The subjective group who underwent toxicology tests

The gap

Evidence profile

Sourced from the limitations of the source papers, classified as general, spanning 3 journals.

Supporting evidence — 3 representative gaps

• The positivity rate of opioid drug urine testing in an emergency department between 2016 and 2024, before and after the introduction of fentanyl testing (2026) · Substance Abuse Treatment, Prevention, and Policy · doi

  The subjective group who underwent toxicology tests may also change over the years, which may lead to biased proportions, as not all ED admissions were screened for toxicology. Another limitation is that physician deci- sions for toxicology screening may include other non- opioid substances as well, influencing results. The trend of other substances is not part of the current manuscript. However, benzodiazepines were reduced, and cannabis increased during the “fentanyl-tested” 2023–2024 period compared with the earlier period 2019–2022. Another limitation is the small duration of the follow-up since the introduction of the fentanyl test in the ED. The regula- tions published regarding opioid prescriptions, which particularly restrict fentanyl, parallel to the fentanyl screening in ED, may change the opioid increase trend in ED, and it is unknown how it would affect users. Another limitation is that while the studied ED is a large tertiary medical center in the biggest municipal city in Israel, treating diverse populations, this is still only a single hos- pital study, which may have limited relevance for other EDs throughout the country. Another limitation is the possibility that naloxone was administered empirically in some cases that weren’t opioid-related. Lastly, the analy- sis is based on de-identified electronic data, with the lim- itation of no possibility to be sure that all patients tested were included.

  generallimitationsevidence 5/5
  Keywords: limitation opioid fentanyl toxicology change screening substances trend tested period possibility subjective group underwent tests
• Impact of health policies on opioid tapering and discontinuation among patients receiving long-term opioid therapy for chronic noncancer pain (2026) · International Journal of Drug Policy · doi

  This study has limitations. Time-varying factors not accounted for in our study may have influenced the study outcomes, such as evolving harm reduction initiatives. As CPSBC released a policy allowing wider prescribing of buprenorphine/naloxone shortly after introducing pre- scribing standards related to opioid analgesics, this may have affected some of our findings regarding the prescribing standards. To account for this, we have considered both policies in our interpretation when rele- vant. As our definitions of rapid vs gradual tapering and discontinuation may have affected our results, we conducted sensitivity analyses varying our outcome definitions to help the reader consider to what extent our findings related to definitions used. Our findings may also have been affected by the interrelation of study outcomes, which was not accounted for in our study design. For example, in cases where a policy was associated with a short-term increase in rapid discontinuation, this might have influenced other study outcomes such as the frequency of longer-term gradual discontinuation. The administrative health data used in our study included information in prescription drug dispensa- tions, but this may differ from patients’ actual use of prescription drugs and we lacked information about use of unregulated drugs. In addition, it was unclear whether changes in tapering and discontinuation re- flected changes in prescriber or patient responses to policies and events or shared decision-making. While we analyzed cohorts by OUD and OAT status, we did not investigate whether policy impacts differed for sub- groups defined by demographic or other patient characteristics. Future research could investigate whether other groups were disproportion- ately affected by impacts of these or similar policies and events on opioid tapering and discontinuation.

  generallimitationsevidence 5/5
  Keywords: discontinuation affected outcomes policy policies definitions tapering whether varying accounted influenced prescribing standards related opioid
• The effects of offering treatment with injectable naltrexone during reentry on long-term mortality (2026) · Journal of Experimental Criminology · doi

  The current study has several important limitations, and the results should be considered with them in mind. These include a relatively small sample size (n = 94), which has implications for statistical power, and a low degree of treatment 1 3The effects of offering treatment with injectable naltrexone during…compliance. Additionally, there are divergences within the demographics of the pilot study population and the complete standing carceral population. For example, the pilot had a meaningful overrepresentation of female individuals (i.e., 40% of the study participants were identified as female, though only about 6% of the carceral population was similarly identified at that time) due to the nature of the participating facilities. A reliance on agency administrative records limits the scope of data available; any individual in the study could have sought other treatment options, including but not limited to MOUD. Though balanced within the research design, outcome data are restricted to mortality in Pennsylvania and so do not reflect the prevalence of events that took place outside of this jurisdiction or where the identity of the deceased individual was not recorded. Temporal and geographic variations in the opioid crisis, particularly as they relate to levels of fentanyl penetration and the resultant impact on overdose risk during the study period (2015–2017), are not cap- tured here but represent an important consideration for future research that employs larger and more temporally and geographically variable samples. Concerning health and mortality, the currently available data do not include records of non-fatal overdoses and other, drug-related harms that did not result in death. These are key outcomes and should be explored to better understand the impact.

  generallimitationsevidence 5/5
  Keywords: treatment population important include within pilot carceral female identified though records available individual mortality impact

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