Abstract：
Long term opioids are commonly prescribed to manage pain. Dose reduction or discontinuation (deprescribing) can be challenging, even when the potential harms of continuation outweigh the perceived benefits. The Evidence-based clinical practice guideline for deprescribing opioid analgesics was developed using robust guideline development processes and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology, and contains deprescribing recommendations for adults prescribed opioids for pain.
Eleven recommendations provide advice about when, how and for whom opioid deprescribing should be considered, while noting the need to consider each person\'s goals, values and preferences. The recommendations aim to achieve: implementation of a deprescribing plan at the point of opioid initiation; initiation of opioid deprescribing for persons with chronic non-cancer or chronic cancer-survivor pain if there is a lack of overall and clinically meaningful improvement in function, quality of life or pain, a lack of progress towards meeting agreed therapeutic goals, or the person is experiencing serious or intolerable opioid-related adverse effects; gradual and individualised deprescribing, with regular monitoring and review; consideration of opioid deprescribing for individuals at high risk of opioid-related harms; avoidance of opioid deprescribing for persons nearing the end of life unless clinically indicated; avoidance of opioid deprescribing for persons with a severe opioid use disorder, with the initiation of evidence-based care, such as medication-assisted treatment of opioid use disorder; and use of evidence-based co-interventions to facilitate deprescribing, including interdisciplinary, multidisciplinary or multimodal care.
To our knowledge, these are the first evidence-based guidelines for opioid deprescribing. The recommendations intend to facilitate safe and effective deprescribing to improve the quality of care for persons taking opioids for pain.
Eleven recommendations provide advice about when, how and for whom opioid deprescribing should be considered, while noting the need to consider each person\'s goals, values and preferences. The recommendations aim to achieve: implementation of a deprescribing plan at the point of opioid initiation; initiation of opioid deprescribing for persons with chronic non-cancer or chronic cancer-survivor pain if there is a lack of overall and clinically meaningful improvement in function, quality of life or pain, a lack of progress towards meeting agreed therapeutic goals, or the person is experiencing serious or intolerable opioid-related adverse effects; gradual and individualised deprescribing, with regular monitoring and review; consideration of opioid deprescribing for individuals at high risk of opioid-related harms; avoidance of opioid deprescribing for persons nearing the end of life unless clinically indicated; avoidance of opioid deprescribing for persons with a severe opioid use disorder, with the initiation of evidence-based care, such as medication-assisted treatment of opioid use disorder; and use of evidence-based co-interventions to facilitate deprescribing, including interdisciplinary, multidisciplinary or multimodal care.
To our knowledge, these are the first evidence-based guidelines for opioid deprescribing. The recommendations intend to facilitate safe and effective deprescribing to improve the quality of care for persons taking opioids for pain.
摘要：
背景：长期阿片类药物通常用于治疗疼痛。剂量减少或停药（取消处方）可能具有挑战性，即使延续的潜在危害超过了感知到的好处。阿片类镇痛药的循证临床实践指南是使用强大的指南制定过程和建议分级制定的。评估,开发和评估（等级）方法，并包含成人处方阿片类药物治疗疼痛的处方建议。
结论：11项建议提供了有关何时，应该如何以及为谁考虑阿片类药物处方，同时注意到需要考虑每个人的目标，价值观和偏好。这些建议旨在实现：在阿片类药物开始时实施非处方计划；如果功能缺乏整体和临床意义的改善，则对患有慢性非癌症或慢性癌症幸存者疼痛的人开始阿片类药物处方，生活质量或疼痛，在实现商定的治疗目标方面缺乏进展，或该人正在经历严重或无法忍受的阿片类药物相关不良反应；逐渐和个性化的处方，定期监测和审查；考虑对阿片类药物相关危害高风险的个人进行阿片类药物开药；除非有临床指示，否则避免对接近生命终点的人进行阿片类药物开药；避免对患有严重阿片类药物使用障碍的人进行阿片类药物开药，随着循证护理的开始，如药物辅助治疗阿片类药物使用障碍;和使用基于证据的共同干预措施，以促进处方，包括跨学科,多学科或多模式护理。
■据我们所知，这些是关于阿片类药物开处方的首个循证指南.这些建议旨在促进安全有效的处方，以提高服用阿片类药物治疗疼痛的患者的护理质量。
结论：11项建议提供了有关何时，应该如何以及为谁考虑阿片类药物处方，同时注意到需要考虑每个人的目标，价值观和偏好。这些建议旨在实现：在阿片类药物开始时实施非处方计划；如果功能缺乏整体和临床意义的改善，则对患有慢性非癌症或慢性癌症幸存者疼痛的人开始阿片类药物处方，生活质量或疼痛，在实现商定的治疗目标方面缺乏进展，或该人正在经历严重或无法忍受的阿片类药物相关不良反应；逐渐和个性化的处方，定期监测和审查；考虑对阿片类药物相关危害高风险的个人进行阿片类药物开药；除非有临床指示，否则避免对接近生命终点的人进行阿片类药物开药；避免对患有严重阿片类药物使用障碍的人进行阿片类药物开药，随着循证护理的开始，如药物辅助治疗阿片类药物使用障碍;和使用基于证据的共同干预措施，以促进处方，包括跨学科,多学科或多模式护理。
■据我们所知，这些是关于阿片类药物开处方的首个循证指南.这些建议旨在促进安全有效的处方，以提高服用阿片类药物治疗疼痛的患者的护理质量。
