Drug overdoses

Problematic use of alcohol and psychoactive substances increases the risk of early death and reduced disability-adjusted life years. In Norway, there were 241 overdose deaths in 2021. The average yearly number between 2010 and 2021 was around 260, with a death rate of 5.2 per 100,000. Opioids, drugs which resemble morphine, are responsible for 80–90% of overdose deaths, and in the United States of America, there were almost 50 000 opioid overdose deaths in 2019—more than twice as many as there were in 2010. The majority of these fatalities involve fentanyl and its equivalents.

Our research data on overdose deaths is largely based on the combination of data from the Norwegian Cause of Death Registry (NoCDR) and the forensic toxicology database of Oslo University Hospital from autopsy cases, and it provides information about the cause of death as well as drug findings in biological samples taken at autopsy. We can identify which drugs led to the poisoning and death by combining these registries. Because poly-drug usage is common in such cases, identifying the precise drug responsible/contributing to mortality is critical. Because the NoCDR does not provide cause of death codes for all individual drugs, but rather so-called aggregated codes in the vast majority of instances, comprehensive information is provided alongside the forensic toxicological data. Forensic toxicological results in addition to the cause of death are crucial in order to examine the trends of certain drugs over time. From the standpoint of prevention, understanding the drugs that contribute to lethal overdoses is crucial.

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

To determine which drugs were involved in drug-related deaths in Norway, with an emphasis on how prevalence changed for 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

Overdoses in the Nordic Countries in 2022

The aim of this project is to evaluate fatal poisoning in drug addicts in the Nordic countries (Denmark, Norway, Finland, Sweden and Iceland) in 2022.
Changes in the individual countries compared to earlier years as well as similarities/differences between the countries will be investigated. Focus will be put on new drugs i.e. designer drugs, tramadol plus treatment of drug addicts.

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
Opioid related deaths 2000-2019
MDMA related deaths
Non-fatal overdoses

Project members

Hilde Marie Erøy Edvardsen (Group leader, PhD)
Stig Tore Bogstrand (Professor, Head of Research, PhD)
Armika Nyman (Scientist, MSc. Pharm.)
Gudrun Høiseth (Head of Research, MD, PhD)
Ragnhild Gjulem Jamt (Scientist, PhD)

Past members

Vigdis Vindenes (MD, PhD)
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) at the Department of Forensic Sciences, Section of Drug Abuse Research, Oslo University Hospital, Oslo, Norway.

Publications

Edvardsen HME, Aamodt C, Bogstrand ST, Krajci P, Vindenes V, Rognli EB (2022)
Concentrations of psychoactive substances in blood samples from non-fatal and fatal opioid overdoses
Br J Clin Pharmacol, 88 (10), 4494-4504
DOI 10.1111/bcp.15365, PubMed 35470456

Jamt REG, Edvardsen HME, Middelkoop G, Kallevik AS, Bogstrand ST, Vevelstad MS, Vindenes V (2022)
Deaths associated with MDMA in the period 2000-2019
Tidsskr Nor Laegeforen, 142 (8)
DOI 10.4045/tidsskr.21.0547, PubMed 35635429

Edvardsen HME, Clausen T (2022)
Opioid related deaths in Norway in 2000-2019
Drug Alcohol Depend, 232, 109281
DOI 10.1016/j.drugalcdep.2022.109281, PubMed 35042099

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