Appropriate use of prescription opioids: how to do a systematic review of strategies

Tags: Poster
Irvin E1, Furlan A1, Van Eerd D2, Munhall C1, Kim J3, Danak S1
1Cochrane Back Review Group, Canada, 2Insitute for Work and Health, Canada, 3Cancer Care Ontario, Canada

Background: The World Health Organization (WHO) estimates that worldwide 69 000 people die from opioid overdose each year; an estimated 15 million people suffer from opioid dependence (i.e. an addiction to opioids).

Objectives: To determine existing strategies, frameworks, collaborative networks, and materials aimed at improving the appropriate use of prescription opioids, and/or reducing the misuse, abuse and diversion of these drugs.

Methods: We conducted a mixed methods review. We searched MEDLINE, EMBASE, PsycINFO, and CINAHL, and identified grey literature by searching websites for the following groups: regulatory authorities for health-related professionals, government, public health and health promotion agencies, prevention and treatment organizations, workers’ compensation boards, private insurance companies, and law enforcement agencies. There were no language restrictions. Our interventions of interest were the types of strategies developed to improve the appropriate use of opioids. Our primary outcomes were: appropriate opioid use for pain, reduction of misuse, abuse, and/or addiction, overdose, diversion and/or crime. We engaged stakeholders from law enforcement, government, public health, and vulnerable groups.

Results: We found a total of 3191 references from the database searches and grey literature. We included 109 references: 26 empirical studies, 53 descriptive studies, and 30 reviews. Some studies only described the strategies, but did not have any empirical evidence to support the implementation of the strategy. We classified the strategies into 14 groups: educational, promotional, campaign, framework, interactions, networking, community, forum, actions, regulations/law enforcement, prescription monitoring, programs, take-home naloxone, and others.

Conclusions: This mixed method review found 14 types of strategies that were relevant and could be disseminated to consumers. The empirical evidence may be examined to provide the effectiveness of some of these strategies on improving the appropriate use of prescription opioids. Outputs from this review included proposed policy, safety kits, and public awareness campaigns.