ADVANCING THE IMPLEMENTATION OF MAT 1 Advancing the Implementation of Medication-Assisted Treatment in Residential Treatment Centers Georgette Quie Edson College of Nursing and Health Innovation, Arizona State University ADVANCING THE IMPLEMENTATION OF MAT 2 Abstract Objective: To assess the attitudes and knowledge of behavioral health technicians (BHTs) towards opioid overdose management and to assess the effect of online training on opioid overdose response on BHTs’ attitudes and knowledge, and the confidence to identify and respond to opioid overdose situations. Design/Methods: Pre-intervention Opioid Overdose Knowledge Scale (OOKS) and Opioid Overdose Attitude Scale (OOAS) surveys were administered electronically to five BHTs in 2020. Data obtained were de-identified. Comparisons between responses to pre-and post-surveys questions were carried out using the standardized Wilcoxon signed-rank statistical test(z). This study was conducted in a residential treatment center (RTC) with the institutional review board's approval from Arizona State University. BHTs aged 18 years and above, working at this RTC were included in the study. Interventions: An online training was provided on opioid overdose response (OOR) and naloxone administration and on when to refer patients with opioid use disorder (OUD) for medication-assisted treatment. Results: Compared to the pre-intervention surveys, the BHTs showed significant improvements in attitudes on the overall score on the OOAS (mean= 26.4 ± 13.1; 95% CI = 10.1 - 42.7; z = 2.02; p = 0.043) and significant improvement in knowledge on the OOKS (mean= 10.6 ± 6.5; 95% CI = 2.5 – 18.7; z =2.02, p = 0.043). Conclusions and Relevance: Training BHTs working in an RTC on opioid overdose response is effective in increasing attitudes and knowledge related to opioid overdose management. opioid overdose reversal in RTCs. Keywords: Naloxone, opioid overdose, overdose education, overdose response program ADVANCING THE IMPLEMENTATION OF MAT 3 Advancing the Implementation of Medication-Assisted Treatment in Residential Treatment Centers Between 1999 and 2014, nearly two million people in the United States (US) suffered from prescription opioid use disorder, with approximately 400 000 opioid overdose deaths (Hughes et al., 2015). Opioid use disorder (OUD) is often linked to legal, interpersonal, and work-related issues. The opioid crisis has resulted in unprecedented demand for services and increasing the use of medication-assisted treatment (MAT) is often a successful intervention in combating the rising overdose death rate. Problem Statement An opioid overdose is a serious problem not only in the United States, but all over the world. Furthermore, the opioid crisis is expected to cost the US $78 billion a year (Ordeda et al., 2015). The continued underutilization of medication-assisted care, a validated form of opioid addiction treatment, is exacerbating the OUD issue. The US Department of Health and Human Services has made fighting the opioid crisis one of its highest national priorities (United States Department of Health and Human Services, 2016). Purpose and Rationale The purpose of this paper is to examine the risk factors for opioid overdose among patients in a residential treatment center, to educate behavioral health technicians on the risk factors of OUDs, pre-lapse behaviors for OUDs, and on when to recommend MAT services. Understanding these factors will help with the identification of high-risk patients, to facilitate the development of policies and procedures to reduce the risk of opioid-related adverse drug events, ADVANCING THE IMPLEMENTATION OF MAT 4 and to improve patient outcomes. Also, dissemination of addiction education into a residential treatment center can help in bridging the gap in treatment utilization for MAT. Background and Significance Internal Evidence A residential treatment center located in the Southwestern U.S. has identified the underutilization of MAT services as an area for improvement within their organization. Behavioral health technician’s make-up a high percentage of the staff and are front-line staff who care for residents with substance use disorder. Key stakeholders at these residential treatment centers denied providing clinical supervision and education to BHT staff. Current practice is that peer support specialists are also responsible for referring patients for MAT. BHTs check on residents every two hours, use dogs to detect drugs on property, and distribute Narcan to residents. Overdose deaths impact not only other residents and their relatives, but also the BHT, and the medical and psychiatric providers. Increased opioid use has resulted in an increase in overdose rates (Baker, 2017). Opioid abuse has been linked to an increased risk of infection with the human immunodeficiency virus (HIV) and Hepatitis C. (Ordeda et al., 2015). In British Columbia, the Canadian province most affected by the opioid crisis, the number of deaths attributed to illegal drug overdose rose by 78 percent in 2016 compared to the previous year (British Columbia Coroners Service, 2017). ADVANCING THE IMPLEMENTATION OF MAT 5 Medication-Assisted Treatment Health services have built and tested models to incorporate medication-assisted treatment (MAT), also known as opioid-assisted treatment, into primary care settings over the last 15 years (Lagisetty et al., 2017). To treat patients with OUD, MAT is an evidence-based clinical approach that includes pharmacological therapies as well as psychosocial care (Lagisetty et al., 2017). Family therapy, counseling, and peer support services are examples of behavioral health therapy that can be used in conjunction with MAT. These programs are recommended to go along with MAT medicine and are thought to be the best (Saxon & Ef, 2016). MAT, on the other hand, appears to be underutilized. In 2012, the difference between OUD prevalence and evidencebased MAT capability was nearly one million people (Jones et al., 2015). Just about half of privately funded substance abuse recovery services have MAT, and only about a third of patients with opioid addiction receive it (National Institute on Drug Abuse, 2016). From 35 percent in 2002 to 28 percent in 2012, the proportion of opioid addiction admissions with treatment plans that included taking drugs decreased (National Institute on Drug Abuse, 2016). Insufficient institutional support is frequently cited as a barrier to implementation (Chou et al., 2016). Also, patients in these residential treatment centers are referred for MAT services by BHTs who have little or no education on when to recommend MAT services. Other reasons for the underutilization of MAT services, as reported by key informants, include inadequate resources and staffing for coordination and integration of care, inadequate provision of nonphysician and nursing staff with expertise in OUDs, in order to implement a team-based approach. ADVANCING THE IMPLEMENTATION OF MAT 6 PICOT Question Among Behavioral Health Technicians taking care of patients diagnosed with opioid use disorder in a residential treatment center, does increase awareness through an online educational intervention on naloxone and opioid overdose response, when to refer patients with opioid use disorders for MAT, and on the screening, brief intervention, and referral for treatment (SBIRT) model, at one-week post-intervention, increase their attitude and knowledge of when to refer patients for MAT services? Search Strategy This literature review included an exhaustive search of the most current evidence to answer the PICOT question. Three databases were extensively searched- PsychINFO, Pubmed, and CINAHL. The database searches included a combination of the following keywords: Barriers to medication-assisted treatment, opioid use disorder, peer support, overdose risk assessment, opioid overdose, residential treatment, MAT referral rates, and pre-lapse behaviors. PsychINFO Search Strategy The initial search of PyschINFO included the key terms barriers to MAT, improving MAT, MAT Treatment, and MAT referral rates. The following is a full electronic search strategy employed for PsychINFO database articles published since 2015: (Barriers to MAT) [All Fields] OR (Improving MAT) [All Fields] OR (MAT treatment) [All Fields] OR (MAT referral rates) [All Fields] AND (Opioid use disorder) [All Fields]. The search yielded 86 results. Other filters such as English language, peer-reviewed, qualitative, systematic review, and meta-analysis were applied to lower the article count to 13 results. ADVANCING THE IMPLEMENTATION OF MAT 7 Pubmed Search Strategy A database search of PubMed utilizing key terms medication-assisted treatment (MeSH Terms), opioid overdose, and residential treatment were used. The following is a full electronic search strategy employed for PubMed database articles published since 2015: (Medicationassisted treatment) [All Fields] AND (Opioid overdose) [All Fields] OR (Residential treatment) [All Fields]. The search yielded 123 results. Additional filters such English language, metaanalysis, qualitative, systematic review, and peer-reviewed articles were added to limit the search count to 26 results. CINAHL Search Strategy The initial CINAHL search included the key terms peer support, medication-assisted education, and overdose risk assessment for opioid use. The following combination was used for the CINHAL database: (Peer support) [All Fields] OR (medication-assisted education) [All Fields] AND (overdose risk assessment for opioid use) [All Fields]. Boolean terms were used to broaden the search. The search yielded 41 results. Filters applied included date of publication (2015 to 2020), English language, and peer-reviewed journal articles. The search produced 11 results. Also, adding the search terms overdose risk assessments for opioid use disorders and pre-lapse behaviors for opioids increased the articles to 16. A gray literature search for unpublished studies, using combinations of search terms and concepts derived from electronic reference database search using Google Scholar was used. The top 30 results were reviewed for articles meeting inclusion criteria. Websites of key medical associations, addiction, and government publications from the United States Department of Health and Human Services and the National