Experts publish new guidelines for safe opioid deprescribing in Australia

Australian and international experts have published 11 recommendations on when, how and in what situation it may be appropriate for clinicians to reduce opioid use, putting the patient at the center of the equation.

Guidelines led by the University of Sydney recommend that doctors develop personalized deprescribing plans from the outset for any patient prescribed opioids.

The guidelines also advise doctors not to abruptly stop opioid treatment without gradually reducing the dose or transitioning to different treatments, as this could increase the risk of withdrawal symptoms. This includes people with severe opioid use disorder, as doing so without giving them access to opioid substitution therapies may lead to a further increase in overdose-related harms.

The recommendations also advise doctors not to prescribe opioids to people nearing the end of life, unless there are side effects.

The recommendations and summary of the guidelines are published in the Australian Medical Journal. The guidelines were led by 17 experts including general practitioners, pain specialists, addiction specialists, pharmacists, registered nurses, consumers and physical therapists.

The Evidence-Based Guidelines for the Deprescribing of Opioid Analgesics are the first international guidelines focused on helping general practitioners to safely reduce opioid use in adults with pain and aim to improve the quality of care for patients. .

Opioids are commonly prescribed to control pain, with more than 1.9 million adults starting opioid therapy each year in Australia. Approximately five percent of patients who fill an opioid prescription transition to long-term use.

Lead author Associate Professor Danijela Gnjidic from the School of Pharmacy says opioid deprescribing may not be appropriate for everyone with emerging evidence that abrupt opioid deprescribing in patients without support or pain control plans , is associated with overdose-related harm and death.

“It is possible to reduce opioid use and harm without worsening pain, maintaining or even improving quality of life. However, pain control should not be one-dimensional,” says Associate Professor Gnjidic.

“Prior to the publication of the guidelines, in Australia, clinical guidelines focused on pain control and opioid prescribing. We needed evidence-based guidelines focused on safely reducing or discontinuing prescribed opioids and individualized care for patients.” patients”.

Pain management should not be “one size fits all”

“Opioids can be effective in pain management. However, in the long term, the risk of harm may outweigh the benefits,” says lead author Associate Professor Carl Schneider of the School of Pharmacy.

“Dose reduction or discontinuation (stop prescribing) opioids can be challenging, with added complexity for Aboriginal and Torres Strait Islander peoples and culturally and linguistically diverse communities. We received strong feedback on the need for specific resources to those communities on how to seek the advice of health professionals and actively participate in decisions.

Lead author Dr. Aili Langford says the best available evidence was interpreted and informed by expert opinion, and refined after extensive public consultation with health professionals, organizations, policymakers, and people who take opioids for pain.

“Internationally, we were seeing significant harm from opioids, but also significant harm from abrupt, unsolicited cessation of opioids. It was clear that recommendations were required to support safe, person-centred opioid deprescribing,” says Dr. Langford, who worked on the report during his PhD at the University of Sydney and is now based at Monash University.

Pain management a national and international priority

Pain and pain-related conditions are one of the leading causes of disability and burden of disease worldwide. In Australia, one in five adults report having chronic pain.

The increasing use of opioids and the subsequent damage has been recognized as an international public health problem. The World Health Organization has set itself the global goal of reducing serious preventable harm related to medication. In 2020, Australia responded by identifying opioids as one of four drugs of interest in the country.

The guidelines complement national standards Standard for administration of opioid analgesics in the clinical care of acute pain, published last year by the Australian Health Care Safety and Quality Commission, which aims to stop the inappropriate prescription of opioids to treat acute pain in hospitals.

It is incredibly important that we prescribe opioids safely and appropriately so as not to compromise the future health of Australians.”

Associate Professor Liz Marles, Clinical Director of the Commission and a General Practitioner

“These new guidelines further support the appropriate use of opioid analgesics and how to safely prescribe and discontinue them. They ask clinicians to consider reducing or discontinuing opioids when the risk of harm outweighs the benefit to the individual.

“Shared decision-making and ensuring patients have ways to manage their pain are essential when discussing a deprescription plan. Ultimately, we are all working to reduce the number of Australians at risk of harm from long-term opioid use. , which have broad social benefits,” says Marles.