Opioid harm reduction: A scoping review of physician and system-level gaps in knowledge, education, and practice

References

• Provisional Drug Overdose Death Counts. Centers for Disease Control and Prevention website. Published October 13, 2021. Accessed October 28, 2021.
   Google Scholar
• Wilson N, Kariisa M, Seth P, et al. Drug and opioid-involved overdose deaths – United States, 2017–2018. MMWR Morb Mortal Wkly Rep. 2020;69(11):290–297.
   PubMed Web of Science ®Google Scholar
• Mahon LR, Hawthorne AN, Lee J, Blue H, Palombi L. Assessing pharmacy student experience with, knowledge of and attitudes towards harm reduction: illuminating barriers to pharmacist-led harm reduction. Harm Reduct J. 2018;15(1):57.
   PubMedGoogle Scholar
• Pitt AL, Humphreys K, Brandeau ML. Modeling health benefits and harms of public policy responses to the US opioid epidemic. Am J Public Health. 2018;108(10):1394–1400.
   PubMed Web of Science ®Google Scholar
• Beletsky L, Davis CS. Today's fentanyl crisis: prohibition's iron law, revisited. Int J Drug Policy. 2017;46:156–159.
   PubMed Web of Science ®Google Scholar
• Larochelle MR, Bernson D, Land T, et al. Medication for opioid use disorder after nonfatal opioid overdose and association with mortality: a cohort study. Ann Intern Med. 2018;169(3):137–145.
   PubMed Web of Science ®Google Scholar
• Hill LG, Evoy KE, Reveles KR. Pharmacists are missing an opportunity to save lives and advance the profession by embracing opioid harm reduction. J Am Pharm Assoc. 2019;59(6):779–782.
   Google Scholar
• Andraka-Christou B, Capone MJ. A qualitative study comparing physician-reported barriers to treating addiction using buprenorphine and extended-release naltrexone in U.S. office-based practices. Int J Drug Policy. 2018;54:9–17.
   PubMed Web of Science ®Google Scholar
• Methadone. Substance Abuse and Mental Health Administration website. Published August 19, 2020. Accessed August 19, 2020.
   Google Scholar
• Naltrexone. Substance Abuse and Mental Health Administration website. Published August 19, 2020. Accessed September 10, 2020.
   Google Scholar
• Thompson EL, Rao PSS, Hayes C, Purtill C. Dispensing naloxone without a prescription: survey evaluation of Ohio pharmacists. J Pharm Pract. 2019;32(4):412–421.
   PubMed Web of Science ®Google Scholar
• Maguire MA, Pavlakos RN, Mehta BH, Schmuhl KK, Beatty SJ. A naloxone and harm reduction educational program across four years of a doctor of pharmacy program. Curr Pharm Teach Learn. 2018;10(1):72–77.
   PubMed Web of Science ®Google Scholar
• Haller C. Overview of state legislation to increase access to treatment for opioid overdose. The National Association of State Alcohol and Drug Abuse Directors; 2015. https://nasadad.org/wp-content/uploads/2015/09/Opioid-Overdose-Policy-Brief-2015-Update-FINAL1.pdf. Accessed August 4, 2020.
   Google Scholar
• Freeman PR, Hankosky ER, Lofwall MR, Talbert JC. The changing landscape of naloxone availability in the United States, 2011–2017. Drug Alcohol Depend. 2018;191:361–364.
   PubMed Web of Science ®Google Scholar
• Xu J, Davis CS, Cruz M, Lurie P. State naloxone access laws are associated with an increase in the number of naloxone prescriptions dispensed in retail pharmacies. Drug Alcohol Depend. 2018;189:37–41.
   PubMed Web of Science ®Google Scholar
• Prescription Opioids Prescribing Practices. Centers for Disease Control and Prevention website. Published August 13, 2019. Accessed September 11, 2020.
   Google Scholar
• Tong S, Sabo R, Aycock R, et al. Assessment of addiction medicine training in family medicine residency programs: a CERA study. Fam Med. 2017;49(7):537–543.
