Concentrations of psychoactive substances in blood samples from non-fatal and fatal opioid overdoses.

AIM: The primary aim was to compare concentrations of psychoactive substances in blood in non-fatal and fatal opioid overdoses. The secondary aim was to assess the concentration levels of naloxone in blood in non-fatal overdoses and the association between naloxone findings and concomitantly detected drugs. METHOD DESIGN: Case-control study. SETTING: Norway. Fatal overdoses from 2017 and non-fatal overdoses from February 2018 to September 2019. CASES: Thirty-one non-fatal and 160 fatal opioid overdose cases. Data from the non-fatal overdoses were collected from hospital records and blood samples, and data from the fatal overdoses were collected from autopsy reports. Concentrations of psychoactive substances (including ethanol) in blood samples were collected at the time of hospital admission for the non-fatal overdoses and during autopsy for the fatal overdoses. RESULTS: The median number of different substances detected was four for fatal and five for non-fatal overdoses. The fatal overdoses had higher pooled concentrations of opioids (188 vs 57.2 ng/mL, P < .001), benzodiazepines (5467 vs 2051 ng/mL, P = .005) and amphetamines (581 vs 121 ng/mL, P < .001) than the non-fatal overdoses. A linear relationship between naloxone and concomitant pooled opioid concentrations was found (95% confidence interval = 0.002-0.135, P < .05). CONCLUSION: The total load of drug concentrations was associated with the fatal outcome of an overdose, while the number of drugs used, to a lesser extent, differentiated between those who survived and those who died from an overdose. Higher opioid concentrations were associated with treatment with higher naloxone doses.

The relative impact of smoking, alcohol use and drug use on general sickness absence among Norwegian employees.

BACKGROUND: It is well documented that tobacco, alcohol and drug use can be detrimental to health. However, little is known about the relative impact of these factors on sickness absence, and whether the association between use of these substances and sickness absence is different for women and men. The aim of this study was to examine the association between tobacco-, alcohol- and drug use, as well as polydrug use, and sickness absence among Norwegian employees. METHODS: During 2011-2014, 1911 employees in Norway completed a questionnaire about their tobacco, alcohol and drug use habits, their total number of sickness absences during the last 12 months, and the length (no. of days) of their last sick leave. Samples of oral fluid were analysed for illegal and medicinal drugs. RESULTS: Daily smoking and current use of medical drugs were significantly associated with sickness absence. Employees who were daily smokers also had an increased likelihood of having long and frequent sickness absence. Use of snus (Swedish moist snuff), binge drinking, current use of illegal drugs and polydrug use were not significantly associated with sickness absence. Women and young participants were more likely to report having had sickness absence the past 12 months. However, the associations between daily smoking and medical drug use and sickness absence, respectively, were only statistically significant for men. CONCLUSION: According to this study, daily smoking and use of medical drugs are the substance use habits most closely associated with sickness absence. Implications for future research are discussed.

Opioid related deaths in Norway in 2000-2019.

AIMS: The aim of the study is to present autopsy-based findings of the most prevalent opioids in overdose deaths in Norway from 2000 to 2019, as such data are lacking in the current literature. METHODS: Data on cause of death obtained from the Norwegian Cause of Death Registry (NCoDR) were linked with forensic toxicological results from forensic autopsies. RESULTS: From year 2000 the annual numbers of overdose deaths decreased, specifically during 2000-2003, thereafter a relatively stable annual number was observed. Opioids were detected in 93% of the cases. Heroin related deaths have decreased, whereas medical opioids for pain treatment have increased with time. Men in their early 40's dominate the overall numbers of deaths, but significantly different sex patterns emerge when studying the specific drugs. During the past 20 years, the mean age at overdose death has increased by 10 years (from 33 to 43 years). Overdose deaths without any illicit drugs present at autopsy have increased in recent years. These deaths, where only potentially prescription medications were detected, were more common among women and with higher age. CONCLUSIONS: In Norway during the past 20 years, we observe a dynamic shift in overdose deaths caused by heroin and illicit drugs, to include a gradually increasing trend of overdose deaths from pill based pain medications and also methadone and buprenorphine. This warrants a shift in preventive responses, as the target groups differ.

Parallel artificial liquid membrane extraction of new psychoactive substances in plasma and whole blood.

