Anne Berit Bech

• Mcdonald, Rebecca Silvia; Bech, Anne Berit & Clausen, Thomas (2023). Flexible delivery of opioid agonist treatment during COVID-19 in Norway: qualitative and quantitative findings from an online survey of provider experiences. BMC Health Services Research. ISSN 1472-6963. 23(1). doi: 10.1186/s12913-023-09959-7. Fulltekst i vitenarkiv Vis sammendrag

  Background For patients receiving daily opioid agonist treatment (OAT) for opioid dependence, several countries relaxed treatment guidelines at the beginning of the COVID-19 pandemic. This involved longer take-home intervals for methadone and buprenorphine doses as well as a reduction in supervised dosing and drug screening. To date, little is known about the medium or long-term experience of OAT deregulation. Therefore, we conducted a survey to explore how OAT providers perceived greater flexibility in OAT service delivery at the end of the second year of the pandemic. Methods Nationwide cross-sectional study of twenty-three OAT units in 19 publicly funded hospital trusts in Norway. OAT units were sent a 29-item online questionnaire comprising closed-format and open-ended questions on treatment provider experiences and changes in OAT service delivery during the past 12 months (January to December 2021). Results Twenty-three (of whom female: 14; 60.8%) managers or lead physicians of OAT units completed the questionnaire reporting that, in 2021, most OAT units (91.3%, n = 21) still practiced some adjusted approaches as established in the beginning of the pandemic. The most common adaptions were special protocols for COVID-19 cases (95.7%, n = 22), increased use of telephone- (91.3%, n = 21) and video consultations (87.0%, n = 20), and longer take-home intervals for OAT medications (52.2%, n = 12). The use of depot buprenorphine also increased substantially during the pandemic. According to the OAT providers, most patients handled flexible treatment provision well. In individual cases, patients’ substance use was identified as key factor necessitating a reintroduction of supervised dosing and drug screening. Collaboration with general practitioners and municipal health and social services was generally perceived as crucial for successful treatment delivery. Conclusions Overall, the Norwegian OAT system proved resilient in the second year of the COVID-19 pandemic, as its healthcare workforce embraced innovation in technology (telemedicine) and drug development (depot buprenorphine). According to our nationally representative sample of OAT providers, most patients were compliant with longer take-home doses of methadone and buprenorphine. Our findings suggest that telemedicine can be useful as adjunct to face-to-face treatment and provide greater flexibility for patients.

• Bech, Anne Berit; Clausen, Thomas; Waal, Helge; Delaveris, Gerd Jorunn Møller & Skeie, Ivar (2021). Organ pathologies detected post-mortem in patients receiving opioid agonist treatment for opioid use disorder: a nation-wide 2-year cross-sectional study. Addiction. ISSN 0965-2140. s. 1–9. doi: 10.1111/add.15705. Fulltekst i vitenarkiv Vis sammendrag

  Aims: To document organ pathologies detected post-mortem in patients receiving opioid agonist treatment for opioid use disorder and estimate the extent to which individual characteristics are associated with pulmonary, cardiovascular, hepatic or renal pathologies. Design: Two-year cross-sectional nation-wide study. Setting: Norway. Participants: Among all 200 patients who died during opioid agonist treatment between 1 January 2014 and 31 December 2015, 125 patients (63%) were autopsied. Among these, 122 patients (75% men) had available autopsy reports and were included. The mean age at the time of death was 48 years. Measurements: Information on pulmonary, cardiovascular, hepatic and renal pathologies were retrieved from forensic or medical autopsy reports, with no (0) and yes (1) as outcome variables and age, sex and body mass index as covariates in logistic regression analyses. Findings: Pathologies in several organs were common. Two-thirds (65%) of the decedents had more than two organ system diseases. The most common organ pathologies were chronic liver disease (84%), cardiovascular disease (68%) and pulmonary emphysema (41%). In bivariate analyses, only older age was associated with any pulmonary pathology [odds ratio (OR) = 1.06; 95% confidence interval (CI) = 1.01-1.10], cardiovascular pathology (OR = 1.11; 95% CI = 1.05-1.17) and renal pathology (OR = 1.05; 95% CI = 1.00-1.11). Older age remained independently associated with cardiovascular pathology (OR = 1.10; 95% CI = 1.04-1.16) and renal pathology (OR = 1.06; 95% CI = 1.01-1.12) adjusted for body mass index and sex. Conclusions: Among autopsied Norwegians who died during opioid agonist treatment in 2014 and 2015, two-thirds had more than two organ system diseases, despite their mean age of 48 years at the time of death. Older age was independently associated with at least one cardiovascular or renal pathology after adjusting for sex and body mass index. Keywords: Ageing; autopsy; buprenorphine; forensic; methadone; multi-morbidity; opioid substitution treatment; pathology; postmortem. © 2021 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.

