• Michael Asamoah-Boaheng, Oluwatosin A Badejo, Louise V Bell, Norman Buckley, Jason W Busse, Tavis S Campbell, Kim Corace, Lynn Cooper, David Flusk, David A Garcia, Mohammad A Hossain, Alfonso Iorio, Kim L Lavoie, Patricia A Poulin, Becky Skidmore, and Joshua A Rash.
• Clinical Epidemiology, Memorial University of Newfoundland, St. John's, Newfoundland, Canada.
• Am J Prev Med. 2021 Jan 1; 60 (1): e15-e26.

ContextThis study is a systematic review of interventions to improve adherence to guideline recommendations for prescribing opioids for chronic noncancer pain.Evidence AcquisitionInvestigators searched CINAHL, Embase, MEDLINE, PsycINFO, the Cochrane Library, and Joanna Briggs Institute Evid Based Pract database from inception until June 3, 2019. Interventional studies to improve adherence to recommendations made by opioid guidelines for chronic noncancer pain in North America were eligible if outcomes included adherence to guideline recommendations or change in quantity of opioids prescribed. Data were extracted independently and in duplicate. Quantitative synthesis was performed using random effects meta-analysis. Confidence in evidence was determined using the Grades of Recommendation, Assessment, Development, and Evaluation.Evidence SynthesisA total of 20 studies (8 controlled and 12 prospective cohort) involving 1,491 providers and 72 clinics met inclusion. Interventions included education, audit and feedback, interprofessional support, shared decision making, and multifaceted strategies. Multifaceted interventions improved the use of urine drug testing (n=2, or =2.31, 95% CI=1.53, 3.49, z=3.98, p<0.01; high-certainty evidence), treatment agreements (n=2, or =1.96, 95% CI=1.47, 2.61, z=4.56, p<0.01; moderate-certainty evidence), and mental health screening (n=2, 2.57-fold, 95% CI=1.56, 4.24, z=2.32, p=0.02; low-certainty evidence) when prescribing opioids for chronic noncancer pain. Very low-certainty evidence suggests that several interventions improved the use of treatment agreements, urine drug testing, and prescription drug monitoring programs.ConclusionsMostly very low-certainty evidence supports a number of interventions for improving adherence to risk management strategies when prescribing opioids for chronic noncancer pain; however, the effect on patient important outcomes (e.g., overdose, addiction, death) is uncertain.Copyright © 2020 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

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