Norway

"By combining the data from 2012 and 2013, we can obtain more precise estimates of prevalence levels for cannabis use and differences between subgroups. The estimated LTP [lifetime prevalence], LYP [last year prevalence] and LMP [last month prevalence] rates among all adults (aged 16–64) were 21.3 per cent, 4.3 per cent and 1.6 per cent, respectively. Among young adults (aged 16–34), the corresponding LTP, LYP and LMP estimates are 30.2 per cent, 10 per cent and 3.4 per cent.

"There are significant gender differences in cannabis use, with males having higher prevalence rates than females. Using the combined data from 2012 and 2013 for all adults, the estimated LTP rate was 25.9 per cent for males and 16.6 per cent for females, while the LYP rate was 6.1 per cent for males and 2.4 per cent for females and the LMP rate was 2.5 per cent for males and 0.7 per cent for females. Among young adults, the estimated LTP rate was 36.2 per cent for males and 23.5 per cent for females, while LYP was 13.9 per cent for males and 5.8 per cent for females and LMP was 5.1 per cent for males and 1.4 per cent for females (all gender differences were significant at p<.05).

"Cannabis use also varies across age groups (Figure 2). Both LYP and LMP rates decline with age. The LYP rate was estimated to be 12.1 per cent for persons in the 16–24 age group, 7.9 per cent in the 25–34 age group and around one per cent or less in the three oldest age groups (35–44, 45–54 and 55–64). The LMP rate was 4.2 per cent in the 16–24 age group, 2.4 per cent in the 25–34 age group and less than one per cent in the three oldest age groups. Even though the biggest differences are between the youngest and the three oldest age groups in relation to both LYP and LMP, the LYP rate in the 25–34 age group is significantly lower (p<.05) than in the 16–24 age group."

"The findings on drug use are based partly on positive findings from urine tests and partly on reported use during the last 30 days. The levels are overall quite similar to 2012. A proportion of 10 per cent reported having used an illegal morphine substance during the past month, 33 per cent cannabis, 16 per cent stimulants and as many as 42 per cent benzodiazepines. This figure includes both prescribed and non-prescribed benzodiazepines. Twenty-five per cent of all patients report having been prescribed the drug by a doctor. In other words, the others must have used illegal sources. There is a clear tendency for high levels of illegal use among patients in units where a lot of medicinal drugs are prescribed. This means that there is nothing to indicate that legal prescription reduces illegal use.

"The situation was also measured by calculating the overall score for frequency of drug use and the severity of ongoing use during the past month. Forty-one per cent had not used illicit substances at all, 12 per cent only sporadically, while 38 per cent reported frequent use. This means that the proportion who use illegal substances regularly has increased from 2012, when 28 per cent reported such use. (SERAF, 2014)."

"In line with a number of other studies, the 2013 survey shows that cannabis is by far the most common illegal drug in Norway. As shown in Figure 2, the LTP rate for cannabis use among all adults was 23.3 per cent, while the LYP rate was 5.1 per cent. By comparison, the LTP rate was estimated to be 4.2 per cent for cocaine, 3.7 per cent for amphetamines, 2.3 per cent for ecstasy, 1.5 per cent for LSD, 1.1 per cent for GHB/GBL and 0.7 per cent for heroin for all adults (Figure 3). The LYP rate was estimated to be less than one per cent for cocaine, amphetamines and ecstasy.
"Among young adults, the LTP rate for cannabis use was 31.7 per cent, while it was 7.2 per cent for cocaine, 6.4 per cent for amphetamines, 4.6 per cent for ecstasy, 2.6 per cent for LSD and 2.2 per cent for GHB/GBL. While the estimated LYP rate was 12.0 per cent for cannabis, it was 2.2 per cent for cocaine, 1.1 per cent for amphetamines and 1.0 per cent for ecstasy. The proportion who had used heroin, LSD and/or GHB/GBL during the past year was not significantly different from zero (p>.05), neither among young adults nor among all adults. Among young adults, the LTP rate for heroin was also so small that it was not statistically different from zero (p>.05), again proving that it is not possible using such methods to estimate the real prevalence of heroin use.
"For the first time, reported use of cocaine is on a par with (slightly above) the level for amphetamines, unlike all previous national surveys that have been undertaken. More surveys are needed before we can say that this is a trend, however."

