[Treatment of acute pain during drug-assisted rehabilitation]. / Behandling av akutte smerter under legemiddelassistert rehabilitering.

Patients on drug-assisted rehabilitation have the same right to pain relief as others. Techniques that reduce the need for opioids should be used when possible in opioid-dependent individuals who need treatment of acute and post-operative pain. Substitution treatment should always be continued. In some situations a switch to a different opioid or route of administration is required. Higher doses of opioids than those needed in other patients may be required for analgesia. Well-designed clinical studies are lacking in this field.

[Toxicological screening of medicines and drugs of abuse in emergency cases]. / Legemiddel- og rusmiddelanalyser som øyeblikkelig hjelp.

BACKGROUND: In some situations, and particularly when intoxications are suspected, it would be advantageous if medicines and drugs of abuse could be swiftly detected in serum or urine. MATERIAL AND METHODS: The Department of Clinical Pharmacology at St. Olav University Hospital has since 2004 been developing a comprehensive toxicology service (at all hours 7-days/week) for immediate quantitative analysis of between 80 and 90 substances. We here present the service in further detail and evaluate its usefulness during its first full year, 2005. Two case reports are presented to further illustrate the possible benefits of this service. RESULTS: Urgent testing was requested for a total of 390 samples; 351 serum and 39 urine samples. The most common indications for requesting such analyses were suspected acute intoxication (46%) and suspected therapeutic failure/adverse drug reaction (31%). 88% of the serum samples obtained for acute intoxications were positive, and 48 different substances were detected. The substances most often found were various benzodiazepines, various antiepileptic drugs, ethanol, carisoprodol, lithium, and other psychotropic drugs. In urine, amphetamine and zopiclone were the substances most often detected. INTERPRETATION: The service seems to be used according to its intentions, and the high number of samples received indicate that clinicians consider the service to be useful. An early and continuous dialogue between the clinician and the laboratory physician is a prerequisite for rational use of the service.

[Reversible infertility from nonsteroidal anti-inflammatory drugs]. / Reversibel infertilitet ved ikke-steroide antiinflammatoriske midler.

BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) and selective cyclooxygenase-2 inhibitors may interfere with ovulation and the rupture of the follicle, causing reversible infertility. METHOD: Literature review. RESULTS: Reversible infertility is shown both in animal and human studies of these drugs. As determined by ultrasound, the drugs may delay or inhibit ovulation. These findings are also confirmed by a few randomized controlled studies showing an increase in time from the luteinizing hormone surge to rupture of the follicle and an increased size of the unruptured follicle. Most of the hormone analyses show values in accordance with the ovulation/menstrual cycle. Also, two epidemiological studies have shown an association between NSAID use and spontaneous abortion. These studies have methodological weaknesses and their findings have to be elucidated in future studies. INTERPRETATION: Women with fertility problems should avoid not only the selective cyclooxygenase-2 inhibitors, but also the traditional NSAIDs. However, women with rheumatic disease responding well to therapy should consult their physicians before stopping treatment. Reduced dose of a NSAID and temporary stop of drug treatment early in the menstrual cycle, or alternative drug treatment, may be a solution. NSAIDs should not be used in the last eight weeks of pregnancy.

[Acute deliberate self-poisonings in the area of Trondheim, 1978-2002]. / Akutte selvpåførte forgiftninger i Trondheims-området 1978-2002.

BACKGROUND: Deliberate self-poisoning is a big health problem. We wanted to study if there had been changes in drug use, morbidity and mortality in this group over the last 25 years in our hospital's catchment area. MATERIAL AND METHODS: In this study, 924 patients admitted to our hospital after deliberate self-poisoning in 1978, 1987 and 2002 were studied prospectively. RESULTS: From 1978 to 1987, there was a significant increase in the incidence of self-poisoning followed by a decline from 1987 to 2002 among both men and women. The age distribution remained the same. Benzodiazepines were the most commonly used drugs during the whole period (20% of patients in 1978, 39% in 1987, and 30% in 2002). There has been a significant reduction in the use of acetylsalicylic acid, tricyclic antidepressants and a significant increase in paracetamol and selective serotonin reuptake inhibitor poisonings. The use of gastric lavage and activated charcoal declined. The main antidote in 1978 was physostigmine, in 1987 and 2002 n-acetyl cysteine. During the whole period, complications (usually minor) were recorded in approximately 10% of cases. In 1978, mortality was 1.3%, in 1987 0.9%; no patient died in 2002. INTERPRETATION: The incidence of deliberate self-poisoning has fallen over the last 25 years. Selective serotonin reuptake inhibitors have to a large extent replaced tricyclic antidepressants and paracetamol has replaced acetylsalicylic acid.