{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,11]],"date-time":"2026-11-11T14:19:42Z","timestamp":1794406782626,"version":"4.9.0"},"reference-count":51,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2021,11,23]],"date-time":"2021-11-23T00:00:00Z","timestamp":1637625600000},"content-version":"unspecified","delay-in-days":22,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Ministry of Health and Care Services, Oslo, Norway","award":["B-1408"],"award-info":[{"award-number":["B-1408"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2021,10,20]]},"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>In order to target the complex health needs of patients with multimorbidity using psychoactive substances, knowledge regarding the association between substance use and multimorbidity in an acute setting is needed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Examine psychoactive substance use patterns among acute medically ill patients, and determine the association between multimorbidity and substance use, and psychological distress.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Cross-sectional study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting and participants<\/jats:title>\n                    <jats:p>2874 acute medically ill patients admitted to a medical emergency department in Oslo, Norway.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements<\/jats:title>\n                    <jats:p>Primary outcome: multimorbidity recorded by the presence of \u22652 International Classification of Diseases 10th revision\u2014physical and\/or mental health conditions per patient, extracted from medical records. Predictor variables: self-reported data on age, sex, occupational status, psychological distress (Hopkins Symptom Check List-5), alcohol use (Alcohol Use Disorder Identification Test-4) and results from blood samples on psychoactive medicinal and illicit drugs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>Of all patients, 57.2% had multimorbidity. Of these, 62.6% reported psychological distress, 85.5% consumed either alcohol, medicinal and\/or illicit drugs and 64.4% combined alcohol with psychoactive medicinal drugs. Patients with risky alcohol use were more likely to have multimorbidity compared with patients with low-risk alcohol use (OR 1.53; 95%\u2009CI 1.05 to 2.24). Patients using psychoactive medicinal drugs were more likely to have multimorbidity compared with non-users (OR 1.34; 95%\u2009CI 1.07 to 1.67).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Multimorbidity was associated with psychoactive medicinal drug and risky alcohol use, and psychological distress. Substance use was widespread, with alcohol and psychoactive medicinal drugs most frequently combined. Monitoring substance use among multimorbid patients is necessary to develop tailored treatments, and reduce burden on the healthcare system.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2021-052428","type":"journal-article","created":{"date-parts":[[2021,11,23]],"date-time":"2021-11-23T12:52:33Z","timestamp":1637671953000},"page":"e052428","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Multimorbidity, psychoactive substance use and psychological distress among acute medically ill patients: a cross-sectional study"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6638-8015","authenticated-orcid":false,"given":"Saranda","family":"Kabashi","sequence":"first","affiliation":[{"name":"Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway"},{"name":"Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8064-779X","authenticated-orcid":false,"given":"Danil","family":"Gamboa","sequence":"additional","affiliation":[{"name":"Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway"},{"name":"Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vigdis","family":"Vindenes","sequence":"additional","affiliation":[{"name":"Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway"},{"name":"Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Berg","sequence":"additional","affiliation":[{"name":"Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thor Arthur","family":"Hilberg","sequence":"additional","affiliation":[{"name":"F\u00fcrst Medical Laboratory, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benedicte","family":"J\u00f8rgenrud","sequence":"additional","affiliation":[{"name":"Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7144-5096","authenticated-orcid":false,"given":"Anners","family":"Lerdal","sequence":"additional","affiliation":[{"name":"Department of Interdiciplinary Health Sciencies, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway"},{"name":"Department of Research, Lovisenberg Diaconal Hospital, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stig Tore","family":"Bogstrand","sequence":"additional","affiliation":[{"name":"Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway"},{"name":"Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,11,23]]},"reference":[{"key":"2025121221372632000_11.11.e052428.1","unstructured":"WHO . Multimorbidity: technical series on safer primary care, 2016."