McCormick Katie A, Samora Jake, Claborn Kasey R, Steiker Lori K Holleran, DiNitto Diana M
Steve Hicks School of Social Work, The University of Texas at Austin, 1925 San Jacinto Blvd., Austin, Texas, 78712. U.S.A.
Addictions Research Institute, The University of Texas at Austin, 3001 Lake Austin Blvd., Ste. 1.204, Austin, TX, 78703. U.S.A.
Drugs (Abingdon Engl). 2025;32(1):1-14. doi: 10.1080/09687637.2024.2306826. Epub 2024 Jan 23.
This systematic review aimed to 1) identify the range of opioid harm reduction interventions implemented at macro-, meso-, and micro-levels in the United States, and 2) summarize the outcomes of these interventions.
We conducted a systematic review of academic literature published between 2011-2023 following PRISMA guidelines. Articles were excluded if they reported on research that was not specific to opioids, did not report the effects of an intervention, or focused on a medical treatment for opioid use disorder. Two coders independently extracted data and reconciled discrepancies prior to narrative synthesis.
Of 6,198 articles initially identified, 36 met inclusion criteria across macro (=7), meso (=8), and micro (=21) domains. Positive evidence for micro- and meso-level interventions is largely consistent, whereas evidence for macro-level interventions is mixed. Among micro- and meso-level interventions, supply distribution interventions were most effective in increasing safe use knowledge and behaviors among people who use drugs.
Most harm reduction interventions demonstrate moderate to strong evidence of effectiveness for addressing the opioid overdose epidemic across domains. Findings revealed a lack of multi-level interventions and a lack of culturally relevant interventions that prioritize Black and Brown communities disproportionately impacted during the opioid overdose epidemic's latter phases.
本系统评价旨在1）确定美国在宏观、中观和微观层面实施的阿片类药物危害减少干预措施的范围，以及2）总结这些干预措施的结果。
我们按照PRISMA指南对2011年至2023年发表的学术文献进行了系统评价。如果文章报道的研究并非专门针对阿片类药物、未报告干预措施的效果或侧重于阿片类药物使用障碍的药物治疗，则将其排除。在进行叙述性综合分析之前，两名编码员独立提取数据并解决差异。
在最初识别的6198篇文章中，有36篇符合宏观（=7）、中观（=8）和微观（=21）领域的纳入标准。微观和中观层面干预措施的积极证据在很大程度上是一致的，而宏观层面干预措施的证据则好坏参半。在微观和中观层面的干预措施中，供应分配干预措施在提高吸毒者的安全使用知识和行为方面最为有效。
大多数危害减少干预措施都显示出在各领域应对阿片类药物过量流行方面有中度至有力的有效性证据。研究结果显示缺乏多层次干预措施，以及缺乏针对在阿片类药物过量流行后期受影响尤为严重的黑人和棕色社区的具有文化相关性的干预措施。
