TY - JOUR
T1 - Patient-targeted interventions for opioid deprescribing
T2 - An overview of systematic reviews
AU - Langford, Aili V.
AU - Schneider, Carl R.
AU - Lin, Chung Wei Christine
AU - Bero, Lisa
AU - Collins, Jack C.
AU - Suckling, Benita
AU - Gnjidic, Danijela
N1 - Funding Information:
Ms A. V. Langford received PhD funding through an Australian Government Research Training Program Scholarship and Supplementary Scholarship from the University of Sydney. Professor C. W. C. Lin is funded by an NHMRC Investigator Grant (1193939). Associate Professor D. Gnjidic is funded by the NHMRC Dementia Leadership Fellowship (1136849). Funding information
Publisher Copyright:
© 2023 The Authors. Basic & Clinical Pharmacology & Toxicology published by John Wiley & Sons Ltd on behalf of Nordic Association for the Publication of BCPT (former Nordic Pharmacological Society).
PY - 2023/12
Y1 - 2023/12
N2 - Background: Deprescribing (reduction or cessation) of prescribed opioids can be challenging for both patients and healthcare professionals. Objective: To synthesize and evaluate evidence from systematic reviews examining the effectiveness and outcomes of patient-targeted opioid deprescribing interventions for all types of pain. Methods: Systematic searches were conducted in five databases with results screened against predetermined inclusion/exclusion criteria. Primary outcomes were (i) reduction in opioid dose, reported as change in oral Morphine Equivalent Daily Dose (oMEDD) and (ii) success of opioid deprescribing, reported as the proportion of the sample for which opioid use declined. Secondary outcomes included pain severity, physical function, quality of life and adverse events. The certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Findings: Twelve reviews were eligible for inclusion. Interventions were heterogeneous in nature and included pharmacological (n = 4), physical (n = 3), procedural (n = 3), psychological or behavioural (n = 3) and mixed (n = 5) interventions. Multidisciplinary care programmes appeared to be the most effective intervention for opioid deprescribing; however, the certainty of evidence was low, with significant variability in opioid reduction across interventions. Conclusions: Evidence is too uncertain to draw firm conclusions about specific populations who may derive the greatest benefit from opioid deprescribing, warranting further investigation.
AB - Background: Deprescribing (reduction or cessation) of prescribed opioids can be challenging for both patients and healthcare professionals. Objective: To synthesize and evaluate evidence from systematic reviews examining the effectiveness and outcomes of patient-targeted opioid deprescribing interventions for all types of pain. Methods: Systematic searches were conducted in five databases with results screened against predetermined inclusion/exclusion criteria. Primary outcomes were (i) reduction in opioid dose, reported as change in oral Morphine Equivalent Daily Dose (oMEDD) and (ii) success of opioid deprescribing, reported as the proportion of the sample for which opioid use declined. Secondary outcomes included pain severity, physical function, quality of life and adverse events. The certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Findings: Twelve reviews were eligible for inclusion. Interventions were heterogeneous in nature and included pharmacological (n = 4), physical (n = 3), procedural (n = 3), psychological or behavioural (n = 3) and mixed (n = 5) interventions. Multidisciplinary care programmes appeared to be the most effective intervention for opioid deprescribing; however, the certainty of evidence was low, with significant variability in opioid reduction across interventions. Conclusions: Evidence is too uncertain to draw firm conclusions about specific populations who may derive the greatest benefit from opioid deprescribing, warranting further investigation.
KW - deprescribing
KW - opioids and opioid receptors
KW - overview of systematic reviews
KW - pain
KW - prescription of drugs
UR - http://www.scopus.com/inward/record.url?scp=85149882033&partnerID=8YFLogxK
U2 - 10.1111/bcpt.13844
DO - 10.1111/bcpt.13844
M3 - Article
C2 - 36808693
AN - SCOPUS:85149882033
SN - 1742-7835
VL - 133
SP - 623
EP - 639
JO - Basic & Clinical Pharmacology & Toxicology
JF - Basic & Clinical Pharmacology & Toxicology
IS - 6
ER -