"According to Statistics Norway, a total of 49,400 drug crimes were reported in 2013. This is 3,500 more than in 2012 and corresponds to 9.8 reported drug offences per 1,000 population. This is the highest level of drug offences since 2002.
"Compared with the year before, more violations were registered in 2013 in relation to both the General Civil Penal Code and the Act relating to Medicinal Products. It is the latter that regulates illegal involvement with drugs, mostly use and possession of small quantities (Figure 11). In total, the almost 24,100 drug offences relating to the General Civil Penal Code represent an increase of just over seven per cent from 2012. These offences include 1,171 serious drug crimes, however, which is a nine per cent decrease from the year before.
"In addition, 25,300 violations of the Act relating to Medicinal Products were reported in 2013. They mainly concern the use and possession of small quantities of illegal drugs. This is almost an eight per cent increase from 2012, and in the last few years, there has been an increase in offences involving the use of illegal drugs in particular. The 15,300 reported incidents of drug use in 2013 represent an increase of more than nine per cent from the year before, and the number is higher than in all the previous years.
"Geographically, Oslo was the county with the highest level of reported drug offences in 2013, both in terms of absolute numbers and adjusted for population size. In Oslo, however, the number of reported drug offences was the same as in 2012, while most other counties recorded fairly large increases."

"In 2013, investigations by the police and prosecution authorities resulted in a total of 174,700 charges against 82,300 different persons. That is almost 1,200 more charges and 1,350 more persons charged than in 2012. The increase was largest for drug offences. A total of 19,623 persons were charged with more than 39,300 drug offences in 2013. This is an increase of nine and eight per cent, respectively, from 2012. A large proportion of those charged with drug offences, 26 per cent, were also charged with other offences that carry a higher maximum sentence. These are classified under another primary group of offences, which means that 14,538 persons were charged with a drug offence as their primary offence, as shown in Table 7. This is 1,450 more than in 2012, and a considerably higher figure than in all previous years for which statistics are available. The increase, and the historically high numbers, relate to persons charged with violations of the General Civil Penal Code and persons charged with violations of the Act relating to Medicinal Products. Persons charged with drug offences as their primary offence accounted for 39 per cent of all persons charged with crimes in 2013."

"As of 1 January 2012, there were a total of 4,052 inmates in Norwegian prisons, including those serving their sentences at home with electronic monitoring and those remanded in custody. Of all inmates at the start of the year, 29 per cent were serving sentences for drug offences (2011: 30%), 22 per cent for crimes against property and 21 per cent for violent crimes as their primary offence. Of the 910 persons held on remand at the start of 2012, 36 per cent had drug crime as their primary offence, approximately the same proportion as in 2011 (37%)."

"The estimated number of injecting drug users in Norway was also reported prior to the revision, using the mortality multiplier method. This method divides the number of drug-related deaths by the likelihood of dying of a drug-related diagnosis in the population of injectors in the 15–64 age group. First, an estimate of the number of recreational users was subtracted from the nominator because they are less likely to have injected the substance that caused the death. The probability of dying of drug-related causes among injecting drug users has been set to 2.03 per 100 person-years, based on cohort studies among such users.

"The estimate for injecting drug users in 2012 was 8,400 persons, with a sensitivity interval of 7,200–10,100. Figure 7 shows a stable trend in the number of injecting drug users since 2004, with a possible decline since 2008. With a growing population of 15–64-year-olds, however, the possible decrease in numbers is shown as a decline in the proportion of injecting drug users per 1,000 capita. Based on the method used , the decline was 15 per cent from 2008 to 2012; from 3.0 to 2.5 injecting drug user per 1,000 capita."

"High-risk opioid users are a heterogeneous group that includes marginalised drug users with long-standing ‘careers’ of heroin use, as well as socially included persons who became addicted to opioids through excessive consumption of prescribed pharmaceuticals. The description of high-risk opioid use does not include stable patients in opioid substitution treatment (OST) or others using pharmaceutical opioids in accordance with a doctor’s prescription. Patients in OST who misuse prescribed drugs or other opioids than the prescribed one(s) shall be included, however. Furthermore, persons not included in OST who misuse prescribed opioids shall be included.

