/j.drugalcdep.2020.108302. Fulltekst i vitenarkiv
• Medved, David; Clausen, Thomas; Bukten, Anne; Bjørnestad, Ronny & Muller, Ashley Elizabeth (2020). Large and non-specific somatic disease burdens among ageing, long-term opioid maintenance treatment patients. Substance Abuse Treatment, Prevention, and Policy. 15, s. 1–9. doi: 10.1186/s13011-020-00311-4. Fulltekst i vitenarkiv Vis sammendrag

  Objectives To describe and explore somatic disease burdens of ageing long-term patients in opioid maintenance treatment (OMT), a unique population emerging in countries offering OMT as a long-term treatment. Methods We used data from the Norwegian Cohort of Patient in Opioid Maintenance Treatment and Other Drug Treatment Study (NorComt). 156 patients enrolled for at least three of the past five years provided data during structured interviews, including on chronic conditions, somatic treatment received, mental distress (SCL-25), and treatment satisfaction. A somatic disease burden was calculated from a list measuring the recent severity of 16 somatic complaints. A hierarchical multiple linear regression analysis identified correlates of somatic disease burden. Results Over half of patients reported at least seven somatic complaints. Reported somatic disease burden was associated with higher mental distress, more chronic conditions, fewer years in OMT, and treatment dissatisfaction. Age was unrelated, and there were few gender differences. These five variables explained 43.6% of the variance in disease burden. Conclusion Long-term OMT patients experience a large range of somatic complaints, and at non-acute levels. As OMT secures longevity for opioid-dependent persons, the clinical focus must be adjusted from acute to chronic care. Providers must address how to optimize health and quality of life while in treatment, as treatment may last for many years.

• Borschmann, Rohan; Tibble, H; Spittal, MJ; Preen, David; Pirkis, Jane & Larney, Sarah [Vis alle 50 forfattere av denne artikkelen] (2020). The Mortality After Release from Incarceration Consortium (MARIC): Protocol for a multi-national, individual participant data meta-analysis. International Journal of Data Science (IJDS). ISSN 2053-0811. doi: 10.23889/ijpds.v5i1.1145. Fulltekst i vitenarkiv Vis sammendrag

  Introduction: More than 30 million adults are released from incarceration globally each year. Many experience complex physical and mental health problems, and are at markedly increased risk of preventable mortality. Despite this, evidence regarding the global epidemiology of mortality following release from incarceration is insufficient to inform the development of targeted, evidence-based responses. Many previous studies have suffered from inadequate power and poor precision, and even large studies have limited capacity to disaggregate data by specific causes of death, sub-populations or time since release to answer questions of clinical and public health relevance. Objectives: To comprehensively document the incidence, timing, causes and risk factors for mortality in adults released from prison.&#x0D; Methods: We created the Mortality After Release from Incarceration Consortium (MARIC), a multi-disciplinary collaboration representing 29 cohorts of adults who have experienced incarceration from 11 countries. Findings across cohorts will be analysed using a two-step, individual participant data meta-analysis methodology.&#x0D; Results: The combined sample includes 1,337,993 individuals (89% male), with 75,795 deaths recorded over 9,191,393 person-years of follow-up.&#x0D; Conclusions: The consortium represents an important advancement in the field, bringing international attention to this problem. It will provide internationally relevant evidence to guide policymakers and clinicians in reducing preventable deaths in this marginalized population.&#x0D; Key words: Mortality; incarceration; prison; release; individual participant data meta-analysis; consortium; cohort.

• Bech, Anne Berit; Clausen, Thomas; Waal, Helge; Vindenes, Vigdis; Edvardsen, Hilde Marie Erøy & Frost, Joachim [Vis alle 7 forfattere av denne artikkelen] (2020). Postmortem toxicological analyses of blood samples from 107 patients receiving opioid agonist treatment: substances detected and pooled opioid and benzodiazepine concentrations. Addiction. ISSN 0965-2140. doi: 10.1111/add.15211. Fulltekst i vitenarkiv Vis sammendrag

  Aims: To present the substances and their concentrations detected post-mortem in patients receiving opioid agonist treatment (OAT) stratified by cause of death, estimate the pooled opioid and benzodiazepine concentrations using established conversion factors for blood concentrations from the Norwegian Road Traffic Act, and explore the association between drug-induced cause of death and the pooled opioid and benzodiazepine concentrations. Design: Cross-sectional nationwide study. Setting: Norway. Participants: One hundred and seven patients who died during OAT (i.e. within 5 days after the last intake of OAT medication) between 1 January 2014 and 31 December 2015, with post-mortem femoral blood available for toxicology. Data were collected from hospital records, the Norwegian Cause of Death Registry and autopsy reports. Measurements: Presence of alcohol and non-alcohol substances in the bloodstream at time of death, determined through records of toxicology of post-mortem femoral blood. Findings: A median of four substances was detected across the causes of death. At least one benzodiazepine was detected in 81 (76%) patients. The median pooled opioid concentration was significantly higher in drug-induced deaths compared with other causes of death (362 ng/mL versus 182 ng/mL, P < 0.001), in contrast to the pooled benzodiazepine concentration (5466 versus 5701 ng/mL, P = 0.353). The multivariate regression analysis showed that only increasing pooled opioid concentration (ng/ML) was associated with increased odds of a drug-induced cause of death (odds ratio, 1.003; 95% confidence interval: 1.001-1.006). Conclusions: In Norway, overall opioid concentration seems to play an important role in drug-induced deaths during opioid agonist treatment in patients prescribed methadone or buprenorphine. Patients prescribed buprenorphine tend to replace their agonist with full agonists, while patients prescribed methadone tend to have high opioid concentrations from methadone as the only opioid.

• Farhoudian, Ali; Baldacchino, Alexander; Clark, Nicolas; Gerra, Gilberto; Ekhtiari, Hamed & Dom, Geert [Vis alle 20 forfattere av denne artikkelen] (2020). COVID-19 and Substance Use Disorders: Recommendations to a Comprehensive Healthcare Response. An International Society of Addiction Medicine Practice and Policy Interest Group Position Paper. Basic and Clinical Neuroscience (BCN). ISSN 2008-126X. doi: 10.32598/bcn.11.covid19.1. Fulltekst i vitenarkiv
• Skurtveit, Svetlana; Hjellvik, Vidar; Sakshaug, Solveig; Borchgrevink, Petter Chr.; Larsen, Børge Myrlund & Clausen, Thomas [Vis alle 9 forfattere av denne artikkelen] (2020). Forskrivning av opioider på blå resept mot langvarige smerter. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 15. doi: 10.4045/tidsskr.20.0153. Fulltekst i vitenarkiv
• Stavseth, Marianne Riksheim; Clausen, Thomas & Røislien, Jo (2019). The clinical consequences of variable selection in multiple regression models: a case study of the Norwegian Opioid Maintenance Treatment program. The American Journal of Drug and Alcohol Abuse. ISSN 0095-2990. doi: 10.1080/00952990.2019.1648484. Fulltekst i vitenarkiv Vis sammendrag

  Background: Selecting which variables to include in multiple regression models is a pervasive problem in medical research. Objectives: Based on questionnaire data (n = 18538, 69.9% men) from the Norwegian Opioid Maintenance Treatment Program, this study aims to compare the performance of different variable selection methods and the potential clinical consequences of choice of method. The effect of missing data is also explored. Methods: The dependent variable was engagement in criminal behavior while in treatment. Twenty-nine potential covariates on demographics, psychosocial factors and drug use were tested for inclusion in a multiple logistic regression model. Both complete case and multiply imputed data were considered. We compared the results from variable selection methods ranging from expert-based and purposeful variable selection, through stepwise methods, to more recently developed penalized regression using the Least Absolute Shrinkage and Selection Operator (LASSO). Results: The various variable selection methods resulted in regression models including from 9 to 22 covariates. The stepwise selection procedures generated the models with the most covariates included. The choice of variable selection method directly affected the estimated regression coefficients, both in effect size and statistical significance. For several variables the expert-based approach disagreed with all data-driven methods. Conclusions: The choice of variable selection method may strongly affect the resulting regression model, along with accompanying effect sizes and confidence intervals. This may affect clinical conclusions. The process should consequently be given sufficient consideration in model building. We recommend combining expert knowledge with a data-driven variable selection method to explore the models’ robustness.

• Muller, Ashley Elizabeth; Skurtveit, Svetlana & Clausen, Thomas (2019). Performance of the WHOQOL-BREF among Norwegian substance use disorder patients. BMC Medical Research Methodology. 19(44), s. 1–9. doi: 10.1186/s12874-019-0690-3. Fulltekst i vitenarkiv Vis sammendrag

  Background Quality of life (QoL) is an established outcome measure of substance use disorder treatment. The WHOQOL-BREF is the gold standard tool, but its appropriateness for particularly vulnerable patient populations must be further explored. This article examines the scaling qualities of the WHOQOL-BREF in a Norwegian substance use disorder population, and explores relationships with social and health variables. Methods 107 participants in a larger national treatment study provided data during structured interviews. Item responses, responsiveness, and domain scaling qualities are reported. General linear models identified correlates of impaired QoL. Results Three out of four domains exhibited acceptable scaling qualities, while the social relationships domain had low internal validity. 59% of the variance in physical health QoL was explained in our model by the negative main or interaction effects of depression, unemployment, social isolation, smoking, residential treatment, and weight dissatisfaction. 52% of the variance in psychological health QoL was explained by depression and being single. Depression also had significant main effects in social relationships QoL (R2 = .27) and environment QoL (R2 = .39), and social isolation and exercise had further interaction effects in environment QoL. Conclusions After one year in treatment, the impact of low social contact in reducing QoL, rather than specific substance use patterns, was striking. The social relationships domain is the shortest in the WHOQOL-BREF, yet social variables were important in other areas of QoL. Social support could benefit from more attention in treatment, as a lack of social support seems to be a strong risk factor for poor QoL in various domains. The WHOQOL-BREF exhibits otherwise satisfactory measurement characteristics and is an appropriate tool among this population.

• Bech, Anne Berit; Clausen, Thomas; Waal, Helge; Benth, Jurate Saltyte & Skeie, Ivar (2019). Mortality and causes of death among patients with opioid use disorder receiving opioid agonist treatment: A national register study. BMC Health Services Research. 19(1). doi: 10.1186/s12913-019-4282-z. Fulltekst i vitenarkiv Vis sammendrag

  BACKGROUND: Mortality rates and causes of death among individuals in opioid agonist treatment (OAT) vary according to several factors such as geographical region, age, gender, subpopulations, drug culture and OAT status. Patients in OAT are ageing due to effective OAT as well as demographic changes, which has implications for morbidity and mortality. Norway has one of the oldest OAT populations in Europe. Because of the varying mortality rates and causes of death in different subgroups and countries, research gaps still exist. The aims of this study were to describe the causes of death among OAT patients in Norway, to estimate all-cause and cause-specific crude mortality rates (CMRs) during OAT and to explore characteristics associated with drug-induced cause of death compared with other causes of death during OAT. METHODS: This was a national, observational register study. Data from the Norwegian Cause of Death Registry and the Norwegian Patient Registry were combined with data from medical records. We included all patients in the Norwegian OAT programme who died not more than 5 days after the last intake of OAT medication, between 1 January 2014 and 31 December 2015. RESULTS: In the 2-year observation period, 200 (1.4%) of the OAT patients died. A forensic or medical autopsy was performed in 63% of the cases. The mean age at the time of death was 48.9 years (standard deviation 8.4), and 74% were men. Somatic disease was the most common cause of death (45%), followed by drug-induced death (42%), and violent death (12%). In general, CMRs increased with age, and they were higher in men and in patients taking methadone compared with buprenorphine. Increasing somatic comorbidity, measured by the Charlson comorbidity index, reduced the odds of dying of a drug-induced cause of death compared with other causes of death. CONCLUSIONS: Both somatic and drug-induced causes of death were common during OAT. Improved treatment and follow-up of chronic diseases, especially in patients aged > 40 years, and continuous measures to reduce drug-induced deaths appear to be essential to reduce future morbidity and mortality burdens in this population.

• Kruckow, Line; Tjagvad, Christian; Clausen, Thomas; Linnet, Kristian & Banner, Jytte (2019). Treatment Status and Use of Psychoactive Substances in Deceased Drug Users. European Addiction Research. ISSN 1022-6877. doi: 10.1159/000503285. Fulltekst i vitenarkiv Vis sammendrag

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

• Gedeon, Charlotte; Sandell, Mikael; Birkemose, Inge; Kakko, Johan; Runarsdottir, Valgerur & Simojoki, Kaarlo [Vis alle 10 forfattere av denne artikkelen] (2019). Standards for opioid use disorder care: An assessment of Nordic approaches. Nordic Studies on Alcohol and Drugs (NAD). ISSN 1455-0725. 36(3), s. 286–298. doi: 10.1177/1455072518815322. Fulltekst i vitenarkiv Vis sammendrag

  Aims: Outcomes in opioid use disorder (OUD) in Nordic countries have improved with integrated treatment and harm-reduction programmes. Approaches and the standard of care are different across the region. Evidence of treatment needs and current approaches are defined from evidence to inform development of a common standard. Method: Evidence of population sizes and treatment approach collected. Common standards for care (harm reduction, pharmacotherapy, psychology/social therapy) defined for each country. Results: Evidence defines number in treatment; potential population needing treatment not defined for all countries. Populations sizes, treatment access (ratio in treatment programme compared to total country population) defined: Sweden 4,000 in OUD care (access ratio 40); Finland 3,000 (55); Norway 8,000 (154); Denmark 7,500 (132). Approach to treatment similar: integrated treatment programmes standard. Care provided by specialists in outpatient clinics/primary care; secondary care/inpatient services are available. Harm reduction is limited in Sweden but available and more accessible elsewhere. Treatment entry criteria: access relatively unlimited in Norway and Denmark, more limited in Finland and Sweden. Standards of care defined: easy access to high-quality services, individual planning, care not limited by time, management of relapse, education for patients, continuous engagement, holistic approach including management of comorbidities, needle equipment programmes without limit, treatment in prisons as community. Conclusion: There are opportunities to improve OUD care in the Nordics. Policy makers and clinicians can advance OUD care and share common success factors. Collaborative work across the Nordic countries is valuable. Further research in clinical practice development can yield important results for the benefit of patients with OUD.

• Birke, Hanne; Ekholm, Ola; Sjøgren, Per; Fredheim, Olav Magnus; Clausen, Thomas & Skurtveit, Svetlana (2019). Tramadol use in Norway: A register-based population study. Pharmacoepidemiology and Drug Safety. ISSN 1053-8569. 28(1), s. 54–61. doi: 10.1002/pds.4626. Fulltekst i vitenarkiv Vis sammendrag

  Purpose Increasing use of tramadol for chronic non‐cancer pain is concerning since tramadol users may be at risk of developing recurrent opioid use with increasing opioid consumption and co‐medication. Therefore, we investigated a complete national cohort of tramadol users. Methods The study population (154 042 adult individuals in Norway, who redeemed ≥ one tramadol prescription in 2012) was stratified into four groups according to their opioid use 2 years before their first tramadol prescription in 2012 and followed until 2016. Information on all dispensed opioid analgesics, benzodiazepines (BZDs), and BZD‐related Z‐hypnotics were retrieved from the Norwegian Prescription Database. Results Six percent of opioid naïve tramadol users (no opioid use 2 years before tramadol use in 2012) became recurrent users (received opioids annually during 4‐year follow‐up), almost doubled their mean opioid consumption (66 to 108 defined daily doses [DDD]). One‐quarter proceeded to strong opioids or was co‐medicated with BZDs, one‐third with Z‐hypnotics. Among former weak opioid users, 39.8% became recurrent users, 18.7% proceeded to strong opioids, mean opioid consumption increased slightly, one‐third used BZDs, or Z‐hypnotics concurrently. Among former strong opioid and users in palliative care; 61%, 70% became recurrent users and developed a similar prescription pattern (high and increasing mean opioid consumption, 301 to 318, 413 to 430 DDD); half of them proceeded to strong opioids and/or used BZDs or Z‐hypnotics concurrently. Conclusions Many patients who developed recurrent opioid use received prescriptions which substantially conflicted with existing guidelines and might lead to problematic opioid use.

• Bukten, Anne; Stavseth, Marianne Riksheim & Clausen, Thomas (2019). From restrictive to more liberal: variations in mortality among patients in opioid maintenance treatment over a 12-year period. BMC Health Services Research. 19(1). doi: 10.1186/s12913-019-4382-9. Fulltekst i vitenarkiv Vis sammendrag

  Background As the effect of opioid maintenance treatment (OMT) on overdose mortality varies both between and within countries, treatment programs need to be evaluated in different treatment settings and over time within settings. We evaluated variations in mortality in a national programme: from the initial rollout as restrictive and low-capacity to its gradual change into more liberal and higher-volume. Methods A 12-year prospective longitudinal cohort study including all persons (n = 6871) applying for and entering OMT in Norway (1997–2009). We followed all patients until 2009 or until death. We used crude mortality rates (CMR) to calculate overdose and all-cause mortality among patients in OMT before, during and after treatment, during a 12-year time-period. We also calculated variations in overdose and all-cause mortality over the course of treatment and after treatment termination. We fitted proportional hazards models with covariates to the data. Results OMT significantly reduces risk of mortality compared to being outside of treatment. The reduction in overdose death was most substantial during the initial phase of the Norwegian OMT-programme, still; we consistently find that overdose deaths were more than halved in all calendar-periods throughout observation. We did not find an elevated risk of overdose death in the first weeks of treatment, nor in the first weeks after treatment cessation. Conclusion In Norway, OMT reduces overall mortality. Reduction in mortality is likely dependent of both treatment delivery and characteristics of the at-risk population.

• Muller, Ashley Elizabeth; Clausen, Thomas; Sjøgren, Per; Odsbu, Ingvild & Skurtveit, Svetlana (2019). Prescribed opioid analgesic use developments in three Nordic countries, 2006-2017. Scandinavian Journal of Pain. ISSN 1877-8860. 19(2). doi: 10.1515/sjpain-2018-0307. Fulltekst i vitenarkiv Vis sammendrag

  Introduction: While the Nordic countries have considerably stricter controls on opioid prescribing for chronic non-cancer pain than other countries, previous research has warned that prescription of strong opioids is increasing. Objectives: This study examines consumption of and developments in dispensed prescribed opioids to individuals receiving ambulatory care from 2006-2017, using publicly available data from each of three Nordic countries’ national prescription registries. Methods: Repeated, cross-sectional design. One-year prevalence of all dispensed prescribed opioids in ATC N02A group were reported for Norway, Denmark, and Sweden in the period 2006-2017 by gender. One-year prevalence of the weak opioids tramadol and codeine and the strong opioid oxycodone were then reported separately over this period for each country. The mean defined daily dose (DDD) per user per year, an estimate of the amount of opioids prescribed, was reported for each of the three opioids in 2016. Results: Patterns of dispensed prescribed opioids differ greatly between 2006 and 2017 and between countries, with tramadol increasing in Norway, codeine declining across the board, and oxycodone increasing in all three countries. Norway exceeded Sweden and Denmark in prevalence of all dispensed prescribed opioids, with 12.1% of the female Norwegian population and 9.2% of the male Norwegian population dispensed at least one prescribed opioid as an outpatient in 2016. Norway’s high overall prevalence rates are tempered by dispensing the lowest mean doses of both weak opioids compared to Sweden. Similarly, Sweden dispenses the lowest mean doses of oxycodone but to the largest proportion of its population (3.0%). Conclusion: Significant shifts have occurred in the dispensing of prescribed opioids in Norway, Sweden, and Denmark over the past twelve years. The increasing prevalence of oxycodone in all three countries should continue to be monitored. Prescription registries provide a wealth of publicly available data that can be used to monitor and to guide prescribing policies in a more knowledge-based direction.

• Zafarghandi, Mohammad Bagher Saberi; Eshrati, Sahar; Vameghi, Meroe; Ranjbar, Hadi; Arezoomandan, Reza & Clausen, Thomas [Vis alle 7 forfattere av denne artikkelen] (2019). Drug-related community issues and the required interventions in open drug scenes in Tehran, Iran: a qualitative study protocol. BMJ Open. 9(10), s. 1–6. doi: 10.1136/bmjopen-2019-030488. Fulltekst i vitenarkiv Vis sammendrag

  Background and objectivesMany low-income and middle-income countries experience problems with open drug scenes and drug-related community issues (DRCIs). These experiences occur in settings with varying levels of health and law enforcement initiatives, and accordingly a range of approaches are implemented to curb the problem. Most of the published literature stems from Western and high-income societies. With this concern, the present study aims to describe a planned project to explore DRCIs in the open drug scenes of Tehran, including its typology, and predisposing and reinforcing factors. In addition, the study attempts to investigate the perceptions with respect to the required interventions and barriers to their accessibility.To this end, the current study focuses on the Farahzad drug scene due to its structure and the difficult access to the scene by harm reduction providers. Data collection techniques encompass field observation, indepth interview and focus group discussion. Further, semistructured interviews are conducted with people who use drugs and other key informants who are engaged at this drug scene, including business, community, voluntary and statutory stakeholders, for an average of 90 min (average of 45 min for each part of the study). Furthermore, as a complementary method, field observation is performed regarding the themes of DRCIs at this scene. Then, focus group discussions are held to further describe the themes of DRCIs as well as to explore the required interventions, for an average of 90 min. Finally, the results are evaluated using qualitative content analysis.Ethics and disseminationEthical approval for the study was obtained from the Ethics Committee of Iran University of Medical Sciences, Iran. Additionally, participants are to provide written informed consent. The findings of the study are expected to play a role in promoting the current intervention.

