Use of Selective Serotonin Reuptake Inhibitors - Validity of Self-Report versus Plasma Concentrations and Pharmacy Dispensations - A Cross-Sectional Analysis of the Norwegian Women and Cancer Study.

Purpose: To validate self-reported current use of selective serotonin reuptake inhibitors (SSRI) in the Norwegian Women and Cancer study (NOWAC) and to identify factors associated with discordance between data sources. Material and Methods: This is a cross-sectional record-linkage study comparing SSRI-use derived from four data sources: 1) Specific SSRI questions in the main NOWAC questionnaire, 2) Open questions on medication use in the small questionnaire following blood samples, 3) plasma concentration measurements for a subsample, and 4) pharmacy dispensations from the Norwegian prescription database (NorPD) where current use of SSRI was defined by Legend Time Duration (LTD). Among 105 855 women, aged 46 to 64 years and randomly selected from the general population, 70,191 had data on SSRI-use from both NOWAC and NorPD. Plasma concentration was measured for 93 pairs of self-reported SSRI-users and non-users, with dispensation data available for 68 pairs. Validity was assessed by sensitivity and specificity; agreement was assessed by Cohen's kappa. Factors associated with discordance between information sources were analyzed by multiple binary logistic regression. Results: We found high sensitivity (89.5%) and specificity (98.7%) for the specific questions in the main questionnaire compared with pharmacy dispensations. Measured against plasma concentrations, current SSRI-use defined by open questions and pharmacy dispensations both had high sensitivity (100% and 92.5%, respectively) and specificity (98.6% both). Agreements (kappa) were similarly high for all comparisons (≥0.80). The factors associated with discordance between data sources included poor health, comorbidity, being single and not being in full time work. Education was inversely associated with discordance. Conclusion: Self-reported current use of SSRI from the NOWAC questionnaires is highly valid and, according to plasma concentrations, perhaps even more so than pharmacy dispensations. Factors associated with discordance between information sources should be taken into account in the interpretation of future analyses which include SSRI-use in the NOWAC study.

The association between prescribed opioid use for mothers and children: a record-linkage study.

PURPOSE: The repeated use of prescription opioids may lead to serious side effects. It is therefore important to examine factors associated with such repeated use. The aim of this study was to investigate the association between the maternal use of prescription opioids and their use by offspring of these mothers. METHODS: Data were extracted from two nationwide registers linked by unique personal identity numbers: the 2001 Norwegian Population and Housing Census and the Norwegian Prescription Database 2004-2009. The study population consisted of 97,574 adolescents aged 15-16 years in 2001 and their mothers. The repeated use of opioids was defined as the issuing of >4 and >15 prescriptions to an adolescent and his/her mother, respectively, during the period 2004-2009. Non-steroidal anti-inflammatory drugs (NSAIDs) are not potentially addictive, and individuals issued prescriptions for NSAIDs were used as the reference analgesic drug group. RESULTS: The proportion of repeated prescription opioid users was higher among adolescents whose mother was registered as a repeated user of prescription opioids (8.4 %) than among those whose mother did not repeatedly use prescription opioids (2.4 %). The odds ratio (OR) was 3.1 [95 % confidence interval (CI) 2.7-3.6] when adjusted for the mother's socioeconomic characteristics and the gender of the offspring. A lower socioeconomic position of the mother increased the risk of repeated opioid use by her offspring. Maternal repeated use of NSAIDs was associated with repeated use of NSAIDs among offspring (OR 1.8, 95 % CI 1.7-2.0). CONCLUSIONS: Among our study population, the maternal use of opioids was associated with the repeated use of prescription opioids among the respective offspring. The same association was seen with NSAIDs, but to a lesser extent.

Dispensing of prescribed analgesics in Norway among young people with foreign-or Norwegian-born parents.

