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Background: Open drug scenes are gatherings of drug users who publicly consume and deal drugs. The authors conducted a study of five European cities that have met such scenes constructively. The aim was to investigate shared and non-shared interventions and strategies in order to increase the understanding of this type of problem. Methods: First a description was made for the cities of Amsterdam, Frankfurt, Vienna, Zurich and Lisbon. These descriptions were sent to contact persons in each city prior to visit by the researchers. The methods and strategies in each city were discussed and core choices and efforts extracted. A report was sent to the contact group for corrections and clarifications. The paper analyses shared and non-shared traits and strategies. Results: All of the cities had initially a period with conflict between liberal and restrictive policies. A political consensus seems to be a prerequisite for effective action. A core shared characteristic was that drug dependence was met as a health problem and drug use behaviour as a public nuisance problem. Low threshold health services including opioid maintenance treatment were combined with outreach social work and effective policing. Conclusion: Prevention, harm reduction and treatment should be combined with law enforcement based on cooperation between police, health care and social services. The aim should be "coexistence" between society and users of illegal substances and the strategy based on several years planning and conjoint efforts. The solutions are found in appropriate combinations of harm reduction and restrictive measures.

<b><i>Background:</i></b> Studies on drug use are limited by the study populations available, which usually only include drug users in treatment settings. Therefore, the knowledge base is limited on drug users not entering treatment for drug use disorder (DUD). Using registers from departments of forensic medicine enables research on decedents with DUD, irrespective of treatment status. <b><i>Objectives:</i></b> The aim of this study is to characterize and compare drug users not receiving treatment and drug users receiving treatment, in relation to cause of death, toxicological findings, and use of nonprescribed medication. <b><i>Methods:</i></b> Retrospective register-based study on deceased drug users with supplemental data from the Registry of Drug Abusers Undergoing Treatment and the Register of Medicinal Product Statistics in 2 observation periods: 2001–2002 and 2011–2012. <b><i>Results:</i></b> Two-thirds of the population were not receiving treatment at the time of death in both observation periods. Drug users receiving treatment were more likely to die from accidental poisonings than drug users not receiving treatment. There was no difference in mean age at the time of death between the 2 groups, and both groups were older in the second observation period. There was no difference in toxicological findings according to treatment status and the 2 groups did not differ in the presence of nonprescribed medication found in the blood at the time of death. <b><i>Discussion/Conclusions:</i></b> The proportion of drug users that received treatment prior to death has not increased, and deceased drug users are mostly not in treatment for their drug use at the time of death.

<b><i>Introduction and Aims:</i></b> Knowledge of attention deficit hyperactivity disorder (ADHD) symptoms among patients in opioid maintenance treatment (OMT) is important for treatment optimization and yet limited. We investigated the prevalence of ADHD symptoms, and factors associated with high ADHD symptom burden in a group of Norwegian OMT patients. <b><i>Methods:</i></b> We interviewed individuals entering OMT across Norway in 2 steps between 2012 and 2016. ADHD symptoms were measured by the Adult ADHD Self-Report Scale (ASRS; <i>n</i> = 175). We compared 2 groups of individuals who scored above or below the clinical cutoff score. Mental distress was measured with the General Symptom Index (GSI) of the Hopkin's Symptom Check-List-25. <b><i>Results:</i></b> A total of 33% of the OMT patients screened positively for ADHD on the ASRS. Participants who scored above the clinical cutoff were younger, and reported more severe substance use and mental distress. When controlling for other significant variables in a logistic regression analysis, scoring above cutoff on the ASRS was associated with higher GSI (OR 1.61; 95% CI 1.03–2.50) and use of stimulants (OR 2.55; 1.13–5.76). <b><i>Conclusions:</i></b> ADHD symptoms were common in these OMT patients. High ADHD symptom burden was associated with higher mental distress and use of stimulants. This underlines a need of more systematic focus on ADHD in OMT to plan treatment accordingly.

Variations within and between opioid maintenance programmes have been identified in other countries such as US and the UK. The aim of this study was to assess possible differences in treatment organisation, practices and outcomes between 14 regional centres within the Norwegian Opioid Maintenance Treatment programme, which were subject to the same government standards. This was a national ecological study conducted in November 2008 in Norway. Marked variations between the centres in caseload, choice of agonists, prescribing doctor, as well as in the use of supervised dispensing and urine drug screening were found. Only prescribed agonist dose was consistent across all centres. Centres in which patients had more illicit drug use had fewer patients with long-term living arrangements, more unemployment, and more patients who reported social security benefits as main income. The differences occurred despite government regulations, policies and guidelines, and frequent national meetings between centre managers. These findings show how government standards may be interpreted and implemented differently

