Global trends show an increase in ADHD diagnoses and medication use. This study aimed to describe the incidence of ADHD among children and adolescents in Norway from 2016 to 2024, and to investigate sociodemographic factors associated with treatment initiation among newly diagnosed individuals. This nationwide longitudinal study used data from Norwegian health registers, including all incident ADHD cases (first diagnosis or medication) at ages 3-17 years between 2016 and 2024. Incidence rates were calculated per 1,000 individuals along with proportion initiating medication 0-3 months and 4-12 months post diagnosis. Logistic regression models were used to assess factors associated with initiation. The overall incidence of ADHD more than doubled between 2016 and 2024 (from 4.4 to 9.0 per 1,000), with 52,149 incident ADHD cases. The most pronounced increase was observed among adolescent females (14-17 years), where incidence rose from 3.1 to 11.4 per 1,000. Among 38,749 individuals diagnosed between 2016 and 2023, the proportion initiating medication within one year of diagnosis increased from 72.8% to 78.4%. Following a peak in 2021, proportion initiation within 0-3 months declined, while initiation at 4-12 months increased. Having a foreign-born parent was associated with lower odds, while older age at diagnosis and lower paternal education associated with higher odds of medication-initiation. This study documents a doubling in the incidence of ADHD diagnoses among children in Norway, and an even stronger increase among adolescent females. Medication initiation increased slightly but evolved toward a delayed approach. Sociodemographic factors, especially age at diagnosis, parental region of birth and father's education influence medication-initiation.

Background:Pain is common among individuals receiving opioid agonist treatment (OAT). This study aims to investigate factors associated with changes in opioid analgesic dispensing among treatment-naïve patients initiating OAT. Methods:We analyzed nationwide health and dispensing records of patients initiating OAT (N = 3783) in Norway from 2014 to 2023. The cohort included new OAT patients who completed their first year of treatment. The primary outcomes were changes in opioid analgesic use during the year before and after OAT initiation. Logistic regression was used to identify factors associated with continued opioid analgesic use after initiating OAT. Results:Over one-third (n = 1329, 35%) of new OAT patients were prescribed opioid analgesics in the year prior to treatment initiation. Following OAT, there was a 37% reduction. Daily opioid amounts in morphine milligram equivalents decreased after OAT initiation across all four percentile strata. Continued opioid analgesic use after initiation of OAT was more likely among women (adjusted odds ratio [aOR] 1.32, 95% CI 1.04-1.68) and participants aged > 56 years (aOR 1.71, CI 1.07-2.72). Pain-related diagnoses (aOR 2.45, CI 1.93-3.11), depression or anxiety disorders (aOR 1.59, CI 1.23-2.03), and bipolar/schizophrenia disorders (aOR 1.89, CI 1.19-2.98) were associated with higher odds of continued opioid analgesic use. Conclusions:Opioid analgesic use was prevalent among OAT patients before treatment initiation, with reductions observed within one year. Continued opioid use among those with pain suggests that OAT alone may not fully address pain management needs.

AIMS:Overdose deaths have been increasing in parts of Europe, including Norway, where opioid analgesics have been the leading cause since 2016. This study quantifies the risk of overdose death following exposure to dispensed opioid analgesics, stratified by sex and age, and examines associated causes of death. METHODS:Nationwide data from 2010 to 2018 on overdose deaths were obtained from the Norwegian Cause of Death Registry and linked with the Norwegian Prescription Database to identify prior opioid analgesic dispensations. Aggregated prescription data and population figures from Statistics Norway were also used. RESULTS:From 2010 to 2018, 42% of individuals who died from an overdose had been dispensed opioid analgesics in the previous year. Among those dispensed strong opioid analgesics, the overdose death rate was low but exceeded the population death rate among men aged 20-49 and women aged 20-39 years. The rate was higher in men and remained stable over time. Opioids other than heroin or methadone were listed as the cause of death in 62% of cases with prior dispensed opioid analgesics, compared with 24% among those without. CONCLUSIONS:The risk of overdose deaths following exposure to strong opioid analgesics was low but higher than population death rates for men under 50 and women under 40 years. Preventive strategies based on risk markers such as sex, age and opioid analgesic strengths, combined with other known risk markers, can help guide safer prescription of opioid analgesics and reduce overdose death.

