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Challenges of opioid deprescribing and factors to be considered in the development of opioid deprescribing guidelines: a qualitative analysis
  1. Aili V Langford1,
  2. Danijela Gnjidic1,
  3. Chung-Wei Christine Lin2,
  4. Lisa Bero1,3,
  5. Jonathan Penm1,
  6. Fiona M Blyth4,
  7. Carl R Schneider1
  1. 1Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia
  2. 2Institute for Musculoskeletal Health, Faculty of Medicine and Health, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
  3. 3Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
  4. 4Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Aili V Langford, Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, NSW 2790, Australia; aili.langford{at}sydney.edu.au

Abstract

Background Chronic prescription opioid use is a major international public health issue associated with significant harms, including increased risk of hospitalisation, morbidity and death. Guidance for healthcare professionals on when and how to deprescribe or reduce opioids is required. A key step for guideline development for deprescribing pharmacotherapy is to understand the perspectives of stakeholders. The aim of this study was to explore the perspectives of healthcare professional stakeholders on the challenges associated with opioid deprescribing and factors to be considered in the development of opioid deprescribing guidelines.

Methods A qualitative study was undertaken with a purposive sample of healthcare professionals including prescribers, pharmacists and nurses. An initial cohort of participants was identified at the 2018 Australian Deprescribing Network annual meeting and two focus groups were conducted (n=20). Individual interviews were conducted with a further 11 healthcare professionals. Focus groups and interviews were audio-recorded and transcribed verbatim. Data underwent inductive thematic analysis using a phenomenological perspective.

Results Healthcare professionals viewed opioid deprescribing as a challenge and identified several key barriers to deprescribing in clinical practice. Medication, patient, prescriber and health system level challenges were identified. Participants requested evidence-based guidance on the withdrawal of opioid therapies and suggested that prospective opioid deprescribing guidelines require a multitarget, multimodal intervention strategy that addresses patient psychosocial factors and incorporates behavioural change techniques.

Conclusion Opioid deprescribing was perceived as a complex and challenging practice with continued prescribing the default behaviour. Evidence-based opioid deprescribing guidelines may be a valuable resource for clinicians to support clinical decision-making and reduce suboptimal opioid use.

  • clinical practice guidelines
  • attitudes
  • healthcare quality improvement
  • pain
  • qualitative research
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Footnotes

  • Twitter @AiliLangford, @jonpenm

  • Contributors All authors participated in the design and conduct of the research, writing and/or editing of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.DG and C-WCL are supported by fellowships from the National Health and Medical Research Council, Australia.

  • Competing interests C-WCL reports non-financial support from Pfizer Australia, outside the submitted work.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by The University of Sydney Human Research Ethics Committee (approval no. 2018/563).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available. The authors do not have permission to share data.

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