New guidelines for safe opioid use are designed to put patients first. 

A panel of Australian and international experts has issued 11 recommendations outlining the appropriate circumstances and methods for clinicians to reduce opioid use while prioritising patient well-being. 

Led by the University of Sydney, the guidelines call for the development of personalised deprescribing plans for patients prescribed opioids from the outset.

Clinicians are advised against abruptly discontinuing opioid treatment without gradually tapering the dose or transitioning to alternative therapies, as this approach may heighten the risk of withdrawal symptoms. 

This caution extends to individuals with severe opioid use disorder, as abruptly stopping treatment without access to opioid substitution therapies can lead to a greater likelihood of overdose-related harm.

However, the guidelines discourage deprescribing opioids for individuals nearing the end of life unless side effects are present. 

The recommendations and a summary of the guidelines have been published in the Medical Journal of Australia. 

The expert panel consisted of 17 professionals, including general practitioners, pain specialists, addiction specialists, pharmacists, registered nurses, consumers, and physiotherapists.

The Evidence-based Guidelines for Deprescribing Opioid Analgesics represent the first international guideline specifically tailored to assisting general practitioners in safely reducing opioid use for adults experiencing pain, with the aim of improving the quality of care provided to patients.

In Australia, opioids are commonly prescribed to manage pain, with over 1.9 million adults initiating opioid therapies annually. 

Approximately 5 per cent of patients who fill an opioid prescription transition to long-term use.

Senior author Associate Professor Danijela Gnjidic from the School of Pharmacy cautions that opioid deprescribing may not be suitable for every individual. 

Recent evidence suggests that abruptly discontinuing opioids without support or pain management plans is associated with overdose-related harm and mortality.

“It is possible to reduce opioid use and associated harms without exacerbating pain while maintaining or even improving the quality of life. However, pain management should not be approached as a one-dimensional issue,” says Associate Professor Gnjidic.

Associate Professor Carl Schneider, also from the School of Pharmacy, notes that pain management should not adopt a “one size fits all” approach. 

While opioids can be effective in pain management, the long-term risks may outweigh the benefits. 

Schneider highlights the challenges involved in reducing or discontinuing opioids, particularly for Aboriginal and Torres Strait Islander Peoples and culturally and linguistically diverse communities. 

The need for specific resources targeting these communities to seek advice from healthcare professionals and actively participate in decisions has been highlighted too.

Lead author Dr Aili Langford explains that the guidelines are based on the best available evidence, interpreted and informed by expert opinion, and refined through extensive public consultation with healthcare professionals, organisations, policymakers, and opioid users.

Chronic pain and pain-related conditions contribute significantly to disability and disease burden worldwide, with one in five Australian adults reporting chronic pain. 

The escalating use of opioids and subsequent harm has been recognised as a global public health issue. 

In response, the World Health Organization has set a global goal of reducing severe, avoidable medication-related harm, with opioids identified as one of the four focus medicines in Australia.