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Dispensation of attention deficit hyperactivity disorder (ADHD) medications in patients receiving opioid agonist therapy; a national prospective cohort study in Norway from 2015 to 2017.

https://arctichealth.org/en/permalink/ahliterature306590
Source
BMC Psychiatry. 2020 03 12; 20(1):119
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
03-12-2020
Author
Jørn Henrik Vold
Christer Aas
Svetlana Skurtveit
Ingvild Odsbu
Fatemeh Chalabianloo
Anne Halmøy
Kjell Arne Johansson
Lars Thore Fadnes
Author Affiliation
Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway. jorn.vold@uib.no.
Source
BMC Psychiatry. 2020 03 12; 20(1):119
Date
03-12-2020
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adult
Analgesics, Opioid - administration & dosage - agonists - therapeutic use
Antiviral Agents - administration & dosage - therapeutic use
Attention Deficit Disorder with Hyperactivity - drug therapy
Female
Hepatitis C, Chronic - drug therapy
Humans
Male
Middle Aged
Norway
Prospective Studies
Abstract
It is estimated that up to a third of patients on opioid agonist therapy (OAT) have attention deficit hyperactivity disorder (ADHD). Treatment by ADHD medication, including a centrally acting stimulant (CAS) or atomoxetine is one of the essential approaches. This study evaluates the use of dispensed ADHD medications in the Norwegian OAT population in the period from 2015 to 2017. Types and doses of ADHD medications, co-dispensations of other potentially addictive drugs like benzodiazepines, z-hypnotics, gabapentinoids, and non-OAT opioids, as well as direct-acting antivirals (DAA) against hepatitis C infection, are investigated.
Information about all dispensed ADHD medication, OAT opioids, and the defined potentially addictive drugs were recorded from the Norwegian Prescription Database. Dispensation rates, the types, and the doses of dispensed ADHD medications were estimated by summarizing the number of dispensations, and the dispensed doses. Logistic regression analyses were employed to assess the associations between ADHD medication, and OAT opioid use, and dispensations of other potentially addictive drugs and DAAs against hepatitis C infection.
A total of 9235 OAT patients were included. The proportion of patients who were dispensed ADHD medication increased from 3.5 to 4.6% throughout the study period. The three most dispensed CAS were short- and intermediate-acting methylphenidate (55%), lisdexamphetamine (24%), and dexamphetamine (17%) in 2017. Buprenorphine, rather than methadone, as OAT opioid (adjusted odds ratio: 1.6, CI: 1.2-2.1) was associated with being dispensed ADHD medication. Among patients who received CAS and OAT opioids each calendar year, the dispensed doses of methylphenidate increased from 63?mg/day in 2015 to 76?mg/day in 2017 (p?=?0.01). Sixty percent of patients receiving ADHD medications were also dispensed other addictive drugs concomitantly in 2017. Similar results were found in 2015 and 2016.
Co-prescription of ADHD medications was low among patients on OAT in Norway, considering a high prevalence of ADHD in this patient group. On the other hand, concurrent dispensations of multiple addictive drugs were common in this population. Understanding the underlying reasons for such prescribing is essential, and research on how to optimize ADHD medication of patients with ADHD receiving OAT is needed.
PubMed ID
32164615 View in PubMed
Less detail

Dispensations of benzodiazepines, z-hypnotics, and gabapentinoids to patients receiving opioid agonist therapy; a prospective cohort study in Norway from 2013 to 2017.