Purpose To examine and compare dispensing of prescribed analgesics between young people with parents from countries with a Muslim majority and those with parents born in Norway. Methods Our study-population constituted 11,542 adolescents from the Norwegian Youth Health Surveys conducted in 2000-2003. Users and non-users of prescribed analgesics at baseline were analysed separately. Self-reported information on their parents' birth country was used to classify them into one of the three predefined groups: Norway, countries with a Muslim majority or others. To study and compare dispensing of prescribed analgesics, data from the youth surveys were linked to the Norwegian Prescription Database (NorPD) 2004-2007. Dispensed analgesics studied were antiinflammatory and antirheumatic products (non-steroid), opioids and other analgesics and antipyretics. Results Among non-users of prescribed analgesics at baseline, 34% of all males with parents born in Norway received prescribed analgesics at least once during 2004-2007, compared to 36% in the group with parents from countries with a Muslim majority. The proportions of females receiving prescribed analgesics were about 44% in both of the two previously mentioned groups. Among users of prescribed analgesics at baseline, the proportion of individuals who were dispensed prescribed analgesics in 2004-2007 was generally higher than for those that were non-users at baseline. Both males and females with parents from countries with a Muslim majority reported more pain compared to those with parents born in Norway. No statistical differences were detected between participants with parents from countries with a Muslim majority compared to those with parents born in Norway in terms of prescribed analgesics dispensed or total amount of analgesics dispensed in 2004-2007. For the dispensing of all analgesics in 2004-2007 the adjusted OR for having parents from countries with a Muslim majority compared to parents born in Norway was 1.02 (0.87-1.21) among non-users of prescribed analgesics at baseline and 0.82 (0.57-1.16) among users. Conclusions There were no differences in the dispensing of prescribed analgesics between young people with parents born in countries with a Muslim majority and those with parents born in Norway. Nor did the amount of prescribed analgesics differ between these groups.

The association between smoking and subsequent repeated use of prescribed opioids among adolescents and young adults--a population-based cohort study.

BACKGROUND: The use of prescribed opioids for chronic non-cancer pain is increasing in many countries. It is, therefore, important to investigate predictors for repeated use of opioids in young non-cancer patients. OBJECTIVE: The aim of this study was to prospectively evaluate adolescent smoking and its association with repeated use of prescription opioids in adolescents/young adults without cancer. METHODS: The study population consisted of 11,809 15-16 year old participants (86% participation rate) in the Norwegian Youth Health Surveys carried out in 2000-2003. The exposure variable, self reported smoking status, was registered in the youth surveys along with potential confounders. Repeated use of opioids, defined as 4+ prescriptions recorded in the nationwide Norwegian Prescription Database during 2004-2008, was used as outcome measure. RESULTS: Among the participants included in our study, 161 had redeemed 4+ prescriptions for opioids. Daily adolescent smoking was associated with repeated use of opioids with an adjusted OR of 2.2 (95% CI 1.3-3.5). CONCLUSIONS: Daily smoking at 15-16 years of age was associated with increased risk of incident repeated use of prescribed opioids later in life. Our study suggests that smoking dependence in adolescents may predict longer lasting and/or higher levels of opioid use.

Prescriptions of opioids to children and adolescents; a study from a national prescription database in Norway.

BACKGROUND: Analgesics are among the groups of drugs most frequently prescribed to children and adolescents. The prevalence of opioid use in children and adolescents is, however, not known. AIM: The primary aim was to determine the 1-year periodic prevalence of opioid dispension in Norwegian children and adolescents below 18 years of age. The secondary aim was to determine to which extent children and adolescents receive opioids for acute or chronic pain. METHODS: All pharmacies in Norway submit data electronically to the Norwegian Prescription Database on all dispensed prescriptions. All prescriptions to any individual are identified with a pseudonym. All Norwegians who were dispensed opioids from 2004 to 2007 are included in the study. RESULTS: In 2004, 6386 children and adolescents received opioid dispensions, a number which had increased by 35% to 8607 in 2007. These numbers correspond to an increase in 1-year periodic prevalence from 0.59 to 0.79%. Each year during the study period, approximately 95% of the patients received only one or two opioid dispensions. Only 262 Norwegian children and adolescents below 18 years of age received opioid dispensions in three successive years from 2005 to 2007. About 93-95% of children and adolescents receiving opioids each year received the weak opioid codeine. CONCLUSIONS: The 1-year periodic prevalence of opioid use in Norwegian children and adolescents is only one-sixteenth of the previously reported prevalence in the Norwegian adult population. Children and adolescents primarily receive opioids for acute pain.

[Serenoa repens in benign prostatic hyperplasia]. / Dvergpalmeekstrakt ved benign prostatahyperplasi.

Serenoa repens is one of many herbal products used to treat benign prostatic hyperplasia. The treatment has been studied extensively, but the methodological quality has often been poor. Metaanalysis of early studies indicate that the treatment may have favourable effects on patients with benign prostatic hyperplasia, but more recent investigations of better methodological quality have questioned these results. The available documentation does not support use of products containing serenoa repens for these patients. Serenoa repens is associated with mild adverse effects comparable to that of placebo.