Scoping evidence review on the prevention and treatment of opioid overdose.
TL;DR
Findings support future international guidelines, such as those of the WHO, to examine the effectiveness of take-home naloxone, peer training, and community-based distribution models, higher-dose naloxone protocols for ultrapotent opioids, and digital delivery models.
Abstract
Background
AND
Aim
Opioid overdose is a public health crisis. Globally, ~ 600,000 deaths each year are attributable to drug use, and roughly three-quarters are linked to opioids. The rising prevalence of high-potency synthetic opioids like fentanyl necessitates comprehensive prevention and treatment strategies. This scoping review aims to map the published literature on the early detection and community management of opioid overdose and post-overdose care and identify research gaps. The aim was also to inform the potential research questions for updating the WHO and other international guidelines.
Methods
We systematically searched PubMed, EMBASE, PROSPERO, and the Cochrane Database for systematic reviews for studies published between January 2014 and March 2024. Inclusion criteria encompassed systematic reviews and review protocols, randomized clinical trials, and their secondary analysis, and guidelines published in those databases, addressing opioid overdose early detection and treatment strategies.
Results
A total of 3,057 unique records were screened, resulting in 105 studies meeting the inclusion criteria. Thirty studies examined the effects of the acute opioid overdose treatment. Among the preventive strategies, 46 studies focused on "Take Home Naloxone" strategies, reflecting a significant emphasis on naloxone distribution as a primary intervention. However, 11 studies examined post-overdose care, highlighting a notable gap in the literature. Additionally, research predominantly concentrated in the Americas (70 studies) and Europe (27 studies), with limited representation from Africa and Southeast Asia. There was a marked absence of studies on polysubstance use and ultrapotent opioids, with one systematic review addressing the treatment of fentanyl overdose.
Conclusion
Findings support future international guidelines, such as those of the WHO, to examine the effectiveness of take-home naloxone, peer training, and community-based distribution models, higher-dose naloxone protocols for ultrapotent opioids, and digital delivery models. This review identifies gaps in post-overdose care, fentanyl and polysubstance overdose management, and research from low-resource settings.