Dan Werb1,2, Ayden I Scheim2,3, Ayorinde Soipe4,5, Samantha Aeby6, Indhu Rammohan2, Benedikt Fischer7,8,9,10, Scott E Hadland11,12, Brandon D L Marshall4. 1. Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, USA. 2. Centre on Drug Policy Evaluation, St. Michael's Hospital, Toronto, Canada. 3. Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, USA. 4. Department of Epidemiology, Brown University School of Public Health, Providence, USA. 5. Division of Nephrology, Department of Medicine, State University of New York, New York, USA. 6. Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada. 7. Schools of Population Health and Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand. 8. Department of Psychiatry, University of Toronto, Toronto, Canada. 9. Centre for Applied Research in Mental Health and Addiction, Simon Fraser University, Vancouver, Canada. 10. Department of Psychiatry, Federal University of Sao Paulo, São Paulo, Brazil. 11. Grayken Center for Addiction and Department of Pediatrics, Boston Medical Center, Boston, USA. 12. Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine, Boston, USA.
Abstract
ISSUES: Non-medical prescription opioid use (NMPOU) contributes substantially to the global burden of morbidity. However, no systematic assessment of the scientific literature on the associations between NMPOU and health outcomes has yet been undertaken. APPROACH: We undertook a systematic review evaluating health outcomes related to NMPOU based on ICD-10 clinical domains. We searched 13 electronic databases for original research articles until 1 July 2021. We employed an adaptation of the Oxford Centre for Evidence-Based Medicine 'Levels of Evidence' scale to assess study quality. KEY FINDINGS: Overall, 182 studies were included. The evidence base was largest on the association between NMPOU and mental and behavioural disorders; 71% (129) studies reported on these outcomes. Less evidence exists on the association of NMPOU with infectious disease outcomes (26; 14%), and on external causes of morbidity and mortality, with 13 (7%) studies assessing its association with intentional self-harm and 1 study assessing its association with assault (<1%). IMPLICATIONS: A large body of evidence has identified associations between NMPOU and opioid use disorder as well as on fatal and non-fatal overdose. We found equivocal evidence on the association between NMPOU and the acquisition of HIV, hepatitis C and other infectious diseases. We identified weak evidence regarding the potential association between NMPOU and intentional self-harm, suicidal ideation and assault. DISCUSSION AND CONCLUSIONS: Findings may inform the prevention of harms associated with NMPOU, although higher-quality research is needed to characterise the association between NMPOU and the full spectrum of physical and mental health disorders.
ISSUES: Non-medical prescription opioid use (NMPOU) contributes substantially to the global burden of morbidity. However, no systematic assessment of the scientific literature on the associations between NMPOU and health outcomes has yet been undertaken. APPROACH: We undertook a systematic review evaluating health outcomes related to NMPOU based on ICD-10 clinical domains. We searched 13 electronic databases for original research articles until 1 July 2021. We employed an adaptation of the Oxford Centre for Evidence-Based Medicine 'Levels of Evidence' scale to assess study quality. KEY FINDINGS: Overall, 182 studies were included. The evidence base was largest on the association between NMPOU and mental and behavioural disorders; 71% (129) studies reported on these outcomes. Less evidence exists on the association of NMPOU with infectious disease outcomes (26; 14%), and on external causes of morbidity and mortality, with 13 (7%) studies assessing its association with intentional self-harm and 1 study assessing its association with assault (<1%). IMPLICATIONS: A large body of evidence has identified associations between NMPOU and opioid use disorder as well as on fatal and non-fatal overdose. We found equivocal evidence on the association between NMPOU and the acquisition of HIV, hepatitis C and other infectious diseases. We identified weak evidence regarding the potential association between NMPOU and intentional self-harm, suicidal ideation and assault. DISCUSSION AND CONCLUSIONS: Findings may inform the prevention of harms associated with NMPOU, although higher-quality research is needed to characterise the association between NMPOU and the full spectrum of physical and mental health disorders.
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