Query 16-07: Options for appropriate prescribing.
This research was funded by the Drug Safety and Effectiveness Network (DSEN) and conducted by the following investigators: Yola Moride, Danae Lemieux-Uresandi, Genaro Castillon, Cristiano S Moura, Louise Pilote, Mareva Faure, Sasha Bernatsky.
- Canada and the United States have the highest levels of prescription opioid consumption in the world. A variety of interventions have been implemented to curb the opioid epidemic. Thus far, evidence regarding their effectiveness has not been consolidated.
- To identify interventions that target opioid prescribing, assessing their effectiveness and evaluating their methodological aspects.
- We searched bibliographic databases (MEDLINE, Embase, and LILACS) for studies published between January 1, 2005, and September 23, 2016 describing any intervention that targeted the prescription of opioids. We also examined websites of relevant organizations and scanned bibliographies of included articles and reviews for additional references. The target population was that of all health care providers (HCPs) or users of opioids with no restriction on indication. Endpoints were those related to process (implementation), outcomes effectiveness), or impact. Sources were screened independently by two reviewers using predefined eligibility criteria. The synthesis of findings was qualitative; no pooling of results was conducted.
- A total of 95 distinct interventions were identified; over half consisted of prescription monitoring programs (PMPs) and mainly targeted HCPs.
- Evaluation studies addressed mainly opioid prescription rates (30.6%) but fewer studies considered overdose death (9.7%) or abuse (9.7%).
- Although PMPs and policies are associated with a reduction in opioid prescriptions, their impact on appropriateness and restriction of access to patients in need is inconsistent.
- Continuing medical education (CME) and pain management programs effectively improved chronic pain management, but studies were conducted in specific settings. The impact of interventions on abuse and overdose-death is conflicting.
- The authors conducted a systematic review of the literature to identify interventions that target opioid prescribing and assess their effectiveness. Our study suggests that existing interventions have not addressed all determinants of inappropriate opioid prescribing and usage.
- Data on the impact of interventions targeting the prescription of opioids is limited. Our review suggests that existing interventions have not addressed the essential determinants of inappropriate opioid prescribing and usage.
Phase 1 of this project, a systematic review, has been completed. Health Canada determined a separate query needed for Phase 2.
Moride et al. A systematic review of interventions and programs targeting appropriate prescribing of opioids. 2017 (ICPE abstract)
Moride Y, Lemieux-Uresandi D, Castillon G, Soares de Moura C, Pilote L, Faure M, Bernatsky S. A systematic review of interventions and programs targeting appropriate prescribing of opioids. Pain Physician. 2019 May;22(3):229-240.
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