Roland Freisler, der berüchtigte Präsident des nationalsozialistischen Volksgerichtshofes, der zahlreiche Menschen in Schauprozessen zum Tode verurteilt hat und als Urbild des »furchtbaren Juristen« (Ingo Müller nach Rolf Hochhuth) gilt, wurde von der Juristischen Fakultät der Universität Jena im Jahre 1922 zum »Dr. iur. utr.« mit der Bestnote »summa cum laude« promoviert. In seiner arbeitsrechtlichen Dissertation zu dem Thema »Grundsätze der Betriebsorganisation« hatte er sich mit den Grundlagen des in der damals noch jungen Weimarer Republik neuen Betriebsräterechtes auseinandergesetzt. Erst- und Zweitgutachter des damaligen Verfahrens sollten in der Rechtswissenschaft der NS-Zeit eine prominente Rolle spielen. Der vorliegende Band dokumentiert unter Einbeziehung umfangreicher Originaldokumente die Beziehungen Freislers zur damaligen Juristischen Fakultät der Universität Jena und ordnet sie in die Zeitumstände ein.

Purpose:This study aimed to examine the association between leisure-time physical activity (PA) and risk of long-term sickness absence (LTSA).Design:Data on LTSA (≥3 consecutive weeks during a 1-year follow-up) were acquired from the Danish Register for Evaluation of Marginalization and linked to a questionnaire via personal identification number.Setting:Eldercare workers from 36 Danish municipalities.Subjects:Data were retrieved from 4605 healthy Danish female eldercare (i.e., workers assisting senior citizens with daily activities and health) aged 19 to 69 years, who answered a questionnaire on health, and work environment in 2005.Measures:Calculated risk of LTSA and its association with self-reported leisure-time PA.Analysis:A Cox proportional hazards model was used to calculate adjusted hazard ratios (HR) and 95% confidence intervals (95% CI).Results:Eldercare workers showed significantly reduced risk of LTSA when performing moderate (HR = 0.67, 95%CI 0.47-0.96), and vigorous leisure-time PA (HR = 0.45, 95%CI 0.25-0.81) (reference group: sedentary). In subgroup analyses, females over 45 years showed a risk reduction of LTSA for moderate (HR = 0.54, 95%CI 0.32-0.90), and vigorous leisure-time PA (HR = 0.43, 95%CI 0.18-0.99), whereas younger eldercare workers did not show significant risk reductions for either moderate (HR = 0.86, 95%CI 0.51-1.43) or vigorous leisure-time PA (HR = 0.50, 95%CI 0.21-1.16) in the fully adjusted model.Conclusions:The results indicate that moderate and, particularly, vigorous leisure-time PA reduced risk of LTSA in eldercare workers aged over 45 years.

Introduction: Negative affect and anxiety frequently precede the onset of drug use in those with substance use disorder (SUD). Low self-esteem may increase the risk of relapse. We examined the short-term effects of exercise on affect, anxiety, and self-esteem in inpatients with poly-SUD. Methods: This is a multicenter randomized control trial (RCT) with a crossover design. Thirty-eight inpatients (37.3 ± 6.4 years; 84% male) from three clinics participated in 45 min of soccer, circuit training, and control condition (psychoeducation) in a random order. Positive and negative affect (PANAS), state anxiety (single item), and self-esteem (Rosenberg SE-scale) were measured immediately before, immediately after, 1-h, 2-h, and 4-h post-exercise. Heart rate and ratings of perceived exertion were taken. Effects were assessed using linear mixed effects models. Results: Compared to the control condition, there were significant post-exercise improvements in positive affect (β = 2.99, CI = 0.39: 5.58), self-esteem (β = 1.84, CI = 0.49: 3.20), and anxiety (β = −0.69, CI = −1.34: −0.04) after circuit training (shown) and soccer. Effects persisted 4-h post-exercise. Reductions in negative affect were observed 2-h (circuit training: β = −3.39, CI = −6.35: −1.51) and 4-h (soccer: β = −3.71, CI = −6.03: −1.39) post-exercise, respectively. Conclusion: Moderately strenuous exercise undertaken in naturalistic settings may improve mental health symptoms in poly-SUD inpatients for up to 4-h post-exercise.

