高清福利片

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

The University of Sydney led guidelines recommend that clinicians develop personalised deprescribing plans from the beginning for any patient being prescribed opioids.

The guidelines also advise clinicians against abruptly stopping opioid treatment without gradually reducing the dose or transitioning to different treatments, saying it could increase risk of withdrawal symptoms. This includes people with severe opioid use disorder, as doing so without giving them access to opioid substitution therapies can lead to a higher rise of over-dose related harms.

Recommendations also advise clinicians not to deprescribe opioids for people nearing end-of life unless there are side effects.

The recommendations and summary of the guidelines is published in the . The guidelines were led by 17 experts which includes general practitioners, pain specialists, addiction specialists, pharmacists, registered nurses, consumers, and physiotherapists.

The is the first international guideline focussed on helping general practitioners to safely reduce opioid use for adults with pain, and aims to improve quality of care for patients.

Opioids are commonly prescribed to manage pain, with over 1.9 million adults starting opioid therapies each year in Australia. Approximately five percent of patients who fill an opioid prescription transition to long term use.

Senior author Associate Professor Danijela Gnjidic from the School of Pharmacy says opioid deprescribing may not be appropriate for every single person with emerging evidence that abruptly deprescribing opioids in patients, without support or pain management plans is associated with overdose related harms and death.聽 聽

鈥淚t is possible to reduce opioid use and harms without worsening pain, whilst maintaining or even improving quality of life. However, pain management should not be one-dimensional,鈥� says Associate Professor Gnjidic.

鈥淏efore the release of the guidelines, in Australia, clinical guidelines have focused on pain management and prescribing of opioids. We needed evidenced-based guidelines focused on safely reducing or stopping prescribed opioids, and individualised care for patients.鈥�

鈥淥pioids can be effective in pain management. However, over the longer-term, the risk of harms may outweigh the benefits鈥�, says fellow senior author Associate Professor Carl Schneider from the School of Pharmacy.

鈥淩educing the dose or discontinuing (deprescribing) opioids can be challenging, with additional complexity for Aboriginal and Torres Strait Islander Peoples and culturally and linguistically diverse communities. We received strong feedback on the need for specific resources for those communities on how to seek advice from healthcare professionals and be actively involved in decisions.鈥�

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

鈥淚nternationally we were seeing significant harms from opioids, but also significant harms from unsolicited and abrupt opioid cessation. It was clear that recommendations to support safe and person-centred opioid deprescribing were required,鈥� says Dr Langford, who worked on the report during her doctorate at the University of Sydney and is now based at .

Pain and pain related conditions are a globally. one in five adults report having chronic pain.

Escalating opioid use and subsequent harm has been recognised as an international public health concern. The World Health Organization has of reducing severe avoidable medication related harms. In 2020, by identifying opioids as one of the four medicines of focus in the country.

The guidelines complement the national , released by the Australian Commission on Safety and Quality in Health Care, which aims to stop inappropriate prescribing of opioids to treat acute pain in hospitals.

鈥淚t is incredibly important that we prescribe opioids safely and appropriately so that we don鈥檛 compromise the future health of Australians,鈥� says Associate Professor Liz Marles, Clinical Director at the Commission and a general practitioner.

鈥淭hese new guidelines further support appropriate use of opioid analgesics and how to safely prescribe and stop prescribing them. They ask clinicians to consider reducing or stopping opioids when the risk of harm outweighs the benefits for the individual.

鈥淪hared decision-making and ensuring that patients have ways to manage their pain are essential when a deprescribing plan is being discussed. Ultimately, we are all working to reduce the number of Australians at risk of harm from long-term opioid use, which will have broad societal benefits,鈥� says Marles.

Declaration: The authors declare no conflicts of interest.

Resources: