Journal Article

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

Kendall, Claire, Beder, Michaela, Magwood, Olivia, Marshall, Zack, Tugwell, Peter, Daghmach, Wahab, Habonimana, Gilbert, Snyder, Ellen, O’Shea, Tim, Salvalaggio, Ginetta, Pottie, Kevin, Hsu, Helen, Lennox, Robin, Kpade, Victoire

2020

Overview

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. 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. 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.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Access / Alcohol / Alcohol use / Alcohol-Related Disorders - epidemiology / Alcohol-Related Disorders - rehabilitation / Alcohols / Biology and Life Sciences / Chronic illnesses / Citations / Consumption / Deaths / Disorders / Drinking (Alcoholic beverages) / Drinking behavior / Drug addiction / Drug overdose / Drug Overdose - epidemiology / Drug Overdose - prevention & control / Drug use / Earth Sciences / Epidemiology / Equity method / Grey literature / Handbooks / Harm Reduction / Health aspects / Health care access / Health Services Accessibility - organization & administration / Health Services Accessibility - statistics & numerical data / High risk / Homeless people / Homeless persons / Homelessness / Housing - organization & administration / Housing - statistics & numerical data / Humans / Ill-Housed Persons - psychology / Ill-Housed Persons - statistics & numerical data / Intervention / Literature reviews / Medicine / Medicine and Health Sciences / Mental disorders / Mental health / Methadone / Morbidity / Mortality / Narcotic Antagonists - therapeutic use / Narcotics / Non-pharmacological intervention / Observational Studies as Topic / Opiate Substitution Treatment - methods / Opiate Substitution Treatment - statistics & numerical data / Opiates / Opioid abuse / Opioid-Related Disorders - epidemiology / Opioid-Related Disorders - rehabilitation / Opioids / Overdose / Overdoses / Pharmacology / Population / Populations / Prevalence / Primary care / Program Evaluation / Public health / Research and Analysis Methods / Reviews / Risk behavior / Risk reduction / Risk taking / Social Sciences / Social well being / Studies / Substance abuse / Substance abuse treatment / Substance use / Substance use disorder / Systematic review / Systematic Reviews as Topic / Treatment Outcome / Vulnerable Populations - psychology / Vulnerable Populations - statistics & numerical data / Well being / Working groups