• Opsal, Anne; Kristensen, Øistein & Clausen, Thomas (2019). Readiness to change among involuntarily and voluntarily admitted patients with substance use disorders. Substance Abuse Treatment, Prevention, and Policy. 14(1). doi: 10.1186/s13011-019-0237-y. Fulltekst i vitenarkiv Vis sammendrag

  Background Health care workers in the addiction field have long emphasised the importance of a patient’s motivation on the outcome of treatments for substance use disorders (SUDs). Many patients entering treatment are not yet ready to make the changes required for recovery and are often unprepared or sometimes unwilling to modify their behaviour. The present study compared stages of readiness to change and readiness to seek help among patients with SUDs involuntarily and voluntarily admitted to treatment to investigate whether changes in the stages of readiness at admission predict drug control outcomes at follow-up. Methods This prospective study included 65 involuntarily and 137 voluntarily admitted patients treated in three addiction centres in Southern Norway. Patients were evaluated using the Europ-ASI, Readiness to Change Questionnaire (RTCQ), and Treatment Readiness Tool (TReaT). Results The involuntarily admitted patients had significantly lower levels of motivation to change than the voluntarily admitted patients at the time of admission (39% vs. 59%). The majority of both involuntarily and voluntarily admitted patients were in the highest stage (preparation) for readiness to seek help at admission and continued to be in this stage at discharge. The stage of readiness to change at admission did not predict abstinence at follow-up. The only significant predictor of ongoing drug use at 6 months was SUD severity at baseline. Conclusions The majority of involuntarily admitted patients scored high on motivation to seek help. Their motivation was stable at a fairly high level during their stay, and even improved in some patients. Thus, they were approaching the motivation stage similar to the voluntarily admitted patients at the end of hospitalization. Therapists should focus on both motivating patients in treatment and adapting the treatment according to SUD severity. Trial registration ClinicalTrials.gov, NCT00970372. Registered 1 September 2008, https://clinicaltrials.gov/ct2/show/NCT00970372. The trial was registered before the first participant was enrolled. The fist participant was enrolled September 02, 2009.

• Stavseth, Marianne Riksheim; Clausen, Thomas & Røislien, Jo (2019). How handling missing data may impact conclusions: A comparison of six different imputation methods for categorical questionnaire data. SAGE Open Medicine. 7, s. 1–12. doi: 10.1177/2050312118822912. Fulltekst i vitenarkiv Vis sammendrag

  Objectives: Missing data is a recurrent issue in many fields of medical research, particularly in questionnaires. The aim of this article is to describe and compare six conceptually different multiple imputation methods, alongside the commonly used complete case analysis, and to explore whether the choice of methodology for handling missing data might impact clinical conclusions drawn from a regression model when data are categorical. Methods: In addition to the commonly used complete case analysis, we tested the following six imputation methods: multiple imputation using expectation–maximization with bootstrapping, multiple imputation using multiple correspondence analysis, multiple imputation using latent class analysis, multiple hot deck imputation and multivariate imputation by chained equations with two different model specifications: logistic regression and random forests. The methods are tested on real data from a questionnaire-based study in the Norwegian opioid maintenance treatment programme. Results: All methods performed relatively well when the sample size was large (n = 1000). For a smaller sample size (n = 200), the regression estimates depend heavily on the level of missing. When the amount of missing was ⩾20%, in particular, complete case analysis, hot deck and random forests had biased estimates with too low coverage. Multiple imputation using multiple correspondence analysis had the best performance all over. Conclusion: The choice of missing handling methodology has a significant impact on the clinical interpretation of the accompanying statistical analyses. With missing data, the choice of whether to impute or not, and choice of imputation method, can influence clinical conclusion drawn from a regression model and should therefore be given sufficient consideration.

• Muller, Ashley Elizabeth; Skurtveit, Svetlana & Clausen, Thomas (2019). Confirming the factor structure of a generic quality of life instrument among pre-treatment substance use disorder patients. Health and Quality of Life Outcomes. 17. doi: 10.1186/s12955-019-1152-7. Fulltekst i vitenarkiv Vis sammendrag

  Background Quality of life (QoL) is a patient-reported outcome of increasing importance in the substance use disorder (SUD) treatment field, and impaired QoL may be an important impetus for treatment uptake. Instruments and methodologies abound, precluding comparison, as does a dearth of population norms. The QOL10 is a generic, overall QoL tool containing ten items and with simple scoring procedures. It is therefore a potential alternative to the gold standard WHOQOL-BREF. This study aimed to assess the two-factor structure of the QOL10 that has been suggested by a previous exploratory factor analysis. Methods Adults entering 21 participating inpatient or outpatient SUD treatment were recruited to join a national longitudinal cohort study. 531 completed the QOL10 at treatment entry and were included in the analysis. Structural equation modelling (SEM) was used to confirm the model fit of a two-factor structure, and the scaling qualities of the QOL10 were reported. Results According to the SEM analysis, the QOL10 was comprised of one latent variable measuring social QoL, and one measuring global QoL, and all ten items were retained. Goodness of fit tests included: root mean square of approximation = 0.063, 90% CI 0.050–0.076; normed-fit index = 0.919; and comparative fit index = 0.943. Conclusions The QOL10 should be considered when clinicians in the SUD treatment field need a short, valid instrument that measures both global QoL and social QoL, with minimum respondent and administrator burden. The social domain is of particular utility and may be used as a stand-alone instrument. Test-retest reliability should be established in future studies.

• Madah-Amiri, Desiree; Gjersing, Linn Renathe & Clausen, Thomas (2019). Naloxone distribution and possession following a large-scale naloxone programme. Addiction. ISSN 0965-2140. 114(1), s. 92–100. doi: 10.1111/add.14425. Fulltekst i vitenarkiv Vis sammendrag

  Aims: To examine uptake following a large‐scale naloxone programme by estimating distribution rates since programme initiation and the proportion among a sample of high‐risk individuals who had attended naloxone training, currently possessed or had used naloxone. We also estimated the likelihood of naloxone possession and use as a function of programme duration, individual descriptive and substance use indicators. Primary outcomes: naloxone possession and use. Random‐intercepts logistic regression models (covariates: male, age, homelessness/shelter use, overdose, incarceration, opioid maintenance treatment, income sources, substance use indicators, programme duration). Findings: Overall, 4631 naloxone nasal sprays were distributed in the two pilot cities, with a cumulative rate of 495 per 100 000 population. In the same two cities, among high‐risk individuals, 44% and 62% reported current naloxone possession. The possession rates of naloxone corresponded well to the duration of each participating city's distribution programme. Overall, in the six distributing cities, 58% reported naloxone training, 43% current possession and 15% naloxone use. The significant indicators for possession were programme duration [adjusted odds ratios (aOR) = 1.44, 95% confidence interval (CI = 0.82–2.37], female gender (aOR = 1.97, 95% CI = 1.20–3.24) and drug‐dealing (aOR = 2.36, 95% CI = 1.42–3.93). The significant indicators for naloxone use were programme duration (aOR = 1.49 95%, CI = 1.15–1.92), homelessness/shelter use (aOR = 2.06, 95% CI = 1.02–4.17), opioid maintenance treatment (OMT) (aOR = 2.07, 95% CI = 1.13–3.78), drug‐dealing (aOR = 2.40, 95% CI = 1.27–4.54) and heroin injecting (aOR = 2.13, 95% CI = 1.04–4.38). Conclusions: A large‐scale naloxone programme in seven Norwegian cities with a cumulative distribution rate of 495 per 100 000 population indicated good saturation in a sample of high‐risk individuals, with programme duration in each city as an important indicator for naloxone possession and use.

• Muller, Ashley Elizabeth; Bjørnestad, Ronny & Clausen, Thomas (2018). Dissatisfaction with opioid maintenance treatment partly explains reported side effects of medications. Drug and Alcohol Dependence. ISSN 0376-8716. 187, s. 22–28. doi: 10.1016/j.drugalcdep.2018.02.018. Fulltekst i vitenarkiv Vis sammendrag

  Background Drop-out is a core problem in opioid maintenance treatment (OMT), but patients’ reactions to and acceptance of the various OMT medications are insufficiently investigated. In Norway, there has been vocal patient resistance to the newest medication, buprenorphine-naloxone (BNX), and complaints have focused on the side effect profile. There has been no comparison of patient satisfaction and side effects of the three most common OMT medications. Aim To compare patient satisfaction with OMT and side effects of BNX, buprenorphine monopreparate (BUP), and methadone (MET) as reported by patients. Methods Data were drawn from a national peer-to-peer survey developed by a patient advocacy group. The survey engaged more than 1000 OMT patients, corresponding to one seventh of OMT patients in Norway. The associations between side effects, treatment satisfaction, and patient characteristics were tested in multinomial logistic regressions. Results High patient satisfaction with OMT overall was reported despite lower satisfaction with medication itself and widely prevalent side effects. Among each medication group, dissatisfaction with medications or OMT in general along with poor health status increased the relative risk ratio of reporting the heaviest side effect burden. MET users reported the highest side effect burden and BNX users the lightest, but BNX users were more dissatisfied with their medication. Conclusions Side effects are a concern for nearly all OMT patients, and they do not appear to accumulate with age or length of treatment. BNX users’ dissatisfaction with their medication is of particular concern, and expectations and preferences of medication may be influencing their dissatisfaction.

• Madah-Amiri, Desiree; Skulberg, Arne Kristian; Næss, Anne-Cathrine Braarud; Dale, Ola; Heyerdahl, Fridtjof & Lobmaier, Philipp Paul [Vis alle 7 forfattere av denne artikkelen] (2018). Ambulance-attended opioid overdoses: An examination into overdose locations and the role of a safe injection facility. Substance Abuse. ISSN 0889-7077. doi: 10.1080/08897077.2018.1485130. Fulltekst i vitenarkiv Vis sammendrag

  Background: Although the United States and numerous other countries are amidst an opioid overdose crisis, access to safe injection facilities remains limited. Methods: We used prospective data from ambulance journals in Oslo, Norway, to describe the patterns, severity, and outcomes of opioid overdoses and compared these characteristics among various overdose locations. We also examined what role a safe injection facility may have had on these overdoses. Results: Based on 48,825 ambulance calls, 1054 were for opioid overdoses from 465 individuals during 2014 and 2015. The rate of calls for overdoses was 1 out of 48 of the total ambulance calls. Males made up the majority of the sample (n = 368, 79%), and the median age was 35 (range: 18–96). Overdoses occurred in public locations (n = 530, 50.3%), the safe injection facility (n = 353, 33.5%), in private homes (n = 83, 7.9%), and other locations (n = 88, 8.3%). Patients from the safe injection facility and private homes had similarly severe initial clinical symptoms (Glasgow Coma Scale median =3 and respiratory frequency median =4 breaths per minute) when compared with other locations, yet the majority from the safe injection facility did not require further ambulance transport to the hospital (n = 302, 85.6%). Those overdosed in public locations (odds ratio [OR] = 1.66, 95% confidence interval [CI] = 1.17–2.35), and when the safe injection facility was closed (OR =1.4, 95% CI =1.04–1.89), were more likely to receive transport for further treatment. Conclusions: Our findings suggest that the opening hours at the safe injection facility and the overdose location may impact the likelihood of ambulance transport for further treatment.

• Abel, Eli Kristine Fiksdal; Skjærvø, Ingeborg; Ravndal, Edle; Clausen, Thomas & Bramness, Jørgen Gustav (2018). Perceived Self-Control is Related to Mental Distress in Patients Entering Substance Use Disorder Treatment. Substance Use & Misuse. ISSN 1082-6084. 53(9), s. 1454–1462. doi: 10.1080/10826084.2017.1413114. Fulltekst i vitenarkiv
• Kakko, Johan; Gedeon, Charlotte; Sandell, Mikael; Grelz, Henrik; Birkemose, Inge & Clausen, Thomas [Vis alle 11 forfattere av denne artikkelen] (2018). Principles for managing OUD related to chronic pain in the Nordic countries based on a structured assessment of current practice. Substance Abuse Treatment, Prevention, and Policy. 13(1). doi: 10.1186/s13011-018-0160-7. Fulltekst i vitenarkiv Vis sammendrag

  Background Long-term use of opioid analgesics (OA) for chronic pain may result in opioid use disorder (OUD). This is associated with adverse outcomes for individuals, families and society. Treatment needs of people with OUD related to chronic pain are different compared to dependence related to use, and also injection, of illicit opioids. In Nordic countries, day-to-day practical advice to assist clinical decision-making is insufficient. Aim To develop principles based on expert clinical insights for treatment of OUD related to the long-term use of OA in the context of chronic pain. Methods Current status including an assessment of barriers to effective treatment in Finland, Denmark, Iceland, Norway, Sweden was defined using a patient pathway model. Evidence to describe best practice was identified from published literature, clinical guidelines and expert recommendations from practice experience. Results Availability of national treatment guidelines for OUD related to chronic pain is limited across the Nordics. Important barriers to effective care identified: patients unlikely to present for help, healthcare system set up limits success, diagnosis tools not used, referral pathways unclear and treatment choices not elucidated. Principles include the development of a specific treatment pathway, awareness/ education programs for teams in primary care, guidance on use of diagnostic tools and a flexible treatment plan to encourage best practice in referral, treatment assessment, choice and ongoing management via an integrated care pathway. Healthcare systems and registries in Nordic countries offer an opportunity to further research and identify population risks and solutions. Conclusions There is an opportunity to improve outcomes for patients with OUD related to chronic pain by developing and introducing care pathways tailored to specific needs of the population.

• Skjærvø, Ingeborg; Clausen, Thomas; Skurtveit, Svetlana; Abel, Eli Kristine Fiksdal & Bukten, Anne (2018). Similarities and Differences in Victimization Risk Factors for Nonoffending and Offending Substance Users. Victims & Offenders. ISSN 1556-4886. 13(4), s. 526–541. doi: 10.1080/15564886.2017.1383332. Fulltekst i vitenarkiv Vis sammendrag

  In this cross-sectional study of substance users in Norway, the authors describe the patterns of victimization and investigate the factors associated with victimization, for nonoffenders and offenders separately. Recent victimization was reported by 59%, and the victimization rate was higher among offenders compared with nonoffenders (69% and 43%, p < .001). Women, regardless of offender status, experienced more victimization. Unstable housing was associated with victimization among nonoffenders, whereas markers for more severe substance use and indicators for poor mental health were associated with victimization in both groups. Addressing these factors may be important in reducing victimization and its negative outcomes among substance users. This research has been published in Victims and Offenders. © 2017 Taylor & Francis

• Towers, Andy; Szabo, Agnes; Newcombe, David A L; Sheridan, Janie; Moore, Alison & Hyde, Martin [Vis alle 12 forfattere av denne artikkelen] (2018). Hazardous Drinking Prevalence and Correlates in Older New Zealanders: A Comparison of the AUDIT-C and the CARET. Journal of Aging and Health. ISSN 0898-2643. doi: 10.1177/0898264318794108. Fulltekst i vitenarkiv Vis sammendrag

  Objectives: The study compared the proportion of older adults identified as drinking hazardously based on the Alcohol Use Disorders Identification Test–Consumption (AUDIT-C) with the older adult-specific Comorbidity Alcohol Risk Evaluation Tool (CARET) and investigated whether sociodemographics, comorbidities, health, medication use, and alcohol-related risk behaviors explained discrepancies between the screens in classification of hazardousness. Method: The AUDIT-C and the CARET were administered to 3,673 adults aged 55 to 89 years. Classification agreement between the screens was evaluated using Cohen’s kappa. Hazardous drinking groups were compared using logistic regression. Results: Analysis indicated moderate agreement between the screens. Drinkers classified as “hazardous on the CARET only” consumed less alcohol, but were more likely to drink-drive. Introducing a drink-driving criterion into the calculation of hazardousness on the AUDIT-C substantially decreased the classification discrepancy between the measures. Discussion: Standard screening can be improved by investigating comorbidities, medication use, and alcohol-related risk behaviors in those initially identified as nonhazardous drinkers.

• Edvardsen, Hilde Marie Erøy; Tverborgvik, Torill; Frost, Joachim; Rogde, Sidsel; Morild, Inge & Waal, Helge [Vis alle 9 forfattere av denne artikkelen] (2017). Differences in combinations and concentrations of drugs of abuse in fatal intoxication and driving under the influence cases. Forensic Science International. ISSN 0379-0738. 281, s. 127–133. doi: 10.1016/j.forsciint.2017.10.045. Fulltekst i vitenarkiv Vis sammendrag

  Background In toxicology, international classification systems focus on single intoxicants as the cause of death. It is, however, well known that very few drug related deaths are caused by a single substance and that information concerning the drug concentrations as well as the combinations of drugs are essential in order to ascertain the cause of death. The aim of the study was to assess whether those prone to fatal intoxications differ significantly from chronic drug users – in terms of demographics and drug exposure patterns. Material and methods Fatal psychoactive drug intoxications in Norway during 2012, where a forensic autopsy including toxicological analysis were performed, were included. Analytical findings in blood were compared with concentrations in blood from apprehended drivers under the influence of drugs and ethanol (DUID) during the same time period. The opioid and benzodiazepine concentrations were assessed as morphine and diazepam equivalents, respectively, in order to compare concentrations across the different groups. Results A total of 194 autopsy cases and 4811 DUID cases were included. Opioids were detected in around 90% of the drug intoxication cases, but in only 16% of the DUID cases. The number of substances detected in fatal intoxications was 4.9 compared to 2.6 in the DUID cases. The total opioid concentrations were significantly higher in the fatal intoxication cases compared to DUID cases (229 ng/mL versus 56.9 ng/mL morphine equivalents, respectively). Benzodiazepines were detected in 90% of the fatal cases. Only one fatal opioid mono-intoxication was found; a case with a very high methadone concentration (1238 ng/mL). Discussion Mono-intoxication with heroin was not seen in any of the fatal intoxications in Norway, and single drug intoxications were rare (1.5%). Fatal intoxications were caused by a combination of drugs with significantly more substances as well as higher total drug concentrations among the fatal cases compared to the DUID cases. The combination of opioids and benzodiazepines seemed to represent an increased risk of death. Conclusion The total load of drugs influence the degree of intoxication and the total concentration level must be considered, including the total number of substances. Our findings imply that international statistics regarding an opioid being the main intoxicant should have a shift in focus towards combinations of drugs (especially opioids and benzodiazepines) as a major risk factor for fatal drug overdoses.

• Madah-Amiri, Desiree; Clausen, Thomas & Lobmaier, Philipp Paul (2017). Rapid widespread distribution of intranasal naloxone for overdose prevention. Drug and Alcohol Dependence. ISSN 0376-8716. 173, s. 17–23. doi: 10.1016/j.drugalcdep.2016.12.013. Fulltekst i vitenarkiv Vis sammendrag

  Background: In order to have a substantial impact on overdose prevention, the expansion and scalingup of overdose prevention with naloxone distribution (OPEND) programs are needed. However, limited literature exists on the best method to train the large number of trainers needed to implement such initiatives. Methods: As part of a national overdose prevention strategy, widespread OPEND was implemented throughout multiple low-threshold facilities in Norway. Following a two-hour ‘train-the trainer course’ staff were able to distribute naloxone in their facility. The course was open to all staff, regardless of educational background. To measure the effectiveness of the course, a questionnaire was given to participants immediately before and after the session, assessing knowledge on overdoses and naloxone, as well as attitudes towards the training session and distributing naloxone. Results: In total, 511 staff were trained during 41 trainer sessions. During a two-month survey period, 54 staff participated in a questionnaire study. Knowledge scores significantly improved in all areas following the training (p < 0.001). Attitude scores improved, and the majority of staff found the training useful and intended to distribute naloxone to their clients. Conclusion: Large-scale naloxone distribution programs are likely to continue growing, and will require competent trainers to carry out training sessions. The train-the-trainer model appears to be effective in efficiently training a high volume of trainers, improving trainers’ knowledge and intentions to distribute naloxone. Further research is needed to assess the long term effects of the training session, staffs’ subsequent involvement following the trainer session, and knowledge transferred to the clients.

• Muller, Ashley Elizabeth; Skurtveit, Svetlana & Clausen, Thomas (2017). Building abstinent networks is an important resource in improving quality of life. Drug and Alcohol Dependence. ISSN 0376-8716. 180, s. 431–438. doi: 10.1016/j.drugalcdep.2017.09.006. Fulltekst i vitenarkiv Vis sammendrag

  Aims: To investigate changes in social network and quality of life of a substance use disorder cohort as they progressed through treatment. Design: Multi-site, prospective, observational study of 338 adults entering substance use disorder treatment. Setting: Patients at 21 facilities across Norway contributed baseline data when they initiated treatment, and follow-up data was collected from them one year later. Methods: The cohort was divided into those who completed, dropped out, and remained in treatment one year after treatment initiation. For each treatment status group, general linear models with repeated measures analyzed global and social quality of life with the generic QOL10 instrument over time. The between-group factor was a change in social network variable from the EuropASI. Findings: Those who gained an abstinent network reported the largest quality of life improvements. Improvements were smallest or negligible for the socially isolated and those who were no longer in contact with the treatment system. Conclusions: Developing an abstinent network is particularly important to improve the quality of life of those in substance use disorder treatment. Social isolation is a risk factor for impaired quality of life throughout the treatment course.

