Peer Support and Overdose Prevention Responses: A Systematic ‘State-of-the-Art’ Review
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Search Strategy and Selection Criteria
2.3. Quality Assessment
2.4. Data Analysis
2.5. Identification of Relevant Papers
2.6. Characteristics of Included Papers
2.7. Overview of the Included Reviews: Primary Focus
3. Results
3.1. Naloxone-Related Interventions
3.1.1. PWUD Engaged and Committed to Peer-Involved Naloxone Interventions
3.1.2. Benefits for the Naloxone Administrator
3.1.3. Naloxone and Expanding Community Level Harm Reduction
3.1.4. Barriers to Naloxone Use
3.1.5. Implications of Naloxone Intervention
3.2. Safer Environments for Drug Use
3.2.1. The Role of Peers in the Social Dynamics of Safer Environments for Drug Use
3.2.2. A Trusted Environment Created by Peers
3.2.3. Benefits for Peer Workers in Safer Environments for Drug Use
3.2.4. Challenges for Peer Workers in Safer Environments for Drug Use
3.3. Overdose Prevention Education
3.4. Opioid Substitution Treatment (OST)
3.5. Drug Checking
3.6. Social Networks and Support Interventions
4. Discussion
4.1. Implications for Policy, Practice, and Research
4.2. Strengths and Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
BBV | Blood Borne Virus |
CPR | Cardiopulmonary resuscitation |
DRDs | Drug-related deaths |
ED | Emergency Department |
HAT | Heroin Assisted Treatment |
HCV | Hepatitis C Virus |
HIV | Human Immunodeficiency Virus |
NSP | Needle and Syringe Programmes |
OEND | Overdose Education and Naloxone Distribution |
OST | Opioid Substitution Treatment |
OPS | Overdose Prevention Site |
PRISMA | Preferred Reporting Items of Systematic Reviews and Meta-Analyses |
PICOS Framework | Populations, interventions, comparators, outcomes and study designs framework for systematic review of literature |
PWUD | People Who Use Drugs |
SCS | Supervised Consumption Site |
RCT | Randomized Controlled Trial |
THN | Take-Home Naloxone |
UK | United Kingdom |
US | United States |
VANDU | Vancouver Area Network of Drug Users |
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Interventions | |
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Comparators | |
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Outcomes | |
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Operator | Definition |
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PsychINFO | |
| TI (peer support OR peer intervention OR peers OR peer mentor) OR AB (peer support OR peer intervention OR peers OR peer mentor) OR KW (peer support OR peer intervention OR peers OR peer mentor) |
| SU (peer support OR peer intervention OR peers OR peer mentoring OR lived experience) |
| 1 OR 2 |
| TI (substance use or substance abuse or substance misuse or drug use or drug abuse or drug misuse or dependence or addiction or alcohol use or alcohol misuse or alcohol abuse or alcoholism or smoking) OR AB (substance use or substance abuse or substance misuse or drug use or drug abuse or drug misuse or dependence or addiction or alcohol use or alcohol misuse or alcohol abuse or alcoholism or smoking) OR KW (substance use or substance abuse or substance misuse or drug use or drug abuse or drug misuse or dependence or addiction or alcohol use or alcohol misuse or alcohol abuse or alcoholism or smoking) |
| SU substance use or substance abuse or substance misuse or drug use or drug abuse or drug misuse or dependence or addiction or alcohol use or alcohol misuse or alcohol abuse or alcoholism or smoking |
| 4 OR 5 |
| TI harm reduction OR AB harm reduction OR KW harm reduction |
| SU harm reduction |
| 7 OR 8 |
| 3 AND 6 AND 9 |
| English language |
| 2000–2020 |
| Removal of duplicates followed by PRISMA guidelines of article sifting: title sift, abstract sift, full-text sift, review reference lists, and articles citing. |
Interventions | Description of Intervention | Number of Papers | Papers |
---|---|---|---|
