Treatment Outcomes in Patients With Opioid Use Disorder Who Were First Introduced to Opioids by Prescription: A Systematic Review and Meta-Analysis

Nitika Sanger; Meha Bhatt; Nikhita Singhal; Balpreet Panesar; Alessia D'Elia; Maegan Trottier; Hamnah Shahid; Alannah Hillmer; Natasha Baptist-Mohseni; Victoria Roczyki; Divya Soni; Maurana Brush; Elizabeth Lovell; Stephanie Sanger; M Constantine Samaan; Russell J de Souza; Lehana Thabane; Zainab Samaan

doi:10.3389/fpsyt.2020.00812

Treatment Outcomes in Patients With Opioid Use Disorder Who Were First Introduced to Opioids by Prescription: A Systematic Review and Meta-Analysis

Front Psychiatry. 2020 Aug 28:11:812. doi: 10.3389/fpsyt.2020.00812. eCollection 2020.

Authors

Nitika Sanger^{1

2}, Meha Bhatt³, Nikhita Singhal⁴, Balpreet Panesar^{5

6}, Alessia D'Elia^{2

7}, Maegan Trottier⁸, Hamnah Shahid⁹, Alannah Hillmer⁸, Natasha Baptist-Mohseni⁸, Victoria Roczyki^{6

8}, Divya Soni¹⁰, Maurana Brush⁴, Elizabeth Lovell^{2

11}, Stephanie Sanger¹², M Constantine Samaan¹³, Russell J de Souza³, Lehana Thabane^{3

14}, Zainab Samaan^{2

3}

Affiliations

¹ Medical Sciences Graduate Program, McMaster University, Hamilton, ON, Canada.
² Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
³ Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
⁴ Undergraduate MD Program, McMaster University, Hamilton, ON, Canada.
⁵ Life Sciences Undergraduate Program, McMaster University, Hamilton, ON, Canada.
⁶ Department of Biology, McMaster University, Hamilton, ON, Canada.
⁷ McMaster Integrative Neuroscience Discovery & Study Program, McMaster University, Hamilton, ON, Canada.
⁸ Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada.
⁹ Arts & Sciences, McMaster University, Hamilton, ON, Canada.
¹⁰ Health Sciences Undergraduate Program, McMaster University, Hamilton, ON, Canada.
¹¹ Postgraduate Psychiatry Program, McMaster University, Hamilton, ON, Canada.
¹² Health Science Library, McMaster University, Hamilton, ON, Canada.
¹³ Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, ON, Canada.
¹⁴ Biostatistics Unit, St Joseph's Healthcare-Hamilton, Hamilton, ON, Canada.

Abstract

Objective: Prescription opioid misuse has led to a new cohort of opioid use disorder (OUD) patients who were introduced to opioids through a legitimate prescription. This change has caused a shift in the demographic profile of OUD patients from predominantly young men to middle age and older people. The management of OUD includes medication-assisted treatment (MAT), which produces varying rates of treatment response. In this study, we will examine whether the source of first opioid use has an effect on treatment outcomes in OUD. Using a systematic review of the literature, we will investigate the association between source of first opioid introduction and treatment outcomes defined as continuing illicit opioid use and poly-substance use while in MAT.

Methods: Medline, EMBASE, CINHAL, and PsycInfo were searched from inception to December 31^st, 2019 inclusive using a comprehensive search strategy. Five pairs of reviewers conducted screening and data extraction independently in duplicate. The review is conducted and reported according to the PRISMA guidelines. A random-effects model was used for meta analyses assuming heterogeneity among the included studies.

Results: The initial search results in 27,345 articles that were screened, and five observational studies were included in the qualitative and quantitative analyses. Our results found that those who were introduced to opioids through a legitimate prescription were significantly less likely to have illicit opioid use (0.70, 95% CI 0.50, 0.99) while on MAT. They were also less likely to use cannabis (0.54, 95% CI 0.32, 0.89), alcohol (0.75, 95% CI 0.59, 0.95), cocaine (0.50, 95% CI 0.29, 0.85), and injection drug use (0.25, 95% CI 0.14, 0.43) than those introduced to opioids through recreational means.

Conclusion: This study shows that the first exposure to opioids, whether through a prescription or recreationally, influences prognosis and treatment outcomes of opioid use disorder. Although the increased pattern of prescribing opioids may have led to increased OUD in a new cohort of patients, these patients are less likely to continue to use illicit drugs and have a different prognostic and clinical profile that requires a tailored approach to treatment.

Systematic review registration: PROSPERO CRD42017058143.

Keywords: meta-analysis; opioid use disorder; opioids; prescription; systematic review.

Publication types

Systematic Review