Parallel artificial liquid membrane extraction (PALME) was combined with ultra-high performance liquid chromatography-mass spectrometry (UHPLC-MS) and the potential for screening of new psychoactive substances (NPS) was investigated for the first time. PALME was performed in 96-well format comprising a donor plate, a supported liquid membrane (SLM), and an acceptor plate. Uncharged NPS were extracted from plasma or whole blood, across an organic SLM, and into an aqueous acceptor solution, facilitated by a pH gradient. MDAI (5,6-methylenedioxy-2-aminoindane), methylone, PFA (para-fluoroamphetamine), mCPP (meta-chlorophenylpiperazine), pentedrone, methoxetamine, MDPV (methylenedioxypyrovalerone), ethylphenidate, 2C-E (2,5-dimethoxy-4-ethylphenethylamine), bromo-dragonfly, and AH-7921 (3,4-dichloro-N-{[1-(dimethylamino)cyclohexyl]methyl}benzamide) were selected as representative NPS. Optimization of operational parameters was necessary as the NPS were novel to PALME, and because PALME was performed from whole blood for the very first time. In the PALME method developed for plasma, NPS were extracted from a 250µL alkalized donor solution consisting of 125µL plasma sample, 115µL 40mM NaOH, and 10µL internal standard. In the PALME method from whole blood, the 250µL alkalized donor solution consisted of 100µL whole blood, 50µL deionized water, 75µL 80mM NaOH, and 25µL internal standard. In both methods, extraction was accomplished across an SLM of 5µL dodecyl acetate with 1% trioctylamine (w/w), and further into an acidic acceptor solution of 50µL 20mM formic acid. The extraction was promoted by agitation at 900rpm and was carried out for 120min. Method validation was performed and the following parameters were considered: linearity, limits of quantification (LOQ), intra- and inter-day precision, accuracy, extraction recoveries, carry-over, and matrix effects. The validation results were in accordance with FDA guidelines.

Use of alcohol and drugs by employees in selected business areas in Norway: a study using oral fluid testing and questionnaires.

BACKGROUND: Alcohol or drug use and associated hangover may reduce workplace safety and productivity and also cause sickness absence. The aims of this study were to examine (i) the use of alcohol and drugs, and (ii) reduced efficiency at work and absence due to such use among employees. METHODS: Forty-four companies were invited; half of them agreed to participate. Employees filled in a questionnaire and provided a sample of oral fluid, which was analysed for alcohol, 12 psychoactive medicinal drugs and 6 illicit drugs. Participation was voluntary and anonymous. RESULTS: Two thousand four hundred thirty-seven employees in eight business areas agreed to participate (92 % of those invited). By combining questionnaires and oral fluid testing, we found that 5.2 % had used psychoactive medication during the last couple of days, 1.4 % had used illicit drugs, 17.0 % had used alcohol during the last 24 h but only one person (0.04 %) was positive for alcohol in oral fluid. About 25 % reported reduced efficiency at work, and 5 % reported absence from work due to alcohol use during the past 12 months. The use of illicit drugs and binge drinking resulting in reduced efficiency and absence was most common among restaurant and bar workers and more common among men than women, whereas use of psychoactive medication was most common among healthcare, transportation and storage workers. CONCLUSION: Impairment at work due to alcohol or drugs was rare, whereas reduced efficiency due to drinking was reported by a fairly large proportion. There were marked differences between some business areas, and across gender.

Use of alcohol and drugs among health professionals in Norway: a study using data from questionnaires and samples of oral fluid.

Working under the influence of drugs and/or alcohol may affect safety and job performance. However, the size of this possible problem among health professionals (HPs) is unknown. The aim of this study was threefold: (i) to analyze samples of oral fluid and self-reported data from questionnaires to investigate the prevalence of alcohol and drugs among a sample of HPs in Norway, (ii) to study self-reported absence from or impairment at work due to alcohol and/or drug use, and (iii) to examine whether such use and absence/impairment due to such use depend on socio-demographic variables.A total of 916 of the 933 invited HPs from hospitals and pharmacies participated in the study (participation rate = 98.2%), and 81.1% were women. Associations were analyzed in bi-variate cross tables with Chi-square statistics to assess statistical significance.Alcohol was not detected in any of the samples. Ethyl glucuronide, a specific alcohol metabolite, was found in 0.3% of the collected samples. Illicit drugs and medicinal drugs were identified in 0.6% and 7.3% of the samples, respectively. Both analytical results and self-reported use of alcohol and drugs during the past 12 months indicate that recent and past year alcohol and drug use was lower among HPs than among workers in other business areas in Norway, Europe and US. Nevertheless, several HPs reported absence from work due to alcohol (0.9%) and medicinal drug use (0.8%) during the past 12 months. A substantial part (16.7%) of the self-reported medicinal drug users reported absence from work because of use of medicinal drugs during the past 12 months, and more than 1/4 of those reported in-efficiency at work because of the use of medicinal drugs during the past 12 months. Reduced efficiency at work due to alcohol use during the past 12 months was reported by 12.2%.This sample of HPs seldom used illicit drugs, few had a high level of alcohol consumption, and few tested positive for medicinal drugs. Absence or hangover related to the use of medicinal drugs or alcohol appeared to be a bigger issue than the acute intoxication or the use of illicit drugs.