Institute on Drug Abuse were also searched and reviewed. ADVANCING THE IMPLEMENTATION OF MAT 8 All studies of people aged 18 years old or older, evaluating peer recovery support services and recovery coaching services for substance use disorders were included. Studies evaluating FDA approved MAT for OUD were eligible, regardless of the route of administration. Peer-reviewed articles published in English language from 2015 to present was also included. Also, studies were limited to hospitals(inpatient), and residential rehabilitation settings. However, studies of humans younger than 18 years of age, pregnant women, and studies before 2015 excluded. Critical Appraisal and Synthesis The Melnyk and Fineout-Overholt’s (2019) rapid critical appraisal was used to evaluate the quality and strength of the ten articles selected for this literature review. All ten studies included were systematic reviews and presented high-level evidence. Nine of the ten systematic reviews included articles that were carried out in both an inpatient and outpatient setting. The systematic review conducted by Maglione et al. (2018) only included articles that were studied in an outpatient setting. Six of the ten articles reported their source of funding, and no bias was recognized in any of the studies. All of the ten studies had an adequate sample size, and the number of articles was greater than or equal to ten in their systematic reviews. The literature review included an intercontinental sampling with all ten of the studies originating in North America (the USA and Canada). Current or previous substance use, past OUD, and a previous mental health diagnosis were listed as risk factors for OUDs in all ten studies. Four of the ten studies identified male sex as a risk factor for OUD. This inconsistency in whether male sex is a risk factor may be due to an interaction between sex and age. Only one of the ten studies conducted a systematic literature search that proved that peer support staff could improve outcomes for patients engaged in inpatient and/or outpatient psychiatric treatment for substance ADVANCING THE IMPLEMENTATION OF MAT 9 use disorder and co-occurring mental disorders. Most of the interventions across the studies included recognizing the higher risk of opioid misuse in patients with a previous or concurrent history of substance use and mental health diagnoses and recommending withholding prescribed opioids to patients who fall in this category. Measurement tools and intervention designs were heterogeneous across all ten studies. However, MAT has shown to reduce overdose rates for OUD in six of ten of the studies. Also, nine of 10 studies were useful to the PICOT since similar concepts were discussed and educating peer support on the risk factors for OUD can increase referral rates for MAT, thereby decreasing mortality and morbidity associated with OUD. Strong reliability and validity can be assumed for all the ten studies due to the priori research designs, a comprehensive search of electronic databases, duplicate study selection, quality assessment of measurement tools, methodology, and results that are statistically significant. Conclusion These studies indicate that a successful strategy for delivering OUD treatment and increasing MAT access in primary care necessitates multidisciplinary and organized care delivery models. MAT has shown to reduce illicit opioid use significantly and increasing access to MAT can reduce overdose fatalities. Also, BHT staff have shown to offer unique advantages to engaging difficult-to-engage populations, improving substance-related outcomes, and reducing substance use. Therefore, educating BHT staff on the benefits of MAT can increase the use of MAT in patients with OUD, thereby, decreasing mortality and morbidity associated with OUD. However, despite the recent adoption of BHTs within substance use treatment programs, there are relatively limited studies rigorously evaluating outcomes of their services. Since patients who report current or previous substance use, past OUD, and a previous mental health diagnosis were ADVANCING THE IMPLEMENTATION OF MAT 10 common risk factors for OUDs in all ten studies, and alternative pain relief treatments should be prioritized for these at-risk patients. Conceptual Framework and Evidenced-based Practice Model The Chronic Care Model (CCM) was selected as the project's conceptual framework (See Figure 1). Despite the fact that patients with OUDs have been mistaken in the past as a bad habit or a moral failure, recent research shows that long-term therapies can be successful in treating patients with substance use disorders. As a result, it's fair to consider an opioid use disorder to be a chronic illness that necessitates long-term treatment. Since OUD is a chronic, relapsing disorder with high medical and psychiatric comorbidity, continuous treatment that includes screening, early intervention, support, and monitoring is crucial (Hser et al., 2017). The CCM is a treatment model that describes the most critical aspects of chronic disease management (Grover & Joshi, 2014). The model emphasizes proactive, patient-centered, multidisciplinary treatment, community resource use, and evidence-based practices (Wagner, 1998). The CCM allows nurses, social workers, and patients to engage in their own care, resulting in a systemic shift in the way people with chronic illnesses are cared for (Hser at al., 2017). The six main elements that interact to facilitate quality treatment for patients with chronic disease are included within this model. Patient protection, cultural competency, care planning, regional policy, and case management are among the other topics covered in the current CCM (Grover & Joshi, 2014). Through offering tools for planning and integration of treatment for patients with OUDs, CCM will ensure a multidisciplinary and team-based approach. The CCM tends to be a valuable framework for achieving evidence-based treatment for OUD with the same care team, deployed in similar ways as for other chronic diseases management. ADVANCING THE IMPLEMENTATION OF MAT 11 Methods Inclusion criteria  Currently employed in the organization as a behavioral health technician.  Adults 18 years of age or older.  Able to speak, write, and understand English language.  Able to provide informed consent.  Willing to participate in the study that requires filling out pre- and post-intervention surveys, time commitment for education, and weekly follow-ups. Exclusion criteria  Individuals who do not fully meet inclusion criteria. Study Procedures  No funding was received for the project.  IRB approval was initially obtained from ASU on 10/01/2020 but due to a change in the project site, another approval was obtained on 11/23/2020.  The initial step was the recruitment phase. The student emailed the recruitment invites to the facility administrator for him to disseminate the project information to interested and qualified participants.  Once potential participants responded to the invite, agreeing to participate in the project, a consent form was emailed along with a request for their availability for a phone call to discuss the project further and go over the consent form to ensure that they understood the purpose of the project and what was required of them. The phone call also provided an opportunity for the student and the participants to go over the consent form and to clarify any questions or concerns that participants they had. ADVANCING THE IMPLEMENTATION OF MAT  12 The student emailed the pre-intervention surveys to assess for knowledge and attitude of opioid overdose management among participants. Participants were expected to return the survey within 7 days or less after receipt. The student had obtained permission from the author of the pre- and post-intervention surveys to use the survey tools. Five participants who met inclusion criteria were recruited to participate in the study.  A zoom invite was sent to participants. During the meeting, the student went over a 2hours PowerPoint presentation on naloxone and opioid overdose response, when to refer patients with opioid use disorders for MAT, and on the screening, brief intervention, and referral for treatment (SBIRT) model.  A recording of the zoom presentation was emailed to participants who could not attend the zoom meeting. A follow-up email was sent to participants after a week of emailing the link to the recorded presentation. This intervention phase lasted for about 7 days.  All five participants completed a post-intervention survey one week after the intervention to assess participants knowledge and attitudes towards opioid overdose management to evaluate the effectiveness of the intervention to the participants. The student also gathered subjective data regarding participant’s experience on participating in the study. This phase took about seven days.  The timeline for the implementation phase for this EBP project lasted about 4-6 weeks. ADVANCING THE IMPLEMENTATION OF MAT 13 Privacy and Confidentiality  The documents such as recruitment papers, signed consent forms, pre-and postintervention surveys, and responses received from participants were printed from the student’s email for hard copies, filed, and labeled in separate folders.  The soft copy of the data collected was stored on a server called drop box with the link to the data accessible only to the student and the student’s mentor. The student’s mentor had to access the data for feedback, guidance, and recommendations.  An encrypted server, password protection, and antivirus barriers were used to secure access to data.  The student developed a master list of the participants indicating their participant ID code which was randomly assigned to ensure de-identification.  An identification code was created and used on all questionnaires to identify participants.  Participants assigned themselves IDs using the year they were born and the last four digits of their phone number. The IDs were entered on the master list and kept in a folder stored in the locked filing cabinet. The participants were informed not to share their IDs with anyone to ensure the maintenance of confidentiality.  The identification code was used to link data from questionnaires to maintain confidentiality.   