},{"key":"2025121221372632000_11.11.e052428.2","doi-asserted-by":"publisher","DOI":"10.1093\/eurpub\/cky098"},{"key":"2025121221372632000_11.11.e052428.3","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1016\/j.pmedr.2018.10.008","article-title":"The global burden of multiple chronic conditions: a narrative review","volume":"12","author":"Hajat","year":"2018","journal-title":"Prev Med Rep"},{"key":"2025121221372632000_11.11.e052428.4","doi-asserted-by":"publisher","DOI":"10.1016\/S0193-953X(05)70081-2"},{"key":"2025121221372632000_11.11.e052428.5","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)61611-6"},{"key":"2025121221372632000_11.11.e052428.6","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.64.7.830"},{"key":"2025121221372632000_11.11.e052428.7","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1016\/S2215-0366(18)30337-7","article-title":"The global burden of disease attributable to alcohol and drug use in 195 countries and territories, 1990-2016: a systematic analysis for the global burden of disease study 2016","volume":"5","year":"2018","journal-title":"Lancet Psychiatry"},{"key":"2025121221372632000_11.11.e052428.8","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(11)61138-0"},{"key":"2025121221372632000_11.11.e052428.9","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/j.cger.2017.08.005","article-title":"Prevention and screening of unhealthy substance use by older adults","volume":"34","author":"Han","year":"2018","journal-title":"Clin Geriatr Med"},{"key":"2025121221372632000_11.11.e052428.10","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1111\/j.1528-1167.2012.03613.x","article-title":"Alcohol and drugs in epilepsy: pathophysiology, presentation, possibilities, and prevention","volume":"53(Suppl 4)","author":"Leach","year":"2012","journal-title":"Epilepsia"},{"key":"2025121221372632000_11.11.e052428.11","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/j.drugalcdep.2014.01.025","article-title":"Alcohol, tobacco, and drug use among emergency department patients","volume":"138","author":"Sanjuan","year":"2014","journal-title":"Drug Alcohol Depend"},{"key":"2025121221372632000_11.11.e052428.12","doi-asserted-by":"publisher","DOI":"10.1111\/add.14892"},{"key":"2025121221372632000_11.11.e052428.13","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/j.drugalcdep.2017.10.007","article-title":"Treatment for opioid use and outcomes in older adults: a systematic literature review","volume":"182","author":"Carew","year":"2018","journal-title":"Drug Alcohol Depend"},{"key":"2025121221372632000_11.11.e052428.14","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/glq208"},{"key":"2025121221372632000_11.11.e052428.15","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1016\/j.pmedr.2018.10.007","article-title":"Medical multimorbidity and drug use among adults in the United States","volume":"12","author":"Han","year":"2018","journal-title":"Prev Med Rep"},{"key":"2025121221372632000_11.11.e052428.16","doi-asserted-by":"publisher","DOI":"10.3109\/02813432.2016.1153242"},{"key":"2025121221372632000_11.11.e052428.17","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)32380-7"},{"key":"2025121221372632000_11.11.e052428.18","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-14-686"},{"key":"2025121221372632000_11.11.e052428.19","doi-asserted-by":"crossref","DOI":"10.1186\/s13690-021-00583-7","article-title":"Chronic disease multimorbidity among the Canadian population: prevalence and associated lifestyle factors","volume":"79","author":"Geda","year":"2021","journal-title":"Arch Public Health"},{"key":"2025121221372632000_11.11.e052428.20","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1003332"},{"key":"2025121221372632000_11.11.e052428.21","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1016\/j.ypmed.2015.09.004","article-title":"Co-occurrence of chronic disease lifestyle risk factors in middle-aged and older immigrants: a cross-sectional analysis of 264,102 Australians","volume":"81","author":"Sarich","year":"2015","journal-title":"Prev Med"},{"key":"2025121221372632000_11.11.e052428.22","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejim.2011.08.029"},{"key":"2025121221372632000_11.11.e052428.23","doi-asserted-by":"crossref","DOI":"10.1186\/s12874-019-0729-5","article-title":"The agreement between chronic diseases reported by patients and derived from administrative data in patients undergoing joint arthroplasty","volume":"19","author":"Podmore","year":"2019","journal-title":"BMC Med Res Methodol"},{"key":"2025121221372632000_11.11.e052428.24","doi-asserted-by":"crossref","DOI":"10.1016\/j.drugalcdep.2019.107588","article-title":"Harmful alcohol use among acutely ill hospitalized medical patients in Oslo and Moscow: a cross-sectional study","volume":"204","author":"Kabashi","year":"2019","journal-title":"Drug Alcohol Depend"},{"key":"2025121221372632000_11.11.e052428.25","unstructured":"Life expectancy in Oslo. : Statistics Norway. Available: https:\/\/www.ssb.no\/befolkning\/artikler-og-publikasjoner\/fortsatt-store-forskjeller-i-levealder-i-oslo"},{"key":"2025121221372632000_11.11.e052428.26","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2019-032572"},{"key":"2025121221372632000_11.11.e052428.27","doi-asserted-by":"publisher","DOI":"10.1370\/afm.1363"},{"key":"2025121221372632000_11.11.e052428.28","doi-asserted-by":"publisher","DOI":"10.1080\/08039480310000932"},{"key":"2025121221372632000_11.11.e052428.29","doi-asserted-by":"crossref","first-page":"808","DOI":"10.1002\/dta.2045","article-title":"Determination of 21 drugs in oral fluid using fully automated supported liquid extraction and UHPLC-MS\/MS","volume":"9","author":"Valen","year":"2017","journal-title":"Drug Test Anal"},{"key":"2025121221372632000_11.11.e052428.30","doi-asserted-by":"publisher","DOI":"10.1093\/alcalc\/agv049"},{"key":"2025121221372632000_11.11.e052428.31","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2007.11.013"},{"key":"2025121221372632000_11.11.e052428.32","unstructured":"Babor TH-B , Saunders JC , Monteiro MG . Audit: the alcohol use disorders identification test: guidelines for use in primary care. 2001."},{"key":"2025121221372632000_11.11.e052428.33","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwn093"},{"key":"2025121221372632000_11.11.e052428.34","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)60240-2"},{"key":"2025121221372632000_11.11.e052428.35","doi-asserted-by":"publisher","DOI":"10.1093\/alcalc\/agu082"},{"key":"2025121221372632000_11.11.e052428.36","unstructured":"NICE . Multimorbidity: clinical assessment and management (NG56), 2016."},{"key":"2025121221372632000_11.11.e052428.37","doi-asserted-by":"publisher","DOI":"10.1111\/add.12079"},{"key":"2025121221372632000_11.11.e052428.38","doi-asserted-by":"publisher","DOI":"10.1001\/jama.294.6.716"},{"key":"2025121221372632000_11.11.e052428.39","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2710.2009.01021.x"},{"key":"2025121221372632000_11.11.e052428.40","doi-asserted-by":"crossref","first-page":"76","DOI":"10.5811\/westjem.2014.11.24720","article-title":"Polysubstance abuse: alcohol, opioids and benzodiazepines require coordinated engagement by Society, patients, and physicians","volume":"16","author":"Ogbu","year":"2015","journal-title":"West J Emerg Med"},{"key":"2025121221372632000_11.11.e052428.41","doi-asserted-by":"crossref","first-page":"1098","DOI":"10.1093\/ije\/dyy027","article-title":"Is smoking heaviness causally associated with alcohol use? A Mendelian randomization study in four European cohorts","volume":"47","author":"Taylor","year":"2018","journal-title":"Int J Epidemiol"},{"key":"2025121221372632000_11.11.e052428.42","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1016\/j.drugalcdep.2017.05.041","article-title":"Illicit drug use is increasing among non-medical users of prescription drugs-Results from population-based surveys 2002-2014","volume":"178","author":"Karjalainen","year":"2017","journal-title":"Drug Alcohol Depend"},{"key":"2025121221372632000_11.11.e052428.43","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1016\/j.amepre.2015.03.040","article-title":"Emergency department visits and overdose deaths from combined use of opioids and benzodiazepines","volume":"49","author":"Jones","year":"2015","journal-title":"Am J Prev Med"},{"key":"2025121221372632000_11.11.e052428.44","doi-asserted-by":"publisher","DOI":"10.1097\/00004583-199701000-00016"},{"key":"2025121221372632000_11.11.e052428.45","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1080\/15563650701586397","article-title":"Reliability of self-reported use of amphetamine, barbiturates, benzodiazepines, cannabinoids, cocaine, methadone, and opiates among acutely hospitalized elderly medical patients","volume":"46","author":"Glintborg","year":"2008","journal-title":"Clin Toxicol"},{"key":"2025121221372632000_11.11.e052428.46","doi-asserted-by":"publisher","DOI":"10.1007\/s40258-017-0346-6"},{"key":"2025121221372632000_11.11.e052428.47","doi-asserted-by":"publisher","DOI":"10.1016\/j.addbeh.2011.07.007"},{"key":"2025121221372632000_11.11.e052428.48","doi-asserted-by":"publisher","DOI":"10.1093\/alcalc\/37.6.591"},{"key":"2025121221372632000_11.11.e052428.49","doi-asserted-by":"publisher","DOI":"10.1016\/j.eurpsy.2007.05.001"},{"key":"2025121221372632000_11.11.e052428.50","doi-asserted-by":"publisher","DOI":"10.1093\/epirev\/mxs009"},{"key":"2025121221372632000_11.11.e052428.51","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.arr.2017.05.003","article-title":"Evidence on multimorbidity from definition to intervention: an overview of systematic reviews","volume":"37","author":"Xu","year":"2017","journal-title":"Ageing Res Rev"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2021-052428","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T05:37:37Z","timestamp":1765604257000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2021-052428"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11]]},"references-count":51,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2021,11,23]]},"published-print":{"date-parts":[[2021,11]]}},"alternative-id":["10.1136\/bmjopen-2021-052428"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2021-052428","relation":{"has-part":[{"id-type":"doi","id":"https:\/\/doi.org\/10.1136\/bmjopen-2021-052428.supp1","asserted-by":"subject"}]},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11]]}}}