Abstract
IntroductionOpioids are routinely used to treat a variety of chronic conditions associated with pain. However, they are a class of medications with a significant potential for adverse health effects, with and without misuse. Opioid misuse, as defined as inappropriate use of appropriately prescribed opioids, is becoming more well-recognized publicly but does not have clear treatment options. Opioid misuse has been linked to variety of poor outcomes and its consequences have a significant impact on healthcare resource utilization. The evidence on harm reduction strategies to mitigate adverse events prompting presentation to acute care settings for patients presenting with long-term opioid use is sparse.Methods and analysisWe will perform a systematic review and meta-analysis to catalog effective harm reduction strategies and identify the most effective ones to reduce avoidable healthcare utilization in patients on long-term opioid therapy who present to acute health care settings with complications attributed to opioid misuse. A search strategy will be developed and executed by an information specialist; electronic databases (MEDLINE, EMBASE, CINAHL, Cochrane Library) and additional sources will be searched. Search themes will include opioids, chronic drug use, and acute healthcare settings. Citation screening, selection, quality assessment, and data abstraction will be performed in duplicate. A comprehensive inventory of harm reduction strategies will be developed. Data will be collected on patient-related outcomes associated with each identified harm reduction strategy. When sufficiently homogeneous data on interventions, population, and outcomes is available, it will be pooled for aggregate analysis. Evaluation of the methodological quality of individual studies and of the quality of the body of evidence will be performed. Our primary objective will be to identify harm reduction strategies that have been shown to result in clinically relevant and statistically significant improvements in patient outcomes and/or decreased healthcare utilization.DiscussionThis study will better characterize harm reduction strategies for patients on long-term prescribed opioids presenting to acute healthcare settings. It will also add new knowledge and generate greater understanding of key knowledge gaps of the long-term prescribed opioid use and its impact on healthcare utilization.Systematic review registrationCRD42018088962.
Highlights
Opioids are routinely used to treat a variety of chronic conditions associated with pain
This study will better characterize harm reduction strategies for patients on long-term prescribed opioids presenting to acute healthcare settings
The goal of this study is to explore patients with presumably appropriately prescribed opioids who suffer a complication related to their use leading to an acute healthcare setting presentation, secondary to either appropriate or inappropriate use
Summary
Opioids are routinely used to treat a variety of chronic conditions associated with pain They are a class of medications with a significant potential for adverse health effects, with and without misuse. Long-term opioid use is less recognized publicly, but has been linked to a variety of poor outcomes such as frequent hospitalizations, unintentional overdoses, and death [7, 8]. This is of particular importance with high-dose usage, which has recently come to be defined as greater than 90 morphine milligram equivalents (MME) daily [9].
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