TABLE 1—

Characteristics of Systematic Reviews Evaluating the Use of Naloxone-Based Interventions for Overdose Rescue

Authors, Country	Focus	Context	Outcomes Examined	Primary Studies	Primary Study Quality Assessment	Data Synthesis	Review Qualitya
Clark et al.,13 United States	OEND program effectiveness	Community-based programs	Naloxone safety and efficacy, knowledge improvement, bystander overdose response, overdose mortality	19 (2001–2013)	Checklist adapted from Jinks et al.14	Qualitative	Lowb
Giglio et al.,15 United States	OEND program effectiveness	Community-based programs	Bystander naloxone efficacy, knowledge improvement	8 (2006–2014)	Checklist adapted from Jinks et al.14	Quantitative	Critically lowc
EMCDDA,16 Portugal	OEND program effectiveness	Community-based programs	Naloxone safety and efficacy, knowledge improvement, bystander overdose response, participant attitudes, overdose mortality	21 (2001–2014)	Cochrane Handbook for Systematic Reviews of Interventions17	Qualitative	Moderate
McDonald and Strang,18 United Kingdom	OEND program effectiveness	Community-based programs	Naloxone safety and efficacy, causality,d feasibility of OEND implementatione	22 (2001–2015)	Checklist adapted from Jinks et al.14	Qualitative	Lowf
Chou et al.,19 United States	Optimal overdose management	Out-of-hospital emergency response	Optimal naloxone formulation, need for hospital transport after overdose rescue	13 (1996–2016)	Methods Guide for Effectiveness and Comparative Effectiveness Reviews20	Qualitative	High
Haegerich et al.,21 United States	Various harm-prevention strategies	Community-based programs, EDs, primary care	Knowledge improvement, public and participant attitudes, overdose mortality	65g (2005–2018)	Study design and sample size examination adapted from GRADE22	Qualitative	Critically lowc

Note. ED = emergency department; EMCDDA = European Monitoring Centre for Drugs and Drug Addiction; EMS = emergency medical services; GRADE = Grading of Recommendations, Assessment, Development, and Evaluations Framework; OEND = overdose education and naloxone distribution.

^aAssessed in duplicate using AMSTAR-2, a critical appraisal tool for systematic reviews on health care interventions.

^bDowngraded from moderate because authors did not mention study preregistration or justification for restricting the literature search to English-language studies.

^cDowngraded from low because authors did not mention study preregistration, give justification for restricting the literature search to English-language studies, or provide a list of excluded studies.

^dEvaluated through 9 criteria developed by Sir Bradford Hill to assess the causal effects of public health interventions in the absence of experimental research.²³

^eEvaluated through 5 criteria developed by the World Health Organization to assess feasibility and implementation of public health interventions.²⁴

^fDowngraded from moderate because authors did not mention study preregistration or provide a list of excluded studies.

^gFrom a total of 251 primary studies on various interventions addressing the opioid crisis, 65 reported on overdose education and naloxone distribution.