All personal information about the participants and the organization was de-identified. Email addresses were collected to distribute cover letters, distribute pre/post-education questionnaires, and distribute link for zoom meetings. ADVANCING THE IMPLEMENTATION OF MAT  14 During the interaction activity done through zoom, participants were assigned a pseudo name (a name different from their real name). The zoom video of participants was turned off except for the co-investigator(student) video to maintain confidentiality.  Email addresses were saved and managed in a separate file from other project data stored on a secure computer accessible only to the student and the principal investigator.  An encrypted server, password protection, and antivirus barriers were used to secure access to data.  All data collected was deleted and destroyed after data analysis was completed.  All individuals with direct access to the data were formally trained in protecting human subjects before working with human subjects or collecting any data.  The risks associated with breaches of confidentiality were minimized by taking the necessary precautions listed above. Applying Evidence to Practice Increased morbidity and mortality among patients with OUD, exacerbated by continued underutilization of an evidence-based form of opioid addiction treatment known as MAT, puts pressure on health care providers to find new and creative ways to improve MAT use OUD in a variety of settings. According to the evidence, increasing OUD-related overdose deaths affect not only patients and their families but also staff, researchers, health policy, professional organizations, and federal lawmakers, according to key stakeholders. Because of the challenges of incorporating MAT in residential treatment facilities, effective implementation methods are likely to include multifactor approaches. It could include payer-clinic partnerships that include funding, contracting, policy reform, process development to improve operation, and consumer input to help organizations change. Data on possible barriers to MAT implementation, including ADVANCING THE IMPLEMENTATION OF MAT 15 resources necessary and how barriers differ depending on the environment, should be collected. Data on how many peer support workers are confident in recognizing patients with pre-lapse habits and withdrawal symptoms for OUD should also be collected. The institutional support through funded preparation, funding, and personnel for planning, alignment of treatment, and provision of non-provider staff with experience in OUD to adopt a team-based approach may all be used to improve MAT referral rates. Another initiative would be to educate peer support personnel to recognize patients with OUD and refer them to the appropriate care settings to initiate treatment. It is consistent with the evidence that peer-delivered rehabilitation support programs are a valuable addition to care for people suffering from drug use disorders (Tracy and Wallace, 2016). Staff awareness of when to refer patients to MAT services and referral rates for MAT services was calculated as outcomes. Potential Outcomes Patients with OUD, their families, and the national healthcare system will all benefit from the implementation of initiatives aimed at increasing MAT use. MAT reduces opioid use, overdose deaths caused by opioids, drug activity, and the spread of infectious diseases (National Institute on Drug Abuse, 2016). MAT improves social functioning and care adherence. Methadone or buprenorphine treatment for opioiddependent pregnant women improves their babies' outcomes (National Institute on Drug Abuse, 2016). The 21st Century Cures Act of 2016 provides states with a onebillion-dollar grant over two years to expand MAT and develop health-care professional capability. By training BHTs, the aim is to increase referrals for MAT services while lowering mortality, morbidity, and OUD-related costs. ADVANCING THE IMPLEMENTATION OF MAT 16 Results Two surveys were administered to five BHTs before and after the educational intervention, including the Opioid Overdose Knowledge (OOKS) and Attitudes (OOAS) Scales. Three subscales and an overall score were calculated for the OOAS and four subscales and an overall score were calculated for the OOKS. In addition, a six-item Overdose Training Evaluation Form was administered at the end of the study. Wilcoxon signed-rank tests were used to determine the significance of improvement in the BHTs’ knowledge of and attitudes towards opioid overdose. The results for the OOAS are shown in Table 1. The BHTs showed significant improvements on the overall score and on all three subscales of the OOAS (p < .05). Table 1 Pre- to post-intervention improvement in attitudes towards opioid overdose Pre-intervention Mean Post-intervention SD Mean SD z* p Opioid Overdose Attitude Scale (OOAS) Competence 32.60 8.71 41.80 3.90 2.03 0.042 Concerns 21.00 7.62 31.20 4.09 2.03 0.042 Readiness 39.40 5.64 46.40 2.51 2.02 0.043 Total 93.00 19.04 119.40 8.17 2.02 0.043 * standardized Wilcoxon signed rank test The results are further displayed in Figure 1. 46.4 50 40 41.8 39.4 32.6 31.2 30 21.0 20 10 0 Competence Concerrns Readiness ADVANCING THE IMPLEMENTATION OF MAT 17 Figure 1. Pre- to post-intervention improvement in attitudes towards opioid overdose The results of the pre- to post-intervention comparison of knowledge concerning opioid overdose are summarized in Table 2. As shown, the BHTs displayed a significant improvement in knowledge overall (z =2.02, p = 0.043), and on two of the four subscales, including Signs and Naloxone Use (z = 2.03, p = 0.042). Table 2 Pre- to post-intervention improvement knowledge of opioid overdose Pre-intervention Mean SD Post-intervention Mean SD Opioid Overdose Knowledge Scale (OOKS) Risk 6.00 2.00 6.20 Signs 5.20 2.17 8.80 Action 9.20 1.48 9.80 Naloxone Use 7.40 2.07 13.60 Total 27.80 6.30 38.40 1.10 0.45 0.84 0.89 1.82 z* p 0.14 2.03 0.82 2.03 2.02 0.892 0.042 0.414 0.042 0.043 * standardized Wilcoxon signed rank test These results are illustrated in Figure 2. 15 13.6 8.8 10 6.0 6.2 9.2 9.8 7.4 5.2 5 0 Risk Signs Pre-intervention Action Post-intervention Naloxone Use ADVANCING THE IMPLEMENTATION OF MAT 18 Figure 2. Pre- to post-intervention improvement in knowledge of opioid overdose The six-item Overdose Training Evaluation Form that was administered at the end of the study indicated a high level of positive responses from the BHTs. (See Figure 3.) The training met my expectations……………………………….. 1 4.6 I feel more confident & will beOverdose able to apply the knowledge learned. Figure 3. Post-intervention Training Evaluation 2 4.2 The content was organized and easy to follow…………………… 3 4.2 The materials were pertinent and useful………………………….. 4 4.6 5 4.6 The trainer encouraged participation and interaction……………… How would you rate this training overall? ....................................... (very poor to excellent) 6 4.8 1 2 3 strongly disagree  4 5 strongly agree Figure 3: Overdose Training Evaluation Discussion The results from the study indicate that training BHTs working in a residential treatment center on opioid overdose response is effective in increasing attitudes and knowledge related to opioid overdose management. The OOKS and the OOAS assessment tools were used to measure knowledge and attitudes respectively. These assessment tools have been validated and used in previous research for similar evaluations. Following the educational session, the overall cumulative scores on the OOKS and OOAS increased, suggesting that awareness and knowledge regarding opioid overdose had improved. Two of the OOKS subscores, Signs and Naloxone Use, ADVANCING THE IMPLEMENTATION OF MAT 19 improved significantly after the educational session. According to previous studies, general practitioners (GPs) have a negative attitude about dealing with patients with SUDs. This conclusion was contradicted by the current research, which found that BHTs provided positive support to patients with SUDs. Although some GPs believed community naloxone coverage was more suitable for specialist drug services, research from Scotland showed that some GPs demonstrated tentative willingness to participate (Leece et al., 2015). The study's results indicate that BHTs might have clear information gaps when it comes to naloxone use. Such particular knowledge gaps may indicate wider deficiencies in opioid overdose response in clinical practice. The results of the study back up previous studies by Binswanger et al. (2015), who discovered that clinical staff sometimes lacks information about how to use naloxone rescue kits in outpatient settings. Brief naloxone preparation and education will improve awareness and attitudes about overdose prevention (Behar et al., 2015). The small sample size, single geographic area, convenience sampling, unique demographics of the patients, and unique clinical environment of a residential treatment center, are all limitations of this study. As a result, the results may not apply to other situations. Also, the interval between follow-ups was extremely variable. This was partly due to the fact that the follow-up interviews were delayed due to a lack of response from participants. Longer follow-up periods could have minimized information retention from the intervention and bias findings away from the observed effect. Despite these shortcomings, the study does point to important research directions for the future, including evaluating the impact of educating all health care workers on opioid overdose response in reducing opioid overdose fatalities. In conclusion, the efficacy of an educational initiative in enhancing patient awareness of opioid overdose and naloxone was demonstrated in this study. Training BHTs working in an ADVANCING THE IMPLEMENTATION OF MAT RTC on opioid overdose response is effective in increasing attitudes and knowledge related to opioid overdose management. 