People at the end of their lives should not be suddenly taken off strong opioids, and healthier patients could benefit from bespoke pain management plans, according to new international guidelines on getting people off the highly-addictive painkillers.
The first-of-their-kind guidelines, developed through a University of Sydney study informed by 17 experts including GPs, pain specialists, addiction specialists and pharmacists, will assist doctors in safely reducing opioid use in their patients.
International and Australian researchers have put together 11 recommendations on how to help people kick their opioid habits, including with guidance on when and how doctors should consider lowering a patient’s use.
The guidelines recommend plans on when and how to get people off opioids, including developing personalised plans to stop taking the drugs from the time a patient is first given the prescription.
Doctors are also discouraged from abruptly cutting off supply of opioids, as this can put patients at the risk of withdrawal.
Instead, doctors are encouraged to gradually reduce a patient's dose or transition them to another medication.
Doctors are also encouraged not to stop prescribing opioids for people close to the end of their lives, unless they are suffering from side effects from the drug.
Significant harm was being seen internationally from opioid use, but at the same time, many were also being hurt after abruptly halting taking the addictive drug, lead author of the study, Aili Langford said.
"It was clear that recommendations to support safe and person-centred opioid deprescribing were required," Dr Langford said.
It comes as the World Health Organization recognises a growth in unsafe prescribing practices is the leading cause of injury and avoidable harm globally, costing about $62 billion annually.
In Australia, some 1.9 million people begin taking opioids every year.
It was essential patients were able to share in the decision making process when tapering off opioids was discussed, and felt empowered with how to manage their pain, Clinical Director at the Australian Commission on Safety and Quality in Health Care Liz Marles said.
“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," she said.
While opioids can be effective in managing pain, the long term risk from the drug can outweigh the benefit, said one of the study’s lead authors, Carl Schneider from the University of Sydney’s School of Pharmacy.
“Reducing the dose or discontinuing opioids can be challenging, with additional complexity for Aboriginal and Torres Strait Islander Peoples and culturally and linguistically diverse communities," Dr Carl said.
"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.”