"In the Norwegian context, the mortality multiplier method was also used to estimate the number of high-risk opioid users, even though the method is not optimal. The definition will then be indirect: It is assumed that, for high-risk users of opioids, the risk of dying an opioid-related death is between 1.5 or 2.5 per 100 person-years. This is similar to the risk of dying a drug-related death among injecting drug users. The reason for this choice is that many injecting drug users are also high-risk opioid users. The number of opioid-related deaths was restricted to the 15–64 age group and excluded intentional deaths (suicides) and recreational users. The average for the years 2010 to 2012 shows that heroin was the cause of death for 47 per cent, methadone for 27 per cent, while, for 26 per cent, other opioids were the cause of death.

"Some patients in OST may have been included, but they cannot be identified. Around 9–10 per cent of OST patients reported having used morphine/heroin substances recently in addition to OST medication (Waal et al. 2013). With a total of 7,450 persons in OST in 2012, this amounts to approximately 700 persons with risky morphine/heroin use in OST. We do not know whether they were high-risk users, however, and we do not know the proportion of high-risk use of other opioids among patients in OST.

"The number of high-risk opioid users was estimated to be 7,700 persons, with a sensitivity interval from 6,200 to 10,300 persons. The estimate includes those with the highest risk of death or other serious consequences."

Source: SIRUS
* Figures are rounded.

"The figures include all injecting use. Heroin is still the most common drug injected, but, for more and more people, amphetamine is becoming the main drug injected. The proportion of injecting drug users in Oslo who had primarily injected amphetamine during the past month was approximately 20 per cent in 2002–2004. In 2008–2010, the corresponding figure was approximately 35 per cent (unpublished results from a study conducted among injecting drug users in Oslo, Bretteville-Jensen, SIRUS). It has also become more common to inject both heroin and amphetamine."

"In 2013, 233 cases of HIV infection were reported to the Norwegian Surveillance System for Communicable Diseases (MSIS). Eight of the cases were among injecting drug users: six men and two women. The median age was 31 years (30 to 37 years). Five of the eight injecting drug users who were diagnosed as HIV positive in 2013 were persons of foreign origin (mostly Eastern European) who had been infected before arriving in Norway.

"As of 31 December 2013, a total of 604 persons had been diagnosed as HIV positive with injecting use as a risk factor. This amounts to 11 per cent of all reported cases of HIV since 1984. In 155 of the cases, the patient had developed Aids (Table 4). No information is available regarding how many of the HIV positive injecting drug users are still alive.

"The incidence of HIV among injecting drug users has remained at a stable, low level for many years, with about 10 to 15 cases reported per year. The number was eight in 2013. The reason for this is not entirely clear, but a high level of testing, great openness regarding HIV status within the drug user community, combined with a strong fear of being infected and strong internal justice in the community, are assumed to be important factors. In addition, many of the sources of infection in the drug user community have disappeared due to overdose deaths, and some have been rehabilitated through substitution therapy or other forms of rehabilitation. However, the extensive outbreaks of hepatitis A and B in the late 1990s and early 2000s, and the high incidence of hepatitis C, show that there is still extensive needle sharing in this group. In the last few years, the majority of injecting drug users diagnosed with HIV have been persons of foreign origin (mostly Eastern European) who had been infected before arriving in Norway."

"In the period 1995–2008, a considerable increase in hepatitis B among drug users nationwide was reported to MSIS. In 2013, four of a total of 30 reported cases of acute hepatitis B involved injecting drug users. During the period 1995–2013, the total number of reported cases of acute hepatitis B infection among injecting drug users was 1,980. Hepatitis B vaccination has been offered free of charge to injecting drug users since the mid-1980s."

"The monitoring of hepatitis C in Norway was intensified from 1 January 2008. The notification criteria were changed so that all laboratory-confirmed cases of hepatitis C must now be reported to MSIS. Previously, only acute illness had to be reported, and this resulted in a very inadequate overview of the real incidence of the disease in the country. In 2013, 1,318 cases of hepatitis C (both acute and chronic cases) were reported. In 47 per cent of the reported cases, no information was provided about the presumed mode of transmission, but in the cases where the mode of transmission is known, 91 per cent were infected through the use of needles. For the time being, data from MSIS cannot distinguish between cases involving new infection with hepatitis C and cases where the infection occurred many years ago. It is therefore not known whether the number of cases of newly acquired hepatitis C infection has declined or increased among drug users in recent years.