https://arctichealth.org/en/permalink/ahliterature306112
Source
BMC Health Serv Res. 2020 Apr 25; 20(1):352
Publication Type
Journal Article
Date
Apr-25-2020
Author
Jørn Henrik Vold
Svetlana Skurtveit
Christer Aas
Fatemeh Chalabianloo
Pia Synnøve Kloster
Kjell Arne Johansson
Lars Thore Fadnes
Author Affiliation
Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway. jorn.vold@uib.no.
Source
BMC Health Serv Res. 2020 Apr 25; 20(1):352
Date
Apr-25-2020
Language
English
Publication Type
Journal Article
Keywords
Adult
Analgesics, Opioid - therapeutic use
Benzodiazepines - therapeutic use
Databases, Factual
Drug Prescriptions - statistics & numerical data
Female
Gabapentin - therapeutic use
Humans
Hypnotics and Sedatives - therapeutic use
Male
Middle Aged
Norway - epidemiology
Prospective Studies
Abstract
Dispensations of benzodiazepines, z-hypnotics, and gabapentinoids to patients on opioid agonist therapy (OAT) are common and have pros and cons. The objectives of the current study are to define the dispensation rates of these potentially addictive drugs, and whether the number and the mean daily doses of dispensed OAT opioids and discontinuing OAT, are associated with being dispensed benzodiazepines, z-hypnotics and gabapentinoids among patients on OAT in Norway in the period 2013 to 2017.
Information about all dispensed opioids, benzodiazepines, z-hypnotics and gabapentinoids were recorded from the Norwegian Prescription Database (NorPD). A total of 10,371 OAT patients were included in the study period. The dispensation rates were defined as the number of patients who were dispensed at least one of the potentially addictive drugs divided among the number of patients who have dispensed an OAT opioid per calendar year. Mean daily doses were calculated, and for benzodiazepines and z-hypnotics, stated in diazepam equivalents. The association between dispensed potentially addictive drugs, and the number and the type of dispensed OAT opioids were calculated by using logistic regression models.
Half of the OAT patients received at least one dispensation of a benzodiazepine or z-hypnotic, and 11% were dispensed at least a gabapentinoid in 2017. For dispensed benzodiazepines or z-hypnotics, the mean daily dose was reduced from 21?mg (95% confidence interval (CI): 20-23) diazepam equivalents in 2013 to 17?mg (95% CI: 16-17) in 2017. The mean daily dose of pregabalin increased from 365?mg (95% CI: 309-421) in 2013 to 386?mg (95% CI: 349-423) in 2017. Being dispensed a gabapentinoid (adjusted odds ratio (aOR)?=?2.5, 95% CI: 2.1-3.0) or a non-OAT opioid (aOR?=?3.0, 95% CI: 2.6-3.5) was associated with being dispensed a benzodiazepine or z-hypnotic. Discontinuing OAT did not affect the number of dispensations and the doses of potentially addictive drugs.
The dispensation rates of potentially addictive drugs are high in the OAT population. Treatment indications, as well as requirements for prescription authority, need to be debated and made explicit. Randomized controlled trials evaluating the benefits and risks of such co-prescription are required.
PubMed ID
32334602 View in PubMed
Less detail

Implementation of the 2013 amended Patients' Rights Act in Norway: Clinical priority guidelines and access to specialised health care.

https://arctichealth.org/en/permalink/ahliterature287255
Source
Health Policy. 2017 Apr;121(4):346-353
Publication Type
Article
Date
Apr-2017
Author
Kjell Arne Johansson
Elizabeth Nygaard
Berit Herlofsen
Frode Lindemark
Source
Health Policy. 2017 Apr;121(4):346-353
Date
Apr-2017
Language
English
Publication Type
Article
Keywords
Cost-Benefit Analysis
Health Policy
Health Priorities - standards
Health Services Accessibility - standards
Hospitals
Humans
Norway
Patient Rights - legislation & jurisprudence
Specialization - standards
Waiting Lists
Abstract
In 2013, the Norwegian Patient Rights' Act was amended in order to simplify the priority setting process for specialized elective health care and to improve access to care. As a result of the amendment, priority for treatment is now determined by only two criteria: 1) clinical effectiveness; and 2) cost-effectiveness of the intervention. There are 33 clinical priority-setting guidelines organised by medical specialty, which help hospitals evaluate whether individual patients have a right to access care. Following the amendment of the Patient Rights' Act, these guidelines had to be revised in order to assure coherence with the new legislation. The revised guidelines define and score a total of 556 condition-intervention pairs, and will give all patients who are evaluated as having a need for specialist elective healthcare the right to access these services. This is different from the old guidelines, where patients could be evaluated as having a need but no right for treatment. According to the new guidelines, a much larger share of patients will be granted a right to necessary specialist healthcare service (93% of condition-intervention pairs versus 77% of condition-intervention pairs in the old guidelines). One reason for this is that the severity of the condition is no longer considered as part of the evaluation process, which means that patients with low levels of severity now have a right to receive treatment. In addition, a new "don't do" list of 40 conditions was created, which may prevent unnecessary treatment.
PubMed ID
28222905 View in PubMed
Less detail

