Furlan Andrea D, Carnide Nancy, Irvin Emma, Van Eerd Dwayne, Munhall Claire, Kim Jaemin, Li Cathy Meng Fei, Hamad Abdul, Mahood Quenby, MacDonald Sara
Institute for Work & Health, Toronto, Ontario, Canada.
University of Toronto, Toronto, Ontario, Canada.
Can J Pain. 2018 Jul 31;2(1):218-235. doi: 10.1080/24740527.2018.1479842. eCollection 2018.
Abuse of prescription opioids is a serious problem in North America.
The aim of this study was to conduct a systematic review of peer-reviewed and grey literature to examine existing strategies aimed at improving the appropriate use of prescription opioids and/or reducing the misuse, abuse, and diversion of these drugs.
The following electronic databases were searched to September 2015 without language restrictions: MEDLINE, EMBASE, PsycINFO, and CINAHL; the grey literature was searched to May 2014. Reference lists of retrieved papers were also searched. Studies were eligible if a strategy was implemented and its impact on at least one of the primary outcomes of interest (appropriate prescription opioid use; misuse, abuse, opioid use disorder, diversion; overdose) was measured. Standardized, prepiloted forms were used for relevance screening, quality appraisal, and data extraction.
A total of 65 studies that assessed 66 distinct strategies were identified. Due to the heterogeneity of the strategies, a qualitative synthesis was conducted. Many studies combined more than one type of strategy and measured various types of outcomes. The strategies with most promising results involved education, clinical practices, collaborations, prescription monitoring programs, public campaigns, opioid substitution programs, and naloxone distribution. We also found strategies that had some unintended consequences after implementation.
Our review identified successful strategies that have been implemented and evaluated in various jurisdictions. There is a need to replicate and disseminate these strategies where the problem of prescription opioid misuse and abuse has taken a toll on society.
在北美，滥用处方阿片类药物是一个严重问题。
本研究旨在对同行评审文献和灰色文献进行系统综述，以考察旨在改善处方阿片类药物合理使用和/或减少这些药物滥用、误用及转移的现有策略。
检索了以下电子数据库至2015年9月，无语言限制：医学索引数据库（MEDLINE）、荷兰医学文摘数据库（EMBASE）、心理学文摘数据库（PsycINFO）和护理学与健康领域数据库（CINAHL）；检索灰色文献至2014年5月。还检索了检索论文的参考文献列表。若实施了一项策略并测量了其对至少一项主要关注结果（处方阿片类药物合理使用；误用、滥用、阿片类药物使用障碍、转移；过量用药）的影响，则该研究符合纳入标准。使用标准化的预试验表格进行相关性筛选、质量评估和数据提取。
共识别出65项评估66种不同策略的研究。由于策略的异质性，进行了定性综合分析。许多研究结合了不止一种类型的策略并测量了各种类型的结果。结果最有前景的策略包括教育、临床实践、合作、处方监测项目、公众宣传活动、阿片类药物替代项目和纳洛酮分发。我们还发现了实施后产生一些意外后果的策略。
我们的综述确定了已在不同司法管辖区实施和评估的成功策略。在处方阿片类药物误用和滥用问题已对社会造成损害的地方，有必要推广和传播这些策略。
