Background: The aim of this study was to establish the prevalence of intimidation, harassment, and discrimination (IHD) reported by resident physicians during their training, to identify factors associated with reported IHD, and to identify adverse sequalae associated with IHD. Methods: This review followed the PRISMA guidelines. Eight electronic databases were searched for cross-sectional studies reporting the prevalence of IHD among resident physicians. Prevalence estimates were pooled across studies using random-effects meta-analysis, with variance stabilization using Tukey double arcsine transformation. Heterogeneity was assessed with forest plots, the I2 statistic, subgroup analyses, and multivariate meta-regression. Results: 52 cross-sectional studies were included in the meta-analysis. The overall pooled prevalence of IHD was 64.1% (95% confidence interval [CI], 51.0-77.1). Verbal, physical, and sexual IHD were the most common forms of IHD reported by residents. Training status (55.5%), gender (41.7%), and ethnicity (20.6%) were the most commonly cited risk factors for IHD. The most common sources of IHD were relatives/friends of patients, nurses, and patients (cited by 50.7%, 47.8, and 41.7%, respectively). Conclusions: The prevalence of IHD among resident physicians is high and associated with multiple negative outcomes, including burnout. Despite the availability of multiple anti-IHD interventions, reports of IHD appear to be rising in many residency programs.

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Background and aimsCriminal justice‐involved individuals carry a disproportionately higher burden of opioid use disorder (OUD) than those not involved with the criminal justice system, and are often unable to access opioid agonist therapies such as methadone and buprenorphine. The opioid receptor antagonist naltrexone (NTX) is effective for the prevention of relapse to OUD and may be more acceptable in criminal justice settings. The objectives of this review were to: (1) provide an overall summary effect across studies for the efficacy and acceptability of oral and injectable NTX for the treatment of OUD among criminal justice‐involved individuals and (2) examine systematic variations in study results to explain heterogeneity among study‐specific effects.MethodsSystematic review and meta‐analysis of 1045 patients across 11 studies (10 randomized controlled trials, one quasi‐experimental study). All available outcomes were pooled using random‐effects meta‐analysis. Subgroup analyses were conducted for oral and injectable naltrexone; meta‐regression analyses were conducted for socio‐demographic and study‐level characteristics.ResultsNTX improved retention in treatment [risk ratio (RR) = 1.31; 95% confidence interval (CI) = 1.05, 1.63], reduced rates of re‐incarceration (RR = 0.70, 95% CI = 0.54–0.92), reduced opioid relapse (RR = 0.63, 95% CI = 0.53–0.76) and improved opioid abstinence (RR = 1.38, 95% CI = 1.16–1.65). While NTX was associated with a greater burden of adverse events overall (RR = 1.49, 95% CI = 1.13–1.95), the findings were inconclusive as to whether or not a difference was present for the number of serious adverse events or overdoses.ConclusionsNaltrexone appears to be efficacious and acceptable for the treatment of opioid use disorder among criminal justice‐involved individuals; however, the risk for adverse events must be weighed against the potential benefits.