International comparison of mitigation strategies for addressing opioid misuse: A systematic review

Objective: This systematic review compares strategies to mitigate opioid misuse among 6 different countries, including the United States. Data sources: A literature search was conducted to retrieve articles regarding policies, laws, and practices regarding opioid prescribing practices in 6 countries (United States, Australia, Chile, Japan, Norway, and South Africa). PubMed, Embase, PsychINFO, Google Scholar, and the National Guideline Clearinghouse were used with a single or combination of various keywords, including "opioid." Study selection: Articles were included if they were published within the past 10 years and concerned opioid drug regulations, mitigation strategies for prescription drug abuse, the prevalence of opioid abuse, or guidance on treatment for noncancer pain. Data extraction: Outcomes were defined as a composite capability score (CCS) developed by the researchers, which a set of metrics related to the laws and policies of the 6 countries compared. Each metric was scored as a "0" (the country has a negative factor or lack of capability) or "1" (the country has a positive factor or capability). Descriptive statistics were used for analysis. Results: A total of 137 articles were reviewed, and 45 were included, including governmental documents. The United States had the highest opioid consumption, with 678 mg per capita, whereas Chile had the lowest with 13 mg per capita. Norway limits prescribing privileges to physicians only, which is a different practice from that in the United States. All the countries except Chile had opioid substitution treatment centers. All 6 had federal regulations to control opioid use and published strategic plans to manage opioid abuse. The higher a country's CCS, the better it was at managing opioid-related health care issues. Conclusion: Guidelines and laws in 6 different countries provided different management strategies for opioid-related health outcomes. The strategies that the United States could potentially employ included targeting the number of opioids prescribed per patient, limiting the type of clinicians allowed to prescribe opioids, and increasing opioid substitution treatment programs. (C) 2020 American Pharmacists Association (R). Published by Elsevier Inc. All rights reserved.