Guidance on opioid tapering in the context of chronic pain: Evidence, practical advice and frequently asked questions

Murphy, Laura; Babaei-Rad, Roshina; Buna, Donna; Isaac, Pearl; Murphy, Andrea; Ng, Karen; Regier, Loren; Steenhof, Naomi; Zhang, Maria; Sproule, Beth

doi:10.1177/1715163518754918

Cited by 25 publications

(18 citation statements)

References 10 publications

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“…Recently, we published a paper in the Canadian Pharmacists Journal with a group of pharmacist coauthors from across Canada, focusing on practical advice for opioid tapering, guided by evidence, and including responses to frequently asked questions. 11 The Alberta College of Pharmacists published their own guidance document for assessment and monitoring of individuals using opioids in 2017. 12 They outlined the responsibilities that pharmacists must accept in the care of patients using opioids, including maintenance of a professional relationship with each individual using opioid medications; thorough assessment, including a review of their electronic health record every time an opioid Practice guidelines is dispensed or sold; detailed documentation of the assessment and written treatment plan; collaboration with prescriber and other health care professionals; and monitoring for signs of opioid misuse, diversion or addiction, with appropriate action if identified.…”

Section: Discussionmentioning

confidence: 99%

A pharmacist framework for implementation of the Canadian Guideline for Opioids for Chronic Non-Cancer Pain

et al. 2019

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Section: Discussionmentioning

confidence: 99%

A pharmacist framework for implementation of the Canadian Guideline for Opioids for Chronic Non-Cancer Pain

et al. 2019

Self Cite

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“…After randomization and at the baseline visit, a written individual treatment plan is established by the physician and reviewed by the nurse and participant in concordance with guidelines [ 27 , 30 ].…”

Section: Interventionsmentioning

confidence: 99%

“…Patients with opioid tapering experience identified social support and a trusted health care provider as facilitating factors for their process [ 21 ]. There are guidelines on how to taper opioids with practical advice where tapering of the long-term treatment is described as a method to determine the benefit–harm ratio for the individual patient [ 26 , 27 ]. An improved research-based understanding on what patients can expect when entering an opioid tapering program could very possibly be helpful in this demanding clinical situation.…”

Section: Introductionmentioning

confidence: 99%

Tapering of prescribed opioids in patients with long-term non-malignant pain (TOPIO)—efficacy and effects on pain, pain cognitions, and quality of life: a study protocol for a randomized controlled clinical trial with a 12-month follow-up

Grelz

Midlöv

Hakansson

et al. 2021

Trials

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Background Opioids are still widely prescribed to long-term pain patients although they are no longer recommended for long-term treatments due to poor evidence for long-term efficacy, risks of serious side effects, and the possibility of inducing opioid hyperalgesia. In a Cochrane study from 2017, the authors identified an urgent need for more randomized controlled trials investigating the efficiency and effects of opioid tapering. The study aimed to assess (1) the efficiency of a structured intervention in causing stable reductions of opioid consumption in a population with long-term non-malignant pain and (2) effects on pain, pain cognitions, physical and mental health, quality of life, and functioning in response to opioid tapering. Methods The study is a randomized controlled trial. The sample size was set to a total of 140 individuals after estimation of power and dropout. Participants will be recruited from a population with long-term non-malignant pain who will be randomly allocated to (1) the start of tapering immediately or (2) the control group who return to usual care and will commence tapering of opioids 4 months later. A 12-month follow-up is included. When all follow-ups are closed, data from the Swedish drug register of the National Board of Health and Welfare will be collected and individual mean daily opioid dose in morphine equivalents will be calculated at three time points: baseline, 4 months, and 12 months after the start of the intervention. At the same time points, participants fill out the following questionnaires: Numeric Pain Rating Scale (NPRS), Tampa Scale of Kinesiophobia (TSK), Pain Catastrophizing Scale (PCS), Chronic Pain Acceptance Questionnaire (CPAQ-8), Hospital Anxiety and Depression Scale (HADS), and RAND-36. At baseline and follow-up, a clinical assessment of opioid use disorder is performed. Discussion A better understanding of the efficiency and effects of opioid tapering could possibly facilitate attempts to taper opioid treatments, which might prove beneficial for both the individual and society. Trial registration ClinicalTrials.gov NCT03485430. Retrospectively registered on 26 March 2018, first release date. “Tapering of Long-term Opioid Therapy in Chronic Pain Population. RCT with 12 Months Follow up (TOPIO).” First patient in trial 22 March 2018.

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“…15 Pharmacists have demonstrated their role in addressing this crisis through various opioid stewardship activities, such as deprescribing, monitoring opioid use disorder, providing education and promoting harm-reduction strategies. 8,9,[16][17][18][19][20][21][22][23][24] With the exemptions, pharmacists are now better equipped to help address the opioid crisis by providing optimal care for patients who receive opioid medications. 25 To better understand the impact of the exemptions on pharmacists' ability to provide patient care, we set out to explore Canadian pharmacists' experiences with using the exemptions in practice.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pharmacists’ perceptions of the Canadian opioid regulatory exemptions on patient care and opioid stewardship

2021

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Background: This study explored the perceptions of Canadian pharmacists about the barriers and facilitators of providing opioid stewardship activities in pharmacy practice, considering the subsection 56(1) class exemption under Health Canada’s Controlled Drugs and Substances Act (CDSA). Methods: Qualitative key informant telephone interviews were conducted with a convenience sample of pharmacists from across Canada. We included community or primary health care team-based pharmacists who self-identified as having experience with providing care for patients using opioids via the exemptions. All transcripts were de-identified, and thematic analysis was conducted to identify themes. Ethics approval was obtained. Results: Twenty pharmacists from community and primary health care teams, from all provinces and from urban and rural practices were interviewed. The following themes emerged: 1) optimization of opioid-related patient care, 2) jurisdictional impact and 3) awareness and education. Barriers and facilitators for opioid stewardship activities were identified. Discussion: The exemptions facilitated the pharmacists’ ability to provide opioid stewardship and positively affect patient care by providing continuity of and timely access to care. Our research demonstrated that pharmacists can responsibly and independently manage opioid prescriptions within this expanded scope, demonstrating the valuable contribution pharmacists can have in opioid stewardship. Conclusion: Pharmacists were willing and able to care for patients receiving opioid medication and thereby played a role in helping address the opioid crisis. The benefits of these exemptions were demonstrated beyond situations related to the COVID-19 pandemic and warrant consideration for consistent implementation across provincial and territorial jurisdictions, thereby ensuring equitable access to care for all Canadians.

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Guidance on opioid tapering in the context of chronic pain: Evidence, practical advice and frequently asked questions

Cited by 25 publications

References 10 publications

A pharmacist framework for implementation of the Canadian Guideline for Opioids for Chronic Non-Cancer Pain

A pharmacist framework for implementation of the Canadian Guideline for Opioids for Chronic Non-Cancer Pain

Tapering of prescribed opioids in patients with long-term non-malignant pain (TOPIO)—efficacy and effects on pain, pain cognitions, and quality of life: a study protocol for a randomized controlled clinical trial with a 12-month follow-up

Pharmacists’ perceptions of the Canadian opioid regulatory exemptions on patient care and opioid stewardship

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