PURPOSE:To assess the incidence of substance use disorders (SUDs) after long-term prescription opioid use (LTOU) and to identify socioeconomic and clinical risk factors associated with SUD among individuals with LTOU. METHODS:Cohort study using linked nationwide registers (2011-2019). We identified 114 916 individuals who used opioids for more than 3 months (LTOU) without previous LTOU or SUD diagnosis. Outcomes were any incident SUD diagnosed in primary or secondary care (ICPC-2: P15-P16, P18-P19; ICD-10: F10-F16, F18-F19) and opioid use-related disorders (OUD) diagnosed in secondary care (ICD-10: F11). We calculated age- and sex-stratified incidence rates (IR), incidence rate ratios (IRR) and age-standardized incidence rates (ASIR). Adjusted hazard ratios (aHR) were calculated using Cox proportional hazards regression. RESULTS:In total, 5.3% (6069/114916) were diagnosed with SUD (ASIR = 28.7 per 1000 person-years), and males had higher IRs compared to females (IRR). Males had higher risk of SUD in both the younger (aHR = 1.59, 95% CI 1.47-1.72) and older (1.66, 1.54-1.78) age group. Low education (1.87, 1.66-2.11) and unemployment (1.26, 1.15-1.38) had the strongest association with SUD in the younger age group versus low income (1.37, 1.21-1.57) and living alone (1.53, 1.41-1.65) in the older age group. Previously diagnosed mental disorders and use of benzodiazepines- or benzodiazepine-related drugs (BZDRs) were associated with SUD in both age groups (1.85, 1.71-2.01; 2.37, 2.18-2.57). Being male and having used BZDRs were the covariates strongest associated with OUD. CONCLUSIONS:Being male, young, having low socioeconomic status, previous mental disorders or BZDR use were associated with SUD diagnosis among individuals with LTOU.

BACKGROUND:Epidemiological surveys have monitored chronic non-cancer pain (CNCP) and investigated associated factors in Denmark for more than 20 years. This study aimed to analyse CNCP prevalence in the Danish population from 2000 to 2023 and its associations with mental health status and loneliness. METHODS:Population-based surveys were conducted between 2000 and 2023. In all waves, residents aged ≥ 16 years were randomly selected to complete a self-administered questionnaire. Samples included 10,089 respondents in 2000, 5292 in 2005, 14,330 in 2010, 13,429 in 2013, 13,050 in 2017, 10,384 in 2021 and 9303 in 2023. CNCP was defined as pain lasting ≥ 6 months. Mental status was assessed by Mental Component Summary score of Short Form-12 and severe loneliness by the Three-Item Loneliness Scale. Calibration weighting was applied to reduce potential non-response bias. RESULTS:The prevalence of CNCP increased steadily by 9.4 percentage points from 2000 (19.5%) to 2023 (28.9%), but with a downward tick during the COVID-19 pandemic in 2021 (25.3%). Women aged 45 years or older had the highest prevalence in all waves. Results showed a worsening of mental health over time in both individuals with and without CNCP; however, the lowest scores were reported by individuals with CNCP. Severe loneliness seemed to be a substantial problem in individuals with CNCP (17.3% in 2021). CONCLUSIONS:In summary, CNCP was highly prevalent over the given period and associated with mental health status and severe loneliness in recent years. SIGNIFICANCE:This study demonstrated alarming trend on chronic non-cancer pain prevalence over time in Denmark. The high estimates of prevalence and related issues, such as mental health and severe loneliness deserve further investigation and prioritisation in the public health agenda.