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Anesthesia & Analgesia, 125(5), 1741–1748 ADVANCING THE IMPLEMENTATION OF MAT 26 Appendix A Evaluation and Synthesis Tables Table 1 Evaluation Table Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice Cragg et Inferred to be Design: Distinct records IV1: Any Two ORs IV1 (OR LOE: 1 al., (2019). theory of Self- Systematic identified (N= current or independent synthesized 3.55; 95%CI Conclusion: Risk Transcendence review of 9,629) previous reviewers from 2.62 to 4.82), The findings of factors for literature substance screened individual the study Full text IV2 (OR reviewed 2.45; 95% CI depicted that misuse of and metause and its publications studies by (n=1114) 1.91 to 3.15), younger prescribed analysis of link to for inclusion. using Outcome IV3 (OR opioids: A observationa Final sample opioid inversevictims are at (n=65 studies) ascertainment 2.19; 95% CI twice the risk systematic l studies. misuse variance methods 1.81 to review and weighted of opioid Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 27 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice metaPurpose: Sample IV2: any included random2.64), IV4 misuse than the analysis To Demographics: mental clinical effects meta- (OR 1.23; older victims. synthesize a systematic health opinion, use of analysis. 95% CI 1.10 Funding: YoungerCanadian the available literature review diagnosis chart or to 1.36). opioids naïve I-squared Institutes victims are evidence which adhered to and its link administrative statistic of Health five-times Chi-square about PRISR to opioid records, urine and MAG, as Research patient-, misuse toxicology test. vulnerable to well as the Meta- IV3: Foundation prescriber-, screening, misuse of medication-, analysis of younger age patient selfGrant opioids and system- Observational report, family and its link compared to to opioid older ones. Studies in Bias: None level risk or clinic staff Countries: Grade: Strong factors for report, opioid Epidemiology misuse Guidelines, for IV4: male USA and recommendatio developing agreement misuse the reporting of sex and its violation, or Canada n. Recognizing systematic link to the higher risk among enrollment in a reviews. patients rehabilitation of opioid Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method prescribed opioids for noncancer pain. Sample/ Setting 28 Major Variables & Definitions opioid misuse Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice misuse associated with a previous or concurrent history of substance use and mental health diagnosis, guidelines should recommend careful prescription of opioids to these program. Two reviewers independently Setting: appraised each Inpatient and outpatient studies included study in Canada and for potential USA. sources of Nine electronic bias. Reviewers sources were used versions searched: of the NIHCE MEDLINE, tool, for EMBASE, sources of Cochrane, Central Register cofounding of Controlled and selection and Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 29 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice Trials, Database measurement group of of Abstracts bias. patients. of Reviews of Strengths: Effects, the Removal of Cumulative studies with the Index to Nursing narrowest CIs and Allied Health in each metaLiterature, the analysis Science Citation reduced Index (Web heterogeneity. of Science Core Weaknesses: Collection), All studies PsycINFO, included in the Social Sciences quantitative Citation Index synthesis were (Web of Science observational, Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 30 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice Core Collection), therefore the and the findings have the potential to Sociology Collection. be affected by Inclusion residual and Criteria: controlled Studies in which confounding. adults or children Application to were first patient exposed to an population: opioid through a Providers can consider prescription. Exclusion prioritizing alternative pain criteria: management Studies in which strategies by all patients Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 31 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice reported first identifying being exposed to high-risk illicit opioids, patients thereby were prescribed decreasing the opioids for risk of opioid cancer pain, or misuse. Utility to were receiving PICOT: palliative care Educating peer were excluded. support on the Attrition: None risk factors for OUD can increase referral rates for MAT, thereby Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 32 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice decreasing mortality and morbidity associated with OUD. Feasibility: One eight-hour education session on the risk factors for MAT is feasible. Harm: None identified Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 33 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice Eddie et Inferred to be Design: Distinct records DV1: Title screen I-squared DV1: LOE: 1 al., (2019). the Systematic identified N=158 Effects of removed 101 test participants Conclusion: Lived review of peer referral duplicate receiving PRSS is theoretical experience framework of literature. on patient’s records, and 11 intensive beneficial in PubMed phenomenogra (n=14) s in new participation records on referral were substance phy detoxification Purpose: EMBASE models of in a 12-step non-relevant more likely To report the (n=26) care for meeting on topics. over the past units, since most up to successfully CINAHL An abstract substance decreasing year have date research (n=55) use the risks review attended at connecting disorder: A on PRSS. associated least one removed 17 individuals to PsychINFO care following (n=63) systematic with OUDs. records. All meeting per Final sample DV2: review of week (OR= studies were detoxification (n=24 studies) Effects of peer 1.38) and had is a persistent checked for recovery greater 12 peer support accuracy by and vexing problem for referral on Demographics: support project leads. Step group A systematic Quality services patient’s involvement providers. Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 34 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice and review of initiations assessment (d= 0.23) and Grade: High recovery literature of of substance form was used. abstinence because the coaching. humans of all age abuse Sources of bias rates (OR= quality of ranges. treatment for each study 1.61). 12 evidence Funding: Setting: and were evaluated Step supporting No grants PubMed, completion with the involvement significant Bias: None EMBASE, QUADAS mediated the differences is CINAHL, and tool. association high. Country: Strengths: PsychInfo data between referral group Priori research USA bases were design, and alcohol searched. comprehensive Inclusion and drug criteria: outcomes and search of Studies were was electronic data limited to RCTs, bases duplicate associated quasiwith better study selection Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 35 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice experimental outcomes and data studies, single above and abstraction of and multi-group beyond study. prospective and group. Weaknesses: Review did not DV2: PRSS retrospective distinguish was studies, and between paid associated crosswith faster peer support sectional/descript ive studies outreach, and workers such related to SUD. as recovery shorter latency to coaches, who Available outcomes were initial clinical are expected to have formal included assessment Exclusion (d= 0.16), and training and criteria: Non certification, higher rates peer reviewed and untrained, of any Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 36 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice items such as treatment volunteer peer book chapters service support who and dissertations initiation. may facilitate were excluded brief Those receiving Attrition: None interventions PRSS were akin to 1-step less likely to calls. complete Application to patient treatment. population: Peer support could be a costeffective way to bridge the gap between detoxification Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 37 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice and longerterm SUD by helping patients enter residential programs and/or engage with recovery programs in the community. Utility to PICOT: Since patients at CR are referred for MAT by peer support staff, Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 38 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice educating peer support staff on the importance of MAT could increase utilization rates for MAT services thereby decreasing OUD-related deaths. Feasibility: Three 8-hours education session on Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 39 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice MAT is feasible. Harm: None identified Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 40 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice LOE: 1 Conclusion: Klimas et Inferred to be Design: Distinct records DV1: Two Population DV1: al., (2019). the theory of identified Identifying investigators incidence of A history of Systematic Strategies Caregiving (N=1287) risk factors independently prescription review and While a opioid use to identify Dynamics associated assessed OUD after metahistory of analysis of Full text patient with opioid quality to opioid disorder (LR reviewed literature. risks of addiction. exclude biased prescription substance range, 17Purpose: To (n=102) DV2: prescriptio or unreliable was review the Examining n opioid study designs estimated by 22) or other use disorder, evidence screening Final sample addiction and extracted collating certain mental substance when examining tools for data from (n=10 studies) data on health factors identifying initiating higher quality opioid use disorder dependence Sample opioids for studies. The associated adult diagnoses, (LR range, demographic: pain: A with opioid patients at PRISMA-DTA and abuse and Studies of adult systematic addiction. high Vs low and STARD from 4.2-17), humans that risks of and review reporting previous concomitant evaluated developing Funding: screening reviews on Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 41 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice CIHR and tools for prescription symptoms guideline was the topic certain prescription of European identifying characteristics, of followed. Incidence of mental certain commissio adult patient prescription OUD n grant patients at characteristics, opioid prescription health psychiatric Bias: None high Vs low and screening addiction. was diagnoses medications