Integrated treatment of hepatitis C virus infection among people who inject drugs: study protocol for a randomised controlled trial (INTRO-HCV).

https://arctichealth.org/en/permalink/ahliterature308263
Source
BMC Infect Dis. 2019 Nov 08; 19(1):943
Publication Type
Journal Article
Multicenter Study
Randomized Controlled Trial
Date
Nov-08-2019
Author
Lars T Fadnes
Christer Frode Aas
Jørn Henrik Vold
Christian Ohldieck
Rafael Alexander Leiva
Fatemeh Chalabianloo
Svetlana Skurtveit
Ole Jørgen Lygren
Olav Dalgård
Peter Vickerman
Håvard Midgard
Else-Marie Løberg
Kjell Arne Johansson
Author Affiliation
Bergen Addiction Research Group, Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway. lars.fadnes@uib.no.
Source
BMC Infect Dis. 2019 Nov 08; 19(1):943
Date
Nov-08-2019
Language
English
Publication Type
Journal Article
Multicenter Study
Randomized Controlled Trial
Keywords
Aftercare
Antiviral agents - therapeutic use
Cost-Benefit Analysis
Counseling
Delivery of Health Care, Integrated - methods
Female
Hepacivirus - genetics
Hepatitis C - drug therapy - etiology
Humans
Male
Norway
Opiate Substitution Treatment
Polymerase Chain Reaction
Quality of Life
Recurrence
Substance Abuse, Intravenous - complications - drug therapy
Sustained Virologic Response
Treatment Adherence and Compliance
Abstract
A large proportion of people who inject drugs (PWID) living with hepatitis C virus (HCV) infection have not been treated. It is unknown whether inclusion of HCV diagnostics and treatment into integrated substance use disorder treatment and care clinics will improve uptake and outcome of HCV treatment in PWID. The aim is to assess the efficacy of integrating HCV treatment to PWID and this paper will present the protocol for an ongoing trial.
INTRO-HCV is a multicentre, randomised controlled clinical trial that will compare the efficacy of integrated treatment of HCV in PWID with the current standard treatment. Integrated treatment includes testing for HCV, assessing liver fibrosis with transient elastography, counselling, treatment delivery, follow-up and evaluation provided by integrated substance use disorder treatment and care clinics. Most of these clinics for PWID provide opioid agonist therapy while some clinics provide low-threshold care without opioid agonist therapy. Standard care involves referral to further diagnostics, treatment and treatment follow-up given in a hospital outpatient clinic with equivalent medications. The differences between the delivery platforms in the two trial arms involve use of a drop-in approach rather than specific appointment times, no need for additional travelling, less blood samples taken during treatment, and treatment given from already known clinicians. The trial will recruit approximately 200 HCV infected individuals in Bergen and Stavanger, Norway. The primary outcomes are time to treatment initiation and sustained virologic response, defined as undetectable HCV RNA 12?weeks after end of treatment. Secondary outcomes are cost-effectiveness, treatment adherence, changes in quality of life, fatigue and psychological well-being, changes in drug use, infection related risk behaviour, and risk of reinfection. The target group is PWID with HCV diagnosed receiving treatment and care within clinics for PWID.
This study will inform on the effects of an integrated treatment program for HCV in clinics for PWID compared to standard care aiming to increase access to treatment and improving treatment adherence. If the integrated treatment model is found to be safe and efficacious, it can be considered for further scale-up.
ClinicalTrials.gov.no. NCT03155906.
PubMed ID
31703669 View in PubMed
Less detail
Source
Tidsskr Nor Laegeforen. 2010 Aug 12;130(15):1448; author reply 1448
Publication Type
Article
Date
Aug-12-2010
Author
Kjell Arne Johansson
Ingrid Miljeteig
Source
Tidsskr Nor Laegeforen. 2010 Aug 12;130(15):1448; author reply 1448
Date
Aug-12-2010
Language
Norwegian
Geographic Location
Norway
Publication Type
Article
Keywords
Health Care Costs
Humans
Infant, Extremely Low Birth Weight
Infant, Newborn
Infant, Premature
Intensive Care, Neonatal - economics
Norway
Quality-Adjusted Life Years
Notes
RefSource: Tidsskr Nor Laegeforen. 2010 Jun 3;130(11):1130-4
PubMed ID
20706295 View in PubMed
Less detail

