Opioids are very good analgesics for acute pain and pain at the end of life but guidance from NICE is clear that opioids are not indicated for chronic pain and guidance from the Royal College of Anaesthetists encourages their use in chronic pain only in specific circumstances and at a low dose in addition to clarifying the harm that can be caused otherwise.
To help support healthcare professionals to address overuse of opioids in chronic pain, a research group from the University of East Anglia (and funded by NIHR ARC East of England) identified six behavioural mechanisms that support prescribers to taper opioids use.
We are working in partnership with the ARC and Norfolk and Waveney CCG to convene a group of key stakeholders to co-produce and pilot an evidence-based strategy to address the six toolkit components (full toolkit available here):
- Generate a clear expectation that tapering is the role of prescribers.
- To develop a care pathway within existing resources to permit timely access to non-pharmacological interventions.
- Create a consistent approach by all members of the healthcare in supporting patients to taper and stop opioids.
- To provide prescribers with the knowledge about how to taper opioid and
- To build confidence in prescribers initiating tapering discussions and managing psychological consequences of tapering.
- To align patient and prescriber expectations of tapering.
The project aims to evaluate the best ways healthcare professionals can improve patient quality of life through a significant reduction in both opioid and other dependence forming medication prescribed for chronic pain.
Our journey to implement the Opioid deprescribing toolkit:
These steps outline how we have approached the rollout of the toolkit. For more detail, see the infographic.
Work with local Prescribing Leads to
identify key stakeholders, identify
potential challenges to engagement and
develop strategies to overcome barriers
to engagement.
See our Stakeholder Matrix.
Activities
- Desk research: Use multiple approaches to identify resources or services, such as, discussion with NHS England and NHS Improvement Medicines Safety team, review examples in the report on Improving chronic pain management by reducing harm form opioids (December 2021), speak to key stakeholders identified in Step 1, speak to other relevant individuals or
organisations identified through
snowballing techniques, review Opioids Aware website. - Practitioner Survey to identify
elements of the toolkit absent from existing service offer and existing elements that required enhancement to support opioid tapering.
Work with local Prescribing Leads to refine the list of key stakeholders. Bring the stakeholders together to achieve a collective understanding of the toolkit, identify key individuals motivated to support the change and better understand the challenges to engaging with unrepresented stakeholders.
Access the presentation for the online workshop.
Activities
- Review and refine local guidelines for tapering opioids for non-malignant chronic pain with key stakeholders in primary and secondary care.
- Develop draft pathway based on
refined guidelines. - Engage with stakeholders e.g., by convening task and finish groups to consult stakeholders to review and design a system-wide pathway, develop referral processes and identify or develop resources to support delivery of the pathway.
- Bring stakeholders together to launch the pathway and guidelines to help clinicians deprescribe opioids in the region, developed in partnership with senior NHS staff and patients.
- Pilot the pathway in a small number of practices and refine as appropriate before system-wide implementation.
Activities
- Process evaluation to describe the process of implementing the opioid toolkit in Norfolk and Waveney.
- Review and mapping of our outputs while operationalising the toolkit.
- Review routine data at baseline and post-implementation to evaluate impact on opioid deprescribing.
- Practitioner Survey completed at (baseline and) post-implementation to evaluate whether the opioid toolkit has been implemented as intended
and targeted barriers to opioid deprescribing have been addressed. - Interviews with stakeholders/focus groups to
explore feasibility and acceptability of the opioid toolkit in practice.
Resources
If you are intersted in launching an opioid deprescribing pathway, you may find the following resources useful. We ask for a few basic details to understand who is accessing these resources.
- An infographic showing the steps to implement the opioid deprescribing toolkit
- Supporting documents:
- Step 1 – Stakeholder matrix
- Step 2 – Practitioner survey
- Step 3 – Workshop presentation
- Step 4 – Guidance for tapering opioids in chronic pain, launch event
- Step 5 – Logic model
Find out more and get involved
These resources are also available on the Norfolk and Waveney ICBs Knowledge Anglia website. If you would like to find out more about this project, contact sophie.knight@healthinnovationeast.co.uk.
We were delighted host the Opioid Deprescribing Pathway Launch event in November 2022 – this included presentations from the project team covering topics such as the National deprescribing priorities, the Opioid Deprescribing Toolkit and the process for the Opioid Tapering Pathway development and implementation. To see the agenda and recording of the event please go here: Opioid Deprescribing Pathway: Online launch meeting | ARC East of England (nihr.ac.uk).
Infographic to show our journey to implement the opioid deprescribing toolkit
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