"Among OST patients, the status survey for 2013 (see Chapter 5.2.2) shows that 63 per cent of the clients were hepatitis C antibody positive, roughly the same proportion as in 2012. This is lower than expected, and the explanation is probably that the percentage with unknown status was as high as 18 per cent.
Since 2002, small-scale prevalence surveys have been carried out in connection with needle distribution and the drug injection room in Oslo in order to register the prevalence of several infectious diseases among injecting drug users. These surveys are the only prevalence surveys that are carried out regularly among a sample of drug users in Norway. The 2012 survey showed that 62 per cent of the injecting drug users tested had had a hepatitis A infection or had been vaccinated against the disease, while 35 per cent had had a hepatitis B infection and 64 per cent had had a hepatitis C infection. Forty-one per cent had hepatitis B markers, indicating that they had been vaccinated against hepatitis B. No survey was carried out in 2013."

"Concerning the 248 drug-related deaths in 2010 that were recorded by Statistics Norway, 173 (70 %) deaths involved opioids with or without additional drugs (Figure 5), 93 were deaths due to heroin (X42, X44, X62, X64 + T401), 36 deaths were recorded with methadone poisoning as the underlying cause (X42, X44, X62, X64 + T403), and 44 with other opioids, either as poisoning or dependency (X42, X44, X62, X64 + T402, F112). The remaining 75 deaths broke down as follows: 16 other synthetic narcotic substances (X42, X44, X62 + T404), 27 psychostimulants (X41, X44 + T436), 13 unspecified narcotic substances (X42, X44 + T406), 19 cases of dependency on other stimulants and dependency on multiple/ other drugs (F152,F192), and zero deaths from cocaine (T405). In 2010, 25 (10 %) of the included deaths were coded as suicides (X62, X64), which is probably a conservative estimate of the suicide rate."

"Many of the drug-related deaths are believed to be due to extensive multiple-drug use. The heroin-specific metabolite monoacetylmorphine was detected in 38 per cent of the deaths, but other substances were found to be present as well in 40 per cent of heroin/morphine-related deaths. Methadone was detected in 16 per cent of the deaths, but it was the only detected substance in only 18 cases. Amphetamine and/or methamphetamine and/or cocaine were detected in 16 per cent of the deaths."

"Of the 6,640 patients in the OST programme in Norway at the end of 2011, 54 deaths from various causes were reported by the centres during 2011, indicating a total mortality rate of about 0.8 per 100 patient-years while in OST. This is on par with the previous year (Table 4). The majority of deaths in OST were due to somatic causes and injuries.
"It is generally accepted that the annual mortality rate among untreated injecting heroin users is in the range of two to four per cent. In a study of Norwegian OST programme participants for the period 1997–2003, an annual mortality rate of 2.4 per cent was found prior to treatment, and 3.5 per cent post-treatment among those who terminated OST. In the same study, the annual mortality rate was 1.4 per cent for those in active OST. For patients in active OST, causes of death were: somatic causes 55 per cent, overdoses 27 per cent and trauma 18 per cent, whereas, for the observed times prior to and after OST, overdoses dominated as the cause of death. The annual mortality rate for patients in OST has gradually decreased in Norway since 2002, from an estimated 1.5 per cent to a current rate of 0.8 per cent."

"The incidence of HIV among injecting drug users has remained at a stable, low level for many years, with about 10 to 15 cases reported per year. The reason for this is not entirely clear, but a high level of testing, great openness regarding HIV status within the drug user community, combined with a strong fear of being infected and strong internal justice in the milieu, are assumed to be important factors. In addition, many of the sources of infection in the milieu have disappeared due to overdose deaths, and some have been rehabilitated through substitution therapy or other forms of rehabilitation. However, the extensive outbreaks of hepatitis A and B in the late 1990s and early 2000s, and the high incidence of hepatitis C, show that there is still extensive needle sharing in this group, although a large number of syringes are handed out every year in Norway."

"Waiting times for treatment for drug and alcohol problems appear to be decreasing. The Norwegian National Patient Register publishes statistics every quarter of waiting times for treatment and violations of treatment guarantees. In interdisciplinary specialised treatment, the average waiting time in 2011 was 72 days for patients who were entitled to prioritised treatment (both alcohol and drug problems), a reduction of eight days from 2009. In the first four months of 2012, the waiting time decreased further to 66 days. The average waiting time for patients in mental
health care was 54 days in 2011, roughly the same as in the two preceding years. If the patient does not wish to accept the offer of treatment he/she is given, but chooses instead to wait for an available place in a particular institution, the waiting time will usually be considerably longer."

