The effectiveness of substance use interventions for homeless and vulnerably housed persons:  A systematic review of systematic reviews on supervised consumption facilities, managed alcohol programs, and pharmacological agents for opioid use disorder


Autoři: Olivia Magwood aff001;  Ginetta Salvalaggio aff002;  Michaela Beder aff003;  Claire Kendall aff001;  Victoire Kpade aff001;  Wahab Daghmach aff001;  Gilbert Habonimana aff001;  Zack Marshall aff006;  Ellen Snyder aff007;  Tim O’Shea aff008;  Robin Lennox aff009;  Helen Hsu aff010;  Peter Tugwell aff010;  Kevin Pottie aff001
Působiště autorů: C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada aff001;  Department of Family Medicine, University of Alberta, Edmonton, AB, Canada aff002;  St. Michael’s Hospital, University of Toronto Dept of Psychiatry, Toronto, ON, Canada aff003;  Departments of Family Medicine & School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada aff004;  Department of Medicine, McGill University, Montreal, QC, Canada aff005;  School of Social Work, McGill University, Montreal, QC, Canada aff006;  Public Health and Preventative Medicine Residency Program, University of Ottawa, Ottawa, ON, Canada aff007;  Department of Medicine, Population Health Research Institute, McMaster University, Hamilton, ON, Canada aff008;  Department of Family Medicine, McMaster University, Hamilton, ON, Canada aff009;  Department of Medicine, University of Ottawa, Ottawa, ON, Canada aff010
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
doi: 10.1371/journal.pone.0227298

Souhrn

Background

Substance use is disproportionately high among people who are homeless or vulnerably housed. We performed a systematic overview of reviews examining the effects of selected harm reduction and pharmacological interventions on the health and social well-being of people who use substances, with a focus on homeless populations.

Methods and findings

We searched MEDLINE, EMBASE, PsycINFO, Joanna Briggs Institute EBP, Cochrane Database of Systematic Reviews and DARE for systematic reviews from inception to August 2019. We conducted a grey literature search and hand searched reference lists. We selected reviews that synthesized evidence on supervised consumption facilities, managed alcohol programs and pharmacological interventions for opioid use disorders. We abstracted data specific to homeless or vulnerably housed populations. We assessed certainty of the evidence using the GRADE approach.

Our search identified 483 citations and 30 systematic reviews met all inclusion criteria, capturing the results from 442 primary studies. This included three reviews on supervised consumption facilities, 24 on pharmacological interventions, and three on managed alcohol programs. Supervised consumption facilities decreased lethal overdoses and other high risk behaviours without any significant harm, and improved access to care. Pharmaceutical interventions reduced mortality, morbidity, and substance use, but the impact on retention in treatment, mental illness and access to care was variable. Managed alcohol programs reduced or stabilized alcohol consumption. Few studies on managed alcohol programs reported deaths.

Conclusions

Substance use is a common chronic condition impacting homeless populations. Supervised consumption facilities reduce overdose and improve access to care, while pharmacological interventions may play a role in reducing harms and addressing other morbidity. High quality evidence on managed alcohol programs is limited.

Klíčová slova:

Alcohol consumption – Death rates – Drug therapy – Heroin – Housing – Morbidity – Opioids – Systematic reviews


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2020 Číslo 1