Naloxone-related interventions | Naloxone is a medication that can reverse the effects of opioids to save lives during an overdose. Interventions include training in recognising signs of overdose and safely administering naloxone, take-home naloxone (THN) programmes which provide naloxone to be used when witnessing an overdose, and peer programmes where people who inject drugs are trained to use it to help their peers. | 23 | [15,17,33,44,46,47,48,49,52,53,56,58,59,61,62,64,68,70,72,76,77,80,82] |
Safer environments for drug use | Creating environments which offer safety or supervision during drug consumption to reduce risk of overdose, such as safe consumption sites. Spaces can be staffed with paid employees, volunteers, or peers trained in the use of naloxone. | 13 | [23,32,35,50,55,60,66,71,76,79,81,82,83] |
Overdose prevention education interventions | Provision of training to bystanders regarding how to intervene during a witnessed opioid overdose. This includes brief interventions, education, and training related to overdose management and intervention. | 7 | [47,53,57,58,66,75,77] |
Opioid substitution treatment (OST) | Treatment to reduce drug dependence and injecting frequency by offering people who are opioid dependent an alternative, prescribed medicine, typically methadone or buprenorphine. | 4 | [17,54,69,78] |
Drug checking | Drug checking services enable individuals to have their drugs chemically analysed, providing information on the content of the samples as well as advice, and, in some cases, counselling or brief interventions. | 4 | [63,74,78,84] |
Social network and support interventions | Relational interventions across different contexts which focus on the provision of social support and connection to PWUD by peers. | 3 | [51,57,67] |
Intervention Type | Theme | Subthemes |
---|---|---|
Naloxone-related | PWUD * engaged and committed to peer-involved interventions | Naloxone administration Naloxone education and training |
Benefits for the administrator | Empowerment Reduction in risk | |
Naloxone and expanding community level harm reduction | Reach in the community Integration in the community | |
Barriers to naloxone use | Micro barriers Macro barriers | |
Implications of naloxone intervention | Unpleasant effects of withdrawal Pleasure from illicit drug use | |
Safer environments for drug use | The role of peers in the social dynamics of safer environments for drug use | Connectivity Mitigation of barriers and risk Constraints |
A trusted environment created by peers | Safety Comfort Trust | |
Benefits for peer workers in safer environments for drug use | ||
Challenges for peer workers in safer environments for drug use | Individual challenges Organizational and macro challenges | |
Overdose prevention education | Peers providing actionable knowledge and skills | |
Impact of overdose prevention education on behaviour | ||
Limitations of peer inclusion in overdose prevention education | ||
Opioid substitution treatment (OST) | Low-barrier community reintegration | |
Peers as Experts | ||
Challenges associated with OST | ||
Drug checking | Hesitancy to engage with technology | |
Social checking | ||
Social networks and support interventions | Reciprocity |
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Mercer, F.; Miler, J.A.; Pauly, B.; Carver, H.; Hnízdilová, K.; Foster, R.; Parkes, T. Peer Support and Overdose Prevention Responses: A Systematic ‘State-of-the-Art’ Review. Int. J. Environ. Res. Public Health 2021, 18, 12073. https://doi.org/10.3390/ijerph182212073
Mercer F, Miler JA, Pauly B, Carver H, Hnízdilová K, Foster R, Parkes T. Peer Support and Overdose Prevention Responses: A Systematic ‘State-of-the-Art’ Review. International Journal of Environmental Research and Public Health. 2021; 18(22):12073. https://doi.org/10.3390/ijerph182212073
Chicago/Turabian StyleMercer, Fiona, Joanna Astrid Miler, Bernie Pauly, Hannah Carver, Kristina Hnízdilová, Rebecca Foster, and Tessa Parkes. 2021. "Peer Support and Overdose Prevention Responses: A Systematic ‘State-of-the-Art’ Review" International Journal of Environmental Research and Public Health 18, no. 22: 12073. https://doi.org/10.3390/ijerph182212073