Key messages

Questions

• What harm reduction-based educational interventions have been found to be effective for improving maternal, neonatal and parenting outcomes in families affected by opioid addiction?
• What components of harm reduction-based educational interventions for families affected by opioid addiction are needed to ensure impact? 

Why the issue is important

• Opioid addiction has emerged as a pressing public-health issue in recent years, with more than 8,000 opioid-related deaths recorded in Canada between January 2016 and March 2018.
• The national trends indicate that opioid-related deaths are increasing and are a serious concern for health and social systems in Canada.
• There are well-documented harms associated with maternal opioid use.
• Reducing harms associated with opioid addiction is an important component of addressing the epidemic, and educational interventions can complement other interventions to support families affected by opioid addiction, but there is no clear consensus on which programs and approaches are most effective.
• This rapid synthesis was requested to provide evidence to inform educational interventions for families affected by opioid addiction in areas such as improving maternal, neonatal and parenting outcomes. 

What we found

• We found 18 relevant documents, including 14 systematic reviews and four primary studies that addressed the two questions.
• For the first question, the literature evaluated two harm reduction-based educational interventions (psychoeducation and family harm-reduction education) and possible components of harm reduction-based educational interventions, with the most relevant components including behavioural therapy, counselling, family therapy, school-based interventions, multi-systemic therapy and motivational interviewing.
• Overall, the literature focused on interventions targeted at addressing drug use in general for both adolescents and adults, and there was limited evidence regarding interventions specifically targeted at addressing opioid addiction.
• For educational interventions:

o psycho-education was found to be less effective than family-therapy interventions;

o in an older low-quality review psycho-education, as well as other components of educational interventions (e.g., multi-systemic therapy and motivational interviewing) were found to be effective at reducing drug use among youth with conduct problems, but the evidence base for psycho-education was noted as being very limited;

o combined substance-use treatment and parenting-skills programs are effective at reducing drug use and improving parenting skills;

o a group-based psycho-educational program for patients with concurrent mental health challenges did not have an effect in a primary study on reducing heroin use (although it did have an effect for other drugs), and heroin users also had a lower retention rate in another primary study; and

o an eight-session education intervention for spouses which was evaluated in Iran at a methadone maintenance clinic resulted in improved marital satisfaction when compared to a control group, but no effect on relapse rates was found for patients.

• In general, there was limited evidence regarding what impact harm reduction-based educational interventions had on neonatal outcomes and maternal outcomes beyond outcomes based on drug use.
• For the second question, the literature described how numerous factors have both enhanced and hindered the impact of harm reduction-based educational interventions for adolescent and adult patients.
• Mechanisms for enhancing the impact included a focus on improving relational aspects of care for patients as well as including complementary interventions, including various types of therapy, and factors identified as hindering the impact of interventions included situations where patients are forced into treatment and not given an active role to participate in the intervention.