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Apr 3, 2024

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Evidence-Based Project, Part 2: Advanced Levels of Clinical Inquiry and Systematic Reviews Patrick Cannon Walden University Essent of Evidence-Based Pract-Spring 2023 Dr. Doris Hill April 2 nd , 2023

Clinical Issue: • With the advent of Fentanyl and other synthetic opiates available to people, the need for new and improved addiction recovery methods are needed more than ever. • Tactics to lessen the withdrawal symptoms and withdrawal period should be emphasized so we can keep patients in treatment. • Secondly, interventions to help patients stay clean after fully detoxing are needed to lessen the percentage of relapse. • The CDC reports that 107,375 Americans passed away from drug overdoses and drug poisonings in the year that ended in January 2022. Synthetic opioids like fentanyl were involved in a startling 67 percent of the fatalities. (Fentanyl Awareness. DEA, 2023). • When treating patients with active opioid use disorder, and patients who are on medicine for an opioid use disorder, the treatment of opioid withdrawal is a significant therapeutic problem in today’s day and age. Nowadays, treatment with partial agonists, such as buprenorphine, opioid receptor agonists, such as methadone, and 2-adrenergic receptor agonists(eg, clonidine and lofexidine) are regarded as the gold standard of care for medically controlled withdrawal. Two more modern medications that are also utilized for treatment include tramadol (which antagonizes the -opioid receptor) and tizanidine (which antagonizes the -2 agonism) (Srivastava, A. B., 2020).

PICOT Question • PICOT QUESTION: What are some alternative or conjunctive therapies to lessen or more effectively manage opiate withdrawal in the addiction recovery population during the withdrawal period? • This question developed out of a great need in the community but still encompasses many options to try. One size fits all doesn’t work for this population so many alternatives need to be tested and tried for efficacy. • Databases Used: CINAHL Plus with Full Text, Embase, MEDLINE with Full Text, and PubMed • The best case scenario was to find multiple systematic reviews on the topic and to be able to sift through them to find those I considered interesting. Because systematic reviews are at the top of the evidence pyramid, they have the highest level of evidence but are also rarer (Walden University Library. (n.d.-h). Quick Answers). • A systematic review is a type of article that examines research as a whole on a set of precisely stated criteria in order to answer a clinical question. Clinical trial and observational study data are routinely used to decide on the inclusion criteria. Reviews can be often updated, and assessments are carried out in accordance with strict rules (Walden University Library. (n.d.-i). Systematic review). • The efficacy of systematic reviews is tied in part to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) group, which primarily consists of Cochrane writers. A systematic will gather and then review all reports that have been published on the specified question or topic. It will then use a number of inclusion and exclusion criteria to gather the reports that should be included in the review, and it will then synthesize the results. Utilizing statistics to interpret the data requires a stringent review including meta-analysis (Selcuk, A.A, 2019).

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