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Crowther D, Curran J, Somerville M, Sinclair D, Wozney L, MacPhee S, Rose AE, Boulos L, Caudrella A. Harm reduction strategies in acute care for people who use alcohol and/or drugs: A scoping review. PLoS One 2023; 18:e0294804. [PMID: 38100469 PMCID: PMC10723714 DOI: 10.1371/journal.pone.0294804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/09/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND People who use alcohol and/or drugs (PWUAD) are at higher risk of infectious disease, experiencing stigma, and recurrent hospitalization. Further, they have a higher likelihood of death once hospitalized when compared to people who do not use drugs and/or alcohol. The use of harm reduction strategies within acute care settings has shown promise in alleviating some of the harms experienced by PWUAD. This review aimed to identify and synthesize evidence related to the implementation of harm reduction strategies in acute care settings. METHODS A scoping review investigating harm reduction strategies implemented in acute care settings for PWUAD was conducted. A search strategy developed by a JBI-trained specialist was used to search five databases (Medline, Embase, CINAHL, PsychInfo and Scopus). Screening of titles, abstracts and full texts, and data extraction was done in duplicate by two independent reviewers. Discrepancies were resolved by consensus or with a third reviewer. Results were reported narratively and in tables. Both patients and healthcare decision makers contributing to the development of the protocol, article screening, synthesis and feedback of results, and the identification of gaps in the literature. FINDINGS The database search identified 14,580 titles, with 59 studies included in this review. A variety of intervention modalities including pharmacological, decision support, safer consumption, early overdose detection and turning a blind eye were identified. Reported outcome measures related to safer use, managed use, and conditions of use. Reported barriers and enablers to implementation related to system and organizational factors, patient-provider communication, and patient and provider perspectives. CONCLUSION This review outlines the types of alcohol and/or drug harm reduction strategies, which have been evaluated and/or implemented in acute care settings, the type of outcome measures used in these evaluations and summarizes key barriers and enablers to implementation. This review has the potential to serve as a resource for future harm reduction evaluation and implementation efforts in the context of acute care settings.
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Affiliation(s)
- Daniel Crowther
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Janet Curran
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
- Quality and Patient Safety, IWK Health, Halifax, Nova Scotia, Canada
| | - Mari Somerville
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
- Quality and Patient Safety, IWK Health, Halifax, Nova Scotia, Canada
| | - Doug Sinclair
- Quality and Patient Safety, IWK Health, Halifax, Nova Scotia, Canada
| | - Lori Wozney
- Mental Health and Addictions Program, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Shannon MacPhee
- Quality and Patient Safety, IWK Health, Halifax, Nova Scotia, Canada
| | | | - Leah Boulos
- The Maritime Strategy for Patient Oriented Research SUPPORT Unit, Halifax, NS, Canada
| | - Alexander Caudrella
- Mental Health and Addictions Service, St Michael’s Hospital, Toronto, Ontario, Canada
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Wang L, Hong PJ, Jiang W, Rehman Y, Hong BY, Couban RJ, Wang C, Hayes CJ, Juurlink DN, Busse JW. Predictors of fatal and nonfatal overdose after prescription of opioids for chronic pain: a systematic review and meta-analysis of observational studies. CMAJ 2023; 195:E1399-E1411. [PMID: 37871953 PMCID: PMC10593195 DOI: 10.1503/cmaj.230459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Higher doses of opioids, mental health comorbidities, co-prescription of sedatives, lower socioeconomic status and a history of opioid overdose have been reported as risk factors for opioid overdose; however, the magnitude of these associations and their credibility are unclear. We sought to identify predictors of fatal and nonfatal overdose from prescription opioids. METHODS We systematically searched MEDLINE, Embase, CINAHL, PsycINFO and Web of Science up to Oct. 30, 2022, for observational studies that explored predictors of opioid overdose after their prescription for chronic pain. We performed random-effects meta-analyses for all predictors reported by 2 or more studies using odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS Twenty-eight studies (23 963 716 patients) reported the association of 103 predictors with fatal or nonfatal opioid overdose. Moderate- to high-certainty evidence supported large relative associations with history of overdose (OR 5.85, 95% CI 3.78-9.04), higher opioid dose (OR 2.57, 95% CI 2.08-3.18 per 90-mg increment), 3 or more prescribers (OR 4.68, 95% CI 3.57-6.12), 4 or more dispensing pharmacies (OR 4.92, 95% CI 4.35-5.57), prescription of fentanyl (OR 2.80, 95% CI 2.30-3.41), current substance use disorder (OR 2.62, 95% CI 2.09-3.27), any mental health diagnosis (OR 2.12, 95% CI 1.73-2.61), depression (OR 2.22, 95% CI 1.57-3.14), bipolar disorder (OR 2.07, 95% CI 1.77-2.41) or pancreatitis (OR 2.00, 95% CI 1.52-2.64), with absolute risks among patients with the predictor ranging from 2-6 per 1000 for fatal overdose and 4-12 per 1000 for nonfatal overdose. INTERPRETATION We identified 10 predictors that were strongly associated with opioid overdose. Awareness of these predictors may facilitate shared decision-making regarding prescribing opioids for chronic pain and inform harm-reduction strategies SYSTEMATIC REVIEW REGISTRATION: Open Science Framework (https://osf.io/vznxj/).
