Norway Country Drug Report 2018

Drug harms

Drug-related infectious diseases

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 people who inject drugs (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. Overall, the reported number of (both acute and chronic) hepatitis C virus (HCV) infection cases has been in decline since 2008; however, the available data suggest that around 8 out of 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 of HCV infection remains high.

Prevalence of HIV and HCV antibodies among people who inject drugs in Norway (%)
  region HCV HIV
Year of data: 2016
Source: national opioid substitution treatment programme
  National 56.99 1.52
  Sub-national : :

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 among high-risk drug 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 wound botulism were reported, including sporadic cases and 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.

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Drug-related emergencies

In Norway, information on acute drug-related emergencies is available for Oslo and Bergen. Two hospitals from 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. In this framework, a review of recreational drug toxicity showed that new psychoactive substances (NPS) were found in around 8 % of the cases, although they were not clinically suspected. Still, the majority of patients treated for recreational drug toxicity had consumed traditional drugs (amphetamines, heroin, benzodiazepines, etc.).

Another source of information is the number of emergency calls resulting in ambulances being dispatched to the Oslo drug consumption room, which decreased slightly in 2016 compared with 2015 (294 and 333 times respectively).

Bergen is the location of another source of information, and provides a biannual report on the number of drug- related emergency calls in the city. More than a third of the drug-related call-outs registered by the Section for Acute Medicine in Bergen between October 2015 and September 2016 were related to opioids, and a quarter to gamma-hydroxybutyrate (GHB)/gamma-butyrolactone (GBL).

In general, injectable opioids (such as heroin) are believed to be the main reason for non-fatal overdoses in Norway. Nevertheless GHB/GBL is also the cause of a significant number of drug-related emergencies.

 

Drug-induced deaths and mortality

Drug-induced deaths are deaths that can be attributed directly to the use of illicit drugs (i.e. poisonings and overdoses).

In 2015, the Cause of Death Register reported an increase in the number of drug-induced deaths compared with 2014 and 2013. Oslo and Bergen reported the highest numbers of deaths; however, drug-induced deaths were detected in all counties. 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, and in 2015 the victims were on average almost 47 years old. According to toxicological reports, opioids, mainly heroin, but also morphine/codeine, methadone and other synthetic opioids, were found to be the drug most commonly involved in drug-induced deaths.

The annual opioid substitution treatment (OST) survey from 2016 showed a mortality rate (all causes) of 1.2 % (corrected rate) per year for patients in OST (similar to the level in 2015), and that these deaths were dominated by somatic causes. Overall, the situation in Norway is stable in terms of the characteristics and contexts of those who died.

The latest European average of drug-induced mortality rate among adults (aged 15-64 years) was 21.8 deaths per million. In Norway, this rate was 81.23 deaths per million in 2015. Comparison between countries should be undertaken with caution. Reasons include different reporting systems and case definition and registration processes, as well as under-reporting in some countries.

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Methodological note: Analysis of trends is based only on those countries providing sufficient data to describe changes over the period specified. The reader should also be aware that monitoring patterns and trends in a hidden and stigmatised behaviour like drug use is both practically and methodologically challenging. For this reason, multiple sources of data are used for the purposes of analysis in this report. Caution is therefore required in interpretation, in particular when countries are compared on any single measure. Detailed information on methodology and caveats and comments on the limitations in the information set available can be found in the EMCDDA Statistical Bulletin.