ObjectiveLimited research exists on how preexisting comorbidities impact retention in opioid agonist treatment (OAT). This study aimed to (1) describe OAT retention and participation, and (2) examine the association of preexisting comorbidities and other patient characteristics with 24-month retention.MethodsThis registry-based nationwide cohort study used linked health records of 1,553 individuals newly initiating OAT in the Czech Republic between 2011 and 2017. Logistic regression assessed the relationship between mental disorders, hepatitis C (HCV), Charlson Comorbidity Index (CCI), age, sex, and type of OAT medication and retention.ResultsAt 24-month follow-up, less than half of patients (44.9% of men and 47.0% of women) remained in continuous treatment. Interrupted treatment occurred in 11.0% of men and 13.2% of women, while 42.0% and 39.4%, respectively, discontinued after a single episode. The mean treatment duration was 489 +/- 272 days for men and 498 +/- 273 days for women, corresponding to mean participation of 67.0% and 68.2%, respectively. Methadone use was associated with lower retention compared with buprenorphine (aOR = 0.46, 95% CI = 0.35-0.62). Higher CCI (OR = 0.85, 0.76-0.94) and HCV (OR = 0.67, 0.53-0.86) were associated with lower retention in crude models, but lost significance after adjustment. Other comorbidities had no effect on OAT retention.ConclusionsPreexisting mental and physical comorbidities did not significantly affect OAT retention, though their high prevalence warrants clinical attention. Lower retention among patients receiving methadone raises public health, clinical, and ethical concerns regarding restrictive OAT regimes in the Czech Republic.

AIMS:Monitoring opioid prescribing across different healthcare systems is essential to understanding population-level exposure and informing global health policies. This study examined opioid utilization in Scandinavian countries between 2010 and 2023 using multiple complementary metrics, addressing the limitations of single-metric comparisons. METHODS:A repeated cross-sectional study utilizing publicly available drug use statistics on opioid analgesics (ATC group N02A) dispensed in pharmacies from Denmark, Norway and Sweden. We assessed annual changes in utilization based on four metrics: 1-year prevalence (users/1000 inhabitants/year), defined daily doses (DDD)/1000 inhabitants/day (TID), morphine milligram equivalents (MMEs)/TID, and MMEs/user/year. RESULTS:Opioid use declined in Denmark and Sweden-in both 1-year user prevalence and volumes of MMEs-while stabilizing in Norway. Norway consistently had a higher and stable prevalence of opioid users. Denmark led in total amounts of MMEs dispensed, likely due to more frequent morphine and oxycodone use, whereas Norway ranked highest in DDDs. Denmark and Sweden showed increasing preference for "strong opioids", while codeine-paracetamol and tramadol remained predominant in Norway. The prevalence of oxycodone users increased in Norway and Sweden, with Sweden having the highest prevalence of users but the lowest annual average volumes per user. CONCLUSIONS:This study found major differences in total opioid use and substance-specific prescribing patterns, reflecting diverse pain management strategies across Scandinavia. Changing use patterns suggest evolving prescribing strategies and possible shifts in the target group for opioid pain therapy. In addition, metric-dependent variation underscores the need for using multiple complementary metrics to accurately interpret opioid utilization trends.

OBJECTIVES:Chronic pain represents a major public health challenge, substantially affecting daily functioning and overall well-being. While self-management strategies can be effective, they are often introduced only after pharmacological or surgical treatments have proven insufficient, highlighting the need for more personalized, accessible, and early interventions in primary care. However, the feasibility and practical implementation of such approaches remain insufficiently explored. Considering these challenges, the aims of this study were to co-create and to evaluate the feasibility of a personalized, multidisciplinary, and coordinated intervention for chronic pain management within municipal healthcare services. METHODS:The intervention included a generic pain management course (part one) and a personalized second part offering various group-based courses. Participants (n = 70) were recruited through an orthopedic outpatient clinic and general practitioners. Individual consultations with course leaders were conducted before, during, and after the intervention. Questionnaires assessing health-related quality of life, alcohol consumption, medication use, and sleep were administered at baseline, midway, and post-intervention, along with a self-reported evaluation of the intervention after completion. RESULTS:Among the total participants (n = 70), 81% completed Part 1 of the intervention, while 61% completed the entire intervention. At baseline, participants had a mean EQ-5D-5L score of 0.65 and an EQ-VAS score of 48.8. Regarding alcohol use, 47% were drinking once a month or less, and no participants were drinking alcohol four or more times a week. Insomnia was reported by 84%. Paracetamol was the most used daily medication (41%), followed by non-steroidal anti-inflammatory drugs and weak opioids (26% each). In Part 2 of the intervention, stress management courses were the most frequently selected (26%), followed closely by physical activity and body-mind activity at 23%. Most participants reported benefit, with 63% (Part 1) and 56% (Part 2) indicating good or very good benefit, and 98% would recommend it to others. CONCLUSION:This feasibility study demonstrates the potential for addressing the complex needs of individuals with chronic pain through a personalized and multidisciplinary intervention in primary care. The high completion rates indicate feasibility and acceptability. The findings support further evaluation of resource use, implementation, and effectiveness in future controlled trials.

