Treatment Outcomes in Patients With Opioid Use Disorder Who Were First Introduced to Opioids by Prescription: A Systematic Review and Meta-Analysis

AbstractObjectiveThere is a dearth of high-quality systematic evidence on the impact of opioid substitution medications on mental health. We compared mental health outcomes between opioid medications and placebo/waitlist, and between different opioids.MethodsThis systematic review and meta-analysis of randomized clinical trials (RCTs) was pre-registered at PROSPERO (CRD42018109375). Embase, MEDLINE, PsychInfo, CINAHL Complete, and Web of Science Core Collection were searched from inception to May 2020. RCTs were included if they compared opioid agonists with each other or with a placebo/waitlist in substitution treatment of patients with opioid use disorder, and reported at least one mental health outcome on a span of more than 1-month post baseline. Studies with psychiatric care, adjunct psychotropic medications, or unbalanced psychosocial services were excluded. Primary outcomes were comparison of depressive symptoms and overall mental health between opioids and placebo/waitlist. Random effects model was used for all the meta-analysis.ResultsNineteen studies were included in the narrative synthesis and 15 in the quantitative synthesis. Hydromorphone, diacetylmorphine (DAM), methadone, slow-release oral morphine, buprenorphine, and placebo/waitlist were among the included interventions. Based on network meta-analysis for primary outcomes, buprenorphine (SMD (CI95%)= −0.61 (−1.20, −0.11)), DAM (−1.40 (−2.70, −0.23)), and methadone (−1.20 (−2.30, −0.11)) were superior to waitlist/placebo on overall mental health. Further direct pairwise meta-analysis indicated that overall mental health improved more in DAM compared to methadone (−0.23 (−0.34, −0.13)).ConclusionsIt appears that opioid medications improve mental health independent of psychosocial services. Potential contribution of other factors needs to be further investigated.

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Acupuncture combined with medication for opioid use disorder in adults: a protocol for systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2019-034554 ◽

2020 ◽

Vol 10 (6) ◽

pp. e034554

Author(s):

Zhihan Chen ◽

Rui Wang ◽

Min Zhang ◽

Yitong Wang ◽

Yulan Ren

Keyword(s):

Systematic Review ◽

Assessment Tool ◽

Meta Analysis ◽

Opioid Use Disorder ◽

Risk Of Bias ◽

Control Group ◽

Opioid Use ◽

Bias Assessment ◽

Assess Quality ◽

Randomised Controlled

IntroductionOpioid use disorder (OUD) is a worldwide health problem. Clinical trials indicated that acupuncture combined with medication is effective in OUD, however, there are different conclusions presented by previous trials. This study is designed to evaluate the efficacy and safety of acupuncture combined with medication in OUD.Methods and analysisPubMed, CENTRAL, Embase, Web of Science, CINAHL, PsycINFO, ProQuest Dissertation and Theses, AMED, OpenGrey, Clinicaltrials.gov and who.int/trialsearch will be searched in September 2019 without a language restriction. Randomised controlled trials (RCTs) and quasi-RCTs which included participants with OUD receiving acupuncture therapy combined with medication versus control group will be included in this study. Two reviewers will independently screen studies, extract data, assess risk of bias by the Cochrane risk of bias assessment tool and assess quality of evidence by Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Any disagreements will be arbitrated by the third reviewer. Data synthesis and analysis will be conducted by using RevMan V.5.3. Subgroup analyses, sensitivity analysis, meta-regression and reporting bias assessment will be conducted if necessary and appropriate.Ethics and disseminationOn account of the nature of this systematic review and meta-analysis, ethical approval is not required. The results will be published in a peer-reviewed journal.PROSPERO registration numberCRD42019123436.

