A woman in her forties who used addictive drugs in very high doses. / En kvinne i 40-årene som brukte vanedannende legemidler i svært høye doser.

BACKGROUND: Following a surgical procedure, a female patient in her forties was prescribed opioids (oxycodone). The prescription escalated into doses that were extremely high, and at a level beyond any experienced previously, either at the various hospital units that were involved in the treatment or in the medical literature. CASE PRESENTATION: The patient had no known history of substance abuse. After the surgical procedure, her general practitioner continued to prescribe the drug. The prescriptions escalated over the course of a couple of years, and at the time of our first contact with her, the doses had reached 11 000 mg oxycodone per day. INTERPRETATION: The high doses were tapered down over the course of around nine months. The spiralling prescriptions had several causes: the oxycodone treatment was initiated without a set plan for withdrawal; the patient had a change of general practitioner during the early stage; and she was a patient without any history of substance abuse. The costs escalated to the extent that the Norwegian Health Economics Administration eventually refused further payments. In such cases there is a need for close cooperation between the inpatient drug rehabilitation care unit and medical and pharmacological units.

Use of drugs for alcohol use disorder in Norway 2004­16. / Bruk av medikamenter for alkoholbrukslidelser i Norge 2004­16.

BACKGROUND: Alcohol use disorder can lead to serious illness and early death. The lifetime prevalence rate among the Norwegian population is estimated at 7-10 %. Many patients are never admitted to any kind of treatment programme, and it is assumed that few of those who are treated receive medicinal treatment. There are a variety of drugs on the market that can help reduce alcohol consumption and maintain abstinence. We wanted to gain an insight into the prescription prevalence rate and practice for these drugs. MATERIAL AND METHOD: We obtained encrypted data from the Norwegian Prescription Database of everyone who received drugs for alcohol use disorder in the period 2004-2016. The drugs included were disulfiram, acamprosate, naltrexone 50 mg and nalmefene. RESULTS: The annual prescription prevalence rate increased from 0.85 to 1.13 per 1000 during the observation period. Half of all patients only received prescribed drugs once, and Disulfiram was the most commonly prescribed drug. There was a slight increase in the prevalence rate in age groups up to and including 55 years, and a significant increase for the over-55s. CONCLUSION: There was a slight increase in the prescription prevalence rate during the observation period. Disulfiram was the most commonly prescribed drug. The prescription increase was greatest among women and in the group of over-55s.

Repeated acetylcholine receptor antibody-concentrations and association to clinical myasthenia gravis development.

INTRODUCTION: We aimed to examine the longitudinal association between Myasthenia Gravis (MG) clinical severity and concentration of acetylcholine receptor (AChR)-antibodies to evaluate if AChR-antibody variations correlate to disease severity. A positive AChR-antibody test is specific for MG. MATERIAL AND METHODS: All patients from western Norway who had two or more AChR- antibody tests in the period 1983-2013 were identified. The Myasthenia Gravis Foundation of America (MGFA) Clinical Classification was used to grade disease development. Multiple ordinal logistic regression analysis was used to estimate a possible predictive effect for AChR-antibody concentration on MGFA classification result. RESULTS: In 67 patients two or more AChR-antibody tests with a corresponding MGFA-score were performed, with a total of 309 tests. 56 patients were treated with immunosuppressive drugs and 11 by pyridostigmine only. There was a positive association between concentration of AChR-antibodies and longitudinal MGFA-score for the subgroup with immunosuppressive treatment, but not for those treated with pyridostigmine only. This association between AChR-antibody concentration and MGFA score declined with increasing time since onset (p = 0.005 for the interaction of group×time×concentration). CONCLUSIONS: For MG patients with immunosuppressive treatment, repeated AChR-antibody measurements give information about clinical development, and can therefore be of support in therapeutic decisions.

Geographical distribution of a seropositive myasthenia gravis population.

INTRODUCTION: To assess age- and sex-specific myasthenia gravis (MG) occurrence and incidence in the different geographical regions in Norway and thereby to identify factors that may contribute to the development of MG. METHODS: Multiple Poisson regression analysis was used to assess variation in incidence dependent on year, gender and onset age in five geographically defined health regions. RESULTS: The study population comprised 419 individuals with first time seropositive tests from 1995 to 2007. Annual MG incidence ranged from < 1 to 14 per million, with an average of 7.04 per million for all five health regions combined. CONCLUSIONS: This is the first nation-wide epidemiological study of seropositive MG that elucidates the geographical differences within a country. The incidence of seropositive MG did not vary significantly between the regions. Mid-Norway tended to have a higher incidence, and North tended to have a lower incidence.