Persistent use of high-dose opioids increases the risk of overdose, particularly when used in combination with other sedatives. The aim of the study was to examine the number of people with persistent use of high-dose opioids in 2011 and 2019, the proportion who received the opioids on a 'blue prescription' (heavily subsidised prescription) and the proportion with concurrent persistent use of benzodiazepines and z-hypnotics. Persistent use of high-dose opioids was defined as the dispensing of more than two defined daily doses or 50 mg of oral morphine equivalents of opioids per day, in at least three out of four quarters. Data from 2011 and 2019 were obtained from the Norwegian Prescription Database. In 2011 and 2019, a total of 7010 (142 per 100,000 population) and 12,199 patients (228 per 100,000 population), respectively, were given high-dose opioids for persistent use. In 2011, 31 % of these patients received at least one opioid blue prescription; in 2019, the proportion was 51 %. In 2011, 45 % of patients receiving high-dose opioids for persistent use also received over 100 defined daily doses of benzodiazepines, and 35 % received over 100 defined daily doses of z-hypnotics. The corresponding figures for 2019 were 30 % and 32 %. The proportion of the population receiving high-dose opioids for persistent use was higher in 2019 than in 2011.

The aim was to estimate all-cause and cause-specific mortality in long-term prescription opioid users compared to the general population. This nationwide registry–based cohort study used data of patients aged 15 to 69 years with no previous cancer diagnosis and a recorded episode of long-term opioid analgesics use (anatomical therapeutic chemical [ATC] group N02A; N = 116,006) in Norway between 2011 and 2019. Sex-specific crude mortality rates (CMR) and age-standardized mortality ratios (SMRs) were calculated for all-cause and cause-specific mortality, ie, natural and unnatural causes for the whole study population and for different age groups (15-34, 35-54, and 55-69 years). Overall, 4.6% (2491/54,535) of men and 2.7% (1680/61,471) of women died during the follow-up period. Crude mortality rates for all-cause mortality were 1194 and 724 deaths per 100,000 person-years (PY) in men and women, respectively. Men had higher CMRs across all causes, particularly unnatural causes (221 and 101 deaths per 100,000 PY in men and women, respectively). Patients with long-term opioid use had a 4 times higher all-cause mortality (SMR = 3.8 [95% CI = 3.6-3.9] in men and 3.7 [3.5-3.9] in women aged 15-69 years) compared to the general Norwegian population of the same age. Excess mortality was observed across all causes, particularly suicide, accidents, and accidental poisoning. Standardized mortality ratios decreased with age and were highest for the youngest age group (15-34 years), particularly among men. Long-term prescription opioid use is associated with an increased risk of death. Clinicians should weigh the risks of long-term opioid use against the benefits.

BACKGROUND:Increasing oxycodone prescribing and its association with opioid-related harms have raised concerns. In Norway, nearly 90% of opioids are prescribed in primary care, making primary care decisions important to overall opioid exposure. In-hospital use may influence primary care practices through several mechanisms. This study analyses oxycodone and morphine use in Norwegian hospitals and its association with primary care prescribing from 2010 to 2021, alongside a review of tender agreements for these medications. METHODS:Morphine and oxycodone, available in all relevant formulations, served as opioid proxies to compare covariation between hospitals and their catchment areas. We analyzed 2010-2021 procurement data from hospital pharmacies and primary care dispensing data from the Norwegian Prescription Database for all hospital trusts. Correlations between hospital and primary care morphine-to-oxycodone prescribing ratios were assessed using Pearson's r. Annual tender agreements were obtained from the national Hospital Procurement Organization. RESULTS:Hospital oxycodone use increased by 67.0% and primary care prescribing rose by 86.5%. Morphine use increased by 12.6% in hospitals but decreased by 23.2% in primary care. A moderate covariation (Pearson's r = 0.48) between hospital use and primary care prescribing was observed. Hospital tender agreements for morphine declined by 80%, while those for oxycodone remained stable. CONCLUSIONS:Oxycodone use substantially increased relative to morphine in Norwegian hospitals and primary care. Prescription patterns show moderate covariation, suggesting a potential link between hospital and primary care prescribing, though causality remains uncertain. Tender agreements may contribute to prescribing trends in hospitals, with possible associations in primary care. SIGNIFICANCE:This study is the first to provide quantitative evidence of covariation between in-hospital use and primary care opioid prescribing across a national healthcare system. Despite recommendations favoring morphine, oxycodone prescribing continues to rise in Norway, with marked geographical variation. By linking procurement data, prescription patterns and tender agreements, our findings highlight the need to consider hospital practices and structural factors when addressing opioid prescribing. These results offer new insights into potential levers for opioid stewardship across care levels.

