. Author manuscript; available in PMC: 2020 Oct 26.

Published in final edited form as: Lancet. 2019 Oct 23;394(10208):1560–1579. doi: 10.1016/S0140-6736(19)32229-9

Table 3:

Current evidence for effects of interventions to address key outcomes and behaviours among people who use opioids extra-medically

	Injecting risk behaviours				Extra-medical opioid use				HIV incidence				HCV incidence				Skin and soft tissue infections				Quality of life
Intervention	Effect	Size of effect	Level	Sources	Effect	Size of effect	Level	Sources	Effect	Size of effect	Level	Sources	Effect	Size of effect	Level	Sources	Effect	Size of effect	Level	Sources	Effect	Size of effect	Level	Sources
Provision of sterile injecting equipment	↓	aOR 0.52 (0.32, 0.83)	A^PWID	¹³¹	-	-	-	-	↓	OR/HR/RR 0.42 (0.22, 0.81)	C^PWID	¹³²	↓?	RR 0.77 (0.38, 1.54)	C	¹⁰⁸	?	-	D	⁸⁶	-	-	-	-
Condom provision	-	-	-	-	-	-	-	-	↓	RR 0.29, (0.20, 0.43)	A^GEN	¹⁷⁹	?	-	C	¹⁸⁰	-	-	-	-	-	-	-	-
Naloxone	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Drug consumption rooms	↓	RR 0.31 (0.17, 0.55)	C^PWID	¹⁸¹	-	-	-	-	?	-	D	¹⁸²	?	-	D	¹⁸²	↓	OR 0.47 (0.23, 0.94)	E	⁸⁶	-	-	-	-
Peer-based self-help groups	-	-	-	-	↓?	-	B^ALC	¹³⁹	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Psychosocial interventions	↓	SMD −0.43 (−0.69, −0.18)	A	¹⁸³	↓	WMES −0.18 (−0.30, −0.06)	A	¹⁸⁴	?	-	D	¹⁸²	?	-	D	¹⁸²	?	-	E	¹⁸⁵	-	-	-	-
Opioid detoxification alone					×
Oral opioid antagonists	×	NE	A	¹⁸⁶	×	RR 1.39 (0.61, 3.17)	A	¹²⁷	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Extended-release opioid antagonists	↓	NE	A	¹²⁸	↓	NE	A	^128,187	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Opioid agonist treatment	↓	RR 0.53 (0.4, 0.7) ^SYNTH	A	¹⁰⁶	↓	RR 0.48 (0.41, 0.55) ^SYNTH	A	¹⁰⁶	↓	RR 0.46 (0.32, 0.67)	C	¹⁰⁷	↓	RR 0.50 (0.40, 0.63)	C	¹⁰⁸	?	-	D	⁸⁶	↑	SMD 0.29 (0.16, 0.42)	C	¹⁷⁰
Residential rehabilitation	↓	NE	C	¹⁸⁸	↓	NE	C	¹⁸⁸	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
HIV testing + informing of serostatus	↓	NE	D^PWID	¹³⁵	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
HCV testing + informing of serostatus	×	aOR 0.97 (0.94, 1.00)	C^PWID	¹⁸⁹	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
HIV treatment	×	aOR 0.78 (0.42–1.45)	D	¹⁹⁰	-	-	-	-	↓	-	D	¹³⁴	-	-	-	-	-	-	-	-	-	-	-	-
HCV treatment	↓	NE	D^PWID	¹³³	↓	NE	D^PWID	¹³³	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
STI treatment	-	-	-	-	-	-	-	-	↓		A^GEN	^191–193	-	-	-	-	-	-	-	-	-	-	-	-
Suicide prevention strategies	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Opioid prescribing limits	-	-	-	-	↓?	NE	D^GEN	¹⁹⁴	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Abuse-deterrent opioid formulations	↓	NE	D	^144,195	?	NE	D	¹⁴⁴	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Prescription opioid monitoring programs	-	-	-	-	↓?	NE	D^GEN	^194,196	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Compulsory drug treatment/drug detention centres	↑	NE	C*	^143,197	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Criminalisation of drug use	↑	NE	C^PWID	¹⁴⁷					↑	NE	C^PWID	¹⁴⁷

	Overdose				Suicide				Other injuries				Overall mortality
Intervention	Effect	Size of effect	Level	Sources	Effect	Size of effect	Level	Sources	Effect	Size of effect	Level	Sources	Effect	Size of effect	Level	Sources
Provision of sterile injecting equipment	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Condom provision	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Naloxone	↓	-	D	¹⁹⁸	-	-	-	-	-	-	-	-	-	-	-	-
Drug consumption rooms	↓	-	D	¹⁹⁹	-	-	-	-	-	-	-	-	-	-	-	-
Peer-based self-help groups	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Psychosocial interventions	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Opioid detoxification alone
Oral opioid antagonists	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Extended-release opioid antagonists	↓?	-	A	¹²⁸	-	-	-	-	-	-	-	-	?	-	A	^128,187
Opioid agonist treatment	↓	RaRa 0.25 (0.18, 0.36) ^SYNTH	C	¹¹¹	↓		E	¹¹²	↓		E	¹¹²	↓	RaRa 0.33 (0.28, 0.39) ^SYNTH	C	¹¹¹
Residential rehabilitation	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
HIV testing + informing of serostatus	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
HCV testing + informing of serostatus	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
HIV treatment	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
HCV treatment	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
STI treatment	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Medication for suicide prevention	-	-	-	-	?	-	A^GEN	²⁰⁰	-	-	-	-	-	-	-	-
Opioid prescribing limits	↓?	-	D^GEN	¹⁹⁴	-	-	-	-	-	-	-	-	-	-	-	-
Abuse-deterrent opioid formulations	?	-	D^GEN	¹⁴⁴	-	-	-	-	-	-	-	-	?	-	D	¹⁴⁴
Prescription opioid monitoring programmes	?	-	D^GEN	^145,196	-	-	-	-	-	-	-	-	?	-	D	¹⁴⁵
Compulsory drug treatment/drug detention centres	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Criminalisation of drug use	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-

Notes on codes used in this table

Presence or absence of effect

× This intervention does not appear to have a significant effect upon the outcome

↑ This outcome may be increased by the intervention

↓This outcome is decreased by the intervention

- No evidence could be located of the impact of this intervention upon the outcome

? unclear evidence on impact of this intervention on the outcome

Level of evidence

A Consistent conclusions across meta-analyses, high quality systematic reviews, or multiple randomised controlled trials

B Evidence from one or two randomised controlled trials only

C High quality systematic reviews of cohort, case-control or cross-sectional studies

D Systematic reviews with inconsistent conclusions from authors or cross-sectional; OR multiple consistent ecological studies

E Cross-sectional association, case series suggesting outcome, single cohort study

GEN Evidence drawn from people who may not specifically use any drugs (including opioids)

PWID People who inject drugs that may not include opioids

ALC Note that this evidence pertains to people attending alcoholics anonymous

NE no pooled quantitative estimate reported

UNotes on codes used in this table