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Affiliation(s)
- Li Wang
- Department of Anesthesia (L. Wang, Busse); The Michael G. DeGroote Institute for Pain Research and Care (L. Wang, Rehman, Couban, Busse); Department of Health Research Methods, Evidence & Impact (L. Wang, Rehman, Busse), McMaster University, Hamilton, Ont.; Department of Anesthesiology and Pain Medicine (P.J. Hong), University of Toronto, Toronto, Ont.; Faculty of Health Science (Jiang), McMaster University, Hamilton, Ont.; Division of Plastic Surgery, Department of Surgery (B.Y. Hong), University of Toronto, Toronto, Ont.; Guangdong Science and Technology Library (C. Wang), Institute of Information, Guangdong Academy of Sciences, Guangzhou, China; Department of Biomedical Informatics (Hayes), College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Ark.; Center for Mental Healthcare and Outcomes Research (Hayes), Central Arkansas Veterans Healthcare System, North Little Rock, Ark.; Sunnybrook Health Sciences Centre (Juurlink); Institute for Clinical Evaluative Sciences (Juurlink); Institute of Health Policy, Management, and Evaluation (Juurlink), University of Toronto, Toronto, Ont.
| | - Patrick J Hong
- Department of Anesthesia (L. Wang, Busse); The Michael G. DeGroote Institute for Pain Research and Care (L. Wang, Rehman, Couban, Busse); Department of Health Research Methods, Evidence & Impact (L. Wang, Rehman, Busse), McMaster University, Hamilton, Ont.; Department of Anesthesiology and Pain Medicine (P.J. Hong), University of Toronto, Toronto, Ont.; Faculty of Health Science (Jiang), McMaster University, Hamilton, Ont.; Division of Plastic Surgery, Department of Surgery (B.Y. Hong), University of Toronto, Toronto, Ont.; Guangdong Science and Technology Library (C. Wang), Institute of Information, Guangdong Academy of Sciences, Guangzhou, China; Department of Biomedical Informatics (Hayes), College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Ark.; Center for Mental Healthcare and Outcomes Research (Hayes), Central Arkansas Veterans Healthcare System, North Little Rock, Ark.; Sunnybrook Health Sciences Centre (Juurlink); Institute for Clinical Evaluative Sciences (Juurlink); Institute of Health Policy, Management, and Evaluation (Juurlink), University of Toronto, Toronto, Ont
| | - Wenjun Jiang
- Department of Anesthesia (L. Wang, Busse); The Michael G. DeGroote Institute for Pain Research and Care (L. Wang, Rehman, Couban, Busse); Department of Health Research Methods, Evidence & Impact (L. Wang, Rehman, Busse), McMaster University, Hamilton, Ont.; Department of Anesthesiology and Pain Medicine (P.J. Hong), University of Toronto, Toronto, Ont.; Faculty of Health Science (Jiang), McMaster University, Hamilton, Ont.; Division of Plastic Surgery, Department of Surgery (B.Y. Hong), University of Toronto, Toronto, Ont.; Guangdong Science and Technology Library (C. Wang), Institute of Information, Guangdong Academy of Sciences, Guangzhou, China; Department of Biomedical Informatics (Hayes), College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Ark.; Center for Mental Healthcare and Outcomes Research (Hayes), Central Arkansas Veterans Healthcare System, North Little Rock, Ark.; Sunnybrook Health Sciences Centre (Juurlink); Institute for Clinical Evaluative Sciences (Juurlink); Institute of Health Policy, Management, and Evaluation (Juurlink), University of Toronto, Toronto, Ont
| | - Yasir Rehman
