SynthesisCanadian family physician Medecin de famille canadien2019
Opioid use disorder in primary care: PEER umbrella systematic review of systematic reviews.
Synthesis in Canadian family physician Medecin de famille canadien, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 5 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
19 citing papers in PubMed, 5 syntheses or guidelines pooled it.
- Guideline
- Management of opioid use disorder: 2024 update to the national clinical practice guideline.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2024Guideline
- Management of opioid use disorder, opioid withdrawal, and opioid overdose prevention in hospitalized adults: A systematic review of existing guidelines.Journal of hospital medicine · 2022Pooled it
- Pooled it
- Managing opioid use disorder in primary care: PEER simplified guideline.Canadian family physician Medecin de famille canadien · 2019Guideline
- Comparative effectiveness of urine drug testing schedules alongside opioid agonist treatment: Emulation of a population-based target trial in British Columbia, Canada.Addiction (Abingdon, England) · 2025Article
- Patient and Prescriber characteristics associated with return to daily-dispense methadone: A multilevel cohort study.PLOS mental health · 2025Article
- Evaluating preferences for medication formulation and treatment model among people who use opioids non-medically: A web-based cross-sectional study.Journal of substance use and addiction treatment · 2024Article
- The Profound Implications of the Meaning of Health for Health Care and Health Equity.The Milbank quarterly · 2023Article
- Incremental expenditures attributable to daily dispensation and witnessed ingestion for opioid agonist treatment in British Columbia: 2014-20.Addiction (Abingdon, England) · 2023Article
- Article
- Impact of Policy Change on Access to Medication for Opioid Use Disorder in Primary Care.Southern medical journal · 2023Article
- Black clients in expansion states who used opioids were more likely to access medication for opioid use disorder after ACA implementation.Journal of substance abuse treatment · 2022Article
- The prevalence of substance use disorders and substance use in anorexia nervosa: a systematic review and meta-analysis.Journal of eating disorders · 2021Review
- Removal of prior authorization for medication-assisted treatment: impact on opioid use and policy implications in a Medicare Advantage population.Journal of managed care & specialty pharmacy · 2021Article
- "It's way more than just writing a prescription": A qualitative study of preferences for integrated versus non-integrated treatment models among individuals with opioid use disorder.Addiction science & clinical practice · 2021Article
- Collaborative Video Consultations from Tertiary Care Based Telepsychiatrist to a Remote Primary Care Doctor to Manage Opioid Substitution Therapy Clinic.Journal of neurosciences in rural practice · 2020Article
- Article
- Caring for people with opioid use disorders.Canadian family physician Medecin de famille canadien · 2019Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
13 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo summarize the best available evidence regarding various topics related to primary care management of opioid use disorder (OUD). DATA SOURCES: MEDLINE, Cochrane Library, Google, and the references of included studies and relevant guidelines. STUDY SELECTION: Published systematic reviews and newer randomized controlled trials from the past 5 to 10 years that investigated patient-oriented outcomes related to managing OUD in primary care, diagnosis, pharmacotherapies (including buprenorphine, methadone, and naltrexone), tapering strategies, psychosocial interventions, prescribing practices, and management of comorbidities. SYNTHESIS: From 8626 articles, 39 systematic reviews and an additional 26 randomized controlled trials were included. New meta-analyses were performed where possible. One cohort study suggests 1 case-finding tool might be reasonable to assist with diagnosis (positive likelihood ratio of 10.3). Meta-analysis demonstrated that retention in treatment improves when buprenorphine or methadone are used (64% to 73% vs 22% to 39% for control), when OUD is treated in primary care (86% vs 67% in specialty care, risk ratio [RR] of 1.25, 95% CI 1.07 to 1.47), and when counseling is added to pharmacotherapy (74% vs 62% for controls, RR = 1.20, 95% CI 1.06 to 1.36). Retention was also improved with naltrexone (33% vs 25% for controls, RR = 1.35, 95% CI 1.11 to 1.64) and reduced with medication-related contingency management (eg, loss of take-home doses as a punitive measure; 68% vs 77% for no contingency, RR = 0.86, 95% CI 0.76 to 0.99).
conclusionThere is reasonable evidence that patients with OUD should be managed in the primary care setting. Diagnostic criteria for OUD remain elusive, with 1 reasonable case-finding tool. Methadone and buprenorphine improve treatment retention, while medication-related contingency methods could worsen retention. Counseling is beneficial when added to pharmacotherapy.
Indexed as
Identifiers
31088885PMC6516704What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.