Overdoses

Problematic use of alcohol and psychoactive drugs is an important risk factor for decreased disability-adjusted life years, and early death. In Norway, 324 overdose deaths occurred in 2020. The annual number of overdoses has not reached 300 in Norway since 2004, with 304 deaths that year. It was 411 overdose deaths in Norway in 2001, and 312 in 2002. The death rate was 8.6/100 000 in 2001 and 6.1/100 000 in 2020. In the period from 2010 to 2020, the mean annual number has been approximately 271 with a death rate of 5.2/100 000. Morphine-like painkillers, opioids, are involved in approximately 80-90% of overdose deaths and roughly 50 000 people died from opioid overdoses in the United States of America in 2019, which was more than double the situation in 2010. Fentanyl and fentanyl analogues are involved in most of these deaths.

Our research data regarding overdose deaths is to a large extent, based on coupling of data between the Norwegian Cause of Death Registry (NoCDR) and the forensic toxicology database of Oslo University Hospital from autopsy cases, and provides information about the cause of death and drug findings in biological samples taken at autopsy. Combining these registries, we can identify which substances that contributed to the poisoning and the death. This is important to reveal the specific drug responsible/contributing to death, since poly-drug use often are seen in such cases. NoCDR does not contain cause of death codes for all individual substances, but so-called aggregated codes in the vast majority of cases, therefore, detailed information are provided with the forensic toxicology data. In order to investigate the trends of individual substances over time, forensic toxicological findings in addition to the cause of death are essential. Knowledge of which substances that contribute to fatal overdoses is important from a prevention perspective.

The overall aims in overdose research are to identify risk factors for death, and more specified aims are:

  • To identify which drugs that contributed to drug related deaths in Norway, with focus on changes in prevalence with age, sex and death year (time trends)
  • To identify associations between contact with the health care service, the ambulance service, disease and drug-related deaths
  • To identify associations between medically or illegal acquired drug use, disease and death, and if certain drugs cause a higher number of deaths related to prescription use than other medical drugs
  • To identify differences regarding drug findings and concentrations between non-fatal opioid overdoses and fatal opioid overdoses

                                                              Photo: Pixabay

 

Funding

Overdose research at Department of Forensic Sciences, OUH, is a permanent assignment based on funding from the Ministry of Health and Care Services. In addition, the Norwegian Directorate of Health has provided funding on targeted overdose research projects.

Ongoing projects

Drug related deaths in a large registry based study

The basic overdose research utilises data from NoCDR and the forensic toxicology database of Oslo University Hospital which identifies which drugs and drug concentrations that are present in deceased with different underlying cause of death. In order to provide more information about overdose deaths, this project will collect data from several health registries to provide data on diagnosis and contact with the health care services prior to death. Furthermore, coupling of data with the Norwegian Prescription Database (NorPD) provides data on whether the detected drugs were obtained through a valid prescription, or illegal use.

This project will also include a control group based on extraction from the National Population Register in order to identify which factors that actually increases the risk of overdose death.

Photo: Pixabay

Opioid related deaths 2000-2019

Trends in detected opioids among overdose deaths during 2001-2019 are studied. Data are collected by coupling data from the forensic toxicology databases of Oslo University Hospital from autopsy cases and the NoCDR. The specific aims are to describe the development of the most prevalent opioids among women, men, different age groups and trends over time, to describe concentrations of pooled opioids, pooled benzodiazepines and the most prevalent other drugs, and differences between sexes and age groups and trends over time, and to describe the most common drug use combinations and the prevalence of illicit drugs in overdose deaths.

MDMA related deaths

This project studies MDMA-related deaths in Norway in the period 2000-2019. Data from the forensic toxicology database at Oslo University Hospital from autopsy cases is coupled with the NoCDR. We compare these findings with MDMA detected in blood samples from drivers that are apprehended by the police due to drugged driving and seizures analysed at The National Criminal Investigation Service.

Non-fatal overdoses

The number of overdose deaths in Norway has been high compared to international overdose statistics. Effective overdose prevention depends on detailed knowledge of risk factors. We know too little about which drugs and blood concentrations that distinguish a fatal overdose from a non-fatal overdose. The purpose of the project is to provide detailed analytical results of drug use among those who survive overdoses. Furthermore, the study will help to monitor fentanyl trends, and increase knowledge about what distinguishes drug use in non-fatal opioid overdoses from drug use in fatal opioid overdoses.

Photo: Oslo Univerisity Hospital

Previous projects

  • Overdoses in the Nordic Countries 1984/85, 2007, 2012, 2017
  • Opioid related deaths in Norway 2000-2017
  • Overdoses in patients receiving opioid maintenance treatment
  • GHB-, fentanyl- and oxycodone related deaths

Project members

  • Hilde Marie Erøy Edvardsen (Scientist, PhD)
  • Vigdis Vindenes (Section Manager, PhD)
  • Stig Tore Bogstrand (Professor, Head of Research, PhD)

Past members

  • Torill Tverborgvik (PhD)
  • Per Trygve Normann (PhD)
  • Svetlana Konstantinova-Larsen (PhD)
  • Asbjørg S. Christophersen (Prof. em.)