Country: risk of tools assessing calculated North developing symptoms of using (e.g, appeared America symptoms of prescription random personality useful for Bias: None prescription opioid addiction effects opioid in the context of estimate Countries: disorder: identifying Australia, addiction pain management from the LR, 27; 95% patients at Canada, Setting: when included MEDLINE and Northern initiating studies and CI, 18-41), higher risk, prescription Embase records performed Europe, and few quality from January Middle opioids for via 1946 to Eastern pain. comprehensi Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Europe, USA Theory/ Conceptual Framework Design/ Method Sample/ Setting 42 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice November 2018 ve metaconcomitant studies were were analysis prescription available and systematically software searched. version 3. of certain no symptoms, Inclusion Data was signs, or criteria: entered into psychiatric Original studies Microsoft medications screening that were Excel included spreadsheets (eg, atypical tools were compared predesigned antipsychoti particularly symptoms, signs, to calculate cs: LR, 17; useful for the risk factors, and screening tool sensitivity, 95% CI, 15- identifying Specificity, among patients 18) LRs, and who developed prescription Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting opioid addiction and those who did not. Exclusion Criteria: Studies of opioid-naïve patients newly starting opioid medications for pain and studies assessing for a diagnosis of OUD among patients already 43 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis their 95% CI. Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice appeared those at lower useful for risk. identifying Grade: low grade. few quality studies available to help health care professionals determine which patients are likely to develop OUD patients at high risk of opioid addiction. Among individual findings, Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting receiving opioid medications. Attrition: None 44 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results only the absence of a mood disorder (negative LR, 0.50; 95% CI, 0.45-0.52) was associated Level/Quality of Evidence; Decision for practice/ application to practice Strengths: Priori research design, risk of bias assessments, and quality assessment tools used. Weaknesses: Few studies were included in the systematic review and meta-analysis Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 45 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice with a lower Application to patient risk of opioid population: This review addiction. found that a DV2: Most history of opioid or screening nonopioid tools substance use disorder, involving concomitant combination prescription of certain s of psychiatric questions medications, prolonged Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 46 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice were based duration of opioid on lowprescriptions (≥30 days), quality higher daily studies or, opioid doses, and a history of when certain mental diagnostic health disorders performance may be useful for identifying was patients at high risk for assessed prescription among high- OUD. Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 47 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice Utility to quality PICOT: studies, Educating peer demonstrate support on the risk factors for d poor can increase performance referral rates for MAT, in helping to thereby decreasing identify mortality and patients at morbidity associated with high vs low OUD. risk. Feasibility: One eight-hour Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 48 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice education session on the risk factors for MAT is feasible. Harm: None identified Lagisetty Systems Design: Records DV1- Effect Two authors I-squared et al., Engineering identified of MAT on independently statistic Systematic (2017). Initiative for through database patient screened titles Tau-squared review and Primary Patient Safety searching outcomes and abstracts statistic metaanalyses OF (N=1844) SMD care (health for eligibility. RCTs or The PRISMA models for outcomes Full-text articles for the treating recommendati quasi on was experimental Assessed for opioid use patient). disorders: eligibility followed in trials and What observationa (n=104) conducting the l studies Final sample actually SR. Two Purpose: (n=41 studies) works? A authors used a To Demographics: systematic standardized review systematicall Studies of adults form adapted y analyze 18 years old or from the Funding: current older with OUD No grants Cochrane Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 49 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice Bias: evidenceSetting: Collaboration LOE: 1 based, to extract data None PubMed, Conclusion: primary care CINAHL, from the By evaluating Countries: OUD MAT included EMBASE, and not only patient North America, efficacy, but interventions PsychInfo data studies, Europe, also structural and identify bases were independently and program and in searched. characteristics Australia. of primary care Inclusion: structures duplicate. Articles were Two authors and models for processes included if the independently delivering intervention: (1) assessed risk MAT, this associated evaluated a of bias via the with review improved primary carevalidated provides key patient insights for based health Downs and PCPs and Black tool. outcomes in delivery model order to where primary researchers Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 50 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice guide future care was defined about ways to policy and as care delivered build upon implementati in a general existing on in practice setting resources and primary care (i.e. private personnel to settings. practice, more academic effectively primary care deliver OUD clinic) by a treatment general medical DV1: Grade: Strong Treatment on recommendatio internist and/or buprenorphin n. With the family medicine need to rapidly physician only, e was (2) targeted positively disseminate adults (18 years associated primary careor older) with based models with Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 51 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice OUD defined as achieving a to provide patients engaged recommended MAT, this in care to treat QHI study their opioid score[(AOR) highlights that addiction, (3) = 2.19;95 % policy makers evaluated patientCI=1.18and health care level outcomes 4.04]. professionals (e.g. patient should strive to retention, urine provide and toxicology pragmatically screens, evaluate at the satisfaction, very least, the effect on health provision of screening for some comorbidities, coordinated etc.), and (4) care. Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 52 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice evaluated the Strengths: By care model using using the qualitative or SEIPS quantitative framework, methods. systems design Exclusion elements within criteria: each Studies that did intervention not include a were described rather than description of the care delivery focusing only on the broad model evaluated, organizational focused framework of exclusively on comparing the intervention intervention; Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 53 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice settings without a Comprehensive detailed search of description of the electronic data primary care bases; Risk of intervention/prog bias ram design, and assessments. Weaknesses: concentrated on Only studies specialty based primary care that were outside of a PCP published in peer-reviewed led primary care practice were literature were excluded. included. Attrition: None Therefore, interventions that may be in Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 54 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice the pilot phase or have outcomes presented via other grey literature such as websites/forum s were not captured. Application to patient population: With the need to rapidly disseminate Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 55 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice primary carebased models to provide MAT, this study highlights that policy makers and health care professionals should strive to provide and pragmatically evaluate at the very least, the provision of some Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 56 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice coordinated care thereby decreasing mortality and morbidity associated with not using MAT. Utility to Picot: Educating peer support at CR on the positive outcomes of using MAT for OUD can Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 57 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice increase referral rates for MAT and increase patient outcomes. Feasibility: Three 8hours education session on MAT is feasible. Harm: None identified Maclean et Inferred to be Systematic N=1199 studies IV1: Lead author Egger’s test, al., (2018). the theory of review of performed an Begg’s test, Full text articles Attention Attentional Selfliterature initial assessed for bias in I-squared bias in Transcendence and metatest, eligibility (n=40) participants screening and with OUD, Cochrane’s Final sample opioid analyses in then Q test, and (n=21 studies) nonusers: A accordance potentially Demographics: systematic with relevant Contourdependent prescription manuscripts All adult review and PRISMA enhanced metastandards participants who opioid were discussed funnel plots. analysis. and evaluated were opioid users, and Purpose: Metahealthy analysis was Funding: To conduct a addicted or in with other conducted No grants systematic authors. treatment for control. Bias: None IV2: Data extracted using a review and opioid use were Countries: Attentional from eligible metaidentified as random UK, USA, studies analysis of “participants with bias in effects Iran, participants included study model using OUD”. attentional Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 58 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice Netherland bias studies Setting: with