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This study was designed to supplement knowledge of three aspects of fatal overdose and imprisonment. Our aims were to investigate whether drug abusers are subject to a higher-than-usual risk of fatal overdose immediately after release from prison, to assess the length of the high-risk period and to investigate the net effect of imprisonment–the pooled effect of both imprisonment and release–on overdose death.The analyses were conducted on the basis of data from a cohort of 338 imprisoned Norwegian drug abusers. Cox regression models were applied including the explanatory time-dependent covariate for imprisonment and the post-release period. We find that the risk of death from overdose during the 2 weeks after release from prison was 10 times higher, and during the 3-week period six times higher, than during other time spent outside prison. An elevated risk was also indicated for the fourth week. Taking into account findings in the literature, the period of elevated risk should be considered to last up to ...

Objective To identify causes of death among Norwegian drug abusers and to investigate the risk factors for fatal overdose and other causes of death, with specific attention to ageing and duration of abuse. Methods In a cohort of 501 drug abusers admitted to treatment in the period 1981–1991, mortality has been calculated as incidence rates. The analyses of time to death were conducted as proportional hazard regression models using a competing risk approach. Results Crude incidence rates for all deaths and overdose deaths did not vary with age. For non-overdose deaths, however, the incidence was significantly higher after the age of 40. Explanatory factors associated with age at fatal overdoses are also associated with age at death by other causes. At every age the risk of death was higher with a long-term abuse of drugs, and more so for fatal overdose than for death by other causes. Conclusions With respect to fatal overdose duration of abuse, but not ageing, is found to be a risk factor. With respect to death by other causes both ageing and duration of abuse are factors associated with such death.

Einar Ødegård & Anne Line Bretteville-Jensen & Astrid Skretting: The development of drug abuse in Norway in the 1990s This article aims to shed light on the development of drug abuse in Norway during the 1990s. The data come from various different sources, including questionnaire studies as well as other data sets describing the extent of drug abuse in the country. There has been a marked increase in drug abuse during the 1990s. Data from annual youth surveys in 1990 to 1995 indicate that between 8 and 10 per cent of youths aged 15–20 had ever used cannabis, whereas the figure during the latter half of the decade was substantially higher at 18–19 per cent. Surveys in the whole population also point at an increase from 1991 through to 1999: in 1991 the proportion indicating they had ever used cannabis was 8.2%, by 1999 the figure had risen to 12.5%. Furthermore, a simple cohort analysis clearly indicates that large numbers are continuing to use cannabis: the figures are also rising in older age groups. With the growing prevalence of cannabis use in younger age groups we may therefore expect to see increasing numbers of regular and frequent cannabis users in the whole population as well. Drug seizures by the police and customs have increased sharply during the latter half of the 1990s: this applies not only to amphetamine and ecstasy but also cocaine and LSD. This is supported by the results of annual questionnaire surveys among youths, who are reporting a marked increase in the use of these types of drugs. In the early 1990s around 1% of youths in the age group 15–20 said they had ever used amphetamine. This figure remained more or less unchanged through to the mid-1990s. However by the end of the decade around 4% said they had used amphetamine. The data from youth surveys furthermore indicate that there is considerable overlap in the use of amphetamine and ecstasy. In this material the sharpest increase is recorded in the proportion of those indicating they have used both amphetamine and ecstasy. There are several indicators which describe the extent of heroin abuse. All these indicators show that there has been a sharp increase in heroin abuse during the 1990s. A simple mortality analysis suggests that the number of heroin abusers has doubled over the past decade. Drug abuse has also spread markedly both in relation to age groups and geographically: today the problem is by no means limited to any specific age group, nor just to a few major cities.