• Madah-Amiri, Desiree; Clausen, Thomas; Myrmel, Lars; Brattebø, Guttorm & Lobmaier, Philipp Paul (2017). Circumstances surrounding non-fatal opioid overdoses attended by ambulance services. Drug and Alcohol Review. ISSN 0959-5236. 36(3), s. 288–294. doi: 10.1111/dar.12451. Fulltekst i vitenarkiv Vis sammendrag

  Introduction and Aims: Opioid overdose fatalities are a significant concern globally. Non-fatal overdoses have been described as a strong predictor for future overdoses, and are often attended by the ambulance services. This paper explores characteristics associated with non-fatal overdoses and aims to identify possible trends among these events in an urban area in Norway. Design and Methods: This is a retrospective analysis of non-fatal overdoses from Bergen ambulance services from 2012 to 2013. Demographic, temporal and geographic data were explored. Results: During the two years, 463 non-fatal opioid overdoses were attended by ambulance services. Ambulance call-outs occurred primarily during the late afternoon and evening hours of weekdays. Summer months had more overdoses than other seasons, with a peak in August. Overdoses were nearly twice as likely to occur in a public location in August (risk ratio 1.92, P = 0.042). Ambulance response times were more likely to be longer to private locations, and these victims were more likely to be treated and left at the scene. There was no difference in arrival time for drug-related and non-drug related dispatch. Discussion and Conclusions: The temporal patterns suggest that non-fatal overdoses occur during non-recreational time periods. The longer ambulance response time and disposition for private addresses indicate potential opportunities for peer interventions. Our analysis describes circumstances surrounding non-fatal overdoses and can be useful in guiding relevant, targeted prevention interventions.

• Skjærvø, Ingeborg; Skurtveit, Svetlana; Clausen, Thomas & Bukten, Anne (2017). Substance use pattern, self‐control and social network are associated with crime in a substance‐using population. Drug and Alcohol Review. ISSN 0959-5236. 36(2), s. 245–252. doi: 10.1111/dar.12406. Fulltekst i vitenarkiv Vis sammendrag

  Introduction and Aims: Crime rates are high in substance‐using populations; therefore, investigation of factors associated with crime in these populations is highly relevant. We describe crime prevalence and associations between crime, pattern of substance use and psychosocial factors, such as self‐control and social network. Design and Methods: This is a cross‐sectional study including substance users (n = 549; mean age 34 years; 27% women) entering treatment at 21 treatment centres across Norway (December 2012 to April 2015). Data on demographics, substance use, psychosocial variables and crime in the 6 months prior to treatment were obtained through interviews. Adjusted odds ratios (aOR) with 95% confidence intervals (CI) were estimated through logistic regression. Results: Sixty‐four percent of participants had committed crime in the 6 months prior to treatment. Of these, 93% committed income‐generating crime. Several factors were associated with increased likelihood of having committed crime: use of stimulants (aOR = 1.82, 95% CI 1.04–3.17), use of a higher number of different substances (aOR = 1.16, 95% CI 1.04–1.31) and spending most of their time with family or friends using addictive substances (aOR = 2.38, 95% CI 1.10–5.16 and aOR = 2.22, 95% CI 1.32–3.73). Protective factors associated with decreased likelihood of committing crime were being older (aOR = 0.95, 95% CI 0.92–0.97) and having higher self‐control (aOR = 0.94, 95% CI 0.91–0.97). Discussion and Conclusions: Stimulant use, higher number of different substances used, lower self‐control, primarily a substance‐using social network and being younger were associated with crime in this substance‐using population. Treatment clinics should consider these risk factors for crime, and suitable interventions should be implemented and evaluated. This research has been published in Drug and Alcohol Review. © 2016 Wiley

• Pasareanu, Adrian Razvan; Vederhus, John-Kåre; Opsal, Anne; Kristensen, Øistein & Clausen, Thomas (2017). Mental distress following inpatient substance use treatment, modified by substance use; comparing voluntary and compulsory admissions. BMC Health Services Research. 17:5, s. 1–9. doi: 10.1186/s12913-016-1936-y. Fulltekst i vitenarkiv Vis sammendrag

  Background Treatment services to patients with substance use disorders (SUDs), including those mandated to treatment, needs to be evaluated and evidence based. The Norwegian Municipal Health Care Act (NMHCA) calls for compulsory treatment for persons with “severe and life-threatening substance use disorder” if these individuals are not otherwise willing to be voluntarily treated and consequently risk their lives over drug use. Mental distress is known to be high among SUD patients admitted to inpatient treatment. The purpose of this study is to describe changes in mental distress from admission to a 6-month follow-up in patients with SUDs, which underwent either voluntary or compulsory treatment. Method This prospective study followed 202 hospitalized patients with SUDs who were admitted voluntarily (VA; n = 137) or compulsorily (CA; n = 65). Levels of mental distress were assessed with SCL-90-R. Of 123 patients followed-up at 6 months, 97 (62 VA and 35 CA) had rated their mental distress at admission, discharge and follow-up. Sociodemographics and substance use severity were recorded with the use of The European Addiction Severity Index (EuropASI). We performed a regression analysis to examine factors associated with changes in psychiatric distress at the 6-month follow-up. Results The VA group exhibited higher mental distress than the CA group at admission, but both groups improved significantly during treatment. At the 6-month follow-up, the VA group continued to show reduced distress, but the CA group showed increases in mental distress to the levels observed before treatment. The deterioration appeared to be associated with higher scores that reflected paranoid ideas, somatization, obsessive-compulsive symptoms, interpersonal sensitivity, and depression. Active substance use during follow-up was significantly associated with increased mental distress. Conclusion In-patient treatment reduces mental distress for both CA and VA patients. The time after discharge seems critical especially for CA patients regarding active substance use and severe mental distress. A greater focus on continuing care initiatives to assist the CA patients after discharge is needed to maintain the reduction in mental distress during treatment. Continuing-care initiatives after discharge should be intensified to assist patients in maintaining the reduced mental distress achieved with treatment.

• Stallvik, Marianne & Clausen, Thomas (2017). HRQoL and its association to clinical severity and treatment needs. Journal of Substance Use. ISSN 1465-9891. 22(5), s. 524–530. doi: 10.1080/14659891.2016.1259366. Fulltekst i vitenarkiv Vis sammendrag

  Health Related Quality of Life (HRQoL) has received more attention recently; however, there is still limited knowledge of the relationship between HRQoL in comorbid samples, and service needs within this population. The rate for additional psychological issues and the drop-out rate is known and reported high and investigating HRQoL might provide more answers on needs within this population. A multi-cite prospective study including 175 treatment seeking individuals from mid-Norway was studied at baseline and three months after treatment initiation. Data were gathered from a structured ASAM interview and a self-report survey covering the SF-36 items regarding HRQoL. The results showed significantly lower HRQoL scores among treatment seeking individuals with a substance use disorder, compared with scores from the general population. Higher psychological burden was associated with lower HRQoL at baseline. At follow-up HRQoL increased and significantly for Physical Function. In addition, the individuals with the lowest HRQoL scores on psychological items received more psychiatric program recommendation by ASAM. The high drop out among those who scored the lowest on HRQoL is of clinical importance. Both SF-36 and ASAM interview based software are considered to be valid and useful tools to retrieve patient centered and relevant information and should be used in a clinical setting to support individually tailored treatment. This is an Accepted Manuscript of an article published by Taylor & Francis, available online: http://www.tandfonline.com.

• Stavseth, Marianne Riksheim; Røislien, Jo; Bukten, Anne & Clausen, Thomas (2017). Factors associated with ongoing criminal engagement while in opioid maintenance treatment. Journal of Substance Abuse Treatment. ISSN 0740-5472. 77, s. 52–56. doi: 10.1016/j.jsat.2017.03.010. Fulltekst i vitenarkiv Vis sammendrag

  Introduction: This study examines factors associated with criminal engagement among patients in opioid maintenance treatment (OMT). Methods: Questionnaire data recorded annually among 5 654 patients in the Norwegian OMT programme between 2005 and 2010 from seven regional treatment centres were available for analyses. Each patient answered approximately 4 times (mean: 4.11, SD: 1.46) generating a total of 18 538 questionnaires. The outcome variable of the study, engagement in criminal activity, was defined as whether a patient had been arrested, put in custody, been charged and/or convicted of a crime within the last 12 months prior to the completion of the questionnaire. Three types of covariates were included: demographical, psychosocial and drug use-related. Missing data were imputed using Multivariate Imputation by Chained Equations and regression parameters were estimated by Generalized Estimation Equations to account for correlated measurements. Results: Having a full-time job (aOR: 0.47, CI: 0.34-0.64) or being a student/having a part-time job (aOR: 0.72, CI: 0.59-0.88) was negatively associated with ongoing criminal involvement, as did having a stable living situation (aOR: 0.70, CI: 0.57-0.87). On the other hand, being male (aOR: 1.83, CI: 1.59-2.10), younger (aOR: 0.96, CI: 0.95-0.97) and using illicit drugs regularly (aOR: 3.00, CI: 2.56-3.52) was positively associated with ongoing criminal activity while in OMT. Conclusions: Stable accommodation and participation in meaningful daily activity was found to be protective in terms of ongoing criminal engagement. Focus on these modifiable, psychosocial factors should therefore be an important and integral aspect of opioid maintenance treatment.

• Bukten, Anne; Stavseth, Marianne Riksheim; Skurtveit, Svetlana; Tverdal, Aage; Strang, John & Clausen, Thomas (2017). High risk of overdose death following release from prison: variations in mortality during a 15-year observation period. Addiction. ISSN 0965-2140. 112(8), s. 1432–1439. doi: 10.1111/add.13803. Fulltekst i vitenarkiv Vis sammendrag

  Background and Aims: The time post-release from prison involves elevated mortality, especially overdose deaths. Variations in overdose mortality both by time since release from prison and time of release has not been sufficiently investigated. Our aims were to estimate and compare overdose death rates at time intervals after prison release and to estimate the effect on overdose death rates over calendar time. Design, Setting, Participants, Measurements: This 15-year cohort study includes all persons (n= 91,090) released from prison (01.01.2000 to 31.12.2014) obtained from the Norwegian prison registry, linked to the Norwegian Cause of Death Registry (2000-2014). All-cause and cause-specific mortality were examined during different time-periods following release: first week, second week, 3- 4 weeks and 2-6 months, and by three different time intervals of release. We calculated crude mortality rates (CMRs) per 1000 PY and estimated incidence rate ratios (IRR) by Poisson regression analysis adjusting for time intervals after prison release, release periods and time spent in prison. Findings: Overdose deaths accounted for 85% (n=123) of all deaths during the first week following release (n=145), with a peak during the two days immediately following release. Compared with week 1, the risk of overdose death was more than halved during week 2 (IRR 0.43; 95% CI, 0.31-0.59) and reduced to one-fifth in weeks 3-4 (IRR 0.22; 95% CI, 0.16-0.31). The risk of overdose mortality during the first 6 months post-release was almost twofold higher in 2000-2004 compared with 2005- 2009 (IRR 0.53; 95% CI, 0.43-0.65) and 2010-2014 (IRR 0.47; 95% CI, 0.37-0.59). The risk of overdose death was highest for those incarcerated for 3-12 months compared with those who were incarcerated for shorter or longer periods, and recidivism was associated with risk of overdose death. Conclusions: There is an elevated risk of death from drug overdose among people released from Norwegian prisons, peaking in the first week. The risk has reduced since 2000-2004 but is greatest for those serving 3-12 months compared with shorter or longer periods. This research has been published in Addiction. © 2017 Wiley

• Abel, Eli Kristine Fiksdal; Ravndal, Edle; Clausen, Thomas & Bramness, Jørgen Gustav (2017). Attention Deficit Hyperactivity Disorder Symptoms are Common in Patients in Opioid Maintenance Treatment. European Addiction Research. ISSN 1022-6877. 23(6), s. 298–305. doi: 10.1159/000484240. Fulltekst i vitenarkiv Vis sammendrag

  INTRODUCTION AND AIMS: Knowledge of attention deficit hyperactivity disorder (ADHD) symptoms among patients in opioid maintenance treatment (OMT) is important for treatment optimization and yet limited. We investigated the prevalence of ADHD symptoms, and factors associated with high ADHD symptom burden in a group of Norwegian OMT patients. METHODS: We interviewed individuals entering OMT across Norway in 2 steps between 2012 and 2016. ADHD symptoms were measured by the Adult ADHD Self-Report Scale (ASRS; n = 175). We compared 2 groups of individuals who scored above or below the clinical cutoff score. Mental distress was measured with the General Symptom Index (GSI) of the Hopkin's Symptom Check-List-25. RESULTS: A total of 33% of the OMT patients screened positively for ADHD on the ASRS. Participants who scored above the clinical cutoff were younger, and reported more severe substance use and mental distress. When controlling for other significant variables in a logistic regression analysis, scoring above cutoff on the ASRS was associated with higher GSI (OR 1.61; 95% CI 1.03-2.50) and use of stimulants (OR 2.55; 1.13-5.76). CONCLUSIONS: ADHD symptoms were common in these OMT patients. High ADHD symptom burden was associated with higher mental distress and use of stimulants. This underlines a need of more systematic focus on ADHD in OMT to plan treatment accordingly

• Gjersing, Linn Renathe; Vinge-Holmquist, Kristine; Skurtveit, Svetlana; Bramness, Jørgen Gustav & Clausen, Thomas (2017). Emergency service use is common in the year before death among drug users who die from an overdose. Journal of Substance Use. ISSN 1465-9891. 22(3), s. 331–336. doi: 10.1080/14659891.2016.1208778. Fulltekst i vitenarkiv
• Dunsæd, Frode; Kristensen, Øistein; Vederhus, John-Kåre; Clausen, Thomas & Høie, Magnhild (2016). Standardisert avrusning ved blandingsmisbruk. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 136(19), s. 1639–1642. doi: 10.4045/tidsskr.16.0308. Fulltekst i vitenarkiv
• Madah-Amiri, Desiree; Clausen, Thomas & Lobmaier, Philipp Paul (2016). Utilizing a train-the-trainer model for multi-site naloxone distribution programs. Drug and Alcohol Dependence. ISSN 0376-8716. 163, s. 153–156. doi: 10.1016/j.drugalcdep.2016.04.007. Fulltekst i vitenarkiv Vis sammendrag

  Background: In order to have a substantial impact on overdose prevention, the expansion and scalingup of overdose prevention with naloxone distribution (OPEND) programs are needed. However, limited literature exists on the best method to train the large number of trainers needed to implement such initiatives. Methods: As part of a national overdose prevention strategy, widespread OPEND was implemented throughout multiple low-threshold facilities in Norway. Following a two-hour ‘train-the trainer course’ staff were able to distribute naloxone in their facility. The course was open to all staff, regardless of educational background. To measure the effectiveness of the course, a questionnaire was given to participants immediately before and after the session, assessing knowledge on overdoses and naloxone, as well as attitudes towards the training session and distributing naloxone. Results: In total, 511 staff were trained during 41 trainer sessions. During a two-month survey period, 54 staff participated in a questionnaire study. Knowledge scores significantly improved in all areas following the training (p < 0.001). Attitude scores improved, and the majority of staff found the training useful and intended to distribute naloxone to their clients. Conclusion: Large-scale naloxone distribution programs are likely to continue growing, and will require competent trainers to carry out training sessions. The train-the-trainer model appears to be effective in efficiently training a high volume of trainers, improving trainers’ knowledge and intentions to distribute naloxone. Further research is needed to assess the long term effects of the training session, staffs’ subsequent involvement following the trainer session, and knowledge transferred to the clients.

• Vederhus, John-Kåre; Birkeland, Bente & Clausen, Thomas (2016). Perceived quality of life, 6 months after detoxification: Is abstinence a modifying factor? Quality of Life Research. ISSN 0962-9343. 25(9), s. 2315–2322. doi: 10.1007/s11136-016-1272-z. Fulltekst i vitenarkiv
• Vederhus, John-Kåre; Clausen, Thomas & Humphreys, Keith (2016). Assessing understandings of substance use disorders among Norwegian treatment professionals, patients and the general public. BMC Health Services Research. 16(1). doi: 10.1186/s12913-016-1306-9. Fulltekst i vitenarkiv Vis sammendrag

  Background Beliefs about substance use disorder (SUD) shape how patients, treatment professionals and the general public view addiction and its treatment. A U.S. developed scale exists to assess such beliefs, but it has never been tested in Norway nor normed on any general population sample. Methods The Short Understanding of Substance Abuse Scale (SUSS) was translated from English to Norwegian and used to assess beliefs about the nature of addiction among addiction treatment professionals (N = 291), patients with SUDs (N = 133) and respondents from the general public (N = 216). The disease and psychosocial model subscales of the SUSS were examined with a multigroup factor analysis to confirm that the constructs were invariant across the studied groups. We also controlled for demographic covariates in a multiple indicator multiple cause model. Results The multigroup confirmatory factor analysis of the SUSS yielded a partial scalar invariant model and thus, we were able to compare latent means between groups. In unadjusted comparisons, patients and the general public reported significantly higher endorsement of disease model beliefs than did professionals. However, the difference between professionals and the general public disappeared when the comparison was adjusted for covariates (i.e., age, gender, education). In both unadjusted and adjusted analyses, the general public group but not the patient group scored significantly lower than professionals on the psychosocial belief scale. Conclusion The SUSS is useable with slight adaptations in Norwegian samples. Norwegian treatment professionals have different views of substance use disorder than do patients and the general public. This may create opportunities for dialogue and mutual learning, but also presents risk of miscommunication and distrust.

• Muller, Ashley; Skurtveit, Svetlana & Clausen, Thomas (2016). Many correlates of poor quality of life among substance users entering treatment are not addiction-specific. Health and Quality of Life Outcomes. 14. doi: 10.1186/s12955-016-0439-1. Fulltekst i vitenarkiv Vis sammendrag

  Background Quality of life (QoL) is an important measure and outcome within chronic disease management and treatment, including substance use disorders (SUD). The aim of this paper was to investigate correlates of poorer QoL of individuals entering SUD treatment in Norway, in order to identify subgroups that may most benefit from different interventions. Methods Twenty-one treatment facilities invited all incoming patients to participate. Five hundred forty-nine patients who enrolled between December 2012 and April 2015 are analyzed. QoL, substance use, mental and physical comorbidities, and exercise behaviors were measured. Multinomial regression analysis was used to determine variables significantly associated with poorer QoL. Results The majority of both genders (75 %) reported “poor” or “very poor” QoL at intake. Depression showed a strong association with poor QoL (relative risk ratio [RRR] 3.3, 95 % confidence interval [CI] 1.0–10.3) and very poor QoL (RRR 3.8, 1.2–11.8) among women. Physical inactivity among men was associated with very poor QoL (RRR 2.0, 1.1–3.7), as was reporting eating most meals alone (RRR 2.6, 1.4–4.8). Evaluating one’s weight as too low was also associated with poor QoL (RRR 2.0, 1.0-3.9) and very poor QoL (RRR 2.0, 1.1–3.7) among men. Consuming methadone/buprenorphine was a protective factor for men reporting poor QoL (RRR 0.5, 0.3–0.9) and very poor QoL (RRR 0.4, 0.2–0.9), as well as for women reporting very poor QoL (RRR 0.2, 0.0–0.6). Conclusions Factors associated with poorer QoL among other healthy and clinical populations, such as impaired social and physical well-being and psychological distress, were also seen associated in this sample. Treatment should be targeted towards patients with these particular vulnerabilities in addition to focusing on substance-related factors, and interventions proven to improve the QoL of other populations with these vulnerabilities should be explored in a SUD context.

• Vederhus, John-Kåre; Pripp, Are Hugo & Clausen, Thomas (2016). Quality of Life in Patients with Substance Use Disorders Admitted to Detoxification Compared with Those Admitted to Hospitals for Medical Disorders: Follow-Up Results. Substance Abuse: Research and Treatment. 10, s. 31–37. doi: 10.4137/SART.S39192. Fulltekst i vitenarkiv
• Clausen, Thomas; Martinez, Priscilla; Towers, Andy; Greenfield, Thomas & Kowal, Paul (2016). Alcohol Consumption at Any Level Increases Risk of Injury Caused by Others: Data from the Study on Global AGEing and Adult Health. Substance Abuse: Research and Treatment. s. 125–32. doi: 10.4137/SART.S23549. Fulltekst i vitenarkiv Vis sammendrag

  Background: Alcohol use is a well-known risk factor for injury. However, information is needed about alcohol drinking patterns and the risk of injury among older adults in low- and middle-income countries as this population grows. We aimed to examine the influence of drinking patterns on the burden of injury and investigate factors associated with different types of injury in older populations in six emerging economies. Methods: Data from more than 37,000 adults aged 50 years and older were included from the Study on Global AGEing and Adult Health (SAGE) Wave 1 conducted in six emerging economies, namely, China, Ghana, India, Mexico, Russia, and South Africa. We investigated past-year reported injuries from falls, traffic accidents, and being hit or stabbed. Alcohol drinking patterns were measured as lifetime abstinence, ever but not past- week use, and gender-specific past-week low-risk and high-risk use. We stratified by gender and used logistic regression models to observe the association between alcohol drinking pattern and risk of injury by controlling for other factors. Results: During the year prior to interview, 627 (2.2%) subjects reported bodily injury resulting from a car accident, 1,156 (4.2%) from a fall, and 339 (0.9%) from being hit or stabbed during the past year. For women, only being a high-risk drinker increased the risk of being hit or stabbed, whereas for men, all levels of drinking were associated with an increased risk of being hit or stabbed. We observed a higher risk of being hit or stabbed from past-week high-risk drinking among women (odds ratio [OR] = 6.09, P < 0.01) than among men (OR = 3.57, P < 0.01). We observed no association between alcohol drinking pattern and injury due to car accidents for either women or men. Conclusions: The risk of experiencing injury due to violence increased with level of alcohol exposure of the victim. The increase in alcohol use in emerging economies calls for further study into the consequences of alcohol use and for public health initiatives to reduce the risk of violence in older adult populations, with special attention to the experience of older adult women.

