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Emergency department-initiated interventions for patients with opioid use disorder: a systematic review.
Acad Emerg Med. 2020 Jun 17;:
Authors: Kaczorowski J, Bilodeau J, Orkin A, Dong K, Daoust R, Kestler A
Abstract
OBJECTIVES: The opioid crisis has risen dramatically in North America in the new millennium, due to both illegal and prescription opioid use. While emergency departments (EDs) represent a potentially strategic setting for interventions to reduce harm from opioid use disorder (OUD), the absence of a recent synthesis of literature limits implementation and scalability. To fill this gap, we conducted a systematic review of the literature on interventions targeting opioid use disorders initiated in emergency departments.
METHODS: Using an explicit search strategy (PROSPERO), the MEDLINE, CINAHL Complete, EMBASE and EBM reviews databases were searched from 1980 to October 4, 2019. The grey literature was explored using Google Scholar. Study characteristics were abstracted independently. The methodological quality and risk of bias were assessed.
RESULTS: 12 of 2270 studies met the inclusion criteria (two of high quality). In addition to the heterogeneity of the outcome measures used (retention in treatment, opioid consumption, overdose), brief intervention and buprenorphine initiation (6 of 12 studies) were the most documented with mixed effects for the former and positive short-term and confined to single ED sites effects for the latter.
CONCLUSION: EDs can be an appropriate setting for initiating opioid agonist treatment (OAT), but in order to be sustained, it likely needs to be coupled with community-based follow-up and support to ensure longer-term retention. The scarcity of high-quality evidence on OUD interventions initiated in emergency settings highlights the need for future research.
PMID: 32557932 [PubMed - as supplied by publisher]