Dr Megan Allen
Reducing Opioid Excess (RedOX): A survey of current opioid stewardship practice and interest and capability for trial involvement
- To determine current practice in Australia and New Zealand regarding perioperative opioid management
- To determine the existing opioid stewardship programs in place and to assess their components
- To determine the interest and capability of anaesthesia and pain management departments across Australia to participate in a multicentre trial of an opioid stewardship intervention
There is global concern regarding prescription opioid use and diversion with a crisis declared in the US. As opioid prescription has escalated dramatically over the last decade so too has opioid related harm including opioid related deaths. As the majority of these deaths are unintentional control of the community pool of available opioids is thought to be an important remedy.
Our group’s prior multicentre study in this area (MH HREC LNR/15/MH/252) has demonstrated suboptimal opioid handling after surgical care in four local hospitals (The Royal Melbourne Hospital, The Western Hospital, The Royal Women’s Hospital and Peter MacCallum Cancer Centre at the Victorian Comprehensive Cancer Centre). At the 2-week follow up 70% of patients had ceased opioid therapy and had left over medication and disposal of excess opioids by the time of follow up was uncommon (5%). Storage in the community was also not consistent with best practice with 88% of patients storing opioid medication in an unlocked location.
Clearly, this raises concerns about current opioid management and presents an opportunity for improving the care of surgical patients. However, the best way to manage the problem of excess post-surgical opioids being prescribed and inappropriately handled is unclear. Interventions trialled with reported success include judicious prescribing aiming to optimise the total quantity of prescribed opioids, recommending adjunct analgesia and educating patients and prescribers about the goals of opioid analgesia and appropriate storage and disposal of medications.
Our team has developed a multifaceted opioid stewardship intervention comprising the following components:
- Education and patients and prescribers and setting analgesia expectations
- Optimisation of supply of adjunctive analgesia and prescription opioids following surgical care
- Education of and communication with General Practitioners as the community prescribers
- Education of patients at the time of hospital opioid dispensing regarding best practice medication management including storage and disposal
We will trial this intervention for feasibility in early 2019 at three sites in Melbourne, with a view to conducting a larger, multicentre study to determine if the intervention is efficacious. However, before undertaking such a trial it is important that we demonstrate that there is a clinical need for this nationally and that there is sufficient engagement within the research community to support conducting such a study. The RedOX Survey aims to capture current practice.
We hypothesise that current opioid stewardship interventions will be diverse and often incomplete. We further hypothesise that there will be interest and capacity to participate in a large trial of an opioid stewardship intervention within the Australian and New Zealand Anaesthesia and Pain Management community.
Dr Megan Allen (Royal Melbourne Hospital; Department of Critical Care, University of Melbourne)
Prof David Story (Department of Critical Care, University of Melbourne)
Prof Kate Leslie (Royal Melbourne Hospital; Department of Critical Care, University of Melbourne)
Ms Anna Parker (Department of Critical Care, University of Melbourne)
Ms Sabine Braat, (Biostatistician, University of Melbourne)
Prof Stephan Schug (Royal Perth Hospital and University of Western Australia)
Dr Charles Kim (Royal Melbourne Hospital, University of Melbourne)
Ms Sally Brooks (Senior Medicines Information Pharmacist, PeterMacCallum Cancer Centre)
Royal Melbourne Hospital
University of Western Australia
PeterMacCallum Cancer Centre
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