Implementation and evaluation of the opioid deprescribing toolkit

This project implemented and evaluated local strategies to improve chronic pain management and reduce harm from opioids and other dependence forming medications

Background

We worked with Great Yarmouth, one of our Populations in Focus in the ARC East of England. Norfolk and Waveney Integrated care systems (ICS) 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 ICS is still the seventh highest prescriber out of the 106 ICSs 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.

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

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

Project Aims

  • To improve patient quality of life through a significant reduction in both opioid and gabapentinoids prescribing for chronic pain.
  • To develop a local strategy to support practitioners in tapering opioids (and other dependence forming medications) in chronic pain. Stakeholders attended virtual meetings in 2022. The NIHR ARC East of England then evaluated toolkit implementation.

Project Activity 

  • The implementation and evaluation of an ARC-funded opioid deprescribing toolkit in Norfolk and Waveney ICS. This involved the development and implementation of a new pain management pathway.
  • Baseline data (pre-implementation have been collected); post implementation evaluation is intended to commence in Winter 2023.

Anticipated Impact

This has led to the development and implementation of a new pain management pathway in Norfolk and Waveney ICS. This will also be evaluated, in order that the impact on opioid prescribing can be assessed. Ultimately patients will benefit from reducing the inappropriate over-prescribing of opioids and professionals will benefit from being supported to prescribe alternatives and give patients appropriate information and support to manage the transition. It will also support professionals to have difficult conversations with patients in a time-pressured environment. We worked very closely with Norfolk and Waveney ICB, as well as primary and secondary care staff in the ICS and patient representatives.

Papers and resources

View the related toolkit for chronic opioid use in non-cancer pain

For more information about this research, read the ARC East of England blog

Who was involved? 

Contact us

Prof Debi Bhattacharya, d.bhattacharya@leicester.ac.uk