Article type
Year
Abstract
Background: Harms from the use of opioids continue to increase in Canada. While many novel tools and guidelines have been implemented to support safe opioid prescribing, the impact that these tools have on the treatment practices of Canadian practitioners remains unclear.
Objectives: To identify, characterize, and summarize the research related to Canadian practitioners’ opioid-related treatment practices and to identify the gaps in literature.
Methods: A scoping review was conducted using a comprehensive protocol, developed a priori, and a pre-tested search strategy. Two independent reviewers screened titles and abstracts for relevance and characterized full-text articles using a pilot tested data screening and extraction form. Any conflicts were resolved by consensus or a third reviewer, if needed. All data were exported to Excel for cleaning. Descriptive analysis of the data was performed using standardized methods.
Results: Preliminary results indicate that 866 relevant articles were captured from the search strategy; half of which (n=433) were conducted in Ontario. The majority of studies were observational by design (n=643, 74%), and many (n=357, 41%) obtained treatment practice data from chart reviews or other existing databases (e.g. Ontario Drug Benefit (ODB) database).
The included studies describe a wide range of pharmacological and non-pharmacological treatment practices for patients using opioids or with an opioid use disorder. The most commonly reported treatment setting was a hospital (n=503, 58%), and opioids were most commonly used for acute pain either before, during, or after surgery (n=375, 43%). Treatment for opioid use disorder (n=140, 16%) and chronic pain (n=119, 14%) were also reasons for using opioids. Opioids were commonly used in combination with other non-opioid medications (n=542, 63%).
Studies reported on the number (n=181, 21%), dose (n=447, 52%), and duration (n=173, 20%) of opioid prescriptions. Many studies however, failed to report the formulation used (n=492, 57%), type of practitioner involved (n=478, 55%), or whether opioids were used as first line treatment (n=559, 65%). Only a small number of studies described practitioner characteristics such as years of training or size of practice (n=117, 14%), or their perceptions and knowledge (n=167, 19%) regarding opioid-related treatment. Statistical associations between a treatment practice and a patient characteristic or outcome were reported in less than half of the included studies (n=347, 40%).
Conclusions: There appears to be a lack of standardized treatment for Canadians who are using opioids or diagnosed with an opioid use disorder. Further research is necessary to elucidate which interventions work, have limited benefit, or lack sufficient evidence. This research will help to inform the continued development of tools which aim to support practitioners’ application of evidence-based treatment.
Objectives: To identify, characterize, and summarize the research related to Canadian practitioners’ opioid-related treatment practices and to identify the gaps in literature.
Methods: A scoping review was conducted using a comprehensive protocol, developed a priori, and a pre-tested search strategy. Two independent reviewers screened titles and abstracts for relevance and characterized full-text articles using a pilot tested data screening and extraction form. Any conflicts were resolved by consensus or a third reviewer, if needed. All data were exported to Excel for cleaning. Descriptive analysis of the data was performed using standardized methods.
Results: Preliminary results indicate that 866 relevant articles were captured from the search strategy; half of which (n=433) were conducted in Ontario. The majority of studies were observational by design (n=643, 74%), and many (n=357, 41%) obtained treatment practice data from chart reviews or other existing databases (e.g. Ontario Drug Benefit (ODB) database).
The included studies describe a wide range of pharmacological and non-pharmacological treatment practices for patients using opioids or with an opioid use disorder. The most commonly reported treatment setting was a hospital (n=503, 58%), and opioids were most commonly used for acute pain either before, during, or after surgery (n=375, 43%). Treatment for opioid use disorder (n=140, 16%) and chronic pain (n=119, 14%) were also reasons for using opioids. Opioids were commonly used in combination with other non-opioid medications (n=542, 63%).
Studies reported on the number (n=181, 21%), dose (n=447, 52%), and duration (n=173, 20%) of opioid prescriptions. Many studies however, failed to report the formulation used (n=492, 57%), type of practitioner involved (n=478, 55%), or whether opioids were used as first line treatment (n=559, 65%). Only a small number of studies described practitioner characteristics such as years of training or size of practice (n=117, 14%), or their perceptions and knowledge (n=167, 19%) regarding opioid-related treatment. Statistical associations between a treatment practice and a patient characteristic or outcome were reported in less than half of the included studies (n=347, 40%).
Conclusions: There appears to be a lack of standardized treatment for Canadians who are using opioids or diagnosed with an opioid use disorder. Further research is necessary to elucidate which interventions work, have limited benefit, or lack sufficient evidence. This research will help to inform the continued development of tools which aim to support practitioners’ application of evidence-based treatment.