In Norway, drug-related infections are notified through the Norwegian Surveillance System for Communicable Diseases (MSIS) and these results are complemented by the results of infectious disease testing among PWID in various treatment and harm reduction settings at national and sub-national levels.
The number of newly diagnosed cases of human immunodeficiency virus (HIV) infection among PWID remains relatively low and has remained stable over recent years. However, the available data (on both acute and chronic cases) for hepatitis C virus (HCV) infection show that almost 9 out 10 HCV cases in which the transmission route is known are linked to drug injecting. The most recent data on HIV and HCV prevalence among clients tested in treatment and harm reduction settings confirm that the prevalence of HIV infection is low, whereas the prevalence if HCV infection is high.
It has been reported that the prevalence of hepatitis B virus (HBV) infections among PWID increased considerably between 1995 and 2008, but has remained relatively stable since then. Free of charge HBV vaccination has been offered to PWID since the mid-1980s.
Injecting remains the most common route of administration of drugs among high-risk users, who as a result are more susceptible not only to viral, but also to bacterial, infections, such as botulism. Between 1997 and 2015, a total of 27 cases of botulism were reported, including minor outbreaks in the Oslo region in 2013, 2014 and 2015. Contamination of heroin or of other substances mixed with the drug was considered the likely source of the infection.
In Norway, information on acute drug-related emergencies is available for Oslo and Bergen. Two hospitals in Oslo participate in the European Drug Emergencies Network (Euro-DEN) project, which was established in 2013 to monitor acute drug toxicity in sentinel centres across Europe. Another source of information is the number of emergency calls resulting in ambulances being despatched to the Oslo drug consumption rooms, which increased slightly in 2015 compared with 2013-14. Bergen provides a semi-annual report on the number of drugrelated emergency calls in the city.
In general, injectable opioids (such as heroin) are believed to be the main reason for non-fatal overdoses in Norway. Nevertheless, the data available from the Euro-DEN for Oslo and the details of emergency calls for Bergen suggest that gamma-hydroxybutyrate (GHB)/gamma-butyrolactone (GBL) is also the cause of a significant number of drugrelated emergencies.
Newly diagnosed HIV cases attributed to injecting drug use
NB Year of data 2015, or latest available year. Source: ECDC.
Prevalence of HIV and HCV antibodies among people who inject drugs in the Netherlands
NBYear of data 2015.
Characteristics of and trends in drug-induced deaths in Norway
NB Year of data 2014.
Drug-induced deaths are deaths directly attributable to the use of illicit drugs (i.e. poisonings and overdoses).
In 2014, the Cause of Death Register reported an increase in the number of drug-induced deaths compared with 2013. According to toxicological reports, opioids were found to be the drug most commonly involved in druginduced deaths. The majority of victims were male. In recent years, there has been an increase in the age of those dying as a result of overdoses in Norway.
The latest European average of drug-induced mortality rate among adults (aged 15-64 years) was 20.3 deaths per million. In Norway, this rate was 75.6 deaths per million in 2014. Comparison between countries should be undertaken with caution. Reasons include systematic under-reporting in some countries, different reporting systems and case definition and registration processes.
Drug-induced mortality rates among adults (15-64)
NB Year of data 2015, or latest available year. Comparison between the countries should be undertaken with caution.