Head of Research centre Preventing drug-related deaths: Policy implications and ways forward. Focus on Norway. Thomas Clausen Head of Research centre Professor (MD, PhD) thomas.clausen@medisin.uio.no October 26th, 2017 Lisbon

Conflicts of interest None Thomas Clausen is a full-time employee at the Norwegian Centre for Addiction Research, University of Oslo, Norway

Agenda Overdose deaths and the Norwegian picture Effective strategies

The Nordic region Sweden Denmark Finland Norway Iceland Populations 9.9mill 5.7mill 5.5 mill 5.3 mill 0.3 mill ODs per 1 mill 101 58 43 76 100+? Numbers in OMT 3 700 6300 3000 7 500 120 Universal health care systems Treatment free of charge, for the patient Public health approaches; population based measures of prevention Access to treatment and harm-reduction measures; high Opioid maintenance treatment provided (50+% of target pop.) Norway; Mean age at overdose death; 43 yrs; on a rise EMCDDA 2017

Treatment and service provision Larney et al, Lancet Glob Health, 2017

Overdose deaths, Norway 289 54 2015 http://www.fhi.no/artikler/?id=117255 Norwegian Institute of Public health

Overdose deaths and OMT; Norway Numbers in OMT Burden of disease report 2016; Norway; FHI

Overdoses in the Nordics; (2012)

Opioid using persons A wider range of subpopulations

The situation and challenges An ageing cohort of heroin users Polydrug injectors; now 50%+ in OMT High somatic and mental health burdens AND New populations using opioids Chronic pain patients NPS users (fentanyl) Most current interventions targeted towards «heroin users» Overdose deaths outside of treatment & somatic causes of deaths in treatment

Norwegian National Overdose Strategy 2014 – 2017 Sure you can quit drugs - but first you have to survive! https://helsedirektoratet.no/Lists/Publikasjoner/Attachments/145/National-overdose-strategy-2014-2017-IS-0418EN.pdf

National overdose prevention strategy Aims at reducing numbers of deaths annually Long-term 0-vision Multidimensional strategy: Improve access to evidence based treatment (OMT) Take-home Naloxone distribution Encourage “SWITCH” from injection to inhalation Improve knowledge and practices in municipalities Included funding (also for evaluation)

Overdose deaths, Norway OMT Naloxone Less inject Population NPS Prescr. op. Ageing Widespread Analytic mt Cohort eff http://www.fhi.no/artikler/?id=117255

Opioid using persons A heterogenous group Outside of treat. Residential long-term In prison Naltrexone Harm reduction OMT

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

A systematic approach A range of services Treatment goals: Coordinated - A treatment system Integrated - Cater for comorbidities Tailored to needs - Primarily in community Long-term - Varying intensity Treatment goals: Reduced risk Improved health Improved quality of life

Waves of opioid epidemic A moving target