• Opsal, Anne; Kristensen, Øistein; Vederhus, John-Kåre & Clausen, Thomas (2016). Perceived coercion to enter treatment among involuntarily and voluntarily admitted patients with substance use disorders. BMC Health Services Research. 16(1), s. 1–10. doi: 10.1186/s12913-016-1906-4. Fulltekst i vitenarkiv Vis sammendrag

  Background Perceived coercion is a sense of pressure related to the experience of being referred to treatment. The sense of pressure arises from the patient’s internal perception of coercion. The sources of coercion may be the legal system, the family, the health system, or self-criticism (internal sources). Here, we studied patients diagnosed with substance use disorders that were involuntarily admitted to hospital, pursuant to a social services act. We sought to determine whether these patients perceived coercion differently than patients that were admitted voluntarily. Methods This study included patients admitted to combined substance use disorder and psychiatry wards in three publicly funded treatment centres in Norway in the period 2009–2011. Participants included 63 patients that were admitted involuntarily, pursuant to the Norwegian Public Health Act, and 129 patients that were admitted voluntarily. All participants completed the Perceived Coercion Questionnaire. Sociodemographic variables were determined with the European Addiction Severity Index. The range of psychopathological symptoms was evaluated with the Symptom Checklist-90-R. Independent sample t-tests, the chi-squared test, and Fisher’s exact test were used to detect statistically significant differences between groups. Results Scores on the Perceived Coercion Questionnaire showed that patients admitted voluntarily and those admitted involuntarily experienced similar levels of perceived coercion. Those admitted voluntarily reported higher levels of perceived coercion from internal sources, and those admitted involuntarily perceived significantly higher coercion from legal sources. No differences between groups were found with the other tests. Conclusions Our results suggested that assumptions about involuntary admissions should be evaluated carefully to determine how best to alleviate counterproductive feelings of coercion when a coerced admission is planned. Informing and collaborating with the patient will most likely facilitate a better experience during admission and treatment. Moreover, the patient is more likely to experience a better recovery process.

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

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

• Tjagvad, Christian; Skurtveit, Svetlana; Linnet, Kristian; Andersen, Ljubica Vukelic; Christoffersen, Dorte J. & Clausen, Thomas (2016). Methadone-related overdose deaths in a liberal opioid maintenance treatment program. European Addiction Research. ISSN 1022-6877. 22(5), s. 249–258. doi: 10.1159/000446429. Fulltekst i vitenarkiv
• Tjagvad, Christian; Skurtveit, Svetlana; Bramness, Jørgen Gustav; Gjersing, Linn Renathe; Gossop, Michael & Clausen, Thomas (2016). Misuse of prescription drugs and overdose deaths. Journal of Substance Use. ISSN 1465-9891. 21(5), s. 515–520. doi: 10.3109/14659891.2015.1077280. Fulltekst i vitenarkiv
• Pasareanu, Adrian Razvan; Vederhus, John-Kåre; Opsal, Anne; Kristensen, Øistein & Clausen, Thomas (2016). Improved drug-use patterns at 6 months post-discharge from inpatient substance use disorder treatment: Results from compulsorily and voluntarily admitted patients. BMC Health Services Research. 16:291. doi: 10.1186/s12913-016-1548-6. Fulltekst i vitenarkiv Vis sammendrag

  Background Treatment services to patients with substance use disorders (SUDs), including those mandated to treatment, needs to be evaluated and evidence based. The Norwegian Municipal Health Care Act calls for mandated treatment for persons with “severe and life-threatening substance use disorder” if these individuals are not otherwise willing to be voluntarily treated and consequently risk their lives over drug use. This study aims to examine substance use–related outcomes at 6 months following inpatient treatment and to analyse factors associated with improved outcomes and abstinence. Method This prospective study followed 202 hospitalized patients with SUD who were admitted voluntarily (VA; n = 137) or compulsorily (CA; n = 65). The European Addiction Severity Index was used at baseline and at follow-up to assess socio-demographic and substance use variables. Regression analysis was conducted to investigate factors associated with abstinence at 6 months of follow-up. Results The frequency of use of a preferred substance showed marked improvement for both VA and CA patients (61 and 37 %, respectively) at follow-up. Seventy-five percent of VA patients using amphetamine reported improvement compared to 53 % of CA patients. At follow-up, the CA group continued to have a higher rate of injection use. The CA group had experienced higher rates of overdose in the past 6 months and lower abstinence rates (24 % versus 50 %) at follow-up. A lower severity of drug use at intake (non–injection drug use), voluntary treatment modality, and higher treatment involvement during follow-up all were significant factors associated with abstinence at 6 months after treatment. Conclusion Voluntary treatment for SUD generally yielded better outcomes; nevertheless, we also found improved outcomes for CA patients. It is important to keep in mind that in reality, the alternative to CA treatment is no treatment at all and instead a continuation of life-threatening drug use behaviours. Our observed outcomes for CA patients support the continuation of CA treatment.

• Muller, Ashley; Skurtveit, Svetlana & Clausen, Thomas (2016). Validating the generic quality of life tool "QOL10" in a substance use disorder treatment cohort exposes a unique social construct. BMC Medical Research Methodology. 16. doi: 10.1186/s12874-016-0163-x. Fulltekst i vitenarkiv Vis sammendrag

  Background Generic quality of life (QoL) instruments provide important measures of self-reported wellbeing that can be compared across healthy and clinical populations. The aim of this analysis is to validate the ten-item QoL instrument “QOL10”, as well as to confirm the validity of the embedded “QOL5” questionnaire and single-item “QOL1” in measuring overall QoL among adults in a substance use disorder treatment study. Methods We used exploratory factor analysis and measured internal and convergent validity of the QOL10 against the gold standard measure of the WHOQOL-BREF, in a subsample of 107 participants in a substance use disorder treatment study. Results The QOL10 displayed internal and convergent validity to the gold standard measure. Factor analysis revealed a two-factor structure that can be interpreted as “social QoL”, containing items about relationships and social functioning, and “global QoL”, comprised of items about health, working ability, self-evaluation, and an overall QoL estimation. Conclusions The QOL10 provides clinically useful and valid measures of social-related QoL and global QoL via two subscales. Interestingly, the QOL10’s social QoL measure, from the current sample, had little relationship to the analyzed groups previously reported to have differential global QoL: social QoL appears to be not only conceptually distinct from global QoL, but also to be less influenced by typical substance- and treatment-specific factors.

• Thylstrup, Birgitte; Clausen, Thomas & Hesse, Morten (2015). Cardiovascular disease among people with drug use disorders. International Journal of Public Health. ISSN 1661-8556. 60(6), s. 659–668. doi: 10.1007/s00038-015-0698-3. Fulltekst i vitenarkiv
• Bukten, Anne; Lund, Ingunn Olea; Rognli, Eline Borger; Riksheim, Marianne; Lobmaier, Philipp Paul & Skurtveit, Svetlana [Vis alle 8 forfattere av denne artikkelen] (2015). The Norwegian offender mental health and addiction study – Design and implementation of a national survey and prospective cohort study. Substance Abuse: Research and Treatment. 9, s. 59–66. doi: 10.4137/SART.S23546. Fulltekst i vitenarkiv Vis sammendrag

  The Norwegian prison inmates are burdened by problems before they enter prison. Few studies have managed to assess this burden and relate it to what occurs for the inmates once they leave the prison. The Norwegian Offender Mental Health and Addiction (NorMA) study is a large-scale longitudinal cohort study that combines national survey and registry data in order to understand mental health, substance use, and criminal activity before, during, and after custody among prisoners in Norway. The main goal of the study is to describe the criminal and health-related trajectories based on both survey and registry linkage information. Data were collected from 1,499 inmates in Norwegian prison facilities during 2013–2014. Of these, 741 inmates provided a valid personal identification number and constitute a cohort that will be examined retrospectively and prospectively, along with data from nationwide Norwegian registries. This study describes the design, procedures, and implementation of the ongoing NorMA study and provides an outline of the initial data.

• Muller, Ashley & Clausen, Thomas (2015). Group exercise to improve quality of life among substance use disorder patients. Scandinavian Journal of Public Health. ISSN 1403-4948. 43(2), s. 146–152. doi: 10.1177/1403494814561819. Fulltekst i vitenarkiv Vis sammendrag

  Background: Quality of life (QoL) is a well-established outcome within clinical practice. Despite the adverse effects of substance use disorders on a wide range of patients’ functionality and the multidimensional composition of QoL, the treatment field does not yet systematically assess QoL among patients. Exercise has established positive effects on the QoL of healthy and numerous clinical populations. The potential to integrate exercise within treatment, in order to improve QoL has not been satisfactorily explored. Aims: To measure changes in QoL after group exercise among residential substance use disorder patients and to explore the feasibility of the program within a treatment setting. Methods: We enrolled 35 patients in four long-term residential substance use disorder treatment facilities in Oslo, into a 10-week group exercise program. We analyzed the 24 participants who exercised as completers, while the 11 participants who did not were analyzed as non-completers. We measured QoL, mental distress, somatic health burden and addiction severity at the beginning and end of the program. Results: The program was feasible for participants and the completion rate was 69%. Completers’ physical health domain and psychological health domain of QoL improved significantly. The program engaged the most physically and mentally vulnerable participants, and flexibility and motivational factors were important elements. Conclusions: This study provided promising evidence that low doses of group exercise can yield appreciable benefits, even to patients with more severe health problems.

• Pasareanu, Adrian Razvan; Opsal, Anne; Vederhus, John-Kåre; Kristensen, Øistein & Clausen, Thomas (2015). Quality of life improved following in-patient substance use disorder treatment. Health and Quality of Life Outcomes. 13. doi: 10.1186/s12955-015-0231-7. Fulltekst i vitenarkiv
• Vederhus, John-Kåre; Zemore, Sarah E.; Rise, Jostein; Clausen, Thomas & Høie, Magnhild (2015). Predicting patient post-detoxification engagement in 12-step groups with an extended version of the theory of planned behavior. Addiction science & clinical practice. ISSN 1940-0632. 10. doi: 10.1186/s13722-015-0036-3. Fulltekst i vitenarkiv Vis sammendrag

  Introduction Individuals with substance use disorders can receive important abstinence-specific support in 12-step groups (TSGs). However, our understanding of key factors that influence TSG participation remains limited. This study used an extended version of the theory of planned behavior (TPB) to enhance the understanding of TSG affiliation. Methods Data were retrieved from a controlled trial of a 12-step facilitation intervention conducted on an inpatient detoxification ward in Norway (N = 140). Surveys at baseline included a TPB questionnaire. The behavioral target was to attend at least two TSG meetings per month in the 6-month follow-up period. Structural equation modeling was used to analyze the predictors of behavior at follow-up. Results We found that attitudes, the moral norm, and perceived behavior control accounted for 81 % of the variance in the intention to participate regularly in TSGs after treatment. Subjective norms did not significantly influence the intention to participate. Moreover, the intention to participate significantly predicted behavior (β = 0.42, p < 0.001). In contrast to theory, there was a substantial, model-independent pathway from past to later behavior (β = 0.22, p = 0.047). The model explained 46 % (p < 0.001) of the variance in behavior. Attending ≥ 12 TSG meetings in the follow-up period was associated with a high percentage of abstinent days at follow-up (β = 0.38, p = 0.023). Conclusions The present TPB questionnaire worked well for assessing patient intentions to attend a TSG. Treatment providers should encourage patient intentions to participate in TSGs post-detoxification.

• Vederhus, John-Kåre; Rysstad, Ole; Gallefoss, Frode; Clausen, Thomas & Kristensen, Øistein (2015). Kartlegging av alkoholbruk og røyking hos pasienter innlagt i medisinsk avdeling. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 135(14), s. 1251–1255. doi: 10.4045/tidsskr.14.0848. Fulltekst i vitenarkiv
• Clausen, Thomas; Åsland, Reidun & Kristensen, Øistein (2014). Pasienter som avbryter LAR-behandling - hvordan går det med dem? Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 134(11), s. 1146–1149. doi: 10.4045/tidsskr.13.0821. Fulltekst i vitenarkiv
• Havnes, Ingrid Amalia; Clausen, Thomas & Middelthon, Anne-Lise Orvin (2014). Execution of control among 'non-compliant', imprisoned individuals in opioid maintenance treatment. International journal of drug policy. ISSN 0955-3959. 25(3), s. 480–485. doi: 10.1016/j.drugpo.2014.01.018. Fulltekst i vitenarkiv
• Martinez, Priscilla; Lien, Lars; Landheim, Anne; Kowal, Paul & Clausen, Thomas (2014). Quality of life and social engagement of alcohol abstainers and users among older adults in South Africa. BMC Public Health. 14(316). doi: 10.1186/1471-2458-14-316. Fulltekst i vitenarkiv Vis sammendrag

  Background: The literature from developed countries suggests a relationship between alcohol use and quality of life and social engagement, where harmful drinkers have lower quality of life and less social engagement. Despite the high rates of harmful alcohol use in South Africa, little is known about the association between drinking pattern and quality of life and social engagement in this context. We aimed to determine if quality of life and social engagement varied across different drinking patterns among older South African adults, contributed to drinking pattern when controlling for socio-demographic factors, and varied differentially between genders. Methods: This is a secondary analysis of data from the Survey on Global Ageing and Adult Health (SAGE). Alcohol use was measured as self-reports of use over the previous seven days, and we constructed gender-specific alcohol variables. The WHO Quality of Life-scale was used to measure quality of life, and social engagement was measured by frequency of participation in social activities. We used ANOVA to observe differences in quality of life and social engagement scores across drinking patterns, and regression models were used to identify factors independently associated with drinking pattern. Results: There were 2572 (84.4%) lifetime abstainers, and 475 (15.6%) persons who had a drink in the last 7 days. In bivariate analysis, quality of life was lowest among at risk drinking men compared to abstainers (OR = 0.21, p = 0.02), although this association was not significant in adjusted analysis. Social engagement did not vary statistically significantly across the drinking patterns in the total sample or within gender. Conclusions: Quality of life and social engagement were not independently associated with drinking pattern among older adults in South Africa in this sample. In order to better understand their alcohol use, further exploratory research is warranted to identify other potentially relevant subjective factors of alcohol use among older adults in South Africa.

• Havnes, Ingrid Amalia; Clausen, Thomas; Mburu, Christina Brux & Middelthon, Anne-Lise Orvin (2014). The role of substance use and morality in violent crime - a qualitative study among imprisoned individuals in opioid maintenance treatment. Harm Reduction Journal. 11:24. doi: 10.1186/1477-7517-11-24. Fulltekst i vitenarkiv Vis sammendrag

  Background Opioid maintenance treatment (OMT) is regarded as a crime control measure. Yet, some individuals are charged with violent criminal offenses while enrolled in OMT. This article aims to generate nuanced knowledge about violent crime among a group of imprisoned, OMT-enrolled individuals by exploring their understandings of the role of substances in violent crime prior to and during OMT, moral values related to violent crime, and post-crime processing of their moral transgressions. Methods Twenty-eight semi-structured interviews were undertaken among 12 OMT-enrolled prisoners. The interviews were audio recorded and transcribed verbatim. An exploratory, thematic analysis was carried out with a reflexive and interactive approach. Findings Prior to OMT, substances and, in particular, high-dose benzodiazepines were deliberately used to induce ‘antisocial selves’ capable of transgressing individual moral codes and performing non-violent and violent criminal acts, mainly to support costly heroin use. During OMT, impulsive and uncontrolled substance use just prior to the violent acts that the participants were imprisoned for was reported. Yet, to conduct a (violent) criminal act does not necessarily imply that one is without moral principles. The study participants maintain moral standards, engage in complex moral negotiations, and struggle to reconcile their moral transgressions. Benzodiazepines were also used to reduce memories of and alleviate the guilt associated with having committed violent crimes. Conclusions Substances are used to transgress moral codes prior to committing and to neutralize the shame and guilt experienced after having committed violent crimes. Being simultaneously enrolled in OMT and imprisoned for a (violent) crime might evoke feelings of ‘double’ shame and guilt for both the criminal behavior prior to treatment and the actual case(s) one is imprisoned for while in OMT. Treatment providers should identify individuals with histories of violent behavior and, together with them, explore concrete episodes of violence and their emotional reactions. Particular attention should be given to potential relationships between substance use and violence and treatment approaches tailored accordingly. What appears as severe antisocial personality disorder may be partly explained by substance use.

• Vederhus, John-Kåre; Timko, Christine; Kristensen, Øistein; Hjemdal, Bente & Clausen, Thomas (2014). Motivational intervention to enhance post-detoxification 12-Step group affiliation: A randomized controlled trial. Addiction. ISSN 0965-2140. 109(5), s. 766–773. doi: 10.1111/add.12471. Fulltekst i vitenarkiv
• Waal, Helge; Clausen, Thomas; Gjersing, Linn Renathe & Gossop, Michael (2014). Open drug scenes: responses of five European cities. BMC Public Health. 14(853 ). doi: 10.1186/1471-2458-14-853. Fulltekst i vitenarkiv Vis sammendrag

  Open drug scenes are gatherings of drug users who publicly consume and deal drugs. The authors conducted a study of five European cities that have met such scenes constructively. The aim was to investigate shared and non-shared interventions and strategies in order to increase the understanding of this type of problem. First a description was made for the cities of Amsterdam, Frankfurt, Vienna, Zürich and Lisbon. These descriptions were sent to contact persons in each city prior to visit by the researchers. The methods and strategies in each city were discussed and core choices and efforts extracted. A report was sent to the contact group for corrections and clarifications. The paper analyses shared and non-shared traits and strategies. All of the cities had initially a period with conflict between liberal and restrictive policies. A political consensus seems to be a prerequisite for effective action. A core shared characteristic was that drug dependence was met as a health problem and drug use behaviour as a public nuisance problem. Low threshold health services including opioid maintenance treatment were combined with outreach social work and effective policing. Prevention, harm reduction and treatment should be combined with law enforcement based on cooperation between police, health care and social services. The aim should be "coexistence" between society and users of illegal substances and the strategy based on several years planning and conjoint efforts. The solutions are found in appropriate combinations of harm reduction and restrictive measures.

• Røislien, Jo; Clausen, Thomas; Gran, Jon Michael & Bukten, Anne (2014). Accounting for individual differences and timing of events: Estimating the effect of treatment on criminal convictions in heroin users. BMC Medical Research Methodology. 14(68). doi: 10.1186/1471-2288-14-68. Fulltekst i vitenarkiv Vis sammendrag

  Background The reduction of crime is an important outcome of opioid maintenance treatment (OMT). Criminal intensity and treatment regimes vary among OMT patients, but this is rarely adjusted for in statistical analyses, which tend to focus on cohort incidence rates and rate ratios. The purpose of this work was to estimate the relationship between treatment and criminal convictions among OMT patients, adjusting for individual covariate information and timing of events, fitting time-to-event regression models of increasing complexity. Methods National criminal records were cross linked with treatment data on 3221 patients starting OMT in Norway 1997–2003. In addition to calculating cohort incidence rates, criminal convictions was modelled as a recurrent event dependent variable, and treatment a time-dependent covariate, in Cox proportional hazards, Aalen’s additive hazards, and semi-parametric additive hazards regression models. Both fixed and dynamic covariates were included. Results During OMT, the number of days with criminal convictions for the cohort as a whole was 61% lower than when not in treatment. OMT was associated with reduced number of days with criminal convictions in all time-to-event regression models, but the hazard ratio (95% CI) was strongly attenuated when adjusting for covariates; from 0.40 (0.35, 0.45) in a univariate model to 0.79 (0.72, 0.87) in a fully adjusted model. The hazard was lower for females and decreasing with older age, while increasing with high numbers of criminal convictions prior to application to OMT (all p < 0.001). The strongest predictors were level of criminal activity prior to entering into OMT, and having a recent criminal conviction (both p < 0.001). The effect of several predictors was significantly time-varying with their effects diminishing over time. Conclusions Analyzing complex observational data regarding to fixed factors only overlooks important temporal information, and naïve cohort level incidence rates might result in biased estimates of the effect of interventions. Applying time-to-event regression models, properly adjusting for individual covariate information and timing of various events, allows for more precise and reliable effect estimates, as well as painting a more nuanced picture that can aid health care professionals and policy makers.

• Clausen, Thomas (2014). Hvor godt virker LAR, og hva er utfordringene? Norsk Farmaceutisk Tidsskrift (NFT). ISSN 0029-1935. 122(10), s. 39–42. Fulltekst i vitenarkiv
• Thapa, Suraj Bahadur; Martinez, Priscilla & Clausen, Thomas (2014). Depression and its correlates in South Africa and Ghana among people aged 50 and above: Findings from the WHO Study on global AGEing and adult health. African Journal of Psychiatry. ISSN 1994-8220. 17(6). doi: 10.4172/Psychiatry.1000167. Fulltekst i vitenarkiv
• Riksheim, Marianne; Gossop, Michael & Clausen, Thomas (2014). From methadone to buprenorphine: Changes during a 10 year period within a national opioid maintenance treatment programme. Journal of Substance Abuse Treatment. ISSN 0740-5472. 46(3), s. 291–294. doi: 10.1016/j.jsat.2013.10.006. Fulltekst i vitenarkiv Vis sammendrag

  Opioid maintenance treatment (OMT) is the most widely used treatment for opioid dependence. Maintenance programmes differ in various aspects and may also change over time. This paper investigates the changes in treatment practices within a national OMT programme during a 10year period (2002–2011), especially with regard to the prescribing of methadone and buprenorphine. Data (n=34,001) were collected by annual assessments questionnaires. In 2002, only 16% of the OMT patients received buprenorphine as their maintenance medication. By 2011 this percentage had increased significantly (p<.001) to 50.3%. In the same period the number of patients more than tripled (from 1,984 to 6,640, p<.001), and programme attrition rates decreased (p=.020). This relatively rapid shift is a part of the increasing reliance of addiction medicine upon a range of medications administered by different routes which has not been previously charted within a national treatment programme.

