Project Title:

Development of a service specification for deprescribing long-term opiates

Type of Research:

Realist review

Background & Scientific Rationale:

Evidence for the long-term benefits of opiates to manage chronic non-cancer pain (CNCP) is limited and evidence for harm is growing.(1) Reducing opiate prescribing is an NHS Improvement goal (2) and UEA Health partners have unanimously identified this as a regional priority. A 2018 BMJ review reported the quality of published evidence for opiate deprescribing interventions to be low, and no evidence for their efficacy or safety. The BMJ review recommendations on opioid reduction were therefore based on expert opinion rather than empirical evidence of benefit. The continuing rise in opiate prescribing for CNCP demonstrates the need for more research which can be widely implemented.(3, 4)

The result of this focus on reducing CNCP prescribing is numerous local and national activities each with varying levels of success. Realist reviews offer a structured approach to capturing the details of these local and national activities in order that we may learn from the existing research literature and the practice environment. A realist review aims to understand what elements of these attempts to reduce CNCP prescribing are effective, for whom, under which circumstances and how. Examples of circumstances include the relationships and attitudes of individuals providing the service, and environment in which the service is delivered. A realist review therefore enables the effective service elements and conducive circumstances to be identified in order to design an opiate deprescribing intervention with effective components that best fit the circumstances that can be feasibly replicated.

Research aims:

  • To identify the mechanisms by which opiate deprescribing interventions are believed to result in their intended outcomes
  • To explore the contexts which determine whether the different mechanisms produce intended outcomes
  • Identify and share materials to support opiate deprescribing in the Eastern region
  • To develop an intervention specification for opiate deprescribing suitable for feasibility testing in an NIHR RfPB or HS&DR application.

Methods:

Literature for the realist review will be generated through two approaches:

  1. Searching electronic databases for long-term opiate deprescribing interventions
  2. Inviting NHS organisations and relevant stakeholders to actively provide details of any interventions together with any evaluation findings

Expected Output of Research / Impact and added value:

  • Realist review publication
  • Increased research capacity in the Eastern region through supporting two practitioner members of UEA Health Partner organisations to conduct research
  • Identification of materials for use within the Eastern region to support a reduction in long-term opiate prescribing
  • Grant application submission to NIHR RfPB or HSD&R to feasibility test draft opiate deprescribing intervention specification

Contact:

For further information on this project, please contact Debi Bhattacharya D.Bhattacharya@uea.ac.uk


References:
1. Manchikanti L, Kaye AM, Knezevic NN, McAnally H, Slavin K, Trescot AM, et al. Responsible, Safe, and Effective Prescription of Opioids for Chronic Non-Cancer Pain: American Society of Interventional Pain Physicians (ASIPP) Guidelines. Pain physician. 2017;20(2s):S3-s92.
2. Faye’s story: good practice when prescribing opioids for chronic pain: NHS South region South West; 2017 [Available from: https://improvement.nhs.uk/resources/fayes-story-good-practice-when-prescribing-opioids-chronic-pain/.
3. Berna C, Kulich RJ, Rathmell JP. Tapering Long-term Opioid Therapy in Chronic Noncancer Pain: Evidence and Recommendations for Everyday Practice. Mayo Clinic proceedings. 2015;90(6):828-42.
4. Sandhu H, Underwood M, Furlan A, Noyes J, Eldabe S. What interventions are effective to taper opioids in patients with chronic pain? BMJ. 2018;362.
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