   PubMed Web of Science ®Google Scholar
• Barry DT, Irwin KS, Jones ES, et al. Integrating buprenorphine treatment into office-based practice: a qualitative study. J Gen Intern Med. 2009;24(2):218–225.
   PubMed Web of Science ®Google Scholar
• DeFlavio JR, Rolin SA, Nordstrom BR, Kazal LA Jr. Analysis of barriers to adoption of buprenorphine maintenance therapy by family physicians. Rural Remote Health. 2015;15:3019.
   PubMed Web of Science ®Google Scholar
• Walley AY, Alperen JK, Cheng DM, et al. Office-based management of opioid dependence with buprenorphine: clinical practices and barriers. J Gen Intern Med. 2008;23(9):1393–1398.
   PubMed Web of Science ®Google Scholar
• The ASAM national practice guideline for the treatment of opioid use disorder: 2020 focused update. J Addict Med. 2020;14(2S):4.
   Google Scholar
• Wilson JD, Berk J, Adger H, Feldman L. Identifying missed clinical opportunities in delivery of overdose prevention and naloxone prescription to adolescents using opioids. J Adolesc Health. 2018;63(2):245–248.
   PubMed Web of Science ®Google Scholar
• Kirane H, Ketteringham M, Bereket S, et al. Awareness and attitudes toward intranasal naloxone rescue for opioid overdose prevention. J Subst Abuse Treat. 2016;69:44–49.
   PubMed Web of Science ®Google Scholar
• Martino JG, Smith SR, Rafie S, Rafie S, Marienfeld C. Physician and pharmacist: attitudes, facilitators, and barriers to prescribing naloxone for home rescue. Am J Addict. 2020;29(1):65–72.
   PubMed Web of Science ®Google Scholar
• Peckham AM, Niculete ME, Steinberg H, Boggs DL. A survey of prescribers' attitudes, knowledge, comfort, and fear of consequences related to an opioid overdose education and naloxone distribution program. J Public Health Manag Pract. 2018;24(4):310–317.
   PubMed Web of Science ®Google Scholar
• Penm J, MacKinnon NJ, Lyons MS, Tolle E, Sneed GT. Combatting opioid overdoses in Ohio: Emergency Department Physicians' prescribing patterns and perceptions of naloxone. J Gen Intern Med. 2018;33(5):608–609.
   PubMed Web of Science ®Google Scholar
• Wilson JD, Berk J, Matson P, et al. A cross-sectional survey using clinical vignettes to examine overdose risk assessment and willingness to prescribe naloxone. J Gen Intern Med. 2019;34(4):507–509.
   PubMed Web of Science ®Google Scholar
• Devries J, Rafie S, Polston G. Implementing an overdose education and naloxone distribution program in a health system. J Am Pharm Assoc. 2017;57(2S):S154–S160.
   Google Scholar
• Han JK, Hill LG, Koenig ME, Das N. Naloxone counseling for harm reduction and patient engagement. Fam Med. 2017;49(9):730–733.
   PubMed Web of Science ®Google Scholar
• Winograd RP, Davis CS, Niculete M, Oliva E, Martielli RP. Medical providers' knowledge and concerns about opioid overdose education and take-home naloxone rescue kits within Veterans Affairs health care medical treatment settings. Subst Abus. 2017;38(2):135–140.
   PubMed Web of Science ®Google Scholar
• Wilson JD, Spicyn N, Matson P, Alvanzo A, Feldman L. Internal medicine resident knowledge, attitudes, and barriers to naloxone prescription in hospital and clinic settings. Subst Abuse. 2016;37(3):480–487.
   PubMed Web of Science ®Google Scholar
• Binswanger IA, Koester S, Mueller SR, Gardner EM, Goddard K, Glanz JM. Overdose education and naloxone for patients prescribed opioids in primary care: a qualitative study of primary care staff. J Gen Intern Med. 2015;30(12):1837–1844.
   PubMed Web of Science ®Google Scholar
• Im DD, Chary A, Condella AL, et al. Emergency Department Clinicians' attitudes toward opioid use disorder and emergency department-initiated buprenorphine treatment: a mixed-methods study. West J Emerg Med. 2020;21(2):261–271.
