Background & Aims
The prevalence of opioid prescription for chronic non-cancer pain has been increasing steadily1,2. Evidence demonstrates that long-term opioid treatment (> 90 days2) is ineffective for chronic non-cancer pain whilst increasing the risks for serious harms3,4,5. Opioid weaning has been associated with no change or improved pain6,7, as well as improved holistic quality of life6,7, and guidelines recommend weaning if used long-term without ongoing benefit3.
The Reducing Opioid Reliance Program (ROR) in the Northern Pain Rehabilitation Service is the first of its kind in South Australia. Led by a multidisciplinary team, it blends medical, psychological, and pharmacy expertise, addressing the biopsychosocial model, filling a need in helping individuals facing difficulties with reducing opioid medication. It aids opioid reduction, offering evidence-based alternatives through group and individual interventions. The primary aim of the presented study is to evaluate and optimise the ROR program
Methods
This is a retrospective audit, conducted in 2023, prior to further program evaluation and development at the Northern Pain Rehabilitation Service.
During the ROR program, long-term opioid users receive an individualized opioid weaning plan from a medical practitioner. The program alternates four group sessions (education and skills building) with four phone consultations (individual support). Upon program completion, progress and further supports required are assessed in a multidisciplinary consultation.
The audit evaluated program participation and outcomes for 24 ROR participants through routinely collected Likert scale data on participants’ confidence to reduce opioid and manage pain at the start and end of the program; oral morphine equivalent daily dose (OMEDD) at the time of the referral, during the program, and at last appointment.
Participant characteristics and audit data was explored and descriptively analysed using IBM SPSS Statistics.
Results
Records of 24 participants (mean (SD) age 56.7 (14.3) years, 58.0% male) was audited. Three chose to discontinue after the first session (as per choice) and were excluded from further analysis. Seventeen (81.0%) participants reduced, and four (19.0%) participants did not reduce their opioid dose by the end of the program. Sixteen (76.2%) participants reduced their total OMEDD by more than 20.0% and 10 (47.6%) reduced their total OMEDD by more than 50.0%; with a mean reduction of 51.3 (41.68) mg. Three (14.3%) participants completely ceased their opioid.
Survey data showed increased confidence in ability to wean, manage pain on lower dose, use alternative methods to manage pain and to get on with life while reducing the dose at program completion. Participants reported an increase in confidence for all four statements with an increase of more than 10.0% increase in three domains including 40.4% (3.3%) increased confidence in their ability to manage pain with a lower dose of opioids.
Conclusions
The study results suggest that an opt-in education and skills building group program in a tertiary pain clinic setting can successfully support opioid weaning. The program was successfully completed by all but three participants, with favourable results.
Whilst there are guidelines available on opioid weaning/tapering these are targeted at primary care and do not take into account the complexities of patients that have previously failed opioid reduction or patient requiring tertiary care. The broader project is currently underway and aims to inform further development of the ROR program. To our knowledge, there are not currently many similar group programs, nationally and internationally to support opioid weaning, and we hope our study results ultimately will inform implementation in other tertiary pain clinics.
References
1)Roxburgh A, Bruno R, Larance B and Burns L Prescription of opioid analgesics and related harms in Australia Med J Aust 2011;195(5):280-284
2)Song IA, Choi HR, Oh TK. Long-term opioid use and mortality in patients with chronic non-cancer pain: Ten-year follow-up study in South Korea from 2010 through 2019. EClinicalMedicine. 2022; 51:101558
3)Faculty of Pain Medicine, ANZCA (2021) PS01 (PM) Statement regarding the use of opioid analgesics in patients with chronic non-cancer pain
4)Rummans TA, Burton MC, and Dawson NL. How Good Intentions Contributed to Bad Outcomes: The Opioid Crisis. Mayo Clinic Proceedings 2018; 93(3): 344–50.
5)Pennington Institute. Australia’s annual overdose report 2022.
6)Fishbain DA, Pulikal A. Does Opioid Tapering in Chronic Pain Patients Result in Improved Pain or Same Pain vs Increased Pain at Taper Completion? A Structured Evidence-Based Systematic Review. Pain Med 2019;20(11):2179-2197.
7)Frank JW, Lovejoy TI, Becker WC, et al. Patient Outcomes in Dose Reduction or Discontinuation of Long-Term Opioid Therapy: A Systematic Review. Ann Intern Med. 2017;167(3):181-191.
Presenting Author
Alette Roux
Poster Authors
Topics
- Treatment/Management: Pharmacology: Opioid