Background:Persistent use of high-dose opioids increases the risk of overdose, particularly when used in combination with other sedatives. The aim of the study was to examine the number of people with persistent use of high-dose opioids in 2011 and 2019, the proportion who received the opioids on a 'blue prescription' (heavily subsidised prescription) and the proportion with concurrent persistent use of benzodiazepines and z-hypnotics. Material and method:Persistent use of high-dose opioids was defined as the dispensing of more than two defined daily doses or 50 mg of oral morphine equivalents of opioids per day, in at least three out of four quarters. Data from 2011 and 2019 were obtained from the Norwegian Prescription Database. Results:In 2011 and 2019, a total of 7010 (142 per 100,000 population) and 12,199 patients (228 per 100,000 population), respectively, were given high-dose opioids for persistent use. In 2011, 31 % of these patients received at least one opioid blue prescription; in 2019, the proportion was 51 %. In 2011, 45 % of patients receiving high-dose opioids for persistent use also received over 100 defined daily doses of benzodiazepines, and 35 % received over 100 defined daily doses of z-hypnotics. The corresponding figures for 2019 were 30 % and 32 %. Interpretation:The proportion of the population receiving high-dose opioids for persistent use was higher in 2019 than in 2011.

Little is known about the overall trends in postoperative opioid use in a Nordic setting. We investigated the trends in Norway between 2011 and 2018. We linked the Norwegian Prescription Database, the Norwegian Patient Registry, the Cancer Registry of Norway and the Cause of Death Registry. Postoperative opioid use was defined as the first opioid dispensing per year within 14 days of a NOMESCO Classification of Surgical Procedure code. We excluded patients with cancer or opioid maintenance therapy. We calculated period prevalence (Norwegian population ≥ 15 years as the denominator), substance distribution, initial amount and proportion of long-acting formulations. Among 746 435 postoperative opioid users ≥ 15 years, the period prevalence increased from 27.0/1000 in 2011 to 30.0/1000 in 2018 (long-term use: 2.0 to 3.3/1000). Codeine was most frequent (67%) in 2011, while codeine and tramadol were equally dispensed (41% and 43%) in 2018; oxycodone increased from 3% to 12%. The initial amount increased for opioids as a group but declined for oxycodone (1236 morphine milligram equivalents [MME]/patient to 914 MME/patient) and tramadol (233 MME/patient to 219 MME/patient). Long-acting depot formulations increased from 5% to 12%. Over time, postoperative opioid use increased, with a shift toward more tramadol and oxycodone in lower initial amounts, and increased use of long-acting formulations.

Pharmaceutical opioids significantly contribute to overdose deaths in Norway. This study investigated the prevalence of prescriptions and examined characteristics of those with filled prescriptions, comparing them to individuals without prescriptions. This cohort study encompassed overdose deaths from 1.1.2005 to 31.12.2021, using toxicology and data linkage from nationwide health registries. Approximately 90