OUD population, Comprehens LOE:1 s, China for OUD. Database versus sample size of ive MetaThe results of searches in healthy group(s), Analysis 3.0 this systematic Google Scholar, controls. biological sex software. review and meta-analysis Attentional distribution in PubMed, and bias refers suggest that PsychINFO of group(s), studies published to the category of individuals with OUD between 200 and cognitive opioid use, 2017. processes in treatment exhibit robust setting, attentional bias Inclusion which to opioid cues criteria: attention is attentional bias Studies were automaticall task type, when engaging included if they y captured stimuli used, in MAT. Grade: Strong by drug experimental (a) evaluated recommendatio attentional bias in cues and setting, use of n. If attentional opioid users, (b) maintained attentional bias Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 59 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice bias precedes opioids use and relapse, interventions that reduce attentional bias may be useful. Strengths: Priori research design, risk of bias assessment, and comprehensive search of used a task to on drug modification, evaluate cues. primary attentional bias attentional bias that included findings, and active response association of to study stimuli, attentional bias (c) were peerwith clinically reviewed, (d) relevant calculated findings. attention bias by To ensure IV1: accuracy, two There was comparing authors insignificant response to drug dependently and neutral attentional stimuli, and (e) bias, i.e., extracted data could isolate and attentional attentional bias inconsistencies Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 60 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice specific to opioid were discussed bias differed electronic versus neutral until full significantly databases. stimuli from bias agreement was from zero Weaknesses: to other salient reached. (M= There were a relatively small 35.53ms, stimuli. 95% CIs = number of Exclusion criteria 23.45, 47.61, studies that assessed Studies that were p< 0.001). not peerThere was attentional bias reviewed, studies between OUD evidence of of humans heterogeneity and healthy in attentional controls, and younger than 18 even fewer that bias across years old, and studies, Q studies of assessed (df= 12) = attentional bias pregnant females. 91.29, p< in low-risk Attrition: None Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 61 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice prescription opioid users. Assessment differed across studies, with different researchers using different tasks, parameters, and stimuli, which can complicate comparisons across studies. 0.001; I2= 86.86%. IV2: There was a significant betweengroup difference in attentional bias (d= 0.72, 95%CIs = 0.46, 0.98, p< 0.001). There was no evidence of heterogeneity Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 62 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice in effect sizes Application to across patient studies, population: Q(df=6) = Patient intervention 8.713, p= that reduce 0.19; I2= attentional bias 31.14%. can be a useful Egger’s test for intercept adjunct to provided no MAT. evidence for Utility to PICOT: publication Educating peer bias support on (intercept = 0.25, p= interventions to 0.91), and reduce Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 63 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice neither did attentional bias Begg’s test can increase (p= 0.65). outcomes of patient on The funnel plot exhibited MAT. little evidence Feasibility: of publication A two-hours class on some bias. of the interventions to reduce attentional bias is feasible. Harm: None identified Maglione Inferred to be MetaN=6877 DV1: Effect Two I-squared et al., the Cognitive- analysis of of MAT on independent statistic Full text articles (2018). Behavioral RCTs using assessed for cognitive reviewers Tau-squared Effects of Frame of the Hartung- eligibility processing. screened statistic (n=1411) DV2: Effect abstracts and SMD medication Reference Knapp of MAT on full texts using Final -assisted method for Physical treatment randomsample(n=40) predetermined function. Demographic: for opioid effects eligibility use models. Studies of adult criteria. The disorder on humans, 18 years DV3: Effect Cochrane Risk A priori research of age or older. of MAT on of Bias tool functional design social Setting: outcomes: was used for PubMed, behavioral A controlled Purpose: To PsychINFO, systematic trials. For function synthesize EMBASE DV4: Effect observational review. evidence on CINAHL, Funding: of MAT on studies, Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 64 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice DCEPHTI the effects of Cochrane neurological representativen LOE: 1 and MAT for Central, function. ess of the Conclusion: OUD on MAT patients USDD and CDSR The functional databases were and baseline weaknesses in searched. the body of Bias: None outcomes, similarity of evidence Inclusion including compared Countries: cognitive, criteria: Studies groups were prevent any North were limited to physical, assessed. strong America occupation, outpatient conclusions and Europe social/ about the settings, studies effects of MAT behavioral were limited to on functional and, controlled trials, neurological with or without outcomes or function. difference random assignment, and among medication Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 65 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice observational types. Some studies. studies that compared Exclusion criteria: MAT patients Pregnant women, to persons with studies carriedOUD who did out in inpatient not receive hospitals and MAT reported significant residential beneficial rehabilitation facilities, crossDV1: effects Compared regarding sectional studies. Attrition: None with matched criminal controls with activity. no history of Grade: Low because the opioid use, Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 66 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice methadone quality of patients in evidence shorter RCT supporting had higher significant verbal differences is memory low. scores (SMD Strengths: Priori research 0.81; 95CI design, 0.25, 1.36). duplicate study DV2: Fewer methadone selection and patients data abstraction (50%) of study reported information, comprehensive fatigue than search of did the Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 67 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice Malta et Inferred to be Systematic Distinct records IV1: Opioid t-test untreated electronic Two reviewers al., (2019). the theory of review of identified use opioid users databases, and independently Opioidself-efficacy peerthrough database intervention (RR 0.78; CI risk of bias screened all related reviewed searching s during 0.56,1.09) assessments. articles in a DV3: No Weaknesses: treatment, literature N=2356 incarceratio two-step significant None noted Full text interventio and metan. screening difference IV2: Not applicable ns, and analyses in reviewed process-first found at four to patient due (n=186) Opioid use outcomes accordance Final sample among with intervention screening the weeks (SMD to weakness in titles/abstracts incarcerate PRISMA s post(n=46 studies) 0.69; CI-0.05, the body of the followed by incarceratio evidence. 1.42) Sample d persons: 2019 the full-text DV4: The Study will not Demographics: A checklist. n. articles. When Purpose: Studies of difference in be used due to systematic consensus To assess review. incarcerated adult mean score limited could not be opioidhumans of age 18 were not evidence. reached among related or older. statistically Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 68 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice Funding: interventions Setting: reviewers, a significant LOE: 1 Support delivered third reviewer (SMD 0.12; The search Conclusion: from during and became CI-0.46, included the This review after involved to 0.69). highlights the following CIHR, The Chair in need to incarceration scientific resolve implement and Addiction among adult literature standing (University population conflicts. scale up databases: of correctional Criminal Justice evidence-based Relevant populations. Abstracts, strategies to Toronto) information Embase, And from ensure was extracted MEDLINE, the incarcerated and inputted individuals HGFCAR, National into a University Criminal Justice with OUD are standardized Reference able to access of form. All Service adequate Auckland. eligible studies treatment and Bias: None (NCJRS), Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 69 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice Country: PsycINFO, were assessed care during and Scopus, and Web for quality postNorth of Science. using the incarceration. America, Articles reviewed Joanna Briggs Australia, Grade: Strong recommendatio Asia, and were published Institute n. Europe. between 2008Critical Health 2019. Appraisal professionals, Inclusion Tools policy makers, criteria: researchers, The review IV1: 76.9% included studies received and legislators conducted among OAT while can work adult participants incarcerated, together to mortality of who (1) were build a system opioidthat helps with opioid users at dependent identifying the time of the Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 70 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice study and/or had incarcerated incarcerated been diagnosed persons was persons with with OUD prior significantly OUD, who can to or during lower among from OAT, and incarceration and those reach similar (2) were receiving levels of incarcerated or OAT in treatment recently released prison, hazard adherence, into the of all-cause health and community (≤90 death was social days post74% lower improvements incarceration). among those as persons with Exclusion receiving OUD without criteria: OAT in incarceration Studies were prison vs. history excluded if those opioidKey: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 71 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice participants were dependent not Strengths: (1) not opioid in OAT Comprehensive users, (2) using (AHR = 0.26, search of opioids for 95% CI 0.13– electronic medical purposes 0.50). database IV2: (not including for search. First OUD), (3) Incarcerated study to persons who released from systematically incarceration for continued review the more than 90 literature to MMT postdays, (4) on release had a assess the probation or effects of both 36% lower parole at the time treatmentrisk of of the study, or recidivism vs. based and non-MMT(5) involved in preventive drug treatment treated group opioid-related Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 72 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice court or other (AHR = 0.64, interventions diversion 95% CI 0.47– delivered programs. 