Article type
Year
Abstract
Background: Systematic reviews (SRs) published by the Cochrane Drugs and Alcohol Group (CDAG) were used as background to develop WHO guidelines on the treatment of opioid dependence.
Objectives: To assess to what extent the available evidence in SRs published by the CDAG can inform treatment policy.
Methods: To compile GRADE (Grading of Recommendations Assessment, Development and Evaluation) profiles based on the 16 SRs of CDAG (The Cochrane Library 2006, Issue 2) on opioid use disorders using the GRADE methodology.
Results: The areas identified by the WHO panel were: 1.Management of opioid intoxication and overdose: no SR on this issue. 2. Management of opioid withdrawal: seven clinical questions (eight outcomes each for a total of 56): 23/56 outcomes were considered in the primary studies; for 18/23 quantitative measures were available; median number of studies was two (range 1 to 11); quality of evidence was low or very low for 21/23 outcomes. 3.Management of opioid maintenance: analysis ongoing.
Conclusions: There were no SRs on the effectiveness of management of opioid intoxication and overdose. In the area where SRs were available and analysis completed, information was there for less than half of the outcomes, the outcomes for which there was the least information were: cost of treatment, mortality, use of other drugs during the treatment. The outcomes for which there was the most information were completion of treatment and side effects. For all the outcomes quality of evidence was low or very low, mainly due to the low number of patients enrolled, observed events, and problems of directness. In the management of opioid intoxication no SRs are available, and for the management of opioid withdrawal SRs can provide only a few high quality answers; as a consequence many recommendations for managing opioid withdrawal will have to be based on expert opinion. More effort should be placed in developing high quality primary research addressing outcomes relevant to clinical practice.
Objectives: To assess to what extent the available evidence in SRs published by the CDAG can inform treatment policy.
Methods: To compile GRADE (Grading of Recommendations Assessment, Development and Evaluation) profiles based on the 16 SRs of CDAG (The Cochrane Library 2006, Issue 2) on opioid use disorders using the GRADE methodology.
Results: The areas identified by the WHO panel were: 1.Management of opioid intoxication and overdose: no SR on this issue. 2. Management of opioid withdrawal: seven clinical questions (eight outcomes each for a total of 56): 23/56 outcomes were considered in the primary studies; for 18/23 quantitative measures were available; median number of studies was two (range 1 to 11); quality of evidence was low or very low for 21/23 outcomes. 3.Management of opioid maintenance: analysis ongoing.
Conclusions: There were no SRs on the effectiveness of management of opioid intoxication and overdose. In the area where SRs were available and analysis completed, information was there for less than half of the outcomes, the outcomes for which there was the least information were: cost of treatment, mortality, use of other drugs during the treatment. The outcomes for which there was the most information were completion of treatment and side effects. For all the outcomes quality of evidence was low or very low, mainly due to the low number of patients enrolled, observed events, and problems of directness. In the management of opioid intoxication no SRs are available, and for the management of opioid withdrawal SRs can provide only a few high quality answers; as a consequence many recommendations for managing opioid withdrawal will have to be based on expert opinion. More effort should be placed in developing high quality primary research addressing outcomes relevant to clinical practice.