   PubMed Web of Science ®Google Scholar
• Varley AL, Lappan S, Jackson J, et al. Understanding barriers and facilitators to the uptake of best practices for the treatment of co-occurring chronic pain and opioid use disorder. J Dual Diagn. 2020;16(2):239–249.
   PubMed Web of Science ®Google Scholar
• Sobel HG, Goedde M, Maruti S, Hadley-Strout E, Wahlberg E, Kennedy AG. Primary care residents delivering care: integration of office-based opioid treatment into an internal medicine residency curriculum. Acad Psychiatry. 2019;43(5):499–502.
   PubMed Web of Science ®Google Scholar
• Tesema L, Marshall J, Hathaway R, et al. Training in office-based opioid treatment with buprenorphine in US residency programs: a national survey of residency program directors. Subst Abuse. 2018;39(4):434–440.
   PubMed Web of Science ®Google Scholar
• Tong ST, Hochheimer CJ, Peterson LE, Krist AH. Buprenorphine provision by early career family physicians. Ann Fam Med. 2018;16(5):443–446.
   PubMed Web of Science ®Google Scholar
• Suzuki J, Ellison TV, Connery HS, Surber C, Renner JA. Training in buprenorphine and office-based opioid treatment: a survey of psychiatry residency training programs. Acad Psychiatry. 2016;40(3):498–502.
   PubMed Web of Science ®Google Scholar
• Ko JY, Tong VT, Haight SC, Terplan M, Snead C, Schulkin J. Obstetrician-gynecologists' practice patterns related to opioid use during pregnancy and postpartum-United States, 2017. J Perinatol. 2020;40(3):412–421.
   PubMed Web of Science ®Google Scholar
• McGinty EE, Stone EM, Kennedy-Hendricks A, Bachhuber MA, Barry CL. Medication for opioid use disorder: a national survey of primary care physicians. Ann Intern Med. 2020;173(2):160–162.
   PubMed Web of Science ®Google Scholar
• Holt SR, Segar N, Cavallo DA, Tetrault JM. The addiction recovery clinic: a novel, primary-care-based approach to teaching addiction medicine. Acad Med. 2017;92(5):680–683.
   PubMed Web of Science ®Google Scholar
• Chouinard S, Prasad A, Brown R. Survey assessing medical student and physician knowledge and attitudes regarding the opioid crisis. WMJ. 2018;117(1):34–37.
   PubMedGoogle Scholar
• Guerrero E, Ober AJ, Howard DL, et al. Organizational factors associated with practitioners' support for treatment of opioid use disorder in the emergency department. Addict Behav. 2020;102:106197.
   PubMed Web of Science ®Google Scholar
• Kennedy-Hendricks A, Barry CL, Stone E, Bachhuber MA, McGinty EE. Comparing perspectives on medication treatment for opioid use disorder between national samples of primary care trainee physicians and attending physicians. Drug Alcohol Depend. 2020;216:108217.
   PubMed Web of Science ®Google Scholar
• Samuels EA, Dwyer K, Mello MJ, Baird J, Kellogg AR, Bernstein E. Emergency Department-based opioid harm reduction: moving physicians from willing to doing. Acad Emerg Med. 2016;23(4):455–465.
   PubMed Web of Science ®Google Scholar
• Szott K. Contingencies of the will: uses of harm reduction and the disease model of addiction among health care practitioners. Health. 2015;19(5):507–522.
   PubMed Web of Science ®Google Scholar
• Kennedy-Hendricks A, Busch SH, McGinty EE, et al. Primary care physicians' perspectives on the prescription opioid epidemic. Drug Alcohol Depend. 2016;165:61–70.
   PubMed Web of Science ®Google Scholar
• Wang L, Cunningham CO, Browder C, Iyer S. Internal medicine residents' feelings of responsibility, confidence, and clinical practice in opioid overdose prevention and naloxone prescribing. J Addict Med. 2020;14(5):e147–e152.
   PubMed Web of Science ®Google Scholar
• Lin LA, Lofwall MR, Walsh SL, Knudsen HK. Perceived need and availability of psychosocial interventions across buprenorphine prescriber specialties. Addict Behav. 2019;93:72–77.