• Bukten, Anne; Skurtveit, Svetlana; Waal, Helge & Clausen, Thomas (2014). Factors associated with dropout among patients in opioid maintenance treatment (OMT) and predictors of re-entry. A national registry-based study. Addictive Behaviours. ISSN 0306-4603. 39(10), s. 1504–1509. doi: 10.1016/j.addbeh.2014.05.007. Fulltekst i vitenarkiv
• Opsal, Anne; Kristensen, Øistein; Larsen, Tor Ketil; Syversen, Gro; Rudshaug, Elise Bakke Aasen & Gerdner, Arne [Vis alle 7 forfattere av denne artikkelen] (2013). Factors associated with involuntary admissions among patients with substance use disorders and comorbidity: a cross-sectional study. BMC Health Services Research. 13. doi: 10.1186/1472-6963-13-57. Fulltekst i vitenarkiv Vis sammendrag

  Background To investigate factors associated with involuntary admissions to hospital pursuant to a social services act of patients with substance use disorder by comparing the socio-demographic characteristics, substance use, and psychiatric comorbidities with voluntarily admitted patients. Methods This cross-sectional study compared two groups admitted to combined substance use disorder and psychiatry wards. Sixty-five patients were involuntarily admitted pursuant to the Social Services Act and 137 were voluntarily admitted. The International Classification of Diseases and Related Health Problems was used for diagnostic purposes regarding substance use disorders, type and severity of psychiatric problems, and level of functioning. Socio-demographic variables were measured using the European Addiction Severity Index, and the Symptom Checklist-90-R instruments were used to evaluate the range of psychological problems and psychopathological symptoms. Logistic regression was performed to investigate the relationship between involuntary admissions and patients characteristics. Results Patients who had been involuntarily admitted were more likely to be females, had utilized public welfare services more often, presented more severe substance use patterns, and had a history of more frequent visits to physicians for somatic complaints in the last 6 months, they also had fewer comorbid mental disorders. Still, considerable burdens of comorbid substance use disorders and mental disorders were observed both among involuntary and voluntary admitted patients. Conclusions More attention is required for involuntarily admitted patients in order to meet the needs associated with complex and mixed disorders. In addition, treatment centers should offer diagnostic options and therapy regarding substance use, psychiatric and somatic disorders.

• Rossow, Ingeborg & Clausen, Thomas (2013). The collectivity of drinking cultures: is the theory applicable to African settings? Addiction. ISSN 0965-2140. 108(9), s. 1612–1617. doi: 10.1111/add.12220. Fulltekst i vitenarkiv Vis sammendrag

  Skog's theory of collective drinking behaviour implies that countries with a strict informal social control of drinking alcohol would not exhibit ‘collective displacement' of consumption (a linear association between population mean consumption and percentile values across the full range of the distribution), as do countries with less informal social control. This paper aimed to test this hypothesis by examining the alcohol consumption distributions in African countries with a strong informal control of alcohol. Design setting, participants and measurements Data on alcohol consumption from the World Health Organization's general population surveys in 15 African countries were aggregated and analysed with respect to skewedness and collective displacement of the distribution. Findings The distribution of consumption was strongly positively skewed, with 10-15% of the drinkers consuming more than twice the mean consumption. Therewas also clear evidence of a collective displacement of the consumption distribution, and the consumption mean was a strong predictor of the distribution percentile values across the full range of the distribution. Correspondingly, consumption mean predicted the prevalence of heavy drinkers. Conclusion The distribution patterns of alcohol consumption in African countries are consistent with those observed previously in industrialized countries. These findings seem to counter Skog's theory of collective drinking behaviour and support the universality of the observation that the prevalence of problem drinking is linked closely to mean consumption.

• Bukten, Anne; Herskedal, Aina; Skurtveit, Svetlana; Bramness, Jørgen Gustav & Clausen, Thomas (2013). Driving under the influence (DUI) among patients in opioid maintenance treatment (OMT): a registry-based national cohort study. Addiction. ISSN 0965-2140. 108(11), s. 1954–1961. doi: 10.1111/add.12275. Fulltekst i vitenarkiv
• Gjersing, Linn; Jonassen, Kristine V.; Biong, Stian; Ravndal, Edle; Waal, Helge & Bramness, Jørgen G. [Vis alle 7 forfattere av denne artikkelen] (2013). Diversity in causes and characteristics of drug-induced deaths in an urban setting. Scandinavian Journal of Public Health. ISSN 1403-4948. 41(2), s. 119–125. doi: 10.1177/1403494812472007. Fulltekst i vitenarkiv Vis sammendrag

  To assess demographic characteristics, treatment utilization and circumstances of death among those who died from drug-induced deaths in an urban setting and to identify possible subpopulations that should be targeted specifically to further develop preventive public health policies. Subjects (N = 231) who died, from drug-induced deaths, in the Norwegian capital Oslo (2006–2008) were identified through the National Cause of Death Registry. Data on toxicology, prison release and contact with health and social services in Oslo were collected. Majority of cases were men (78%) and the mean age was 37 years. Nearly all cases (90%) were polydrug intoxications. Heroin was implicated in 67%. Residential address was the most common place of death (67%). Most cases (82%) had been in contact with health and social services in the year before death. Women were 4 years older, more often Oslo residents (82% vs. 64%) and fewer died from heroin intoxication. Non-Oslo residents were younger and more likely to have been found outdoors with heroin as the main intoxicant. Other identified subpopulations were those who died after prison release and those discharged from drug treatment. The findings suggest that the majority of cases could have been available for preventive measures through their contacts with health and social services. Yet, the heterogeneity among cases indicates that such measures need to be multifaceted. Finally, it is important for policymakers and health and social workers in various countries to consider subpopulations such as women and non-city residents when developing public health interventions to prevent overdose deaths.

• Vieweg, W. Victor R.; Hasnain, Mehrul; Howland, Robert H.; Clausen, Thomas; Koneru, Jayanthi N. & Kogut, Christopher [Vis alle 10 forfattere av denne artikkelen] (2013). Methadone, QTc interval prolongation, and torsade de pointes: Case reports offer the best understanding of this problem. Therapeutic Advances in Psychopharmacology. ISSN 2045-1253. 3(4), s. 219–232. doi: 10.1177/2045125312469982. Fulltekst i vitenarkiv
• Havnes, Ingrid Amalia; Clausen, Thomas & Middelthon, Anne-Lise Orvin (2013). 'Diversion' of methadone or buprenorphine: 'harm' versus 'helping'. Harm Reduction Journal. 10:24. doi: 10.1186/1477-7517-10-24. Fulltekst i vitenarkiv Vis sammendrag

  Background 'Non-compliant’ individuals in opioid maintenance treatment, OMT, are often met with tight control regimes to reduce the risk of 'diversion’, which may lead to harm or death among persons outside of OMT. This article explores reported practices of, and motivations for, diversion of methadone and buprenorphine, in a group of imprisoned individuals in OMT. Findings 28 in-depths interviews were conducted among 12 OMT-enrolled, imprisoned individuals, most of whom were remand prisoners. All had experienced tight control regimes prior to imprisonment due to varying degrees of 'non-compliance’ and illicit drug use during treatment. Their acquired norm of sharing with others in a drug using community was maintained when entering OMT. Giving one’s prescription opioids to an individual in withdrawal was indeed seen as an act of helping, something that takes on particular significance for couples in which only one partner is included in OMT and the other is using illicit heroin. Individuals enrolled in OMT might thus be trapped between practicing norms of helping and sharing and adhering to treatment regulations. ’Diversion’, as this term is conventionally used, is not typically understood as practices of giving and helping, but may nevertheless be perceived as such by those who undertake them. Conclusions As we see it, the need to sustain oneself as a decent person in one’s own eyes and those of others through practices such as sharing and helping should be recognized. Treatment providers should consider including couples in which both individuals are motivated for starting OMT.

• Skeie, Ivar; Brekke, Mette; Clausen, Thomas; Gossop, Michael; Lindbæk, Morten & Reinertsen, Even [Vis alle 8 forfattere av denne artikkelen] (2013). Increased Somatic Morbidity in the First Year after Leaving Opioid Maintenance Treatment: Results from a Norwegian Cohort Study. European Addiction Research. ISSN 1022-6877. 19(4), s. 194–201. doi: 10.1159/000345229. Fulltekst i vitenarkiv
• Bukten, Anne; Røislien, Jo; Skurtveit, Svetlana; Waal, Helge; Gossop, Michael & Clausen, Thomas (2013). A day-by-day investigation of changes in criminal convictions before and after entering and leaving opioid maintenance treatment: a national cohort study. BMC Psychiatry. 13. doi: 10.1186/1471-244X-13-262. Fulltekst i vitenarkiv
• Waal, Helge; Brekke, Mette; Clausen, Thomas; Lindbæk, Morten; Rosta, Judith & Skeie, Ivar [Vis alle 7 forfattere av denne artikkelen] (2012). Fastlegers syn på legemiddelassistert rehabilitering. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 132(16), s. 1861–1866. doi: 10.4045/tidsskr.12.0124. Fulltekst i vitenarkiv
• Vederhus, John-Kåre; Kristensen, Øistein; Clausen, Thomas & Gossop, Michael (2012). Turn something bad into something good. British Journal of General Practice. ISSN 0960-1643. 62(594), s. 32–32. doi: 10.3399/bjgp12X616382. Fulltekst i vitenarkiv
• Havnes, Ingrid Amalia; Bukten, Anne; Gossop, Michael; Waal, Helge; Stangeland, Per Ingolf & Clausen, Thomas (2012). Reductions in convictions for violent crime during opioid maintenance treatment: A longitudinal national cohort study. Drug and Alcohol Dependence. ISSN 0376-8716. 124(3), s. 307–310. doi: 10.1016/j.drugalcdep.2012.02.005. Fulltekst i vitenarkiv
• Bukten, Anne; Skurtveit, Svetlana; Gossop, Michael; Waal, Helge; Stangeland, Per Ingolf & Havnes, Ingrid Amalia [Vis alle 7 forfattere av denne artikkelen] (2012). Engagement with opioid maintenance treatment and reductions in crime: a longitudinal national cohort study. Addiction. ISSN 0965-2140. 107(2), s. 393–399. doi: 10.1111/j.1360-0443.2011.03637.x. Fulltekst i vitenarkiv
• Lobmaier, Philipp Paul; Dalsbø, Therese Kristine & Clausen, Thomas (2011). Nalokson nesespray kan redusere risikoen for dødelige heroinoverdoser. Norsk Epidemiologi. ISSN 0803-2491. 21(1), s. 107–111. doi: 10.5324/nje.v21i1.1433. Fulltekst i vitenarkiv Vis sammendrag

  Bakgrunn: Antall overdosedødsfall blant heroinmisbrukere i Norge er høyt. Behandling med motgiften nalokson er kun tilgjengelig gjennom helsepersonell. Nalokson kan også gis som nesespray av ikke helsepersonell. Økt tilgjengelighet av nalokson kan redusere både antall fatale overdoser og fare for stikkskader og blodsmitte med hepatitt C og hiv blant helsepersonell. I denne artikkelen presenterer vi kunnskap om bruk av nalokson nesespray i behandling av opioidoverdoser. Material og metode: Vi har gjennomført søk etter relevant forskning om effekt av nalokson nesespray i databasene Medline, Embase og Cochrane library. Artikler er valgt ut basert på skjønn og forhåndsbestemte kriterier om behandling og pasientpopulasjon. Det var ingen restriksjoner på hvilken studiedesign som var benyttet eller metodologisk kvalitet. Konklusjonen er basert på innhentet material. Resultater: Ni relevante studier ble identifisert og inkludert, hvorav fire hadde kontrollgrupper men kun to var randomiserte sammenligninger. Ingen av studiene var utført i Norge. Nalokson nesespray gitt grunnet mistanke om opioidoverdose synes å føre til rask klinisk respons. Ved sammenligning med dagens praksis med injisert nalokson peker funn mot nesten like rask normalisering av åndedrett ved nesespray. Bruk av nalokson nesespray kan gi redusert behov for nalokson injeksjoner og derfor redusert fare for stikkskade blant helsepersonell. Hvis også legfolk utenom helsepersonell læres opp til å gi nalokson nesespray vil tilgjengeligheten av motgift og kunnskap rundt forebygging av overdoser kunne økes. Fortolkning: Det er foreløpig for få studier av høy kvalitet til å kunne konkludere endelig med effekt av nesespray. Men de studiene som foreligger tyder på at nalokson i form av nesespray kan være effektiv i behandlingen av overdoser. Nalokson nesespray anbefales derfor utprøved ytterligere i randomiserte studier i Norge sammenlignet med dagens praksis. Videre bør opplæringen i bruk for pårørende, brukere og ansatte i eksisterende lavterskeltiltak evalueres da dette vil kunne øke nalokson tilgjengeligheten og bidra til å redusere antallet overdosedødsfall.

• Opsal, Anne; Clausen, Thomas; Kristensen, Øistein; Elvik, Ivar; Joa, Inge & Larsen, Tor Ketil (2011). Involuntary hospitalization of first-episode psychosis with substance abuse during a 2-year follow-up. Acta Psychiatrica Scandinavica. ISSN 0001-690X. 124(3), s. 198–204. doi: 10.1111/j.1600-0447.2011.01700.x. Fulltekst i vitenarkiv
• Bramness, Jørgen Gustav; Clausen, Thomas; Duckert, Fanny; Ravndal, Edle & Waal, Helge (2011). Addiction Research Centres and the Nurturing of Creativity The Norwegian Centre for Addiction Research (SERAF). Addiction. ISSN 0965-2140. 106(8), s. 1381–1385. doi: 10.1111/j.1360-0443.2010.03086.x. Fulltekst i vitenarkiv
• Fredheim, Olav Magnus; Borchgrevink, Petter Chr.; Nordstrand, Berit; Clausen, Thomas & Skurtveit, Svetlana (2011). Prescription of analgesics to patients in opioid maintenance therapy: A pharmacoepidemiological study. Drug and Alcohol Dependence. ISSN 0376-8716. 116(1-3), s. 158–162. doi: 10.1016/j.drugalcdep.2010.12.014. Fulltekst i vitenarkiv
• Opsal, Anne; Kristensen, Øistein; Ruud, Torleif; Larsen, Tor Ketil; Gråwe, Rolf W. & Clausen, Thomas (2011). Substance abuse inpatients admitted voluntarily and involuntarily to acute psychiatric wards: a national cross-sectional study. Norsk Epidemiologi. ISSN 0803-2491. 21(1), s. 85–91. doi: 10.5324/nje.v21i1.1430. Fulltekst i vitenarkiv Vis sammendrag

  Background: Substance abuse and mental disorder comorbidity is high among patients admitted to acute psychiatric wards. The aim of the study was to identify this co-occurrence as a reason for involuntary admission and if specific substance use-related diagnoses were associated with such admissions. Methods: The study was a part of a multicentre, cross-sectional national study carried out during 2005-2006 within a research network of acute mental health services. Seventy-five percent of Norwegian hospitals providing acute in-patient treatment participated. Substance use was measured using the Clinician Rating Scale and the ICD-10 diagnoses F10-19. Diagnostic assessments were performed by the clinicians during hospital stay. Results: Overall, 33.2% (n=1,187) of the total patient population (3,506) were abusing alcohol or drugs prior to admission according to the Clinician Rating Scale. No difference in the overall prevalence of substance abuserelated diagnoses between the two groups was found. Overall, 310 (26%) of the admissions, 216 voluntarily and 94 involuntarily admitted patients received a double diagnosis. Frequent comorbid combinations among voluntarily admitted patients were; a combination of alcohol and either mood disorder (40%) or multiple mental disorders (29%). Among involuntarily admitted patients, a combination of poly drug use and schizophrenia was most frequent (47%). Substance abusing patients diagnosed with mental and behavioral disorders due to the use of psychoactive stimulant substances had a significantly higher risk of involuntary hospitalization (OR 2.3). Conclusion: Nearly one third of substance abusing patients are involuntarily admitted to mental hospitals, in particular stimulant drug use was associated with involuntarily admissions.

• Bukten, Anne; Skurtveit, Svetlana; Stangeland, Per Ingolf; Gossop, Michael; Willersrud, Astrid Brandsberg & Waal, Helge [Vis alle 8 forfattere av denne artikkelen] (2011). Criminal convictions among dependent heroin users during a 3-year period prior to opioid maintenance treatment: A longitudinal national cohort study. Journal of Substance Abuse Treatment. ISSN 0740-5472. 41(4), s. 407–414. doi: 10.1016/j.jsat.2011.06.006. Fulltekst i vitenarkiv
• Hanssen, Anne-Randi; Ropstad, Geir; Kristensen, Øistein & Clausen, Thomas (2011). Kurs i røykeavvenning for cannabisbrukere - en oppfølgingsstudie. Sykepleien Forskning. ISSN 1890-2936. 6(4), s. 368–374. doi: 10.4220/sykepleienf.2011.0188. Fulltekst i vitenarkiv
• Vederhus, John-Kåre; Timko, Christine; Kristensen, Øistein & Clausen, Thomas (2011). The courage to change: Patient perceptions of 12-Step fellowships. BMC Health Services Research. 11. doi: 10.1186/1472-6963-11-339. Fulltekst i vitenarkiv
• Bukten, Anne; Skurtveit, Svetlana; Gossop, Michael; Waal, Helge; Stangeland, Per Ingolf & Clausen, Thomas (2011). The influence of programme differences on crime reduction in opioid maintenance treatment : an analysis of regional patterns in Norway. Norsk Epidemiologi. ISSN 0803-2491. 21(1), s. 99–106. doi: 10.5324/nje.v21i1.1432. Fulltekst i vitenarkiv
• Gjersing, Linn Renathe; Waal, Helge; Røislien, Jo; Gossop, Michael & Clausen, Thomas (2011). Variations in treatment organisation, practices and outcomes within the Norwegian Opioid Maintenance Treatment Programme. Norsk Epidemiologi. ISSN 0803-2491. 21(1), s. 113–118. doi: 10.5324/nje.v21i1.1434. Fulltekst i vitenarkiv Vis sammendrag

  Variations within and between opioid maintenance programmes have been identified in other countries such as US and the UK. The aim of this study was to assess possible differences in treatment organisation, practices and outcomes between 14 regional centres within the Norwegian Opioid Maintenance Treatment programme, which were subject to the same government standards. This was a national ecological study conducted in November 2008 in Norway. Marked variations between the centres in caseload, choice of agonists, prescribing doctor, as well as in the use of supervised dispensing and urine drug screening were found. Only prescribed agonist dose was consistent across all centres. Centres in which patients had more illicit drug use had fewer patients with long-term living arrangements, more unemployment, and more patients who reported social security benefits as main income. The differences occurred despite government regulations, policies and guidelines, and frequent national meetings between centre managers. These findings show how government standards may be interpreted and implemented differently.

• Martinez, Priscilla; Landheim, Anne; Clausen, Thomas & Lien, Lars (2011). A comparison of alcohol use and correlates of drinking patterns among men and women aged 50 and above in Ghana and South Africa. African Journal of Drug and Alcohol Studies. ISSN 1531-4065. 10(2), s. 75–87. Fulltekst i vitenarkiv
• Martinez, Priscilla; Røislien, Jo; Naidoo, Nirmala & Clausen, Thomas (2011). Alcohol abstinence and drinking among African women: data from the World Health Surveys. BMC Public Health. 11. doi: 10.1186/1471-2458-11-160. Fulltekst i vitenarkiv Vis sammendrag

  Background Alcohol use is increasing among women in Africa, and comparable information about women's current alcohol use is needed to inform national and international health policies relevant to the entire population. This study aimed to provide a comparative description of alcohol use among women across 20 African countries. Methods Data were collected as part of the WHO World Health Survey using standardized questionnaires. In total, 40,739 adult women were included in the present study. Alcohol measures included lifetime abstinence, current use (≥1 drink in previous week), heavy drinking (15+ drinks in the previous week) and risky single-occasion drinking (5+ drinks on at least one day in the previous week). Country-specific descriptives of alcohol use were calculated, and K-means clustering was performed to identify countries with similar characteristics. Multiple logistic regression models were fitted for each country to identify factors associated with drinking status. Results A total of 33,841 (81%) African women reported lifetime abstinence. Current use ranged from 1% in Malawi to 30% in Burkina Faso. Among current drinkers, heavy drinking varied between 4% in Ghana to 41% in Chad, and risky single-occasion drinking ranged from <1% in Mauritius to 58% in Chad. Increasing age was associated with increased odds of being a current drinker in about half of the countries. Conclusions A variety of drinking patterns are present among African women with lifetime abstention the most common. Countries with hazardous consumption patterns require serious attention to mitigate alcohol-related harm. Some similarities in factors related to alcohol use can be identified between different African countries, although these are limited and highlight the contextual diversity of female drinking in Africa.