- Department of Anesthesia (L. Wang, Busse); The Michael G. DeGroote Institute for Pain Research and Care (L. Wang, Rehman, Couban, Busse); Department of Health Research Methods, Evidence & Impact (L. Wang, Rehman, Busse), McMaster University, Hamilton, Ont.; Department of Anesthesiology and Pain Medicine (P.J. Hong), University of Toronto, Toronto, Ont.; Faculty of Health Science (Jiang), McMaster University, Hamilton, Ont.; Division of Plastic Surgery, Department of Surgery (B.Y. Hong), University of Toronto, Toronto, Ont.; Guangdong Science and Technology Library (C. Wang), Institute of Information, Guangdong Academy of Sciences, Guangzhou, China; Department of Biomedical Informatics (Hayes), College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Ark.; Center for Mental Healthcare and Outcomes Research (Hayes), Central Arkansas Veterans Healthcare System, North Little Rock, Ark.; Sunnybrook Health Sciences Centre (Juurlink); Institute for Clinical Evaluative Sciences (Juurlink); Institute of Health Policy, Management, and Evaluation (Juurlink), University of Toronto, Toronto, Ont
| | - Brian Y Hong
- Department of Anesthesia (L. Wang, Busse); The Michael G. DeGroote Institute for Pain Research and Care (L. Wang, Rehman, Couban, Busse); Department of Health Research Methods, Evidence & Impact (L. Wang, Rehman, Busse), McMaster University, Hamilton, Ont.; Department of Anesthesiology and Pain Medicine (P.J. Hong), University of Toronto, Toronto, Ont.; Faculty of Health Science (Jiang), McMaster University, Hamilton, Ont.; Division of Plastic Surgery, Department of Surgery (B.Y. Hong), University of Toronto, Toronto, Ont.; Guangdong Science and Technology Library (C. Wang), Institute of Information, Guangdong Academy of Sciences, Guangzhou, China; Department of Biomedical Informatics (Hayes), College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Ark.; Center for Mental Healthcare and Outcomes Research (Hayes), Central Arkansas Veterans Healthcare System, North Little Rock, Ark.; Sunnybrook Health Sciences Centre (Juurlink); Institute for Clinical Evaluative Sciences (Juurlink); Institute of Health Policy, Management, and Evaluation (Juurlink), University of Toronto, Toronto, Ont
| | - Rachel J Couban
- Department of Anesthesia (L. Wang, Busse); The Michael G. DeGroote Institute for Pain Research and Care (L. Wang, Rehman, Couban, Busse); Department of Health Research Methods, Evidence & Impact (L. Wang, Rehman, Busse), McMaster University, Hamilton, Ont.; Department of Anesthesiology and Pain Medicine (P.J. Hong), University of Toronto, Toronto, Ont.; Faculty of Health Science (Jiang), McMaster University, Hamilton, Ont.; Division of Plastic Surgery, Department of Surgery (B.Y. Hong), University of Toronto, Toronto, Ont.; Guangdong Science and Technology Library (C. Wang), Institute of Information, Guangdong Academy of Sciences, Guangzhou, China; Department of Biomedical Informatics (Hayes), College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Ark.; Center for Mental Healthcare and Outcomes Research (Hayes), Central Arkansas Veterans Healthcare System, North Little Rock, Ark.; Sunnybrook Health Sciences Centre (Juurlink); Institute for Clinical Evaluative Sciences (Juurlink); Institute of Health Policy, Management, and Evaluation (Juurlink), University of Toronto, Toronto, Ont
| | - Chunming Wang
- Department of Anesthesia (L. Wang, Busse); The Michael G. DeGroote Institute for Pain Research and Care (L. Wang, Rehman, Couban, Busse); Department of Health Research Methods, Evidence & Impact (L. Wang, Rehman, Busse), McMaster University, Hamilton, Ont.; Department of Anesthesiology and Pain Medicine (P.J. Hong), University of Toronto, Toronto, Ont.; Faculty of Health Science (Jiang), McMaster University, Hamilton, Ont.; Division of Plastic Surgery, Department of Surgery (B.Y. Hong), University of Toronto, Toronto, Ont.; Guangdong Science and Technology Library (C. Wang), Institute of Information, Guangdong Academy of Sciences, Guangzhou, China; Department of Biomedical Informatics (Hayes), College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Ark.; Center for Mental Healthcare and Outcomes Research (Hayes), Central Arkansas Veterans Healthcare System, North Little Rock, Ark.; Sunnybrook Health Sciences Centre (Juurlink); Institute for Clinical Evaluative Sciences (Juurlink); Institute of Health Policy, Management, and Evaluation (Juurlink), University of Toronto, Toronto, Ont
