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However, no systematic assessment of the scientific literature on the associations between NMPOU and health outcomes has yet been undertaken.<\/jats:p><\/jats:sec><jats:sec><jats:title>Approach<\/jats:title><jats:p>We undertook a systematic review evaluating health outcomes related to NMPOU based on ICD\u201010 clinical domains. We searched 13 electronic databases for original research articles until 1 July 2021. We employed an adaptation of the Oxford Centre for Evidence\u2010Based Medicine \u2018Levels of Evidence\u2019 scale to assess study quality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Key Findings<\/jats:title><jats:p>Overall, 182 studies were included. The evidence base was largest on the association between NMPOU and mental and behavioural disorders; 71% (129) studies reported on these outcomes. Less evidence exists on the association of NMPOU with infectious disease outcomes (26; 14%), and on external causes of morbidity and mortality, with 13 (7%) studies assessing its association with intentional self\u2010harm and 1 study assessing its association with assault (&lt;1%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Implications<\/jats:title><jats:p>A large body of evidence has identified associations between NMPOU and opioid use disorder as well as on fatal and non\u2010fatal overdose. We found equivocal evidence on the association between NMPOU and the acquisition of HIV, hepatitis C and other infectious diseases. We identified weak evidence regarding the potential association between NMPOU and intentional self\u2010harm, suicidal ideation and assault.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion and Conclusions<\/jats:title><jats:p>Findings may inform the prevention of harms associated with NMPOU, although higher\u2010quality research is needed to characterise the association between NMPOU and the full spectrum of physical and mental health disorders.<\/jats:p><\/jats:sec>","DOI":"10.1111\/dar.13441","type":"journal-article","created":{"date-parts":[[2022,4,19]],"date-time":"2022-04-19T05:49:11Z","timestamp":1650347351000},"page":"941-952","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Health harms of non\u2010medical prescription opioid use: A systematic review"],"prefix":"10.1111","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0614-9386","authenticated-orcid":false,"given":"Dan","family":"Werb","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases and Global Public Health University of California San Diego  San Diego USA"},{"name":"Centre on Drug Policy Evaluation St. Michael's Hospital  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayden I.","family":"Scheim","sequence":"additional","affiliation":[{"name":"Centre on Drug Policy Evaluation St. Michael's Hospital  Toronto Canada"},{"name":"Department of Epidemiology and Biostatistics Dornsife School of Public Health, Drexel University  Philadelphia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayorinde","family":"Soipe","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Brown University School of Public Health  Providence USA"},{"name":"Division of Nephrology, Department of Medicine State University of New York  New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samantha","family":"Aeby","sequence":"additional","affiliation":[{"name":"Institute for Mental Health Policy Research Centre for Addiction and Mental Health  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Indhu","family":"Rammohan","sequence":"additional","affiliation":[{"name":"Centre on Drug Policy Evaluation St. Michael's Hospital  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2186-4030","authenticated-orcid":false,"given":"Benedikt","family":"Fischer","sequence":"additional","affiliation":[{"name":"Schools of Population Health and Pharmacy Faculty of Medical and Health Sciences, University of Auckland  Auckland New Zealand"},{"name":"Department of Psychiatry University of Toronto  Toronto Canada"},{"name":"Centre for Applied Research in Mental Health and Addiction Simon Fraser University  Vancouver Canada"},{"name":"Department of Psychiatry Federal University of Sao Paulo  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott E.","family":"Hadland","sequence":"additional","affiliation":[{"name":"Grayken Center for Addiction and Department of Pediatrics Boston Medical Center  Boston USA"},{"name":"Division of General Pediatrics, Department of Pediatrics Boston University School of Medicine  Boston USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brandon D. 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