Wha t we kn ow , an d do n 't kn ow , abou t th e im p act of state p olicy an d system s-level in t erven t ion s on pr escri pt ion dr u g overd ose

a b s t r a c t Ba ckgrou nd: Drug overdose deaths have been rising since the early 1990s and is the leading caus e of in ju ry death in the Un it ed St at e s. Overdos e from prescription opi oid s constitutes a large proportion of this burden. St at e policy and system s-level interventions have the potential to im p act prescription drug m isu se and overdose. Methods: We searched the lit erature to id enti fy evaluations of state policy or syst em s-le ve l interventions using non-comparative, cross-sectional, before-after, time series, cohort, or com p arison group designs or random ized/non-random ized trials. Eligib le studies examined in terv e nti on effects on provider behavior, patient behavior, and health outcomes. Resu lts: Ove rall study q ual it y is low , wi t h a lim it ed number of time-series or experimental designs. Kn ow led ge and p res crib in g practices were meas u red more often than health outcomes (e .g., overdoses). Lim itations include lack of baseline data and com p arison groups, inadequate statistical testing, sm all sam p le sizes, self-reported outcomes, and short-term follow -up. St rat egies that reduce in appropri ate p res crib in g and use of m u lt ip le providers and focu s on overdose response, such as prescription drug moni t orin g programs, in su rer st rateg ies, pain clin ic le gislati on , clin ical gu id elin es , and naloxone distri- bution programs, are p rom isin g. Evid en ce of im p rove d health outcomes, particularly from safe st orage and disposal strategies and patient education, is weak. Con clu sions: Whi le im p ortant e fforts are underway to affect prescriber and patient behavior, data on st ate p olicy and system s-level in t erven t ion s are lim it ed and in consistent. Im p rovin g the evidence base is a crit ical need so states, regulatory agencies, and organizations can mak e in form ed ch oice s about policies and practices that w ill im p rove prescribing and use, whi le protecting patient health. Pu bl ish ed by Elsevier Ire lan d Lt d .