Abstract
BackgroundLong-term prescription of opioids by healthcare professionals has been linked to poor individual patient outcomes and high resource utilization. Supportive strategies in this population regarding acute healthcare settings may have substantial impact.MethodsWe performed a systematic review and meta-analysis of primary studies. The studies were included according to the following criteria: 1) age 18 and older; 2) long-term prescribed opioid therapy; 3) acute healthcare setting presentation from a complication of opioid therapy; 4) evaluating a supportive strategy; 5) comparing the effectiveness of different interventions; 6) addressing patient or healthcare related outcomes. We performed a qualitative analysis of supportive strategies identified. We pooled patient and system related outcome data for each supportive strategy.ResultsA total of 5664 studies were screened and 19 studies were included. A total of 9 broad categories of supportive strategies were identified. Meta-analysis was performed for the “supports for patients in pain” supportive strategy on two system-related outcomes using a ratio of means. The number of emergency department (ED) visits were significantly reduced for cohort studies (n = 6, 0.36, 95% CI [0.20–0.62], I2 = 87%) and randomized controlled trials (RCTs) (n = 3, 0.71, 95% CI [0.61–0.82], I2 = 0%). The number of opioid prescriptions at ED discharge was significantly reduced for RCTs (n = 3, 0.34, 95% CI [0.14–0.82], I2 = 78%).ConclusionFor patients presenting to acute healthcare settings with complications related to long-term opioid therapy, the intervention with the most robust data is “supports for patients in pain”.
Highlights
Long-term prescription of opioids by healthcare professionals has been linked to poor individual patient outcomes and high resource utilization
Meta-analysis was performed for the “supports for patients in pain” supportive strategy on two system-related outcomes using a ratio of means
The number of emergency department (ED) visits were significantly reduced for cohort studies (n = 6, 0.36, 95% CI [0.20–0.62], I2 = 87%) and randomized controlled trials (RCTs) (n = 3, 0.71, 95% CI [0.61–0.82], I2 = 0%)
Summary
Long-term prescription of opioids by healthcare professionals has been linked to poor individual patient outcomes and high resource utilization. Reductions in prescription rates in Ontario (Canada) lead to a doubling of opioid mortality due to an increase in street opioids [2] This shift in the nature of the opioid crisis to illicit opioid use has been seen in multiple locations over the years and paralleled these interventions [3]. Considering such findings, illicit drug use and harm reduction related to their use has become the focus of most current efforts to limit the impact of the opioid crisis and the impact of opioid prescriptions has taken a backseat It remains that there are patients on long-term opioids for chronic painful conditions without diagnosed or suspected opioid use disorder that are at risk for complications.
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