0.88, p < during and 0.01). after Attrition: None incarceration among adult correctional populations. Weaknesses: The determination of whether there was a meaningful effect for each study outcome Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 73 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice was based on statistical significance, which does not necessarily represent clinical or populationlevel significance. Application to patient population: This study reinforces the positive impact Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 74 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice of providing OAT in correctional settings. OAT decreases mortality rates, reduces opioid use, and improves addiction treatment intake and retention postincarceration. Utility to Picot: Since Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 75 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice most of the patients at CR are incarcerated educating peer support on the importance of OAT can increase referral rate for OAT, thereby decreasing mortality and morbidity associated with OUD Feasibility: Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Murphy & Inferred to be the theory of Polsky, Caregiving (2016). Economic evaluations of opioid use disorder interventio n: A systematic review. Funding: Systematic review and metaanalysis of literature. Sample/ Setting 76 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice A three, eighthours class on some of the interventions to reduce attentional bias is feasible. Harm: None identified Articles IV1: A sensitive Cost benefit identified Economic approach was analysis. through database evaluation used to ensure searches of MMT a N=98 comprehensive Final sample list of relevant A decision (n=49 articles) articles. analytic Demographics: The model. Studies of adult Drummond humans of age 18 checklist was Purpose: years old and used to To review the literature above. evaluate and on economic Setting: categorize Searched evaluations studies of opioid use databases according to included: their quality. Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 77 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice No funding disorder PubMed/MEDLI LOE: 1 received. intervention. NE, Cochrane Conclusion: Library, CostThe evidence Bias: None Effectiveness on MMT Country: supports North Analysis America, previous Registry, Web of Asia, Science, JSTOR, findings that Europe, MMT is an ScienceDirect and Google and economically Scholar, UK advantageous Australia opioid-useNHS Economic Evaluation disorder Library therapy. Grade: Low Database, because the EconLit, literature PsycINFO, Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting SciELO Citation Index, Social Science Citation Index, and the Derwent Innovations Index. Inclusion criteria: 78 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice comparing MMT to other OUD pharmacothera pies is still quite limited. Strengths: Quality assessment of studies and comprehensive electronic search. IV1: Studies of beneficiaries who received MMT had the lowest costs ($7,163 [2004 Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America Articles that focused on opioid-use disorders and the treatment of opioid use ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 79 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice disorders as an USD]), Weaknesses: outcome were followed by Among those included. studies of studies that did members incorporate Exclusion effectiveness with 2 or criteria: measures, more Articles were outpatient many were excluded for not clinical in addiction containing treatment nature. One sufficient visits and no problem with information on clinical methadone costs or other ($14,157), outcomes is pertinent and members that they fail to economic with 1 or 0 capture many variables; articles of the outpatient that focused addiction consequences Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 80 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice associated with opioid misuse, such as changes in quality of life. Application to patient population: Not applicable to patient population due to limited evidence comparing MMT to other solely on treatment identifying the visits and no costs of opioid methadone misuse or of ($18,694). providing a service; and articles that were poster abstracts published in conference proceedings; Studies were excluded if they were not an economic evaluation of an Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting OUD intervention. Attrition: None 81 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice forms of OUD treatment. Utility to PICOT: Not applicable due to limited evidence. Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 82 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice Ordeda et Inferred to be A systematic N=5281 IV1: The Data from all Cost benefit al., (2015). the theory of review was prevalence selected analysis Final sample conducted to (n=21) of POMA articles were Prevalence self-efficacy and update the extracted by Demographics: IV2: Cost of POMA economic 2009 results Studies of adult two burden of by reviewing humans 18 years independent of age or older. prescriptio literature reviewers, any Setting: n involving discrepancies opioid PubMed, humans between misuse and published in Embase, and extractions abuse. A English from OpenSIGLE (for were verified systematic gray literature) 2009-2014. for accuracy Purpose: review. databases were by an Funding: To update independent ere searched with and focus on the cost CDC third reviewer. synthesize Bias: None Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 83 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice Country: all evidence and prevalence of Published LOE:1 USA around POMA. checklists were Conclusion: prevalence used to assess Inclusion This systematic and costs of criteria: the relevance literature review shows opioid abuse Studies that and credibility that abuse of assessed abuse of of prescription observational prescription opioids, studies, opioids is retrospective characterized including OUD, database by substantial poisoning, and direct fatal and nonanalyses, and healthcare economic fatal overdose were included. model studies. costs, medical Exclusion utilization, and criteria: related societal costs. Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting Studies that did not provide specific data for the prescription opioid abusing subgroup of a broader population of licit and illicit substance users were excluded. Attrition: None 84 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice Grade: Strong recommendatio n. An improved understanding of the magnitude of these costs will inform policy making. IV1: POMA prevalence ranged from 1.6 – Strengths: 2.66/1000 in Relevance and US privately credibility of insured and Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 85 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice studies performed; duplicate study selection. 5.0 – 8.7/1000 in Medicaid. 5year VA prevalence Weaknesses: was Study designs 11.1/1000. Prevalence in varied considerably the US increased making it difficult to from 1.8/1,000 to directly 5.0/1,000 in compare Florida findings. Medicaid and 0.5/1,000 to Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 86 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice Application to patient population: Due to the increased cost, mortality, and morbidity caused by opioid use, MAT has shown to reduce cost, mortality, and morbidity among people 1.6/1,000 in commercially insured from 1999-2006. Global illicit opioid dependence rate was 2.2/1000. IV2: Total US societal costs of POMA were $53.4 -$57.7 billion. Prescription Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 87 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice dependent on opioids. Utility to PICOT: Educating peers at CR on the importance of MAT for opioids can increase referral rate for MAT, thereby decreasing mortality and morbidity opioid poisoning accounted for $15.9 billion. Excess annual medical costs in commercial claims data for patients with diagnosed opioid abuse and dependence Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 88 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice Sordo et Inferred to be MetaDistinct records IV1: Cause All abstracted t-test was $9,456associated with al., (2017). theory of analysis of identified and data were $20,546. OUD. Poisson Mortality Caregiving RCTs using N=2033 overdose checked for Similar distribution Feasibility: risk during Dynamics the Hartung- Medline mortality accuracy by results were Three 8-hours for the (n=1215) observed education and after Knapp rates during project leads. seen in number of Embase (n=729) periods in opioid method for Two Medicaid and session on Lilacs(n=729) substitutio randomand out of investigators the VA which MAT is deaths and PsychINFO n effects treatment independently fixed person were feasible. Harm: None treatment: models. (n=486) with reviewed the years at risk. ~$15,000. Systematic methadone titles and The per event identified A priori Other searches Mortality research (n=102) rates in and review and and abstracts cost for design out n=20 Buprenorph identified in metaopioid abuse Purpose: Retained for ine analysis of the search, and treatment related To compare review (n=328) IV2: cohort retrieved were jointly ED/inpatient the risk for Evaluate Final sample studies. articles to combined care was all cause and (n=20 studies) heterogeneit determine across $18,891 Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 