| | - Corey J Hayes
- Department of Anesthesia (L. Wang, Busse); The Michael G. DeGroote Institute for Pain Research and Care (L. Wang, Rehman, Couban, Busse); Department of Health Research Methods, Evidence & Impact (L. Wang, Rehman, Busse), McMaster University, Hamilton, Ont.; Department of Anesthesiology and Pain Medicine (P.J. Hong), University of Toronto, Toronto, Ont.; Faculty of Health Science (Jiang), McMaster University, Hamilton, Ont.; Division of Plastic Surgery, Department of Surgery (B.Y. Hong), University of Toronto, Toronto, Ont.; Guangdong Science and Technology Library (C. Wang), Institute of Information, Guangdong Academy of Sciences, Guangzhou, China; Department of Biomedical Informatics (Hayes), College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Ark.; Center for Mental Healthcare and Outcomes Research (Hayes), Central Arkansas Veterans Healthcare System, North Little Rock, Ark.; Sunnybrook Health Sciences Centre (Juurlink); Institute for Clinical Evaluative Sciences (Juurlink); Institute of Health Policy, Management, and Evaluation (Juurlink), University of Toronto, Toronto, Ont
| | - David N Juurlink
- Department of Anesthesia (L. Wang, Busse); The Michael G. DeGroote Institute for Pain Research and Care (L. Wang, Rehman, Couban, Busse); Department of Health Research Methods, Evidence & Impact (L. Wang, Rehman, Busse), McMaster University, Hamilton, Ont.; Department of Anesthesiology and Pain Medicine (P.J. Hong), University of Toronto, Toronto, Ont.; Faculty of Health Science (Jiang), McMaster University, Hamilton, Ont.; Division of Plastic Surgery, Department of Surgery (B.Y. Hong), University of Toronto, Toronto, Ont.; Guangdong Science and Technology Library (C. Wang), Institute of Information, Guangdong Academy of Sciences, Guangzhou, China; Department of Biomedical Informatics (Hayes), College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Ark.; Center for Mental Healthcare and Outcomes Research (Hayes), Central Arkansas Veterans Healthcare System, North Little Rock, Ark.; Sunnybrook Health Sciences Centre (Juurlink); Institute for Clinical Evaluative Sciences (Juurlink); Institute of Health Policy, Management, and Evaluation (Juurlink), University of Toronto, Toronto, Ont
| | - Jason W Busse
- Department of Anesthesia (L. Wang, Busse); The Michael G. DeGroote Institute for Pain Research and Care (L. Wang, Rehman, Couban, Busse); Department of Health Research Methods, Evidence & Impact (L. Wang, Rehman, Busse), McMaster University, Hamilton, Ont.; Department of Anesthesiology and Pain Medicine (P.J. Hong), University of Toronto, Toronto, Ont.; Faculty of Health Science (Jiang), McMaster University, Hamilton, Ont.; Division of Plastic Surgery, Department of Surgery (B.Y. Hong), University of Toronto, Toronto, Ont.; Guangdong Science and Technology Library (C. Wang), Institute of Information, Guangdong Academy of Sciences, Guangzhou, China; Department of Biomedical Informatics (Hayes), College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Ark.; Center for Mental Healthcare and Outcomes Research (Hayes), Central Arkansas Veterans Healthcare System, North Little Rock, Ark.; Sunnybrook Health Sciences Centre (Juurlink); Institute for Clinical Evaluative Sciences (Juurlink); Institute of Health Policy, Management, and Evaluation (Juurlink), University of Toronto, Toronto, Ont
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