The Development of an Australian Evidence-Based Clinical Practice Guideline for Deprescribing Opioid Analgesics

Abstract

Overprescribing of opioid analgesics is a major public health problem. Pain management guidelines provide advice regarding the initiation of opioids yet rarely address reduction or cessation (deprescribing). The aim of this thesis was to develop an evidence-based guideline for deprescribing opioids. A multidisciplinary guideline panel was assembled. Qualitative studies were conducted with healthcare professionals and consumers to inform the guideline scope and content. An overview of systematic reviews examined the effectiveness and outcomes of opioid deprescribing interventions, with the certainty of evidence determined using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Recommendations were tailored to the target setting using Evidence to Decision (EtD) frameworks. A 60-day public consultation period was conducted (February 2nd to April 3rd, 2022), followed by independent expert and methodological review. The guideline target audience was defined as General Practitioners and the target population as adults taking opioids for pain. Qualitative studies revealed a disconnect between healthcare professionals’ and opioid consumers’ perceptions of opioid deprescribing, informing the need for resources to support recommendation implementation such as a conversation guide. Evidence on the effectiveness and outcomes of opioid deprescribing was predominantly low certainty. When contextualising draft recommendations, a conflict was revealed between the most effective deprescribing strategies and those which were feasible to implement. Multidisciplinary pain programs showed the greatest evidence for opioid reduction yet had poor implementability. Eleven recommendations were developed, providing guidance on when, how, and for whom opioid deprescribing should be considered. This guideline provides actionable recommendations, serving as a tool to standardise care and enable safe and effective opioid deprescribing in clinical practice.