89 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice Funding: OD Demographics: y of eligibility, and methadone LOE: I ISCIII mortality in prospective and mortality to extract study and Subutex Conclusion: Network people with retrospective rates over data. by using Retention in and opioid multivariate methadone and cohort studies in time in and Quality assessment buprenorphine EMCDDA dependence individuals with out of effects metatreatment, is opioid form based on analysis. Bias: None during and treatment, dependence that Country: after particularly standardized associated with Australia, reported deaths and substitution within the substantial Canada, treatment reductions in from all causes or first few extensively Northern with weeks after used OD during the risk for allcause and Europe, follow-up periods treatment instruments methadone overdose in and out of was used: initiation or Middle The Eastern buprenorphi opioid and mortality in ne as well as substitution methodology cessation. people who Europe, checklist for USA dependent on treatment with to cohort studies opioids. characterize Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 90 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice trends in risk methadone or developed by The induction of mortality buprenorphine. the SIGN. The phase onto after the checklist for methadone and Setting: Inpatient initiation and outpatient drug-related the time studies in and studies immediately cessation of Australia, developed by after leaving treatment. Canada, Northern the NDARC, treatment with Europe, Middle Australia. both drugs are Eastern Europe, periods of particularly and USA. The pooled all-cause Medline, increased mortality Embase, mortality risk, rates in the which should PsychINFO, and be dealt with LILACS three databases were buprenorphin by both public e cohorts health and searched by Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 91 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice clinical strategies to mitigate such risk. using specific were 4.3 and index terms 9.5 deaths per linked to the 1000 persons topics of opioid years in and dependence, out treatment Grade: Strong opioid respectively. All-cause substitution recommendatio mortality n. treatment, rates varied Precautions mortality, and cohort studies widely across should be taken during and the 16 Inclusion after opioid Criteria: methadone cohorts substitution prospective or retrospective (P<0.001). treatment to The pooled increase safety. cohort studies in people with Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 92 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice Strengths: Synthesized evidence from cohort studies published until 2016, first study that quantified mortality changes overtime during and after methadone treatment. opioid all-cause dependence that mortality reported deaths rates were during follow-up 11.3 and periods in and 36.1deaths out of opioid per100 substitution persons years treatment with in and out of methadone or methadone buprenorphine. treatment Exclusion respectively (unadjusted criteria: No data out-to-in rate in humans, ratio of 3.20, people in prison 95% or recently confidence released, no all Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 93 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice cause or OD interval 2.65 Weaknesses: mortality as to 3.86). In Did not include outcome or no pooled trend studies in lowdeaths over analysis, alland middlefollow-up cause income Study not mortality countries, study included focused on dropped observational people with sharply over studies, the opioid the first four weeks of same patients dependence, no are compared methadone original research. Attrition: None treatment and throughout decreased follow-up gradually two periods in and out of weeks after substitution leaving Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 94 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice treatment. treatment, but All-cause these patients mortality leave and reremained enter treatment stable during in a noninduction and random way. remaining Also, by the time on study design, buprenorphin overdose e treatment. mortality was Overdose not captured mortality when opioid evolved substitution similarly, was obtained with pooled on illicit drug overdose markets. Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 95 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice Application to patient population: Due to the numerous deaths caused by opioid use, Methadone and buprenorphine have shown to reduce mortality among people dependent on opioids. mortality rates of 2.6 and 12.7 per 1000 person years in and out methadone treatment (unadjusted out-to-in rate ratio 4.8, 2.90 to 7.96) and 1.4 and 1.6 in and out of buprenorphin e treatment. Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 96 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice Utility to the PICOT: Educating peers at CR on the importance of MAT for opioids can increase referral rate for MAT, thereby decreasing mortality and morbidity associated with OUD. Feasibility: Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT Citation Theory/ Conceptual Framework Design/ Method Sample/ Setting 97 Major Variables & Definitions Measurement/ Instrumentatio n Data Analysis Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice Ten 8 hours education session on MAT is feasible. Harm: None identified. Key: AHR- Adjusted Hazard Ratio; AOR-Adjusted Odds Ratio; CDC-Center for Disease Control; CI-Confidence interval; CIHR-Canadian Institutes of Health Research; CR- Crossroads; DCEPHTI-Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; DfDegrees of Freedom; DTA- Diagnostic Test Accuracy; EMCDDA- European Monitoring center for Drugs and Drug Addiction; HGFCAR- Huge Green Foundation Chair in Addiction Research; ISCIII- Institute De Salud Carlos III; LOE-Level of Evidence; LR-Likelihood Ratio; MAG- Metaanalysis Guidelines; MAT-Medication Assisted Treatment; M=Median; MMT-Methadone Maintenance Treatment; NDARC; National Drug and Alcohol Research Center; NHS- National Health Services; NIHCE- National Institute for Health and Care Excellence; OAT-Opioid Agonist Treatment; OD-Overdose; ORs-Odds Ratios; OUD-Opioid Use Disorder; PCP-Primary Care Physician; POMA- Prescription Opioid Misuse and Abuse; PRISR-Preferred Reporting Items for Systematic Reviews; PRISMA- Preferred Reporting Items for Systematic Reviews and MetaAnalyses; PRSS-Peer recovery support services; QUADAS- Quality Assessment of Diagnostic Accuracy Studies; QHI-Quality health care Indicators; RCTs- Random Control Trials; RR-Random Ratio; SIGN- Scottish Intercollegiate Guidelines Network; SMD-Standard Mean Differences; SR-Systematic Review; SUD- Substance Use Disorder; STARD-Standards for Reporting Diagnostic Accuracy; USDD- United States Department of Defense; UK-United Kingdom USA-United States of America ADVANCING THE IMPLEMENTATION OF MAT 98 Table 2 Synthesis Table Author Year Design LOE Theory of SelfTranscendence Theoretical framework of phenomenograp hy Theory of Caregiving Dynamics Systems Engineering Initiative for Patient Safety CognitiveBehavioral Crag g et al. 2019 SR I Eddi e et al. 2019 SR I Klimas et al. Lagisett y et al. Maclea n et al. 2019 SR I 2017 SR I 2018 2018 2019 SR SR SR I I I Theory/Conceptual Framework X X Maglione et al. Malta et al. Murphy & Polsky Ordeda et al. Sordo et al. 2016 SR I 2015 SR I 2017 SR I X X X X X X Key: LOE-Level of Evidence; MAT-Medication Assisted Treatment; NR-Not Reported; OUD-Opioid Use Disorder; SR-Systematic Review; UK-United Kingdom USA-United States of America; ↑-Increased risk of OUD; ↓-Decreased risk of OUD; ↓ *-Decreased mortality and morbidity associated with OUD; %-Percentage ADVANCING THE IMPLEMENTATION OF MAT 99 Frame of Reference Theory of SelfEfficacy X X Study Characteristics Inpatient Outpatient Inpatient and Outpatient SR of adults only SR of adults and Children Male (%) Number of studies Included in the SR X X X X X X X X X X X X X X X X X X X X 72.8 65 NR 24 NR 10 38.32 41 61.3 21 NR 40 82 46 36.7 49 43.8 21 NR 20 Reliability of Instruments X X X X X X X X X X North America Europe Asia Australia X X X X X X X X X X X X X X X X X X X X X X Any current or previous substance use X X X Independent Variables X X X X X X Setting X X X X Key: LOE-Level of Evidence; MAT-Medication Assisted Treatment; NR-Not Reported; OUD-Opioid Use Disorder; SR-Systematic Review; UK-United Kingdom USA-United States of America; ↑-Increased risk of OUD; ↓-Decreased risk of OUD; ↓ *-Decreased mortality and morbidity associated with OUD; %-Percentage ADVANCING THE IMPLEMENTATION OF MAT Previous Mental health diagnosis Younger age (18-30 years) Male sex Past opioid use disorder X X X X X X X X X X X X X X X 100 X X X X X X X X X X X X X X X Dependent Variables Peer support referral Identifying risk factors associated with opioid addiction Examining screening tools for identifying adult patients at high Vs low risks of developing symptoms of prescription opioid addiction Attentional bias MAT outcomes on cognitive processing X X X X X X X X X X Key: LOE-Level of Evidence; MAT-Medication Assisted Treatment; NR-Not Reported; OUD-Opioid Use Disorder; SR-Systematic Review; UK-United Kingdom USA-United States of America; ↑-Increased risk of OUD; ↓-Decreased risk of OUD; ↓ *-Decreased mortality and morbidity associated with OUD; %-Percentage ADVANCING THE IMPLEMENTATION OF MAT MAT on Physical function MAT on social behavioral function 101 X Effect of MAT on neurological function. X X X X X X Cost of MAT MAT mortality rates X X X Findings Effect of younger age on OUDs Effects of peer support referral History of previous substance use MAT treatment Attentional bias ↑ ↓ ↑ ↓* ↓* ↓* ↓* ↓* ↓* ↑ Key: LOE-Level of Evidence; MAT-Medication Assisted Treatment; NR-Not Reported; OUD-Opioid Use Disorder; SR-Systematic Review; UK-United Kingdom USA-United States of America; ↑-Increased risk of OUD; ↓-Decreased risk of OUD; ↓ *-Decreased mortality and morbidity associated with OUD; %-Percentage ADVANCING THE IMPLEMENTATION OF MAT 102 Appendix C Models and Frameworks Figure 1 The Chronic Care Model Wagner (1998). ADVANCING THE IMPLEMENTATION OF MAT Figure 2 Hubs and Spokes Model Department of Vermont Health (2020). 103