Peer involvement and cross-sector efforts in establishing integrated treatment of hepatitis C virus infection for people with substance use disorders: experiences from Norway.

https://arctichealth.org/en/permalink/ahliterature307575
Source
Subst Abuse Treat Prev Policy. 2019 12 21; 14(1):58
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
12-21-2019
Author
Ole Jørgen Lygren
Ronny Bjørnestad
Else-Marie Løberg
Martine Lepsøy Bonnier
Vibeke Bråthen Buljovcic
Kjell Arne Johansson
Lars T Fadnes
Author Affiliation
ProLAR Nett, Søgne, Norway.
Source
Subst Abuse Treat Prev Policy. 2019 12 21; 14(1):58
Date
12-21-2019
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Delivery of Health Care, Integrated
Hepatitis C - complications - therapy
Humans
Norway
Opioid-Related Disorders - complications - therapy
Peer Group
Substance Abuse Treatment Centers
Substance Abuse, Intravenous - complications - therapy
Abstract
For people with opioid dependence in Norway, chronic hepatitis C virus (HCV) infections contribute to high mortality and high morbidity. Around 50% of patients in medically assisted rehabilitation (MAR) have been shown to have HCV, and the current prevention and control efforts have been mostly unsuccessful. Thus, there is a need for new strategies for people-centred service delivery and innovative methods to improve health outcomes.
Over the last few years, the city of Bergen, Norway, has developed a cross-sector collaboration with substantial peer involvement in research and health provision related to substance use. User group representatives for people receiving MAR, addiction medicine health personnel, infectious disease specialists, policy makers in the municipality, low-threshold health care centres for people with substance use disorders in Bergen Municipality and researchers in the INTRO-HCV project have made concerted efforts in this regard. We will present here some of the strategies and steps we have taken.
We have established an integrated HCV treatment scheme for people who inject drugs or who have opioid dependence. More than 800 persons have been tested for HCV within these frames, and more than 250 persons have been given treatment for HCV within the project. The integrated treatment of HCV is offered both in MAR outpatient clinics, municipal low-threshold healthcare centres, and local and regional prisons. The preliminary results indicate an increase in HCV treatment uptake among those receiving integrated treatment (96% initiating treatment compared to 75%). The user group organisation ProLAR Nett has established an outreach service to screen for HCV, increase awareness and reduce the proportion of people unknowingly living with HCV while informing and motivating people to receive treatment. Together with the other stake holders, peer user group, health care, research planning, concert events, and policy panels have been held.
Peer involvement seems to have increased testing rates for HCV and acknowledgment of its importance. This seems to have improved health care for people with opioid dependence in Bergen over the last few years, particularly relating to the treatment of HCV. These experiences might be helpful in the planning of integrated policies in other settings that seek to eliminate the HCV endemic.
PubMed ID
31864396 View in PubMed
Less detail