• Bech, Anne Berit; Clausen, Thomas; Waal, Helge; Vindenes, Vigdis; Edvardsen, Hilde Marie Erøy & Frost, Joachim [Vis alle 7 forfattere av denne artikkelen] (2020). Postmortem toxicological analyses of blood samples from 107 patients receiving opioid agonist treatment: substances detected and pooled opioid and benzodiazepine concentrations. Addiction. ISSN 0965-2140. doi: 10.1111/add.15211. Fulltekst i vitenarkiv Vis sammendrag

  Aims: To present the substances and their concentrations detected post-mortem in patients receiving opioid agonist treatment (OAT) stratified by cause of death, estimate the pooled opioid and benzodiazepine concentrations using established conversion factors for blood concentrations from the Norwegian Road Traffic Act, and explore the association between drug-induced cause of death and the pooled opioid and benzodiazepine concentrations. Design: Cross-sectional nationwide study. Setting: Norway. Participants: One hundred and seven patients who died during OAT (i.e. within 5 days after the last intake of OAT medication) between 1 January 2014 and 31 December 2015, with post-mortem femoral blood available for toxicology. Data were collected from hospital records, the Norwegian Cause of Death Registry and autopsy reports. Measurements: Presence of alcohol and non-alcohol substances in the bloodstream at time of death, determined through records of toxicology of post-mortem femoral blood. Findings: A median of four substances was detected across the causes of death. At least one benzodiazepine was detected in 81 (76%) patients. The median pooled opioid concentration was significantly higher in drug-induced deaths compared with other causes of death (362 ng/mL versus 182 ng/mL, P < 0.001), in contrast to the pooled benzodiazepine concentration (5466 versus 5701 ng/mL, P = 0.353). The multivariate regression analysis showed that only increasing pooled opioid concentration (ng/ML) was associated with increased odds of a drug-induced cause of death (odds ratio, 1.003; 95% confidence interval: 1.001-1.006). Conclusions: In Norway, overall opioid concentration seems to play an important role in drug-induced deaths during opioid agonist treatment in patients prescribed methadone or buprenorphine. Patients prescribed buprenorphine tend to replace their agonist with full agonists, while patients prescribed methadone tend to have high opioid concentrations from methadone as the only opioid.

• Bech, Anne Berit; Clausen, Thomas; Waal, Helge; Saltyte Benth, Jurate & Skeie, Ivar (2019). Mortality and causes of death among patients with opioid use disorder receiving opioid agonist treatment: A national register study. BMC Health Services Research. ISSN 1472-6963. 19. doi: 10.1186/s12913-019-4282-z. Fulltekst i vitenarkiv

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• Bech, Anne Berit (2024). Bruk av VR for å fremme sosial deltakelse blant personer med ROP-lidelse: en randomisert kontrollert studie.
• Bech, Anne Berit (2023). Somatisk helse og levevaner.
• Bech, Anne Berit (2023). Somatisk sykelighet og dødelighet-hva kan gjøres.
• Bech, Anne Berit & Toft, Helge (2023). Psykisk helse og rus: Slik kan sykepleiere ivareta pasieners somatiske helse. Tidsskriftet sykepleien. ISSN 0806-7511. doi: 10.4220/Sykepleiens.2023.93125.
• Nesse, Linda; Mcdonald, Rebecca Silvia; Bech, Anne Berit & Clausen, Thomas (2023). Medborgerskap: Et perspektiv for brukermedvirkning i LAR. Rus & samfunn. ISSN 1500-8614.
• Bech, Anne Berit (2023). Cannabis- forbud, avkriminalisering, legalisering.
• Bech, Anne Berit (2023). Cannabis-forbud, avkriminalisering, legalisering.
• Bech, Anne Berit; Clausen, Thomas & Mcdonald, Rebecca Silvia (2022). Revised service delivery of opioid agonist treatment in Norway in 2021, the second year of the pandemic: a national cross-sectional study of treatment provider experiences.
• Bech, Anne Berit (2022). Cannabis - erfaringer med forbud, avkriminalisering, legalisering.
• Bech, Anne Berit (2022). Stigmatisering i språk og begreper.
• Bech, Anne Berit (2018). Bedre sykepleie til kreftpasienter med ruslidelse eller psykisk lidelse. Tidsskriftet sykepleien. ISSN 0806-7511.
• Bech, Anne Berit (2018). Sykepleiere kan forebygge lekkasje av LAR-legemidler. Sykepleien.no.
• Bech, Anne Berit (2022). Mortality during opioid agonist treatment in Norway: a comprehensive study of the years 2014-2015. 7Letras.
• Bech, Anne Berit; Bukten, Anne; Lobmaier, Philipp Paul; Skeie, Ivar; Lillevold, Pål Henrik & Clausen, Thomas (2022). SERAF RAPPORT 2/2022 Statusrapport 2021-Siste år med gamle LAR-retningslinjer. 7Letras.
• Bech, Anne Berit; Clausen, Thomas & Lillevold, Pål Henrik (2022). SERAF rapport 1/2022 - Forebygging og håndtering av covid-19 i LAR-tiltakene i spesialisthelsetjenesten 2021 - Erfaringer og tiltak. 7Letras.

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