(256) The impact of an educational group session on opioid treatment agreement violations

A systematic review of strategies to improve appropriate use of opioids and to reduce opioid use disorder and deaths from prescription opioids

“…A strategy could have more than one type of content: one strategy had five contents, 77 3 strategies had four, 44 , 67 , 81 13 strategies had three, 37 , 41 , 43 , 48 , 51 , 53 , 60 , 63 , 66 , 70 , 76 , 79 , 85 29 strategies had two, 31 , 32 , 34 , 38 – 40 , 42 , 45 , 46 , 49 , 52 , 55 , 59 , 62 , 65 , 69 , 72 – 74 , 80 , 82 – 84 , 87 , 88 , 91 , 93 , 94 and 20 strategies had a single content. 33 , 35 , 37 , 47 , 50 , 54 , 56 – 58 , 61 , 63 , 68 , 71 , 78 , 86 , 89 , 90 , 92 , 95 , 96 The association between the number of contents and the impact factors was small for all three outcomes of interest: 0.32 for appropriate use, 0.08 for misuse, and 0.14 for ov...…”

“… 65 Thirty-five strategies involved education. 31 , 32 , 34 , 35 , 37 – 39 , 41 – 44 , 48 , 49 , 52 , 53 , 55 , 60 , 63 , 65 , 67 , 70 , 72 , 74 , 76 , 77 , 79 , 81 , 82 , 85 , 88 , 90 , 91 , 93 , 94 , 97 Clinical practice. These strategies involved changes in how health care was delivered, such as implementation of recommendations from clinical practice guidelines, 87 using a tool to improve opioid prescribing, 86 implementing urine drug tests, 85 or using disease management programs.…”

“…Among the 66 strategies described, 19 (29%) had some type of unintended consequence 41,42,[44][45][46]49,53,57,59,60,68,71,[73][74][75]79,82,84,90 and 4 reported no unintended consequence. 47,55,64,65 It was unclear in 43 studies whether there were any unintended consequences or not.…”

“…Consequences that affected the target population of the strategy were reported, such as patients not receiving necessary prescriptions 71 ; patients paying for their prescriptions out of their own pockets 71 ; overdose due to rotation from other opioids to methadone 57,74 ; more overdose by morphine, hydromorphone, and heroine 68,75 ; stolen naloxone kits 53,60,82 ; being harassed by police over possession of naloxone 82 ; stigma associated with carrying a naloxone kit 60 ; stigma associated with receiving a prescription for addiction 79 ; a paradoxical increase in overdose because suspension of physicians who were prescribing improperly led to patients on withdrawal and overdosing from other sources 41 ; patients had a false sense of privilege because of participation in an educational session, leading to more opioid abuse 90 ; and possible beliefs that naloxone access enables addiction to opioids. 49 There were consequences to the staff involved in the implementation of strategies: extra burden on the clinical staff (pharmacists and/or physicians) 42,71 ; burden on pharmacy staff who had to assemble intranasal naloxone kits; or risks of needle stick injury to staff who had to assemble intramuscular naloxone.…”

“…The results showed that those who attended the educational session were 1.8 times more likely to be discharged due to violation of the treatment agreement, and the explanation was that participants in the educational session could perceive a false sense of privilege becaus they had participated in their care beyond a typical first physician office visit. 90 Sixteen strategies had no effect on this outcome, 31,33,35,37,38,47,52,59,61,66,71,73,75,83,86,89 10 strategies had a small positive effect, 37,38,56,62,65,77,78,85,87,92 six strategies (seven studies) had a moderate positive effect, 34,40,44,58,80,95,97 and seven had a large positive effect, which included (1) a standard protocol for buprenorphine with naloxone for patients with low- The aim of study was to demonstrate noninferiority rather than superiority of the intervention.…”