A rough estimate indicates that women amount to one third of the heroin user population in Norway. However, among the youngest users females account and have accounted for a larger proportion. Given this greater representation of females in the younger age groups one would expect that the gender difference in the general population of users would be reduced over time due to a cohort effect. However, the ratio of male to female users has remained stable. The prevailing explanation for this stability is based on the claim that women are more likely to overcome their abuse. This paper addresses both the basis for the assumption of a missing cohort effect and examines an alternative explanation linked to the way into abuse rather than the way out. The study primarily draws upon two distinct data sources. The first body of material consists of interviews carried out in the period 1993–1997 with people attending the only needle exchange service in Oslo. The second data source consists of police records, which provide the number of persons arrested each year in the period 1984–1997 for using, possessing or selling heroin distributed by age and gender. We find that the age of injection debut has increased and that this is especially true for male users. Applying a simple quantitative model, the effect a change in recruitment may have on the male-to-female ratio is analysed. The results indicate that a higher debut age may have contributed to stabilizing the gender gap. The finding suggests that more research is needed on the conditions of recruitment in order to better predict the future population demographics and to avoid hasty and incorrect conclusions.

Section 12 of the Norwegian Prisons Act provides for convicted persons to be transferred to a treatment institution as part of the serving of their sentence. In recent years with a growing drugs problem this provision of section 12 of the Prisons Act has been applied to an ever greater extent in the case of inmates with a drug abuse problem. One purpose of transferring inmates to a treatment institution has been to prevent recidivism. The aim of this study was to analyse the effect of serving under section 12 with respect to criminal relapse. We find no preventive effect from serving under section 12 with respect to recidivism.

Today we see that effort is made to establish comparable data in the drug field. Such effort should be welcomed. At the same time one should be aware of the problems with causal interpretation on the basis of such data. There are difficulties not just linked to the etiological aspect, as uncertainty of the status of a relation between variables. The problems already arise in the descriptive project because of the uncertainty of validity of data. The aim of comparative research which analyses differences between countries in the drug area will not only be pure description, but also to explore what works and what does not work.

In a public survey conducted in the Spring of 1993, a randomly selected sample were asked about their attitudes toward counter measures in drug policy. According to the survey there is general support for both preventive, therapeutic and repressive actions. Also more controversial measures such as electronic room bugging, which the Norwegian Parliament rejected, has public support. However, the respondents seem to give priority to preventive actions, such as working with young people, in preference to society's main answer so far: sharper punishment. In public discussion about the level of punishment, it seems to be accepted as a premise that the penal practice has its correlate in public opinion, which supports sharper punishment. In response to a general question about the penalties for drug offences, a clear majority of the respondents said they are “too lenient”. When specifying the crimes, however, the respondents were not more repressive than the courts. This paradox indicates that the correspondence between public attitudes and legal sanctions, thought to be of almost causal nature, has to be reconsidered.

The purpose of this study was to explore to what extent alcohol is a factor in non-fatal overdoses on the basis of records of ambulance emergencies, and to what extent this varies across gender and age. Furthermore, we wanted to investigate whether alcohol intake, in relation to an overdose, is associated with the risk of recurrent overdoses, and if so, whether such an association varies across gender and age. To investigate the role of alcohol intake in non-fatal overdoses, analyses were conducted both at the event level and at the individual level. Bivariate associations were explored in table analyses and by comparisons of means. To determine whether alcohol intake was associated with experiencing recurrent overdoses, survival analyses were conducted applying Kaplan-Meier estimation and Cox regression models. Furthermore, a linear regression model was estimated to assess the impact of gender age and number of overdoses on the proportion of overdoses in which alcohol was involved. Between groups of clients who had overdosed once, several times or many times, we found that there was a U-shaped relationship. The proportion of overdoses with alcohol involved was highest among those who had overdosed once and those who had overdosed more than ten times. The probability for a recurrent overdose was higher among those who were reported with no alcohol intake in the first overdose. Being female and having alcohol involved in the first overdose registered during our observation period reduced the risk for a recurrent overdose. However, age seemed to be a gradient with respect to alcohol’s association with recurrent overdoses. While alcohol was associated with a significantly lower risk for recurrence in the two youngest age groups, this is not the case in the oldest age group. A possible explanation might be that it is a change in the pattern of drug use as an effect of aging where infrequent heroin use in combination with frequent alcohol intake increases with increasing age. For this type of drug users the individual’s risk of recurrent overdoses may be lower due to fewer events of heroin intake.