Abstract
BackgroundThe North American opioid crisis is driven by opioid-related mortality and morbidity, including opioid use-associated infections (OUAIs), resulting in a substantial burden for society. Users of legal and illegal opioids are at an increased risk of OUAIs compared to individuals not using opioids. As reported for hepatitis C virus (HCV), human immunodeficiency virus (HIV), bacterial, fungal, and other infections, OUAIs transmission and acquisition risks may be modifiable. Several systematic reviews (SRs) synthetized data regarding interventions to prevent infections in persons using drugs (e.g., opioid substitution therapy, needle and syringes exchange programs, psycho-social interventions); however, their conclusions varied. Therefore, SR of published SRs is needed to synthesize the highest level of evidence on the scope and effectiveness of interventions to prevent OUAIs in people using opioids legally or illegally.MethodsWe will comprehensively search for SRs in the PubMed, Embase, PsycINFO, Cochrane Database of Systematic Reviews, Epistemonikos, and Google Scholar databases from inception to November 2020. Data selection and extraction for each SR will be performed independently by two researchers, with disagreements resolved by consensus. All SRs regarding interventions with evaluated effectiveness to prevent OUAI in legal and/or illegal opioid users will be eligible. Risk of bias assessment will be performed using the AMSTAR2 tool. The results will be qualitatively synthesized, and a typology of interventions’ effectiveness with a statement on the strength of evidence for each category will be created.DiscussionOur pilot search of PubMed resulted in 379 SRs analyzing the effectiveness of interventions to prevent HCV and HIV in persons who inject different types of drugs, including opioids. Of these 379 SRs, 8 evaluated primary studies where participants used opioids and would therefore be eligible for inclusion. The search results thus justify the application of SR of SRs approach. Comprehensive data on the scope and effectiveness of existing interventions to prevent OUAIs will help policy-makers to plan and implement preventive interventions and will assist clinicians in the guidance for their patients using opioids.Systematic review registrationRegistered in PROSPERO on 30 July 2020 (#195929).
Highlights
The North American opioid crisis is driven by opioid-related mortality and morbidity, including opioid use-associated infections (OUAIs), resulting in a substantial burden for society
Hepatitis C (HCV) and human immunodeficiency virus (HIV) are two commonly cited OUAIs associated with a substantial burden for individuals and society: approximately 10–20% of hepatitis C virus (HCV)-infected individuals are at risk of hepatic cirrhosis, hepatocellular carcinoma, and hepatic failure in the 20–30 years post-viral acquisition [14]
Patients treated with pharmaceutical opioids [11] appear more susceptible to viral, fungal, and bacterial infections when compared to patients not treated with opioids [16,17,18,19,20,21]
Summary
The North American opioid crisis is driven by opioid-related mortality and morbidity, including opioid use-associated infections (OUAIs), resulting in a substantial burden for society. As reported for hepatitis C virus (HCV), human immunodeficiency virus (HIV), bacterial, fungal, and other infections, OUAIs transmission and acquisition risks may be modifiable. Hepatitis C (HCV) and human immunodeficiency virus (HIV) are two commonly cited OUAIs associated with a substantial burden for individuals and society: approximately 10–20% of HCV-infected individuals are at risk of hepatic cirrhosis, hepatocellular carcinoma, and hepatic failure in the 20–30 years post-viral acquisition [14]. In higher doses, prolonged therapeutic use of opioids seems to facilitate virus entry and replication (hepatitis A, B, C, and HIV) and increases the risk of opportunistic bacterial, fungal, and parasitic infections [20, 21]
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