Developing a national overdose warning system - the Norwegian experience

Aim: This presentation outlines the design, content and functionality of a proposed new national overdose warning system (OWS), commissioned by the Norwegian Directorate of Health in autum 2023.

Background: Over the last two decades, Norway has reported among the highest levels of drug-related deaths per inhabitant in Europe, a problem that resulted in a new national OD-strategy in 2014. In the following 10 years, a number of different measures have been implemented to enhance the response to overdose prevention, with key elements including: the promotion of less harmful administration of drugs; free and easy access to smoking foil and clean syringes; widespread distribution of Naloxone and first aid training to both service providers, users of drugs and their next of kin.  After more than 10 years of a national overdose strategy, the figures for drug-induced deaths have stabilised, but remain at a relatively high level, with 321 drug overdose deaths recorded in 2022. Responding to this and in recognition of a new global imperative with the appearance of new and extremely potent synthetic opioids, policy makers asked how might a country like Norway prepare, and what could be the elements in a new and more offensive policy? 

Method: In late 2023, an expert group, financed by the Directorate of Health, was established to make proposals for an overdose warning system (OWS). A process of evidence review and international consultation ensued.

Results: The recommended approach selected a target group of people who are using drugs in a way that expose them to overdose events. Family and friends, user organisations, low threshold services, emergency services, etc. will be a secondary target group.  

Central elements include a warning function for PWUD, with both a non-cost wristband with a “push button function” – warning an OD directly to the emergency services, an OD-warning app’ linked to a web page with information, and a “news service” – utilising monitors in emergency units, low threshold services, GP offices etc. to show alerts, drug-related news, first aid information etc. 

Another key element in overdose warning systems is the possibility to test illicit substances on the market for adulteration, potency etc. Under Norwegian law, drug-testing services need to be linked to research purposes or user room facilities. Drawing on the experiences from an ongoing drug-testing pilot, it is anticipated that this component will be incorporated in the OWS system in the future. There are also plans to further extend the EMCDDAs syringe residue analysis system (ESCAPE)  to 3 Norwegian cities in addition to Oslo. The inclusion of hospital emergencies data via the Euro-DEN project, is another consideration.   

Conclusions: The proposal recommends implementing the OWS systematically from 2025, followed by an evaluation.