Aims: We aimed to investigate the association between being an immigrant and long-term prescription opioid use in Norway in 2010–2019. Methods: Nested case–control study. The cases were all persons 18 years of age or older with long-term opioid use – that is, the use of prescription opioids longer than 3 months ( N=215,642). Cases were matched to four controls who filled at least one opioid prescription, but never developed long-term opioid use in the study period ( N=862,568) on sex, age and year of starting long-term/short-term opioid use. Being an immigrant was defined as being born outside of Norway to two foreign-born parents and four foreign-born grandparents. Adjusting for socioeconomic variables and clinical confounders, analyses were stratified on three age groups (18-44 years, 45-67 years and ⩾68 years). Results: For the youngest age group, being an immigrant was inversely associated with long-term opioid use (adjusted odds ratio 0.75; 95% confidence interval [0.72–0.77]) compared with being native-born people. For this age group, the odds ratio differed between people born in Africa (0.56 [0.52–0.62]), Central or South America (0.70 [0.62–0.79]), Europe outside the European Union (EU) (0.71 [0.65–0.77]), Asia including Turkey (0.80 [0.77–0.84]) and EU/European Economic Area (EEA) (0.81 [0.77–0.85]). For the middle age group, increased odds were found for immigrants versus natives (1.05 [1.02–1.08]) in particular for those born in North America (1.26 [1.13–1.40]) and the EU/EEA (1.13 [1.09–1.18]). There was no association in the oldest group. Conclusions: Compared with native-born people, immigrants had lower odds of long-term opioid use among younger adults, higher odds among middle-aged and similar odds among older adults.

We have previously shown that the use of hypnotic drugs increased among young Scandinavians during 2012–2018. This study aimed to explore psychiatric and somatic morbidity among adolescent hypnotic drug users in a cohort study of 13–17-year-old individuals during 2008–2018 in Norway. Data sources were (i) prescription data from the Norwegian Prescription Database linked to specialist health care diagnoses from the Norwegian Patient Registry and (ii) sleep disorder diagnoses from the Primary Health Care Database. Hypnotic drugs were defined as the sedative antihistamine alimemazine and the ATC group “Hypnotics and Sedatives” (N05C), excluding midazolam. In 2017, 2519 girls (16.5/1000) and 1718 boys (10.7/1000) were incident (new) users of hypnotic drugs. Most of these new users (82% of girls, 77% of boys) were referred to secondary health care, where the most frequent diagnoses were mental and behavioral disorders (51.8% of girls, 46.2% of boys), while only 3.2% received a specific sleep disorder diagnosis. The most common mental and behavioral disorders were “Neurotic stress-related disorders” among girls (27.4%) and “Behavioral and emotional disorders” among boys (23.6%). In conclusion, the trend of increasing hypnotic drug use among adolescents reflects the initiation of hypnotic drugs in a subgroup of the population with a higher disease burden, mainly due to psychiatric disorders, than the general population.

29.01.2024: Originalartikkel - Forekomst av diagnostiserte psykiske lidelser og plager blant pasienter med vedvarende opioidbehandling av langvarige ikke-kreftrelaterte smerter i 2019 var høyest i den yngste aldersgruppen (18–44 år) og blant dem som fikk opioider utelukkende på hvit resept.

BackgroundThe utilization patterns of opioid analgesics and the proportion of long-term opioid use after surgery in Norway is largely unknown.MethodsThis study aimed to estimate the proportion of one-year long-term prescription opioid use among all Norwegian postoperative opioid users. Complete data from central health registries (NPR, NorPD, Statistics Norway, CoDR) were linked via the personal identification number unique to all citizens. The study period was January 1st 2010 until December 31st 2019. Long-term opioid use was defined as at least two opioid dispensings within two subsequent 90-day periods, with a minimum average use of 10 MME/day for the first 90 days.ResultsThe study population consisted of 693 495 post-operative opioid users (53.6% women), whereof 73.2% had not used opioids the year before surgery (new users). Among the postoperative opioid users, 3.8% were one-year long-term opioid users. The corresponding figures for new and previous opioid users were 0.4% and 13.1%, respectively. The highest proportions of long-term opioid use were found after transluminal endoscopy, eye surgery and assessments related to surgical procedures. In previous opioid users, the proportion of one-year long-term use was higher among women than men in all age groups, a difference that increased with age.ConclusionsThe proportion of postoperative long-term opioid use in Norway is generally low. We detected higher proportions of long-term opioid use after certain types of surgery, but our crude surgery definition warrants further examination. Previous opioid users pose a particular challenge in the management of postoperative pain.Trial registrationThe study used national health registry data from the period 2010-2019. A pre-registered analysis plan is available at Open Science Framework.