Project 13.05.2022

Implementation and evaluation of the opioid deprescribing toolkit - AMM31

This project aims to implement and evaluate local strategies to improve chronic pain management and reduce harm from opioids and other dependence forming medications

Introduction 

We are working in Great Yarmouth, one of our Populations in Focus in the ARC East of England. Norfolk and Waveney CCG are amongst the highest prescribers of opioid analgesics in England. In recent years, significant attention and resource has led to a reduction in opioid prescribing in the region. However, the CCG is still the seventh highest prescriber out of the 106 CCGs in England. Additionally, it has been observed an increase in the prescribing of gabapentinoids, rather than the use of non-pharmacological measures to manage chronic pain as recommended by NICE guidance.

The opioid toolkit was an NIHR CLAHRC funded project in 2018/19 to help organisations support prescribers to slowly stop opioids. We surveyed NHS organisations in England to find out whether they had already tried to help prescribers stop opioids. They told us what had worked and why. We also took from trials what worked and why. We used theory about how to change people’s behaviour and experts on the topic of stopping opioids to combine the evidence from research trials with evidence from the real world. This gave us six things that we know help prescribers to slowly stop opioids. No existing opioid tapering intervention addresses all six mechanisms.

Project aims

We are convening a group of key stakeholders across the Norfolk and Waveney CCG to co-produce and implement a theory and evidence-based strategy to:

  • Generate a clear expectation that tapering is the role of prescribers.
  • To provide prescribers with the knowledge about how to taper opioid and gabapentinoids.
  • To build confidence in prescribers initiating tapering discussions and managing psychological consequences of tapering.
  • To develop a care pathway within existing resources to permit timely access to non-pharmacological interventions.
  • To align patient and prescriber expectations of tapering.

Project activity 

  • In November 2021, we began working with the Eastern AHSN who will project management and build relationships to facilitate us in working with the Norfolk and Waveney CCG to implement the toolkit.
  • In December 2021, we made the decide to postpone activities with healthcare professionals due to COVID-19 response pressures.
  • In January 2022 we asked stakeholders to complete a survey to diagnose the enhancements required within the region to deliver elements of the toolkit.

Project aims

We aim to improve patient quality of life through a significant reduction in both opioid and gabapentinoids prescribing for chronic pain

We aim to develop a local strategy to support practitioners in tapering opioids (and other dependence forming medications) in chronic pain. Stakeholders will attend 2-3 virtual meetings in 2022. We have organised the first of these workshops for March 2022. The NIHR ARC East of England will then evaluate toolkit implementation.

Resources

Who is involved 

Principal investigator: Prof Debi Bhattacharya, University of East Anglia

Dr Jessica Rees, University of Hertfordshire

Eastern Academic Health Science Network

Get in touch

Dr Jessica Rees: j.rees3@herts.ac.uk