Opioid Deprescribing at Transitions of Care in Australia

Abstract

Opioid analgesics are widely used for acute, chronic, and perioperative pain, but long-term use has contributed to increased misuse, dependence, and opioid-related harm. Transitions of care, particularly from hospital to primary care, can be high-risk periods for medication errors, oversupply, and poor follow-up. Deprescribing, defined as the planned reduction or cessation of medicines that may cause harm or are no longer beneficial, has emerged as a key strategy to mitigate these risks. However, evidence on how best to implement opioid deprescribing at transitions of care remains limited.

This thesis aimed to synthesise international and Australian evidence on opioid deprescribing interventions and explore healthcare professionals’ confidence and perspectives on available supports. A mixed-methods approach was used. A scoping review (n=79 studies) examined intervention types, outcomes, complexity (iCAT_SR), and implementation factors (RE-AIM), followed by a national survey of 105 Australian healthcare professionals.

Mixed, multicomponent interventions combining pharmacological and non-pharmacological strategies were most common and reduced opioid use, though they were more complex and poorly described in terms of implementation. While clinicians reported confidence in initiating deprescribing, key barriers included limited workflow-integrated supports, time constraints, and competing priorities. Satisfaction with existing resources was low, with preference for locally approved policies and evidence-based guidelines.

Overall, opioid deprescribing is recognised as essential at care transitions, but implementation remains underdeveloped. Findings highlight the need for co-designed, context-specific strategies that align with clinical workflows and patient goals to support sustainable practice.