Opioid prescribing and deprescribing: an investigation of preferences, perspectives, effectiveness of interventions and guideline recommendations.

Abstract

This thesis explores the preferences, perspectives, effectiveness of interventions and guideline recommendations surrounding opioid prescribing and deprescribing (the systematic process of tapering drugs with the intention to cease when the potential harms outweigh the benefits) targeting key patient populations and settings. Chapter one provides a summary of current evidence and challenges in ensuring safe opioid prescribing and deprescribing. Chapter two systematically reviewed the evidence on the effectiveness of interventions aimed at reducing opioid use in patients after orthopaedic surgery. The study found that multimodal analgesic interventions were more effective at reducing opioid use than placebo/no intervention/usual care or active control at the medium-term (<90 days) time point, while there was no compelling evidence that other pharmacological or non-pharmacological interventions were effective. Chapter 3 investigated factors associated with general practitioners’ (GPs) prescribing decisions to a patient with chronic low back pain, to understand influences on clinical decision making and GPs’ willingness to accept risks versus benefits. The study found that GPs were more likely to choose a non-steroidal anti inflammatory drug (NSAID) compared to an opioid analgesic for a patient presenting with chronic low back pain. Chapters four and five explore the perspectives of Australian GPs and patients with chronic non-cancer pain on the barriers, facilitators and resources for opioid deprescribing. Overall, these studies found that GPs identified barriers such as patient’s reluctance and having a lack of time to deprescribe, while having rapport and being able to provide suitable resources to their patients facilitated the deprescribing process. Chapter six evaluates and compares international clinical guideline recommendations on opioid deprescribing in patients with chronic non-cancer pain.