Department of Drug Abuse Research and Method Development

Transcription

1 Department of Drug Abuse Research and Method Development Division of forensic sciences National Institute of Public Health Stig Tore Bogstrand, PhD, project leader Saranda Kabashi, MSc Vigdis Vindenes, Dep. Dir, MD, PhD

2 Outline of the presentation Presentation of NIPH An earlier hospital study from Norway frequency of drugs of abuse among injured patients Problematic drug and alcohol use and somatic illness outline for discussion

3 NIPH: One out of three Ministry of Health National Directorate of Health Norwegian Institute of Health Norwegian Board of Health Supervision Politics Knowledge Supervision

4 Epidemiology Environmental medicine Psychiatric health Forensic Sciences Infectious diseases Main sciences at NIPH Around 1300 employees

5 Div of Forensic Sciences National experts within forensic medicine In total around 240 employees Genetic - DNA-analyses / biological traces Forensic pathology autopsies Sudden Infant Death Syndrome Forensic toxicology analyses of psychoactive substances and interpretation Drug Abuse Research

6 Forensic toxicology Analyse drugs and psychoactive medicines samples from imprisoned - urine Around 8000 driving under the influence cases - blood and oral fluid Around 2000 autopsy cases - blood and urine Medicinal cases, work place tests, social cases urine, oral fluid etc.

7 Department of Drug Abuse Research and Method Development Neurobiology Experimental drug abuse research Analysis Method development and special analysis Epidemiology Epidemiological drug abuse research

8 Alcohol, Drugs and Injury Prevalence of alcohol and psychoactive substances in a Norwegian Emergency Department

9 Background International literature on psychoactive substance use and injuries found high prevalence among patients treated in emergency departments Few studies used blood samples to assess prevalence

10 Background The hospital study on injured patients: Preformed at Ullevål Hospital from Dec Dec 2008 Included all acute injured patients admitted for treatment 2000 patients participated in the study 93% of the patients consented to participate Main aim: to assess the prevalence of alcohol and drug use among these patients

11 Background Collaborative project between: Norwegian Institute of Public Health (NIPH) The Emergency Department at Ullevål Hospital Norwegian institute of Alcohol and Drug Research

12 Materials and methods All injured patients >18 years were included by the ED - nurses The blood samples were analyzed at NIPH (n= 2000)

13 Most prevalent substances

14 Combinations and alcohol alone was Medicinal drugs was prevalent among prevalent women > among 65 years men of < age 35 years, more than half tested positive for a psychoactive substance

15 15 Prevalence 44% positive for any substance 27% alcohol 1.5 mean Combinations of drugs and/or alcohol was detected in 12% of the samples Most prevalent substances: Illegal drugs 9%: 6 % Cannabis 3 % Amphetamines 2 % Cocaine Medicinal drugs 21%: 7% Vival, valium etc. 5% Z- hypnotics 4% Codeine

16 Problem drug and alcohol use and somatic illness Prevalence of problematic drug and alcohol use among acute ill patients in somatic treatment Outline for discussion

17 Background (cont.) Accident risk increases with higher blood alcohol concentration Risk of acute illness and injuries is correlated with high consume over some time Especially hepatic conditions, but also infections, hypertension and cerebrovascular stroke are associated with alcohol dependence or high alcohol consume

18 Background (cont.) Prevalence of drug and alcohol dependence or problem use is probably higher among patients who seeks treatment for acute illness Because problem drug and alcohol use is associated with poor health A hospital admission or other contact with the health service; is a possibility for intervention It is possible to screen all patients The patient might be more motivated for change Health professionals with intervention competence are close by

19 Materials and Methods The study will be preformed in two hospitals in Russia (Moscow and Murmansk), and one hospital in Norway (Oslo) The study population is patients admitted to hospital for treatment of acute somatic illness (not injuries) The aim is to include 3000 patients from each country We will seek ethical approval for the Norwegian study this autumn A laboratory method for testing of illicit drugs, psychoactive medicinal drugs and alcohol metabolites will be validated early 2016 The aim is to start to recruit participants in Oslo in February/ March, Start in Russia somewhat later To collect comparable data the study population, methodology including laboratory analysis and questionnaires will be identical at all sites.

20 Outcome When the study results are ready a report will be made on: Prevalence of high risk drug and alcohol use associated with acute somatic illness Suggestions for interventions The results will also be published in international peer reviewed journals A key issue to succeed with the project is exchange of knowledge and expertise between the countries Exchange of laboratory personnel in order to harmonize laboratory methods and training in new methods is planned. Joint meetings of clinical staff will also be planned later in the study. The main aim of these exchange and meetings is to ensure that the study is conducted as identical as possible. A secondary outcome of the project is exchange of knowledge on treatment of these patients and laboratory analysis of alcohol and psychoactive drugs.

21 Visual outline Prevalence: - Biomarkers - Health outcomes Resource consumption: - Length of stay - Re- admissions Interventions: - Treatment of use disorder and physical disorder Cross national comparison -to assess alcohol and drug impact