• Gjersing, Linn Renathe; Waal, Helge; Caplehorn, John RM; Gossop, Michael & Clausen, Thomas (2010). Staff attitudes and the associations with treatment organisation, clinical practices and outcomes in opioid maintenance treatment. BMC Health Services Research. 10. doi: 10.1186/1472-6963-10-194. Fulltekst i vitenarkiv
• Clausen, Thomas & Wilson, Adrian (2010). Twenty five years of expectation: where are the services for the older mentally ill in Africa? International Psychiatry. ISSN 1749-3676. 7(2), s. 32–34. Fulltekst i vitenarkiv
• Gjersing, Linn Renathe; Caplehorn, John RM & Clausen, Thomas (2010). Cross-cultural adaptation of research instruments: language, setting, time and statistical considerations. BMC Medical Research Methodology. 10. doi: 10.1186/1471-2288-10-13. Fulltekst i vitenarkiv Vis sammendrag

  Background Research questionnaires are not always translated appropriately before they are used in new temporal, cultural or linguistic settings. The results based on such instruments may therefore not accurately reflect what they are supposed to measure. This paper aims to illustrate the process and required steps involved in the cross-cultural adaptation of a research instrument using the adaptation process of an attitudinal instrument as an example. Methods A questionnaire was needed for the implementation of a study in Norway 2007. There was no appropriate instruments available in Norwegian, thus an Australian-English instrument was cross-culturally adapted. Results The adaptation process included investigation of conceptual and item equivalence. Two forward and two back-translations were synthesized and compared by an expert committee. Thereafter the instrument was pretested and adjusted accordingly. The final questionnaire was administered to opioid maintenance treatment staff (n=140) and harm reduction staff (n=180). The overall response rate was 84%. The original instrument failed confirmatory analysis. Instead a new two-factor scale was identified and found valid in the new setting. Conclusions The failure of the original scale highlights the importance of adapting instruments to current research settings. It also emphasizes the importance of ensuring that concepts within an instrument are equal between the original and target language, time and context. If the described stages in the cross-cultural adaptation process had been omitted, the findings would have been misleading, even if presented with apparent precision. Thus, it is important to consider possible barriers when making a direct comparison between different nations, cultures and times.

• Anchersen, Katinka; Hansteen, Viggo; Gossop, Michael; Clausen, Thomas & Waal, Helge (2010). Opioid maintenance patients with QTc prolongation Congenital long QT syndrome mutation may be a contributing risk factor. Drug and Alcohol Dependence. ISSN 0376-8716. 112(3), s. 216–219. doi: 10.1016/j.drugalcdep.2010.06.015. Fulltekst i vitenarkiv
• Vederhus, John-Kåre; Laudet, Alexandre; Kristensen, Øistein & Clausen, Thomas (2010). Obstacles to 12-step group participation as seen by addiction professionals: Comparing Norway to the United States. Journal of Substance Abuse Treatment. ISSN 0740-5472. 39(3), s. 210–217. doi: 10.1016/j.jsat.2010.06.001. Fulltekst i vitenarkiv
• Anchersen, Katinka; Clausen, Thomas; Gossop, Michael; Hansteen, Viggo & Waal, Helge (2009). Prevalence and clinical relevance of corrected QT interval prolongation during methadone and buprenorphine treatment: a mortality assessment study. Addiction. ISSN 0965-2140. 104, s. 993–999. doi: 10.1111/j.1360-0443.2009.02549.x. Fulltekst i vitenarkiv
• Clausen, Thomas; Waal, Helge; Thoresen, Magne & Gossop, Michael (2009). Mortality among opiate users: opioid maintenance therapy, age, and causes of death. Addiction. ISSN 0965-2140. 104(8), s. 1356–1362. doi: 10.1111/j.1360-0443.2009.02570.x. Fulltekst i vitenarkiv
• Vederhus, John-Kåre; Kristensen, Øistein; Laudet, Alexandre & Clausen, Thomas (2009). Attitudes towards 12-step groups and referral practices in a treatment culture unfamiliar to 12-step ideology; a survey study. BMC Health Services Research. 9(147). Fulltekst i vitenarkiv
• Clausen, Thomas; Havnes, Ingrid Amalia & Waal, Helge (2009). Overdosestatistikk - et komplisert regnskap. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 129(21), s. 2233–2236. Fulltekst i vitenarkiv
• Vederhus, John-Kåre; Kristensen, Øistein; Laudet, Alexandre & Clausen, Thomas (2009). Attitudes towards 12-step groups and referral practices in a 12-step naive treatment culture; a survey of addiction professionals in Norway. BMC Health Services Research. 9. doi: 10.1186/1472-6963-9-147. Fulltekst i vitenarkiv Vis sammendrag

  Background Addressing substance use disorders effectively requires a long-term approach. Substance abuse treatment is typically of short duration; referring patients to Twelve Step based self-help groups (TSGs) – e.g. Narcotics Anonymous, represents a promising complementary recovery resource. Clinicians' attitudes and referral practices towards the TSGs have mainly been studied in countries with high integration of the 12-step philosophy in their substance abuse services and where the TSGs are widely available, such as the US. In Norway, there are currently 294 weekly TSG meetings (6 per 100,000 inhabitants). This study describes clinicians' attitudes and referral practices to TSGs in Norway where health authorities seek to promote self-help participation, but where the treatment culture is unfamiliar with 12-step fellowships. Methods Data collected by a self-administered questionnaire, adapted from established US and UK instruments. Information covered the attitudes, knowledge and referral practices towards TSGs among addiction treatment professionals in Norway in mid 2008. Results The return rate was 79.7% (n = 291). Participants had moderately positive attitude scores towards TSGs, but referral to these groups among Norwegian addiction professionals was low, as was the level of knowledge about TSGs. More than six out of ten did not refer any patients to TSGs in the previous week. Local variation with more referrals to TSGs in the county with the one established 12-step treatment facility was observed. Respondents' integration of the 12-steps in their own treatment work, higher self-efficacy for making a successful referral, and greater TSG knowledge were associated with referring patients. Conclusion Low referral rates to TSGs point to the need for education and training to raise the awareness and knowledge about it among addiction professionals unfamiliar with these 12-step fellowships. Training should focus on the usefulness of these groups for all types of treatment models regardless of therapeutic orientation. Increased knowledge is expected to lead to higher referral rates, which in turn would maximize the likelihood of positive long-term patient outcomes.

• Clausen, Thomas; Rossow, Ingeborg; Naidoo, Nirmala & Kowal, Paul (2009). Diverse alcohol drinking patterns in 20 African countries. Addiction. ISSN 0965-2140. 104(7), s. 1147–1154. doi: 10.1111/j.1360-0443.2009.02559.x. Fulltekst i vitenarkiv
• Clausen, Thomas; Rossow, Ingeborg; Naidoo, Nirmala & Kowal, Paul (2009). Diverse drinking patterns in 20 African countries. Addiction. ISSN 0965-2140. 104(7), s. 1147–1154. doi: 10.1111/j.1360-0443.2009.02559.x. Fulltekst i vitenarkiv Vis sammendrag

  ABSTRACT Aims This paper describes drinking patterns in 20 African countries, exploring the extent of abstention, heavy occasional drinking and daily light drinking and how these aspects of drinking are inter-related. Design and participants Data were collected as part of the World Health Survey in 2002–04 and comprise national representative data sets from 20 African countries. A cross-sectional survey of 77 165 adults aged 18 years and older were undertaken by face-to-face interviews in respondent households. Measures Drinking behaviour was assessed in terms of life-time abstention and the following measures over the 7 days immediately preceding interview: high consumption (15 or more drinks); heavy drinking occasions (five or more standard units at at least one session) and daily light drinking (one or two drinks daily). Findings In four countries (Comoros, Mali, Mauritania and Senegal), virtually all respondents were life-time abstainers. The prevalence of current drinkers (previous week) did not exceed one-third in any country. Among current drinkers the prevalence of heavy drinking varied between 7% and 77% and the prevalence of daily light drinkers varied between 0% and 21%. Overall drinking patterns varied significantly between and within the examined African countries. Conclusions African drinking patterns are diverse, and although life-time abstinence dominates in African countries, a single typical pattern of drinking for the African continent, such as the alleged ‘all-or-none’ pattern, was not observed.

• Vederhus, John-Kåre; Kristensen, Øistein; Laudet, Alexandre & Clausen, Thomas (2009). Attitudes towards 12-step groups and referral practices in a 12-step naive treatment culture; a survey of addiction professionals in Norway. BMC Health Services Research. 9. doi: 10.1186/1472-6963-9-147. Fulltekst i vitenarkiv
• Vederhus, John-Kåre; Kristensen, Øistein; Tveit, Helga & Clausen, Thomas (2008). Tolvtrinnsbaserte selvhjelpsgrupper en ressurs i rehabiliteringen av rusmiddelavhengige. Tidsskrift for Norsk psykologforening (Psykologtidsskriftet). ISSN 0332-6470. 45(10), s. 1268–1275. Fulltekst i vitenarkiv
• Clausen, Thomas; Anchersen, Katinka & Waal, Helge (2008). Mortality prior to, during and after opioid maintenance treatment (OMT): A national prospective cross-registry study. Drug and Alcohol Dependence. ISSN 0376-8716. 94. doi: 10.1016/j.drugalcdep.2007.11.003. Fulltekst i vitenarkiv

Se alle arbeider i NVA

• Gjersing, Linn; Clausen, Thomas; Edvardsen, Hilde Marie Erøy; Bergem, Anne Kristine; Buvik, Kristin & Eide, Desiree [Vis alle 21 forfattere av denne artikkelen] (2025). Overdoseboka. En helhetlig gjennomgang. Cappelen Damm Akademisk. ISBN 9788202852610. 284 s. doi: https:/www.cappelendamm.no/boker/overdoseboka-9788202852610. Fulltekst i vitenarkiv Vis sammendrag

  Boken omhandler et bredt spekter av temaer knyttet til overdoseproblematikk. Den går i dybden på rusmidlers virkning, risikofaktorer og relaterte helseutfordringer. Politikkens og myndighetenes rolle i forebygging og behandling presenteres. Boken utforsker også skadereduksjon og oppfølging i tjenesteapparatet, og gir et innblikk i brukeres, pårørendes og helsepersonells opplevelser og erfaringer. Videre belyses politiets arbeid, obduksjoner og registrering av dødsfall. Målet er at boken kan bidra til en mer helhetlig forståelse, og dermed bedre tjenester og en reduksjon av overdoser.

Se alle arbeider i NVA

• Bukten, Anne; Mehlum, Lars; Fazel, Seena; Lokdam, Nicoline Toresen; Skurtveit, Svetlana Ondrasova & Ericson, Øystein Bruun [Vis alle 11 forfattere av denne artikkelen] (2026). Risikofaktorer for selvmord under fengsling og etter løslatelse. Fulltekst i vitenarkiv
• Bukten, Anne; Mehlum, Lars; Fazel, Seena; Lokdam, Nicoline Toresen; Tverborgvik, Torill & Skurtveit, Svetlana Ondrasova [Vis alle 12 forfattere av denne artikkelen] (2026). Psykisk helse i fengsel. Risikofaktorer for selvmord under fengsling og etter løslatelse. doi: https:/www.fagligforum.no/event/rus-og-psykisk-helse-2026/. Fulltekst i vitenarkiv
• Bukten, Anne; Mehlum, Lars; Lokdam, Nicoline Toresen; Fazel, Seena; Tverborgvik, Torill & Skurtveit, Svetlana Ondrasova [Vis alle 12 forfattere av denne artikkelen] (2025). Suicides among people in prison. Fulltekst i vitenarkiv
• Bukten, Anne; Stavseth, Marianne Riksheim; Tverborgvik, Torill; Clausen, Thomas; Lothe, Johan & Havnes, Ingrid Amalia [Vis alle 8 forfattere av denne artikkelen] (2024). Rus og psykisk helse. Fulltekst i vitenarkiv
• Stavseth, Marianne Riksheim; Tverborgvik, Torill; Skardhamar, Torbjørn; Clausen, Thomas; Lothe, Johan & Havnes, Ingrid Amalia [Vis alle 8 forfattere av denne artikkelen] (2024). Rus og psykiske lidelser. Fulltekst i vitenarkiv
• Comiskey, Catherine; Bergeron, Henri; Clausen, Thomas; Colman, Charlotte; Ferrer-Wreder, Laura & Fischer, Gabriele [Vis alle 15 forfattere av denne artikkelen] (2024). The importance of co-produced, multi-method, independent scientific evidence in times of alternative truths and global policy debates. doi: 10.1016/j.drugpo.2024.104481. Fulltekst i vitenarkiv
• Myklebust, Lars Henrik Ryther; Eide, Desiree; Arnevik, Espen Ajo; Dadras, Omid; Pirro, Silvana De & Ellefsen, Rune [Vis alle 14 forfattere av denne artikkelen] (2024). Evaluation of heroin-assisted treatment in Norway: protocol for a mixed methods study. BMC Health Services Research. 24(1). doi: 10.1186/s12913-024-10767-w. Fulltekst i vitenarkiv Vis sammendrag

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

• Ericson, Øystein Bruun; Eide, Desiree; Lobmaier, Philipp Paul & Clausen, Thomas (2024). Correction: Staff preferences towards electronic data collection from a national take-home naloxone program: a cross-sectional study (Substance Abuse Treatment, Prevention, and Policy, (2022), 17, 1, (13), 10.1186/s13011-022-00440-y). Substance Abuse Treatment, Prevention, and Policy. 19(1). doi: 10.1186/s13011-024-00609-7. Fulltekst i vitenarkiv
• Borchgrevink, Petter Christian & Clausen, Thomas (2024). Advares mot langvarig bruk av sterke opioider som oksykodon ved kronisk smerte. Thomas Clausen og Petter Borchgrevink fra POINT-prosjektet intervjuet av TV2 Nyheter 07.05.24. [Journal]. TV2.no. Fulltekst i vitenarkiv
• Eide, Desiree; McDonald, Rebecca & Clausen, Thomas (2024). Overdoses in the drug consumption room: route of administration matters! Fulltekst i vitenarkiv
• Eide, Desiree; Pirro, Silvana De; Myklebust, Lars Henrik Ryther; Melis, Francesca; Oldervoll, Ann & Clausen, Thomas (2024). Norway's first heroin-assisted treatment clinics: initial impact of the intervention. Fulltekst i vitenarkiv
• Eide, Desiree; Ericson, Øystein Bruun & Clausen, Thomas (2024). Update on Drug Checking. Fulltekst i vitenarkiv
• Clausen, Thomas & Skurtveit, Svetlana Ondrasova (2024). Bruken øker kraftig blant unge. Ingen vet hvorfor. [Internet]. TV2. Fulltekst i vitenarkiv
• Nesse, Linda; Mcdonald, Rebecca Silvia; Bech, Anne Berit & Clausen, Thomas (2023). Medborgerskap: Et perspektiv for brukermedvirkning i LAR. Rus & samfunn. ISSN 1500-8614. Fulltekst i vitenarkiv
• Clausen, Thomas (2023). Når det går galt. Fulltekst i vitenarkiv
• Skurtveit, Svetlana Ondrasova & Clausen, Thomas (2023). Hun kjemper mot abstinensene smertene og skammen har norge en opioid krise. [Journal]. A-magasinet : uketillegg til Aftenposten. Fulltekst i vitenarkiv
• Skurtveit, Svetlana Ondrasova & Clausen, Thomas (2022). Flere kvinner dør av smertestillende piller. [Journal]. Aftenposten (morgenutg. : trykt utg.). Fulltekst i vitenarkiv
• Clausen, Thomas (2022). OxyContin: – Det er jeg som hører at hun gråter om natten. [Internet]. NRK Nyheter. Fulltekst i vitenarkiv
• Mcdonald, Rebecca Silvia & Clausen, Thomas (2022). Revised service delivery of opioid agonist treatment in Norway in 2021, the second year of the pandemic: a national cross-sectional study of treatment provider experiences. Fulltekst i vitenarkiv
• Bjørnestad, Endre Dahlen; Vederhus, John-Kåre & Clausen, Thomas (2022). High smoking and low cessation rates among patients in treatment for opioid and other substance use disorders. Fulltekst i vitenarkiv
• Uleberg, Oddvar; Kristiansen, Thomas; Nordseth, Trond; Stenehjem, Jo S.; Gran, Jon Michael & Clausen, Thomas [Vis alle 8 forfattere av denne artikkelen] (2022). Skader etter vold og ulykker - den glemte pandemi? 142(8), s. 678–679. doi: 10.4045/tidsskr.22.0261. Fulltekst i vitenarkiv
• Gjerde, Line Cecilie; Handal, Marte; Nesvåg, Ragnar; Clausen, Thomas; Lid, Torgeir Gilje & Hamina, Aleksi [Vis alle 8 forfattere av denne artikkelen] (2022). A nationwide registry-linkage study of mental disorders in chronic pain patients: Characteristics of users of opioid versus non-opioid analgesics. Fulltekst i vitenarkiv
• Hamina, Aleksi; Odsbu, Ingvild; Hjellvik, Vidar; Gjersing, Linn; Lid, Torgeir Gilje & Clausen, Thomas [Vis alle 7 forfattere av denne artikkelen] (2022). Fatal overdoses in a cohort of chronic pain patients. Fulltekst i vitenarkiv
• Odsbu, Ingvild; Handal, Marte; Borchgrevink, Petter Chr.; Clausen, Thomas & Skurtveit, Svetlana Ondrasova (2022). Endringer i opioidbruken i Norge må tas på dypeste alvor. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. doi: 10.4045/tidsskr.21.0909. Fulltekst i vitenarkiv
• Clausen, Thomas (2022). Dagsrevyen Avhengig av medisiner. [TV]. NRK Dagsrevyen. Fulltekst i vitenarkiv
• Bukten, Anne; Lokdam, Nicoline; Skjærvø, Ingeborg; Ugelvik, Thomas; Skurtveit, Svetlana Ondrasova & Gabrhelík, Roman [Vis alle 20 forfattere av denne artikkelen] (2022). PriSUD-Nordic—Diagnosing and Treating Substance Use Disorders in the Prison Population: Protocol for a Mixed Methods Study. JMIR Research Protocols. 11(3). doi: 10.2196/35182. Fulltekst i vitenarkiv Vis sammendrag

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

• Hamina, Aleksi; Odsbu, Ingvild; Clausen, Thomas & Skurtveit, Svetlana Ondrasova (2022). Intentional overdoses and associated mental health challenges, an overlooked sub-population of overdoses. Fulltekst i vitenarkiv
• Clausen, Thomas (2022). What lessons from Norway’s experience could be applied in the United States in response to the addiction and overdose crisis? Addiction. ISSN 0965-2140. 117(7), s. 2126–2126. doi: 10.1111/add.15845. Fulltekst i vitenarkiv
• Uleberg, Oddvar; Stenehjem, Jo S.; Nordseth, Trond; Clausen, Thomas; Natvig, Bård & Skurtveit, Svetlana Ondrasova [Vis alle 12 forfattere av denne artikkelen] (2022). The injury prevention and outcomes following trauma (IPOT) project: is a nationwide registry-based study in Norway feasible? Fulltekst i vitenarkiv
• Bech, Anne Berit; Clausen, Thomas & Mcdonald, Rebecca Silvia (2022). Revised service delivery of opioid agonist treatment in Norway in 2021, the second year of the pandemic: a national cross-sectional study of treatment provider experiences. Fulltekst i vitenarkiv
• Stenehjem, Jo S.; Røise, Olav; Nordseth, Trond; Clausen, Thomas; Natvig, Bård & Skurtveit, Svetlana Ondrasova [Vis alle 12 forfattere av denne artikkelen] (2021). Injury Prevention and long-term Outcomes following Trauma - the IPOT project: a protocol for prospective nationwide registry-based studies in Norway. Fulltekst i vitenarkiv
• Rosseland, Leiv Arne; Stenehjem, Jo S.; Nordseth, Trond; Clausen, Thomas; Natvig, Bård & Skurtveit, Svetlana Ondrasova [Vis alle 12 forfattere av denne artikkelen] (2021). The Injury Prevention and Outcomes following Trauma project: a prospective nationwide registry-based study in Norway. Fulltekst i vitenarkiv
• Opsal, Anne; Kristensen, Øistein & Clausen, Thomas (2019). Perceived coercion to enter treatment among involuntarily and voluntarily admitted patients with substance use disorders. Fulltekst i vitenarkiv
• Muller, Ashley Elizabeth; Bukten, Anne & Clausen, Thomas (2019). How can we measure the quality of life of high-risk groups in Norway? Scandinavian Journal of Public Health. ISSN 1403-4948. 47, s. 10–10. Fulltekst i vitenarkiv
• Muller, Ashley Elizabeth; Medved, David & Clausen, Thomas (2018). Long-term opioid maintenance treatment patients and the role of benzodiazepines. Fulltekst i vitenarkiv
• Medved, David; Clausen, Thomas & Muller, Ashley Elizabeth (2018). Disease burden in ageing long-term opioid maintenance treatment patients; the triple burden. Fulltekst i vitenarkiv
• Muller, Ashley Elizabeth; Odsbu, Ingvild; Sjøgren, Per; Clausen, Thomas & Skurtveit, Svetlana (2018). Prescribed opioid analgesic use developments in the Scandinavian countries, 2006-2017. Fulltekst i vitenarkiv
• Muller, Ashley Elizabeth & Clausen, Thomas (2018). Somatiske helseutfordringer i LAR: NorComt-studien. Fulltekst i vitenarkiv
• Kristensen, Øistein; Opsal, Anne & Clausen, Thomas (2018). Tvangsinnleggelse for rusbehandling? 138(8). doi: 10.4045/tidsskr.17.1114. Fulltekst i vitenarkiv
• Edvardsen, Hilde Marie Erøy; Tverborgvik, Torill; Frost, Joachim; Rogde, Sidsel; Morild, Inge & Waal, Helge [Vis alle 9 forfattere av denne artikkelen] (2018). Corrigendum to "Differences in combinations and concentrations of drugs of abuse in fatal intoxication and driving under the influence cases". Forensic Science International. ISSN 0379-0738. 283, s. 219–219. doi: 10.1016/j.forsciint.2017.12.040. Fulltekst i vitenarkiv
• Bukten, Anne; Stavseth, Marianne Riksheim & Clausen, Thomas (2017). De første dagene er de mest kritiske! - Rusfeltets hovedorganisasjon. [Internet]. rusfeltet.no. Fulltekst i vitenarkiv Vis sammendrag

  Forskere fra Seraf har gjennomført en omfattende studie på dødsfall etter løslatelse fra fengsel. Studien ble presentert under et lanseringsseminar 20.mars. Resultatene var delvis som forventet, men tallene var mer entydig enn det forskerne hadde sett for seg.

