Outcomes of an opioid reduction tool among patients with chronic noncancer pain in primary care.

BACKGROUND

In a previous study, an opioid reduction tool was designed to reduce inappropriate opioid treatment in patients with chronic noncancer pain.

OBJECTIVES

This study aimed to assess whether the tool facilitated opioid tapering in patients with chronic noncancer pain and long-term opioid treatment in primary care. In addition, it evaluated the impact on pain-related outcome measures.

METHODS

In a cohort study, 55 general practices and 30 collaborating pharmacies were recruited to implement the tool containing six reduction measures. Patients on long-term opioid treatment (>3 months) for chronic noncancer pain received a tailored taper programme from their healthcare provider and were monitored via questionnaires. The primary outcome was reduction in oral morphine equivalent daily dose over 3 months retrieved through pharmacy dispensing data. Secondary outcomes included trends in opioid use over 9 months, pain severity, pain interference, well-being, withdrawal symptoms, discontinuation rate, and nonopioid analgesic use.

RESULTS

Of the 366 patients approached, 116 agreed to taper, of whom 27 were included in our cohort. The median oral morphine equivalent daily dose decreased significantly from 40.0 mg (interquartile range (IQR), 16.5-120.0) at baseline to 15.2 mg (IQR, 0.0-60.0) at 3 months. Opioid dose continued to decrease over 9 months, with 12 participants discontinuing completely. Pain-related outcome measures remained stable throughout the study period.

CONCLUSION

With a significant decrease in opioid dose without negative impact on pain, this study showed promising results for an opioid reduction tool tapering long-term opioid treatment in primary care. A larger controlled trial is needed to assess the effectiveness of the tool.