Dose reduction of long-term opioids: our duty as clinicians.

Abstract

We are all aware of the harm associated with long-term prescriptions of opioids and the potential for opioid dependence. Protracted use of opioids is associated with a host of adverse effects, including a 7-fold increase in mortality in patients taking 100 mg/24 hour of morphine (or equivalent), compared with doses equivalent to <20 mg/24 hour.1 Moreover, long-term opioid use does not improve quality of life, pain, or functioning in patients with chronic non-cancer pain.1–3 Where pain remains uncontrolled with doses equivalent to 120 mg/24 hour morphine, the patient should be considered non-opioid responsive.3 In view of the evidence, can we honestly say that we are doing enough to encourage reduction and withdrawal of opioids in our patients? Medication reviews are an essential part of practice, but with overrun surgeries it is often easier to …