• Muller, Ashley; Clausen, Thomas & Skurtveit, Svetlana (2017). Building an abstinent network to support quality of life gains through treatment. Fulltekst i vitenarkiv Vis sammendrag

  Research questions - How does QoL change as patients progress through treatment? - Can certain social network developments support QoL improvements?

• Muller, Ashley Elizabeth & Clausen, Thomas (2017). Social network changes predict adherence to opioid maintenance treatment. Fulltekst i vitenarkiv
• Berntson, Eirik; Bernhard-Oettel, Claudia; Christensen, Marit; Clausen, Thomas & Mauno, Saija (2016). The Launch of a New Scandinavian Journal of Work and Organizational Psychology. Scandinavian Journal of Work and Organizational Psychology. 1(1), s. 1–2. doi: 10.16993/sjwop.12. Fulltekst i vitenarkiv
• Madah-Amiri, Desiree & Clausen, Thomas (2016). The use of public health infrastructure probably the best strategy for national and large-scale naloxone distribution programmes. Addiction. ISSN 0965-2140. 111(7), s. 1309–1310. doi: 10.1111/add.13400. Fulltekst i vitenarkiv
• Lobmaier, Philipp Paul & Clausen, Thomas (2016). Radical red tape reduction by government supported nasal naloxone: the Norwegian pilot project is innovative, safe and an important contribution to further development and dissemination of take-home naloxone. 11(4), s. 586–587. doi: 10.1111/add.13261. Fulltekst i vitenarkiv
• Havnes, Ingrid Amalia; Clausen, Thomas & Bukten, Anne (2016). Anabolic androgenic steroid use prior to and during imprisonment - findings from a Norwegian national prison survey. Fulltekst i vitenarkiv
• Clausen, Thomas (2015). Coherent long-term treatment approaches–superior in the treatment of opioid dependence. Addiction. ISSN 0965-2140. 110(6), s. 1006–1007. doi: 10.1111/add.12922. Fulltekst i vitenarkiv
• Skeie, Ivar; Clausen, Thomas & Bukten, Anne (2014). I. Skeie og medarbeidere svarer: :. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 134(16), s. 1548–1548. doi: 10.4045/tidsskr.14.0922. Fulltekst i vitenarkiv
• Skeie, Ivar; Clausen, Thomas & Bukten, Anne (2014). Legemiddelassistert rehabilitering – viktig behandling med dilemmaer :. 134(11), s. 1156–1158. doi: 10.4045/tidsskr.13.1429. Fulltekst i vitenarkiv
• Clausen, Thomas; Kristensen, Øistein & Åsland, Reidun (2014). Re: Pasienter som avbryter LAR-behandling - hvordan går det med dem? Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 134(16), s. 1548–1549. doi: 10.4045/tidsskr.14.0927. Fulltekst i vitenarkiv
• Wüsthoff, Linda Elise; Rognli, Eline Borger; Waal, Helge & Clausen, Thomas (2013). Lost in Downtown Oslo - How did they get there and how do they get out? - A Project presentation. Fulltekst i vitenarkiv
• Bukten, Anne & Clausen, Thomas (2012). Økt bruk av legemiddelassistert rehabilitering kan føre til færre heroinmisbrukere i norske fengsel. Aktuelt for kriminalomsorgen. ISSN 0803-6438. 1, s. 16–16. Fulltekst i vitenarkiv
• Bukten, Anne & Clausen, Thomas (2012). Kriminalitetsreduserende rusbehandling. Rus & samfunn. ISSN 1500-8614. s. 12–14. Fulltekst i vitenarkiv
• Gjersing, Linn Renathe & Clausen, Thomas (2011). Holdninger og behandlinger. Rus & samfunn. ISSN 1500-8614. 5(3), s. 28–29. Fulltekst i vitenarkiv
• Clausen, Thomas (2011). Mortality is reduced while on opiate maintenance treatment, but there is a temporary increase in mortality immediately after starting and stopping treatment, a finding that may vary by setting. 16(3), s. 94–95. Fulltekst i vitenarkiv
• Bukten, Anne; Røislien, Jo; Skurtveit, Svetlana & Clausen, Thomas (2011). GENDER DIFFERENCES IN CRIME DURING PERIODS OF TRANSITION IN OPIOID MAINTENANCE TREATMENT: A NATIONAL COHORT STUDY. Drug and Alcohol Review. ISSN 0959-5236. 30, s. 16–16. Fulltekst i vitenarkiv
• Hjemdahl, Bente; John-Kåre, Vederhus & Clausen, Thomas (2011). Quality of Life (QoL) - Perceived QoL among Patients Admitted to Detox. Fulltekst i vitenarkiv
• Waal, Helge & Clausen, Thomas (2011). The Importance of a Life Long Perpective in Opioid Maintenance Therapy (OMT). Theoretical Analyses and Empirical Evidence. Fulltekst i vitenarkiv
• Gjersing, Linn Renathe; Jonassen, Kristine Vinge; Skurtveit, Svetlana; Bramness, Jørgen Gustav & Clausen, Thomas (2011). A descriptive registry study of those who died from drug-induced deaths between 2006-2008 in Oslo. Fulltekst i vitenarkiv
• Havnes, Ingrid Amalia; Bukten, Anne; Waal, Helge & Clausen, Thomas (2010). Violent crime before, during and after opioid maintenance treatment; a national cohort study. Fulltekst i vitenarkiv
• Havnes, Ingrid Amalia; Bukten, Anne; Waal, Helge & Clausen, Thomas (2010). Voldskriminalitet før, under og etter LAR. Fulltekst i vitenarkiv
• Havnes, Ingrid Amalia; Bernard, Jean-Paul Anthony; Waal, Helge; Clausen, Thomas & Mørland, Jørg (2010). Methadone treatment and methadone-related deaths in Norway. Fulltekst i vitenarkiv
• Fredheim, Olav Magnus; Borchgrevink, Petter Chr.; Nordstrand, Berit; Clausen, Thomas & Skurtveit, Svetlana (2010). Prescription of analgesics to patients in opioid maintenance therapy - a pharmacoepidemiological study. Fulltekst i vitenarkiv
• Bukten, Anne; Havnes, Ingrid Amalia; Skurtveit, Svetlana; Gossop, Michael; Waal, Helge & Stangeland, Per [Vis alle 7 forfattere av denne artikkelen] (2010). Kriminalitet - før, under og etter LAR (1997-2003)Fokus på regionale forskjeller. Fulltekst i vitenarkiv
• Bukten, Anne; Skurtveit, Svetlana; Gossop, Michael; Havnes, Ingrid Amalia; Waal, Helge & Clausen, Thomas (2010). The effect of Opioid Maintenance Treatment on rates of criminal charges during a 7 year study period: A longitudinal national cohort study. Fulltekst i vitenarkiv
• Anchersen, Katinka; Hansteen, Viggo; Gossop, Michael; Clausen, Thomas & Waal, Helge (2009). QTc Prolongation during opioid maintenance treatment: congenital long QT syndrome and cardiac management. Fulltekst i vitenarkiv
• Clausen, Thomas (2009). Age and its relationship with cause of death among opiate users. Fulltekst i vitenarkiv
• Clausen, Thomas (2009). Samfunnets reaksjoner og sanksjoner; bruk av tvang. Fulltekst i vitenarkiv
• Gjersing, Linn Renathe; Waal, Helge & Clausen, Thomas (2009). BENZODIAZEPINE USE AMONG PATIENTS IN OPIOID MAINTENANCE TREATMENT (OMT) CENTRES WITH DIFFERENT TREATMENT APPROACHES. Drug and Alcohol Review. ISSN 0959-5236. 28, s. A24–A24. Fulltekst i vitenarkiv
• Clausen, Thomas (2009). Opioid Maintenance Therapy (OMT) and cardiac arrhythmia; Mortality assessment in a Norwegian national registry study. Fulltekst i vitenarkiv
• Clausen, Thomas (2009). Mortalitet før, under og etter LAR. Fulltekst i vitenarkiv
• Vederhus, John-Kåre; Kristensen, Øistein; Laudet, Alexandre & Clausen, Thomas (2009). Attitudes toward 12-step groups and referral practices in a culture naive to 12-step ideology. Fulltekst i vitenarkiv
• Clausen, Thomas; Langva, H. A. & Gudmestad, Ove Tobias (2007). Heated Arctic Bundles, Proceedings of Russian Arctic Offshore Conference, RAO 2007. Russian Arctic Offshore Conference, RAO 2007. s. 139–139. Fulltekst i vitenarkiv
• Clausen, Thomas; Langva, H. A. & Gudmestad, Ove Tobias (2007). Heated Arctic Bundles. Fulltekst i vitenarkiv
• Clausen, Thomas & Rossow, Ingeborg (2007). Diverse alcohol drinking patterns in 20 African countries. Fulltekst i vitenarkiv
• Clausen, Thomas & Waal, Helge (2007). Patterns of mortality after Opioid Maintenance Treatment. Fulltekst i vitenarkiv
• Eide, Desiree; Ericson, Øystein Bruun & Clausen, Thomas (2025). Et forslag til plan for rusmiddeltestingstjenester i fire norske byer; på oppdrag fra Helsedirektoratet. Universitetet i Oslo. doi: https:/www.med.uio.no/klinmed/forskning/sentre/seraf/publikasjoner/rapporter/2025/seraf-rapport-1-2025---forslag-til-plan-rusmiddeltesting.pdf. Fulltekst i vitenarkiv
• McDonald, Rebecca Silvia; Bech, Anne Berit & Clausen, Thomas (2025). Evaluering av implementeringen av revidert nasjonal faglig retningslinje for legemiddelassistert rehabilitering (LAR) ved opioidavhengighet. Universitetet i Oslo. doi: https:/www.med.uio.no/klinmed/forskning/sentre/seraf/publikasjoner/rapporter/2025/seraf-rapport-2-2025---evaluering-av-implementeringen-av-revidert-nasjonal-faglig-retningslinje-for-lar.pdf. Fulltekst i vitenarkiv
• Bukten, Anne; Lillevold, Pål Henrik; Skeie, Ivar & Clausen, Thomas (2025). SERAF rapport nr 5/2025 Statusrapport 2024. Universitetet i Oslo. doi: https:/www.med.uio.no/klinmed/forskning/sentre/seraf/publikasjoner/rapporter/2025/seraf-rapport-nr-5-2025-statusrapport-2024.pdf.pdf. Fulltekst i vitenarkiv
• Lunde, Rose Elisabeth; Oldervoll, Ann; Clausen, Thomas & Eide, Desiree (2025). Evaluering av brukerrom i Oslo og Bergen. Senter for rus- og avhengighetsforskning. doi: https:/www.med.uio.no/klinmed/forskning/sentre/seraf/publikasjoner/rapporter/2025/seraf-rapport-4-2025-evaluering-av-brukerrom-i-oslo-og-bergen.pdf. Fulltekst i vitenarkiv Vis sammendrag

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

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

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

• Eide, Desiree; Bjørnestad, Ronny; Brummer, Julie Elizabeth; Dadras, Omid; Pirro, Silvana De & Ellefsen, Rune [Vis alle 17 forfattere av denne artikkelen] (2024). Midtveisrapport om heroinassistert behandling fra 2022-2023 (SERAF rapport 4/2024). Senter for rus- og avhengighetsforskning. Fulltekst i vitenarkiv Vis sammendrag

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

• Nesse, Linda; Lobmaier, Philipp Paul; Skeie, Ivar; Lillevold, Pål Henrik & Clausen, Thomas (2024). Statusrapport 2023: Tjuefem år med legemiddelassistert rehabilitering (LAR). Universitetet i Oslo. Fulltekst i vitenarkiv
• Nesse, Linda; Lobmaier, Philipp Paul; Skeie, Ivar; Lillevold, Pål Henrik & Clausen, Thomas (2023). Statusrapport 2022: Første år med nye LAR-retningslinjer. Universitetet i Oslo. Fulltekst i vitenarkiv Vis sammendrag

  SERAF utarbeider en årlig nasjonal statusrapport for legemiddelassistert rehabilitering (LAR) på oppdrag fra Helsedirektoratet. Statusrapportenen er basert på en kartlegging som alle LAR-tiltakene gjennomfører en gang i året. Formålet er å kartlegge pasientenes situasjon, behandling, og behandlingsutfall i LAR. Denne spørreundersøkelsen har blitt gjennomført gjennom de siste 23 årene, og har vist at LAR over tid har utviklet seg til å være en godt etablert, standardisert behandling for de fleste med opioiddominert avhengighet. I statusrapporten oppsummeres sentrale funn om situasjonen til pasienter i LAR, aktuell behandlingsstatus, medikamentell behandling (inkludert valg av medikament og dosering), psykososial oppfølging (som behandlingsmål, individuell plan, ansvarsgruppemøter og behandling for psykiske helseproblemer), psykiske helseproblemer og rusbruk siste fire uker, og rusbruk og helserelaterte forhold siste år, og tilfredshet med behandlingen. I tillegg presenteres funn om dødsfall blant pasienter i LAR siste år. Ivar Skeie har analysert mortalitetsdata og har fulgt LAR-tiltakene tett for å kunne inkludere komplette tall på overdoser, suicid og naturlige dødsfall. Årets statusrapport bygger på svar fra 18 ulike LAR-tiltak fordelt på fem regioner. Innføringen av det elektroniske journalsystemet Helseplattformen ved St. Olavs hospital og i Nord-Trøndelag har medført utfordringer som har gjort at disse LAR-tiltakene ikke har hatt mulighet til å gjennomføre statusundersøkelsen. Dette innebærer at tallene som presenteres for region Midt ikke kan sammenlignes med fjorårets tall for samme region, og at nasjonale gjennomsnitt ikke inkluderer St. Olavs hospital og Nord-Trøndelag. I 2022 ble det innført nye LAR-retningslinjer, og dette er den første statusrapporten som er gjennomført etter dette. I tillegg inneholder årets statusrapport flere nye elementer. LAR-tiltak som benytter det elektroniske journalsystemet DIPS Arena har besvart en noe videreutviklet versjon av statusundersøkelsen som inkluderer nye tilleggsopplysninger. Tiltakene det gjelder er Oslo, Bergen, Fonna og Førde. De nye spørsmålene omhandler blant annet opplevde bivirkninger av LAR-medikament, og ulike spørsmål om fysisk helse, sykdommer og behandling siste år. Spørsmålene er besvart av omtrent 1 av 4 pasienter i LAR, og bidrar til å videreutvikle kunnskap om behandlingen og om pasientenes situasjon. Samtidig er det første gang pasienter som er i heroinassistert behandling (HAB) deltar i statsundersøkelsen. I et av kapitlene oppsummeres hovedfunn for pasienter i HAB. Vi ser at økningen av gjennomsnittsalderen i LAR fortsetter også i år. Vi minner om at en aldrende LAR-populasjon er å anse som en suksess i seg selv. LAR har medført at mange personer med opioidavhengighet kan eldes med sykdommen. Samtidig ønsker vi i fremtiden å styrke forutsetninger for gode levevaner, tilgjengelig utredning og behandling for psykiske lidelser, utredning og behandling for somatiske sykdommer som hepatitt C, og regelmessige legeundersøkelser. Det er viktig at LAR fortsetter å være en behandlingsmodell som oppleves tilgjengelig, til å leve godt med over tid, med høy faglig kvalitet og forsvarlighet. Samtidig er det viktig å støtte majoriteten av pasientene i å ha en rimelig god rusmestring. Denne balansegangen utgjør hverdagen til pasienter og behandlere i LAR. Denne rapporten er resultatet av betydelig innsats i hvert LAR-tiltak. Vi takker for innsatsen fra pasienter i LAR som har besvart statusundersøkelsen, LAR-ansatte over hele landet for arbeidet med innsamling av svar, og for et godt samarbeid med LAR-tiltakene og med Helsedirektoratet.

• Bech, Anne Berit; Clausen, Thomas & Lillevold, Pål Henrik (2022). SERAF rapport 1/2022 - Forebygging og håndtering av covid-19 i LAR-tiltakene i spesialisthelsetjenesten 2021 - Erfaringer og tiltak. 7Letras. Fulltekst i vitenarkiv
• Bech, Anne Berit; Bukten, Anne; Lobmaier, Philipp Paul; Skeie, Ivar; Lillevold, Pål Henrik & Clausen, Thomas (2022). SERAF RAPPORT 2/2022 Statusrapport 2021-Siste år med gamle LAR-retningslinjer. 7Letras. Fulltekst i vitenarkiv
• Bukten, Anne; Lokdam, Nicoline; Clausen, Thomas & Skjærvø, Ingeborg (2021). Bruk, besittelse og ruspåvirket kjøring blant innsatte i Norske fengsel 2000-2019. Senter for rus og avhengighetsforskning (SERAF). Fulltekst i vitenarkiv
• Lobmaier, Philipp Paul; Skeie, Ivar; Lillevold, Pål Henrik; Bussesund, Kari; Waal, Helge & Clausen, Thomas (2020). Statusrapport 2019 Nye medisiner - nye muligheter? SERAF RAPPORT 1/2020. Fulltekst i vitenarkiv
• Stavseth, Marianne Riksheim; Clausen, Thomas & Røislien, Jo (2019). Annual assessment data from the Norwegian opioid maintenance programme: A methodological perspective. Universitetet i Oslo. ISSN 9788283774603. Fulltekst i vitenarkiv Vis sammendrag

  Background and aims: Application of statistics to medicine has been named one of the greatest advances of the second millennium and there has been an expansive growth and development in statistical methods within this field of research. This study investigates clinical and methodological aspects regarding the annual assessment questionnaire from the Norwegian Opioid Maintenance Treatment (OMT) programme. In addition, it facilitates the description of complex statistical methods and illustrates the advantages and disadvantages of the methods to a wider audience. Material and methods: The data utilized in this study was collected among patients in the Norwegian OMT programme. Aggregate data based on 34 001 questionnaires collected between 2002-2011 were used to study the development of the OMT programme. Person-level data consisting of 18 538 questionnaires collected from 5 654 unique patients in 2005-2010 were used to study clinical and methodological aspects of ongoing criminal activity in OMT. Trends in the OMT programme were investigated using a Mann Kendall trend test and factors associated with engagement in criminal activity were examined using generalized estimation equations (GEE). Through an extensive simulation study including six different imputation methods, the handling of missing data was investigated. How to perform variable selection was explored with a range of methods in a case study. Results: The Norwegian OMT programme expanded widely in the 10-year period between 2002-2011, while shifting the main substitution medicine from methadone to buprenorphine. Having a full or part-time job, being a student and living under stable conditions is negatively associated with ongoing criminal in OMT, while being male, younger, and using illicit drugs regularly was positively associated with ongoing criminal engagement while in OMT. Handling missing data becomes especially important when the proportion of missing data is high (≥20%) and when the sample size is small. Complete Case analysis should be used with caution is this setting, while Multiple Imputation using Multiple Correspondence Analysis has shown promising results. The choice of variables to be included in a logistic regression model will depend on the aim of the study. However, a variable selection strategy should always be carefully considered. Using a combination of expert-based selection and automated procedures is recommended. Discussion and conclusion: Based on aggregate data recorded over a long time period, several marked changes in the Norwegian OMT programme were observed. Despite the varying quality of the data, the findings are important to monitor and evaluate many aspects of the treatment programme. Person-level data give more information and allow more detailed analysis. By using GEE to account for dependencies in clustered data, important association between engagement in criminal activities while in OMT treatment could be identified. Ignoring the presence of missing data and failing to handle it may result in distorted clinical conclusions, both in regard to effect estimates and the associated confidence intervals. The choice of variables selection procedure may also influence clinical conclusions, as it affects both which covariates are selected and the effect sizes. Increased awareness concerning the importance of handling missing data and performing variable selection will be crucial in a world where science is being questioned while more and more data is collected.

• Eide, Desiree Soraya; Muller, Ashley Elizabeth & Clausen, Thomas (2019). Behandling av opioiddominert ruslidelse: et prøveprosjekt med heroinassistert behandling. Senter for rus- og avhengighetsforskning (SERAF). Fulltekst i vitenarkiv
• Skjærvø, Ingeborg; Bukten, Anne; Skurtveit, Svetlana & Clausen, Thomas (2018). Substance use and crime: Characteristics of victim and offender roles in a longitudinal study of patients entering substance use treatment. Universitetet i Oslo. Fulltekst i vitenarkiv Vis sammendrag

  Sammendrag Det tas ofte ikke høyde for at rusbrukere som utfører kriminalitet samtidig kan være utsatt for kriminalitet selv. For å bedre utfall av rus- og kriminalomsorg er det viktig at tiltakene og ikke minst politikere er oppmerksomme på at en stor andel personer i rusbehandling og under kriminalomsorgen kan ha behov for offeromsorg. For å redusere utført kriminalitet blant rusbrukere kan fokus på risikogrupper være viktig, spesifikt brukere av amfetaminer, personer med lavere selvkontroll og personer som hovedsakelig tilbrakte fritiden med andre rusbrukere. For de som har vært utsatt for kriminalitet ser vi at boligpolitikk og fokus på psykisk helse i behandling er viktig. Funnene er fra NorComt-studien (www.norcomt.no), en stor norsk studie av over 500 personer som startet omfattende rusbehandling (i form av døgnbehandling eller legemiddelassistert rehabilitering). Deltagerne ble intervjuet ved behandlingsoppstart og ett år senere. Vi så at 64% av pasientene hadde utført kriminalitet i månedene før behandlingsstart. Samtidig hadde 59% vært utsatt for kriminalitet i den samme perioden. Det viste seg at det var en stor overlapp mellom de to gruppene. Vi så at amfetaminer var spesielt assosiert med utført kriminalitet, og fikk bekreftet og understreket viktigheten av tiltak rettet mot selvkontroll og sosiale nettverk for å redusere kriminalitet. Mer spesifikt så vi at bruk av amfetaminer, nivå av selvkontroll og om man hovedsakelig tilbringer fritiden med andre rusbrukere, hang sammen med både risiko for kriminalitet før behandling, og sannsynligheten for at man hadde sluttet med kriminalitet ett år etter behandlingsstart. Pasienter som hadde vært utsatt for kriminalitet i perioden før behandling hadde alvorligere rusbruk, hadde oftere en ustabil bosituasjon og de hadde flere symptomer på dårligere psykisk helse, i form av angst, depresjon og tidligere selvmordsforsøk. Disse funnene viser viktigheten av en trygg boligpolitikk og oppfølging av psykiske symptomer i rusbehandling.

