1. 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)
October 26th, 2017
Lisbon

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

3. Agenda
Overdose deaths and the Norwegian picture
Effective strategies

4. 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

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

6. Overdose deaths, Norway
289 54
2015
Norwegian Institute of Public health

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

8. Overdoses in the Nordics; (2012)

9. Opioid using persons A wider range of subpopulations

10. 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

11. Norwegian National Overdose Strategy 2014 – 2017
Sure you can quit drugs - but first you have to survive!

12. 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)

13. Overdose deaths, Norway
OMT
Naloxone
Less inject
Population
NPS
Prescr. op.
Ageing
Widespread
Analytic mt
Cohort eff

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

15. 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

16. 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

17. Waves of opioid epidemic A moving target