Clinical Practice Guideline for Deprescribing Opioid Analgesics: Summary of Recommendations

Abstract

Introduction

Long term opioids are commonly prescribed to manage pain. Dose reduction or discontinuation (deprescribing) can be challenging, even when the potential harms of continuation outweigh the perceived benefits. The Evidence-based clinical practice guideline for deprescribing opioid analgesics was developed using robust guideline development processes and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology, and contains deprescribing recommendations for adults prescribed opioids for pain.

Main recommendations

Eleven recommendations provide advice about when, how and for whom opioid deprescribing should be considered, while noting the need to consider each person’s goals, values and preferences. The recommendations aim to achieve:

• implementation of a deprescribing plan at the point of opioid initiation;
• initiation of opioid deprescribing for persons with chronic non-cancer or chronic cancer-survivor pain if there is a lack of overall and clinically meaningful improvement in function, quality of life or pain, a lack of progress towards meeting agreed therapeutic goals, or the person is experiencing serious or intolerable opioid-related adverse effects;
• gradual and individualised deprescribing, with regular monitoring and review;
• consideration of opioid deprescribing for individuals at high risk of opioid-related harms;
• avoidance of opioid deprescribing for persons nearing the end of life unless clinically indicated;
• avoidance of opioid deprescribing for persons with a severe opioid use disorder, with the initiation of evidence-based care, such as medication-assisted treatment of opioid use disorder; and
• use of evidence-based co-interventions to facilitate deprescribing, including interdisciplinary, multidisciplinary or multimodal care.

Changes in management as a result of these guidelines

To our knowledge, these are the first evidence-based guidelines for opioid deprescribing. The recommendations intend to facilitate safe and effective deprescribing to improve the quality of care for persons taking opioids for pain.

The full study can be viewed at Medical Journal of Australia.

Langford, A. V., Lin, C. C., Bero, L., Blyth, F. M., Doctor, J., Holliday, S., Jeon, Y., Moullin, J., Murnion, B., Nielsen, S., Osman, R., Penm, J., Reeve, E., Reid, S., Wale, J., Schneider, C. R., & Gnjidic, D. (2023). Clinical practice guideline for deprescribing opioid analgesics: Summary of recommendations. Medical Journal of Australia. https://doi.org/10.5694/mja2.52002