Equianalgesic doses of opioids – their use in clinical practice

Natusch, D.

doi:10.1177/2049463712437628

Cited by 12 publications

(6 citation statements)

References 14 publications

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“…If the starting opioid has been escalated recently after a prolonged period of stability then a dose closer to the previous stable level may be a more appropriate place to start. [24,25] In our clinical experience, many appropriate candidates for opioid rotation have chronic use of opioids, and while there are tables to calculate opioid analgesic equivalency these tables are often based on opioid-naïve patients and reflect variable patient populations.…”

Section: Opioid Rotationmentioning

confidence: 99%

An update on the safety of prescribing opioids in pediatrics

Parikh

Amolenda

Rutledge

et al. 2019

Expert Opinion on Drug Safety

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Introduction: The opioid abuse epidemic and its toll on the adolescent population has heightened awareness for safer opioid prescribing practices in pediatric pain management. Opioids remain the mainstay of therapy for severe pain, although there is an emphasis on multimodal therapy. Areas covered: In this update, the authors present information on parenteral/oral opioids commonly used in pediatrics. Recommendations for opioid use in special circumstances including neonates and developmental pharmacokinetic concerns are discussed. Due to noticeable interindividual variability, pharmacogenomics may be important for tailoring pain regimens. In particular, the role of CYP2D6 phenotypes on opioid selection/dosing and clinical implications are discussed. A summary of adverse effects and opioid safety data, and the role of regulations, risk assessment, CDC guidelines, follow up and monitoring for compliance in opioid prescribing, are detailed. Expert opinion: "One size does not fit all" describes the need for public policies focused on pediatric pain and opioid use, as children are not "little adults". Clinical trials to evaluate pharmacokinetic-pharmacodynamics of opioids are currently lacking. Development of novel biased opioid agonists, clinical integration of genetics in informed decision making, and emphasis on top-down approaches to pain management will be key to decrease opioid reliance.

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Section: Opioid Rotationmentioning

confidence: 99%

An update on the safety of prescribing opioids in pediatrics

Parikh

Amolenda

Rutledge

et al. 2019

Expert Opinion on Drug Safety

View full text Add to dashboard Cite

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“…They therefore do not reflect complex and heterogeneous clinical situations. 13 When performing an opioid rotation, it is recommended to reduce the calculated equianalgesic dose by 30-50% because of the possibility of incomplete cross-tolerance. Patients can use additional IR opioids if necessary.…”

Section: Opioid Rotationmentioning

confidence: 99%

Perioperative management of opioid-tolerant patients

Simpson

Jackson

2017

BJA Education

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“…Challenges exist insofar as gaining agreement on conversions which are unequivocal (Shaw and Fudin 2013;Schatman et al 2016). However, the arguments around using OMEQ as a measure of prescribing burden, are perhaps conflated with disparate views on equianalgesic dosing in clinical practise (Natusch 2012;Shaw and Fudin 2013;Schatman et al 2016).…”

Section: Introductionmentioning

confidence: 99%

“…Equianalgesic dosing is generally a clinical action, whereby a prescriber attempts to determine the dose of one opioid which provides the same level of analgesia as a specified dose of another (Natusch 2012). Disparities in how equianalgesic doses are calculated either by individuals (Rennick et al 2016) or when using purposefully designed 'calculators' (Shaw and Fudin 2013) have been demonstrated however.…”

Section: Introductionmentioning

confidence: 99%

“…Using equianalgesic dosing to determine dose limits is suggested to be problematic as individuals handle medicines differently and dependent on multiple other factors including other illnesses, medicines, renal function and so on (Schatman et al 2016). However, if an individual requires an opioid medicine but is unable to tolerate their current prescription, prescribers will require some idea of a roughly equivalent dose of an alternative to change them to (Natusch 2012).…”

Section: Introductionmentioning

confidence: 99%

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Trends in Opioid Prescribing for Non-Cancer pain and Associated Resource Utilisation in Wales

Davies¹

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Background:Opioid prescribing in the UK has increased significantly since the start of the millennium and has been associated with a rise in chronic pain reporting. In Wales, despite concern about rising rates of opioid analgesic prescribing, no detailed examination of the data had been undertaken to assess the changes in prescribing and its consequent impact on the population. Methods:In this study, anonymised, individual level data of people diagnosed with non-cancer pain in Wales was extracted from the Secure Anonymised Information Linkage (SAIL) Databank and used to scrutinise opioid analgesic prescribing trends in people aged 18 years and over, establish whether legislation or clinical guidance impacted on those trends and examine associations with increased healthcare use. The study was conducted in two phases. Phase 1 included a retrospective, repeated cross-sectional analysis of opioid analgesics issued from Primary Care, stratified by gender, age and socioeconomic status. Phase 2 of the study evaluated differences in healthcare service use and costs between individuals receiving opioids for defined non-cancer pain-related diagnoses and matched patients not receiving opioids. Results:Total opioid prescribing increased by 43.6% and strong opioids by 306.2% between 2005 and 2015. Women received 1.5 times more prescriptions than men. Increasing age was associated with higher prescribing rates. People in the most deprived areas received 2.4 times more prescriptions than in least deprived. People receiving opioid prescriptions accessed primary care four times more frequently than controls and had twice the number of hospital admissions. Opioid prescription was associated with 41% higher healthcare costs than noted in controls. Conclusion:This research highlights the need to develop a national strategy to address pain management and opioid stewardship in Wales. We must consider how to address the wide variability observed, particularly between areas of differing socioeconomic status. Further research should investigate what underlies continued opioid prescribing and how alternative strategies can be implemented in practice to reduce population harm and optimise the use of limited healthcare resources.

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Equianalgesic doses of opioids – their use in clinical practice

Cited by 12 publications

References 14 publications

An update on the safety of prescribing opioids in pediatrics

An update on the safety of prescribing opioids in pediatrics

Perioperative management of opioid-tolerant patients

Trends in Opioid Prescribing for Non-Cancer pain and Associated Resource Utilisation in Wales

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