• Edvardsen, Hilde Marie Erøy; Rogde, Sidsel; Clausen, Thomas & Vindenes, Vigdis (2018). GHB-, fentanyl- og oksykodonrelaterte dødsfall. Universitetet i Oslo. Fulltekst i vitenarkiv
• Madah-Amiri, Desiree; Clausen, Thomas & Lobmaier, Philipp Paul (2017). Opioid overdoses and overdose prevention: The establishment of take-home naloxone in Norway. Universitetet i Oslo. Fulltekst i vitenarkiv Vis sammendrag

  Naloxone is the antidote to an opioid overdose, and has long been used by health personnel to reverse overdoses. More recently, non-medical bystanders have also been equipped to recognize and respond to an overdose with naloxone. In 2014 the National Overdose Prevention Strategy included the provision of naloxone to bystanders, becoming one of the first government-supported naloxone programs. The aims of this thesis were to describe characteristics of opioid overdoses occurring in Bergen, Norway, and to evaluate the introduction and implementation of a widespread take-home naloxone program in Norway. This was done using ambulance records, a pre-test post-test analysis, and questionnaires from participants trained to use naloxone. Participants were mostly opioid users, and nearly all had previously witnessed or experienced an overdose. Distribution goals were met within the first 18 months, demonstrating that that the use multiple existing facilities achieved rapid, high volume distribution of naloxone to an at-risk group. Together the findings support the appropriateness and feasibility of implementing a widespread naloxone distribution program.

• Muller, Ashley Elizabeth; Skurtveit, Svetlana & Clausen, Thomas (2017). Quality of life, substance use disorders, and social lives: Exploring one-year outcomes and intrinsic links. Universitetet i Oslo. Fulltekst i vitenarkiv Vis sammendrag

  Substance use disorders are increasingly being recognized as chronic diseases, with important treatment implications: not only should a finite course of treatment not be expected to be curative, but outcomes of interest must be relevant to the patient and not limited to reduced substance use. While quality of life is a standard outcome measure among other chronic disease treatment, the substance use disorder treatment field has lagged behind in systematically evaluating it. Sustained contact with the treatment system lasting beyond intensive inpatient treatment appears best to maintain treatment’s benefits long-term, therefore the social environments of patients – the larger contexts of their lives, including but not limited to treatment – must also be addressed. The overall objective of this thesis was to examine changes in quality of life along with natural treatment progression and explore the relationship of these changes to underresearched social factors in order to inform the clinical approach to patients’ social lives. The specific aims were to identify patterns in poor quality of life at entry to SUD treatment; to examine how quality of life changes along with social network developments through the treatment course; and to validate and confirm the utility of a new quality of life instrument. This thesis used data from The Norwegian Cohort of Patients in Opioid Maintenance Treatment and Other Drug Treatment study, an observational, prospective study of adults entering substance use disorder treatment in 21 facilities throughout Norway. 548 patients entering treatment enrolled at were administered a battery of questionnaires, such as the EuropASI, HSCL-25, and QOL10, through structured interviewed by trained facility staff. One year later, regardless of treatment progression or drop out, participants answered the same questionnaires through interviews with research staff. 338 were included in the longitudinal analysis. The majority of the sample entered treatment with extremely impaired quality of life as measured through a single item, along with substance-using social networks, poor mental health, and polysubstance use. Depression was associated with the poorest quality of life among women, while physical inactivity, weight dissatisfaction, and eating alone were the most important factors for men. Opioid maintenance treatment medication was a protective factor for both genders. After one year, 75% of participants were still receiving treatment, 9% had completed, and 15% amount as at study inclusion reported no network (17.5%). Global and social quality of life measured by the QOL10 improved for the entire sample, although global quality of life remained below population norms. The trend in each of the three treatment status groups, and statistically significant for those still in treatment, was for participants who gained or maintained an abstinent network to report the largest gains in quality of life, and for participants who gained a substance-using network or were socially isolated to report the smallest, or clinically negligible, improvements. In a validation study of the QOL10, factor analysis revealed the QOL10 to measure two domains described as “global quality of life” and “social quality of life”. The global domain correlated negatively with symptoms of clinical anxiety, depression, and physical inactivity; the social domain was only weakly correlated to anxiety. Both domains had satisfactory internal validity, scores were easily calculated, and the QOL10 as a whole presented minimal administrative and participant burden. At both treatment initiation and one year later, we found quality of life to correlate with lesser explored factors such as physical inactivity and social isolation. These vulnerabilities, along with mental health, should be evaluated immediately in the clinical setting and addressed through exercise and network interventions. Entering treatment without a social network may be a particular risk factor for both dropping out and failing to experience improved quality of life, and network interventions need to be further developed to explicit help isolated patients. Any contact with the treatment system appears to be beneficial to quality of life, but the combination of remaining in treatment after one year and building or maintaining an abstinent network resulted in the highest quality of life. Quality of life is not a simple proxy for health or for disease or treatment progression, although undoubtedly influenced by these factors. To fully understand how best to support patients’ quality of life, network building, and treatment retention, and to understand the causal mechanisms in these relationships, repeated measurements and sustained contact with patients are needed.

• Bukten, Anne; Stavseth, Marianne Riksheim; Skurtveit, Svetlana; Kunøe, Nikolaj; Lobmaier, Philipp Paul & Lund, Ingunn Olea [Vis alle 7 forfattere av denne artikkelen] (2016). Rusmiddelbruk og helsesituasjon blant innsatte i norske fengsel. Resultater fra The Norwegian offender mental health and addiction study (NorMA). Universitetet i Oslo. Fulltekst i vitenarkiv
• Tjagvad, Christian; Clausen, Thomas & Skurtveit, Svetlana (2016). Addictive medication in relation to drug treatment and overdose death. Universitetet i Oslo. Fulltekst i vitenarkiv Vis sammendrag

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

• Havnes, Ingrid Amalia; Clausen, Thomas; Middelthon, Anne-Lise Orvin & Waal, Helge (2015). Violence and diversion of prescribed opioids among individuals in opioid maintenance treatment.A complementary methods study of violent crime convictions in a national cohort and qualitative interviews among prisoners. Universitetet i Oslo. ISSN 9788282649445. Fulltekst i vitenarkiv
• Tjagvad, Christian; Petersen, Helle; Thylstrup, Birgitte; Biong, Stian & Clausen, Thomas (2014). Forgiftningsdødsfald og øvrige narkotikarelaterede dødsfald i Danmark 2008-2011. SERAF - Senter for rus- og avhengighetsforskning. ISSN 9788293019046. Fulltekst i vitenarkiv
• Opsal, Anne; Clausen, Thomas & Larsen, Tor Ketil (2013). Involuntarily admitted patients with substance use disorders. Universitetet i Oslo. Fulltekst i vitenarkiv Vis sammendrag

  Tvangsinnleggelse av pasienter med ruslidelser Forsker og sykepleier Anne Opsal har i sin studie vist at en stor del av tvangsinnlagte pasienter både etter Psykisk helsevernloven og Helse- og omsorgstjenesteloven har samtidig rus- og psykiatrisk lidelse. Mens menn dominerte blant tvangsinnlagte pasienter med ruslidelser etter Psykisk helsevernloven, var det relativt flere unge kvinner innlagt etter Helse- og omsorgstjenesteloven. Tvangsinnlagte til tverrfaglig spesialisert behandling etter Helse- og omsorgstjenesteloven hadde mer bruk av trygdeytelser, tyngre rusbelastning og oftere legekontakt på grunn av somatiske helseproblemer enn frivillig innlagte pasienter. I en nasjonal studie av pasienter med ruslidelse innlagt i akuttpsykiatriske avdelinger samvarierte det å bli tvangsinnlagt med bruk av amfetamin. En annen delstudie viste at blant førstegangs psykosepasienter er det større forekomst av tvangsinnleggelser dersom man har samtidig ruslidelse. Samtidig rus- og psykisk lidelse virker med andre ord til å komplisere behandlingsforløpet og er assosiert med tvangsinnleggelser. Dette tyder på at kliniske rutiner for å identifisere både rus- og psykiatriske lidelser, bør gis høy prioritet i behandlingssystemene. Mange av pasientene vil kunne ha nytte av integrerte spesialisthelsetjenester innen mental helse, somatisk helse og tverrfaglig, spesialisert rusbehandling.

• Martinez, Priscilla; Lien, Lars; Clausen, Thomas & Landheim, Anne (2013). Alcohol use in special populations in Africa. Data from the World Health Survey and Study on global AGEing and adult health. Universitetet i Oslo. Fulltekst i vitenarkiv Vis sammendrag

  Background Alcohol use is an important factor in a population’s risk for disease and mortality. Alcohol has a long history of use in Africa, and changes in drinking behavior are underway in many African states. Women and older adults are two special populations that comprise sizable proportions of the general population and whose use of alcohol will have important consequences for public health in Africa. There is limited information about the drinking behavior of women and older adults, what factors are associated with different drinking patterns and how these populations compare to one another across African nations. Such information is necessary for the development of effective public health policies and for advancing our understanding alcohol epidemiology in Africa.<br><br> Aims We aimed to determine the prevalence of various types of drinking patterns, correlates of these patterns and cross-national similarities and differences of both drinking patterns and associated correlates among African women and older adults.<br><br> Methods This work is a secondary analysis of publicly available data from the World Health Organization. We used material from two nationally representative population-based surveys, the World Health Survey (WHS) and the Study on global AGEing and adult health (SAGE). The WHS was conducted in 20 African countries and SAGE in Ghana and South Africa. Both surveys collected data through face-to-face interviews using standardized instruments on alcohol use and a variety of measures of socio-demographics, health behaviors and well-being. We constructed alcohol measures based on self-reported use over the previous week.<br><br> Results A total of 40,739 African women were included in the WHS, and 4289 adults aged 50 and above in Ghana and 3666 in South Africa in the SAGE Survey. Overall, lifetime abstention rates ranged from 56% in Mauritius to 99% in Comoros among women. Among older adults, lifetime abstention was 42% in Ghana and 75% in South Africa. Among currently drinking women, rates of risky single-occasion drinking varied from 0.5% to 58% in Mauritius and Chad, respectively. Among current drinking older adults, at risk drinkers comprised 26% in Ghana and 37% in South Africa. Socio-demographic correlates of current drinking among women included increasing age, having any education, working for pay, being married/cohabitating and living in an urban setting. Increasing age was the most common and consistent correlate, and few other correlates were consistent across states. Among older adults in Ghana and South Africa, the most common correlates of drinking pattern included ethnic group, religion and smoking. Among women, 4 clusters of countries were identified based on the prevalence rates of the different drinking patterns and few correlates were common by cluster or geography, save the high rates of lifetime abstention among Muslim states in northern Africa. The older adult populations in Ghana and South Africa differed on all alcohol measures, while smoking was a common correlate of drinking behavior between the two countries. Discussion and Conclusion The high rates of lifetime abstention among African women are consistent with historical and current reports, and rates of risky single-occasion drinking are cause for concern and action. Drinking patterns among older adults in Ghana and South Africa mirror that of the general populations. The correlates identified suggest socio-cultural factors such as religion and tribal association are important factors in drinking behavior, as well as lifestyle factors such as smoking. The variety of drinking patterns and associated correlates across the states among both women and older adults suggests nations would benefit from tailored national alcohol policies that take into account alcohol use among women and older adults, and that continued monitoring of drinking patterns and associated correlates among these groups would be an important piece for understanding alcohol epidemiology in a dynamic African context.

• Christensen, Marit; Aronsson, Gunnar; Borg, Vilhelm; Clausen, Thomas; Guthenberg, Johan & Hakanen, Jari [Vis alle 8 forfattere av denne artikkelen] (2012). Building engagement and healthy organisations. Validation of the Nordic Questionnaire on Positive Organisational Psychology (N-POP). norden. ISSN 9789289323970. Fulltekst i vitenarkiv
• Bramness, Jørgen Gustav; Clausen, Thomas; Ravndal, Edle & Waal, Helge (2012). LAR- forskningen 2011. 7Letras. Fulltekst i vitenarkiv
• Waal, Helge; Clausen, Thomas; Håseth, Atle & Lillevold, Pål Henrik (2012). Statusrapport 2011 LAR i Helseforetakene. Universitetet i Oslo. Fulltekst i vitenarkiv
• Bukten, Anne; Clausen, Thomas & Skurtveit, Svetlana (2012). Criminal convictions among patients in opioid maintenance treatment in Norway. : A national cohort study. Universitetet i Oslo. Fulltekst i vitenarkiv Vis sammendrag

  The reduction of criminal activity is an important aspect of drug treatment. Opioid maintenance treatment (OMT) is one of the most widespread treatment approaches for opioid dependence, and over the past decades researchers have generally agreed that OMT reduces criminal activity. Several factors may affect treatment outcome. Patients retained in long-term and continuous treatment experience less involvement in criminal activity during OMT, while patients who drop out of OMT tent to relapse into higher levels of drug use and criminal activity. There is also research supporting a link between patient outcome and the manner in which treatment programme services are delivered. In Norway, criminal activity among patients in OMT and associations with long-term treatment has previously not been sufficiently studied. On this background, this thesis focuses on the investigation of criminal convictions among a national cohort of OMT patients.<br><br> Study aims<br> The specific aims of this thesis were to investigate criminal convictions among patients before, during, and after OMT and to explore how the long-term retention patterns were associated with criminal convictions. Furthermore, to investigate criminal convictions among patients in four different treatment regions in Norway, and to estimate the time-continuous probability of criminal activity during OMT transition periods.<br><br> Materials and methods<br> In this study, the Norwegian OMT patient register was cross-linked with the Norwegian crime register. The OMT patient register comprised information on all patients who applied for (n=3789) and subsequently started (n=3221) OMT in Norway between 1997 and 2003. The Norwegian crime register comprised detailed information on all crime cases, and included the date of the criminal event and the indentified offender. Data from the national OMT register and the crime register were linked using a unique identification number assigned by the Norwegian state of all residents. The study included all registered criminal convictions for the cohort before, during, and after treatment.<br><br> Results<br> During the three years prior to OMT application, the cohort had more than 24 000 convictions. Almost 80% of all convictions were for acquisitive crimes and drug offences. Differences were found among those applying for treatment; almost 40% had no criminal convictions whereas 10% of the sample was responsible for about 40% of all convictions in total. During treatment the overall rates of criminal convictions were reduced to less than half of pre-treatment levels. Patients retained in continuous and long-term treatment had the lowest rates of criminal convictions during OMT, whereas patients who left treatment had relatively high levels of convictions during treatment regardless of whether they returned to treatment or not. Patients who dropped out of treatment had high levels of criminal convictions during the periods out of OMT. In the Central-Northern region more than 80% of patients were in continuous treatment compared to about 60% in the Eastern region. Regional differences were found in criminal convictions among patients in continuous treatment; compared to patients in the Eastern region, patients in the Southern and the Central-Northern region had respectively 44% and 81% less criminal convictions during treatment, and patients in the Western region had 60% more convictions. During the years prior to onset of treatment, the probability of a criminal event in the cohort was relatively stable, at approximately 0.4% daily. About three months before initiation of OMT criminal activity started to decrease before stabilizing at the onset of OMT at a new, significantly lower level of approximately 0.2% per day. During the weeks before dropping out of treatment, criminal activity increased, up until the final day of treatment. After treatment, the higher levels of criminal activity were stable and high. The patterns during periods of transition were the same across gender, age and pre-treatment convictions levels.<br><br> Discussion and conclusion<br> During treatment the overall rates of criminal convictions were reduced to less than half of pre-treatment levels. Patients who left OMT relapsed to more criminal convictions when out of treatment, and this elevated probability of criminal convictions could be identified during a critical period in the months prior to drop out. The increased levels of criminal convictions may serve as a visible marker of other forms of risk behaviour, and it is essential that clinical staff offer support to OMT patients who are at particular risk of dropping out of treatment. Awareness of the process by which the programmes are delivered is essential for improving treatment effectiveness. Treatment centres known to provide OMT with a particular focus on psychosocial rehabilitation were found to have most improvement in terms of reduction in crime during treatment. Rapid expansion of the national OMT programme without accompanying sufficient resources to maintain high standards of treatment might represent a challenge in term of optimal treatment delivery.

• John-Kåre, Vederhus & Clausen, Thomas (2012). Addiction professionals’ and substance abuse patients’ attitudes towards and usage of 12-step-based self-help groups. Universitetet i Oslo. ISSN 9788282642590. Fulltekst i vitenarkiv
• Waal, Helge; Clausen, Thomas; Håseth, Atle & Lillevold, Pål Henrik (2011). SERAF rapport 1/2012. Statusrapport 2011 LAR i helseforetakene. 7Letras. Fulltekst i vitenarkiv
• Gjersing, Linn Renathe; Clausen, Thomas & Waal, Helge (2011). Staff attitudes towards opioid maintenance treatment (OMT) and the associations with treatment. Universitetet i Oslo. Fulltekst i vitenarkiv Vis sammendrag

  This thesis, in addiction medicine, investigated staff attitudes towards opioid maintenance treatment (OMT) in different settings, and their association with treatment differences within the Norwegian OMT programme. In New South Wales, Australian prison health staff were found to discourage inmates from entering or remaining in OMT. Thus, the first aim of this thesis was to investigate staff attitudes towards and knowledge of OMT among prison health staff. In Norway, annual assessments of the Norwegian OMT programme had identified treatment differences between the 14 regional OMT centres since 2004. There were some indications that these differences were associated with staff attitudes. The second aim of this thesis was to cross-culturally adapt the instrument used among Australian prison health staff into Norwegian and to assess Norwegian staff attitudes towards OMT. It also explored treatment differences within the Norwegian OMT programme and their possible associations with attitudes. The three studies had cross-sectional designs. The prison health staff study (n=396) was conducted in 2003 in NSW, Australia. The Norwegian attitudinal staff study was undertaken in 2007 in Oslo among 140 OMT staff and 180 harm reduction staff. The assessment of the Norwegian OMT programme used aggregated data from the annual OMT assessments from November 2007 and 2008. Australian prison health staff with little knowledge of methadone treatment were more likely to be abstinence-oriented. These staff were more likely to encourage inmates to leave the OMT programme prior to release from prison. In the Norwegian staff study there were differences between the regional OMT in attitudes towards OMT. Centres that were more likely to support discharge from treatment due to drug use and advocate limitations on who should have access to OMT had smaller caseloads, more frequent urine drug screening and increased case management. In addition less of their patients used drugs previous four weeks and more patients had long-term housing facilities and employment. These studies show that staff attitudes towards OMT are important factors that may influence treatment in many ways.

• Waal, Helge; Gjersing, Linn Renathe & Clausen, Thomas (2011). Open Drug Scenes and Overdose Mortality - What to Do? Lessons from five European cities. Universitetet i Oslo. ISSN 9788293019022. Fulltekst i vitenarkiv
• Gjersing, Linn Renathe; Biong, Stian Nissen; Ravndal, Edle; Waal, Helge; Bramness, Jørgen Gustav & Clausen, Thomas (2011). Dødelige overdoser i Oslo 2006 til 2008 : En helhetlig gjennomgang. Senter for rus- og avhengighetsforskning (SERAF). ISSN 9788293019039. Fulltekst i vitenarkiv
• Waal, Helge; Clausen, Thomas; Håseth, Atle & Lillevold, Pål Henrik (2010). SERAF rapport 1/2010 Statusrapport 2009. SERAF - Senter for rus- og avhengighetsforskning. Fulltekst i vitenarkiv
• Christensen, Marit; Straume, Lisa Vivoll; Kopperud, Karoline Hofslett; Borg, Vilhelm; Clausen, Thomas & Hakanen, Jari [Vis alle 9 forfattere av denne artikkelen] (2009). Validation and test of central concepts in positive work and organizational psychology. The second report from the Nordic project Positive factors at work. TemaNord. Fulltekst i vitenarkiv
• Gjersing, Linn Renathe; Waal, Helge & Clausen, Thomas (2009). Evaluering av Klinikk Motivasjon (SERAF rapport 3/2009). Unipub forlag. ISSN 9788293019008. Fulltekst i vitenarkiv
• Waal, Helge; Clausen, Thomas; Håseth, Atle & Lillevold, Pål Henrik (2009). LAR i Norge 10 år; Statusrapport 2008 (SERAF rapport 2/2009). Universitetet i Oslo. Fulltekst i vitenarkiv
• Kopperud, Karoline; Christensen, Marit; Straume, Lisa Vivoll; Borg, Vilhelm; Clausen, Thomas & Hakanen, Jari [Vis alle 9 forfattere av denne artikkelen] (2008). Positive Factors at Work. The First Report of the NordicProject. Tema Nord. Fulltekst i vitenarkiv
• Christensen, Marit; Straume, Lisa Vivoll; Kopperud, Karoline Hofslett; Borg, Vilhelm; Clausen, Thomas & Hakanen, Jari [Vis alle 9 forfattere av denne artikkelen] (2007). Positive Factors at Work. Ekspressen Tryk & Kopicenter. Fulltekst i vitenarkiv

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