Agonist Pharmacotherapy for Treating Pharmaceutical Opioid Dependence - Research Review Paper Example

The notion of systematic research review is critical in the fields of Nursing as it aids in giving a clear summary of evidence through a comparative critique of methodologies which transforms to the quality of research findings. This paper, therefore, is aimed to critique the systematic research review regarding the treatment of pharmaceutical opioid dependent individuals through a comparative analysis, the application of research rigor, clarity of the overall findings, conclusion, and implications of the judgment to the nurse practitioner.

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Relevance of the Research Problem

Controversies have existed as a result of the differing results obtained by the nurses employing different pharmacotherapy methods in the treatment of an opioid related condition. As a consequence of this, demand on the side of the nurse practitioners arose to identify the actual cause of disparity since the effect mainly emerges from heroin and other related illegal drugs based on the research focus. It is important to acknowledge that the issue causing controversy concerns the different characteristics held by the clients applying the opioid agonist treatment and those making use of the pharmaceutical opioid treatment methods. It was identified that those who use pharmaceutical opioids unlike those who use heroin are likely to be employed, have a reduced likelihood of using drugs through the means of injection and have higher chances of having mental or physical challenges. To achieve the objective, research aimed at assessing the effect of the therapy had to be conducted for the purpose of attaining clear judgment to bridge the disparity through clear findings and a well thought out judgment (Higgins, 2011). The primary concern was to be able to clearly outline the impact of the different characteristics of the treatment of the condition.

Critique of Research Rigor

For purposes of maintaining the quality of the study, the research objective which was aimed at assessing the implications of agonist pharmacotherapy for purposes of treating pharmaceutical opioid dependence patients was clearly stated (Higgins, 2011). In consideration of the review, a Randomized Controlled Trials (RCTs) methodology was applied as it was the best in fulfilling the objective through quality findings.

Participants in the study involved a section of the population that was initially assessed to meet the standard created by the Diagnostic and Statistical Manual of mental disorders for the 4th edition (DSM-IV) together with another body known as International Statistical Classification of Diseases (ICD-10) and other concerned health issues. The significance of these two institutions was to bring an aspect of quality as there are standard guidelines applied in the research to hinder biases that may emerge in the process (Higgins, 2011). Furthermore, besides the involvement of the organizations, a group of clinicians were also available to assess the participants before engaging in the process. Categories of members involved a group of the population that met the requirement for addiction and not those whose physiological conditions portrayed dependence. To enhance quality, where participants were allegedly identified as opioid dependent and not pharmaceutical opioid as directed by the research, an examination of the initial treatment must have been the pharmaceutical opioid, the relevance of this was to curb biases and enhance similarity among samples.

In the trials, a comparative study of the maintenance agonist treatment was incorporated, and the tests were perceived to be a minimum of 30days of agonist treatment. The similar research topics involved the full versus the partial opioid agonist for purposes of maintaining treatment. Another theme of comparison included the total or partial agonist about other forms of treatment such as psychological therapy. From the research, both the primary and secondary outcomes were presented, but there was a need to assess the evidence to approve the degree of accuracy and relevancy of the results.

Critique of Level of Evidence

For purposes of maintaining standards and quality of proof, there was a need to involve an organization. In this context, the Grading of Recommendation, Assessment Development, and Evaluation group (GRADE) organized a particular scheme to be applied in classification (Balshem et al., 2011). Some of the critical issues that it highlighted to be of importance included; aspects of precision, directness, consistency in the outcome and the varying forms of biases that were portrayed from the secondary outcomes. In comparison to the position held by different authors, there were varying degrees of preferences depending on the fundamental characteristics of the participants. According to the author, GRADE applied several criteria in the grading system involving both qualitative and quantitative (Balshem et al., 2011). In the Quantitative aspect, the range often started from high implying a high degree of confidence that the results reflect a close estimate of the actual effects whereas very low meant that the results give a subtle reflection of the effect. In the qualitative aspect, the figures did range from 1 to 4 depending on the significant risk ratio (RR). In 1. There was substantial evidence of association having a great RR greater than two whereas, in 4, the presence of all the plausible aspects of confounders would have reduced the impact of the findings (Moore et al., 2007).

Critique of Clarity of Systematic Research Review

The author acknowledges the fact the SRR was more comprehensive as it highlighted all the required information in all the aspects regarding the health of the population relevant to the objective of the study. The information captured and degree of quality of findings are quite high as the author has involved a lot of qualitative and quantitative methodologies having clearly identified references (Higgins, 2011). Furthermore, the author has made a clear summary of the evidence in a tabular form for easy analysis and to ensure clarity of information for easy analysis and identification of the possible gaps hence giving room for further research. In addition to this, a flow chart indicating all the sources of information ranging from 9076 records from relevant data-bases, 49 articles, 6 qualitative synthesis and other 6 quantitative syntheses have been applied by the author to indicate the degree of research and depth of vision injected to the research. To show the validity of the outcomes, the author has made use of several relevant bodies to bring an aspect of standardization and quality about the findings to reduce the effects that may result from biases (Higgins, 2011). To put an element of emphasis, the references used by the author covers a range of duration starting from the 1900s to the current days. The span of time captured implies the degree of quality and validity reflected in the research.

