The Expert Panel of Pain Management Clinicians has released what will be the first international guidelines for general practitioners on opioid analgesic deprescription in adults.
The recommendations describe best practices for discontinuing opioid therapy, emphasizing slow taper and individualized discharge plans for each patient.
general practitioner, pain specialist, Dependence For professionals, pharmacists, registered nurses, consumers, and physical therapists, the guidelines state that discontinuing prescriptions may not be appropriate for all patients, and that abrupt discontinuation may lead to an increased risk of overdose. I point out that there is.
“Internationally, we have seen significant harm from opioids, but we have also seen significant harm from abrupt opioid discontinuation on one side,” said a PhD student at the University of Sydney (Sydney, Australia). Dr. Airi Langford, the lead author of the study, said: “It was clear that there was a need for recommendations to support safe, individual-centred opioid deprescribing.”
It was discovered that publish online June 26th Australian Journal of Medicine.
Discharge plan
Consensus guidelines include 11 recommendations for stopping prescribing adult patients taking at least one opioid for any type of pain.
Recommendations include implementing a plan to taper off opioids when they are first prescribed, and gradual and individual tapping with regular monitoring and review.
Clinicians should consider stopping prescribing opioids in patients at high risk from opioid therapy who do not show clinically meaningful improvement in function, quality of life or pain, study says they point out. Patients at high risk of opioid-related harm are also good candidates for prescription reversal.
Discontinuation of opioid therapy is not recommended for patients with severe opioid use disorder (OUD). For such patients, treatment of her OUD with medication and other evidence-based interventions are recommended.
“Opioids may be effective in pain control,” said co-author Dr. Karl Schneider, Associate Professor of Pharmacy, University of Sydney, Sydney, Australia, in a press release. “But in the long run, the risks of harm may outweigh the benefits.”
“Global problem”
comment on the guidelines of Medscape Medical NewsOrman Trent Hall, Ph.D., assistant professor of addiction medicine in the Department of Psychiatry and Behavioral Health at The Ohio State University Wexner Medical Center in Columbus, said these recommendations are similar to those published by the U.S. Centers for Disease Control and Prevention in 2016 and 2022. said that , but provides additional information that might be helpful.
“The new guidelines may help practitioners by providing clearer advice on managing taper and withdrawal. New international guidelines could provide a framework for addressing this issue, as we may need it,” he said.
It’s also important that the guidelines highlight the potential risk of drug discontinuation in some patients, Hall added. Patients tapering off opioid therapy may experience worsening pain and decreased function, which may affect quality of life.
“Patients may also experience psychological harm and experience an increased risk of opioid use disorders and death. suicide “Opioid prescribing is discontinued following opioid discharge. Therefore, health care providers should carefully weigh the risks of prescribing and rescinding and engage patients with personal-centered communication and shared decision-making.” It’s important,” Hall said.
This study was funded by grants from the University of Sydney and the National Health and Medical Research Council. Full disclosure information is available in the original article. Hall provided expert opinion to medical consultancies Lumanity and Emergent Biosolutions on the overdose crisis.
Med J Austra. Published online on June 25, 2023. overview.
Kelly Whitlock Burton is a reporter for Medscape Medical News covering psychiatry and neurology.
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