<b><i>Background/Aims:</i></b> Increasing rates of overdose deaths involving opioid maintenance treatment (OMT) medications and particularly methadone have been observed concurrently with the implementation of liberal OMT strategies (i.e. minimum of control and high doses prescribed). This study examined methadone-related overdose deaths in a liberal OMT programme. <b><i>Methods:</i></b> Drug-overdose deaths (n = 130) with detection of methadone in Copenhagen, Aarhus, and Odense Municipality, Denmark, during the period 2008-2011 were identified from a registry. Cases with and without prescribed methadone as OMT were compared. Treatment delivery strategy among OMT-prescribed methadone cases was investigated. <b><i>Results:</i></b> Methadone was detected in 130 overdose deaths (71.4% of all overdose deaths). Among these, 63.1% were receiving methadone maintenance treatment. Of these, 79.3% had co-detection of benzodiazepines. Concomitant detection of heroin, non-prescribed benzodiazepines, and younger age were associated with having non-prescribed methadone in the toxicological findings (adjusted OR 3.1, 4.0 and 9.5, respectively). Of the decedents, 43.8% were prescribed a higher methadone dose than recommended (>120 mg daily), of which 80.0% did not have supervised intake of methadone. <b><i>Conclusions:</i></b> Liberal OMT access does not necessarily prevent overdose deaths overall. Prescription of higher doses of methadone combined with benzodiazepines may result in an increased risk of overdose for individuals in as well as outside OMT.

<b><i>Background:</i></b> Pharmaceutical opioid (PO) overdose deaths have increased in many Western countries. There are indications that those dying from a PO overdose differ from those dying from other types of overdoses. These differences might pose a challenge as the majority of current preventive measures are tailored toward those with the characteristics of "conventional" overdose deaths. <b><i>Objective:</i></b> We investigated differences in the characteristics of persons who died from PO overdoses compared to all other overdoses. <b><i>Material and Methods:</i></b> Using the Norwegian Cause of Death Registry, we retrieved information on overdoses classified according to ICD-10 and identified PO overdoses (T40.2; T40.4) and all other overdoses (T40.X; T43.6) in 2010–2019. By linking data from nationwide registers, we analyzed data on opioid dispensations and the history of mental and behavioral disorders. 1,224 persons were registered with PO overdoses and 1,432 persons with other overdoses. <b><i>Results:</i></b> Persons in the PO overdose group were older and were more frequently women (35.0% vs. 20.5%) than persons with other overdoses. They had a higher prevalence of chronic pain (35.8% vs. 13.2%), history of cancer (8.1% vs. 1.8%), filled prescriptions of analgetic opioids more frequently the month before death (38.8% vs. 12.0%), and used threefold higher doses of prescribed opioids compared to individuals in all other overdose group (66 vs. 26 oral morphine equivalents/day). In the PO overdose group, oxycodone and fentanyl were more frequently dispensed, while codeine was more frequently dispensed in the other overdose groups. A lower proportion of those in the PO overdose group had recorded diagnoses of substance use disorders, schizophrenia, and hyperkinetic disorder compared to the other overdose groups. <b><i>Conclusion:</i></b> Persons dying from overdoses on POs often differ from the population targeted by existing prevention strategies, as they are more frequently older women with chronic pain and using high doses of prescription opioids.

<b><i>Background:</i></b> Mortality is increased among people with opioid use disorder but reduced while on opioid agonist treatment (OAT). However, the impact of patient and treatment characteristics on mortality and causes of death is insufficiently studied. <b><i>Objectives:</i></b> The objective of this study was to explore mortality and causes of death and examine the impact of patient and treatment characteristics on mortality in an OAT cohort with high retention in treatment. <b><i>Methods:</i></b> <i>Design</i>: longitudinal cohort study. <i>Setting</i>: Norway. <i>Observation period</i>: time from OAT start as of 1998 until death or end of 2016, 2,508 person-years (PY) in total. <i>Sample</i>: 200 persons starting OAT 1998–2007. <i>Data sources</i>: hospital records, interviews, the Norwegian Cause of Death Registry, Statistics Norway. <b><i>Results:</i></b> Retention: 86.4% of the observation period was on OAT, 9.0% off, 4.6% unknown OAT status. All-cause crude mortality rate per 100 PY during the whole observation period was 1.64 (95% CI: 1.19–2.20), for deaths of somatic cause 0.88 (0.56–1.31), for drug-induced deaths 0.44 (0.23–0.76), and traumatic deaths 0.24 (0.10–0.50). Off-versus-on-OAT all-cause mortality ratio was 2.31 (1.00–4.85). On OAT, 58% of the deaths were of somatic cause and 21% drug-induced; off OAT, 38% of somatic cause and 50% drug-induced. Increasing baseline age and rate of somatic hospital treatment episodes were independently associated with <i>increased</i> all-cause mortality risk, while increasing rate of in-patient psychiatric treatment episodes was associated with <i>reduced</i> risk. Increasing duration of nicotine and cannabis use and alcohol dependence as well as increasing severity of polydrug use were associated with increased all-cause and somatic mortality adjusted for age and sex. <b><i>Conclusion:</i></b> The long observation period made it possible to demonstrate the importance of long-term retention in OAT to reduce mortality. Further, the preponderance of somatic and reduction of drug-induced causes of death during OAT underlines the need for follow-up of chronic diseases and health-promoting lifestyle changes. These findings add to the knowledge about long-term OAT effects, not least in ageing OAT populations.