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Efficacy of Acupuncture for Treating Opioid Use Disorder in Adults: A Systematic Review and Meta-Analysis

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2018/3724708 ◽

2018 ◽

Vol 2018 ◽

pp. 1-15

Author(s):

Zhihan Chen ◽

Yitong Wang ◽

Rui Wang ◽

Jin Xie ◽

Yulan Ren

Keyword(s):

Systematic Review ◽

Assessment Tool ◽

Meta Analysis ◽

Sham Acupuncture ◽

Opioid Use Disorder ◽

Cochrane Central Register ◽

Opioid Use ◽

Link Type ◽

Registration Number

Objectives. To assess the efficacy of acupuncture in treating opioid use disorder (OUD). Design. Systematic review and meta-analysis. Methods. PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, ProQuest Dissertation and Theses, Allied and Complementary Medicine Database (AMED), Clinicaltrials.gov, and who.int/trialsearch were searched from inception to 23 December 2017. The methodological quality of selected studies and the quality of evidence for outcomes were assessed, respectively, by the Cochrane risk of bias assessment tool and the GRADE approach. Statistical analyses were conducted by RevMan 5.3. Results. A total of nine studies involving 1063 participants fulfilled the inclusion criteria. The results showed that acupuncture could be more beneficial than no treatment/sham acupuncture in terms of changes in craving for opioid (MD -2.18, 95% CI -3.10 to -1.26), insomnia (MD 2.31, 95% CI 1.97 to 2.65), and depression (SMD -1.50, 95% CI -1.85 to -1.15). In addition, these findings showed that, compared to sham electroacupuncture (EA), EA had differences in alleviating symptoms of craving (SMD -0.50, 95% CI -0.94 to -0.05) and depression (SMD -1.07, 95% CI -1.88 to -0.25) and compared to sham transcutaneous acupoint electrical stimulation (TEAS), TEAS had differences in alleviating symptoms of insomnia (MD 2.31, 95% CI 1.97 to 2.65) and anxiety (MD -1.26, 95% CI -1.60 to -0.92) compared to no treatment/sham TEAS. Conclusions. Acupuncture could be effective in treating OUD. Moreover, EA could effectively alleviate symptoms of craving for opioid and depression, and TEAS could be beneficial in improving symptoms of insomnia and anxiety. Nevertheless, the conclusions were limited due to the low-quality and small number of included studies. PROSPERO registration number is CRD42018085063.

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The role of social network support on treatment outcomes for medication for opioid use disorder: a systematic review protocol

10.21203/rs.2.20720/v1 ◽

2020 ◽

Author(s):

Navin Kumar ◽

Benjamin A. Howell ◽

Marcus Alexander ◽

Patrick G. O'Connor

Keyword(s):

Systematic Review ◽

Social Network ◽

Treatment Outcomes ◽

Systematic Reviews ◽

Opioid Use Disorder ◽

Opioid Use ◽

Support Functions ◽

Network Support ◽

Social Network Support

Abstract Background Although medications for opioid use disorder (MOUD) models are the most efficacious evidence-based treatment for opioid use disorder, there remains a high percentage of patients experiencing unfavorable treatment outcomes. Greater understanding of how social network support functions with respect to MOUD treatment outcomes may possibly increase treatment outcomes. Social network support are the kinds of support, such as assistance or help, that people receive from friends, family, peers and neighbors, paid or unpaid, in their social network. We aim to provide quality evidence to understand the role of social network support on MOUD treatment outcomes. Methods A systematic review of experimental and observational studies will be conducted. PubMed, MEDLINE, Embase, PsycINFO and Sociological Abstracts will be searched, updated to capture current literature. Primary outcomes will include adherence to MOUD, defined as continuation in or completion of an MOUD program; and opioid use, defined as the percentage of urine samples negative for opioids and/or self-reported drug use. The systematic review will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Quality assessments will be conducted using criteria from the Cochrane Handbook. A narrative synthesis will be conducted for all included studies. Discussion This systematic review seeks to provide policymakers, administrators, practitioners and researchers with a systematic and reproducible strategy to query the literature around the role of social network support on MOUD treatment outcomes. Systematic review registration International Prospective Register for Systematic Reviews (PROSPERO), CRD42018095645.

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