A systematic review of strategies to improve appropriate use of opioids and to reduce opioid use disorder and deaths from prescription opioids

Abstract

Background: Abuse of prescription opioids is a serious problem in North America. Aims: The aim of this study was to conduct a systematic review of peer-reviewed and grey literature to examine existing strategies aimed at improving the appropriate use of prescription opioids and/or reducing the misuse, abuse, and diversion of these drugs. Methods: The following electronic databases were searched to September 2015 without language restrictions: MEDLINE, EMBASE, PsycINFO, and CINAHL; the grey literature was searched to May 2014. Reference lists of retrieved papers were also searched. Studies were eligible if a strategy was implemented and its impact on at least one of the primary outcomes of interest (appropriate prescription opioid use; misuse, abuse, opioid use disorder, diversion; overdose) was measured. Standardized, prepiloted forms were used for relevance screening, quality appraisal, and data extraction. Results: A total of 65 studies that assessed 66 distinct strategies were identified. Due to the heterogeneity of the strategies, a qualitative synthesis was conducted. Many studies combined more than one type of strategy and measured various types of outcomes. The strategies with most promising results involved education, clinical practices, collaborations, prescription monitoring programs, public campaigns, opioid substitution programs, and naloxone distribution. We also found strategies that had some unintended consequences after implementation. Conclusions: Our review identified successful strategies that have been implemented and evaluated in various jurisdictions. There is a need to replicate and disseminate these strategies where the problem of prescription opioid misuse and abuse has taken a toll on society.

‘Communities are attempting to tackle the crisis’: a scoping review on community plans to prevent and reduce opioid-related harms

“…Also lacking was the use of evidence to support the selection of intervention components in community opioid-related plans; thus, conclusions about which interventions constitute best practice in local plans cannot be made. Evidence supports several interventions aimed at reducing opioid or substance-related harms that were used in plans, including: supervised consumption services,130 131 needle and syringe programmes,132 overdose education and naloxone distribution,133 methadone maintenance or buprenorphine treatment134 and school-based strategies that address youth protective factors 135–137. Several plans included interventions that have been found ineffective (eg, Drug Abuse Resistance Education programmes)138 or have little evidence for effectiveness (eg, medication take-back programme) 139 140.…”

Health communication campaigns to drive demand for evidence-based practices and reduce stigma in the HEALing communities study

“…Indeed, there is relatively little research to guide the design of campaigns for opioid-related topics and stigma ( National Academies of Sciences, Engineering, and Medicine, 2016 ). Furlan et al (2018) conducted a systematic review of the effectiveness of various strategies to reduce OUD and opioid overdose deaths and, based on limited evidence from five studies, found communication campaigns to be one of the most promising strategies.…”

“…Reviews of these campaigns have found evidence for small to moderate impacts on stigma-related knowledge, attitudes, and intended behavior, but also found that campaigns often failed to identify goals and objectives and did not reach the intended audiences in a sustained or adequately frequent manner ( Gronholm et al, 2017 ; NAS, 2016). However, there are few studies to guide the design of campaigns for opioid-related stigma ( Furlan et al, 2018 ; NAS, 2016).…”

Strategies aimed at preventing chronic opioid use in trauma and acute care surgery: a scoping review protocol

“…[26][27][28] Up to now, most efforts have been concentrated on studying the effects of strategies to reduce the use of opioid in patients already on chronic therapy. 29 Recently, mandatory prescription limits have been associated with a reduction of opioid use after elective surgeries. [30][31][32][33] However, our knowledge of the potential strategies is limited, and none are currently broadly applied as standard of care interventions.…”