"In 2011, reports were submitted to the NPR [Norwegian Patient Registry] from 159 units in the specialist health service concerning a total of 8,817 patients who started treatment for primarily drug-related problems (2010: 8,750 patients from 158 units). The number of patients broke down as 3,921 in in-patient treatment and 4,896 in outpatient treatment, including OST [Opioid Substitution Treatment]. Around 68 per cent of the total number of patients in treatment were men. The average age of patients in in-patient treatment was 35 years for men and 34 years for women, fairly similar to patients in outpatient treatment (men: 34 years, women: 35 years)."

"The proportion treated with methadone was 47 per cent, while 53 per cent were treated with buprenorphine-based medication. Nationwide, 67 per cent now get their medication prescribed by their GP. GPs thus play a key role in OST, a role that seems to be increasing. Almost half (47%) are issued their medication at a pharmacy, and an additional 32 per cent receive it from municipal services. Only three per cent received their medication from an OST centre."

"The Norwegian OST programme was established in 1998. It was run by 14 centres in the four health regions until 2010. Special guidelines were introduced from 1 January 2010, which emphasised, among other things, that OST should be integrated in the ordinary specialist health service (see NR 2010 Chapter 11). The basic model of a tripartite collaboration comprising social security offices, GPs and the specialist health service was retained, and the indication for OST shall be assessed by the specialist health service.
"Integration of OST in the health trusts was completed in 2011. OST centres are no longer a separate type of measure, and the system of special decision-making powers has been discontinued. The health trusts’ admission bodies have been given overriding authority. Each health trust shall have a body that makes an overall assessment of whether OST is the correct treatment option, but how this is organised is decided by the health trusts. The same applies to how the treatment start-up and stabilisation shall take place. Following the change, OST has been established as a separate unit with a separate management in some places, as a dedicated team in other places, and in yet others as an integral part of the interdisciplinary specialist treatment without a separate management over and above a coordinator."

"The accident and emergency service in Oslo has a project called Prosjekt ungdom og rus på legevakta (‘Young people and alcohol/drugs at the accident and emergency service’), which is a specialised team that is part of the municipal emergency drug and alcohol facilities. In a collaboration between the municipality and the health authorities, the accident and emergency services in Oslo and Bergen have set up dedicated reception facilities for people with drug or alcohol problems, and observation beds for short-term admissions. Wards have been established in both Oslo and Bergen to take care of persons with drug or alcohol problems in emergency situations.

"The ambulance service is often called out to drug addicts who have overdosed. Figures from the emergency medical communication centre (AMK) for Oslo and Akershus show that a total of 3,300 ambulance call-outs in 2011 were due to overdoses. The AMK centre in Bergen registered 97 overdose call-outs relating to the use of opioids during the period October 2011–March 2012, compared with 224 in the previous half-year. In the same period, 108 call-outs relating to overdoses of GHB/GBL were registered, compared with 101 in the previous half-year. The AMK centre also registered 66 overdose call-outs where the type of drug was unknown during the
period October 2011–March 2012."

"The primary objective of needle exchange programmes is to reduce the risk of infectious diseases associated with the sharing of injection equipment. Approximately 3.3 million syringes were handed out in Norway in 2007, largely through low-threshold services. In a follow-up survey carried out by SIRUS, 14 towns/municipalities reported that almost 3.1 million syringes were handed out in 2009. Of these, 85 per cent or 2,635 million were distributed in the three biggest cities Oslo, Bergen and Trondheim. In 2011, these cities reported about the same number, 2,639 million, 1.87 million of them in Oslo alone (see also Chapter 12). Sales through pharmacies come in addition, but we lack an overview of sales to drug users in this context."

"Naloxone is the most common antidote used for overdoses. It is normally ambulance personnel who administer naloxone in connection with opioid overdoses, and doses are administered by intramuscular or intravenous injection. It is now being discussed whether naloxone in the form of a mouth spray should be available to others as well, as first aid for someone who has overdosed
until the ambulance arrives."

"The Norwegian welfare model, which includes drug and alcohol policy, is based on rights and universal schemes under which benefits and services are provided according to needs and not symptoms. Expenditure on drug-related problems is divided between several budget chapters, mostly in the form of universal welfare services and rights irrespective of diagnosis. The uncertainty attached to calculating the size of drug-related expenditure is so great that it is simply not possible. In addition, there is a lot of grant funding for which ‘drugs’ is one of several purposes.
"In 2012, more than EUR 125 million (NOK 1 billion) more will be spent on the drugs and alcohol field than was the case in 2005. Strengthening of the municipalities’ finances and the increase in the basic allocations to the four regional health authorities comes in addition."