<b><i>Introduction:</i></b> Places where people deal and/or use drugs publicly are known as open drug scenes (ODSs). Drug-related community impacts (DRCIs) refer to drug-related issues that negatively influence public and individual health, communities, businesses, and recreational and public space enjoyment. There are no well-established criteria for identification of DRCIs. We therefore performed a scoping review of literature to determine DRCIs indicators associated with ODSs. <b><i>Methods:</i></b> The review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews (PRISMA-ScP). We searched English articles in PubMed, Scopus, Web of Science, and EMBASE databases from 1990 to 2021. The keywords were drug-related crime, drug-related offense, misconduct, social marginalization, homeless drug users, open drug scene, drug-related street disorder, public nuisance, and community impact. <b><i>Results:</i></b> Sixty-four studies were identified. Twenty-five studies were included. Two studies (8%) were about drug-related public nuisance, 1 (4%) considered drug-related social problems, 2 (8%) focused on drug-related social disorder, and 18 studies (72%) discussed indicators of community impacts such as crime, drug-related litter, safety, noise, and drug use in public. Two studies (8%) included the frequency of drug use in ODSs. <b><i>Discussion:</i></b> DRCI indicators are heterogenic, and various factors affect the indicators. The factors include social mores, political discourse, and historical approaches to dealing with and using drugs. Some societies do not tolerate the existence of ODSs. In contrast, many countries have adopted harm reduction programs to manage DRCIs. Identified DRCI indicators were drug using and dealing in public, drug-related litter, crime, drug-related loitering, street-based income generation activities, noise, and unsafety feelings in inhabitants. To solve the problems associated with DRCIs and to make a major change in ODSs, it is necessary to pay attention to the improvement of the economic conditions (e.g., employment opportunities), amendment (e.g., determine the limits of criminalization in drug use), and adoption of social policies (e.g., providing low-threshold and supportive services for homeless drug users).

Abstract

Objectives
To investigate the predictive validity of 32 measures of the Danish Psychosocial Work Environment Questionnaire (DPQ) against two criteria variables: onset of depressive disorders and long-term sickness absence (LTSA).


Methods
The DPQ was sent to 8958 employed individuals in 14 job groups of which 4340 responded (response rate: 48.4%). Depressive disorders were measured by self-report with a 6-month follow-up. LTSA was measured with a 1-year follow-up in a national register. We analyzed onset of depressive disorders at follow-up using logistic regression models, adjusted for age, sex, and job group, while excluding respondents with depressive disorders at baseline. We analyzed onset of LTSA with Cox regression models, adjusted for age, sex, and job group, while excluding respondents with previous LTSA.


Results
The general pattern of the results followed our hypotheses as high job demands, poorly organized working conditions, poor relations to colleagues and superiors, and negative reactions to the work situation predicted onset of depressive disorders at follow-up and onset of LTSA during follow-up. Analyzing onset of depressive disorders and onset of LTSA, we found risk estimates that deviated from unity in most of the investigated associations. Overall, we found higher risk estimates when analyzing onset of depressive disorders compared with onset of LTSA.


Conclusions
The analyses provide support for the predictive validity of most DPQ-measures. Results suggest that the DPQ constitutes a useful tool for identifying risk factors for depression and LTSA in the psychosocial work environment.

Introduction: Among people receiving current or previous opioid maintenance treatment (OMT), the leading cause of premature death is an opioid overdose. However, other causes of mortality remain high in this group. An understanding of causes of deaths across multiple settings can be useful in informing more comprehensive prevention responses. The aim of this study was to describe all non-overdose causes of death in three national cohorts (Czechia, Denmark, and Norway) among OMT patients and to explore associations of non-overdose mortality with age and gender. Methods: This prospective comparative cohort study used national mortality registry databases for OMT patients from Czechia (2000–2019), Denmark (2000–2018), and Norway (2010–2019). Crude mortality rates and age-standardized mortality rates (ASMRs) were calculated as deaths per 1,000 person years for cause-specific mortality. Results: In total, 29,486 patients were included, with 5,322 deaths recorded (18%). We found variations in causes of death among the cohorts and within gender and age groups. The leading non-overdose causes of death were accidents in Czechia and Denmark, and neoplasms in Norway. Cardiovascular deaths were highest in Czechia, particularly for women in OMT (ASMR 3.59 vs. 1.24 in Norway and 1.87 in Denmark). Conclusion: This study found high rates of preventable death among both genders and all age groups. Different demographic structures, variations in risk exposure, as well as variations in coding practices can explain the differences. The findings support increased efforts towards screening and preventative health initiatives among OMT patients specific to the demographic characteristics in different settings.