Introduction

The perspectives of a range of healthcare professionals on the challenges associated with opioid deprescribing, and the factors to be considered in the development of opioid deprescribing guidance were explored in a research study published in BMJ Quality & Safety. Medication, patient, prescriber and health-system challenges were identified as having a key role.¹ 

A systematic review then looked to identify barriers to and enablers of monitoring and deprescribing opioids used for chronic non-cancer pain. 

Five main barrier themes were identified: 

• Limited alternatives to opioids
• Management of pain as a top priority
• Patient understanding, expectations and experiences
• Prescriber pressures
• Reluctance to change. 

Four main enabler themes were identified: 

• Negative effects of opioids and benefits of deprescribing 
• Clear communication and expectations for deprescribing 
• Support for patients
• Support for prescribers.² 

Both papers help to recognise deprescribing opioids as a unique process, one that needs different approaches for its management. The inclusion of opioid deprescribing in several target-based initiatives indicate that it is a priority in practice. However, these initiatives may also create further challenges. 

For example, expert consensus and the best available evidence suggest that risk of harm from opioid use increases significantly above a daily dose of 120mg oral morphine equivalent (OME). Targets and any linked incentives are usually focused on achieving this dose level. However, this does not consider significant reductions to the existing dose, or a change in patient attitude towards deprescribing. This presents a challenge in practice, as pharmacy professionals may find themselves under pressure to widely apply dose reductions, but this outcome may not be clinically appropriate for all individuals. Therefore, it is crucial to tailor the reduction strategy to each individual.