Collaboration

  • Thomas Clausen (Professor), Norwegian Centre for Addiction Research (SERAF), University of Oslo, Oslo, Norway
  • Svetlana Skurtveit (Professor), Norwegian Institute of Public Health, Oslo, Norway; University of Oslo, Oslo, Norway
  • Eline Borger Rognli (Senior Scientist), Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
  • Kirsten Wiese Simonsen (Forensic Chemist, PhD), Department of Forensic Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
  • Pirkko Kriikku (Forensic Toxicologist, PhD), Forensic Toxicology Unit, Finnish Institute for Health and Welfare; Department of Forensic Medicine, University of Helsinki, Helsinki, Finland.
  • Gunilla Thelander (Chemist), Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden
  • Svava Thordardottir (Senior Researcher), Department of Pharmacology and Toxicology, University of Iceland, Reykjavik, Iceland.
  • Charlotte Uggerhøj Andersen (MD, PhD), Department of Forensic Medicine, University of Aarhus, Aarhus, Denmark.
  • Anna Jönsson (Forensic Toxicologist), Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden.
  • Joachim Frost (Associate Professor), Department of Clinical Pharmacology, St. Olavs Hospital - Trondheim University Hospital, Trondheim, Norway.
  • Dorte Christoffersen (Head of Section, PhD), Section of Forensic Toxicology, Departmen of Forensic Medicine, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
  • Gerd Jorunn Møller Delaveris (Head of Section, PhD), Department of Forensic Sciences, Oslo University Hospital, Oslo Norway; Institute of Forensic Medicine, University of Oslo, Oslo, Norway.
  • Ilkka Ojanperä (Professor), Department of Forensic Medicine, University of Helsinki, Helsinki, Finland; Forensic Toxicology Unit, Finnish Institute for Health and Welfare, Helsinki, Finland.

 Press and Media Reports

If you have questions about the project or suggestions for research collaboration, please contact: Hilde Erøy Edvardsen (himlun@ous-hf.no) or Vigdis Vindenes (vigvin@ous-hf.no) at the Department of Forensic Sciences, Section of Drug Abuse Research, Oslo University Hospital, Oslo, Norway.

Publications

Langberg C, Hadley CL, Midtrevold M, Edvardsen HME, Molden E, Shafiei M, Jacobsen D (2021) Quetiapine Poisoning – Epidemiology, Toxicokinetics and Review of the Literature
Lupine Online Journal of Medical Sciences
Quetiapine Poisoning – Epidemiology, Toxicokinetics and Review of the Literature (lupinepublishers.com)

Bech AB, Clausen T, Waal H, Vindenes V, Edvardsen HME, Frost J, Skeie I (2020)
Post-mortem toxicological analyses of blood samples from 107 patients receiving opioid agonist treatment: substances detected and pooled opioid and benzodiazepine concentrations
Addiction, 116 (4), 845-855
https://doi.org/10.1111/add.15211, PubMed 32738014

Simonsen KW, Kriikku P, Thelander G, Edvardsen HME, Thordardottir S, Andersen CU, Jönsson AK, Frost J, Christoffersen DJ, Delaveris GJM, Ojanperä I (2020)
Fatal poisoning in drug addicts in the Nordic countries in 2017
Forensic Science International, 313, 110343
https://doi.org/10.1016/j.forsciint.2020.110343, PubMed 32563797

Edvardsen HME, Tverborgvik T, Frost J, Rogde S, Morild I, Waal H, Clausen T, Slørdal L, Vindenes V (2017)
Differences in combinations and concentrations of drugs of abuse in fatal intoxication and driving under the influence cases
Forensic Science International, 127-33
https://doi.org/10.1016/j.forsciint.2017.10.045, PubMed 29128652

Simonsen KW, Edvardsen HME, Thelander G, Ojanperä I, Thordardottir S, Andersen LV, Kriikku P, Vindenes V, Christoffersen D, Delaveris GJM, Frost J (2015)
Fatal poisoning in drug addicts in the Nordic countries in 2012
Forensic Science International, 248,172-80
https://doi.org/10.1016/j.forsciint.2015.01.003, PubMed 25645132

Simonsen KW, Normann PT, Ceder G, Vuori E, Thordardottir S, Thelander G, Hansen AC, Teige B, Rollmann D (2011)
Fatal poisoning in drug addicts in the Nordic countries in 2007
Forensic Science International, 207 (1-3), 170-6
https://doi.org/10.1016/j.forsciint.2010.10.001, PubMed 21036495

Steentoft A, Teige B, Vuori E, Ceder G, Holmgren P, Kaa E, Kristinsson J, Normann PT, Pikkarainen J (1989)
Fatal intoxications in the Nordic countries. A forensic toxicological study with special reference to young drug addicts
Zeitschrift für Rechtsmedizin, 102, 355-365
https://doi.org/10.1007/BF00200244, PubMed 2567559