   PubMed Web of Science ®Google Scholar
• Martin A, Kunzler N, Nakagawa J, et al. Get waivered: a resident-driven campaign to address the opioid overdose crisis. Ann Emerg Med. 2019;74(5):691–696.
   PubMed Web of Science ®Google Scholar
• Sell J, Visconti A. Harm reduction: assessing the educational needs of family medicine residents in care of persons who inject drugs. Fam Med. 2020;52(7):514–517.
   PubMed Web of Science ®Google Scholar
• Appel G, Avery JJ, Ho K, Livshits Z, Rao RB, Avery J. Improved emergency medicine physician attitudes towards individuals with opioid use disorder following naloxone kit training. Am J Emerg Med. 2020;38(5):1039–1041.
   PubMed Web of Science ®Google Scholar
• Kermack A, Flannery M, Tofighi B, McNeely J, Lee JD. Buprenorphine prescribing practice trends and attitudes among New York providers. J Subst Abuse Treat. 2017;74:1–6.
   PubMed Web of Science ®Google Scholar
• Lin LA, Lofwall MR, Walsh SL, Gordon AJ, Knudsen HK. Perceptions and practices addressing diversion among US buprenorphine prescribers. Drug Alcohol Depend. 2018;186:147–153.
   PubMed Web of Science ®Google Scholar
• Andrilla CHA, Coulthard C, Patterson DG. Prescribing practices of rural physicians waivered to prescribe buprenorphine. Am J Prev Med. 2018;54(6 Suppl 3):S208–S214.
   PubMed Web of Science ®Google Scholar
• Knudsen HK, Studts JL. Physicians as mediators of health policy: acceptance of medicaid in the context of buprenorphine treatment. J Behav Health Serv Res. 2019;46(1):151–163.
   PubMed Web of Science ®Google Scholar
• Davis CS, Carr D. Physician continuing education to reduce opioid misuse, abuse, and overdose: many opportunities, few requirements. Drug Alcohol Depend. 2016;163:100–107.
   PubMed Web of Science ®Google Scholar
• Hill LG, Sanchez JP, Laguado SA, Lawson KA. Operation naloxone: overdose prevention service learning for student pharmacists. Curr Pharm Teach Learn. 2018;10(10):1348–1353.
   PubMed Web of Science ®Google Scholar
• Schartel A, Lardieri A, Mattingly A, Feemster AA. Implementation and assessment of a naloxone-training program for first-year student pharmacists. Curr Pharm Teach Learn. 2018;10(6):717–722.
   PubMed Web of Science ®Google Scholar
• Monteiro K, Dumenco L, Collins S, et al. An interprofessional education workshop to develop health professional student opioid misuse knowledge, attitudes, and skills. J Am Pharm Assoc. 2017;57(2):S113–S117.
   Google Scholar
• Buring SM, Bhushan A, Broeseker A, et al. Interprofessional education: definitions, student competencies, and guidelines for implementation. Am J Pharm Educ. 2009;73(4):59.
   PubMed Web of Science ®Google Scholar
• Cooper HLF, Cloud DH, Young AM, Freeman PR. When prescribing isn't enough – pharmacy-level barriers to buprenorphine access. N Engl J Med. 2020;383(8):703–705.
   PubMed Web of Science ®Google Scholar
• Moses TE, Chammaa M, Ramos R, Waineo E, Greenwald MK. Incoming medical students' knowledge of and attitudes toward people with substance use disorders: implications for curricular training. Subst Abuse. 2020;9:1–7.
   Google Scholar
• Komaromy M, Duhigg D, Metcalf A, et al. Project ECHO (Extension for Community Healthcare Outcomes): a new model for educating primary care providers about treatment of substance use disorders. Subst Abuse. 2016;37(1):20–24.
   PubMed Web of Science ®Google Scholar
• Berland N, Lugassy D, Fox A, et al. Use of online opioid overdose prevention training for first-year medical students: a comparative analysis of online versus in-person training. Subst Abuse. 2019;40(2):240–246.
   PubMed Web of Science ®Google Scholar