Health harms of non‐medical prescription opioid use: A systematic review

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.

Patterns of filled prescriptions and the association with risk of drug‐induced death. A population‐based nested case‐control register study

“…6,14,15 Many pharmaceuticals are associated with drug-induced death, and these may be prescribed or used nonmedically/illicitly, especially OA. 16,17 Use of opioids depresses respiration and may be a direct cause of death. 18 Sedatives like benzodiazepines and benzodiazepinerelated drugs may interact with opioids and increase the risk of death.…”

“…Many pharmaceuticals are associated with drug‐induced death, and these may be prescribed or used nonmedically/illicitly, especially OA 16,17 . Use of opioids depresses respiration and may be a direct cause of death 18 .…”

Association between Non-Medical Use of Prescription Drugs and Emotional and Behavioral Problems among Chinese Adolescents: The Mediating Effects of Social Support

“…A recent national survey conducted in China showed that 17.6% of Chinese school children and adolescents were identi ed as having EBPs [12]. A systematic review showed that NMUPD can also cause several adverse mental health outcomes, including neurotic, stress-related and somatoform disorders, intimate partner violence and so on [13]. Despite there have been su cient studies demonstrated the association between NMUPD and mental disorders, previous study usually focused on speci ed aspects of EBPs [14] or mainly took opioids misuse [15,16] into consideration.…”

Opioid Analgesics after Bariatric Surgery: A Scoping Review to Evaluate Physiological Risk Factors for Opioid-Related Harm

“…At present, geographical and practice variations in opioid prescribing are high [ 5 , 6 ], potentially indicating inappropriate use but complicating a thorough evaluation of the exact societal burden. Nevertheless, there is a confirmed risk for nonfatal overdose, morbidity and mortality [ 7 , 8 ]. In addition to other harms such as cardiovascular and endocrine complications, chronic opioid use is also associated with opioid use disorder (OUD) development [ 9 , 10 ].…”