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

Abstract

Background: Harm reduction includes treatment and prevention approaches rather than abstinence, as a public health strategy for mitigating the opioid epidemic. Harm reduction is a new strategy for many healthcare professionals, and gaps in knowledge and practices may lead to barriers to optimal treatment. Our objective was to identify and describe gaps in physicians’ knowledge, education, and practice in harm reduction strategies related to opioid overdose. Methods: We searched the PubMed, CINAHL, and Web of Science databases for articles published between 2015 and 2021, published in English, containing empirical evidence, addressing opioid harm reduction, and identifying gaps in physicians’ knowledge, education, or practice. Results: Thirty-seven studies were included. Studies examined how physicians’ perceptions or stigma influenced harm reduction efforts and addressed clinical knowledge gaps in overdose treatment and prevention and OUD treatment. Less than half of the studies addressed access issues at the system level, above the individual healthcare professional. Conclusion: Individual-level interventions should be addressed with professional continuing education and curricular-based changes through experiential and interprofessional education. System-level gaps can be remedied by increasing patient access to care, creating policies favorable to harm reduction, and extending resources to provide harm reduction strategies.

Keywords:

• Opioid
• harm reduction
• physician
• knowledge
• scoping review
• naloxone
• buprenorphine
• methadone
• opioid use disorder

Acknowledgments

An abstract summarizing key finding from the review was presented at the 2021 American Pharmacists Association Annual Meeting. The content of this study does not represent the official view of SAMHSA or the Texas Health and Human Services Commission.

Author contributions

EG and OB were co-first authors, responsible for study design, literature screening, selection of articles, full-text article reading, data extraction, and manuscript writing. LM and CB contributed to the study design, selection of articles, and data extraction. LM, CB, and LH contributed to the study conceptualization, interpretation of results, and revisions of the manuscript. All authors contributed to the development of the final manuscript and approved submission.

Disclosure statement

The authors declare no financial interest or benefit that has arisen from the direct applications of this research.

Additional information

Funding

This study was supported by grant 1H79TI081729-01 from the Substance Abuse and Mental Health Services Administration (SAMHSA). The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.