International cross-sectional study «Surveillance of alcohol and drug use among hospitalized somatic patients» Updated results, August 2017 Participants: Oslo University Hospital Lovisenberg Diakonale Hospital, Oslo Moscow Research and Practical Center on Addictions City Clinical Hospital № 68, Moscow Prof. Evgeniya Koshkina, Deputy Director for Science Moscow Research and Practical Center on Addictions, Russian Federation Stockholm, 7 September, 2017

The project was initiated by the Expert Group on Alcohol and Drug Abuse (ASA EG) of Northern Dimension Partnership and has been carried out with the support of the Government of Norway since 2014 During the preparation of the project (2012-2014) joint bilateral consultations were held to familiarize relevant experts with the activities of counterpart institutions and to draft the study protocol.

Purpose and object of the study Study of the relationship between hospital admissions to somatic departments due to internal organs diseases and the problematic use of alcohol and other psychoactive substances. Survey is conducted by combined analysis of questionnaires and biological blood markers.

Objectives of the study: Find out to what extent the risky practice of drinking alcohol and use of other psychoactive substances is associated with the emergence of acute somatic conditions or exacerbation of chronic pathology. Determine how the problematic use of alcohol and other psychoactive substances is recorded in the patient's medical records.

Objectives of the study: 3. Find out whether patients with problematic use of alcohol and other psychoactive substances are more resource-consuming, by assessing: The length of stay in the hospital and the frequency of hospitalization (number of hospitalizations during life and last year); If the patients were observed in other healthcare institutions, including addiction clinics or dispensaries.

Target group of the study Patients, admitted to somatic departments of Clinical Hospital № 68 (internal medicine, cardiology, pulmonology, neurology). It is planned to study 3000 patients aged 18 years or over.

Patients are selected according to the selection criteria throughout the year on a daily basis to capture possible seasonal and diurnal hospitalization fluctuations. Comparative analysis of all results is carried out anonymously.

The study design At the time of admission to somatic departments internal medicine cardiology pulmonology neurology patients aged 18 years or over are asked to participate in the study. Patient is provided with written and/or oral information on the study. Patient is asked to sign the Informed Consent.

The study design Patient fills in the questionnaire consisting of the following questions: Screening test AUDIT-4 on the use of alcohol Two modified questions from the «Drug Use Disorders Identification Test» (DUDIT – on the use of other psychoactive substances) Five questions concerning anxiety and the depression from the «Symptom Check List – 5» (SCL-5) Blood sample is taken from a patient for testing for the psychoactive substances.

The study design Healthcare professional completes Questionnairy 1.

The study design After the patient is discharged the medical investigator completes Questionnairy 3 using data from patient’s medical record.

Blood samples are tested for psychoactive substances: Alcohol Laboratory tests are carried out in chemical and toxicological laboratory of MRPCA Blood samples are tested for psychoactive substances: Alcohol Benzodiazepines Narcotic drugs and psychotropic substances (opioids, amphetamine, cocaine, cannabinoids, other psychoactive substances).

By the 30th of August, 2017 in the somatic departments of Clinical Hospital №68 2190 blood samples were taken, out of them 123 patients rejected to participate in the study (did not sign IC) 2067 patients took part in the study. For each patient according to the study protocol 3 questionnaires were completed questionnaire 1 is completed by medical investigator questionnaire 2 is completed by the patient with the help of medical investigator questionnaire 3 is completed by medical investigator after the patient’s discharge (using data on hospitalization from the hospital electronic database) Processed and entered into the database 469 questionnaires

Current enrollment in the somatic departments of Lovisenberg Diakonale Hospital, Oslo (by August, 2017 ) 1878 patients are enrolled in the study 200-250 patients are included each month

By the 30th of August, 2017 Chemical toxicological laboratory of Moscow Research and Practical Center for Addictions Received 2190 blood samples Abuse of alcohol detected in 323 cases (14,7%) (PEth exceeding 0,3 Mmol/l) Abuse of narcotic drugs and psychotropic substances (including diazepam and phenobarbital) detected in 137 cases (6,3%)

