Home > 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.

Magwood, Olivia and Salvalaggio, Ginetta and Beder, Michaela and Kendall, Claire and Kpade, Victoire and Daghmach, Wahab and Habonimana, Gilbert and Marshall, Zack and Snyder, Ellen and O'Shea, Tim and Lennox, Robin and Hsu, Helen and Tugwell, Peter and Pottie, Kevin (2020) 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. PLoS ONE, 15, (1 e0227298), e0227298. https://doi.org/10.1371/journal.pone.0227298.

External website: https://journals.plos.org/plosone/article?id=10.13...

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.


Item Type
Article
Publication Type
International, Open Access, Review, Article
Drug Type
Alcohol, All substances, Opioid
Intervention Type
General / Comprehensive, Treatment method, Harm reduction, Psychosocial treatment method, Rehabilitation/Recovery
Date
2020
Identification #
https://doi.org/10.1371/journal.pone.0227298
Page Range
e0227298
Volume
15
Number
1 e0227298
EndNote

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