Developments in the Norwegian overdose situation

Transcription

1 Developments in the Norwegian overdose situation Thomas Clausen Professor (Dr. med) October 2013

2 Agenda The overdose-situation Development and trends National responses Norwegian OMT

3 Norway and Europe Population: 5 mill

4 Overdoses in Europe 2010 EMCDDA- Annual report 2011

5 Comparisons Europe? Nordic countries? Within one country

6 N 600 Overdose- differences France Netherlands Norway Norway (P)

7 Overdoses in Norway and Oslo N OMT Norway

8 Overdoses and the stats; deaths 80% opioids, 0 cocaine 17% suicides (within definition) 9/10 overdose deaths; autopsy deaths overall in Norway GMR 2075 Unknown cause (5%) in total 3072 autopsies (75 per 1000 deaths) 13 cases of AIDS/HIV, and 13 cases of Hep C

9 Why so many overdoses? Heroin dominates Injection of heroin (85-90%) Polydrug use (Heroin-Benzodiazepines) Old and ageing user-population Suboptimal treatment delivery? High case-detection rate (Autopsy) Low levels of competing risks? Binge drinking and drug taking culture?

10 Introduction of opioid maintenance treatment - OMT 1964 USA 1968 UK 1987 Austria 1998 Norway 1970 Denmark 1977 Portugal 1990 Spain 2001 Estonia 2011 Tanzania Netherlands Italy 1992 Germany 2010 Kampuchea 1967 Sweden 1995 France

11 National responses OMT opioid maintenance treatment since 1998 Injection room (1 in Oslo) Syringe exchange Residential treatment Treatment in prisons Etc.

12 Tapering off OMT Stable Abstinence Abstinence oriented treatment AO Drug treatment A comprehensive model Dual diagnosis clinics Voluntary OMT Buprenorphine Methadone ACT Syringe exchange Low-treshold-OMT User room Heroin Stabilizing Harm reduction Compulsory treatment Abstinence oriented in prison OMT in prison Compulsory From; Wim van den Brink

13 Norwegian OMT Development and results

14 History 1998; high threshold, low volume Based on current available evidence High dose, rehabilitation as goal Rapid expansion, gradual liberalisation Based on «local» evaluations and research Today; 50-60% coverage National treatment programme National guidelines

15 Numbers of patients in OMT Norway

16 Numbers waiting for OMT; East South West Middle North Norway

17 Developments Norway introduced OMT late compared with other countries National treatment system Annual evaluations of OMT National research centre; OMT research Improved access to treatment From «restrictive» to more liberal system

18 OMT-patients in Norway 1/3 women 20 yrs of age when first starting heroin Age at OMT initiation 37yrs 64% retention in treatment, ( ) 50% Methadone Mean dose; 110 mg Met. & 16 mg Bup.

19 Psychosocial rehabilitation Treatment contacts Previous 30 days (2008): 50% meeting with multidisciplinary team 60% contact with social service centre 50% contact with OMT-centre Less than 10% contact with psychiatric treatment

20 Drug-use in treatment % use previous 30 days

21 Observational Cohort studies Pre-treatment In treatment Post treatment Timeline Mortality Morbidity Crime Drug-use Quality of life Mortality Morbidity Crime Drug-use Quality of life Mortality Morbidity Crime Drug-use Quality of life

22 Mortality before, during and after OMT in Norway % pr year 4 3,5 3 2,5 2 Overdose Non-overdose 1,5 1 0,5 0 Pre-treatment In treatment Post treatment Clausen T. et al. Drug and Alcohol Dependence, 2008, Mortality prior to, during and after opioid maintenance treatment (OMT)

23 Treated in hospital Rate per 100 py Somatic drug-related incidents; before, during and after OMT in Norway I. Skeie et al, BMJ Open 2011

24 Crime convictions Before, during and after OMT in Norway Rate per person year 2 1,8 1,6 1,4 1,2 1 0,8 0,6 0,4 0,2 0 Continues Drop out Pre-treatment In treatment Post-treatment A. Bukten et al. Addiction 2011

25 Treatment effect Mortality, morbidity and crime; before, during and after OMT Standard Rate Time Pre-treatment In treatment Post treatment

26 Summary Norway has high rates of overdoses Overall mortality rates among heroin users, less extreme in Norway OMT; low-threshold & liberal within comprehensive system