Opioids on Trial: A Systematic Review of Interventions for the Treatment and Prevention of Opioid Overdose

Background: Canada is in the midst of an opioid epidemic. In 2016, there were more than 2800 apparent opioid-related deaths. Although improved access to naloxone has saved countless lives, it is unclear if there are other effective pharmacological or nonpharmacological interventions for the treatment and prevention of opioid overdose. In this systematic review, we aim to synthesize published findings on such interventions. Methods: We searched 5 electronic databases for randomized controlled studies using either pharmacological or nonpharmacological interventions to treat or prevent opioid overdose, and subsequently extracted and synthesized data from appropriate studies. Results: Twelve studies met our inclusion criteria. Naloxone, nalmefene, and physostigmine were effective in reversing opioid overdose, whereas naltrexone was effective in preventing opioid overdose. Opioid agonists, including methadone, buprenorphine, and diacetylmorphine, were effective in improving secondary outcomes with variable effects on overdose prevention. No trials using primarily nonpharmacological interventions were identified. Conclusions: In this systematic review, naloxone, nalmefene, and physostigmine emerged as effective in treating opioid overdose, whereas naltrexone showed evidence in preventing opioid overdose. Opioid agonists were found to be effective in improving retention in treatment and in reducing illicit opioid use. Pharmacological interventions play a key role in addressing the opioid epidemic; however, evidence for a multidisciplinary approach involving harm reduction and addressing psychosocial barriers could be the topic of subsequent literature reviews.