Overall Findings of the SRR

Full opioid agonists versus Partial agonists

In the application of the illicit opioid, there was no acknowledged disparity in some days in the use of opioid which were unsanctioned (MD -1.41 days, 95%, CI -3.37 to 0.55, a study carried out among 129 participants) (Higgins, 2011). Furthermore, regarding the urine analysis results, the rate of prevalence was not significant (RR 0.81. 95%, CI 0.56 to 1.18, an analysis carried out among 192 participants). About retention, there was no observable difference in the number of patients at the end of the treatment (RR 0.69, 95%, CI 0.39 to 1.22, a study carried out among 360 participants). According to (Higgins, 2011), in the option of the secondary outcome, findings were recorded about pain, response to risk and adverse effects. According to the two studies carried out by 156 individuals and the author recorded no significant effect. Statistics realized outlined about their behavior were as follows; RR0.52, 95% CI 0.02 to 12.64.

According to Nielsen (2013), he examined adverse effects independently and realized a significant no effect; an experiment carried out by 196 individuals. Other aspects of focus such as employment, the quality of life, the physical and mental health were also parts that the author considered and realized no significant effect about the aspects mentioned (Higgins, 2011).

Full or the partial opioid versus detoxification and psychological Treatment methods

Regarding illicit opioid use, there was no identified impact on the number of days that were sanctioned for opioid (-0.31, 95%, CI -0.66 to 0.04). About the process of urine analysis, the author observed an obvious implication for buprenorphine methodology about the prevalence determined at the end of the study (Higgins, 2011). The statistics for the observation included RR 0.63, 95%, CI 0.43 to 0.91. In achieving the results of the experiment, a group of 206 participants was used. In regards to the aspect of retention, the findings were for buprenorphine as the desired characteristics were obtained at the end of an investigation. The study carried involved 247 participants (RR O.33, 95% CI 0.23 to 0.47). Other questionable aspects such as employment and quality of life encountered no report.

Critique of Conclusion and Implication

In conclusion, the author, based on the findings acknowledged the fact that there is low-quality evidence existing in support of the application of agonistic pharmacotherapy in the treatment of the pharmaceutical opioid condition. In regards to the current data and the tabled statistics both processes of methadone and buprenorphine proved to be equally effective (Higgins, 2011). In comparison to the two methods, none seemed to have better significance about the other. Additionally, about detoxification and psychological treatment methods, the author was for methadone as it was more efficient than the other methods. Observably, the nature of the findings as the author holds are too simple, smaller and moderate hence there is a possibility of changing the outcome in case further research is conducted. About the aspects of pain, the author suggested that the prevalence of depression is higher in people suffering from pharmaceutical opioid dependent (Lusted et al, 2014). The author holds that there is a need for more research to be carried out to determine to measure the severity of pain in both primary and secondary outcome instead of applying a Randomized Controlled Trials (RCTs) where the population with pain are recruited. The author further asserted that when this position is reached, quantitative and qualitative aspects of pain and other related components of the infection will be determined.

References

Balshem, H., Helfand, M., Schunemann, H. J., Oxman, A. D., Kunz, R., Brozek, J., ... & Guyatt, G. H. (2011). GRADE guidelines: 3. Rating the quality of evidence. Journal of clinical epidemiology, 64(4), 401-406.

Higgins, J. P., & Green, S. (Eds.). (2011). Cochrane handbook for systematic reviews of interventions (Vol. 4). John Wiley & Sons.

Goldner, E. M., Lusted, A., Roerecke, M., Rehm, J., & Fischer, B. (2014). Prevalence of Axis-1 psychiatric (with focus on depression and anxiety) disorder and symptomatology among non-medical prescription opioid users in substance use treatment: systematic review and meta-analyses. Addictive behaviors, 39(3), 520-531.

Moore, B. A., Fiellin, D. A., Barry, D. T., Sullivan, L. E., Chawarski, M. C., OConnor, P. G., & Schottenfeld, R. S. (2007). Primary care office-based buprenorphine treatment: comparison of heroin and prescription opioid dependent patients. Journal of general internal medicine, 22(4), 527-530.

Nielsen, S., Hillhouse, M., Thomas, C., Hasson, A., & Ling, W. (2013). A comparison of buprenorphine taper outcomes between prescription opioid and heroin users. Journal of addiction medicine,...