Overprescribing of prescription opioid analgesics is acknowledged to be a major international public health problem. Globally, the use of opioids has more than doubled with the most notable increases observed in the United States, Canada and Australia. In Australia, according to the 2018 Australian Institute for Health and Welfare report, 3.1 Australians had one or more prescriptions dispensed for opioids during 2016-17. There is an increasing body of evidence on potentially inappropriate opioid use leading to clinically significant adverse events, and limited evidence regarding the efficacy of opioids in the longer term. Every day in Australia, 150 people are hospitalised and 14 emergency presentations involve opioid-related harm, and 3 people die from opioid-related events. As such, regular monitoring of chronic prescription opioid use and deprescribing (medication withdrawal) may be required to minimise the risk of harms. Deprescribing is defined as the act of reducing or ceasing medication that is no longer necessary or that may cause harm. Current prescribing guidelines provide advice regarding initiation of treatment and rarely address monitoring or medication discontinuation, or, where they do, provide inadequate cessation guidance and support. Therefore, novel opioid cessation approaches are needed to ensure appropriate opioid use. To address this gap, we aim to develop evidence-based opioid deprescribing guidelines to provide guidance on how and when to stop opioids. Opioid deprescribing guidelines are required because opioid prescribing guidelines focus on the clinical initiation and management of opioids and do not provide dedicated advice on deprescribing nor address psychosocial factors involved in deprescribing. Development of opioid deprescribing guidelines is timely, due to the increased awareness regarding the inappropriate use of opioids, thus providing the impetus for major societal impact.
We have completed the planning stage of guideline development and have entered the development stage. We are following the process of developing class-specific deprescribing guidelines. The process is based on a comprehensive checklist for successful guideline development and the AGREE-II instrument. This process involves a systematic review and application of the GRADE criteria to assess the quality of the evidence to inform recommendations. The standard guideline structure will be informed by the Bruyère Research Institute process of developing class-specific deprescribing guidelines. We have incorporated the requirements for the Australian NHMRC external guideline approval (Procedures and Requirements for Meeting the 2011 NHMRC Standard for Clinical Practice Guidelines).
Dr Danijela Gnjidic is supported by the Australian National Health Medical Research Council [Dementia Leadership Fellowship (1136849)]. We have also recruited a PhD Student, Ms Aili Langford, School of Pharmacy, University of Sydney to work on the guideline development as part of her PhD degree. Ms Aili Langford is supported by the Research Training Program (RTP) Scholarship and internal top up scholarship.