Primary care-based interventions for secondary prevention of opioid dependence in chronic non-cancer pain patients on pharmaceutical opioids: Systematic review

Research output: Contribution to journalArticle (Academic Journal)peer-review

Abstract

Background
Globally almost one third of adults with chronic non-cancer pain (CNCP) are prescribed opioids. Prevention of opioid dependence among these patients is a public health priority.

Aim
Synthesize the evidence on the effectiveness of primary care-based interventions for secondary prevention of opioid dependence in CNCP patients on pharmaceutical opioids.

Design and Setting
Systematic review of randomized controlled trials (RCTs) and comparative non-randomized studies of interventions from high-income countries.

Methods
We searched five databases for studies on non-tapering secondary prevention interventions such as tools for predicting dependence, screening tools for early recognition of dependence, prescribing/medication monitoring, and specialist support. We examined multiple outcomes, including reduction in opioid dosage. Primary analyses were restricted to RCTs with data synthesized using an effect direction plot. Risk of bias was assessed using the Cochrane risk of bias (RoB2) tool.

Results
Of 7102 identified reports, 18 studies were eligible (8 RCTs). Most used multiple interventions/components. Of the seven RCTs at low risk of bias or ‘some concerns’, five showed a positive intervention effect on at least one relevant outcome, four of which included a nurse care manager and/or other specialist support. The remaining two RCTs showed no positive effect of automated symptom monitoring and optimized analgesic management by a nurse care manager/physician pain specialist team, or of a mobile opioid management app.

Conclusion
We identify a clear need for further adequately powered high quality studies. The conclusions that can be drawn on intervention effectiveness are limited by the sparsity and inconsistency of available data.
Original languageEnglish
Article numberBJGPO.2024.0122
JournalBJGP Open
Early online date4 Jul 2024
DOIs
Publication statusE-pub ahead of print - 4 Jul 2024

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