Strategies to address the opioid crisis: A review of systematic reviews
Background : North America is experiencing an unprecedented wave of overdoses, often related to opioids. It affects not only people who use drugs, but also those who use prescribed opioids. Several strategies are being used to reduce the harm and deaths associated with overdoses. This study aims to identify North American strategies in response to the crisis, as well as the barriers and facilitators to their development and access. Methods: A review of systematic reviews was conducted. The literature search was conducted in the CINAHL, Medline, PsychINFO and PubMed databases using PRISMA guidelines. A quality assessment of the selected articles was conducted using the Critical Appraisal Skills Program (CASP) assessment tool. Results: Nine systematic reviews were selected for strategies targeting: the prescription of opioids or alternatives; naloxone distribution ; psychosocial interventions in conjunction with opioid agonist therapy; and research on opioid use disorder. Several barriers and facilitators were identified in relation to these strategies. They are most often deployed at the community and societal levels, on a large scale, and rarely at the individual and interpersonal levels. Conclusions: This study identified strategies used in North America to address the opioid crisis, their facilitators, and barriers. Except for naloxone distribution, the strategies evaluated had little or no demonstrated effectiveness in preventing overdose or associated harms. Thought needs to be given to linking research to the needs of people at risk of overdose in order to reduce opioid-related complications and deaths. To achieve this, it is necessary to individualize strategies based on the needs of individuals.