"On 22 June 2012, the Government presented a white paper on drugs and alcohol policy.⁴ This is the first white paper setting out a comprehensive drugs and alcohol policy that covers alcohol, drugs, addictive medicinal drugs, and doping as a social problem. In the white paper, the Government presents targets and measures ranging from effective prevention, early intervention and help for people with extensive drug and alcohol problems to measures targeting next-of-kin and third parties affected by the harm caused by drug and alcohol use.

"The main topics in the report are challenges and policies relating to alcohol, which is the substance that causes most harm, and drugs.

"The policy relating to doping as a social problem is integrated in the white paper. Based on the fact that doping can cause physical, mental and social problems, the Government advocates mobilising against doping through preventive, treatment and crime-combating measures, and it proposes criminalising possession and use of doping. The white paper also describes efforts to achieve the correct prescription and use of addictive medicinal drugs."

"Pursuant to the Patients’ Rights Act, referrals to the specialist health service shall be assessed within 30 working days. In cases where the patient is granted a right to treatment, an individual deadline shall be set for when he/she shall receive the necessary treatment at the latest. A special waiting time guarantee for children and young people under the age of 23 with mental health problems or drug-related complaints stipulates that they shall be assessed within ten working days.
"The Patients’ Rights Act entitles patients to free choice of treatment facility, but not free choice of treatment level. For example, a patient cannot choose in-patient treatment if he or she has been granted a right to outpatient treatment."

"With effect from 1 February 2012, the Storting Implementation of the national action plan introduced ‘drug driving limits’ for 20 narcotic substances and potentially intoxicating medicinal drugs. Norway thereby became the first country in the world to set legal and sentencing limits for substances other than alcohol. The amendments to the Road Traffic Act entered
into force on 22 July 2012. Among other things, the amendments are intended to ensure greater agreement between the Road Traffic Act’s provisions on drink driving and the regulation of driving under the influence of other intoxicating or narcotic substances."
[Note: The Storting is the Norwegian Parliament.]

"For 20 intoxicating substances, it has been documented that use entails an increased risk of a road accident. Concentration limits corresponding to a blood alcohol level of 0.2 mg/ml have been adopted for these substances.
"Sentencing limits corresponding to 0.5 mg/ml and 1.2 mg/ml
"For 13 of the 20 substances, sentencing limits have been adopted that correspond to the intoxication normally associated with a blood alcohol level of 0.5 and 1.2 mg/ml, respectively. There is documentation that intoxication becomes more pronounced at higher concentrations of these substances. As for alcohol, the development of tolerance to such substances is not taken into consideration.
"The limits are linked to one individual drug, and not to combinations of drugs. If several substances are found in a case, and the concentration of one of the drugs is higher than the highest sentencing limit, it will not be necessary to carry out an individual (expert) assessment."

"The municipality is responsible for organising an accident and emergency service to attend to the population’s need for emergency assistance. This includes emergency assistance for people with mental illness and drug or alcohol problems.
"Emergency drug and alcohol treatment facilities have been established in several cities in recent years. The measures are organised differently, and the type of services offered varies. What they have in common is that they are open 24 hours a day, are easily accessible and provide assistance to users in an acute life situation."

"The Government will task the Directorate of Health with drawing up a separate national strategy for reducing overdoses in collaboration with relevant agencies, such as user and next-of-kin organisations and the municipalities. The goal is an annual reduction of the number of overdose fatalities. The purpose is to stimulate the development of more local strategies for municipalities that have registered overdose fatalities. The local strategies should have concrete targets and measures in the following areas:
"• Responsibility for further development and coordination of the health services and a clear assignment of responsibility when there is a risk of overdose fatalities
"• Further competence-raising among particularly involved personnel, such as ambulance personnel and accident and emergency services staff
"• Prevention of overdoses following discharge from institutions
"• Necessary information to and involvement of next-of-kin
"• Influencing the user culture (reducing the extent of injection) and further developing
life-saving measures.
"The results will be summarised and evaluated after five years. The Directorate of Health will prepare indicators for measuring the development of the overdose situation and assess the need for professional guidelines."