Priority rules as solutions to conflicting health care rights.

https://arctichealth.org/en/permalink/ahliterature285749
Source
Med Health Care Philos. 2017 Mar;20(1):67-76
Publication Type
Article
Date
Mar-2017
Author
Anna-Karin Andersson
Frode Lindemark
Kjell Arne Johansson
Source
Med Health Care Philos. 2017 Mar;20(1):67-76
Date
Mar-2017
Language
English
Publication Type
Article
Keywords
Conflict (Psychology)
Health Policy - legislation & jurisprudence
Health Priorities - legislation & jurisprudence
Humans
Medicine
Negotiating
Norway
Patient Rights - legislation & jurisprudence
Abstract
Recent health legislation in Norway significantly increases access to specialist care within a legally binding time frame. The paper describes the contents of the new legislation and introduces some of the challenges with proliferations of rights to health care. The paper describes some of the challenges associated with the proliferation of legal rights to health care. It explains the benefits of assessing the new law in the light of a rights framework. It then analyses the problematic aspects of establishing additional priority rules as solutions to rights conflicts. It then defends adequacy criteria for acceptable priority rules when such rules are unavoidable. It finally defends our proposed method and explores concrete applications.
PubMed ID
27592208 View in PubMed
Less detail

Too much or too little opioids to patients receiving opioid agonist therapy in Norway (2013-2017): a prospective cohort study.

https://arctichealth.org/en/permalink/ahliterature305278
Source
BMC Health Serv Res. 2020 Jul 20; 20(1):668
Publication Type
Journal Article
Date
Jul-20-2020
Author
Jørn Henrik Vold
Svetlana Skurtveit
Christer Aas
Kjell Arne Johansson
Lars Thore Fadnes
Author Affiliation
Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway. jorn.vold@uib.no.
Source
BMC Health Serv Res. 2020 Jul 20; 20(1):668
Date
Jul-20-2020
Language
English
Publication Type
Journal Article
Keywords
Adult
Analgesics, Opioid - therapeutic use
Databases, Factual
Drug Prescriptions - statistics & numerical data
Female
Humans
Male
Middle Aged
Norway
Prospective Studies
Abstract
Dispensations of opioid analgesics to patients on opioid agonist therapy (OAT) may increase the risk of overdoses. The current study's objectives are to investigate the dispensation rates and mean daily doses of dispensed opioid analgesics among patients who received OAT opioids in Norway during 2013-2017 and evaluate whether discontinuing OAT opioids affects the dispensed dose of opioid analgesics.
Information on opioids was collected from the Norwegian Prescription Database. Dispensation rates were calculated by dividing the number of patients who were dispensed at least one opioid analgesic by the number of patients who were dispensed an OAT opioid. We calculated the mean daily dose of opioid analgesics in oral morphine equivalents. The OAT opioid dose was defined as a ratio between the dispensed doses divided by the mean recommended dose. We used logistic regression to estimate the association between the dispensation of an opioid analgesic, a dose of OAT opioids, having chronic pain, and being on palliative care.
A total of 10,371 patients were dispensed at least one OAT opioid during the study period. In 2017, 18% were dispensed an opioid analgesic with a mean daily dose of 29?mg of oral morphine equivalents. Being dispensed an opioid analgesic was associated with having chronic pain (adjusted odds ratio (aOR): 3.6, 95% confidence interval: 3.2-4.2), being on palliative care (aOR: 6.1, 4.7-7.9), and receiving an OAT opioid dose below half of the recommended OAT dose (aOR: 1.7, 1.4-2.0). Similar results were seen in 2013-2016. The discontinuation of OAT opioids could increase the dose of dispensed opioid analgesics.
Reducing the dispensation of opioid analgesics can be achieved by increasing the OAT opioid dose for patients on a low OAT dose, and by extending the period needed to taper off the OAT opioid dose at discontinuation.
PubMed ID
32690022 View in PubMed
Less detail

8 records – page 1 of 1.