Effects of Medication-Assisted Treatment (MAT) for Opioid Use Disorder on Functional Outcomes: A Systematic Review
Abstract
At the request of the Defense Centers of Excellence (DCoE) for Psychological Health and Traumatic Brain Injury, this systematic review (PROSPERO 2017: CRD 42017058608) synthesizes evidence on the effects of medication-assisted treatment (MAT) on functional outcomes among patients with opioid use disorder (OUD). Functional outcomes included cognitive (e.g., memory), occupational (e.g., return to work), physical (e.g., fatigue), behavioral/social (e.g., family function), and neurological (e.g., balance) function. We searched five databases from inception to January 2017 and bibliographies of systematic reviews to identify English language controlled trials, case control studies, and cohort comparisons of one or more groups; cross-sectional studies were excluded. Two independent reviewers screened identified literature, abstracted study-level information, and assessed the quality of included studies. Meta-analyses used the Hartung-Knapp method for random-effects models. The quality of evidence (QoE) was assessed using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. A comprehensive search and 1,327 full-text publication screenings yielded 27 randomized controlled trials (RCTs) and ten observational studies meeting inclusion criteria. The studies reported highly diverse functional outcome measures. No RCT was rated as having low risk of bias, but several methodologically sound observational studies were identified. The statistical power to detect differences in functional outcomes was unclear in the majority of studies. Regarding cognitive outcomes, a large observational study found that MAT users had twice the risk of injurious traffic accidents as nonusers (low QoE). Two studies reported that MAT users performed significantly worse in working memory and cognitive speed than matched controls with no history of substance use disorder (SUD) or opioid use (very low QoE).
Document Details
- Document Type
- Technical Report
- Publication Date
- Jan 01, 2018
- Accession Number
- AD1063628
Entities
People
- Christine Chen
- Ervant J. Hernandez
- Gulrez S. Azhar
- Laura Raaen
- Margaret A. Maglione
- Mimi Shen
- Nima Shahidinia
- Roberta M. Shanman
- Susanne Hempel
Organizations
- RAND Corporation