Preliminary results of Chemical toxicological laboratory, Oslo University Hospital (by August, 2017 ) PEth cutoff: >0,3 Mmol/l signifies a clearly harmful alcohol usage pattern 10,2 % of analyzed samples (n=1270) have a PEth-value above 0,3 Mmol/l

Preliminary data from 469 questionnaires, entered in the project database Gender :        Department:                     male 224 female 245 Neurology 88 Internal medicine 242 Cardiology 41 Pulmonology 98

Internal medicine (242 patients) % from the number of patients Intermediate data on nosological entities in internal medicine department Internal medicine (242 patients) ICD code male female total % from the number of patients J 18 26 34 60 25 I 50 13 16 29 12 I 11 1 15 6,5 K 74 8 5 D 50 3 T 78 - 6 2,5 Other:   42.5 J 18 Pneumonia I 50 Heart failure I 11 Hypertensive heart disease К 74 Fibrosis and cirrhosis of the liver D 50 Anemia T78 Adverse effects not classified elsewhere

Intermediate data on nosological entities in neurology department Neurology (88 patients)   ICD code male female total % from the number of patients G 40 16 7 23 26 M 51 12 4 18 I 67 5 9 10 G 62 3 11 M 54 Other: 25 G 40 Epilepsy М 51-54 Dorsopathy I 67 Cerebrovascular diseases G 62 Polyneuropathy

Intermediate data on nosological entities in pulmonology department Pulmonology (98 patients) ICD code male female total % from the number of patients J 18 21 20 41 42 J 45 9 17 26 26,5 J 44 12 3 15 J 41 - 4 J 20 Other:   9.5 J 18 Pneumonia J 45 Asthma J 44 Chronic obstructive pulmonary disease J 41 Chronical bronchitis J 20 Acute bronchitis

Intermediate data on nosological entities in cardiology department Cardiology (41 patients) ICD code male female total % from the number of patients I 50 13 7 20 49 I 48 6 2 8 19,5 I 20 3 5 Other:   12 I 50 Heart failure I 48 Atrial fibrillation and flutter I 20 Angina pectoris

The reasons for the sample size differences by the departments Differences in the number of patients in the departments selected for the study are due to the following reasons: Departments have different number of beds; Emergency patients are admitted to some departments only after a number of days in intensive care and therefore doesn’t fit the inclusion criteria; Departments have different percentage of emergency patients. In case of planned hospitalization the patient doesn’t fit the inclusion criteria.

Different possibilities for data collection in Russian Federation and in Norway due to: The absence of comprehensive patient’s register in Russia; Questionnaire 3 is filled in by copying data from the clinic’s database. It is not integrated in the United medical information and analysis system of Moscow and doesn’t have tools to analyze admittances to other medical installations of the region.

Expected results Presentation of the study results on individual nosological forms of diseases with the indication of the identified substance use: harmful use of alcohol harmful use of drugs harmful use of psychotropic substances (including diazepam and phenobarbital) harmful use of different psychoactive substances in combination

Reports and publications Surveillance of alcohol and drug use among hospitalized somatic patients. Koshkina E.A. , 14th meeting of the NDPHS Expert Group on Alcohol and Substance Abuse (ASA EG), 17th of March, Copenhagen, Denmark. Surveillance of alcohol and drug use among hospitalized somatic patients. Nadezhdin A.V. Conference on Joined Russian-Norwegian program on healthcare, 27th of March, Kirkenes, Norway. Publication: Phosphatidylethanol as the new alcohol abuse biomarker. Petukhov A.E., Nadezhdin A.V., Bogstrand S.T., Bryun E.A., Ramenskaia G.V., Koshkina E.A., Melnik E.V., Smirnov A.V., Tetenova E.Y. Narcologia 2 (2017): 42-47.

Thank you for attention!