Patient‐targeted interventions for opioid deprescribing: An overview of systematic reviews

Abstract

BackgroundDeprescribing (reduction or cessation) of prescribed opioids can be challenging for both patients and healthcare professionals.ObjectiveTo synthesize and evaluate evidence from systematic reviews examining the effectiveness and outcomes of patient‐targeted opioid deprescribing interventions for all types of pain.MethodsSystematic 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.FindingsTwelve 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.ConclusionsEvidence is too uncertain to draw firm conclusions about specific populations who may derive the greatest benefit from opioid deprescribing, warranting further investigation.

Clinical practice guideline for deprescribing opioid analgesics: summary of recommendations

“…Systematic evidence retrieval and synthesis was conducted via an overview of systematic reviews (containing both randomised clinical trials and observational studies) 24 . Five databases — Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, Excerpta Medica Database (EMBASE), Medical Literature Analysis and Retrieval System Online (MEDLINE) and PsycINFO — were searched for systematic reviews published in the past ten years examining one or more interventions for deprescribing opioids in adult populations (aged ≥ 18 years).…”

“…There is insufficient evidence to determine which individual or tapering characteristics are associated with greater success of opioid deprescribing 24 . Given the heterogeneity of studies examining opioid deprescribing and the limited reporting of deprescribing protocols and participant baseline characteristics, we were unable to assess the comparative effectiveness of different opioid tapering approaches.…”

“…The target care setting is community primary care; however, the recommendations may be relevant to other care settings (residential care, inpatient and outpatient). Overall, the certainty of evidence informing recommendations was rated as predominantly very low to low 21,24 . The full guideline 28 and supporting documents are available online at http://www.opioiddeprescribingguideline.com/guideline.…”

“…Opioids are used to relieve pain and/or breathlessness for persons nearing the end of life, and there is insufficient evidence to inform the benefits and harms of opioid deprescribing for this population (Recommendation 5) 24 . Existing clinical practice guidelines recommend against opioid deprescribing as a stand‐alone strategy for individuals with opioid use disorders 46‐48 .…”

“…Evidence for the effectiveness of different co‐interventions to achieve opioid deprescribing for the management of chronic pain was inconclusive and varied substantially across the interventions examined 24 . Consistent low certainty evidence suggests that regardless of intervention, mean pain scores and functional measures improved or did not significantly change for most persons who reduced or discontinued opioids 33‐39,57‐59 .…”